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Case Study - Page 4

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By Steve Andreas

Janina Fisher describes a successful case, based on a useful approach. My comments only highlight a few ways in which it might have been conducted even more efficiently and effectively.

Fisher begins by describing Marcia's announcement, "I want to give up my children and leave my husband." Below is an initial response to that announcement that would directly accept what the client initially presents, while shifting the focus to the underlying positive intention.

Therapist: "OK, great; you want to give up your children and leave your husband. What would that do for you? What would you accomplish by doing that?" (The words, "OK, great" may sound strange to some readers, but I've found that they effectively convey an unconditional acceptance of whatever the client has just said. The second part of the response redirects attention to the positive intent underlying her stated goal.)

Client: "I've been terrible to my kids. I erupt with rage at them and sometimes I get drunk or hide in the closet instead of taking care of them." (Most clients will describe the problem behavior rather than the positive intention, because the problem is what they're primarily attending to.)

Therapist: "OK, so you've done some terrible things with your kids. What would be positive about giving them up?" (This again redirects the client's attention from the problem in the present to the solution in the future, a useful reorientation even when the solution doesn't seem very appropriate.)

Client: "They wouldn't have to experience my outbursts. Someone else would take better care of them."

Therapist: "OK, so you want your kids to have a better life. You must really love them a lot." (At this point the client would likely cry loving tears-a useful change in state, which lays a "strengths-based" foundation for exploring alternate solutions, and for addressing her anger, judgment, and shame.)

In this case, the pivotal intervention involves Fisher's inviting Marcia to respond to the angry/abused part of herself as she would a foster child-locating the feeling of hurt and sadness in her chest, placing her hand there, and saying, "I'm here now." This is clearly helpful to Marcia, who goes on to imagine this part of herself in "a baby carrier across the front of her body," developing a feeling of tenderness and welcome toward a previously denied aspect of her experience.

However, at this point, Marcia still experiences the hurt child as separate from her, while the ultimate goal of parts work is integration. The next step would be to invite the hurt child to fully become a part of her. One way to accomplish that would be to say something like the following, in a soft, slow, hypnotic tone of voice:

"Marcia, I want you to close your eyes. As you feel the warmth of that younger you there on your chest, comfort her: tell her anything that seems appropriate, and respond fully and honestly to anything she says or asks . . . . Now, ask her if she'd like to become fully a part of you, so that you'd always be with her and able to protect her. Remind her that you're from her future, so you can guarantee that she survived those horrible events. When you're sure, by observing her responses, that she's ready for this, slowly reach out with both of your hands and gently bring her into your body so she becomes fully a part of you, from the hair on your head all the way down to your toenails."

In doing this kind of "parts work," it's important to emphasize to skeptical clients that no "leap of faith" is required. The intervention can be offered simply as something to try, to find out whether or not-or to what extent-it's useful. As was true in this case, clients will soon find that there's a positive, useful shift in their relationship with previously negative and rejected aspects of their inner experience.

Janina Fisher, Ph.D. is a faculty member of the Sensorimotor Psychotherapy Institute and instructor at the Trauma Center in Boston. She writes and lectures on the integration of neuroscience and attachment research, body-centered approaches to treatment, and traditional talk therapy. Contact:

Steve Andreas, M.A., has been learning, researching, developing, and teaching methods for personal change for more than half a century. He's the author of Transforming Negative Self-Talk; Six Blind Elephants; and Virginia Satir: The Patterns of Her Magic. With his wife, Connirae, he's the coauthor of The Heart of the Mind and Change Your Mind-and Keep the Change. Contact:

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