Healing the Emptiness

Alone, Billy Pasco

One of the reasons I’ve neglected the blog is that I have been working on understanding better. I’m still not entirely there but I want to share my thoughts so far and ask readers for their experiences. I’ll tell you at the end about my other reasons for being scarce. (Image by Billy Pasco)

The explanation I have given so far for intense attachment to the therapist and related issues, is to picture a small child, whose main job in life is to make sure that the grownups do what they are supposed to do to provide the love and attention necessary for life. I have pictured a sort of grieving process, whereby the inner child gradually comes to accept the reality that some of the primary love that was missed will never be fulfilled, while other parts, like having an empathically connected witness can be fulfilled.

In this scenario, the therapist’s job is to provide empathy without seeming to promise the full primary love that is not possible. The empathy creates a positive context with which to face the pain of not having what can’t be.

But I’m not sure that is the whole story. Too often, my proposal has felt inadequate. Many of you have questioned when the yearning will lessen and how the emptiness can end.

The other possible issue

For a long time, I have held the idea that, under good conditions, people internalize a sense of connectedness to the primary caregiver which then gives them a permanent feeling of everything being ok and not being alone. This sense is so deep and nonverbal that it is taken for granted and not even noticed by those who have it. There is something that has been called “basic trust.” I think that is the the same thing, the result of internalizing primal love. It is also what makes for “object constancy,” the sense that the other can be relied upon to return if absent, and that relatedness exists regardless of physical presence.

Margaret Mahler, who introduced the concept of object constancy, pointed out that in children, this sense of connectedness and safety, even if acquired, is vulnerable to disruption under conditions of stress. It can be lost, then regained. So what about the many people whose early experience has been so disrupted that whatever sense of connectedness they internalized was shaky or nonexistent?

I have often wondered about that, and here I’ll propose some answers. First, a caveat. As you can imagine, there is an active nodding of heads by those whose inner child is hoping to use this explanation as a reason for insisting all the more vehemently on having the parental love they have been waiting for. To make matters more difficult, I don’t know a sure way to tell which mechanism might be operating. So anyway, here I go…

So what can we do?

I have known a certain number of people for whom I really think object constancy has never been sure. Some I have worked with long enough to see it appear where it was not before. What they have in common is that in between sessions, they really don’t have a sense of being connected. They experience a deep and genuine sense of being alone and disconnected from anyone. Their aloneness between sessions or during the night is profound and real, requiring some quite drastic measures to get through those times. By drastic measures, I mean psychological defenses and strategies of a primitive nature.

What has happened, is that over time, very slowly, perhaps even over decades of reliable and constant therapeutic relationship, I have seen a sense of being OK in spite of being alone, begin to appear. I think this represents an internalization of a reliable presence and relationship, coming and going, but always coming back.

All I know about Internalization

So let me tell you what I know about internalization. I think there is internalization fast and slow. The slow kind takes its time, and very gradually accrues. It is not hurried, but keeps getting stronger and more reliable under stress. That’s the simple and easy one, if only the conditions are met. Under good conditions, it happens over decades in development and is there to support the successful emancipation of young adulthood.

Then there is the other one. I first became interested in internalization when I realized that the low self-esteem experienced so regularly by trauma survivors is very hard to eliminate. I realized that what had happened, is that they had internalized the exact attitudes of their abusers, and those attitudes were exceedingly hard to get rid of. The fact that, even with successful therapy, a series of bad events could bring back all those bad feelings about the self told me that these internalizations were not only bad, but might be permanent. They were either deposited someplace where change isn’t possible, or they were guarded by some important mechanism.

Then I realized that there was a reason for their being kept unchanged. These attitudes are part of the conscience, which begins to function around 18 months. That’s when Schore says the prefrontal cortex is myelinated. Then the conscience starts to function around age three. So I began to put together that the conscience, which uses shame, and guilt as negative reinforcement and pride as positive reward, uses internalized values, attitudes, ideals and prohibitions, as measuring sticks to decide what to reward and punish. That very useful system, which, as best I can tell, animals don’t have, involves the cortex, not just the limbic system and gives humans a way to self-regulate, primarily towards the end of social cohesiveness (more on this in my new book, mentioned at the end of this post).

