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My Therapy Method

I have developed a new way of approaching therapy based on my readings and knowledge of both Mary Goulding’s Redecision Therapy and Francine Shapiro’s EMDR noted in sections 1.15 and 1.14, respectively. Because it is difficult for patients to spontaneously access painful memory for which there is amnesia especially in chronically traumatized and/or emotionally rejected vulnerable individuals. I have developed therapy tools that are based on concepts drawn from both EMDR and redecision therapy. These therapy tools are lists of emotionally laden verbalizations and thoughts of self in interaction that provide reminders to help patients to elaborate on memories and emotionally laden cognitive representations relating to a specific memory. These thoughts are holistic assessments of self in interaction that in any combination can describe the nature of any individual’s relationship in interaction and the state of attachment or breach of attachment in any relationship as well. These thoughts in any combination also account for an individual’s “working model” or “representational model of attachment figures and of self” as described by John Bowlby (1969, 1973, 1980) and can account for the nature of any persons heightened or low self-esteem.

I have developed a list of parental injunctions and examples of parental injunctions or statements that are used at the start of therapy to help the patient to ease into the therapeutic process with less resistance. These parental injunctions that are characteristic of the attachment relationship in interaction (Bowlby, 1980) ask a patient to underline all those that apply to a specific relationship. The following is a sample that has been taken from a four page document:

I ask the patient to select 4 statements that are particularly disturbing and develop a written homework assignment that lists each of the four statements. I ask the patient to elaborate on the situation or context in which each statement was made. I ask the patient to note who else had been present and what did this person say to the other’s statements and behaviors. I ask the patient to write down on a piece of paper what his or her response was to this situation as if the patient were talking to each person in the present tense. The patient is required to note how he/she is feeling in response to one or both individuals throughout the written dialogue. The patient works on this written assignment and prepares it for our next meeting. When we meet again we review that which was written. I read the assignment aloud, try to elicit more details about the statements, and events, and ask the patient to select the most disturbing statement of the four. I then take out a blank list of assessments of self in interaction and ask the patient to highlight those assessments of self in interaction that had applied to his/her sense of the world at that time when the statement was made. These assessments are essentially implicit emotional summaries that each of us makes to describe our emotional responses to interactions with other people over time. These statements describe our sense of safety, how each of us lives up to the expectations of others, the level and degree of responsivity of others, etc. Some examples taken from this list are the following: I can’t get it right. I can’t be good enough. I am unlovable. I don’t belong; I can’t get close. I am powerless. I am unsafe. I then ask the patient to highlight those assessments of self in interaction that the patient brings into his/her experience in the present and to give examples when the patient in the present thought of him/herself in the same way.

It would look like the following:

Parental injunction: Don’t be close.*
Example: Get outta my sight.
Context noted during therapy: Patient wrote the following. After I cleaned the barn the way you wanted me to, you told me to “get outta my sight”, because your friends are over. You pushed me and hurt me. Grandma says “leave your dad alone. You should know better.” Dad you have no right to push me away like that. Grandma why do you blame me for what he does? I am angry grandma because it’s not my fault. During the next therapy session the patient tells me, “I was proud because I cleaned the barn. My dad was partying with friends and didn’t want me interrupting him. He grabbed my arm and threw me across the room and hurt me. I was mad. I was confused because I cleaned the barn just the way he wanted me to. My grandmother told me to leave my dad alone that I should keep away from him he gets like this when his friends are over. She said that I should know better. I was mad at grandma for taking my dad’s side. She always took his side when he was mean to me.
Highlighted assessments of self in interaction: I can’t get it right. I can’t be good enough. I am unlovable. I don’t belong; I can’t get close. I am powerless. I am unsafe.
Emotion: Anger because I did what he wanted me to do, but didn’t care. Sad because I cleaned the barn just the way I thought he wanted it because I wanted him to respect me. Sad because he told me he wanted me to be a certain way, but I didn?t know what to do to be the way that he wanted me to be.
SUDS: Disturbance of 6 then, 4 now.
Current example: I got mad when my boss flicked me off when I wanted to show him my corrections.

We repeat this sequence for the next 2-4 sessions with different examples and parental injunctions. Then we conclude by reviewing all our work. After the patient has completed this part of the therapy, the patient has gained a clearer sense of the nature of the attached state with significant caregivers in his or her life. After completing this aspect of therapy it is also easier to identify early childhood traumas for which there has been amnesia. We then go onto the next part of therapy, which is processing trauma.

After the patient has identified and processed the nature of significant attachment relationships from early childhood in following the above course, the patient then identifies a trauma or disturbing event and describes its occurrence in a written homework assignment. The homework assignment asks the patient to reflect on a troubling occurrence. State what happened. State who was there and what was said. What was your response to what was done and said. Describe your reaction (e.g. thoughts, emotions, visceral responses, behaviors, etc.) How did the other participants respond? How did it conclude? During the next session the therapist reviews the assignment and asks questions to elicit further details. Then the therapist transfers the contents of the assignment onto a worksheet, which has been devised to coordinate with the worksheet that the patient uses in the course of therapy. The therapist then reads the trauma one sentence at a time and one frame at a time. The adult patient is encouraged to identify from a list the cognitive representations or thoughts of self in interaction that pertain to each event frame. The following is an example of such a session.

I was five years old and playing at the beach. I was busy trying to build a sandcastle. I imagined that I could make it real big. My mom said “Come into the water; it’ll cool you off!” My dad came along and scooped me up. He wanted us to join my mom deeper in the water. I resisted him and said “Let me go. I don’t wanna go!” As I struggled to free myself I knocked my dad’s favorite sunglasses off his face. His sunglasses fell into the ocean and were never seen again. I saw my father’s disappointment immediately. He refused to talk to me the rest of the day. I felt really bad for losing his glasses.

As suggested by John Bowlby (1980-page 233) we review the role and behavior of source in the troubling interaction or trauma and the nature of selected thoughts in interaction. Attention is paid to examining the thought progression for the later development of self-blame that produced constructions that internalized the event. This internalization has underlied the current rigidity and persistence of the low self-esteem. In addition any expectations for different behaviors that the patient may have had for source are also examined. After processing we examine the development of new positive thoughts in interaction, a redecision (of Mary Goulding) or positive cognition (of EMDR) that can modify the existing cognitive bias (Bowlby, 1980). Each trauma or disturbing event is processed in this way until all events that have a capacity to impair adaptation and produce behavioral symptoms have been processed. The method?s results are not state-dependent, as reductions in arousal necessitate medication reductions.

References

Bowlby J (1969): Attachment and Loss-Volume 1-Attachment. Basic Books, New York.

Bowlby J (1973): Attachment and Loss-Volume 2-Separation: Anxiety and Anger. Basic Books, New York.

Bowlby J (1980): Attachment and Loss-Volume 3-Sadness and Depression. Basic Books, New York.

* Goulding MM & Goulding RL (1979): Changing Lives Through Redecision Therapy. Grove Press, New York.