Retrieved attachment-based schemas that are amenable to reparative attachment work can also undergo transformational change through methods other than reparative attachment. The work with a woman we will call Regina, age 36, exemplifies this. We will describe some representative segments of work, but not cover all aspects of Regina’s therapy, which spanned 18 sessions. She sought therapy for relief from frequent episodes of strong anxiety or panic during or right after interacting with others in many contexts, had no idea what was causing this, and was troubled that it meant she was “crazy.”
The therapist learned that Regina was an only child and, throughout childhood, her mother frequently and unpredictably erupted into a rageful tirade of disgust and denigration toward her over anything in Regina’s behavior, big or small, that displeased her. Even innocent, ordinary actions could bring this on, such as being found with crayons and papers spread about for drawing (“making a mess”), bumping into a tree while riding her tricycle, or asking to go play with a girl who lived next door. The tirade often included a sharply unfavorable comparison of Regina to the neighbor’s daughter, extreme verbal abuse (“You’re a piece of shit!” was frequent), and sometimes took place in front of visiting uncles, aunts, and cousins, deeply humiliating and shaming her. Being put in her room alone for hours was the most dreaded of the punishments. Sometimes it took days before her mother’s punishing negativity would end and life would be normal again. So, the moment of seeing her mother begin to be displeased with her was one of blind, helpless panic over the unstoppable ordeal to come. Regina’s father was benign and at times tried, surreptitiously, to comfort and support Regina through these episodes, but he was fearful of his wife and did nothing to actually protect his daughter. This was a case of severe complex trauma and, given the nature of her mother’s behaviors, it seems clear that Regina
suffered the insecure-disorganized type of attachment. She now lived far from her parents but phoned every week and similar patterns continued, though “milder” than in the past.
In the discovery work it became apparent that Regina’s bouts of anxiety always began with a perception or construal that someone had become even slightly displeased with her. That first moment of seeing possible signs of displeasure or cooled feelings was a strong trigger of her implicit emotional learning that a brutally punishing rejection would now ensue, but this linkage, so obvious once accessed, had never before come into awareness. The therapist guided her to compare a recent instance of that first moment in a social setting with a memory of Mom, and Regina, looking very small in her chair, nodded waif-like that the two felt the same. It was quickly clear from this plunge of emotional deepening into traumatic memory that affective flashbacks were easily retriggered, so the retrieval work needed to proceed in small-enough steps.
By the end of her third session, one of Regina’s main attachment-based, implicit emotional learnings had been retrieved, verbalized, and written on an index card in this way:
The slightest imperfection makes me completely disgusting and unlovable, so Mom starts hating me and wants to get rid of me and have some other girl instead, and I’m really scared that she might actually get rid of me. I’m acceptable and lovable only if I do everything perfectly. Everyone I ever know will reject me whenever some imperfection becomes visible, and I’m always dreading that and feel panic each time I think it’s happening.
This schema was the underlying, coherent cause or emotional truth of the symptom of social anxiety as well as perfectionism. In it is a mental model of herself as unlovable, of terms of attachment that are the problem (with a generalization to all people, as we saw above for Travis), of specific, expected sufferings that must be avoided, and of a tactical solution of perfectionism.
The cluster of constructs inscribed on her index card was an important target for dissolution. To that end, the main clinical task—
in Coherence Therapy in particular and in the therapeutic reconsolidation process more generally—was to guide Regina to find
or create contradictory knowledge that felt so real that it would disconfirm the target constructs in a juxtaposition experience. Would reparative attachment work be suitable? In the decision path on page 104, the answer to the first two question was yes because the symptom-necessitating schema consisted of terms of attachment. This left the third question: Do the particulars of this schema allow for the possibility of disconfirmation by the client’s experience of interacting with the therapist? The answer was yes because it was possible to imagine experiences of direct disconfirmation taking place in the client–therapist relationship; for example, when Regina was late for a session or when she accidentally spilled coffee on the therapist’s rug, the therapist could have interacted with her to have her see and feel that these “imperfections” were not having the expected negative effects on the therapist’s regard of her.
