What are the brakes on therapy and emotional healing?

Identify them and release them.

A note for my Spectrum postgrad group about possibly making therapy more effective.

I suspect we have all had experience of mentioning psychotherapy in a social situation and having people tell us why they would never do psychotherapy and/or why they think it is a bad idea for anybody to do so. Remarks like ?It?s very self-indulgent? or ?Self-pity is pathetic? or ?You?d be opening a can of worms?.

I have compiled a list of some reasons that people give and I would like to examine that list with you and extend it and look for ways to respond to those objections.

But this is not a marketing issue. It is not about trying to persuade people that they should start therapy. It is I think something more important and perhaps less obvious than that.

Because it is my growing experience that even in people who have started therapy or are deeply engaged with it, these prejudices and objections against it in fact remain at some deeper level in the mind and unconsciously but significantly inhibit progress. They cause resistance and ongoing ?self-repression? which blocks healing.

To step back and start at the beginning: I assume we all believe that the mind has a great capacity to heal and to change – but I am puzzled and frustrated at the sometimes slow pace of this in therapy and the blockages that I meet in both my clients and in myself.

It is as if we are trying to ride bicycles which should be able to move freely but are not doing so. We may put a lot of effort in and pedal harder and achieve some jerky progress but it still feels wrong.

But I ask – what if they have their brakes stuck on? That would explain the difficulty in making smooth progress.

If this is true and if we could identify those brakes and release them, then the bicycles would run freely. I.e. a small intervention at that carefully chosen specific point of the brakes would have a disproportionate effect.

In terms of therapy – If it is true that some beliefs and habitual ways of thinking are applying a brake to therapy then a small intervention at that specific point would have a disproportionate effect and healing could be achieved much more effectively.

In fact healing could become more natural and not require so much outside assistance. It would give people more power to heal themselves.

Therefore I would like to look at some of the reasons that people give why they would resist or object to therapy and see what work we can do on those beliefs which, as I say, I believe remain powerful at some unconscious level for many years.

To put it in terms of styles of work, it may be that using some CBT to deal in an accurate and focused way with some attitudes, beliefs and habits may unlock the potential for a more successful psychodynamic way of working.

I will spell out the list first and try and identify different categories. And I will see what we can do in terms of working with those resistances.

Obviously as soon as you start to list them you see that some are simple rationalisations and denial; some articulate anger and /or fear ? or perhaps anger reflecting the fear beneath. And, as we go down the list I have arranged, some are about showing more insight.

It?s not a question of working out arguments to use against them. For me there are two aspects of the work: firstly simply getting people to spell them out, hear themselves saying it, think about whether they really believe that ? and if so why? Go a bit deeper into what they think.

But secondly there are some interventions which I have found to be effective and I add them to some of the items on the list. But there isn?t an intervention to each point.

As I write this I realise that in some degree this is my exploration of my whole therapeutic approach. I would be really interested (and quite anxious) to hear people?s reactions to these interventions and to hear of ones that they find effective. Some people may find me excessively interventionist. I can only report what my clients have told me and shown me that they have found useful.

[What is also interesting to me is that I have found it surprisingly hard to think about this. As if the blockages I am writing about ? block me. Obviously a lot of this is me talking about my longest serving client ? myself – and I acknowledge that and it is probably why I am doing this.]

Initial:

? I can’t afford therapy. I haven’t got time for therapy.

Cost of therapy is a real issue for some people. For others it might be as cheap as some of their extravagances and in terms of time, it is interesting how much TV many people watch.

One advantage of working for eleven years with the Camden Bereavement Service is that the service is free so the first objection is missing. And people come who are in some senses ?naiive?, coming because of a death which ?gives permission? to people to seek counselling who would otherwise not have done so – for precisely the reasons explored in this note. And they retain those beliefs more explicitly perhaps than the usual client who has chosen to come for counselling or therapy for what they perceive as problems that they want to address.

? I don’t need therapy. I had a happy childhood.

I have a client who came for therapy ?even tho? he had had a happy childhood?? and then with almost no prompting told me multiple horror stories of his early life. I was not going to challenge his failure to crystalize the fact that what he in fact knew was so different to what he was prepared to admit* explicitly. I let him notice the mismatch over time. See below for more about this.

But interestingly he still has that taboo on admitting the reality and scale of his abuse. It is still work in progress four years on although many of the actual symptoms / reasons he first came have very much reduced. I think he could go further if he was able to admit it.

[* my current favourite word is ?Admit?: strong double meaning: Confess or state something shameful and to let in.]

Rationalistic:

? Even if I had problems, I am dealing with them successfully.

This often refers to being successful in a worldly, career sense. Any problems in the emotional field are maybe too sensitive to air. Given time they come out. See below.

