Emotion-Image Therapy. Analysis and Implementation. Nikolay Linde
The imagined gradual plunging into the water showed that the fear comes when the water touches her throat. It seems to the girl that the water can strangle her. To the question if anyone ever strangled her in the past she answered in the affirmative: “A man attacked me in the dark park, tried to strangle me. But some people were passing by, so he got frightened and ran away”. She is afraid of dark alleys too.
The hypothesis is obvious:
a] the frustrating need of security;
b] the barrier to feeling safe and secure is her past experience, when the client couldn’t defend herself, felt helpless and frightened. The fear materializes in the situations which, by association, make her remember the trauma [water touching her throat or dark alleys];
c] the event that caused the fixed state of fear – the attack of the maniac who tried to strangle the girl. The memories don’t come by themselves probably because they were ousted, the emotions are experienced without the realization of their connection with the initial situation.
The final check of the hypothesis happened after using the method of restructuring of the past experience. For this purpose, the client was asked to imagine herself to be strong, invincible and doing with this scoundrel all she wants. She beat him till felt fully satisfied, and he [in her imagination] didn’t run away. She felt that she was not afraid of him any longer, the imagined plunging into the water didn’t frighten her either. In her mind, she could plunge into the water not only to her throat but even with her head underwater and she didn’t have any fear. This confirms that the hypothesis and curing actions were correct.
This case is quite simple to analyze, that’s why it is given here as an example. But even here you can notice that there appear some new aspects of the hypothesis. For example, the idea is raised in what way the past experience gives rise to fear and why the client remembers only emotions and not the traumatic situation.
A hypothesis can have many additional ideas explaining:
1] in what way inner psychological conflict originates symptoms;
2] what the meaning of every symptom from the viewpoint of its place in the structure of the problem as a whole is;
3] why the client doesn’t understand some psychic phenomena;
4] in what other way the inner problem can tell on the client’s life;
5] what forms of adaptation the client uses to avoid facing the problem;
6] what he gains from the existence of the problem;
7] how the problem is connected with the character of the client of some particular features of his parents’ family and so on.
For example, if you answer points 1—4 about the previous story, you may suppose;
1] that the client has distorted relationships with men;
2] that she doesn’t only refuse to go into the water bur develops a pseudo theory that something is “happening with her head”;
3] that she has a closed character, that’s why she didn’t tell anybody about the attack;
4] that she displays a helplessness complex in other situations and so on.
You can verify these suppositions asking the client additional questions, but they may be unnecessary because the main reason is clear and the treatment has taken place.
The given example, however, doesn’t reveal the process of creating the hypothesis, you may say that it just “fell” in the hands of the doctor practically in the form of clear knowledge. So, we should reveal not only what the ideal form of a hypothesis should be but also how it is created and checked.
1. First and foremost, the basis of creating a hypothesis is a certain psychotherapeutic theory. It may be psychoanalysis, Alfred Adler’s theory [30—32], transactional analysis of Eric Berne [33—36], gestalt therapy [37—39], Victor Frankl’s logotherapy [40], and so on. Usually a doctor naturally advocates one definite concept and creates a hypothesis in the frameworks of concepts used in it. But he may use another theory most suitable to explain the given case. Such eclectic approach seems to be most sensible at present.
2. The awareness of the so called particular models facilitates the search for an adequate hypothesis. These models readymade theoretical constructions which exist in scientific psychotherapeutic world. They explain the origin of different symptoms. The doctor tries the patterns known to him to explain the phenomena he faces and chooses the one that is most suitable, checking it by asking test questions. A lot of such models are described in my book “Psychological counseling. Theory and practice” [5].
3. The knowledge of different therapeutic cases also helps the doctor. New cases may be somewhat similar to those he had in his practice before. Or it may remind those he read about in literature. Or those he watched in the work of other professionals, for example when he studied in a group.
4. His own practice of being a client in the course of the so-called learning therapy. He solves many problems by analogy with problems he solved before, using the whole arsenal of methods of the professional instructing him. Gestalt therapists joke that “the client always brings us our problem”. For that reason psychotherapy cures the psycho-therapist himself, and curing the client is a by-result. But there is more truth than humor in this joke. The doctor always applies the client’s problem to himself, if he can solve it for himself he will solve it for the client too.
5. The doctor is also helped by broad erudition, the knowledge of philosophy and religion, just great life experience, being familiar with various life collisions and people’s characters.
6. The doctor is led by intuition, his ability to empathy, using the feeling of emotional resonance with the current state of the client, his ability to put himself in the situation of the client, being attentive to details, meditations leading to insight.
7. Finally the doctor must be very shrewd and have a great intellect. His work at the stage of creating a hypothesis is like the work of an investigator. Among detectives you can meet a Sherlock Holmes and a useless Lestrade, the same may be true of doctors. You should train your professional and psychological thinking.
8. But probably the most important thing that helps a doctor is the skill of looking for “evidence”. In psychoanalysis this is the method of free associations and dream analysis, in A. Adler’s therapy it is the analysis of early memories, in therapy through emotions and images it is the work with the images of emotional states, in cognitive therapy this is registration and analysis of automatic thoughts and so on.
A ready hypothesis originates very seldom. At first it is very vague, then is verified and checked. They are collected as parts of a mosaic from very different sources. To collect them you use various methods allowing to extract the necessary information out of the subconscious world of the client and from the anamnesis. But you should remember that you can get part of the information by asking simple questions about the life story of the person. A client may deliberately hide some information, he may distort some information, and he may simply not know something about himself. We gain some information watching his non-verbal behavior, and some we “calculate” analyzing the facts given by the client.
We have already mentioned that in the EIT the main source of “evidence” are images produced by the client, when he is asked to imagine how feelings and emotions look. For example, a girl complains about the pain the whole left part of her body. She is asked to create the image of what causes this pain. In surprise, she said that she saw her father who is shouting something in her ear and she didn’t want to hear it. The reason of her psychosomatic state becomes quite clear, though you can still ask her many questions clearing up her relations with her father and thy will probably take us to her distant childhood. To correct her state, I asked her to offered her to tell the image of her father: “Shout, shout louder, I want to hear you better!” In surprise, she confirmed that “the father” calmed down and the pain she felt passed.