A Therapist’s Handbook to Dissolve Shame and Defense

Master the Moment

Susan Warren Warshow

• Publisher: Routledge
• Year: 2022
• Print ISBN: 9780367024383
• eBook ISBN: 9780429680120
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

The effort to surmount shame and formidable defenses in psychotherapy can trigger shame and self-doubt in therapists. Susan Warren Warshow offers a user-friendly-guide to help therapists move past common treatment barriers. This unique book avoids jargon and breaks down complex concepts into digestible elements for practical application. The core principles of Dynamic Emotional Focused Therapy (DEFT), a comprehensive treatment approach for demonstrable change, are illustrated with rich and abundant clinical vignettes.

This engaging, often lyrical handbook emphasizes "shame-sensitivity" to create the safety necessary to achieve profound interpersonal connection. Often overlooked in treatment, shame can undermine the entire process. The author explains the "therapeutic transfer of compassion for self," a relational phenomenon that purposefully generates affective expression. She introduces a three-step, robust framework, The Healing Triad, to orient therapists to intervene effectively when the winds of resistance arise. Chapters clarify:

• Why we focus on feelings
• How to identify and move beyond shame and anxiety
• How to transform toxic guilt into reparative actions
• How to disarm defenses while avoiding ruptures

This book is essential reading for both advanced and newly practicing mental health practitioners striving to access the profound emotions in their clients for transformative change.

1THE WARRIOR THERAPIST

DOI: 10.4324/9780429399633-2

The warrior therapist that I envision does not overpower, bully, push, or show aggression in any way. Warrior therapists risk fear and loss for the sake of love. They must reach for reserves of strength and courage within themselves to help their clients battle the forces that destroy their lives. I found that I needed bravery to grapple with my own internal barriers in this process. “I believe great power exists in the warrior stance as it translates clinically to the embrace of uncertainty. During. psychotherapy, this means not having to know that which cannot yet be known. To adopt this mental attitude allows us to remain emotionally open, cognitively poised and spiritually strong enough to withstand the heat of intense emotion, confusion, even delusion in our patients, not to mention ourselves.” (Tarlow, T.M., 2012) When I began practicing with intensely emotion focused therapy, I feared the feelings that might be encountered and mishandled in a session. What if I were to alienate my client? Although people want change, habitual patterns of self-protection prefer to remain entrenched. Working with resistance requires risk-taking and tolerance for uncertainty. Racker writes, “The neurotic is a prisoner of his resistances and needs constant and intense help from the [therapist] if he is to liberate himself from his chains” (Racker, 1968, p. 178). The warrior therapist must take chances to support the client's will to be free from shaming, punitive, and restrictive barriers. Resistances can lead to attacks on the therapist as well as the client. In my learning process, I had to face my fears so my clients could face theirs. The self-protective system, designed to ward off rejection and injury in the past, would rebuff my attempts to help in the present.

With permission from my client, I would reflect reality even when painful, trusting and sharing my perceptions in a more real, sensitive and vulnerable way. I would immerse myself in my client's experiences, involving mind, body, spirit, imagery, impulses, and imagination. With a shared willingness to risk, profound unlockings of feelings became possible within hours of knowing each other. This extraordinary experience, repeated often, laid the foundation for secure attachment relationships for numerous clients.

In the following vignette, the client began our first session describing his sense of failure that he'd been unable to connect to any emotions in his prior therapy. He suffered from high social anxiety. I started by acknowledging his willingness to be vulnerable with me in the present:

Th:It takes courage to let me know your struggles, and I appreciate that. I sense and care about your pain. (My face reveals caring. He grimaces and shakes his head with skepticism.)

Ct:I guess I don't understand the value in that (fidgeting with his hands). I told Carol (his former therapist) very early on, I have such trouble accepting statements like that. What does that mean to me? It doesn't make me feel any better to know that you're there with me. I don't get any relief from that. I don't get any satisfaction or joy or anything from that. So, I think it should mean something to me, and I should be able to make that connection, but I don't.

Th: I'm glad you told me the truth. You don't get any satisfaction from another person caring about you?

