Emotion-Image Therapy. Analysis and Implementation
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11. Impacts and interpretations. At the moment when the doctor is sure that he understood the real cause giving rise to suffering, and the image of this cause is clearly manifested here and now, he can give his explanation [interpretation] of the problem. After that he offers the client to use one or another means of impacting [see below] the image of the cause to adequately resolve the initial dynamic conflict.
At this point the pace of the work and current feelings are very important, if you lose the moment the vital feelings will go away, the image will lose touch with emotions and the impact on it will be useless. For that reason, sometimes you shouldn’t spend time on interpretations. But it is quite necessary that the client agree to some actions with the image and take these actions himself in his inner world, informing about the results. The doctor assesses these results as confirming his hypothesis or disproving it. The work with the image goes on in the real- time, the doctor follows the dynamics of the client’s feelings and his psychosomatic reactions in the course of the impact. If the dynamics of the changes are positive, he offers to repeat the impact several times, until the full positive change of the image and the state is achieved. If the result is negative the doctor interprets it too, then this impact can be canceled and a new impact of a completely opposite meaning may be applied. But the reasons of the initial failure are analyzed and sometimes it turns out that in spite of the explanations and clear instruction, the client did everything in the opposite way. For example, the doctor asked him to accept the Inner Child but the client rejected it again. The reasons of such actions are again analyzed together with the client.
The interpretations are often given later when the correction is successfully completed. Though, when the individual work lasts long and consists of a number of séances, numerous interpretations and explanations are given, many impacts are made which let remove layers of psychological defenses and delusions one after another.
Different technics, which will be described below, may be used to correct the problem revealed. A special chapter will be devoted to these technics. They are used not automatically but according to the meaning of the problem. The methods of correction themselves are essentially emotional impacts, not just “technical” changes of images.
12. Working with resistance. A client is often resistant to realizing something about himself and changing it, even though he says he seeks self-knowledge and recovery. We have said already that in keeping with the principles used in psychoanalysis, we analyze the resistance itself. Usually we ask the client to create the image of what prevents him from understanding and changing himself. Then this image it studied as all others.
For example, a woman participating in the work of a therapeutic group, who usually answered my questions promptly and without thinking, suddenly started “to brake”. The reasons of that were not clear and I asked her to present an image of her “braking”. For some reason, it was the image of a three-year-old girl. Then I asked her to sit down on the chair where the image of the girl was projected and identify with it. When she did so her “braking” became even stronger, she stopped answering my questions altogether: why? what for? I guessed and asked: “Who are you braking for?” She answered at once: “For my grandmother!” Then I found out that at the age of three the girl was brought up by her authoritarian grandmother and resisted her by passive stubbornness. It turned out that her resistance to me as a doctor was the transfer of her resistance to her grandmother! In psychoanalysis, it is considered that the realization of the fact is sufficient for removing the resistance, but in actual fact it is not true, because the initial conflict is not resolved. Because of that we went another way, we offered this woman to tell her grandmother on behalf of the girl that she is clever enough and doesn’t want her grandmother’s lectures and pressure. After some repetitions the girl [and the client in the same person] felt full liberation from the grandmother’s influence and “the braking” stopped.
My student Irina Tabolina offered her original method of working with resistance. When the client, having identified himself with the image, doesn’t answer questions, doesn’t see the image and doesn’t feel anything, she asks him to stand up from the chair, move behind the back of the chair and tell who he is and who doesn’t let the client speak. If the client is still silent, he is asked to make another step back and stand behind the back of the previous imagined character. He is asked once again who he is and why he doesn’t let the client speak. This process sometimes continues as far as seven steps back. But sooner or later after one more step the client begins to speak, and then it becomes clear which parts of his personality or images of other people stopped him from moving forward. After that the resistance stops.
Other methods of work with resistance are also possible, for instance those which are traditional in psychoanalysis and in other therapeutic modalities. For example, you can praise the client for fortitude and resourcefulness that he displayed showing his resistance. You can say that he is awarded the honorary medal “Hero of Resistance”. You can conclude an additional agreement with him: “I will gain success in therapy even if my mother [my father] and my doctor don’t like it”. After that the resistance diminishes or completely disappears.
2. Creating the hypothesis
We have already said that the whole study of images is conducted proceeding from a hypothesis, that in some way emerges in the mind of the doctor. It is necessary to pay special attention to this process as everything depends on it. How does a hypothesis appear? This is a creative process and it can’t be fully discovered. But we can explain what a hypothesis is and define some important prerequisites for it to emerge as well as the procedures of its verification.
A hypothesis is a well-grounded supposition of the consultant about mechanisms and the psychological reason, that gives rise to the client’s problem. In the course of the work the hypothesis turns into a sure knowledge.
