rogers famIly therapy & real self centered
It's finally all about You, Your self & Why. From your point of you.
"Trauma creates changes you don’t choose.
Healing is about creating change that you do choose."
NEW YEAR'S REVOLUTION:
Remembering your Self
- How to achieve true Self acceptance?
December 31, 2018
Accept it. You are not like everyone else. That's the good news. Wanting to belong, to be liked and to ultimately feel loved and accepted is a very real motivator for people to conform. To be what has been so ubiquitously labeled as people pleasers.
I am proud to say that I work hard to not only help as many people as I can remind themSelves of the strength of themSelves, but also a very real desire to add to the clinical dialogue and evolution of the field of Psychology by being a significant contributor to the field I've fallen in love with. By challenging what appears to be what I call "The Dogma of Diagnosis," I 've realized that for many, having a label or diagnosis is not only preferable but profitable.
However, I also know and see the irony in the notion that to conform is to actually sentence one's Self to a lifetime of loneliness. In my practice (within AND in), I specialize in working with those patients whose trauma symptoms are so acute, so pervasive and so potentially lethal that they are usually given a diagnosis of one of the most misdiagnosed and misunderstood mental health conditions in the field.
To have been diagnosed with Borderline Personality Disorder or BPD, you would have experienced unstable relationships, emotional reactivity and dysregulation, impulsivity, and other challenging interpersonal features.
BPD is one of the most heavily stigmatized mental health conditions a person can experience. This rampant stigma has both tangible and emotional consequences that can worsen existing difficulties with BPD. In the form of judgments, blame, negative assumptions and discrimination, stigma can lead a person experiencing BPD to feel ashamed and hide their suffering. Part of the inner torture is that the one relationship dynamic that will help - EMPATHY - is the one most elusive to them because of their behaviors (defenses) toward others.
The thing is, to be able to successfully help people heal and move through (NOT get over) their too often horrific childhood traumas, I have to think that it’s less about the diagnosis, and more about placing all of the complex trauma people have experienced in a context that has been studied, researched, measured and clinically defined. Then, using this information as a GUIDE to find the best support and ACTUALLY HELP them live their best life!
Researching, working with and now specializing with this “disorder," has proven to be a significant contributor to the answer of what I believe is everyone’s greatest mystery and the true, unearthed and final answer to why everyone can use strong therapy.
It is my contention that everyone who participates in the therapeutic process, will find and be able to definitively answer for themSelves WHY ARE YOU HERE, OR WHAT IS YOUR EMPATHIC PURPOSE?
I have a theory that when successfully TREATED, these once victimized children with an almost psychic intuition about others and who have experienced what I’ve surmised as The Trauma of the Forgotten Self, are the emotionally based thought leaders for the world. IF treated. However, what too often is accepted dogma in the field of Psychology (not to mention its many [too many] sycophant-like members label as Borderline Personality Disorder.
As treaters , we are their insight into remembering their own grace when their outer world of relationship inevitably falls apart and they once again forget themSelves. And while they will always have to find a way to manage this responsibility (the answer is: NOT ALONE) , this constant reminder of the extremely deep and irreversible loss, will continue to cycle of Self-doubt, deprecation and often Self injurious behaviors.
If we as mental health professions don’t accept this ... mission to help these pained children in adult bodies, we will all remain in that loss. And rather than help them and our Selves be found (seen, known, accepted and deeply loved), we will be forever lost to the victimization and may never (or at least in this lifetime) keep from trying to catch up to Basic.
As the leaders of a more progressive, a more evolved and ironically more mature existence, and I've been witness to the only members of society (along side those with whom schizophrenia has taken hold), permission to not only think outside the box, but dream with the kind of ambition known only to risk takers.
Those who have abandonment as the bases for "justified Self destruction, and whose core sense of identity is interwoven with the burden of emotional sensitivity so acute, they are often described by clinicians as being burn victims. Their outer protective layer of skin removed and so being hugged is so rare, that for them to be touched, is torture. Empathy from others (especially those closest) is experienced as condescension, and therefore relationships are merely a vehicle to prove how unlovable they feel.
As a therapist it has been confirmed that this level of pain is so subtle and authentic, unconscious to many until it is so very obvious to everyone is pervasive that at this time it seems that the only treaters who are also members of this particularly painful club could pick up on it. Very often misdiagnosed as Bi-Polar and unconscious to someone not familiar with its symptoms, Borderline Personality Disorder and more importantly, the stigma around it may be killing our evolutionary objective.
It would be nice to imagine that there were some scientific way to determine diagnosis. A biological or chemical tests to establish diagnoses, we fall back on consensus reality and an understanding of people and relationships between them., of relations between emotions and on local custom and ways of perking experiences. One outgrowth of this approach - an attempt to develop, by consensus, descriptions of all disorders thought to be reflective of one illness of one kind or another. categories have been expanded and elaborate in the years since McWilliams' first edition was published; yet all but the rarest categories still depends on the subjectiveness of the examiner. Local custom, training of the examiner, examiner biases, and of course insurance coverage.
In the end, it IS time to learn how to be attracted to what's healthy, because if you are someone who has been told how much potential you have or warned not to waste your talents, then you may have also never been told HOW not to do those things. Strong therapy can help you learn the how by being curious (not critical) of the WHY and when that's personally satisfied you'll feel WHEN and that's how.
More than just a phase
December 31, 2018
The following is an excerpt from the book Psychoanalytic Doagnosis by Nancy McWilliams. In my work with those who have had much loss in childhood, from a clinical perspective becoming Depressed is a forgone conclusion.
