Pivotal Moments - Conclusion

"The world isn't created of atoms and molecules, but of stories.  Maybe I wanted to create a world.  A new one … where I, and we, could be happy and safe."

              C. Anthony Martignetti.  Beloved Demons: Confessions of an Unquiet Mind.

Anthony Martignetti is a psychotherapist, who came to writing late in life.  He had the good fortune to be close to Amanda Palmer, who introduced him to the well-known writer Neil Gaiman, when Amanda and Neil became a couple.  

I do understand why so many psychotherapists begin to write.  It's a chance to re-visit, to make new pilgrimages to old places.  So much of therapy is about hints and clues passed back and forth.  Your pivotal moments.  My pivotal moments.

Sessions unfurl like the thread of Ariadne, leading us deep into the maze of our own self-remembrance.  With each successive new encounter, we are offered another chance at re-creation and re-imagining.

I was sad to hear that, shortly after the Winds of Change conference, Jim Duvall announced that he will no longer maintain his active affiliation with Hincks-Dellcrest.  I imagine him down somewhere in the American south, taking it slow, reflecting under glistening stars.  I heard Jim once say: If there's pathology, it's the system, not the patient.  It's good to remind ourselves that such is so.

I did promise I'd share Jim's relating of a pivotal moment, taken from his clinical practice.  I don't have a lot of the details, but his story told of a musician who severed his relationship with music for many years, after suffering a trauma.  Much later, along the post-traumatic path of his own string of pivotal moments, he saw his relationship with music-making in a new, transformed manner.  Finally, he started playing again.  Now, he possessed an alternative relationship with music, which had taken on new meaning in his life.

If we stand in the ambiguity and uncertainty of the pivotal moment, we are offered a chance to re-incorporate old gifts and identities with the fruits of new learning.  Something shifts.  Jim recalled how someone asked Ray Charles how his music had evolved.  Ray answered that there were less notes and more space between the notes - that's what made his music sound better.

During the workshop, we asked ourselves if we could imagine what might be happening in the brain when we stay in a pivotal moment long enough to achieve new meaning and outlook.  I'm not that enamoured by what we know at this point in neuroscience to struggle too hard with this question. But I have heard enough from people like Pat Ogden, Daniel Siegel and David Grand to believe that there can be a powerful re-orginazation of brain structures during these episodes, with the undoing of old, restrictive defensive dissociations.

At best, our goal is to help these moments of growth to stick.  Brain scientists know that neurons that fire together wire together, which challenges us to find ingenious ways to deepen the experience of this new organization of experience.

As a sensorimotor-trained psychotherapist, I sometimes see big shifts come in a different manner than the narrative therapists do.  Working with traumatic cues as they arise, we utilize clinical skills to engage the brainstem and to re-organize truncated animals defences that have been disabled during events where patients were unable to complete an active defence before an immobilizing one (freeze or feigned-death) took over. These patients - without this kind of work - continue to manifest these thwarted and disorganized defensive patterns decades after the traumatic event, leaving them at risk in the world.

I remember in one case we were completing a truncated defence in session.  The patient had been severely abused by her father, and carried many scars and embodied traumatic beliefs with her as sequelae.  When these techniques work, they are quite dramatic to watch, because there's a reorganization that starts in the primitive brain and then shifts into cognition.  You can literally see (if you've been trained to see this sort of thing - I happen to have been an emergency physician for over two decades, which helps a great deal) the autonomic nervous system cycling back and forth and finally settling into a more balanced and calm state.

As her nervous system re-set itself, my patient began to see her father in a different light.  She did not see him as better or different, but was able to form a more nuanced, less emotional view of him.  She could see his own wounded-ness, and sense the abuse as less personal, less a reason to remain held in an oppressive victim consciousness.

So, in sensorimotor psychotherapy, we don't stop there.  We note the shift in the body and the transformed belief that goes with the new somatic state.  We deepen this new, stronger state and we then help the patient to begin a daily practice, linking the five core organizers of thought, emotion, internal body sensation, five sense perception and movement.  We bring it all together into a new, more resourced way of being.  

