A Clinical Vignette:




by Martha Stark, MD / Faculty, Harvard Medical School


Ever in search of a quick cure but willing to work hard to get it, Janelle is an extraordinarily resourceful woman whom I have been seeing for about a year now. Because of financial constraints, however, our work has sadly been limited to once or twice monthly sessions.


A married 34-year-old mother of four, Janelle – self-sufficient, smart, hardworking, and solution-focused – is impressively high functioning and, to the casual observer, would appear to have it all.


But Janelle carries inside her a tremendous amount of psychic pain – a quiet despair, a deep sadness, a closed heart, an inner void, an insatiable hunger, an unrelenting sense that nothing will ever be enough, a profound mistrust of others, and a haunting loneliness. She is disconnected, shut down, closed off, not engaged, frozen, and terrified – terrified of being vulnerable, terrified of opening her heart, terrified of needing someone, terrified of being dependent, terrified of being hurt, terrified of being disappointed, terrified of feeling pain, terrified of feeling…


Janelle also suffers from frequent nightmares, the content of which varies but most of which involve scenes in which Janelle feels that she is in danger and her life at risk.


Early on in the treatment, Janelle came to realize, at least intellectually, that the self-protective wall behind which she hides in order to avoid being hurt or disappointed has been there for as long as she can remember. But because Janelle has so few memories of her childhood, we have never been able to understand exactly why it is that she has always felt such a powerful need to protect herself.


Several months into the treatment, I had shared with Janelle the brain-based concept of therapeutic memory reconsolidation as offering the possibility of bringing to bear the analytic wisdom of brain consciousness on the targeting and updating of old, fearful, maladaptive narratives locked in body consciousness. Self-limiting beliefs and self-defeating narratives, I had explained, derive from unmastered early on relational traumas and fuel present-day symptoms and defensive patterns of behavior.


Because Janelle, ever solution-focused, was clearly fascinated and eager to hear more, I had gone on to explain that, if all went well, the persistent disconfirming juxtaposition of an adult perspective that was here-and-now with a childhood experience that was there-and-then would eventually trigger release from emotionally charged, traumatic memories and their replacement with more modulated, more evolved, and more adaptive mental schemas.


I also highlighted that this deep, transformational work would be most effective were it to be conducted in the context of a collaborative relationship between patient and therapist, one that was characterized by gradually evolving mutual trust.


Although Janelle was indeed slowly relaxing into feeling more comfortable with me, she and I both recognized that, despite her ever-present impatience and persistent desire to move forward with finding solutions, but of course the exciting option of memory reconsolidation would not yet be available for her because she was unable to remember much from her childhood…


But Janelle came to her next appointment (two weeks later) with a big surprise!


After the session in which I had explained the concept of therapeutic memory reconsolidation, Janelle had found herself suddenly remembering an extremely traumatic experience that she had had when she was 14, an experience that had shaken her to her core and that, in retrospect, she realized had probably constituted a turning point in her life – and something from which she had never fully recovered.


One day her father, an embittered, depressed, and broken man who mostly kept to himself, suddenly (and uncharacteristically) turned his bitterness on her and directed some very harsh words her way. Later, however, he had gone up to her room to apologize for his unkind and unjustified outburst.


What ended up happening, however, was that as soon as her dad began to speak, he suddenly broke down and burst into tears as he, for reasons not entirely clear, began to unload onto her about his pent-up heartbreak and desperation – unleashing psychic pain and grief that he had carried inside him for decades. Through choked sobs, he downloaded onto Janelle his brokenness, his self-loathing, his profound regret, his shattered dreams, his sense of utter defeat, and his unrelenting terror. He spoke of the gun that he always carried in a desperate attempt to make him feel safe and the whiskey that he always had close at hand in a futile effort to ease his mental anguish. He harkened back to the serious car accident in which he had been involved as a hapless young teen, an accident that had left him with chronic physical pain and episodic seizures. With his head bowed in shame and in almost a whisper, he confessed his unrelenting despair and periodic tormented thoughts of suicide.