Loss is experienced differently by different people, however, to the extent that a deep Depression follows not only so much loss, but the suppression of those feelings, appears to be something that acrosss the board all children of loss experience.
I believe this writer explains it well.
Not just early loss but conditions that make it difficult for the child to understand realistically what happened, and to grieve normally (I prefer the term naturally), may engender depressive tendencies. One such condition is developmental.
Two-year-olds are simply too young to fathom fully that people die, and why they die, and are incapable of appreciating complex interpersonal motives such as “Daddy loves you, but he is moving out because he and Mommy don’t get along.” The world of the 2-year-old is still magical and categorical. At the height of conceiving things in gross categories of good and bad, the toddler whose parent disappears may generate assumptions about badness that are impossible to counteract, even with reasonable educative (or empathic) comments. A major loss in the separation–individuation phase virtually guarantees some depressive dynamics within the person experiencing this very natural part of development.
The solution of the child becomes the problem of the adult. Therapy can help that part of you emotionally grow up in the way that you and all children would have liked and deserved too. With love. Also known as: encouragement, boundaries, consistency, mindfulness, consideration, more boundaries, with adult hands off, and empathy in. Not perfect. But enough.
In the Beginning
In the work I do (sometimes met with critiqued curiosity or even direct criticism from colleagues), I find my Self moved beyond description because to REALLY experience the transformation of someone actualizing and viscerally letting go of their False Self, one would have to be in the room to really understand how it can sometimes take years to get there. and achieve healing.
Why so long? Because while specific symptoms of life not going well can bring people into therapy, and a clinician’s diagnosis based on a medical model (and insurance standards) can help keep people in treatment; there is (I believe) a deeper and more meaningful reasoning for people who are willing to participate in therapy. Deeper than maintaining a regimen of sobriety or managing Depression or even monitoring a personality “disorder.”
DEEPER and more meaningful, not instead of. and that is to accept the “challenge” of what Socrates (in the voice of Plato I say..but that’s for another discussion..😉) professed: “an unexamined life is not worth living.”
People may come in for infidelity or behavior problems at school. They may stay (or terminate and return years later) to receive support around the losses they have or a saddened childhood they’ve been suppressing and from which Depressiin and Anxiety have surfaced.
But it is answering the most important question in anyone’s lifetime that any and all of us continue to live a life worth examining: WHO ARE YOU, WHY ARE YOU HERE & WHAT WILL YOU SHARE WITH OTHERS AS YOUR MISSION IN CONSCIOUS EXISTENCE?
It is from this incredibly deep personal space and place of respect I have for my patients and the emotional courage they’ve agreed to trust me with, that at age 50 has me more motivated to contribute as best I can to the field, and of course most importantly to their personal lives.
This quote sums it up for me. Thanks for reading. 🙏🏾
“I have often thought that the best way to define a man’s character would be to seek out the particular mental or moral attitude in which, when it came upon him, he felt himself most deeply and intensely active and alive. At such moments there is a voice inside which speaks and says: “This is the real me!”
William James in a letter to his wife, 1878
The trauma of “I.T.” = I-dentity T-heft
In childhood we can experience identity theft . Caretakers (even with the best intentions are really In-Tension because of how THEY were raised) but who make everything about themselves only, take our sense of Self. Instead of accepting whom we are becoming and then reflecting back to us who and how they experience us (being mindful and considering we are in a process of learning), they cease on the potential for us to have a strong Self, and their selfishness establishes the groundwork for our own Self-doubt.
TOXIC CARE TAKING
This is because when children show them who they are, toxic care taking or toxic parenting takes them (their Self), keeps their Self to themselves without ever giving them back with encouragement or positive reinforcement. Negative reinforcement works temporarily. It gets the task that THEY want completed, but it is also the geniuses of pattern of temporary achievement and of a false belief or narrative that says, "be hard on me (teaching me to be even harder on my Self later) and because being hard on me hurts, I will excel so I can finally exhale!" or "I'll show you!." and yes, it works. Temporarily. It's the long term success we're wanting isn't it?
Encouragement as a way of positively reinforcement establishes independence, self reliance, the courage to keep trying when we are disappointed or challenged and it is the main ingredient in obtaining Self Confidence, perpetuating Self-Esteem and establishing the most important part of success in all relationships (and therefore life): Self Worth.
Instead, this taking without giving back fosters toxic dependence, establishes Self-doubt, and kick starts the child’s search to find themselves in others. And very specific others. As the child grows, they are only going to be attracted to others who only steal the child’s sense of Self because that’s what they know.
It becomes the norm to people please, accommodate, and stay in the loop of codependency because of their first experience of intimate relationship:
Identity Theft or I.T.
THE ORIGIN OF THE ABANDONED SELF
So when people say “Just get over it,” what they’re saying is to get over having your Self taken from you, and the establishing and cementing of years when you did not know that your sense of Self has been taken from you? This is the beginning of abandonment. How does one just “get over” the abandonment of the sense of themSelves?
Caretakers take your sense of you. You feel loss of being lost, alone, no one sees you. So you belief you aren’t in there somewhere. But you’re not lost, and there’s no part of you that’s missing or empty. It’s buried. Buried underneath other people's agendas, telling you who they want you to be, and your acceptance of this as accurate.
THE MAGICIAN'S TRICK
Self-Centered Care Taking is a magician’s trick. It’s raising you to BELIEVE that the real you doesn’t exist. That you’re not worthy of being mindful of. That you’re a crazy person or too sensitive when all you’re doing is trying to be YOU.