As I complete this series, I am reminded of watching what seems to me to be my first display of how powerful a pivotal moment can look.  It comes from watching Gary Craig, the masterful founder of Emotional Freedom Technique, a form of energy psychology.  Gary was working with a Vietnam vet who had been overwhelmed by guilt after shooting a child who was preparing to throw a grenade at him.  Years of talk therapy had not helped him and his life was stuck until, during the meridian point tapping, he stopped trembling, his body came out of hyperarousal and he said, matter-of-factly: I get it now.  It was either him or me.  I had my own children back home and I needed to get back to them. Was it the tapping helping to activate both hemispheres simultaneously, or was it the calming delivery of Gary Craig.  It's impossible to know.

What I do know is that these moments are unmistakable.  The shift in the body and in stubborn and deeply held beliefs are profound and quite sudden.  They cannot be forced but we can be midwives to their appearance. They define the work of good therapists and good therapy.  They invite us to slow down and to pay attention.

A few notes:

- in the workshop, Jim Duvall also mentioned that one of his patients had experienced a pivotal moment after contacting the memory of making snow angels.  I had just watched the movie The Perks of Being a Wallflower a few days earlier, where the troubled main character leaves a party to make his own angels in the snow.  Sometimes, different threads come together like this, and I ask myself who is doing all this cosmic weaving.  Have even the heavenly beings taken up needlework for stress relief?

Anyway, as I promised earlier, I will be blogging about this touching and heartfelt movie soon.

- for those of you interested in these things, you can read an article entitled, Research as Retelling: Capturing Pivotal Moments in Therapy and Training, at:

http://www.brieftherapynetwork.com/documents/Duvallarticle.pdf

One of the authors is Faye Mishna, MSW, PhD, who presented one of our Wednesday evening sessions in March, 2012.

Angel Yuen, from the Narrative Therapy Centre in Ontario, presented a Wednesday evening talk entitled: "What is Narrative Therapy" in October, 2012.

- I thank one of my patients for introducing me to Anthony Martignetti last year.  My patients do seem to be quite enthusiastic in recommending books (and movies and articles) for me to read.  For the last few years, I've been so behind in reading everything I want to read that it hardly seems to matter if I add more to my list.  But, if you, my reader, decide you too want to recommend a book to me, please take brief pause.  Hopefully, if you do recommend something, I'll be seeing your suggestion after my first coffee of the day.

Pivotal Moments - Part Two

Today, somewhere in the middle of her session, a patient of mine paused for a very short moment, turned reflective and interrupted her narrative to say: something woke up in me.  Her oldest child was transitioning through a milestone, and was passing through her own transformation.  As she described the event, from the perspective of a witness, a participant in the milestone, and a mother, for a moment, she touched into new territory.  Her story had opened up into a pivotal moment.

In Part One of this article, I mentioned that these moments often come and go, and - like a forgotten dream - are not allowed to impart their sense of new possibilities.  Often, unless we are reviewing our own sessions on videotape, with trained supervisors, we won't even know these moments have arisen, been missed and passed us by.  Or else, we may not even recognize that we did play our part in altering the rhythm of the session, thereby allowing the pivotal moment to expand and deepen.

I find in these moments, we can meet our patients both implicitly (via body language, tone of voice and gaze) as well as explicitly (verbally and directly).  So, changing the prosody of our delivery, we might simply state: something changed there for you, or, can you tell me more about how that feels, to have something awaken in you.

In this case, there was a great shifting of values and priorities, and a chance to allow memories of early messages from her mother to emerge.  She recalled being encouraged, at a young age, to distance herself from the world of approval-seeking and of mainstream displays of success.  Now, an accomplished mother herself, she was perhaps preparing to impart a similar message, refined by her own experiences, to her own children.

When I think about other pivotal moments, one that comes to mind is an old one told by Ram Dass.  Back when he was Richard Alpert (not to be confused with the ageless character on the TV series Lost), he travelled through India, searching, until one day he met a man who could see him as he was.  The act of being seen, of knowing that his interiority was recognizable by another, set off a radical transformation of his sense of living in the world.

