A EMDR Methodology for Working with Trauma

EMDR is a form of psychotherapy originally designed for trauma therapy. EMDR provides a here-and-now stimulus as the client recounts his/her traumatic memories. Tapping or eye movements keeps the client in the present and in the observer position. This keeps the client stable, so that he/she can remember stressful experiences without being re-traumatized.

EMDR is very much a relational-therapy application which I find very useful for integrating into my work.

EMDR is founded by Francine Shapiro. Here are 2 lectures of EMDR by Shapiro herself.

About Shapiro’s Way with EMDR

History and research history on EMDR

Commonly administered EMDR Process

EMDR process has a structure. The actual procedure administered is unique to each individual. The therapist, during the session, has to remain focus on the phenomenology of the patient. Keep in mind that simply following the steps alone is not therapy.

1. EMDR therapy begins with a clarification of a trauma-specific case history. The client reveals a traumatic event(s), it’s symptoms and these are to be worked on. The treatment process is also explained to the client.

2. The effectiveness depends on the choice of the outcome situation, and the unveiling of the cause of the traumatic situation.

3. Stabilization of the current situation of the client is important. The client is also prepared internally for the exercise. e.g. the client is asked to use a stop signal if he/she feels too uncomfortable. The client also gets to describe a safe place.  In other words, the client is asked to consider the resources he/she has.

4. Estimation of the degree of severity of the experience. The client is ask to rate the degree of feeling felt at the moment about an event. The client is asked to describe and rate a negative aspect of the event (e.g. feelings of fear or guilt). The client is also asked to describe and rate a positive outcome of the event (e.g. feeling of freedom from guilt).

5. The client is asked to estimate how strong the feelings of stress at the moment is.

6. The client is asked to describe how he/she feels in the body.

7. Pre-processing step: to ask the client to relax and recount the event. Allowing the client to creatively enter into the scene. The therapists begins to lightly tap on the client’s wrists or knees, or guides the client with eye-movements, and encourages the client to describe the situation(s) as they arise to consciousness.

8. The weaving in of the here-and-now situation with past situation.  The client gets to see the traumatic experience as a more mature person (as opposed to a child when he/she suffered a trauma).  The client also gets to view the situation from a vantage point of a safer present.

9. Re-evaluation of the feelings of the traumatic events.

10. Anchoring: the client is asked to recite what he/she has learnt from the experience (the positive experience) as the therapists taps the client’s wrist a little more.

11. Body scan test: to check how the feelings in the body. And to find out what else  that is stressful that is felt in the body.

12. Closing conversation and dialogue: something light hearted, breathing, relaying.

13. Next session, the previous treatment is rated again to see how the treatment is integrated. If the stress is still there, therapy can be repeated, if it is successful, anchoring work can be done.

Sometimes the client does stabilize after the therapeutic work. It is useful to be patient and listen to the patient’s current experience. The goal of the therapy is not to completely resolve every stress in one sitting, but to bring stability week to week, until the client learns to integrate the treatment.

Often the client feels permanent relief of a certain degree of stress.

Own work experience

I decided to use the tapping technique with a client who mentioned a car accident in which she was a driver that happened 20 years before. She is a successful businesswoman in her 50s, and had never mentioned this incident prior. This incident came to light as a result of  a dream recollection.

The client had left a going-away party with some friends, had some drinks. It was also midnight, which was the day of her birthday. As she drove home, she collided with a drunk pedestrian, who got severely injured and died.

During the therapy, the client expressed fear and guilt which she had shut off all the years. She never had a chance to talk about her trauma to anyone and felt lonely.

The tapping allowed the client to see the event as if it were a movie. She could experience the emotions and was able (with hesitation) to vocalize the feelings. Her arms began to sweat.  She began to remember more details of the night after the accident when she went home, and the morning after, how she felt like it was a nightmare, but it was for real.

At the end of the session, the client felt her loneliness, but was relieved about being able to share. Her fear level regarding the event went from a high 10 to 0.  She still processes sadness and guilt about the event, which was later our work-in-progress.

Bibliography

Schubbe, O. (2004). Traumatherapie mit EMDR. Order, 22, 99.

