PSI Therapist Community Forum

Hey all - here are my notes from last week's session on Transference. Enjoy! (and feel free to let me know if there are edits) May 24 - supervision session with happy monkeys (Notes by Rachel) Tier 1 work Client knows his body is processing. He has a sense of the world and event memory. Tier 2 work • He doesn’t have sense of anything outside of the world created by medicine. Completely immersive. • Can be dark landscape that gets created. • Tends to arise organically. Can’t really target it. • Occurs when you are ready to shift your core sense of identity and world around you. • Tier 2 is FABRIC OF REALITY. • Go watch SHUTTER ISLAND and you’ll understand tier 2! TRANSFERENCE Wave and corrective aspects: When you become attuned as the savior parent that the client never had, you’re stepping into a transferential role with them - you’re interjecting that into an event memory that didn’t have savior in it. That is the corrective aspect. The Wave aspect is Selective Inhibition - mental physical emotional - but the two big pathways to grab event memory are physical and transference. Maintain sustained eye contact, and you’re not just asking client about their experience but also asking them how they feel about you. As soon as ask question you’re knocking on door for relational memories… e.g “you feel distant.. feel like you don’t care… “ Staying neutral vs entering into the role: There’s going to be different articulations of the transferential relationship they are expressing onto you. One way: Playing Neutral First just play it with a straight face. You don’t have to play into it but also don’t deny it. e.g. someone says you seem bored… “OK, really notice what it feels like to you when I’m bored and don’t care.” That’s one way - being relatively neutral Second way: Hold the Negative Role - while maintaining SI The other thing you can do, if you are confident you can hold the negative role, is when someone hands you the role, you can dream into the script, the language, the motto of that role. E.g client who had early molestation, she kept in him in savior role. Then she started to project perp onto her spouse. So the SI probe I gave was “I’m going to touch you… “ (That’s a perp probe) and it signals to her system that he’s the perp. And once system identifies you as that role (they have to say in SI for this) then they will have reactions and responses to defensive IARS that come up in response to that role. E.g. they don’t have that projection then you hav a semantic conversation about it (not about what it means) invite role, have them stay in contact with you, and the body turns on the waves… Start with positive role for a period before moving into negative roles: There’s the beginning phase where you are in positive role - stay there for a while. Let them keep you in one of these positive roles for a time before flipping out. There’s some ritualistic cue that give signal to client that even though they will feel this way outside this exercise it’s an Identifying marker that we’re going into this. Ideally if they complete the wave they will see you in more neutral way. If not they may stew on you being in this role. It is an act of generosity to allow yourself to be seen in this way by a client. It’s not easy work. It’s one thing when their secondary consciousness is enough on board, but another when it’s not. It’s easier if it’s all held in the SI container: Let’s say someone Is ready to work with observer parent and you’re late to the session, their system will go to town with it because there’s something real in the present moment reality that you’re late. It’s easier if it’s all held in SI session. Tell the client “We’re going to work with bystander parent and I’ll put that role on for you…” maintain sustained eye contact, and client realizes that they only feel this way towards therapist when doing this specific activity, i.e. it’s held in container. Once you start exploring you’ll see it’s always there. Little bits go very far, e.g. Rachel’s example of “the look her husband gave her. it sent signals to her system. When to ditch the waves and go for relationship building: Don’t underestimate someone’s unconscious assessment as to whether they can do this work, e.g. Steve’s client who is chronically in states 3 and 4, weak and without solution. In this case. dump any focus on the wave and go for deep relationship building. You can use medicine for that. e.g. Ketamine to build secure attainment and loving interjects. Positive transference role - savior parent: For Saj after two years of SI strategic work then this therapist would take him in her hands and overwhelmingly show how much she cared about me. She wasn’t indifferent. She was the parent stepping in and being personally affected when his lifestyle choices affected him. For him it was new. Intrusive and also nurturing, building a positive transference role. For example, if a client feel suicidal find the place in you that really cares about this person. Even if you have to fake it to some degree. Give her kid place a sense that it really matters to you. You’re talking to their abandoned kid that didn’t get the parenting they needed. Say what they want to hear, e.g “I’m going to make sure you’re OK.” Miriam’s example with Annie going tiny a wave where she didn’t feel safe. Miriam said to Annie “You’re safe and Annie said, “No I’m not.” Is this overstepping bounds? When stepping into positive transference role you’re entering into parenthood. So yes you’re overstepping bounds, but to a 4 year old they want that. If they keep saying you’re no safe you just outlast them. For Annie though she was adult dealing with mother who has borderline personality disorder and it’s not safe to be with her. She’s aggressive and