So when you really want something you are not supposed to have, if the internalized book of rules could easily be changed, then the conscience would be of no use at all. Therefore, it makes sense that the book of rules should be written in indelible ink.

Now, what about fast internalization? My search for answers took me to cult indoctrination. There I learned that under conditions of high stress, often helped by social pressure, music, ceremony, smoke, hunger, and lack of sleep, people who are ready, will internalize a whole new set of values and attitudes towards life. This works best when there is what I call “attachment anxiety.” Once people join a cult, it is very hard for them to be “de-programmed.” The story of Patty Hurst is, I think, illustrative. The more the person has a shaky sense of self and belonging, the more they are susceptible to this kind of indoctrination. Another classic example is the end of Shakespeare’s Taming of the Shrew, where sleep and food deprivation plus social rejection are used against the protagonist.

Internalization and Trauma

Learning about this has led me to examine other situations. Trauma is an example. Here, stress is at a maximum level, and I don’t know any situation where one might feel more alone, then as the object of an abuser who is intent on personal gratification and has no empathy or caring for the person being abused. I began to believe that these are exactly the conditions that promote rapid internalization.

What is the purpose of internalization? It is to maintain one’s connection with other humans. That is why people join cults, but it is a basic need we all have, that can be heightened at times of great stress. So it made sense that the reason behind the Stockholm syndrome, and the mechanism of “identification with the aggressor,” would be to preserve a sense of connection. And it made sense that victims of abuse would also internalize the attitudes of their abusers as a way of gaining a sense of connection, since adopting the point of view of the other is a way of securing a vulnerable connection.

From all this, I came to believe that bad internalizations happen as a result of terrible stress, where the need to be connected to someone leads to rapid, perhaps instantaneous, internalization of negative attitudes and values.

Undoing bad Internalization

Now we can talk about how this might heal. Given the general propensity to relapse, I don’t think that old internalizations can be “erased.” I could be wrong, but this is my belief so far. That means that even the amazing mechanism of memory reconsolidation, which allows for re-programming of erroneous beliefs, can’t undo this kind of mental content.

There are some who would disagree. Francine Shapiro, who invented EMDR, is one of the few, at least in her original book, who recognizes that core values are not the same as other mental contents and require different treatment. Most of the therapy community seems to have forgotten the superego and classified its values as the same as any other belief. I know that is incorrect. The way you can tell is if failure to live up to a belief leads to shame and success to pride, then it is a value. If not, it is a simple belief. Do you feel proud when you eat your favorite breakfast? Do you feel proud when a story has a happy ending? No. On the other hand, what do you feel when you exercise great self-control?

Unfortunately, even Francine Shapiro seemed to think that all you have to do is “install” a new value by waving a finger or making alternating clicks. It would be great if that was all it takes, but I remain skeptical. Please let me know if the EMDR community has learned otherwise. Meanwhile, the distinction between beliefs and values continues, in my view, to lead to a failure to adequately investigate what is special about values.

A closer version of what really happens is that we can establish a new internalization, capable of overriding the old, bad one, even if the old one is still imprinted somewhere in our neural networks.

Now, you may have noticed I am putting internalized values and object constancy in the same category. I think that is warranted, but object constancy goes so far back, that it is not a source of pride or shame. Otherwise, I have a feeling it operates using many of the same principles and mechanisms.

Now I’m getting far into conjecture, because the research has not been done, to the best of my knowledge. I’m guessing that internalization of the connection with the other, even though it is gradual, happens at moments of connection stress. In other words, I’m guessing that it is the pang of loneliness that happens at the moment of saying good bye, that allows a little bit of internalization to take place. I’m guessing that over decades, what has allowed some people to internalize a new sense of secure connection, who didn’t have it before, are the collected moments of angst at separating from the other, not so much the steady presence.

