from symptom to self in experiential therapy

8/2/2019 From Symptom to Self in Experiential Therapy

1/16

94 Person-Centered and Experiential Psychotherapies, Volume 8, Number 2

From Symptom to Self in Experiential Psychotherapy

Depestele 1477-9757/09/02094-15

Frans DepesteleAarschot, Belgium

From Symptom to Self inExperiential Psychotherapy

Abstract. In a symptom such as a severe inner critic, part of the self is occupied by an urge (the critic)while another part of the self (the criticized part) is prevented from speaking. In this article an attempt

is made to describe the experiential therapy process by which the occupied part of the self may becomefree and the prevented part of the self gets the opportunity to develop itself.

This therapy process is described as a series of differentiated steps and substeps, developing in acertain order. The interplay between symptom and self is explained and explored in a way that makesvisible important leads for experiential therapy work, in which what was symptom may become new self.

Keywords: symptom, self, experiential psychotherapy, therapy steps, urge, trauma

Vom Symptom zum Selbst in der experienziellen PsychotherapieBei einem Symptom wie dem harten inneren Kritiker ist ein Teil des Selbst mit einem Drang besetzt(dem Kritiker), whrend ein anderer Teil des Selbst (der kritisierte Teil) nicht reden darf. Dieser Artikel

versucht, den experienziellen Therapieprozess zu beschreiben, durch den der besetzte Teil des Selbst freiwerden kann und der blockierte Teil des Selbst die Mglichkeit bekommt sich zu entwickeln.

Dieser Therapieprozess wird als Serie voneinander abgegrenzter Schritte und Teilschritte beschrieben,die sich nach einer bestimmten Ordnung abspielen. Das Wechselspiel zwischen Symptom und Selbstwird erklrt und auf eine Weise erforscht, die wichtige Anhaltspunkte fr experienzielle Therapiearbeitsichtbar macht: Wo Symptom war, kann neues Selbst werden.

Del sntoma al self en psicoterapia experiencialEn un sntoma tal como una parte del severo crtico interno del self es ocupado por un impulso (elcrtico) mientras otra parte del self (la parte criticada) se ve impedida de hablar. En este escrito intentamosdescribir el proceso de terapia experiencial por el cual la parte ocupada del self puede liberarse y la parte

impedida del self tiene oportunidad de desarrollarse.Este proceso de terapia se describe como una serie de pasos y de sub-pasos diferenciados, desarrollndose

en cierto orden. La interaccin entre el sntoma y el self se explica y se explora de una manera que hacevisible importantes iniciativas para el trabajo en terapia experiencial, en el cual lo que antes era unsntoma puede convertirse en un nuevo self.

Author Note. Address for correspondence: Frans Depestele, Grotstraat 100, 3200 Aarschot, Belgium. E-mail:[email protected]


2/16

Depestele

Person-Centered and Experiential Psychotherapies, Volume 8, Number 2 95

Du symptme au self dans la psychothrapie exprientielleDans un symptme intrieur tel quun juge intrieur svre, une partie du self subit une pression (lejuge) alors que la parole dune autre partie du self (la partie critique), est empche. Cet article tente dedcrire le processus de la thrapie exprientielle par lequel la partie oppresse du self peut se librer et lapartie empche peut se dvelopper.

Ce processus thrapeutique est dcrit comme une srie dtapes et de sous-tapes diffrencies, qui

voluent dans un ordre particulier. La description du jeu dinter-relation entre le symptme et le self estexplicite et dveloppe pour dmontrer des pistes importantes dans le travail de psychothrapieexprientielle : lancien symptme peut alors devenir un nouveau self.

Do sintoma ao selfem psicoterapia experiencialNum sintoma como uma crtica interna e severa do self, parte do self invadida por um impulso (ocrtico), enquanto a outra parte (aquela que criticada) impedida de se expressar. Neste artigo procura-se descrever o processo da terapia experiencial, atravs do qual a parte invadida do self pode libertar-se ea parte inibida tem a oportunidade de se desenvolver.

O processo teraputico descrito como uma srie de etapas e sub-etapas diferenciadas, que sedesenvolvem segundo uma determinada ordem. O interface entre o sintoma e o self explicado e explorado

de tal forma que traa de forma evidente pistas importantes para o trabalho da terapia experiencial, noqual aquilo que foi inicialmente um sintoma pode vir a fazer parte do novo self.

