Psychotherapy Off the Wall

Just before the next planned session, George phoned Felicity in a panic. He said, “It’s happened again.” There was genuine despair in his voice. Felicity suggested that they could talk about it at their planned session in a few days time. When George appeared for that appointment, he carried on his face a mixture of self-depreciation and wonderment. He said he had indeed exposed himself on the one occasion a few days earlier, but he had not felt compelled to repeat the action since. Felicity decided to respond in a matter-of-fact and supportive way, and he encouraged George to ‘forget about it’. George thought Felicity was out of his mind and told him so. Felicity shrugged and said, “Probably.”
Of course, George could not know what was behind Felicity’s lack of concern. Felicity had observed two interesting things about people who were undergoing the SCARS procedure which he had used with George. First, if the frequency of sessions was such that there was less than 48 hours between sessions (i.e., sessions held daily), it tended to take almost a half again as many sessions to complete the basic anti-anxiety treatment task as it did if there was at least 48 hours between sessions. He had concluded that what is called ‘short-term consolidation’ of learning requires about 48 hours. So, with those people seen daily, short-term consolidation of the learning from one session was not yet complete before the learning from the next session was introduced. This may have been why treatment was ‘slowed down’ in these cases.
Second, he had noticed something else which was more relevant to George’s current situation. Following completion of this kind of treatment, at about six week intervals, many people reported a temporary recurrence of their symptoms. The recurrence was often accompanied by an increased intensity of reported anxiety or distress. Felicity had concluded from this observation that long-term consolidation of learning must take about 6 weeks. He thought that new learning must be stored in temporary memory for a while. At some point in time (perhaps after 6 weeks), the brain’s executive function decides that the new learning is appropriate, and that it should become part of the long-term habit storage system. At this point, the new learning is probably ‘dumped’ into the more or less permanent organization of behaviour, which is called personality. But the existing structure of habits in the personality would be somewhat inconsistent with the new learning, for example, from treatment. Consequently, the personality would have to re-adjust itself and its motivational force fields to accommodate the new learning. This action should involve a general disruption of the organization of the personality system. This disruption might well be experienced as distress, and might well allow old habits to re-appear temporarily, particularly if they were anxiety-related.

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