IS IT
WORKING?
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14 Holding On/Letting Go:
Your Symptom's Last Stand
"Is it working?" is a delicate question with this kind of therapy. My mind-body
approach isn't designed to get the quick, dramatic results that can follow a shot of
steroids or an antibiotic. Signs of progress can take many forms, including some that
easily escape your notice.
It's a critical question because stalls and slowdowns in progress are very
common in this kind of therapy. Psychotherapists call it resistance, and it means your
symptom is holding on despite your efforts. It's not a sign of failure but a great
opportunity to understand the needs, fears, and emotional tasks that give the
symptom its power. Just to recognize that you or your symptom are holding on can
be a major breakthrough.
"Is it working?" can be hard to answer because individual responses to therapy
vary so widely. I've found that most skin patients get at least some results in six to
twelve weekly sessions, but the range is enormous. One patient who had a rash
around his genitals worked (mainly on his own) through four years of improvements
and plateaus before he reached the point where he was symptom-free 90 percent of
the time; another reported her warts disappeared immediately after she called me
for an appointment!
What expectations are realistic? As a general rule (exceptions are numerous),
the longer you've had the problem, the longer it will take to leave. Jean, whose
eczema dates from birth, may get as good results as Jane, whose skin was fine until
last February, but it will probably take a lot more time and energy to get there.
Similarly, a severe, widespread rash will probably demand more effort than a limited
eruption.
Symptoms on the central body – chest, stomach, back, or genitals – seem to take
the longest to get better. Those on the head and neck are more tractable, and those
on the hands and feet respond quickest of all. Perhaps the subtle physiological
changes of relaxation and hypnosis are most readily achieved in areas farthest from
the body's center, or the body symbolism we discussed in chapter 5 plays a part: it
takes more work to dislodge symptoms closest to the heart, head, and gut.
You are another critical factor. Younger people are usually in a more active state
of flux and formation than their elders, and this gives them a head start in making
changes. When skin symptoms are tied to a time of upheaval, such as adolescence or
divorce, they often improve quickly. If your symptom is a persistent annoyance in an
otherwise satisfactory settled existence, gains will probably come more slowly than
they will to a person whose whole life is distressed and in turmoil, who feels he's
absolutely had it with his symptom and must make something happen.
I get the impression that patients do best who have had particularly poor results
with conventional dermatology and are ready to embrace something completely
different. If you still believe that some wonder pill might come out of a laboratory
tomorrow or that Dr. Right is in the next professional building, you're likely to be
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more tentative with the work we're doing here.
Remember that progress can take many shapes and forms. The disease itself
may improve in one way or another: the rash disappears or attacks are shorter and
less frequent; you continue to have flare-ups but in smaller areas. Your symptom may
be unchanged but you suffer less: itching, burning, or pain are not the torment they
once were; they no longer rule your life. It may be an emotional impact that's
reduced: less shame, fear, revulsion, or sense that your life and body are out of your
control. This intangible improvement is progress just as sure and significant as a
drop in the number of pustules.
If you're discouraged and uncertain whether my approach is working at all,
make sure your eyes are open to changes on all three fronts. I'd recommend going
through all the diagnostic material and then using treatment exercises for at least
three weeks – with lots of energy and commitment – before making any judgment. If
absolutely nothing has happened, it could be this kind of treatment has nothing to
offer you. (In my experience, this is extremely rare.) Check your condition, using the
Micro Time Line and the Griesemer scale of chapter 4, and review that chapter's
Introduction and Time Line exercises for any indication that your symptom may be
emotionally responsive.
Only if the results are uniformly negative – no progress of any sort, no
suggestion that your skin has any link to your head and heart, or a low percentage on
the Griesemer scale – would I start to think that you have nothing to gain from my
program. Otherwise, before passing this book on to another afflicted friend or a tag
sale, I'd give serious thought to the possibility that you're holding on.
What's happening, in this case, is that the same power that has kept your
symptom entrenched for months or years is now redoubling its efforts against your
attempts to dislodge it. There's no weakness or blame here. Consciously, you want to
be well, but the wishes, fears, and needs under the skin are intent on roadblocks and
sabotage. A certain amount of holding on is inevitable when treatment efforts come
close to home. Rather than flagellate yourself, have some respect for the strength of
your inner self.
Such roadblocks can be quite concrete. Judy D., a teacher, came to me with
painful plantar warts on her right foot. She'd been through such therapies as freezing
and acid, but nothing worked for long. We got off to a fine start with hypnosis; the
first night she tried self-hypnosis, she said, she saw that it might have a major impact.
However, from that point onward, things got difficult. She missed appointments,
blaming heavy traffic en route to the office. She arrived for one session with her arm
so painfully strained from softball the day before that she couldn't raise it above her
shoulder, and thus could not practice the arm levitation that was part of her hypnotic
procedure. Judy insisted she was eager to continue with therapy but her actions said
something different.
