Emerging Practice in Focusing-Oriented Psychotherapy

Innovative Theory and Applications

Greg Madison

• Publisher: Jessica Kingsley Publishers
• Year: 2014
• ISBN:
  9780857007223
• Topic: Psychology
• Subtopic: Movements in Psychology
• Index: Psychology

Emerging Practice in Focusing-Oriented Psychotherapy brings together some of the world's most influential contemporary psychotherapists in the field to look at the future of Focusing-oriented approaches.

Focusing-Oriented Psychotherapy - a form of therapy that involves listening to the innate wisdom of the body - is a dynamic and growing field that has evolved greatly since Eugene Gendlin first published the text Focusing-Oriented Psychotherapy in 1996. This book explores recent innovations such as Focusing-Oriented Psychotherapy as a response to trauma, Wholebody Focusing, and how Focusing has been adapted in Japan and South Korea. One section looks at specific contemporary issues and emerging practical applications of Focusing-Oriented Psychotherapy, such as how Focusing can be used in wellbeing counselling and to help decision making processes in counselling and therapy. By offering new alternatives to working effectively with difficult issues and specific client groups, this volume will appeal to a broad range of therapists, coaches, and other practitioners.

Jessica Kingsley Publishers also publishes a companion volume, Theory and Practice of Focusing-Oriented Psychotherapy: Beyond the Talking Cure, edited by Greg Madison [9781849053242].

PART I

Focusing-Oriented Therapy
as a Response to Trauma

The first part of this volume opens with three chapters each exploring the topic of trauma from very diverse perspectives. First of all we have Emmanuil Vantarakis’s use of Greek myth as an allegory for post-traumatic stress disorder (PTSD), bringing a rich human dimension to a topic that can become over-populated with prescriptive techniques. By drawing on recent research on trauma, Vantarakis offers an overview of current understanding and where Focusing-Oriented Therapy (FOT) might sit within this evolving field.

By contrast, Mary Armstrong, an established trauma therapist, shares a deeply personal account of discovering at the age of 50 that she had suffered from childhood sexual abuse. She takes us through her own experiential journey and demonstrates how Focusing was instrumental in her healing process.

This part of the book culminates with an account of Aboriginal FOT by Shirley Turcotte and her son, Jeffrey Schiffer. They describe an in-depth integration of Focusing attitudes and practices embedded within a culturally sensitive model of Aboriginal health care and well-being. They include evocative stories of “land-based” and intergenerational responses to complex trauma.

The topic of trauma is increasingly prevalent within psychotherapy discourse. We are pleased to provide three unique and deeply human accounts of how the gentle and respectful approach of FOT can be healing for anyone who is suffering from trauma of any kind.

CHAPTER 1

Trauma, Myths, Focusing

Emmanuil Vantarakis

Introduction

King Telephus was wounded in the thigh by the spear of Achilles during the first, failed, campaign of the Greeks at Troy. The Greeks failed to make headway and returned without achieving their goal. The wound of Telephus, however, became chronic and refused to close, despite all therapeutic attempts. Thus Telephus turned to the oracle at Delphi to seek help. The reply from the oracle was, “he that wounded shall heal.”

Telephus went in disguise to meet Achilles at Aulis, where the Greeks were preparing a second expedition against Troy. In the palace, however, he was discovered and threatened with death. Odysseus then intervened and defused the dangerous situation with his observation that it was not Achilles in fact who had wounded Telephus, but his spear. Odysseus suggested that the spear of Achilles might be capable of healing Telephus and so scraped off a little rust from the spear over the wound of Telephus, who was then finally healed. Telephus, by way of repaying the favour, led the Greeks to Troy.

The prophecy delivered by the oracle “he that wounded shall heal” refers to the therapeutic principle whereby, in order to heal our trauma, we must encounter our past traumatic experience, as it is transferred to the here and now by our organism.

Post-traumatic stress disorder (PTSD)

Our reference to the wound of Telephus leads us to a discussion of chronic psychological trauma, or post-traumatic stress disorder (PTSD). The development of PTSD is the result “of exposure to an overwhelming and inescapable event which overcomes a person’s coping ability, thus encapsulating the interaction between the individual and the traumatic event” (Johnson 2009, p.4). According to DSM-IV, PTSD involves some “direct personal experience, witnessing, or learning about an event involving actual or threatened death or injury. The response must involve intense fear, helplessness, or horror,” and is accompanied by symptoms involving re-experiencing the trauma, avoidance, numbing and hyperarousal or hyper-vigilance (APA 2000).

Due to the restricted interaction between the individual and his traumatic experience, the experiential processing is skipped (“process skipping”; see Purton 2004, p.144) or blocked (p.185) along with the ability to create any symbolization of it. This leads to the creation of psychological trauma, given that “failure to process information on a symbolic level is at the very core of the pathology of postraumatic disorder” (van der Kolk, Hopper and Osterman 2001, p.28).

