THE STAGES OF HEALING

Thought it might be useful to have all of the STAGES OF HEALING in one post, since I've posted them separately in the past. Its a full read, but since it's the weekend, here they are -

THE STAGES OF HEALING, PART ONE: BASIC TRUST - FORMING A THERAPEUTIC ALLIANCE

Basic trust is the first issue in therapy, just as it is the first issue in life. In a sense, a person coming to therapy initially is somewhat like a newly arriving human being in that the new patient is acting from her natural impulse to reach out in an act of trust when it is in crisis of need. That capacity is innate within all of us at birth. The first call to the therapist is an expression of basic trust. It is the first positive diagnostic sign. Even though the new patient doesn’t know the therapist, he still makes the call for help, somehow, just as a baby will reach out for the caregiving adults around it that it doesn’t really know in any way…except intuitively.
Indeed, intuition and gut feelings are strongly at play in the first contacts between a patient and therapist, beginning even before the first session, over the telephone. Little children and animals, naturally connected to their own “6th sense”, either trust you or “bark” at you almost immediately. This is often true of persons in an emotional crisis, when our guts are very active in providing guidance.
A patient in a first session will respond very strongly to energetic and aesthetic details in the same way, though perhaps less consciously, that you, the therapist, will assess a new patient’s presentation of self. Your office décor and ambiance, including colors, smells, knickknacks, pictures, etc., your clothes and general appearance, your body language and character structure, attitudes, etc., all will be reacted to by the person sitting across from you in those first moments. (Freud believed that there was a direct communication between the patient’s and the analyst’s unconscious.) However, this doesn’t necessarily mean that if a patient doesn’t take to you as a therapist or she decides not to see you that you are not trustworthy. It could just mean that the energetic chemistry wasn’t comfortable between you, as happens in any relationship. And the therapeutic relationship is a real relationship.
So…how does basic trust develop further, beyond the innate movement to reach out, and become the basis for a relationship that will prove beneficial for the individuals involved?
This is not a matter of technique, and technically, it can’t be taught. A therapist cannot learn how to act trustworthy toward a patient and expect to be experienced as genuine. A therapist can become able to trust herself in the same way that a patient does – through a process of discovering the inherently loving nature of who we truly are and the inner guidance that is always present within ourselves.
If a lack of basic trust develops in infancy, it is at first in relation to an environment that was hurtful, depriving, frightening, etc. – not trustworthy. Yet, it is mainly the infant’s not trusting its own impulses to reach out for help, nourishment, and love that become the lasting source of dysfunctional behavior and characterological problems. The main channel for healing, then, becomes the patient’s willingness and capacity to reach out, which will tend to be proportionally related to the therapist’s willingness and capacity to reach out…or reach back.
So, as the person doing the guiding, the therapist must have done and/or be doing that work on himself in order to help the patient to do it. Basic trust will develop in the therapeutic relationship, therefore, to the degree that therapist and patient become able to trust themselves as capable of giving and receiving.

THE STAGES OF HEALING: PART TWO, UNCOVERING BELIEFS AND IMAGES

Part of the healing of basic trust is accomplished by unlearning, or deconstructing, the beliefs and images one has held from childhood that have led to not trusting oneself (or others). Whatever the level of dysfunction, whatever the degree of obsessive or chaotic thinking, and however blocked emotionally, most people have some access to logic and some connection to reality. Therefore, there is a part of almost every adult patient in therapy that is capable of examining objectively the beliefs that they hold about life, others and themselves.
Very often, people are acting according to beliefs that they don’t even know are there, so initially, simply becoming aware of one’s beliefs advances the healing process. Insight-oriented therapies, in which the main therapeutic tool is exploring the mind, provide some relief from neurosis and free up some psychic energy primarily by increasing the patient’s level of self-awareness, particularly of what has been suppressed or repressed out of consciousness. To “not remember” or to dissociate from significant beliefs, memories, feelings or interactions with others depletes or fragments a person’s access to energy. Remembering and facing honestly the traumas that led to these defensive maneuvers furthers the healing process by returning some amount of access to psychic energy. It is not always necessary or possible, however, for a patient to specifically recall traumatic events. In most cases, a person cannot remember experiences from the pre-verbal times of the first few years of life. Traumatic memories are instead “stored” in the body, expressed through character structure features.
Helping a patient uncover beliefs does require technical skill on the part of the therapist. Particularly important is his ability to listen to, track and translate the coded language of a patient’s belief system. Crucial to identifying beliefs are hearing the key words that are reminiscent of the childish mind, which always thinks in absolutes and extremes, and without any real sense of past or future. Words like “always”, “never”, “all” or “nothing” in a statement about oneself or others or life are usually coming from an old childhood belief system. (“I will always have to struggle with money.” “Love is never easy.” “All men/women are__.” “Nothing gets done right unless I do it!”) Beliefs are always generalized to give the child some sense of predictability in an environment that was painfully unpredictable. Also, practically any statement that includes the word “should” is based on a child-created rule that is meant to control some painful aspect of life that, in fact, could not be controlled.
Many types of cognitive-rational therapies today work with beliefs, and up to a point, focusing on beliefs is an effective approach for creating some amount of change in a person’s life. Again, most people have some access to rational thinking, and by simply reflecting back to them what they are “really saying” and “really doing”, many patients will “get it.” Having achieved a level of self-awareness and understanding, however, isn’t “enough” for every person who comes to therapy.

