Sunday, September 13, 2009

Appreciations (11) – Learning by saying

Appreciations (11) – Learning by saying.

Torrey Orton

September 13, 2009

Speaking truth is power. The injured often have trouble speaking their pain, anger to the powerful. Even formulating the idea that they are unjustly injured may be difficult. This can take many sessions in therapy. And, even when the truth of their experience is acknowledged to themselves, speaking it is another thing. The repression which keeps historical hurts out of sensory range is a powerfully focussed energy.

I was reminded of that power by a new patient who is not at all reticent professionally. He even acts from anger too often privately and publically. That's one reason he started therapy. In our first session he was suddenly floored by a slight insight in our closing minutes that he "couldn't speak your pain" to his mother, ever. A similar effect occurred with another male patient still living in the home where his physically and emotionally violent mother terrorised all four children (he was the third). Though physically unprepossessing now, she can still invade his world anytime she chooses, including his bedroom. He has installed deadlocks for prevention. Just thinking about her elevates his pulse and breathing rates to flight levels.

On the way to managing his social phobia (one of a number of symptoms of her enduring threat), I practiced him in pre-empting a phobia-inducing shopping event. It only involved asking the floor manager in a store to keep floor staff away until he was ready to be served. By the third time around in trialling words for the intervention, he remarked: "I feel stronger". And he sounded that way too. His starting place for the exercise had been: "I can't do this". Entering the practice process itself involved confronting a mini-phobia in our room.

I used the same process with a generational peer of more classical male Aussie temperament and non-verbal preferences. He was somewhat stunned to be in a therapist's office in the first place, but had a clear agenda of self-endorsed behaviour change and desired by his partner. This included letting her know things he was planning for them both (eg – weekend social commitments, etc). In exploring those items, we discovered that he had an assertion matter of his own relating to one behaviour of hers he found disrespectful of him. Our process experience was essentially the same as above, and with same effect. He reported a week later he had taken both steps with satisfactory effect (so far).

From motivation to motion
Pre-emption is the tool of preference for high grade anxiety reduction. If you can change your circumstances, you can change your feelings at two levels. First, the situational triggers are reduced / nullified and second, your actual capacity to control things is increased. The second recursively reduces the strength of the triggers. This is empowerment through training! Changing thinking alone won't do this because the trigger events and contexts recur, with their attendant injustices, embedded in long term social relations.

A CBT-critical interlude
Some perceived injustices are real. Even the famous CBT specialist Aaron Beck recognises this, then turns away from its implications. In his book on anger and violence – Prisoners of Hate (Harper Collins 1999) - he acknowledges "..there does not seem much likelihood for adequate alleviation of the socioeconomic conditions" which support violent anger (pg. 168). These conditions (unemployment, drugs, and continuous conflict with authorities) were among the objective forces maintaining violent street ideologies in inner city gangs 10 years ago. Parallels now are not hard to find.

Powerless to change these destructive forces visited unequally on some parts of our societies, Beck attempts to salvage the therapeutic enterprise of anger management on the big social stage by recommending parenting training for the parents of the wayward adolescents. Socio-economic structures of inequality are relatively widely recognised for their impact on individuals' and groups' potential and performance, though an endless 'debate' goes on about how much so, and what to do – nothing or a little. Have a read of Deer Hunting with Jesus by Joe Bageant (Scribe 2009) for a take on an American underclass he numbers around 35 million, better than 50% of whom are white, non-city. These are not only monstered by similar socio-economic conditions, but also by their ideological leaders who continue to pretend their failure is a consequence of the godless and communistic afflictions of other Americans.

Back to practice
Prior to the two events above, I had approached pre-emption practice as a late stage in work on disempowering anxieties (themselves arising from disempowering historical events and their present social system recurrences). So, I was surprised how effective going straight (almost) to the recuperative behaviour felt to the patients, where the thought/feeling/behaviour anchors had not been thoroughly exposed and analysed. Perhaps this is a verbal example of the famous 'change the practice to change the behaviour' prediction often claimed to have been proven by introduction of seatbelts in Victoria 35 years ago.

Once again, learning from my patient clients.

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