Therapeutic Intensity: Level One
Level One in psychotherapy, referred to colloquially as `sitting up' therapy, contains the following issues: the therapist and patient talk to each other from a sitting position in a comfortably structured room. This body configuration supports a conscious, defensive presentation of both selves. Therapist and patient are polite and rational by normal standards. The effect is somewhat the same as having a serious discussion in the carefully constrained conventions of a tea party. Distance from deep pain is maximal, both for the therapist and the patient. The patient presents a story and talks about events in an essentially logical, linear, discursive manner. The discussion is under conscious control where thinking about and actively recalling past events take place. The therapist offers thoughtful, objective listening and makes client-centred reflective statements. The therapist may or may not offer advice. Patients want support, clarification, and validation thus hoping, by and large, that their defences will not be too deeply challenged. They want their beliefs and values and, in short, their personality structure, to remain for the most part intact.
There is no serious threat to their rational idea of themselves or to their function. The patient can look forward to some mild relief from current feelings and behaviour, usually for a limited period of time. The Central Nervous System remains essentially closed and there are no deep shifts in personal processes. This method of therapy is offered by most mental health professionals from psychiatry to social work. It is traditional, safe, and leads to minimal change.
Therapeutic Intensity: Level Two
At this level we see the emergence of what we call `lying down' therapy. The patient lies in a comfortable, structured room and because of this body position starts to be freed from the conscious daytime, defensive external self. The therapist usually sits up in a comfortable chair. The all-important shift at this level is towards the dismantling of daytime logic which is replaced with the use of free association, a technique developed by Freud. In allowing thoughts to come to us, rather than consciously manipulating them, we enter the world of non-logical experience which allows deeper material to come up into consciousness with more ease and fluidity. Connections now occur more freely by association instead of logic. We become for the first time, at Level Two, receivers of information more directly from the deeper levels of the mind.
Patient conversation becomes more obedient to the imperative that unfinished material within us must seek expression.
Powerful material, when it arrives in our awareness, is still however being converted to linear verbal expression and feeling is still being channelled into logical conversation. This ensures that Level Two psychotherapy will not go deeper and tip over into Level Three. It also ensures considerable limitations around the experiencing of deeper pain.
Over time, deeper penetration into personality may be achieved and some real challenge to our basic ideas of self may occur, with consequent deeper shifts.
Vulnerability at this level is deepening as is the necessity for trust in the therapist. The therapist remains in a sitting up position and, by and large, in his logical mind `professionally removed from the patient's pain', courteous, helpful, intuitive to a degree but nonetheless detached and intellectually analytical. Imperatives for the direct emergence of deeper material are stillborn and frustrated. Because of this, psychotherapies, like psychoanalysis, have been known to continue for vast numbers of years without resolution.
Therapeutic Intensity: Level Three
At Level Three one of the most significant breakthroughs in modern psychotherapy takes place. For the first time feelings and body sensations are used to guide free association towards deep unconscious pain. They are also kept to the forefront as the therapy hour unfolds, to anchor and render more intense and meaningful the insights that arrive into consciousness.
The simple and profound truth of depth therapy which has been discovered all over the world, especially in North America, is this: if we lie someone down in a comfortable, neutral position on their back, with arms at their side and legs uncrossed, and if we ask them to focus not on thoughts but on feelings and/or on internal body sensations and discomforts, these sensations, after a brief period of reorientation in the mind/body system, begin to act like magnets and draw towards themselves those memories that have been repressed.
One of the most well-known contributors in this field of what I would call Level Three medium intensity therapy is Eugene Gendlin at the University of Chicago. He has given us great help with the problem that we all face at this depth. When we open the door directly into the unconscious using feelings and body sensations as a guide, we encounter in the upper levels of the unconscious extremely elusive material. Thoughts and images move through the shallows like minnows pursued by a child on a beach. To develop a feeling connection with these little fish, maintain it and then to bring the insights up into consciousness is extremely tricky. The moment we start talking or thinking about one of these dimly perceived, quick, darting insights we find ourselves `in our head' and the feeling is lost. So we end up back at Level One, talking about and distancing ourselves from the very events we are trying to feel.
The object of work at Level Three is to have a feeling experience of the self. Thus, if I ask a patient who has become aware of a constriction in the throat to simply go ahead and talk about it, the intensity disappears, rendering the insight intellectual and useless. Gendlin suggested that, if instead of talking about it we remain attentive to the feeling and allow a single word or phrase to come to us from the body sensation, we will remain connected to the unconscious material. This simple cortical but non-intellectual connectedness is even further solidified by saying the word over and over again, matching it back to the feeling. The body senses if the word is making an accurate connection and at that point we can request further information in a simple form. The patient, if handled very carefully and not allowed to drift into too much intellectuality, will have what we might call a connected or grounded insight. The body actually experiences that something within it has shifted.
For example, the patient with the constriction in her throat, once centred in that feeling, may utter the word `swallow' and be asked to repeat it several times. The feeling or body sensation acting as a magnet may draw in the connection. `I just cannot swallow any more pain from my boss.' This intensity of feeling and connectedness to the body symptom, when insisted upon by the therapist, before moving to the intellectual connection, leads to a felt shift internally. This grounded insight has power and often produces real therapeutic change.
In this case, for instance, the constriction in the throat may disappear or shift in some other way. This in turn might lead to an improved self-defining with the boss. He will get feedback from the patient about what he does which might make him less difficult to swallow.
Once again, however, we are converting a feeling or a sensation, i.e. the constriction in the throat, to an insight, I just cannot swallow any more pain from my boss, too quickly. The speed with which we have facilitated this conversion insures that a Level Three intensity therapy will not tip over into Level Four.
In Level Four she would have a direct experience of her uncle filling her mouth with semen at age three, thus setting her up for a lifetime of swallowing things dished out to her by aggressive men. We will deal with Level Four experiences in a moment. Many modern therapies now anchor insights to feelings and body experiences. Two examples would be Alexander Lowen's Bioenergetics and Ida Rolf's Deep Pressure Massage.
Therapeutic Intensity: Level Four
In Level Four there is direct experiencing of deep, repressed material. Imperatives emerge that are new to psychiatry; imperatives that we have shunned since the dawn of this healing art and yet they are so obvious when the issues of this level are revealed. We now are dealing directly with white-hot unconscious material. Here, once we start the process in motion, the forces are so powerful the necessities must be honoured.
Once the Wright Brothers were in the air they did what the air demanded. Movements quite unlike anything people make on earth. Once the lumberjack steps onto the flow of rolling logs, he does what they demand, a strange, exotic dance completely out of place in a restaurant but an absolute necessity for him at that moment if he is to preserve his life. In Level Four when we finally have the shark by the tail, we ride it downward. We deepen and intensify feelings and sensations until they take us down through terrible pain to the landscape of early experience. In that landscape we assist the actual reliving of those experiences.
There are three main problems associated with Level Four deep regressive psychotherapy: 1- How do we trigger a descent into those depths?
2- How do we contain such powerful experiences within an ego structure which varies in its tensile strength from person to person?
3- How do we behave with a wide-open agonized childhood or infantile Central Nervous System? What are the necessities of life itself and healing in this vulnerable and chaotic place?
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