Ct:(He shakes his head.) No. When I think about dating, I wonder, “Why would anybody want to be with me?”

He rebuffed my attempts to draw closer and encouraged me to feel discouraged, as he did with his ex-wife. I may be tempted to withdraw but instead chose to “take a stand for good.” I face the rejecting part of him, risking more rejection, so he might see how his distancing mechanism hurts him and our relationship.

Th:Sadly, you expect rejection, Kevin, and I believe there's a viciousness toward yourself that operates within you. (He listens attentively and nods with agreement.) A part of you tells you that when you go online, “Why would anybody want to be with me?” It also tells you to dismiss another person's caring for you. Like mine. (He agrees.) And then you feel desperately alone. There's something inside you that doesn't want you to know your value or to experience your worth to others. (He continues to fidget with hands.)

Ct:Almost like there's another side, an evil side.

Th:A cruel side. A very cruel part that does not want you to know a caring relationship. (He nods in agreement.)

Ct: A cruel side. Why would that be? (He fights back his tears.)

Th: Yeah (said in a whisper). It's very sad.

Ct: (He wipes both eyes with his left hand and keeps his eyes covered, rubbing his eyes, sighing.) Yeah, it's sad.

Th:It's sad that you've learned to withhold caring from yourself (he nods and bites bottom lip, eyes diverted downward in shame), to deprive yourself, so cruelly, for many, many years.

Ct:Yeah. (He breaks into sobs.)

He had a full breakthrough in this three-hour session of rage, grief, guilt, and love toward a parent who taught him to hate himself. If I had backed off, as his shame and fears of closeness wanted me to do, Kevin would have lost this powerful new experience.

Another client said in an initial session, “I've had therapy before, and it never helped me. I don't believe it will now.” Other dismissive comments expressing doubts about both our abilities followed. Before I became more practiced working with challenging distancing defenses, I sometimes felt overcome by them, as if this work would burn up every cell of my body. The complexity of two psyches could overwhelm me. The intersections between our lives created reverberating waves of poignant and piercing feelings, memories, and associations. The search for coherence in our two narratives seemed to extend into infinity. And then a third dimension emerged, as a newly formed relationship took shape, an entity that was neither my client nor me but us. No wonder therapists can feel lost in a labyrinth. Some avoid this vulnerable experience by claiming to be sure of their knowledge. But the path of discovery benefits from humility.

Exploring the unconscious mind is akin to illuminating the layers in the sea where light does not penetrate. “These deep zones are where we find the most bizarre and fascinating creatures in the sea. As we dive into these largely unexplored places, the temperature drops and the pressure increases at an astounding rate” (Knight, 1998). At times, the chaos of the unconscious could hit me like a massive wave, with wild sea organisms laughing at my inability to tame or make sense of them. Our shared ventures in psychotherapy take us into far-reaching layers of the fascinating and foreboding emotional memory system. Being human, both therapeutic partners have suffered varying degrees of trauma. When we get too close to unresolved pain, the shaming furies hiss and scowl and belittle us into becoming small and unseen.

In the following vignette from a second session, Brian became aware of how his mother's hatred took root in him as a young child. I help him to recognize that I see him differently than she. This session precedes profound work that scares him and would have frightened me at one time.

Ct:There's this other part I would never—I'm not going to show. I mean, I want to show. It's like dying, really. It's like dying.

Th:Hmm. Hmm. So, you hide something so vitally important inside of you, even kill it off, and reveal only the parts you feel will be safe to show me.

Ct:Well, I feel really weak. Just really weak, innocent in a way, and so fragile, really. So fragile.

Th:Hmm. What's telling you that you're weak and fragile?

Ct:I have the idea I could break down any minute. Once this thing comes up, it feels like this wave that will take everything with it. And I'm just not safe (wiping away tears). I'm going to drown and also it's going to be too much for others as well (meaning me). I'm too much for the other person. It's too much. It's like, “Go away, please.” (I counter his shame by recognizing it with compassion. He finds comfort in being seen.)

