CASE STUDY - FREEDOM AND SPACE

Working with Claustrophobia using Eye Movement Desensitisation and Reprogramming and Process Oriented Psychology

“Praise the Lord for I am mended! I've never felt so free. Thank you for everything!”

This slightly tongue in cheek text was sent from a client as he left my office having used the very small lift for the first time.

The following is a short explanation of how this client and I worked together over 6 weekly 90 minute sessions and transformed his life.

This was a man in his 60's who had suffered from claustrophobia all his adult life. The impact of this fear meant he was severely restricted from going inside any small structure such as lifts, small tents, crowded buses and so on. The fear also had an effect on his relationship life so that he rejected people before they were able to reject him. He needed freedom and space in his relationships too.  Although he could see the link between the claustrophobia and his relationship problems as a result of years of talking therapy, it was a purely intellectual understanding which he felt unable to change. However, as a result of working with me, he was able to make a congruent commitment to his long-term partner and they will be getting married soon.

Below is a description of how the 6 sessions went. It should be pointed out that E.M.D.R. has a fairly strict protocol and structure to which I adhered. However, in some sessions we did not do E.M.D.R. as it looked important for him to process his current issues using process-oriented psychology alone. This was a combination that was especially effective for him.

Session 1

The first session involved a fairly detailed history taking, in particular asking him about traumatic incidents in his life, finding out if there were any serious contraindications to his undergoing E.M.D.R treatment and discovering how he copes with stress or distressing experiences. The answer to this last question was that he rationalises and compartmentalises. This was to prove something of a challenge in the work as I will show later. 

According to the E.M.D.R. protocol, the first session involved him being shown how to identify and access his own “special or safe place.” This is an inner state where one can find calm in the midst of anxiety or stress. It is recommended that a new client to E.M.D.R. learns this as sometimes the processing of traumatic incidents can continue between sessions, and the new client needs to feel able to handle things independently of the therapist.

This client's special place was on the top of a hill in driving wind and rain which was a “feeling of being in the here and now and in nature”. The client is asked to pick some cue words that will lead him to the special place automatically. His were “freedom and space”.
According to the protocol, I installed this special place using slow eye movements. He was very happy and excited to feel this powerful sense of freedom and space and he was able to access it easily without my help.

Session 2

In this session I asked him to give me more information about the claustrophobia, its triggers (small lifts or tents, planes, crowded buses), the emotions and thoughts that went with it, and some recent experiences of it. He told me he had recurrent dreams of being trapped in a coffin. The emotions that went with the dream and the daytime experiences of claustrophobia were fear of annihilation, panic, a sense of powerlessness and being out of control. Next was to find the touchstone memory which is a technique in E.M.D.R. where the client floats back in their imagination, beliefs, emotions and body feelings to the very earliest experience which they can remember of the same emotions and cognitions.

His touchstone memory was when he was deserted by his mother at a few weeks old and then adopted. This was unusual for a touchstone memory as he was very young to have had much in the way of conscious memory of the experience. However, this was clearly such a significant moment for his life and one which had dominated everything. He had been unable to truly trust his adoptive parents, and the same pattern of lack of trust worked its way into all his subsequent relationships. Years of therapy had not changed the anguish he still felt about it.

Session 3

At this session, we targeted this touchstone memory. This begins with the assessment stage where the client is asked for the worst part of the memory, often an image but can be sound, smell or thought or feeling. In this case it was the fear of something happening that he had no control over. Next comes the identification of  the negative and positive cognitions. When the person recalls the target memory, it is how this memory makes them feel about themselves in the present (in his case “I'm not loveable”)-this is the negative cognition. When the person recalls the target memory, it is how they would like to feel about themselves in the present-this is the positive cognition and is often the polar opposite of the negative cognition (in his case “I am loveable”). The client is then asked what emotion goes along with the memory and where do they feel it in the body. For him it was sadness and he felt it deep in his guts. According to the protocol, he was then asked for the Subjective Unit of Distress (S.U.D.) i.e. how distressing was the feeling on a scale of 0 to10-he said 8. He was also asked how strong was his belief in the positive cognition on a scale of 1-7 where 7 is total belief-he said 1.

The next phase begins as the client is asked to hold the worst part of the memory, the negative cognition, the emotion and where it is felt in the body all together and to follow the therapist’s fingers with their eyes as they move rapidly from side to side. At least 24 eye movements take place in each set with breaks for the client to feedback verbally to the therapist what was happening during the set.  As a therapist who is trained in non-verbal signal awareness (my process work training), it makes it easier for me to notice any changes (e.g. skin tone, facial expression) that might be happening with my client during each set. However, I am also very aware that one must never make assumptions about the inner world of another person and it is always fascinating to find out how each person experiences the effect of the eye movements. What is often the case is that the traumatic memory eventually recedes in intensity of emotion and insights are gained about what happened and why.

In this instance, the client had a big experience of feeling lost, withdrawn, confused and a sense of not being able to trust anyone and a certainty that he would never let this happen to him again. During the sets he also had an experience that I was invading him right there-the trust issue was already surfacing in the here and now-and I stopped to check out whether we should continue and to watch his verbal and non-verbal reactions to that. He was sure he wanted to continue and his non-verbal signals were congruent with what he was saying. Of course this might have been different with someone else, and especially with people with abuse histories who may not have strong patterns of saying “no”. It shows how important it is for the therapist to really be aware of non-verbal signals so as not to re traumatise someone or push someone into something they are not ready for.

