Middle Phase of Therapy: Self-Soothing
John expressed anguish and emotional suffering when recalling memories of himself as a boy, feeling very unloved. The use of the intervention of self-soothing is indicated for feelings of anguish and emotional suffering in relation to past interpersonal needs that were never soothed by others. During this intervention, the therapist guides clients to provide compassion and soothing to the part of themselves that is in pain. The end goal is to promote automatic soothing, whereby clients instinctively soothe themselves and feel calm and secure. John’s therapist helps him soothe this painful feeling of anguish in relation to his childhood by using this two-chair self-soothing intervention to have his adult self, soothe and provide compassion to the wounded child. The first step was to ask John if he could imagine seeing the part of himself who is the vulnerable wounded boy from his childhood. Once John was able to picture that part of him in front of him, he is guided by the therapist to provide compassion for that part, “As the caring father you are now, what he would you want to say or do for that boy to soothe him when he feels so alone and wounded?” The therapist referenced John’s role as a father because he had previously expressed compassionate and loving feelings in relation to his son. Having a client access an existing feeling of compassion towards someone else is helpful for clients who have difficulty with compassion towards themselves, as once the feeling of compassion is activated it can be directed towards the self. John starts to cry, and says, “He feels so alone and unloved [silently crying]. I just want to be with him and hold his hand so he’s not alone.” The therapist then guides John to imagine taking his younger wounded self to his own safe place, “Can you reach your hand out to him and imagine taking him to your safe place where you can hold his hand and be with him, so he is not so alone?”. John nods and is engaged in the task. To deepen this experience, the therapist asks, “What does the boy need from the adult part of you now to help him feel loved and not alone?” John is tearful and then eventually responds, “The boy just needs me to be there with him and love him, no words are needed.” The therapist assesses John’s tears as being healthy compassion and sadness for the boy’s suffering and conjectures, “It must mean a lot to him for you to be there because he has not felt loved or cared for before?” John nods through the tears. The therapist asks John, “Where exactly is the boy right now? Can he take in your love and presence? To this John points, “He was there across the room, but now he is here right here on my lap. … He feels happy that I am with him.” This intervention facilitated new healthy feelings of compassion towards a vulnerable part of himself in anguish, and John reported a feeling of resilience as he was able to successfully soothe this state of anguish. In addition, the healthy feeling of the sadness of grief was expressed in relation to the childhood unmet needs for love. In terms of good emotional process, the intervention of self-soothing requires the client expressing compassion towards the part of self in anguish and acknowledging the pain and suffering of that part, in addition to grieving the unmet personal needs. A resolution of this task leads to feeling of resilience, comforted and secure.
Homework in relation to this self-soothing task was collaboratively identified to help John strengthen and carry forward this newly emerging feeling of self-compassion: Collaborating with John in assessing what he needs to support this new change and carry it forward between sessions was important:
Therapist: What does that vulnerable little boy need from the adult part of you over the course of the week to remind him that he is okay? What could you do to show him this?
John: He needs me to accept him unconditionally.
Therapist: How would you do that?
John: I could tell him he is okay.
Therapist: In what situations?
John: No matter what he does.
Therapist: Can you see him there and try that now?
John: [says to boy tearfully] You are okay no matter what you do. I am here for you. I love you. [To therapist] I just want to give him a hug.
Therapist: Can you imagine doing that so he can really feel it in his heart?
John: nods tearfully
Therapist: I can see that it means so much to him when you do that. This is an important need that the little boy didn’t get, that you didn’t get. All kids need to feel loved and accepted unconditionally, and you just did that for him! You can also continue to do that for him outside of our sessions.
John: [tearfully] yes, I want to do that.
Therapist: You have said before that it is so easy to get caught up in the busyness of your everyday life. It would seem important to be able to protect some time to do that for him?
John: Yes, I think so. [20 second pause] maybe a few minutes every day when I get up early, there is no one around and we can take the dog out together.
The between-session proposed exercise highlights a few important points in relation to creating effective homework. It transpires from the current in-session experiential change. It is co-constructed as John is not instructed what to do but is asked how he can best practice and carry forward the work he just experienced in-session. In addition, the therapist provides experiential teaching regarding the relevance of the current in-session work to John’s core pain, and a clear rationale about why the between-session exercise would be helpful. The therapist also guides John to do the co-constructed homework in the session so he would have an experience of doing it successfully. Consequently, the task becomes about deepening and carrying forward a change that John experienced in-session. The therapist is encouraging and positive by highlighting that John just successfully did the task in-session. Finally, the therapist asks John to reflect on specific details of what the ideal situation would be for him to be able to do the task successfully in order to help tailor it to John’s unique daily life which promotes a positive experience of the tasks. This example demonstrates the importance of being attuned to the client’s current moment-by-moment processing and co-constructing the homework so it’s realistic and personalized to the client’s daily life details.
Self-Soothing is an example of the principle of automatic regulation and it leads to clients being able to instinctively engage in self-empathy, self-compassion, and self-soothing, and following this intervention. In John’s case, self-soothing dialogues were engaged in and deepened throughout the therapy, and between-sessions John was able to develop the ability to automatically soothe the part of him that feels pain and anguish for not having his childhood needs met. In addition, self-soothing is also an example of the transformation principle of changing emotion with emotion. The primary pain of feeling unloved is transformed by: the healthy need to feel loved, emerging feelings of compassion towards the vulnerable wounded part, and the sadness of grief for the suffering endured.