Repairing Shame and Guilt

Webinar and Special Events:

My webinar sponsored by the ISTDP Institute on “Interrupting Defenses as a Form of Compassion” is coming up on 5/11/12. Go to istdpinstitute.com to register. There will be live role plays to demonstrate how we can work effectively with a wide variety of defenses.

Also, I’m offering a one day special event to be held on both 6/9 in LA and 6/16 in Glendale on “Penetrating Defenses to Awaken the Self.” Go to www.warrenwarshow.com to register! This event includes recorded session material showing a style of dissolving defenses that conveys and evokes compassion for self in our clients/patients.

SHAME AND GUILT

We’ve had a passionate exchange of ideas and conflicting perspectives within our professional community on how to conceptualize and deal with shame and guilt with our patients. Are they affects? Do they inhibit, hence are they “inhibitory affects,” or are they defenses to be treated as we treat all defenses?

As I share my perspective, I put forth one caveat, I do hold all my theories lightly, as suggested by Nemeroff!

I just spent an entire session in which the patient was flooded with guilt because she’d injured a close friend. Her friend was hurt because my patient had cancelled a special celebration that her friend had planned for her (albeit with her friend’s compliant permission). My patient avoided her painful feeling of guilt (due to love) by projecting (“She was critical of me”; “She was overly sensitive”) and repressing the pain of guilt. The session involved delicate work but it led to some new awareness that took her back to how she defended as a child against being unfairly blamed and had been transferring her mother onto other people. She also saw how she mercilessly attacked herself. She was also able to reconnect with her love for her friend and saw the value of a simple apology. As she allowed the feeling of guilt to be experienced, she noticed a rise in anxiety over the sense of vulnerability over letting in how important she was to her friend… and how important her friend was to her.  She realized that she had been afraid to similarly expose her own hurt feelings over past events when her friend had also treated her dismissively. This also opened a door to recognize her defenses of numbing, denial and minimization, which she did not want to carry forward.

Posted in Conference, Other Topics, Therapist Concerns, Treatment Process, Uncategorized | No Comments »

Many Masters

Announcing New Events!

First presented in 2006 and back by popular demand, my special one-day event, “Penetrating Defenses to Awaken the Self,” will return on 6/9/12 at the Skirball Cultural Center in L.A. and on 6/16 at the Embassy Suites-LA in Glendale. So, finally it is here! Several video analyses will reveal the riveting road to buried affect, as patient and therapist grapple with sabotaging forces that resist emotional intimacy. I’ll also be presenting to the dynamic SFV Chapter of CAMFT on Sunday, April 15, from 9-11, on “When Therapy Stalls.” Also, there are few time-limited openings for my current training program, “Accessing and Integrating Deep Affect,” held one Saturday a month at the Skirball Cultural Center in LA. Register for all events at my website, www.warrenwarshow.com.

The Dilemma of Practicing Without “Answers”

My priorities for this post keep shifting. My first intention was to respond to the excellent questions raised by the marvelously dedicated therapists who began studying with me and then concurrently with others. They also made me aware of the confusion they are experiencing as they seek the expertise of “many masters.”  So, suddenly I had two topics for this post and I will begin by exploring the latter.

Many Masters

I’m reminded of my own years in training and what it was like to be taught by several great teachers. In spite of their many similarities, I encountered the ways in which they inevitably contradicted each other through variations in interventions, timing of interventions and personal style. Sometimes there would be both positive and also negative evaluations of the same piece of material. While I found advantages to the range of exposure, I also oriented myself to a primary teacher to shepherd me through training. When I came to a fork in the road in a given session, I had to choose one path, one intervention in the moment.  That being said, I also celebrate integration, when the timing is right at our stage of professional development.

The Teacher Within

As a trainee, I felt almost desperate at times to know the “right” thing to do as each new client presented a different challenge. I’d jokingly say, “I did the right thing but the client didn’t follow the script!” Some things changed for me with increasing experience and awe for the unknowable. While I still eagerly embrace the exciting discoveries of psychotherapy researchers, I no longer seek certainty (or see it as possible) given the complexities and mysteries of the mind and human relationship. I find substantial relief in this point of view. I’m also amazed at the information and guidance that comes to me in moments of stillness with a client, how something pops into my brain that takes us on a fruitful path. While not a formal researcher, I closely observe and experiment with my clients, relying heavily on “response to intervention.” I also appreciate and identify with the desire to master a structured approach with empirical validation. But within those principles we choose to adopt, there are surprising spaces for spontaneity. To my delight, many useful interventions that came to me in session gathered research validation or were written about by others without my knowledge.

Dr. Robert Neborsky’s comment, “Your work is best when you remain intuitive,” remains my cornerstone. I urge therapists to also tap into their own wells of creativity (assuming a foundational knowledge base, of course) and allowing unexpected “answers” and discoveries to present themselves. I find rigid theory of any persuasion to be an anathema and deadening to an otherwise amazing, dynamic process between two human beings, perhaps best described by Martin Buber as the “I-Thou” relationship. We should never push ourselves into a mold that doesn’t feel right from the inside, even when we have rationales to do so. Chew on each new teaching but don’t swallow anything that you’re not ready to assimilate.

Absolutism in Theoretical Orientation

Absolutism is based on a mirage that there is but one path, one correct way. That being said, teachers of a preferred approach tend to be highly opinionated, so that is well to keep in mind. It may be well to remember that Davanloo, whose theories influence my work and those in our community, did in fact ex-communicate just about all who studied with him and disapproved of aspects of everyone’s interpretation and application of his work. Also to be remembered about Davanloo is that his Central Dynamic Sequence, a powerfully effective series of interventions, were based largely on observation and feedback from his patients, who were meticulously and systematically interviewed during a time span of 40+ years. Jon Frederickson, a brilliant therapist and teacher who studied directly with Davanloo, stated that many of the theoretical questions explored below were never fully clarified by Davanloo. Ambiguity and personal bias can be found in all psychotherapy theories and practices but this does not have to diminish their value.

All opinions stated in this post are expressed with humility and the utmost respect for esteemed colleagues who may disagree.

Anxiety’s Relation to Feelings

Anxiety, according to Davanloo, is triggered by forbidden and painful complex feelings, activated in a current relationship but linked to a primary attachment figure. In other words, feelings that have a history of being responded to with rejection, contempt, withdrawal, etc., become too frightening to the child and later the adult to allow into awareness. Distancing defensive maneuvers to ward off a replay of relational pain often follows symptoms of anxiety.