Van symptoom tot zelf in experintile psychotherapieIn een symptoom zoals een strenge innerlijke criticus is een deel van het zelf bezet door een drang (decriticus) terwijl een ander deel van het zelf (het bekritiseerde deel) niet kan spreken. In dit artikel wordteen poging ondernomen om het experintile therapieproces te beschrijven waarbij het bezette deel vanhet zelf vrij kan worden en het onderdrukte deel van het zelf de gelegenheid krijgt om zich te ontwikkelen.

Dit therapieproces wordt beschreven als een reeks gedifferentieerde stappen en substappen, die zichin een bepaalde orde ontwikkelen. De wisselwerking tussen symptoom en zelf wordt op zon manieruiteengezet dat belangrijke leidraden zichtbaar worden voor experintieel therapiewerk, waarin wat tevorensymptoom was nieuw zelf wordt.

INTRODUCTION

In this article I want to show: first, the different aspects of the structure of a symptom, andsecond, how these different aspects may be approached therapeutically in an experientialway. What I say comes from my own clinical experience, it does not claim generality, and itonly intends to present a certain way of considering a symptom, which may be helpful intherapy.


3/16



First I want to clarify that by using the term symptom, I do not mean the traditionaldefinition of that term, namely sign of a disease. Let me illustrate this with an example.

A clients reaction to a painful experience is: I must be able to accept that. The clientsdaughter leaves for Paris for three months, and the daughter had not been willing to spendher last evening with the client. This was so painful for the client that she took pills, drank,

and then went for a drive in her car. Nevertheless, in the session, she demands of herself: Imust be able to accept that and she does not attend to the other side of her experiencing,where she would feel the pain ofthat. Somehow she blocks herself.

This is a description of a symptom from within the process. This is different from anexternal description of signs, for example, of depression or of cognitive deficits of a client.

SYMPTOM

Symptom and self

In the example we see that the experiencing process is constrained. In the internal relationshipof the person with his or her self, a lot of symptoms that clients present in therapy seem to havethe following structure: a part of the self is occupied by an urge (e.g., the urge I must be able toaccept that) while another part of the self is prevented from coming into existence and speaking(e.g., is prevented from experiencing the painful that). This is what happens tothe self.

With regard to the sympton, a sympton may be considered as having two sides: on thefamiliar side there is an urge, on the scary side there is an avoided pain. We can see thiswith the mother who says: I must be able to accept that. This demand or urge comesalmost immediately. It does not leave the self free to take a moment and to pause at the spotwhere the painful meanings of the situation could be felt. The urge is similar to what Gendlin

calls a terrible tendency where he writes: [P]eople have the terrible tendency to give upon what is inside (Gendlin, 1974, p. 215).

The urge constrains the self. It immediately occupies the part of the self which we maycall the usual selfbecause it is the part of the self one is used to, the part with which one isfamiliar in regard to a particular symptom. This is in contrast with the other part of the selfthat one is not used to. We may call this the other selfmore because it belongs to the other sideof ones self, the side that one is afraid of, that one wants to avoid. The urge is on the side ofthe symptom we are familiar with. I will refer to it as thefamiliar side. The other side is thepain side of the symptom, which is avoided. I will refer to it as the scary side.

Changes of the self and changes of the symptomSo we have four elements: usual self, other self, urge (familiar side), and avoided pain (scaryside). Let us continue with the example of the mother. Her usual self is immediately occupiedby the urge I must be able to accept that and this occupied usual self prevents her fromaccessing the scary side and feeling the pain. The mother neither pauses nor makes a space forexperiencing the painful that. The reason for this inner avoidance seems to be that just feelingthe same pain again and again does not lead to progress or change. Nevertheless, the lurking


4/16

Depestele


pain and avoidance of it are part of the symptom (we can also use the term trauma as ageneral term for the pain side of a symptom), while finding an experiential way of accessingand working with the pain side will be part of the therapy. So the usual self is occupied, andthe other self is prevented from coming into existence.

Correspondingly, the aim of therapy will be to free the occupied part of the self, and to

allow the suppressed

or prevented part of the self to emerge. So the aim is two-fold: to freeoccupied self and to let new self form. The therapist may propose to the mother: Okay, wehave heard the part that said I must be able to accept that. But behind that I also hearanother part in you that has much difficulty in accepting that: (1) Can you make yourself freefrom the demand that you must be able to accept that?and (2) Can you ask inside What isthat other part feeling? Can you create a free space inside for that other part? By doing sothe usual self becomes free, makes a free space for the other self, and the other self can speak.These changes of the self go hand in hand with changes of the symptom.