Couples Therapy: Helping children cope with parents’ separation and divorce

Children do suffer much when parents separate or divorce. Read how couples therapy can help reduce the emotional stress and confusion in children who have to face their parents separation.

Children are wired to be ultra-sensitive to changes in their parents’ relationship.

Some children are so tuned-in that they pick up unhappiness within the couple long before the couple even acknowledge the gravity of their problems. How do we know this?

Family therapists have long understood — through working with parents and their children — how children’s developing symptoms can emerge out of anxiety over their parent’s state of mind or relationship. This is a known phenomenon from the field of the family system.

Secure parental bonds are important to children.

The younger and more vulnerable the child, the more important to them are the parental bonds. Stable bonds mean safety. When there is a threat to this stability, children get anxious. This anxiety can amount to panic. From the experience of working with adult clients, I have learnt how even older children in their late teens get affected by their parent’s separation.

Children face anxiety and panic when parents separate

“What will happen to my home?”,”who will take care of me?”,”will mommy or daddy leave me?” These questions speak the language of a child’s fears of being abandoned and left exposed to the environment. The resultant “symptom” is anxiety and panic.

Children blame themselves for their parents’ divorce

Older children and teenagers develop an added strategy to withstand this kind of anxiety. They blame themselves. Blaming is a way of assigning power to the object of blame. If being abandoned makes one feel vulnerable, the way to overcome vulnerability is to assign power to the self. The unconscious tendency is to assign blame to the self for what has happened.

There is a tendency for children to blame themselves for their parents’ marriage breakdown.

In their adult years, children of parents in conflict can bear symptoms such as depression, mood swings and anxiety. Many have difficulty with intimate relationships themselves and some even adopt self- harming behaviors. Psychotherapy sessions in my practice has uncovered oftentimes this link.

What can divorcing parents do to minimize harm to their children?

Be open and reassuring with your children. Even very small children can grasp parental conflict. This does not mean that you should fight in front of the children. To be open about conflict is to acknowledge that there is one, without explaining why, or who is at fault.

Be careful not to use the child to take sides.

Reassure the children that their parents love them, no matter what happens. Reassure them that they are good children.

Engage a professional whom the child can regularly talk to. This could be a counselor or psychotherapist.

Engage a marriage counselor or couple’s therapist to help you and your spouse separate with mutual understanding and respect. Psychotherapists provide the supportive environment for the couple to deal with the emotional pain that arises from the separation process. This relieves the child from being the incidental bearer of this pain.

The last point is worth taking seriously. We know that causing pain to our children is the last thing we want happen in the separation process. Unfortunately, without professional support, the unconscious takes over. In high conflict and stressful situations like divorce, people become unaware of themselves and oblivious to what happens.

Envy… and Gratitude

Envy is the idealizing of an object outside oneself, with the wish to devour the coveted object. This object is something possessed by another person or persons. The trappings of envy is that one cannot find peace through separation of oneself from the envied object and the envied other. The resultant is hatred and the need to destroy the other.

Envy can also be seen as a projection of goodness into another person, so that one idealizes the other while devaluing oneself, and eventually hating the other. Envy is a painful emotion and is almost not in the awareness of the individual. It is also integral to being human, and hence it exists in every reasonably living functioning person.

Envy vs. Jealousy

Envy is exists in terms of two persons– it involves you and me. I want what you have, because that is what I lack. Jealousy involves a third person. I am not allowing that other person to take you / your attention/ love, etc away from me.

Destructive Envy

If I cannot have what you have I’ll seek to destroy that coveted thing. Sometime this destruction is abstract.

Greed

Greed is a means to extract all the goodness from the other. Greed doesn’t necessarily seek to destroy. Greed is to consume without gratitude. Hence greed never gets satisfied.

Defenses against feelings of envy

Vanity or grandiosity is a defense against envy. To make oneself more superior to overcome envy of another. Self idealization, feeling omnipotent, not needing or depending on others.

Invidiousness, is a means to act so that the other becomes envious of you.  To projective identifying or evoking emotions of envy in the other. The problem this causes the person to fear the envious eye of other.

