 |
|
March 20, 2008 Enhancing emotional availability through reciprocal interaction "So why do my girlfriend and a co-worker say I am passive aggressive?" This is how John starts our session. "Better yet, what does it mean to be passive aggressive?" I resist the temptation to offer a clinical definition. Instead I ask him to tell me what is important about the question. John, a successful middle age professional, came to me because he felt frustrated and unsuccessful in his personal life. His girlfriend told him that he does not talk about his feelings and she feels alone. She loves him, as he does her, so he accepts the need to seek help with "getting in touch with his feelings." He shakes his head slowly as he recalls a recent dinner out with his girlfriend. "As we were eating, she reached over and took a French fry from my plate. This prompted me to ask if she wanted her own plate of fries." "Interesting," I say. "Were there any other thoughts or feelings you didn't express when she took the fry?" He expresses his discomfort with the whole scenario, "This happens a lot with her. Why is this so damn important? It seems like such a simple exchange." In a raised voice, his irritation showing, he says, "Of course I was angry! She didn't care about my feelings, only her own needs. She took the fry without even asking me, and if I had told her the truth, World War Three would have started." At this point I ask him how he feels about my asking so many questions and not answering his initial question. He regards me with a cautious expression and says, "You're just doing your job?" "Yes," I reply, "and what feelings might you not be talking about right now?" He pauses, glances down at his hands, and then looks up reluctantly with a tentative expression, "Now that you mention it, I am annoyed that you haven't answered my first question." "I can understand why you would feel annoyed and perhaps angry; maybe you would feel ignored and even dismissed by me because I haven't responded to your request. "Do you think your response to the French fry incident and your response to my not answering your question have something in common?" He pauses and then asks, "I didn't reveal my feelings of being annoyed, frustrated or angry?" "Isn't it interesting that you make this statement as a question? I am wondering if you have some other feelings you are not talking about by doing this." Looking off into the distance, he says, "Well, I guess I may be afraid that by not answering correctly, I would disappoint you or make you angry." "Sounds like not disappointing me, not hurting my feelings or your girlfriend's and answering correctly are important. It also appears you may not want to be the object of disappointment, disapproval and anger in spite of how you really feel. "There appears to be a lot going on here, right now between us. I would like for you to pay attention to how your body feels. Are you aware that you are sitting on the edge of the chair? Perhaps you are not feeling safe or accepted by me." He is quiet. "Let's back away for a minute and see if we can help you feel more comfortable just now." Sitting back in his chair, he relaxes a bit. After a moment I ask how his body is feeling and he acknowledges feeling less tense. The therapist's questions represent more than good technique. They embody the intention of the therapist to pay attention to the client's needs. Emotional availability and attunement of the therapist happen when we are able to attend to more than our client's words. Clearly the words and sounds uttered are important, but also important is the awareness of the deeper level of information that may not be verbally communicated. The information disclosed by the client when I did not answer the opening inquiry proved helpful. It provided the opportunity to discover a deeper meaning, which was not being verbalized within the client's interaction with his girlfriend and me. David Wallen, in his book Attachment in Psychotherapy points out: "We risk allowing the words we exchange in therapy to monopolize our intention. By doing so we lose sight of the fact that beneath the words is a flow of critically important experience that provides the underlying context for the works. This unarticulated experience with its fundamental emotional and relational quality is often where we find the greatest leverage for therapeutic change." The data available as a result of the attachment studies of Bowbly, Ainsworth, Fonagy, and Main document the developmental importance of secure attachment in the early years of life. Secure attachment involves the caretaker's ability, and his intention, to pay close attention to information communicated by the child. Responding to the needs of the child is the end result. Clues can be given through the spoken word, laughter, crying and cooing. Our ability to monitor messages like facial expression, body tension, and eye movement are examples of the body providing information. Finally our "gut feeling," our subjective experience, also provides information that enables attunement. As therapists, we become the partner/caregiver. We strive to be attuned to all the available data that surfaces within the clinical relationship. The theraputic relationship affords us the opportunity to access information, which comes from our subjective experience, as well as the client's feelings. The client's question allowed me to stop and look into his eyes, be aware of the tension in his body and see how on edge he seemed, sitting on the front of his chair. It also allowed me to be aware of the tension in my own body. This reciprocal interaction or intersubjectivity is where we discover the richness of the theraputic relationship. This is where the action is. Not answering the question made it possible for both of us to be more present and to engage in a deeper conversation. Providing a shame-free environment helped the client to discover his fear of the fear, his anger, fears of rejection, and his vulnerability. The concepts of intention and attention as seen within the clinical vignette provide a perspective on one way to approach treatment. Advances in the science of social neurobiology tell us that brain development, neurogenesis, is a result of social interaction. Reciprocal interaction allows the therapist to become an active and clinically responsible part of the relationship. "If it is OK with you, let's continue." He nods yes. "I am aware of still not answering your initial question. Can you wait a little longer?" He nods. "Are you curious as to why you may fear anger and being a disappointment?" "Yes, I am." "Great! Let's see if we can make some sense out of your apparent reluctance to express your anger. Let's start by reviewing your family history. Remember what it was like, the middle child of four, growing up in a rigid Irish Catholic family system where feelings were not expressed. You reported being a very responsible child, always doing what was expected of you and much more. You were so proud that you never complained or made waves like your older sister did. You observed how overwhelmed your parents were, just making ends meet, and didn't feel as though you had the right to complain. In fact, you felt selfish expressing discontent, given how difficult life was. "Could it be possible you may have felt a little discounted, perhaps unimportant and dismissed, as a result of your family's inability to acknowledge your feelings?" He sits forward in his seat and puts his head in his hands. "Take a minute and check in with your body. I'm wondering if I said something which may have made you feel uncomfortable. You're sitting on the edge of your chair again." "I am feeling uncomfortable. I feel so guilty when I consider thinking about my parents in this way." "What way?" I ask. "You know, as if they did something wrong." "Yes, I can understand how bad that might make you feel. After all, you do love them and yet they may have been human and made a few mistakes in trying to do the right thing. What a conflict this must be for you!" Now he sits back in his chair, and I point out that he appears less tense. He nods and indicates how hard this is to talk about. "Yes, I can see that it is hard for you. Do you think our interaction within today's session might be similar to some other past experience?" He sits silent, thinking. "Perhaps you and I may have had a similar experience as you did growing up in your family." "How so?" "When I didn't answer your question about passive aggressive behavior, you discovered that you were annoyed. You may not have felt acknowledged or may have felt dismissed by me." He nods yes. "Perhaps that was the same experience you sometimes had with your parents when you didn't have the opportunity to be heard?" "I don't know. I loved and respected my parents, but they really didn't have time. How could I be mad with them?" We sit quietly for a few minutes. "We've done a lot today, but we're going to have to stop here. I'm aware that I still haven't answered you. I want you to know that you and your question are very important to me, and next time we'll pick up with your question." |