Further characteristics of a symptom

Many symptoms seem to be made up of an addressing component and an addressedcomponent (Depestele, 2006). When a severe inner critic is at work, the critical part addressesanother part of the experiencing, which is criticized and suppressed; the usual self agrees withthe critic and repeats the blames over and over (occupation), and the other self receives theseblames and is in pain. In a symptom such as a repeated urge to ask others for reassurance, wesee that uncertainty is relieved by reassurance. Or when there is an urge to reassure his or herself, the client is addressing his or her self with reassurance, therebyavoiding the anxious partof his or her self. The urge may be a desire to control everything, an urge to overeat, or adelusion (a psychotic experience substitutes for a more unbearable experience).

In many symptoms it seems that an urge comes up which occupies the usual self and

makes it say things like, I must be able to accept that. Thereby the occupied usual selfaddresses and manipulates the other side of the self into hiding, and prevents it from becomingable to feel and to explore the experienced painful situation. It prevents the client fromputting into words the experiential nuances that are implicit in the experienced painfulsituation, in the whole painful that.

THERAPY

In our discussion of therapy, it must first be specified that the creation of a symptom occursin the internal relationship of a person with his or her self as we have seen in the example ofthe mother above. Another example is the inner critic on the one side and the pained,criticized part on the other side. If we accept that a symptom originates at the reflective levelof coping with oneself (the reflective space: Depestele, 2004), then eventually we must dealwith it at that level.

Although a symptom is created at the inner level of coping with oneself, it usually revealsitself in the relationship with the clients relatives (e.g., the client with obsessive doubts always


5/16



asks their partner for reassurance). The symptom also may reveal itself in the relationshipwith the therapist (e.g., the client asks the therapist for reassurance). Therefore, often muchwork is needed on the therapeutic relationship (e.g., the therapist doesnt give reassurance)before the inner therapeutic work becomes possible (it becomes possible to help the client toexplore the anxiety which comes to the foreground).

This paper will now focus on this inner work. We can define this part of therapy aschanging the interplay between symptom and self: The self mustget freeagain as far as it isusual self and occupied, and it must develop itself as far as it is other self and prevented. Ofcourse this inner work alternates with relationship work; they are not clearly separated. In therelationship work the therapist helps to process problems in the external relationship betweenclient and therapist. In the inner work the therapist helps to process problems within theclients internal relationships. Although presence remains the main attitude here, the therapistwill act sometimes also as a guide.

A series of steps and substeps can be distinguished in this process, which may develop ina certain order (Table 1). I will elaborate them, and illustrate some of them with brief examples.

This scheme of steps and substeps is the result of my personal development of thinking andpracticing experiential psychotherapy as originated by Gendlin (Depestele, 2004). It ispresented here as a hypothesis, open for research. It has several points in common, but alsodifferences, with some process-experiential practices (see Elliott, Watson, Goldman, &Greenberg, 2004). It would also be interesting to compare this scheme with the literaturethat studies the dialogical self and internal multiplicity in psychotherapy.

Table 1Summary of therapy steps and substeps

1. Brief contact with both sides: brief awareness1.1 of thefamiliar sideand of the occupation

1.2 of the scary sideof the symptom

2. Usual selfdifferentiatesfrom urge

2.1 Becoming aware of occupation and sensing occupation

a) becoming aware of occupation

b) sensing characteristics of the occupying urge

2.2 From occupied to neutral position

a) bringing usual self in a process of differentiation from occupied position

b) from content to form of the urge

c) making a free space both for urge and usual self

d) unoccupied innerlistening

3. Usual selflistensto urge

3.1 Inviting thefamiliar sideto speak in a new manner


6/16

Depestele


3.2 In the new listening environment thefamiliar sidewill be able to develop further

4. Usual self now turns to and differentiatesfrom the scary sideof the symptom

5. Usual selflistensto the scary sideof the symptom

5.1 Eventually we must get to the scary sideor pain side of the symptom

5.2 Overcoming anxiety for the scary side

5.3 From scary sideto other self

5.4 Going directly from thefamiliar sideto the scary side

6. Integration of all that which came into a new-and-advanced self

6.1 Results of the previous work

6.2 Dialogue between thefamiliar sideand scary side, facilitated by usual self

6.3 Other self and usual self integrating

1. Brief contact with both sidesIf possible, we first briefly contact both sides of the symptom. The client momentarily recognizesthat there are two sides and glimpses both for the first time.