Spoiling, devaluing, rigid idealization, projection of envy (a superego that attacks and devalues own achievements) are examples of means to counteract feelings of envy.

When envy is strong, even what’s seems as a good object becomes a source of pain.

In normal experience good experience predominates over bad. Pathology aries when bad predominates good internally and externally.

Positive use of Envy

Constructive envy is one that inspires one to work harder to improve oneself. If I am envious of somebody’s abilities, e.g. piano playing, I practice harder. We also witness the energy derived from envy in the masterpieces created by highly creative people.

Gratitude as the Antidote to Envy

Melanie Klein tells us that gratitude is the antidote to envy. To be thankful is to be able to see the glass half full. Gratitude allows one to feel satisfied with what one has achieved or bestowed.

Bibliography

Carveth, D. (2016) Introduction to Kleinian Theory 4. Youtube. https://www.youtube.com/watch?v=bb-L_QXNyQU&t=2s

 

notes;

Pathologically violent projective identification, where the object (ego) is splintered, attacked. Reality is seen as persecutory and hated. When envy is intense, the perception of the good object is as painful as the bad object.

46:00 Psychopathology is  the result of early decision to try to base your life upon evading pain (Bion).  Psychotherapy is the process of turning this around. To help the individual face the pain and move on to more functional existence.

Bob and Rita Resnick: Gestalt Couples Therapy

In this video, we learn what couples therapy can look like, what gestalt couples therapy is focussed on. Here is an interview with the Resnicks on their perspective on couples therapy in the psychotherapeutic practice.

Couples Therapy Films – with Rita F. Resnick, Ph.D. and Robert W. Resnick, Ph.D. from GATLA Videos on Vimeo.

How Psychotherapy Works

How does psychotherapy work? What is the difference between psychotherapy, psychiatry and CBT?

Here is useful information for those interested in engaging a psychotherapist.

Transcript of this video:

Psychiatry, CBT and Psychotherapy

When one is in a bad place in one’s head the modern world offers three main sources of help: Psychiatric meditation, CBT and psychotherapy. Each one of these advantages and drawbacks. Medication can be exemplary in a crisis that points when the mind is so under siege from fear, anxiety or despair that thinking things through cannot be an option. Correctly administered without requiring any conscious cooperation from us, pills play around with our brain chemistry in a way that helps us get through to the next day and the one after we may get very sleepy, a bit nauseous or rather foggy in the process, but at least we’re still around, more or less. Then there is cognitive behavioral therapy or CBT. Normally administered by psychologists and psychiatrists in six to ten hour-long sessions which teaches techniques for arguing rationally with and with any luck at points controlling the ghoulish certainties thrown up by our internal persecutors: paranoia, low self-esteem, shame and panic.

Lastly, there is psychotherapy, which from a distance looks like it has only drawbacks. Psychotherapy has a very hard time showing its efficacy and scientific trials and it has to plead that its results too singular neatly to fit the models offered by statisticians. Also, it takes up a large amount of time demanding perhaps two sessions a week for a couple of years and it’s therefore by far the most expensive option on the menu. 

Finally, psychotherapy requires active engagement from its patients and sustained emotional effort. One can’t simply allow chemistry to do the work and yet psychotherapy is a hugely effective choice which properly alleviates pain not by magic or chance, but for three solidly founded reasons.

Our unconscious feelings become conscious with psychotherapy

A founding idea of psychotherapy is that we get mentally unwell have a breakdown or develop phobias because we are not sufficiently aware of the difficulties we’ve been through.  Somewhere in the past we’ve endured certain situations that were so troubling or sad, they outstripped our rational faculties and had to be pushed out of day-to-day awareness. For example, we can’t remember the real dynamics of our relationship with a parent. We can’t see what we do every time someone tries to get close to us.  Nor trace the origins of our self-sabotage or panic around sex. Victims of our unconscious, we cannot grasp what we long for or a terrified by. In such cases, we cannot be healed simply through rational discussion, as proponents of CBT implicitly proposed, because we can’t fathom what is powering our distress in the first place. 

