I was, and still plan to, do a post for therapists on handling strong attachment, but some recent experiences make me want to share some thoughts. (Photo, tetsuya yamamoto, Flickr, Lic. CC BY 2.0).
It isn’t new news that humans do many things to distance from painful, uncomfortable, or overwhelming feelings. In fact, that is the basis of the Affect Avoidance Model, which is the conceptual framework I use to make sense of the kinds of problems where psychotherapy can help. On the other hand, it is easy to lose track of how consistently we tend to avoid feelings and how serious the consequences are each time we do.
Imagine that every time a painful feeling shows up at the door to consciousness there is a fork in the road, a choice to be made about what to do. One choice is to do something to make the pain go away. The other is to face it. What is critical is that this choice has consequences. If you choose to avoid the feeling then no healing or growth takes place. The feeling is simply put aside till next time and sick patterns remain unchanged. Meanwhile, the things that have been done to make the feeling go away have their consequences, which play out in the real adult world. Think of acting out in some way like cutting or obsessing or picking a fight with someone, etc. It is easy to be distracted by the consequences and dealing with them, and soon the original feeling is far away.
On the other hand, if you take the other fork and face the feeling, holding it for a few seconds, then permanent healing can take place. This is what I have referred to as “catharsis,” in honor of Freud’s original description in 1893. By doing this over and over, the pain will lose its power and no longer dominate life.
Here’s the important point: People who come to therapy for serious emotional problems and trauma, come with a history of taking the avoidance fork about 99.9999% of the time. This is entirely natural. Once you develop patterns of avoidance and practice them, it is no surprise that each time there is stress, the impulse to avoid is acted upon. What that means is that suffering people have almost no experience whatsoever with healing. All their experience is with acting out and dealing with the consequences of their acting out. The result is an increasing sense of hopelessness about ever escaping from a life of problem after problem.
Once again, I want to honor Freud, who started out as a trauma therapist, and quite a good one. Very early in his discovery of psychotherapy, he found that people generally prefer to act out their feelings instead of feeling them. He was so right, but why? Imagine a child who experiences the stresses of parental expectations. When we have to perform, we all naturally want someone to hold our hand. Demands and stresses trigger neediness. As children (and adults, too), we need more love, nurturing, holding, etc. at times when we are having trouble coping emotionally. When emotional support is not adequate or some other factor (such as a sibling with major needs) makes attention seeking unacceptable, then the child in us does without, but experiences intense yearnings for love and support. This is not only very painful, but when brought into adulthood, it is embarrassing and unacceptable. The availability of emotional support when needed is a necessity many people have not had available. So what choice is left? They do things to minimize the pain…and no healing takes place.
Now let’s turn to the good fork in the road. What I try to do in therapy is to help my patient be in direct contact with the painful yearning and to share that consciousness with me. I use words to make sure I understand the feeling precisely and with the compassion that should have been there in the first place. I try to make sure that the feeling stays in the room for at least 30 seconds, which is harder than you think. The necessary elements are that the painful feeing has to be experienced consciously with its visceral component. You have to actually feel it. Simultaneously, as I have described elsewhere, the patient (and their neural networks) are exposed to the witness’s understanding and compassion. This is soothing, and healing. It doesn’t take away the pain, but makes it less distressing and compelling. Importantly it takes away the feeling’s power to make avoidant acting out seem necessary.
At the same time, I look for the patient to become a parent to his or her own inner child, not the impatient, used-up parent from the past, but a compassionate, understanding parent from today. As this new attitude towards the self is internalized, the processing of feelings and healing becomes easier. It is not as necessary to wait for an outside witness to provide compassion, one can learn to have compassion for oneself.
Why do patients resist the good fork in the road? 1. They don’t feel confident that it can “contain” their pain. They are afraid the pain will be too much to bear and will never heal. 2. They are afraid to trust that healing will work and if it does, that it will ever work again. They protect themselves from future painful disappointment by turning away from the feeling instead of towards it. 3. Acting out has its own satisfactions and payoffs. There are righteous satisfactions in being a victim and showing that the other person was bad. There is excitement in the emotional storm and others’ reactions to it. There is distraction from the original feeling and distancing from its pain.
So the point of this post is to underline how rare and important are moments of healing where we feel our childlike pain in a safe and compassionate context. It is to emphasize how precious each healing experience is, and how taking the good fork in the road is the only way to bring permanent healing to the inner child. Let me say it a different way:
At points of stress, deep inner feelings push up from our past and present a fork in the road. You can go towards the feeling or away from it. When you start to go towards the feeling and do so in a context of connection and compassion (your own compassion or another’s), then the rare and crucial phenomenon of healing takes place and you are a step closer to no longer needing to be symptomatic.
How many of these encounters does it take to change? My best metaphor is paying a mortgage. At first all you pay is interest and it seems interminable. Very gradually, your payments start going more towards principle. At the end, there is little interest left and much principle being paid off each month. With therapy, the first experiences of healing are rare and don’t seem to make a big difference. As they become more familiar, then the need to take the avoidant fork decreases and the number of healing encounters increases. As healing moments become more common, their effect accumulates. Eventually, acting out seems unnecessary and wasteful, a thing of the past. Of course at moments of stress, the old fork will present itself. That is why some ongoing recovery activities or vigilance are still necessary.
So the take-home is to focus much more of the energy and attention in therapy on tuning in to the inner child’s original pain and going towards those feelings as opposed to going away from them and dealing with consequences of acting out.
As I put up this post, I’m closing comment on the previous one, “Working With the Inner Child.” Please continue the discussion here. I think the discussion and comments on the last post have been extraordinary, and I’m leaving room to continue that discussion here, but I believe it is time to focus on the feelings that underlie attachment to the therapist. I hope you agree.