October edit 2026

0:00 Alan, I have one question. >> Okay. >> Um I have a client who, you know, had a lot of attachment trauma and working with his anger, which has a hard time feeling in his body, but somehow we ended up, you know, with his um talking about feeling the pain. And so that he could feel in his body. >> Yeah. >> And so I was wondering whether in some ways working with his anger was going too fast. >> Um possibly. >> do with the pain part? >> Um so um this diagram may help here because basically the easiest easier feelings to feel the grief

0:45 even when rage and guilt goes over the threshold, uh the grief can sometimes be felt and that's what you see with the first breakthrough uh where the main feeling is felt is grief about the trauma, grief about the past, grief about losses and the rage and guilt are still hard to access and they still can induce cognitive disruption or projection or or repressive symptoms. So it it's expected that you're going to the grief is going to come first and with all the feelings, just if they can feel it, let it go through, experience it. Um and they don't need to observe the body of a compo- component of this, it's just to feel it. So just um help them so- focus on the loss and the painful component of it and um and the widths of a waves of grief. And then the rage and guilt will usually

1:32 follow afterward or will try to follow afterward and it may induce symptoms up here that you can then regulate. And you might need to use your your graded format, um you know, your capacity building things, you might have to regulate anxiety, you might have to um do other things to um like recap. Uh you might do guilt immersion. You know, if they're talking about anger and they only break through the grief, then there's some guilt that's turning into the stomach or into confusion. So, help them observe that there's guilt there. And then just using graded formula log here uh, to move up to higher capacity. And the goal one of the main goals is always capacity building.

2:19 You know, you're always trying to raise that threshold above which that the person, you know, that person can tolerate a higher level of of complex feelings all the time. Is that okay? >> Yeah, that's helpful. Thank you. >> Okay. Uh, Wester? >> Um, I have two female patients with fragility and they both reported that when having heated arguments with their boyfriend and rage instead of CPD or nausea or muscle tension, they experience uh, a strong contractions in the general area. How do you understand that? >> So, if there's a history of sexual abuse and sexual trauma uh, or there's a sexual component to the

3:04 rage, then there can be uh, a genital effect from that. So, the rage uh, wants to do sexual violence in retaliation to whoever did something to the person, then they'll experience that. Uh, so be like a partial erection if it's a man or arousal, general arousal in a uh, female as a component of the rage. So, that's uh, that's the main way you see that. >> Okay. Thank you. >> Yeah. It's usually not going to be the first breakthrough. I'll tell you that. That's That's a later thing usually. If you're going to see that, it's after some repeated breakthroughs in my experience. Sort of it's layered down underneath there li- lighter layers of rage and guilt.

3:50 So, sexualized uh, rage is usually underneath other layers of rage and guilt in in my experience. Okay, uh is there any other questions or um you know, we're we're uh on capacity building, we're on uh uh this patient's had some breakthroughs already and different levels of intensity of the feelings uh is bring brings various increases of certain types of uh anxiety uh channels. So, remember the lighter feelings of the of the of the grief, you know, like uh violence and such they only mostly make muscle tension. These low-level ones make muscle tension and intellectualizing, but when it gets

4:36 to the primitive rage, it makes the smooth muscle and repression, and when it gets to the torturous rage it it goes to um it goes to cognitive perceptual disruption and primitive defenses. So, you're going to see more of that temporarily when the heavy zones of rage and guilt are mobilized. So, we'll see um Um so, we this is a patient who now has a capacity to look to stand under the threshold and look at what's going on above the threshold most of the time. So, so that's uh a good sort of relatively more solid position and then you're have five sessions left and the goal is how much processing can take place and how much capacity building can take place inside of your 20-session

5:23 time-limited treatment course. So um So, I think what we can do if there's no other questions for the moment is uh go to the uh next uh go to the we can just watch the rest of session 15. Let's just roll it through and chat about it. Uh it's in the we're in the middle of a breakthrough piece here. So, okay, so um now your options when you're over the threshold here, what can you do? What are your options? >> Recapping. >> You could recap. You could do a body focus like a for regulation.

