TIFT #81: Applying the Affect Avoidance Framework

This is a continuation of TIFT #80, Confronting Therapist Anxiety. Here I share my own experience combining clinical knowledge with modern neuroscience to activate old patterns and deliver disconfirming information such that it reaches the limbic neurons where information needs to be rewritten.

Finding the implicit learning without dousing the affect

Let’s make this concrete, returning to Rachel, introduced in TIFT #80. She is a single woman in her 30s, stuck in a pattern in which she sabotages her own growth and progress in life through distractions and hard-to-resist impulses. She is aware of the pattern and the fact that each time she commits to changing, she ends up doing the same things as before.

The most common tipoff to an opportunity for a healing moment is when spontaneous words are accompanied by affect. At the beginning of one session she brought up that she had been upset by concerns about the health of her mother. Affect was palpable and the intensity in her voice seemed greater than might be expected for an adult with an elderly mother in less than perfect health. My aim was to dig into the specifics of why she was so worried without getting too intellectual or distracting her from the affect. My interest awakened her curiosity as well. Soon, she offered, “I don’t think I could survive the death of my mother.” The words had depth, as if rooted in some bedrock truth. That had to be my portal to her limbic system and some powerful implicit learning contained there.

Implicit learning carries a problem-solving strategy

For years, she had fought inner impulses, recognizing that they were not rational or reasonable. But how might those impulses make sense? How might they solve a problem? How could we get closer to the implicit learning that would make sense of an adult not being able to survive without her mother. An element of surprise would keep her from becoming too analytical. I asked the unthinkable question: “Why couldn’t you survive the loss of your mother?” The answer came quickly, surely representing what Daniel Kahneman calls “thinking fast,” the emergency form of thinking that is unconscious and not so precise, as opposed to “thinking slow,” the logical and anti-emotional process of conscious abstract thought. She said, “I’d have no one to support me.” The statement came from the mouth of a competent adult but reflected a much younger reality. Why did my client’s inner mind see her as not to be ready to face life alone?

The insoluble problem

I already knew that the parents had been well meaning but often misattuned and generally inadequate. For a child, that must have felt like an insoluble problem. She was powerless to induce the parents to be more effective in their support. And it was a problem of existential importance, a necessity for her to accomplish what instinct told her was her purpose in life, to arrive at her full potential. 

I had developed a working hypothesis that her solution was to wait for the parenting she had never gotten. I guessed that the contents of her implicit learning might simply be a principle that “you can’t make it on your own without support from a big person.” That was close to what she actually said. The strategy would be to keep the hope alive that, sometime soon, she might find the missing ingredient to successfully traversing childhood. That would stave off hopelessness for as long as it took, even though the true and definitive solution would be to accept the limitations of her family. Acceptance equates to hopelessness, and, for children, that is essentially never an option. The purpose of the implicit learning is to avoid the unsurvivable pain of powerlessness. Thus, inventing and holding the principle that parental support is an absolute requirement would be a strong candidate for the implicit learning. Continuing to seek fulfillment of that principle would keep a sense of possibility alive and support the hope of reaching her potential. In doing so, it would keep the dreaded limbic emotion of hopelessness and its conscious manifestation at bay.

All this cognition might seem too much for the unconscious mind to handle, but it is not actually so complex and could be held in a completely nonverbal form, simply as a goal or requirement, the need for some big person to provide support.

Summary of how the young mind avoids problems and therapy solves them

In nonverbal form, and located primarily in the limbic system, the mind identifies life-and-death problems by activating negative (unconscious) limbic emotion. To quell that emotion, the mind develops a strategy in the form of implicit learning, which could also be described as a set of rules about life, designed to block the troublesome limbic emotion. Adherence of those rules is powerfully guarded and maintained, under threat of the limbic emotion being re-triggered. Therapy seeks to re-activate the limbic emotion in a context of simultaneous delivery of disconfirming information, essentially communicating that the painful limbic emotion can be survived and processed once and for all.

Disconfirming information

One might think that exposing the client to disconfirming information is as simple as correcting an error. But no! It’s true that, as a competent adult, she no longer needs the kind of parental support that children should receive. The rub is that to come to acceptance she will have to face exactly the hopelessness and accompanying pain that her childhood strategy was designed to avoid. Until she faces it, it will remain as daunting as in childhood.

 What will need to take place on a limbic level is the simultaneous experience of hopelessness along with two mitigating realities of adult life. First, unlike the childhood experience, she now has adult resources to solve whatever problems might come up as she goes on to fulfill her potential. Second, she will not be alone as she had been as a child with parents who could not see their own inadequacy. While she won’t have the comfort of someone else ultimately responsible for her growth, she will have an empathically engaged witness to her feeling of hopelessness. As these new realities are received on a limbic level, they will hopefully counterbalance her terror enough to allow the pain while taking in the new truth that she can survive without maternal support.

The delivery

How will her limbic mind know it’s safe to embrace the new reality? Let’s learn from pharmaceutical advertising: It will be more from the therapist’s positive facial expression and optimistic tone of voice than from the accompanying intellectual content. The difference is that, in this case, the stakes are emotionally life-and-death, and the delivery will have to be entirely genuine.