There is some relevant observation. Freud talked briefly about “identification with the lost object.” Also when kids are left alone by a parent at an appropriate age, say 10 or 12, then they often have a tendency to act more responsibly than when they are with the parents and feel safe about acting up and then being told to behave.

A Reader’s Experience

Recently a reader of this blog told me how she was abruptly dropped after over a year with a good therapist. Apparently the clinic where the therapist worked suddenly decided to crack down on good treatment and insisted that the client be thrown out of the facility and terminated without ceremony. She was devastated, and wondered if I had any ideas about what to do. Here was my thought.

Might it be possible for her to try to internalize the love and genuine caring that she had already received. Could she allow herself to notice that she had already received a good amount of what had been missing? I don’t know how much wanting to internalize makes a difference, but I now that children often want to internalize some attitude or value they consider to be good. So I thought it was not entirely unrealistic, that noticing the positive of what she had received might improve her ability to internalize a sense of mattering in the world and not being alone. Is that correct? I don’t know. I wonder if readers have any relevant observations?

For now, this is all I have to say. In the years I have held these beliefs, they have not bee contradicted, nor can I say they have been proven true. If research does not pick up this issue, then maybe we can collect experiences that do shed light.

What I’ve been up to recently

I said I would mention what else has been distracting me for a while. I have given some hints. It is that I want to develop a therapy training program, especially for psychiatrists, who often receive only minimal training in psychotherapy. 

What worked for me was to develop an understanding of just how people change. Rather than following a method, I could then focus on trying to identify what change processes needed to happen, then work on supporting them. I want to give others that experience, which, by the way, naturally moves us away from the competing schools model where therapists must choose to be disciples of one particular camp. 

Towards that end, I created a brief “info-graphic” to simplify the common infrastructure of psychotherapy. This is in no way a challenge to existing theories and methods, just filling in the part that couldn’t be filled in before. Having done the info-graphic, I thought there was a need for something to give away free to anyone who would give me their e-mail address, so I just finished a new e-book. The Common Infrastructure of Psychotherapy is a short (75 page) introduction to the material covered in my other books. Here is the link to the info-graphic: “I want the free info-graphic showing The Common Infrastructure of Psychotherapy!” From there you will be able to get the new book, also free, but please join my email list or go to the page even if you are on the list. (I won’t ever sell or give your info to anyone. It will be kept on Mail Chimp for now, or, if I have to change, some other platform that cares about protecting you.)


  • I think it would be helpful to encourage the Reader you mention to try to internalize the love and caring she received from the good therapist. She could remember the therapist, the sessions she had with him/her, little things that happened that she enjoyed. I think she could try to remember on a regular basis, a little each day. She could also try talking to the therapist in imagination. She might be able to hear the therapist and imagine things the therapist would say. I think this is what would happen at the termination of a good therapy. She could try other things as well at the same time, like imaging other nurturing figures, real or fictional, that are concerned for her, and, as you have suggested previously, being nurtured by her adult self.

    Lisa Feldman Barrett, a neuroscientist, has written a book called How Emotions Are Made. (She also has a website, lisafeldmanbarrett.com.) She talks about dealing with emotions as well. Her research might be helpful with internalization.

  • I have seen a large number of therapists in my life, most only 2-3 times, and a couple for 3 years. I struggled mightily with attachment to those therapists. I am doing better. I am no longer ruled by an intense need for attachment. At times, that longing returns, but I don’t find it helpful to imagine the times with my therapist, as Jeffrey suggested to his reader, and Lynn reiterated in the comments. Trying to imagine your beloved therapist taking care of you is frustrating, because it’s just an imagination. The therapist is not really doing it. I have found grounding techniques more helpful. My favorite is called “5-4-3-2-1”. You look at 5 things in your immediate environment; feel or touch 4 things (this can include feeling the couch you are sittting in, or the feel of your clothes on your skin); listen for 3 things you can hear; 2 things you can smell; and 1 thing you can taste. It brings you into your present. You can do it as many times in a row until you feel a little calmer. I think treatment is helpful, but I agree with Jeffrey from an earlier blog that real hope is in the “real” adult world, where you can form actual relationships that are mutually satisfying and not based on money. I will also say that I have received a lot of treatment, which has been helpful, but this grounding exercise is one of the most valuable tools I have. It has gotten me through some extremely tough emotional situations, including psychiatric hospitalization. If you have the present, you feel a little less empty.