1.1 Brief awareness of the familiar side and of the occupationC (client): I must be able to accept that.T (therapist, after acknowledging, may say): Can you just sense the must for awhile?

1.2 Brief awareness of the scary side of the symptomT (after acknowledging, may further say): Can you make a space for the whole painfulthat?

After this brief contact, the client may choose which side to continue with. The familiarside of the symptom is often selected.

2. The usual self differentiates itself from the urge

2.1 Becoming aware of the occupation and sensing the occupation

2.1a Becoming aware of the occupation

Being occupied is often so familiar to the client that he or she is unaware of it. The clientis just suffering and mostly does not know from what exactly. Simply becoming aware isan initial avenue to the experiential level. It is a first experiential discovery.

A client with obsessive problems after becoming aware that she was timing everysingle action (e.g., the whole weekend was planned, almost to the minute) saidthat she felt good in doing this timing and planning. She said: Everything isperfect, except these moments of anxiety and even panic.


7/16



The therapist proposed to her: Try once, as an experiment, to prepare a mealby following your feeling and not by following the clock to the second for eachseparate action. After this experiment she changed that habit.

Because the clients self is occupied, the therapist will usually be the one who notices thatan occupation is occurring. The therapist may just reflect this aspect, or he or she may tryto direct the clients attention to it.

The therapist invites the client to describe how he locks up his office at the end of theweek on Friday evening and then the client discovers that he cannot leave withouteverything being meticulously in order.

Gendlin (1996, p. 257) provides a nice example of becoming aware of an occupationand the felt difference it may give:

C: Thats my personality, formed then. Nothing I can do about it.

T: Thats not your personality.

C: What is it then?T: Thats whats in the way of your personality.

C: (Long silence) I can feel the green on the other side of this! Free for seeing and hearing and

sunlight. It feels like ice melting.

2.1b Sensing the characteristics of the occupying urge

Gradually the therapist may help the client discover that the inner tendency or theoccupying urge is not only familiar, but that it is also always the same; that it repeats itself;that it is blocking and giving a bad feeling; that it is addressing, leading, and dominating;that it is stronger than the person in some way. It is stronger in the sense that it comes

almost immediately, as an automatic reflex,without the person being aware of its coming,quicker than the person can cope with. It is stronger in the sense that it catches andcontinues to occupy the person.Example that illustrates the immediate reflex of the urge:

C says: [When I am faced with an expectation or a task] I have already said yesbefore I have thought.

Example that illustrates the strength of the urge:

One client, referring to his fast-paced and overbooked lifestyle, said: I see myselfdoing it, but I keep doing it.

Each of these aspects, when the client realizes it, may give him or her a sense of discovery.In order to be discovered or sensed, such an aspect needs a moment of inner attention.

2.2 From occupied to neutral position

2.2a Bringing the usual self in a process of differentiation from the occupied position

The therapist helps the client who is occupied to find ways to sense something like: This


8/16

Depestele


urge is not entirely me; it is only part of me. I feel occupied by it, but I amdifferentfromit. With a client who is occupied by the urge to get reassurance, for example, he or shemight include: I am more than that wanting and asking for reassurance.

The therapist tries to bring this difference to the foreground. He or she tries to use aprocess of differentiation to bring the usual self from an occupied position to a free

position.

The following are some examples of attempts to differentiate:

With a delusionalclient the therapist may reflect, You are completely convinced ofthese ideas and reasonings. Or, to evoke the sense of occupation the therapist mayreflect: These ideas and reasonings have persuaded you completely. In these reflections,at least the therapist distinguishes a familiar side (these ideas and reasonings) and aself (you).

This example concerns a hallucinatingclient, who is psychotic and suicidal at themoment. She says that the voices of her parents command her to join them: I haveto go with them to the great hotel [to commit suicide]. The voices say that she hasto obey. She has a strong tendency to obey, but now and then she also says: I want tobe left in peace. This last sentence is very important and the therapist grasps thischance to plant a seed for free self, by reflecting: There is a sense in you that says thatyou have to obey. And apart from this first sense, there is a sense in you that wants tobe left in peace. She confirms this clearly.

Now the therapist tries to fortify this second sense: Dont struggle against the firstsense; just give attention to this sense (of wanting to be left in peace). And feel that atleast the voices are not able to reach this. They can press you with much force, but

they cannot reach this sense; because this is yours, this is one hundred percent yoursense. The client tries it and it seems to give her some relief.