? You don’t need therapy to deal with problems, you just use willpower and self discipline and control of any negative behaviour or feelings.

Gently exploring if this includes the inability to relax? To love?

? All I need to do is to understand where certain problems come from and I can do that by reading books and by thinking about it myself.

? And when they start therapy it is all about gaining insight, rational explanations.

It may be good to explore the role of emotions in processing events and the modern science about this. And I find that reference to bereavement are really valuable here and in many places.

Bereavement has the value that it is simple in the sense of being unequivocal. There is no doubt that the person has died. This cannot be fixed and it is good to note the powerful instinct – symbolically but futilely to try to fix it by the equivalent of insight – enquiries, explanations, blame and campaigning. It may help with short-term anaesthesia ? it doesn?t heal and in fact if it is prolonged can hinder healing, which ? crucially – requires emotion.

Secondly the bereavement grief process has some respect given to it and there are some traditions or ceremonies in our culture. People are allowed to grieve. Exploring bereavement and the legitimacy of grief is a start in legitimising sorrow generally. Grief ? a processing emotion; not the fixing emotions of fight and flight: anger and fear. Or searching.

? There is no evidence that talking cures work.

There is. And it?s quite useful to have it handy.

? I need my neuroses. They drive my career and my success.

Black and white thinking. All or nothing. Explore the cost to the client of the pressurised workaholic perfectionism. Is it really optimum? And if you were less neurotic what are the possible advantages? Could you imagine a calmer, more measured style? Better with people? Avoid burnout?

Disgust – to some extent directed at themselves.

? It is boring to blame my upbringing. It is negative and pointless.

? It is self-indulgent to talk about oneself. Other children had it worse. My parents had it worse.

? You should take responsibility.

? It is a sign of weakness to need therapy.

I find it is effective to introduce the idea that doing therapy requires considerable courage.
Equally I use the expression ?emotion work? quite a lot. Which is a shock and a paradoxical reframing for people who see work as good and noble whereas emotions are bad and shameful.

? I do not wish to appear “needy”.

I explore the language which incorporates values: the pejorative tone of ?needy? and how it compares with simply saying ?having needs?? Sometimes asking a client to state what every child needs just highlights what they didn’t have. And can trigger real grief.

I am working with a woman sent away to boarding school quite young who is so far unable to feel any emotion about that and the bullying she received. But she can look at young children in the street and feel horror at the idea of them being sent away.

Talking about other children who had a similar experience causes empathy and sorrow ? but as soon as it come close to one?s own experience ? bang comes down the steel shutter of self-repression. This is work in progress. For her and me.

Feeling sorry for yourself and self pity are the worst things.

An approach I have in my mind is again a language issue – although I rarely share it explicitly: Some people (eg my step mother) do / did in fact feel very sorry for themselves (although they may be highly critical of others who they accuse of this) What they have not been able to do and need to do in fact is to feel real sorrow for themselves as children.??

Fear:

? If I start to cry, I will never stop. I never cried.
? I wouldn’t want to go there. It is a can of worms. It?s too complicated.

Explicitly reassuring a client that one is experienced and other clients have had this fear which was misplaced. See below re Crying.

Also I find that, working with a client who feels their history is impossibly complicated, it helps to have a family tree and a life chronology. One hugely abused and traumatised client I am working with has a simple A4 sheet – a chart of dates – and even looking at it is triggering memories and she is saying the unsayable? feeling what was forbidden to feel.

? If I told my therapist what is really going on in my head they would be disgusted and would reject me.

? If I tell a therapist my shameful secrets s/he will tell others.

There are things that we can say to reassure a client in this area. I am currently working with that same client who is still suffering serious domestic emotional and sexual abuse. She was very wary and inhibited in disclosing. When I mentioned that I have worked for many years with people in domestic abuse situations she started crying with relief and in her words ?the floodgates opened?. And she didn’t drown – it just washed away some of her shame.

? I would overload the therapist and stress them out and damage them.

Reassuring a client that one is experienced and well supported can offset this fear.

Fear /anger at therapists:

? Are you saying I am mad, needing therapy?

? I know you therapists, you are going digging into people?s brains and cause damage.

? You try and control people and tell them what to do.

One image I use in my head to be more skilful and less interventionist and interpretive is that if there is an unhealed wound there, then going digging is counter productive; ripping off bandages is dangerous, retraumatising.

Slow softening of the cover and creating a warm partial vacuum over a wound draws out the pus and infection in the safest way? ie patient listening and sometimes long warm silences are needed. I always remind myself of this, to offset my tendency to be too quick, clever and interpretative. .

? You therapists want us to hate our parents but they are dear old people now. They are nice people. There’s no point in attacking them. I can’t believe they were nasty to me (even though I have those memories.)

? It is all on nothing. Either you love someone and respect them – or you hate them.