6:09 Yeah. Those are the two main ones. You could focus back into the guilt. That's the That's the third. So, just underscoring that there's a guilt coming on its own should should make the anxiety go into the smooth into the striated muscle. So, it's like kind of like this. You shot over into threshold. You press on the caring and the guilt. At least make awareness of the guilt and it should bring the striated muscle, sighing muscle, sighing respirations and get out of the gut into striated muscle. The escalating claw the escalating aspect of this thing. You know, remember that when the rage when there's guilt Let's go up here. Um when there's guilt be can be felt, it moves it up enables the next level of rage. When they feel a little bit of

6:55 guilt about that, it lets the next level of rage. Before she's feeling the the guilt, though, she can get nauseated or anxious or cloudy or something. But then when you press and help her feel it and be aware of the guilt, it lets the next piece of rage move and then that itself has another layer of guilt in it. But the guilt and caring allow the next rage to move. The rage allows the next layer of guilt to move. The guilt allows the next level of rage to move. So, it's like a a chain reaction in the unconscious. Is that clear? Uh Does that make sense for people? This is extremely extremely important that you need the caring and positive feelings to be side by side with all the rages for this to be a safe process for every patient.

7:41 Go ahead. Uh comment. >> Is there some amount of like helplessness that's coming up here cuz she's pounding on him and he's just laughing, right? So, since she's not actually hurting him, um and and it kind of blocks the guilt from coming up. >> Um, I think that See, I've kind of centered back that there's that she has some empathy or sympathy for him, and that's letting the rage move more. Now, the the process of seeing him as a like a still hostile to her is just that that's just the next piece of rage coming up. It just lets the next piece of rage move. And helplessness is probably how she felt in the past. So, you might see a little echo of it, but you're going to help her not be helpless, you see? When she was going through it, she was helpless. She was small, right?

8:26 >> For sure. >> So, Okay. >> um >> Yeah. >> I have I have the question concerning uh this love issue. Like you told that that the process is safe for the patient when the patient is connected with the love. And the love is towards herself or towards the one she's murdering right now? >> Both both ultimately, but it has to be towards the other person. There has to be some empathy or caring for the other person. Even if it's moral guilt or just sort of general ethical guilt or whatever you want to call it. Um, about not wanting to be a torturer, right? >> And what about What about self-empathy?

9:12 That that she has not only rage towards the person, but also there is the base of love in her. Like there is attachment that the attachment needs to work hard. >> Yeah. >> That's why there is so much anger. >> Yeah, and it also because there's an attachment drive, that's why there's guilt too right? She had an attachment drive with this person, and then that makes the guilt when the rage comes. >> All right. >> Okay? Yeah, so. But again, there's only a partial experience of this, so you're only going to see a partial of the guilt because the guilt is still some will go to

9:59 repression, some could still skip into some projective, some can make you confused, some can go into, you know, a mixed bag of things. It can only partly be felt. But the grief is more easy for her to feel. The grief of the trauma that she went through these kind of some of these kind of the same abuses. Um, and she's felt a decent amount of the rage, but some pieces of guilt here, and this is important to to to get to and to um, follow as much as you follow every feeling, stay with every feeling that comes. But this rage is when they come like this, they have like a wave. The rage goes up and then it goes down, then it goes up, then it goes down. And um, so there there's been several waves. I mean, we saw some of it here, but we

10:45 saw some of it last time. This is a continuation of a passage of torturous rage. And now processing some of the painful feelings and guilt about it. Uh, what we did there, okay? She went through this whole round of complex feelings with the with the uh, with one person. It's then linked to other family members, and it's a and that rage, guilt, and grief are parallels with abuser and the neglecter who enabled the abuser. It's the same zone of feelings. And so, that's going to be another heavy zone right? Maybe worse in a way because this is someone who's supposed to protect and leaves her to suffer, okay?

11:30 So now we're I'm following the alliance through all this and see what it what it has to say here. But notice that she's not no symptoms right now. Her striated muscle, sighing respirations, reflecting well. We're down here under threshold with some feelings coming up. Does that make sense? Is it a lot kind of logical? But this is beautiful that she has empathy first and then a bit of nausea and then the guilt. And now she can see the guilt is being felt for a second before some of it slips over into the nausea. You see, into the thresh over the threshold. So an aspect of the guilt is felt then an aspect goes in the stomach into repression. But she's seeing it. And at the same time see she's she's

12:16 gaining confidence, she's gaining mastery of her system and um she's a bit proud of that that she can see these things right? Uh but this all I hope all of it is making more and more and more sense to everyone watching here that these processes are very specific and they're also repetitive. These are I'm doing the same things over and over and over again throughout these 15 sessions and throughout all these treatment courses that you've seen. People have been here for more than one. And you know, when we're we're up here, uh you know, we're not even up here. We can't even talk about it because this diagram doesn't have it, but we're in an open unconscious where there's still some thresholds to deal with. But I'm using the anxiety regulating the guilt focus um portraying um

