If clients say yes, away moves work, I model flexibility by validating their experience that sometimes suffering is so intense that closing down seems to be the only option. There will be further opportunities to come back to a contextual functional analysis through the matrix. Looking at any experience through the prism of the matrix, including an experience of stuckness, allows clients to notice their experience in context and gradually shapes flexibility and a broadening of their behavioral and attentional repertoire.
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169 What is important is for therapists to be themselves— to be able to choose to act on the right side of their own matrix. This will prompt clients to engage in their own toward moves and promote functional generalization of new behaviors.
Celia
Having described the skills that the matrix can cultivate, I will now illus-trate them with examples from my clinical practice, starting with Celia, a ten- year- old who won’t touch doorknobs. Her compulsions are a major impediment to her.
Therapist: Look at this little diagram I call the matrix. What you don’t like is on the left, and what you really want to do is on the right. So what do you put on there?
Celia: To the left, doorknobs!
Therapist: And what do you do when you see a doorknob?
Client: I don’t want to touch it.
Therapist: And what happens when you don’t want to touch it?
Client: I get stuck and I can’t do what I want.
Therapist: Good. You noticed that. And what do you really want to do?
Client: I’d like to do all the things I want to do.
Therapist: Good. And what’s stopping you?
Client: The doorknobs. Everybody’s touched them!
Therapist: Oh yes, your head tells you this. And when your head says this, what do you do?
Client: I get stuck!
Therapist: Good, you noticed that. And does that move you toward or away from what you really want to do?
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Client: Away.
Therapist: Good, you noticed that too. So on the left is what gets you stuck, and on the right what you really want to do.
What do you choose? Do you do what your head tells you and get stuck, or do you do what you really want to do?
Client: I’d choose what I really want to do, but my head tells me fifty people have touched this doorknob!
Therapist: I see this is hard for you. Here’s a little exercise that could help us. Try to have the thought I can’t raise my hand, and when you have it, raise your hand to show me. Okay?
Client: Okay. (Raises her hand.)
Therapist: Good. And what did you notice?
Client: Well, I was thinking that I couldn’t raise my hand, and still I did it.
Therapist: Yes. Do you see a connection with what you’re thinking about doorknobs?
Client: That I could not always do what my head says?
Therapist: Good. You noticed that! So, Celia, when your head tells you to do something on the left and what you really want to do is on the right, could you practice noticing if you can see both sides of your matrix, and then see if you can choose what you do— whether on the right or on the left? What counts is that you can choose, because when your head tells you not to touch the doorknob, does it give you a choice?
With Celia, I conducted a contextual functional analysis from the very first session, using the matrix as the perspective from which to conduct the clinical conversation. Celia went home with a small paper matrix and instructions to practice noticing when the matrix showed up
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171 in her life. In other words, I invited her to conduct her own contextual functional analysis every time anxiety showed up in her life.
Celia came to the second session with functional contextual stories, such as “My head was saying fifty people had touched the doorknob, but it was important to me to get through that door to do what I really wanted. First I avoided touching the doorknob because of fear, but it was still important to do what I really wanted. I saw the two sides, left and right, and I saw that opening the door was possible. So, even with the fear, I touched the doorknob.”
Michael
Michael is stuck at home. He has anxiety attacks that bring tremors and uncontrollable head shaking. He’s lost his job and lives on welfare. After presenting the matrix and its perspective on a life that works, I initiated this dialogue.
Therapist: Given the stuff that shows up, how is your life working?
Client: I live on the left. I live on the left…
Therapist: Living on the left, that’s when all of our actions are linked to our suffering and fears, when everything we do is in the service of moving away from anxiety. Is this how it works for you?
Client: Yes, I spend all my time worrying about when the next anxiety attack might happen.
Therapist: And does that stop you from doing things that would be important to you?
Client: I don’t do anything anymore. I don’t even see my friends anymore.
Therapist: Ouch. What’s important to you that gets left behind?
Client: I don’t do anything anymore. I didn’t even go to my dentist appointment for fear of an anxiety attack.
Therapist: Could you describe to me how these attacks feel?
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Client: My neck stiffens, my head twists… It’s so stupid to be like this!
Therapist: So you get all these sensations and thoughts.
Client: It’s happening again, right now. I can’t keep my head straight. My neck is stiffening and I’m shaking!
Therapist: Yes, it’s exactly how you were describing your anxiety attacks. Would you be willing for us to continue, using this session as an opportunity to notice what’s happen-ing right here, right now?
Client: You’re a doctor after all. I know you can understand me.
So okay.
