Sunday, January 24, 2010

Compassionate Self-soothing Dialog for Stuck/Collapsed Self State:

Entry for 14 January 2010:

Draft Task Description (R. Elliott; EFT-3; version 14/1/10)

We’ve been talking about a self-soothing task for years, but have never gotten around to writing it up. Now, however, it’s turning out to be a really important part of our work with clients with Social Anxiety, where we are using it as part of a process of helping clients build up a sense of themselves as being able to stand up to their critic. A recent peer supervision session with Lucia about a kind of work that she learned from her supervisor Paolo Nuttrini inspired me to write up the following outline of the work, which I then tested out with the EFT-3 group. I’m next going to add the work to the EFT-2 curriculum for later this year.

A. Background:

•New chair work task; being developed in EFT & other approaches

•Flip side of self-criticism split work

•cf. Paul Gilbert, Compassion-focused therapy (CBT + Buddhism): Compassion dialogs

•Useful with Post-trauma, social anxiety, borderline processes, depression; also within Two Chair Dialogue and Empty Chair Work

•Changing emotion with emotion (emotion scheme restructuring, memory reconsolidation)

•Use to strengthen self

B. Markers: Collapsed/stuck state of self

1. Self-critical or interpersonal loss process leading to collapsed/weak self

2. Strong emotional pain plus stuckness (e.g., vulnerable self with implacable other in Empty Chair work; repeated “I don’t know”)

3. Fails to respond to usual strategies for reactivating collapsed self (heightening critic or deepening experiencing self)

C. Therapist stance:

•Active, genuine compassion for client

•Active process guiding with collaborative co-construction of exercise

•Close empathic tracking


D. Different Self-Other combinations:

1. Imagine yourself in the other chair as a small/hurt/lonely/scared etc child and speak to them.

2. Imagine some other scared/lonely/hurt child in the other chair and speak to them (from Liz Ballinger & Lorne Korman, EFT therapists from Toronto who working with clients with depression/opiate abuse).

3. Imagine a very close friend of yours, so similar that they have had the same experiences as you and are feeling the exact same way as you. What do you want/wish for them? What would help them? What can you give them to help this? Try it. Are they convinced? If not, what would help instead? (from Italian Gestalt therapist, Paolo Quattrini by way of Lucia Berdondini)

4. Imagine your parent/significant other in the other chair not as they were but as you needed them to be (idealized parent). Ask them for what you need. Then have them speak to you. (Extension of Empty Chair work)

E. General suggestions for facilitating client work:

•Be patient; don’t try to move too fast into self-soothing. Make sure you spend time helping the client evoke and experience the emotion pain and collapsed stuckness.

•Make sure you have a firm empathic/compassionate connection with this aspect.

F. Proposed Task Resolution Model

Client Resolution Stages

Therapist Facilitating Responses

1. Marker: Collapsed/stuck self; high arousal

Therapist: Reflect marker; propose task

2. Task initiation: Selects and evokes sad/scared/ collapsed self-aspect or other

Therapist: Propose an appropriate self-other combination to enact; adapt as needed.

•Ask client to imagine the sad/scared/ collapsed aspect; use evocative language

•If possible, help identify what client needs/wants/wishes

•Provide solid empathy for this aspect and allow client to really experience the collapsed/ stuck state before moving on

3. Offer self-soothing: Enact compassionate self-aspect or other

Therapist: Encourage client in Compassionate person role to offer collapsed aspect what is wished for it or what it needs

•Model soothing, compassionate stance

4. Partial resolution: Experiences emotional/bodily relief

Therapist: Listen for, reflect bodily felt shift in response to compassionate, soothing offer

•Encourage client to stay with the new feeling

5. Shifts toward more positive, empowered view of self

Therapist: Help client explore the emergent, stronger sense of self

6. Considers how to extend this process in their life

Therapist: Help client explore possibilities for carrying self-soothing or empowered self forward in their life

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