13:02 indirectly I'm I'm challenging repression by by um recapping. Uh and I'm making it she doesn't tend to at this point to really dissociate in any significant in significant way. The clouding is more or less blocked. And instead she goes to nausea. So this is the standard stuff. A lot of repeats and um our job is to try to find which of the handful of interventions are most useful now, how to apply them, and watch the result, and see how you respond to the result. And we're always responding to the response. Our whole this whole model is about responding to responses, and our job is to try to figure out what response is there. And sometimes we can't really tell, and we have to inquire, we have to

13:48 observe, we have to ask, we have to be, you know, wait and see kind of thing. But then we get a response, that gives us a likely interventions that can likely help. And then we watch when we deliver it, does it is it beneficial? And we what does it do? What's the next response for me to respond to? And in that way, you know, um you're never in a situation, or you're rarely in a situation that you have to sort of be um kind of doing something without any guidance, you know, like so dropping an interpretive bomb of some kind, or or telling the patient what to do, or you're you're reading responses as much as you can do. So, any questions on that? Like that's general theme that I'm underscoring there, I hope you can kind of see uh

14:35 that this is getting more and more clear for people. You know, what the work is over here, up here, compared to what the work is on thresholds, when there's low rise, mid rise, high rise, and when there's an open unconscious at this point. Um down here you're activating work, you're pressing pressing bracing grading. Um mobilizing the unconscious alliance once you get up over here. Any questions on that? Uh What is it or is it >> Alan May, uh it's more like a comment and question. Um when you know, when when you went through with her, and she went through that rage, torturous rage with with her grandfather, and the guilt associated with that, and then the repression came,

15:20 she was tired and all that. So, I noticed that you went uh you know, like you recapped. And then like because she had brought up the family, so you sort of tied the family into that recap. And almost like preemptively sort of did a bit of a guilt immersion kind of thing that is sort of painful. And then it sounds like I wonder if that sort of then got her out of that sort of exhausted, tired sort of repressed >> Exactly. >> It did a guilt >> It did a guilt Yeah, it did a guilt immersion up here kind of thing if you like. See, I knew that she wasn't nauseated. Then she mentioned the parents the other family members were like co- co-abusers in some way. And then she got nauseated. So, I said, "So, what are we missing in the middle there?" We missed that there was also

16:07 feelings towards the family member, and she mostly went to the mother, and then we went to a picture that putting the mothers through the same things. It's a little different, and then guilt and some grief and empathy came through as well parallel to the other >> Yeah. Cuz one thing I notice is how quickly cuz it's an exhausting work. I mean, I think for for her and can be tiring. It can be difficult for us as well. But I think going through that sort of piece of recap and sort of guilt immersion, I think it probably helps her and helps us as well. I mean, when when we are recapping as well. Thank you. >> Yeah, very much so. And good thanks for reminding me. If we're getting tired, probably the patient is and take a break, recap, take your time, walk your way through it. The other thing the reason I went for this kind of shortcut thing that landed onto the mother was that we only had 15 minutes left in the session.

16:54 And I wanted to make make like do something with that because the unconscious was open and tying it to her, that one at least put a place card there. A place card that there are feelings there that are going to still make nausea unless we can face them. So, that's that's the other thing I wanted to get in there, and then that's going to lead me to final recapping here, which I think should be should be coming pretty soon here. >> So, it really really mobilized her guilt a lot. Um it seemed like it it really made her connect with the guilt and she shifted back to to the anger or some anger came up in the same sort of cycle. Uh but it was it seemed like a very strong intervention there.

17:39 >> Yeah, I think it it did quite a quite an impact. Um uh because you know, I I'm pressing her to take care of herself in order to take care of others. In order to do the best thing for everyone right? And so, that's a lot of pressure and that mobilized complex feelings also with me, right? So, it brings complex feelings with me and complex feelings with everyone else, too. Because it's ultimately she wants to give a gift, but she doesn't want to give a gift, you see? She's still not at the point she wants to give the gift. Right? And and as long as there's a giant burden of guilt, she's not going to give the gift. That's the sort of the principle. Okay.