2.2b From content to form of the urge

We can find a way for the usual self to approach the urge from a neutral position bymaking a distinction between the content and the form of the urge. When I sayneutralposition, I mean neutral in the sense of neither agreeing nor arguing (see below).

The usual self can go from the occupied position where it obeys and follows the contentof the urge to the neutral position where it reflectson the form of the urge. For example, theusual self goes from agreeing with the urge that says You are useless to reflecting on the

demanding, dominating, and blaming way that the urge delivers this content.This is already a brief moment of independence and freedom, and from there theusual self may start to interact with the urge, instead of just undergoing it.Example of such an attempt by the therapist (same client with hallucinations):

C: They [the voices] are right: I am useless (= content; the message)T: But you find it interfering that they are troubling you and pressing you?(= form; the way in which)C: I dont know.


9/16



2.2c Making a free space both for the urge and for the usual self

For example, imagine that part of me wants to get reassurance. I can be in that part. Butnext to that, I may want to be free from that urge to get reassurance. I can have a clearsense too of the wanting to be free from that.

In order to achieve this, I may say inside: The part that wants reassurance may exist;

it may exist on its own. I say that, not as the occupied self who just agrees with that part,but as a more or less free self who can acknowledge that part. Saying and sensing the partthat wants reassurance may exist is giving it a free space, at the same time as it is givingmy usual self a free space. Through this inner act I make a space for that part thereand afree space for my usual selfhere. The wanting reassurance is thereand the wanting to befree from that is here. Both may exist.

In the space here, I feel free from the urge. From hereI can have a bodily sense (and itis vital that I feel it bodily) of the wanting reassurance being there. I have found a newposition: before I was occupied by the wanting reassurance, now I can relate to it.

2.2d Unoccupied inner listening

The client tries to get a free space for the usual self from where it can listen to the urge, tothe familiar side of the symptom. The usual selfs new listening relationship with thefamiliar sidecorresponds with what Weiser Cornell (2005) calls being with (p. 57) orpresencein focusing and experiential work. For example: first I was occupied by thewanting reassurance, now I can relate to it. First I was occupied by the urge, now I can bewith it. First there was a being occupied, now there is a being with. She defines presenceor being with an inner feeling as keeping [it] company without doing anything (p. 57),as well as an effort to not to argue or agree (p. 81).

Presence or being with can be attained by different means. One is language. A clientwho says This is stupid about something he or she thinks, may also be saying: I amsensing something in me that says this is stupid (Weiser Cornell, 2005, p. 114). Thisdifferent phrasing may give the client a different feeling. In the new phrasing the usualself gives it a distinct space as being something that at the same time as it gives itself(I) a free space. The usual self reflects on the critical agency at the same time as it freesitself somewhat from its occupation.

3. The usual self listens to the urge

3.1 Inviting the familiar side to speak in a new manner

By taking up the new position (see 2.2d) the usual self tries to become a listener, forexample, a neutral listener to the critical agency. The usual self is no longer that part of theself that being occupied agrees with the blames and repeats them over and over, andit also is not the other self that receives these blames. Now it is a neutral listener to thefamiliar side or urge.

Thus the usual self is no longer a representative of the blames of the critical agency buta listener to the motives of that agency, to its good reasons (Weiser Cornell, 2005, p. 55;


10/16

Depestele


see also Stinckens, Lietaer, & Leijssen, 2002) for being critical. It is no longer a representativeof the explicitexpressions of the critical agency (the blames themselves), but a listener tothe implicitintentions of that agency (the underlying motives or concerns of the blamingagency).

By becoming a listener, the person makes a free space for the familiar side (e.g. the

critical agency). Saying and sensing the familiar side may exist, gives the familiar side afree space at the same time as it gives the usual self a free space. Because the familiar sidehas something to say, it may exist in a free space, where it can express itself in a newmanner, not in its usual manner.

In order to be able to speak in a new manner the familiar side (the urge) needs theusual self as a neutral listener and no longer as the representative of its explicit messages.Weiser Cornell (2005) further defines presence or this inner listening as: not trying tochange what we find, but only to hear it, so that it can find its own change if it needs to (p.112). I would add here: trying to hear it and therefore trying to give it space so that it can speak.

The therapist may ask the client: Can you make a free space both for what the

familiar side is right now, and at the same time a free space for your self, listening to thefamiliar side in an open-minded, nonjudgmental way?