Eventually his subjective experience of the memory did become “more distant and less threatening” and he said he felt good not being in control. A session in E.M.D.R. is deemed complete if the S.U.D. is down to 0 and the belief in the positive cognition is 7 out of 7. This session then was incomplete in that his S.U.D. was not down to 0 although greatly reduced to 3 and his belief in the positive cognition (“I am loveable”) was 6 out of 7. When asked what it would take for him to rate it at 7 out of 7, he said it was good to keep some cynicism as “life is not like that”. This then was a crucial part of his process-the need to protect himself from further hurt and rejection by keeping himself separate from others, and a deep fear of being out of control.

Session 4

After consultation with my E.M.D.R. supervisor, I decided to target next his most recent experience of claustrophobia rather than to target again the touchstone memory simply because it had been incomplete. However, when he arrived at my office, he was in a certain amount of distress and had been having headaches. We could have plunged into another E.M.D.R. session, but my experience and his feedback to me told me that something needed to be processed first. And that something was his “inner critic”. Since the last session, his headaches had gone along with a lot of self-abrogation and self-hatred. One way to work with this is a technique I learnt from Joe Goodbread and Kate Jobe (international process workers) at their “Extreme States” workshop in 2010. It is a simple technique in a way but it helps many clients as they need only sit, watch and make comments on the therapist as she represents in a role play two sides of an inner polarisation.

This I did with my client, expressing his inner critic with its full power and bullying tactics on the one side, and on the other side, in discussion with my client we tried to find a response to this inner bully. Normally my client would consciously and unconsciously agree with the inner critic against himself but I modelled for him standing up to the bully and he loved it! I used what might be called profane language against the critic which shocked him into taking a much less dominating position. My client's inner critic had never been spoken to like that before.
Supporting the position of  the inner critic was a great need for safety and security, and it became clear to my client that he had compromised himself for the sake of this feeling of security, which also felt to him like boredom and an inability to take risks. It was totally understandable as a result of his personal history and early abandonment. At this point we explored models of who can take risks and also stand up to bullies and stay true to their principles. He needed a new pattern as so far he only had his critic with its overly cautious and conservative attitude (the “Victorian headmaster”) and his previously cowed response to it. Two people occurred to him.  One was Frank Field the left wing politician who he saw as “compassionate, decent and not a slave to anyone”. The other was Richard Branson the entrepreneur. This latter was a new pattern which became very significant to him and he later got closer to it by reading his autobiography. The qualities of it were an ability to take risks and not be anxious about the consequences, to live in the moment, to stop thinking and analysing and to simply follow himself and his impulses. This was his inner pattern of freedom.
Using a process-oriented approach we had found the new pattern he needed and he imagined himself as Richard Branson, how he sits, moves, thinks and feels. Then using an E.M.D.R. approach I helped to install this pattern or future template by using a few sets of slow eye movements. The client left in a very different place, his headache and anxiety gone.

Session 5

By this session he was ready to target his most recent experience of acute claustrophobia. This was when he was on holiday in Turkey and he had a panic attack while on a crowded bus. The worst part of the memory was the realisation that there were too many people on the bus for him to get out and that this was too much for him. He then had some very extreme physical reactions, his blood pressure went up, he felt cold yet was sweating and a feeling of imploding. The negative cognition was “I am in danger” and the positive “I am safe at this point in time”. The emotion was sadness that he couldn't control himself and with a S.U.D. of 8, he felt it in his legs. The score for his positive cognition was 7 out 7 which is unusual before the eye movement stage of the treatment takes place. The reason for this was that he said he was good at compartmentalising and, since the positive and negative cognitions are based on a perception of oneself in the present in relation to the memory, he could put the memory intellectually into the past and feel safe in the present.

During the next eye movement phase, he had many insights. His overwhelming sadness was connected to his inability to trust the people around him and his old belief that if you show your vulnerability, people will take advantage. By the end of  the session, he saw that owning up to fear in order to get help could actually be empowering and was a way of dealing with such a situation in future. He also saw how this could be generalised to other situations in his life where he had battled on alone where help from others was what  would have helped him the most. The session was incomplete but fruitful and we returned to this memory at the next session.

Session 6

During this session, we completed work on the target memory of the panic attack in Turkey, and he found for himself a way or pattern for dealing with this situation. He would remind himself of his inner strength and inner space. This inner space was something he felt able to access at will and was now represented by images of Montana and a feeling of natural clear air. Using slow eye movements, I helped to install this further. Together it became clear to us that his critic had dominated all the “air” of his inner world and I was reminded of when working with his critic, I had felt unable to breathe and had literally needed to open the windows. Now that this critic was taking a smaller role, my client could breathe and be himself and truly take his space in the world.
Without telling me in advance, my client left the office by  way of the extremely small lift and sent me the text with which I began this article. We met again one more time to talk and consider whether he would like to continue seeing me for sessions, but he felt he was for the time being “done” and his many emails during and after the work sum up his gratitude and feedback. Below are a couple of extracts:-

This work is simply changing my life and giving me liberation for the very first time

Words can’t express what I’m experiencing; it’s almost like flying. It’s the very first time I’ve felt true to myself.