Self-Centered care taking keeps you in the dark about your Real Self. It’s mixed messages or sarcasm in childhood. It’s gaslighting and denying that you have an intuition. But it’s not your denial at first, it’s them denying you.
Without a healthier environment, relationship or experience of encouragement, you then accept their denial as yours and start to deny your Self on your own. You pick up where they left off. Since then you’ve been trying to get your needs met from THIS point of view, crisis, insecurities and defenses (and your behaviors in response to them) have informed you of who you believe you are. This is trauma.
TOO MUCH TOO SOON OR TOO LITTLE FOR TOO LONG
Too Much (situations where emotional maturity is demanded).
Too Soon (before you are ready to fully emotionally accept what’s happened).
Too Little (natural need(s) not being met).
Too Long (the timeframe of feeling as though everything will be alright) This is different for everyone, but all children need to know sooner than later that everything is going to be ok... so that they really KNOW. FEEL and BEHAVE like they are.
So the next time someone or even you say to yourSelf, "I should’ve or I should or they should JUST get over it," remember what the “It” really is!
The Lost childhood of the therapist
“There is a traumatic condition that has developed early in the lives of almost every psychotherapist I have known, or at least in the lives of those who become committed to working with very serious disorders. I will call this the situation of the lost childhood. There are two basic pathways along which it seems to occur.
The first and most frequent story is one in which a child is enlisted at a young age to support and sustain a depressed or otherwise emotionally troubled parent. I am speaking here of something extreme, wherein a reversal of roles takes place and the parent comes to depend on the child rather than the other way about. The identity of the son or daughter then crystallizes around making nurturing provisions, the activity of caregiving being the only way open to maintaining bonds of secure connection in the family. There has generally been an emotional void in the parent’s own background, and the child is then given the task of filling it.
A compromise of the child’s autonomy and authenticity occurs as the little “psychotherapist” materializes, a slave to the needs of the mother and/or father. Impulses to disengage and pursue a separate life in this context are felt by the parent as unbearable injuries, always producing reactions of great distress and sometimes of rage. When the child tries in some way to be a person in his or her own right, the parental response may be: “Why are you killing me?” This is a pathway closely resembling the one described by Alice Miller in her very fine book, The Drama of the Gifted Child (1982).
The “gift” to which she was referring here is the natural sensitivity and empathy of certain children that lead a wounded parent to draw them into this role. Miller’s original title for her book was Prisoners of Childhood, a very apt description of the imprisoning effect of such an upbringing, which includes the dissociation of important sectors of the child’s personality as the child is not allowed to become the person he or she might otherwise have been.
The most natural thing in the world for such an individual, later grown up, is to seek out a career in counseling and psychotherapy. Their training for the work has been occurring from an early age. Thus is generated what I call a Type 1 Clinician, one seen especially frequently in the field of psychoanalysis.
The second situation leading to this career is based not on serving the needs of a troubled parent, but rather on an experience of traumatic loss. Here too there is an imprisonment that takes place, and a resultant lost childhood that compromises the full development of the individual’s own unique personality.
The story runs as follows. A fundamentally loving relationship with one or both parents is in place in early life, a bond within which the emerging identity of the developing child is supported and the stability of family life is felt to be secure. An irrevocable change then occurs, something making it seem that formerly secure ties are lost, leaving the child bereft.
A parent may grow ill and die, vanish for reasons unknown, be perceived as having disappointed or betrayed the child unforgivably, or undergo an emotional breakdown from which there is no recovery. The early world, now missing, becomes idealized in memory, contrasting sharply and painfully with the desolation that has taken its place. The longing for the parent who has inexplicably changed or disappeared intensifies and becomes unbearable.
The loss of the mother or father at this point is restituted by an identification process, one in which the child becomes the one who has gone missing. A transformation of personal identity has thus taken place, in which the loving, rescuing qualities of the longed-for parental figure now reappear as aspects of the child’s own selfhood.
By the magical act of turning oneself into the absent beloved one, the trauma of loss is undone and the shattered, chaotic world is set right. In this way a loving parental attitude is installed within the child’s personality, and his or her subsequent relationships in every sphere of life come to be dominated by a theme of caregiving. Any breakdown of the identification with the idealized figure leads to a resurgence of the chaos and pain of the original loss.
This too can eventuate in a most terrible captivity, for the trajectory of the child’s own development here has been interrupted and frozen by the need to stand in for the parent who has been lost. Who that child might have been or wanted to become as a distinctive person is thereby sidelined as the identification solidifies. One can appreciate how easy it would be for such a person to fall into a career as a psychotherapist. This is the situation of a Type 2 Clinician.
There would also be mixed cases, in which the early developmental history of the psychotherapist included both kinds of experiences, traumatic emotional exploitation by a disturbed parent and traumatic loss. I am myself an example of the second type, with the central loss being that of my mother when I was a boy. The great theorist D. W. Winnicott, if I have understood him correctly, was a clinician of the first type, affected most importantly by a mother who suffered from severe depressions.
Obviously there may be other pathways to choosing a life of service to the emotionally disturbed, but almost all of the clinicians I have known fall into one or both of my categories. My friend and colleague, Robert Stolorow, on hearing about these ideas, suggested that he is himself “a mild case of Type 1.” At first, I agreed with this notion, although I wasn’t so sure about the supposed mildness. On further reflection I came to think he is a mixed case, with an early pattern of caregiving to wounded parents intertwined with issues of emotional desertion and loss that were magnified by devastating tragedy in his adult years (see Atwood & Stolorow, 2014, chapter 7).