Psychotherapy is a tool for correcting our self-ignorance in the most profound ways. It provides us with a space in which we can in safety say whatever comes into our heads. The therapist won’t be disgusted or surprised or bored. They’ve seen everything already. In their company we can feel acceptable and our secrets sympathetically unpacked as a result crucial ideas and feelings bubble up from the unconscious and are healed through exposure interpretation and contextualization we cry about incidents we didn’t even know before the session.  The ghosts of the past are seen in daylight and a laid to rest.

The importance of working with one’s transference relationships in psychotherapy

There’s a second reason why psychotherapy can work so well. Transference. Transference is a technical term that describes the way once therapy develops a patient will start to behave towards the therapist in ways that echo aspects of their most important and most traumatic past relationships. A patient with a punitive parent might for example develop a strong feeling that the therapist must find them revolting or boring a patient who needed to keep a depressed parent cheerful when they were small might feel compelled to put up a jokey facade whenever dangerously sad topics come into view. We transfer like this outside therapy all the time but there what we’re doing doesn’t get noticed or properly dealt with. Psychotherapy is a controlled experiment that can teach us to observe what we’re up to, to understand where our impulses come from and then adjust our behavior in less unfortunate directions . A therapist might gently ask a patient why they’re so convinced they must be disgusting or they might lead them to see how they use of jokey sarcasm is covering up underlying sadness and terror. The patient thereby starts to spot the distortions in their expectations set up by their history and develops less self-defeating ways of interacting with people in their lives going forward

Psychotherapy provides “the first good relationship”.

The third reason why psychotherapy works it is the first good relationship. We are many of us critically damaged by the legacy of past bad relationships. When we were defenseless and small we didn’t have the luxury of experiencing people who were reliable who listened to us who set the right boundaries and helped us to feel legitimate and worthy. However when things go well the therapist is experienced as the first truly supportive and reliable person we’ve yet encountered. They become the “good parent ” we so needed and maybe never had. In their company we can regress the stages of development that went wrong and relive them with a better ending now we can express need we can be properly angry and entirely devastated and they will take it, thereby making good years of pain. 

One good relationship becomes the model for relationships outside the therapy room. Some moderate, intelligent voice becomes part of our own in a dialogue.

We are cured through continuous repeated exposure to sanity and kindness.

Psychotherapy won’t work for everyone. What has to be in the right place in one’s mind? 

One has to stumble on a good therapist and be in a position to give the process due time and care. But all that said with a fair wind psychotherapy also has the chance to be the best thing we ever get around to doing.

Symptoms of Anxiety and Panic Disorders in the Context of the World We Live in

Anxiety and panic disorders are getting increasingly common among young adults. This is a phenomenon observed and mentioned by mental health professionals who work in Europe, Asia and America. There are several hypothesis to this observation. The logic that resonates most with me is the one by a psychiatrist colleague from Italy, Gianni Francesetti.

Francesetti attributes panic disorder to “an acute attack on solitude (loneliness)”. This actually implies that the symptoms of panic and anxiety attacks, while observed to be affecting an individual person, is in fact contributed by this person’s relationship to the world around him/her. Why? Because we cannot be lonely if we are in contact with some other persons in the environment. Hence to be lonely is to be left in the cold with on one for company.

The word panic is descriptive of the state of being left exposed in the wilderness. It is said to have been derived from the name of the Greek god, Pan. Reading the characteristics of Pan one would derive the keywords, all-encompassing, wilderness, solitude, rejection, stomach-churning cry and death. The word panorama describes the wide open field space. A young animal separated suddenly from its mother and exposed to the cold environment would panic. In its panic it would cry out.

Neuroscientist Panksepp’s lecture explains to us how the panic pathway in the brain is wired up. He also tells us in the video below that the baby animal in panic would be quiet again once it is held warmly. If it were not held, it cries would ultimately stop, and the animal would fall into a state of what looks like depression in humans. The panic system generates loneliness and sadness, and it is observed to be the gateway to depression.

The panic system is related in mammals (including humans) to separation distress and over exposure. Human suffers experience the onset of panic disorder usually as young adults, the age when one leaves the parental home.

