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Repairing the Broken Self
with Expiation of Anger, Understanding,
Forgiveness and Nurturing Love.


The Role of Trauma to the Self
(Lack of Love) in Neurosis



Joaquin F. Sousa-Poza of Galiano Island BC Canada
Ex-Professeur Agrégé de Psychiatrie, Université de Sherbrooke, Québec, Canada.


This section is a direct derivative of a paper originally published in the
International Journal of Psychotherapy (Volume 9, Number 3, July 2005).
It is reproduced here (with modifications) by permission.


 

Click here for abstract

Introduction

1. As you will see later in the psychospiritual section, we consider that there is only one self inflicted trauma to the human mind. This trauma of traumas or technically a meta-trauma is what gives rise to all human suffering and particularly to the so called neuroses (now scattered in a series of disorders).

2. We postulate that without the separation of the human mind from the divinity, human suffering, including neuroses, would turn out to be unnecessary and obsolete. However, while we don't achieve reunion again with the divinity, neuroses have, of course, to be treated. Unfortunately ruled by the male-mind, "love" has always been a four letter word in psychiatry and psychology and was transmuted to sex (like making love). You can make sausages but true love is an attribute that belongs only to the divinity.

3. In fact you can and will become an outcast in my profession if you give love any relevance whatsoever and much less as the principal of the psyche (like the Lovability Principle).

4. Alluding to what we call here the Divinity, Sogyal Rimpoche (1993) writes:

5. Saints and mystics throughout history have adorned their realizations with different names and given them different faces and interpretations, but what they are all fundamentally experiencing is the essential nature of the mind. Christians and Jews call it “God”; Hindus call it “the Self,” “Shiva,” “Brahman,” and “Vishnu;” Sufi mystics name it “the Hidden Essence;” and Buddhists call it “Buddha nature.” At the heart of all religions is the certainty that there is a fundamental truth, and that this life is a sacred opportunity to evolve and realize it.

6. Theists would, of course, argue that that ultimate reality Sogyal calls “the essential nature of the mind” is God, but this is no place to enter into that argument, only to highlight the commonality of spiritual knowledge, pointing to the incompleteness of the human condition due to the eons-old Separation from what we generically call here the Divinity. If that is the case, the human mind carries embedded in it a much more ancient Separation-related (which we capitalize for emphasis on its primordial nature) wound than the one we are concerned with in this book. In the ultimate narcissistic act, the male-mind, enraptured by itself, attempted the impossible: the usurpation of the throne, by challenging the Divinity’s supremacy. Psychologically, one can deduce, that this was a trauma of enormous magnitude for the human mind, not different from the separation of the child from the mother, but belonging to an entirely different order of magnitude. A collective separation (“anaclitic”) reaction of gigantic proportions that we will endure until the reunion with the mind of the Divinity is achieved by each of us—which is essentially the teaching of all mystics. In one particular treatise the aftershock of the Separation was put as follows:

7. You who prefer separation to sanity cannot obtain it in your right mind. You were at peace until you asked for special favour [at least superiority—autonomous equality with the Divinity]. And God did not give it for the request was alien to Him, and you could not ask this of a Father who truly loved His Son. Therefore you made of Him an unloving father, demanding of Him what only such a father could give. And the peace of God’s Son was shattered for he no longer understood his Father. He feared what he had made, but still more did he fear his real Father, having attacked his own glorious equality with Him. A Course in Miracles. (1975)

8. In summary, we are referring to what Christians call “the fall from grace” or what is implied in the Buddhists “obscurations” that hide our true Buddha nature, and we are ascribing to it, in psychological terms, the quality of a narcissistic gesture directed at dethroning God and declaring ourselves god. We maintain that such ancient error is still recognizable in the current psychological workings of the male-mind, and throughout the gore of history stemming from the god-like narcissism inherent in the male-self of kings, emperors, generals, generalissimos and other assorted, self-anointed Deities.

9. In other words the ballooning male ego obliterates by it's sheer size the most basic need of the mind as little boys and girls know all to well.

10. Furthermore we have observed that properly treating the wound of love considerably expedites the reunion with the divinity.

11. This treatment involves exposing the feelings of the emotional self which, together with nurturing, leads to the realization that the "emperor has no clothes". It's not surprising therefore that all male-mind cultures keep a tight lid over the emotional self as a prerequisite to keep their god-like status. Faced with that dilemma male-mind controlled psychiatry (psychoanalysis having failed) has now enthusiastically resorted to the next fig leaf: psychochemical-psychiatry only.

12. Obviously in a wretched condition we are more adept at understanding things than beings because if you were to understand beings it would inexorably follow that you would understand not only that we are not god but furthermore that the greatest craving of the human mind is not a chorus for bigger shopping malls, powerful cars and jewels but to recover the long lost total intimacy with the divinity.

13. Yes brother, you have presented us with plenty of evidence that you have to heel before you heal .

13.1 Therapists Must Recognize and Treat Historical Trauma


Text

14. After having traversed the Casriel (1972), Janov (1970), and anaclitic (Sousa-Poza, Eagle, Rohrberg & Steinberg 1986) stages in the development of emotional trauma theory (Sousa-Poza, 2005), I am now working with the attachment-informational model whereby intra psychic conflict is primarily conceived as taking place between the patient's self and his or her introjects (Sousa-Poza, 2005). Hence, conflicts, rather than being "downloaded" onto the therapist via the "transference," are transacted in a series of dialogues enacted between the patient's self and his or her introjects, as well as with other meaningful persons from past or present relationships; these in turn "talk back" via the patient enacting their roles, thus rendering audible the silent hallucinations (Sousa-Poza, 2005) induced by the introjects. Instead of the recumbent position traditionally used for this type of work, a sitting position is used in a way similar to Gestalt-type "chair work," giving control

15. Full emotional expression is encouraged, and the emotional sequence of feelings is tracked at least as carefully as the mental/verbal content. The therapist guides the patient through five steps, constantly scanning for emotional and cognitive errors that are derived mostly from the patient's inability, due to defensive exclusion and parental deification (Sousa-Poza, 2005), to recognize primal anger. The patient is led to target that anger against the introject instead of dumping (projecting/displacing) it into everyday triggers, or "swallowing it" and turning it against the self. The therapist's fundamental role is to insure that the patient "wins" in her or his ongoing struggle to assert her or his lovability negated by the introject. Challenging both emotionally and cognitively the introject's "reasons" to wrong the self leads to the former's gradual erasing and eventual ejection.

16. Trained, emotionally healthy therapists and assistant therapists conduct concurrent nurturing/restitution sessions to provide validation of the intrinsic "rightness" of the self, subsumed under the rubric: "They were wrong, YES, you are lovable!" Nurturing is similar to "downloading a patch" to repair a computer's operating system. Female and male nurturers provide the necessary information to reconstruct healthier maternal and paternal introjects in the patient. Working sessions and "support" (nurturing/restitution) sessions are conducted separately and usually during alternate weeks. As discussed later, medication is prescribed as required.


Trauma to the Self Method

17. The trauma to the Self method described here constitutes an ultra specialized, major medical/psychological intervention, one with potentially severe risks if the leading therapist lacks proper professional training and personal experience with the procedure. Being very malleable, however, the method can be changed into an effective type of talking psychotherapy or counseling, or a problem-focused or time-conscious method. In these lighter forms (to be described elsewhere), which suit many patients, primal anger is not fully mobilized and the self's wounds are not fully opened. There is, therefore, no need for nurturing.

Stages
18. Treatment length, which varies according to the degree of damage to the patient's self, traverses several distinct phases:
1. The information/evaluation period, which lasts about one month.
2. The acclimatization period, which lasts a few months during which the patient becomes thoroughly fluent with the method.
3. The discovery period, which lasts up to two years or more and consists of the progressive opening of increasingly severe, traumatic emotional files (Sousa-Poza, 2005).
4. The mourning period, which lasts a couple of years during which the patient uncovers enough traumatic biographical information to make a sober appraisal of the damage to the self and its impact on his or her life course. The anger is not yet fully entitled and comes out mixed with protestation.
5. The restitution period, which lasts up to two years and is characterized by a strong bonding with the nurturing therapists and a consistent "winning" of the self over the introject in working sessions. The anger of the former overpowers that of the latter, nullifying the sacrilegious taboo of parental deification. Nurturing sessions become very peaceful, without interruptions that necessitate "working" the introject’s disruptive intrusions. Primal outrage at the desecration of the self is now fully entitled.
6. A follow-up period that permits a monitoring of the discontinuation of sessions and medication.

Setting
19. Required is a soundproof room with minimum dimensions of 12 ft by 15 ft (3.64 m by 4.55 m) with the capacity to sit a maximum of eight patients and the therapist(s). Three chairs, instead of the classical two of Gestalt therapy, are placed in the center. To de-emphasize the “social persona" these three working chairs are lower than the others in the room. One chair is for the self, or patient, and it faces the other two. The one to its left is the "female" chair; the one to its right is the "male" chair (see later discussion), These two chairs are slightly lower than the patient's chair .

20. The second component of the working room is a batting station located at one end used to express high levels of anger. It consists of a strong plastic baseball bat that is used to strike a boxer's punching bag rolled up in foam and strong cloth. The contraption lies horizontally on a soft mat to absorb the (considerable) impact of the bat and to prevent resonation onto the floor. The station has two sides: one belongs to the self, or patient, and the other belongs to whomever, person or introject (masculine or feminine), the patient is working in the primal dialogue. The patient switches from one side to the other to maintain the dialogue as necessary. Retargeting tabooed primal (historical) anger is the centerpiece of emotional trauma therapy. Working anger in total depth functions as the emotional scalpel used to incise the self's wounds, dissecting away the parasitic introject.

Patient Screening and Preparation
21. Patient population ranges in age from about 25 to 75 years old; their occupations and status represent a cross section of society. The majority, however, are females in the 35 to 54 age bracket. If after a full psychiatric evaluation the patient is deemed a suitable candidate, he or she is invited to begin the information/evaluation period. This method is of course not suitable for patients with psychotic or organic disorders. For all others, psychodynamics and motivation are more relevant factors, by far, than DSM-IV-TR (4th edition, text revision) based diagnoses (American Psychiatric Association [APA], 2000). It is imperative for prospective patients to attend a few group sessions as observers. Explanations, readings, and so on fail to convey the essence and intensity of the procedure—so essential to obtaining truly informed consent. Patients are informed that "this is a nonstandard form of psychotherapy possibly involving the ‘off label’ use of medication as well as physical contact with the therapist(s)." Full disclosure includes access to other patients (with their consent) for private discussions, if desired.


Working Sessions

Training Period: General Instructions for New Patients
22. The terms of the patient-therapist relationship are established under the basic premise: "Nobody can know your mind better than you do. If I am the therapist here it is because we assume I have done enough 'homework' to know my mind better than you know yours." We acknowledge the patients as the ultimate experts regarding their own minds, thereby relieving them from equivocated illusions and the therapist from a godlike status doomed to disappoint. New patients are trained in the working method in individual sessions and are then integrated into existing therapy groups. The result is more "individual sessions in a collective setting," rather than the classic interactive group therapy, since the only interaction is the feedback given by other group members concerning only the last step or commitment made by the patient who has just finished working.

23. As the training session starts and instructions are given, the first reflex of a new patient is to look toward the therapist. He or she is told: "Look straight ahead, eye level, to the two chairs in front of you, as if there were two persons sitting there. The chair to your left is the so-called female chair, for working female characters. The chair to your right is the so-called male chair, for working male characters. The chair you are sitting on is the self's 'chair, your chair. Be attentive to my instructions but do not look at me." With time, a patient can follow instructions even while working out a storm of anger.


Emancipating the Self from the Dysfunctional Introject:
The Five Steps of the Working Session

24. A session consists of five simple steps. As in the game of chess though, simply knowing the rules by which to move the different pieces (the technique of five steps here described) is insufficient to intervene in the ongoing Grand Masters' "game" taking place between the self and the introject. It is impossible to explain, within the confines of this paper, all the possible permutations of the disconfirmatory pathological premises that can unfold in the primal dialogue. Only the self-knowledge of the therapist can fill the gaps between the opening moves and the final one.

25. What unfolds in working sessions is akin to a "family quarrel" One or two members, the maternal or paternal introject or both, attempt to wrong and subjugate the self by irrational means. The main role of the therapist is to insure that the patient responds by making the right emotional and verbal moves to eventually neutralize the introject. All neuroses involve flaws of emotional and cognitive logic implanted during childhood. Therefore, since even the most gifted therapist works mostly by inference, he or she must, like an actor, "get inside" the characters (self or introject) to discern what these flaws are. Then the therapist helps the patient to move his or her "chess pieces" in such a way as to insure that, this time, the introject ends up cornered in a "checkmate" and, eventually, wiped off the table.


First step: the present conflict.

26. In neurotic life, the present is profusely contaminated by the automatic, involuntary download of past historical files (Sousa-Poza, 2005). Thus the session begins with what is called the present conflict. The patient is instructed as follows: "The present conflict is whatever is bothering you the most at the moment, or of late. Contrary to what you may think, it does not have to be something 'very bad."' As the mental self can abstract but the emotional self cannot, themes such as "nobody loves me," "my husband does not treat me well," and so on are discouraged in favor of working at the more precise, concrete event level. We often help the patient to transition from theme to event by asking: "What are the facts?"

27. The patient is helped in working the present conflict via a series of dialogues with the characters involved (husband, boss, girlfriend, etc.). The dialogue is constantly maintained by the patient moving to the appropriate chair. If, for instance, a female patient is working an issue with a female boss, the dialogue takes place via successive moves from the patients chair (self) to the left (female) chair, and so on. The therapist does not intrude into the ongoing dialogues, other than to facilitate the flow (such as by saying "respond now" "change chairs," "what would your boss say to that?" etc.) and to encourage, at appropriate moments, the fullest possible emotional expression.As the patient keeps working the conflict, the "emotional temperature" of the dialogue invariably rises and a distinct feeling emerges. New patients, though, tend to suppress that feeling, and the therapist must help them express it by encouraging them, for instance, to "speak louder." If an angry theme ensues, as is often the case, the therapist may ask the patient to continue at the batting station. There, the patient will strike the bag with the bat while vocalizing, switching from one side of the bag to the other to maintain the dialogue.

28. During the working of the present conflict, a moment will arrive when the feeling rises disproportionately beyond the implied or perceived insult. If that projection is allowed to continue, the patients confusion between what constitutes the trigger (present person or event) and the target (historical character) will be reinforced. Clearly, it is time to go onto the next step, and if the patient had been at the batting station, he or she is asked to return to his or her (the self's) chair.


Second step: "identifying the feeling" underlying the present conflict

29. Being analogically encoded, feelings are better suited than ideas to retrieve by association damaged (neurotic) historical files analogous to the present conflict. Thus the feeling underlying the present conflict is used as the "tracer" to steer the mind toward the historical conflict. This would be a simple step were it not for the fact that, culturally, people tend to be somewhat emotionally mute and illiterate. Even very intelligent patients may have considerable difficulty in appropriately labeling how they are feeling. Usually they respond with a lengthy thought or explanation, and the question "How do you feel while working the present conflict?" gets lost. With consistent help, however, patients can easily overcome this pitfall. Only when the feeling is clearly and succinctly identified (as "sad " "angry" "jealous," etc.) do we move on to the third step.


Third step: the historical conflict.
30. The neurotic informational kernel is lodged in the historical, suppressed ("no access") files of the emotional self. When treating a neurosis, it is imperative to retrieve, open, and work through the files' concealed information (verbal and emotional completion of the original aborted experience). The relevant suppressed file that is being opened is defined as the historical conflict. Taking the present conflict back to the past constitutes the primal hop of the session.

