A Session with an Upset (Fragmented) Client
By Riley K. Smith, M.A., LMFT
PREMISE: The upset about a current experience will have roots in an individual’s early history and effective psychotherapy addresses both – current event and early history.
One of my favorite topics covered in my Study/Support Series is a matrix for a somatic psychotherapy session that I learned as part of Integrative Body Psychotherapy1. It’s called Steps Out of Fragmentation.
My experience of the Steps Out of Fragmentation, both as client and therapist, is that it is both a powerful mental health tool and a step-by-step outline for a profound therapy intervention. Profound in that it addresses our upset pattern at the root of the problem and offers a self-healing experience at the level of the attachment injury. In the process of guiding our clients out of their fragmentation, we are also teaching them a way to handle their own upset whenever it comes up.
“I haven’t been able to sleep or think straight for 2 days,” David was talking as he came through the door and flopped down in the chair.
This was David’s fourth session. I had learned his history. He had responded well when I introduced him to Charge Breathing2 leading to a feeling of aliveness and calm. I had helped him identify his Basic Wound3 which is the tender place, the attachment injury that is the primal source of his upset and the problem that brought him in.
David slouched in the chair looking miserable. This was a perfect opportunity to take him through the “Steps Out of Fragmentation” so that he can begin to learn to do the process for himself. I asked him if he’d like to learn how to get himself out of “the miseries.” He said he did, looking slightly hopeful. I guided him through the steps.
STEP ONE: Notice that you are fragmented. What you’re experiencing right now and for the last two days, the upset you feel, we’ll call it Fragmented.
“Describe it as best you can .”
“I made a mistake at work and it came out in a meeting. I felt exposed and ashamed, just like when I was a kid at school.”
“What’s the feeling in your body?”
“My face is hot. My solar plexus is on fire. I want to cry but I can’t breathe .”
“My mind is racing. That’s why I can’t sleep .”
“All those feelings and thoughts are parts of being fragmented. That’s the experience of being fragmented.”
STEP TWO: Reality check. Say, “I’ve been fragmented before and gotten out of it. I’ll be fragmented in the future and I’ll get out of it and I’ll get out of it this time too.” Say it until you can feel the truth of it in your body. This will usually bring a little relief and calm so that you can proceed to the next step.
STEP THREE: Identify the fragmenting event or events.
“When did you fragment? When was the last time you were calm?”
“I was calm when I went into the meeting. When my boss identified my mistake, I felt like I’d been pole-axed and I’ve been like this ever since.”
STEP FOUR: What happened in your childhood that felt that way – the earlier the better? He told of an experience of being shamed in class when he was in second grade. What nurturing or parenting was missing in that moment that would have soothed or prevented the upset? Make a note of the missing nurturing message(s). Examples of nurturing messages: I see you and I hear you. It’s not what you do, but who you are that I love. I’ll take care of you. You don’t have to be alone anymore.
STEP FIVE: I coached him in Charge Breathing until he was energized, present, alert and calm.
STEP SIX: Give yourself the nurturing message(s) as if you were talking to the upset child that you were. I fed him the nurturing messages that he had identified, one at a time. He repeated them until he could experience the effect of each one as a body sensation. Each message deepened the relaxation and calm that he felt until he was peaceful and present. I then asked him to think about the upsetting event at work and report what he experienced right now. He reported that he had lost the upset about it and was beginning to think about what to do to fix the mess.
He said that it didn’t feel like a catastrophe anymore, only a problem to solve.
ABOUT THE AUTHOR: LMFT in private practice since 1976. Faculty member at the Integrative Body Psychotherapy Central Institute in Venice since 2004. Trained therapists for eight years as Clinical Director at an out-patient drug program. AAMFT certified supervisor till 2008. Co-author of How to Be Happy Partners, a cooperative problem-solving manual for couples. Member of CAMFT, AAMFT and U.S. Assoc. of Body Psychotherapists.
1Integrative Body Psychotherapy was developed by Jack Lee Rosenberg, Ph.D., Beverly Kitean-Morse, Psy.D., Marjorie Rand, Ph.D, and others. For more information about IBP and the training, see www.ibponline.org Also there is a summary of IBP at www.wikipedia.org
2Charge Breathing. Breathing fully is essential to feeling and being alive. Regulating the breath is also the first and most fundamental somatic pattern for coping with the Basic Fault. When an infant experiences the stress of a need not being met, it reduces its breathing to reduce the intensity of the stress it feels. Reduced breathing also makes it impossible to feel fully alive and present. We must breathe fully to experience our Core Self. In IBP, breathing fully is the most important tool for attaining and sustaining mental and physical health.
3BASIC FAULT. The Basic Fault is the bad feeling, the somatic reaction, psychological upset, confusion and negative belief about the self that results from needs not met in infancy. It is the primal wound that is the foundation and reason for the psychological, behavioral and somatic patterns that interrupt aliveness and wellbeing. The Basic Fault is a lie about the Self that is held deep in the body and the psyche. It is also the root of upsets in the present. Everyone has a Basic Fault.