Psychotherapy Networker, July/August 2014
Most people come to therapy for help with emotional or behavioral responses that aren’t under their conscious control: destructive habits, troublesome emotional moods, outbursts, addictions, and so forth. These responses are generated by processes that clients are mostly unaware of — which is clear when they say things like “I don’t know what makes me do (or feel) that.” Although effective approaches to such responses usually involve a change in the unconscious process that generates them, most therapy focuses on the client’s conscious mind by developing insight, expressing feelings, discussing the past, talking about neurological explanations, and other attempts at cognitive understanding. Many a well-intentioned therapist has suggested to a client to “just let go” of hate, as if it were a heavy load that he or she could simply drop to the ground and walk away from. But as we all know, hate isn’t a tangible object: it’s an internal feeling, which arises as a spontaneous response to internal images, thoughts, or other triggers.
Simply telling a client to let go of it — without showing them how to do it — is a conscious instruction that will only result in frustration, compounding the presenting problem. Now the client has the same troublesome feeling of hate, plus an added layer of self-criticism and blame for continuing to “hold onto it.” And since the client is failing to achieve the desired outcome, the therapist may also feel stuck and discouraged, and think that the client is “resistant,” adding yet another layer of complication. Therapy this isn’t!
Luckily, the boundary between what’s unconscious and conscious is quite permeable. With appropriate questioning, it’s possible to elicit the unconscious process that causes the trouble, which typically has a fairly simple structure involving images, sounds, and thoughts in a particular configuration. Once this structure is identified, the therapist can guide a client through a specific process to quickly transform it.
When Sally Met Craig
When Sally, in her mid-30s, called me for a phone session, she said that for the last four years she’d hated a man named Craig, who lived in her small, rural town, and she wanted to have a more comfortable response to him. At the time, this is all she told me, and it was all I needed to know, but later she relayed more about how she’d initially met Craig at a public event. He was about 20 years older, recently divorced, and came across as an intelligent, worldly, family man. Right away, he’d started complimenting her, acting interested in her life, joking a lot, watching her intensely.
A few months later, Sally found herself working in the same office with him. Given her first impressions, she was happy about this, but she quickly realized he was part of a group of people in the company who were using shady business tactics. He also aligned himself with all the men in the company, dismissing anything a woman added to a conversation.
“When he noticed I was becoming friends with one of the more powerful women in the company, he started to act cold toward me, often as if I wasn’t in the room,” Sally told me. “At one point, I stood up for her at a meeting, and he flew into a rage, accusing me of all these crazy things that caught me so off guard I couldn’t say anything. His attitude toward me after this continued to be mistrustful, aggressive, and threatening.”
Craig’s presence was so stressful for Sally that she quit, and the company soon dissolved because of how he and this group of people were running it. Afterward, whenever she’d run into him in public, he’d act as if they were best friends. “How are you doing? It’s so good to see you!” he’d say in a loud voice.
Although she tried to avoid him, there were inevitably times when their paths crossed. Whenever she saw him, even from a distance, she felt tightness in her chest, intense anger, and disgust that put her almost on the verge of tears. As much as she wanted to have a more comfortable response to him, she couldn’t control the strong and automatic feelings of hate that were triggered by his presence.
To begin the process of change, I asked Sally to think of a particular resource experience — someone she’d hated in the past but now felt okay about. My goal in making this specific request was to help her find a memory in which she’d already succeeded in unconsciously resolving hate. This is an example of what legendary therapist Milton Erickson described as “what you know, but you don’t know that you know.” Everyone has had an experience of hating someone and later somehow finding a comfortable resolution, but we often don’t realize that we’ve done that. That experience, however, holds the unconscious key to changing a present hate in a useful way.
When Sally said she’d thought of someone who fit these criteria, I asked her to see her inner image of that person and her image of Craig at the same time. “As you see both those images,” I instructed, “I want you notice the sensory differences between them, starting with the location of each image in your visual field. One might be closer and the other farther away. One might be more to your right or left, one might be higher or lower.”
After a few moments of silence, Sally reported that she saw Craig’s upper torso and face straight in front of her, about two or three feet away. In contrast, she saw the full body of the person she’d hated in the past but was now okay with about 15 feet away and 20 degrees to her left.
“Great,” I said. “Now tell me what other differences you notice in the images. One might be clearer than the other. One might be in color while the other is in black and white. One might be more in focus, or have more vivid contrast.”
Sally said Craig’s image was “big, clear, and in vivid color,” and the other image was “much smaller, faded, foggy, and in muted color.”
When I asked if there was any sound in either image, she said there was no sound, but she felt that the image of Craig “held a quiet, menacing anger.”
