Core Affects

❖ The energy moves “outward”

❖ The experiences is relieving and drops anxiety and defenses

❖ Leads to transformation of character

❖ Desensitized client to what was feared (impulses and emotions)

❖ Increases client’s sense of power and stability

The Core Attachment Affects

❖ Anger/rage

❖ Guilt

❖ Grief/sadness

❖ Positive Feelings

❖ Sexual/closeness

❖ Excitement/interest

Three components to true affect experiencing: 1. Name the feeling: “I feel angry”

2. Physiological pathway of feeling: “I feel a heat rising inside me”

3. Impulse/action tendency: “I want to shake him”

Affect Experiencing

The somatic pathway of Core Attachment Affects

❖ Anger/rage:

❖ Guilt:

❖ Grief/sadness:

❖ Positive Feelings:

❖ Sexual/closeness:

❖ Excitement/interest:

Inhibitory Affects

❖ “Inward moving”

❖ Shuts down the client

❖ We do not want to encourage a deeper experience of these

❖ Serve a defensive function

❖ Perpetuates suffering

They Are:

• Shame/humiliation

• Disgust/contempt

• Anxiety

• Embarrassment

• Unrealistic, punitive guilt

Anxiety

Anxiety

❖ In therapy, anxiety is caused by feelings and impulses triggered by our attempts to have emotionally close relationship with the client

❖No objective threat in the therapist office

Fear vs Anxiety

What is fear?

❖Our threat detection system

❖Promotes safety and survival —Run!

❖Based on objective threats

Feelings or experience

Threaten bond

Triggers (anxiety)

Example:

• My anger makes mom avoid me • My sadness makes dad scold me

WhyFeelingsTriggerAnxiety

AnxietyAssessment:PathwaysofAnxietyDischarge

3 Pathways of Anxiety:❖ Striated Muscle

❖ Smooth Muscle

❖ Cognitive Perceptual Field

Why important?❖ Informs us that emotions are being activated and lets us

know we are in “the right place”❖ Informs us where to focus our interventions (signals)❖ Informs us of client’s capacity to experience and tolerate

their feelings❖ Guides us in our pacing of interventions❖ Gives us an idea how long treatment will take

❖ Helps us to know if client is Fragile or not

Striated Pathway

Examples:

✓ Thumbs, hand clenching

✓ Tension in the arms, shoulders, legs, neck and face

✓ Clenching of the jaw, biting, chewing

✓ Tension in the chest— sighing respirations

Striated Examples

Smooth MuscleExamples:

✓ Nausea, vomiting

✓ Cramps

✓ Heartburn

✓ Migraine headache

✓ “Jelly legs”

✓ Bladder Urgency

✓ Diarrhea

Smooth Example

Cognitive Perceptual DisruptionExamples:

✓ Dizziness, Fainting

✓ Foggy thinking

✓ Numbness, loss of feeling in body

✓ Freezing, limpness

✓ Drifting

✓ Ringing in the earsWhenanxietyisgoinghere,thenthereisnotensioninthemuscles,thepa5entlookscalmandcanbe“indifferent”althoughisconfusedetc.

CPD Example

Associated Medical Issues

❖ Striated Tension: Tension headache, panic attacks, chest pains, Fibromyalgia, chronic pain syndrome

❖ Smooth Muscle: Migraine headach, IBS, Hypertension, Urinary track issues, acid reflux, abdominal cramps

❖ CPD: Visual blurring, fainting, tunnel vision, memory loss, pseudoseizures, dizziness, blindness.

Anxiety Exercise 1: Identify the Pathway

Therapist Intervention Client Response Anxiety Pathway

Couldwelookatanexampleofwhenthiswasaproblemforyou?

(Sighs),Acoupleofdaysagoshesaidshewantedtodumpme…

Whatisyourfeelingtowardsherforsayingthatshewantedtodumpyou?

(Hearstomachgurgles)..mmmIfeelkindasicktomystomach

Whatdoyounoticefeelingherewithme?

(Patientstarespastyou)…Ilostmytrainofthought.Couldyourepeatthequestion?

Whatisyourfeelingtowardshimforhittingyou?

(Clencheshands)Ifeelreallytenseandworriedheischeatingonme

Youseemanxiousrightnow,whendidthatbegin?

