Mental Pain And Trauma: How To Deal With It In Psychotherapy

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

Mental pain is a reaction to the loss of any value and violation of boundaries in the organism / environment field

Also, in my opinion, pain acts as a complex affective phenomenon, which has a basis in the form of suppressed experiences, the modality of which is secondary to pain, in contrast to their strength. In other words, mental pain can be the result not only of those stopped in the experience of sadness, despair, anger, anger, rage, but also blocked love, tenderness, joy, etc. Simplifying the definition under consideration even more, I note that mental pain is the emotional effect of stopping or deforming the process of experiencing. Naturally, on the other hand, pain is an inevitable companion of the liberation in therapy of the process of experiencing from the power of the chronic ways of organizing contact that blocked it, in particular from symptoms.

In its most general form, I would metaphorically designate mental pain as a door to the building of mental trauma or post-traumatic stress disorder (in the most general sense, to the building of any psychological disorder or dysfunction). That is why, in the process of therapy, clients often become emotionally more difficult at the moment when, it would seem, the main task - the restoration of the experience in rights - is completed. Until that moment, the client's symptoms protected the client from unbearable mental pain [1]; after the overthrow of their power, the person finds himself alone with an ocean of pain. The natural desire of a person in this case is the desire to restore the status quo, which often provokes a negative therapeutic reaction.

K., a young woman of 28 years old, sought therapeutic help on the urgent recommendation of her friend. She complained that she was confused in her life, she could not find herself. By the time of contact, I had once again changed my job, which once again in speed ceased to bring satisfaction. K. never had close friends, which, however, was not viewed by her as a problem of concern. Starting therapy, K. assumed that the therapeutic process would help her to deal with the difficulties in relationships with colleagues, to determine her profession. Outwardly, K. looked aloof, somewhat frightened, as if expecting something from me. At times she was very talkative and told a lot of details from her life.

In contact with her, I often felt unnecessary, although I was filled with sympathy, a desire to take care and some vague painful aching sensation in my chest. Any attempt to draw K.'s attention to our relationship turned out to be unsuccessful, aroused genuine surprise and sometimes irritation in her. At times I felt a growing despair and a reciprocal desire to reject. Once, in the course of K.'s story, I felt an acute pain-response to her story, which I informed her, as well as my readiness to be there. K's face changed and burst into tears, saying that no one had ever cared about her, she was used to the rejection that she faced all her life, and I just cannot be an exception to this terrible rule. I asked her not to leave contact with me for some time, to look at me, no matter how painful it was, and to try to tell me about what would happen to her. Over the course of several sessions, K. told me about all the pain she has to deal with in life, about the rejection and violence she was used to, about the violation of her personal boundaries by other people, which she notices only after a while, when the violation develops into violence. From time to time K. stopped, as if checking whether I was still with her. After this difficult but ultimately alleviating period of therapy, K.there was an opportunity to experience the newly emerging feelings of anger, anger, pleasure, joy. For the first time, she took the risk of meeting a young man with whom a relationship is currently developing. She began to experiment with ways to defend her boundaries, her sensitivity increased significantly. Professional uncertainty, which was a consequence of the difficulty for K. to be in contact with other people, resolved itself.

Another short vignette showing how close pain sometimes comes to a possible experience process without reaching it.

The described event has nothing to do with psychotherapy, at least in the strict sense of the word. It demonstrates the "travel companion effect", when it is possible for one person to "pour out his soul" to another, a complete stranger. The situation took place on the Moscow-Makhachkala train, in which my colleague and I were traveling to a conference on psychotherapy in Astrakhan. Our fellow traveler was L., a native resident of Dagestan, a doctor by profession. Talking about Caucasian customs, he imagined himself to be a strong, courageous man, invulnerable in relation to life's hardships, difficulties and crises. According to him, real men don't cry. Feeling in contact, these words were not empty words, they really defined L.'s life. Nevertheless, I nevertheless attempted a confrontation, asking how he felt about events that still cause pain. To this L. replied that a real man can only cry at the funeral of his father or mother. After that, his eyes filled with tears and he burst into tears. For the next hour and a half, L. talked about his pain associated with the death of his father, the most dear and beloved person in his life. But also about how he was afraid of him as a child, hiding under the bed and holding back his feelings. At that moment L. seemed to me completely different, more sensitive, vulnerable and warm.

Sometimes pain accompanies a person throughout his life, being outside the zone of his awareness. Often people prefer to experience difficulties in life or suffer from psychosomatic illnesses, which can be complained about, than to face the inevitability of experiencing pain. In this case, it is necessary to reduce the sensitivity to the boundary of its contact with the medium up to its complete loss. Moreover, the strength and depth of mental pain are directly proportional to the severity of this tendency. At the same time, creative adaptation in contact with the environment is replaced by chronicled patterns of its organization, mental functioning is fixed to the level of its awareness.

