Post on 05-Aug-2020
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Core Affects
❖ The energy moves “outward”
❖ The experiences is relieving and drops anxiety and defenses
❖ Leads to transformation of character
❖ Desensitized client to what was feared (impulses and emotions)
❖ Increases client’s sense of power and stability
The Core Attachment Affects
❖ Anger/rage
❖ Guilt
❖ Grief/sadness
❖ Positive Feelings
❖ Sexual/closeness
❖ Excitement/interest
Three components to true affect experiencing: 1. Name the feeling: “I feel angry”
2. Physiological pathway of feeling: “I feel a heat rising inside me”
3. Impulse/action tendency: “I want to shake him”
Affect Experiencing
The somatic pathway of Core Attachment Affects
❖ Anger/rage:
❖ Guilt:
❖ Grief/sadness:
❖ Positive Feelings:
❖ Sexual/closeness:
❖ Excitement/interest:
Inhibitory Affects
❖ “Inward moving”
❖ Shuts down the client
❖ We do not want to encourage a deeper experience of these
❖ Serve a defensive function
❖ Perpetuates suffering
They Are:
• Shame/humiliation
• Disgust/contempt
• Anxiety
• Embarrassment
• Unrealistic, punitive guilt
Anxiety
Anxiety
❖ In therapy, anxiety is caused by feelings and impulses triggered by our attempts to have emotionally close relationship with the client
❖No objective threat in the therapist office
Fear vs Anxiety
What is fear?
❖Our threat detection system
❖Promotes safety and survival —Run!
❖Based on objective threats
Feelings or experience
Threaten bond
Triggers (anxiety)
Example:
• My anger makes mom avoid me • My sadness makes dad scold me
WhyFeelingsTriggerAnxiety
AnxietyAssessment:PathwaysofAnxietyDischarge
3 Pathways of Anxiety:❖ Striated Muscle
❖ Smooth Muscle
❖ Cognitive Perceptual Field
Why important?❖ Informs us that emotions are being activated and lets us
know we are in “the right place”❖ Informs us where to focus our interventions (signals)❖ Informs us of client’s capacity to experience and tolerate
their feelings❖ Guides us in our pacing of interventions❖ Gives us an idea how long treatment will take
❖ Helps us to know if client is Fragile or not
Striated Pathway
Examples:
✓ Thumbs, hand clenching
✓ Tension in the arms, shoulders, legs, neck and face
✓ Clenching of the jaw, biting, chewing
✓ Tension in the chest— sighing respirations
Striated Examples
Smooth MuscleExamples:
✓ Nausea, vomiting
✓ Cramps
✓ Heartburn
✓ Migraine headache
✓ “Jelly legs”
✓ Bladder Urgency
✓ Diarrhea
Smooth Example
Cognitive Perceptual DisruptionExamples:
✓ Dizziness, Fainting
✓ Foggy thinking
✓ Numbness, loss of feeling in body
✓ Freezing, limpness
✓ Drifting
✓ Ringing in the earsWhenanxietyisgoinghere,thenthereisnotensioninthemuscles,thepa5entlookscalmandcanbe“indifferent”althoughisconfusedetc.
CPD Example
Associated Medical Issues
❖ Striated Tension: Tension headache, panic attacks, chest pains, Fibromyalgia, chronic pain syndrome
❖ Smooth Muscle: Migraine headach, IBS, Hypertension, Urinary track issues, acid reflux, abdominal cramps
❖ CPD: Visual blurring, fainting, tunnel vision, memory loss, pseudoseizures, dizziness, blindness.
Anxiety Exercise 1: Identify the Pathway
Therapist Intervention Client Response Anxiety Pathway
Couldwelookatanexampleofwhenthiswasaproblemforyou?
(Sighs),Acoupleofdaysagoshesaidshewantedtodumpme…
Whatisyourfeelingtowardsherforsayingthatshewantedtodumpyou?
(Hearstomachgurgles)..mmmIfeelkindasicktomystomach
Whatdoyounoticefeelingherewithme?
(Patientstarespastyou)…Ilostmytrainofthought.Couldyourepeatthequestion?
Whatisyourfeelingtowardshimforhittingyou?
(Clencheshands)Ifeelreallytenseandworriedheischeatingonme
Youseemanxiousrightnow,whendidthatbegin?