THE STAGES OF HEALING, PART THREE: ENERGIZING, MOVING & RELEASING FEELINGS

Whatever the person’s stated reasons for coming to therapy are, and regardless of the symptoms, the main problem of every “patient” (person in pain) is that they are not as happy as they feel they could be. (This does not mean that every patient’s “goal” in therapy is going to be finding happiness, nor does it mean that every patient is going to stick around until they do.)
Emotions are the movements of energy in the body which are perceived and interpreted by the mind in order to decide upon an action relative to the emotion. Joy, pleasure, love and happiness are emotions which, under natural circumstances, move us toward the sources of the “positive” stimulation. Pain, fear and anger move us away from the catalysts of those feelings. However, if we are unable to move towards the sources of pleasure or away from the causes of pain, as is the case when we are helpless and dependent in childhood, we go into a crisis that feels life-threatening to the child. The only recourse to the child in such a situation is to try and move away from the feelings themselves. To do this, she will clench her muscles and distort her body structure to inhibit the flow of energy. While this approach seems to avoid the unpleasantness of the “negative” feelings, it also makes the experience of happiness and pleasure equally inhibited.
These characterological defensive structures are built into the body as well as the mind and therefore cannot be dismantled with insight and awareness (the mind) alone. The body must be engaged in a therapy process if the aim is to facilitate the person’s full capacity to experience real happiness and pleasure. Only minimal and partial relief can be attained through minimal and partial therapies, and very often, the positive results of limited therapies often don’t last because the person’s basic defensive structure has been left intact. (In many cases, however, patients - and therapists - are satisfied with Freud’s “goal” for therapy, once expressed in his famous quote that “the best psychoanalysis can offer is a return to a state of common unhappiness.”)
A fully therapeutic bodywork psychotherapy includes working with the physical/emotional aspects of the person in the following ways: 1. Unblocking, loosening and strengthening; 2. Expressing; and 3. Restructuring.
Knots, kinks, contracted or overextended muscles, etc., can be directly worked on by the therapist to aid the unblocking, loosening and strengthening. Hitting, kicking, stamping, jumping, screaming, shouting, biting, etc., can all be used to facilitate the expression and release of long-held emotions. Corrective breathing and vocal toning, various posture and movement techniques and skeletal adjustments, as well as detoxifying, internal cleansing programs can all be used to help the freeing-up person restructure their bodies to prepare for “full permission living.” (Rolling can be used for everything!)