It was an absolutely overwhelming and heart-shattering experience for young Janelle, who could literally feel herself closing off and shutting down. To think that Janelle had been only 14 at the time – all alone and without a mother who had the capacity to tolerate pain (whether her husband’s or her daughter’s) and to whom Janelle could therefore have turned for comfort. Small wonder that the traumatizing experience would have marked a pivotal point in Janelle’s life and would then have fueled the nightmares that intensified shortly thereafter.


But I was now in for another surprise!


The ever self-reliant, resourceful, creative, and determined Janelle went on to tell me that, upon recovering the traumatic memory about her father, she had then decided, on her own initiative and ever intent upon moving forward in her life, to do therapeutic memory reconsolidation on herself!


Because the only times in her life when Janelle had felt safe and unafraid were when she gave herself the pleasure of an acupuncture treatment, she decided to select that setting for an ingenious experiment. With the tiny acupuncture needles strategically placed by the healer in such a way as to facilitate the flow of information and energy throughout her body and in a deeply relaxed state, Janelle forced herself to reactivate the memory of her father’s traumatic confessions and heartrending unburdening onto her of his pain, torment, anguish, despair, and terror.


Janelle made herself visualize as many of the details as she could about that fateful day 20 years earlier and made herself tune in to the range of terrifying feelings and distressing somatic sensations (including heaviness in her chest and upset in her stomach) that were being triggered as she began to remember what her heart and her body could not forget.


In an earlier session, I had suggested to Janelle that moving the eyes back and forth behind closed eyelids would facilitate the retrieval and reprocessing of traumatic memories because bilateral alternating stimulation would indeed facilitate accessing emotionally distressing memories held in the right brain and then bringing online the analytic wisdom of the left brain. And I had highlighted that this tapping into the wisdom of both the past-focused right brain and the present-focused left brain could be reinforced by rhythmically chanting, “That was then, this is now.”


As she lay otherwise still on the table, Janelle had therefore shifted her eyes back and forth, back and forth, as she was remembering, reliving, reprocessing, and softly chanting to herself, “That was then, this is now,” “That was then, this is now.” In her mind’s eye, she was envisioning her more-evolved adult self holding, comforting, and protecting her less-evolved and oh-so-vulnerable-and-frightened child self.


By the time Janelle was able to share her story with me, Janelle was no longer remembering specific details – other than that, as soon as she got up off the table, she felt a little different, as if something had shifted inside; she felt a little lighter, a little less burdened, somehow relieved, a little more grounded, a little safer, a little freer, a little more hopeful, and a little less afraid.


In our session 12 days later Janelle, with uncharacteristic excitement, explained the uplifting experience to me as follows, “It is as if things are now more laid to rest. I think I released something that day. I simply let go of the burden of my dad’s pain. I realize that his pain does not have to be my story too. I don’t need to carry his despair anymore – I can let go of it. It is not my responsibility. My heart had shut down when he told me about how much regret he had and how much pain he lived with. But I feel that I am beginning to let go of all that now. I feel much freer and lighter.”


Interestingly, it was not by way of grieving that Janelle experienced this transformational shift. Rather, Janelle had cleverly choreographed her own healing and masterminded, all on her own, the replacement of outdated, maladaptive, fear-infused, life-negating narratives with updated, more reality-based, more hopeful, life-affirming narratives.


Time will tell with respect to how enduring this piece of Janelle’s relationship to self, others, and the world will turn out to be over the long haul and, of course, Janelle and I continue to work on various of her characterological issues (including, for example, her discomfort with working collaboratively, her trouble tolerating delays, her reluctance to take ownership of her sexuality, and her difficulty putting into words her tender and loving feelings).


But since that time when Janelle, targeting the heaviness in her heart and the deeply embedded terror in her soul, implemented her own version of therapeutic memory reconsolidation, she really has started to feel again, to take more risks in her life, to be more open, to be more genuinely engaged, to be more present, to be more alive, and to be more joyful.


Oh, and the nightmares have all but disappeared…