Th:So, there's shame, a shame that you have when any of these overpowering feelings come up inside of you, as though your feelings are bad. And if they're seen by me, that I'm going to recoil, be disgusted, be overwhelmed.

Ct:Um, hum. Yeah. That's exactly right.

Th:Well, how about if we take a look? Do you see any signs of me reacting as you imagine? (Guiding him to check out his projection of my contempt and inability to handle his feelings).

Ct:(Chuckling) Okay. (He sees reality and the absurdity of his expectation.)

Th:What do you see?

Ct:It doesn't seem to be that way now, but I've not opened the gates.

Th:Of course. Well, why would you, when somewhere along the line, you've become convinced you're unsafe. What do you experience now with me?

Ct:You seem to be interested. My reactions don't seem to affect you negatively.

Th:Actually, I felt deep sadness when I realized how frightened you've been of your feelings since you were a young child. You link your feelings with being bad and assume you will overwhelm others who won't want you if you reveal yourself. It just felt very sad to me.

Ct:Yeah, so—

Th:Well, how does it seem to you when you look at that little boy's experience? (It's essential that he feels caring for himself.)

Ct:Well, on the one hand, it feels really sad to me too that he's still out there, still unacknowledged. And ashamed. And on the other hand, I want him to go away, just leave me alone.

Th:So, you see the part in you that rejects him, and it looks like it's coming from other people, like me. But Brian, something in you doesn't forgive or accept (said with tenderness).

Ct:Yeah. That's true. Yeah. I just, in a way, I hate that guy, you know.

His tragedy pierced me. Brian hated the child that he was. Facing the reality of his self-loathing impacted him. He agreed this had to change for our work to go forward, and he broke into sobs. To gain privileged access with a broad spectrum of people—those who shut down with shame like this man; others who push back by debating, dismissing, and belittling; and others who are consumed by anxiety—I would need bravery to speak straightforwardly about the barriers to closeness. In a short exchange, I addressed Brian's shame and his projections onto me. At an earlier time, I would not have been this clear.

For many years in my practice, I worked within my comfort zones. I made observations about my client's defensive system but failed to directly engage with it, resulting in sessions that left dysfunctional dynamics untouched. Recently a man ranted about the money he'd spent on his couple's therapy, barking that his wife hadn't changed in six months. He had anger toward our profession, which implicated our relationship. Today, I would be prepared to explore his feelings toward me, which proved to be fertile territory. Remaining in my head felt familiar and safe. I'd empathize with conscious feelings but had not discovered the path that led to the more significant unconscious emotions. I gave inadequate attention to bodily sensations and lacked a comprehensive understanding of their meaning. An example of how a therapist might skirt uncomfortable feelings occurred when I sought personal help when my mother was declining before her death. I felt overwhelmed. In the first session, I noticed butterflies in my chest and felt relief when the therapist did not draw attention to my bodily sensations. My physical discomfort embarrassed me. Yet those internal signals held the key to the necessary work that might have helped both my mother and me before she passed. Had I given voice to the fluttering in my chest, we might have uncovered my anger and desperation that she had given up on herself along with the rise of painful complex feelings.

Society and family pressure us to appear “put together,” and I found it difficult to admit, “I've got some wild feelings going off in my chest.” I needed my therapist's help to explore beyond the surface of my presenting problem. Could he have been intimidated to...

Table of contents

• Cover Page
• Half Title Page
• Endorsements Page
• Title Page
• Copyright Page
• Dedication Page
• Contents
• Foreword
• Acknowledgments
• Introduction: Sitting on Therapeutic Gold
• 1 The Warrior Therapist
• 2 I Don't Feel Like Feeling
• 3 Desire is the Engine of Treatment: Bringing Goals into Focus
• 4 Forging a Life-Altering Alliance
• 5 The Healing Triad: Bypassing Treatment Barriers
• 6 Shame is the Gatekeeper
• 7 Anxiety: Static on the Airwaves
• 8 Grappling with Guilt
• 9 Disarming Defenses Deftly
• 10 When the Dam Breaks
• 11 The People Whisperer
• Epilogue: Dynamic Emotion Focused Therapy (DEFT)
• Index