The Body Keeps the Score

Home > Other > The Body Keeps the Score > Page 36
The Body Keeps the Score Page 36

by Bessel van der Kolk MD


  As Schwartz states: “If one accepts the basic idea that people have an innate drive toward nurturing their own health, this implies that, when people have chronic problems, something gets in the way of accessing inner resources. Recognizing this, the role of therapists is to collaborate rather than to teach, confront, or fill holes in your psyche.”14 The first step in this collaboration is to assure the internal system that all parts are welcome and that all of them—even those that are suicidal or destructive—were formed in an attempt to protect the self-system, no matter how much they now seem to threaten it.

  SELF-LEADERSHIP

  IFS recognizes that the cultivation of mindful self-leadership is the foundation for healing from trauma. Mindfulness not only makes it possible to survey our internal landscape with compassion and curiosity but can also actively steer us in the right direction for self-care. All systems—families, organizations, or nations—can operate effectively only if they have clearly defined and competent leadership. The internal family is no different: All facets of our selves need to be attended to. The internal leader must wisely distribute the available resources and supply a vision for the whole that takes all the parts into account.

  As Richard Schwartz explains:

  The internal system of an abuse victim differs from the non-abuse system with regard to the consistent absence of effective leadership, the extreme rules under which the parts function, and the absence of any consistent balance or harmony. Typically, the parts operate around outdated assumptions and beliefs derived from the childhood abuse, believing, for example, that it is still extremely dangerous to reveal secrets about childhood experiences which were endured.15

  What happens when the self is no longer in charge? IFS calls this “blending”: a condition in which the Self identifies with a part, as in “I want to kill myself” or “I hate you.” Notice the difference from “A part of me wishes that I were dead” or “A part of me gets triggered when you do that and makes me want to kill you.”

  Schwartz makes two assertions that extend the concept of mindfulness into the realm of active leadership. The first is that this Self does not need to be cultivated or developed. Beneath the surface of the protective parts of trauma survivors there exists an undamaged essence, a Self that is confident, curious, and calm, a Self that has been sheltered from destruction by the various protectors that have emerged in their efforts to ensure survival. Once those protectors trust that it is safe to separate, the Self will spontaneously emerge, and the parts can be enlisted in the healing process.

  The second assumption is that, rather than being a passive observer, this mindful Self can help reorganize the inner system and communicate with the parts in ways that help those parts trust that there is someone inside who can handle things. Again neuroscience research shows that this is not just a metaphor. Mindfulness increases activation of the medial prefrontal cortex and decreases activation of structures like the amygdala that trigger our emotional responses. This increases our control over the emotional brain.

  Even more than encouraging a relationship between a therapist and a helpless patient, IFS focuses on cultivating an inner relationship between the Self and the various protective parts. In this model of treatment the Self doesn’t only witness or passively observe, as in some meditation traditions; it has an active leadership role. The Self is like an orchestra conductor who helps all the parts to function harmoniously as a symphony rather than a cacophony.

  GETTING TO KNOW THE INTERNAL LANDSCAPE

  The task of the therapist is to help patients separate this confusing blend into separate entities, so that they are able to say: “This part of me is like a little child, and that part of me is more mature but feels like a victim.” They might not like many of these parts, but identifying them makes them less intimidating or overwhelming. The next step is to encourage patients to simply ask each protective part as it emerges to “stand back” temporarily so that we can see what it is protecting. When this is done again and again, the parts begin to unblend from the Self and make space for mindful self-observation. Patients learn to put their fear, rage, or disgust on hold and open up into states of curiosity and self-reflection. From the stable perspective of Self they can begin constructive inner dialogues with their parts.

  Patients are asked to identify the part involved in the current problem, like feeling worthless, abandoned, or obsessed with vengeful thoughts. As they ask themselves, “What inside me feels that way?” an image may come to mind.16 Maybe the depressed part looks like an abandoned child, or an aging man, or an overwhelmed nurse taking care of the wounded; a vengeful part might appear as a combat marine or a member of a street gang.

  Next the therapist asks, “How do you feel toward that (sad, vengeful, terrified) part of you?” This sets the stage for mindful self-observation by separating the “you” from the part in question. If the patient has an extreme response like “I hate it,” the therapist knows that there is another protective part blended with Self. He or she might then ask, “See if the part that hates it would step back.” Then the protective part is often thanked for its vigilance and assured that it can return anytime that it is needed. If the protective part is willing, the follow-up question is: “How do you feel toward the (previously rejected) part now?” The patient is likely to say something like “I wonder why it is so (sad, vengeful etc.).” This sets the stage for getting to know the part better—for example, by inquiring how old it is and how it came to feel the way it does.

  Once a patient manifests a critical mass of Self, this kind of dialogue begins to take place spontaneously. At this point it’s important for the therapist to step aside and just keep an eye out for other parts that might interfere, or make occasional empathic comments, or ask questions like “What do you say to the part about that?” or “Where do you want to go now?” or “What feels like the right next step?” as well as the ubiquitous Self-detecting question, “How do you feel toward the part now?”