31. The patient is now instructed: "Focus on that feeling. Follow it backwards in time, holding onto it as you would hold onto a handrail. Describe what was happening to you the first time you ever remember having such - or similar - feelings. Once you see the scene, describe it in detail and in the present tense, as if it were happening again—right here, right now. Trust what comes first to your mind; don't try to consciously 'choose' the 'best’ scenario. There is no 'right’ or 'wrong’ way to do this work. Spontaneity is what counts."

32. The patient soon localizes, often in the very first session, a valid enough historical conflict to work with. Advanced patients often abruptly stop working the present conflict and spontaneously switch, with full feeling, to the historical one—which is defined in the same factual fashion as the present conflict and is worked according to the same rules. Well over 90% of the time, the historical conflict spontaneously retrieved by a new patient is a childhood, parental-related event. It seems as if, once the matrix or template is initially created for a particular feeling, all feelings similar to that are thereafter processed through it. Once the historical conflict has been satisfactorily worked (when the feeling associated with it is exhausted), the patient returns to his or her chair, and we move to the fourth step.


Fourth step: defragmentation of the self via the connection
33. Meaningful relationships between present and past conflicts known as the connection (akin to "insights") have to be established to defragment the self and achieve the final conscious integration of the aborted traumatic experience and its consequences. The patient is now asked: "What do you see in common between the present and past conflicts? How do they resemble each other?" Although few patients have difficulty with this step, new patients often need help to avoid long explanations and side issues. Quite reasonably, they tend to want to talk extensively because they see it as the most immediate way of obtaining relief. We encourage them to talk succinctly by explaining: "You will obtain greater benefit if you define the connection(s) clearly and succinctly. Your mind, the emotional self in particular, will have difficulty retaining a long speech." Once a clear, cogent statement is achieved, we move to the last step.


Fifth step: the commitment or behavioral step
34. There must be an effective, corrective change in the life of the patient if there is to be an end to the repetitive, dysfunctional, and self-defeating cycle of neurotic behavior. Such a step is termed the commitment. The instructions are as follows: "This is the last step. Please take a good look at the present conflict with which you started the session. In view of your new feelings and insights, make a commitment about what might be the minimal step(s) you could take to correct, to learn to avoid, or otherwise to improve things in regard to that present conflict" The commitment "buckles up" the work, dovetailing the session onto itself and thus making it a self-contained unit, and adding a behavioral dimension to the session's experiential (feeling work) and cognitive (connection and verbalization of conflict) aspects.

35. Once the commitment is properly formulated, we instruct the patient (during the training period) that the session is over. We invite him or her to reestablish face-to-face contact with the therapist, and say: "What you did today was to work out a piece of the jigsaw puzzle that represents your self and the damage done to it. With time, more and more pieces will be added to the puzzle, until you have a fairly clear map of what happened to you and why you suffer the way you do. When you attend a group session the only difference is that other members will give you feedback - but only on your commitment. Nobody will ‘get on your case' or 'play therapist.' Just listen as they give you feedback about your commitment. Ask for clarification if you want, but do not engage in debate. You may decide to adopt some of the suggestions or none at all. At the end I will ask you if you want to reformulate in view of the feedback received or stick with your commitment." It should be noted that each group session begins with members reporting on how the last commitment was accomplished.


36. Two to three individual training sessions usually suffice to learn the steps of the method. The major obstacle at this stage is that patients may have difficulty raising their voices at all, even if very angry, beyond a socially acceptable tone due to the prevailing cultural emotional mutism and a misunderstood mandate of "politeness" And men, in particular, may choke back their tears. In the beginning, therefore, the therapist must encourage the patients; once assigned to a group, however, they do tend to learn faster simply by watching the work of more advanced patients since emotions contain a contagious or phatic resonance (La Barre, 1964).


Psychodynamics and Psychopharmacology
37. Each "bite size" session shaves off a thin sliver of defensive exclusion. Eventually this process will perforate the defensive neurotic armor, unavoidably leading to the core of the primal wound and the disconfirmation, by whatever means, of the self's lovability principle (Sousa-Poza, 2005). Biographic ally, the wound can be made up of beatings, neglect of physical or emotional needs, sexual abuse, and so on. Often, however, no physical violence or even classic abusive language has occurred, the emotional trauma having been inflicted "softly" as an early and persistent disconfirmation of the child's lovability. In effect, words and feelings subtly wronged the patient in the private sanctum of the parent-child bond, and that leaves no "objective" traces since feelings do not qualify as facts in most cultures. Parents do not need to lift a finger to cripple for life the self of a child.

38. As the veil of defensive exclusion is lifted, two things happen. First, childhood falsifications and hopes of retribution that unconsciously have persisted into adulthood ("One day, if I just get it right, they will love me"—or derivatives thereof) begin to collapse. The intensity of the corresponding feelings, in particular anger at the desecration of the self and the subsequent derailment of one's life, reaches an intensity impossible to describe via the written word. Second, the false mental self begins to crumble as the true self separates and ejects the introject altogether. All these factors destabilize the self of the patient because, lacking the parental "backup" (confirmatory love) of a positive introject and losing the neurotic illusory hope of ever obtaining it, the self enters into a high level of entropy. A certain degree of general hypervigilance usually ensues, affecting sleep and producing a low serotonin syndrome.

39. In the beginning of what our patients informally call "the dive" sleep is the first neurophysiological function impacted and 25 to 50 mg of doxepin together with 0.5 mg of clonazepam may suffice. Most patients, however, progress to a more severe, if temporary, clinical picture with anxiety, fear, and depressive elements (though characteristically the mood does not lower as in a true depressive state) that require treatment with an SSRI antidepressant (or tricyclic). In my experience, veniafaxine (75 to 300 mg am) has the widest therapeutic spectrum and seldom fails to arrest the deeper dive. Trazodone (50 to 150 mg hs) and clonazepam (0.5 to 1.0 mg hs) are prescribed. Lately, I have found gabapentin (100 to 300 mg hs) to be useful as well, in some cases counteracting somatized tension/anxiety. If patients are very damaged, such as when they exhibit borderline personality traits, I have found olanzapine (5 mg hs) to be effective in alleviating their considerable suffering. Olanzapine seems particularly effective when there has been physical abuse, such as beatings or brutal rapes or similar traumas at a very early age. When the "voices" of the introjects punishing injunctions "still ring in the head," as one patient puts it, risperidone (0.5 to 1.5 mg hs or am) seems to have the unique property of dampening them and calming the concomitant generalized state of fear and anxiety. The medication regime has to be constantly adjusted according to the stage of therapy the patient is traversing.


Treatment of the Inner Holocaust

Restitution/Nurturing Sessions

Downloading a Patch
40. It could be catastrophic to lift the wound's scar and open it fully without doing the concurrent nurturing/restitution work. The working sessions of the emotional trauma method only incise and open the wound and then dissect the introject; they are a means to an end. Resorting again to a computer analogy, it is the therapist's self that scans the self of the patient to detect the flaws of emotional logic that prevent it from overriding the introjects injunctions. Although the step of connection (insight) carries out the "defragmentation" we now have a self in a high degree of entropy (manifested as fear/anxiety). As one patient puts it: "The amount of mom and dad in my mind has considerably shrunk" Nurturing/restitution thus has to be implemented because, as parts of a diseased introject come out, parts of a healthy one have to "get in."

41. Nurturing/restitution sessions are conducted sitting at floor level on firm cushions. At the start of treatment, sessions begin with the patient and nurturer talking face-to-face. Sessions soon progress to include physical contact, with the patient in the reclining position (lying backwards against the nurturer). As a patient advances and feels more at ease, she or he moves into the cradling position with the nurturer. The sessions are similar, in many ways, to a parent-child holding situation with the nurturer emotionally comforting and supporting the patient. Soon enough, the setting itself induces a natural regression in the patient to the child state, a phenomenon that can be periodically enhanced with subpsychedelic doses of ketamine hydrochloride. Since there is often very little conversation during nurturing/ restitution sessions, patients write a report of their experience, as does the nurturer.

Medication-Enhanced Nurturing (Ketamine Hydrochloride IM)
42. The deeper the patient progresses into exposing the wound, the deeper the nurturing must be. Years ago, the question arose as to whether there were any psychopharmacological means available to enhance the nurturing process. The first products used in open, naturalistic trials in the mid 1970s at the Department of Psychiatry at the University of Sherbrooke were mainly benzodiazepines and sodium amytal. None were satisfactory because they tended to cloud consciousness and their effects sometimes lasted too long for office use. Around 1981, through experimentation and proverbial serendipity, I discovered ketamine hydrochloride, using it in intramuscular doses of about 0.5 cc (about 25 mg).

43. Ketamine hydrochloride, or 2-(o-chlorophenyl)-2-(methylamino) cyclohexanone hydrochloride, is a synthetic drug that has been used clinically since 1970 for its anesthetic, analgesic, and psychotropic properties. The average intramuscular dosage for surgical anesthesia is 8 to 10 mg per kg of body weight; that is, 560 to 700 mg for a standard 70 kg adult (Tomlinson, 1994). My average IM administration of 0.5 cc, equivalent to 25 mg in the standard IM presentation of 50mg/ml, constitutes a very low dosage, or about 1/25th of the recommended adult dosage for anesthetic purposes.


44. Investigators have reported other indications for the therapeutic use of low doses of ketamine (Fine, 1999; Jansen, 1999; Krupitsky & Grinenko, 1997; Mills, Park, Manara & Merriman, 1998). In effect, repeated use has shown no serious adverse effects and may even have neuroprotective properties (Fitzal, 1997). In 1999, Jansen provided an authoritative commentary on the effects of this drug as the main agent in psychotherapy; that usage, however, differs considerably from that described here since it relied mainly on the drugs effects rather than its participation as part of a holistic psychodynamic process. Taking into account the all-important variables of "set and setting," I would say that if the drug contributes 5 to 10 % variance of the experience, the rest (95-90 %) can be directly related to the therapeutic context and the emotional ability of the nurturing therapist to contact and gratify the self's needs for confirmation of lovability.


45. Psychedelic drugs are controversial, both for factual and spurious reasons, and ketamine is no exception. Nevertheless, I have now used it (prescription in Canada is not subject to restrictions) for about 20 years at the 25 mg IM dose and higher in hundreds of patients and without the slightest negative incident. As concluded in a recent review conducted by Prof. J. L Gonzalez De Rivera (2002): "... in view of the available recorded experience, it seems that ketamine is a safe and useful drug to be used in combination to the special form of interactive human support that characterizes the nurturing sessions of anaclitic [emotional trauma] therapy." The patient nevertheless has to be properly informed that this is a nonstandard procedure involving the off label use of that medication.

46. The advantages of ketamine are several;
1. It has a lack of negative side effects or significant drug interactions.
2. It enhances the regression towards the self of the nurturer.
3. It temporarily, but strongly, quiets down the "inner chatter" of the mental self, particularly the introject's disturbing injunctions. This chatter constitutes the major emotional and cognitive obstacles to the patient being able to "hear" and bond with the nurturer while in the primal state.
4. Patients are able to leave the office safely after resting for a half hour or so in the waiting room. Patients are advised, however, not to drive or be near heavy machinery and so on for about two hours.
5. It facilitates analogical-digital translations. That is to say, patients are more able under its influence to put words into feelings and vice versa.
6. Any slight psychedelic effects do not last beyond the second or third session, although they may briefly recur in later sessions if the dose is increased.
7. It has a lack of habituation effect when spaced in series of four sessions on a once-per-week basis. I usually conduct two series per year, and up to three or four in advanced patients.


Samples of Session Reports

47. Patients are evaluated from both a psychodynamic and a DSM-IV-TR criterion, yet since we are concerned only with illustrating the structures of the sessions, limited patient information is provided. (All names have been changed to ensure anonymity.)


Working Session


48. Brittany is a 34-year-old single woman referred because of a life derailed by failure of intimate relationships, school, career, etc. Symptomatically, she feels "depressed."


First step: the present conflict

49. Brittany (B): (patient chair) "My conflict is that I've been irritated really easily."

50. Therapist (T): "Give some examples."

B:"Yesterday I was vacuuming and I kept ripping the plug out and it kept getting caught and it just about ended up going flying through the window."

T: "What else?"

B: "I was at work and this woman that is... I don't know what her problem is with me but she's got this attitude around me that drives me nuts."

T: "Like what? Give the facts."

B: "She used to be really fine and helpful and then something happened. Like the woman who I'm looking after had a major accident in one of the rooms and I went to go and find a care aid to help get her cleaned up and I found her and I said, 'there's been an accident down here' and she said ‘I’m busy' and just walked away.”

T: "Put her in the chair, just start there."

51. B: (patient chair—addressing Laura in left chair) "Laura, there's been an accident down at the end of the hall and I need your help."

B: (left chair—Laura's response) "Well, I just came off my break and I'm busy."

T: "Go to her side of the bag, what's she saying, what's the message? Just start, don't think about it, what did she say?"

B: (other side of batting station—Laura) "Well, you'll have to find someone else."

B: (patient side of batting station) "Laura, you work here, it's your job to help the residents here."

T: "Speak as if you didn't have to be appropriate, this is if you could say what you really want."

B: "Thank you for clarifying."

T: "Keep going,"

B: "Look you f---- bitch, it's your f---- job to help her. Don't give me this s---- that I've got to find someone else. If there was anyone else around I would have f---- asked them.

T: "Switch"

B: (other side of batting station—Laura) "Well, I'm too busy to help you and your client gets way too much f---- attention anyway. You don't see any of the other residents having a companion in here almost every day to look after her for hours at a time. She's f---- spoiled."

B: (patient side of the batting station) "She's not f---- spoiled, she's treated like everybody else should be treated in here. She's getting what she needs."


Second step: "identifying the feeling" underlying the present conflict

52. T: "So what's the feeling?"

B: "Anger. Anger and frustration."

T: "Take it back whenever you can, keep going."


Third step: the historical conflict

53. B: "She doesn't get more than she deserves and it's your f---- job. Argh, I could f---- kill you, walking around here with that f---- attitude. It just reminds me of my dad. He used to walk around with this attitude in the house and you couldn't talk to him about it."

T: "Come over here [other side of batting station]... here's your father, so how did he do that attitude?"

B: "Like I should just talk what he's doing?”

T: "Yeah, like what's the message in the attitude? Let him put it out verbally."

B: (other side of batting station—father) "I'm just going to walk around here like I own the joint, like I own everybody. You see this look on my face, see how my nostrils are just slightly flared and see how my jaw is kind of set. See how I'm avoiding eye contact with you and when I do make eye contact with you it's a challenge. I'm challenging you, just f---- try me. I need somebody to get this anger out on. I know that you're going to step out of line sooner or later and when you do, I'm going to f---- unleash this on you!

B: (patient side of batting station) "You know you scare the shit out of me so much I can't even say anything. I can't even express what I'm feeling because you scare me so much."

B: (other side of batting station—father) "Well, that's what I'm supposed to do. You're just a f---- kid. You don't f---- know anything. You f---- open your mouth, I'm going to shut you up permanently."

B: (patient side of batting station) "I'm sick of being scared! I'm so f---- tired of being scared! You shouldn't have this much power over me, you don't deserve to have this much power over me! F---- control me and you don't even have to open your mouth. I'm scared to open my mouth, I'm scared to stand up for myself. I'm scared to say what I need, and I'm scared to talk about what I need to talk about, I'm f---- scared to have any f----feelings 'cause they'll be wrong."

54. B: (other side of batting station—father) "You're acting like you've got some sort of right to be here. This is a f---- privilege that I let you stay. You stupid, f----, over emotional, irrational little shit head! I'm not going to give you anything to yell at either, I'm just going to be polite, I'm going to say all this without opening my mouth so you got nothing to say. You're just obviously oversensitive and irrational and overemotional just like your mother."

