Self Harm & Emotional Pain

Psychotherapy, self harm and emotional pain.

This page features a collection of video lectures on the subject of self harm orNon-Suicidal Self-Injury (NSSI) and it’s connection to emotional pain.  These resources, I hope, will provide some personal and professional answers in dealing with, or appreciating the phenomenon of self harm. The aim of this learning is to bring awareness of what is possible and what is needed to assist others with the same issues. Self harm is a behavior to be respected, because it serves the person. It is also a behavior to be taken seriously, and with compassion.

Willis, J. on “Bullicide”

Willis tells us about the impact of bullying on people who self harm. He also explains with neuroscience that both physical and emotional pain activates the same area of the brain.

Lewis, J. on his personal experience with self harm

Lewis’ sharing of his experiences of self harming may resonate with many people. As in the above video, bullying is known to be a trigger for self harm.  Lewis tells us of the value of loving people who are suffering from emotional pain.

Working with Self Harm in Psychotherapy

Self harm is a clear indication of the need to cope with un-bearable emotional pain. The most important aspect of treating clients who have learnt this coping strategy is to authentically respect the person, what he/she does and feels. The therapy sessions will then deal with the emotional turmoil that underlies the need to self harm. Therapist and client work together to understand the origins of difficult feelings. Reminiscing past experiences in a secure therapeutic environment bring up emotions attached to these experiences. As Lewis explains, it is the cutting that silences the emotions. Therapy brings the voice back to these emotions. This voice is also heard by the therapist who respects the process.

Scapegoating in Groups and Families

Scapegoating is a phenomenon that happens in almost all human groups. A. Colman (video below), begins the above talk by saying that it is the root of evil in humanity. Is he exaggerating this? Or are there truths in his remark?

bullying

What makes a group?

A group is made up of a bunch of individuals (and we are referring to human individuals here), who have to be together because of a certain task or function. A company of workers is a group. There are social groups, church groups, political groups, hobby groups, support groups and the like. Families are also groups.

In my article Bion: The Function of Myths in Groups, I explain that a group is a body that has a mental state and creates a phantasy. The group becomes more than the sum of people that come together to form it. The group has its own dynamics and it is its own organism.

Groups are like organisms, and they strive to keep themselves intact

The group connects the inner worlds of people. Narcissistic tendencies and psychological traumas get played out in groups. Like a living organism, the group strives to keep itself intact.

In order to do so, any form of aggression that naturally and unconsciously arises from the group becomes a threat to the status quo of the group. There is a tendency then for the group to move towards “doing something” to maintain harmony and equilibrium. The individuals then strive to retain their own idea of their “good self” and deny their part in the aggression that threatens the group.

Groups need scapegoats so that the members can disown their responsibility for the group’s destruction

The aggression that is latent in the group becomes disowned by the individuals (who do not want to be blamed for their group’s destruction), and transferred on to an external object of blame. This object of blame is the scapegoat.

Oftentimes the scapegoat is a member of the group. Sometimes it appears in the form of someone from outside the group– people from another culture, immigrants, women, etc.

Scapegoating in Groups

Scapegoating is the most ancient human rituals. It used to come in the form of practices such as child & animal sacrifice, adult sacrifice, witch hunting. Large groups of people can also become scapegoats, as we have witnessed during the Holocaust, Apartheid, and other genocides.

A Scapegoat is a person, subgroup, collective idea … who is made to take the anxious blame for the other people in their place.

The process of scapegoating is done in order for the rest to feel more comfortable, or to be more efficient, and whole.

The scapegoat embodies the transformational, creative and/or destructive potential within the group.

The scapegoat has often creative potential, and is often different from the others in the group. Sometimes this person has the potential to make changes in society.

Scapegoating is victimization of the other

Many who have been young victims of bullying in school or in the family have experienced from a young age, what it is like to be in the position of the scapegoat.

The scapegoat is usually the different / outsider. Not being able to bear the difference. Potential scapegoats are usually people who are racially different.