In literature, there is practically no information about how a therapeutic hypothesis is created. It is connected with the fact that, as it was said before, it is nearly impossible to describe the creative process that leads the doctor to his guesses. Besides a hypothesis is created on the basis of this or another theory, that’s why hypotheses may be different and the process of creating them differs in different schools. However, we will try to fill this gap as much as possible, despite differences in schools.
A well-formed hypothesis contains the answers to the following questions:
– What unrealized [frustrated] desire [or attraction] of the client gives rise to the problem under study?
– What is the nature of the barrier that doesn’t let achieve the desired?
– Which conditions or events of the client’s past were conductive to the origin of the conflict?
For example, a client has the fear of water. The imagined gradual plunging into the water showed that the fear comes when the water touches her throat. It seems to the girl that the water can strangle her. To the question if anyone ever strangled her in the past she answered in the affirmative: “A man attacked me in the dark park, tried to strangle me. But some people were passing by, so he got frightened and ran away”. She is afraid of dark alleys too.
The hypothesis is obvious:
a] the frustrating need of security;
b] the barrier to feeling safe and secure is her past experience, when the client couldn’t defend herself, felt helpless and frightened. The fear materializes in the situations which, by association, make her remember the trauma [water touching her throat or dark alleys];
c] the event that caused the fixed state of fear – the attack of the maniac who tried to strangle the girl. The memories don’t come by themselves probably because they were ousted, the emotions are experienced without the realization of their connection with the initial situation.
The final check of the hypothesis happened after using the method of restructuring of the past experience. For this purpose, the client was asked to imagine herself to be strong, invincible and doing with this scoundrel all she wants. She beat him till felt fully satisfied, and he [in her imagination] didn’t run away. She felt that she was not afraid of him any longer, the imagined plunging into the water didn’t frighten her either. In her mind, she could plunge into the water not only to her throat but even with her head underwater and she didn’t have any fear. This confirms that the hypothesis and curing actions were correct.
This case is quite simple to analyze, that’s why it is given here as an example. But even here you can notice that there appear some new aspects of the hypothesis. For example, the idea is raised in what way the past experience gives rise to fear and why the client remembers only emotions and not the traumatic situation.
A hypothesis can have many additional ideas explaining:
1] in what way inner psychological conflict originates symptoms;
2] what the meaning of every symptom from the viewpoint of its place in the structure of the problem as a whole is;
3] why the client doesn’t understand some psychic phenomena;
4] in what other way the inner problem can tell on the client’s life;
5] what forms of adaptation the client uses to avoid facing the problem;
6] what he gains from the existence of the problem;
7] how the problem is connected with the character of the client of some particular features of his parents’ family and so on.
For example, if you answer points 1—4 about the previous story, you may suppose;
1] that the client has distorted relationships with men;
2] that she doesn’t only refuse to go into the water bur develops a pseudo theory that something is “happening with her head”;
3] that she has a closed character, that’s why she didn’t tell anybody about the attack;
4] that she displays a helplessness complex in other situations and so on.
You can verify these suppositions asking the client additional questions, but they may be unnecessary because the main reason is clear and the treatment has taken place.
The given example, however, doesn’t reveal the process of creating the hypothesis, you may say that it just “fell” in the hands of the doctor practically in the form of clear knowledge. So, we should reveal not only what the ideal form of a hypothesis should be but also how it is created and checked.
1. First and foremost, the basis of creating a hypothesis is a certain psychotherapeutic theory. It may be psychoanalysis, Alfred Adler’s theory [30—32], transactional analysis of Eric Berne [33—36], gestalt therapy [37—39], Victor Frankl’s logotherapy [40], and so on. Usually a doctor naturally advocates one definite concept and creates a hypothesis in the frameworks of concepts used in it. But he may use another theory most suitable to explain the given case. Such eclectic approach seems to be most sensible at present.
2. The awareness of the so called particular models facilitates the search for an adequate hypothesis. These models readymade theoretical constructions which exist in scientific psychotherapeutic world. They explain the origin of different symptoms. The doctor tries the patterns known to him to explain the phenomena he faces and chooses the one that is most suitable, checking it by asking test questions. A lot of such models are described in my book “Psychological counseling. Theory and practice” [5].
3. The knowledge of different therapeutic cases also helps the doctor. New cases may be somewhat similar to those he had in his practice before. Or it may remind those he read about in literature. Or those he watched in the work of other professionals, for example when he studied in a group.
