Relationship With A Bodily Symptom

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

The episode described in the article happened to me in December 1995. I was just starting then to practically apply Gestalt therapy. I acted mostly intuitively. But, then, quite often he returned to him in communication with colleagues and clients. So I decided to end this story by writing it down and realize what happened then.

I was approached by a client who started a course of psychotherapy in the form of NLP with one of my colleagues at the City Center for Social and Psychological Assistance, who was on vacation at the time. From the very beginning I was focused on 1-2 sessions. During the first session, the client mostly described her situation. At the time of our meeting, the client was about 56 years old. Of these, she was married for about 30 years. Her husband suffered a massive stroke 10 years ago and became disabled. One of its consequences was attacks of anger and aggressive behavior, aimed mainly at loved ones. Any act of his wife and son could make him mad. The son chose to live separately. Neuropathologists and psychiatrists, with whom the client spoke, convinced her that this was not a manifestation of her husband's ill will, but a symptom of the disease. You should not take offense at him, just as they do not take offense at a cough in a patient with pneumonia. The client decided to follow their advice, but soon felt "overwhelmed and overwhelmed." She quickly got tired, and her sleep was disturbed. There were severe bouts of pain in the heart. Doctors diagnosed her with coronary heart disease. And they said that emotional stress is strictly contraindicated for her. They can cause disease progression and even death.

- Well, what should I do with this? - the client asked me after 40 minutes of anamnestic conversation.

- Honestly, I don’t know myself? - I answered. - What would you like?

The conversation then consisted of my unsuccessful attempts to understand how the client formulated the therapeutic request. Not without my participation, the client came to the conclusion that health is more important and simply vital for her. I also questioned the “don't worry” attitude. I was also interested in what the client might feel besides anxiety, the signs of which were, according to the client, on her face. Although, in my opinion, it was more about anxiety. This is how I ended the first session by breaking the confluence and working with introjects. I was simultaneously trying to restore the balance of the self functions, referring mainly to the ego and the id.

The second session took place about a week later. The client looked depressed. She sat hunched over and her shoulders dropped, talking in a low and slow voice, her face retaining a monotonous, painful expression. She said that the day before she had a major conflict with her husband. He was followed by a heart attack. I had to call an ambulance. She is now on sick leave. But this makes her even worse, since now she is forced to be with her husband all the time. I drew the client's attention that now her husband is not around, but her state of health is unlikely to suit her. The client replied that

feels pressure and pain in the region of the heart and worries about the possibility of a repeat heart attack. She would like to change how she feels. I suggested working with this symptom using the two-chair technique. The client presented her heart in the second chair. She turned to him with words of regret that she could not do the right thing and care enough for him. In response, the heart began to blame the client. I drew the client's attention to what she really squeezes, hurts her heart. I propose to combine this with her regrets. This was a problem for the client and was achieved after several role swaps. At the same time, the client's condition began to fluctuate sharply.

On the chair of the “heart”, her speech acquired a defiant shade, and the number of reproaches increased. On chair 1, the client continued to speak in an increasingly mournful and plaintive voice, while the pain and pressure in the chest increased. Especially at that moment when she spoke to her heart about them. After 15 minutes, according to the dynamics and severity of pain, I realized that the client was developing another attack of angina pectoris. Here I was frightened, because by virtue of my medical education I was aware of its danger. After some internal struggle, I decided that if within a few more minutes I did not change the situation, then I would start looking for nitroglycerin for the client. Then I suggested that the client put her husband's hearts on a chair. In doing so, I changed the client's ego function, but at the same time reverting retroflection to the level of projection. My proposal was met with resistance. The client began to object: "The husband is big, but the heart is small." Although he, too, behaved in an impudent manner. I continued to insist. Taking into account the client's advancedness in NLP, I proposed to reduce the image of the husband to the size of the heart. The client succeeded surprisingly easily.

“Here he is sitting on the edge of a chair, swinging his legs,” she exclaimed.

“Well, now let's crush him and hurt him,” I suggested.

The client began to discuss this proposal with noticeable interest. And a couple of times she hit her husband on the head with an imaginary frying pan.

- How is your husband? I asked.

- Quiet and silent, - answered the client.

All these actions were accompanied by a decrease in the feeling of pain and pressure. After that, I suggested to the client in various ways to increase the expressiveness of the expression of aggression, while simultaneously focusing on her feelings. The client gradually became aware of her anger.

“Well, I know he makes me angry,” she said. - And what to do with him? Do not hit him, in fact, on the head. She's already weak.

- What did you do now to reduce the pain? I asked. - I don't think I have a husband or a frying pan in my office.

The client noted with noticeable surprise that the realization and acceptance of her anger, even in fantasy, helped her feel better. We discussed with interest the purchase of a punching bag and attaching an enlarged photograph of her husband to it, and a number of other less effective and more realistic and safer ways for the client to express anger. The client decided to experiment with their use at home. With less than 10 days left before her therapist left vacation, we agreed that the client would meet with me again in case of any unforeseen difficulties. But she did not appear at the reception either to me or to my colleague.

Now, in hindsight, I realize I used roughly the same technique as Perls. Firstly, it is a "shuttle", when the client alternately moves from the inner zone of sensations to the intermediate zone of thoughts and relationships. But this process also has certain stages, described by Perls for working with another phenomenon of the intermediate zone, the dream.

1. At the first stage, a certain change in the projection mechanism occurs. A dream, or rather an image of a dream, like a symptom, for all its projective nature, has a peculiar partial and internal character. A part of the soul is alienated, but some kind of formal connection with it remains. Perhaps we are talking simply about a more primitive and, therefore, ancient phenomenon of projective identification, which in Gestalt is designated as a combination of projection and retroflection. I think I was good at my symptom work. transformation of partial projection into total … This is evidenced by the subsequent, after identification of the client with the diseased organ, the actualization of symptoms.
2. On the stage reconstruction of personal context, I intervened by asking the client to clarify the relationship with her husband. In my opinion, this follows quite organically from the previous material of the sessions. I made a substitution of the client's ego function, which may be necessary at the stage of partial reversal of retroflection. This is also justified because the actualization of the counter-symptom slowed down and curtailed the sensation of the symptom. And in our situation, without this, it seemed to me impossible to continue the work.
3. On the stage assimilation projection the client and the husband seem to be changing places. Already the client becomes uncontrollably aggressive, and the husband becomes quiet and silent. I see this fusion as a sign of the client's full contact with her anger.
4. And here, completeness retroflection reversals is not completely clear to me. The client chooses the technical testing of the new-found responsibility directly in the relationship with the husband. I trust her in this. But the question remains whether I could have created the conditions for this during the session.