Scapegoat’s Adjustment

In order to survive being scapegoated, the person either turns into the

  • victim /patient (as in children who develop illnesses or develop behavioral problems in school).
  • avenger (someone who takes revenge)
  • the messiah / prophet (someone who saves the group)

09:10 Colman, in the video above provides us with literary examples of some of these scapegoat transformations.

In Families, the child who becomes the Scapegoat is also the Symptom Bearer

Scapegoating happen in almost all families. Most of the time a child in the families bears the brunt of the scapegoating. If the family is relatively harmonious, the scapegoat feels simply like a “black sheep”, and grows up to be an adult who can function well.

In families that are dysfunctional, or in families where mental disorders and/or addictions or illnesses exist, the scapegoat child develops symptoms or syndromes that affect his/her ability to function emotionally as an adult. Some of these scapegoated children develop psychological issues like depression, anxiety, eating disorders. Some also develop the tendency to self harm.

This is usually seen (which I witness in practice) in a families where parents strive to stay together, despite the fact that one or both parents are abusive or psychologically unstable. What would have been a natural course of action, a break up, is avoided by members of the family at all costs. A superficial picture of stability is often seen in these families.

The “only” problem this family seem to have is a problem child — a child who is doing poorly at school, has behavioral problems, has eating disorder, self harms or has other emotional difficulties. When as therapists we see such children, we understand them to be symptom-bearers.

The experience of being a child scapegoat is one of Childhood trauma. There is immense feeling of loneliness because his/her feelings towards the family are negated by their own parents and siblings. These are the children who’d take the blame for their parents’ worries. Many grow up believing that they are flawed. Many introject the blame. Self blame lead to self hatred, self harm and sometimes suicide.

Psychotherapy for Child Symptom Bearers

Usually families bring themselves into therapy because of a “problem” or “sick” child. In successful family therapies, the therapeutic work centers around the relational dynamics between the family members, and not focussed on the “problem child”. Helping the parents and other members become aware of their roles in the family system releases the afflicted child of having to bear the intrinsic problems that exist in the family.

Psychotherapy for Adult sufferers of Scapegoating

One does not always know that one is being made a scapegoat. In the working environment, the scapegoat may simply find work in the office stressful with conflicts.

Sometimes, of course, in the course of therapy the client realizes that he/she was his/her family’s symptom bearer, or that he/she was a scapegoat in a group.

Being a scapegoat brings with it feelings of loneliness. You are being targeted as the cause of problems. Because of this, there’ll also be feelings of having done something wrong, or being flawed. This progresses to self blame. Psychotherapy involves

  • addressing these feelings of loneliness, shame, fear and betrayal
  • re-aligning oneself by being awareness of the group reality,
  • finding oneself again being independent of the group,
  • finding resources outside the group
  • getting support from others

Contact me freely for more information on this topic, or for therapy.

Psychotherapy in Vienna & on Skype

Find out more about:

Therapy in Vienna …. Therapy over Internet

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.

Resnick: Gestalt Therapy Principles in Today’s Context

What is gestalt therapy? Resnick explains gestalt therapy principles in just 30 minutes with this video. Is Gestalt therapy for you? Watch this.

 

“The relationship is not as important as the research shows but what happens in the relationship. When there is an interaction between therapist and client.”

This is the best video resource to understand, ” what is gestalt therapy?”.

 

 

An Introduction To Gestalt Therapy Theory from GATLA Videos on Vimeo.

Ellenberger: THE PATHOGENIC SECRET AND ITS THERAPEUTICS

This 1966 article, The Pathogenic Secret and Its Therapeutics,  by Henri F. Ellenberger may explain why psychotherapists are bounded by strict confidentiality in their work.

Ellenberger highlights what he calls the “pathogenic secret”. This is a secret of what has happened to us, or what we have witnessed first hand, or what we have been told, that is so “heavily-disturbing”, thus unbearable for us to come to terms with.  This is the secret that we keep to ourselves. Sometimes it is a secret that we keep from ourselves, out of our consciousness. Oftentimes belongs to an an event that had occurred in early childhood.

Under certain circumstances, the confession of the pathogenic secret has been known for time in memorial to have healing qualities.