(sighs)assoonasIsatdown.Myshouldersfeelreallytightrightnow
Signs Patient is Exceeding Threshold❖ Dizziness, Fogginess
❖ Slowed thinking, blanking out (w/o Striated)
❖ Fainting, nausea
❖ Abnormally slow respiration
❖ Limpness
❖ Migraines
❖ Ringing in ears
❖ Blurred vision
❖ Dissociation
❖ Hallucination
Anxiety level
Striated Muscle Anxiety
-Cognitive perceptual disruption -Smooth Muscle
Anxiety Threshold: Optimal Level
Threshold
When we reach threshold (How to Regulate)
Stop Exploring Feelings
Explore feeling in a different corner
Review until anxiety disappears
Review sequence
Attention to anxiety Symptoms
Example Anxiety Regulation “how do you feel towards your daughter for lying to you?”
Observe & attend to anxiety
Inventory anxiety in the body / name anxiety symptoms
Describe Causality Have client review for you
Explore feeling in different area
Clt:“I’mgettingaringinginmyears”
Yousayyouarehavingaringinginyourears.Doyounoticefeelinganxiousrightnow?
Linksymptomtoanxiety:
Theringinginyourearsissignofanxiety.
OR
Feelinglikethrowingupisasignofanxiety
Ect……
Soyouhaveafeelingtowardsyourdaughterforlyingtoyou.Thatfeelingmakesyouanxious,andtheanxietymakesyourearsring.
Doesthatmakesense?
Couldyourepeatbackwhatyouheardmesaytomakesurewearebothonthesamepage
Couldwelookatanotherexample?
Anxiety Regulation Role PlayEach student takes a turn
❖ I will be the client
❖ You will ask “how do you feel towards your daughter for lying to you?”
❖ Continue pressure to feeling until you see that I have reached an anxiety threshold
❖ Stop pressure and go through anxiety regulation steps
Common Mistakes
❖ Assuming the client has no anxiety if they present as limp and calm
❖ Moving ahead to feeling to quickly
❖ Pressing to breakthrough to feeling in face of unregulated anxiety
❖ Mistaking a freeze response for striated discharge
Quiz
❖ Describe the difference between fear and anxiety
❖ Name 3 pathways of anxiety discharge
❖ Which pathway is a “green light” to explore feeling?
❖ Identify three signs your patient has exceeded anxiety threshold
❖ Describe the process for regulating anxiety
Complex Transference Feelings (CTF) I
❖ Complex feelings mobilized in therapy which are linked to the past bond, trauma, pain, rage and guilt about rage.
❖ Includes deep appreciation for the therapist persisting with them for the best outcome. As well includes irritation toward the therapist (T) because of the challenge to resistance.
AngerAnxiety --muscle tension, sweat, heart race, mind blanks.
Defense: —tantrum, self-attack obsessiveness, critical,
devaluing, passive aggressive, defiant
Impulse/Feeling --Heat/energy rising, volcano, urge to grab, hit, kick, inflict
harm
Spectrum of Psychoneurotic Disorders
Patterns of Problems from Attachment Trauma
1. LowResistance2. ModerateResistance3. HighResistance
4. HighResistancewithRepression5. Mild-ModerateorSevereFragileCharacterStructure:repression,splitting,andprojectiondominant
Spectrum of Psychoneurotic Disorders
Fragile Spectrum
The Low Resistant Patient: Open access is already there
❖ LowResistantpatientscomewithanallianceinplace—-thereisnoRage,thusnoMajorResistance
❖ Onlyhavetacticaldefenses❖ Theygototheissuethendancearoundituntilyou
encouragethemtofeelthegriefaboutthelossinthepast.