3.2 In the new listening environment the familiar side will be able to develop further

With this attitude the usual self tries to listento all that the familiar side has to reveal. Inthe new listening environment the familiar side may now be able to reveal its implicittendencies instead of just repeating its explicit messages, and thus it will be able to developfurther.

In this listening, the important point is not so much that the usual self can hear

everything, but that the familiar side can speak: that it can symbolize and thereby carryfurther what it wants to resolve. It is important that it can speak as completely as possibleits concerns, its sources, its desires, and its good reasons.

Example:A client speaks loudly in the session. This is not a habit of hers. There is somethingcompelling in it. The therapist invites her to pause and look for its motive. She saysshe recognizes the speaking loudly which is the familiar side of her symptom and she says that often she has the experience that people dont like her: In a group ofclassmates I am never accepted. The motive of the familiar side is: I am afraid that

others will ignore me. I must continuously block the tendency to impose my presence.Later she translates this tendency into the tendency to force my belonging, the tendencyto make sure that I am certainly not left out.

In order to help this revealing and speaking, the usual self can ask inviting questions. Forexample: What is the criticizing part afraid of? What does it not want for me? What doesit want for me? (Weiser Cornell, 2005, p. 120). The usual self must receive all that the


11/16



familiar side explicates. It must acknowledge each aspect that is revealed, make a freespace for it.

When the familiar side explicates its implicit intentions, it is no longer speaking in itsusual way, namely e.g., criticizing or speaking loudly. Something new happens. Beinginvited to speak brings some change in the familiar side and thus entails another interaction

of the familiar side with the usual self(less occupying) and thus indirectly also anotherinteractionwith the scary side(less addressing).

So there is a change in the familiar side and in the usual self; the difference will be feltbodily. The tendency and force of the familiar side to occupy the usual self will diminish:the urge will calm. Then the usual self, being freer and having acknowledged and takenin to some extent the developed implicit intentions of the urge, will be somewhat moreable to go to the scary side or the pain side of the symptom.

4. The usual self now turns to the scary side of the symptom and first differentiatesitself from it

The usual self turns to the pain side of the symptom, which was avoided before, anddifferentiates itself from it. For example, the pain side is: feeling inadequate. A phrase likeI feel inadequate shows that the usual self is identified with the criticized part. There isno difference between the I and feeling inadequate. The client may change the phraseinto Im sensing something in me thats feeling inadequate. This may feel different.

Means other than language can also help with differentiation. For example, a girl Iona(name changed), who has been assaulted, cannot speak about some things that happenedduring the attack. She feels much shame. The therapist invites Iona to treat herself as shewould treat her best friend: Imagine that Iona is your best friend, and she has had such anexperience. Imagine that you do everything to make it comfortable for her so that she cantell it to you, so that she really can come home with what she has experienced. Whensomething awful happens to us, we need to be able to come home with it and tell it to ourfellows. Can you make a warm and safe place for Iona so that finally she can come homealso with this part of the story, the most difficult and emotionally charged piece of herexperience? The girl succeeded in working with this configuration. With the help andpresence of the therapist she was able to invite Iona to talk about all of what the shame isabout, and invite Iona to ask inside for the aspects of the situation that create this shame.

5. The usual self listens to the scary side of the symptom

5.1 Eventually we must get to the scary side or pain side of the symptomThis is the most important step. In my opinion, when working through a symptom, thescary side is more important than the familiar side because it is the side of the trauma.Eventually we must get to the trauma or the experienced difficult situation.

The manner of approaching this is crucial. It is not just going to the pain and feelingit again. This is what happens at the source of the symptom; it may be re-traumatizing(Littrell, 1998). It needs to happen in a therapeutic way. Therapeutically going to the


12/16

Depestele


scary side happens with a present therapist and from a usual self that is now freer. It is freerin the sense that it is no longer occupied by the familiar side and also no longer completelyoccupied by (and just suffering from) the pain side or the scary side, but is differentiatedfrom it (see the Iona example above).

The usual self now does not just turn toward the pain side but turns to the sense

via an inner act of focusing the attention on the bodily sense of the whole thatwhichthe pain is about, or the whole sense of the situation which the pain is about. At the sametime it invites that sense to allow its different implicit meanings and implied actions toevolve. A question inside may be: How exactly, in which various respects did the situationhit and hurt me? After some revelations, a further question may be: What does thesituation cause me to do?

