TIFT #26. Case Study: Four EMPs

Anne, in her mid 50s illustrates several common problems and how they can be resolved. She grew up with an alcoholic father who was physically abusive to her mother and hypercritical of his children. Her mother died when she was seven.  She started therapy in her twenties, eventually entering a healthy marriage and having a successful career. This post is about how breaking down her problems into smaller units adds clarity to the therapy. As in previous posts, I'm calling these basic units of pathology "Entrenched Maladaptive Patterns" (EMPs) to be addressed as they become accessible.

EMP #1:  Abusive Men

At the start of her first therapy, she had had a series of relationships with abusive men. She was eager to listen to her therapist and eventually stopped accepting abuse and married a kind and successful man in a lasting and successful relationship.

Why is the dynamic of repeating abusive relationships so common? Freud identified it as a compulsion, but the precise purpose is not accessible to consciousness. What is most often reported is the wishful thinking that maybe enough love or simply compliance might lead to the abuser’s changing for the better. Of course that doesn’t work.

Using the inner child concept as a way of getting inside the unconscious mind, a very useful working hypothesis would be that the inner child gains hope through the possibility that re-staging the original unresolved problem could lead to a better outcome. Hope is not only one of the most powerful motivators, but also an antidote to despair, which children cannot tolerate. The inner child concept is also advantageous because it elicits compassion, rather than punitiveness. An understanding attitude towards the unconscious problem solver is always more effective in therapy.

Anne was able to see, from an adult point of view, that her repetition did not work, and she was eventually able to marry happily to a supportive and successful man. She decided not to have children, herself.

EMP #2:  Others Before Self

Anne developed a maladaptive pattern of consistently fulfilling others’ wishes at the expense of her own needs. As in essentially every such case, there was what I privately call an “inner bean counter,” a hidden part of her mind, fully aware of the unfairness of her EMP and a source of occasional bursts of anger. Nonetheless, she continued to indulge the whims of others, like her demanding and entitled mother in law.

The tried and true metaphor from the airlines that you should put on your own oxygen mask before trying to help others was of some use in supporting motivation to change the behavior. On the other hand, when she tried to take better care of herself, she felt shameful and unworthy. These feelings made change very difficult.

When I hear shame in this way, I immediately identify the feeling as related to the conscience. As described in TIFT #9, shame is not one of the core subcortical emotions shared with other mammals. Rather, it is generated in the cortex as a result of a judgment. Such judgments represent a comparison of reality with an internalized attitude, value, ideal, or prohibition. In Anne’s case, she seems quite literally, to have internalized the expressed attitudes of her critical and rageful father. Against those, she could never be judged adequate.

Distinguishing these unique emotions is important because modifying them requires changing the values on which judgments are based. And those, like the US Constitution, are hard to change. Both clinically and theoretically, internalized standards are, in fact, probably permanent. That doesn’t mean there is no therapeutic pathway. What seems possible is to internalize or reawaken a healthier value that can, with practice, take precedence over the unhealthy one.

Anne’s case illustrates one of the most important principles in treatment. She did need to understand that her values came from a flawed source and were simply wrong and unhealthy. But that was not enough to lead to change. She had also to change her behavior. Consciously working on setting boundaries with her mother in law was hard and uncomfortable, but with conviction, led to feeling better about herself, less shameful, and ready to take better care of herself.

EMP #3:  Lack of Motivation

As Anne began to pay more attention to her own needs, she found more free time. She had stopped working when her boss and friend died, and had been spending most of her time and energy servicing others like her mother in law. We began to explore what she might want to do for herself. As you will see, this eventually led to discovering a problem with perfectionism, but first we dealt with helping her discover her inner source of motivation.

In a culture that constantly pushes the idea of “following one’s passion,” there are, sadly, too many people who don’t have a passion. Often they don’t because their lives have been focused on survival rather than flourishing. The question sheds a very important and interesting light on the inner child. The inner child is the source of our most passionate motivations. As I understand it, around age five, when children begin to be able to conceive of the arc of their lives, (See TIFT #10), they begin to form ideas about what they might want to pursue. As with Anne, these wishes have no place in a survival-oriented life, so they remain dormant or fail to develop in the first place. In Anne’s case there were dormant interests.

My favorite technique for exploring these was suggested by a motivational speaker who suggested getting a big piece of paper and writing down ideas until one makes you cry and that’s it. (I’d love to give credit, but I can't locate who it was.) In Anne’s case, she came up with two ideas. One was to write a novel, which turned out to be what her father admonished her to do, and not her own wish. The other was baking. She is now deep into an online baking course and loving it. Her SEEKING system, the inner child’s source of motivation, is thoroughly engaged in each new stage of the course. As the end of the course is in sight, we talked about how having a regular clientele might be a way to sustain her pleasure and motivation going forward.

EMP #4:  Perfectionism

As she worked on her baking projects, she realized that she also suffered from perfectionism. Even “very good” was not good enough to earn pride from within. Yes, we were dealing with an internalized value or standard, against which her hard work and considerable success were never good enough. But an understanding of unconscious logic (TIFT #22) offered additional clarification about why.

The unconscious mind possesses many “chunks” of information of all kinds. As described in the above-referenced TIFT, knowing how information is stored in amorphous but interconnected neural networks, makes it understandable how stored information can include objects, feelings, sounds, concepts, values, any and every kind of information, each stored as a group of cells that tend to cause one another to fire. When young people ask, “is that a thing?” they are referring to the existence of such a chunk of information. 

For Anne’s inner child, one of those chunks could be described as “not good enough” and another could be described as “perfect.” The two are related in one of the only two types of relationships permitted, that is, as opposed, rather than positively associated. Such a binary system of logic does not have a place for “shades of gray” or degrees, including "very good." It only recognizes the poles. Thus, for Anne, “very good” was not on the radar, except, perhaps that it was equated with “not good enough.”

In terms of unconscious logic, the solution was for her to establish a new “thing,” one we could call “very good.” Piaget would call this accommodation, that is, establishing something new, instead of assimilating the thing into a pre-existing chunk. As a new “thing” it could then begin to establish associations with other positive things.

In practice, what this meant, was for her to make a conscious effort to recognize “very good,” and remind herself that very good is just that, something to be proud of and to seek out. The difference, now, was to recognize that her usual excellent performances were not inadequate, but were actually something to be proud of. 

Here she was working on establishing a new internalized value. This new value is similar to the one mentioned above, where she came to value herself. The difference is that "very good" is embodied in thought, not behavior. There was no behavior to change, other than excessive modesty in talking to others. The main change was in her own way of looking at her accomplishments.

Conclusion

I hope this example shows some of the clinical value of taking the time to think about how the unconscious problem solver thinks and works. Since many EMPs were first invented early in life, they often bear the stamp of young forms of thought. The inner child can and does grow in therapy in much the same ways that healthy children grow and develop in life.

Another point of this post is that identifying and working with EMPs helps us divide problems into compassable units and makes it natural to focus our work on whichever maladaptive pattern is most accessible. Once again, the inner child metaphor provides a useful way to conceptualize the clinical phenomenon of a mind that actively continues to seek childlike solutions to the unfinished business of early life.

Jeffery Smith MD

Photo: evgeni-tcherkasski, unsplash