Bridget Quebodeaux helps all of us with her probing questions and observations, e.g.,” I don’t see the feeling as coming up and the anxiety as coming from up to press down on it as you describe in your layer model.  I see both feeling and threat response (anxiety) as coming from below—and when a system is healthy, the threat response is regulated and the feeling gets through the gate to be evaluated and responded to which will bring the system back into equilibrium/relief.  When the anxiety is not regulated (the system has a tendency to be overwhelmed) the gate gets shut and the feeling cannot be evaluated and responded to.  And defenses must be employed to manage the anxiety/bring the system back into a state of equilibrium. In my mind they both (F/A) rise from the bottom but anxiety gets to the gate first and shuts it. “

I don’t think Bridget and I are seeing these phenomena that differently, and there’s an issue of semantics. I do see anxiety as creating a “static on the airwaves” that interferes with a clear reading of the feeling signal. So, does anxiety interference “push down” on feelings, coming from the higher brain? I envisioned the “layer model” of anxiety as a cloud cover for feelings but not as part of the higher brain. Anyone who’s been highly anxious knows it overtakes everything else. The anxiety response does occur in a millisecond alongside core affect and both are primitive, coming from “below” in that sense. But the anxiety would not occur were it not for the immediately threatening rejection response to feelings that were originally intolerable to the parent and subsequently to the child. So, to my way of viewing this, the rejection of feeling occurs first and is the stimulus for fear. The physiology of fear and anxiety are not different. However, I differentiate core fear as being reality based and anxiety as a form of fear that may have been reality based at one time but no longer poses a rational threat.

This concept of causality is important to our patients because, once they make the link (forbidden feeling leads to anxiety), it becomes possible to separate their fear from their emotions. As an example, if I become anxious each time a dog enters my field of vision but don’t recognize that I’m having this reaction because a dog bit me once, I then have no power over this reaction. If I can examine the causality, I then can recognize that I am anxious because a dog entered the room and can differentiate between what kinds of dogs pose a true threat and which do not. The fear response will no longer be automatic and it becomes possible to regulate.

Does Guilt Over Rage Lead to Self-Punishment?

Bridget also asks, “In your opinion/in your model is the purpose of a defense to protect us from avoided feeling [and the unfortunate by product is self punishment]? Or is the purpose of the defense to punish the self and fear/anxiety is part of that mechanism? Or both?” There is tremendous complexity in any attempt to answer this question, and I will offer some perspectives here.

Defenses are fear-driven mechanisms… a child’s learned or devised antidotes to the pain of anticipated rejection, separation and unbearable feelings. From this perspective, defense is not a conscious attempt at self-punishment but rather a way to contain and divert dangerous emotional currents that threaten to erupt and destroy the attachment relationship.

Some ask if there is agreement that guilt over unconscious murderous rage causes the avoidance of complex feelings and leads to self-punishment? There has certainly been much theorizing on this question. Patients who have viscerally connected with murderous impulses towards figures they also love typically tell us or show us that they feel guilty. This is often made apparent by some version of, “I’ve done a terrible thing.” “How could I feel this way? My Mom did so much for me.” “I have no right to succeed in life when she was always miserable.” “I shouldn’t have talked about her but should keep the family secrets.” “This proves I’m a bad person and why would anyone want to be close to me?”

People do in fact begin to isolate themselves, place themselves in “solitary confinement,” and engage in a variety of behaviors to insure that no one gets close to them. They may recklessly abuse alcohol and drugs, gamble their financial security, jump from bed to bed, or literally kill themselves to destroy the self they believe to be disgusting and worthless. This can certainly be seen as guilt, both conscious and unconscious, leading to self-punishment. However, these self-destructive paths are embarked upon without the awareness of an available alternative. The person has internalized the coping mechanisms, which the parent(s) modeled, and also the self-hatred that was projected onto them (parent has contempt for himself and treats child with the same contempt or neglect).

When murderous impulses are uncovered in therapy, the patient often shuts down the emerging grief over the losses experienced in the relationship with that parent. There is a sense that, “Mom and I missed so many golden opportunities to be close and they can never be recovered.” However, this grief is stifled due to a return of defenses, which by nature harm the self that wishes to be open and free. Often there is also grief over the damage done to the self as a result of certain parenting practices. “Now I’ve had all these years of anxiety because my Dad had an explosive temper and it was completely unnecessary.”

However, guilt, shame and anxiety can shut down the grief, causing the patient to stifle his emerging feelings and withdraw from the therapist, which can be viewed as self-punishment. But I would rather describe this as inadvertently hurting the self. Some of my patients speak of their defensive parts with tenderness, not because they see them as good, but rather because they were primitive attempts to protect them, like a worn, tattered blanket that kept them warm as a child. Typically, the patient is not making a conscious decision to harm himself but that is nevertheless the result of their primitive defenses.

Two powerful cures for this kind of guilt over rage include internalizing the therapist’s empathy for these emerging feelings, normalizing the rage and welcoming the grief, and also discovering the intense feelings of love and essential goodness that lay beneath the rage (i.e., seeing rage as a righteous, inevitable, hard-wired protest against separation and loss). Rage can then be viewed, with the therapist’s help, as a conqueror of that which threatens attachment and closeness. It can be seen as a protector, a fighter for good, and a force that can enliven and energize the self in vital and necessary ways.

On the subject of rage converting to self-destructiveness, I frequently (not always) find that murderous impulses are a direct mirror of rage that has been turned against the self. A woman with migraines has unconscious desires to bang her mother’s head against the pavement. A man who gets shortness of breath has impulses to choke his father. A patient with jaw tension has impulses to bite and rip with his teeth. Do we conclude that guilt over rage therefore turns to self-punishment? I would say that what results from repression of feeling, often due to guilt and fear over feelings, is inherently self-harming. But there is a difference between that which is self-harming and that which is self-punishing. Most people don’t set out to harm themselves but to escape the unbearable. Even self-cutting can be a way to feel alive or to alarm others to gain needed attention or to be a release for unbearably painful feelings that have no other channel. Intense emotions demand loving awareness, which in itself brings release. Loving awareness = release. Loving attention to feelings and anxiety and defense = release and healing. From my perspective, this is an enormous amount of information to guide our work.

Additional perspectives on guilt from Maneet Bhatia: “Others feel guilty for having joyous feelings or having self-compassion e.g. ‘I would be cocky or arrogant and that is not good.’ ‘I am a selfish person when I think about myself.’ [Or, someone may feel] ‘guilty because they were sexually aroused and then shame because it makes them a “bad” person.’ So guilt is one of the many reasons why we avoid feelings from an Affect Phobia Therapy perspective.”

Another question: Does guilt belong on the defense pole of the triangle of conflict since it self-inhibits? I see anxiety, shame and guilt as being inhibitory affects, actual feelings and therefore not defense mechanisms as traditionally defined. I’m sure there will be additional ways to look at this.

Healthy Remorse

And finally, there is the form of guilt that we can describe as healthy remorse. This is guilt not over forbidden feelings (i.e. we see feelings as forces of nature that should not be judged), but rather guilt over actual actions or neglect that harmed another. There is a value to this type of healthy guilt when it motivates us to change and become more caring towards others. When we become aware of substantial pain we’ve caused others, whether purposeful or due to lack of awareness, there is a need to grieve. This type of guilt-laden grief would be correctly placed on the impulse/feeling corner of the triangle of conflict, therefore guilt as core feeling rather than an inhibitory affect.

Is it effective to inquire into the patient’s goals for treatment if defenses are ego-syntonic?

I believe that it is. True, the patient may be unable to assert a healthy goal because self-contempt or sense of unworthiness precludes this. However, inquiry into goals and aspirations uncovers where a patient is blocked as well as patterns of self-neglect, self-minimization and devaluation and lack of self-awareness. This provides the opportunity to bring this sabotaging process to the patient’s attention, in a kind and caring manner, which often mobilizes an increased alliance with one’s healthy strivings and with the therapeutic process. This also raises the important question whether the therapist or the patient should determine the problem to be addressed?

