Repetition, frozen structures and differentiation

Summary

Client’s present with frozen structures (OCD, GAD, Substance misuse) where a trigger, results in distress and a response to the distress creates more of the distress. This cycle is maintained as the trigger and distress and undifferentiated, they have singular descriptions for instance “That was unfair”, “I am angry”, which result in singular responses, “I drink to lessen the anger”.

Through differentiating them into a more intricate description then it  encourages different responses.  It does this via de-associating trigger and distress as they are experienced differently post differentiation and also by encouraging different responses to all the differentiated parts. To work with a client to differentiate their experiences can be aided by a therapist attitude of both a gentle tentativeness and the belief that experience is always richer than our description of it.

 

Article

There seems something clients often present with which is repetitive thoughts\behaviours where there is a feeling of being stuck somewhere, the process that they are part of seems something of a frozen structure, repeating itself over and over, like wriggling a key in a lock without the door opening.    These presentations may be substance misuse, OCD, GAD to name but a few.

There seems something that can be in common throughout all of them:

 

There is a trigger (e.g. a situation where I’ve been working hard, or not had the outcome I want etc).

There is distress (e.g. anger, disappointment, boredom etc).

There is a response to this that gives short term relief from this (e.g. substance use, ritual, worry).

But the response produces more triggers\distress (e.g. hangovers, increased anxiety, self-criticism) and it doesn’t develop any more useful ways to deal with the initial distress/trigger.

And so the cycle begins.

 

It seems then two things can be helpful for clients:  to have more understanding of the components of the process and the process itself and to use different ways to manage the distress, or the trigger.

To get a deeper understanding we differentiate. We start with the single description of the experience, say anger, and we differentiate it into all the differing aspects of the experience.

In deepening an understanding of the parts of this cycle, it enables new possibilities. The old cycle says for instance when angry then I drink. As we differentiate the anger, it changes and the anger becomes anger with other aspects, the injustice, the tiredness, the need to achieve and the like. Now with a different stimulus the client can more easily disconnect from their habitual associated response and look for other more helpful ways of responding. Likewise, as anger has been broken up into its component parts, then it becomes easier to manage as the bits are smaller and also calls for different responses. How do I respond to the unfairness, my tiredness, my need to achieve?

 

To differentiate then we can explore the phenomena and experience of the trigger and distress somatically, cognitively, and emotionally.  Both trigger and distress can be understood independently and as we get new information about one of them, it can in turn aid to an increase of understanding in the other.  They are two sides of the same coin. So as a cognition from the trigger arises: “he shouldn’t have treated me like that”, then this can in turn point to some emotions, maybe disappointment, expectation, sadness etc. As an emotion arises from the experience of the distress, for instance a feeling of sadness along with the anger, this can in turn point back to the trigger to open up the thought of  “he treats me like that because he doesn’t value me”.

 

To find the differentiation within the trigger or the distress then what you are looking for is an edge which can provide an entry to the experience, so the client engages more with it.  One thing you may well notice on either trigger or distress is that the client describes them in singular ways, for instance: “I was treated unfairly” and “I was angry”.  The frozen structure above needs to have the same pieces to be able to continually repeat itself. So these singular ways of description,  ”unfairly” and “angry” are key to keeping the structure frozen.

To find an edge, to go further into this singular description,  is predominantly something you will best understand with your client, but some general ways that seem  useful to do this is  to give time in reflecting and also use tentative language to encourage the client to go further, for instance “so you feel it rather unfair”. Using this slightly uncertain language can encourage a clarification from the client, for instance: “No it’s not just unfair, its uncaring too!”

It can also help to point at the client’s experience of this. So as the client engages with their sense of this situation, then you might say “you’re noticing that part of it feels rather unfair”. In doing this you both encourage them to engage with their experience of the situation and to imply by the word “part” that there’s more there. This being the process of disidentification.

The therapists attitude here also helps, being tentative, having a gentle explorative engagement, which encourages the client likewise. In some ways the therapist joins the client as they both engage with the client’s experience; they both sit on a log together and wonder about the nature of the client’s experience.  This attitude says there are always at least three people in the room.

 

So, using a phenomenological and focusing attitude then we can differentiate the respective understandings of trigger and distress.

The same approach can be used to explore the response. This time we can also supplement this with understanding what the function of this behaviour is and then to also pick out secondary gains which may then point to an unacknowledged trigger.

Then with the understanding of the component parts developed, an understanding of the circularity can be developed, showing what the reinforcers are that stimulate the repeated behaviour.

As much as the differentiation weakens the connection between trigger and distress, distress and response, so this can then be supplemented with other ways to manage the distress, which this time will be related more finely to the presenting situation.

In summary then, to thaw frozen structures, it is a case of developing the intricacy of experience on from singular descriptions. This in turn enables a client to disidentify with the description of their experience as there is always more to experience.  As experience is understood with more nuance this then encourages a range of response.