TIFT #108: Penelope and the Five Key Questions

Linda revealed that the source of her shame was “Penelope,” the name she gave to an inner critic who cut her to shreds for any attempt to live a brighter, more interesting life. In this post, I’ll show how our quest to deepen our understanding and support change followed the path of the Five Key Questions introduced in TIFT #101.

Introduction to the Questions

Other sets of questions have been proposed as guidance for therapy. What’s special about these five is that they follow the science behind the problems we treat, as well as the essential steps for change. They were developed specifically to make teaching of trainees and therapists more efficient by clarifying the critical elements leading to enduring change, regardless of the therapy or technique.

Especially in teaching therapy, the trend has been to abandon theory. This isn’t surprising as there are too many of them and they are not compatible with one another. Instead, the field has taken to focusing on “common factors,” proven to correlate with success in therapy. The trouble is that these factors, mostly defining a positive therapeutic relationship, still don’t address the specific problems our clients bring. Too many therapists are practicing “how-ya-doing” therapy,” being a good listeners but with not much lasting change taking place.

The Five Key Questions provide a simple way to do both. By focusing on mutual goals and valuing the individual, they lead to a positive therapeutic relationship. Simultaneously, they address change in the specifics by fulfilling the requirements for memory reconsolidation. “Common factors set the table but memory reconsolidation is the meal.” 

Linda’s Initial Presentation

Linda presented in early 2021 after her psychiatrist/therapist retired. Fifty-four years old, she complained that her life was dull and unsatisfying. Her marriage was a high point and she was satisfied with her choice not to have children. Seven years earlier, she had retired from an unsatisfying job. Since then, her time has been spent on volunteer activities and giving aid to her difficult stepmother and her elderly mother-in-law. She is a college graduate and almost finished a masters degree in journalism. For 25 years she had sought therapy on and off with her psychiatrist to address depression and lack of confidence in herself. She was treated with an antidepressant was well as stimulant medication for ADHD, deemed responsible for impulsiveness and difficulty following through on projects. She had felt supported by her doctor and found her helpful to talk to, though she had not made much progress. She still had bad feelings about herself and was continuously unhappy with her life.

Question One:  What is the Entrenched Maladaptive Pattern (EMP)

The word “question” starts with “quest.” While the answer is sometimes obvious, more often, seeking to describe the problem pattern as clearly and deeply as possible is the beginning of process. Her main source of distress was her bland life but what was the pattern behind this situation? Her original therapy with the psychiatrist had helped with anger and with finding some sense of meaning in her activities, but low self-confidence and deep dissatisfaction continued. She demanded perfection of herself but got little good feeling from accomplishments. Services given to her ungrateful stepmother and mother-in-law left her resentful and depleted but she felt compelled to keep giving.

The first answer to Question One was that she repeatedly felt compelled to undertake service activities but did not gain any personal satisfaction from them. When she accomplished other things of value, perfectionism robbed her of positive feelings.

She seemed consistently to choose goals and activities that were inherently unrewarding, but the pattern had existed so long that it was not obvious whether anything else might engage her deeper inner wishes and desires. On exploration, her spontaneous thoughts led to two areas of interest, baking and writing. She quickly dismissed writing, recalling how her alcoholic and abusive father would urge her to become a writer. In pursuing that, she would be following her father’s wishes, not her own true desire. So she took up baking with some sense of hope.

She enrolled in an online baking class and dared to show photos of her work. She felt some satisfaction, but was intensely critical of what she had baked. The picture was beginning to form that she was self-critical even when doing something she liked. It took more time to see that baking was not her true passion. It actually represented a compromise with the inner critic whom she now identified as “Penelope.” We realized that Penelope had only accepted baking because it was providing a service that still kept her at a distance from her deeper desire to stand out in the social world. Soon she was back to the idea of writing, realizing that it was Penelope who had so quickly found a reason to discourage her. Writing was much closer to her wish to be recognized as “somebody,” but, the more she tried to make progress, the more Penelope would shower her with shame and discouragement. At last, we understood her EMP. For over a year, she had been too ashamed to reveal to herself her true desires or why she could not achieve them. Only now was it clear that Penelope, her inner critic, had been stopping her from fulfilling the dream of a more exciting and outwardly visible life.