We can begin by highlighting a problem that we see, “Are you aware that you’re anxious?” and lead the patient towards a goal in this way and get good results. In the DEFT approach, however, the results are not all that matter. This may sound peculiar but there is an issue of showing respect for the patient by giving the patient’s observer the leadership position, even when the perpetrator is dominating. So, when we begin by asking, “What is it you hope to gain, internally, from our work together?” we give the patient the leadership position. I do not want to explore the patient’s anxiety or defenses without first gaining his permission to focus internally. This often evolves once the patient becomes aware that he does not have the internal focus to state a goal and is sufficiently bothered by this to work with the therapist to change this pattern of self-neglect. Again, we can arrive at similar places with different approaches, but I prefer to lead from behind.

Can the therapist’s empathy drown the patient’s healthy force?

Absolutely, if there is not a simultaneous focus on the patient’s lack of empathy for self. I’ve often said to a patient, “My caring alone will get you nowhere.” That being said, many patients have told me that the compassion they see in my eyes, in response to suffering due to anxiety and defense or for the pain of their attachment traumas, has allowed them to internalize this soft and caring response towards themselves. It is my sense that most therapists do feel empathy for their patients but that it may not come naturally to express it. Practice can make us better at anything. It is certainly valuable to practice showing empathy and respect by increasing the softness in our voice, by directing less, by holding a caring gaze, and by openly engaged body language (uncrossing our legs, sitting forward, etc).

There is fear and sometimes disdain amongst practitioners for the “overly” positive affects that a therapist may demonstrate to a patient. While a therapist can overwhelm a patient with positive feelings, this greatly depends on timing and attunement to a particular patient. If the patient responds with defense to positive affect, this then becomes yet another opportunity to explore the complex feelings aroused (a “pocket of rage” as mentioned by Abbass in response to love). At the same time, a patient may respond negatively if we appear to lack empathy or come across critically or with superiority, which is not always a projection.

Is it OK to have loving feelings towards a patient?

If we become a lone cheerleader and take full responsibility for treatment, we not only overwork but also can actually overshadow or dampen the patient’s healthy side. We must help our patients to differentiate the parts within that are healthy and the parts that harm the self, thereby creating an intra-psychic struggle. Sometimes our patients are not aware they even have a healthy side, and I teach numerous ways to raise this awareness and thereby instill hope. We present the patient with the choice to recognize their achievements, such as the fact that are in a recovery program or have married a loving partner. Ultimately, it is the patient’s right to choose which part they will allow to dominate. The patient is the captain of her ship, whether she sees that or not, and we should never usurp that role.

When a patient gives us access to their most vulnerable parts, sans defenses, sometimes occurring before and sometimes during breakthroughs to core affects, this intimacy often generates warm, close, even loving feelings within both patient and therapist. It just does. Should these feelings be revealed? The avoidance of such feelings can be a defense against emotional closeness. The expression of mutual, deeply felt appreciative feelings between therapist and patient can indeed be a joyful celebration of deepening connection made possible when defenses are relinquished. It is crucial to be aware if the patient’s healthy force is on board and is a true, engaged participant in such an exchange.

Posted in Conference, Therapist Concerns, Treatment Process, Uncategorized | No Comments »

Touch and Therapy

Thought I’d post some of my comments and also excerpts from an article that I shared with the IEDTA (International Experiential Dynamic Therapy Association) list serve in a discussion on touch between therapist and patient. A colleague had been told she should not have allowed her patient to give her a hug before the session.

Years ago, I had the good fortune to be in a supervision group led by Dr. James Grotstein, the esteemed and brilliant analyst. This very subject came up after I presented a case in which I mentioned touch during a session in which the patient was in the throes of enormous grief and wanted me to touch her hand. Dr. Grotstein felt at that time that no touch should occur ever between therapist and patient (gratifying the longing) but rather that the need to be touched should be interpreted. I remember feeling quite alone in my point of view that there were in fact instances in which touch proved helpful and normalizing and healing. Dr. Grotstein asked that I stay after the group to continue the discussion and he gathered a number of articles on the subject to help me to see the error in my thinking. Although we continued to disagree on that particular case (there would be others in with I would avoid touch), I found him to be caring and devoted in that way.

I came upon an excellent article on the touch question, Zur, O. and Nordmarken,N. (2011). To Touch Or Not To Touch: Exploring the Myth of Prohibition On Touch In Psychotherapy And Counseling. Here are excerpts:
“Therapists can deliberately employ many forms of a touch as part of verbal psychotherapy.These forms of touch are intentionally and strategically used to enhance a sense of connection with the client and/or to sooth, greet, relax, quiet down or reassure the client. These forms of touch can also reduce anxiety, slow down heartbeat, physically and emotionally calm the client, and assist the client in moving out of a dissociative state.”

“Recent research done by the Touch Research Institute has demonstrated that touch triggers a cascade of chemical responses, including a decrease in urinary stress hormones (cortisol, catecholamines, norepinephrine,epinephrine), and increased serotonin and dopamine levels. The shift in these bio-chemicals has been proven to decrease depression (Field, 1998, 2003). Hence, touch is good medicine. It also enhances the immune system by increasing natural killer cells and killer cell activity, balancing the ratio of cd4 cells and cd4/cd8 cells. The immune system’s cytotoxic capacity increases with touch, thus helping the body maintain its defense against pathogens (Field, 1998).”

“The traditional psychoanalytic emphasis on the analyst’s neutrality and distance and the focus on clear, rigid, inflexible boundaries omit touch as a therapeutic possibility. (For an excellent historical review of attitudes toward touch in therapy, see Bonitz, 2008).”

“The fear-based paranoid notion, promoted by the slippery slope idea, that non-sexual touch on the part of the therapist inevitably leads to sexual relationships and exploitation, discourages therapists from utilizing touch.”

“The meaning of touch can only be understood within the context of who the client is, the therapeutic relationship, and the therapeutic setting. Accordingly, before employing touch, it is essential that the clinician consider unique treatment elements for each client including factors, such as culture, history, presenting problem, diagnosis, gender, history, etc. One must also consider the therapists’ education, training, theoretical orientations and comfort with non-sexual touch. Systematic touch should be employed in therapy only when it is well thought out and is likely to have positive clinical effects. Touch must be approached with caution with borderline or acutely paranoid clients. Special sensitivity is also required when working with people who tend to sexualize relationships and/or have been abused, molested or raped. There is also a growing body of
knowledge that shows the damage done by the systematic and rigid avoidance of all forms of touch in therapy.”

From Dr.Kai MacDonald came a highly cautionary message for male therapists: “An important statistic that comes to mind on this topic comes from a course I run for health care professionals—mostly MDs–who have been referred for boundary violations. Our study of this group (as well as past literature) indicates that 90 + % of participants are male.”

Posted in Therapist Concerns, Treatment Process, Uncategorized | No Comments »

Beyond our Upper Limit

Spaces are still available for my new 1-3 year certification program, Intensifying and Integrating Deep Affect. Check out the link to my site. Please fax your registration form to 818-704-1986 ASAP. If you have a serious interest in the training but aren’t sure about committing due to lack of knowledge about it, you will have the option to come to the first meeting and then decide (fee: 195.00). The material is powerful, which is what inspired me to teach it. If you haven’t yet been exposed to it or if you have, you will benefit from this opportunity!