Chronic skipping of experiential processing of traumatic experiences is related either to incongruence between the structure of the self and the organismic experience of the trauma (Mearns and Cooper 2006), and/or with disorder in the symbolic processing of traumatic experiences at a neurophysiological and conceptual-linguist level (Porges 2009; Tudor and Tudor 2009). “Individuals in a state of fear/terror undergo a radical shift from top-down to bottom-up processing in which access to conceptual-linguistic thought processes is severely restricted and the frontal regions of the cortex are no longer able to override impulses from the brain stem and midbrain regions” (Catherall 2003, p.76).

The organism actively continues to move towards actualizing its needs in the context of whatever conditions are prevailing at the time, and is intrinsically “motivated to increase congruence between self and experience” (Joseph 2005, p.196). Therefore, the organism tries to complete the skipped or blocked processes in order to make sense and find meaning in their traumatic experiences (Regel and Joseph 2010). This involves striving to balance their competing needs: to avoid pain during the re-experiencing and integration of the traumatic experience, “the cycle of intrusion and avoidance is thought to reflect the struggle [of the organism] to reconcile these discrepancies” (Cordova and Ruzek 2004, p.217).

Thus in focusing-oriented traumatherapy, the symptoms of PTSD are to be regarded as a biologically adaptive process. “In response to trauma and adversity, people do the best they can in the circumstances as they experience and perceive them” (Tudor and Tudor 2009, p.139). As the traumatic experience remains inadequately integrated, memory processes can activate concrete internal or external cues as traumatic reminders (Ehlers, Hackmann and Michael 2004) that trigger re-experiencing of the traumatic situation. In response, the survival strategy of fight-flight-freeze is activated to cope with the internal threat.

The re-experiencing of traumatic experience is to be understood as an automatic biological procedure, which is an expression of the organismic need to complete the half-finished aspects of the trauma. It is the psychosomatic attempt on the part of the organism to complete the gap in the unfinished cycle of the survival strategy of fight-flight-freeze (Levine 1997).

Avoidance and numbing express the organismic need for safety and protection of the self from the pain of traumatic experience. The individual avoids feelings, thoughts and types of behavior and relations that trigger the experience of trauma. According to Taylor et al. (1998; c.f. Feuer, Nishith and Resick 2005, p.166), numbing is an automatic consequence of uncontrollable physiological arousal, whereas avoidance is an active means of coping with trauma-related intrusion. Hyperarousal is related to extended exposure of the individual to traumatic re-experience, to the anticipation of impending hurt, to a feeling of vulnerability and to a conflict of competing needs of the organism (Elliott, Davis and Slatick 1998).

The development of PTSD, then, can be regarded as the result of the skipping or the blocking of the experiential process of a traumatic experience. In the organism, on the one hand the traumatic experience is held stored, in a not yet symbolic form, in the emotional and non-verbal subcortical centers of the brain (Tudor and Tudor 2009). When reminders of the traumatic episode reactivate these unprocessed experiences, a traumatic circuit is triggered in these subcortical structures on the brain (Ogden, Minton and Pain 2006). On the other hand, the organism is activated, also, by the competing needs of the traumatized individual. Given the prevailing incongruence, these needs are not organizable into one system which is internally consistent and which is, or is related to, the structure of self” (Rogers 1951, p.513) and thus remain unsatisfied since they cannot remain in consciousness and be processed through accurate symbolization.

There is more to the understanding of PTSD, however, than simply quoting the symptoms that accompany it. It also includes phenomenological changes in the understanding of the individual that are produced by traumatic experience. The experience of trauma “fundamentally disrupts the whole assumptive frame upon which our sense of self is founded…by one sudden, catastrophic event” (Mearns and Cooper 2006, p.65). It leads the individual to a state of disorganization, since the image of the self and of the world fragments and collapses, along with the sensation of meaning and coherence and the cultural identity of the individual (Atkinson, Nelson and Atkinson 2010; Janoff-Bulman 1992; Serlin 2008).

These phenomenological changes, which distinguish the various life stages of the individual into before,1 during and post traumatic experiences, form a state of existential transition (Mearns and Cooper 2006; Papadopoulos 2007) and existential crisis that leads to a loss of the sense of meaning, to a sense of helplessness and of mortality. “Trauma is experienced subjectively as the confrontation with nothingness, death, and terror. It can be terrifying to feel as though one is living in a universe with random death and suffering” (Serlin and Cannon 2004, p.315).

Therapy as a process of symbolization

Psychological trauma is considered to be a “psychopathology,” a compound of the words “psyche,” “pathos” (pain) and “logos” (meaning). The word “psychopathology” raises many questions, such as: what truly is the reason that our psyche suffers when we are psychologically traumatized? Or what is it that causes us to suffer during psychological trauma? The suggestion is that a psychopathological symptom is related to the loss of meaning of the experience (Hillman 1975, p.71). The loss of the meaning of traumatic experience involves the failure to achieve symbolization and this forms the core of its development in PTSD.

How, then, is it possible for the meaning of the traumatic experience to emerge and for us to be led towards therapy? Perhaps at this point a description of therapy in ancient Greece, which is preserved on a marble stele in the National Archaeological Museum in Athens, is illuminating (Figure 1.1). It refer...