As we discussed the history of her warts one day, an important clue emerged.
The first doctor who treated them was the father of a friend, who used an effective
but extremely painful therapy. Shortly afterward, the doctor died. In adulthood, the
warts came out of remission following the death of a colleague.
My guess was that the child Judy had been angry with her first doctor for the
pain he caused – a natural reaction – and then felt secretly responsible and guilty
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when he died. The later death of her colleague rekindled the feeling. When it became
clear that my treatment might make the warts go away, she panicked: the last time
that happened, someone died! She'd never dealt directly with the painful feelings of
that childhood episode or with earlier guilt and fears that were tied in with it.
Holding on to the warts was less painful than confronting the feelings that had
overwhelmed her as a child and in the timeless parts of her heart and mind
overwhelmed her still.
Often, holding on serves the same emotional task that gives the symptom its
power. Joseph K., a thirty-year-old teacher, had atopic eczema from infancy through
early childhood, then hay fever until his teens, when eczema took over again.
Outwardly, Joseph was a most compliant patient, but however hard he tried to
please, no therapy ever worked for long. When he worked with me, it became clear
that despite his best intentions, he could follow his exercise program only in fits and
starts.
I saw that this pattern had a special meaning in Joseph's life. His mother had
been an extremely controlling woman, and he'd always passively complied with her
demands despite a boiling anger that never reached the surface. With his wife, his
neighbors, and his kids, he was relentlessly Mr. Nice Guy, agreeable on the surface
and eager to please, although his natural drive for adult independence had never
withered away.
In therapy, he was similarly all cooperation up front. Yet with me, as with a
series of dermatologists, he harbored the same underground resistance that had
protected his autonomy against his mother and then his wife. Giving up the symptom
because of my efforts would be, in a sense, giving up his soul.
An important turning point came when I suggested to Joseph that his scratching
was the healthiest part of his life. His mother told him to stop; his wife told him to
stop; first his dermatologist and now his psychotherapists tried to make him stop,
but he kept on scratching! This was one place where he was his own man.
Pointing out to Joseph K. that scratching was indeed an act of vigorous
independence ironically enabled him to stop. Around the same time, he reported that
turmoil was coming to the surface in his relationship with his wife. In a surprising
display of autonomy, he announced that he wanted to continue work on his skin
alone – using the techniques we'd developed in therapy – and the last I heard he was
doing well. Recognizing your own holding on may open the door to self-knowledge: if
you can come to grips with the feelings you're protecting yourself from, you'll give
your efforts a major boost. Exploring the roots of holding on can yield the same inner
information as the dreams, daydreams, and other diagnostic exercises of part 1.
Holding on often feels as if it's happening to you – you just can't find the time for the
exercises, you're interrupted, or something is preventing you from concentrating. A
critical first step is acknowledging that you yourself are doing it – on some level, that
is, you are actively holding on. How can you clue yourself into the process?
The first question is simple. Are you really doing the work? Have you done both
diagnostic and treatment exercises seriously, consistently, in an atmosphere free
from interruption? Or did you give them a quick once-over then shelve them for
later? Did you run through them superficially and conclude that nothing would
happen? Did you always seem to be interrupted? What seems like a force of
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circumstance – "I just can't find the time or place" – is often holding on.
Frequently, people report that they give the exercises their best shot but
nothing happens. "Nothing comes to my mind. It's a blank," they say. The mind
constantly produces thoughts, feelings, images, and associations; to make it truly
blank is a capacity that yogis and mystics spend years developing. So ask yourself,
"What is creating this blank in my mind? What feelings or thoughts am I avoiding?
What pain am I backing off from?" Let your mind drift over the notion "I'm avoiding
something" and see what occurs to you.
You may feel that you've been an exemplary patient. You do the diagnostic
exercises conscientiously, and as you do, all sorts of painful, fascinating, guilty
revelations bubble up. Yet you don't feel that anything's happening. This maybe
because you're not feeling the emotions that belong to the memories: your exercises
are all head and no heart. Despite the magnitude of your surface efforts and effects,
inside you're backing away or holding on. You're like a person who's afraid of heights
but who forces himself to climb mountains – he's done something difficult but he's
still afraid of heights at the end of the day! People who hold on in this way were often
good little boys and girls, straight-A students, and model workers despite the
troubles and dissents boiling within.
Because holding on – resistance – is so widespread in psychotherapy, it has
been extensively studied, and we can use some of these insights. Dr. Ralph Greenson
has compiled the classic signs that holding on is taking place.lxxvii Among them:
Either you experience no emotion as important information
emerges (see above) or the emotions are inappropriate: you
giggle when you think of something sad or your eyes water
when you remember something happy.
Postures are a clue. As you work on the exercises, you hunch into a
stiff, rigid posture; your fists clench, your neck muscles
tighten, your feet curl up; or you perform repetitive
movements: your feet bounce, your head nods, your fingers
tap.