This information made it clear why Sally’s hatred for Craig was so intense. It wasn’t because she had a schema, engram, neural circuit, or flashbulb memory that was etched or burnt into her brain, as many therapists often insist. It was simply because she had a big, clear, vivid image of him that was literally straight in front of her in her mind, and she responded accordingly. In addition, the differences between the images provided specific information about exactly how to change her response to Craig. This kind of information is unconscious for most people, but can easily become conscious in response to a therapist asking the kind of simple questions I posed to Sally.
In the next step, I asked Sally to take the image of Craig and allow it to move to the location of the other image. “Let that image of Craig move out to 15 feet away,” I instructed. “Let it become smaller, faded, foggy, and muted in color, and then shift it about 20 degrees to your left.” When I asked her how she felt with the image of Craig in this new position she hesitated, and then in a doubtful voice she said, “I feel a little better, but the feelings of anger dragged along with the image.”
Because she still had anger, rather than the comfortable response she wanted, I knew there was something about her resource image that didn’t quite fit for her, so I gathered more information about the person whom she’d once felt anger toward but now felt okay about. “What was it about that person that allowed you to have a different response?” I asked.
In a soft voice she said, “I was thinking about my brother. I was really angry at him at one time, but I came to care for him and trust him.”
When I responded, “It certainly wouldn’t be appropriate to care for and trust Craig, would it?” she laughed and heartily agreed. Therefore, we needed to find a more appropriate resource experience that satisfied additional criteria. “Think of someone you once hated, and still don’t care for or trust, but have come to have a more comfortable response to,” I said. When she was silent for a while, I added half-joking, “Surely there must have been someone.”
She laughed and then said that she’d thought of someone. When I asked her about her image of this person, she said it was also full-body, about 15 feet away from her, small, faded, foggy, and in muted color. However, instead of being 20 degrees to her left, this image was straight ahead of her, down about 30 degrees from horizontal.
When I asked Sally to allow her image of Craig to move into the position of this new image, I heard a soft, full exhalation on the phone. Then, in a voice that was animated and strong, she said, “I immediately felt my anger dissolve, and the tension in my chest released. I can breathe easily now.”
“That sounds good,” I said. “Tell me what’s happening internally.”
“When I imagine Craig now I have a kind of shoulder-shrugging, â€˜So what? You don’t matter to me’ kind of response. Before I’d really felt at his mercy, now I feel way more in control.”
The Power of Inner Images
The location of an image is a primary way we all unconsciously sort our experiences — and its size, vividness, color, distance, and sound are also important factors. These sensory parameters of an image are usually far more significant determinants of the intensity of emotional response than the content of the image itself. Someone can have truly horrible memories, but if their images are small, dim, far away behind them, and silent, they won’t be bothersome. In that configuration, it’s easy to say, “I’ve put all that behind me” — a literal description of what’s been done internally.
Although it’s impossible to erase troubling memories — and even if it were possible, it’d be dangerous, since we often need those memories to warn us of unsafe situations and people — it’s quite easy to adjust a memory by changing its sensory parameters. This is why Milton Erickson said of therapy, “Your task is that of adjusting, not abolishing.”
Now that Sally had the comfortable response to Craig she wanted, the next step was to rehearse it in her imagination, to make sure that her new response would transfer automatically out into the real world, where she needed it most.
“Sally,” I told her. “I want you to imagine seeing Craig somewhere around town, perhaps somewhere you’ve seen him before, and simply notice your response.”
After a pause, Sally said in an even tone of voice, “It’s like, â€˜Whatever. He’s over there. It’s OK.’ I don’t want to have anything to do with him, but I don’t have that intense, hateful reaction I used to have.” As she experienced this scenario a bit more, she added, “Wow, this sure feels better.”
“Great,” I responded. “Now I want you to imagine seeing Craig in several other places where you might encounter him, and again simply notice your response.” She imagined seeing him at the gym, at the post office, on the street near her office, and each time she reported the same “whatever” response in an even tone of voice.
These mental rehearsals had two important functions. First, they tested whether Sally was satisfied with her new response in a variety of contexts. If she wasn’t satisfied with it, which was the case after my first intervention, we could modify her internal images until her spontaneous response was fully satisfying. This modification might have involved finding a different resource image — as we did after the first one proved unsatisfactory — or experimenting with making the image of Craig more distant, fuzzier, and so forth. Second, these rehearsals connected Sally’s new response to the cues in the real world, so that it’ll occur spontaneously the next time she encounters Craig.
After these rehearsals, which Sally said all went well, she exclaimed with surprise, “Now I’m actually looking forward to encountering him to find out how I respond. That’s sure different!” I asked her to contact me again after she’d actually seen Craig, which would be the real test of what we’d done together.