M., a 35-year-old woman, a member of a therapy group. Attractive, well-educated, communicative, creative. In relations with group members, mainly men, she often behaved with a significant degree of aggression, which was mostly indirect in nature - in the form of irony, sarcasm or indirect communication about the shortcomings of the other, which are degrading in existing contexts. In view of the described patterns of contact, her relationship with the group members was not easy to build - the expressed initial desire to get closer to her was soon replaced by the same strong desire to reject her and get away from contact. In this vignette, I will describe only one individual session with M., which, I think, will demonstrate the place and role of mental pain of traumatic genesis in organizing contact based on the principle of its avoidance. At the beginning of the session, M. stated that every year on the eve of Christmas she becomes very irritable towards others. When I asked what she would like to receive from them and does not receive, she replied that she wants someone to take care of her. Although she immediately announced that she knows how to organize contact in order to receive this care. At the same moment, she begins to talk about her envy of another member who can receive care right in the group, as well as her irritation towards a man who cares about the latter with tenderness. At some point, M. appears to me as a little girl or teenage girl who really wants love, but who avoids it in every possible way.

I share my fantasies with her, after which M. tells me a story about how her mother left her at the age of 3 months with her grandmother, taking her 2 thousand kilometers and visiting 2 times a year. This went on for 7 years. It should be noted that throughout the session M. speaks in a completely even, calm and even slightly soothing tone. I find myself at a loss from a monstrous mismatch - M.'s words speak of strong feelings of anger and resentment, as well as shame and envy, and there is not even a hint of their real existence in contact. I inform M. about this, assuming that her feelings are much stronger than she allows herself to experience. M.'s eyes at this moment become very sad, she again looks like a little girl who faced "very early with the need to grow up" (according to M. herself) and lost her childhood in the abyss of pain. Or a person who is grieving over the loss of childhood.

At this moment in the session (which took place on the eve of the New Year), the metaphor "about the premature loss of faith in the existence of Santa Claus" appears in our contact. M.'s eyes fill with tears, I also have tears with an accompanying mixture of pain and tenderness for M. In response to my question, what would M. now want in our contact, she lowers her eyes, says that she feels intense shame and shows desire to stop the session due to unbearable feelings. I still manage to keep M. in contact for some time. She is crying and, perhaps, for the first time in a long time meeting her, I quite distinctly feel that she is crying for me personally. It was only a few seconds after which she asked to hug her. M. clearly felt that, as before, she needed protection and care from someone stronger than her. Needs, despite the intense pain and shame that she is forced to experience in contact. So, in the life of M. her childhood and Santa Claus returned. Nevertheless, while beyond the boundaries of this session remained her pain from the feeling of uselessness, anger and anger for the feeling of abandonment, shame from the feeling of her insignificance and fear of rejection. They still need to be experienced, although it is no longer possible for M. to ignore them.

Unbearable mental pain often anesthetizes the self to the limit. That is why traumatics are often insensitive to their boundaries, not noticing the fact of their violation by other people. Others' insults, unlawful demands, rejection reactions, outright attempts at exploitation (professional, sexual, etc.), etc. go unnoticed by them. The restoration of sensitivity in contact to such reactions and other field phenomena is fraught with flooding with pain, which "border anesthesia" keeps out of awareness. Even a group of people as a whole may be susceptible to the development of this mechanism "pain - loss of sensitivity".

For example, a therapeutic group, at the initial stage of its work during one of the sessions, faced an extraordinary event due to its strength and unexpectedness - one of the participants, N., had a father died. Upon receiving this message, N. was in shock, the group was horrified and desperate. At the next session, one of the participants did not appear in the group, however, no one paid attention to this. N., experiencing grief, also did not talk about his feelings. The fact of the pain of loss, ignored in this way, allowed the process of experience to be blocked even deeper. The therapeutic process progressed extremely sluggishly and slowly, in the course of it all new participants left the group until it was reduced to a minimum. But even this probability of the impending death of the group was beyond the possibility of experiencing it. Only after the group therapists noticed this dynamic feature was it possible for the group members, after some resistance, to restore the process of experiencing their feelings related to the events taking place. After several group sessions devoted to the experience of experiencing the loss of loved ones, the group process stabilized, sensitivity to group and individual boundaries was restored.

It should be noted that such a situation with a loss of sensitivity to boundaries can be provoked not only by blocking the experience of such an extraordinary event as just described. Loss of sensitivity to boundaries can be caused, for example, by blocking discussion and experience of other pertinent group phenomena. For example, with the default shape of competition, the process might be similar. I think that the process of blocking a group figure is, in one way or another, associated with stopping or deforming the experience that relates to it. This kind of "group latent trauma" can also cause a loss of sensitivity to boundaries. On the other hand, even an extraordinary event, with its legalization and support of the process of experiencing by the participants, can be assimilated and transformed into a new experience integrated into self.

At one of the group therapy sessions, O., a 38-year-old woman, reported that she was dying of cancer. The news shocked the group, which remained silent for a while. However, after that, one of the participants, P., spoke about her own fear of dying due to a serious illness, which she experienced about two years ago. P. spoke about the pain and horror that she had to endure, about the fear for her children left without care and care. After that, quietly crying all this time, O. was able to tell about her feelings, which she is experiencing at the moment, first personally to P., and then to the whole group. The incident allowed many members of the group to share their experiences and feelings in the form of pain of loss, fear of death, guilt, which made them bearable and possible to experience.

Summing up the above, I would like to note that mental pain is one of the most important criteria that mark a traumatic experience. In addition, the ability to experience pain is an effective predictor of successful trauma therapy.

[1] Psychosomatic symptoms are leading in terms of the effectiveness of blocking pain. That is why the therapy of psychosomatic and somatoform disorders is fraught with significant emotional deterioration in the client's condition during the course of therapy. This fact, most likely, also explains the duration and instability of the process of therapy of psychosomatic diseases.