Change of State: Learning How To Manage Unmanageable Feelings and States

Bristow, J., 2006. Change of State: Learning How To Manage Unmanageable Feelings and States. Reformulation, Summer, pp.6-7.


I was sharing how I have integrated the work of Allan Schore and others on affect regulation into my practice of CAT. By affect regulation I mean the ability to experience a wide range of feelings and restore a dynamic equilibrium in a healthy way. Schore, Trevarthen and others have shown how we learn this critical capacity in our early attachment relationships, in which we can have the most intense formative emotional experiences. Social and emotional development seem to occur together, and are probably organised in the same places in the brain, affecting our sense of self in relation to others and the world. The mother (as well as others) excites and calms, disappoints or disturbs and comforts, restoring stability and the relationship. The child learns to regulate emotions subconsciously, having had the inter-subjective experience of attuning, soothing, containing that regulated previous intense emotions non-defensively. S/he can then access this in her/himself or seek it from another. The anxious, angry or withdrawing parent can lead the child to try to handle its state as best it can by cutting off and withdrawing, perhaps somatising, or discharging by acting out impulsively and aggressively or self-harming. In more severe cases, in which the child has suffered the effects of considerable trauma and deficit, s/he has emotional experiences that cannot be completed or integrated.

The part of the brain that regulates affect develops almost entirely after birth, with the first 20 months laying the foundations. The development of this critical capacity is dependent on experiences in relationships with attachment figures. It remains plastic, able to change  throughout the life span. But further change and development seems to be dependent on corrective experience, in the context of a relationship, such as therapy. This is first and foremost a nonverbal relational, felt experience. Insight alone is not enough. It needs to be accompanied by making new sense of the previously dysfunctionally regulated states, by finding new explanations and meaning with the help of another. This helps develop the capacity to sense and reflect on strong emotions by representing them in images or words, or by using metaphor and analogy. As more subtle distinctions between strong emotions are made, it becomes easier to channel and use them adaptively, and to express them in ways that others can tolerate and understand. Feelings in these states are no longer just encoded in earlierdeveloping parts of the brain (e.g. sensori-motor level of affect), but now link to higher levels of cognition.

The therapist can act as an affect regulator, just as an attachment figure can do in early years. This can help unblock the dysfunctional state that has become generalised into a core part of the self process and identity. The client might need help in either accessing the feelings, or in bringing down arousal levels to make them more tolerable. The therapist lets her/himself be impacted and express how s/he feels (through look, face, voice, words) so that the client can see and feel that s/he is seen and felt, non-verbally understood, with the therapist participating in their experience and communicating safety through containing the feelings. If the feelings provoked or elicited in the therapist reflect what the client cannot handle or has learnt to expect from others, then this too is an opportunity for affect regulation in a different form: the working through of chronic states of dysfunctional regulation, by containing rather than retaliating or avoiding, in non-verbal as well
as verbal responses.

I have found very useful Schore’s development of Klein, Winnicott and Kohut’s ideas about the splitting of extreme states (cf. reciprocal roles), and how the “good enough parent” not only loves and cares for the child but also helps it learn to experience and recover from the mis-attunement, disapproval or conflict that occurs in their relationship, and from feelings of shame or inadequacy, in their own and others’eyes.. By learning to integrate these strong emotions in this way, they can put the bad in context, so that it does not drive out, or split off from, the good. Without this there can be deficits in the metaprocedures in CAT that link and mobilise procedures: partial dissociation or fragmentation at level 2 and lack of self-reflection at level 3, on top of limitations, distortions and restrictions at level 1. (Ryle and Kerr 02 p10). Corrective experience often includes the therapeutic relationship going through bonding, rupture and repair, or idealising, shame or  vulnerability and recovery. There is then a dynamic middle ground between positive and negative affective experiences in relationships and in sense of self, with each person having a kind of “emotional thermostat” (as one of my clients put it) with preferred limits within which to restore equilibrium, and achieve a coherent sense of self (German: Selb=same).

I illustrated the use of a simple framework for tracking the progress of a therapy:

  1. Assessing deficits and traumas, including the capacity to regulate affect.
  2. Focusing the therapy on the dysfunctionally regulated states (e.g. CAT diagram).
  3. Predicting how these states can manifest in the transference, and what kinds of corrective experience might be needed
  4. Working with the unmanageable feelings and unmet needs in these states:
    (a) Being able to experience the painful, shameful or frightening feelings by creating, maintaining and returning to a safe context. Regulating the level of arousal. Tolerating, accepting and integrating the state.
    (b) Understanding it through images, metaphor and description, and revising the conclusions and meaning derived from experiencing this state.
    (c) Accessing other affects and responses to self and others. This can involve completing the experience of an original trauma, loss or  deprivation, and relegating it to the past.

