On the Difference Between Abreaction and Feeling (Part 8/15)

Feeling is healing. No feeling, no healing. Connection is the Key.

 So how do we guard against abreaction and produce genuine feelings? There are two important factors at play. First, the patient must arrive at a particular feeling/pain/need untrammeled by other feelings, which are often compounded by a history of unrelenting pain from childhood trauma and neglect. That is, the therapist must be acutely aware of the leitmotif in the session – which feelings are critical and which are peripheral. It takes much experience to know how to do it because often, there is a tendency to conflate feelings and go off on the wrong tangent. If the wrong feeling is addressed, we get abreaction. For example, if a patient is in a feeling and suddenly starts gagging and coughing as a result of first-line intrusion, the therapist should steer him back to the original feeling because the intrusion is a diversion, and that diversion itself is the abreaction. Or if the patient comes in bitching about his wife – “she is just suffocating me with her demands” – and then he begins gagging, we know that the origin of his complaints is deep in the brain, likely the part of the brainstem concerned with breathing. We do not push the patient into the birth trauma unless he is far along in therapy and ready for such an experience. Otherwise, he is steered back into the original feeling, to explore why he feels suffocated. It is indeed a thin line to know which level the patient is on and what level he can access without unbearable pain.

 The same is true of a patient who comes in crying on the third line and never goes beneath it, to older pains. That too is abreaction. He is discharging deeper feelings on a higher level of brain function, unable or unwilling to take it back further and deeper. The result is not a full feeling; rather it becomes a chronic discharge of the energy of the feeling with no final resolution. For example, a patient may come in and cry only about a film he just saw, but never connect it to his own life and his past experience. He is stuck on the third line, and abreacting. Screaming and yelling in and of itself always remains a simple discharge. Feeling ultimately means an experience in context. The problem is that yelling, crying and screaming with no context still feels good and can form a groove of relief.

 This is where it gets tricky because there are levels of contexts: the ideas (top level), the emotional experiences (limbic system) and the infantile (brainstem) level. The contexts deepen as the patient is able to go deeper in his therapy. A complete primal experience means encompassing all three levels of brain function involved in a single feeling. That comes later in therapy when access allows the patient to travel to the beginnings of experience and of life. He is then allowed to complete the cycle of feeling and obtain resolution. In this kind of primal the patient feels the entire crucible of his behavior and symptoms. It is no longer a mystery, so long as we allow evolution to do its job. It is too tempting sometimes for a therapist to push the patient into something very dramatic so as to show his so-called skill.

 So we need to know on what line or level the patient is operating on, so that we help him and us to focus. This avoids a mélange of levels that also prevents proper connection. We see this with patients who wander over several feelings and disparate subjects during a single, scattershot session. Nearly always, the patient’s wandering over many subjects means there is a mélange of great underlying pain pushing him from one place to another. Needless to say, this is the patient who often suffers attention deficit for the same reason: too strong a primal force, preventing focus.

 Feelings must be felt on all levels but in an orderly sequence, not all at once. The therapist must get the patient back on track so the natural feeling can be allowed to unfold in tune with the natural resonance that links the levels of feeling together neurologically. Once the patient is on the right track, resonance will take its course, leading the patient naturally deeper and more remote over time. In abreaction, it’s often the therapist that is leading the patient in the wrong direction, creating all manner of bad outcomes.