According to research, theoretical orientation and technique in psychotherapy are important but less significant of factors then the therapeutic relationship or alliance. Confidentiality and a buy in to the therapist and approach are important factors as well when considering the efficacy of therapy, client satisfaction and creating desired change. As in the above cartoon, psychiatrists, psychologists, psychotherapists, counselors and the like no longer have clients prostrate themselves upon a couch neither are solely problem oriented but strength based. Although this can help someone feel relax, comfortable and even safe as to ease the tension of sharing their story and struggles; therapy has evolved to understanding that the relationship and strengths of the process need attending to more then any particular approach or intervention. Often an approach can become a conduit or medium for that relationship to thrive and facilitate or create desired change for an individual and their respective environments.
However, the following blog page is to share some of the recent therapeutic techniques and interventions I have executed and experienced with my clients. This is to allow you to familiarize yourself with myself and the plethora of possible therapeutic interventions. My hope in this is that you glean from the experience and process described as to help yourself experience change for yourself and respective relationships.
Advocacy Letters
I recently have had clients with loss and trauma write advocacy letters. I have verbally articulated this in therapy acting as their advocate and voice. Loss and trauma can often silence us leaving us with a victimhood, sense of lack of control, power and safety in life. Acting as a voice and advocate for a time then assisting the individual find their own voice again is helpful. So in these advocacy letters I model reframing and externalizing the problem. I model setting boundaries with a perpetrator and having a voice most of all as to take back the power and control that the loss or trauma ripped from the individual. In these letters are several other psychological techniques. In the end, the client uses mine as a reference and model to find their own and we collaborate through that process. This in and of itself is cathartic and liberating. Sometimes we burn them. Sometimes we shred them. Sometimes we mail or email these to those correlated with the loss and trauma.
For one client and her spouse we entitled the advocacy letter "Dear Traumatic Brain Injury" "Dear Trauma & Domestic Violence Events" The couple created this together as it was intimate to their marriage as much as individually. These emotional memories were casual in her struggle to feel and be intimate with him. This was not just sexually but on all levels of intimacy. It was in the way of her viewing him as a lover, spouse, and father to her children. He became a child to her in away. It was a great burden that the TBI created for this couple. As complicated and multidimensional the case was we worked on the marriage as much as parenting or helping her husband heal from the negative changes a TBI presents.
On account of several years of care taking her young husband while he recovered from a TBI this client became disconnected from her partner. His dissociative states, split personality and mood volatility created a sense of loss and disconnection. Although he recovered these past three years with great strides much hurt had occurred; specifically three separate domestic violence episodes where his impulse control was absent and over something small escalated things to stabbing her in the leg with car keys and intimidating her to the point that she called 911. He once spent a week in jail. These moments are hard because she once knew a loving and kind husband that had not been violent with her or struggled so much with his moods and behaviors. A lack of trust and knowing that as much as he has improved the possibility of another event is likely.
The couple began to email each other almost daily utilizing the levels of communication:
Level one- Talking about the whether, news and other small talk to stay connected and touch base with your partner.
Level two- I feel statements about your thoughts, behaviors and experiences of the day or week. I am feeling upset as I am struggling to stay on top of this project at work. This is what is going on. They personalized it a little more eventually and stated things like "I feel hurt when you struggle to acknowledge how I do parent, I read to the boys, I bath them and I cook dinner most nights. I am no longer always being taken care of…"
Level three- Core issues…The advocacy letter became how they addressed core issues of the TBI presenting a partner with continued loss and possible trauma, disconnection and so forth. They built to a communication pattern that could allow for tolerance of difficult topics and conversations.
In that process they united and were able to collaborate in externalizing the problems, loss and trauma to once again feel a sense of intimacy and connection in the story of their suffering and hardship. At this juncture this was the second round of therapy as I treated this couple in crisis more then 8 months earlier. At this time the husband was back in college from assistance with vocational rehab and they had had a physical separation for more then six weeks and other major events they had weathered together. Much healing was required.
This lead to another technique of using mindfulness with visual imagery to reframe and compartmentalize the different aspects of her husband. Setting boundaries when the bedroom door is closed that he doesn't have to be his TBI or one more person to caretake. Both partners had things they worked on. He worked on taking better care of himself as that was a token to her that he was trying to improve and cared for himself. This helped her feel attracted to him. In the end, as John Gottman would say a couple has to turn toward each other. Advocacy letters can help a couple unite against that which afflicts them. In that unity there is strength and healing. Below is an example of doing this with a survivor of incest, sexual abuse history and a battle with major depressive disorder.
General Letter:
(Boundaries)
Dear Family,
I feel it necessary to communicate new boundaries as to assist myself in maintaining a greater measure of health and well-being.
At this time I don't feel it productive to provide my mother meals on Monday night. I wont be providing her meals or having as consistent of communication. I am unsure of when I will reengage my mother in this manner. I love mom yet with recent conversations I need to acknowledge that it is unhealthy for me at this time to stay engaged. Mom has asked me to not stir things up or be open about our past as a family. Our family history has been harmful to me and I continue to struggle with major depressive disorder and various other impairing symptomology.