Save June 9, 2012, for a special one-day event to be announced soon. I’ll be teaching a model that I’m now calling Dynamic Emotion Focused Therapy. This is my personal blend of ISTDP’s Central Dynamic Sequence with an emphasis on empathic engagement and neurobiological attunement (attention to body language, facial expression, eye gaze, and tone of voice). It includes a style of defense interruption that emphasizes compassion for self, vivid language and metaphor to bring the therapeutic process to life, and interventions utilizing the latest research on hope.

I’ve been very curious at the small percentage of therapists who pursue post graduate training.  I see talented therapists who develop exciting new skills and report the impact on their clients yet become debilitated and discouraged: “My patient had a breakthrough and got better and worked out big problems with her boss but then she got depressed again. I feel terrible.”

An accomplished therapist in STDP training who gave me permission to share his comments emailed: “I have struggled sometimes with what to do with resistance, though I have gotten better at recognizing it. I get breakthroughs to rage eventually sometimes, but often helping people to see the triangle of conflict clearly and realize that they spend a lot of time quite anxious but have been unaware of it, often leads to quite significant changes. Most clients seem to get to anger but have difficulty going past a portrait at best.”

“My dad often raged around me so I think that I have difficulty with patient’s rage some times. I have noticed difficulty in bringing out a patient’s feeling in the Transference, especially if it is rage. I feel I don’t know where to go with it to help them get to the impulse. So often their defenses quell the anger before I see a clear motoric impulse and I don’t seem to have the language to help spur them along at that moment.”

I was struck that his point that his new skill level “often leads to quite significant changes” was barely noticed or relished. He is saying that even without major breakthroughs, he is a far better and effective therapist. How sad that we take little notice or pleasure in the enormous gift of a therapeutic relationship growing deeper!

It was heartening that he could make the observation: “I could easily tell you whether I was seeing a response of Feeling, Anxiety, or Defense, which type, where we were in the Central Dynamic Sequence, whether or not the client was projecting will/Punitive,Superego or stuck in identification with a previous aggressor, etc. …So I expect too much sometimes of myself as I am learning.

Ah, yes…”expecting too much as I am learning.” Familiar anyone?? If I may free associate, one of the most riveting conferences I can remember was one I attended many years ago, “On “Death and Dying.” The presenters were some of the leading scientific researchers in the world on near death experiences (including Dr. Raymond Moody), who reported on studies of thousands of people of all ages from a great many cultures. I was especially fascinated with the “life review.” From Wikipedia, “A life review is a phenomenon widely reported as occurring during near-death experiences, in which a person rapidly sees much or the totality of his or her life history in chronological sequence and in extreme detail, a ‘flash before the eyes.’ …A reformatory purpose seems commonly implicit in accounts.” Significant numbers of survivors report a transformation after experiencing a “life review” when they recover because they were in a state of complete acceptance, without judgment, able to comfortably observe their life experiences. From a place of safety, they looked at how they hurt or overlooked people and how they missed opportunities to connect and to love and these revelations influenced their lives. Keywords: “From a place of safety.”

In our everyday lives, we often do not make it safe to look at our “messes.” To do so, we must pass through the halls of shame and self-degradation, being whipped by the Furies for our transgressions, blindness and unnecessary losses and we fear being banished. It’s painful to look, and yet how do we truly change anything if we don’t look? The STDP therapist is in the most uncomfortable position of drawing attention to the ways in which the elephant inside the patient stomps on him. As the therapist in training told me, ““I would say that learning ISTDP is far more provocative for the therapist than any other form of therapy I’ve learned. We so directly and pointedly violate a lot of social strictures and rules that it takes time to settle in and see the good that this kind of direct care does people and learn to trust it.”

He further observes how he can stomp on himself, “After all, ISTDP is very complex in its moment-to-moment perceptual tasks and decision-making. I also go after myself for not “seeing” what is happening with a client and then get stuck. I tend to want to see everything in the big picture and to talk with the client in that fashion when they just need their new understanding built up from here-and-now micro-observations done together. … I also see that this may be a defensive stance in which I don’t act until I feel I can excel. … I also tend to intellectualize too much; both a defense against intimacy that was prized in my family of origin, a badge of quality, and also just a habit borne of too much academic training (and probably the same basic defense).”

Yeah, I get it. It’s easy to see why therapy that works with our core is painfully activating and can be the “road less travelled” for patients and therapists alike. And so it becomes imperative that we do everything possible to create safety for our patients, our colleagues and ourselves… so that we can all continue to learn and grow and truly break through our self-imposed upper limits that hinder our professional advancement.

Posted in Conference, Therapist Concerns, Treatment Process, Uncategorized | No Comments »

The People Whisperers

I am most thrilled to announce a new, expanded skill-building training entitled “Intensifying and Integrating Deep Affect,” beginning February 11, 2012. Participants will have the option to pursue three levels of certification over the course of three years. Check out the link to my website. My commitment is to help colleagues to significantly elevate their work and to create a nurturing atmosphere so necessary for this to occur. Now, on to my topic…

OK, I admit it and I apologize to those who have been faithfully reading my blog… I dropped the ball right after I saw the movie, “Buck,” a take-your-breath away documentary about Buck Brannaman, a 3rd generation horse whisperer. He’s a rare breed himself… an open, vulnerable, wise cowboy who has transcended the most horrific trauma at the hands of his violently abusive father and was rescued by foster parents who are true angels. He determined not to perpetuate the agony of his childhood upon other living beings.

I was so fired up to write a post about how Buck could get a horse to enjoy a dance with him through the power of gentle, always kind-yet-confident, non-verbal cues… the two of them gliding sideways across a majestic terrain or a horse following him with no halter and matching Buck’s pace exactly…because I saw something that could be applicable to those of us who aspire to be people whisperers. I saw metaphors that we can remember, as attuned therapists, as we practice interrupting defenses and coaxing our patients into whole new ways of relating to us and to others.

But then I thought, this subject is not scientific and horses have nothing to do with people, and if I write about this, it will look like I’ve wandered off the range! So instead I kept thinking about it off and on and essentially stymied myself and stopped writing. So now I’m going to get these observations out of my system and hope you’ll bear with me, because you know I have you in mind.

From the time I was a kid, horses could transfix me, and a most painful childhood experience was dreaming that I’d been given a horse and then waking up to discover it wasn’t true! I was always fascinated by the way a horse looked at me… not a direct gaze…but rather a peripheral glance. Yet I learned from Buck just how much these creatures are actually taking in, how much they read about the man or woman approaching them, and first and foremost they want to be safe and they also want to please.

And then I talked to my sister, Linda, about it because she raises championship Arabian horses surrounded on all sides by the gorgeous Shenandoah Mountains, not another house in sight. She and her husband watch the pregnant mares round the clock on closed-circuit TV and know when to race out to the barn they built and mid-wife that breathtaking baby into the world. She’s studied with Clinton Anderson, one in the line of great horse whisperers, because she loves her magnificent creatures with the chiseled, aristocratic faces almost as much as her 8 grandchildren, and that’s a mighty amount.