Paying attention to the nonverbal content, I introduced the thought that she might be able to make it without her mother. She seemed shaken and even depressed. Her limbic system was shocked. I was suggesting the unthinkable, that which she had avoided for many years. Her childhood reality came out in adult words of protest: “But look at my life. It’s a shambles. How could I make it? I don’t think I am capable.”

I quietly pointed out the illogic in what she said. “Yes, but the shambles is only because you have been holding yourself back, waiting for the support your inner mind thought was an absolute necessity. The only thing that has kept you from success is your own self-sabotage and you don’t have to do that any more. Without holding yourself back, there is nothing to stop you from having the life you want.”

I then suggested another (obsolete) reason for her holding back.“Your inner mind calculated that if you act competent, your mother will conclude that you no longer need her support. She will feel relieved that you are just fine and will abandon any sense of obligation to support you. Your problems in life have been a way of motivating the big people around you to do what they should have done long ago. By exercising your full capability, you will be letting go of your cry for help and your justification for needing it.”

Still not good enough

She was tempted, but still reacting as if I was pointing her in the direction of hopelessness. The intellectual content was carrying a message of hope but her childlike inner mind was interpreting my communication as yet another big person unwilling to respond to her need. I had to do better in delivering my positive message in a form that would travel down to the limbic areas where she needed to feel hope. I tried a new tactic, a positive story about her.

“I’d like you to think about a new narrative, one in which you may feel sad about not having the kind of support you had hoped for, but you are now the captain of your own ship and a very good one at that. You are strong and capable, we both know that. I know you can make it!”

With my tone of voice and suggestion of a new narrative, I hoped to remind her of truths that part of her mind already knew. A sense of safety and reassurance might allow the inner mind to trade her unfulfillable hope for an achievable one. In that way, I was sending disconfirming information by two channels at the same time, the intellectual channel and the nonverbal channel. The latter is what Les Greenberg, founder of Emotion Focused Therapy, calls transforming emotion with emotion.

Did my intervention work? It wasn’t the classical ah-hah moment where everything comes together at the same time. That is because this disconfirming schema was not an easy one to swallow. Time will tell. We may very well need to keep working towards a moment where new hope outweighs old dread. There will also be a need for emotional processing of anger and grief over what she missed and will never receive. Ultimately, her old implicit learning will need to be re-written to reflect the reality that she is highly capable and that her best hope is to rely on her own very substantial adult skills and on recruiting others as needed for adult support and help. In short, she will need to accept real happiness in exchange for the illusory hope of someday finding what was missing in childhood.

How therapy recapitulates development

In many ways, though an employee, I was offering exactly what she had missed out on, support as she goes through painful emotions. Our work will, in adulthood, accomplish the processing of the painful reality of her childhood, something that was simply not possible at the time. And the processing will be the same kind a good mother employs when disappointment is unavoidable. A good enough mother acknowledges a child’s sadness, tolerates her pain and anger, and helps her move on. 

The problem is that her attention is focused elsewhere, on a different goal. Her inner mind is focused on changing a once-unwilling big person to one who is ready to help. I was irrelevant in this case, as I remained the same throughout and did not trigger this transference. Her inner schema said further that moving the other from unwilling to willing would only happen if earned by her demonstration of success and charm so amazing that they would overwhelm and overcome the big person’s unwillingness. 

The evidence of this came from her pattern of relationships. She had fallen in love with one avoidant man after another. Each time, she ignored the yellow flags and believed her powerful charms would change them. They would be so in love with her that their avoidant characteristics would evaporate. Each time, the strategy failed but she would not let go until the next one came along. This part of her implicit learning kept her hope intact but prevented her from realizing that the support she needed was actually at hand.

Notes on delivering the antidote

Delivering disconfirming information is often a delicate operation. The “corrective emotional experience” can be far more dramatic than the words suggest. The skill is first to explore and open up (activate) powerful and delicate feelings without triggering blocking defenses. Then it is finding true disconfirming information and presenting it in such a way that it travels down to the limbic locations where change needs to take place. 

In the process, we must not only change implicit learning, but accomplish the work of acceptance that has been avoided since childhood. For Rachel, the path to change requires acknowledging, grieving and, ultimately, accepting the failure of parenting in her early life and accepting that she actually has both the equipment and the support to make it as an “orphan.”

How neurophysiology sharpens clinical practice

The point of this post is that recent science, by elucidating the requirements for memory reconsolidation, sheds light on clinical practice. In particular it solves the age-old problem of balancing emotion and insight. It turns out not to be a matter of balance but of needing both at the same time. We need affect as an indicator of activation of limbic implicit learning, and we need new insight as a source of disconfirming information. Furthermore, affect tells us that the channel for delivering that information is open. This specific and subtle understanding of the relationship between affect and insight allows further refinement of technique as we focus on process, rather than method.

Therapist anxiety

If we understand how change happens and what conditions are required for it to happen, then we can gain confidence in managing those parts of therapy that are unique and specific to each client without needing to narrow our technique to a particular brand of therapy. Furthermore, using our knowledge of neurophysiology, we can come a step closer to monitoring whether we have created the conditions for change and whether change has taken place. Such lucidity about where we are and what to do next is a substantial antidote to therapist anxiety.

Jeffery Smith MD

Photo Credit: Etienne Girardet, Unsplash