THE STAGES OF HEALING, PART FOUR: REALIGNMENT

If a person in therapy has developed basic trust and formed a genuine alliance with her therapist, has uncovered his inner beliefs and faced the childhood traumas they were based on without any glossing over, and finally, if he or she has freed herself up emotionally and physically, this person has broken through her character structure. This is an incredible and heroic accomplishment! If entering into therapy is reminiscent of the initial crisis of being born in a desperate state of need, then breaking free of one’s character structure is the equivalent experience to being “born again”, only this time into a healthy, loving inner environment with all the powers, faculties and wisdom of an adult.
This time around, the newly “born” person’s basic trust stays intact, because the patient has now become her own loving parent. So, the person can go about the business of exploring life, just like a well-loved and secure baby does, outside of the inhibiting armor of a defensive structure. Stimulation and sensations in the internal and external worlds are experienced as new again, and, as such, are felt to be both exciting and frightening at first. Just as the newborn child needs to learn how to walk and talk and orient himself to life on planet Earth, a newly opened adult needs to re-learn how to do those things outside of the cramped confines of an inhibited life and contracted or de-energized body.
Also like an infant who doesn’t have an identity based on roles or images yet, a newly released adult has a much more fluid and undefined sense of self. At first, many people at this stage of therapy complain that they feel “lost” or say, “I don’t know who I am anymore”, or “I don’t know where I’m going.” This feeling is not “replaced” with a new identity, however. Instead, the person, over time, gets used to living more like a spirit, free of the limited notions of a clearly defined self, and free from rigid ideas about space and time. More and more moments of exhilarating freedom and a humble but genuine self-confidence begin to infuse the person as a result.
Finally, like a baby who has no conception of the past or future but is totally in the moment, focused only on the immediate input to its five senses, the free adult is once again a sensate being, connected to the now. The richness of physical life and the importance of pleasure become clear. Judgments about one’s desires fall away. Ruminating about the past and worrying about the future no longer occupies the mind. The actualized adult’s ego is “repaired”, and assigned to its proper functions of observing, mediating and remembering, instead of controlling, punishing and suppressing.
This stage of the healing process is a time of getting used to expansive influxes of energy, and once again, as in infancy, it is a time of feeling emotions and sensations in one’s body intensely. The therapist needs to explain that the feelings of fear the patient is having now are not regressive, “old” feelings, but rather, they are appropriate, natural feelings of fear that anyone on a new adventure has. The therapist can reassure the patient that he or she will no longer be paralyzed by strong emotions, and that there is no longer the possibility of regression. This could take time, but now, for the person at this stage, time is an ally. The patient who has broken through his character structure has re-ignited his natural healing process and will only “get better” with the passage of time. This person will truly “age gracefully.”
Inevitably, at this time in the person’s development, sexual gratification and creative expression become paramount issues for the patient. No longer suffering “neurotically” (unconsciously repeating childhood scenarios symbolically over and over again), the patient now becomes focused on the adult needs to share deep intimacy and pleasure with another and to fulfill what Erikson called “generativity”, the desire to give back to the world and the next generation through creative expression. This will often be a time, regardless of the patient’s age, of going back to school, changing careers, and exploring one’s sexual nature, including for many, “learning” how to enjoy sex joyfully, without guilt or shame.
The therapist is mostly engaged in supportive counseling and “teaching” at this time, no longer needing to focus on uncovering hidden images and beliefs or unblocking feelings in the body. This patient knows her own story now and he can cry or laugh fully when the moment calls for it. Meditation and journal writing are very valuable tools to facilitate the process at this stage of development, because just as the body has to re-adjust to free living, so does the mind. Habitual ways of thinking and behaving will assert themselves occasionally, particularly under stress or fatigue, but since the person is now operating consciously, and not locked in her body, subtler techniques will bring him back to a centered, balanced place in shorter and shorter amounts of time.

THE STAGES OF HEALING, PART FIVE: AWARENESS TO UNDERSTANDING TO BEING

What comes after re-alignment, a great accomplishment in itself? Well, once you've gone that far, it's likely, I'd say almost inevitable, that you're going all the way.

