Abreaction - Catharsis: Stirring Dull Roots with Spring Rain
Abreaction - Catharsis: Stirring Dull Roots
with Spring Rain
Dr Patrick Jemmer
BA (Hons) CertPgStud MA (Cantab) MA (Oxon) PhD (Birmingham)
EurChem EurPhys MRSC MInstP MIMA CChem CPhys CMath CSci
LHSLNCPMNCH(Lic)FRSH
SoCEIS Northumbria University Newcastle UK NE1 8ST
Abstract:
This essay first presents the 'classical' philosophy of abreaction-catharsis, rooted in its historical
context, and based on the premise of 'stored trauma' that needs to be 'purged' to effect a 'cure.' We
then go on to discuss modern approaches to this crucial therapeutic 'nexus' and contrast 'stored
trauma' approaches and 'content free' methods for generating lasting and effective change. Crucial
to a successful outcome is the role of the therapist as a guide who is competent to cope with the
(sometimes dramatic) affects expressed as therapy progresses, and who prevents the client becoming 'out of control' or 'stuck; and we describe how, as the client 'works through' these affects, he
gains insight and learns to cope, in a process of discovery and learning eminently achievable under
the appropriate therapeutic guidance.
Keywords:
Catharsis, cleanliness, purgation, ecstasy, exorcism, crisis, trauma, anticathexis, catharsis, experiential therapy, Neuro-linguistic programming
"April is the cruellest month, breeding
Lilacs out of the dead land, mixing
Memory and desire, stirring
Dull roots with spring rain..."
T S Eliot (1922): The Waste Land: 'I. The Burial of the Dead.'
European Journal of Clinical Hypnosis: 2006 volume 7 - issue 1
Dr Patrick Jemmer
In order to understand the nature of the
therapeutic phenomenon called 'abreactioncatharsis' which might be said to "stir the
dull roots" of neurosis with the "spring rain"
of therapy, we need to go on a journey back
into prehistory. In the most ancient recorded
cultures, the idea of 'uncleanliness' originated in the very real disgust and avoidance of
physical impurity, uncleanness or just plain
'dirtiness.' We still feel this today: when encountering bodily secretions (such as blood,
faeces, semen, urine, and so on), for example, which are seen as 'contaminating.' By
extension certain persons became 'unclean,'
either by virtue of disease (such as lepers),
or due to other circumstances (such as menstruating women, or those whose work was
with unclean substances or persons). This is
still observed today in the Hindu caste system, for instance, as described in Sharma [I]
and Ross [2]. These ideas ramified further
to the extent that eventually certain actions
or places in themselves became 'taboo,' and
lead to uncleanness: just to perform such an
action or be present in such a place (or be in
contact with an impure person) lead to 'ritual
impurity.' So, just as you would bathe and
wash your clothes after performing hard
physical labour to remove the sweat, in ancient times you had to 'purify' yourself and
surrounding objects after 'ritual contamination.' Purification rites are recorded in different cultural milieux, as discussed in detail
in Brunius [3]. The ritual purification was,
for example, performed by means of blood,
clothing change, fire, sacrifice, water or wine
in a consecrated location. These rituals were
closely linked to other primitive proto-religious practices, some of which are still in
operation today, as with "Bodily purification
before offering a sacrifice to God without
foregoing provisions for spiritual purification also," as discussed in Isizoh [4]. Moore
quotes: "The Greek scholar Jane Harrison
said of the ancient worshiper that he or she
had to 'drink of Lethe, must present a clean
sheet for the revelation to come.' Lethe is
the river of forgetfulness" [5]. In the Judaic
tradition, purification involved washing and
bathing in the sacred ground of the Temple,
European Journal of Clinical Hypnosis: 2006 volume 7 - issue 1
as described, for example in the book of Leviticus. This 'ritual purification' of the Old
Testament was modified in the 'New Covenant' of Jesus, when a new understanding
of the nature of impurity and 'sin' developed
as discussed below. In the Christian tradition purification was performed by means of
baptism as discussed in John [6]. Even today,
as Moore points out: "Religions around the
world begin their services with rites of purification. A Sufi master washes his hands; a
Catholic priest dips his fingers in water and
makes a confession" [5]. The link between
the rituals of the ancients and modern-day
practices is elaborated by Barbour: "It turns
out that we may have something to learn from
a group that formerly we have not had much
respect for... a strange group that probably
wore beads, fur, and feathers, shook rattles,
burned incense, danced, chanted, sang, and
pounded drums... long before "acting out"
there were 'witch doctors,' 'medicine men,'
shamens, and native healers... Since the
mind and body were connected, they treated
the whole person... they concentrated on ...
abreaction ... a catharsis which would result
in an extreme feeling of serenity" [7].