It runs through my mind that the great German philosopher Friedrich Nietzsche exemplifies the life theme I have called Type 2. He lost his beloved father at the age of 4, and reacted to the death by becoming his father once more; in the process however the child he had been disappeared as an active presence in his life. That is the downfall of this solution to loss: identifying with and thereby substituting for the missing parent leads to the disincarnation of the original child, whose independent hopes and dreams never have a chance to crystallize or be pursued.
Nietzsche, catapulted at a young age into a precocious paternal maturity, became a psychotherapist for civilization itself, a kind of father figure (Zarathustra) for all humanity in its journey into an uncertain future. His prodigious creativity spiraled forth from the tensions generated by his personal tragedy, and so did his eventual madness.
The division between the two pathways I have described is not absolute and may be pictured too sharply. Those who are drawn into the role of soothing and healing a wounded parent are not strangers to the experience of disruptive separation and loss; correspondingly, those bereft children who identify with a lost mother or father are often doing so, in part, to heal a family that has been shattered by tragedy. Perhaps one could think of my Type 1 and Type 2 clinicians as opposite sides of the same coin, differing in individual lives only in their relative salience.
Anyone embarking on a career aiming to help people come to terms with their traumatic life situations and histories needs to do everything possible to address his or her own. In the early history of psychoanalysis, a requirement was established that analysts in training complete their own personal analyses before they could be officially certified. This seemed like a good idea at the time, decreed by Freud and Jung. These fathers of our field, however, exempted themselves from this requirement, which I think should upset analysts tremendously.
Here is the problem. The analyst’s unprocessed trauma, like the parent’s, is inevitably passed on to the next generation. Freud and Jung, by refraining from applying their injunction to themselves, guaranteed that specific areas of their unconsciousness – those pertaining to their unhealed wounds - would be visited upon their descendants. This is why our field’s continuing interest in the lives of its progenitors is so important. Identifying zones of incompleteness in their self-analyses holds out the possibility of our emancipation from all they were unable to understand.
Clinicians must be aware of what has happened in their lives and grieve the losses they have incurred. Nothing else will do. The healing of the traumas of which I am speaking is a lifetime project, and so the important thing is that the journey commences. Mourning needs to occur, both for the parent who was lost or was never there in the first place, and as well for the unobstructed childhood that never had a chance to unfold.
The psychotherapist’s healing will be a theme in all of his or her work, most often in the background, but included nevertheless in any constructive developments that take place. Psychotherapy is not a procedure performed upon one person by another; it is a dialogue between personal universes, and it transforms both. Our field has not caught up to this idea, but the time is coming in which it will be regarded as axiomatic.” – George Atwood.
False Self. The Saboteur
July 4, 2019
Abandonment Depression - when a child is separated from mother (can be physical -mom leaves, emotional- mom is unavailable due to mental illness or drugs & alcohol, or perception - messages of unworthiness sent to child via neglect),
Guilt is fed by the guilt we internalize in early childhood from the disapproval expressed by the mother for self-actualization or individuation. It is then reinforced later in childhood and in adolescence.
Even after striking out on our own, a strong, reprimanding voice, fixed in the psyche, reminiscent of parents, teachers, and authority figures from the past can echo down the corridors of time in our daily lives when we entertain those special thoughts and wishes we know would, in the past elicit disapproval.
The real self’s genuine urges, however - staring a new career, beginning a relationship with someone , moving out of town, spending an evening away from the family, spending a little extra money on a new hobby or pastime - should not produce guilt feelings. When the false self is solidly in control, those harmless, natural desires for self expression can trigger the voice of warning, the rebukes, the disapproval we have kept locked in our psyches over the years.
In people who have a strong sense of their real selves, such undertakings do not provoke guilt; or if they do, the real self calmly recognizes it as an echo of mother’s or father’s disapproving voice and perhaps even laughs at it for coming up inappropriately. Operating from their real selves, such people put aside the incipient guilty feelings and proceed as they wish.
For people with an impaired real self, however, the guilt produced by this warning can be as paralyzing as it was when they were five years old. They feel guilty about that part of themselves that wants to individuate. Not being able to face up to the internalized guilt-trip, these individuals will suppress making any moves in the forbidden direction and resort to the old familiar clinging behavior that they remember made them safe and good years ago.
In some cases, especially among adolescents and young adults, clinging behavior may be directed to the actual mother, which reinforces all their vividly a person’s that he is not strong enough to carve out a healthy, independent lifestyle. In other cases, the clinging may no longer be to the real mother, but to another person who represents security and approval. In effect, we expect someone to take care of us like a parent whether that person wants to or not. In either case, the false self argues convincingly the clinging is the only reliable strategy to avoid feelings guilty.
Helplessness springs from the patient’s inability to active his impaired real self to deal with the painful feelings. Everyone is helpless at one time or another. We need other people for services, knowledge, and companionship. As members of society we come to rely on others in those areas where we have little or no skill or expertise. Ordinarily such experience reminds us that we are not in Toal control o four lives or totally independent.
As healthy individuals we accept these limitations and balance feelings of helplessness with confidence that in some areas we can and do support ourselves and satisfy our own needs. Healthy individuals evaluate the situation, recognize the extent of their own competence, and get the help they need knowing that at other times they will be capable of handling things on their own.
Helplessness as part of the abandonment depression, however is abiding and total. Although specific incidents can trigger it, it is not caused by specific incidents, but persists like a gloomy backdrop to life, casing a pall one the most activities and life situations. Unlike a healthy person who says, “Well this is one those situations at which I’m not very good,’ the false self says, “You are totally helpless and good for nothing.”
Mastery depend upon self-assertion, but asserting oneself brings on the fear of abandonment.