However, the therapist did not use methods of reparative attachment and opted instead to create contradictory knowledge by employing the overt statement technique (as illustrated in Chapter 4) in Regina’s next session.
Th:How in touch do you feel, with what we found and put on the card last time?
Cl: Pretty much in touch with it.
Th:How would you say it to me in your own words—the way it feels to you right now?
Cl:
Well—any imperfection in what I do is really disgusting, and my mother is right about me, so my only hope is to hide all
imperfections and show only perfection, or else I’ll always be rejected by everyone.
Th:
By everyone; mm-hm. [Therapist now thinks for a few seconds, sees a possible way of guiding her into an experience of
strongly contradictory knowing through an overt statement, and proceeds to pursue it.] Do you have a grandparent or an aunt or uncle who’s special to you?
Cl: Mm-hm.
Th: Who is it?
Cl: My Uncle Theo—my dad’s younger brother.
Th: Good. So, picture Uncle Theo. And you’re with him, and it’s really nice. [Pause] Do you have that?
Cl: [She has closed her eyes.] Yes.
Th:
[With a somewhat slower, softer voice suitable for guiding inner imaginal process] And you’re feeling such a warm
fondness for him; all the little things about how he talks, how he gestures, his sense of humor—
Cl: The special little wink he gives me.
Th:Yeah. And you can actually feel the warmth of your love for him in your heart area—yeah?
Cl: Yeah.
Th:
Good. And now say to him—either out loud or internally, whichever feels more natural—the words of your emotional truth, “But you love me only because I seem perfect, and you’d stop loving me if I let any of my imperfections show.” [That is a use of the overt statement technique for bringing an existing contradictory knowledge into awareness through mismatch detection.]
Cl: [Silence for about 15 seconds as she says it internally to Uncle Theo. She is very still and appears to have stopped breathing.]
Th: What’s happening now?
Cl: [A tear slides down her cheek. In a quieter voice] I said it, and then the look on his face—he was so hurt by it.
Th: He’s hurt by it. How do you understand him being so hurt by it?
Cl: [Silence for 10 seconds] It’s like—it was a deep insult to his love for me.
Th:I see; a deep insult. Can you say more about why it was an insult to his love?
Cl: It’s because I’m saying his love is lightweight and superficial, and he knows it isn’t.
Th:He knows that his love is—[leaving the sentence incomplete, for her to finish it].
Cl:
[Eyes tear up and overflow; softly crying as she says] He knows he really loves me with all his heart—[cries]—and imperfections wouldn’t change that. So it’s like I’m totally wasting his love if I think it’s only because I seem perfect.
Th:
[Silent for about 30 seconds, allowing client’s conscious knowledge systems to incorporate this new knowing] You’re seeing that he knows he really loves you and your imperfections wouldn’t change that. How is it for you to see and feel that?
[Pause] Does it feel true?
Cl: [Nods yes while dabbing her eyes with a tissue]
Th:
It does feel true. He really loves you whether or not your imperfections show up. [She nods again.] [Client is now having a vivid experience of contradictory knowledge, as needed for creating a juxtaposition experience, so therapist now proceeds to guide her into the juxtaposition experience.]
So just look at him, knowing that he really loves you even when your imperfections show up; and knowing that, to him you’re lovable, and that doesn’t change because of imperfections. Can you just look at him, knowing and feeling that?
Cl: Mm-hm. Yeah.
Th:
Good. And now keep him in view and keep knowing that, as you widen the picture and also see, maybe over on the other side of the room, your mom. Can you do that?
Cl: Yeah.