The phenomena described in the preceding
paragraph were abstracted from the realm of
the physical into a generalized form of emotional cleansing or 'catharsis' in the tragedies
of the ancient Greeks (we shall investigate
the origin and meaning of 'abreaction' subsequently). The English word 'catharsis' is
derived from the Greek KaOapoq, ('pure,
utterly clean, spotless'), which generates
KaOopi^co ('cleanse, purge') and hence
KaOapaiq, ('purification'). At the end of a
Greek tragedy, the audience members would
be drawn into the intense, 'ritualized' suffering of the protagonists, as detailed in Brunius
[3]. This would stimulate emotional outpouring, and thus personal spiritual purging. Aristotle (as translated by Golden [8]), wrote in
Poetics (Chapter 6): "A tragedy is the imitation of an action that is serious and also, having magnitude, is complete in itself ... with
incidents, arousing pity and fear, wherewith
27
Abreaction - Catharsis: Stirring Dull Roots with Spring Rain
to accomplish its catharsis of such emotions." However, as Lucas comments: "This
'purgation of pity and fear' constitutes an
integral part of tragedy by supplying a relief,
or purification, of these emotions and leaving a feeling of fulfilled pleasure. Aristotle's
definition, however, leaves us wondering
just what catharsis meant for him and how he
thought 'pity and fear' produce the necessary
purgation" [9]. Nevertheless, whatever the
mechanism, at the end of the play the audience felt 'ecstatic' (from the Greek e^raaig,
meaning 'astonishment'). Literally, to be
'ecstatic' means to be 'outside oneself.' The
ecstasy was described as a trance-like state,
transcending everyday awareness, whereby
the individual's attention was focused intently on specific thoughts, tasks or emotions in
the noumenal world, and directed away from
the distractions of the everyday phenomenal
world. Thus the ecstatic individual would
have increased capacity in various modes of
operation: whether emotional, physical, spiritual or intellectual, he or she might therefore
attain depths of feeling, spiritual revelation,
intellectual insight, or physical prowess not
accessible under mundane conditions. In
the Greek tradition of the poets Homer and
Hesiod, and the mystery cults of Delphi and
Eleusis, these states of catharsis and ecstasy,
and the resulting increase in self-awareness
(allowing spiritual and moral cleansing of
'sins'), were formalized into disciplines or
rituals. As Christianity spread with the Roman Empire, the Greek words KaOaplOpiOg
or Kadapiapia were spread with the New
Testament: for example, we find in John
2:6 the phrase Kara
TOV
KaOapiOfiOV TUJV
iou5anov,_ "after the manner of the purifying of the Jews," as reported in Hurt [10].
Such practices are very much in evidence in
modern society: we have only to look at the
Roman Catholic ritual of 'Confession,' as
described by Puljic, which begins with the
penitent's words "Bless me Eather, for I have
sinned," and ends with the priest saying "I
absolve you" [11]. The cathartic resonances
of this ritual need no further elaboration.
28
A history of therapeutic abreaction-catharsis
is given in Stratton [12] (the reason for referring to the nexus, as defined in Jemmer [13],
as 'abreaction-catharsis' rather than the other
way round is motivated by the clinical commentary, described below, on how to deal with
an abreaeting client). Gassner (1727 - 1779)
inaugurated in 1775 what Ellenberger describes as "the birth of dynamic psychiatry"
[14]. He exorcised daemons, with the process
culminating in a dramatic 'crisis' in which
the possessed individual underwent physical
convulsions and emotional release. Mesmer
(1734 - 1815) essentially refined the 'exorcism' by staring into the patient's eyes while
pressing on the hypochondrium (the part of
the abdomen just below the ribcage); with
repetition, the intensity of the resulting crises
subsided in a gradual 'desensitization' process. If, after time, the crises abated entirely,
the patient was deemed to have been 'cured.'