18:25 Um so, let's see. Um let's take a break then. Um unless there's not any other unless there's a question in the chat. Just a second here. What's the psychological terminology for staying sick to punish others? Um well, ultimately a punitive super ego, a guilt-driven uh system uh works that way. Person suffers in a way uh to make other people keep feeling bad for the trauma they caused caused her in her case. Uh so, Julia, you're commenting about projective processes. Um well, I think she had complex feelings

19:11 coming up with me rather than projection though. You know, it says there's anxiety around it. There's mixed feelings around it. It's not You know, there's bits of split things and bits of something like but you don't need to operate with it or think about it like projection. You're not regulating it. You're not reflecting on it. You're not You know what I mean? You're you're working differently then. Uh yeah, it's the But basically staying sick, everyone survives. Right? But she suffers. But they suffer, too. So, everyone survives though. It's a trade-off, right? She doesn't torture everyone. So, everyone it lives. But she suffers and they suffer. Uh how do I know that she wants to give

19:57 give them a gift? Everyone, go ahead. You want to give it a shot? Why do you think Why do I know that there's something in her that wants to give them a gift? It's really what we're centering on a lot in this last 20 minutes. It's the positive feelings for herself and them as well. Caring, yeah. Ultimately, attachment drives. So, that's what you're talking about really. >> I think she would like to get well, but I'm not sure if she she would like to gift them. You know, it's like >> Well, it's going to happen though. You can't have one without the other. If she's well, they get a break. You know what I mean? Like um They actually get feel a relief of the burden of having made the made her

20:43 suffer. And that relief viscerally can impact on their well-being. The rest of their lives. >> If she gets well, it's unavoidable that they're going to get get get it as a gift. >> Yeah, and that's also why every person you're working with is kind of un They're doing therapy for the last multiple generations. I mean, they're They're doing multi-generational um therapy uh for their family uh and trying to stop something they they could transmit to others, but it's also giving breaks even to the person's dead in the spirit world, their spirit gets a break. >> Mhm. >> So, my I know we studied it. We've been to heaven. So, Okay so All right, I'm sorry. >> going to say I'm just so sorry.

21:29 >> Sorry. Uh wasn't it like a an extremely positive thing for her to say on about her family there that they were kind of sort of Uh I don't remember the exact expression. She said something like they were relatively otherwise okay family or otherwise good family. Like it was >> Yeah. >> like a lot of the good moved in to to consciousness and she was able to express it more almost more than she she ever did I think in these sessions. >> I agree. She did and that's because she went through this raging guilt enough to free up more positive, see? And and she's going to have a different perspective on them over time if she can keep processing these things. Yeah. Was there some other comment let me take her? >> Yes, for me. I was just wondering about

22:17 how do you see her posture like sitting with her feet up? >> Uh I think that's a nice comfortable way to sit on a couch and do therapy. >> Okay. >> If she was in my office, I don't know that she would have her feet like that. Uh >> Yeah. >> There's a couple sessions coming up where she's in the office. I think she still brings a wheelchair in at this point. Like >> Okay. >> to get in and all that or a walker or something and whatever it was at this point. Yeah. So, part of why I'm Evan's comment uh why I'm bringing it up at this point because it's part of the overall process of the trajectory of the treatment. What we've done, what there is to do, what benefits there are, what's coming ahead. I'm kind of talking about down the road when she is improved, it's going to reduce the

23:03 burden on others. Um and it's also motivation for her to in one way to take care of herself as much as she can to work on the keep working as hard as she is. And that there's going to be more than one to benefit from it. But um but it's going to be conflicted, right? So, I'm raising raising that conflict for her as well. Um And and also if she wants to harm the family, the way to do it is to keep suffering. So, that's the other thing. So, in other words, it's it raises the conflict. Okay. Is there anything else? Uh or we can just take jump right into the beginning of the next session, which is

23:49 an in-person session. Um and we'll see how this looks. It's a There's a bit of grading. Um so, there's some grading up of the complex feelings, which of course means the alliance. We're going to grade up together, right? Ushering them up with bracing and pressing and bit little bit of recap here and there. And a little portraying, but the portrait of course is a violent rage. And of course, that's about all that belongs in to you. You get a push. There's Where is it? A grab, shake, you know, when you Something like this. All striated muscle, lovely. Bit of guilt. Uh and the other thing is you're doing is you're pulling the rope. I like the concept of the emotional cascade as as a central aspect of this approach when it comes to