It becomes an inescapable cycle that can twist one’e thinking patterns for the rest of one’s life, even in therapy, where it becomes translated:”Getting well mens taking charge of my life, but I can’t take charge of my life until I can get over feelings so helpless, and I must be helpless why am I sill in therapy?” And of course feeling so helpless works - it is an essential feature of the abandonment depression which drives the person into a clinging relationship wither with a mate, a friend, a family member, or a therapist.
Many people assume the passive, helpless role in relationships, oozing for someone to take care of them rather than someone who will love an respect them as equals. The false self will keep a person playing the “little girl” or Little boy” who sill needs to be told what to do and, in addition, needs a wiser, firmer hand to heal him do it. At work the false self can prevent us from assuming more responsibility, applying for promotion, making decisions, stand-in up for what we think is right teen though others around us disagree. Many people dominated by a false self stay in unrewarding jobs that neither challenge their talents and skills nor pay what those skills could command in a different job situation. To ward off feelings o abandonment, the prisoner of the false self will stay underpaid and underworked and then wonder why his or her job provides so little satisfaction.
The problem is much more serious than just the universal penchant for griping about work. It is part of the human condition to complain about jobs and the need to work for a living. A healthy real self recognizes frustrations and problems at work and either resolves them or accept s them as necessary deficiencies in an otherwise rewarding situation. For the false self, however, the lack of satisfaction has little to do with specific problems intrinsic to the line of work and more with the internal fear at activating the real self.
Some people’s false self will actually lure them into drugs, alcohol or abusive behavior. Others sink into passivity or dead-end activities, such as excessive daydreaming, mindless shopping, overeating, or unfulfilling sexual liaisons. Some will cling to people, familiar places or objects such as furniture, clouting, art, or daily schedules and routines that do little to further the meaningful activities they are ostensibly engaged in. Their primary purpose is to avoid the fear associated with independence and self-expression-fear of the abandonment depression.
Trigguh please !
(Repost from 2018)
Within our society’s lexicon, A Trigger is defined as an emotional/psychological reaction caused by something that somehow relates to an upsetting time or happening in someone’s life. This reaction is often found to happen in war veterans, people suffering with PTSD, depression, and other mental disorders.
As of late, social media has jumped on and added its own definition of what it’s like to be triggered (heads up! Trigger Warning!). Well, I say it’s time to let go of old ways of reacting to new stimuli. Release that childhood, past traumatic and very real experience of pain and move on!
Notice I did not say ‘Get over it.’ That phrase (along with ‘I’m fine’ or ‘whatever,’) and oh so many other antiquated words of expressing relief needs to go! For those who are courageous enough to look at themselves empathically, ‘getting over’ past pain, loss or trauma actually means MOVING THROUGH and then Moving on.
Triggers can be reminders, as pain is, that something isn’t finished, hasn’t been worked through… unprocessed. That the current painful emotional situations we find ourselves in are influenced and are informed by our past experiences and those feelings.
Those unprocessed feelings (think of it as a range from 0–30) stick around and when something present occurs (a 30–60 range), we (and those in front of us) experience the emotional reaction as a full 0–60!
To be triggered (from a clinical point of view), means to react as if what’s happened in the past is happening currently. Work with a strong therapist takes you back to the original emotionally painful place(s) (say you were forgotten to be picked up from school: feelings 0–30) and authentically validates how that might have been for you.
That way when your current partner returns from the grocery store and doesn’t remember to bring home the kind of cereal you like (30–60, a valid disappointment) your reaction isn’t: “What the hell?! Do you even know me, you never consider me??!!” (0–60).
Minimizing how we’re triggered to the point of managing our emotional life isn’t easy. The world will through us curve balls in the form of disappointments, loss, feelings of confusion; and those curve balls can have us emotionally reaching back to a time of serious pain. But doing the inner work required can address those valid but historical feelings and keep your current reactions from being all mighty and hysterical. To borrow from Alcoholics Anonymous: If it’s hysterical, its historical.
From TFP Treatment of BPD
By Barry Stern, PhD & Frank Yeomans, MD, PhD
YES, IT'S LONG and the print may be too small. However, if you really want to know what I do in the room. If you want actual answers to what it is that some find so very much criticism for and if you'd like to know how it all really works... here it is:
"The fundamental goal of the treatment is to help the patient learn to reflect on emotional states that were previously not understood and were acted upon without reflection.
-To be more curious than critical about their emotional reactions, leading to less judgments about their behavioral responses.- (TR)
Transference is the redirection of feelings and desires and especially of those unconsciously retained from childhood toward a new object (such as a psychoanalyst conducting therapy)
Central to TFP is a negotiated treatment contract between patient and therapist, being the treatment frame. Change is achieved through analyzing and interpreting the transference relationship, focusing on the here-and-now context. Prominent techniques are exploration, confrontation, and interpretation.
Recovery in TFP is reached when good and bad representations of self (and of others) are integrated and when fixed primitive internalized object relations
My approach to personality disorder treatment and research is based on the understanding of personality disorders in general and BPD in specific is that Transference-Focused Psychotherapy is grounded in contemporary psychoanalytic theory. Since i believe that psychoanalytic thinking has much to offer in terms of understanding and treating personality disorders.
However, my approach includes specific modifications of technique to address the therapeutic needs of patients with borderline and other personality disorders. My patients do not lie on the couch, do not come to see me four or five times per week, and as the therapist, am far from silent and removed from the process.