We detect an approximation of the modern
hypnotherapeutic approach in the 'perfect
crisis' of de Puysegur (1751 - 1825). Here
the patient went into a deep trance (called
'somnambulism') ; in this state there were no
convulsions and the patient could talk clearly
and in a detached manner about the sensitive
issues of relevance. The termination of this
'perfect crisis' often resulted in amnesia of
anything that was said or done whilst in the
somnambulistic state. The terms relating to
'hypnosis' were introduced in 1843 by Baird
(1795 - 1860), who experimented with bright
lights or swinging watches to induce the
trance state, as discussed in Piccione [15].
He found hypnosis to be particularly useful
in cases where there was no obvious physical cause for a patient's symptom's (such as
headaches); he also essentially pre-empted
the modern Neuro-linguistic programming
idea of the 'anchor,' using a single word
or object to rehypnotize a patient. Charcot
(1825 - 1893) introduced the dimension of
scientific neurology into hypnotism. When
he treated hysterical patients they showed
epileptic-like symptoms when in trance, and
he concluded that the hypnotic state was
a type of 'induced seizure.' Breuer (1842
- 1925) and Ereud (1836 - 1939) reported
European Journal ot Clinical Hypnosis: 2006 volume 7 - issue 1
Dr Patrick Jemmer
their use of abreaction-catharsis in treating
"Anna O" in Studies in Hysteria [16]. Their
method, as far as they describe it, went as
follows. They first hypnotized the patient
and directed her to concentrate on the presenting symptom; she was then encouraged
to talk about her experiences or to free-associate. Unfortunately it is not at all clear from
their writings exactly how the hypnotic state
was induced, nor how deep it was. There is
no mention of whether the outcome of the
process was a severe 'crisis' or a more gentle
resolution. Breuer and Freud did comment
however that in some cases there was an
intense 'reliving' of the traumatic incident
(later to become known as 'abreaction,' a
translation of the German abreagieren, 'to
react away from'). They were the first to notice that such a 'flashback' could give great
insight into the causes and nature of the
presenting problem. Moreover, they saw that
if the abreaction was experienced in a safe
environment, and a better feeling resulted,
then the overall outcome was positive (and
this later became identified with 'catharsis').
They thus theorized that repressed traumatic
episodes were at the root of all neurosis, and
that it was crucial to overcome the patient's
resistances, to uncover the trauma, and to
force abreaction, in order to effect a 'cure.'
Even with these great insights, however,
Freud had problems performing hypnosis,
and found that his method sometimes had
the reverse effect in that it generated an 'anticathexis,' defined in Inhibitions, Symptoms
and Anxiety as "the reinforcement of the attitude which is the opposite of the instinctual
trend that has to be repressed" [17]. The last
hypnotic straw snapped for Freud in 1896
during a time of intense personal crisis. A female patient hugged him when she emerged
from a trance, and the two were seen by a
servant. After this incident he severed his
ties with Breuer, ceased using hypnosis, and
resorted instead to dream interpretation, free
association, massage, pressure to the head,
and suggestion. At this time he stated, in
The Aetiology of Hysteria that, "catharsis
produces only transient change" [18]. In fact
with hindsight, we realise that Freud was
European Journal of Clinical Hypnosis: 2006 volume 7 - issue 1
searching for controlled, intellectual tools
for his own self-analysis: this search resulted
in The Interpretation of Dreams [19] and the
birth of Psychoanalysis. We note in passing
that after initial investigations into 'trauma
theory' [20], Jung abandoned suggestion
and abreaction as useful tools in treating
neurosis. He writes: "I soon discovered
that, though traumata of clearly aetiological
significance were occasionally present, the
majority of them appeared very improbable.
Many traumata were so unimportant, even so
normal, that they could be regarded at most
as a pretext for the neurosis. But what especially aroused my criticism was the fact that
not a few traumata were simply inventions
of fantasy and had never happened at all
... I could no longer imagine that repeated
experiences of a fantastically exaggerated
or entirely fictitious trauma had a different
therapeutic value from a suggestion procedure" [20], and continues, "The belief, the
self-confidence, perhaps also the devotion
with which the analyst does his work, are far
more important to the patient (imponderabilia though they may be) than the rehearsing of
old traumata" [20].
