For these clients, feelings often have a physical instead of an emotional presence. Because they seem to reside in the body, it is the body that has to be soothed. Physical actions like use of drugs, alcohol, sex, binging, purging, over-exercise and starvation can be attempts to not only maintain self-cohesion but also soothe the body self where the feelings are. Yet while these activities may provide momentary solace, they often increase feelings of shame, discomfort, and low self-esteem, thus undoing the positive effects and requiring further and often greater solace-seeking behaviors. Negative body image both represents these intolerable emotions and also leads to further attempts to manage them physically. With clients who are verbal and appear to be insightful, it would seem that understanding the meanings of the behaviors would help them make the changes necessary. Further, it often seems to clinicians that these clients should be able to understand the harmful consequences of their bodies, and should be able to change as a result of education about the dangers of the behaviors. Over the years as I have listened to my own clients, as well as to colleagues and supervisees describe their frustration and confusion when their clients continue to engage in these behaviors even after seeming to understand these dangers, I have found that alexithymia helps to explain what is happening when these interventions do not lead to change. What may appear to be intentional resistance can be understood through the lens of alexithymia as an inability to use language to manage both the of dynamic “as-if” frame exploration and also the feelings that are stirred up by these explorations. Literal thinking can lead to both self-blame and parent-blaming when understanding historical antecedents is expected to both explain and undo all complex, painful and confusing feelings. A wordless fear of dependency, a sense of possibly exploding or imploding, and a dread of being both overwhelmed by feelings that cannot be managed and sucked into a black hole of emptiness can interfere with a to join fully with a clinician, no matter what approach or technique is offered. The client’s ability behaviors that are in question become even more necessary for soothing. The danger of losing
For these clients, feelings often have a physical instead of an emotional presence. Because they seem to reside in the body, it is the body that has to be soothed. Physical actions like use of drugs, alcohol, sex, binging, purging, over-exercise and starvation can be attempts to not only maintain self-cohesion but also soothe the body self where the feelings are. Yet while these activities may provide momentary solace, they often increase feelings of shame, discomfort, and low self-esteem, thus undoing the positive effects and requiring further and often greater solace-seeking behaviors. Negative body image both represents these intolerable emotions and also leads to further attempts to manage them physically. With clients who are verbal and appear to be insightful, it would seem that understanding the meanings of the behaviors would help them make the changes necessary. Further, it often seems to clinicians that these clients should be able to understand the harmful consequences of their bodies, and should be able to change as a result of education about the dangers of the behaviors. Over the years as I have listened to my own clients, as well as to colleagues and supervisees describe their frustration and confusion when their clients continue to engage in these behaviors even after seeming to understand these dangers, I have found that alexithymia helps to explain what is happening when these interventions do not lead to change. What may appear to be intentional resistance can be understood through the lens of alexithymia as an inability to use language to manage both the “as-if” frame of dynamic exploration and also the feelings that are stirred up by these explorations. Literal thinking can lead to both self-blame and parent-blaming when understanding historical antecedents is expected to both explain and undo all complex, painful and confusing feelings. A wordless fear of dependency, a sense of possibly exploding or imploding, and a dread of being both overwhelmed by feelings that cannot be managed and sucked into a black hole of emptiness can interfere with a client’s ability to join fully with a clinician, no matter what approach or technique is offered. The behaviors that are in question become even more necessary for soothing. The danger of losing
final__listening_for_cswj_si_ed__apr_16_2015.docx