Therapist: Thank you for your trust. Now, can you bring your attention to your bodily sensations…and the thoughts that show up…and at the same time notice the sensa-tions around your breathing? See if you can just notice what shows up, without trying to change those sensa-tions or thoughts or push them away. See if perhaps you can receive them with curiosity and kindness. See if you can slow down and notice all this from the central point on your matrix, the perspective from which you can notice all of this while keeping some distance from it.
Client: I can notice my bodily sensations and my thoughts.
Therapist: Congratulations for courageously staying with all of this without trying to run away, and for staying connected in our exchange. Could it make a difference if you could do this in your life?
Client: Yes. It would allow me to reconnect with people and look for work.
Therapist: Would you be willing to see if you can spot the matrix in your experience between now and next week? When you do, could you simply sort what shows up as five- senses versus mental experience, and then see if you have a chance to choose to do a toward move?
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173 In this example, Michael had opportunity in session to notice the different aspects of his anxiety attacks while I encouraged him to notice the right side of his matrix: what’s important to him and what actions he could do in valued directions. I then invited him to bring this perspective to his life.
Corrina
Corrina is a forty- seven- year- old woman who’s been suffering from loneli-ness since the breakup of her twenty- five- year marriage. She says her life is over. She cries a lot and feels utterly stuck in despair.
Client: It’s been a year since my husband left me, and I’ve lost all zest for life.
Therapist: Where does this go on your matrix?
Client: “I’ve lost all zest for life,” that’s suffering, so to the left. It’s like last Sunday: I went on this outing with a group of people who like impressionist art and I felt so bad. I can’t feel good with other people anymore. I should have stayed home and watched TV. It would be better if I simply disappeared. (Sobs.) Therapist: I see that there’s a lot of suffering around connecting
with others. When suffering is very intense, it can make us feel stuck and become rigid. I too feel stuck when you tell me this. Is that also how it is for you?
Client: Yes. I can’t feel good with other people anymore. I don’t feel like going out anymore.
Therapist: And where does that go on your matrix?
Client: On the left. It’s linked to my suffering.
Therapist: And what did spending the afternoon with this group allow you to do? What was on the right? What was important?
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Client: We visited the museum and learned about this painter, Courbet. I could share with others in the group. I could never share about art with my husband.
Therapist: I’m touched that you would share with me that art is important to you. And where does sharing about art go on your matrix?
Client: On the right side.
Therapist: And as we talk about this together, does it make us move closer to or further away from one another?
Client: Closer.
Therapist: I’m also noticing that it brings us closer, so thank you for sharing about art.
Client: Yes, I really like art. But my husband never had an interest.
Therapist: Could you notice, as you were on that museum outing, that two types of experiences were present, on the left and on the right?
Client: Yes. But I feel horrible, and it would be better if I disappeared.
Therapist: When suffering is very intense, our minds can suggest that we should escape our suffering by whatever means, including suicide. Is that how it is for you? And where do you see that on the matrix?
Client: I don’t want to feel this pain inside. That’s in the lower left corner.
Therapist: And yet does sharing about art with others count less when the pain is there? Does it bring you closer to or further away from other people?
Client: It’s important and brings me closer.
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175 Therapist: Would you be willing to notice how it feels inside when
you share with others about art and your mind tells you that you should end it all? What do you choose to do?
Client: I choose to share with others.
Therapist: That’s a courageous choice to make, because when you choose the right side, the left side also comes along for the ride. And this choice that you’re making right now, here— could it make a difference to your life if you could make that choice for everything that shows up?
Isn’t it a great freedom to be able to choose what’s important, rather than letting suffering rule your life?
Client: Hmm. I guess I’ll get back in touch with the impression-ists appreciation group and see what other outings they have planned.
Therapist: It makes me feel closer to you to hear you say that. I’ve appreciated sharing with you around your passion for painting. How about you?
Client: I’ve liked it too.
In this example, I consistently invited Corrina to broaden her atten-tion toward the right side as a means to help her stuck story become more flexible. When she opened up, I reinforced this by expressing the impact her sharing had on me.
Gina
Gina is thirty- three years old and has lived with her partner for three years. She dearly wants children, but her partner has already fathered two daughters and doesn’t want more kids. She resents it but is afraid to discuss it with him. Here’s an excerpt from our first session.
Therapist: There’s a lot of suffering around your wish to have children.
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Client: Yes. I wonder what I’m gonna do. He even tells me, “If you don’t like it, you can leave.”
Therapist: How does it feel when he says that?
Client: I freeze. I can’t discuss it anymore, and I feel bad.
Therapist: As if your life has narrowed?
Client: Yes, exactly.
Therapist: And a broader life, what would that contain?
Client: It would be a life in which I could speak sincerely with my partner and be listened to.