An example is the usual self, which passes from I must be able to accept that, toasking inside: Can I sense the something-having-pain-about-that? The mother mayask inside: What does it really mean to me that my daughter has not been willing to

spend that last evening with me? In which various ways did it affect me? Did it dosomething to me? Did it mean something to me?

It is in this way that the client asks inside: Can I, usual self, evokethe scary side? Can Imake afree spacefor it? The client, being together with the therapist both of themcarefully acknowledging the inner pace and each nuance that comes in the client asksinside and listens to what the scary side reveals from its free space.

5.2 Overcoming anxiety for the scary side

Often the first thing that comes is an anxious feeling. The usual self is occupied by a fear

of the scary side. Then another step of differentiation may be needed first, and one cansay: Can I give a free space to this anxious sense? or: Its okay. The shame may exist or:Im sensing something in me that is ashamed.

Then, after acknowledging the emotion itself (for example, anxiety; or shame, e.g.,Iona), one can ask: Can I get a sense of all that in the scary side that Im anxious about?This will bring the clients attention to the midst of the scary side, while the usual selfenters into a listening relationship with that scary side.

The therapist can offer much help to the client with overcoming his or her anxiety forthe scary side of the symptom, and with contacting it.

With a client who was paranoid toward her colleagues (the paranoid ideas are thefamiliar side) it was possible to get her beyond the anxiety, to bring her in touch withthe most painful experience with these colleagues (the scary side), and to help herexplicate it as deeply as possible. Afterwards this session appeared helpful.

5.3 From scary side to other self

When the usual self listens to the bodily felt scary side of the symptom, that side will


13/16



reveal itself bit by bit. This means the other selfstarts speaking. The scary side revealsitself means the other self starts speaking.

What is the difference between the scary side and the other self? Now the scary side is:only experiencingwhat the pain (difficulty, anxiety, etc.) is about; that was avoided before.The other self is: speaking from that experiencing.

The other self explicates the implicit meanings of the painful situation. Instead of theusual self just feeling pain or being occupied by pain, now the implied meanings of thepainful situation reveal themselves to the usual self. Each sentence that comes brings alittle bit more self. Speaking from that experiencing issaying it, ismaking it (more) me, isbeginning tointegrate it (full integration will come in stage 6). It is a beginning becauseat first the usual self may find it unusual. Although relieved by what the usual self receives,it will remain at a distance from the other self for a while, because this is still new for it.

But the fact that the other self is speaking implies that the usual self is freer from thepain side of the symptom (differentiation) and thus it implies a possible association of thelistening usualself with the speaking otherself. The other self may begin to mix here with

the usual self. They may start to change into each other.

5.4 Going directly from the familiar side to the scary side

Sometimes work is needed that goes directly from the familiar side to the scary side,directly from the urge to the difficult or painful aspect. Such work is needed at points inthe session where the client always again leaves the painful aspect and leaps back into theurge. The client only just contacts the difficult aspect (scary side) and then immediatelyreturns to the urge (the familiar side); the urge takes over immediately.

A client, talking about a friend who does not answer messages and does not contacther, spontaneously asks herself: Is it my fault? Am I beneath her? After the therapistinvited her to come to the painful aspect where the client might feel My frienddoesnt like me, the client says: The idea of she doesnt like me doesnt even occurto me; instead, I immediately ask Am I beneath her? Instead of feeling the difficultaspect, there is an immediate reversal to the urge of self-blame.

Sometimes the reversal urge is so pushy that the therapist needs to intervene strongly,inviting the client in a way like this: put that voice to mute, stay with the scary side, letit speak; after that we can return to the voice. Gendlin (1996, p. 247, 2003, p. 98) and

Turcotte (1998, p. 2) provide examples.

6. Integration of all that which came into a new-and-advanced self

6.1 Results of the previous work

As a result of the previous work both the familiar side and the scary side have changed.The familiar side (the urge) is calmed and may disappear. Both its content and

form may disappear (e.g. a symptom like overeating: see example below), or only its


14/16

Depestele


form may disappear (e.g. the demanding, blaming way of the inner critic). Once theclient who said I must be able to accept that has worked on this urge, it may reduceto a healthy form, let us say a form which offers protection. More importantly, the urgeno longer rules over everything. The familiar side still speaks and is active, but nolonger in a form that occupies the usual self and suffocates the scary side. It functions in

its healthy form, as it is integrated in and lets the other implicit aspects (what wasprevented before) function.