    • Thanks for your comment and for the 5-4-3-2-1 technique. I agree, that at some point, changing behavior has to be part of the recovery. JS

    • Thank you for your comment. This method remains of a grounding exercise from the book about Self- Compassion. ( The Mindful Path to Self- Compassion: Freeing Yourself from Destructive Thoughts and Emotions) Christopher Germer. It all about finding best technic for yourself.

  • A bit of background: I had a long-term therapist who dropped me. I got upset when I asked for a hug and was told no. He refused a final session for reasons I still don’t understand. The attachment I had for him over that year was awful.

    I had a visualisation strategy that helped me internalise the excellent therapy I received before I got dumped, as I didn’t want to lose the progress I’d made.

    I would take meaningful conversations or ideas that had happened between us and imagine them as a sticker. The sticky part of the sticker was the insight I could take forward, the non-sticky part was him, and I imagined throwing this in the bin in his office.

    The other visualisation strategy I had was to imagine me packing up his office. I ‘took’ the paintings I liked, the exceptionally comfortable sofa, and the bookcase, etc. I ‘left’ all the things I didn’t like. This helped because I felt he robbed me not only of my supportive person, but my supportive space. I would ‘set up’ the space in my head when I needed a place to think or just be calm.

    These strategies have helped me internalise the useful insights and strategies I found during my time with him.

    But… I’m now angry with him. Livid even. It’s been a year and a half, and not a day goes by that I don’t think of going to his house and keying his car. I feel like I played the therapy game: expressed my emotions, said I was angry he wouldn’t hug me, didn’t abuse him physically or verbally… and was abandoned for it. I can’t get rid of this rage, and I don’t understand why.

    Don’t know what to do. I will never see a therapist again, so that’s not an option to figure this out. If you have any insights, they’d be very appreciated.

    • Oh my, Diana. I’m so sorry. It seems to happen much too much that therapists seem to be able to handle strong emotions in a professional way, then don’t when it comes too attachment. I see anger, like grief, as a process. Anger works well with people who are worthy of trust. They listen and respond appropriately. But when there is no satisfaction like that, the process is allowing the anger, acknowledging it, sharing it, and letting it fade until one is clear that it is time to move on, because it’s a waste of emotional energy that won’t get you anywhere. When it doesn’t fade, then I think it might be because there is a part of the person that is waiting for satisfaction that won’t come. It is hard to say if that might be the case, and that’s where a competent therapist could help. It’s hard to say how long the process takes. Like grieving, as long as there is some progress from week to week or month to month, then it’s best to let the process find its own time. JS

  • I am not usually the type of person to comment on a blog site, but I found this one hit so close to home that I feel obliged to throw in my two cents. As it happens I am reaching termination with my therapist of 1 ½ years and quite frankly was quite taken aback by my strong feelings.

    Before I get into this, I would like to first explain a little about my previous therapeutic relationship. I was seeing my former therapist for three years, it was a rocky relationship from the start, and it didn’t end well. It took me a while to work out just what had happened. As you’ve discussed many trauma patients, particularly with trauma at a young age, have attachment issues and I “feel” like you have hit the nail on the head regarding Object Consistency. Lack of attachment/poor attachment often means mistrust that others are actually there or reliable to be so, which leads to the empty void of existence. My first therapist, in my opinion, had weak boundaries. He allowed me to contact him anytime, he would shuffle his schedule to fit me in, he often discussed his family and personal relationship problems, and he would text or email me often to tell me how much he cared about me. To be ‘seen’ by another human being, a human being who is so attentive and validating, to a person with attachment issues, it’s like giving food to a starving man. I found myself experiencing intense feelings towards him. But on the flip side of this attention, he was flaky. He sometimes missed our scheduled appointments or cancelled at the last min (sometimes when I was actually there), he went on vacation without telling me, and sometimes he wouldn’t respond to messages for a week. It felt like an emotional rollercoaster, caused significant distress and exacerbated my symptoms.