I’ve came to call this place of beingness: “Full Permission Living.” The phrase came to me spontaneously after I broke through my own character structure. I felt that I could now be more and more able, as time progressed post-character structure, to follow my desires, trust my impulses, act spontaneously – basically, do whatever I wanted – and that, in so doing, I could trust that I would be living in my own best interest, and in harmony with others and with life.
Full permission living is a place of being. Having moved from awareness to understanding to knowing, a person at this level of their development is simply a human…being. Eva Broch, in Pathwork Guide Lecture #127, delineates four stages of the evolution of consciousness: “automatic reflex, awareness, understanding and knowing.” (See Lecture #127 in this month’s reading assignment). Spinning off from that lecture, one can think of the movement through states of consciousness in the healing process as having four stages: awareness, understanding, knowing and being.
Awareness and understanding come by freeing up the mind. This is accomplished first by clearly seeing what is going on in one’s inner and outer life (awareness), and then making the cause and effect connections about the events (understanding). Awareness can begin increasing right in the first therapy session with the therapist’s initial reflections and assessment. Often in a first session, a patient may say in response to the therapist’s observation about something, “Oh! I never realized that before.” His awareness has been activated.
Understanding comes somewhat afterwards as connections are made mentally and repetitive patterns that were previously thought of as mysterious or cruelly random are seen in their predictable light. Hidden agendas, intentions and beliefs are accepted as personal realities.
Knowing comes with freeing up the emotions in the body. It is only from our gut, from within our bodies, that we can ever say “I know” something with certainty. That is why we say, “I just feel it”, when we are definite about something. The person who truly feels, knows their own truth confidently. Getting to a place of knowing takes hard work and determined effort. In addition to developing awareness and understanding, one must now undertake the “breaking” of the body’s defenses and armoring, and really feel, especially, at first, the difficult feelings of sorrow, rage and fear. This is the “point of no return.” If a person breaks through here - and it could take 6 or more years - they will never “go back” to their previous levels of functioning. They are on their way to being.
Being is just living, spontaneously and naturally, and comes from letting go. Of everything! It is living without attachment. Although awareness, understanding and knowing are part of being, they are incorporated now without effort, without thinking in the usual sense. Basic trust has been firmly re-established, but now combined with the knowledge, courage and wisdom of an adult
The re-establishment of basic trust leads to the rediscovery that at its base, life “works”, and that at our own cores, we are loving, creative, compassionate beings. At this phase of development, a person knows that he or she creates their own reality and he accepts responsibility for his creations without judgement or blame. She lives without attachment to outcomes, without regrets about past events, without worry about future happenings. Dualistic thinking falls by the wayside, and there is a true sense of oneness felt in connection with all others and with life. Body, mind and spirit are felt to be one. The person here doesn’t think of herself as “sick” when she has a symptom, but rather experiences pain as information and guidance. There is no irrational fear of death…or life. Perfection is not demanded from oneself or others. Life is lived spontaneously.
In one way, life at this point resembles life before therapy. Neurotic individuals operate pretty much automatically in their lives (coming from what the “Guide” calls automatic reflexes”), acting out the dictates of their unconscious mind unquestioningly. It is only the suffering that keeps intruding into their daily existence that makes them question what’s going on and seek out guidance. Their suffering is caused by the fact that the unconscious dictates they’re acting out are coming from the wounded child aspect of the personality. The healing of this wounded aspect in us requires a very intense and focused period of intrusive “excavation” into the unconscious mind and body. It is an immersion in self-examination, questioning, exposing, analyzing, surfacing, penetrating, releasing, cleansing, re-educating and re-aligning that takes years. (Sorry!)
However, once the “hard work” is done, in a sense the person can go back to living automatically again. Only this time, it is the most developed aspect of the self, the “higher self”, that is motivating actions more directly. This higher self aspect is also unconscious to the person for the most part, but the free adult can understand and sense its workings more clearly because now the ego has gone back to its original, natural function: observing. Whatever happens in the person’s life at this point, including what used to be thought of fretfully as obstacles, problems or illness, he just observes events without judgement or irrational fear, and accepts everything as information and guidance. The person here is identified with “that which observes”, rather than ‘that which is observed”, as Eva Broch puts it in Guide Lecture #189 (See this month’s reading assignment.) (Saint Thomas Aquinas described the realization at this level of consciousness this way: “Who we are looking for is who is looking.”)

THE STAGES OF HEALING, PART SIX: AUTONOMY VERSUS TERMINATION

How does the therapeutic relationship end? “Termination” is the ominous term used to describe the end-phase of conventional therapies. In this phase of therapy, the patient is thought to go through the final throws of separation and individuation issues, played out in transference with the therapist. This is also supposed to be a time when the patient will temporarily regress into a final crisis, until finally arriving to a state of autonomy. A requirement here, in traditional thinking, is that the patient and therapist must sever all contact after a formerly agreed-upon last session. Thus, the absoluteness of the word, “termination.”
Yet, it seems obvious that if a patient needs to have such an absolute cut-off dictated to them by a dictating “authority figure”, the implication is that the patient is still quite prone to dependency... so, how “successful” could the therapy have been? (Ironically, termination is thought of as one of the most important phases of the treatment process and yet, it is the least talked or written about in the psychotherapy profession.)
There often is a crisis period that occurs in the later stages of a full-spectrum healing process as well, but it is not precipitated by the pending “termination” of the relationship with the therapist. This crisis occurs within the context of the therapy at its own natural time, without needing to have set an ending date to initiate it. It occurs naturally when the person is strong enough and no longer needs to be defended and armored against deep feelings. It is a deeply healing crisis. It can be a final grieving for the losses of one’s early life, or a final release of the terror caused by childhood traumas, or perhaps a final expression of anxiety as a patient’s sexual feelings emerge in full force.
The actual ending, in whatever form it takes, of the therapeutic relationship becomes kind of anti-climactic, then, more like a transition experienced with a celebratory sigh and embrace, not with a somber tone of severance. Because neither the patient nor the therapist are neurotically dependent on one another, the ending need not be compulsorily absolute. What actually ends at the “end” of a successful therapy is the continued making of transferences to the therapist – and for that matter, to any other people in the patient’s life. The patient acknowledges comfortably at this point that the therapist and he or she are “equals”, adults who are not in need of parental figures anymore. So, the therapeutic relationship, like every relationship, can end or transform gracefully, according to the nature and purpose of the connection between the two individuals.
Posted by PETER LOFFREDO, LCSW at 10/13/2008 1 comments Links to this post