mean. Miriam - could say “OK, you’re unsafe here but I’m right here with you” That’s lighter version of savior parent. If someone describe what happens in childhood and because it’s an event memory they feel it’s in the present moment, you as therapist can step in and find your anger for how angry you’d be if it happened to kid you care about. For example, “OMG if I know this was happening I would be pounding on that door and not stop till someone call police.” Find your righteous rage.. If you have a relationship with someone and their kid hears you say that, they will melt in your arms. Criteria for setting up container for transference: Two criteria that have to be there before go in 1. YOU HAVE TO BE READY TO DO THIS! 2. The client is handing it to you. How you can tell is they will see you initially as the helper and ally when in savior role, then at some point they will (not consciously) start handing you another role.. e.g. victim, where someone in family saw eldest brother beaten by dad and they were the observer. they may hand you the role of victim and see you as weak, sickly, needing help. Mottos for different roles: 1. Savior - “I don’t have any problems myself but I’m responsible for the problems of those around me.” This is the most empowered transferential role there is. Super hero. It’s seductive for therapists. 2. Victim - “I have problems and there’s nothing I can do about them.” Disempowered 3. Bystander - “What problem?” When things stressful dad turns on football game.. 4. Perp - “I am the problem.” I am the threat. So get familiar with what people are starting to hand to you. Also, watch for when client not handing you a negative role but is handing it to someone else important in their life.. e.g. their spouse. When to introduce the idea of transference: We want to be transparent. Let people know at beginning of therapy that this is tool in tool kit. You need Introduce idea of transference well before the session, e.g. they come to you with perp in their family of origin then let them know it will come out in therapy. What it you’re not ready for it and they are ready to go to war with you? Then refuse it “No this is not what we’re doing,” you correct the client, “No I care about you.. I’m your ally… “ They won’t like it because they want to work perp with you, but I it’s not appropriate at this stage. If they are new and hand you prep what the relationship will blow up and the client will not come back after 2-3 sessions. They will be less excited if you insist on a positive role, but it’s important to build rapport before you go on a wild journey. There is a caveat: the type of client who walks in an intent on a giant set up for positive or negative right off the bat will probably be borderline client. You need months of good rapport before you can be good bystander. Then, eventually, (for example) you could “did that really happen to you?” Probes have nothing to do with current reality. They are more for the role. How to play the role of perp? For example, the client says “I feel like you’re really mad at me right now,” You can be neutral where you don’t even have to say a word about it, and simply say, “How do you feel now?” It’s all about how ready their system is. You don’t have to add much at all. Their system will take care of it. Or if want to you can lightly find a problem e.g. like curl your lips, furrow your brow, anything is enough to do it. ‘ Therapy done well. First I can do no wrong, then I can do no right, then it becomes more reality based after that. Set up an off ramp Be as clear as possible, e.g. “I can play any role if you feel this way, but if you want me to turn back to how I normally relate, then just lift a finger and that’s a sign I can go back.” The attuned parent should always be accessible. When to shift to corrective sessions? Kerry has sleepy client - lots of sessions, not seeming to complete waves Maybe relax the wave project. She needs corrective and relational foundation. If someone working with cannabis and Ketamine and has not significantly shifted in 4 or so sessions, t’s a pretty decent indicator you might want to go to corrective at that point - with or without medicine. Can use Ketamine for the corrective session (Saj has never used cannabis for that ) Just focus on resourcing and relationship. They may be spending time in sleepy state because they spent years in their life in this state. Non-transference questions: Susan - Doctor who is meditator - not going into waves. Saj: “Have a conversation at front end about why beneficial to have discomfort. You can also welcome their resourcing outside the session - e.g. "You spent time developing this ability and you can use it between sessions. Ie. DON”T GO TO WAR WITH THEIR RESOURCING CAPACITY. Also can say “Can see see what happens if your nervous system is unmanaged?” It’ might raise the question “why do I have to manage it all the time?” That said, for some people, especially ER doctors, they are not out of the war zone, seeing people die each day, perhaps we just need to find ways to help them be functional and do what they are doing because perhaps they can’t be fully associated and see what they see every day. Client experiencing God in state 4? One of Saj’s client - found God in state 4… it’s something in their system that got developed in childhood.. he worked with it carefully “We’re not taking away God, it’s a legit place,” He had them continue to stay with body while experiencing divine and they started saying,“Things are feeling a little numb… even God feels numb." They had a lot of grief feeling this process would take away their sense of the sacred. There really is the divine here and it can evolve. It doesn’t have to be this thing that develops in childhood, it can look other ways.