    On the one hand, I couldn’t rely on his presence or existence, there was no object consistency, worse still, I felt compelled to continue with him because of my otherwise intense feelings which triggered guilt and shame (other forms of self-loathing) thus, reinforcing negative (bad) internalization. Essentially, repeating abusive relationships of my past. It wasn’t until he really crossed a line (I won’t go into the details) that I could see how bad the relationship was and I left—taking a whole bunch of new baggage with me.

    So, enter my latest therapy arrangement. It took me a long time to recover from my first experience, but my symptoms were making it difficult to manage my everyday life, so I decided to once again into the fray. This time I was warier, did more research and asked a lot of questions (in writing). My new therapist is a trauma specialist with more than 20 years’ experience working with trauma survivors. He has healthy boundaries, which I’ve learned has been good modelling for me. But more than his knowledge base or his calm, stable demeanour, I think as much as anything, the success of our relationship has been in the consistency of our interaction. We established ground rules early on, I can email him, and he will respond within 24 hours, he is never late or misses a scheduled appointment, if he is going to be away he will let me know well in advance. On the surface, it appears to be overly simple, but in those times when I feel most lonely and disconnected (yes often at night) I find myself thinking about him and his consistency. I know he is there, and it helps!

    As for internalization, I have felt a recent shift, which seemed sudden. However, I think it has been bubbling away in the background and has come more to the foreground since my therapist, and I started talking termination. The beginnings, I think, appeared during our COVID lockdown. Over this time, there was a disruption in access to my therapist, and it was distressing at first, enough so that I considered ending it altogether. But I didn’t quit. Instead, I sat with my feelings for a while and realized that it was ok because I knew that even though we had a physical disruption to our work, he would be there when the time came to reconnect. Once we did reconnect, we worked on forgiveness. I completed a written exercise to find forgiveness for my childhood abuser.

    I never thought forgiveness was possible, but there it was. Once I completed that assignment, I discovered newfound freedom, like my connections to that particular trauma, were sanitized. The dirt washed away. And with it much of my feelings of shame and guilt. Could this be a clearing of my ‘bad’ internalization? I will explain a little further. Now we are talking termination. Surprisingly to me, I was able to express my feelings, to an extent, with my therapist. I feel grief and sadness at the potential loss of this reliable and stable connection to another human being. But, on the flip side, I also feel a certain amount of excitement for the future due to my newfound positive outlook (at least that’s how I see it). I find myself seeking/desiring connections with other people, who have always been there, but to me, they were unseen, until now. This desire is different than before, not one of desperation for approval and validation that I am normal. I suddenly, feel more secure in my imperfections, less concerned to be ‘seen’ as I am. As I see it, my internalized value has shifted, no longer broken, damaged, shameful or unloveable. Just an imperfect human being, maybe one with a little more mileage than the average.

    I guess, to sum up. I think I agree with your interpretation, at least from my perspective. The reliable connection I had with my therapist allowed me first to believe that he was there, even when he wasn’t. Having this faith is a game-changer in terms of safety, obviously. Also, I think a crucial vector for ‘positive’ internalization occurs when the reliable, consistent person reflects positivity and acceptance upon seeing your worst, ugliest truth. For me, once I found forgiveness, things seemed to shift quickly. That consistent message of positivity and acceptance feels more congruent, dare I say internalized.

    Of course, this is still new, and I cannot say there won’t be a relapse if something big comes my way. It is one of my fears (which I also expressed to my therapist). And of course, he responded that if that were to happen, then he would be there if I needed him.

    • Dawn, It’s very nice to see a positive experience (in the end) and you at a good place. Wishing you continued growth and enjoyment of life as an imperfect but lovable person. JS

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