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LibraryInner Relationship Focusing:
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Stages of Inner Relationship Focusing |
The Cycle of Attachment, Bonding and Trust |
Coming In
This is a quiet stage of acceptance that sets the stage for safety of the experience that emerges. |
Experience of need Caretakers need to be mindful of ourselves, so they can tune into the infant’s needs in that present moment. Bringing awareness to our bodies facilitates bringing our attention to the moment so they can optimally tune in. The caretaker looks for, listens, senses, and intuits what the infant is wanting. The caretaker receives feedback from the infant, maybe a certain kind of cry, or body movement, or facial expression, which offers a message of what might be needed. |
Making Contact
This stage is when contact with what wants to be attended to happens. |
State of arousal The caretaker considers the feedback: Hungry? Wet? Afraid? Sleepy? The caretaker checks these possible needs. For example, when the mother checks to see if the infant needs a diaper change, she sees the infant’s diaper is dry which suggests, no, that’s not it. The caretaker moves on to check for something else. Hungry? The caretaker checks by offering a bottle, the infant is soothed, giving her feedback, yes, that’s it: hungry. |
Deepening Contact
This is the deepest stage of connection with what inside us experiences our company, attention, to be listened to or heard. |
Satisfaction of Need The caretaker stays with the infant and his/her need. The caretaker continues to offer her attention to notice if the infant’s need has been fully heard/tended to. The mother might say, “there now, little one, you were a very hungry baby”. |
Coming out
At this stage, what wanted our attention has shifted, there’s a change, a relaxing, clarity, a spaciousness and connectedness inside. |
State of Relaxation The caretaker observes, checks, senses for the infant’s satisfied need. If the infant is full, the caretaker stops feeding. If the infant has another need, the mother tends to that, with more feeding, or burping. The caretaker notices the infant’s changed state. She knows now the infant’s need has been satisfied. She and the infant connect throughout this process. The caretaker by repeating these natural steps, instills the sense of trust within the infant that she will be back to tend to all of the infant’s needs. The caretaker brings her awareness back to other thoughts, other activities of the day. |
Vignettes
This section includes two vignettes that demonstrate how Inner Relationship Focusing can benefit processes with our clients. The first vignette illustrates how the clinician uses her own Focusing session to process counter transference issues she feels are blocking treatment with a particular client. The second is a segment of a session done with a client with issues of depression and self-esteem. Identifying information about each case is withheld for the purpose of confidentiality.
Vignette #1
(Session takes place on the telephone. Prior to the following interchange between Focuser and Partner, the Focuser leads herself in to a state of presence which facilitates the sense of acceptance and welcoming for what wants her attention in the session. In IRF, the Focuser can use a combination of grounding, breathing, imagery or other ways to guide the client to facilitate a ‘Self-in-Presence’ state.)
Focuser (F) : (the clinician, in this case): So, I’m aware of wanting to tell you a little about what I want to Focus on today; it’s a case I have, and I’d like you to have a little background.
Partner (P ): Yes, so take some time to share what feels right to share. (Despite its deep facilitative process, IRF does not require the sharing of any personal content or information the Focuser does not wish to share. This can be extremely relieving for people who prefer not to “tell the whole story” or who simply prefer to say a lot.)
F: I have worked with this client for many years. She has Complex Post Traumatic Stress Disorder and significant dissociation and depersonalization symptoms. She is very intelligent, creative, has a great sense of humor and the average person would never believe she has such severe mental health symptoms. As I’m talking, I’m sensing shallow breathing and something constricting in my chest. (Focuser’s affect is becoming dysregulated. She has learned through IRF to notice breathing and sensations in her body as a way to cultivate presence and facilitate the IRF process.)
P: So you’re sensing something there in your chest, like constriction, and shallow breath… . (Partner supports Focuser, with repeating back key words or phrases. This can be a grounding aspect of the process which helps facilitate presence.)