(sighs)assoonasIsatdown.Myshouldersfeelreallytightrightnow

Signs Patient is Exceeding Threshold❖ Dizziness, Fogginess

❖ Slowed thinking, blanking out (w/o Striated)

❖ Fainting, nausea

❖ Abnormally slow respiration

❖ Limpness

❖ Migraines

❖ Ringing in ears

❖ Blurred vision

❖ Dissociation

❖ Hallucination

Anxiety level

Striated Muscle Anxiety

-Cognitive perceptual disruption -Smooth Muscle

Anxiety Threshold: Optimal Level

Threshold

When we reach threshold (How to Regulate)

Stop Exploring Feelings

Explore feeling in a different corner

Review until anxiety disappears

Review sequence

Attention to anxiety Symptoms

Example Anxiety Regulation “how do you feel towards your daughter for lying to you?”

Observe & attend to anxiety

Inventory anxiety in the body / name anxiety symptoms

Describe Causality Have client review for you

Explore feeling in different area

Clt:“I’mgettingaringinginmyears”

Yousayyouarehavingaringinginyourears.Doyounoticefeelinganxiousrightnow?

Linksymptomtoanxiety:

Theringinginyourearsissignofanxiety.

OR

Feelinglikethrowingupisasignofanxiety

Ect……

Soyouhaveafeelingtowardsyourdaughterforlyingtoyou.Thatfeelingmakesyouanxious,andtheanxietymakesyourearsring.

Doesthatmakesense?

Couldyourepeatbackwhatyouheardmesaytomakesurewearebothonthesamepage

Couldwelookatanotherexample?

Anxiety Regulation Role PlayEach student takes a turn

❖ I will be the client

❖ You will ask “how do you feel towards your daughter for lying to you?”

❖ Continue pressure to feeling until you see that I have reached an anxiety threshold

❖ Stop pressure and go through anxiety regulation steps

Common Mistakes

❖ Assuming the client has no anxiety if they present as limp and calm

❖ Moving ahead to feeling to quickly

❖ Pressing to breakthrough to feeling in face of unregulated anxiety

❖ Mistaking a freeze response for striated discharge

Quiz

❖ Describe the difference between fear and anxiety

❖ Name 3 pathways of anxiety discharge

❖ Which pathway is a “green light” to explore feeling?

❖ Identify three signs your patient has exceeded anxiety threshold

❖ Describe the process for regulating anxiety

Complex Transference Feelings (CTF) I

❖ Complex feelings mobilized in therapy which are linked to the past bond, trauma, pain, rage and guilt about rage.

❖ Includes deep appreciation for the therapist persisting with them for the best outcome. As well includes irritation toward the therapist (T) because of the challenge to resistance.

AngerAnxiety --muscle tension, sweat, heart race, mind blanks.

Defense: —tantrum, self-attack obsessiveness, critical,

devaluing, passive aggressive, defiant

Impulse/Feeling --Heat/energy rising, volcano, urge to grab, hit, kick, inflict

harm

Spectrum of Psychoneurotic Disorders

Patterns of Problems from Attachment Trauma

1. LowResistance2. ModerateResistance3. HighResistance

4. HighResistancewithRepression5. Mild-ModerateorSevereFragileCharacterStructure:repression,splitting,andprojectiondominant

Spectrum of Psychoneurotic Disorders

Fragile Spectrum

The Low Resistant Patient: Open access is already there

❖ LowResistantpatientscomewithanallianceinplace—-thereisnoRage,thusnoMajorResistance

❖ Onlyhavetacticaldefenses❖ Theygototheissuethendancearoundituntilyou

encouragethemtofeelthegriefaboutthelossinthepast.