The Concept of the Pathogenic Secret

Pathogenic secret  manifests itself as chronic neurosis resulting in symptoms like “melancholia, neurasthenia, hysteria, or even psychosis”, i.e. what we know today as psychopathology.

“The nature of the pathogenic secret can also differ widely. In certain patients, it is the matter of secret thwarted love or some other suppressed passion, such as jealousy, hatred, or ambition. Sometimes it is a matter of physical illness or infirmity, of which the patient feels ashamed. Frequently the secret is related to some kind of moral offence which can range from petty theft to murder, but frequently also it is of a sexual nature (adultery, incest, abortion, infanticide, etc.). The secret can also be the painful remembrance of some traumatic event, sometimes connected with a secret of another person (for instance a young girl discovering her mother’s adultery).” There is often experience of shame involved in the pathogenic secret.  The type of the pathogenic secret can differ widely, and it’s effect varies with how the individual attaches meaning to it.

Healing Power of the Confession

Working with confessions is not a new concept. It is observed within ancient healing practices. Confessions of sins or taboos have been documented as healing methods in ancient civilizations in places like Mexico and Mesopotamia.

In the Roman Catholic religion, confessions are practiced, as a form of the self reconciling with the social world.  In Catholicism, confessions are sealed in secrecy to the point that under no circumstances is the confession revealed.  Once absolved from sins revealed in the confession, the confession is free from his/her sin.

In the Protestant religion, the concept of “Seelsorge” or “cure of souls” as the result of being in the presence of another in a dialogue that can be an exchange and containing of a secret.

The Pathogenic Secret in Literature

Ellenberger also cites examples of the destructiveness of the pathogenic secret and it the healing effect of the secret’s revelation in literature like Nathaniel Hawthorne’s The Scarlet Letter, Jeremias Gotthelf’s Wie Anne Babi Jowager haushaltet und es ihm mit den Doktorn ergeht,  Ibsen’s The Lady from the Sea,  Marcel Prévost’s L’Automne d’une Femme (The Autumn of a Woman),  Heinrich Jung-Stilling’s Theobald oder die Schwarmer.

The Pathogenic Secret in Criminology

Then there is the confessions of the pathogenic secret in criminology. The author cites 19th century literature,  Philosophie Pénale, published in 1880 by Gabriel Tarde, documenting the effect that the confession of the crime has on the person who committed it.

A problem which seems to have attracted less attention is that of the long range effects of the burden of the secret upon the criminal, should his crime not be discovered. It would seem that the secret exerts a permanent and profoundly disturbing effect on certain criminals.”

Another literature cited was that of Austrian criminologist, Hanns Gross, in his textbook of criminal psychology in 1898.

C. G. Jung (12) tells the story of a woman, unknown to him, who came to hisoffice, refusing to divulge her name, and told him how twenty years earlier she had poisoned her best friend in order to marry her husband. But the husband died soon after she married him, the daughter of this marriage disappeared in turn; even animals turned away from her so that she could no longer ride horses nor own dogs and finally she fell into an unspeakable loneliness; this was the reason why she felt that she must make a professional man share the knowledge of her crime. Jung never saw that woman again and wondered what happened to her. Actually the long-range disturbances caused by a secret of that kind in the mind of an undetected criminal are one of the least-known chapters of criminology.

Hypnosis & Pre-psychotherapy

The notion of the burdening secret became known to magnetists very soon after the discovery by Puységur of the state of “magnetic sleep”, now known as hypnosis.

Moritz Benedikt (1835-1920) in the late 19th Century was already able to explain how symptoms like hysteria was cured with revelation of a pathogenic secret in the individual’s “second life” and thus “inner life”.

Freud’s Psychoanalysis  and Psychotherapy Today

Freud’s earliest publications illustrate the curative process of revealing of innermost difficult-to-bear secret to a trustworthy professional in a therapeutic dialogue, or “talking cure”.  In psychotherapy, this pathogenic secret is something in the unconscious that is revealed in the course of therapy. This revelation is the curative change that occurs in therapy.