She sent me the following about Monty Roberts, who wrote the book, Horse Sense for People, and gives demonstrations in sold-out arenas all over the world. “Corporate executives, educators, psychologists and experts who work with victims and violent victimizers, autistic children or in the field of substance abuse, study Monty Roberts’ methods to learn how they might apply these same trust-based communication and training principles to their own work. In Monty’s experience with over 250 major companies, he has seen the same dynamics at work, time and time again. …From horses he has learned guidelines for “improving the quality of our communication with one another; for learning to ‘read’ each other effectively; and for creating positive, fear-free learning environments.” Horse Sense for People has at its core an inspiring belief in the power of gentleness, positive actions, and trust as the basis of success.”

OK, so what did I see in the film “Buck” that applies to STDP? Buck would walk into a ring with a new horse he’d never met before, and the horse would exhibit an endless variety of rude misbehaviors, essentially to “create distance” from him. As he explained, no one ever taught these horses how to be a member of their herd. So, as my sister explained to me, you walk sideways up to a horse, which can be translated to…remember to use a graded approach when people are anxious. Don’t just walk up and keep asking, “How do you feel” without reading the body signals and adjusting your approach according to the level of safety that’s been created.

When Buck saw misbehaviors (defenses), he’d gently flap the flank of the horse with some kind of soft rags on a stick to gently irritate the horse enough so he wouldn’t like it but would also recognize that no harm was meant. My sister added that consistency in applying this “pressure” was all-important until the new behavior was learned. To be effective, the intervention needed to be very clear, leaving no room for doubt or confusion. Of course, unlike with horses, we intervene with our patients only with their permission and understanding. So, when we draw attention to the defenses and compassionately point out that they carry a cost, this is irritating to the part of the patient that has relied on these self-protective habits.

Therapists so often back away at this point because who wants to be an irritant? Yet, just like a “good enough horse whisperer” or a “good enough parent” or a “good enough therapist,” we don’t stand idly by while our patients are hurting themselves. And our patients sense that we mean no harm and are expressing our caring engagement. We are also providing clear teaching about the specific defenses being employed and do not ignore self-destructive mechanisms one minute while emphasizing them at another time. Are they important or not? Of course, our patients are adults, so they have the right to hurt themselves with pathological defenses. But it is our responsibility to be sure they are aware of the consequences of their choice.

Linda told me, “It’s ALL body language.” She said, “Your body needs to be RELAXED (people whisperers, listen up…we FIRST must attend to our own anxieties which are so often fueled by our own toxic self-criticisms)! She said: “Your eyes and face need to be soft.” I absolutely cannot second this point enough!! And there must be instant praise when the horse is trying, like when he backs up a foot when you’ve asked him to. My sister said cutely, “You should have a “happy tone” to let a horse know he has done something pleasingly because they so want to please! Linda demonstrated this to me with a lilting voice that was charming. As Buck said, “You love on ‘em.’” So to “create a sense of mastery,” one of the top 4 or 5 positive therapy outcome factors, we need to signal our patients with a warm smile or word of praise and appreciation when they courageously risk a new level of self-disclosure or intimacy.

Linda made another interesting point: horses do not learn from pressure but rather learn from “release from pressure.” She told me that when you are trying to get a horse to move his forequarters, you tap in rhythm with a stick, and when the horse moves, you stop tapping and rub affectionately. How fascinating! So, can we say that it is the positive reinforcement and encouragement when a patient drops a defense that actually creates the learning experience? Perhaps something like, “You really allowed me to feel close to you when you dropped that wall of detachment and let me see your tears.” Another point Linda made: “The release of the pressure must be perfectly timed or the horse becomes confused by the signals.” She said, “The signal must be “clear, decisive and positive.” Ah yes, timing really is everything!

I’ll end on a most encouraging note. Horses don’t forget what they’ve learned! So as our patients have new attachment experiences with us, as neuroscience tells us, brain structure is actually altered over time and our patients will not forget how to relate in the new ways they’ve experienced with us!

Posted in Other Topics, Treatment Process, Uncategorized | No Comments »

Reflections on WSP Summer School

See new photo gallery by clicking on the “Gallery” link at top of this page.

You’re invited to join my new 5 part extended workshop for therapists, “Intensifying Deep Affective Processing,” beginning August 13, 2011. Therapists will practice skill building exercises aimed at forming an alliance to penetrate defenses, attend to anxiety effectively and work through buried emotions. It will be held monthly on Saturdays, 11:00-4:00 p.m. (Aug. 13, Sept. 10, Oct. 15, Nov. 12 and Jan. 14) at the beautiful Skirball Cultural Center in L.A. Register soon as there are only a few remaining spaces!

I’ve missed blogging over the last few weeks as my readers do stay in my mind and I miss the contact! Whatever happened to the lazy, hazy days of summer laden with delicious excess time? It’s been more like a Santa Ana whirlwind in the last few weeks, with some amazing stuff getting stirred up at the Washington School of Psychiatry’s 
6th Annual Summer Immersion Course
 in Intensive Short Term Dynamic Psychotherapy this past June 5 -10, 2011 in Syria, VA. Check out the wonderful photos by clicking on “Gallery” at the top of the page. This event is the brainchild of Jon Frederickson and I was thrilled to be invited back as his co-presenter. Edward Weston wrote in his daybook that he’d spent the day in a “holiday of work, but work which was play.” This is the atmosphere that Jon created in our amazing week together as we journeyed to become better therapists, inspiring our hearts, our minds and our spirits.

As Monica Urru reminded us, we were a group of therapists meeting at a lodge on Graves Mountain, apropos of the central theme of our workshop… learning to help our patients to bury the pathological, punitive superego and thereby restore hope through the liberated self. This represents victory in a battle co-fought by the patient with the assistance of the therapist against all that had been associated with abuse, cruelty, neglect, devaluation, abandonment, irrational fear, toxic guilt and shame…destructive forces that had become internalized and were perpetuated within and against the self. “We have to learn to be our own best friends because we fall too easily into the trap of being our own worst enemies. ~Roderick Thorp, Rainbow Drive.”

As we sat at U-shaped tables, with our collective unconscious focused intently on all internal processes that are destructive to the self (perpetrator watch), I began to have images of a communal burial ground in the center of our spacious meeting room overlooking the majestic Shenandoah mountains. We were directing a fiercely bright spotlight on any perpetrator activity within the psyche and it was impossible not to become acutely aware of one’s own self-destructive parts as well. There was a shared vulnerability as self-doubts, self-criticism, shame and anxieties rose to the surface. Along with the excitement of learning powerful new healing tools and the joy of sharing the journey together, pain was also palpable in our group at times… tears as well as fears.

“Am I sufficiently smart and knowledgeable enough to become skilful at this approach? (Never mind the hard earned degrees after our names).
“Will I harm my patients?” (Do athletes fall and hurt themselves and each other in practice? Does it stop them? As one client said to me “It is the repair that matters.”)
“Do I have to abandon all that I already know and start over?” (Absolutely not! Please, integrate new skills slowly as they make sense, and continue to value your hard earned knowledge in other approaches).
“I’ll never be able to do it like _______(fill in the blank). (Shouldn’t we rejoice over our individuality? Do we really want clone therapists? And if I’m trying to be someone else, where is the authenticity?)
“There is one right way to do this.” (Then we’re all doomed).
“My heart is racing and my palms are sweating as I open to the unknown.” (Then let us beat back all that would prevent us from our birthright…to keep growing!)
“My dad abused me too. Can I myself handle the pain of revisiting such painful emotions?” (Yes, you can. It’s the price of freedom and we’re in this together!)

