TIFT #93: Becoming a Better Therapist in 2024

A lucid therapist is one who strives continually to gain greater clarity about underlying principles and processes and how they manifest in day to day psychotherapy. This past year I came to appreciate the role of visualization in seeing, moment to moment, what is happening and what to do next. Looking back at posts from 2022 and 2023, that’s been my aim and trajectory. Writing, teaching, and psychotherapy coaching have all stimulated exploration of how best to help clients trade unhelpful patterns for better ones. In this post, I’ll share a few ways I have evolved to where I am today in 2024.

1. Visualization and Personification

If there is one insight that has been important this past year, it is the idea that learning and practicing are enhanced when they are visual. Pictures are worth a thousand words because they communicate more directly to the limbic places where problems originate and change takes place. For those of us who depend on words, we need to think of them as tools for communicating the picture we have in mind. I have often talked about “accurate empathy,” a phrase that, for me, captures the goal of understanding in a concrete and real way the full experience of our client. What really gives meaning to those words is the ability to visualize the person facing an existential problem so dangerous that the best solution available at the time becomes an anchor, blocking further growth for however many years.

As I work with clients, I am trying to picture the younger individual who resides as the limbic self, still struggling for survival. How old are they? What happened? What did if feel like? What were the tools available? What was the strategy they adopted and are still pursuing? Then I picture the flow of new information, new light on the old threat. Is it blocked? Can they picture a different solution? Can they visualize how life might be different? What might catch their attention? How can I tell them the war is over, that it it would be OK to let go, to complete the stress cycle and finally experience rest.

In the fall of 2022, I wrote posts about Internal Family Systems therapy, and the value of visualizing a self within the self. Those ideas struck home and their impact has continued. I loved Richard Schwartz’s terms, “firefighters” and “managers” because they bring up pictures of protectors fighting for their lives, but with very different styles. What had the most staying power was not so much putting inner selves into categories, but working with my client to picture the unique inner individual. It works best to do this as a collaboration where we both have curiosity and compassion for the lost self we encounter. It usually turns out that the inner self holds the keys to motivation and is still highly active behind the scenes. When the adult client can relate to this, we can talk about how we might craft a new message and work together to deliver it across the gap from consciousness to the inner limbic self.

In one case, I wanted so much to help my adult client accept and have compassion for an inner self who was still looking for the primal love she had never had. The inner one was so fixed in her hope of finally receiving what she missed that she could not see what she really needed. The true answer was that she needed a witness to help her through the limbic emotions of rage and grief she had hoped to avoid. What made this hard was that each time I tried to ally with an observing adult, the inner child would take over and shut down the conversation. This was not dissociation. Rather, it was transference, which, by the way, I now see as an active inner self, rather than the traditional idea that it is a distortion of perception. From the child’s point of view, I was one more parental figure trying to justify my unwillingness to give what she needed and that was often the only point of view in sight. I had no better answer than to keep trying. Eventually, (you won’t believe how long I persisted) her rage at my “unwillingness” helped her exhaust the rage she had held against her ungiving mom. Somehow the adult self stayed with the therapy. The anger finally lost some of its steam, and an alliance began to form with my adult client.

In other cases, the idea of relating to a distinct inner self took hold and allowed those clients and I to build a warm and productive understanding of a difficult part within. In one instance, I suggested a book that long ago caught my attention, Wayward Youth, originally published by August Aichorn in Germany in 1925. Aichorn, a student of Freud, was working with troubled teens after WWI. The tough street kids he helped seemed very similar to my client’s inner child, who was still on duty protecting my patient’s dignity from ever being hurt again.

Sometimes, the self who owns the maladaptive coping is not fixed at a certain age. When the challenges are continual and the coping develops gradually, it doesn’t have the sharp outlines of a particular young self. Then we build a less specific image of the one we are dealing with. That’s where I tend to use the more generic, “inner self” or “nonconscious problem solver” to characterize the self who owns a coping strategy we want to change.

My take-home from 2023 is that together with my adult client, picturing a younger self coping with existential stress leads, better than anything, to the accurate empathy that is critical to connecting with the inner self and to change.

2. Mind: “The information processing function of the brain”

Thinking about how to distinguish the problems psychotherapy treats from those that are uniquely amenable to biological therapies, I found myself digging into the meaning of “mind” and realizing how much my understanding is expressed in terms of information processing, the exact domain of mind. When I dared to mention the word, “information” in that context, some colleagues thought that meant I had no interest in emotion! Shocked, I realized the importance of specifying the extraordinary breadth of information the brain can handle. Of particular concern to us as therapists are the kinds of information that can be received and processed in the limbic system. That led me to a definition of the kinds of information that the human brain can encode and store (as clumps of neurons that tend to fire together). Here is my definition: "The human mind can take in, store, and process anything that can be described in poetry.” I hope that puts an end to any notion that “information” excludes emotion. In fact, understanding the kinds of information processed in the limbic mind leads to a fuller appreciation of why and how psychotherapy is an art, governed by principles of science. The mind is a metaphor engine and the art of psychotherapy is finding within our own mind a metaphor that is right for our client at a moment in time.

3. The Dread: Limbic Emotion

 In addition to the idea of personifying the limbic self, another key concept appeared in posts in the fall of 2022 and has been prominent in 2023. It is the idea that a central dread was the focal point of the maladaptive coping we are aiming to change. The idea was that the mind signals a serious threat to survival by activating limbic neurons, typically in the amygdala. I have come to call that signaling, “limbic emotion.” Visualizing that activation, not so much as neurons firing, but as emotion is enormously helpful in doing therapy. Once we think of it as emotion, we naturally seek specificity about both the emotion and the circumstances under which it has arisen. The maladaptive coping that psychotherapy seeks to change represents the mind’s attempt to block or quiet down that specific limbic emotion. In other words, we can picture that the limbic self has a dread of awakening a particular emotion.

