Consult Your Inner Wisdom: It Has All the Answers

This past year, or two, in my clinical work, I experimented with a therapeutic technique that I cribbed from clinician/writer Sarah Krakauer. I found it useful both for my clients and for myself. I share it with you.

The assumption behind this idea is simple: at bottom, no matter how fractured our identity, or sense of self, there is within us a wholeness and a wisdom that we can consult as a sort of inner gyroscope. The theory goes that there is a unity within, and if we can gain access we can find a treasure trove of wise guidance.

I have worked with individuals who were highly “fractured” due to  severe trauma histories, as well as more intact individuals. The technique worked well with all kinds of people but I found that individuals with these fractures had an easier time accessing the “inner wisdom.”

The technique involves a simple visualization. One woman with whom I was working is diagnosed with Dissociative Identity Disorder, formerly known as Multiple Personality Disorder. This means, simply, that her identity is complex and multiple: she has very distinct and separate identities within a seemingly stable “self.”

Each “part” of this individual has a discrete and often contradictory point of view on any matter you could imagine: what to buy in the supermarket, for instance, junk food or organic kale . Or on any particular day if I am perceived as benign or as a threat. So checking across parts as to what the inner wisdom might suggest on any given topic is relevant to our enterprise.

What surprised me was that when we went through the inner wisdom I got the same answer to the question of the day: no contradictions, no evasions.

With this particular client I was often uncertain as to how to go forward in any given session, which part to address, how much to push for the traumatic memories that were just outside of her awareness. They could either liberate her from painful symptoms and/or de-stabilize her. Actually I was almost always struggling with these choices.

The inner wisdom always directed me to the traumatic material: go for it, it seemed to say. Don’t pay so much attention to the complaining about the pain that this causes. And the inner wisdom was right. After a period of turmoil, which was always difficult to weather, my patient was more solidly grounded, more mature, and eventually more integrated.

Now this is not magic, if the client was in retreat, warding me off, defending herself from incursions, I might get nothing. But this was relatively rare.

I describe the technique belo. Do try this at home.  Its perfectly safe.  Its probably more effective to have someone read this to you,   or record it yourself so you can hear the suggestions, not just imagine them.
Sit in a quiet place, close your eyes and visualize a corridor. This is a safe place. Off the corridor are doors. The door on the left is labeled “Hall of Inner Wisdom.” Open the door into a room that resembles a small movie theatre. The seats are comfortable. Sit down and see that at your finger tips is a keyboard. Type in the question that we are working on today: why does my hip hurt so much today, or what should I do about a troublesome relationship, should I change doctors, etc. Look up at the screen in front of you and there will be an answer.

Here you may see pictures or writing. You may just get thoughts popping up. If nothing comes, just sit quietly for awhile and see what happens.

I have tried this myself, going through the same steps of visualization. It feels a little like meditation, but with a very specific goal. Sometimes I get an answer. Not as frequently as my patient, alas. Often the answer surprises me. That’s what makes me think that this really is coming from a source quite different than my logical, linear, and deliberative mind.

What I think is going on here is that with the right tools and probably a bit of practice, one can have access to a part of the mind that is less rigid, less defensive, more intuitive, and more astute than the reasoning mind. I find it exciting and re-assuring that there is a guidance within with which I can make contact.

More on Story-Telling: The Cambodian Healer

Phaly Nuon is a Cambodian survivor of Pol Pot’s killing fields of the 1970’s. An educated woman who managed to disguise her origins and her learning in order to survive the mass murder of the educated classes, she witnessed the rape and murder of her teenage daughter and the starvation of her baby. She survived for three years in the jungle, trying to protect her two surviving children, living in isolation, hiding and eating only what she could forage in the jungle. She and one child walked out of the jungle. Her baby died.

While in the refugee camps following the war she noticed many women whose mental state made them virtually inert, unable to care for themselves or their children. Their PTSD (post traumatic stress disorder) was going to kill them and their children. She set out to help them and developed her own system of psychotherapy which was remarkably effective. This woman has been on the short list for the Nobel Prize many times for her work with these depressed women as well as the development of an orphanage (the Future Light Orphanage), which the recovering victim/survivors run.

Phaly Nuon has a three part system of therapy (which actually has at least 5 parts).

1. She teaches the women to forget their atrocities. 2. Then she teaches them to work. Some of the work is with orphans who have lost their parents in the war. 3. Then, she says, I teach them to “love.’

Interestingly both she and Andrew Solomon (¬The Noonday Demon: An Atlas of Depression (http://www.noondaydemon.com/biography.html ). fail to notice that the first step is not the first step. The first step in her system of therapy, as Solomon recounts this, is the telling of the story of their ordeal. And then the re-telling.

I quote Solomon:
"First, she would take about three hours to get each woman to tell her story. Then she would make follow up visit to try to get more of the story, until she finally got the full trust of the depressed woman. "p.36

"Forgetting,"  involves getting them involved in their present life.

Step two, work, is an important part of that. And step three, teaching them to love, is all about focusing on relationship. The women that Phaly Nuon has ministered to have formed a healing community. Just as a footnote, Freud thought the ability to love and to work were the hallmark of mental health.   Evidently Phaly agrees.
There is another step, by the way. This is teaching the women to give manicures and pedicures to each other (!) This is the final phase and as a lover of pedicures myself, I can testify to the healing potency of this process, which is both intimate and impersonal.

This step, perhaps, represents the importance of engaging the body, in the healing process

This story, I believe reinforces the importance of story-telling in healing. Phaly took it as a starting point and created something truly amazing.