The first layer of EMP

As we pursued question one, exploration and experiences combined to reveal how Penelope, true to her Homeric roots as the epitome of faithfulness, was using all her power to protect Linda from unbearable pain. Inappropriate shame is a very common type of EMP. Under healthy conditions, the conscience is built on internal values consistent with those of parents and community. Those form the basis of judgments that determine pride, shame, and guilt, which then steer the individual towards good citizenship. However, the mind can also make use of these mechanisms to build a deterrent against actions associated with pain. It does so by internalizing specific values, which come to stand as deterrents to behaviors experienced as risky.  (See TIFT #4) 

Personifying the inner critic is often helpful in treatment, giving the client clarity that the source of shame is not the true self. Penelope demanded not just perfection, but an impossibly superlative performance. We began to form a picture of this demanding but protective inner self, giving out intense criticism no matter what Linda did, thereby limiting the activities she dared to undertake, all for the sake of protecting Linda from the dreaded inner emotions that are the subject of the next question.

Question two: What is the DREAD the EMP is designed to avoid?

Every EMP is triggered by the unconscious limbic mind experiencing or predicting a painful unconscious emotion (TIFT # 57) 

Asking what it is that Penelope most dreads will usually lead to an answer in some spontaneous but unexpected form. Linda soon remembered her father coming home drunk, grilling her on her school performance and unleashing devastating verbal and physical punishment for her failure to satisfy his standards, which naturally grew more stringent as he became more intoxicated. Penelope was ever faithful in her efforts to spare Linda from these horrific experiences.

Dreaded inner emotions are the precise place where clinical wisdom and biology intersect. Neurophysiologists agree that protective responses are triggered by nerve impulses coming from limbic structures. The best studied is anxiety, where fear responses, maladaptive or not, are triggered by impulses from the amygdala. Shame and other self-reflective emotions are a bit more complicated in that they start out life in the cortex, but they have motivational power fully equivalent to other unconscious limbic emotions in that they trigger important EMPs.

Understanding her dread allowed us to make better sense of the EMP. In order to avoid the pain of being criticized and punished by her father, she had internalized a value requiring an unattainable level of perfection along with one that said it is bad to promote oneself in any way. Finally we could make sense of her dissatisfaction with life. It was dull and unsatisfying because Penelope was constantly on duty discouraging Linda from doing what she truly wanted while destroying her pride in any accomplishment that slipped by.

Question three: What is your THEORY of the origin of this EMP?

With what we know so far, this one is pretty easy. Linda’s mother lived under the father’s alcoholic rein of abuse until Linda was six, when her mother suddenly died. Linda was sent to live with relatives but was later brought back to her father's home. He continued to be rageful and physically abusive as well as intensely critical. When she was 9, he married a woman who showed her no love and still doesn't. Penelope took on the job of protecting Linda by imposing impossibly strict standards, which, like all internalized values, remained unchanged, standing guard against any risk of the dreaded criticisms and punishments.

Question four: What is the RULE that leads to the EMP?

In generating EMPs, the mind performs two determinations. First, it detects conditions likely to lead to the dreaded limbic emotion. That determination depends on pattern matching, encoded as procedural memory. In other words, the mind recognizes current conditions whose similarity to past experience predicts the likelihood of again experiencing the painful limbic emotion. That prediction, signals the need for a protective response. The second determination is to assess what response (EMP) will best succeed in preventing the dreaded emotion. In this case, the rules were simple. In verbal terms, “If an activity is contemplated that could bring shame, don’t do it.” And, if she had already done something, “Look what a bad job you have done!”

Question five: What new experience might disconfirm the limbic logic?