F : Yes, and what I also want to tell you as this client is as difficult as she is wonderful to work with. I hate using our pathological labels, but honestly, the diagnosis Borderline Personality comes to mind as I think of her now…..she’s so capable, yet she really isn’t…she’s just so hard to help.
*P: Yes, so take some time to acknowledge something about how it’s hard to help, something about Borderline Personality….noticing how that area in your chest is feeling….(Partner senses Focuser could benefit from the suggestion for Focuser to return to her body.)
F : I’m feeling that constriction, tightness, and my face feels hot….
P : So tightness and a sense of how your face is feeling…. (Partner accompanies Focuser with brief repeating of key words)
F: Yes, my face feels so hot, like it’ s getting a sun burn. I’ m taking time to say hello to it and as I do it feels calmer, like it was hot and also sizzling (saying hello is a way to be in relationship with what we are experiencing).
P: Taking time to feel how that feels as you notice it is calmer now. (*these interchanges demonstrate how the partner accompanies the Focuser, supporting the Focuser in presence. The partner suggests that the Focuser allow the calmer state to be noticed, therefore strengthening that inner calm which helps to regulate affect.)
F: Yes, and something in me pictures her sitting across from me, talking about the same things she has talked about so many other times, and I want to yell, “Shut up! Stop! Do you hear yourself? When are you going to get it? You can make changes; it’s you, not everyone else!!!” That’s what I want to say to her….
P: You are sensing something in you* that wants to say all of this to her (*Partner using presence language to support Focuser’s own presence with what comes in the Focusing session).
F: Yes, some part of me wants to scream this at her. It can’t take it anymore… (Focuser, again, refers to the inner experience as “it”, which facilitates relational way of being with what is experienced).
P: Part of you wants to scream, like it can’t take it anymore...maybe you want to let that part know you really hear it, how it’s feeling….like it wants to scream….
F: It wants to tell her to find a new therapist, obviously this isn’t working, find someone else! I’m noticing a deep breath. It feels so good to say this out loud….like a release….
P : Yes, and take time to notice how that release feels in your body.... (Supporting the calming, soothing, response the Focuser is having.)
F: No wonder my face felt so hot... it feels cooler now…like all this frustration was stuck there….
P: So, it’s like you are saying, no wonder it felt so hot like something was stuck.
F: Yes…..something in me felt it wasn’t okay to feel I wanted to tell my client to shut up and find a new therapist…I’m sensing that part now...l ike it’s not so sure even now…. I can sense a shakiness in my chest….
P: Yes, you’re sensing something feeling shaky…like it might not feel it’s okay to express those feelings…. (Partner shows no judgment, offers a completely accepting attitude.)
F : There’s an image, it’s vague like something is showing me a young girl…Oh, like it’s me as a child, and I’m really mad at my sister, and I want to yell at her and tell her to stop, but I’m not allowed to…like I’m not allowed to be angry at anyone.
P: So you are remembering….and you are aware of an image. It’s showing you a young girl, and something about not being able to be angry….
F: Yes, that feels right….she has her head down, like she’s been bad, or done something wrong. I’m noticing a deep breath…..and my chest is more open….her head has lifted some….
P: Yes, you are with her, like keeping her company….
F: Yes, she likes that; she expected to be scolded....like she wasn’t allowed to be angry, or to express that she was, or both. I’m sensing if that fits and another breath...it feels like she’ s letting me know, yes, she has always felt like she had to be nice all the time....that she shouldn’t have such negative feelings or judgments about this client….the client has been through so much trauma…
P: So you might sense if there is more she’d like to let you know...
F: Yes…I’m sensing a relief, and deeper breathing... (Focuser laughs a little)…she, that young girl…is smiling…she’s glad it was okay to be angry…..Hmm, I’m noticing now that when I think of this client I have much more whole picture of her, what she’s been through, how hard all of this must be for her…and that it’s hard to be her therapist sometimes….
