The accuracy of these reflections is always borne out by the patient's sense of their rightness. When the therapist is wrong the patient quickly knows it, and the empathic moment crumbles. Therapy is an ongoing, self-corrective process which falters in the midst of therapist inaccuracy. This ability to reflect back to the patient what they're talking about on Levels One through Four when, and only when, the patient is ready to hear it, greatly deepens rapport and allows each thing to lead to the next. When we add to this a feeling- and body-based orientation, making sure that the patient never strays very far from this, each hour becomes deeper than the hour before.
NECESSITIES AT LEVEL FOUR REGRESSIVE THERAPY
d: Beyond Therapist Neutrality
The road to optimum depth therapy is paved with seeming paradoxes. We now encounter a paradox which has paralyzed psychotherapy for more than one hundred years. On the one hand, I have said that therapist clarity and lack of contamination of patient processes is primary. On the other hand, I have shown a degree of involvement in my therapy practice which by any usual standards would seem unsupportable. This paradox is resolved when we understand the dual nature of psychoptherapy.
1- Therapy as Insight-Oriented, Re-experiencing
Helping a client draw unconscious connections and experiences to the surface requires the feather-light touch of absolutely clear, reflective statements. As the material emerges, if it is continuously re-grounded in feelings and body states, the regressive landslide we spoke of earlier is a natural consequence. The essence of this process is the emergence of one thought after another, one feeling after another, one re-experiencing after another. These delicate chains of connectedness between internal phenomena can only begin to emerge if the process in the patient is not derailed by therapist intrusion. It is in this area of psychotherapy that lack of contamination is essential for forward movement. When a therapist's presence ceases to be resonant and congruent, therapy fails. It is this failure in the therapist which is the largest single safeguard against catastrophe. It prevents therapy from attaining real depth.
As with so many issues in therapy, goodwill, caring, and trust on both sides will see the therapeutic process through many a potentially difficult moment. A therapist must be able to withstand ambiguity and confusion of an intense nature. You will remember how the man made faces for weeks and weeks without the resolution of an insight. If these weeks of bizarre behaviour had caused me, out of my own anxiety, to put forward some reassuring theoretical truth,this journey would have been blocked. If I had mistaken his behaviour, again out of my own anxiety, for a borderline psychosis, I might have given him major tranquillizers basically to soothe myself and derailed his therapy altogether. On the other hand, another deep-working male client began to think that people could actually read his mind. In this case I gave him anti-psychotic medication to avoid a major paranoid-schizophrenic breakdown. Understanding these differences is very much a part of any psychiatric training. Recognizing that the making of these faces was a non-psychotic body necessity, allowed him the permission to finally bring us home to his insight.
2- Therapy as Re-Parenting: With Touch, Holding, and Personal Sharing
Small children grow in the textural presence of their parents. Imagine for a moment a child being raised by machinery, robotics, and video programming. Imagine for a moment an infant trying to cuddle and relate with any machine. The notion is horrifying. The human central nervous system and body unfold, within a holding environment of continuous touch and parental presence, with all the texture good and bad which this supplies. Texture and healthy growth are synonymous.
In deep regressive Level Four psychotherapy, when we as therapists re-encounter the child, we must bring texture. And that often means holding and touch for nourishment, holding and touch for containment of painful re-experiencing, and holding and touch for facilitation in the emergence of childhood issues. This texture provides the physical basis for regrowth.
How can we give at this physical level clear and helpful facilitative contact? I have discovered, through trial and error, that just as there is client-centred verbal therapy, there is such a thing as client-centred physical therapy.
Touch and holding are natural human empathic responses. The difficulty is to know when these responses facilitate and when they block growth. Cuddling can promote re-experiencing, or it can `cuddle away' the patient's feelings, thereby immediately stopping the therapy work.
A middle-aged man lies in my primal room having left the present behind. He is a child again entering his home one day after school.