It may not be obvious and we can explore the possibility of being angry with someone that you love. At Spectrum many years ago there was an article on the notice board which simply explored the hugely important fact that Anger is a Feeling; Aggression and Violence are Actions. Two very different things. But in our culture it is curiously hard simply to feel anger and not act on it. Hard but healthy?

This may seem strange but quite an effective and surprising intervention is that, rather than quote proper psychology books etc, I quote Pretty Woman where Julia Roberts says ?Your father must be very proud of you? and Richard Gere takes a deep breath and says ?I am very angry with my father. And that?s $20,000 worth of therapy speaking..? It can lead to good exploration of this issue of how hard it is to dare to be angry with one?s parent. (And the son and father were reconciled by the end of the film.)

But at the same time it may help to notice that we come from a blame culture. I sometimes think that we run our minds on criminal models – Goodies ?v- Baddies logic.? ?Much healthier is the classical concept of Tragedy?- to let go of blame and just see the Sadness. Yes parents did what they did because of what they had experienced. Yes, you can leave blame out of it – it?s a different matter ? It still wasn?t what you as a child needed. It?s simply sad. It?s OK to sit with anger and sadness. Ignore the ?call to action?. Just feel the feelings.

? I like my neuroses and my neurotic behaviour. It is my character. I do not want to become average and boring.

A client said exactly that to me recently. More anxious, black and white thinking – although in fact it just dissolved as she simply heard what she is saying and thought that one through.

Impatience once started:?

? Ok we have started?but ? it?s not happening instantly. I feel worse? I need medication.

I use metaphors from organic processes and clients seem to work with them. It is worth pointing out that in our culture there may be a tendency to think of our brains as computers and expect instant change. I offer a gardening metaphor. Clearing dead grass, opening up old, maybe fetid compost heaps and letting the air turn it into soil. Plant seeds. It?s often a mucky business, maybe smelly, but it is safe. And crucially it needs time and patience to see results.

Getting more insightful ? ie what people don?t say or not initially:

? Emotions are silly, pathetic, irrational, contemptible.

I sometimes ask a client to do a thought experiment: ?If I tell you there is an emotional person in the next room ? what is your picture of them?? and explore the fact that Emotion is often identified with what they see as negative emotions – anger, hysteria, danger?and let the client explore other emotions of grief or joy or hope.. And become aware of what their assumptions are.

I have found it useful to ask a client to say what their parents told them about Emotions? I don?t usually need to point out that in some part of our mind we still believe what we were told, even if our adult part rejects that.

? The Taboo on self-pity. ?Survivor pride.?

Crying: One client I am working with apologised in the first session for getting tearful. She was usefully shocked when I told her ?Crying is not exactly compulsory here ? but it is entirely accepted and welcomed.?

I also mentioned that one of the best simple books on bereavement work is called ?The Gift of Tears?. Crying is healthy. Since then she has cried a lot about subjects she has never talked about before. And says she feels two stone lighter.

I sometimes tell the story from many years ago of a very disturbed client (in fact a legal client) who had been hideously abused by Irish monks. He leant forward in his chair and fiercely told me ?But I never cried.?

The client I am telling this to now can usually see or be helped to see that he meant he never cried at the time ? which was necessary to maintain pride and was probably safer. And he ?wouldn?t give them that satisfaction.? And that he has never cried since ? hence why he was still so disturbed.

He so needed to cry. He was so unable to let himself. He is hanging onto what I call Survivor pride.

(I referred him to a counselling service provided by the Irish state for victims of that abuse. )

For me maybe the central task of therapy is to: Say the unsayable. Think the unthinkable. Feeling the? forbidden.

Cry List. As a humanistic practitioner I give myself permission to disclose quite a lot to clients if it is genuinely in their interest. Not my history, but what I find useful in practice and this includes the Cry List. A list of things that make you cry ? not sad ones but positive ones?

I had a client who claimed she never cried – and nor did her macho husband who sets a certain culture in the home. (He told her before coming for sessions ?Don?t display any weakness?).

When I got her to write a Cry List she ?admitted? that she cries at standing ovations, achievements. And when I mentioned the classic Susan Boyle Youtube she said her husband watches that quite often and he always cries?.

Because it is short term therapy and she has her macho husband at home I had to tip- toe around the real message here. That you cry about seeing other people getting affirmation, praise, rescue ? love. Ie what you needed ? didn’t get and crucially learnt not to want.

If I ask ?I see you cry for others. . is that about you?? ? again ? crash – down comes the steel shutter, the taboo on self compassion.

Current work in progress is exploring these double standards ? ?yes other children need and needed those things but me? I was ok without them. In fact I didn’t need them. And I don?t deserve them now??