P: You might take some time to really feel that relief and allow your breathing to be as deep as it wants.
F : Hmm... I feel so much better, like I really care about her and my work with her again….how I have felt most of the time she’s been coming to see me….
(Focusing session ends after this, with a gentle closing, acknowledging that the Focuser/Clinician is open to returning to what came in her session if more attention is needed at another time.)
The clinician resumes her work with this client as scheduled and notices a major shift in her own presence with the client. She no longer feels she needs to be hypervigilent about maintaining composure as she listens to her client. She feels openness inside, like she is listening with new, fresh ears and a renewed commitment to providing optimal clinical treatment. This shift continues and the client’s ability to self regulate and observe her own experience is evident in her progress over many more months of treatment.
Vignette #2
The following vignette is one that takes place within a psychotherapy session. The client has had three to five sessions. She has been depressed and has self-esteem issues. She feels stuck, destined to have to live her life the way she feels now. The clinician has introduced some of the concepts of Inner Relationship Focusing to the client, but has not yet guided the client, in a Focusing way.
Client (C) : I'm doing okay this week. Things seem to be going a little better. Work has been kind of crazy, but things at home seem less tense. There's something, though.....I keep saying that, trying to figure it out. Maybe I need to just chill out, relax; maybe I have expectations that are just too high. Everything doesn't have to be great all the time.....
Focusing Oriented Psychotherapist (FOP): So, overall things are okay, work is crazy, less tension at home….and you sense there's something about expectation....
C: Yes. But what? I've spent a lot of time talking and thinking about this. I'm stuck.
FOP : Hmmm…something about feeling stuck. We might take some time using some Focusing here....it sounds like you have tried many ways to understand and feel better....how does that sound?
C: Okay, how do we do that?
FOP : Well, many people like to close their eyes, or gaze down, and I'll guide you as you bring your attention to this....a stuckness....some things are better…yet a sense there’s something more….
C : Okay.... (Client closes eyes)
FOP leads client to bring her awareness to her inner sensation.
FOP : So… you are bringing awareness to the inner area of your body, as if you are offering an invitation for what wants your attention about how things are going…. take some time to sense what's there....
C : I notice the sounds of the building we’re in, the fan in the room....oh; I notice my breath is short, like I just ran to get here....
FOP : So you're noticing sounds around you....and noticing your breathing…..
C : Yes....oh, now my breathing is slower...that's better....I'm noticing a lot of thoughts, like all the things I have to do, errands, things for work, call back a friend who called....
FOP: So, you sense your breathing is slower.....and noticing thoughts..... Just take some time to acknowledge the thoughts, like you are saying, "Oh, I know you are there, listing things....work, friend...." And as you do, see how it would be to take some time to notice that inner area of your body.....chest, stomach, belly....(FOP suggest that client bring awareness to her body while acknowledging her thoughts, this helps bring a sense of wholeness to what she can notice in her experience).
C: Oh, it feels tight....like pressure....in my chest...
FOP : So you are sensing something there in your chest, pressure, tightness.....maybe check if those words fit or if something else fits better...
C : It's like a knot, or a jumbled up ball of rope or twine....
FOP : So it's like a knot or twine jumbled up....you might say hello to it....
C : Hmm...I’m also noticing images coming...work, my husband, kids....and my father....
FOP : Yes, so you are also noticing images that come....taking time to acknowledge those....
C: Yes, and that knot feels looser....and I'm sensing a sadness....oh wow, I'm tearing up....I think this is grief stuff about my dad... I didn't know....I thought that was all kind of okay....
FOP: So you're sensing it feels looser....and tears come....and something in you wondering, maybe this is some sadness….grief…about your dad…you might stay with that, sense how it feels as you check….
C: There’s an image of my dad…he’s there, my dad was so kind and gentle…I think he raised his voice once… (Client laughs a little)…
FOP: Hmm…an image of your dad; his kindness…and some laughter comes….