I felt sadness imagining a communal burial ground because that which lay beneath the dirt, while needing to be left behind, included destructive remnants of precious loved ones (who may have meant well or just been sadly limited and emotionally damaged) as well as some very old, familiar and seemingly self-protective parts of myself and others. Pruning is bittersweet. After all, those dead branches and parasitical vines that now sucked our life force were once a living part of our families and us. Yet, if the healthy tree (i.e. healthy self) is to produce new fruit, that which is anti-relationship, anti-growth and anti-joy simply has to be separated from the tree and discarded. In Gretchen Rubin’s delightful bestseller, The Happiness Project, (a book that I picked up in the Atlanta airport on the return to L.A. that is based on her personal application of happiness research), she reminds us that we have a responsibility to nurture happiness within ourselves… even when the going gets rough. Not surprisingly, strong personal bonds, mastery and an atmosphere of growth bring the most personal happiness to people (supplemented with an occasional fashion magazine, listening to drummer Danny Seraphine of Chicago fame as he jams with other local greats, and writing this blog…if you happen to be me).

Jon and I both placed a high priority on self-reflection, self-care and, as Jon put it, a “culture of compassion.” At the sunset gatherings arranged by Jon after the workshop, sitting on rocking chairs or leaning against old pillars on our porches, sipping wine and sometimes swatting bugs and watching our makeup melt in the humid air, I found myself just loving this community of deep sea divers of the unconscious. So much passion to learn and bravery too! There was lots of laughter, giggling, morning yoga and long walks about the hills and woods too… to work off the bowls of steaming Southern dishes that greeted us at each family style meal. But what made the experience especially extraordinary were the intimacy and our collective commitment to kindness to self and other. We could express anger in our group process but devaluing was off limits. We could acknowledge what we didn’t know and wanted to learn but putting ourselves down would be met with clear resistance. We could challenge each other’s ideas but only in an atmosphere of respect. This didn’t mean we might not have superego reenactment, being human after all, but this was a culture that would support each of us in our personal struggles to practice what we preached.

Posted in Conference, Therapist Concerns, Treatment Process | 1 Comment »

Sustaining Therapist Hope

I’ve missed blogging with my friends and colleagues! Check out the video on the sidebar and remember that I love your questions and feedback. My new highly experiential, extended workshop for therapists, with clinical video illustrations, “Intensifying Deep Affective Processing” will be held on 5 Saturdays, 11:00 – 4:00 P.M., on August 13, Sept. 10th, Oct. 15th and Nov 12, and Jan. 14, 2012 with lunch and materials included. It’s been a terrific experience to have co-led a similar workshop with a highly motivated group of therapists with the superb Thomas Brod, MD. The new series will have a heavier emphasis on the experiential component. My intention is to devote significantly more time to role playing practice of specific interventions for different phases of treatment with a broad spectrum of psychoneurotic disorders. Please email me right away at swarshow@me.com or call 818-378-1418 to tell me of your commitment so that I can confirm the beautiful Skirball Cultural Center in L.A. for our location. The fee is $850. before May 27, 2011 and $1000. thereafter. More details to follow shortly on my website, www.warrenwarshow.com.

You’re invited to join my Monthly Mondays supervision/teaching group, which offers engaging experiential opportunities to learn the art and skill of reaching and processing deep affect. We’d welcome new members. Call Susan at 818-703-1145 for more information.

Don’t forget another terrific training opportunity with Jon Frederickson, MSW, and myself at the beautiful Graves Mountain Lodge in Syria, VA, on June 5-10, 2011 for the Washington School of Psychiatry’s 6th Annual Summer Immersion Course.

I will be speaking on “Awakening Hope to Defeat Resistance.” It’s been fascinating to reflect on the importance of therapist hope within the therapeutic dyad. We tend to focus on the client’s sense of hopefulness but not our own. We’re told to stay hopeful and to project hopefulness, but we are not told how to do this. I’ve been recently challenged myself when it seemed that no intervention was working and the client raged, “OK, I know I’m self-destructive and I know I act out, and I know I push people away, and I know that I’m anxious but so what that I know that? I make some progress and then I slide back and here I am out of control again! And I know what I need to do but I don’t do it!” Perhaps the patient adds, implicitly or explicitly, “And it’s your fault!” It’s especially delicious when the client projects all responsibility for the setbacks on the failures of the (dare I say beleaguered) therapist and refuses to stop ventilating and discharging and projecting and abandons all self-reflective capacity.There may have been a medication reaction exacerbating this particular client’s outbursts and curiously, he also reported having new recent successes. (Uh Oh, I just remembered that perhaps his relapse in session was DUE to perpetrator activity BECAUSE of the recent successes)!

Yes indeed, there are times when we lose hope…for all sorts of reasons. So, how do we sustain our sense of hope after a discouraging session or a treatment failure? And by the way, if anyone ever says they don’t have treatment failures, be very suspicious! I remember a great article in the Psychotherapy Networker magazine in which the author (don’t remember his name), an accomplished therapist, did research on his treatment outcomes and was amazed that some patients, whom he thought had positive reactions, in fact had not. And others, whom he thought did not respond positively, actually had! Also, his perceptions of what had occurred in session often did not match the patient’s! We also know of seemingly “successful” treatments in which the patient sought another therapist eventually or whose problems reoccurred.

At discouraging times, what can we do to sustain our sense of hope? We do need to remember, always, that a successful treatment takes two to tango. The client simply must have enough will, self-care and self-reflective capacity to actively engage in the treatment process. Yes, it is our role to attempt to mobilize these healthy forces within the patient, but we absolutely cannot do it singlehandedly. We also must be compassionate towards our own vulnerabilities and missteps. Don’t we all sometimes wish we’d selected a few phrases differently? Or maybe we mishandled a new skill we’re just getting the hang of? Sometimes a client just won’t make room for our attempts at repair and the forces of self-sabotage are too great. But will we be forgiving within ourselves? Or maybe a particular dyad simply is a misfit…who can be right for everyone? Will we allow for these personal limitations?

Self-compassion sustains my own sense of hope, and I sometimes need reinforcement from others to reconnect with that. I also need to be selective with the clients I work with as I must be with other relationships. A sense of progress in treatment is necessary for me to keep the hope flame burning within myself. It also helps me to remember the successful treatments in my practice, past and present, as well as the successful aspects of a very frustrating case. Sometimes we forget that even bad experiences can still contain good parts. Wonder if anyone has studied a patient’s positive memories or outcomes related to a disappointing therapy? Many patients who come to me, having been in therapy with someone else, will still tell me of important progress they made with that therapist. Rarely is it black and white, if we’re honest.

I wish you a very Happy Easter and Passover.’Til next time!

