101 stories from the therapy room

(A non-clinical approach to psychotherapy and counselling)

This anecdote is about a 20-year-old client of mine – a tall, physically well-built man who takes the extra effort to keep his muscles toned by working out consistently. He looks very intimidating, and nobody would dare challenge him and he plays the fitting role of a bouncer at a pub. However, he always imagines himself being beaten up. He described this scenario in detail to me.

He fantasizes about being with an imaginary girlfriend and they get stuck in an isolated place where they are confronted by some people who intend to cause them harm. He struggles to protect himself and his girlfriend and even if he does manage to physically fight and defend himself, he worries about more people joining in to cause harm..

Just imagining these scenarios made him exhausted and filled him with self-doubt – “Am I really strong?”; “Am I worthy?” He said he was planning to carry some weapons to protect himself – but the thought of arming himself caused reactions in his body that he was not able to understand. Then, the cycle of imagining himself being attacked when he is unarmed begins again. This cycle was reinforcing his belief “I am not good enough”, fueling his shame of being perceived as powerless.

These imaginary scenarios in his mind had given rise to anxiety, which made his nervous system hypervigilant and the hyper-arousal situation was further leading him to shut down, making it difficult for him to have a social life and enjoy time with his friends. The only thing that made him feel better during such a depressive state was going to the gym and working out.

In the first few sessions I found it hard to understand why the client was having these fearful thoughts of being beaten up. He then shared a memory from when he was 11 years old, of playing tennis with an older boy from his neighborhood. Two bullies had come to beat up the older boy and my client went into shock and was unable to understand what was going on. The older boy’s voice cut through his shock, as he heard his friend’s voice asking him to run from there and inform his family, which is what he did. The next day at the tennis court, another boy teased and laughed at my client saying he ran like a coward. This memory was the cause of the client’s stressful experiences imagining himself in a potentially harmful situation.

These reactions were part of PTSD (post-traumatic stress disorder) and I gave the client some information on this topic and also suggested some grounding techniques so that he can stay rooted in the present and not regress to the past. This knowledge of PTSD and how to help himself during such situations was a great solace for the client.

Our next step was to figure out how the client was going to manage his constant fear of being attacked and beaten up. How was the client going to stop the flood of fantasies that haunted him?

What happened when he was 11 years old was still troubling him 9 years later. As a therapist, some of the options to continue was to work with the client on the cognitive level, or use the two chair technique in Gestalt or a NLP process. However, instead, I invited my client to be curious and think about how this event influences his current situation.

After a few sessions, we had a breakthrough.

The traumatic experience of having witnessed violence as a young boy had led to dissociation. The traumatic experience got split into 3 dissociated parts and each part was coping in a unique way:

1. Witnessing a friend being beaten – coping   “I should not get beaten up”
2. The bully who was oppressive and aggressive – coping “I need to be strong (like the bully)”.
3. Being laughed at and called a coward – coping “Anyway you will get beaten up” 

His brain had stored the memory as three dissociated parts representing the trauma and these three parts were interacting to relive the trauma as the brain’s way of protecting him from further facing any such situations.

The interaction of these parts played out in a sequence in his imagined scenarios – he is worried about being attacked, so he gathers his energy to get ready to attack and there is a sudden drop in energy associated with the feeling of being a coward and not good enough to protect himself and others.

When I explained my understanding to my client, he felt seen and for the first time he had a language and words that described what was happening inside his brain for years. We decided to explore possibilities to integrate these three dissociated parts and build a coherent experience, because incoherent experiences lead to repetitive compulsions.

I asked the client to give names to these three parts. He named the part which was getting beaten as Niranjan, the bully is Vimal and the teasing part is Harsha. Metaphorically, it was like three different people were living in his head.

We decided to do a process. The client and I stood up and we located three different places on the floor to represent the three parts of his memory. I asked the client to move around these parts and say what those parts represented, and I told him that I would stay with him through the experience.

The client stepped into Niranjan’s position and said, “I want to be strong and don’t want to get beaten.” Then he stood at Vimal’s position and said, “I am strong and I need to be the one who beats up others” and then he moved to Harsha’s position and said, “I am incapable and I am going to be beaten anyway.”

Once the dissociated parts were anchored to the positions on the floor, I asked my client to repeat the same thing, but this time I asked him to also say “I accept you as you are” as the adult, grown up version of himself to each of the three parts. So, the client went to Niranjan’s position and he said, “I want to be strong and don’t want to get beaten.” Then he stepped out of the position and his current, grown-up version stepped back in and said, “Niranjan, I accept you as you are.” The client did the same thing in the other two positions as well. After doing this a few times, the client’s body relaxed a little and became less tense.

We closed this session and in the follow-up session the client mentioned that the number of times he has imaginary scenarios of violent attacks have reduced. Even when these fantasies began playing out in his mind, he was able to step in to negotiate with the three parts together, thereby interrupting the fantasy.

In these sessions with this client, the key was identifying and working with the dissociation which was leading to regression. Any other method that did not address dissociation and regression would have not helped us address the distorted relative states that the brain had constructed to cope with the trauma.