I also feel it necessary to remove myself from family functions for a time. It is hurtful and unnecessary to expose myself over and over again to siblings who have been unable to take accountability for the harm our childhood and family history has done.
If you would like to speak concerning these things I would request that I have a witness or advocate as I feel utterly alone and rejected at this time by my mother and family. It appears to be more important to keep our secrets and silences then to heal. Currently, my advocate is my therapist.
Find some of your own words but stay congruent with the message. Email me your version. Lets start working on another general email to the family, brothers and to your mother as well as your deceased father.
Dear Brothers,
In writing this letter I want to address and acknowledge our father and a family secret or history as much as break the silence with those who have colluded to my suffering. I do this not to hurt you but to further my progress and heal from devastating psychological ill and symptomology. I still struggle with major depressive disorder and suicidal thoughts at times pertaining to what I am about to share. "Blank" should understand that this is true and directly correlates and is even causal in nature.
I am unaware of what you remember as his sons. I am also unaware if you are willing to take accountability in this family history. Our family secret and history is one of sexual impropriety; even incest.
I recall our father having an issue with pornography. I remember specifically witnessing that he watched porn videos late at night on occasion. I also recall witnessing him pray and seek forgiveness for his impropriety. I hold onto the good memories of him providing for us and working so hard especially on the farm. I love our father. Nevertheless, both realities are true. Dad never touched me but he did have an addiction to porn. I believe that sexual impropriety may have lead to your struggles with sexuality and a hurtful family history.
I have wondered whether this affected you as his sons and what exposure you had to pornography? I also wonder how it may have correlated with the sexual impropriety Diane and I experienced with you. As young as we were, this was not ok or appropriate. I believe it made me vulnerable to outside victimization. When I told mom of all of this I was told that I was to blame as I was victimized outside of the home and a difficult teenager with my own sexual impropriety.
I have suffered with shame and guilt sense my teenage years as I was not only victimized by neighbors sexually but my own brothers. I remember the sexual impropriety on the bunk beds as we switched back and forth. I remember being subjected to dance naked on the hearth. I remember "blank" having me touch him inappropriately on the inner thigh and higher.
Mom has asked me to just attend the temple and move on. I have tried to move on my whole life and all it does is leave me feeling broken and ashamed. It has left me with a persistent and pervasive challenge with various mental health disorders. keeping silent is not healthy in these cases.
It hurts me to see how you have moved on and appear to be successful fathers, husbands and professionals. This is a lie. Making peace with our story in this life is important as much as it will resolve itself in the next. I have held my self accountable for decades and suffered greatly. In ways I have overcome my own choices and that of my perpetrators to find health and happiness. In the end, it is not healthy or just to continue to be silent and protect a few while others suffer and perish.
***I tried to use some of her own language during the last session as to reflect back o her that she has a voice and has found away to advocate for herself. This reprocessing and solidifying it by journaling it or writing it is an important part of internalizing that new voice or story and externalizing the trauma.
***What advocacy letter might you write for yourself or relationship?
***What advocacy letter might you write for yourself or relationship?
Inner Child Work
I had a gentlemen in his late forties struggling with feeling as he did when his parents divorced at the age of seven. He remembered all of the sudden feeling ashamed and insecure upon their disclosure and thereafter. In the present moment he was feeling those same emotions. He had recently been unfaithful to his wife of 22 years. They have been repairing their relationship as it had been disconnected for sometime. As he was taking accountability for his infidelity and repairing his marriage things were intense but dramatically improving. Nevertheless, he had never felt so insecure, vulnerable and ashamed since a child.
I introduced him to resolving this issue with inner child work. This is a man that has been sober for more then two decades and well versed in AA principles and other self-healing and coping measures. I was hesitant but proceeded. The next session we revisited the idea and he had made the decision to try it.
I asked him to start breathing from his diaphragm and walked him through early stages of becoming relaxed and comfortable in the chair, the room and with me. When he appeared relaxed I counted up to the age of three then five and stopped at age seven. I asked him to visualize him self at that age. As he continued to breath and relax we walked him through some memory that triggered emotional memory. He spoke to his inner child and stated his intent and desire to heal further from feeling ashamed and insecure. He reported in great detail his visual and emotional experience with his inner child. When a secure connection to self and sense of safety was established I became the voice of his parents and we had the conversation that he was never allowed to have surrounding their divorce. We also addressed the child and walked through some positive self-healing aspects of his childhood.
I have done this intervention several times with different people over the years but understand that some struggle to visualize as I do. He reported having a very visual emotional experience that helped him have resolve with his parents divorce and those emotions as well as getting back into touch with that inner child and that his childhood after that point wasn't as miserable and insecure as he remembered it. He was able to re-adjust his perspective to be more congruent with the actually reality.
The adjustment to his parents divorce and life in a way distorted memory and getting back in touch with that inner child helped him realign it as to be more congruent. The emotion he must have felt did overwhelm him and shape his perception of reality at that time that he didn't acknowledge the other reality that he was secure, safe and enjoyed childhood beyond his parents divorce.
I believe this was important for him to make peace with the past as he was currently under duress in the present with similar emotions. It all seemed to correlate. It also gave him a new sense of connectedness to self and a cathartic moment to catch his breath and press forward again.
No comments:
Post a Comment