B: (patient side of batting station) "You f, f- , f---- a----! How dare you say that I have no right to be here! You f---- brought me here. ARGH! You don't f---- invite me here and then treat me like s---- , like you're doing me some kind of f---- favor! ARGH! I'm not here for you, that's not my job. I'm not your f---- whipping boy, I'm not you f---- slave, I'm not your f---- puppet! You don't f---- like me being here, find somewhere else. I'm sick of f---- swallowing everything that you're f---- dishing out, I’m so f---- pissed! ARGH! I can't f---- get you enough, I can't kill you enough, I can't scream at you enough, I can't f----hate you enough! It was your f---- job to look after me, not the other way around. It was your job to look after me. When did you ever f---- do that? When? Never!"

B: (other side of batting station—father) "You have no right to complain, you have a nice house, you live in a safe neighborhood, you go to a safe school, I make sure that you don't hang out. with any riffraff. I judge everybody to make sure that you're hanging out with the right people, in fact I don't let you hang out with anybody because there aren't any people that are good enough. You get food on the table, you've got a sister to keep you company, you've got me to look after you, you've got nothing to complain about.”

55. B: (patient side of batting station) "I'm so f---- sick of hearing this. You're f---- wrong! You're up the f---- creek if you think I'm supposed to be f---- happy! I don't have to leave the house and be f---- frightened by the f---- riffraff that you f---- judge, I'm f---- scared right here in my own f---- bedroom, I'm not f--- safe in my own house! I'm not even safe in my own skin! I'm not even allowed to have the f---- reactions that I have in my body, you f- prick! Don't tell me I don't have any f---- right, you're f---- wrong! You go to hell. I have so much f---- pain in my body, I have so much rage in me! It's f---- stockpiled from every minute of every f---- day that I was alive! This wasn't a one shot f---- deal, this was every goddamn day! You expect me to f---- live with that? You expect me to succeed with that? You expect me to f---- be happy with that? I cant be any of those things, there's no room! I'm so f---- filled up with your lies, I'm so filled up with all the bullshit that I had to swallow with all the feelings that I had to swallow, every time I was angry and I wasn't f---- allowed to be angry because you were going to hit me or you were going to just reject me. Every f---- time I had to swallow that. Every time I was scared with you and mum fighting, with mum f---- committing suicide, how am I supposed to live with that? ARGH! I'm not going to f---- do this anymore! I'm not protecting you, I'm not looking after you, I'm not f---- being frightened of you anymore! You're just a stupid, pathetic piece of s----. You don't deserve my respect, you don't deserve my fear, you don't f---- deserve one f---- inch of me. ARGH!"


Fourth step: the connection

56. T: "So the connection between how you feel lately..."

B: (patient chair) "Its all these feelings that I had when I was a kid that I had to swallow because having them meant being rejected by my parents.

T: "You had to swallow your anger back then."

B: "Yeah, I had to swallow my anger and fear and anything so now I've kind of opened up Pandora's box, I think, and it's just rage and rage and rage and rage and I think the irritability is just the rage sitting right under the skin ready to explode any minute "



Fifth step: the commitment

57. T: "So what's your commitment?"

B: "To not throw Laura out the window. And to ... sometime in the next two weeks, to talk to the supervisor at the nursing home about her not helping because it's really dangerous for my client. And to keep working this issue in therapy.


Samples of Working Sessions

(T: Therapist)
(C: Client)

December 9, 2004

PRESENT CONFLICT:

C: My conflict is that I’m just getting completely squashed and annihilated by my introject.

T: Why don’t you reenact then in the two chairs, the mother and father squashing you. You start in the maternal and then the paternal then switch, OK Just put out what is going on in your head.

C: (maternal chair) There’s no point in bothering with this. What are you doing? I don’t see what you are doing. You have to be like me. You’ve got to be like me. I’m your mother and you are my daughter and you have to be like me. That’s just the way it is. There’s no point. There is no point. You’re tired and you are never going to get anywhere and there is no point. There is just no point.

C :(Paternal chair) What is your problem? What the f*** is your problem? You can’t drive... I mean where were you born? Were you born in a barn? You can’t do this and you can’t do that, you can’t put your stuff away, you can’t do your dishes, you can’t feed yourself properly... What is wrong with you? You’re wasting your time and what the hell are you doing? You didn't’t take that full time job that you had an opportunity to get. What the hell were you thinking? You need the money. What were you thinking? You think I’m going to take care of you? I’m not going to take care of you. You have to learn how to take care of yourself. Or you have to go and find a man who is going to take care of you. I can’t take care of you, I’m not going to take care of you. What were you thinking... Where were you driving? Why can’t you remember everything at the same time? Why do you have to keep going back and forth and back and forth and you go to your car and then you have to go back in ‘cause you forgot something and then you go back out and then you forgot something else. Why can’t you get more organized? And why can’t you think about... Why can’t you think ahead... Why can’t you just plan things? Why can’t you keep a schedule and why is it you can’t seem to keep your appointments and why is it you cancel things and why can’t you be more organized? What you need is a schedule. And why can’t you look after your mother? You can’t expect me to be there all the time, why can’t you look after your mother? And why is it that you can’t just make this family happy. Because all I can see is you just ignoring people’s needs. I mean your sister needed a babysitter for her kids and why weren't’t you there? And why is it you don’t look after your mother? You see she is working so hard, you see she is tired, why don’t you look after her because that is what your life is about... Looking after us! Why the hell can’t you get that straight? And why is it you get behind these people who don’t know how to f****** drive when you’re late? And why is it that you are late in the first place because you should be more on time. And why is it that you bother with a baby bird that is sick... It’s going to die anyway. What the f*** is your problem? Why is it that you can’t control your dog when she goes barking after people? And why is it that you spend so much time with her anyway? Because you should just lock her up in the house for ten hours while you are working. Why is it that you f****** bother with her? And why is it that you are doing all these things? What is wrong with you? You should get up in the morning, you have your breakfast, you go to work, you have you lunch, you go back to work, you have your supper, you come home, you help your mother. And that is the way your life should be. You should go to bed at a decent hour and you get up at a decent hour and what the f*** is wrong with you?

C: (at the bat on ‘self’ side) what the f*** is wrong with you? You expect me to live my life the way you want me to! Well f*** y**!! F*** y**! I am not you! I am not you! I don’t care about the things you care about. I don’t care about that! I don’t care what other people think is right! I don’t care what other people choose to do with their life. I don’t care what society thinks is the right thing or the wrong thing. I don’t care about other people’s schedules. I don’t care that things are going to die. I don’t think that is a reasonable excuse to ignore suffering! I don’t care what your idea of right and wrong is. I don’t care what your idea of what i should care about is! I don’t care that you think that i should care about this family just because i am blood! I don’t care, i don’t care about my sister’s needs because the only time she phones me is when she’s phoned everybody else and she’s totally desperate and so she decides to pull the “auntie _____” card. I don’t care! I don’t care! I don’t care about your family because the only time they want to have me over for dinner is at some unreasonably stressful time of year that they call Christmas. Well they don’t have the foggiest f****** idea what Christmas is about! It’s about love and none of you have the foggiest f****** idea what love is. It’s all about obligation. I’m somehow obligated to do what you want me to do because i’m part of this family. I don’t want to have anything to do with this family!!! All you do is fill my head with anger and stupidity. You’re so f****** stupid!

C: (other side of the bat) You know you are not going to go anywhere with that attitude. You’re not going to go anywhere. You’re going to be put out on the street, nobody is going to want you. You’re going to be put out on the street with all of those other out of control people. All those other people who didn't’t know how to obey their father. .. How to honor their mother and father. You’re going to be on welfare for the rest of your life. You want to be on welfare for the rest of your life? You know you are never going to go anywhere unless you learn how to obey me. Unless you learn how to make decisions that I think are good for you. Until you learn how to do the things that I tell you to do, you’re never going to go f****** anywhere.

C: (self side of the bat) You f****** bastard! I haven’t f****** gone anywhere because i’ve been too busy obeying you! I haven’t gone anywhere because I have been putting all of my energy into looking after you in all of your many forms with all of your endless needs. F***!!! F***!!! I can’t believe how much time I have wasted! And that f**** job I dropped, you know, I am finally moving towards what I want and I almost f**** bought it! I almost f***** bought it! 40, 50 hours a week... That would bring in some good money, pay the bills, wouldn't it Dad? That would get me out of debt, wouldn’t it Dad? You f****** ass****! I don’t want that job! You know what f****** happens if I take that job? If I take that job, i’ll have no energy , no energy left to do what I want to do! To pursue my goals, to go to school, to do my writing, to have the energy to follow myself for once! For once in my f****** life, I’m following myself! So f****** what??? I’m intense, so f****** f****** f****** what? So f****** what? Nobody likes me, so f****** what? I look like a bum, so f****** what? I can’t afford new clothes or vacations or entertainment that all those other people can afford, so f***** what? So what????? SOOOOOO WHAAAATT???? HISTORICAL:

C: (continuing on self side of bat) If you had provided something for me when I was a kid, if you had f**** provided something except for a roof over my head and clothes on my back and food on my table.... Where the hell was the attention to me???? So what, you looked after the physical body... What the f*** is that? What the f*** is that???? I’m not a f****** physical body that has some other abstract content. I am me, I have a self, I have a soul, I am me and my body is just where I live. You f****** ignored me. You ignored me! Myself was totally turned on. You betrayed me, you turned your back on me. You didn’t want to see anything of me and I turned my back on myself and in doing so, I turned my back on God, you bastard! You bastard, you bastard! I’m not going to take that f****** job for you. And I’m not going to turn into some sort of fucking raging maniac because of you. I am not going to get buried in your anger. I am not going to find myself so squashed down that I stay in bed all day because I’m too f****** exhausted !! I’m not going to let myself slide into the position of not being able to do anything for myself except keep myself distracted from the anger and the rage and the disappointment that I am with you. I will not f****** have it! And I’m not f****** wasting my life doing what you want anymore. I have had f****** 60 hour a week jobs, I have had clothes, I have had vacations, I have been there, done that and you know what??? I was not happy!!!! I was not happy! And I won’t be happy until I have myself. And if that means that I lose every good goddamn thing other than myself, so be it! I would rather have myself and be a nomad wandering around in the pouring rain but have myself and my faith than to have any of the s***, any of the f****** luke-warm watered down, diluted crap, any of the abusive f****** ignorance that you tried to pass off as family or love or important. F*** you! F*** you! And I will keep asking to come to group when I f****** need to come to group and beat the crap out of you. I will not be buried by you! F***!

CONNECTIONS:

T: connection, commitment?

C: (in self chair) connection is that when I was growing up my parents, particularly my dad because he was actually a strong character, whereas my mother was just passive, but they didn’t see me, they just squashed myself as a sacrifice so that they could... I don’t know... Project all of their needs and desires and their sense of what was important onto me. And I just lost myself in it and i’ve been following their agenda all this time and I’m not following their agenda, even if it doesn’t logically make sense. Like this full time job and being in debt, I could take it but it’s just going after what is important to them. The money and the clothes and the house and what I’m trying to follow here is about my soul and my faith and my self and .. T: so what’s your commitment?

COMMITMENT:

C: my commitment is to keep following myself and keep asking for extra groups to get this out so it doesn’t squash me cause they just... The more I follow myself, the faster my introjects try and shove me down and I end up not taking care of myself and getting tired and getting sick and so I’m just going to keep working it and keep moving in this direction and asking for the support that I need to get there.

 

 

 

 

December 16, 2004

PRESENT CONFLICT:

C: (In self chair) My conflict is that I’m being driven completely out of my mind. My head is... I just cannot shut up. I cannot shut up and I feel like I’m full of resistance and ‘no’ and... left chair?

T: mmm, hmmm put the voice out. Whatever is going on in your head that you don’t like, you put that out there. C: (negative self chair) um.... now it shuts up.... can I start in the right chair? It’s more dad so...

T: yeah, start wherever you want

C: (in paternal chair) Now I want you to pay attention to me. You need to pay attention to me. Everything that you are doing is wrong and you need to pay attention to me, listen to all of my instructions. I’ll have an instruction for you every single minute of every single day so you need to listen to what I have to say and I’m going to tell you all about what people think and I’m going to tell you what the truth is in this world. And the truth is that you are bad and the reason why you don’t have a job and you don’t have your own place and you don’t have a community of friends and you don’t have a partner and you don’t have a career ... the reason you don’t have all those things is because you are irresponsible and you’re lazy and you are stupid and you are not devoted enough and you cause too much trouble and you talk too much and um... you are too boisterous and you’re too ... your too much. You talk to much and you want too much and you think too much and you act out too much and you create too much of a fuss and you.... you just... you make too much conflict and you just need to go along with people and get along with people and just say yes all the time. That’s what you need to do. Just say yes and go along with it and do whatever is asked of you and just think whatever it is that people are wanting you to think and just be agreeable. If you are just agreeable then you will go far in this world. But you are too stubborn and you are too negative and you’re too bad. You’re just too much.

C: (self chair) I’m just trying to think about what I need to be doing in my day here and I’m trying to get it together and I know that I have these things that I want to do in the next three hours before I leave the house and I’m trying to think about what it is that I need to do. I’m just trying to think and your voice just distracts me constantly. It’s like you just won’t shut up.

C: (paternal chair) there’s no good on blaming other people. The only person you can blame is yourself. And you know this is your fault. If you have things going on in your head it’s because you can’t concentrate and you don’t focus and you just spend too much time day dreaming and you are ... you do really stupid things. You don’t pay attention and you don’t go to bed on time and you don’t eat properly and you don’t talk about things that are interesting and you don’t do anything that is interesting and you don’t play along with the game and you are just wrong.

C: (self chair) (crying) I just get to feeling so beaten down by you. You are just constant and getting proper sleep is just f****** impossible with you. You know, my body... I wake up in pain and then I can’t get back to sleep even if I get comfortable again because you are in my head and you are just f****** constant. I’m having to battle you all the time. And you take so many different faces.

C: (paternal chair) I don’t take different faces, it’s just that these friends of yours that you are no longer friends with, I know what they are thinking because I know you and I know what a f*** up you are and I know what you should be doing and I know what you should say and I know what they are saying do I’m going to tell you all the time what it is that they are saying. That you are the problem in their life. You are the one to blame because you just... you won’t listen and you don’t care and you don’t let them do things and ...

