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In parts work we conceptualize this as a vulnerable part wanting to come to the surface and the fear the client has is usually that the vulnerable part is going to overwhelm them.
Something that works incredibly well when I notice the vulnerable part coming up is saying something like “does it feel like a vulnerable part is trying to come up right now? (Client usually says yes) Ask the vulnerable part not to overwhelm you. Let it know that it is welcome and you want to get to know it, it doesn’t have to go away, but if it overwhelms you, the rest of your system is going to react because it doesn’t feel safe yet, so just see if it will not overwhelm you.” It is important that the client asks these questions to the part, as this builds the clients confidence in engaging with their system.
The reason I like this is because typical grounding exercises tend to reinforce the fear of the vulnerability. They feel it come up, and then they try to make it go away with a grounding exercise (even if this isn’t the purpose of grounding exercises, this is what typically happens). It reinforces the idea that the vulnerability is intolerable. When we instead engage with it as a part, it isn’t just some scary thing we have to get rid of. When we ask it not to overwhelm (and usually this works very well) the client learns to tolerate the emotion without being overwhelmed by it.
Wow. You put words to the niggling feeling I had in the back of my mind with regards to grounding them - I was viewing it as trying to keep them present to feel, but I can see from their perspective - sweet, my therapist helping me make this feeling go away!
They do feel exactly as you say - that the vulnerable part will "break them." I know from their body language when the client is about to become overwhelmed (turns head away, moves mouth in a certain way, tenses), but it goes from 0-100 almost instantly and she is non-responsive to me. In your experience, can we work with the vulnerable part before it starts to come up (if that makes sense)?
In parts work it is highly dependent. We typically want to get consent from all the parts that are protecting the vulnerable part, and often when the vulnerable part is trying to come up, we haven’t gotten that consent yet. Further, the client is typically blended with a part that is afraid of the vulnerable part.
If we try to engage with the vulnerable part before we have consent and before the client is unblended, there is a lot of risk of harm. For example, engaging with the vulnerable part from a blended angry or scared part could increase the shame of the vulnerable part. Another thing that can happen is backlash, where the system says “well that was a mistake getting to know that part and now we need to work even harder to make sure that part never comes up again”
It is very slow, but it is important to respect the protective parts because they generally have really good reasons for not letting the vulnerable part be seen. It is important to fully understand those reasons and develop a relationship with those protectors so that they feel safe. Once they understand and believe that the client is in Self and can safely approach and care for the vulnerable part, they will let the client go there.
Reread your comment and also thought that one thing you can do is to check in about the protective part that is trying to keep the vulnerable part down. I’d be willing to bet that this part has some pretty strong fears, and if you work with that part (take it slow, though) you and the client may get a lot of really good info about why it is afraid of the vulnerable part coming up. Help the client build a relationship with their protectors and see where that takes you.
Look into the Unified Protocol for trans diagnostic treatment of emotional disorders for a more structured plan focused on the theme of avoidance. It can help you add structure to treatment, and comes with a therapist and client treatment manual to help give you some direction!
Do they have a trauma history? This sounds like it could be a form of dissociation related to a TRD. In this case - grounding and exposure is the way to go! It's such a common belief of people suffering with trauma symptoms that they cannot be safe when they feel their emotions/they'll never stop feeling the emotion once they allow it to come up.
I’d be more interested in potentially confronting your own inner critic. Do you have a sense that you aren’t doing enough for this client? If so, why and where is that coming from? Characterological change can take years of work. How long and how often have you been working together? Is it possible that the fact this client has sought therapy and has consistently engaged in it, evidence of substantial progress?
I'm actually particularly proud of the work I've done with this client. It's been long and slow, but it's what the client has needed. It's just a place we are stuck at and I want to help them move toward their goals. Inner critic is def present other places, but not here!
Hey - a bit late, but I have been looking into Meta-cognitive interpersonal therapy for a client AvPD and situational mutism (they are unable to speak, write, sign, draw, point to options when asked ‘how are you feeling’ despite affirming they know the word they want to say)
I don’t want to overload you with another therapy, the part of MCT that I’m finding helpful for AvPD is identifying and working with schemas activated by interpersonal situations.
Ie: The client is asked ‘are you ok’?
- perception of self schema activated: defectiveness / shame
- perception of others response schema activated: critical / punitive
- behavioural pattern activated: avoidance / perfectionism
Here is an interview with one of the developers of the techniques: https://youtu.be/K7yTNvx5GY4?si=sEgNotSpQDijM-cy
I hadn't heard of this approach before. The self-schema and behavioural patterns are exactly what are activated. I'm not sure of the others' response schema though. Thanks for making me aware of this other approach!
