Heather asked a really useful question the other day on the Attachment-Focused Google Group, and I thought it might be useful to post my response here for more general perusal. (Noting that I have changed language to ensure confidentiality).
I would appreciate your thoughts. My question is in working with a someone whose cause of her low self esteem and overwhelm and anxiety goes back to childhood and mother, with a classic story of criticism, enmeshment, invalidation etc.
The client is intelligent and professionally successful, but having relationship problems with a partner relatively recently moved in. The client doubts themselves and feels always in the wrong. My gut feeling as therapist is that the partner is, yes, manipulative but can be kind etc. The partner’s mother is also critical of the client, treating them what feels like disrespect.
Where do I start processing? Choose distinct memories…..first, worst and most recent of mother? Or identify current distressing event (there is one each week), do phase three, trace it back and process that, then current event, then future template.
The target of mother is so large and pervasive I’m not sure I can break it down.
To which, my (Mark Brayne’s) response:
This kind of presentation, I have to say, is almost my favourite. A new distressing event every week, triggering self-esteem and overwhelm experiences that are all rooted in the same early childhood programming.
And, yes, I’m afraid it almost always goes back, in my experience, to Mum – not in the sense of blaming her or holding her primarily responsible for the child/adult’s distress, but reflecting how said child learned, or didn’t, to self-soothe in those earliest formative years. It’s how evolution works, and any colleagues who’ve come on my recent Unleash workshops will know that I now bang on about this incessantly.
Namely asking myself:
- How did this client get to be this way;
- How did they learn to self-soothe (patterns laid down particularly powerfully in the first 1000 days after conception);
- And in that context, what happened to them…
So with a client like this presenting with generalised anxiety being triggered all over the place in the present, having got a reasonably comprehensive trauma history (CAPS, ACE, PCL5 and/or ITQ), I now most often ask my clients at the beginning of the session (after checking how last week’s has settled down, any dreams etc):
What would you most like to get out of this week? If there’s one thing you could seriously change in the next 45/50 minutes, what would that be?
Then, it’s Laurel Parnell’s brilliant (as in, biggest single contribution to our field, in my view) Bridging:
- What’s the picture that goes with that? (and accept whatever it is)
- What’s the feeling?
- Where’s that happening in your body?
- And, what’s the belief that goes with that?
Then, again, 1-2-3 bridge:
- Trace it/drop back in time;
- Go back as far as you can go;
- Without censoring it.
And WHEREVER you land (pre-12 or so, and whether initially positive-appearing or obviously negative, that’s your point from which to “petal” as I phrase it, with deep curiosity as to what this is REALLY about.
Thinking what I call the four Levels of Trauma targeting:
- What happened TO, this person; (e.g. bullying at school, sexual abuse, violence…)
- The Attachment-Informed MEANING they made of it (how parents and family responded, if at all, and the way the client therefore dealt with the impact);
- What of this is parental introject and not really the client’s stuff at all (often maternal anxiety or paternal violence/anger, observed, experienced and internalised);
- And what’s intergenerationally handed down, through culture, behaviour, narrative, epi-genetics, star signs, the way the wind blew at birth (no, in my book just the first four….)
And as you conclude your email, Heather, yes, get that one event/experience down to a zero, VoC to a 7 (if you’re using that scale at this point, but definitely tap in the solid emerging PC) and bring the positive forward to the presenting trigger that started the session, and check the future template. All in one session if you can, though clearly often leaving past stories with more to do later…
Simples! Once you get the hang.
I use this structure much of the time in my work, of course with lots of good and rich interweaving and resourcing where appropriate, and also appropriate target planning with clients who have a LOT of explicit stuff to get through.
But it does mean that you can work sometimes with a different presenting issue every week, using it to get back into the same early attachment dysfunctional patterns until they’re well and truly done.
Might take a long time, of course, but it’s our old friend the jigsaw, patiently putting together the bigger picture, which, yes, almost always reflects those early experiences of either the presence in those earliest attachment-intensive years of dysfunctional soothing from mother, primarily, or the absence of appropriate soothing.
A long email which I hope helps other colleagues as well, at least those who’ve read this far.