This is the antidote. It might be the recall of an accomplishment that actually was satisfying or witnessing someone else having an appropriate feeling of satisfaction. It might be refusing to back away from a positive challenge. Often the antidote is an action but it can also be a realization or an image. What it accomplishes is communication, in the metaphorical language of the limbic system, that the old procedural memory is no longer valid and can be replaced with the new version. That can apply to both determinations, appraisal of the need for a response, as well as the choice of response, or both.

The ideal situation for memory reconsolidation and complete erasure of the old pattern is where the limbic activation is at its maximum intensity. The most dramatic examples in my experience are when the original experience has been dissociated and kept from recall since it first happened. Clinically, this is when the client experiences the trauma memory as if the events had just happened. When activation of the old pattern is less sharp or less connected with affect, the result may be a temporary suppression through the alternative mechanism of extinction or perhaps a partial rewriting through memory reconsolidation, resulting in only partial erasure of the old pattern.

In situations like this, where an inner critic is protecting the adult from pain, many trauma experts utilize personifications like Penelope to represent the inner self. While somewhat contrived, this characterization is accurate in that it validates the inner mind’s deep purposefulness and dedication to its protective mission. Therapists may recommend some kind of dialog, for example, Linda taking on the role of parent and showing Penelope that the danger is over. It can also involve humor or inner discussion. It could be to consider how Penelope’s protective strategy was targeting an audience of one who has long since passed away. The initial instinct is often hostile towards a Penelope, but this doesn’t work any better than with real children. In all cases, what is required is for the adult client to connect withe the inner self from a place of empathy and respect for the individual. One word for that is accurate empathy. Perhaps a better one is "complex caring," not generic caring, but caring with an appreciation and respect for the unique, individual young self. The therapist may model attitudes of warmth, trustworthiness, and support, balanced with firmness that the old pattern is no longer valid and should not determine behavior.

Two additional layers

EMPs come in layers. In Linda’s case, there were two earlier layers of EMPs. New layers like the one personified as Penelope are “invented” when the earlier layer is in danger of failing in its protective role. Linda’s case is typical in that between her youth and ADHD impulsiveness, she likely had trouble avoiding the father’s criticisms and punishments. The initial defense of simply trying harder to keep in his good graces could not be sustained by a child. Under those circumstances each “failure,” including those where she had done nothing wrong, would result in an internal call for a solution even more potent than "doing her best." As in many cases, shame became the new, more potent layer of protection. Establishing internalized values to serve as an “internal electric fence” became the new layer of defense, far more robust and constant than previous attempts at self-discipline.

Exploration made us aware of yet another layer explaining an additional aspect of her shame. Linda’s natural reaction to her father’s abuse was anger. Anger at a drunken and violent father was far too dangerous and had somehow to be suppressed. Once again for a child, suppressing such anger would be unsustainable. The subtle additions to her value system were a prohibition against assertiveness and seeing service to others as a duty.

I won’t formally go through the Five Key Questions in relation to each of these earlier layers of EMP, but as a learning exercise, readers and trainees are invited to do so. In addition, it is worth pointing out the common occurrence where value layers generating shame or inappropriate guilt may cover up earlier, unsuccessful layers of self-inhibition. The emotions of fear that originally triggered attempts at self-restraint may be obvious but still inaccessible to therapy. In those cases, even though the original fear and trauma might be clear, treatment will first need to address the newer layers of shame and distorted values.

Conclusion:

I hope this brief example of the Five Key Questions method shows how it can bring trainees and therapists into close contact with the most critical aspects of the problems clients bring to therapy. The questions do that efficiently by placing the focus on those limbic events most relevant to enduring change in already established entrenched maladaptive patterns.

For those who are new to the Five Key Questions, our introduction of the framework and the method starts with TIFT #101.

Jeffery Smith MD

Photo Credit: Yann Caradec from Paris, France - Exposition Paris-Athènes au Musée du Louvre à Paris #parisathenes, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=111190054