24:35 fragility repression uh and other patients patients with capacity issues. The attachment positive feeling often comes first. And then that brings the other uh feelings behind it. The trauma, the pain, the rage, the guilt, and then that of course brings wherever you're at, right? It shoots and does its thing. It either goes it can go up to uh you remember like positive feeling here like it might go to over if it's down here, the positive feeling's going to shoot into split modes. If positive feeling's here, it's going to go to projection. If positive feeling here, they're going to get fuzzy head. Here, they're going to get repressive. And then over here,

25:21 the positive feeling's going to shoot into muscle tension. Or they're going to feel it. And it's going to Are they going to feel then the grief? And when they get enough capacity, positive brings the grief, brings the rage, brings the guilt. You see they don't have a threshold, they can do that. Uh but for now, I mean, we're we have some thresholds, but we're not seeing anything of it yet. Not yet today. Uh but you know, this whole concept of pulling the rope or the emotion cascade from the attachment, grief, rage, guilt, right? You're this I mean, I'm really it's become to me clear that this is really like an anatomy and physiology of how this mind tends to operate in the in a vast most many fragile patients.

26:09 It's really all this stuff that we're talking about. And it's really a handful of diagrams. If you have these planted in your mind, you can have like road maps, multiple little road maps to help you to say, "Okay, I saw what that was. Now I'm going to go here. I saw what that was. Now I'm going to go here." You know, like you you have you get your get your guessing will get better as to what you're responding to and what to do. Okay? So, any questions on that? I mean, I hope it's clear what the capacity issues You know, we just went right up with nice striated and isolation of affect. Complex feelings have been felt already. And this already is already on the way to some kind of unlocking or partial unlocking or first breakthrough here.

26:57 You know, where we've got this complex feelings have been felt. Alliance is going to move. Defenses are going to drop. Right? Already. Just from what we've done. Mobilizing the complex feelings of rage and guilt get to the preconscious. She feels a bit of something with me and more grief's going to come later in the session. And some linkages are going to come. Whether that's a first breakthrough or partial unlocking to partial unlocking, there's more passage to the rage and guilt and then the link comes. That's just a difference compared to this first breakthrough. You know, this this drop down is is greater. And there's more window into the um Uh sorry, into the uh

27:44 uh you know, more more alliance stronger than resistance. Any questions on those things? Is it Is it Is it Is it getting clearer for most people both processes? Hopefully hopefully it is. That's the whole point of this course. Is it Is these repeats repeats repeats and it it just gets to be more routine for you and then you apply it over in your session and you look at this and then apply it over in your session and get your your reading ability improved and then and watching responses. So, she did have grief first. So, she did have this, but you see underneath when she feels this little mix of violent rage with me and guilt, the primitive torturous system is starting to come up tied in linking to

28:30 me. So, remember primitive torturous system, what's that going to bring, right? It's going to shoot those other other zones of anxiety and defense, right? It's going to bring the primitive system. And right? So, just this it shoots this. It shoots the torturous and the primitive. And then for a split second she thinks that someone's going to punish her, I could punish her. And then if you go to the other diagram, you say, "Okay, positive uh in grief. But then the rage and guilt are coming up and the little nib of it you could say it's it's she's not really cloudy but maybe it's kind of a little no nausea, but the I like something projective almost like the these sessions are all you can say in

29:16 continuity with one another. It's like one long session. And there's things happening between and sometimes it changes things, but often it's just a continuous session. Because we're back to the issue that the mother from the previous session, remember that piece that we didn't quite get to process? We had 10 minutes of it and it was kind of like putting a place card there. Well, now that instance come back now and she has, you know, would have 35 minutes here in this session if she if it's going to work that way. It was going to be a big focus on that one. So um you know, I hope it you know, it's it's a relatively comfortable process here. I hope it looks comfortable. It's conversational almost. And this is kind of like the river

30:03 after the rapids. You know, the early work is the rapids. It's it's bumpy. It's challenging. It's complicated. It's effortful. But this is now like we're like, you know, we're in the we're in the jungle and we're on the little river. It's kind of after the rapids and then we see, "Oh, that's an elephant. Oh, that's a giraffe. Let's process that." You know, it's a little bit more like that. Of course, it's more intense and terrible stories and painful stuff, but it has a different feel to it. And I hope you can see the difference. This is what you want to get to. And patients it takes a lot of effort to for them to get there. And um but you get that rhythm together and, you know, it it's self builds sort of security and kind of guardrails. And it makes it so that they can go to

