Emotional exposure in action
So from time to time I will post a case illustration depicting the utilization of Integrative Mindful Exposure techniques such as the Emotional Surfing exercise. This particular exercise is from a recent session which might help illustrate the relationship between anxiety and toxic shame. As I indicated in the last post, anxiety may often have at its core not fear as is often assumed, but shame.
This middle age woman, with whom I have been working for a short time came into the office for this particular session appearing quite distressed. She stated that during the past few days she has been experiencing almost unrelenting panic and anxiety. Her efforts at relaxation, breathing, distraction and exercise were providing only minimal and transient relief. She is currently undergoing training for a new position at a call center and is soon to commence her actual duties under close supervision and scrutiny. This woman has an unfortunate history characterized by physical, sexual and emotional abuse.
To reiterate the Emotional Surfing techniques (see previous posts on this topic) which borrows heavily from eastern mindfulness and behavioral exposure (primarily Implosion Therapy which will be described in a future post), the client is led directly into their avoided feelings. As feelings are mindfully exposed, they are asked to attend to arising thoughts, images, memories and physical sensations and their points of primary origin.
OK, so I asked her to close her eyes and focus on the panic/anxiety.
She described acute physical and emotional pain in her upper abdominal region. As she was helped to focus on this pain I asked for accompanying thoughts.
She stated that “I have to be perfect at work tomorrow”.
I asked her to label that feeling. She stated, “I feel nauseous”. I asked her to focus on the nausea and describe the accompanying emotional feeling. She replied “fear”.
I asked her to focus on “I have to be perfect tomorrow”. I asked her to identify whose voice that really is. She readily yelled out, “That’s my Dad!”.
I asked her to focus on the accompanying feeling.
She said “shame”.
I asked her to describe the shame as a physical substance. She initially described it as a black crusty hard substance that was immensely huge. I asked her to continue focusing on the feeling and the accompanying image. The image quickly turned into black tarry “shit” *(meaning feces).
I asked her to focus on that image and accompanying emotions.
I then asked her for accompanying thoughts.
She responded (crying loudly), “I was supposed to be a boy. They always reminded me of that. I’m sorry but it’s not my fault, it’s not my fault.”
I asked for other thoughts.
I always blamed myself for not being good enough for them. I carried their shame all these years.
I asked her if she would like to give it back to them.
She stated “Yes!”
I asked her to scoop up all the shit inside of her and bring it to her parents grave site and pour it into their graves. I suggested that she state that “I am returning the shame that you have made me hold for you. This is not mine to bear. I no longer wish to carry it and so I am returning it to you” (this is a variant of a John Bradshaw: Author of “Toxic Shame” and “Homecoming”, exercise).
All this took place in only about 8-10 minutes. Upon opening her eyes there was a dramatic change in her countenance and demeanor. She stated that the panic and anxiety were completely vanished as well as the nausea and stomach pain.
She stated that she felt something dramatically “lift” inside of her. She stated that she now recognizes her anxiety is actually shame. Everything in the world feels like a test that she can only fail since she never felt “good enough” since her parents never made her feel loved.
She was asked to repeat the in session exercise for homework and to keep labeling the experience of shame whenever it arose.
So, that’s how it goes.
Please feel free to provide comments, experiences, questions, or insults, to help make this a more dynamic experience for all.