Neurotic traits. I powerfully salute the client as survivor including the sometimes uncomfortable or unattractive neurotic structures and thought habits that they have created to survive. The bunkers they have built to stay in. So often those structures, habits and bunkers are a source of shame to them.

So to salute them is another shocking reframing. Only if they have been named, acknowledged and valued can they be let go of, reduced. Or simply accepted as a part of the person ? not the whole person.

A description of oneself as ?superficially functioning but under that false mask really terrified or furious or to have fantasies of persecuting others or surrendering and welcoming victimisation? is not an accurate way of describing it with the implication of guilt and fakery.

It is possible to be really terrified or furious and at the same time to be functioning well as a family person, friend and professionally. It is not fakery or a cue for shame. It is heroic and work in progress.

Going into the roots:

As I have mentioned I sometimes I ask them to tell me simply what they were told by their parents about Emotions? about anger, fear, crying etc. But going deeper to explore the original articulated apparently calm repressive messages, so often from the parents: ?This is normal. You have nothing to complain about. When I was your age I had it worse ? Boys don’t cry. Girls don’t get angry.?

Parents? messages especially many years ago may have been that emotions were ?unmanly?, ?unladlylike?, ?hysterical? even ?un-English?.

Absurd though that may sound, at some ashamed level we may still believe those messages and getting them articulated may draw the sting of it.

But the most powerful roots are the much more charged, secondary abuse of repression

? ?Don?t you dare be angry with me or complain or be sad or sulk or be anxious.? An old and very disturbing expression “if you cry about that, then I’ll really give you something to cry about.” i.e. being punished for having a natural response of fear of protest or anger or sorrow. Creates the hugely important conditioned reflex to self-repress.

The really traumatised client mentioned above actually reported that experience word for word. Emotion work there is much more profound than what I have referred to as the CBT approach.

Focusing in therapy on the fact, the moment of repression as well as or more than the fact and experience of abuse and neglect I suggest may be key. The deeper side of releasing the brakes.

Body work.

I have worked for many years on body issues and continue now with my current therapist . I am making links to the development of trauma work like Peter Levine, Babette Rothschild, Le Doux, and best of all Van der Kolk?s The Body Keeps The Score.

I am exploring in myself the trauma-induced body state of breath held / closed throat / shallow breathing, the physical / muscular tensions and the blocked body language. I am coming to see that all of these amount to continuing ?self-protection? which is in fact now self-repression.

I have worked on a note on this area which I have given to colleagues and some clients. This explores the possibility of reversing the flow ? undoing the body states and releasing the emotions that have been blocked and held in the body.

There is nothing very new here as much of it links back to thousand year old wisdom of yoga and Tai chi but putting it into my own words and involving modern information about the autonomic nervous system and the hormonal implications of breathing is maybe my CBT to reduce self repression; taking the brakes off and freeing up healing.

This note on the subject ? stress body, breathing, body release – some clients and colleagues say they have found unreadable and some have said has been very helpful. One social worker colleague said it was the best thing he had read on the subject. Useful pink envelope encouragement.

I wonder if some people resist any physical, eg endocrinological explanations for things because it seems humiliating. It implies there are things going on that they do not understand in their bodies and minds. The same applies generally to unconsciousness which is resisted.

Certainly there is a snobbery around physical work because of the supremacy of the rational model and willpower. If the client is receptive ? bibliotherapy can be effective in helping them see that this is a part of a well accepted and growing body of evidence and good practice. Like the books mentioned above.

If they come from a more spiritual side or are more open to wisdom from older culture in India and China then linking modern understanding of body systems with Yin and Yang and with the qualities from the Yogic system of Gunas ? Rajasic, Tamasic and Satvik is really interesting and may give motivation to work on breathing and other body work. This is my current area of work. And is explored a little in the note.

What I have not approached is the issue of?

? Do you really want to change? To heal. Addictiveness to the neuroses. Repetition compulsion.

I know from my own experience that there is a strong pattern which can be summarised in three words that morph into each other: Adapt. Adopt. Addict.

If you adapt to a negative experience ? childhood abuse and neglect – then you somehow adopt that as the norm, the familiar, the Home. And then there is an addiction to it. A repetition compulsion.

The same phenomenon when labelled the Stockholm syndrome is noticed in certain adult traumatic situation like hostage taking or kidnapping etc. which echo an abusive, powerless childhood

I have often felt defeated by that. It seems such a powerful force.

But I am beginning to think (and doing this note has helped) that this compulsive and addictive return to the familiar abuse is triggered or emphasised by deep anxiety especially separation anxiety. The repetitive, stuck, addictive behaviour can be reduced by working with that, going back to the original rejection and abuse and raising the steel shutter, letting it in – admitting it ? and feeling grief for the child.

And body work and meditation open the door to that.

David