He discovers blood on the floor. Moving as in a nightmare, he follows the trail of it from room to room. He comes finally to his father lying, wrists slashed, upon a chesterfield, the blood still pumping out of his arms and forming pools on the floor.
The child in the past and the man in my room begin to scream. Finally, the man in my room sits bolt upright to break the contact with his childhood self. I put my arms around him and hold him close.
Have I reacted too soon, have I reacted too late? Am I responding to my horror or to his? Am I blocking his growth? Am I facilitating it? Am I containing a shattered ego? Am I nurturing a shattered child who has taken refuge in a lifetime of alcoholism?
Am I client-centred, or am I acting out? How can I know the answer to any of this?
The answer is that therapy work has a life, a texture, and a forward movement of its own which is discernible by the therapist. This discernment lies at the heart of clinical experience and only experience can teach the therapist when to touch and when not to touch. This knowing is the most difficult thing in the world to explain, but there are some guidelines. First, the whole subject of touch and holding can be openly discussed with patients at the beginning of depth therapy. I may simply say, for instance, that sometimes people need to be held when re-experiencing childhood pain, and that the patient can ask for this physical contact if they need it. In fact however most people are reluctant to make such an intimate request. From time to time therefore, during moments of pain, I will ask again if they would like to be held.
Some clients ask me directly whether I will hold them if they choose to do depth therapy. Some will not come into my practice unless they know they will have that safety net.
Many people just don't know what they will need, but during the pain of therapy will automatically reach out for my hand. Many people cannot allow any pain to surface unless there some physical connection.
In the end there is no substitute for intuition and the courage to offer what you sense is needed even though you may make a mistake. * * *
Therapists must be able to share judiciously of themselves when asked. We are in the same situation as a child's parent, sharing creates texture and the trellis upon which the child within the client grows. Further, when our patients intuit that we are deviating from absolute honesty and accuracy, we must stand ready to verify their growing sensitivity. Naturally, all this is subject to good sense, diplomacy and client-centredness.
There is a difference between information which encourages dependency and information which supports growth. There is a difference between information based on therapist arrogance and information which has an intrinsically healthful feeling. Again, experience, dedication to catalyzing growth and a sense of balance are all necessary in this area. - How am I doing in my therapy?
- Are you asking me how you feel?
- No, I want to know if you think I'm getting better.
- Are you asking me how you feel?
- Well...I guess I am.
- I can't tell you how you feel ask yourself.
- Well, I do feel better than I did six months ago.
- So, how are you doing in your therapy?
- I guess I'm getting better.
* * * - I've been feeling awful lately. Is it common for people to feel worse and worse in this kind of therapy?
- Yes it is.
- Well I sure have been very, very down lately.
- In the midst of all this downness, do you have any sense that you are dumping a lot of `garbage' out of yourself which has been inside you for a long, long time? - Well, yes I do feel I am getting at things that I haven't experienced before. But it sure does hurt. If I get too depressed, can we use some medication?
- If we go beyond your body's ability to cope and remain functional, we certainly can calm things down and/or support your mood with medication.
- How will I know if I need them? - There are signs, such as weight loss, sleeplessness and exhaustion, as well as very low mood and too much fear. We will stay on the alert.
* * *
- Have you ever felt so bad you just wanted to die?
- Yes I have.
- What did you do?
- I lay down and centred myself inside the feeling. I repeated over and over again those very words, `I just want to die.' I repeated them many, many times until finally the feeling of wanting to die ebbed away.
- You never had any further problem with suicide then?
- This issue does come up from time to time in my life if I am sufficiently deeply stressed. When it does, I use this technique and the feeling of wanting to die always passes.
- So life has been a struggle for you too?
- Yes it has, it's a struggle for all sensitive human beings.
There are no rules about when and how to share; only an informed and loving heart. My own therapist used to say, `Don't dump your stuff onto your patients and don't spend a lot of time defending yourself.'
