321: Help I’m Having Panic Attacks pt 2 of 2

Yikes! Do I REALLY have to share my feelings?  Last week, we featured Part 1 of a live therapy session with Keren Shemesh, PhD,  a licensed clinical psychologist who began having intense panic attacks when her mother and father visited from Israel.  Today, we feature the exciting conclusion of that session, with follow-up. If you are interested, you can listen to the follow-up with Keren and Jill who joined us st the end of today's podcast. They comment on the session as well as the details of what happened following the session. I (David) raised the question of why so many of us have trouble being honest and open with our feelings, especially anger. Jill suggested that it might be due to the false dichotomy people see, contrasting aggression with love. But you can be honest and loving at the same time, including when you express feelings of anger. Of course, we make the Five Secrets of Effective Communication sound easy, but these powerful tools actually require an enormous level of skill as well as commitment. Part 2 of the Keren session: M = Methods We began the Methods part of the session with a bit more Paradoxical Agenda Setting, and listed some really GOOD reasons NOT to open up more to her mother.

1. I want to protect her because it may be hard and upsetting to her.
2. I’m not used to being vulnerable with my parents.
3. I don’t want to rock the boat or change the status quo.
4. I’m not sure I want a closer relationship with my mother. NOTE: David and Jill were thinking that we often resist intimacy because we have negative pictures in our mind of what real closeness is. For example, if you think it means something yucky and upsetting, you obviously won’t want to get “close.” Jill tried to finesse around this by suggesting Keren might aim for a more “honest” relationship instead of a “closer” relationship.
5. There are things about me that they’ve rejected, like the fact that I don’t really want children. And I’m not so sure I want to make myself vulnerable and get rejected again!
6. I’m afraid I’ll get swallowed up and enmeshed.

We asked Keren what kinds of feelings she was hiding from her mother.

1. My feelings of nervousness and intense anxiety, and the intense somatic symptoms, like the knot in my stomach.
2. I am scared for her future, since she is not in good health and she’s not taking care of herself.
3. I have feelings of anger and resentment about the fact that I’m not the kind of daughter they wanted.
4. I’m sad about her health and seeing her struggle.
5. I feel hurt when I think how I have failed them and let them down.
6. I sometimes feel like I don’t really belong.

At this point, I became so absorbed in the session that I stopped taking notes, so you will have to listen carefully to the recording of the session which was fascinating. I do recall, however, that we began working on communication, using the Five Secrets of Effective Communication (LINK), as well as tips on how to proceed, taking it one step at a time and not trying to do it all at once, and role playing practice. Then we did some Externalization of Voices with the thoughts on Keren’s Daily Mood Log, using several strategies: Self-Defense, the Acceptance Paradox, and the CAT, or Counter-Attack Technique. You can see the Daily Mood Log she completed after the session, based on the work we did in the session, at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session In addition, Keren and Jill will be with us to record the follow-up. T = End-of-Session Testing You can review Keren’s BMS and EOTS (Patient’s Evaluation of Therapy Session) at the end of the session at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session As you can see, her depression score fell to 1, indicating substantial improvement, while her suicidal thoughts and urges remained at 0. Her feelings of anxiety vanished, but her feelings of anger remained fairly elevated, falling from 7 to 4. We would not expect further improvement in this dimension until she’s had the chance to share more of her feelings with her mom. Her feelings of happiness only increased from 10 to 13, again any further improvement would not be expected until she’s had the chance to do her “homework” following the session. However, her satisfaction with her relationship with her mom increased from 19 to 26 out of 30, which is substantial, while still leaving some room for improvement. On the EOTs, you will see that our Empathy and Helpfulness scores were perfect, along with our scores on the Satisfaction with Session, Commitment to homework, unexpressed Negative Feelings, and honesty scales. Here’s what she like “the least” about the session: “Nothing. This has been a powerful experience.” Here’s what she like “the best” about the session: “This has been empowering. The hidden emotion is like a blind spot. I know it is there, but I cannot see it. I loved when David pointed to my avoidance, and I am glad we focused on the hidden emotion. Jill and David were able to see the depth in situation and I feel seen and understood.” Follow-Up We exchanged a number of emails following the session, and will also talk to Keren and Jill live on the podcast so you can catch up on what happened. But here is an excerpt from one of Keren’s emails: Here is what has happened so far: On Friday morning, she made some comments about my gray hair and that the fridge gasket was not properly clean. I got really annoyed, but did not say anything. To be honest, I was too angry to use the 5 secrets and needed time to cool off. About after half an hour later, on our way to the acupuncturist, I told her that I love having her over and that it is special to me that we spend time together. She thanked me for everything that I am doing for her on this trip. Then I added: "this morning, when I came to check on you, you commented on my hair and then you told me to clean the fridge gasket..." I was going to follow up with 5 secrets, but before I was able to finish, she interrupted me and said "Gosh, I am so critical! I am sorry, I didn't mean it that way. I can see now why your sister gets upset with me. I can't believe myself." I told her that I love her honesty and while her criticism comes from a caring loving place the how and when she says things sets tone. This was a breakthrough because even though I did not finish using the 5 secrets I got through to her and felt heard. It was encouraging for me to feel that I could be understood and accepted by her.  I have clients who say that they love the 5 secrets, but like to call it the 3 secrets because they find it effective enough to use only 3. (I still encouraged them to use all 5). I can see now what they mean, I did not finish my 5 secrets spiel and got some good results. I believe that my conservation with my mother will further trickle during her stay. Perhaps because there is a lot to cover, or perhaps it's the way we communicate. In either case, I feel good about having the talks that I previously dreaded. I have not had any panic attacks since, but I don't think they have completely gone. I believe they will be there to remind me to address certain emotions that need addressing.. . . I will keep you posted and may even send this to the group. Just need to think about it a bit longer. Responses from the Tuesday Group
who observed our work with Keren Here are just a few of the comments from the 35 therapists who observed the session. This is part of the feedback we get on the quality of our teaching at the end of every Tuesday training group. Please describe what you specifically disliked about the training/ Nothing. The live work was fascinating to watch. David and Jill were masterful as always! This was a truly moving and inspiring and helpful session. I can't think of anything I didn't like about it. Nothing I disliked. I think I would have liked to see Keren do more deliberate practice with the 5 secrets with grading and more roleplaying. Conceptualization was a bit hard to follow. Please describe what you specifically liked about the training. Thank you for such an authentic, moving, beautiful session. And tour-de-force demonstration of TEAM therapy. Observing David and Jill as co therapists in service of Keren was an amazing learning opportunity! The power between them was exponential and felt like they successfully addressed every angle. . .  I had not considered using EOV and loved how effective that was in crushing Keren's thoughts. I also loved how Jill finessed gently guiding her to address Hidden Emotion, having clear conviction that this was where the "action" was. I can understand what Keren said that she wants to be closer but does not want to be enmeshed. I think that it helped us in our work with immigrants and those who live away from where they were born. The discussion about the desire to be a parent or not, was another aspect of the work that I really respected. Excellent class tonight! Keren's gift to the class was priceless and David and Jill's masterful teaching was outstanding as always. Thank you!!! I got to feel closer to her and to several group members through their sharing. David touched me with the notion that opening up to one's parents is an important gift that many of them don't get to receive. Thanks for listening today! Rhonda, Keren, Jill, and David