Stratton goes on to discuss the work of Janet
[21,22], who worked with Charcot and was
Freud's main rival in France. He claimed to
have developed the cathartic cure, before
Freud and Breuer, by means of "automatic
talking" as reported in the cases of patients
Marcel and Justine. We note in passing
that Janet could be said to before his time
in having implemented some of the current
techniques of Neuro-linguistic programming
by using hypnotic states to modify visual
images, and, as Ellenberger [14] points
out, in applying ideas now associated with
the 'permissive hypnotherapy' of Erickson
(J902 - 1980) (see Battino and South [23]),
and the 'structural integration' of Rolf (1896
- 1979) (see [24]). However, Janet's exact
methodology nonwithstanding, Haule notes
that the patients "... both appeared to change
their pathology under the influence of Janet's
treatment. Both manifested distinguishable
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Abreaction - Catharsis: Stirring Dull Roots with Spring Rain
States of consciousness (like the dissociation
in hysteria), and in both cases the somnambulic state could be duplicated by hypnosis
(again as with hysteria). But in both cases,
when the fixed ideas were made conscious,
they did not become integrated with the dominant personality (as in the cure for hysteria);
rather, both patients became obsessive" [25].
So Janet's methodology was far from being a complete success in all cases. During
and after the First World War, Freud's ideas
were used as a basis for treating 'shell shock'
and other so-called 'war neuroses.' As the
US National Library of Medicine explains:
"Soldiers displaying such somatic symptoms
as paralysis, muscular contracture, and loss
of sight, speech, and hearing for which no
organic bases could be found came to be regarded ... as suffering from conversion hysteria. In these cases, psychogenic explanation
focused on unconscious conflicts between
'fear' and 'duty' with a resulting 'flight into
illness'" [26]. Simmel used abreaction-catharsis with the "numerous patients who had
hitherto, despite long and careful medical effort, showed themselves to be impossible to
be influenced" [27] with good success.
It is interesting to note that even Freud was
impressed by these results, commenting, as
quoted in Stratton: "The practical results of
the cathartic treatment were excellent. Its defects.... were those of all forms of hypnotic
treatment" [20]. Tucker-Ladd [28] discusses
how Adler [29] extended Breuer's and
Freud's ideas of repressed trauma into a 'developmental' theory of an individual's "life
story." He observed that people generally
changed little psychologically between say
two and sixty years of age, and conjectured
that this was because the 'two-year-old self
is always present in the psyche, and that our
earliest memories determine our "life story"
and hence our future course. This story is
built from beliefs as to 'Who am I? ... Who
are others? ... What is the world?' These
in turn are underpinned by motivators like
'What do I want? ... What is my place in
the world?' that drive our behaviour towards
unique and meaningful goals. Finally we
30
have options, for example 'How do I achieve
my goals? ... How do I stay in my place?'
The infantile self's beliefs, motivators and
options inhere and operate unconsciously
throughout life. This is reinforced by Leman
and Carlson [30] who conjecture that one's
earliest memories are the best descriptors and
limiters of one's current self. To paraphrase
their example: imagine a child who had her
trust broken by a carer's sexual abuse, and
whose protests were silenced by threats and
guilt. As an adult, this victim of childhood
trauma presents in therapy with evidence of
sexual immaturity and insecurity, leading to
disturbed or pathological relationships. She
feels fearful and untrustworthy of others;
and at core her beliefs are that she is worthless, and 'impure.'
So, putting together all the ideas discussed
above, we can give a definition of the abreaction-catharsis nexus in a modern therapeutic
context. Edgerton and Campbell [31] define
'abreaction' as follows:
"abreaction: The discharge of energy
[emotion] involved in recalling an event
that has been repressed because it was consciously intolerable. The experience may
be one of reliving the trauma as if it were
happening in the present, complete with
physical as well as emotional manifestations (also called revivification). A therapeutic effect sometimes occurs through
partial discharge of, or desensitization to,
the painful emotions and increased insight.
Abreaction can happen spontaneously or
can be therapeutically induced through
verbal suggestion or hypnosis."
So, in modern psychotherapy the term 'abreaction' describes an emotional outburst
consistent with a traumatic memory, experienced when an individual relives that trauma.
It is usually thought of as accompanied by,
or followed by, a 'catharsis' or psychological 'cleansing' (and this is why 1 consistently
European Journal of Clinical Hypnosis: 2006 volume 7 - issue 1
Dr Patrick Jemmer
refer to the nexus in this order). Bower [32]
quotes from the American Heritage Dictionary which explains it in this way:
"ca-thar-sis noun, 1. Medicine. Purgation,
especially for the digestive system. 2. A purifying or figurative cleansing of the emotions, especially pity and fear, described
by Aristotle as an effect of tragic drama
on its audience. 3. A release of emotional
tension, as after an overwhelming experience, that restores or refreshes the spirit. 4.