  A LIFE IN PARTS

  Joan came to see me to help her manage her uncontrollable temper tantrums and to deal with her guilt about her numerous affairs, most recently with her tennis coach. As she put it in our first session: “I go from being a kick-ass professional woman to a whimpering child, to a furious bitch, to a pitiless eating machine in the course of ten minutes. I have no idea which of these I really am.”

  By this point in the session, Joan had already critiqued the prints on my wall, my rickety furniture, and my messy desk. Offense was her best defense. She was preparing to get hurt again—I’d probably let her down, as so many people had before. She knew that for therapy to work, she’d have to make herself vulnerable, so she had to find out if I could tolerate her anger, fear, and sorrow. I realized that the only way to counter her defensiveness was by showing a high level of interest in the details of her life, demonstrating unwavering support for the risk she took in talking with me, and accepting the parts she was most ashamed of.

  I asked Joan if she had noticed the part of herself that was critical. She acknowledged that she had, and I asked her how she felt toward that critic. This key question allowed her to begin to separate from that part and to access her Self. Joan responded that she hated the critic, because it reminded her of her mother. When I asked her what that critical part might be protecting, her anger subsided, and she became more curious and thoughtful: “I wonder why she finds it necessary to call me some of the same names that my mother used to call me, and worse.” She talked about how scared she had been of her mom growing up and how she felt that she never could do anything right. The critic was obviously a manager: Not only was it protecting Joan from me, but it was trying to preempt her mother’s criticism.

  Over the next few weeks Joan told me that she had been sexually molested by her mother’s boyfriend, probably around the time she was in the first or second grade. She thought she’d been “ruined” for intimate relationships. While she was demanding and cr
itical of her husband, for whom she lacked any sexual desire, she was passionate and reckless in her love affairs. But the affairs always ended in a similar way: In the middle of a lovemaking session, she would suddenly become terrified and curl up into a ball, whimpering like a little girl. These scenes left her confused and disgusted, and afterward she could not bear to have anything more to do with her lover.

  Like Marilyn in chapter 8, Joan told me that she had learned to make herself disappear when she was being molested, floating above the scene as if it were happening to some other girl. Pushing the molestation out of her mind had enabled Joan to have a normal school life of sleepovers, girlfriends, and team sports. The trouble began in adolescence, when she developed her pattern of frigid contempt for boys who treated her well and having casual sex that left her humiliated and ashamed. She told me that bulimia for her was what orgasms must be for other people, and having sex with her husband for her was what vomiting must be for others. While specific memories of her abuse were split off (dissociated), she unwittingly kept reenacting it.

  I did not try to explain to her why she felt so angry, guilty, or shut down—she already thought of herself as damaged goods. In therapy, as in memory processing, pendulation—the gradual approach that I discussed in chapter 13—is central. For Joan to be able to deal with her misery and hurt, we would have to recruit her own strength and self-love, enabling her to heal herself.

  This meant focusing on her many inner resources and reminding myself that I could not provide her with the love and caring she had missed as a child. If, as a therapist, teacher, or mentor, you try to fill the holes of early deprivation, you come up against the fact that you are the wrong person, at the wrong time, in the wrong place. The therapy would focus on Joan’s relationship with her parts rather than with me.

  MEETING THE MANAGERS

  As Joan’s treatment progressed, we identified many different parts that were in charge at different times: an aggressive childlike part that threw tantrums, a promiscuous adolescent part, a suicidal part, an obsessive manager, a prissy moralist, and so on. As usual, we met the managers first. Their job was to prevent humiliation and abandonment and to keep her organized and safe. Some managers may be aggressive, like Joan’s critic, while others are perfectionistic or reserved, careful not to draw too much attention to themselves. They may tell us to turn a blind eye to what is going on and keep us passive to avoid risk. Internal managers also control how much access we have to emotions, so that the self-system doesn’t get overwhelmed.

  It requires an enormous amount of energy to keep the system under control. A single flirtatious comment may trigger several parts simultaneously: one that becomes intensely sexually aroused, another filled with self-loathing, a third that tries to calm things down by self-cutting. Other managers create obsessions and distractions or deny reality altogether. But each part should be approached as an internal protector who maintains an important defensive position. Managers carry huge burdens of responsibility and usually are in over their heads.

  Some managers are extremely competent. Many of my patients hold responsible positions, do outstanding professional jobs, and can be superbly attentive parents. Joan’s critical manager undoubtedly contributed to her success as an ophthalmologist. I have had numerous patients who were highly skilled teachers or nurses. While their colleagues may have experienced them as a bit distant or reserved, they would probably have been astonished to discover that their exemplary coworkers engaged in self-mutilation, eating disorders, or bizarre sexual practices.