· You don’t have to drink the Kool-Aid for your nervous system to do the work.  · Defining integration = having your secondary consciousness catch up to your primary consciousness. · Sy: How do we create a space for respite while people are doing this work? Maybe it is something you just have to sit with this. How can we utilize ritual and other experiences to anchor someone as they go through this process? · Tier two is horrendous – it’s diving into mind set of when trauma happened. Tapping into the early imprinting of the events. · The model is going to get richer and richer – and people with different expertise are going to be bringing more richness to this process. · Open this work up with non-medicinal version. When dealing with people with very early defense mechanisms, go in without medicine. · When working with someone – go for the cold because that is where the most value can be. But do whatever creates movement, go for that. You can build an entire practice on working with states 1 and 2. If what you’re doing isn’t creating movement, stay with the cold. · Nicki: client got stuck – couldn’t end the SI. Saj has never seen that happen. o Exit protocol – take that deep breathe. Usually when they do that, that is enough of a signal to the system that there’s a shift. o Once you break SI in once place, it breaks it all over. o Next time, have her have a light version of SI – shorter time in it. Don’t have her go too deep into it. Be there for a few minutes and have her take the breath. “Let’s practice doing this” so she can get familiar with the process. · Tightness is a hot symptom. · When you see some tension going on but it isn’t going into a wave, their secondary consciousness might not be letting them hit the wave or that the wave is in the cold and it is building. · What do you do when cold doesn’t change? Cold can take a long time to build, especially if this is their first time, or they are not tracking that well. Most people that have cold waves don’t have their feet in a bucket of ice cold. What happened in his feet was really significant. It will crawl up his legs and up into his thighs. It could take 30-40 minutes. For the cold to clear completely it may take multiple sessions. But when someone says their feet are in a bucket of ice, that’s significant. · If you have major trauma, go slow through this process. · Rule of thumb: If someone has hot and cold symptoms – go with the hot and see if it creates a wave. If it doesn’t, then you know that it is bounded in the cold. In that case, leave the hot entirely and focus on the cold. · Can the client be bored? When you have internal movements taking place, people are captivated by what is causing this movement. It is like an interesting dream – it is just going slow. The only person that will be bored is the therapist. · Don’t need to be goal oriented – let’s just see what happens. We all will have set ideas of what good work looks like, because you’re wondering Is this not working because I’m not doing an okay job? All of that is something we’ll encounter. The more sessions we do, the more we’ll realize that this is about the speed of the body and the speed of trust. All of these things have their own speed which is completely separate from our anxiety around ourselves. · Is there any therapeutic benefit to not completing a wave? Yes – even if you didn’t complete a wave, you hit a wave. He is developing trust in his own process. The process will get deeper each time. · How many sessions should we plan for when starting with a client? You can’t promise people anything. At a minimum three sessions, but have them leave room for more just in case they’re right in the middle of something big. · What we’re doing is as much an art form as it is a science. Establish comfort with client saying no. When the client knows that they can say no, there is nothing broken in the relationship. If something is painful, yeah – keep going. But if it is too painful, they can say no. Do you want to exit this? If they say yes, that’s a win. If they say no, that’s a win. Allow this to be their dream. They intuitively can trust the pain. · When you’re working with someone who is slippery, be a bulldog with the SI. Stop chasing, and find one piece, and then stay with it so they can undo that pattern. You ultimately have to contain the system. There’s nothing in someone’s secondary process that will want to go back in those hellish places. So, it does require some real containment to get to the waves. You may see some negative transference when that happens. If there’s a way to enter SI without a power struggle, that’s what you’re looking for.

Hey all, here are some of my notes - focusing on Sac's prompts and questions for Nicki's fishbowl session on the third day. I'm also writing up Lee's session. Can post that in a day or so. Enjoy!! (and thank you Nicki for being so raw and real... I learned so much from your session. :-)