❖ 5percentofofficereferrals
Davanloo, H. 1995. Abbass 2002
Low Resistant Patient
Grief
Tactical Defences
Eg. Maybe, perhapsEg. Kind of, a little
Eg. vaguenessEg Smile
No Rage= No Major Resistance
Only Tacticals
Moderate Resistant
❖ Withmoreresistance,thepatientbringsmoredefensesthatobstructtheprocess
❖ PressureisneededtomobilizeComplexTransferenceFeelings(CTF)
❖ Resistancesmountandneedtobeclarified,blockedorchallenged
❖ PresenceofMurderousRage,Guilt,Grief
Davanloo, H. 1995. Abbass 2002
Moderate Resistant Client
Murderous Rage, Guilt, Grief, Craving
Major Resistances: Isolation of affect
Eye avoidanceDetaching
RationalizingEg Smile
Highly Resistant Patient
❖ TheyhavemajorresistancesandgotoresistanceintheTransference
❖ HeavyfocusintheTransferenceisneeded❖ StandardinterventionisPressure,clarification,challenge,
Head-on-collisions❖ Smallbreakthroughsfirsttoweakentheresistance❖ LaterinprocesstypicalbreakthroughsofMRorPMRin
theTwhichtransfertheimagetothepastfigure❖ PrimitiveMurderousRage,Guilt,andGrief/pain,love
Davanloo, H. 1995. Abbass 2002
The Highly Resistant Patient: The Locked Unconscious
Murderous Rage and Guilt
Major Resistances
Slowing downHelpless
ExternalizingDefiance
Grief
Arguing Devaluing
High Resistance With Repression❖ Instead of feeling rage, it is repressed into the body
❖ In face of feelings, client goes “flat”, loses tone and energy, instant repression takes place. Often “weepy”
❖ Will often have physical symptoms: IBS, Stomach upset, migraines
❖ Anger is turned inward to protect attachment figures from the anger
❖ Common among depressed clients
Highly Resistant Patient with Repression
Primitive Rage, Guilt, Grief, Craving
Major Resistance: Repression
RepressionGoing flatHopeless
Fragile Character Structure❖ Severe trauma plus weak attachment
❖ Cognitive disruption when anxious
❖ Primitive defences: projection, splitting, dissociation, regressive defences
❖ Lack clear sense of self
❖ Self-harm common (cutting, drugs/alcohol, acting out)
❖ 25% of office referrals
❖ 45-200 sessions to treat
Davanloo, H. 1995. Abbass 2002
Dr Allan Abbass 2017
Pressure Moderate Resistance
Striated muscle anxiety
plus feel complex transference feelings
High Resistan
ce
Depression, smooth muscle anxiety or motor conversion
High Resistance
with Repression
Cognitive-perceptual disruption or
primitive defenses
Fragile Character Structure
GO FLAT: No striated muscle anxiety
Capacity Building Formats
Repeated unlocking,
working through,
termination
Striated muscle anxiety plus feel complex
transference feelings
Breakthrough of grief about loss
Low Resistan
ce
Complete treatment in 1 or 2 sessions
Inquiry
Resistance Rises
Resistance crystallizes in the transference
Clarify, Challenge,
Head on Collision
Technical Blockers of Rise in UTA and CTF
❖ Lack of pressure (reaching to the patient)
❖ Misplaced pressure (same as no pressure)
❖ Premature challenge
❖ Lack of challenge or misplaced challenge
❖ No delivery of the reality of the situation (lack of head on collision)
❖ Missing the passage of feelings
Why No Signals??
Blockers of Primary Engagement in the Process
❖ Ambivalence re interview process: 1 foot in 1 foot out
❖ Forced to be there and don’t want to cooperate: Conscious defiance
❖ Absence of unconscious Problem
Unc Anxiety going other places:
❖ Cognitive/ Perceptual Disruption
❖ Smooth Muscle anxiety
❖ Somatic
❖ Gum chewing, tensing and relaxing
❖ Hiding the tension consciously
Characterological Unconscious Defenses blocking rise in Core Feelings
❖ Defiance❖ Compliance❖ Externalization❖ Passivity❖ Hopelessness❖ Helplessness❖ Major Intellectualization❖ Syntonic defensive system: cant see problems❖ Denial❖ Devaluing
Organic or Brain Factors
❖ Actual confusion about the process
❖ Below Average Intelligence
❖ Physical Illness and exhaustion
❖ Drugs or Sedating Medications
Why no Signals
❖ Projection or Projective Identification
❖ Suicidal or Homicidal plans
❖ Repression of Feelings
• Depression
• Conversion
Why no Signals
Therapist technical issues:
❖ Not enough pressure
❖ Pressure in wrong place, to defense or feelings which are not present
❖ Premature challenge
❖ Transference activation: In the parent’s shoes