Therapist: I see this is precious to you. And what actions could move you toward that?
Client: I could tell him how important it would be for me to have children.
Therapist: What obstacles stand in your way?
Client: He’s told me that he has enough kids as it is, especially considering how badly things are going with his ex.
Therapist: And how does that feel?
Client: I feel stuck and I clam up.
Therapist: You feel stuck. And does clamming up make you move closer to or further away from him?
Client: I think it will never be possible, and I feel I’m moving away from him.
Therapist: Would you be willing to look at how this works with two matrices? When he says, “If you don’t like it, you can leave,” where is he in his matrix?
Client: Upper left.
Therapist: And what does that make you do?
Client: I get stuck on the left too.
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177 Therapist: Well noticed. Does that bring you closer or further
away?
Client: Further.
Therapist: And what would moving toward your relationship values look like?
Client: Telling him that it’s important to me that he listens and takes my wishes into account. But he tells me he doesn’t want more kids.
Therapist: So you feel stuck. But is what’s important to you still important to you?
Client: Yes.
Therapist: And do you choose to let fear control your life, or to be guided by what’s important to you?
Client: What’s important. But he won’t talk about it!
Therapist: And where is that on your matrix?
Client: Lower left.
Therapist: And what does that make you do?
Client: Clam up.
Therapist: And does that bring you closer or further away?
Client: Further.
Therapist: What would moving closer look like?
Client: Telling him what I feel.
Therapist: Great! And how would you do that?
Client: I’d tell him, “You never want to talk about what’s important to me.”
Therapist: And would that be on the right or on the left?
Client: Well. … On the left?
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Therapist: It’s a judgment, something our minds tell us when we’re struggling, so yes, it seems to be on the left. What could you say on the right to move closer? We often move closer to one another by sharing our feelings.
Client: I could say, “It’s hard for me when you won’t talk about what’s important to me.”
Therapist: Great! Would you be willing to ask him what he feels around the idea of having children? It would be like asking him to show you the lower part of his matrix. In this way, you could maybe move closer to what’s impor-tant to you in your relationship, regardless of the result.
Client: Okay.
In our second session, I continued to invite Gina to take the perspec-tive of the two matrices (hers and her partner’s) to help her navigate their interactions. I also used the two- matrix perspective of client and therapist to work on inflexible repertoires in the context of the therapy relationship in the service of helping Gina generalize enhanced flexibil-ity to interactions with her partner.
Client: I think I’m not going to come back. In any case, the problem is him, and I can’t change him.
Therapist: When you say this, I feel stuck. I’m on the left of my matrix. How about you?
Client: I’m on the left too.
Therapist: And what does that make you do?
Client: It makes me move away and want to stop therapy.
Therapist: So you noticed that. And is what’s important to you less important to you?
Client: No. It will always be important to me to have children.
(Looks away and starts crying.) Therapist: I can see you’re moved.
Client: Yes, it’s very painful.
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179 Therapist: It’s moving to see how painful it is for you. I was moved
when you told me how important it is for you to have children. I’m wondering whether you could also do this with your partner— if he too might be moved if you told him.
Client: Yes, but it’s not possible. He doesn’t want to hear about it.
Therapist: And where are you in your matrix right now?
Client: On the left.
Therapist: And what would moving toward what’s important look like?
Client: But I’ve already told him I’m an honest person, and if we ever separated, I’d let him see his children.
Therapist: And is that on the left or on the right?
Client: Well, it’s linked to my fear, so it’s moving away.
Therapist: Well noticed. Arguing is often in the service of control-ling fear. What impact does it have on your partner when you argue?
Client: He starts arguing back.
Therapist: And where are both of you on your matrices?
Client: We’re both on the left.
Therapist: What would moving to the right look like?
Client: Well, I could tell him that I understand it’s hard for him to think of having children again— that I can see it’s not easy for him. I could ask him if it’s important for him to have children and what he could do if he had more children.
Therapist: Yes. You could ask him to show you his matrix. You could validate what he feels and help him notice the different aspects of his experience. You could also show
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him your matrix and let him know how important it is for you to have children. You could ask what you could do together and see if maybe he’d be touched like I was when you shared how important it is for you.
Client: I think I want to continue therapy so we can work on this.
It’s also possible to do couples therapy with both partners using a two- matrix perspective and noticing their interactions in session. The therapist would encourage toward behaviors, and train both partners not to get stuck in trying to get rid of suffering by engaging in away behaviors
It’s also possible to do couples therapy with both partners using a two- matrix perspective and noticing their interactions in session. The therapist would encourage toward behaviors, and train both partners not to get stuck in trying to get rid of suffering by engaging in away behaviors