Salt Lake City, Utah
It is my belief that most patients who do not display serious psychopathology and for whom the trauma is not unusually severe (e.g., brutal rape or gang rape, torture, or cult abuse) are capable of experiencing an age regression back to a negative event or traumatic episode, and enduring a full abreaction of feelings about the event. When this is possible, therapy progresses more rapidly. However, facilitating a complete abreaction also requires that the therapist is someone who is experienced and skilled in this type of work.
As indicated earlier, I always ask the patient's unconscious mind if "it would be all right for us to go back and explore, and understand, and resolve" whatever happened at a specified age that has already been identified as relevant to the patient's problem. Given the contraindications already stated above, it is my experience that if a patient has inner apprehensions or serious reservations about reexperiencing a traumatic event, he or she will not give permission for the regression. This is an indication for consideration of other less intense abreactive alternatives and methods of dissociative regression which require more time but are gentler.
It is generally believed that feelings associated with more specific events will probably respond more favorably to abreaction than generalized feelings toward someone that have evolved through the process of many unpleasant (but not particularly traumatic) events, although this is not always the case. It is also commonly believed in the field that the more intense a traumatic episode, the more extreme the abreaction that will eventually be required to work through the incident. In cases of particularly severe trauma, an abreaction may have to be repeated two or three times, until almost no emotion is evoked by the regression. This may be done in one of two ways: (a) In an extended time interview where the patient is given five- or even ten-minute "sleep" periods between abreactions. At the beginning of the "sleep" period the patient may be given suggestions for having "peaceful" dreams and for time distortion so that "in a few minutes of this special trance time, it can seem as if hours of peaceful, restful, refreshing sleep have occurred." (b) Abreactions may also be repeated in sessions one day, several days, or a week apart.
After the patient has been regressed back to the beginning of an incident, instruct him/her to, "Tell me where you are, and what's happening." Further detail may be obtained through giving the following suggestion: "You will find yourself thinking and feeling as you did then, and everything you're thinking and feeling, just say out loud." The latter suggestion may be repeated from time to time. This suggestion not only assists in identifying the emotions involved, but also frequently allows you to identify the internal dialogue—what is going on in the patient's mind and how he was interpreting what is occurring. Both as the patient reports what is happening and after the details of the incident have been reported, you should seek to intensify the expression of emotion.
As the patient reexperiences the past trauma, you may facilitate the release of the emotions associated with it through some of the following types of suggestions: "That's right. Just let all the feelings out. Just like a dam breaking, all those feelings can come out now." "Let all those feelings out. You don't have to keep them inside anymore." "And as you let those feelings out, it's as though they evaporate. As you let those feelings out, they'll no longer influence how you think, or feel, or see things. Let go of all those feelings, so that this incident will no longer influence your thoughts, or your feelings, or your actions."
After the patient has narrated the entire event, I will often have her confront the perpetrator of abuse in imagination. For instance, if a woman was incestuously molested by her father, I may ask her to imagine that he is in front of her, in the same room with us, but now unable to harm or do anything to her. She is then asked to speak directly to her father. This procedure generally facilitates much more intense expression of affect, and a great deal of reframing and working-through is accomplished simultaneously with the expression of feelings.
The suggestions below are frequently used in this process. Typically one such comment will be made, and then, after the patient has vented feelings and begins to "run out of steam," another comment will facilitate continued and more thorough expression of emotion. In this process I focus on encouraging the patient's expression of the four primary feelings of anger, hurt, fear, and guilt.
"And tell [e.g., your father, mother] now all the things you couldn't tell him then." "Speak directly to [e.g., your grandpa], as if he's here right now, and tell him about all the anger and hatred inside." "Say that to him again, even louder." "That's right. Just let all the fear out. Tell him how scared it made you." "Tell him what it was like." "And tell him how bad that hurt. Tell him what that did to you inside." "Tell him the words that go with the tears." "Tell him what your tears are saying." "That's right, just let out all that pain." "Tell him what you'd like to do to him." In some cases the patient may even be allowed to imagine acting out against the perpetrator of the trauma.
Following a certain amount of abreaction, it is sometimes useful to use ideomotor signals to determine which primary emotions are unresolved: "Now I'd like to ask that little four-year-old girl down inside, and you can communicate with me through the fingers. Are you feeling frightened? Are you feeling hurt and a lot of pain inside? Are you feeling angry? Are you feeling guilty?" Later, following reframing and interpretive work, a check can be con ducted to determine that each of these feelings has been resolved and that they do not require further abreaction or interpretive work.
Depending upon the individual patient, you may select one of the many methods that follow to reduce the intensity of the cathartic experience during age regression. However, most patients who have been through a significant trauma, will sooner or later need to experience a full confrontation with and abreaction of the material. I have treated many patients who talked extensively about traumatic events with previous therapists, but on a more intellectual level, with limited release of emotion. Many of these patients consciously believed that the past experience was resolved and that the root of their continuing problems was elsewhere. Through ideomotor exploration, however, we have commonly discovered that the events were still unresolved emotionally, at a deeper level. Following age regression and more adequate abreaction, these patients became asymptomatic. Incomplete abreaction of underlying feelings has also been cited by many others as a cause of therapeutic failure (Kline, 1976; Kluft, 1982; Maoz & Pincus, 1979; Putnam, 1989; Rosen & Myers, 1947; Shorvon & Sargant, 1947; Watkins, 1949).
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