Posted in Conference, Therapist Concerns, Treatment Process, Uncategorized | 1 Comment »

Self-Hatred in a Dying Patient

Hope you’ll check out the “Special Events” section at the top of this page (it’s not up on my website yet) and join Jon Frederickson, MSW, (amazing clinician and teacher!) and myself in Virginia at the Washington School of Psychiatry’s 6th Annual Summer Immersion Course in Intensive Short Term Dynamic Psychotherapy from June 5 -10, 2011. Last time I did this with Jon a couple years ago, it was a breathtaking experience. Also, there’s still room in my intimate supervision/training group, “Monthly Mondays,”  from 12:30-2:30 p.m. in my Woodland Hills office.

I had a recent email exchange with a therapist that I repeat here with her permission. She has the most heart-wrenching task of trying to help a young woman in her 20′s to find some internal peace as she faces death from cancer. The patient asks, ”How can I not feel that I did something to deserve this?”  The therapist says that in probing a little further it almost seems that this self contemptuous stance is defensive albeit masochistic as she said to me,  “I cannot love myself…it would be harder to feel weak and accept death.”

This young woman, who I understand has felt self-hatred for a long time, lets her therapist know that she has anger/rage inside of her (see below).  However, her terrible suffering is increased not by her rage but by rejected rage that is forced to turn against the self rather than have it’s natural trajectory, directed outwards. She is in fact “attached to anger” (see  Dr. Clayton’s comment below) because she will not permit herself to experience it towards anyone or anything but herself, and once she opens that door, she fears or feels guilt about the feelings that would follow. It would also seem that her perpetrator has defined self-hatred as a source of strength and perhaps necessary for survival.

Were she to unleash her feelings, we can only imagine the grief to follow the rage involved in facing her death as well as other feelings towards significant others. I’m imagining that like many people, she has come to associate painful feelings with weakness and is not recognizing the great courage and strength involved in facing them. But I would want to ask her how it is that she associates acceptance of death with weakness? I will admit that my own fears and grief over death have never been worked through enough to arrive at the state of acceptance that Kubler-Ross describes as the final stage of grief…a state that I would see as a triumph…but I do believe it’s possible.

My husband, Donn Warshow, Ph.D., said to me, “Her self-hatred is a form of cancer.” My comments in the email exchange with her therapist are italicized below:

2/16  Th: “So I just had a very sad session with ____ who has relapsed with four new tumors in her pelvis (this is her fourth relapse.)  She says something to me repeatedly which leaves me speechless.  What she says is that she feels angry, but can’t focus the anger outside of her because the cancer is inside, so how can she not be angry toward her body/herself?  Any thoughts?”

Susan: I’d ask, “Might you turn your anger on the cancer and hate it rather than yourself, your essence, your core? Your self-hatred is tragic as it inflicts more suffering upon yourself than you’re already enduring. I feel deep pain as I witness this lifelong rejection of yourself. Do you not want to have the experience of compassion and love for yourself while you live and sit here with me? For once in your life??”  Also: “How do you experience that I feel towards you?” “Are you aware how profoundly affected I am by your pain? How deeply I feel compassion for you? How much I despise the part that withholds love from you?” If she does:  ”How is it for you to see that compassion in my eyes? What do you feel as you see my caring for you?” If she does not: “So, you need to push my caring away from you and to also withhold it from yourself?  If it were your sister (or someone she loves), what would you say to her if she spoke to you of her self-hatred, especially at such a time as this?”

2/28 Th: “Thanks for letting me vent about …my cancer patient.  She starts big guns chemo tomorrow and is filled with dread.  She still can’t give herself any slack.   I asked her if she could feel and take in my compassion.  She said she was terrified that if she did that, I would find out something bad about her and reject her.  I asked her what that might be and she had no response.  My heart is breaking for her as I dont think she is going to come out of this alive (not according to her doctor.)  Interesting side note;  I spoke to her psychiatrist who is prescribing her anti-depressants.  Her response to this relapse was to up the dosage of her meds and her words to me were,  ’Don’t get too close to her.’  Too late for that…”

Susan: I would suggest telling her something like, “Of course there is a risk that if you begin to treat yourself more compassionately and become freer to share yourself with me, there would be a possibility of experiencing feelings that I could reject. On the other hand, it is far more likely that you would reject yourself than I would…could we look at the track record? At your own experience with me? Nevertheless, you may choose to keep yourself at a distance from me, which I have no choice but to accept, but at the same time, you will tragically be inflicting even more pain and isolation upon yourself as well as a life not fully lived. I empathize with the struggle this involves for you and with the fear you’d have to face. But it is also possible that you might let me stand alongside you in facing your fears, that I will not reject you and that you will feel more at peace with yourself than ever before in you life.  But of course, only you can make the choice to take that risk.”

Re. the psychiatrist’s comment:

Susan to therapist: “So, we should try to be close in life but not in death? Or perhaps never be close?” It is indeed an overwhelming prospect to allow all the torrential feelings to which we are exposed on a daily basis to resonate through our bodies. I used to wonder myself if I’d “make it” with this degree of exposure to emotion. Is this psychiatrist right that we do need defenses against closeness as we are exposed to so much human pain? (Another question for another time: Should we limit our caring feelings towards someone who may never let them in?).

Scroll down to the reference to an article written by forensic psychologist F. Barton Evans III, Bethesda, Maryland and Department of XX George Washington University Medical School on 10/13/10 that eloquently addresses this issue. My answer is that we need boundaries but not defenses, self-care and self-compassion, intermittent breaks like walks around the block and lunch with a friend. Behaviorists would say this is an exposure (to feelings) therapy and desensitization is part of the cure…for patient and therapist alike. Seems to me that there’s something magical inborn within us that makes this closeness thing seemingly boundless and infinite.

I was just rereading a wonderful comment to my blog from Dr. Rob Clayton in which he says, “We can also see how attachment to anger is counterproductive from both a Buddhist and a psychological perspective. We have all encountered clients who seem to be a seething mass of anger, with almost no ability to experience the pain of the (psychological) attachment wound that underlies it. The (dharmic)attachment to anger here is a defensive use of affect.” Along this line, McCullough (1991) tells us that “borderline rage…hides enormous sorrow over unmet, and natural, longings for validation of experience.” So, do we say that rage is a defense against grief and the experience of loss or do we say that rage is potentially a pathway to grief and subsequent empowerment? It is my perspective that we cannot arrive at the underlying attachment wound except THROUGH THE TUNNEL of rage, but at that point, there is generally fear and guilt that prevent curative processing. In other words, it is resistance to rage that blocks underlying grief over the attachment wound.

I believe it is fear and guilt over rage that is defensive, not anger itself, and that fear and guilt can cause us to become stuck in anger (i.e. “attached to anger.”) There are those who hold the belief that anger is a destructive, negative force to be gotten rid of as soon as possible. Rather I find that the shared experience of anger/rage, with an awareness of its physiological (bodily) manifestations, and also releasing guilt and fear about the emotion of anger, almost invariably leads to calmness, inner peace and greater capacity for relationship. And very importantly, it can lead to insight into old wounds; empowerment/newfound strength to defeat that which abuses and neglects in order to protect self and others in healthy ways; and more clarity in the decision-making process.