Most clients who complain of panic attacks are independent and forward-looking people. Feelings of being exposed or separated are not part of their conscious awareness. These experiences belong to the client as toddlers or babies, and are overwhelming. Many clients manage to uncover this hidden past experience after months of psychotherapy.

Psychotherapy for Anxiety or Panic Attacks – A case study

Clarise, 26 years old, a student who holds also a job as a medical receptionist. She had her first panic attack when she was 20 and had just left her family home and moved to another country, Vienna. She explained that the onset of subsequent panic attacks happen when she is about to leave the family home when she is on holiday there. Strangely, this is also related to her leaving her younger brother, Mike.

Proud of being an independent worker, she came to therapy often talking dryly about happenings at work, talking about panic attacks and medication, and avoiding topics about her relationships. I could perceive her avoiding experiencing her emotions, and her intense fear of going there. Sessions in the first 4 months felt slow. I soon had difficulty remembering her among the other clients.

The slow, almost deadening atmosphere in the sessions soon became clear to me. I felt like I was in conversation with someone who was trying to make herself invisible to me. Yet I felt a longing between us for contact. Clarise came every week for therapy faithfully. I decided on several experiments during the sessions. The most useful of which was very simple: to walk around the room as we spoke. Clarise, while walking, became more animated. It seemed as if in order to make herself invisible, she kept her body still. When she had to walk around, her energy flowed. She appeared then more alive and open to being in conversation with me.

Over time, Clarise was able to talk about her childhood. Keywords were: Unwanted child. Emotionally abusive mother who was devaluing, abandoning, de-validating of her feelings, denying, contradicting. Her mother favors her younger half-brothers. As a child she had to look after the boys. She was also competitive with mother with regard to the brothers. She became overtly responsible for Mike.

Her childhood memories were fragmented, indicating a kind of trauma, perhaps from neglect. Only mother’s feelings of those days could be recalled by Clarise. In the therapy room, it felt to me as if her mother always present. Sometimes I would use the mother’s “presence” as an intervention.

Clarise admits to be constantly yearning for attention. This is a paradox, because of the way she unconsciously makes herself invisible. She admits to flattening her voice to control emotions. Clarise has little body awareness, which she became aware of as we walked around the room.

Gestalt Psychotherapeutic intervention for panic attack symptoms

Clarise’s case shed light on the polarities that emerged during our work.

Polarities are:

  • Fear vs. Curiosity,
  • Attention yearning vs. Self-hiding
  • Being forgettable vs. Forgetting

“I must be afraid so that mother can feel good about herself.”

“When my boyfriend is not at home, I am not in danger of having a panic attack.”

“I make my breathing shallow to press against my chest, so that I won’t cry here.”

Clarise also exhibited tendency for Self-ISOLATION, even if it were unconscious to her. One of her strategies was to dissociate. To disappear. To forget. She admitted that as a child, it was “Safer to be unseen.” If her mother was at home, she would not be able to predict if she would be treated with kindness or anger.

Clarise realised that she could use illness and lately the panic symptoms to garner support from people around her. “When I’m in dire straits, people will come to me and they won’t harm me.”

Looking at PSYCHOPATHOLOGY from the perspective of the relationship between client and therapist.

In the therapeutic alliance, suffering is not located only within the client, but is an emergent phenomenon. This means that we as therapist can feel, perceive ourselves as being part of the symptom. We are impacted by the symptom.

When I am able to acknowledge how being with this client impacts me– in this case the feeling of stagnating stillness and forgetting– I am able to adjust my being with her. In so doing, the atmosphere changes. In gestalt therapy we acknowledge this the as the field.

3 levels of observing anxiety disorder symptoms based on this case study
Single person LevelDyadic Interaction Level Aesthetic Field Level
“My client has panic attacks.” “I forget the client. I overlook her. She seems to make herself invisible to me.” “There is stillness and monotony in the air. I can hear the clock tick. The room feels empty. I feel tingly. There is a sense of longing.”

Conclusion

What I attempt to present here is a cutting-edge perspective of treating symptoms of panic disorder in a patient in the clearest way possible in a blog. Medication and quick therapies have not managed to effect lasting relief for most patients of anxiety. This is why we, as gestalt therapists, look to the broader field. We look beyond the person. We have found useful to see the client in context of the socio-cultural environment. We use this field during the session. We move ourselves in the field. We allow ourselves to be impacted. In this way we make small adjustments. These work as tender changes within the psyche of the client.