C: (self side of bat) For starters you don’t know what the hell people are thinking. You just made this crap out of your own fear and your own judgment and your own sh**. You enjoy criticizing me and then holding me responsible for everything and everyone else’s life. And the second thing, if people are f****** blaming me and thinking that it’s my fault and holding me responsible and being critical and judging me for things that are going on in their life or not going on in their life or f***** whatever, you know, that is their sh**. That’s their sh** just like this is your sh**. I don’t need to carry around all this crap. You have just made me so f****** tired. Not only do you keep me awake with all this crap that has nothing to do with me, but also just by the f****** emotional burden of carrying around all this responsibility that you put on my shoulders. (crying) (batting)

C: (other side of bat) Well I don’t really know what is wrong with you. I mean, your mother and I get along with everybody. We get along with people just fine. I’ve run a business for 60 years and I’m ... I get along with everybody. I don’t get into arguments and I don’t get disagreeable like you do. You know if you just do what people want you to do... if you just do what I want you to do, if you just do what your mother wants you to do and your teachers want you to do and your friends want you to do and the rest of the world wants you to do... if you would just do all that and just be agreeable then you wouldn’t have this problem. You wouldn’t have these conflicts with people and you wouldn’t have this problem in your life and you wouldn’t be so much of a big f****** failure. HISTORICAL: C: (self side of the bat) F*** Y**. Just f*** y**. You know I was never allowed to disagree with you... let alone not do what you told me to do. I wasn’t even allowed to voice my f****** opinion. I wasn’t even allowed to say “I don’t want to” or “I don’t like it” or “I want something different”, I wasn’t f****** allowed to say anything. I had no f***** freedom! I had no rights! But don’t f****** think that I didn’t think it all the time. Don’t think that every time you opened your mouth... well every time you opened your mouth and you said something to me, I just wanted to f****** kill you! I hated you! I was stuck every f****** time you opened your mouth. I was stuck because I wanted to say NOOOOOO, I don’t want to do that!!! NOOOOOOOOOO!!!! I don’t want to eat that!!!!!!! NOOOOOOOOOOOOOOOOOO I don’t want to wear that! NOOOOOOOO I don’t want to do that for you!!!!!! NOOOOOOOOOOOOO! My whole f****** body wanted to say NOOOOOOOOOOOO! GET OUT! Leave me alone!!!!!! GO AWAY!!!!!! You can’t make me do anything, YOU CAN’T MAKE ME! NOOOOOOOOOOOOOOOOO!!!!!!!! But instead I was stuck f****** doing your will. I was stuck following your instructions. I was stuck wearing the clothes you picked. I was stuck getting the affection that you wanted to give to me even though I f****** hated it because it was never affection that I wanted. I could tell by the look in your face, your body language, it wasn’t affection, it was showing off. So what you didn’t molest me... the only time you ever touched me was when you wanted to put your arm around me and say ‘oh yeah, here’s your little girl, here’s your little girl” Well, f*** you!!!! F*** YOU!! I’m not your little girl and I don’t like the things that you have to offer me. And I don’t like the things that you want me to do! And I don’t like any of it and I was f****** stuck and now my whole body is full! I’m full of a whole lifetime of not being able to express “NNOOOOOOOOOOOOOOOOO, NOOOOOOOOOOOOOOOOOO, NOOOOOOOOOOOO!!”. What the hell was I supposed to do with it? What the hell was I supposed to do???

C: (other side of bat) Well, you just don’t... just don’t feel that way. It’s just mind over matter. It’s just mind over matter. Just think about something else. Just do what I tell you to do. Just make peace with everybody, just go along with things, just be passive like your mother, just f****** take it all. Just take it all. Just swallow it all! JUST SWALLOW IT ALL!

C: (self side of the bat) F***!!!!!!!!! F***!!!!!!!!!!!!!! I hate, hate you!!!!!! IHATE YOU! I DID F******* SWALLOW IT ALL. I DID SWALLOW IT ALL. I SWALLOWED EVERY F****** THING. But it wasn’t because I loved you, or respected you or cared about you, it was because I was f****** terrified of you! I was terrified of you hurting me. I was terrified of you putting me out on the street, I was terrified of you hurting my mother, I was terrified of you taking it out on my sister, I was terrified of being rejected by the only family I knew! I was f****** terrified of your criticism, I was terrified of your voice, of your hands, I was terrified of the wooden spoon, I was terrified of the stick, I was terrified of the golf club, I was terrified of rulers, and I was terrified of yard sticks, I was terrified of f****** everything that you used to control me!!! I was f****** terrified of you!

C: (other side) I was a good father, I was a good father for you. I provided for you, I never treated you with anything but respect, I sent you and your sister to a good school. I didn’t get rid of your mother eve though she was just useless and fat. I didn’t get rid of you even though you were obstinate and willful and ugly and fat. I was a good father. I stayed with the family, I stayed with this family. That’s what makes a good father. I stayed with this family.

C: (self side of the bat) I hate you. I so f****** wish. Sometimes I wish you were dead when I was a baby. Maybe somebody would have taken us in. Maybe somebody who knew what it was like to care for a child. Maybe f****** somebody would have cared. You didn’t f****** care about anybody but yourself. You had no right to have a child. NOOOOOOOOOOOOOO, NOOOOOOOOOOOOOOOO,NOOOOOOOOOOOOO,NOOOOOOOOOOOOOOOO,NOOOOOOOOOOOOOO! I’m f****** left with all of this NO and all of this resistance and you’re dead and gone and all of this f****** resistance, all of this conflicted stuff inside me! It’s stuck inside me and it drives me f****** crazy!! It drives me crazy!!! And I’m on all of the f****** anti-crazy drugs, thank you very much! And I’m still driven crazy by you!!! I’m driven crazy!! You’re stuck inside me. All of the resistance is stuck, all of my ‘no’ is stuck, all the memories of all of the times that I was forced, forced into prostituting myself, whether it be physically, sexually, mentally, emotionally f****** prostituting myself! All in the name of terror of you! I’m f****** stuck with the knowledge that I have spent my entire life living in fear! I’ve spent my entire life not knowing what love was because I was soooo, sooooo, soaked in fear in anger because of you! And it f****** still works against me. Dead and f****** gone for I don’t even know how many years anymore, I don’t even care! I don’t even remember you on your goddamn birthday, I don’t even remember when you died. You f****** prick! You ruined my life! And now when I come up to the point when I’m f****** feeling ready to make some choices for myself, YOU, YOU, You are still there inside me, you are still criticizing me, you are still trying get me to be distracted from my self, you still want me to swallow myself, you still want me to do your will, to run around your little chicken coop instead of walking my own path, you f****** bastard! You have ruined my life and some days I f****** feel like I will never get free of you! And I f****** hate you and that’s inside me. It’s not out there where I can fight it with a gun or a spear or a sword or a f****** fork that I could poke in your eye and twist around like spaghetti! It’ s f******* inside me where all it does is torture me and make me sick and put me in pain and I gotta get you out! I gotta f***** get you out!!! OUTTTTT, OUT! NOW!!!! NOW!!!! I will f***** get you out if it’s the last thing I do! NOOOOOOOOOOOOOOOOOO!!!!!!!!!

T: connections and commitment?

CONNECTIONS:

C: (in self chair) (crying) My introjects from dad ... when I was little he demanded that I swallow myself and distracted me from myself and he threatened me with abandonment and punishment and pain and when I was trying to express myself, there was just no room for any discussion with him I wasn’t even say that I didn’t like something without being punished. There was no freedom of expression in that way at all. I didn’t do it because I loved him, I did it because I was terrified of him and my whole life I’ve been getting into situations where people are wanting things from me and even if they are not threatening me, in the moment I still feel threatened like I did from dad and so I have never been able to say “no’ and I’ve never been able to express my own opinion and my own desires and my own rejection of things. And I feel like I just have all this whole life time buildup of this huge need, huge need to say no and reject and I’m left with all of the people and relationships and situations and I’m just left with a whole entire lifetime of... of... that’s not mine, but I have to carry it. And ... T: what’s your commitment?

COMMITMENT:

C: (in self chair) My commitment is to just keep coming and working it and try to get it off me, get it out of me so I don’t have to carry it anymore T: what about in the concrete? Seems like there is a lot of things going on and you’re not saying no or something? C: (in self chair) No, I am. I can finally say no but it brings up all of the introject as soon as I ... I have my appropriate boundaries with people and I don’t care if they don’t like me but it just makes the introject attack me a hundred fold for doing it... you know, it’s all my fault and the introject just gets me in the middle of the night or all day long just trying to tell me how it’s all my fault.

 

 

 

 

December 17, 2004

PRESENT CONFLICT:

T: what’s in you that makes you triggered by that?

C: it doesn’t make any sense because I feel so young right now talking about it and full of shame. But their adults... the experiences that I’ve had as an adult... but it’s like... the last sexual experiences that I had was a couple of years ago and I sometimes... you know... when I’m talking to the person or thinking about the person... not in a sexual way but... just when I’m thinking about them or... it’s like the sexual experience that I had with them will flash through my mind and I just wanta... I don’t want it to have happened at all... I’m so disgusted I wanna f****** kill them. And the same thing happens when I think about the sexual experiences I’ve had with other people.

T: to work that here you have to get into details

C: (crying and quiet for quite a while) OK, when B. started talking I just had this general feeling of disgust about anything sexual... like ... uuugghhh... and like something really gross on my body and that brought to mind times more recently that I thought about this experience that I had with a person that I didn’t really want to be there at all and ... (crying) ... and it’s totally with the awareness and the boundaries that I have now that I know how much I didn’t want to be there. ‘Cause at the time I was just checked out, I guess. I didn’t really even realize how far away from the experience that I was but now in retrospect... um... I’m on the bed and we’re naked and he’s touching my body and he is just getting off on touching me and...

T: talk to her...

C: (addressing female chair) You’re like ... I don’t know what kind of experience you are having but it seems to me that you are just totally getting off on this and you’re touching my body ... running your hands over my body and touching me in really private places and ... I’m wondering what it is that you are feeling and what is going on with you and why it is that I have such a knot in my stomach and I’m focusing on this knot in my stomach and I’m trying to make it go away because I don’t think it should be here right now, I don’t think I should have this huge knot in my stomach. Why do I have this knot in my stomach? I don’t get it. I’m safe here, you’re not trying to hurt me. Why do I have this knot in my stomach? (crying) And you’re making noises and you’re moving your body and ... and just gross!... and

T: continue at the bat... C: (self side of the bat)(crying)

T: start batting... keep batting and just repeat the last thing you said... it was gross..

C: (crying) F****** gross. I just feel like I want to crawl up into a ball... I don’t want to be here. I don’t want to be here! I don’t want you to touch my f****** body! Get your f****** hands off my body!!! Get your fingers out of me! I f****** hate the stink of you! I hate feeling this vulnerable. I don’t want to straighten up, I don’t want to uncurl, I don’t want to come out of my stomach. I’m lying here... I’m f****** lying here and all I’m wondering is, “why is my stomach tight?”, “why is my stomach tight?” “why is my stomach so tight” F***!!!! F***!!! I’m boiling myself inside. F***!! F***!!! Why can’t I just tell you to get the f*** away from me??? Why can’t I just tell you to get your stinking f****** needs off me? Why can’t I tell you that the f****** sight of you makes me disgusted?

C: (other side of the bat) Oh, you’re so young and you’re so ... so vulnerable and you’re so ... you’re so available, and you’re so innocent and you’re so easy. You’re so f****** easy. We all think so, you know. We all see how young you are. Look at those eyes... you know what’s behind those eyes... it’s like you’re only five years old, it’s like you’re untouched... it’s like you’re so pure and innocent and vulnerable and easy... you’re so f****** easy. And we like that. We like that, we like you to be so young, we like to feel so powerful, I like to feel like I’m the big one, I’m the adult and you’re the child, I like that.

C: (self side of the bat) You’re all f****** pedophiles, f****** pedophiles! That’s why I feel so f****** little! I am f****** little! I never f****** grew up. When the hell did I have a chance to grow up? When did you all start screwing me? When did you start screwing me? F*** F***!!! F***!!! I didn’t know how to say no! I have never f****** known how to say NO! You tell me I want you? Well, I don’t f****** want you! I have to shove myself off and hide in my f****** belly. Why does my belly hurt? Why is my belly so tight? Why does it feel like my belly... F*** F***!!!! F***!!!! GOD! How do I live with this disgust??? How do I live with this disgust? How many showers does it take to get your f****** fingers off me? How much scrubbing do I have to do to get your fingerprints off my body??? How many years is it going to take to get this memory of your f****** mouth, your tongue stuck in my mouth??? I f****** hate it stuck in my mouth! Get it out of my mouth!!! Get your f****** probing, intrusive, tongue out of my mouth!!!! C: (other side of the bat) You’re just remembering this all wrong. You know, I was there, I remember, you liked it. You were enjoying it, you initiated it, you liked it. You liked me touching you, you liked touching me, you liked kissing me

C: (self side of bat) If I f****** like it so much, why do I want to puke? I want to puke right on your face, in your mouth, I want to puke! Puke it out! I don’t f****** like it, I’m not even there! You think you’re so f****** good, you think you’re so f****** psychic or spiritual or connected or smart or whatever the f*** you think you are? (pause) Well fine. Maybe you f***** are eh? Maybe you are, maybe you can f****** see me. Maybe you can see me. Maybe you can see me. Maybe you can see exactly how f****** young I am. Maybe you can see exactly how I don’t have any backbone to say no to you. Maybe you f****** like me so much because you are terrified of rejection and you see no sign of that in me, whatsoever. You know by now .... You know you can do whatever the f*** you want and I won’t stop you. That you can talk me into whatever the f*** you want. That I’ll do whatever the f*** you want. You want! You want! You want! You want! You want! F***!!! F***!!!! F***!!! I have f****** sold my soul for you!! T: can you take it back? The emotional part?

HISTORICAL:

C: (continue on self side of bat) crying and sobbing for a while) All I can remember is being a teenager... and wanting to be accepted so much. I need to be accepted sooo much! My life depends on it. My depends on it! You said you loved me, you said you loved me! You f****** hurt me! You said you loved me and you hurt me. You f***** hurt me. You f****** hurt me and if I say I’m being hurt then I’m spoiling it for you and I’m going to be rejected... again! Again, again, again. (crying) C: (other side of the bat) You’re not good enough. You’re just not good enough. You think you can get something for nothing? Huh? You think you f****** get something for nothing? You think you’re good enough? You’re not f****** good enough. You’re not f****** good enough. It doesn’t matter what is going on inside you... it doesn’t f****** matter! It doesn’t matter today what is today what is going on inside you. You’re not f****** good enough! You try harder! You f****** harder. You try harder, you try harder. You want to be part of this family, you try harder. It’s not enough to just be here... you don’t get to be here... you have to work... You Have To Work to be a part of this family. You’ll f****** do what I tell you. I don’t care if you have cleaned your room, you haven’t done everyone else’s. I don’t care that you practice, you’re not good enough. I don’t care that you tried, you fell short. You f****** fall short! I’m not going to f****** stop until you give me what I want! I will never stop! I will never stop! I will never stop having my eye on you. I will never stop correcting you! I will never stop punishing you! I will never stop threatening you! I will never stop hanging this over your head until you give me what I want!

C: (self side of the bat) If you want me to f****** die, you almost get your wish. If you want me to suffer, you definitely get your wish. If you want me to prostitute myself for my whole life, you don’t get it! I have spent thirty five f***** years catering to your whim. Catering to anybody’s whim who is older than me because it reminds me of you, you prick! Respect your elders! Respect your f****** elders! Do what elders want, listen to your elders! F*** You! F*** You! You f****** set me up! When you finally did let me out of your sight for five f****** minutes, it wasn’t because I was good enough, it was because you gave up on me. You f****** gave up on me! You renounced me as your daughter! You threw me out! You threw me out! What the hell was I supposed to do? What the hell did I know except for what you had taught me. Do what everyone else wants... all those f****** ass*****.... fourteen years old and I was with some thirty year old f****** drunk. And I think that I’m blessed! Blessed! I thought for thirty five f****** years that I was blessed to be screwed by a thirty year old man when I was fourteen! Fourteen! F*** I was a child! I was only a child! I didn’t even know I was a child at the time because you never let me be a child. I didn’t even know what it was like to be a child!! But they could see it! They could see that I was still a child. He could look into my eyes and see that I was as easy to mold as Plasticine. He could see it! He could see no resistance right down to the fact that my own f****** mother knew what was going on and f****** endorsed it! I was abandoned by you! I was abandoned by you! You threw me away! Now what do I do? What do I do with these years of disgust? With these years of being scrunched up into my belly? What the f***** do I do? All I can do is keep coming here and keep trying to kill you and keep trying to f****** get it out of me and have all these reactions. Thirty five f****** years of reactions that I swallowed! I swallowed! I’ve never been able to fight for myself. I never even knew I had a self, you bastard! I fought for your rights, not mine! Well, it’s my f***** turn! It’s my f****** turn! And I’m not taking any sh** and I’m not taking the blame and I’m not taking any of that crap any more! F***!!! F*** You!!! T: Good. Connections?