Th:
And what you know about her love is so different, because her love quickly disappears and turns into disgust and rejection when any imperfections show up, yes? [Client nods yes.] So, just see how it is for you to be in touch, like this, with both kinds of love at once, and each is so clear, but they’re so different: On one side, there’s Mom with love that’s so fragile and so quickly flips into rejection over any imperfections that displease her; and you could easily expect that’s how it would be with anyone. [That is a deliberate, explicit re-evoking of the target construct.] And on the other side, there’s Uncle Theo with love that is so steady and reliable and unaffected by imperfections, and he just sees and feels how lovable you are and nothing changes that. And both kinds of love feel so real, but they’re so different. Can you feel both at once? [Client nods yes.] Good. What’s that like for you—seeing so clearly that both kinds of love exist, and that you’re actually experiencing both kinds?
[Silence for many seconds] I never thought of it like this before.
Cl:
[Pause] Th: Yes, it’s very new to see it this way—that you actually already experience both kinds of love. [Pause] And as you look back and forth at your Mom and Uncle Theo, what happens? [Prompting her to look back and forth at them is a repetition of the juxtaposition experience.]
Cl:
[Silence for about 15 seconds] It’s strange, but my Mom looks smaller. [This is a first marker of a transformational shift in her construction of Mom.] And it’s like—what’s wrong is in her, not in me. [Pause] It’s over there in her, not over here in me. [This is a marker of a transformational shift in the
meanings she has attributed to her mother’s harsh, rejecting behaviors.]
Th: Mm-hm. And how does it feel to know that?
Cl:
It feels scary—because, you know, then I can’t have any control over it. If it’s in me, I have a chance of controlling it. [Her own purpose and agency for maintaining self-blame has now come into awareness. This is further retrieval of implicit knowledge (Step B): her solution to the problem of terrifying
powerlessness has been to blame herself rather than her mother.]
Th: Control it by hiding everything imperfect?
Cl:
Right; and being really, really good. But if the reason she blows up at me is that she’s messed up, then I can’t possibly control it, and that’s scary. [Silence while gazing into her lap] But I’m also feeling relief, too.
Th: Relief because—?
Cl:
—because if she’s the problem, then maybe there’s nothing
seriously wrong with me after all; and maybe I won’t be rejected forever by anyone who gets to know me.
Th: Does Uncle Theo know you pretty well?
Cl: [Grins happily] He does, yeah.
Th:
So, look at him again and this time, try out saying to him, “You love me with my imperfections, and that means the world to me.”
Cl: [Silence as she says that to him] Yeah.
Th: It fits and feels true?
Cl: Yeah, it does. And he smiles at me; he’s happy that I understand.
The therapist and Regina then worked on writing some simple limbic-language sentences to put on an index card to help her stay in touch between sessions with key elements of this work. The card read:
Mom’s kind of love, and Uncle Theo’s kind of love. With Uncle Theo, I don’t have to be perfect to be lovable and loved. Mom’s love is so fragile because of trouble inside her, not because of me. That means I don’t have control over getting her to stop rejecting me, the way I thought I had, and that feels scary and sad.
Read daily, those sentences would prompt repeated experiences of the juxtaposition and of the knowings that emerged from it. The therapist also asked Regina to read the card just before phoning her mother and to keep the card in front of her during the conversation.
Regina’s juxtaposition experience had begun to dissolve her implicit mental model that love operates only in her mother’s manner and that the cause of her mother’s eruptions of hostility was her own defectiveness. Those models were replaced by a new, expanded model that included her mother’s type of love but also recognized the existence of her uncle’s type of love, as well as the view that the cause of her mother’s eruptions was something “messed up” in her mother, not in herself. She was therefore now beginning to inhabit a world in which steady, secure love was possible and available to her, and she was worthy of it and intact.
In the next session, the therapist invited and guided her to identify who else, among her relatives, friends, teachers, and work colleagues, would similarly feel hurt by learning that Regina sincerely believed that their fondness of her was only a superficial enjoyment of how perfectly she pleased them. She was surprised by how many people were in this group. This exercise, understood in terms of the therapeutic reconsolidation process, was an accessing of the same contradictory knowledge in many different contexts so that the target constructs would undergo a disconfirming juxtaposition experience in each context, which, as noted above, tends to be needed for thorough dissolution when a target schema operates in different contexts that have different memory networks. This work continued nonlinearly across about 10 sessions, alongside and
alternating with other lines of coherence work that had developed.