Two beliefs that inform my work, that I share with most psychoanalysts, and that distinguishes my work from that of say, cognitive-behavioral therapy (for example, Dialectical Behavior Therapy [DBT], another treatment for BPD) is that:
1. "Symptoms," the observable, behavioral manifestations of any disorder, are explained significantly by internal, mental or emotional factors, not generally visible to the naked eye, and that attention to these internal emotional factors or states is an essential part of the treatment process; and
2. Over the course of a psychotherapy, some of the emotional factors that influence the problematic behaviors or symptoms and that had previously been unclear to the patient and therapist become clear to both through their mutual, careful attention to the goings on in the treatment relationship, which includes the transference of images within the patient's mind, which they may not be fully aware of, to the person of the therapist (and others in their life). So with this overview, let us now proceed to build on our understanding of personality disorders to explain how I conceptualize treatment.
Within the International Society for Transference-Focused Psychotherapy, one of the more challenging aspects of my work, as a therapist specializing in the treatment of personality disorders, is the process of sharing with patients my impression of their diagnosis, and outlining for them the type of treatment we are proposing.
Albeit difficult, this process is an essential, and legally required aspect of the process of starting treatment, called "informed consent." Generally, we start with an explanation of the term: Personality disorder, as a term, may sound negative and judgmental and it is important to have a clear understanding with my patients of the meaning of the term.
I explain that there is a group of disorders that are thought to be long-term and enduring, in contrast to episodic, personality styles that at their core are defined by difficulties in the person's subjective, internal sense of identity, and chronic difficulties in his or her interpersonal relationships.
I explain that, while the world is enriched by the variety of personality styles that exist, when a person personifies and lives out a particular personality style in an extreme and inflexible way that causes a certain level of distress in one's emotional and interpersonal life, they meet criteria for a personality disorder.
I find it helpful to give an overview of BPD as a disorder comprising difficulties in four areas:
1) emotions tend to be intense and rapidly shifting;
2) relationships tend to be conflicted and stormy;
3) there may be impulsive, self-destructive or self-defeating behaviors; and
4) there is a lack of a clear and coherent sense of identity (this last problem may underlie all the preceding ones).
I also, in reviewing the particular symptoms of BPD that I have noted in the diagnostic phase I have just completed with the patient, note that there are different sub-types of BPD patients, each with different sets of primary or most-problematic features.
Some may be more impulsive and overtly inappropriately angry, whereas others may be more "under the radar," characterized more prominently by the sense of emptiness, fears of abandonment, suicidal feelings, and more subtle shifts in their experience of others, from idealizing others to more quietly feeling devaluing or contemptuous of them.
So with each patient I explain my understanding of his/her/they BPD symptoms and we inquire as to whether this understanding makes sense to the patient.
With this understanding of personality disorders and BPD my treatment model, Transference-focused Psychotherapy (TFP), logically follows. This twice-per-week individual psychotherapy combines many of the elements described in the Guidelines for the Treatment of Borderline Personality issued by the American Psychiatric Association with a deep understanding of mental processes.
TFP has demonstrated efficacy across two randomized clinical trials to date in the treatment of the symptoms of BPD. In contrast to other models of treatment, models that tend to focus on reducing symptoms through behavioral control, skill-based teaching, and overt therapist support, coaching, and guidance, TFP has a very different mechanism of action.
Although TFP, like other models, places special emphasis on patient assessment / evaluation, and on setting up a treatment contract (a mutually agreed upon set of conditions that serve as a framework for the work of the treatment), the emphasis in TFP is on helping patients understand the shifts in their experience of themselves, and in their experience of others, as this split sense of identity plays out through their experiences in work and relationships, and, importantly, as it plays out in the treatment relationship itself.
The work of TFP is roughly divided into an initial phase of establishing a structure for the treatment that includes limit-setting with respect to the patient's destructive behaviors and a longer phase of exploration of the patient's mind and sense of identity.
In reality, the two phases overlap since there is observation and exploration from the beginning, and limit-setting may continue far into the treatment.
After confirming the patient's diagnosis, the therapist and patient work to identify factors in the patient's life that might interfere with the consistency and conduct of the treatment. Factors such as drug abuse or addition, chronic misuse of medication, a severe eating disorder, and self-injury and suicidality - each of these factors constitute not only a threat to the patient's safety and well-being, but also to the treatment, and therefore, must be contained in order for the therapist and patient to do the work of TFP. Whereas some therapies work to provide concrete support in the moment that the patient is about to engage in one of these behaviors, TFP works differently.
In TFP, it is presumed that the patient can largely take responsibility for these behaviors, at times with the help of adjunctive treatment such as Alcoholics Anonymous or an eating disorders support group, and in other cases simply through an agreement about how suicidality and self-injury are to be managed, with the understanding that the patient is in conflict about these urges and can try to stay with and strengthen the side that wants to refrain from the behavior.
As behavioral symptoms of personality disorder are contained through the discussion of and limit setting associated with the treatment contract, the psychological structure that is believed to be the core of the disorder is observed and understood as it unfolds in the transference, i.e., the relation with the therapist as perceived by the patient.
The focus of treatment is on the patient's difficulties tolerating and integrating disparate images of the self and of others and on the misunderstandings that arise when the patient mistakenly sees aspects of his/her own feelings that are difficult to acknowledge as coming from the other person.
While I call my treatment Transference-Focused Psychotherapy because of the centrality of the exploration of the patient's experience of self and others through observation of the patient's experience of the therapy and the therapist, the treatment also focuses on the patient's difficulties in work and relationships outside the treatment.
These areas are important in the exploration of the experience of self, others, and relation to the world. These areas are also where, along with improvement in the patient's sense of self, we will see the benefits of treatment.