Gott Mit Uns and Dieu Avec Nous

In his soldier's memoir and moral history of the Great War, Under Fire: The Story of a Squad (Le Feu: Journal d'une Escouade), Prix Goncourt recipient Henri Barbusse leaves us with an unforgettable scene.  In it, he is underground, surrounded by a overflowing sea of wounded men.  Near the end of a French offensive, the sleepless medics and doctors lack the manpower or resources to care for all the casualties, who endure their maiming and pain mostly quietly.  One of the wounded the narrator overhears is known only as the aviator.  He has been badly burned and is patiently awaiting treatment or evacuation.  The aviator relates his story of flying over No Man's Land on a Sunday morning, where he can - for a moment - simultaneously view both a French and a German religious service.  He is mesmerized by the fact that they are essentially identical.  And yet how can God be with both sides.  Isn't this impossible?  Struggling with this, he briefly surmises: "But there's only one God.  It's not where the prayers come from that bother's me, it's where they go."

In pivotal moments, often we are struggling with a new, more mature spiritual view of life.  As it has been said, religion is for those fearful of hell, while spirituality is for those who have already endured it.

So, I can imagine that the aviator may continue to deepen his outlook as he processes this haunting image and his wounds, but instead the dugout comes under shellfire, and we are unsure if he ultimately survives.

If war is ultimately about confusion and loss, sometimes therapy can be a powerful opportunity to re-visit painful, obscured and traumatic memories, now with the support of an attuned and caring therapist and the calm of the present moment.

Yours Will Do Nicely: Writing and the Pivotal Moment

In her first collection of short stories, "death is not an option" young American writer Suzanne Rivecca seems particularly adept at creating characters who find their way to pivotal moments.  Like her, they struggle with their Catholic upbringing.  They also struggle with what are poignantly contemporary struggles; with belonging, identity and self-image.  Near the end of the story Yours will do Nicely, the young female character confronts the recent act of lying to a man for whom she possessed a powerful attraction.  This man recognized her lies and discontinued their relationship.  At the same time, a male "best friend" is next door, seeking solace after she had read aloud from a sex magazine she had found in his apartment, while ostensibly helping him to move.

"It was then - sitting alone on the only remaining piece of furniture in Tom's apartment as he jerked off in his bedroom and those kids spun below me, suspended at the end of their long chains like marionettes - that I thought about, for the first time, how I'd lied to Jason.  And I'd known all along, but still the knowledge felt new, and stunning.  The palm-reader thing was true but none of the rest.  I was never anorexic.  Tactless strangers regularly asked me if I was; but I'd always been naturally skinny.  And all I could remember about Catholic school were the hymns and laughing with Rachel all the time and how an ancient priest said, "Just try to be nicer", when I confessed the sin of mocking some poor girl's hair.  The guy at the Rainbow Festival didn't try to rape me.  Maybe he would have, but I never went into his tent with him.  I would never have been that stupid.  And even though I knew these things weren't the exact truth, they were a variation of it, and they felt true as I wrote them down.  And they still felt like the truth - as if on some deeper, irreproachable level, those incidents hatched me like a newborn chick and I'd crawled from the wreckage of them with a bright new face.  They had to have happened, because if they hadn't, how could I explain the unhappy accident of myself?"

It's a pleasure to write these words down, to sense the deepening of experience here, meaning created through shifting connections, disconnections and reconnections.  We all know from hard experience in the trenches of therapy that change is neither linear nor straightforward, or at least we know that change like that never lasts or withstands the challenges of everyday life.  True change emerges like this, erratic and unsteady.  At first it sounds unreal and contradictory, until finally, if we can hold space, a new sense emerges, a deeper albeit less clear sense of things that can endure the challenges of life.  This new sense of being and interconnectedness with life is now flexible enough to allow us to navigate what Dan Siegel calls the river of awareness, which flows between the treacherous regions of rigidity and chaos.

In Part 3, I will complete this series, providing a clinical example related by Jim Duvall in the Hincks-Dellcrest workshop.

Take some time again to reflect on your own experiences, when - in a pivotal moment - a new vista opened up before you, and you walked away with a more mature, less simplified, less rigid or less defensive attitude towards life.

"Their eyes are opened. They are beginning to make out the boundless simplicity of things. And Truth not only invests them with a dawn of hope, but raises on it a renewal of strength and courage." Henri Barbusse, Under Fire.