Psychology, a. A technique used to relieve
tension and anxiety by bringing repressed
feelings and fears to consciousness, b. The
therapeutic result of this process; abreaction."
Now that we have investigated the birth and
historical growth of abreaction-catharsis,
let us pursue its maturation (and maybe the
beginnings of its death) in modern therapy.
Stratton comments on the next stage in the
expansion of the technique: "It was the development of experiential therapy in a group
setting that created conditions in which the
potential of these methods could be taken seriously" [20]. This was particularly relevant
"In a publicly chaperoned situation, when a
patient underwent a major catharsis with the
enactment of unconscious issues." The ideal
bedding-ground for advancement in self-actualization was the 'Human potential movement,' championed by Perls (1893 - 1970),
Rolf, Satir (1916 - 1988) and Schutz (1899
- 1959), at the Esalen Institute in California.
The Esalen Institute today describes itself as
a place where people
".. .come from all over the world to participate in Esalen's forty-year-long Olympics
of the body, mind, and spirit, committing
themselves not so much to 'stronger, faster,
higher' as to deeper, richer, more enduring.
They come for the intellectual freedom to
consider systems of thought and feeling
that lie beyond the current constraints of
mainstream aeademia. They come to discover ancient wisdom in the motion of the
body, poetry in the pulsing of the blood.
They come to rediscover the miracle of
self-aware consciousness. At best, they
European Journal of Clinical Hypnosis: 2006 volume 7 - issue 1
come away inspired by the precision of
a desire to learn and keep on learning
through all of life, and beyond" [33].
According to Grohol this "freedom to consider," as it has been described, "... came
out of the social and intellectual milieu of
the 1960s, and was formed to promote the
cultivation of the extraordinary potential believed to be largely untapped in most people.
The movement is premised on the belief that
through the development of largely untapped
potential for extraordinary capabilities, humans can experience an exceptional quality
of life filled with happiness, creativity, and
fulfilment" [34]. Zaiv explores the growth
of the Human potential movement by posing the question, "What would happen if a
group of people, as practice for life, related
in full honesty with one another? Would we
argue? Defend ourselves? Project, or accuse,
or apologize? Would we learn to drop our
walls and heal our patterns enough to get
truly close to one another? Would we learn to
understand, even to love, ourselves and others?" [35]. The 'Encounter group' was born
in order to answer this exact question. At the
same time many other 'New age' methods,
techniques and therapies were being inaugurated and investigated, amongst them Bioenergetics, Gestalt therapy, Neo-Reichian
bodywork, Neuro-linguistic programming.
Primal therapy, Psychodrama, Rebirthing and
Transactional analysis. Lewin (1890 - 1947),
quoted in Potter as saying, "If you want truly
to understand something, try to change it"
[36], extended the Encounter group idea to
form the T-group.
This process is described in the following
way by ODCT: "In 1947, the National Training Laboratories Institute began in Bethel,
ME. They pioneered the use of T-groups
(Laboratory Training) in which the learners
use 'here-and-now' experience in the group,
feedback among participants, and theory on
human behaviour to explore group process
and gain insights into themselves and others... AT-Group is not a group discussion or
a problem solving group" [37]. Smith [38]
discusses in depth the influence of Lewin
on modern theories of group dynamics and
group therapy. A particularly important point
is made by Potter who emphasizes that "The
T-Group nowadays is usually so dominantly
31
Abreaction - Catharsis: Stirring Dull Roots with Spring Rain
thought of as a form of 'therapy for normals,'
and as a way of becoming sensitive to faceto-face relations between people, that the
laboratory of its birth is forgotten. It is therefore surprising that in the early days general
sessions were held within the programmes
on generational problems: the meaning of
democracy, values, and nuclear power.