Case examples were used to show some of the differences between people in each of these areas, and the way it was possible to work with them, for example: difficulty in accessing feelings or in thinking about what is being felt, and the way we moved between “top down and bottom up” processing.

From Schore and others I have learnt to slow down and give much more attention to sensing and observing my own and the client’s bodily reactions. Gendlin’s felt sense (“focusing”) has helped here, not only in accessing  feelings but also in lowering arousal. I use it as a therapist and help the client to use it to gain the mental space for both experiencing feelings or response tendencies and observing them at the same time. I too can have a better balance between being-feeling-seeing-with, and thinking-and-talking-with, the client. The felt sense also helps clients recognise key states more quickly outside therapy and gives them a way of  reducing their intensity and duration. This opens the way for corrective experiences that contradict former expectations, and previous beliefs about the world and oneself in relation to it.

Once established, the processes of implicit learning, and self observation and reflection, can carry on after therapy, as long it takes the relevant structures and procedures, that organise experience and behaviour, to be supplemented or changed. Such changes can be observed now, not just in behaviour, but in MRI scans of the brain. But it is important for realistic goals and expectations to be established in the early stages of therapy. Some people will need extensive preparation before feeling ready to have the experiences they need. Others may only be able to recognise and manage the problem states so that they have less power and significance, and less impact over their lives.

John Bristow

Full Reference

Bristow, J., 2006. Change of State: Learning How To Manage Unmanageable Feelings and States. Reformulation, Summer, pp.6-7.

Search the Library

Related Articles

Attachment, The Body and Trauma
Diamond, N., 2005. Attachment, The Body and Trauma. Reformulation, Autumn, pp.25-26.

Therapeutic Change that is Dialogically Structured, Mediated by Signs, and Enabled by a Relationship – A Case Example
Bristow, J. and Reason, A., 2010. Therapeutic Change that is Dialogically Structured, Mediated by Signs, and Enabled by a Relationship – A Case Example. Reformulation, Summer, pp.31-33.

CAT and CFT - Complementary in the treatment of shame?
Jameson, P., 2014. CAT and CFT - Complementary in the treatment of shame?. Reformulation, Winter, pp.37-40.

Metaprocedures in Normal Development and in Therapy
Hayward, M., McCurrie, C., 2008. Metaprocedures in Normal Development and in Therapy. Reformulation, Summer, pp.42-45.

Book Review of: Beatrice Beebe and Frank Lachmann (2002). Infant Research and Adult Treatment: Co-constructing Interactions. Published London: Analytic Press.
Lloyd, J., 2009. Book Review of: Beatrice Beebe and Frank Lachmann (2002). Infant Research and Adult Treatment: Co-constructing Interactions. Published London: Analytic Press.. Reformulation, Summer, pp.34-35.

Other Articles in the Same Issue

Book Review: An Intimate History of Humanity
Julia Clark, 2006. Book Review: An Intimate History of Humanity. Reformulation, Summer, p.18.

CAT in the North-East of England
Anna Jellema, 2006. CAT in the North-East of England. Reformulation, Summer, p.19.

CAT Skills Training in Mental Health Settings
Freshwater, K. and Kerr, I., 2006. CAT Skills Training in Mental Health Settings. Reformulation, Summer, pp.17-18.

CAT with Teenagers and Teenagers Leaving Care
Jenaway, A., 2006. CAT with Teenagers and Teenagers Leaving Care. Reformulation, Summer, pp.3-4.

Change of State: Learning How To Manage Unmanageable Feelings and States
Bristow, J., 2006. Change of State: Learning How To Manage Unmanageable Feelings and States. Reformulation, Summer, pp.6-7.

CPD Events
Miranda Buckley and John Bristow, 2006. CPD Events. Reformulation, Summer, p.18.

CPD in the South West
Yvonne Stevens, 2006. CPD in the South West. Reformulation, Summer, p.18.

Family Constellations and CAT: Reciprocal Roles Through The Generations?
Bancheva, M., 2006. Family Constellations and CAT: Reciprocal Roles Through The Generations?. Reformulation, Summer, pp.15-17.

Help

This site has recently been updated to be Mobile Friendly. We are working through the pages to check everything is working properly. If you spot a problem please email support@acat.me.uk and we'll look into it. Thank you.