Imaginal work, such as was done with Regina, is of enormous value for guiding strong experiences of both attachment schemas and contradictory knowledge, as needed for successful schema-dissolving juxtaposition experiences. Creative use of imaginal process gives therapists virtually unlimited avenues for guiding such experiences beyond the limitations of relying solely on the client’s experiences of the therapist for reparative attachment work. Imaginal work can be so effective because the emotional brain responds to imagined experiences almost indistinguishably from how it responds to physically enacted experiences (see, for example, Kreiman, Koch,
& Fried, 2000).
In another form of experiential work, the therapist guided Regina into a practice that created both integration and juxtaposition experiences. We refer to it as the I’m in memory practice. At the start of her fifth session, Regina described a particularly strong panic attack that had occurred on the previous day as soon as she left a lunch meeting with several co-workers and returned alone to her car;
she was still, one day later, feeling quite shaky from it. At lunch there had been more than enough snide comments made and ambiguous social signals sent to trigger Regina’s expectation of disastrous rejection several times over. In fact, in re-telling the incident to the therapist, she became retriggered into a significant level of anxiety, and said so.
The therapist then said, “Okay, I’ll guide you to try something that could help with this, and I’ll explain it first. In our previous sessions, we’ve learned a lot about what it really means when your anxiety or panic ignites: It means somebody’s behavior has at least looked like a possibly negative response toward you, and we know why that perception is so charged and scary for you: it’s all those hundreds of times when you first saw a negative response starting in your mom, and then whammo! Really painful, humiliating, scary things would happen—a grueling ordeal that could keep going for days. Your emotional brain learned that the first moment of displeasure toward you means that now a horrible ordeal is coming. All of that emotional
learning and suffering went into your emotional memory, and emotional memory just doesn’t fade out over time—that’s how the brain evolved. Someone seeming to become displeased with you in the present closely enough resembles that terrible moment of your mom becoming displeased with you that it retriggers all of that emotional memory, and to your emotional brain this means that the ordeal is about to happen again right now! The emotional brain mixes up the past and the present. It uses the past to make sense of what’s happening in the present, and expecting the same ordeal to happen again now triggers an anxiety or panic attack. So here is what I want you to do right now:
“Put one of your palms on your heart, the way you might do if you were comforting a child who’s terrified. Good. Next, softly but out loud say this sentence to yourself about that lunch meeting: ‘This situation is reminding me of what I suffered back then, when Mom would start to get displeased with me.’ [Regina said the words.]
Good. Now say, ‘This raw fear I’m feeling is my living memory of what I felt and suffered back then.’ [Regina said the words.] Good.
Now, as you say this next sentence, gently pat your heart area with your hand: ‘It was so awful; it was so horrible for me—and this situation is reminding me of it.’ [She did this.] Good. Then say all of it one more time; I’ll lead you again …”
After saying those self-compassionate sentences a second time, Regina said with surprise that her anxiety had already diminished greatly—on a scale of 0 to 10, it was down to 2 from 8—and she added, “It has never faded out so fast once it’s triggered!” She also commented—and this was particularly indicative that the technique was working as intended—that “saying those words made something shift in my whole perspective—it was such a relief to realize that something awful isn’t really happening now, and also that this crazy feeling is actually coming from something and I’m not crazy.”
After saying those self-compassionate sentences a second time, Regina said with surprise that her anxiety had already diminished greatly—on a scale of 0 to 10, it was down to 2 from 8—and she added, “It has never faded out so fast once it’s triggered!” She also commented—and this was particularly indicative that the technique was working as intended—that “saying those words made something shift in my whole perspective—it was such a relief to realize that something awful isn’t really happening now, and also that this crazy feeling is actually coming from something and I’m not crazy.”