321: Help I'm Having Panic Attacks pt 2 of 2

Yikes! Do I REALLY have to share my feelings? Last week, we featured Part 1 of a live therapy session with Keren Shemesh, PhD, a licensed clinical psychologist who began having intense panic attacks when her mother and father visited from Israel. Today, we feature the exciting conclusion of that session, with follow-up. If you are interested, you can listen to the follow-up with Keren and Jill who joined us st the end of today's podcast. They comment on the session as well as the details of what happened following the session. I (David) raised the question of why so many of us have trouble being honest and open with our feelings, especially anger. Jill suggested that it might be due to the false dichotomy people see, contrasting aggression with love. But you can be honest and loving at the same time, including when you express feelings of anger. Of course, we make the Five Secrets of Effective Communication sound easy, but these powerful tools actually require an enormous level of skill as well as commitment. Part 2 of the Keren session: M = Methods We began the Methods part of the session with a bit more Paradoxical Agenda Setting, and listed some really GOOD reasons NOT to open up more to her mother.

1. I want to protect her because it may be hard and upsetting to her.
2. I’m not used to being vulnerable with my parents.
3. I don’t want to rock the boat or change the status quo.
4. I’m not sure I want a closer relationship with my mother. NOTE: David and Jill were thinking that we often resist intimacy because we have negative pictures in our mind of what real closeness is. For example, if you think it means something yucky and upsetting, you obviously won’t want to get “close.” Jill tried to finesse around this by suggesting Keren might aim for a more “honest” relationship instead of a “closer” relationship.
5. There are things about me that they’ve rejected, like the fact that I don’t really want children. And I’m not so sure I want to make myself vulnerable and get rejected again!
6. I’m afraid I’ll get swallowed up and enmeshed.

We asked Keren what kinds of feelings she was hiding from her mother.

1. My feelings of nervousness and intense anxiety, and the intense somatic symptoms, like the knot in my stomach.
2. I am scared for her future, since she is not in good health and she’s not taking care of herself.
3. I have feelings of anger and resentment about the fact that I’m not the kind of daughter they wanted.
4. I’m sad about her health and seeing her struggle.
5. I feel hurt when I think how I have failed them and let them down.
6. I sometimes feel like I don’t really belong.

At this point, I became so absorbed in the session that I stopped taking notes, so you will have to listen carefully to the recording of the session which was fascinating. I do recall, however, that we began working on communication, using the Five Secrets of Effective Communication (LINK), as well as tips on how to proceed, taking it one step at a time and not trying to do it all at once, and role playing practice. Then we did some Externalization of Voices with the thoughts on Keren’s Daily Mood Log, using several strategies: Self-Defense, the Acceptance Paradox, and the CAT, or Counter-Attack Technique. You can see the Daily Mood Log she completed after the session, based on the work we did in the session, at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session In addition, Keren and Jill will be with us to record the follow-up. T = End-of-Session Testing You can review Keren’s BMS and EOTS (Patient’s Evaluation of Therapy Session) at the end of the session at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session As you can see, her depression score fell to 1, indicating substantial improvement, while her suicidal thoughts and urges remained at 0. Her feelings of anxiety vanished, but her feelings of anger remained fairly elevated, falling from 7 to 4. We would not expect further improvement in this dimension until she’s had the chance to share more of her feelings with her mom. Her feelings of happiness only increased from 10 to 13, again any further improvement would not be expected until she’s had the chance to do her “homework” following the session. However, her satisfaction with her relationship with her mom increased from 19 to 26 out of 30, which is substantial, while still leaving some room for improvement. On the EOTs, you will see that our Empathy and Helpfulness scores were perfect, along with our scores on the Satisfaction with Session, Commitment to homework, unexpressed Negative Feelings, and honesty scales. Here’s what she like “the least” about...