Mindfulness and Exposure Psychotherapy: Emotional Surfing 2

OK, so I will provide an example of Emotional Surfing in action with a client presenting with significant psychopathology. This is from a very recent session with a young woman who is diagnosed with bipolar disorder, possible borderline personality disorder and PTSD secondary to a rape and stabbing assault.I have only seen her a few times at this juncture. She was considering going on disability due to her inability to work since extreme panic and anxiety was interfering with her ability to leave her house. Preceding this session she had engaged in an episode of self cutting and was exhibiting some passive suicidal ideation (no active plan or intent). OK so that’s the background. So me, being the cruel guy that I am led her directly into the vortex of her painful emotions that were arising. At the outset of the session she was experiencing profound levels of anxiety and actually had to be accompanied to the session by her boyfriend

So the first thing I asked her to do is close her eyes and intently focus on her anxiety.

I asked her to name the emotional feelings she can identify (rather than just the undifferentiated experience of anxiety) and the physical location of those feelings. After a time she identified tremendous fear in her stomach. With some prompting I helped her to hold her attention in the fear. Naturally, one’s instinctive reaction is to leave the fear.

After a minute or so, I witnessed a change in her affect. I again asked her to focus on her feelings, label her feelings and their physical location. She identified a deep sense of helplessness and powerlessness which she identified as somewhere between her stomach and solar plexus region. She was asked to intently focus on this feeling.

After a brief period, she began crying and reported sadness in her chest. After focusing there for a while, she expressed recognizing intense anger in her chest and throat. When she was asked for accompanying thoughts, images, memories she reported intense rage at the attacker. She expressed flashing images of the attack (which she had never previously allowed).

Quickly, her anger morphed into a deep sense of guilt for “having not done more to prevent this”. She was asked to focus on the guilt in her chest and deep sadness again returned. She described a profound sense of loss due to the change in her occupational status, symptomatic impairments and loss of activity and interpersonal connections.

After a couple of minutes when she appeared much calmer she was asked to open her eyes. She appeared a little bewildered as to what just transpired. She reported that the anxiety and panic were completely gone. She displayed a sense of somewhat bewildered empowerment. As she described she spent all her energy and resources into not allowing feelings (her family system and personal conditioning history placed a large taboo on emotional expression) and always assumed that to do so was either either a sign of weakness or would make her feel worse. (If I had a nickel for every time I heard that I’d be rich).  She left the session with an entirely different physical posture and gait.

This whole procedure was quite brief, I’d say it lasted maybe 12 minutes.

She was asked to repeat any amount she could of this exercise for homework.

At the outset of the next session she displayed tearfulness. Somewhat to my surprise, she stated for the first time in many months, she experienced a measure of inner peace. She experienced an absence of panic and no impulses to self-cut. Moreover, when painful emotions surfaced, she was less inclined to “numb out” or otherwise distance herself from the pain (which was the primary impetus for self-cutting). She gave permission for feelings to rise knowing know that they, of themselves are not “dangerous” or “overwhelming”. Now, I don’t want to overstate this as a miracle cure. To be sure there is much work yet to be done, but this did represent a huge step forward in her process.

Please feel free to post comments to help make this a more vibrant interchange. Individuals are also invited to contact me privately with questions or other input.



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