If I am asked a question about my life from within a spirit of healing, and with goodwill, I will often share from within myself. This is part of the re-parenting texture. It provides a relational connectedness with the patient. Sharing is analogous to physical presence. It is the trellis. The starvation of psychoanalytic neutrality is actively avoided, although silence is still one of our main tools. Patients need our humanity and our humanity, if carefully offered, does not have to distort their own burgeoning sense of self. For instance it is my practice to offer anecdotes from my life when I feel they are truly appropriate. In a loving and growth-oriented situation, these anecdotes are accepted as genuine contributions to the therapy.
NECESSITIES AT LEVEL FOUR REGRESSIVE THERAPY
e: Therapeutic Belief in Feeling
The therapist must believe in the central paradox of feeling-oriented therapy that if we go to the centre of the most painful and difficult feelings, no matter where they lead, and re-experience their shame and horror, we will gradually unburden and heal.
Therapy is rarely straightforward and usually takes months or years to bring these experiences to the surface. Even after we do so, individual growth sequences must often be repeated many, many times.
Enormous levels of trust are built and momentum is gained so that the patient naturally wants to share more and more. Honesty with the therapist, and with the self, becomes an impassioned goal, washing away a lifetime of falseness.
There are many more necessities in the practice of Level Four Psychotherapy: a few of them are: * The therapist must possess a loving heart. Technical excellence will not carry the day. It is not enough of a companion in the wasteland of a damaged childhood. * The therapist must be curious and have great energy for exploring the unknown, but this must never lead to an over-zealous application of the techniques. * The therapist must have a gentle yet firm hand in defining him or herself in the face of patient needs. The more years I spend in the depths of the mind, the more I realize that things do keep shading off into the unknown into some final place from which all the processes of the universe emerge. The fact of the matter is that I do not know, in any given moment, what will happen next and, to paraphrase Alan Watts, a famous 20th-century thinker, 'I am at all times surrounded by darkness and am very limited in my ultimate ability to see.' In the face of this, I observe and I trust. After 25 years and 32,000 hours of experience, I have achieved a certain comfort with the unknown, that it resolves itself one way or the other.
The principles hold firm. When we clear the mind of its debris and offer comfort, healing almost always comes about.
NECESSITIES AT LEVEL FOUR REGRESSIVE THERAPY
f: Qualities Required in the Patient:
The ability to lie inside a feeling and to experience the feeling without acting on it, is the most necessary requirement for anyone in deep regressive psychotherapy. Some have this ability; some can learn it; many, however, simply cannot tolerate this experience without confusing the difference between feeling a feeling and acting on a feeling. Where childhood damage has filled the ego container with too much chaotic material, and where childhood damage has too-greatly weakened the container itself, powerful feelings sometimes give rise to acting out, in order to avoid the overwhelming tension of a disintegrating personality.
Worldly living teaches us to neutralize unpleasant feelings by doing something about them. The `doing' of the world is opposite to the `doing' of depth therapy.
In the `doing' of the world if we are hungry, we eat; if we are angry, we give hurt; if we need, we seek gratification.
In the `doing' of depth therapy we lie down and feel. The feeling brings insight; the insight brings clarity; the clarity brings balance, and all this leads to the emergence of a new organic self.
The organic self does not struggle to do. The organic self spontaneously and integrally responds to outer and inner stimuli, naturally, harmoniously and without effort. The organic self does not strive and struggle for control. It simply moves and has its being from the automatic self-balancing core of a brain freed from conflict.
Often patients ask, `What do I have to do?' The answer is that there is nothing they have to do except the inner work of therapy. Worldly `doing' will begin to come naturally if they do their inner work on the mat.
For example, in the world we have assertiveness training classes which teach techniques of self-definition. We are taught what to say and how to say it, if someone encroaches on our personal boundaries.
In depth therapy, the awakening sense of the extraordinary preciousness of the `self' leads automatically to comfortable self-definition. I say `no' when it comes to me that my selfhood is in jeopardy, not because I have learned how to say `no.' I say `no' because I no longer wish to say `yes' to that which harms me.
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