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 Section 7 Factors Impacting the Recovery Process (Part 1)
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 In the last section, we discussed   overriding obsessive anxiety.  In  addition to discussing ways clients   can prepare for this technique, we focused  on the two steps to   overriding obsessive  anxiety.  The two steps are exposure and response prevention.   Clearly your client’s present is   inextricably linked to his  or her past.  Do you recall Janelle from    Section 5: Uncertainty Training?  Janelle  was weighed down by regret,   pain, and guilt over things that happened decades  ago   and was therefore  unable to live  fully in the present.  Would you   agree  that as long as Janelle perpetually gazed over her shoulder, she   would  continue to struggle with anxiety?  Think  of your Janelle.    Does your client feel  distracted?  Does he or she complain of  feeling   less alive than he or she is?   Does your client’s past seep into the   present and contaminate almost  every one of his or her thoughts,   feelings, and actions? In the next two sections, we will discuss Past Redemption.    Our  discussion will be identified by the first  and second keys to   past redemption.  This section will cover the first key to past    redemption.  We will also introduce  the "Healing Hurts" Technique.  As   you read this section, you might  consider your anxiety client.    Could he  or she benefit from hearing this section, perhaps in a future   session?   ♦ The First Key to Past RedemptionFirst, let’s discuss the  first key to past redemption. As you  know,   buried feelings, especially painful ones, have a high rate of    resurrection. I stated to Janelle, "This  isn’t my opinion. It’s a fact.   Unfinished business takes on a life of its  own because the brain   remembers incomplete tasks or failures longer than any  success or   completed activity. It’s technically referred to as the "Zeigarnik    effect." When a project or a thought is  completed, the brain places it   in a special memory.
 
 "The brain no longer gives the project priority  or active working   status, and bits and pieces of the achieved situation begin  to decay.   But regrets have no closure. The brain continues to   spin the memory trying  to come up with ways to fix the mess and move it   from active to inactive  status. But it can’t - not without our   deliberate help. That’s why the first place to begin a journey toward   redeeming the past is where it hurts. Healing your   hurts, particularly if they run deep, will likely bring  closure to many   parts of your past. Be  aware, however, that healing your hurts is a process of painful  self-exploration. Personal growth almost    always is. But no matter how painful the  process, it’s worth the   price."
 Before Janelle got too nervous about   rummaging through  painful memories, I explained why it was necessary.    I stated, "By healing the pain from your  past, you will be protecting   yourself from repeating the pain in your present - especially in your   relationships.  That  may sound strange, but we use new relationships as   replacement parts for old  hurts and old losses.  
 "For example, think  of a parent or an ex-spouse. Every  relationship,   in a sense, gives you another chance to resolve issues you didn’t  get   squared away in the previous one. But  if you do not heal your hurts,   you’ll never get them squared away. You’ll just continue to repeat   relationship  problems and replay your pain again and again."
 
 ♦ Dad's Change of Plans
 As I spoke with Janelle, she recalled an infuriating scenario that played itself out on several occasions when she was a   child. The issue involved sudden changes in plans  that meant missing   out on something Janelle was excited about.
 
 Janelle stated, "Of course, this happens to  everyone.  But my dad   seemed to have this  down to an art form.  It could be as  simple as a   trip to get ice cream or as involved as a trip to Hawaii.   But it   happened all the time.  Many times, just as we would be closing in on    whatever it was I was looking forward to, dad would go on another drinking binge.    He’d be gone for days, spend all  his money, and come back like it was   no big deal.  I got kind of used to it so I started  thinking, ‘No   harm, no foul, right?’  After  all, we can get ice cream tomorrow.  We    can go to Hawaii next year."
 As you probably know, the repetition of   being deprived of  things she looked forward to led Janelle to harboring   negative feelings.  I asked Janelle how her reactions as an adult    toward similar situations compared with those of when she was a child.  
 Charlie's Change of Plans
 Janelle stated, "I remember when I first got    married, I guess this history came with me and my baggage - and I can’t   even  remember packing it.  The first time Charlie,  my husband, tossed   out an idea for changing plans for something I was counting  on, I   nearly went berserk.
 