With the further development of psychoanalysis, the concept of the pathogenic secret became gradually absorbed into the wider frame of reference of traumatic reminiscences and of repression, and later in the concept of neurotic guilt feelings.

Psychotherapy Law of Confidentiality

It is law in Europe that psychotherapists are committed to confidentiality in their work with clients. This means that whatever the client tells his/her therapist is bounded to confidentiality. The therapist has duty and also the right to maintain this secrecy. The therapist cannot be forced or tricked by anybody– regardless of power or authority– to reveal information given to him/her by his/her client.

This professional code of conduct (in German) for psychotherapists in Austria can be downloaded here:  Berufskodex für Psychotherapeutinnen und Psychotherapeuten

The only consideration to break confidentiality is when  it concerns the welfare of children and if lives are at risk. Even so, the therapist would consult their counsel of psychotherapists for advice and support.

Being trained in Austria, I am not sure at this point if this rule is applicable to other parts of the world. However, in this article, I would like to highlight the importance of confidentiality for the effectiveness of psychotherapy itself. The wish is that there is a worldwide recognition of the special role of psychotherapy as a profession, and respect for the autonomy of psychotherapists in keeping confidential the material obtained from their clients. As a therapist in Austria, I am committed by the license and by the law to keep all information of my clients secure. Documents are locked up, and information are encrypted so that no client information is compromised. When doing research or case studies, the information that is provided is altered in such a way that no person can be remotely identified in the work. All this is monitored by ethics commissions and peer groups.

This code of the psychotherapeutic profession, it’s protection by law of the therapists and clients, in countries like Austria, creates an environment safe for people to use psychotherapy as a means of healing.

Bibliography

Ellenberger, H. F. (1966). The pathogenic secret and its therapeutics. Journal of the History of the Behavioral Sciences2(1), 29-42.

Mental Illness: DSM definition of what is mental disorder is and what isn’t

This is the definition of the term “mental disorder” according to the DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS FIFTH EDI T ION DSM-5  (pg.20):

A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.

Mental disorder is a syndrome

The definition describes what mental disorder is. It is a syndrome, which is a group of related symptoms that the individual might encounter. Mental disorders are observable as clinically significant disturbances. This means that if the emotional regulation, behavior or cognitive processes of an individual is not clinically seen as significant, it is not a mental disorder. The mental disorder has to reflect a dysfunction that has underlying causation.

Mental disorders affect daily functioning

A  mental disorder is considered as such only when it has consequences to the daily functioning of the individual. This means that even if a person suffers from schizophrenia, if this individual is able to work, live, have relationships and play, he/she does not have a mental disorder.

Distress Caused by Life Situations are Not Mental disorders

Distressing events  e.g. death of a loved one, or a divorce can cause emotional /and physical pain.  These emotional setbacks that a person faces are unpleasant but is does not mean that the person has a mental disorder.

Socially Deviant Behavior is Not Always the Result of Mental Disorder

Socially deviance is not considered a product of mental disorder unless this behavior is accompanied by a person who has the above-said mental disorder.

Psychotherapy is not only in the business of working with mental disorder.

Psychotherapy is different from psychiatry in the sense that it is not a profession that works only in the face of mental disorder. Even if mental disorder diagnosed, the therapy is focussed on the persons’ emotional state and self support.

Most of my clients are not in my office because of a mental disorder, but because of life events that they need to cope with. Psychotherapy lends the client a space to be heard, to introspect, interact and experiment; so that he/she can realize the choices he/she has to live a stable, functional and even thriving life.

Anorexia & Eating Disorders in Children: What Parents and Family can do

When a child in the family develops symptoms of eating disorder (like anorexia nervosa, anorexia bulimia or binge eating disorders), other members in his/her family, in particular the parents may feel overwhelmed by the situation and even helpless.

The ways in which different families deal with the illness vary individually.

As parents or guardians the most immediate thing to do is to get for themselves support from a professional in treating eating disorders, be they doctors /psychiatrists  and/or psychotherapists.

What parents can do

The actual diagnosis and treatment of the physical and psychological aspects of the eating disorder is conducted by doctors. Usually these are done by specialists.