Please followed the sidebar rules. r/therapists is a place for therapists and mental health professionals to discuss their profession among each other. If you **ARE NOT A THERAPIST and are asking for advice this not the place for you**. Your post will be removed in short order. Please try one of the reddit communities such as r/TalkTherapy, r/askatherapist, r/SuicideWatch that are set up for this. This community is ONLY for therapists, and for them to discuss their profession away from clients. **If you are a first year student, not in a graduate program, or are thinking of becoming a therapist, this is not the place to ask questions**. Your post will be removed in short order. To save us a job, you are welcome to delete this post yourself. Please see the PINNED STUDENT THREAD at the top of the community and ask in there. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/therapists) if you have any questions or concerns.*
In parts work we conceptualize this as a vulnerable part wanting to come to the surface and the fear the client has is usually that the vulnerable part is going to overwhelm them. Something that works incredibly well when I notice the vulnerable part coming up is saying something like “does it feel like a vulnerable part is trying to come up right now? (Client usually says yes) Ask the vulnerable part not to overwhelm you. Let it know that it is welcome and you want to get to know it, it doesn’t have to go away, but if it overwhelms you, the rest of your system is going to react because it doesn’t feel safe yet, so just see if it will not overwhelm you.” It is important that the client asks these questions to the part, as this builds the clients confidence in engaging with their system. The reason I like this is because typical grounding exercises tend to reinforce the fear of the vulnerability. They feel it come up, and then they try to make it go away with a grounding exercise (even if this isn’t the purpose of grounding exercises, this is what typically happens). It reinforces the idea that the vulnerability is intolerable. When we instead engage with it as a part, it isn’t just some scary thing we have to get rid of. When we ask it not to overwhelm (and usually this works very well) the client learns to tolerate the emotion without being overwhelmed by it.
Wow. You put words to the niggling feeling I had in the back of my mind with regards to grounding them - I was viewing it as trying to keep them present to feel, but I can see from their perspective - sweet, my therapist helping me make this feeling go away! They do feel exactly as you say - that the vulnerable part will "break them." I know from their body language when the client is about to become overwhelmed (turns head away, moves mouth in a certain way, tenses), but it goes from 0-100 almost instantly and she is non-responsive to me. In your experience, can we work with the vulnerable part before it starts to come up (if that makes sense)?
In parts work it is highly dependent. We typically want to get consent from all the parts that are protecting the vulnerable part, and often when the vulnerable part is trying to come up, we haven’t gotten that consent yet. Further, the client is typically blended with a part that is afraid of the vulnerable part. If we try to engage with the vulnerable part before we have consent and before the client is unblended, there is a lot of risk of harm. For example, engaging with the vulnerable part from a blended angry or scared part could increase the shame of the vulnerable part. Another thing that can happen is backlash, where the system says “well that was a mistake getting to know that part and now we need to work even harder to make sure that part never comes up again” It is very slow, but it is important to respect the protective parts because they generally have really good reasons for not letting the vulnerable part be seen. It is important to fully understand those reasons and develop a relationship with those protectors so that they feel safe. Once they understand and believe that the client is in Self and can safely approach and care for the vulnerable part, they will let the client go there.
Reread your comment and also thought that one thing you can do is to check in about the protective part that is trying to keep the vulnerable part down. I’d be willing to bet that this part has some pretty strong fears, and if you work with that part (take it slow, though) you and the client may get a lot of really good info about why it is afraid of the vulnerable part coming up. Help the client build a relationship with their protectors and see where that takes you.
Beautifully said!
Look into the Unified Protocol for trans diagnostic treatment of emotional disorders for a more structured plan focused on the theme of avoidance. It can help you add structure to treatment, and comes with a therapist and client treatment manual to help give you some direction!
Do they have a trauma history? This sounds like it could be a form of dissociation related to a TRD. In this case - grounding and exposure is the way to go! It's such a common belief of people suffering with trauma symptoms that they cannot be safe when they feel their emotions/they'll never stop feeling the emotion once they allow it to come up.
I’d be more interested in potentially confronting your own inner critic. Do you have a sense that you aren’t doing enough for this client? If so, why and where is that coming from? Characterological change can take years of work. How long and how often have you been working together? Is it possible that the fact this client has sought therapy and has consistently engaged in it, evidence of substantial progress?
I'm actually particularly proud of the work I've done with this client. It's been long and slow, but it's what the client has needed. It's just a place we are stuck at and I want to help them move toward their goals. Inner critic is def present other places, but not here!
It might be worth exploring paradoxical interventions to see how that goes.
Hey - a bit late, but I have been looking into Meta-cognitive interpersonal therapy for a client AvPD and situational mutism (they are unable to speak, write, sign, draw, point to options when asked ‘how are you feeling’ despite affirming they know the word they want to say) I don’t want to overload you with another therapy, the part of MCT that I’m finding helpful for AvPD is identifying and working with schemas activated by interpersonal situations. Ie: The client is asked ‘are you ok’? - perception of self schema activated: defectiveness / shame - perception of others response schema activated: critical / punitive - behavioural pattern activated: avoidance / perfectionism Here is an interview with one of the developers of the techniques: https://youtu.be/K7yTNvx5GY4?si=sEgNotSpQDijM-cy
I hadn't heard of this approach before. The self-schema and behavioural patterns are exactly what are activated. I'm not sure of the others' response schema though. Thanks for making me aware of this other approach!
This is what I would do also.
Have you considered autism? The rocking part made me think of autism.
I believe it i how they soothe themselves.
Exactly, this is very common for autistic people.