Using a Blocking Belief as a Sub-protocol

The next target that Madeline and I worked on was her being in the hospi- tal, helpless and severely injured. Here the components were

Picture: being in multiple casts in her hospital bed Negative cognition: I am trapped.

Emotion: terror and sadness SUDS: 6

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It was during this processing that we ran into a blocking belief. Although Madeline had had a number of intense trauma-processing sessions and had even screamed, she had not shed any tears. When tears started welling up during this protocol she swallowed them back down. She experienced her- self as having a lot of negative self-judgments that made her choke back all the tears she kept locked inside. Madeline was clear that she was not ready to continue processing at the moment. As we dialogued, she voiced a deep blocking belief: I am weak if I cry. The standard way these blocking beliefs are usually processed is by adding a cognitive interweave and just starting another set once the client’s train is back on the tracks. A cognitive inter- weave is an adaptive suggestion to link into the blocked process. An exam- ple of an interweave I used was, “I’m confused, are you saying that only weak people cry?” That intervention did not link to an adaptive connec- tion. Then I asked, “What if this was your child, or your best friend — would they be weak if they cried?” In most cases, this intervention seems to do the trick, but in this case I tried a few interweaves without success. To me, working relationally means using my best judgment to vary my responses, even if that means a deviation from a standard procedure.

When blocking beliefs like this arise, and cognitive interweaves do not seem to enable productive information processing, it can sometimes be useful to “float back” to earlier memories to process their origins related to the core trauma. I have learned that a sub-protocol (my term) is a useful manner of focusing on older state-dependent memories. When I asked Madeline to identify and target her blocking belief about crying, she said that crying is a sign of weakness. I asked her how she learned this belief, and she was confounded. Then I had her hold the belief, I am weak if I cry, and notice what she felt in her body. She said there was a tightening in her chest and tension in her arms and legs.

One of the ways I like to do the floatback technique is as follows: I have the client imagine a scene that is congruent with a calm experience. In Madeline’s case, I had her envision standing on a mountaintop in late spring with the sun shining, gently warming her. From there she could see a whole vista of mountains and valleys covered with trees. I then had her imagine calling her mountaintop “the mountain of the present.” I asked her to pick one of the other mountains, about 200 yd away, and we would call that “the mountain of the past.” Next I asked Madeline to imagine a big wrought-iron bridge with foundations sunk deep into the earth that connected these two mountains.

I suggested that she begin her journey across this bridge thinking the words, “I am weak if I cry,” and holding the sensations of tightening in her chest and tension in her arms and legs. I asked her not to try to remember

anything, but just to notice what old memories floated back into her mind. I let her know that I would give her as much time to cross this bridge as she needed, and that I would sit in respectful silence while she completed her process. About 15 sec into her journey, Madeline’s eyes opened, her jaw dropped, and she uttered the words, “Oh, my God!” (An interesting choice of words for an atheist, I thought.)

She reported to me that a very old memory had come into her mind. She was 3 years old and her brother was 1. They shared a room. One after- noon, Madeline’s baby brother began crying uncontrollably in his crib. She was in her own crib and tried to climb out to comfort him, but got trapped between the top of her crib and her dresser. Her head was stuck in such a way that all she could see was the parquet floor. She cried out for her mother, who (unbeknownst to Madeline) was down the street visiting neighbors. Her mother did not come. Madeline realized that she had to focus all her energy on holding on between the crib and the dresser. She could not climb back into her crib, and she could not just let herself drop. The floor looked too far away; she knew she would die if she fell. Her brother’s crying continued unabated, and Madeline could remember feel- ing angry at him for making this moment even more difficult.

We decided to develop a sub-protocol to release the trauma that was the source of her blocking belief that crying was a sign of weakness. (While we could have just processed the memory that came up while using the float- back technique, Madeline’s propensity for analyzing was too intense at that point in treatment, and I decided that some additional structuring via the procedural steps outline would enable her to get back into the pro- cess.) The elements were

Picture: holding on between the crib and the dresser, looking down at the floor

Negative cognition: I am trapped. Emotion: terror and sadness SUDS: 10

Body: tightness in the chest, arms, and legs

Notice the similarity between these components and the previous ones. Madeline’s negative cognition, emotions, and body sensations were nearly identical to those representing the hospital trauma that she had been unable to process. This was a very significant moment in Madeline’s treat- ment. Up until this point, she had been adamant that she would only deal with issues related to her car accident and its sequeli. But having now had some positive experiences in processing trauma, she was more open to taking a wider view of what experiences may have been trapped inside her.

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Madeline was quite surprised by the result of her floatback experience. I gently explained to her that often associated channels of trauma that are held in separate memory networks are connected through core negative belief systems and body sensations. She had noticed the similarities as well. The result was that in one double session, Madeline was able to release the pain of being trapped between the dresser and the crib, and she also remembered her mother rushing back into the room and grabbing her just as she was losing her strength. She remembers bursting into tears at that moment and hearing her mother say, “Now, now, big girls don’t cry.”

Torrents of tears poured forth as Madeline felt the feelings of the helpless little girl locked inside her who was trapped and terrified of dying. We were able to desensitize that memory down to a SUDS of 0. However, because this was a sub-protocol of her hospital trauma, I asked her to continue working and to re-access the original incident. Madeline again remembered seeing herself in the hospital bed with casts and bandages all over her. Now there was no need to continue the rest of the procedural steps; Madeline’s awareness had shifted, and anything more than returning to the target might have caused her to become deactivated, so we just started with the image. During the next two double sessions, Madeline successfully pro- cessed the trauma of being helplessly trapped in her hospital bed.