Nevertheless, the therapist's attention is ultimately directed to transference because I believe that observation of the patient's moment-to-moment experience of the therapist provides the most direct access to understanding the make-up of the patient's internal world. As the un-integrated representations of self and other get played out in the patient's life and in the treatment relationship itself - often accompanied by the intense experience of emotion
the therapist helps the patient contain the emotions and observe the representations and understand the reasons, the wishes, fears and anxieties that support the continued separation of these fragmented senses of self and other.
The therapist also helps the patient to observe shifts in the dominant self experience, using therapeutic techniques that include:
1) clarification of internal states,
2) confrontation of contradictions that are observed, and
3) interpretation that help explain the divisions and links between different states.
For example, when a meek and unassuming patient suddenly shifts into an overtly dissatisfied or hostile stance, the therapist might start by inquiring: "Have you noticed a shift in your feelings?" The therapist might continue: "Let's see if we can understand what you were experiencing in me as your feeling in the room shifted, and how the way you were experiencing yourself also shifted at that moment."
Through this type of "detective" work (sometimes using an image of the TV detective who calmly and quietly explored the evidence), we can begin to flesh out the patient's inner world of representations of self and other, to track the shift, usually a volatile and chaotic shift, between the patient's various self states, and ultimately help them to reach a more reflective stance about his or her emotional life –
The fundamental goal of the treatment is to help the patient learn to reflect on emotional states that were previously not understood and were acted upon without reflection.
-To be more curious than critical about their emotional reactions, leading to less judgments about their behavioral responses.- (TR)
The combination of understanding within the context of emotional experience can lead to the integration of the split-off representations and the creation of an integrated sense of the patient's identity and experience of others.
This integrated psychological state translates into a decrease in emotional turbulence, impulsivity and interpersonal chaos, and the ability to proceed with effective choices in work and relationships.
In other words, there is a positive cycle in which understanding of one's representational and emotional world leads to an increased ability to modulate emotions and, in turn, the enhanced modulation of emotions helps the patient further increase his or her capacity to reflect and understand.
Ultimately, my experience is that the integration of the initially fragmented psychological structure can result in the resolution of the personality disorder and help establish stable and deep relationships and commitments to work and other life activities."
Partnering with your self or going with the comfort of abuse
I am here as a support to you and how you feel about your life, including your relationships the you choose to be or not to be in. What you are experiencing is very common when you are involved in a relationship with someone who has had the severe kind of trauma it seems your partner has has to be with.
That is not an excuse for her behaviors or the contradictions you also seem to have experienced. Your therapy is about helping you to uncover why your behavior (which you are not happy with) happened and continued to happen. Especially since you know and have known how hurtful it was and has been to your wife.
One of the reasons it seems so crazy making for you is because her trauma (and yours) and the results of that trauma were not known to you until there was a crisis in your lives. That again, is pretty common. What is not common, is that you are so willing to look at yourself and do it with a kindness and empathy to work hard at why.
Yes, for your wife, but I think mostly for you. Which is a great thing! Because when in your life have you been provided a chance to take the time, look at your life and see how many times the pattern of accommodating other people over yourself?
THIS is the root of your therapy, and this is going to provide you with answers to what you’ve done, but it will also give you a chance to continue your life awake! Awake to YOUR PART in all of the confusion and sadness and disappointment you’ve experienced.
Of course there has been joy and relief and pride and all of the good feelings about yourself in your life, but from what you’ve said, those feelings have not lasted as long as you’ve wanted and in my professional opinion - that you have deserved.
Looking at yourself in therapy can also provide you with the Self-Worth that your parents helped you have, but (as all human parents did) they also did not do right by you in the way you really needed and deserved.
The messages that you received from them were not as clear as you needed. Not because you couldn’t or wouldn’t understand, but because you were a child. You (as we all do) needed guidance (the right amount) to be able to make small and big decisions. Instead, you had to figure so much out on your own. Great for a leader and successful career man, not so great for the child who needed to do his own homework so he could experience his worthiness without HAVING to DO something for OTHERS first.
Your upbringing (as with all of us) also did not provide you with ENOUGH experience to know (thoughts), feel (emotions) and do (behavior) what is needed in an intimate relationship. Especially with a women. But here is the thing also: YOU ARE DOING (and have done) EVERYTHING YOU CAN to take responsibility for your behavior (affairs), let yourself feel the guilt and shame (emotions), and RE-consider or rethink (thoughts) what you grew up thinking about yourself. YOU ARE DOING THE WORK.
However, (and believe me, I get why, I really do get it) your mind (thoughts) is taking over when it comes to making a decision that has to do with emotions (feelings). You and I have really only started to look at your acting out (behaviors) but your mind is trying to “protect” you from your emotions like it did for you as a kid. It worked then. Less emotional as a kid playing sports, makes him a star athlete.
That allows him to leave his small town that had him feeling small, when the reality is you weren’t and aren’t a small fish in the ocean like others had you believe, and that you continued to believe even as you succeeded. You were a big fish in a small pond and it could have killed you.
Small towns can (not always) but can keep people’s minds small. So small (not in intelligence), but in limiting themselves. They keep themselves to themselves and secrets about them grow, within.
Sometimes those secrets are being kept inside so long, that it can turn into a physical illness. One that can kill. THAT IS NOT YOU. You got out. But your mind, is extremely strong and still thinks it has to protect you from feelings. Protect you from processing all of the big and little losses you’ve had growing up.
You have been able to realize that one of the biggest, if not THE biggest lost, was your Self. Your sense of your Self. Well, you really didn’t lose your Self (as many people who have been abandoned think and therefore feel they do), but you were made to believe you lost such a big part of your Self.
