A tried a true approach to following the dicates of neuroscience and Family Systems work.
Psychoanalytically informed work is rapidly moving in the direction of sensitivity to the patient’s primary effects.
There is an evolving body of neuroscience data proving that the primary affects of shame and disgust underpin many of the distressing self-states of adulthood and inhibiting happiness, confirming long-held understandings in Attachment Theory and Family Systems.
Shame needs to be addressed first. The neural pathways that are later associated with feelings of shame begin to take recognizable form early in life. Shame is observable and mutable in adults and youth through verbal and behavioral interactions.
Disgust and shame emerge in two different and overlapping pathways. Krystal, H. (1998), "proposed that all later-developing affects evolve out of a neonatal state of contentment and a state of distress that differentiate into two developmental lines, an infantile nonverbal affect system and an adult verbalized, desomatised system."
The nonverbal affect state of disgust includes touch and smell, and is not as interconnected to verbal development. Therefore, disgust needs to be explored in the latest stages of this type therapy when the patient can tolerate exploring concepts such as Jung's "Shadow," and not feel ashamed for harboring the Shadow's dark influences.
Shame states develop along the pathways of the "adult verbalized, desomatised system." These same pathways grow along with our language based cognition.
Our talk therapy approaches give us access to these volatile primitive organizations. Feelings of inadequacy, being flawed, inferior or ashamed; can, and should, be illuminated early in therapy.
Many groundbreaking analysts have professed this same belief about the requirement of exploring shame. The Clinical Diary of Sandor Ferenczi on June 3, 1932 stated this very firmly, "Analysis must make possible for the patient, morally and physically, the utmost regression, without shame."
Discussing early childhood feelings of embarrassment or shame allows the therapist and patient to synchronize the intensity of their affective responses to those episodes within lags of split seconds.
They can sensitize each other about concepts critical to the depth of their felt sense of attunement and misattunement. The process of two brains resonating in low and high arousal states allows a new strategy for modulating these states with each holding the other in mind.
This suggested therapy process is not at all formulaic; however, it is amazingly similar with patients across the board, from six to 80 years old. In the live clinical moment, when our clients experience their worst feelings about themselves, utter regression, they need a feeling of belonging with another human-being.
The patient then has a felt sense of attunement. This is not rocket science. It is simply being empathic at the moment of the patient's deepest perceivable distress. It can, and should be accomplished early in therapy about feelings of inadequacy, shame and being flawed.
Early in the process of getting to know my patient, after therapeutic rapport is established, I ask them to tell me about their earliest memory of shame. It needs to be done in an informational gathering mode, or else the need to resist the awareness of this pattern may block their awareness.
This shame episode becomes a touchstone for the rest of the counseling relationship in order to clarify their current self-deprecating thinking. The adult form of this thinking will contain obvious distortions. We can breakdown this defense by accurate self-appraisal.
Making conscious these early verbal patterns can facilitate unraveling shame-based thinking. You will discover that this thinking is related to blind spots in patient's caregiver environments.
It is present to protect us socially and psychologically, however instead it draws us to people who we know how to defend against, and it makes it more likely healthy people will use their little used aggressive or passive defenses.
According to the book Shame: The Underside of Narcissism, (Morrison A. 1989, p. 180) "I am convinced of the central importance and significance of shame as an affective experience—for each of us, as for our patients."
We will all have feelings of "flawedness" in areas where our caregivers were unaware of our needs. These areas are easier to uncover than you might think. Illuminating this early event will continue to become more clearly related to the patient's current life distress.
The neurological substrata of later developed shame structures can be detected in the first few months of life. These patterns are more easily noticed by tracing the etiology of adult defensive structures.
In Shame: The Underside of Narcissism states our defensive-self gets ever more effective at holding off use of spontaneous gestures because of the futility of their use. Therapy needs to allow the down-regulation of stressful high arousal states through soothing and up-regulate low-arousal in play states.
Both of these processes act as epigenetic mechanisms by which the connectivity between the central nervous system and the autonomic nervous system in the emotional right brain is enhanced in the lived experience of the therapy hour.
We hear the story, feel the affect, down-regulate stressful high-arousal states; and up-regulate low-arousal states in all of our different clinical modalities. The patient can imagine the mind of the therapist living through, and benefiting from, their experiences and emotions.
During our patient's terror and/or hopeless states we want to be a hand to hold in the darkness, so they experience a felt sense of attunement, with the intention of both patient and analyst to sense the "psychoanalytic thirdness."
Bill Maier, LCSW is complying a book about softening shame structures by utilizing sublimation, with chapters appearing on his website. He has successful used this non-formulaic, weekly approach with hundreds of adults, youth, couples and families in a private practice setting.