  Gradually Joan started to realize that it is normal to simultaneously experience conflicting feelings or thoughts, which gave her more confidence to face the task ahead. Instead of believing that hate consumed her entire being, she learned that only a part of her felt paralyzed by it. However, after a negative evaluation at work Joan went into a tailspin, berating herself for not protecting herself, then feeling clingy, weak, and powerless. When I asked her to see where that powerless part was located in her body and how she felt toward it, she resisted. She told me she couldn’t stand that whiny, incompetent girl who made her feel embarrassed and contemptuous of herself. I suspected that this part held much of the memory of her abuse, and I decided not to pressure her at this point. She left my office withdrawn and upset.

  The next day she raided the refrigerator and then spent hours vomiting up her food. When she returned to my office, she told me she wanted to kill herself and was surprised that I seemed genuinely curious and nonjudgmental and that I did not condemn her for either her bulimia or her suicidality. When I asked her what parts were involved, the critic came back and blurted out, “She is disgusting.” When she asked that part to step back, the next part said: “Nobody will ever love me,” followed again by the critic, who told me that the best way to help her would be to ignore all that noise and to increase her medications.

  Clearly, in their desire to protect her injured parts, these managers were unintentionally doing her harm. So I kept asking them what they thought would happen if they stepped back. Joan answered: “People will hate me” and “I will be all alone and out in the street.” This was followed by a memory: Her mother had told her that if she disobeyed, she would be put up for adoption and never see her sisters or her dog again. When I asked her how she felt about that scared girl inside, she cried and said that she felt bad for her. Now her Self was back, and I was confident that we had calmed the system down, but this session turned out to be too much too soon.

  PUTTING OUT THE FLAMES

  The following week Joan missed her appointment. We had triggered her exiles, and her firefighters went on a rampage. As she told me later, the evening after we talked about her terror of being put into foster care, she felt as if she were going to blast out of herself. She went to a bar and picked up a guy. Coming home late, drunk, and disheveled, she refused to talk to her husband and fell asleep in the den. The next morning she acted as if nothing had happened.

  Firefighters will do anything to make emotional pain go away. Aside from sharing the task of keeping the exiles locked up, they are the opposite of managers: Managers are all about staying in control, while firefighters will destroy the house in order to extinguish the fire. The struggle between uptight managers and out-of-control firefighters will continue until the exiles, which carry the burden of the trauma, are allowed to come home and be cared for.

  Anyone who deals with survivors will encounter those firefighters. I’ve met firefighters who shop, drink, play computer games addictively, have impulsive affairs, or exercise compulsively. A sordid encounter can blunt the abused child’s horror and shame, if only for a couple of hours.

  It is critical to remember that, at their core, firefighters are also desperately trying to protect the system. Unlike managers, who are usually superficially cooperative during therapy, firefighters don’t hold back: They hurl insults and storm out of the room. Firefighters are frantic, and if you ask them what would happen if they stopped doing their job, you discover that they believe the exiled feelings would crash the entire self-system. They are also oblivious to the idea that there are better ways to guarantee physical and emotional safety, and even if behaviors like bingeing or cutting stop, firefighters often find other methods of self-harm. These cycles will come to an end only when the Self is able to take charge and the system feels safe.

  THE BURDEN OF TOXICITY

  Exiles are the toxic waste dump of the system. Because they hold the memories, sensations, beliefs, and emotions associated with trauma, it is hazardous to release them. They contain the “Oh, my God, I’m done for” experience—the essence of inescapable shock—and with it, terror, collapse, and accommodation. Exiles may reveal themselves in the form of crushing physical sensations or extreme numbing, and they offend both the reasonableness of the managers and the bravado of the firefighters.

  Like most incest survivors, Joan hated her exiles, particularly the little girl who had respon
ded to her abuser’s sexual demands and the terrified child who whimpered alone in her bed. When exiles overwhelm managers, they take us over—we are nothing but that rejected, weak, unloved, and abandoned child. The Self becomes “blended” with the exiles, and every possible alternative for our life is eclipsed. Then, as Schwartz points out, “We see ourselves, and the world, through their eyes and believe it is ‘the’ world. In this state it won’t occur to us that we have been hijacked.”17

  Keeping the exiles locked up, however, stamps out not only memories and emotions but also the parts that hold them—the parts that were hurt the most by the trauma. In Schwartz’s words: “Usually those are your most sensitive, creative, intimacy-loving, lively, playful and innocent parts. By exiling them when they get hurt, they suffer a double whammy—the insult of your rejection is added to their original injury.”18 As Joan discovered, keeping the exiles hidden and despised was condemning her to a life without intimacy or genuine joy.

  UNLOCKING THE PAST

  Several months into Joan’s treatment we again accessed the exiled girl who carried the humiliation, confusion, and shame of Joan’s molestation. By then she had come to trust me enough and had developed enough sense of Self to be able to tolerate observing herself as a child, with all her long-buried feelings of terror, excitement, surrender, and complicity. She did not say very much during this process, and my main job was to keep her in a state of calm self-observation. She often had the impulse to pull away in disgust and horror, leaving this unacceptable child alone in her misery. At these points I asked her protectors to step back so that she could keep listening to what her little girl wanted her to know.

 

‹ Prev