❖ 5percentofofficereferrals

Davanloo, H. 1995. Abbass 2002

Low Resistant Patient

Grief

Tactical Defences

Eg. Maybe, perhapsEg. Kind of, a little

Eg. vaguenessEg Smile

No Rage= No Major Resistance

Only Tacticals

Moderate Resistant

❖ Withmoreresistance,thepatientbringsmoredefensesthatobstructtheprocess

❖ PressureisneededtomobilizeComplexTransferenceFeelings(CTF)

❖ Resistancesmountandneedtobeclarified,blockedorchallenged

❖ PresenceofMurderousRage,Guilt,Grief

Davanloo, H. 1995. Abbass 2002

Moderate Resistant Client

Murderous Rage, Guilt, Grief, Craving

Major Resistances: Isolation of affect

Eye avoidanceDetaching

RationalizingEg Smile

Highly Resistant Patient

❖ TheyhavemajorresistancesandgotoresistanceintheTransference

❖ HeavyfocusintheTransferenceisneeded❖ StandardinterventionisPressure,clarification,challenge,

Head-on-collisions❖ Smallbreakthroughsfirsttoweakentheresistance❖ LaterinprocesstypicalbreakthroughsofMRorPMRin

theTwhichtransfertheimagetothepastfigure❖ PrimitiveMurderousRage,Guilt,andGrief/pain,love

Davanloo, H. 1995. Abbass 2002

The Highly Resistant Patient: The Locked Unconscious

Murderous Rage and Guilt

Major Resistances

Slowing downHelpless

ExternalizingDefiance

Grief

Arguing Devaluing

High Resistance With Repression❖ Instead of feeling rage, it is repressed into the body

❖ In face of feelings, client goes “flat”, loses tone and energy, instant repression takes place. Often “weepy”

❖ Will often have physical symptoms: IBS, Stomach upset, migraines

❖ Anger is turned inward to protect attachment figures from the anger

❖ Common among depressed clients

Highly Resistant Patient with Repression

Primitive Rage, Guilt, Grief, Craving

Major Resistance: Repression

RepressionGoing flatHopeless

Fragile Character Structure❖ Severe trauma plus weak attachment

❖ Cognitive disruption when anxious

❖ Primitive defences: projection, splitting, dissociation, regressive defences

❖ Lack clear sense of self

❖ Self-harm common (cutting, drugs/alcohol, acting out)

❖ 25% of office referrals

❖ 45-200 sessions to treat

Davanloo, H. 1995. Abbass 2002

Dr Allan Abbass 2017

Pressure Moderate Resistance

Striated muscle anxiety

plus feel complex transference feelings

High Resistan

ce

Depression, smooth muscle anxiety or motor conversion

High Resistance

with Repression

Cognitive-perceptual disruption or

primitive defenses

Fragile Character Structure

GO FLAT: No striated muscle anxiety

Capacity Building Formats

Repeated unlocking,

working through,

termination

Striated muscle anxiety plus feel complex

transference feelings

Breakthrough of grief about loss

Low Resistan

ce

Complete treatment in 1 or 2 sessions

Inquiry

Resistance Rises

Resistance crystallizes in the transference

Clarify, Challenge,

Head on Collision

Technical Blockers of Rise in UTA and CTF

❖ Lack of pressure (reaching to the patient)

❖ Misplaced pressure (same as no pressure)

❖ Premature challenge

❖ Lack of challenge or misplaced challenge

❖ No delivery of the reality of the situation (lack of head on collision)

❖ Missing the passage of feelings

Why No Signals??

Blockers of Primary Engagement in the Process

❖ Ambivalence re interview process: 1 foot in 1 foot out

❖ Forced to be there and don’t want to cooperate: Conscious defiance

❖ Absence of unconscious Problem

Unc Anxiety going other places:

❖ Cognitive/ Perceptual Disruption

❖ Smooth Muscle anxiety

❖ Somatic

❖ Gum chewing, tensing and relaxing

❖ Hiding the tension consciously

Characterological Unconscious Defenses blocking rise in Core Feelings

❖ Defiance❖ Compliance❖ Externalization❖ Passivity❖ Hopelessness❖ Helplessness❖ Major Intellectualization❖ Syntonic defensive system: cant see problems❖ Denial❖ Devaluing

Organic or Brain Factors

❖ Actual confusion about the process

❖ Below Average Intelligence

❖ Physical Illness and exhaustion

❖ Drugs or Sedating Medications

Why no Signals

❖ Projection or Projective Identification

❖ Suicidal or Homicidal plans

❖ Repression of Feelings

• Depression

• Conversion

Why no Signals

Therapist technical issues:

❖ Not enough pressure

❖ Pressure in wrong place, to defense or feelings which are not present

❖ Premature challenge

❖ Transference activation: In the parent’s shoes