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.