4. His own practice of being a client in the course of the so-called learning therapy. He solves many problems by analogy with problems he solved before, using the whole arsenal of methods of the professional instructing him. Gestalt therapists joke that “the client always brings us our problem”. For that reason psychotherapy cures the psycho-therapist himself, and curing the client is a by-result. But there is more truth than humor in this joke. The doctor always applies the client’s problem to himself, if he can solve it for himself he will solve it for the client too.
5. The doctor is also helped by broad erudition, the knowledge of philosophy and religion, just great life experience, being familiar with various life collisions and people’s characters.
6. The doctor is led by intuition, his ability to empathy, using the feeling of emotional resonance with the current state of the client, his ability to put himself in the situation of the client, being attentive to details, meditations leading to insight.
7. Finally the doctor must be very shrewd and have a great intellect. His work at the stage of creating a hypothesis is like the work of an investigator. Among detectives you can meet a Sherlock Holmes and a useless Lestrade, the same may be true of doctors. You should train your professional and psychological thinking.
8. But probably the most important thing that helps a doctor is the skill of looking for “evidence”. In psychoanalysis this is the method of free associations and dream analysis, in A. Adler’s therapy it is the analysis of early memories, in therapy through emotions and images it is the work with the images of emotional states, in cognitive therapy this is registration and analysis of automatic thoughts and so on.
A ready hypothesis originates very seldom. At first it is very vague, then is verified and checked. They are collected as parts of a mosaic from very different sources. To collect them you use various methods allowing to extract the necessary information out of the subconscious world of the client and from the anamnesis. But you should remember that you can get part of the information by asking simple questions about the life story of the person. A client may deliberately hide some information, he may distort some information, and he may simply not know something about himself. We gain some information watching his non-verbal behavior, and some we “calculate” analyzing the facts given by the client.
We have already mentioned that in the EIT the main source of “evidence” are images produced by the client, when he is asked to imagine how feelings and emotions look. For example, a girl complains about the pain the whole left part of her body. She is asked to create the image of what causes this pain. In surprise, she said that she saw her father who is shouting something in her ear and she didn’t want to hear it. The reason of her psychosomatic state becomes quite clear, though you can still ask her many questions clearing up her relations with her father and thy will probably take us to her distant childhood. To correct her state, I asked her to offered her to tell the image of her father: “Shout, shout louder, I want to hear you better!” In surprise, she confirmed that “the father” calmed down and the pain she felt passed. Because the pain originated from virtual struggle with the opinion or her father whom she was afraid of. When the struggle stopped, the pain disappeared.
But whatever method a doctor uses he collects the necessary and sufficient information about how the problem reveals itself at present and in the life story of the client and tries to make one whole of it from the point of view if cause and effect. If the picture he created lack some parts, he asks additional questions to fill these gaps. All methods like those of free associations of creating images are just ways to ask the right question. The task is to get answers to key points of the hypothesis, enumerated above, which must be revealed.
Let me give an example that will show clearly the stages of creating a hypothesis and its verification, besides it illustrates our principles of working with the problems of “the Inner Child” [see below].
Fig. 4. Creating a hypothesis with the help of theoretical structures unites in one system: symptoms – emotions – images – inner conflict – past events – chronic negative state.
Example 9. “A nasty rat”
At a seminar a student asked me to help her solve her problem. She dealt with gestalt therapy, asked the gestalt therapist to help her, but he failed and she was disappointed. She agreed to solve her problem in the presence of all her student groupmates. She complained about feeling inner weakness, apathy, but her main symptom as she thought was “the fear of her stomach”. In other words, there were some unpleasant feelings hidden in her stomach, like some tension, some fear and these feelings became stronger when somebody touched her stomach, even if tis somebody was a friend. She struggled with this feeling she even made a hole in the area of her navel for a ring, but nothing helped. She was also tortured by the thoughts whether or not she would be able to have children in future [she was 20 years old and not married yet]. Let’s call her Kate.
I asked her to create the image of this “fear of the stomach” on the chair in front of her. She said at once that it was a nasty dirty rat with a long tail. The rat wanted to eat something in her stomach, some black spot. It was this spot that was afraid! So the symptom [it was fear] turned into an image.
– Ask her why she is doing it?
– For me not to exist…
– Why is it necessary that you not exit?
– It simply wants me not to exist…
– Why?
– Because I am unnecessary, not wanted…
Commentary. Evidently, “the rat” expressed the hidden desire of the girl to die [the hidden suicide]. Most often it appears under the influence of something the parents say or do, which have the meaning “don’t live”. The feeling that that you are not wanted is the result of those words or actions. What was left was to learn how it happened…
– Tell me since what time and why you feel not wanted?