 "We were going  out to eat - a big weekend splurge for grad students - when   he suggested a  different restaurant than the one we had previously   decided upon. 'How could you even suggest going to Hamburger  Hamlet?!   We already decided we would eat at Green    Street, and I’ve been   looking forward to this all  week.  You said you wanted to go there. I    can’t believe this!  I know exactly what  I want to have, and now you   want to deprive me of it?!?'
 
 "I can still remember Charlie’s face when I said this.  He was   stunned, probably thinking steam would  soon start shooting out of my   ears like a gasket ready to blow.  My new husband   surely thought he had married a  temperamental woman that could be   totally thrown by a simple suggestion.Charlie  began to get upset, and I   had gone over the edge  of becoming a major jerk.  What was  happening   to me?"
 As you know, the pain from Janelle’s past   was suddenly more  painful than she ever wanted to admit.  If  your   client was wounded by betrayal from a friend in his or   her past and that  pain has never been healed, that client is likely to   become highly sensitive to  signs of betrayal in present friendships.  
 Does he or she read into innocent behavior  motives that aren’t really   there?  Why?  Could it be because of unfinished business, and  painful,   buried feelings?  Unconsciously,  clients like Janelle look for   relationships which never fail to somehow erase  pain from the past.    Would you agree that  the end result is typically disappointment?
 By the way, when this pattern of trying to heal the past through current relationships develops, clients will have created a   much bigger  problem.  In addition to anxiety, clients  may no longer   relate to people, but only to what they represent, which in turn  causes   additional anxiety.  In other  words, the new person in a client’s life   will not really be the object of their  feelings.  
 Would you agree that these  relationships become what he or she   symbolizes - an opportunity to work through the  issues they had with   someone else?
 ♦ Technique:  Healing HurtsI suggested to Janelle a Cognitive Behavior Therapy technique for healing hurts.
 1.     I stated,  "First, begin by reviewing your personal history   and make note of any memories  you have of feeling abandoned or   neglected.  Give this serious consideration. Use a notepad  to record   your thoughts.  Are there  people from your past you blame for not being   there for you? Who are they and  what do you blame them for?"
 2. Next, I stated, "Consider ways that these painful   memories may still be impacting your present.  How do they determine the   choices you make?   Finally, ask yourself what is keeping you from   forgiving whoever is  involved in your painful memories (a parent, a   friend, etc.)."
 
 Could forgiveness be a productive way for your  client to release resentment?  How might  your client find ways to forgive?
 In this section, we discussed the first key to past redemption.  We also introduced the "Healing  Hurts" CBT Technique.In the next section, we will discuss the   second key to past redemption.  As you will see, the second  key to past   redemption is restitution.   We will also discuss living in  the   present. 
 - Nakamura, B. J. Pestle, S. L., & Chorpita, B. F. (2009).     Differential Sequencing of Cognitive-Behavioral Techniques for Reducing     Child and Adolescent Anxiety. Journal of Cognitive Psychotherapy, 23(2), 114-135.
 - Stallard, P., Taylor, G., Anderson, R., Daniels, H., Simpson, N.,     Phillips, R., & Skryabina, E. (2014). The prevention of anxiety in     children through school-based interventions: study protocol for a     24-month follow-up of the PACES project. Trials, 15(1), 1-6.
 Reviewed 2023
 
 Peer-Reviewed Journal Article References:
 Chan, K. K. S., & Lam, C. B. (2018). The impact of familial   expressed emotion on clinical and personal recovery among patients with   psychiatric disorders: The mediating roles of self-stigma content and   process. American Journal of Orthopsychiatry, 88(6), 626–635.
 
 Garverich, S., Prener, C. G., Guyer, M. E., & Lincoln, A. K. (2020). What matters: Factors impacting the recovery process among outpatient mental health service users. Psychiatric Rehabilitation Journal. Advance online publication.
 
 Petros, R., & Solomon, P. (2020). Examining factors associated with perceived recovery among users of wellness recovery action plan.Psychiatric Rehabilitation Journal, 43(2), 132–139.
 
 
 QUESTION 7  What are the three steps in the "Healing Hurts" CBT technique? To select and enter your answer go to .
 
 
 
 
 
 
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