Parents can help the professionals by offering information on the family situation when these questions are posed to them by the diagnostician.  If there is such an interview given, it is best to provide the information as openly and honestly as possible.  This would facilitate un-hindered support for the children.

Once in the care of professionals, it is best for parents to allow the process to take place. 

It is a common reaction for worried parents to want to “take things into their own hands” when they perceive that help is not achieved adequately or quickly enough. Reacting to the child’s treatment in any way, so as to affect the relationship between the child and the professionals treating him/her, or to affect the child’s emotional state can be counter-productive.

If you are a parent of a child who is being treated for eating disorder, and feel uncertain or unpleasantness about the progress of the child’s treatment, do seek a conversation with the professionals in charge, before taking other action to change the treatment process.

Eating disorders arise and develop out of different situations. Sometimes the causes are linked to family dynamics, and other times it is not the case. Regardless of this, there is a tendency for parents and other family members to hold feelings of sadness, anger and guilt, as the result of realizing that a child is suffering from the disorder.

Difficult emotions being felt by parents, when ignored, can make problems worse, rather than better. This is because, when the emotions are pushed aside, they become stress factors that result in actions or behaviors that cause more stress in the family environment. In turn this may snowball into more problems for the child, and his/her other siblings.

It is hence recommended that parents themselves seek some kind of counseling from a psychotherapist, or a self-help group (if such is available).

Having counseling for parents, does not mean that the parents are in any way at fault, or have problems themselves. When parents go for counseling they are supporting the child by helping to provide a stable environment at home for him/her to get better.  

This short article is written with the wish that parents of children suffering from eating disorders take to heart that in order to support the healing of their children, they can do well by taking care of their own emotional state. Having a child diagnosed with eating disorder is, after all, stressful and riddled with questions and judgements of and from the self and others.

It is good to consider this metaphor taken from the aircraft emergency procedures:

“In the event of emergency, put your oxygen mask on first.”

The consequence of not following this aircraft safety advise is the loss of emotional bearings due to hypoxia (lack of oxygen in blood), rendering the person unable to help others, and worse…

In the case of supporting the child with eating disorder, counseling  for the self is the oxygen mask. It helps provide emotional stability in times of stress in the family.

Other Readings

Cottee‐Lane, D., Pistrang, N., & Bryant‐Waugh, R. (2004). Childhood onset anorexia nervosa: The experience of parents. European eating disorders review12(3), 169-177.

Bundesministerium für Arbeit, Soziales, Gesundheit und Konsumentenschutz (2018). Essstörungen: Was Angehörige tun können. Web source from URL:https://www.gesundheit.gv.at/krankheiten/psyche/essstoerungen/was-angehoerige-tun-koennen. Retrieved on 06.2018.

Honey, A., Boughtwood, D., Clarke, S., Halse, C., Kohn, M., & Madden, S. (2007). Support for parents of children with anorexia: what parents want. Eating disorders16(1), 40-51.

Lask, B., & Bryant-Waugh, R. (Eds.). (2000). Anorexia nervosa and related eating disorders in childhood and adolescence. Taylor & Francis.

Crisp, A. H., Harding, B., & McGuinness, B. (1974). Anorexia nervosa. Psychoneurotic characteristics of parents: Relationship to prognosis: A quantitative study. Journal of Psychosomatic Research18(3), 167-173.

Brief Therapy Interview Strategies

Icebreaker Compliment or Positive Statement (Examples)

I’d like to thank you for getting here so promptly today.
I do appreciate that very much.
I’d like to thank you for taking the time to come in today.
I’d like to thank you for filling out all those forms.
I’d like to thank you for answering all those questions on the forms you filled out.
I’d like to thank you for coming in and giving me the time to go over some things with you.

Basic approach to changing the mindset of clients from involuntary to voluntary status:

Our work with them follows this schema:

Whose idea is it that you come here?  What makes ___ think you should come here?  What does ____want you to be doing differently? Is this something you want? (Goal frame)
If yes, proceed as with a voluntary client.
If no, ask: Is there something you would like out of coming here? (Goal frame)

If yes, proceed as with a voluntary client.
If no, explore the consequences of not coming to sessions.