C: Yes…and I’m not feeling sad like I thought…tearful, yet not sad…
FOP: Yes, so see how it is to take some time with that…tearful…not sad…
C: My dad never yelled at us…oh …now I have an image of my boss…how he yelled at our staff meeting the other day…
FOP: So something about your boss…yelling…..you might take some time to sense your body. Chest…stomach…throat….
C: Hmm…okay…it feels heavy…like something hard…
FOP: You’re sensing something hard…you might notice where you feel that…
C: In my middle area (client puts her hand on stomach)….
FOP: So you might check if that word hard fits or if there’s something that describes it better….
C: Hmmm….yeah…no, it’s not hard, it’s firm….it’s not okay to yell at us! It’s…..now I feel mad….it’s not okay to yell at us…my dad never yelled, but we always knew when he was setting the limit….oh wow….I’m…taking this deep, deep breath…..
FOP: So something feels firm there, like it’s saying, it’s not okay to yell…there are other ways…and you notice a deep, deep breath…
C: Yes…oh wow…It feels so different…my breathing is different…I didn’t realize how my boss’s behavior impacted me….I just don’t respect that….
FOP: Yes, so take some time to notice how that feels, as you fully sense how it feels to acknowledge how this impacted you….
C: Oh my gosh….now I have an image of myself yelling at my kids…..
FOP: So you’re noticing another image….
C: Yes….and my chest is so tight now…..like a big knot.
FOP: You might put a gentle hand there, like you’re letting it know you know it’s there, feeling tight….like a big knot….
C: Yes….oh…it’s loosening up a bit…wow…like a big wave came over me and now I’m okay….This Focusing is a amazing….(client laughs and lets out a sigh)
FOP: So it’s coming to the time we need to stop…. (Focusing Oriented Psychotherapist guides client out of Focusing session….) You might take some time to sense if there’s anything more that wants to come and be known before we end…..
C : Hmmm….I’m feeling like I just did some really deep work….something about feeling respected….that it matters how I’m spoken to by others and it’s not okay to be disrespected…..
FOP : Yes, so feeling respected….you’re sensing how important that is….you might acknowledge that you hear that….
C : Yes, I do, and I feel so much better than before…. (Client naturally opens her eyes and engages her therapist in a dialogue about her experience using Focusing.)
(Following this session, the client reports that she has been yelling at her kids less, and has been able to catch herself before she does things that she knows she will regret, such as eating too much, or staying up too late. She also continues to request using IRF as part of her therapy sessions, and she practices bringing her attention to her body as a way to help herself become present.)
Mindfulness Practices
So far, this article has discussed IRF as a tool for the healing of attachment issue. A related topic that has gotten a lot of attention lately, and is important to mention, is “mindfulness practices” (such as meditation and yoga). Research validates that these practices can improve the mind-body healing. I consider Inner Relationship Focusing a process which cultivates a body-oriented, relational, mindfulness. As Siegel discusses (2006), “Mindful awareness has the quality of receptivity to whatever arises within the mind’s eye, moment to moment. Recent studies of mindfulness practices reveal that it can result in profound improvements in a range of physiological, mental, and interpersonal domains of our lives. Cardiac, endocrine, and immune functions are improved with mindfulness practices (11). Empathy, compassion, and interpersonal sensitivity seem to be improved.
People who come to develop the capacity to pay attention in the present moment, without grasping on to their inevitable judgments, also develop a deeper sense of well-being and what can be considered a form of mental coherence” (P.4). When we can slow down, pause, be aware, or mindful, we can pay attention to the small steps we might make for change, or notice and enjoy the feelings when we experience fun, play, and the accomplished or mastered feelings of hard work.
