Michael was apprehensive about starting the interpersonal work. In part
this was because he was concerned that the therapist would challenge his
relationship beliefs in an invalidating way. More importantly, Michael
felt vulnerable. He worried that his therapist would come to see the
true and vast extent of his social isolation and think less of him for
it. Instead, the therapist simply acknowledged his social isolation, and
referenced that they would find practical strategies for working on that
later. Most importantly, the therapist took steps to identify Michael’s
relationship models by exploring their own relationship.
T: So, Michael, today we are going to move into our interpersonal
relationship work, and I know that you have found the Feelings
Monitoring Forms to be really helpful. You mentioned that having things
written down gives you something to look back at, and it actually helps
to organize your experience.
M: Yeah, it didn’t seem like it would work. But having an experience
written down on a piece of paper, in black and white, is powerful. The
reality of the situation hits home. It motivates my desire for change
and helps identify how to begin that process.
T: You’ve done very well with the Feelings Monitoring Forms so far. We
are ready to move into a new worksheet today called the Relationship
Patterns Worksheet or the RPW which describes interpersonal situations
and problems. As we have discussed, trauma impacts our beliefs about
ourselves in the context of the relationships we share with others.
M: Well, I don’t know how effective this is going to be because I don’t
have that many people that I talk to.
T: Yeah, I know that that’s something that you’ve mentioned before. One
of our goals, if you agree, would be to increase the amount of social
connections that you have. But for now, I wanted to take a moment and
refer back to last week. I thought it was a really important session
because you were vulnerable with me and shared how much I might not be
able to help you deal with the consequences of the AIDS epidemic because
I did not experience it. It is understandable that you have some
concerns about that. This is something we could discuss. What do you
think?
M: Well, I think you’re the person I’ve interacted with most, and you
seem to be pretty honest with me. So, I think that might be a good step
to try.
T: Let’s do it then. What specific situation comes to mind?
M: You asked me about my thoughts on the interaction that happened at
the coffee shop, and I felt like you had an ulterior motive with you
wanting to know how I felt.
T: I see. Okay, so, the situation we have identified is “The therapist
asked me about the interaction at the coffee shop”, and the thoughts
you had about me were, “The therapist had ulterior motives toward me.”
I would like to know more about the ulterior motives. What kind of
ulterior motives did you think I had?
M: Well, in my history, it seems that people who show that they care
about you do it because they have a reason to. Since you’re a therapist,
I know you’re getting paid to help me out here, so I guess as long as I
continue seeing you and I continue to be happy and you’re asking me
about my life, I’m going to continue to talk. So, I’m going to keep
coming and you could keep making money.
T: Thank you for sharing that. And as you tell me that, what are you
feeling?
M: I’ve had doctors that I felt the same way about. Every time I go in
they push for me to do STD tests even after I tell them I am not
sexually active. They are just trying to squeeze that extra fifty bucks
out of me. I think my feelings start with anger, and maybe some
resentment.
T: Okay. And what do you think I was feeling toward you?
M: I think you were doing it because you had to do a job. You do seem to
care, but I don’t know if you care about me anymore than you’d care
about anybody else who comes in here. So I can’t understand why you’d
care about my problems.
T: So, did you think I was feeling indifferent?
M: Yeah, I do think indifference is something that I felt.
T: Alright. You’ve done a great job identifying what you think I was
feeling and thinking, and also what you were feeling. It sounds like
what you are thinking is there’s no way she actually cares about me,
Right?
M: Yeah.
T: Okay, and then what did you do in response to having those thoughts?
M: I realized I was closing up. I didn’t want to tell you more.
T: Good. Okay. Let’s see if we can distill this down to a relationship
model or pattern. We could try to take this example as illustrative of a
belief you have about other people. Let me help you get started. So
maybe something like, “If someone acts like they care about me, then”
what?
M: If someone acts like they care about me, then I close myself off.
T: Alright, Good. Then what do you do?
M: I feel my wall going up.
T: Yeah, and I felt that, too. I was so grateful that you allowed the
opportunity for me to keep talking, and for you to even be curious about
how it could potentially be different. Curiosity is really at the heart
of this: What could be different now in the present in my life? Because
you were curious, we were able to talk it through. I think another
trauma-based belief might be, “If I feel close to someone, then” what?
M: They are going to leave me.
T: Okay. That is what has happened to you in the past, so it makes sense
that you have that belief. The good news is that through time and work,
these beliefs can be changed as they might apply in the present. But,
for now, let’s stick with this. What other beliefs about relationships
emerge from this example?
M: I’ve got to look out for me. I’m the only person who’s gonna look out
for me and I’m the only person who ever has looked out for me. That’s
something that I really do believe is true.
T: Right. Part of your old belief is “She doesn’t really care about
me.” Sometimes it’s helpful to even just say to yourself, “Maybe she
does care, or at least has my best interests at heart.”
M: Yeah, I could do that. And I think there have been times when I’ve
noticed that people care, but it’s so hard to believe that I find that
sometimes I push people away, maybe a little too soon.
T: Yeah, and again, it makes sense that you would do that, given the
things that have happened in your life. It does take tolerating that
fear to try something different, even just not putting your walls up
automatically. I am wondering what you might feel instead if you
thought, “Maybe she does care about me.” What other emotions might you
feel instead of suspicious or angry?
M: Well, I think first I’d probably feel intrigued. I’d want to know why
you care. Even if I assume it’s for a positive reason, I’m still going
to be intrigued by why. Then I think I’d be thankful because whatever
issue you are showing care for, I wouldn’t have to go through it alone.
I am so used to being alone, and it’s so exhausting.
T: Yeah, it really comes at a price. What alternative thoughts could you
have about me? Towards the end of our session what did you think I was
thinking and feeling?
M: We got to talk through some of the problem, so at the end of our
session I thought I could have been wrong, and maybe you really did want
to know how that interaction went because maybe you thought you might be
able to help me.
T: Okay, good. So. an alternative thought could be, “She really does
want to know how the interaction went.” And the feeling I could be
having could be concern, maybe?
M: Yeah, that feels right. When we continued the conversation, I
realized that it was probably not as bad as I thought it was at the
moment.
T: That is incredible! Excellent! Finally, let’s get to the new
relationship model. So the old belief is “If I get close to someone,
then they will leave me.” What could it be instead?
M: If I get close to someone, then they might add something to my life
that I don’t already have.
T: Oh, wow, that’s great. The second old belief was, “If someone cares
about me, then they will leave me.” What could it be instead?
M: If someone cares about me, then it might not mean that I’m as bad as
I think I am.
The therapist anticipates that Michael’s relationship models relate to
his trauma history. This will be explored during the narrative work. The
relationship models certainly guide his current interactions. If the
beliefs are a consequence of his trauma history, the therapist and
client can begin the task of determining to what extent and under what
conditions the trauma-generated beliefs are still applicable versus when
he might feel the freedom to try on some of the alternative models that
have been generated in the session.
As the above dialogue indicates, the presence of strong and ongoing
relationships is not necessary to identify relationship models. In this
case, the therapist used an interaction between the therapist and client
to distill the beliefs. Relationship models tend to be stable and highly
generalized. The SNT protocol provides guidance about how to work
through relationship models related to themes of assertiveness,
flexibility/power and intimacy. In this case, the treatment remained
focused on themes of abandonment and rejection, because they were so
central to Michael’s anger and social isolation.