CONNECTIONS:

C: (in self chair) My connection... I don’t really know but... when I was little I was just trained to just try and try and try and try and try and try and put all of my energy into trying to meet someone else’s needs... namely my parents and any other adult that came into my life. And that transferred over to sexual relationships really early on with much older men and I was so far removed from those experiences because I had learned how to just detach myself from reality because of how horrible it was to be with my parents. And it’s only as I start re-attaching to myself and having boundaries that make it safe to do that and having the support that I start realizing how horrible these experiences were and how disgusted I am and how far away I was from the truth.

T: commitment?

COMMITMENT:

C: (self chair) to not let that happen ever again and to just keep fighting to have my self back.

T: good.  

 

 

 

 

January 22, 2005

PRESENT CONFLICT:

C: My conflict is kind of with my neighbor and kind of with myself. He’s been making sexual innuendos and pushing that edge and I have not been liking it. I’ve been feeling really uncomfortable. I tried... I’ve been wanting to talk to him about it but I’ve been feeling really scared and the other day I went over to let my dog play with his dog and I thought this is the perfect opportunity to talk to him about it. So I was trying to get up the courage to talk to him about it while he was telling me some other story and then at the end of his story came another one of these comments that...

T: right chair.

C: (in right (male) chair) I had to go and fix this friend’s flat tire because he has a cast on his foot and he can’t drive his car. So I drove into town and I took his car to the gas station to get it fixed and it was really nice. It was a 12 cylinder engine... that’s a lot of power. And it’s the kind of car that it would... it would make a bad person feel like taking that fast car and finding a fast girl and getting out of town. And ...

C: (self chair) Oh, as if you would take off out of town.

C: (male chair) well, I couldn’t find you anyway, you were busy so that was that.

C: (self chair) so what’s that supposed to mean? You know I’ve been trying to talk to you about these inappropriate comments that you are making and now you are making inappropriate comments like you would like to come and pick me up in your fast car like I’m a fast girl and you are going to drive out of town with me? What the f*** is that? I haven’t invited this at all. I haven’t...

T: go to the bat

C: (self side of the bat) I haven’t invited this sh** at all. It’s taken me a long time to talk to anybody in this neighborhood . it’s taken me a long time to talk to you. It’s taken me a long time to feel strong enough and sure and trust myself enough to make sure I wasn’t going to make some kind of stupid flirtatious moves just to get your approval. It’s taken me a long time to be able to get that out of my system... it’s taken me a long f****** time to get rid of that! And I haven’t invited this for one f****** second. I have been nothing but straight with you. I have not injected any kind of that poison into this relationship. And still I have to deal with your crap! Still I have to deal with the fact that all of you men in your sixties who .... I’m as old as your daughter... you all still want to f****** play your fantasies on me. And I’m left trying to look at my own behavior. What am I doing wrong? What am I doing wrong? I must be doing something wrong? I can’t say anything about it because I must be doing something wrong. That’s the stupid f****** feeling that it leaves me with. I’m frozen like a f****** rabbit! What did I do wrong to make you treat me that way? What did I do wrong for you to not be able to see me? Or I got to f****** flip it around and you can’t be my nice kind neighbor and owner of my favorite dog. You can’t be that nice man who is married to the nice woman who has the nice garden, who talks about interesting things and cares about birds and cries when his cat dies. You can’t be that man because I have to make you into some big monster. I got to make you into some big f****** monster because I can’t even put up a boundary because I’m silenced by my own fear. F*** I hate it! I hate it! I’m pretty sure that if I said, look, I am so uncomfortable with that and I really don’t appreciate you making those sexual comments at me... I’m pretty sure you would back off... but when I wanted talk to you after that... after that last one, all I wanted to do was rip your head off! I was going to cut you down... I was going to take you out! But it’s not your stuff. You’re just some f****** middle aged man having some fantasy about your f****** neighbor who is half your age. You know you’re just like any other f****** middle aged man I’ve met who has f****** fantasies about young girl because he’s got to feel like he’s still virile. That doesn’t make you bad, it just makes you pathetic. This is just the fact that I’ve been so f****** frozen with this sh** and I know this time it’s not going to happen. I know because I would rather die... I would rather take the f****** hedge clippers to you before I let anyone touch my body ever again! T: keep taking it historical and threading it

HISTORICAL:

C: (self side of the bat) This isn’t about you... this is about all those f****** men... this is about all the times that men made sexual overtones on me. This is about every time... about the hundreds of times that men have made sexual overtures to me and I stood there like a fucking deer in the headlights with a f****** grin on my face because daddy likes a little girl who’s happy and I want to have a daddy who’s happy with me. So I sit there and shut up and let you do what you want with me. I let so many men cross my boundaries. I have let so many men take my clothes off. I have participated in so many acts ... I’ve slept with men that I don’t know, let alone like! I don’t know if I like them or not because I don’t even f****** know them. They’re just some guy I met on the ferry or in the bar or at the store or at school or on the street or at the swimming pool or f****** whatever! It doesn’t matter. They play their fantasy on me and I’m f****** frozen!!!!! Solid!!!! That’s my rage!!!! EVERY F****** TIME THAT I COULDN’T STOP IT!!! I couldn’t stop it

T: because?

C: F***! F***! All of those men standing in front of me looking at me, with those eyes wanting me to fulfill their fantasy and I’m terrified! Terrified that I wouldn’t live up to what they wanted from me, terrified that I wouldn’t be right so they would reject me, terrified that it would be my dad... my own father standing there protecting his own f****** fantasy about the perfect little girl! And so what it wasn’t sexual with him. He was such a f****** prude, he gave up his sexuality a million years ago it wasn’t about that it was just about his fantasy about me!!!! It was his fantasy about what he wanted his little girl to be like. And it was about the fact that if I stepped outside of his fantasy ... whack! I would f****** get it!!! F*** You! F*** You! F*** You! What were my options? What the f*** were my options dad? What the f*** were my options? What the f*** was I supposed to do? You bastard! You f****** had me helpless... f****** helpless... needy ... dependent... vulnerable... open...loving... receptive to your crap! You f****** had me at your bidding! You had me and you didn’t even have to try! I was born, geared up, wired to please you! Wired to manipulate you into loving me. Wired into manipulating you to get my needs met! Hoping that you would love me and take care of me. F***! Every f****** male that I have met has represented you! You prick! Unrequited love... unrequited f****** love!!!! I wonder why I’ve been obsessed by those stories of unrequited love... daddy!? I wanted your love!!!!!!!! I f****** WANTED YOU TO LOVE ME!!!! I NEVER GOT IT RIGHT!!!!! You f****** prick! You f****** prick! You didn’t know the honor that you had! You didn’t know the honor of creating a new life! You didn’t know how to respect that!

C: (other side of the bat) I don’t want you. I’m going to put you out on the street... I don’t want you. You’re not my daughter... no daughter of mine would speak like that! No daughter of mine would talk back to her father!

C: (self side of the bat) I wasn’t your f****** daughter. I was never your daughter! I always wanted to be your daughter! I was never your daughter... not for one f****** day!!! You just saw me as a tool to get your needs met. To be your nursemaid, to be your f****** joker, to be what it was you wanted... your clown, your informant, your scholar, whatever the f*** it was that you wanted. That’s what you wanted for me. You never wanted me... me, dad! You never wanted me, your daughter... to you, she didn’t exist... I didn’t f****** exist. To you all you wanted was *my name*, the girl you made up, *my name*, the girl that you named, *my name* the girl that you named after some aunt that you loved... who you loved... who used to give you candy when you were a little boy... and you just wanted me to give you your goddamn candy! My life! My life! You expected me to give you my life! What kind of f****** father does that? What kind of f****** father demands that his daughter sacrifices her life for him???? It’s supposed to be the other way around, you prick! You’re supposed to sacrifice your life for your creation! When the f*** did you do that? I was not your f****** daughter. You never protected me. A father would protect his daughter! You never nurtured me! A father would nurture his daughter! You were never there for me, I could never count on you, I could never come to you with whatever problem I had because you would come up with some way to humiliate me or make me feel stupid. You would f****** silence me because problems were not in the equation of what you wanted!!! F*** YOU!!!!! You left me f****** empty, you left me not knowing myself so much that anybody... any f****** vagrant, any drug addict, any f****** whorish man could walk into my life and take what he wanted because there was no one here to stand up against him!!! You left me manipulating man after man after man right from the time I was fourteen!!!! Trying to get you to love me!!! Trying and it never f****** worked!!!! All I did was get hurt and those f******* days are gone you prick. You’re f*******dead and gone. Even though you lived on in me for far too long for my liking. You are dead! And I am not giving my body! I am not bending my f****** will for anyone anymore!!! So I may be standing there silenced temporarily but I’ll tell you this! I will come and work this f****** issue with my neighbor every f****** week until I can stand there and look him in the eye ... not look at my feet, not look at his belly, not look at the dog... I will look him in the f****** eye and I will tell him clean... “it is not OK!”

T: good. Connections and commitment.

CONNECTIONS:

C: (self chair) the connection is that my father when I was a kid, he didn’t see me at all... he didn’t want to see me. He just wanted “me” dead so that he could replace me with his f****** weirdo fantasies about what he wanted his “daughter” to be and I was terrified because I was taught to be... you just didn’t go against my dad... I was terrified... paralyzed... he threatened to put me out on the street all the time... he threatened taking things away, my mother dying, selling me, to everything and I just learned how to keep my mouth shut and freeze while someone was playing out their fantasies on me. I desperately needed him to love and accept me and I had to choose: have myself and be abandoned, or sell myself to try and win his love. And that has played out through my whole life as man after man has put their fantasies on me. Half of it is me because I’ve been trying to manipulate men (my dad) to love me my whole life and even though I don’t think I have a sexual tone in it, that “I want you to want me” energy just brings out that sexual energy in men. With my neighbor, he’s just ... he’s not an aggressive abuser who would do it anyway, he’s just an older man wanting to toy with his fantasy but its’ not comfortable for me.

T: commitment?

COMMITMENT:

C: My commitment is that I will keep trying to say something to him and if I can’t do it then I’ll just keep bringing it ... this is the only thing I’m going to work until I can stand there and look him in the eye and say it is not OK  

 

 

 

 

Sept 16, 2009,

Wednesday

PRESENT CONFLICT

T: Conflict?

C: I was going to work something else but I got triggered when (she) was saying the things that she got taught when she was a kid and how it didn’t prepare her… at least that was my interpretation.

T: It doesn’t matter, it’s your scene

C: it just made me think about or feel really emotional about how hard I’ve had to work to get to this place… Therapist: Tell them PRESENT

C: B (Mother) and L. (Father), when I heard (her) working, it just made me think about how f**** hard I’ve had to work to get to this point right now in my life where I am just starting to feel competent like I might be able to do this life as an adult. And I’m 41 years old and it’s taken me this long to feel like I can live on my own and that I can pay my own rent and that I can trust myself to get a job and to support myself and that I don’t need to lean on other people to the point where I’m basically selling myself to be supported like I had to do with you guys. And it just makes me really f**** mad, even though I’m sitting here crying… Therapist: go at the bat

HISTORICAL

C: (self) It just makes me really f**** mad when I think about the fact that this is the feeling I was supposed to have when I was a kid. It was your job to make me feel like this… like the beginnings of feeling competent and like I could be myself and I could achieve just the most basic level of success in my life on a day to day basis. This is just the f***** basics of what I am entitled to in this life… is to feel competent in myself, feel confident that I can make it through the day being myself, making choices that reflect who I am. That is just the most f***** basic human right and you robbed me of that. You filled me with all that crap and you made me sell out on myself every f***** day. If I wanted your f***** love, I had to sell out. I had to be somebody who I wasn’t, I had to follow your rules, your guidelines, your f***** stupid ideas about what was success and what wasn’t success and that thing…. I just started thinking about all those rules… all those things that you taught me…

T: Switch

C: (Father) It’s my job as your parent to teach you what you need to know in life and I take that job very seriously. I’m going to tell you everything that you need to know. So I’m going to tell you how to wash the dishes and I’m going to tell you how to be nice to strangers and I’m going to tell you how you have to , even though you are really really uncomfortable, you have to go and give your auntie a kiss or hug this adult friend… or you just have to make everybody else comfortable… that’s the most important thing. I want you to make sure that you are socially adept. Don’t make any one uncomfortable, don’t cause any conflict, make sure you are giving everybody what they want and that’s what you need to do. You also need to get straight A’s… 100% , 97 isn’t good enough… what happened to the other three percent? How do you expect to get anywhere in life if you don’t apply yourself, if you don’t concentrate, if you don’t apply yourself, if you don’t pay attention. F***** pay attention! How are you ever going to learn how to be a human being if you don’t f***** pay attention!

C: (Self) How the f**** am I supposed to pay attention when every two seconds you have some other f**** rule that I gotta follow? How the hell am I supposed to pay attention to anything when I’m so full of anxiety about accidentally screwing up one of the f***** rules??? How am I supposed to pay attention to anything when I’m so f***** anxious. You threatened me every five seconds that I’m not going to be part of the family, that I’m not going to make it, that I’m not going to be successful, that I’m going to fail, that I’m going to screw up, that you’re going to get depressed (mother), that you’re going to be upset (both) that you’re going to get angry (father), that you’re going to f***** suicidal (mother). How the hell am I supposed to take care of all the f***** rules??? D: (father) the rules are very simple, just pay attention to me, pay attention to your mother, pay attention to us, pay attention to your teacher, pay attention to your friend’s needs, pay attention to any relatives or friends that we have, pay attention to your environment, pay attention to your sister, pay attention to what everybody wants. Pay attention to what we want you to do, and eat and feel and f***** everything.

C: (self) I’m so sick of you. I’m so sick of you. Do you know there were things that I wanted to do as a kid?You know that, you a**h*****? I wanted to do my music and you wouldn’t let me, I wanted to ride horses and you wouldn’t let me, I wanted to do all these things that I was interested in doing and you wouldn’t let me do any of them because I was so f***** busy making you happy, doing what you wanted. Looking after your sorry f***** needy asses. Argh. When I think about how hard it is that I have had to fight just to get to here, you know finally after doing 7 long stupid years of therapy I can finally feel like I can get up in the morning and I can pull myself together and I can walk out the door with a certain amount of confidence that I’ve got my shit together and I’m forty f**** one years old! Do you know how badly you failed in your job that it’s taken me this long and this much personal work to feel like I am competent? You f***** losers! How dare you put your incompetence on me, how dare you make me wear it! And then you’ve got the god damn nerve… argh…

C: (father) That’s interesting that you’re saying you’re competent because I’ve been watching you lately and I got to tell you that you may think or feel that you have your sh** together but I can tell you, girlfriend, you don’t. You don’t have your sh** together. I mean, you don’t even know what you are going to do! You were supposed to graduate this year and you couldn’t even get your shit together to do your math 12 in the summer. I mean, what kind of competence is that? What kind of an achievement is that? And everybody else at school seems to know exactly what they are going to do and exactly what courses they need to take and exactly what teachers they need to talk to and what research projects they need to get involved with to get to their goals and you don’t even know what the f****you want! Huh? You don’t know if you want to go into clinical psych, or social psych or if you want to do another degree here or if you just want to quit and do something else. You don’t even know what you want. So don’t talk to me about successful… and this is entirely your fault. If you hadn’t pissed away so much energy and spent so much time in therapy, maybe you would have got your shit together. Maybe you would have been able to sit down and organize yourself and figure out what you needed to do and what you wanted to do… an quit f***** getting in debt just to get where? Where? Where are you going to? Huh? You think you can just go out there and start taking courses and everything’s going to OK? Well now you’re 50 thousand dollars in debt, what are you going to do now, girly? Huh?