I first heard Andrew Solomon tell this story on the Moth broadcast on WNYC. Here’s the link: http://www.themoth.org/

For more on Phaly: http://emailfosterparents.org/PhalyAutobio.htm

Why Does Psychotherapy Take So Long--Part 2

An important part of the psychotherapy process, as I understand, and have practiced it, involves constructing a narrative of one’s life.

This may seem like a curious task given that we all know, or should know, the story of our lives. We’ve been imagining the movie to be made from that story, forever, right?

Well, that may be true of some us, but a surprising number of people actually don’t have a coherent story, something that hangs together, makes sense, and has some internal consistency to it.

There is some compelling evidence that the coherence of one’s story is a key component of sound mental health. I derive this from solid research findings that the quality of one’s attachment to one’s off spring is strongly influenced by said coherence. What researcher’s found was that the strongest predictor of stable, secure attachment in babies was the caretaker’s (read mom’s) ability to recount a coherent story of her own life. That story didn’t need to be historically accurate. It didn’t need to be positive. It was not necessary for her to have had a happy childhood. She just needed to be able to narrate the story to herself and the interviewer, of course, in a manner that hung together.

A baby’s “attachment” status reflects the ability of the young infant to bond with their parents, an important, maybe the most important, measure of their emotional well being.

Given the robustness of this research finding, frankly, I don’t understand why everyone who wants to be a parent, or is a parent doesn’t run to their nearest therapist. It would seem to be the best argument for undertaking this admittedly arduous and expensive process.

So back to what we do in therapy. We construct a story. This is the story of the client/patient. Its not mom’s story, dad’s story, or the story of the siblings, its not the therapist’s story, it’s the patient’s story.

So many of us have accepted, wholesale, someone else’s version of our lives. If you have been told forever that your childhood was idyllic you might be tempted to go along and not validate some of your own memories, or even weak suspicions that things were not always perfect. If you were always told that you were an overly sensitive child you might buy this wholesale. Never mind your own observations that people were actually pretty mean to you

This is tantamount to not being on your own side. Empathy for others, those adults who did the best for us growing up is a positive thing. But not if it’s prioritized over empathy for the self.

It is truly amazing how much fog, depression, confusion, and anxiety begins to lift when the story one narrates starts to be one’s own. It needn’t be a pretty story or even a wholly accurate story—just one’s own.

Sometimes the story is there but it is self-condemnatory and unfair. A woman who was raped at the age of 16 has told herself forever that she consented to sex with a man much older than her that she barely knew and was therefore a slut. All the adults in her family would agree (if they knew the story): a 16 year old is a grown up and responsible for her actions.

I had her look up the definition of “statutory rape.”

It took years for her to empathize with her frightened and confused 16 year old self and for her to re-structure the story to reflect her naiveté, her fear, her helplessness and her isolation at the time.

Story construction is central to the project of psychotherapy. Coherent stories evolve only slowly.

Why Does Psychotherapy Treatment Take So Long?

This is a question I have heard, in one form or another, many times from my
clients/patients.

Sometimes the question is not posed explicitly, but the client assumes at the opening of our work together that he/she will be in and out in six weeks (said client having just told me that she has a long history of failed relationships, periodic dark depressions, and an eating disorder).

There are of course treatments that are shorter, but I tend to think in terms of years, if a client is suffering a great deal and has for some time.

Explaining why psychotherapy treatments are not generally brief affairs is complicated. My model of therapy is of course not everyone’s model. Models of short term therapy exist. I am not a practitioner, although I am aware of these modalities and have read their literature.

I think of the realtor’s motto—there are three things important in the sale of a home “location, location, and location.” In the kind of psychotherapy treatment that I practice, those three important things are : “relationship, relationship, and relationship.” What happens between therapist and patient is the cornerstone for effective change with and for the patient. The relationship is the crucible for change. Obviously building a trustworthy resilient (if not perfect), mostly predictable relationship takes time. If there has been a major betrayal at the heart of a person’s life experience, building trust can take a very, very long time.

In the ordinary course of events the relationship stumbles, there are crises, loss of faith, mistakes made, failures of understanding and empathy. As in life, so in therapy, it is in the repair of those rents in the fabric of the connection that hold the real promise of lasting change in the structure of the self. This is a basic tenet in many theories of therapeutic change.

Within the context of the mostly safe relationship, our clients have the opportunity to develop new skills. Most of us developed our coping skills early in life. We adapted to whatever conditions we faced with the best tools available to us at the time, that time being childhood. Checking out (dissociation), cheerful denial, taking care of others, distancing ourselves from others, controlling others, numbing ourselves, living in a fantasy world are only a few of the popular choices.

As circumstances in our life change we fail to update the toolkit. We go on automatic. This is true for all of us. If you have always been cheerfully unaware of thunderclouds on the horizon you will probably continue to be so, even if the consequences are dire. It takes a lot to get us to reconsider our choices or even to become aware that we are making choices(!) and to re-evaluate the appropriateness of our adaptations.

That’s where the therapist comes in. Its their job to identify those automatic choices and to help the client evaluate them. Dissociation, to take an obvious example, is wonderfully adaptive for a child trapped in an abusive family. Why not check out, if there’s nothing you can do to remediate the situation? Obviously this is not so adaptive for an adult who needs to find the wherewithal to get out of an abusive marriage, a heinous job situation, a sadomasochistic friendship. But now the dissociation is ingrained and it takes real work and real time (!) to turn that around.

So the blood, sweat, and tears that it takes to build a relationship and the difficulties of learning new tricks are two important factors contributing to the long term investment involved in change.

These are only two of several factors that make therapy very hard work. I will leave more commentary for another post.