But what is limbic emotion? It is important to be clear that emotion in the limbic system is not the same as conscious feeling. Not only is conscious feeling more complex and elaborated, but consciousness can be, and often is, entirely unaware of a limbic emotion. Think of all the times a client has experienced a change of mood but has no awareness of why. When we try to trace it down, it is usually not to difficult to find the circumstance that provoked the emotion. Usually it's a situation that had a much more potent effect than the client realized. Neurophysiologically, that means neurons in the limbic system were triggered and set off the response, but it takes a word like "limbic emotion" to convey the specificity. That is why the concept of limbic emotion is so important.

As therapists, when we really want to understand limbic emotion, we can visualize it as a precursor to more familiar conscious emotions. This is what we do when we ascribe emotions to a dog or a baby. In both cases, we have no way of truly knowing what their consciousness might be like, but we use our own powers of empathy to picture the other’s emotion. We can think of the emotion we conjure up as a metaphor for the limbic emotion. When our description matches something in the client’s limbic system, we may get a confirmation: “Yes, that resonates.”

In this way, It is extremely helpful in practice, to picture and articulate just what the client’s limbic system is dreading. Dread is a good word because it implies prediction, and that is what the inner mind evolved to do; predict things that could have an impact on survival. Of course, for humans, as highly social beings, survival is not just physical wellbeing, but more often involves social and emotional survival. With the complexity of today's social life is it any surprise that the mind comes up with less than satisfactory coping in relation to social challenges?

In the case I mentioned above, the hardened inner kid’s dread was about being caught off guard and having his dignity crushed. My client has continued well into adulthood to invest a tremendous amount of energy into being ready for any assault on his dignity. His inner self never had a chance to realize that his dignity can’t really be taken away. It belongs to him and is his forever. We’re still working on how to communicate that to the heavily braced, untrusting inner kid.

4. Why we humans have problems

The last area where I see myself having grown in 2023 is a greater clarity about the precise cause of maladaptive coping. Having used the concept of mind to narrow down the problems that psychotherapy addresses and having seen limbic emotion as the thing the mind is trying to quiet down and avoid, the question that came into view was whether there might be a universal explanation for why these survival strategies are maladaptive.

Asking a question is like beginning a story. The mind naturally wants to resolve the initial tension by pursuing the answer. The answer to my question about why humans get themselves in such trouble came clear in 2023. Responses are maladaptive because, at the time, there was no satisfactory response. When we don’t have a good answer, like lawyers who don’t have a case, we still come up with an answer, but not a good one. Most often the less-than-satisfactory answer is to avoid, to stave off the dreaded limbic emotion into the future. In TIFT #92, "On Hope," I described how setting one’s mind on a quest for the miraculous solution to an insoluble problem is one way of avoiding the inevitable. There are many others like using fantasy or denial or drugs so as not to activate the dreaded limbic emotion. Avoiding new behaviors arrests development, but it can also prevent exposure to dreaded limbic emotions. Some strategies like avoidant attachment may actually be adaptive in an unhealthy family, and only later maladaptive. The number of less than satisfactory solutions is infinite, but what promises to simplify our work is realizing that their function is always the same, to attenuate or block dreaded limbic emotions arising from an essentially insoluble problem.

What this means clinically is that my client and I want to understand the insoluble problem that first threatened to awaken or activate a dreaded limbic emotion. Was it deprivation? Was it a traumatic experience? Maybe it was a situation the child knew was beyond their limited strength or ability. If that situation were to take place, (and the child’s mind doesn’t have the ability to understand time, so it could be tomorrow) then the emotion would be existential helplessness. That is a limbic emotion too painful to face. I’m thinking of two cases where boys became aware that they might have to function as men and knew they were not ready. In one, the answer was lifelong anxiety and the need for constant reassurance. In the other, it was hyper-development of the ability to make an independent living, but inability to accept support or help from a partner.

Is the dread always singular? Usually, but sometimes the answer to one dread leads to activation of another. One man solved the problem of his father’s disapproval of success by abandoning his healthy ambitions. That took care of the dreaded feeling of disloyalty to his father, but left him with an equally dreadful limbic emotion of failure to fulfill his potential. For most of a lifetime, he compromised between the two.

And are there multiple layers of dread? Yes. As I have described elsewhere, after the first layer, each time the mind senses that a layer of protection may fail, a new layer is established with a new strategy for avoiding catastrophe. Also, as I have said elsewhere, therapy, itself, may be the latest threat as we promise to take away coping strategies the inner self has relied upon for years. That is a major source of “resistance.”

Putting it all together

Being a lucid therapist means one never stops growing and learning. In 2024, my plan, and I hope yours, too, is to practice visualizing the nonconscious problem solver still at work, using familiar, but less than optimal strategies. We will follow our curiosity to picture the conditions that made it necessary to calm limbic emotions generated by insoluble problems of existential significance. My hope is that we will become ever more adept at helping our clients develop compassion for their valiant problem solvers. As they do, I hope we will continue to cultivate the art of opening young eyes to a better way to cope, expressed in terms they can take in and put to work for themselves. Sometimes the answer is for inner selves to grow just like real children. At other times It might be gaining adult skills like acceptance. It could be a more effective way of handling a difficult circumstance. Or it could be realizing that what was once a life and death threat is no longer so. The permutations are infinite and uniquely individual. 

To sum it up, 2023 has been a good year for lucid therapy but leaves plenty of room for growth in 2024.

Jeffery Smith MD