Remembering the hypothesis that panic is an acute attack of loneliness, the work with Clarise revealed it to be so. Although Clarise never admitted that she was lonely, she revealed her natural tendency for self-isolation. In making herself forgettable, it was I who ended up feeling left alone in the therapy room. Noticing this and sensing our longing for contact, I could affect the field around us. When the field changed, the client eventually changed. Clarise learned to cry. This was a relief to her. It was a relief to feel safe and be vulnerable. It was a relief to her that she did not have to go into a state of panic to afford company.

Bibliography

Francesetti, G. (Ed.). (2007). Panic Attacks and Postmodernity. Gestalt therapy between clinical and social perspectives. FrancoAngeli.

Coming off Psychiatric Medications

Taking psychiatric medications is not the same as taking over-the-counter flu medication. When one gets a flu, one simply takes a pill and stops when the symptoms subside. With psychiatric medications, however, this is different. Having started on a course of psychiatric pharmaceuticals for mental health symptoms like depression, anxiety or psychosis, one must follow carefully the directions of the physician, and to consume the right dosage at the prescribed intervals. When the symptoms subside, or when one feels that the meds do not help, the patient should not simply stop taking the medication. He/she should first consult the psychiatrist who would advice the patient on how the dosage can be reduced.

This controlled reduction of psychiatric medication is an important measure of harm reduction. Why harm reduction? Psychiatric drugs are chemicals that alter the balance of one’s brain biochemistry. On consumption of these drugs, the body and brain cells adapt to the drugs. This adaption process does not happen spontaneously, but take weeks. Genes are switched on and off. A hormonal and a neurobiochemical balancing act takes place. When you decide to stop taking the drugs, you’d need to allow time for your balancing neurobiological system to adapt back to life without these medications.

Measures to take before thinking about coming off antidepressants:

  • Find support from the people around you. Going off these meds can be an unpredictable process. One my feel moderate to severe swings of mood, disordered sleep, anxiety and even rage.
  • Plan beforehand to take up some wellness and coping skills. Some of the most effective are body-based activities that require controlled breathing, like weight-training, yoga, swimming, dancing and meditation. Different people have different preferences.
  • Get support from a psychotherapist at least 6 months before you decide to reduce your medication. This will help you resolve internal conflictual issues that triggered the symptoms in the first place.

In the video below, Will Hall, a former psychiatric patient turned psychotherapist and harm reduction educator explains how and why coming off psychiatric drugs need special attention.

Download Will Hall’s free booklet on coming off psychiatric drugs.

How to Contact Me for Psychotherapy in Singapore

Going through Crisis, Dealing with Crisis

This article discusses what is means to experience crisis and dealing with crisis. The word, “crisis” has its Greek origin, krinein, which means, “to judge”. In Chinese, the word for crisis is 危機– the first word 危 means danger and the second word 機 means opportunity.  This indicates that to be in crisis is to be in a state of having the possibility to make choices. This requires evaluation and re-evaluation of what used to be, or what we have been used to.

dealing with crisis

To be in crisis, is to experience a loss or a possibility of a loss of something that was important, that had a meaning in your life. The loss can be something that is tangible, like the loss of a loved one or loss of health, or something spiritual / mental, like loss of trust in someone/something.

Dealing with crisis is a process of creatively adapting to the crisis situation.

 The Change Process in Dealing with Crisis

The loss usually translates into very meaningful changes for the person in crisis.

It is possible that such changes are impetus for growth; though that is not always the case. Experience of crisis can be extremely disturbing and anxiety provoking. When we go through crisis, there is also the feeling of being very alone in it.

Types of Crises

A crisis may be the result of loss of one’s previous identity or role. The loss of (or the expected loss of) a significant person, often changes how the individual sees him/herself in his/her world.  The loss of health or a body part impacts likewise.

