PSYCHOTHERAPY BEYOND THE FRINGE, continued
It seemed likely that her respiratory disorders and her quiet speech merely expressed her attempt to ‘choke herself off’ so that she could not answer back, contradict or express any anger. The therapeutic task was seen as involving several successive elements. First, it would be necessary to reduce some of the anxiety which maintained her vigilant defensive posture. This was addressed by means of systematic desensitization using Wolpe’s RIT method. Her creativity and sensitive imagery both facilitated and impeded this process. On the one hand, she was able to create bright and emotionally-meaningful images for herself. On the other hand, their intensity tended to evoke too much anxiety so that progress had to be particularly slow and careful. The latter trend finally worked against this approach to therapy since she became sensitized to the procedure itself and wanted to terminate it.
Second, she would have to be helped to find ways to stand up for herself in a modestly assertive fashion. This initiative was started early in the treatment process and continued for a long time. Progress in this procedure was slow. Relabelling of responses and feelings was attempted along with some standard assertive training procedures. At the same time, her very carefully chosen language was examined repeatedly with her. She was surprised to discover how often the words and phrases she chose confirmed and justified for her the self-defeating attitudes she had adopted. They often confirmed her beliefs that her father was always right, that there were absolute rules of conduct and order which she must discover and apply, that she was in error, that she should feel guilty when she failed to follow the rules, that she must be governed by others’ views, and that she was destined to be weak, vulnerable and ill. As this process developed, she had brief periods of improved health and robustness.
However, each time she seemed about to blossom forth in health and strength, something happened as if to verify that she was destined to be frail and vulnerable. She fell off a piece of furniture she was standing on; she was involved in a traffic accident; she developed a resistant infection; or she lifted something heavy and ‘injured’ her back. The sequelae of each of these sorts of incidents had to be managed as a priority. It did not occur to her that an accident is an inevitable occurrence due to the action of immutable natural laws of which she might have been aware, or that she was accident-prone. To face that idea would lead her to feel responsible for these accidents, so that it would be incumbent upon her to feel additional guilt.