It is certainly vital to pay attention to our anger in a timely way, which does involve not only registering the degree of its internal intensity, i.e. “How great is the force of this rage?” but also sitting with it in order to become additionally aware of the following: “To whom is it directed?” and  ”Are these feelings in any way familiar and who comes to mind?” and finally “What other feelings follow upon it?”

A woman says, “I ran into Carol and Tom today and they’re going to the Getty museum with friends. But I don’t care because I don’t enjoy their friends anyway.” She cannot permit herself to experience anger…therefore she is unconsciously attached to it because there is no path for release. As she self-reflects, she becomes aware of disappointment, feeling left out. “Why did they tell me without inviting me?” Eventually anger comes to awareness…disappointment almost always having components of anger…then memories of being excluded from other groups as a child come to mind. I ask, “Who is it that has been excluding you, really?” “Who is it that bypasses your angry feelings instantly and drives them out of awareness?” “If these friends do in fact exclude you regularly, shall we look at the self-hurting part within you that has ignored your anger and remained attached to them for years?” Or “You tell me they often spend time with you, which is clearly inclusive, so what is the cruel part that will not allow you to take in their caring and uses the Getty comment to clobber you (anger turned against self)?” “But now that you are thankfully aware, certainly an achievement, that the anger is present… shall we follow it’s true course and see what it feels like inside your body?” Etc. Bottom line, I believe in embracing all emotions, trusting we have access to them for a purpose.

Posted in Conference, Therapist Concerns, Treatment Process | No Comments »

Dalai Lama or Davanloo, #2.

I wish to express much gratitude to Bridget Quebodeaux for her penetrating questions/comments that inspired my last posting, “Dalai Lama or Davanloo.” I alerted the STDP listserve of this vibrant topic and counted 39 thought provoking exchanges that resulted.

Before sharing further reflections on this topic, I’m happy to say that my excitement over both practicing and teaching ISTDP continues to grow. Dr. Tom Brod and I are currently conducting an extended workshop in ISTDP to a terrific group of therapists in L.A. We are including an experiential portion that invites therapists to share their feelings as they are exposed to our teaching, as they participate in our group, and towards us as well. It brings us to a deepening level of connection, compassion and respect for one another and lessens barriers to learning. Now, to continue on the topic…

Bruce Ammons, Ph.D.. Clinical Psychologist, quoted Jack Kornfield,  a teacher of the Buddhist mindfulness practice known as Vipassana, who tells us that while “some people have come to meditation after working with traditional psychotherapy…[and have] found therapy to be of value, its limitations led them to seek a spiritual practice. For me it was the opposite. While I benefited enormously from the training offered in the Thai and Burmese monasteries…I noticed two striking things… first, there were major areas of difficulty in my life, such as loneliness, intimate relationships, work, childhood wounds, and patterns of fear, that even very deep meditation didn¹t touch; second, among the several dozen Western monks (and lots of Asian meditators) whom I met during my time in Asia, with a few notable exceptions, most were not helped by meditation in big areas of their lives. Many were deeply wounded, neurotic, frightened, grieving, and they often used spiritual practice to hide and avoid problematic parts of themselves.”

I see inevitable limitations and also breathtaking strengths in many of our therapeutic and spiritual practices simply because we are, after all, humankind. It is our nature to evolve and yet never to arrive. I believe it is a fearful thing to be human in a grand universe over which we have little control and both the Dalai Lama and Davanloo advocate the wisdom of surrender, utilizing our capacities for discipline and awareness, as have many other great teachers. Each teach us different aspects of surrender. Davanloo would have us flow with, rather than against, the feeling forces within us and also to engage in the daily practice of self/other compassion.

The grand debate seems to whether anger is a less evolved state, an emotion to rid ourselves of, or whether it is a feeling to be trusted and fully experienced. I subscribe to the latter and have found invaluable direction, protection and also satisfaction through respect for this emotion. Anger is not pleasant but both physical and psychological pain is always made worse by resistance and fear, which also serve to suppress our joyful, loving feelings. Anger is also a part of ourselves, like it or not, so to reject it is to turn away from a vital part of who we are. There are 2 relationships we cannot live without…to self and other. I happen to be among those who believe that a spiritual relationship is also vital to our fulfillment.

James Phillips, MBACP  UKCP reg., tells us “the Buddhist writer Pema Chodron’s motto for meditating on difficult emotions is ‘neither repress nor indulge’ which I think is exactly what we train our patients to do, to experience their full range of emotions and impulses as they arise within, without either repressing them or acting out. I do struggle to get some patients, who are very identified with ‘transcending’ anger, to see that this amounts to repression and is the surest way to guarantee that the anger will in fact hang around and leak out in all kinds of undesirable and unconscious ways.”

Thanks for this contribution, James. I do have one suggestion…When you say “to get some patients to,” you may be placing more of a burden on yourself than is necessary. I might say to such a patient, “We see how your attempts to transcend anger has not prevented it from coming out in ways that you do not want. It is futile to try to convince you that there is a link between your disdain for your anger and your (explosive outbursts) or (cutting comments to your wife). However, we could experiment with a new way of approaching and fully exploring your anger and you will then see for yourself if you get a better result. On the the hand, you could continue to pursue transcending rather than experiencing your anger. It is up to you.

My hope is to help people to SEE their dilemma..to risk cooperating with the ISTDP therapist’s approach or to guarantee that the treatment will fail. It helps a great deal that I have grown so confident in its efficacy. I really can’t think of a patient who has CHOSEN to try the ISTDP approach and engage in a practice of tracking emotions, anxiety and defense…working through rage, guilt, grief and almost inevitably arriving at longing/love…and practicing caring treatment towards the self…who has not seen real change, often character change, in themselves. Success over the resistance to deep exploration of feelings will depend both on the client’s choice and the therapist’s skill, but once this path is embraced, the outcomes are rich.

James goes on to say, “I would agree that many writings about Davanloo’s work lead one to believe that it’s about “anger, rage, murderous rage, etc.” but my experience of his tapes has been different (and I’ve been to quite a few of his metapsychology workshops in Montreal).  He does work in very penetrating ways, and the work he shows illustrates a high rise in complex transference feelings.  The tapes almost always include anger, and they often stir up a lot for the therapists watching them, but ultimately his work is about freeing the person from the repressive forces which haunt them.  This, in turn, gives room for re-connection and forgiveness to arise – and for a more caring and compassionate life.  Whether we talk about it from a ‘spiritual’ perspective or a ‘psychotherapeutic’ perspective, isn’t that what it’s all about?

One listserve participant shared this quote from Einstein: ’A human being is part of a whole, called by us the ‘Universe,’ a part limited in time and space. He experiences himself, his thoughts and feelings, as something separated from the rest – a kind of optical delusion of his consciousness.  This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest us.  Our task must be to free ourselves from this prison by widening our circles of compassion to embrace all living creatures and the whole of nature in its beauty.’ ”

One of my supervisees had a patient who declared, “I do not WANT” to care about others.’ My question to her would have been, ‘And do you WANT to care about yourself?” To “widen our circles of compassion,” must we not start within?

Posted in Home, Therapist Concerns, Treatment Process | No Comments »

Dalai Lama or Davanloo?

Posted in Conference, Home, Therapist Concerns | No Comments »