C: (self) you are such a f****** Prick! F*** you! F*** you! How dare you, how dare you criticize me? How f**** dare you after I’ve had to spend so much energy and time and money getting what you should have f**** given me in the beginning. How dare you! You got some f**** nerve coming in my head and starting to f*** around with me…. Criticizing me on not knowing what I’m going to do. You f****** ass****! If you hadn’t filled my head with so much of your own f****** neurotic bullshit**, I would have known what I wanted because I would have been able to feel myself and follow my own goddamn flow this whole time instead of f***** cow towing to you and trying to drown my anxiety with drugs and sex and relationships and whatever else I’ve done. I f****** hate you! I can’t believe that after what you did to me you are now trying to pin it on me and say that I don’t have my sh** together! You got some kind of f****** nerve! If you had even paid one tiny little bit of attention to what I needed or who I am or what I wanted or where the f*** I was going I would not be here. Just one little tiny bit, but you never f***** did. You could never get beyond what you wanted, how it reflected on you, what it meant about you as a parent, how you look, what people would think about you. You f****** said that people would be ashamed of me… they’re not ashamed of me, you were afraid that you would be embarrassed… that they would be shaming you. It had f****** nothing to do with me, I was just a kid. I was supposed to be learning and growing and changing on my own goddamn time clock, not yours. And because you had so many f****** rigid rules that you hung around my neck with threats following them of withdrawing love or withdrawing food or withdrawing clothing or withdrawing family, you f****** prick, you threatened me all the time and I learned that I should be afraid in this world…. Not explore it. Not go out there and try things and fail and that it was OK I never learned that. I never tried anything that I thought I might fail because I knew that it would mean that you don’t love me anymore, you would throw me out, I would be alone and f****** dead. You can’t f****** learn without making mistakes… it’s part of the definition, you f***. I f****** hate it that you did that, you son of a bitch, you selfish son of a bitch! How dare you have children when you have nothing, NOTHING to give! F***!!! I hate you and I should have f****** told you that at the time. But I couldn’t because I was so f****** dependent and that is what you counted on and that makes you a f****** ass****. That makes you a user… and that makes you…. I don’t know what it makes you but f*** you!! F*** You!!! Get the F*** off my back!!! And shut up! Therapist: Very good. Connections?

C: (back in the self chair)

CONNECTION:

the connection is that when (she) was talking about the expectations and the things that she was taught, it just brought back to me that real mind-f*** game of, “We’re just teaching you, we’re just helping you to grow (meant as from the parents)” and meanwhile it’s just counterproductive. It might be well intended but it doesn’t matter from this end. It doesn’t make any difference from the subjective point of view because you just hear it when you’re a kid as “you’re not good enough, you’re never going to be good enough and you’re not safe in the world and for god sakes don’t make a f****** mistake!” …which means that you can’t grow or change or do anything.

COMMITMENT:

C: Commitment: is to keep working and …

T: the more you know yourself, the more you will know what you want.

C: Yeah, and the other conflict was feeling ashamed while I’m in groups of people, like having a critic coming up afterwards so that kind of tied into it. Like when I’m in a group of people, when I’ve been oddly comfortable and just being myself, when I leave I get this huge critic in my head that I talk too much and that Therapist: You save that for Saturday (next group) D: Anyway, that was sort of the same thing and um… trying to put it on me that I should feel ashamed and it wasn’t me, it was them. Therapist: I know what you’re talking about. When you start being yourself you then go “AH, what did I do? “ because they catch you… you did this, you said that, you should have said this…” Well yeah, you have your conflict ready for Saturday.  

 

 

 

 

January 23, 2010

Saturday

PRESENT CONFLICT:

T: Conflict?

C: I had a conflict this morning and last night about if I should come today... or not. And it was ... there ended up being so much involved in it... I ... just took it to so many whacked out places and ... um... um... I don’t quite know how to work it because there are so many different pieces of it that are kind of significant. And just the argument itself is significant.

T: so do the argument in your head in the chairs.

C: (self chair) I’m going to go to group on Saturday.

C: (left chair) I don’t know if you should go to group on Saturday, I mean there is a lot going on, you have all those exams next week and you really need the time to study because you haven’t got enough done yet so you really shouldn’t go to group.

C: (self chair) but I haven’t been to group for a bit and I think should go because I have all this stuff going on in my head all the time.

C: (left chair) well you know maybe she didn’t even write you down for an appointment because you were ... you cancelled that one week and then you remember last week she had you down as a question mark and you said not that week but I’m coming next week. And I’m not sure she heard you say that... she might not have written you down. And you know what she said... she said that there’s a lot of people that show up for group and not everybody gets to work sometimes and do you really want to go over and spend your whole day over there when you could be studying? When you might not even get a chance to work (at therapy)? I mean... how are you going to feel about that? You’re going to be pissed and you should be pissed and there’s no point in going so really to take responsibility for yourself, you should not go because if you do go and you don’t get to work then you are going to resent it so really your boundary is that you should not go.

C: (self chair) Um.... well.... that’s a good argument.... but I’m pretty sure that she had me written down and that doesn’t sound like there’s very much trust in the situation. It just sounds like there’s a whole lot of fear coming out there.

C: (left chair) well, no, it’s not fear. I’m not afraid of anything. It’s just that you have to take care of yourself and you don’t really know what is going on and everything is kind of up in the air anyway. And maybe they aren’t even here and someone just forgot to phone you and tell you that group was cancelled. It could be that they have gone away somewhere and you just haven’t heard. I mean, if she doesn’t have you written down then you don’t even know what is going on so you shouldn’t go because it could just be a whole f****** waste of time. You could just be going over there for absolutely nothing.

C: (self chair) Ok Look. I think I should go because this is crazy. Having this conversation...

T: continue at the bat.

C: (self side of the bat) (batting) you know, having this conversation with you just feels a little insane. I mean, this is not that complicated. It’s like... am I going to go to the island or am I not going to go to the island? I mean, it’s really not that complicated. You know, so the fact that you are going on and on and on about all the different nuances of the argument... It just seems a little f****** crazy. So that makes me feel like I should... I really should go to the island because I get a little tired of...

T: why should you go to the island?

C: (continuing on self side of the bat) I should go to the island because I need to deal with this introject. I need to deal with this craziness going on. Obviously you’re affecting me.

T: switch C: (other side of the bat) well if you want to go and waste your time, you go and waste your time. And ... so fine. So go. Go to the island.

C: (self side) well I don’t know if I’m going to go. I’m going to set my alarm to get up in time to go.

C: (other side) oh, you know you have so much work to do, you shouldn’t go. You shouldn’t go to the island. You got so much studying to do and you say you can do it on the ferry but you know you won’t. You’ll start talking to people and you won’t, you won’t do your work. You won’t do it. You’re just going to end up socializing and the whole weekend will be blown and you’ll be stuck sitting in your exam at 1:00 on Monday and you won’t know what the f*** is going on because you won’t have studied properly.

C: (self side) Well, I’ll tell you. I’m going to be able to study a whole lot better if you’re not f****** continuing this stupid argument in my head. Because when I’m trying to study and all I can hear is you yammering on and on and on and on and on about some f****** argument that is ridiculous and doesn’t have anything to do with anything it just distracts me and it drives me crazy. And you have been getting increasingly disturbing to me in the last week and I’m going to go to the island and deal with it.

C: (other side) Ahhh but you have forgotten something. You feel good about that decision but you’ve forgotten something. You have forgotten about the fact that J. needs something from you. He needs that work that you were going to do for him. He needs that and yeah, you got some done, you’ve been doing it but you are too slow. And it’s not good enough and you haven’t got enough done and you haven’t got it finished and he’s gonna just be pissed at you and he might not even let you work just because he is so pissed at you. I mean you can’t follow through, why the f*** should he follow through? Huh? Why the hell should he follow through if you can’t f****** finish something. So you can’t go to the island. You have avoid that. You have to avoid it completely because you can’t see him. You can’t see him. You can’t go... don’t go. HISTORICAL CONFLICT:

C: (self side) Yeah... that was the last straw this morning because I recognize that voice. I recognize that one more than any other one. That is that “you’re not good enough” shit. That’s the ... I don’t measure up so I don’t get my needs met crap. I recognize that. That is you Dad. I didn’t do it good enough. Actually it’s both of you (mum and dad) I didn’t do it good enough so I get punished.

C: (other side)(mother) That’s right honey. You just have to pay more attention to your father. You just have to pay more attention to him. If you are quieter and if you do exactly what he says and make sure that you are paying attention to his needs and you take care of his needs every single second of every single day. Then he wouldn’t hit you. Why can’t you get that through your head. You are just not good enough. You have to be good enough if you don’t want to be punished.

C: (self side) That is just a crock of sh**! Argh. Argh!

C: (other side) Well, you know that we are right. You know and we’re right. We’re just right. You don’t deserve it. You didn’t measure up, you didn’t finish it.... you’re just not good enough. It just doesn’t matter what you did. It just doesn’t matter. Just like you were talking to D on the way on the ferry... it doesn’t f****** matter. You ... so what... you’ve been in therapy for what? Eight years this year? And look at you, you’re still not working enough to stop yourself from going into debt, you’re still not getting the grades you need to get a scholarship, you’re still missing deadlines, you’re still f****** up. You’re still not getting the work done, you’re still not keeping your friendships up, you’re still not in good enough shape, you’re not committed enough to exercising, you’re not looking after yourself, you’re not getting to bed on time, you’re not f******* getting a study schedule set up, you’re not getting your assignments good enough, you’re not getting your transcripts done, you’re not doing the research, you’re not f****** measuring up! Do you hear me???

C: (self side) (batting) ah God. The other side of that argument though is... is....

T: go with your anger

C: (self side)(batting) I’m just so f****** pissed off!! I’m so pissed off that this has to be so f****** hard! I’m so pissed off that I have to spend my weekends going to therapy so I can think straight. I’m so pissed off that I have to work so f****** hard.

T: take that back

C: (self side addressing parents)(batting) I’m so pissed off that nothing is ever good enough for you!

T: tell them what you have accomplished against all odds

C: (self side) at the beginning of therapy... you know I’ve been typing my transcripts and you know I’m listening to it from five or six years ago. F***. I was living with my f****** mother in a codependent relationship with her. I didn’t have any job. I didn’t have any education. I didn’t have any friends, I didn’t have any life at all. I didn’t have any self confidence, I didn’t have anything. I had f****** nothing. Nothing! I was still finding myself in the middle o f these crisis all the time without even knowing how I got there. I mean, f***! You know there was a goddamn grandpa aged neighbor that I ended up in bed with! That’s what was going on five years ago.... I was getting triggered by some assh*** who reminded me of you! And man, I was so smart when I was little, I was so smart! I learned that fighting with you (father) was only going to get me hurt more. The only way that I could protect myself from you was to seduce you...Was to make you be in love with me. The only way that I could protect myself from you hurting me was to charm you... to do everything I could to be everything that you wanted. So the minute I got scared by some f****** asshole, I would seduce them to stay safe! And then I would be living in this f****** fantasy world that I built to protect myself from you. My whole f****** childhood was a f****** fantasy! I used to say I was so lucky because I lived in this fantasy world. I was so lucky, my parents loved me, I lived in a middle class community, I went to a good school, nobody was an alcoholic, nobody was sexually abusive, they didn’t get divorced, how f******* lucky am I???? Well, the reason I lived in that world was because it was a fantasy. The truth was I was living in that middle class community, in hell! Suicidal f****** depressed mother, I mean, it had only been two years since you got out of a f******* mental institution for major depressive disorder before I was born! You know what? You still belong in a f****** mental institution. ‘cept now, instead of doctors and drugs, you’re using me and sucking me dry! And you’re allowing (dad) to abuse me!!! So I live in a fantasy world just five f****** years ago. I didn’t have a home, I had nothing. And since then, I have fought so f****** f****** f****** hard! It took me three months of going up to university and plugging the parking meter and having anxiety attacks and driving away and standing there shaking... it took me three months of doing that almost every day before I could do it enough that I could go and get a f****** application! I had to get somebody to hold my hand!... when I’m 38 years old!!! I had someone walk me to the office to apply! I was so f****** scared! I was so scared of not being good enough and being punished! Because of you! And then I had to listen to your criticisms day in and day out, day in, day out, I’m not good enough...

C: (other side:father) You’re not good enough. You didn’t get a good enough grade on that test. You didn’t get a good enough grade, you’re not listening well enough, you’re not thinking well enough, you’re not making friends, you’re not getting involved. You’re not f****** good enough, NOT GOOD ENOUGH!!!!!

C: (self side) How the hell am I supposed to study when you’re just f****** raging in my head? But somehow despite that, I f****** made it through! School all week, therapy on the weekend, school all week, therapy on the weekend, I f****** made it though! You f****** assho**!! And then I had to move out... I had to get my own place. Well, I f****** did it! I’ve got my own place, I go to school, and I’ve almost.... I’m .34 away from an A- average, you f****** son of a bitch! And it’s got nothing to do with you!!! I’ve had to FIGHT SO F******* HARD!!!!! If I had left it up to you, you would taken me out of that.... do you know how many times I was in my place in the morning and I called Lise, and she gave me a lecture to get my ass to school. Get my ass to class! I had to carry Lise’s voice around in my head every f****** day to counteract your f******* sabotaging messages. You’re trying to attack me all the time! I had to come to therapy and f****** BEAT YOU DOWN! I had to work so f****** hard to counteract the effects of your abuse and your neglect! And I’m doing a f****** degree where it’s f****** thrown in my face all the time.

C: (other side of the bat)(various people) Well, you know, there is not actual evidence of the trauma theory. You know, if you really want to be a respected psychologist, you need to go into the cognitive-behavioral side of things. Because it’s just a matter of reprogramming the thought patterns and if you reprogram your thought patterns then you’ll be able to overcome these deficits that you have.

C: (self side) You f****** prick!!! You don’t know what the hell you are talking about. You have your head so far stuffed up you’re a**. You will never, ever see the sun! F****** moron!

C: (other side) well, it is clear that you have some unhealthy attachment to the past and what you have to do is you have to rise above these unhealthy attachments that you have to the past and notice that that is in the past. And just let the thought go... just recognize that you are thinking it and let the thought go. And rise above it and then you can change these unhealthy attachments that you have to the past and you can continue on in life in a more positive direction.

C: (self side) ARGGHH!!!! Positive f******, F******, F****** direction! Oh yeah! ‘Cause that is working so well for everybody! Our world is so f****** well adjusted and balanced isn’t it? We’re so f****** connected to ourselves and the earth and we take such good care of everything. I guess that’s why the crime rate is rising eh? I guess that is why everyone is so everyone is in so much f******* debt because they are trying to buy their happiness, to move forward and to try and cover up the past that they are not f****** letting them acknowledge. The reason we’re in that f******* mess in the first place is because of all of that f****** bullsh**. Because of all of that f****** nonsense about paying attention to the positive, just don’t pay any attention to the negative, pay attention to the positive. Look for the happy in everything, make everything ok, if you can’t change the situation, change your attitude. Well F*** you! Change this you pricki!!!!! AARRRGGGHHHH!!! That kind of a f****** attitude had my major depressive disorder mother, suicidal mother, pretending that f****** rays of sunshine were floating out our chimney! That everything is f****** sunny because you can just ignore it... argh.

