February 12, 2011: Arlene Feinblatt
Dr. Arlene Feinblatt began treating Dr. Sarno's TMS patients in 1973, and played an integral part in developing the TMS treatment approach. She has also trained or mentored all of Dr. Sarno's other most trusted psychologists. During the February 12, 2011 Peer Supervision Teleconference, she discussed her use of Intensive Short Term Dynamic Psychotherapy and her incorporation of Habib Davanloo's ideas. Several of the participants made the following responses.
Responses
I was excited to hear about short-term dynamic psychotherapy and am looking forward to reading some of the material from Dr. Davanloo.
It was helpful for me that Dr. Feinblatt endorsed challenging the client's defenses and making them responsible for being invested. A lot of times clients come to therapy thinking the therapist will "cure" them and that is not the case.
It was also helpful that Dr. Feinblatt gave some suggestions to my specific case of the client who is very intense and not having any success in getting rid of his pain. In review, she suggested to notice the client's physical behavior: how is he sitting, what movements he is making, etc. and address these. What do I see happening and how I see himmoving, appearing rigid, etc. She suggested I ask, "Why are you trying so hard?" I thought this was very good as he "tries so hard" in every area of his life, including TRYING to get rid of his pain. Dr. Feinblatt gave an example: "You look like you are guarding. What's it like for you to be so intense, so guarding? Also, she said "when you stop thinking about the pain, it will go away" and "your pain will go away when you are ready for it to go away." That led me to realize that his TRYING so hard to get rid of his pain is actually detrimental to his recovery. So, my focus needs to be on what makes him try so hard in general and to explore the psychological reasons behind his intensity and pretty much don't address the pain.
Thank you for setting up the teleconference with Dr. Feinblatt. It was a very valuable experience for me. Some of the highlights included her references to Habib Davanloo, her emphasis on the active role for the therapist, and never allowing a defense to go unchallenged. She makes the patient responsible for their time. She has seen several new cases of pseudoseizures. She talked about a reluctance to become completely free of symptoms, so that a patient could stay longer in therapy. Issues mentioned included perfectionism, sensitiveness, and needing validation. There was the matter of a patient not believing in the psychological model. A strategy was presented of asking what would happen if all of a person's pain went away, leading to the uncovering of a number of underlying emotions and defenses. There were many other ideas presented and discussed. Discussions such as these are essential for continuing to learn and develop the many aspects of therapy.
Thank you, Dr. Feinblatt!
I did find the talk interesting, especially with Dr Feinblatt speaking about the dynamic approach to therapy. When a patient of mine has had therapy this certainly seems to have been the most effective approach. My whole approach is about self empowerment and providing tools/suggestions to help the patient become self reliant, so I was pleased to hear that she finds this approach to therapy successful and does not usually require long term involvement.
I agree with Patti [Thomas] that a damning message that we receive about aging and discomfort in the body is, "get used to it...at your age". Well I say hogwash! When we tell ourselves, "I get stiff in the AM because I'm older now", we are too focused on our bodies. What a sad way to program ourselves. Say instead, “I get stiff because my MIND is stiff.” As we agreed, "If you stop worrying and focusing on your pain, it will go."
Kudos to Dr. Nadas for valuing the potentials of the work of the mind and respecting the limits of medication for neurotic disorders. Also, we can add, "sensitiveness and needing validation" to the list of characteristics of a person with TMS.
I like the way that Dr. Feinblatt made the distinction: never allow a defense to go unchallenged; though don't attack the patient, attack the defense.
Furthermore, our job as therapists is to engage the patient and help them to become invested in the process. We can do this with:"do you notice how silent you are?"; "why are you here?"; "it's self-defeating - you spend a lot of money and time, why aren't you speaking?"; "Look, you will leave this room and I have done my best - then what will you say?"
Help the patient to become responsible for the process -- that is, after all, ultimately the mentality that leads to the cure for TMS. The patient will be relieved to know that you won't let anything go, that they can rely on you. Have chairs that are the same, facing each other to encourage the investigation of "what do you declare about yourself." Dr. Feinblatt - I'm glad that you broke through Dr. Sarno's resistance and convinced him to give you the job long ago!
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