The last issue may give a clue to one direction the T-Group took in the sixties
and seventies: the personal growth movement" [36]. Despite the emphatic statement
that "A T-Group is not a group discussion
or a problem solving group," and therefore
was never intended to be a forum for abreaction-catharsis as such, the very burgeoning
of such groups, together with the myriad of
other 'New Age' therapies mentioned above,
began to disconcert 'traditional' practitioners
of psychiatry and psychoanalysis. In general,
they reacted with suspicion, and exaggerated or misinterpreted the ineffectiveness or
dangers which might arise in such groups or
from such therapies. Indeed Yalom, one of
the main investigators into, and commentators on, the panoply of these therapies, later
wrote: "The casualty research findings have
resonated with so many preeoneeptions that
encounter groups per se are now, as a result
of the study, described as more dangerous than I, the principal investigator of the
casualty research, believe them to be" [39].
Tucker-Ladd adds weight to this comment,
writing: "Several scientists ... have sloppily
accepted many diverse acts as being 'catharsis' and prematurely concluded that all kinds
of catharsis are ineffective or harmful" [28].
And so what of the situation at the turn of
the 21st Century? As with most things, the
acceptability and respectability of abreaction-catharsis as a therapeutic tool lie on a
spectrum. Sunnen gives the point of view of
a medical practitioner as follows: "Another
facet of the therapy involves the ventilation
and catharsis of repressed affect, which although not integrative in itself, provides for
attenuation of emotion and for subsequent
easier handling" [40]. In modern psychoanalysis abreaction-catharsis is not highly regarded at all. Neuro-linguistic programming
practitioners would say that there are other
techniques at hand and thus abreaction is
outmoded and unnecessary [41]. Exponents
32
of Rotter's Social learning theory believe
that it can be helpful or harmful depending
on the client and the situation. Behaviourists
regard it as involuntary and sometimes useful. Therapists advocating the Hart-Thorne
Eclectic methodology find it useful. And,
Humanist practitioners (using Transactional
analysis or Gestalt therapy) believe it is very
important. It is particularly meaningful in
terms of 'body-based' therapies described by
Bernet as "the abreaetive therapies (Reichian, bioenergetics, primal therapy), gestalt,
Jungian, existential therapies, psychodrama
and encounter groups" [42].
So, in summary: either as a client or as a
therapist, you 'pay your abreaction and take
your catharsis!' It really does come down
to a matter of personal choice and appropriateness to the individual and their needs.
The Neuro-linguistic programming (NLP)
perspective is explored in detail in other articles: for example Jemmer [41] investigates
the use of NLP in treating phobia and trauma
"quickly and painlessly," without recourse to
abreaction-catharsis.
Let us now turn attention to the actual use of
catharsis in a therapeutic setting. Watts [43]
emphasizes the critical nature and timing of
abreaction in therapy, particularly if one is
not to damage the client, and even more so
if one desires a positive cathartic outcome.
He states: "One can say that it is generally
agreed that no therapist should attempt to induce catharsis artificially. One should simply
do good therapy and eventually the catharsis
will happen of its own aecord" [43]. He goes
on to delineate three entirely separate trauma-traces, which in general resurface with
different force and import at different points
in therapy, and which must be dealt with accordingly. First, there is the (usually visual)
perception of the trauma (the 'initial sensitising event') itself: a 'picture' of what has
happened. Then, there are the physical sensations associated with the event. And finally,
and most importantly, there is the emotional
response to the sensitizing event. Initially in
abreaction, according to Watts, the trauma
is "revivicated." The client recalls strong
European Journal of Clinical Hypnosis: 2006 volume 7 - issue 1
Dr Patrick Jemmer
physical sensations which are often initially
uncoupled from the emotional content of the
events, or from any other memories.
In revivieation the autonomic nervous system can react to remembered pain and this
ean lead to aetual physical manifestations.
Eor example, suffoeation trauma can lead to
diffieulty in breathing; gripping or slapping
can lead to finger marks on the arm or face.
In fact the revivieation can be accompanied
by a violent emotional response, and Watts
observes: "A client may scream, shout, sob,
sweat, shake violently, curl up into a foetus,
gag; and all these manifestations can be a
truly unnerving experienee for the unwary!"
[43]. During all of these affects, the therapist must maintain an attitude of confident
'watchful waiting' and as Watts warns:
"You must not show fear, excitement, anger,
or any affect that eonveys to the client that
you are responding differently to this event
than you do to the usual therapy" [43]. The
therapist is present as a guide as the client
'does the work'of the therapy on his/her own
terms, and must ensure that he/she partakes
of his/her experienee fully. In particular the
therapist should avoid physical contact, and
must respect the client's responses, acknowledging that 'riding out' of pain in this particular context can be aeceptable, and indeed
empowering. He should restrain the urge to
comfort him/her. It is however critical that
the client revivicates the true 'initial sensitising event' to get to the root of the presenting
problem. Watts comments on the philosophy
behind this approach: "In terms of therapy,
something wonderful is happening; the client is setting themselves free from a prison
of their mind's making and their life is going
to change immeasurably for the better over
the next few months" [43]. So, now, the abreaction has abated: often the client emerges
from his/her trance-like state spontaneously;
if this is not the case then the therapist should
awaken his/her as appropriate. After the abreaction the client may or may not remember
the incident.
