Tuesday, August 6, 2013

Clinical Techniques: the gaze of the object

There are two rules I follow for testing the efficacy of a specific intervention.
A. It leads to an emotional response.
B. It leads to progressive communication.

I shared the technique of 'I statements' in a previous post but lately I've stumbled upon a refinement of it.

It began when a patient was complaining about being low energy and being in a "haze". The word came up enough times that it caught my attention as significant and it's idiosyncratic in the patient's normally articulate speech. I asked for her association to "haze" and she said fog. I asked for her first association to fog and she said the mountains in X. She shared about driving through the mountains and how the fog reduced visibility to 0 at 15 feet or so. She went on to talk about the way the light couldn't pierce into the fog and it made me aware that inside of the fog was something significant. I asked her to imagine that she was inside of the fog and that she saw the light outside, unable to penetrate, and to describe what else was going on inside. She said that she felt cold, vulnerable, and in danger. I said 'danger?' and she said that something could come into the fog. I asked for the first dangerous thing that could come in and she winced with embarrassment and after some coaxing said a bear. I asked how she imagined the bear would attack or hurt and she said with its mouth...

Ultimately, 'being inside the fog and expecting an attack' led to the patient expressing how she sometimes would rush home to be alone. She said that she finds it very taxing to be around people and having to 'chit chat'. She is in danger around people.

The same patient a few sessions later casually referred to others at her work as mosquitos. She described mosquitos as annoying, insignificant, and blood-sucking. It didn't feel right to ask her to say these adjectives as I-statements and see how they feel nor did I feel like they referred to a particular person she had been talking about. So, I again asked her to reverse the point of perception from subject to object. I asked her how she would look to mosquitos and she, with surprise, and again required some coaxing, said 'giant' and then turned it to 'grand' and said 'moral'.

These little surprises are where the unconscious is for me.

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