You were convinced that by not feeling safe enough in relationships to initiate or express. All of the vulnerable feelings that you undoubtedly went through, alone. Feelings like shame, disappointment and yes, sadness.
You had very little, if any, control (empowered) over how emotionally safe your relationships needed to be let alone had a choice whether they were or not. Not as a child. Not as kid or young person, a teen or young man. The one factor that seems to be the biggest determinant of child vs adult is choice. Life happens TO kids, they have no choices, except their own feelings and thoughts.
But they don’t know that until they are adults, and after relationships (which demand each of us to be our true selves and express how we feel). Relationships that instead of showing us how we deserved better as kids, only REPEAT patterns of Self-doubt and making decisions (especially big ones) when we are filled with years of Self doubt make it almost impossible to decided what’s right.
Those adults who as children had care takers who did not know or have the experience of establishing and encouraging themselves, from THEIR care takers' lack of a Self-Worthy Core, patterns of toxic communication and expression continue and the family crest becomes Dysfunction, Degrading, Debilitating and Destructive.
Most everyone who wants or has children (especially by choice) tell themselves and anyone who will listen, they will NOT become their parent. They will NOT raise their kids like they were raised. And for the most part that is true. People ARE trying to do and be better.
But if you are an Olympic swimmer and you've the talent and resources to be able to stand alone side other highly talented, extremely disciplined athletes from around the world. When you get to the starting block, equal in all but "UMPH" - when suddenly you look closer and realize you are the only one no wearing a swim suit. Nobody bothered to tell you. Nobody knew to tell you, because they've never been to the olympics and they just assumed as long as you got encouraged and worked hard you could be there too. And you are!
But unlike everyone else standing and waiting for their "shot" you don't have one of the main requirements to ACTUALLY actualize your dream. You don't have enough, so you believe YOU aren't enough. What I'm trying to saythat the biggest indicator of a child's well being, is a parents' Self understanding. grow up with more Self-Doubt than Self-Confidence, with less and less Self-Esteem so by the time we start dating, we date at the level of our own Self-Esteem. about your Self Worth, you don’t KNOW and therefore it doesn’t FEEL like the only 'right' decision is the one YOU make. And that is based on how you feel, think and then see yourself doing.
Yes, you’ve been self confident and had a lot of self esteem. Your accomplishments over your life (especially coming from a childhood of … inaccurate believes about yourself), are truly amazing. Seriously, it’s not a logical thing and from a professional therapist’s point of view, your history does not lay the ground work for the kinds of success you’ve had professionally. You are have done incredible things by rebuilding yourself and never giving up!
But this kind of decision isn’t like boot camp or even graduating school and the academy. You can’t but your head down and plow through. This kind of decision (as we found out), is not even about staying married or not. This decision is about THRIVING IN YOUR LIFE BY STAYING YOURSELF. Forgive me if this hurts you, but isn’t it what your dad has been unable to do. BE HIMSELF AND NOT ONLY SURVIVE, BUT THRIVE IN LIFE. A life HE get to choose.
I know this is an unorthodox and very different kind of email from your therapist. Not to mention LOOOONG, but I really feel and absolutely believe that you deserve to hear from someone who has seen, worked with, known and really enjoyed (still do) working with you AND having worked with your wife.
Your work in therapy (two different kinds remember) would have any therapist feeling proud of you and your courage. But I want you to know that it’s not your accomplishments and hard work in therapy that have me writing this out to you and feeling proud. It’s because I’ve gotten to know you Andrew.
You have allowed me into your personal struggles and told me your successes which allows me to see and experience different parts of the whole you. THIS is your promotion, your reward and at least a big chunk of your purpose: TO HONOR AND SERVE YOUR TRUE SELF with the same (if not better) kind of empathy and consideration, the same kind of mindfulness and hard work in protecting and providing for others with. IT’S TIME FOR YOU TO DO THE SAME FOR YOU.
As an adult, the decision is and always has been yours.
ARE WE IN RELATIONSHIPS WITH OTHERS WHO LOVE US MORE THAT THEY LOVE THEMSELVES? And if so….. Are you okay with that? Something I hope you’ll consider talking with me about when we meet again.
I sincerely hope you receive this email with the intention I am trying to express. That I am in support of whatever you decide. Truly.
Because if you choose to place yourself to the side (in all decisions remember not just this one), I am fully confident I can help you with skills on how to keep remembering yourself when the relationship starts to feel dissatisfying again.
That’s not the part I’d be concerned with. The very real downside would be (unless you put your foot down about each of you staying in therapy) the down side would be that you will always HAVE TO remind yourself that you are your own person.
In healthier relationships (non- Co-dependent ones), you would not HAVE TO keep remembering yourself. Because you and your partner would be working hard (I’m biased but you’d do it in therapy) at always being yourselves. Without an established boundary of making BOTH of your mental health a priority…. Well, you’ve experienced exactly what happens.
Remember, it is completely and totally possible to have a successful relationship after an affair, and even after several affairs. It is even possible to have a successful relationship with someone who has what must have been a horrible traumatic childhood. But no successful relationship happens without significant changes from BOTH people and having strong boundaries and following through with those boundaries would be mandatory.
Of course deciding to prioritize yourself and your needs and expectations (not JUST yours, yours first THEN other people’s) is another way to go with a decision like this. So if you think about it , and then let yourself feel about it…. THAT is why the decision isn’t about staying or going. Because both ways, in both choices, YOU would be expecting YOURSELF to stay yourself. YOU would be doing what you have been doing lately since moving out. You'd be doing YOU.