C: (other side) the way that you do it is that you just ignore it. Just ignore it! Doesn’t matter what is going on with him, it doesn’t matter, doesn’t matter, doesn’t matter, just ignore it. Ignore it, ignore it, ignore it, it’s not going on. It’s all ... it’s just... you just have to ignore it all and look for the positive. He’s hitting you or he’s chasing you around or he’s being highly critical, or nothing is ever good enough, or he’s threatening to throw you out of the house or he’s threatening if you... if a stranger is nice to you then he probably wants to chop you in little pieces and put you in a ditch somewhere and you know... you have to look for the positive spin on it. The positive spin is that he loves you. He’s hitting you and chasing you around the house and criticizing you and threatening you with your very life because he loves you and that is the thing that you need to focus on. How much he loves you. You’re his little girl and he loves you. He’s just loving you.

C: (self side) ARGH! You’re so f******* psychotic! Do you know how f****** up a mother has to be to allow that situation to go on and pretend like everything is ok You think that me coming to therapy and dealing with my past is some sort of unhealthy past attachment issue? You’re my unhealthy attachment issue by the way... just so you f****** know! I’m f******* attached to little miss f****** strawberry shortcake. Little miss, oh yeah, I’m going to kill myself, but everything is great. Little miss, don’t worry about your super f******* sadistic father, because he really loves us all, he just doesn’t know how to show it. Don’t f****** worry, that’s my f******* attachment issue, you bitch. I attached to that and I equated that with reality with myself. I did all those things, I stuffed it all down, I squished it in little places it didn’t belong, I just about f*******imploded from the inside. I mean, do you remember taking me to the doctor when I was thirteen and I was puking up brown crap all the time and my stomach hurt so much I couldn’t get out of bed. And do you remember the doctor said that unless I could reduce my stress level I was going to end up with a f****** ulcer? Well as it turns out, maybe ulcers are viral but you know what? The stress was f****** real! It was ripping me apart. It was making me sick constantly. Constantly!! Do you know how little I have been ill, physically ill, since I started therapy? It’s because all of that f****** stuff that you made me stuff down, that you told me to turn into the positive, that you rise above, all the crap that’s underneath the carpet manifests itself in your body, you stupid ignorant son of a bitch!! How much gastritis does one teenager need? How many bouts of vertigo does one teenager need? How many cigarettes do I have to smoke to let you know that there is something very f****** wrong here? How many earaches do I need? How many headaches, how many colds, how many times do I have to get the flu? How many backaches? How many times to I have to damage my knee? How many unneeded trips to the doctor to I have to make pretending that I’m sick just so I can have some peace and quiet from you? Because if I actually expressed clearly and cleanly what my f****** problem is, which is that I live in a f****** crazy house, where everyone is pretending that reality doesn’t exist! F***!!!!!! If I actually expressed that, I would be killed by you! You would have... at least my perception when I was a child... maybe you both would have just dropped dead of shock that I actually was honest about something... but the truth is ... I felt... the message you gave me... my reality was that if I dared express any of that, that I would be kicked out of the house, that I would be chopped up into little pieces, that I would be thoroughly rejected by my mum and my dad, that I would be all alone, that I would f****** die. That was my reality! That is the risk that I would have to take to express how f******* pissed I am, and how confused and how betrayed, and how f******* terrified I am every f****** day! And I wasn’t willing to take that risk so instead, I charm him(father), I save your life(mother) ... you tell me everyday that I’m the only reason you don’t commit suicide because I listen, because I’m there for you. Well f*** YOU!!!! I’m 4! I’m not a therapist!! So I do that and then I get sick. I betray myself. My body tells me “there is something wrong here”. Every f****** cell.. and I mean that f****** literally... every cell in my body there is something wrong! And it’s screaming, “THERE’S SOMETHING WRONG!!! THERE’S SOMETHING SOOOO WRONG!!! HELP!!!! HELP!!!!! “ So whereas you f****** betrayed me, my body never let me down. Even if you lived in a fantasy world, my body kept telling me the truth. It kept telling me the truth that SOMETHING IS SO WRONG HERE AND I NEEDED HELP!!!!! So don’t give me this f****** crap about positive crap, about rising above it, about leaving the past behind and moving on in a positive direction. I am f******* moving forward in a positive direction but it’s not by ignoring reality like you want! I have a home of my own that I pay for with my own money. I go to university, I get A’s, I have a four year long term, healthy, loving, accepting relationship with someone who knows that sometimes I’m pissed off about my past and it’s ok because there’s a lot to be pissed off about. And I have people in my life who f******* value the truth. I have an awesome therapist, Joaquin, who fights with his life every day for the truth! And his partner who fights for the truth and all of my group members who are here all the time fighting for the truth! And none of it is thanks to you. So you can take your f****** fantasy and you can take your f****** criticism and you can take your f****** whatever it is you want to take, your scientific reasoning of why people are so screwed up and how you’ve got the master key to fix it, the quick fix that everyone is willing to throw money at because everyone wants a quick fix. No one wants to actually do the work and I can’t f****** blame them because it sucks! But the reality is I get the chance to live in reality and you never will!!! T: glad you came. Connection CONNECTION: C: (in self chair)connection is that it is easy to get dragged into the illusion stuff, the fantasy, the disconnected messages that come out of trauma. And I was fighting with that about whether or not to come today and I win.

T: big time

COMMITMENT:

C: and my commitment is to keep working and keep being connected to reality and get nurturing. Get some support.  

 

 

 

 

Restoration of The Lovability Principle Through "Nurturing" 

Nurturing/Restitution Sessions
(transfer of love from the self of the therapist to the self of the patient)

Monica is a 32-year-old separated woman referred because she is going through a divorce and other transitions. She feels "exhausted and depressed." Her report of her fifth nurturing session with me (medicated with 0.4 cc ketamine IM) highlights the relevance of enhancing the emotional contact and quieting the mind to be nurtured (15th month of therapy).

At first I was apprehensive about losing my head again [the observing ego losing "control"] but as the medication kicked in I was already feeling safe in the cuddling position. I felt semiconscious, my feelings were more activated than my head and yet my head still knew what was going on, it was a very comfortable place to be. I felt like a child being held by daddy. I was safe and very relaxed. I felt like a solid person because I was loved and protected, the hugging made me feel warm, loved and contained in a very safe and peaceful manner. I don't think I ever felt that way before with a man. Interesting, at this point I became very aware of the male energy, it was strong and grounded, peaceful and protective. I felt I needed that kind of energy in my life to feel complete. I thought, how nice to be able to be myself and feel relaxed while being held by a man who is giving me love, peace, and making me feel entirely safe and protected, without asking anything of me. What a wonderful experience, I can be myself and be loved by a man. Unconditional love. I never experienced that before. I felt like a child and yet I know that I never felt like that with my real father. I was always uncomfortable in his presence because I felt that I couldn't be myself and please him at the same time. He was so critical and demanding. There was always this tension and I couldn't relax and be spontaneous, his needs definitely came before mine. Today, for the first time I felt this idea! father-like love, someone who doesn't expect anything in return and just gives love, protection, safety, and security. 


Nurturing report I

November 8 2008

Pre session
I had been working towards filing tax returns. I had not filed taxes since I left my ex-spouse 7 years ago. The pressure was always in the background yet I was stuck and immobilized. Luckily, I guess, Revenue Canada started to garnish 30% of my gross wages in addition to the usual 20%. It still was difficult to move forward to do this but I finally went to an accountant approximately 2 ½ weeks ago.

Then, just a few nights before the nurturing session, I had a very profound dream that involved me acting in a uncharacteristic and new way. In the dream I was standing in the side yard of a house. I was talking to my “ex” (who still had the same “ex” status). We were talking about what we were going to do about a politically repressive government’s regime who was sending out police agents to round people up and send them away. The atmosphere felt like what I had seen in films about the Nazi occupation in Europe. Both C. and I separately deciding what to do as the police agents were going to be in our area within minutes. C. tried to argue for acquiescing and going along with the roundup of political prisoners and fatalistically hoping for the best. I knew in an instant that this was not going to be my choice. As the agents approached I ran before they saw me. C. turned himself in. I ran into the back yard of the house and I burrowed under fallen leaves and vegetative undergrowth. I planned on staying in hiding until the agents left the area.

After a period of time, I could hear footsteps approaching, so I held my breath. An agent came into the back yard to do a search. He didn’t see me, yet he seemed to hesitate as though he could sense my presence without seeing me. As he looked away, I burrowed deeper and hoped to hide even better and
held my breath again. A minute later he was almost standing over me. I knew it would be only a matter of minutes or less before he discovered me. I had to decide quickly what I was going to do… I was going to be seen by the agent. Suddenly, as the agent looked away briefly, I turned over from my stomach to my back so I could stand up and fight! No more hiding so I couldn’t be seen: I was willing and committed fighting for my freedom and my life. I woke up feeling liberated.


The session was with Joaquin and it was medicated. I always anticipate Joaquin’s nurturance, embrace and happy regard. As I nestled into his arms I felt particularly bonded to his body. As the
medication took effect I fell deeper into a place of emotional comfort. It felt like I suddenly landed in my childhood family living room while still being in Joaquin’s embrace.

I could really recall all the details of my family home- the living room in particular as it existed when I was five years old. I could see my dad sitting on the couch reading hi newspaper- unaware of my presence. I could smell his man ??? presence. It was familiar and emotionally neutral for me.
I remember wondering if really belonged there (emotionally speaking). It was like the house/home did not belong to me. I was like an intruder or at best a guest. Then it was as though, by virtue of Joaquin’s presence and emotional strength, it occurred to me that I had a right to feel as though I belonged, as though I could put “down roots” here. It was my home in spite of how not present my dad (reading his newspaper) and my mom (who was not even in the room) were for me. I felt a little-kid determination to have a place for myself, my body (which was safely embraced by Joaquin) in the world. My body. My house. My life. The words that came out of my mind were “safe” and “house”- as in my body, Joaquin’s body and even more generally, my body as in having a life itself. In my living room, I knew that my parents weren’t available, that they were broken sad people. But I felt so safe so grounded by Joaquin’s presence, (his body or his “house” that he shared with me) that my parents’ problem no longer made me want to abandon my life or hide. I felt complete.


Post session
Within an hour post session, it felt like I had gone on a very long journey, far, far away from home and my present life. The feeling of really being away was experienced first in my body and then in my mind. It felt like it was the best vacation I could ever imagine. I felt satisfied and strengthened.


 

 


Nurturing report II

November 20 2008

This was a magnificent session in so many ways. I felt the connection to Joaquin almost immediately, like all the tension and neuroses fell away in an instant and I was transported into a realm which I can only describe as “spiritual”. I try so hard sometimes to feel a connection to God and the chatter in my head, the obsessive need to do things over rides this simple thing. But when I am in male nurturing it is possible to let go of all outside pressure and be in a receptive state to receive love and be the loving child/adult I was meant to be. I felt a strong, strong sense that I was “good”, a “good girl”. I told Joaquin about this. Almost immediately I started to feel hungry. I haven’t felt hungry in a long time, I am having to be very vigilant to make sure I consume a reasonable amount of calories every day- sometimes a tall order. But I felt natural hunger as soon as I was with him (and after the session I took myself to my favorite restaurant and ate a meal).

The effects of the Ketamine were not overwhelming but quite strong and the positive effect on my well being has lasted for a long time. I felt so loved so much like a good person, not bad, not ashamed. During the session I felt the need to work and it was very strange. I think I was half-singing half-talking an aria from Handel’s Messiah: “How beautiful are the feet of them that preach the gospel of peace and bring glad tidings of good things”. And this was my answer to all the evil that I see in the world- particularly in my world- both past and present. My answer. My feet bother me constantly in a phantom kind of a way whenever I am in the therapeutic setting and at home whenever I am stressed. This week my feet actually hurt from being rubbed together constantly.

It seems like in this nurturing session I was so close to knowing why it is my feet that bother me so much. This much was clear: they hurt my feet and they hurt me because I was a beautiful child of God and though my arrival into their world was “Glad Tidings” they ignored that and used me like garbage.

I am working very hard to get to the bottom of the historical reason on why I am so hooked into helping B. one last time before I can let go and feel that I have done everything I can… there is something there; something deep historically- I got close to it in my work yesterday at group but I think I have not quite grasped it. I know it’s there the answer to this question and possibly the one about my feet too. I asked Joaquin why would the “introjects” have so much power right now just as I am moving into the final stages of my work and he answered “Ask your feet”. And its true- they seem to answer “they hurt you because you were good and pure and they couldn’t bear looking at you. They hurt you to make you like them but it didn’t work.”

The strangest thing about that session was though I was aware of a world of Love and Good, I was very much aware of the Evil that also exists.


 

 

 

Nurturing report III

June 16th, 2009

Dear Mom and Dad:

I cannot begin to explain to the both of you the transformation I have undergone this past year. The changes that have occurred within me are incredible. Here I will attempt to describe to you what I feel I have uncovered about my upbringing, and about which I am still uncertain or concerned.

When I began therapy last summer, I felt tired and hopeless. Actually, I had never felt like I had felt any hope in my life, but I had always been a fighter and had pushed through. Last summer, after A. was hospitalized for the third time, I didn’t want to fight anymore. I felt like there was no point, like the struggle would be lost and that I would never be free of my responsibility to him and this family. That made me feel depressed and like there was no point in trying to accomplish anything for myself anymore. I also was just ending a relationship with the worst choice of man I had made yet. He was the epitome of all the bad choices I had made in boyfriends: he was verbally abusive, controlling, threatened, and stupid.

About one month into therapy, or perhaps when I began nurturing with L., I began to notice changes in myself. These changes have been cumulative up until now and will hopefully continue with more work. I have noticed, in general, that my sense of self-worth has skyrocketed compared to what it used to be. This has affected all areas of my life. In terms of men, I still made some mistakes this past year, but since February, I have not dated or slept with any man (unusual for me), and have raised my standards much higher than they have ever been before. I no longer feel the desperation I once felt to have a boyfriend.

Also, I feel as though I can finally see you both and A. on my own terms. This has been extremely difficult for me, as I fight a lot of feelings of guilt, fear, and sadness from day-to-day about not being a good daughter or sister (especially sister). I also feel sometimes that my ambition to travel or move elsewhere for work will be abandoning my responsibilities to my family. This feeling I hope can change with more work.

Overall, by not having the distraction of bad men or a needy family on my back, I have been able to focus more on my career and furthering my education and the possibilities I am able to ponder. Working and nurturing with __ has given my a feeling of freedom I never thought could exist for me. It has opened doors in my mind and my heart that I never fathomed could be opened. I have become more independent, proud, and stronger than I ever thought possible.

Though I have made a lot of progress, I know I have much more to work on. First, I want to continue working on the feelings of guilt and abandonment I feel towards myself so far as my family is concerned. Once I eliminate these feelings, then I have confidence that I will be able to love my brother more truly for who he is rather than loving him because I fell obligated to do so.

Also, I still feel unconfident in my abilities and who I am in some situations. A week ago in therapy, I worked feelings of worthlessness and ineptness when I met a man who was an accountant at a large firm in Vancouver. Clearly, I have more work to do in this area and in general. I feel strong but my strength and confidence is often unexpectedly shattered in certain situations which I cannot seem to predict. I know that I need to work more with Dr Sousa-Poza. In particular, I feel I should begin to nurture with him…although I do not know what I will feel when this happens. I have never had a father figure in my life that I trust. To me Dr Sousa-Poza is an unknown, which is probably why he intimidates me. As well, L. mentioned I should try some sessions with ketamine; I agree with her.

In summation:
Mom: I know now that you were controlling, guilt inducing, and competitive with me. You pushed me to succeed, yet you often put me down. You awarded me more responsibility than any child could withstand. As such, I have lived with anxiety and small bouts of depression my entire life.

Dad: I have learned that you made me chase you and no matter what I tried, I could not hold your attention or your love. Beyond this, you were silent, and I know I have not begun to comprehend the damage you have caused me.

