Post-traumatic stress disorder (PTSD) can be defined as recurrent episodes of anxiety and panic in reaction to a pastexperience that was overwhelming at both sensory and emotional levels. Theindividual was unable to process and assimilate the experience, and the emotional trauma becomes repressed, only to reoccur in the future. The basic direction of psychotherapy for PTSD is to help the client re-process theseemotions into a form that can be re-assimilate; essentially completing theprocess that was left undone. However, the methods for doing this areproblematic for two main reasons. Firstly, the intensity of the associatedemotions and resistance to re-experiencing the trauma; and secondly, thecomplex superstructure of secondary reactivity that accumulates around theprimary experience, which makes it difficult for the client to access and workon the core emotions.
One approach, which I have found particularly helpful, is a form of psychotherapythat combines mindfulness and experiential imagery, called Mindfulness Meditation Therapy (MMT). In this approach, the client is taught how to form anon-reactive relationship with his traumatic memory. The individual literallylearns how to “sit” with the felt-sense of the trauma, without becoming caughtup in the contents. The purpose here is not to simply re-experience thetraumatic memory and emotions, but to learn how to experience them differently.This Mindfulness Based Relationship creates a therapeutic space around thememory imagery and associated emotional energy that allows the client togradually stop the secondary reactivity of resistance and avoidance. Now a newcreative space is created which allows the emotions, which have been confinedand frozen in place, to become malleable and change. This process of innerchange leads to the eventual resolution and transformation of the trauma. Inshort, reactivity inhibits change, whereas mindfulness facilitates change andhealing.
Mindfulness has of course attracted a great deal of attention in recent years, althoughthere has been little systematic attempt to describe, let alone define,mindfulness. In my view mindfulness describes the quality of consciousrelationship with experience in which there is complete presence for theexperience and the absence of any form of habitual subjective reactivity. Thisis invaluable in psychotherapy, because it allows the client to investigate thedeep structure of his trauma, rather than staying stuck at the superficialsurface structure.
Indeed, when one begins to investigate theinternal structure of a traumatic memory, it is always surprising to discoverthe wealth of subtle feelings that lie just under the surface. Differentiationof the feeling structure of an emotion like anxiety or panic is an essentialpart of any successful therapy and the conscious experience of this innerstructure is transformational.
In addition to feelings, traumatic memories also have a specific internalstructure in the form of intense experiential imagery. This imagery may bephotographic in quality, revealing the actual memory of the traumatic event,but more often the imagery has an abstract structure with specific colors andshapes, in something resembling a surrealistic collage. Emotional energy isencoded in each of these specific sub-modalities of size, color, intensity,movement and texture. An intense emotion is likely to be encoded in intensecolors, such as red and orange, and the imagery is likely to be large and closein the person’s inner visual field, whereas neutral emotions are likely encodedin neutral colors, such as pale blue or white, and appear small and distant. The investigative dimension of mindfulness provides the best approach touncover the detailed inner structure of the emotion and provide meaningfu lcontent. This is called the Structural Theory of Emotions, which goes on topropose that by changing the structure of the imagery it is possible to changethe intensity of the emotional reaction. Thus, if the color changes fromintense red to soft yellow, and the imagery becomes smaller, it is very likely that the emotion will become much less intense. However, for this to work effectively the imagery must arise experientially from the emotionalfelt-sense, rather than be created through deliberate visualization. Similarly,the direction of change must arise experientially, rather than be imposedexternally. This is why mindfulness is such an important part of the transformationalprocess, because it allows the client to be exquisitely sensitive to what ismeaningful and what is not.
A central focus in MMT is to uncover this internal structure of the traumaticmemory and then to investigate this experiential content. There is no attemptto interpret what arises, only to experience fully and know completely whateverarises. This process essentially de-constructs the emotional complex intosmaller parts that the psyche can digest and integrate into more stable configurationsthat do not continue to generate emotional suffering. Of course, this requiresconsiderable preliminary preparation so that the client can experience theinternal imagery without becoming overwhelmed. Therefore, the preliminary phaseof MMT is focussed on establishing the Mindfulness Based Relationship (MBR) inwhich there is sufficient stability and non-reactivity to allow the imagery tounfold into present awareness. There are many approaches to achieve the rightMBR, such as watching the imagery as if projected on a screen or placing theimagery at some distance in front. Through mindfulness and carefulinvestigation, the client can discover for himself what works best forestablishing the MBR. However, once a client begins to witness specific detailsabout the imagery, he inevitably finds it much easier to observe the imagerywithout becoming reactive, because the specific structural details give him aspecific focus and this tends to prevent hyper-reactivity. The MBR is anessential part of the transformation process for many reasons, the primaryreason being that it allows the compacted emotional complex to unfold into moremanageable parts. At another level, the MBR allows the client to fundamentallychange the way that he relates to his inner emotional experience and he beginsto break free from seeing himself as a victim of the emotional trauma. This initself is an essential requirement for change.
In a relatively short time, the client begins to discover the detailed internalstructure of the trauma and associated emotions in the form of experientialimagery. Now he can begin to investigate what changes need to happen in theimagery that allow the emotion to resolve. Mindfulness helps thistransformational process by creating a therapeutic space in which there is nointerference from the ego. The client begins to discover intuitive changes thatcan be very subtle and beyond rational deduction, but are clearly felt to makea difference. Experiential imagery frequently differentiates into parts, oftenwith different colors and textures and the internal interaction of these partscan be very important for resolution. One client described her anxiety as ablack pulsating blob, located on the upper left of her inner visual field thatsent tentacles out to her throat, literally strangling her. As she focusedmindfulness on this black blob, I asked her what needed to happen next. To hercomplete surprise, the answer that came up was that the black blob wanted to beallowed to die. It was strangling her to get her attention! Eventually, throughcontinued presence and complete attention to the black blob, it feltsufficiently reassured that it could let go of her throat and proceeded to die.It became white and brittle like ash and crumbled into a small pile on theground.
Onecould spend many hours trying to interpret and understand this process, butwhat was much more important, was her direct experience of the resolutionprocess at the subtle and concrete level of experiential imagery and this ismade possible by mindfulness, the sensitive attention to detail and theinvestigation of the deep structure of experience.
Throughout the whole process of MMT, the client is repeatedly exposed to the source of hisor her fear, but in new ways that don’t involve being overwhelmed. This exposure desensitization effect is regarded by most schools of psychotherapy asan essential part of overcoming PTSD and Mindfulness Meditation Therapyprovides a very subtle and specific way of doing this through the client’s internalexperiential imagery.