Crises occur with the natural course of life: puberty, leaving home, emigrating, having a child, getting divorced or approaching middle-age. These are some events in life in which people find themselves leaving familiar territory and having to make choices.

Getting Help in Times of Crisis

Help, to a person in crisis, is not a matter of giving advice or providing treatment. The best form of help comes in the supporting of the person through this difficult time of change.

Time is a main and stable resource. Stressful experiences occur when we expect a quick way out of the difficult feelings. Effective help comes in the form of one who is patient enough to be present with the person in crisis till he/she can fully integrate with the losses, and can come to terms with his/her new way of being.

This is also the “paradoxical theory of change” adopted by gestalt therapists.

Dealing with Crisis with Someone’s Help

If you are going through crisis yourself, find others who are able to provide you with the support to integrate the new meaning into your life. You can help them to help you, by telling them what you need and what you don’t need.

If you, for example, do not find the advice/consolation of well-meaning friends useful, say to them (if you can muster it), “I need you just to be with me, we do not have to find solutions right now.” Find someone to speak with about your difficult feelings of anxiety, guilt, sadness, grief, etc.

Certainly, getting professional support from a therapist or counsellor is also a good option.

How emotional writing can improve your mood — and health

I am inspired by the many special people with whom I have learnt this to be true; of the healing benefits of writing about life’s experiences expressively.

“Am besten gefällt mir noch, dass ich das, was ich denke und fühle, wenigstens aufschreiben kann, sonst werde ich komplett ersticken. ”  Anne Frank 1944

Translated as: “The nicest part is being able to write down all my thoughts and feelings, otherwise I’d absolutely suffocate.”

Research like those by Pennebaker et. al. in the 1980s have shown that groups of people who have been asked to write expressively about difficult times of their lives 15-20 minutes a day for 5 consecutive days benefitted more from the control group (who were asked to write  about superficial themes) in these areas (Horn et. al 2011):

  • they needed fewer doctor’s visits.
  • they had better immune parameters
  • less medical symptoms
  • less depressive and anxiety symptoms
  • experience overall better sense of wellness.

Putting into handwritten words your negative emotions, is especially useful. The term “negative”, refers to  painful feelings that we normally try to avoid and conceal from others and ourselves. These emotions are not “negative” in the sense that they are bad or wrong. These emotions, like fear, sorrow, panic, shame, envy, anger, grief, loss and sadness, have everything to do with us being human.

Emotions are embodied. This is not commonly acknowledged fact. However, when panic, for example, sets in, we feel it in the body.  This is why the panic attack is paralyzing. It makes us feel vulnerable.

Depression is not an emotion in itself. It involves a bodily action. Emotions are being controlled. Feelings of rage, anger and fear are being surpressed. There is so much energy in this surpression that the physical energy gers sapped out, leaving us weak.

Writing is a uniquely human activity. It is action. It is intellectual, and it is language. Writing expressions of emotions brings to action the emotions that underlie painful memories. Unlike speaking out or physically acting out the emotions, writing has a protective effect: it is a form of expression that is somewhat energetically controllable. The fact that the writer is control of his/her pen is an important factor for individuals who are psychologically fragile, who risk being overwhelmed (or even traumatized) by painful memories.

Since writing is also language, writing helps us to understand these emotions.

“(T)he most important thing for me is to understand. For me, writing is part of this process of understanding. Writing is an integral part of the process of understanding… If others understand in the same way I’ve understood, that gives me a sense of satisfaction… wie ein Heimatsgefühl*” Hannah Arendt 1964  (Gaus & Arendt, 1964).

*a feeling of being at home.

Expressive Writing in Psychotherapy

Personal experiences allow me to understand the usefulness of writing.

I encouraged almost everyone I know to keep journals, write blogs or keep sketchbooks.  There is no need to write in prose or even correct sentences (although many do write impressively). Simplicity is effective. Write everything down, even if there are doubts if the words are real/true/right or belong. Anything written wrong can be cancelled out later, but write first.

In the therapy session itself, difficult experiences or deeply emotional fantasies, dreams and thoughts can be written down.  Sharing between therapist and client during the sessions are potentially contactful moments.