Source: Walter, J. L., and Peller, J. E. (1992). Becoming solution-focused in brief therapy, 247. New York: Routledge.

Utilization strategy

It involves the therapist learning from the outset as many of the specific strengths and resources the client possesses.
Asking questions that will evoke positive data.

e.g. Work history in a particularly interesting or difficult job • Interesting profession • Challenging work experiences • Hobbies • Talents • Interests • Sense of humor • Desire for change • Positive attitudes • Use of language • Beliefs • Intentions • Narrative abilities • General experiences

Conversational Questions

Conversational questions maintain effectiveness not only because of the engaging attitude of the therapist, but also because of the quality and substance of well-chosen questions. Clients might be asked about what kinds of questions they felt the therapist should have or could have previously asked in the session (but didn’t); or about what kinds of things prior therapists did that could have been done differently or better; or what they did that was totally useless and ineffectual. In all, this strategy constitutes an elemental therapeutic process of entering and expanding the areas of the unsaid or the not-yet-said (Anderson & Goolishian, 1988, p. 381).

“You have seen many therapists. What do you suppose they overlooked or missed with you?”
If I were to work with another family just like you, what advice would you give me to help that family out?
Who had the idea in the family to go for therapy?
If there were one question you were hoping I would ask, what would that be?
If there were one issue in this family that has not been talked about yet, what would that be?
Who in the family will have the most difficult time taking about this issue? (Selekman,
Who probably had the most difficult time coming here today?
What is one major thing holding everyone back?
What is one major reason for not talking together as a family?
What are some things I should be asking about you?
If you’ve been to other therapists, what are some of the things you didn’t like about the questions they asked or how they asked the questions?
What do you think are some needs that we should discuss first, before moving forward?
What did you like or dislike about your prior therapists?
What people in the family could change things if they had the power?
What people do you trust the most? Why is that so?
What is one small thing that could be changed to help get us started today?

 Dyadic questioning and triadic questioning#

The client’s voicing of what others might believe and what others might be saying or thinking paradoxically allows the therapist access into the client’s world.

Scaling questions and percentage questions

“On a scale from one to ten, how painful was it for you to come here at the beginning of this session? Ten being no pain, and one being very painful.”

“If the number one stands for a low level of confidence to lose five pounds and ten stands for a high level of confidence to lose five pounds, what was your level of confidence at the beginning of this session?”
“What would it take to bring your level of confidence up to a four? What needs to happen?”
Percentage questions are slightly different…

Normalization

Therapist use of statements to imply client problems not necessarily viewed “as pathological manifestations but as ordinary difficulties of life”
(O’Hanlon & Weiner-Davis, 1989, p. 93).

The goal of this strategy is to pre-emptively depathologize client problems and the client’s view of the problems.

The normalization statement also contains the counselor’s implicit acceptance of the client.

Deframing

Deframing is defined as a strategy that introduces uncertainty into the client’s present and past view of things which have not been shown to be useful (O’Hanlon & Beadle, 1997 p. 35).
Deframing is achieved by calling into doubt the client’s beliefs or belief system.

Examples of Deframing Questions:

How do you know that to be so? What makes you say that? How is that so? Where did you get that idea? On what basis have you reached that conclusion? What do you think is the origin of that belief? What is the foundation on which you rest your case? Did you ever have any doubts about those thoughts? Are you sure that’s accurate? What makes you so sure? What are the benefits in believing that? What influenced you to think along those lines? Why would you want to stick with that belief?

Positive connotation

whereby the therapist—after examining the family interactional patterns—ascribes worthy motives and noble intentions to what otherwise might be considered only symptomatic behavior

Coping questions

With families that . . . do not respond well . . . I shift gears and mirror their pessimistic stance by asking them:

“How come things aren’t worse?”;

“What are you and others doing to keep this situation from getting worse?”