Several weeks later, Sally emailed me. “I saw him today. It used to be that if I saw him from a distance I’d get a sudden adrenaline rush, followed by the type of anger where you can’t think straight, and then I’d ruminate about it,” she wrote. “Today, I glanced up, saw him, and just thought, â€˜Ugh, I don’t even want to talk to him,’ so I looked in the other direction and kept walking. There was a tiny blip of irritation, and then I was over it in about 4 seconds — and I didn’t even think about it again until now, when I thought about emailing you. That’s fantastic!”
If I’d simply asked Sally to let go of her hatred with conscious effort, she wouldn’t have been able to, especially not in a 12-minute phone session. But by eliciting her internal images of both her problem and a solution that she’d already unconsciously achieved, I could help her make a straightforward transition — and make necessary adjustments to it when it didn’t work the first time. This process gave Sally the experience of letting go of her hate, as opposed to an intellectual understanding of it. It’s a basic method that can be used to quickly change a wide variety of unwanted unconscious responses, including common problems such as grief and shame.
My phone session with Sally occurred two years ago, and I recently got in touch with her to ask for a brief follow-up report. “I just ran into Craig at the post office last week,” she said. “My initial reaction now when I see him is a big eye roll and an internal groan of â€˜Ugh, so annoying, eww.’ He runs a program now at a local school, so whenever I see his name in print for an event, I feel the same inward groan of irritation and also disbelief that anyone lets him run anything! But my response hasn’t changed since we first tested it. Before, I felt kind of small and capable of being hurt and overwhelmed by him, as if he was much more powerful than me. Now I feel on the same level with him, and I don’t feel like he has the capacity to hurt or overwhelm me.”
By Wendy Behary
In this vividly detailed case, Steve Andreas shows the power of using sensory readjustment via imagery to transform a client’s overwhelming mindâ€“body experience of hatred. He shows Sally how she can take control of her distress and reduce it by systematically reorganizing her inner representations of anger, hatefulness, and perceived powerlessness. But before generalizing the application of this clearly powerful method, it’s important to recognize what’s distinctive about Sally as a client. Despite her challenges, she appears to be a well-adjusted, securely attached person with a sturdy enough emotional constitution to profit from the rapid readjustments brought about in brief treatment.
There are limitations, however, to a brief-strategies approach, especially when used with clients with more sensitive temperaments, whose internal world may be fractured by trauma and who’ve never had their developmental needs met growing up. With such clients, rigid survival systems formed in response to painful or shameful early experience lead to rigidly held self-defeating patterns that aren’t so easily transformed. These are the clients we call borderline or narcissistic, and they need more than the kind of technical intervention described in this case.
For them, the key to successful treatment begins with a secure attachment to the therapist, who can act as both a good parent and an authentic presence in their life — someone they can learn to trust. That process takes more than the 20 minutes that it took Andreas to help the fortunate Sally reorient her responses to Craig. This case underlines the difference for us in helping clients get past more discrete problems that are disturbing to them — as opposed to problems rooted in traumatic early experience, which have a more pervasive effect. Clearly, the resourceful Sally was fortunate enough to connect with Andreas, a therapist who was able to build on her strengths efficiently and skillfully help her get past a temporary stuck place in her life.
Steve Andreas’ Response
Successful therapy can be divided into three fundamental aspects: engaging clients to secure and maintain their cooperation, utilizing that cooperation to intervene and elicit a new response, and ensuring that the new response transfers from the office into the real world. My case example is focused primarily on the latter two, whereas Wendy Behary’s response is focused mainly on the former, which is a formidable task with some clients.
Not only is Sally a resourceful woman, as Behary points out, but she’d already congruently decided that she wanted to feel differently. Since she was already fully cooperative, I could focus entirely on eliciting a new response and transferring it. Many clients in her position would have a number of strong objections to resolving hate, and these would have to be satisfied before intervening.
Once cooperation has been achieved, the kind of brief intervention illustrated in the case is effective. Wendy mentions shame and trauma as significant obstacles to brief therapy. The same basic method is particularly useful with shame, because the client doesn’t have to reveal any embarrassing content — and I have yet to find anyone with any objections to resolving their shame.
Steve Andreas, MA, has been learning, teaching, and developing brief-therapy methods for more than 45 years. His books include Virginia Satir: The Patterns of Her Magic, Transforming Your Self, and Transforming Negative Self-Talk. Contact: andreas [at] qwest.net.
Wendy Behary, LCSW, is the founder and director of The Cognitive Therapy Center of New Jersey and The New Jersey Institute for Schema Therapy. She’s also the president of the International Society of Schema Therapy and the author of Disarming the Narcissist. Contact: wendy.behary [at] gmail.com.