Most modern methodologies hold that the
therapist should acknowledge that some
European Journal of Clinical Hypnosis: 2006 volume 7 - issue 1
'event' has happened, but that further discussion of that event will depend on the client's
recall. It is usually some time after this
'physical' abreaction that the emotional ('cathartic') content that has beeome attached to
the initial sensitising event (such as anger,
guilt, shame or vulnerability) manifests itself, and thus we refer to the nexus as 'abreaction-catharsis.' Watts cautions: "It was
once considered that a catharsis arbitrarily
meant a breakthrough. Today, that is only so
if it takes the client back to the 'defining moment'of a life program or 'script,'and brings
back with it valuable information about that
script, whether or not this information is
conscious to the client!" [43]. In any case,
the therapist must act solely as an observer
and guide as the client interprets and gains
insight for him/herself. Information resulting
from the catharsis is regarded as neutral, and
the client must be facilitated in 'moving on.'
Care must be taken not to get 'sidetracked'
into other issues due to embarrassment, or
the potential or actual pain of the process.
The therapist must help the client constantly
to pursue the initial sensitising event, for
as Watts warns us: "... if the emotional response does not start to fade within a few
minutes, or if it returns to its former strength
each time the memory is accessed, then there
is still work to do...Keep going until the
negative emotion has cleared and cannot be
restored" [43]. However, once the emotional
'memory' is discharged then it is generally
found that the symptoms associated with
the presenting trauma abate and eventually totally disappear. Watts comments: "It is
not fair to say that all their symptoms will
disappear overnight, but from that eathartic
moment onwards, the client will start to feel
well and his/her symptomatic work will very
soon start to fade" [43].
Of course the prime motivator for all of the
above approaches is the Freudian idea of
'stored trauma' which must be 'purged' to
effect a 'cure.' Essentially these approaches
hold that when we experience trauma, the
event creates a 'trauma-trace' and a new
33
Abreaction - Catharsis: Stirring Dull Roots with Spring Rain
trauma response is 'learned.' In Neuro-linguistic programming terms we 'learn to "do"
the trauma.' This response is then constantly
re-experienced and forms the basis for future
behaviour. This leads to models of therapy
which presuppose some kind of underlying
'problem,' whether conscious or not, in the
aetiology of every presenting client. The
therapist is duty-bound to use careful elieitation to uncover the (potentially repressed)
trauma. Baffa eomments on this philosophy
from a different point of view: "The problem
with this kind of 'always' theory is the understanding of context, or a lack thereof. What
you want, where, when, and with whom you
want it are more relevant to the process of
effective useful change.
It doesn't really matter where or when they
learned how to do what they are doing now.
All that matters is that they did learn" [44].
Another problem with the "always theory" is
that even if a client does not have a 'stored
trauma,' with enough psychological probing
the therapist can always manage to install
one! The modern toolkit of Neuro-linguistic
programming (NLP) provides a different approach to life-change and personal growth
which avoids these pitfalls, and as Baffa
comments, "I don't deal with trauma, or
anything else for that matter. Instead I embrace the individual personality before me"
[44]. In essence, as O'Connor and Seymour
[45] point out, NLP presupposes that the
individual personality is "not broken." On
the contrary, people are extremely competent subeonscious learners, and can 'selfprogram' thoughts, feelings, internal voices,
emotions and physieal feelings accurately
and sometimes very quickly; and of course
the subconscious always acts with positive
intent. Moreover, people are different, and
each individual has his/her own 'map of
the world.' So context is all: what would be
trauma to one person would be excitement
to another.