30:49 these difficult places and uh be able to do the good work there. I mean, you see she only has one one little second of cognitive disruption with sheep walked, a little you know, nausea that we did a little thing on. That's it. Otherwise, it's nice cruising. So, why do you think it went like that? We were hanging around a Rolodex of how many people uh we were thresholdy, thresholdy, you know, we're over threshold, little fuzz, little of this repressive stuff. You know, so you could say we're up uh well, the other diagram, but we're somewhere we're operating up here somewhere. Uh fuzz, we're some repression, little regulating, we can portray sooner than

31:35 later. But why does it go to the transference? Why? Why does it go that way? Any thoughts on that? Why does the patient go to the transference anyway? Why do they bring you into this? It can be that >> They can get more guilt. They can get more guilt that way maybe. >> Well, I think it's it's a it's the safest place for one. So, there that means that all the feelings are better able to move and be together. So, potentially the guilt is more possible. Uh she's looking for a boost from me. She's looking for me to be comfortable that I'm okay with whatever's coming. Uh she's probably looking for a little recappy. There's also I mean, look at it.

32:21 This is so Look at what I'm asking her to do in a sense and I'm telling her I'm with you, but this is a hard process. You know, look at the what the the work that she's done and it's been, you know, at my encouragement that she does this work for herself. There's going to be feelings with us. So, there's another reason is just that there's feelings with me. Um and um the alliance The other simple way to say it is the alliance need more power. That means more rise in the complex feelings. To do that, we need probably bracing and grading up in the T. But, that's just some thoughts. But, let's see actually what what experience but from the parent of uh of

33:06 being nothing. The parent sees the child as nothing. I had a patient whose mother uh referred to him as it. Um like an object. So, um so, that's worse than being hit or yelled at, if you think about it. It's like it's death. It's also probably terrifying. You know? Imagine to be very small and the parent's doing this. Do you You're going to die. It's going to be a terrifying thing for a little one to go through. Uh and where life and death is is based on someone knowing that you exist. You get me? So, these are kind of core to the fragility uh trauma.

33:54 This type of basic basic invalidation of being a person. So, this is what she's getting at here is this kind of core trauma. And uh it's fascinating that you know, in one way she uh one level would want me to feel that, to know what that is, by just taking off and disappearing that I'm dead. Uh and uh you can sort of imagine what the process of the mother must have been. Some kind of projective dissociative kind of thing. Uh probably from the whatever she went through with her own father. We could We could speculate that's probably what the whole thing was that she ended up unconsciously automatically doing to the daughter. Uh Nat, when you guys presented about DID and stuff, but but fear, you know, um where fear

34:41 um this is kind of a way to man- to work with fear. When she's scared, she's experiencing it, and you're validating it, you're walking through it. You're uh helping her de-fear herself in a sense and empathize with the little one with the fear. And you know, because you can't go through this. You can't go through fear. When a person's in that, you can't go around it or try to push your way through it, or they'll go into projections and everything else, and you get all this dysregulation up here. And then the patient could get so scared they leave your office, they run out. I've had it happen. Uh I had it happen to a guy who was uh he was a recovering addict, and I was working I didn't This is like I didn't realize that way the hell up here

35:29 I we're way the hell and he said, "I got to go. I got to do that." And he went out. He came back the next session, but he was scared. And like I didn't recognize that it was like, "Wow, he's scared." So anyway, um so I don't know. Worth You got a word or two Nat? >> Um Yeah, I've had people run out of the office also when I didn't realize that that they were afraid. >> Yeah. But so it's it's one of those things is you have to have a space in your off- your office can't be frightening, you know? It can't be a scary experience. Like you have to have the security to offset the fear and that they can co-reg- You can help co-regulate the fear and the excessive anxiety. It's all a And then this is kind of an example of doing that when it arises, I think.