In IRF , the qualities of presence behold an internal model of security. Presence is welcoming, calm, curious, accepting-- everything a secure environment encompasses. In IRF , when the felt sense is welcomed into presence, the outcome can be a felt shift, an internally felt transformation which facilitates an ongoing process of regulating one’s inner feelings. In IRF , presence allows all parts, or aspects of ourselves, (even when there is inner conflict) to connect and communicate. This provides a healthy relational quality inside us. IRF allows change to come naturally; it increases flexibility, a sense of flow, an ease, a way of being in the world that is calmer, clearer, and more patient. In the practice of IRF , we develop what I sometimes call “mindfulness muscles.” The more we practice, the stronger and more defined our mindfulness muscles become, therefore supporting the profound improvements that are possible.
Because of the effects of my own IRF practice, my clients are now sitting with a therapist who has a more integrated brain; one whose emotional, mental and physiological regulating systems are working better and better all the time. Professionally, I listen better, conceptualize a client’s needs faster and respond to transference and counter transference issues with faster recognition, more ease, and clarity. IRF is not only a body-oriented mindfulness practice. It is also a practice which mirrors the original cycle of interaction that is at the core of our well-being: the cycle of attachment, bonding and trust. Dan Siegel, as quoted in Simon and Sykes Whylie’s (2002) article Discoveries from the Black Box, says: “The openness and emotional availability of the therapist seems to be the triggering mechanism. Openness and emotional availability are also the prime features of secure attachment...psychotherapy which works is using an interpersonal relationship to change self-regulatory circuits of the brain. It isn’t just that a person temporarily feels better. At the level of the brain, therapy changed the mind by changing neuronal connections.”(p.29). Again, Badenoch (2008) stresses her point. “Preparing our minds to hold the fullness of another’s experience may then be the most important aspect of our ongoing training as therapists.”(p. 5).
For those who know and practice IRF , I hope this article supports and validates your own inner knowing of its transformational benefits. For those who do not know Inner Relationship Focusing, I hope to inspire you to learn it, use it and share it. IRF can be taught to individuals as a self-growth skill. It can be taught in pairs, or in a “peer counseling” model. It is also taught to children in school programs. Professionally, it can be used by an array of healing professionals in conjunction with other modalities.
I would like to thank Ann Weiser Cornell for her encouragement, mentoring and editing of this paper. The paper wanted to be written, and it may have sat inside me somewhere, waiting to be written, without Ann’s ever-present support of the project.
Copy Written 2010 by Carol J. S. Nickerson
References
Books
Badenoch, Bonnie, Being a Brain-Wise Therapist, A Practical Guide to Interpersonal Neurobiology W. W. Norton & Company, New York, Edition 1, July 2008.
Perry, Bruce and Szalavitz, Maia, The Boy Who was Raised as a Dog, Basic Books, New York, 2006.
Siegel, Daniel, Parenting From the Inside Out, Tarcher/Penguin, New York, 2004.
Weiser Cornell, Ann, The Radical Acceptance of Everything, Calluna Press, May, 2005.
Journal articles
The Effects of a Secure Attachment Relationship on Right Brain Development, Affect Regulation, & Infant Mental Health , Allan N. Schore, Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles School of Medicine, Originally published in: Infant Mental Health Journal, 2001, 22, 7-66. Note that this online version may have minor differences from the published version.
An Interpersonal Neurobiology Approach to Psychotherapy: Awareness, Mirror Neurons, and Neural Plasticity in the Development of Well-Being Daniel J. Siegel, M.D. Associate Clinical Professor, Foundation for Psychocultural Research / UCLA Center for Culture, Brain, and Development ( CBD .ucla.edu), Co-Director, UCLA Mindful Awareness Research Center (MARC.ucla.edu);Executive Director, Mindsight Institute (DrDanSiegel.com) Working Pre-Publication Copy, not final draft: Future Reference of final draft: Psychiatric Annals 2006 IN PRESS.
Websites
"http://www.healingresources.info/trauma_attachment_stress_disorders.htm", Sponsored by Santa Barbara Graduate Institute Center for Clinical Studies and Research and L.A. County Early Childhood Identification and Intervention Group, Retrieved, July 17, 2008.