Yours truly,

O.


 

 

 

Nurturing report IV

The enthusiasm and confidence I now have with regard to the rest of my life is as it should be.

A brief story of Phoenix rising.

In 2002, I returned to Victoria from a 10-month placement from an island in the South Pacific. This had also been a “therapeutic holiday”. The botched volunteer placement and lack of support from Cuso (a Canadian NGO) had left me in a very bad state. Recently, I had a telephone interview with Cuso during which I became so distraught and angry that I cut the conversation short. I was surprised by the depth of my reaction. I recognized that the emotion I felt (both in the present and during the overseas experience) also contained the pain and terror of the abandoned child set loose in a world she did not understand, and where no one was in her corner. This primal reaction has led me to believe that on my return from overseas, I was probably suffering from Post Traumatic Stress Syndrome.

From that time until 2004, I struggled to find and to keep employment – unsuccessfully. This resulted in the loss of my apartment, poverty, use of local food banks, and finding myself in serious crisis. Fortunately, I was approved to receive CPP Disability, and I qualified for a 20’ x 20’ apartment in a building restricted to people aged 55 and over
( a downtown neighbourhood of the city with a high population of drug abusers). At the time, I felt a miracle had taken place and I had been rescued from becoming a homeless person. That was true, but I also believed myself to be disabled and old and thought perhaps I would be lucky enough to live in this concrete box until the end of my life. (That could be 30 years or more!!) What an outlook.

With food and shelter stability, and with continued therapy, I began my recovery from several years of extreme emotional stress. I gradually became more involved with life. For a period of over 2 years, I worked part time as one-to-one caregiver for young children. For three years I have volunteered with a non-profit society supporting women living in poverty by providing them with clothing for job interviews. I also found part-time work in an office. Now, I am on the Board of Directors for that non-profit society, and continue to perform my office job with efficiency and competence.

Victoria is not where I want to see myself in five year’s time, not even in one year’s time. I have stayed in this living situation to have access to therapy, to be near my daughter, and because I believed I had no options. It is time for me to create the life I want.

Primarily, I will be leaving Victoria. For several months, I have been planning to move to the Comox Valley. I have now established a place to live for the short term, and will be moving at the end of August. My plan is that once I am living in Comox, I will find a job. Next, I will find an apartment that is walking distance to the sea and where I can have a cat.
My longer-term plan is to start a business in that area. I will sell high-end items for the home on a consignment basis. I have always been an entrepreneur. This will be my fifth time creating livelihood for myself. I know I can succeed. In Comox, I will have more nature around me and I will be within 30 minutes of my younger sister who I love very much and with whom I want to spend more time. I have some long-time friends who live in the area and I look forward to being around people with similar backgrounds to my own.

On a daily basis, I am aware of God within and around myself and others.

There is still an observing voice in my head but it has become my cheerleader. This voice says things like – “Wow P. You really did that well, good for you”.

I am creating the life I want and it is not restricted by a need to be in my daughter’s pocket. It is also not restricted by thinking of myself as “disabled” or “old”.

This is the beginning of yet another phase of my life. I know it will be the best phase of my life. I am equipped with love and respect for myself plus admiration of my best qualities, one of which is resourcefulness. My happiness does not depend on anything that is outside of me. Maybe my physical comfort does, but not my happiness.


The long version: MAJOR LESSONS IN THIS LAP OF THERAPY

One night I watched a movie. A man was visiting his girlfriend at her apartment. The woman left the room and the man saw her open diary on the table. He began to read it, and continued to read it. My reaction to seeing that was anger and shock. How could someone so violate the privacy of someone he cared for?

How does that reaction display a change in me?

Throughout my past, I had no qualms about snooping or spying on people who allegedly loved me. I was always fearing and expecting rejection, always looking for proof that they did not really love me, or that they were not who they seemed to be. I sensed that my reality was not accurate; I needed to constantly check and test. This was the atmosphere of my childhood. I was so confused, and anxious, desperate to understand the people around me; my older sister, my father, my mother, all of whom were supposed to love me. Who were these people? What do they care about? What does love look like? How would I recognize it? Could I even believe in it? No.
As an adult, this played out in all of my relationships; especially with my daughter and with my lovers. I searched for clues of how they wanted me to be and became that. I searched for evidence that they did not love me. I was sneaky, disrespectful, pathetically anxious, believing that no one could actually love me. Nothing was sacred. I considered my daughter’s life, to be my life. She was in fact my one true thing and yet I was obsessed with finding evidence that she was not honest with me. After all, how could she be? I was so unlovable.

THEN:
A couple of years ago, I was given the privilege of taking notes during therapy sessions. One day, while looking for the report of a particular patient, I saw the report of my daughter (who was in therapy at the time). I started to read it. I had to force myself to stop it. I confessed and stayed after that group to work this transgression. I remember defending myself and screaming, “What mother could possibly see the chart of her daughter (with whom she is out of communication) and not be compelled to read it? I knew I had done something wrong, but I believed it was justified, excusable, and even natural to do such a thing. That event was of course the end of my note taking. I had broken the trust Dr. Sousa-Poza had had in me, and I had betrayed my daughter.

NOW:
What kind of a mother could resist that temptation? A healthy one.
Recently, my daughter asked me to cat-sit while she went to Regina to visit her boyfriend. I spent many hours in her apartment while she was away. I had absolutely no urge or temptation to look at her diaries or her letters; to look in her drawers for private things. I also had no temptation to clean up her place or to rearrange anything (as I would have done in the past, rationalizing that I was doing something loving for her). The very idea was alien to me. I was in the apartment of J., her things, her style, her comfort zone. I did not touch anything, or want to. I fed and played with the cats.

INSIGHT:
I recognize that my daughter searched for clues of how I NEEDED her to be and became that. I recognize that my emotional wounds crippled both my daughter and myself. This is not about love.
I now respect my daughter and in so doing, I respect myself. This is about love.


My commitment had been for years that I would not contact J.( my adult daughter, also in therapy)- it was up to her to contact me when she wanted to see me. (We were out of contact for 6 years with few and minor exceptions). My daughter contacted me when she was ready to begin seeing me again – I told her she would need to check that out with L.! Of course, she did. And then, I checked it out too which led to two or three very intense (very angry) working sessions that dispelled my myth that it was because of L. and J., I was not allowed to see my daughter. Wrong thinking. Funny, bullshit usually has a stronger smell!

I did finally recognize that I had not been in contact with J. for all this time because that was J.’s choice! POW – right in the kisser! Through a couple of very difficult sessions (for myself as well as for L.), I got it. I experienced intense pain and grief and over a couple of months, came to terms with reality. Intellectually, I had understood that J. could not express her full anger at the mother I was if she was attached to me in the present. I had prided myself on what a good mother I was being to stay away from J. so that she could do her therapy; that this was my act of love. I believed that if I gave J. the smallest opening she would run to me and I could nurture her and blah blah blah – happy ending. la la la
In fact, it was an act of love, but not a measure of a martyred mother’s endurance. What I had failed to recognize was that J. needed to become stronger in herself before she would be able to be herself around me – she had been so well trained to be who I needed, I had crippled her from being herself. This new understanding really made me grow up>

What a gift was given to me – the opportunity to begin a new, loving and true, healthy relationship with my daughter. And what a gift to observe myself giving to my daughter from my true heart. I have a few tears of happiness as I write this.

I am still taking Ritalin SR 20mg each morning. The Ritalin definitely helps me - I am more aware of what it does for me if I forget to take it or decide not to take it for a day or two. Without Ritalin, I really struggled to concentrate and stay with tasks until they are done. For now, I want to continue taking this medication.

I have learned how to make the most of the times that my attention is sharp. I have also learned to recognize when it is not. I have attention problems when something is not either of interest for me, or challenging me. I also have poor retention of numerical facts (for instance, when repeating information heard on the radio news) and, unlike L., I do always have to look up the phone numbers of my friends - even J.'s. I do not retain numbers well. I work with numbers very accurately in fact, but do not retain them.

I now know that I work best for 45 minutes to 1 hour, then I need a change of activity for maybe 30 minutes, and I can work very well again. Learning this about myself has been beneficial and will help me with future employment. It will facilitate my ability to make the best use of my attention and still dance to my own drum while respecting time frames set by others for completion of tasks.

God Bless You Dr. Sousa-Poza. Your therapy is brilliant. It has been an honour to watch how you work with such total integrity, love, patience, knowledge, and compassion. In addition, it has truly been the blessing of my life to have arrived in the same corner of the planet as you did.

P. (2009)


 

 

Click here for references

Reprints of the original background paper " Anaclitic Etiology and Treatment of Neurosis: An Information-Attachment Model" (Sousa-Poza, Eagle, Rohrberg & Steinberg, 1986) are available directly from me at the email address listed at the bottom of the page. The early groundwork for this research was supported by Grant MA-5661 from the Medical Research Council of Canada (currently the Canadian Institutes of Health Research).

 

 

 

Amongst the feedback to this page, some was good, some was non printable;
I simply have chosen that of highest ranking professionals


"Excellent page Joaquin!
If we both follow the same track it may mean we are on the right track."

Professor José Luis Gonzalez de Rivera y Revuelta .
http://www.thesauro.com/jlgderivera/



 

 



"Dear Joaquin

I have just finished the articles and I was overwhelmed . I think it is a tour de force - integrating many bodies of knowledege. Of course I will have to reread it many many times to digest its full value.

I think it will make a considerable contribution to our knowledge base.

Congratulations my friend. May you be GRATIFIED".

The late Dr Fern Cramer Azima, Ph.D.
World renown psychotherapist
McGill University, Montreal


 

 

 

(Edited for brevity)

Dear Joaquin,

I was fascinated by both of your articles and the presentation you made to the Third World Congress of Psychotherapy.

I have experienced most of what you write about, with the exception of the medications. What I found most fascinating about what you wrote is the concept in your theory paper about:

(The) value of a message. They discern two parts to a message; the content and the command. At the command (self-data) level, the message is always personal and never neutral. It carries an emotional, usually nonverbal (tone of voice, setting, gesture, etc.) valence that, I propose, confirms or disconfirms the lovability principle. The fact that a message is communicated mostly nonverbally accounts for the surreptitious psychopathology of disconfirmation.

I have looked for ways to express this understanding, and you have given me the words. I grew up in a family of competition at all levels and this explains what was going on and continues in my life. (By the way, I won the competition. My father slept with me. My mother slept alone. Of course, this was rather inappropriate and not very good for my development.)

When this "content/command" event happens in my life, I realize what is going on these days and can identify the triggers but now I have a way of expressing what is going on in my awareness. I will be able to explain to those around me what is going on inside me when I need to.

As for your presentation at the Congress on Psychotherapy. Fantastic. I understand when you talk about:

"There is no greater impediment to overcome the transcendental error than to live under the yoke of a neurosis (biographical error) in an emotionally dysfunctional culture". Psychotherapy, if properly understood, could play a much needed role in helping us to recover part of our long lost sanity.

Do you have clients who see this insanity? I have seen it most of my life. The disconnect in my childhood from the culture around me erupted from what I saw around me (and probably the neurosis from my experiences of "unlovability".) That is why I have never married or really bought into the American culture. It's all insane. I've always enjoyed the role of "outsider". I've played that role with the monks.

I do like your definition of "neurosis"....biographical error. This makes sense to me.

I was very lucky to find a therapist who followed a lot of your modalities. And his belief that therapy must include the spiritual component, is what attracted me to his method of unraveling the trauma. I have always felt so blessed that this wonderful man "reparented me" and did a good job! The four years of intense therapy is quite a story that I hope to write about in the future. (I am Chapter Two in Alice Miller's book, The Drama of the Gifted Child. I found that book so comforting.)

Stay in touch,
FS  (An Artist)

 

 

 

 

Dear Joaquin,

I am getting more substance about who I am without really searching for it but by observing myself in situations or in decision making. I think this time without therapy is good for me to integrate all what you have given me and all the work I did all those years. It is nice to feel solid and confident without being "somebody.''

I owe a lot to you, it is true you saved my life and for this I will ever be thankful, grateful and words are really limited here because when I see all those people, women for the most part in my group, I am amazed at the quality of human beings that have come out of one single human being non accepting the status quo and trusting himself through hell to heal himself and his fellow "patients". That is called courage; that is called integrity. You are our Nobel Prize. WHAT A BEAUTIFUL MIND!

SX


 

 

 

Hi Joaquin,
Powerful stuff/overwhelming -the long train-wreck of the human experience. ...maybe too much to process....the beheadings are brutal but are, at least, done tastefully (that's tongue in cheek)...

Bob Eagle
Teacher and humanist


 

 


Hello Joaquin
Dedicating your lifetime work to Alice Miller could not be more honorable and appropriate.
I truly salute you for it.
Be well.

E.

 

 


"A special man you do so much that you heal the wounded with your touch and words, the very ill you truly care, you always make sure they have their air. You do much more than simply tend talk to patients, time you spend when you smile and reassure that becomes half the cure even the most fragile and weak, your special care, they always seek. they know your heart is very warm, special care will defeat their storm."

Kate


 

 


Very graphic and emotional and above all PERSONAL. People these days tend to take that as being "complaining." One is supposed to "suck it up " and just "get on with life." I believe it is humanity's way of saying "we can't deal with that stuff." Somehow need to get across that "my story is your story is our story."

P.


 

 


Dear Dr. Sousa-Poza:

I just read your paper on the internet. I wanted to tell you that I thought it was brilliant. I am very interested in psychoanalytic thought and theory and do a lot of reading about it. Your paper explains so much of human pathology in such an understandable and fascinating way. I learned a great deal from reading it. Thank you so much for your work.

N. D.

 

 


From Mr. X, renowned editor and book reviewer

Dear Dr. Joaquin F. Sousa-Poza,

Last night when I found your proposal I thought it was just a regular book writing job you must be seeking a writer for it. Simple as arranging word making it meaningful. That’s all other book tasks are usually. Anybody who has writing experience can do that.

But then I went to your web page http://joaquinfsousapoza.com/index.html to check it as you gave a link on the job description. I read all the pages by title; Inner Holocaust, Outer Holocaust, Holocaust of Human Self, Repairing the Broken self, Psycho Spirituality. Genial piece of work on human psychology and spirituality and their relation with religious belief and human tendency just like a chest box full of things having history of a man a life-time in themselves.

But as you said you don’t need an expert in Psychology that true because what I read in your web site is clear - you are genius of your field. “Simply superb Doctor!”

But you need a writer who understands what you really want to project through your book and should make it a master piece for you because all your words are like puzzle pieces but need to be arrange in a proper manner to makes the jigsaw puzzle complete. I won’t discuss psychology with you because I am nil in front of you. But because I belong to a family with medical background I understand it quite well enough. And for Spirituality I live in a country that have population of 1.25 Billion people with dozens of religions and beliefs. Since childhood, I went through all kinds of knowing of all religions and their rituals right from Adam to Abraham to Moses, to Solomon to Jesus, to Mohammed to Indian -I won’t say completely -but partially to the extent I understand what you want to say in your book and believe me your project is a master piece in itself, and if you think I will be right person to work with it will be a great honour for me to be a part of your book writing team. I will deliver my best effort for completing and making a meaningful book. So that a great work can be arranged in proper sequence.

Regards, Mr. X

 

 

 


"Oh, I would have to say that the same thought crossed my mind! "He is a genius!" I even said that to my husband... "I think this doctor I have been talking with on Elance is a genius." That is nothing to be shy about!"

Mrs. S (editor and book reviewer)



Thank you to the following people for their contributions.

Joaquin F. Sousa-Poza, M.D., D.(M.)Sc, F.R.C.P.(C)

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