36:16 Does that look all right? Okay. Great. Thanks. The flow is going I mean between I Actually, why doesn't someone Why don't you guys tell me what you think is going on here? Let's hear what you guys think is going on here. over these minutes. What's diagram's useful? Maybe this one. Someone want to give a crack at it? I mean Here's what the way I'm seeing it is

37:02 there's all the different feelings are are moving around. They're they're all within time of each other. They're close to each other. Positive for them, grief, rage, guilt. Uh and you see this experience of this dissociative piece here which is like a thicker zone if you like a CPD. Yeah, and they that's another way to think of it is the guilt is is coming up but it's also the grief and there's the there was the fear layer over all this thing part of the trauma being the fear. And um but she's kind of moving between these different feelings kind of or you know naturally. And I'm just sitting with her with those. Um

37:47 I'm open to if the transference is where it needs to move otherwise that zone in that that hell room in the basement uh the torture chamber um is where she's sitting. And she's doing doing really well. Yeah. But you see it's so painful and so heavy that it there's a tendency to dissociate away but she catches it and pulls herself back. So no surprise that dissociation is the way it goes when there's this kind of intense trauma. I mean what else can a kid do? They can project. Uh but it even if they try to project, that can get jammed sometimes and then they're stuck to dissociate off whole aspects of themselves or whole pieces of memories or whole

38:35 aspects of the mind. Uh or just being in other CPD standard CPD all the time. Okay. I hope you can see that how immediate it is when you point to the guilt, the caring, the compassion, the the you know, positive aspects of the person in these moments and the wish not to do it, that those symptoms just go. Or um when you help them to feel the emotion a bit more, the symptoms just disappear. It's it's like it when you when you have this many rounds working together this many times, um the interventions work quickly, typically. And um she and you getting on the do the brain things you need to do to

39:20 regulate. And you do it seamlessly, like after a while you become like it just becomes like a flow. Uh and that lets them do the deepest work they can do up to their capacities. And and you know, you're patient, you're not in a hurry, you're not pushing anything, you're just there for whatever the patient can do. And that's a very important stance to take here. You know, and real you realize, okay, this is horrible, brutal, you know, uh horrendous. It's a painful thing, terrible thing, right? And you sit with that, you know what I mean? And then the patient learns to be able to sit with that. And you get used to this too after a while, you get used to these things, even though the stories are always a little different. But you'll get used to it. And then when you're more used to it you're

40:07 you're viscerally toughened up to it and you can you can sit through it. And and that lets them see your strength and they draw on that then they can do harder work and based on that. So, these things are kind of a core aspects of this process. Yeah, exactly. This is like a witnessing of her unconscious. Yeah absolutely. You know, and I'm in this and this is when uh you got to you know it's it's it's it's interesting. You can go through this and the person and it doesn't matter what they've done. Uh you know, she's done terrible things uh and uh apart from hurting herself.

40:52 But, it doesn't it's fine it's fascinating to me that it doesn't matter what the patient has done. You can understand the whole thing from start to end. And when you can, it's like it's such a validating experience for the patient, you see, and it makes that safety and security that you're not going to start attacking them, judging them, or being abandoning them, abusing them, and all that stuff. So, that's so important for these patients. They can smell it a mile away if you're going to do any of those things. And they'll just disappear out of treatment and they do, you know, drop out they'll you know, act out uh you know, something happens, they're just gone. So, it's it's uh it's a place to get to. It's a place to work at being comfortable um and certainly it's not simple and it's not even natural, I don't think.

41:39 You know, it's not natural. Uh these are unnatural things for a person to have to go through. You know, so you're witnessing an unnatural thing, you know, like it's not it's not natural. I mean, most people can't haven't been through this to be able to say, "Oh yeah, I know what that thing is like." You know, I I haven't been through that to know what those things are like. So, you got to learn it from the patients, you learn it from watching these videos, it gives you the kind of a bit of a visceral parallel experience, and that gets you so you're kind of prepped for when you when you get there with certain patients so. Okay. Um It's It's interesting she has moved from it's disgusting that I could think these things to whose fault

42:26 is that that I am thinking these things? Exactly. Yeah. Where did this come from? You know, this is not born into her, right? So Yeah, so she's oscillating between empathy, you know, guilt, rage, grief, and it's just it's flowing one to the other, one to the other, one to the other in a nice kind of soup of complex feelings. Yeah. Yeah, I'm not married to the outcome. I'm not married to anything. I'm very I'm very I guess I'm a Buddhist. I don't know. Someone tell me. I'm not attached to it. Because the thing is there's no point to be attached to something that's you don't have any control over, you know? Like I don't control how this is going to go. I bring what I can bring.