For clients who have difficulty feeling or expressing emotion, this process is especially useful. Keywords are offered to them. These individuals learn first to intellectualize the meanings of the emotional word, then link them to the experience of the events. The possible outcome of which is a gradual encounter of the person with the realm of feelings.

Unlike spoken narratives, the client remains in control of how much he/she wants to write or express.  He/she has time to consider. Everything slows down. This is especially useful for very delicate clients.

Writing has an added dimension. The words do not disappear — unless the paper is destroyed.

Conclusion

Horn et. al. explains the immunological connection with expressive writing. Mentioned in the article presented are also theories behind how this activity can have such impact (p.254-257).

Writing can be part of the therapy session. The process of writing can shared — the client puts down the words while the therapist supports and provides a safe environment.

 

 

Bibliography

Gaus, G., & Arendt, H. (1964). Gespräch mit Hannah Arendt. R. Piper. Retrieved from web: https://www.youtube.com/watch?v=J9SyTEUi6Kw

Horn, A. B., Mehl, M. R., Detters, F., & Schubert, C. (2011). Expressives Schreiben und Immunaktivität: Gesundheitsfördernde Aspekte der Selbst-Öffnung. Psychoneuroimmunologie und Psychotherapie. Stuttgart: Schattauer, 208-227.

 

Panic disorder and loneliness

Panic disorders are sensed as physical symptoms. Often the root cause of these symptoms are not initially known to the person experiencing these attacks . This “not knowing” makes the physical reactions seem unpredictable, spontaneous and frightening. The sufferer is left feeling vulnerable to his/her condition when a panic attack seemingly arises out of nowhere.

In the field of neuroscience, a part of the brain is acknowledged as having something to do with panic (Solms & Turnbull 2002,  Solms 2015). This part of the brain is also connected to the feelings of loss and depression. It is very common to observe clients who experience depressive episodes, also feel panic. As the course of therapy progresses, feelings of loss emerge .

Changes in life situation can trigger panic attacks. Leaving home, moving to a new country or entering a new marital status, etc. become moments of new learning where trusted supports of the past are no longer available. Unfamiliar ground sets the cycle of feelings of loss of security. Panic attacks seem begin at times when the individual begins to develop a sense of autonomy in life.

Connection between panic attack and loneliness

Francesetti’s  (2013) mention of the link between panic attack and loneliness is noteworthy. He quotes a patient named Marco as saying “panic attack is basically an attack on acute loneliness.”

Reflecting on personal encounters with individuals who struggle with panic attacks…

The client narratives often speak of situations of leaving, being left behind, suffering emotions alone, having had to escape mentally from somewhere. Frequently encountered are narratives of terror feelings experienced by the person as a young child. With the progress of therapy, it often becomes clear how this  episode (and perhaps recurring episodes), gets to be experienced as something suffered alone. The adult client lives with the memories, but cannot make sense of them because he/she could not get the required acknowledgement from others that the event actually occurred.  The isolation and confusion is felt most deeply if the members of the family who were actually part of the scene of terror flatly deny the occurrence or severity of the event(s).

The consequence of such experiences is the embodiment of the fear, disbelief in one’s own experiences, guilt, and a need to distance the self from these feelings.

In therapy the task is to identify the emotions  and wounds associated with these early childhood experiences. These are then worked through together with the client in an experiential and empathic atmosphere. Being authentically present with the client, acknowledging that the events, its severity, containing the emotions that the client is too afraid to encounter, and validating the feelings and thoughts that exist with this event have provides relief.

Panic disorder is one of the most common reasons why people seek psychotherapy.  The decision to seek a remedy in this way is quite likely to be an instinctual one.

Bibliography

Framcesetti, G. (2013). Gestalt therapy perspective on panic disorder. In Francesetti, G., Gecele, M., & Roubal, J. (Eds.) Gestalt therapy in clinical practice: From psychopathology to the aesthetics of contact. Kindle Ed.  position 11673

Solms, M. (2015). The animal within us. Source: Youtube URL https://www.youtube.com/watch?v=JfqVIG9bejU.

Solms, M., & Turnbull, O. (2002). The brain and the inner world: An introduction to the neuroscience of subjective experience. Karnac Books.