The real problem arises when we get 'stuck
in a loop' and replay an old, outdated, inappropriate or unhelpful 'program' over and
over. As Baffa explains: "Human beings do
that sometimes. Rather than sit down and
ask, 'How many different ways can I accom-
34
plish this,' they quickly pick a method, and
wind up... you know what I mean. There is
always another way. In fact, given our neurological flexibility, there really is no way that
it can't be done. It's just a matter of finding
a way that works. And as creatures of habit,
we sometimes choose what we are comfortable with first. And when that doesn't
work?" [46]. The thrust of NLP techniques is
to 'break the loop,' based on the idea that if
have learned then we can relearn. So how is
this done? And do we need to dig and delve
into 'stored trauma' to achieve this relearning? The 'NLP answer' is given by Baffa
who says, "As far as I can tell, what's done is
done - that's why they call it the past. There
is no such thing as unfinished business. The
business is finished, they just don't like the
way it turned out" [47].
Using the NLP toolkit we find, and remove
anchors for the old behaviour pattern whilst
installing new, more appropriate and congruent feelings; we can change a client's
internal 'map' of the world, and therefore
their perceptions. This is explained by Baffa
as helping the client "... to learn how to interpret his/her own behavioural patterns as
means of continuously building in flexibility" [48]. And central to this process is the
belief, outlined in Baffa, that "Plain and simple, the brain does not need to go baekwards
as a means of moving forward. And most
certainly, the person who has experienced
some painful situation does not need to be
convinced to go through it again" [48]. Any
'NLP-er' 'worth his salt' would have calibrated his client at an early stage in therapy
for the minute physiological indicators of
his/her discomfort, and would be constantly
vigilant for these. Moreover, an authentic
NLP practitioner would be careful to provide the client with anchors to secure and
resourceful states. So, if any unproductive
effects or harmful affects should inadvertently surface, the client could quickly and
easily be brought back to a place of quiet and
tranquillity. These approaches are explained
and exemplified in detail in the context of
the NLP treatment for phobia and trauma in
Jemma [41]. Other NLP patterns and tools
for effective non-invasive change such as
European Journal of Clinical Hypnosis: 2006 volunne 7 - issue 1
Dr Patrick Jemmer
the 'Swish pattern' are given in Andreas and
Andreas [49]. James [50] discusses at length
the theory and practice of 'Timelining.' Yet
another excellent means of effecting change
is 'Parts therapy' as described in Hunter
[51].
In conclusion, the 'classical' philosophy of
abreaction-catharsis is based on the premise
of 'stored trauma' that needs to be 'purged' to
effect a 'cure.' The therapist acts as a guide
who is competent to cope with the (sometimes dramatic) affects as therapy progresses,
and who prevents the client becoming 'out
of control' or 'stuck.' As the client 'works
through' these affects, he/she gains insight
and learns to cope. This is summed up by
Sunnen: "In most hypnoanalytic interventions, supportive as well as insight methods are used. Supportive measures, in this
context, do not imply blanket reassurances
for the patient. Rather, they convey, first,
an understanding of dynamic forces, and
then a strategy of encouraging or reinforcing healthy constructive ones and repressing
or weakening those which are not" [40]. In
contrast, NLP methodologies are not based
on a belief in 'stored trauma' which must be
' purged,' but rather offer a toolkit for 'content
free' change. As Baffa explains ".. .using the
skills that I have come to respect, what we
loosely call NLP, I help them build in new
dreams, hopes and desires. Then I show them
how to have fun, how to learn, how to enjoy
all that life has to offer" [44]. And I think we
can all agree with Baffa when she says: "I do
think human beings are very capable creatures, and that the words learning and change
mean the very same thing. Without learning,
there is no change, and without change, there
is no learning" [46]. In short, when a client
presents, and is in pain, in a "cruel place,"
a "dead land" [52 — 56], the therapist's
job is to facilitate a move to a less painful
place, using methodologies of learning and
change which "mix memory and desire" to
validate and develop that particular client
[57,58]. However all the evidence presented
above suggests that change and growth are
eminently achievable under the appropriate
conditions, and on this note we finish with an
uplifting quote from Ybrahim Ozdemir [59]
which sums up this article:
"And the cleanliness and purification ...
cleans and makes beautiful all the beings in
the universe."
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Case Reports
The Editor of the journal would like to invite medical doctors,
psychotherapists, hypnotherapists and other mental health practitioners to
submit relevant Case Reports for inclusion in the EJCH.
Case Reports can be a useful way to illustrate new insights and approaches.
To submit papers please email: [email protected]
36
European Journal of Clinical Hypnosis: 2006 volume 7 - issue 1