43:12 And for her, because she's been so controlled by others, I think it it's a good match for her to be not married to an outcome and not, you know, in you know, insisting on something or, you know, like these kind of things. Um Because to me this is pretty brutal. It's pretty heavy. Um you know, it's not kind of countertransference uh feelings, by the way. Just human human feelings about uh hell that people go through and uh and how could you know, how and also how that people deliver to others. And it's just basic human feelings about you know, terrible things that happen and um you know, people that also deliver it to the other people by not in order to not clean up

43:59 their own system. That's kind of a, you know, summary of it from my perspective. What I Any thoughts you have, comments. Um You know, you can certainly see uh where people run into trouble if they have a loaded unconscious like this because it's what the hell are they going to You know, what's a person going to do with that? It's uh you know, it's going to be some kind of self-destruction or damage to some other people or criminal activity. It's going to be some kind of brutality somewhere directed inward, directed outward. You know, maybe they'll you know, get a power position and start harming other people or other whole whole countries. I mean, that's the other thing. If he becomes crazy,

44:45 uh the harm that can a person can do to in order to avoid himself in a sense. So But any thoughts um as we we wrap up here um you know, it involves being careful with our you know, taking care of ourselves to do this work. Being gentle with ourselves to do this work right? Um Try to feel your way through it. Be reflective on on on what this what's going on within you as a way to regulate it, but also process if there's anything that just pulls up from yourself, from your life, from things that you've witnessed or been through with and this is also a very natural event to happen. Um so it's a double healing can take

45:32 place there. But be careful. Uh how many patients do I see? Oops. This disappeared. How many of these Okay, so I would have not I don't have that many patients these days. So I'd say no more than like eight. No more than eight at a time. >> Eight like eight like this? >> Eight that are Yeah, very fragile, wheelchair, with seizures, functioning, fainting uh That's the max. That's the max. >> But in terms of their trauma burden? >> Our trauma burden? Well, um okay, now let me think here. Um 1 2 3 No.

46:18 I mean, I'd say this is probably 5% of all the patients that have this kind of load if I think about it in my whole career. So, 1 in 20 have this load, and then there's like another 15 have mild and moderate fragility, and it's a little different to work with them, and then it's uh but it's 20% of fragility in the private practice I had. Uh 1 in 5. Um with this kind of abuse level, um repeated and early and all that stuff, oh god, I mean, that's not that's not that common, I would think. I mean, it's not that common in our my practice. I think they land in other places. I mean, some of them end in jail. I think a lot of them die. They don't make it up to 37 or whatever, 27.

47:05 So, yeah. Yeah, I totally understand what you're saying, Bill. I mean, you want to think it's not true. You want to think that this isn't what people can do to each other. It's just that bad. I mean, uh you know, uh you hear about people that are that that that get these repeated severe abuse early on. I mean, or it's it's almost most of the time it's girls. Um you know, it's I'd say it's like 1 in 5 would be male that would get to us at the most. Uh but it's so it's young girls that are going through it, and you think, "God, can this happen? Does the world do these things?"

47:51 You know, like it's just terrible, right? Yeah. Um did mentioned her that her being okay would be a gift to those who abuse it crossed my mind. You were hinting at her incapacity to walk as a way to punish her mother. Yes, indirectly, Arnold. Indirectly, I'm saying it's both. If she suffers, other people suffer and they keep their guilt and they go to their grave guilty. If she gets well, at least some part is healed inside herself and of the parents. Uh oh, yeah. The urge to dissociate. Like look I mean I I don't think you're human if you don't think that that's a good option when you're watching this content. To dissociate your way. You know what I'm saying? Because it's

48:37 brutal. I mean think about it. If they made a movie about this, people would sit in the theater and they wouldn't remember anything. They'd just leave. They would They wouldn't be able to remember anything because it would be completely dissociated away. Cuz that's that's how bad it is, so. And then you understand that helps us understand dissociation as a defense operation right? So. >> Yeah. >> Any other questions? >> Alan? Yeah. Yeah, Julia here. Um I I had a sense in this session that she's been able to talk to other people perhaps close to her about what happened to her, but my sense was this is the first time she ever talked with anyone else about what her system wants to do

49:22 and the cruelty that she can feel coming up inside of her. And to have you sit there and just calmly walk through this and not leave her, right? >> Yeah. >> Well, I think what a gift that is for her right? >> Yeah. Yeah, I mean it it's it's it's it's privilege for for me. As terrible as it is that someone had is that kind of confidence in me. And so it's it's a two-way thing, but yeah, I mean, it's tough for people to sit with, right? Yeah. >> Yeah. >> Uh >> So much So much isolation isolation in her life got changed in this session, I

50:08 think.