Once the parents respond with some specific exceptions, I shift gears again and amplify these problem-solving strategies and ask:

“How did you come up with that idea!?”;

“How did you do that!?”; “What will you have to continue to do to get that to happen more often?” (Selekman, 1993, pp. 65–66)

“I’m just very curious as to how come things haven’t gotten any worse?”

“So what else is there that has prevented things from getting any worse?”
“So, it seems like something positive has already begun. How did you get that to happen?”

“So what other changes do you think you might have started and not have realized until our conversation today?”

 Pessimistic questions

In effect, the therapist’s act of joining clients in their worsening situation helps to create a reverse psychology scenario where the therapist—now being one of them, so to speak—is suggesting pre-emptively a kind of hopelessness that, ironically, the client might best handle with some kind of positive activity.
Often this line of questioning will enable family members to generate some useful problemsolving and coping strategies to better manage their difficult situation. Typical examples of pessimistic questions are as follows:

“What do you think will happen if things don’t get better?”;

“And then what?”; “Who will suffer the most?”;

“Who will feel the worst?”; “What do you suppose is the smallest thing you could do that might make a slight difference?”; “And what could other family members do?”; “How could you get that to happen a little bit now?” (Selekman, 1993, p. 72)

Problem tracking

involves tracing past behavioral transactions for the express purpose of noting problem-interaction sequences;
use this when strategies don’t seem to be working effectively…

“If you were to show me a videotape of how things look when your brother comes home drunk, who confronts him first [asking a sibling of the identified client], your mother or your father?”;
“After your mother confronts him, what does your brother do?”; “How does your brother respond?”; “Then what happens?”; “What happens after that?” Ideally the brief therapist will secure a detailed picture from the family members regarding the specific family patterns that have maintained the presenting problem. (Selekman, 1993, pp. 76–77)

Therapists may also employ other prominent strategies such as those listed below.
• Exception-oriented questions
• Miracle question sequence
• Problem dissolution.

Problem dissolution

Integrative therapists O’Hanlon and WeinerDavis begin

“with the assumption that it is possible to negotiate a therapeutic reality that dissolves the idea that there is a ‘problem’ ”

(1989, p. 57).
This involves introducing uncertainties that challenge the client’s dysfunctional beliefs and past dysfunctional behaviors, and debunks and demystifies them.
problem tracking (leading to)
—> exception orientated questions
—> miracle questions
—> problem dissolution

Exception-oriented questions
————————

There are always times when the identified problem is less severe or absent for clients. The counselor seeks to encourage the client to identify these occurrences and maximize their frequency. What happened that was different? What did you do that was different?
wikipedia

The miracle question

The miracle question or “problem is gone” question is a method of questioning that a coach, therapist, can utilize to invite the client to envision and describe in detail how the future will be different when the problem is no longer present.
“If you woke up tomorrow, and a miracle happened so that you no longer easily lost your temper, what would you see differently?” “What would the first signs be that the miracle occurred?”

Use of silence

The pause serves to give the client time and psychological space to think especially if the therapist’s question involves something painful
“So far we’ve spent about 15 minutes together, and you’ve said very little. We’ve already discussed the consequences of your not coming to future sessions. Your parents may decide to take action that may not please you. I’ll remain silent for a while, and whenever you feel like saying something to get things moving along, I’ll welcome your remarks.”

Source

Interviewing and Brief Therapy Strategies: An Integrative Approach

George Carpetto ISBN-13: 9780205490783

Chapter 7: Excerpt http://www.pearsonhighered.com/samplechapter/0205490786.pdf

Dreams and Dreamwork in Psychotherapy     

The publication On Dreams was written by Freud (1900) after having written his (what was labeled) “book of the century”, Interpretation of Dreams. With these writings,  Freud tries to make his innovative ideas of dream analysis accessible to the wider audience. His was the aim of reaching the “educated and curious minded reader” (Quinodoz, 2013).

Freud prides himself in taking the mystique out of dreams. He says dreams are composed of latent and manifest content. The manifest content, Freud explains, is material that appears in a dream. The latent content is the material that underlie the dream that is hidden within the unconscious. Using his own dreams he analyzed himself on paper. With that Freud brings us on a journey towards his own dream work.