– Always. Because my parents didn’t want to have me, I was not planned, my mother wanted to make an abortion. I was the last born, extra, they had had children already, they didn’t want any more children. The more so because when I was born they had a very hard time, they had very little money. Later, though, they all loved me and they love me now, love me very much both father and mother. Nevertheless, I am always trying to oblige them, to make them like me, to justify, somehow, my existence. [The hypothesis is confirmed].
– [Addressing the students] In theory we call it “the myth of birth”, I told you about it in my lectures. The child takes on himself the guilt for his being born “at the wrong time” or for “the wrong birth”. As a result, depression and hidden desire of suicide emerges. In fact, you have already said about your desire not to exist…
– I am ashamed to admit that it is true. At the same time I understand that it is not right. [The hypothesis is confirmed]
– Do you understand that the rat is doing in your stomach exactly what your mother didn’t do? I mean the abortion – the rat is biting out the ovule that is frightened?
– Yes, I understand… [The hypothesis is confirmed]
– Do you want to get rid of autoaggression, embodied in the image of a rat?
– Yes, certainly! But I don’t know how…
– In this case I recommend you to tell this rat, that you will not destroy it or send it away or reject it. Tell it that it is good, and you accept it as it is, that you need it. Tell: “You are a very necessary for me rat”.
Commentary. By that time everything had become clear and the hypothesis became certainty. The symptom turned into the image of a black spot and a rat showed the conflict, the reason of the conflict was confirmed by memories about the corresponding events in the client’s childhood, which generated the chronic feeling of being not wanted. This feeling pushed the client to the hidden desire of the suicide and “the fear of the stomach”. The recommended impact must remove the chronic feeling of being not wanted and then all other consequences. The rat is the image of a rejected child who makes a symbolic abortion for the beloved parents. The whole of this scheme corresponds to the theory of Mary and Robert Goulding [34], students of Eric Berne, about the emergence of depression and a hidden suicidal desire.
– Shall I tell it aloud or to myself?
– Better to yourself… But tell me what is happening to the rat while you are telling it this.
– [She is working for some time in a concentrated way.] The rat is getting smaller.
– And are you feeling better or worse? In the stomach?
– Better…
– Then keep on telling it the same words…
– [She is working for some time.] Now there is a puppet instead of the rat.
– Do you like it?
– It is very nice.
– Oh! Your eyes started shining! How are you feeling?
– [Confused, but smiling happily.] Very well. I don’t know why, but I feel hot, as if something warm entered me.
Commentary. A warm attitude to yourself which tells even on the physiological level returns.
– Do you like this puppet? Do you agree to accept him for good, as a part of your personality?
– Yes, of course!
– What are you feeling in the stomach area?
– Excellent! No tension. The feelings are fine.
– Imagine that somebody touches your stomach, young man, for instance…
Commentary. This is the verification of how actual the changes are with the help of an imagined situation. The hypothesis was confirmed once and for all.
– [Looking confused.] Everything is fine. No bad feelings.
– Do you want these changes to remain with you forever?
– Certainly, I want it very much.
Commentary. The sincere consent of the client is sufficient for a final fixing of the results. Now explanations may be given, they will not cause resistance.
– Now I’ll explain to you what happened, if you don’t mind… There happened the rejection of the Inner Child as the result of your feeling yourself not wanted and not needed. The Inner Child began realizing the subconscious desire of self-destruction, that is abortion. So the Inner Child turned into a repulsive aggressive rat, attacking your stomach, and the stomach instinctively became tense. That is why you started to doubt if you will be able to have children. Now that you accepted your Inner Child it became your friend, autoaggression stopped, the tension disappeared. This is actually all…
If you have questions or doubts about the results, we can continue…
– No, everything is clear. I feel fine and I know that I will like that in future… I turned to another doctor and was very disappointed. Thank you so much, I didn’t believe it was possible.
– Well, wonderful, then the séance is over.
In about two weeks I asked her how she was feeling and got another confirmation that everything was all right.
Commentary. The séance took 15—20 minutes, we solved the problem that was a most important problem for all the further life of Kate. A year later Kate gave birth to her first baby and came to her classes with a pram.
3. Verification of a hypothesis
The verification turns the hypothesis into a certainty. When the hypothesis is fully formed, it may be explained [but you shouldn’t do it every time] to the client. The confirmation of the hypothesis by the client is an important proof that it is correct. But the doctor can find some confirming arguments by other means too. It may be particularly important when your hypothesis may antagonize the client or elicit his strong resistance, in this case you shouldn’t share it with him
The doctor can “calculate” the consequences of the problem in different areas of the client’s life and make sure that he is right by asking questions. For example, if you suspect that the client suffers from some obtrusiveness, you can ask him if he does some senseless rituals to protect himself from some accident of if he suppresses his sexual thoughts. The client may confirm he is surprised by you being so shrewd.