Everyone cares about coronavirus but I am a little more concerned than others
The case of Alessia, a former patient who finds herself in difficulty during the emergency from Covid-19: the rescripting of the traumatic memories associated with current fears, through Video Imagery Rescripting and Self Mirroring Therapy in Interpersonal Metacognitive Therapy.
an ex-patient of mine writes me: it is obviously an urgency. She sits at a safe distance, disinfects her hands, is very alarmed and critical of herself for this fear.
“I know the patient very well, Alessia: therapy in the past has had good results, because today you cannot overcome this impasse by yourself?
Probably the amount of conflicting information about CoVid-19 and the widespread fear mean that she does not allow herself to explore her emotions in depth, that a part of herself assumes that her personal story has nothing to do with it and that feel totally powerless to control anxiety to the point of being crushed by it. She is almost ashamed to ask for help, so much so that when I reassure her “it is normal to be afraid at this moment, we all have a little” and then I ask her “what scares you of the coronavirus?”, She replies “but how ? with everything you hear around ?! “. I had normalized her fear, but the very idea that there was a residual of fear more tied to personal aspects was unacceptable to her.
Such a generalized statement does not allow me to have access to the knowledge prior to anxiety, constituting an obstacle to the formulation of the case. In these cases it is recommended to use specific techniques aimed at improving metacognitive monitoring.
I decide to investigate, taking up the conceptualization of the case already reconstructed with the Interpersonal Metacognitive Therapy in the previous therapy. In our meetings Alessia had come to understand her own problematic functioning in the face of certain situations and had started to modify it.
The interpersonal pattern that has often emerged with you since recent autobiographical episodes and connected to past experiences is this:
The wish (healthy and universal desire) is one of belonging. Starting from this motivation, and from the other’s responses to their desires, the person approaches reality, makes predictions, interprets and filters information, reasons about their behaviors and consequences (“procedure if … then” and “response of the ‘other’: in this case “if I try to get closer to the other, to a group, the other will refuse me, and humiliate me, they will exclude me”). The response of the other (imagined, or real but interpreted in the light of the scheme), induces in the person a cognitive, emotional and behavioral “response of the self to the other’s response”. In Alessia’s case: “if the other humiliates me, he is right because I am stupid”, anxiety, sadness, avoidance of the relationship; this leads to discover the negative nuclear image of oneself which in Alessia is: “different, excluded, inadequate “. At this point, as a coping strategy, Alessia has a transition from one motivational system to another: she passes to the domain of rank. It replaces the desire to belong and share the competitive desire to prevail.
In these early narrations of his return to therapy, the healthy part of the scheme does not emerge. In the previous therapy I had helped Alessia to access the positive nuclear idea of herself as equal to others and worthy of being part of a group, but here she can no longer recall it.
I decide to explore the active scheme in his fears related to CoVid-19 to understand if it is something already known related to his previous schemes and to share it with her.
The excited tone is frightened, stops.
At this moment we are unable to access the healthy part, to facilitate it I therefore decide to use an experiential technique.
I choose Self Mirroring Therapy, in the version of Video Imagery Rescripting to help you understand your emotions “from within”, through mirror neurons.
Self Mirroring Therapy is a technique that is applied in session with the patient who is filmed in the various phases of therapy (video 1) and then filmed again while observing and commenting on the first video (video 2). By observing in video 1, the patient is able to better recognize his emotions and to look at himself with acceptance and empathy, because it no longer involves the use of self-reflexive skills, which are often lacking, but the mirror neuron system, which is normally used in a way automatic and pre-reflective to understand the emotions of others and empathize.
We need a strong relationship with the therapist, who creates a relaxed and accepting atmosphere, has in mind a project of care and the objectives on the basis of which he selects and proposes the most suitable clips, modulates the patient’s emotions, underlines the insights and strengthens them.
The emotion is intense.
I decide to ask you other examples of specific autobiographical memories, to reformulate and share the dysfunctional interpersonal scheme
I remember it very well, we had already analyzed it together: colleagues invite her to dinner for Christmas, she forces herself to go but she would like to avoid. She tries to participate in the conversation, but when others talk about their relationship as a couple, she imagines having to reveal that she has always been single and that she will be the victim of sarcastic jokes and gossip so, seized with anxiety, she runs away to the bathroom and cries .
We choose a significant memory of the school to work on it in imagery
I therefore ask Alessia for permission to turn on the webcam and record the “video 1”
I accompany her to immerse herself in the scene until she relives the emotion and feels it in her body.
The desk leaves room for a middle school desk, It is green, peeling, with the names of the boys and all previous generations engraved on it with the tip of the compass, an old room, the woods beyond the windows “where I would like to hide!” .
It’s enough. A few breaths, feet firmly on the ground, we go back to the study and watch together the part of the video in which the patient describes the school scene. I ask her to look at herself as if she were looking at a friend in difficulty, to encourage care.
The webcam is always on and frames her face. With Self Mirroring Therapy it is important to video record the patient’s face while looking at herself in pain, to capture the moment when empathy and care for herself emerge (“video 2”). In this case, I used Self Mirroring Therapy to rewrite traumatic memories (Video Imagery Rescripting).
In the first video we see an adult woman, strong, with the expression of the frightened girl. The contrast is very clear for me who observes it, even more so for her who looks at herself. In fact, he is moved and says to himself: “come on, come on”, then he is silent, but everything is recorded in this second video.
Let’s watch video 2 together, to help you deepen that exhortation that spontaneously gave itself, and register it again (video 3). Seeing herself empathetic and friendly towards herself frightened activates a further change.
Rescripting allowed the patient to access a healthy part, another idea of herself and the other, to differentiate and assume a critical distance from her dysfunctional beliefs.
During Self Mirroring Therapy the observing self, Alessia who looks at herself suffering, becomes a new “other”, embodied in the same person. Alessia observes herself and feels benevolent towards herself fragile and vulnerable.
In this case the Video Imagery Rescripting has given more power to the experience, because in the video 1 Alessia was able to observe herself completely immersed in a painful memory, suffering which she spontaneously and intensely expressed with her face. By seeing each other again, through the system of mirror neurons, another “different” is activated, different from the rejecting one typical of his scheme. Alessia becomes attentive to herself and this experience appears much more incisive than just narrative memory. The mirror system favored empathy and my indications and the fact of being in a strong and stable helping relationship with me helped Alessia to look at herself with tenderness and encouraged self-care in her.
I leave this part of the video for you to watch at home, to memorize the contact you have had with your healthy part and help you generalize the experience.
At the end of the session she appears clearly more relieved and serene.
In this interview we managed to offer a different reading key for current fears, to reconstruct the active interpersonal pattern and to link it to the patient’s past experiences, to perform a live and experiential rescripting, in a collaborative atmosphere that strengthened the therapeutic relationship . In addition, the “video testimony” of your healthy part, which I leave for you to review at home, will be a good starting point for subsequent sessions, more intense and meaningful than just the written scheme.
The “embodied scheme”, reconstructed and questioned in such an intense experience in therapy, becomes an important moment of sharing and a reference for the future. During the session Alessia experienced a profound change in her way of relating to herself and to others, which was fixed in her memory and on the webcam: the goal now is no longer to discover another self, healthier, but to make it stable and generalize an already experienced progress.