Freud and Adler’s Differences


Alfred Adler’s work on dreams is an elaboration of Freud’s.  While here is fundamental agreement of both theories, the main difference is that Adler is very much focused on the individual’s awareness of one’s position in society, and expression of one’s “style of life”, viewing dreams as having a forward-looking, problem solving function. Adler also realizes that the conscious and unconscious are not contradictions to each other, but a unity (Ansbacher & Ansbacher, 1956).

Adler made a point about dream analysis that transcended Freud’s: by acknowledging that even made-up dreams are significant to analysis (p. 359). It implies that the act of talking about dreams alone is fundamentally relevant to the therapy—no matter from where the dream arises. The use of dreams in psychotherapy functions in a manner to facilitate therapeutic process, help patients gain insight and self-awareness, provide clinically relevant and valuable information to therapists and provide a measure of therapeutic change (Eudell-Simmons & Hilsenroth, 2005).

Gestalt Therapy Attitude towards Dream Work in Therapy

How the analysand describes his/her dream is rich in not only the latent content of the dream, but also the latent content of the moment of analysis. Gestalt therapists work on dreams by acknowledging the phenomenon within the client at the moment of analysis.

Enright (1980) recounts a dream work done by Fritz Perls in Los Angeles 1963 (found in the section Memory Gems). After the client recounts his dream, Perls would ask the client to identify himself with elements of that dream, by talking about it in the first person. In an example, an elderly, subdued man had a dream of seeing some friends off on a train. The man worked at first by identifying himself as himself, then as his friends with no effect. As the man identified himself with the train, he felt a bit more energy. Perls then asked the man to “become the station itself”. Enright writes, “At first it seemed as unproductive as the rest. Then, as he said, ‘I’m old-fashioned and a little out of date—I’m not very well cared-for; they’re letting dust and litter accumulate—and people just come and go, use me for what they want, but don’t really notice me,’ he began to cry, and for the next few minutes the current and recent past thrust of his entire life became obvious—what was happening, what he was doing that wasn’t working, and even some possible new things to do.”

Perls, in this example, demonstrates a way of working in the moment. While working with a dream, client and therapist remain in dialogical contact. Nobody gets lost in analysis. The therapist deals with the process of the dream work rather than the content of the dream. Working with process allows a lot of creative freedom; the dream is treated like a work of art, “fruit of the extraordinary creative powers of childhood” from which the patient must be able to experience freely, free of theoretical considerations; so that the person can communicate with and re-create his/herself  (Sichera, 2003. p. 95).

Conclusion

Dreams are useful material for use in understanding the self. If the client brings a dream to the session, and if the dream has significant emotionality attached to it, it is worth spending time on. Recurring dreams are especially interesting, according to Fritz Perls.

The time and setting is also considered before such work is done. There are moments when working on particular dreams lead somewhere important. There are moments when dream work is not appropriate, or when the dream topic is a distraction from current material that is more important for the client.

Working with dreams are tools, but are not ends to itself. The focus lies always on the here-and-now.

Read also:

Dream Analysis

Fritz Perls: Working with Dreams in Gestalt Therapy

Bibliography

Ansbacher, H. L., & Ansbacher, R. R. (1956). The individual psychology of Alfred Adler.

Enright, J. B. (1980). Enlightening gestalt: Waking up from the nightmare. Pro Telos.

Eudell-Simmons, E.M. & Hilsenroth, M. J. (2005). A review of empirical research supporting four conceptual uses of dreams in psychotherapy. Clinical psychology and psychotherapy. 12, 255-269. John Wiley & Sons.

Freud, S. (1900). On dreams, Standard Edition of the Complete Psychological Works of Sigmund Freud. Vol.5. pp. 633-686.

Quinodoz, J. M. (2013). Reading Freud: a chronological exploration of Freud’s writings. Routledge.

Sichera, A. (2003). Therapy as an aesthetic issue: creativity, dreams, and art in Gestalt Therapy. In M. Spagnuolo Lobb & N. Armendt-Lyon (Eds.). Creative License: The art of Gestalt Therapy. NY: Springer.

 

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.