The scary side has also changed. It is no longer being addressed, instead it is nowspeaking. Perhaps we may say that first, at the previous stage (stage 5), it spoke justforitself, explicating itself. Here, at this subsequent stage (stage 6), it also speaks to the familiarside. The something-that-feels-the-whole-painful-thatcan now speak to the something-that-says-that-I-must-be-able-to-accept-that.

Example of integration: overeatingA client complains about her obsession with food and her overeating. The therapist

invites her to listen to (the) something in me that wants to eat a lot and wants tothink about eating a lot (familiar side). She associates: My ex-lover always deridedthe food of my country (scary side). Invited by the therapist to sense for a possiblelink between the deriding (scary side) and the wanting to eat (familiar side), she says:When I was with him, I could not eat. When I was alone afterwards, I overate.When we were in Singapore he wanted to lose weight; so several times he decided thatwe shouldnt eat. Because of his comments (about our food) my appetite diminished(scary side). This led to overeating (familiar side). She further says: He created a needin me (scary side), and He made me unfree, he limited my choice (scary side). Soshe had to take back her freedom (familiar side).

In this kind of a dialogue between the scary side and familiar side, both reveal theirunderlying meanings. Six months later she confirms that she has not overeaten sincethat session.

6.2 Dialogue between the familiar side and the scary side, facilitated by the usual self

After both the familiar side and the scary side have been able to develop and change a bit,it may come to a dialogue between the two, facilitated by the usual self, which is alsochanging. A dialogue becomes possible because all the participants can speak and actfreely now. There is no tension anymore because one side is not dominating everything

and suffocating the rest.

6.3 Other self and usual self integrating

At this point, the three participants (familiar side, scary side, and usual self ) may becomeintegrated with each other as well as integrated into the whole experiencing process. Theimplicit tendencies of the three participants are now freely or implicitly functioning. Themass of implicitly functioning meanings is the base of the self. So by working through a


15/16



symptom the self has built some new base for itself.There is another important facet of this integrative dialogue. We said that after the

other self had spoken, the usual self remained at a distance from it for a while. The usualself needed some time to get used to the other self.

Here in the final stage, the other self gets integrated into and fully accepted by the

usual self, which further changes the usual self. Both usual self and other self merge intoeach other and into what becomes a new whole self. What was symptom, or what wasurge and pain, becomes new (additional) self.

CONCLUDING REMARK

I have made an attempt to make explicit the process by which a symptom becomes integratedinto the self. This is a theory, and thus a hypothesis, that distinguishes the different eventsthat may occur during the changing interplay of symptom and self in experiential

psychotherapy, and that places them in a certain order in order to show how they are linkedto each other. This differentiated scheme of therapeutic components may offer interventionstrategies to therapists, and it may make this process of change more accessible for research.

REFERENCES

Depestele, F. (2004). Space differentiation in experiential psychotherapy. Person-Centered andExperiential Psychotherapies, 3, 129139.

Depestele, F. (2006). Linguistic characteristics of the different spaces of experiential psychotherapy.

Person-Centered and Experiential Psychotherapies, 5, 5365.Elliott, R., Watson, J. C., Goldman, R. N., & Greenberg, L. S. (2004). Learning emotion-focused

therapy. The process-experiential approach to change. Washington, DC: APA.Gendlin, E. T. (1974). Client-centered and experiential psychotherapy. In D. A. Wexler & L. N. Rice

(Eds.), Innovations in client-centered therapy(pp. 211246). New York: John Wiley & Sons.Gendlin, E. T. (1996). Focusing-oriented psychotherapy. A manual of the experiential method. New

York: Guilford.Gendlin, E. T. (2003). Focusing: How to gain access to your bodys knowledge. London: Rider.Littrell, J. (1998). Is the reexperience of painful emotion therapeutic? Clinical Psychology Review, 18

(1), 71102.Stinckens, N., Lietaer, G., & Leijssen, M. (2002). Working with the inner critic: Fighting the

enemy or keeping it company. In J. C. Watson, R. N. Goldman & M. S. Warner (Eds.),Client-centered and experiential psychotherapy in the 21st century: Advances in theory, researchand practice(pp. 415426). Ross-on-Wye, UK: PCCS Books.

Turcotte, S. (1998). Contributions from the Pacific Center for Focusing: The mission of the PacificCenter for Focusing. The Folio, 17, (1-2),14.

Weiser Cornell, A. (2005). The radical acceptance of everything. Living a focusing life (featuring B.McGavin). Berkeley, CA: Calluna Press.


16/16

from symptom to self in experiential therapy

Documents