You often find yourself drowsing and falling asleep during the
exercises.
There are conspicuous gaps and omissions. You dredge up lots of
memories about your father and sisters but nothing about
your mother or a particular brother. Nothing that relates to
anger or to sexuality ever seems to come up.
You approach diagnostic or therapeutic exercises rigidly,
concentrating on them at a particular time of day but
forgetting them utterly otherwise. It's as if you're
encapsulating the effort to keep it from permeating your
entire life. (If you're not holding on this way, it's almost
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inevitable that passing thoughts about this book will occur to
you throughout the day.)
One or more avenues of insight seem closed to you. That is, you're
picking up diagnostic dues from your daydreams, family
photographs, and the like but you can never remember early
life events.
Cheerfulness and enthusiasm, though usually praiseworthy and
pleasant, may indicate holding on. If you find yourself telling
everyone of the terrific book you're reading and the exciting
discoveries you're making about yourself, take a step back and
consider: a lot of what I'm asking you to do is demanding and
painful. Why hasn't it dampened your enthusiasm – at least a
little bit?
Your style of holding on may point to the emotional needs or fears at the bottom
of it. Are you constantly peeking ahead, reading bits and pieces of various chapters
before getting down to work? Skimming is fair enough unless you do it instead of
getting down to work. You might ask yourself if you're generally prone to the
superficial once-over: do you avoid the full force of suspense by checking out the end
of mystery novels before it gets too intense? You may be avoiding full emotional
commitment in the same way here.
Perhaps you're not following the program in the proper sequence because
you're struggling for control; the adolescent within you is digging in his heels in
reaction to the idea that "somebody's telling me what to do." Consider going through
this book in an orderly, methodical manner. Does the image bother you?
Some people start off great guns and then peter out. After four days of serious,
sustained diagnostic work, they no longer can find time to continue until they finally
lose all momentum. Have you seen this pattern elsewhere in your life? Does a siege of
self-doubt often torpedo promising progress?
It could be that initial gains are checked by a fear of success; it may be
threatening to think of yourself as an effective heavyweight rather than a dilettante.
Remaining an incompetent child is a way of protecting yourself from the anger of
adults or the retribution of a wrathful parent who exists only in the timeless mind.
Others report a similar pattern in which a little progress ends in a plateau or
even a backslide: it feels impossible to secure temporary gains. It may be that
progress ends when the emotional ante gets too high; that's when the lone soldier
barricades himself within his cave. Try to come to terms with whatever it is within
that limits your ability to change and confront emotions. Did you taper off when
results were too good? Did you find yourself growing fearful and anxious as results
began to show? What fears were stirred up within you? What boat was rocked?
Some of my patients first report frustration: "I'm working but the techniques
aren't." They've put serious, consistent effort into both diagnostic and therapeutic
exercises, they've engaged their hearts as well as their minds in the effort, but the
impact has been zero.
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My advice for these people is to look systematically and objectively at the three
areas in which change takes place: the physical symptom, your subjective experience
of it, and its emotional impact. Ask friends and family if they've noted any change for
the better – any change at all in you or your skin. Do you seem more relaxed, more
cheerful, easier to live with? Being blind to improvements often means holding on to
your sense of yourself as sick.
If your feeling that the book has failed is accompanied by acute disappointment,
ask yourself if this seems familiar. Do you often feel you're being set up, promised the
moon, and then let down? Am I just the latest in a series of unclothed emperors? If so,
you might wonder if all these are echoes of childhood, when a supremely important
emperor left you in the lurch when you needed him or her. People can become so
used to their rhythm of great expectations and dismal disappointment that when it's
time for the bottom to fall out, it does fallout; they experience failure no matter
what's happening.
In a more subtle kind of holding on, people grant that something's happened,
some gains have been made, but nothing sufficiently major or magical. They suspect
that they're missing out on the "flash" that everyone else enjoys, that the approach
works better for everyone else than for them. This can be a simple crisis of
confidence, a sign of self-doubt that refuses to believe that you can do what others
can. Whatever results you get are automatically devalued because it's you who got
them. Like Groucho Marx, who refused to belong to any club willing to accept a
person like him as a member, you may be rejecting any technique that works for the
likes of yourself. If so, adjust your estimate of success upward by twenty bonus
confidence points (as you'd calibrate a meter that always read too low) and be sure
to supplement your own evaluation with those of people whose judgment you trust –
then start exploring the roots of your self-disparagement.
A particular distressing kind of holding on may make your symptoms seem
worse. This, in fact, will happen to about 30 percent of patients at some time during
treatment. When it does, you need courage to keep on persevering. Be reassured:
This is a sign that the approach is working. Enough hidden feelings are stirring to
arouse your symptom into a counterattack: you are having an impact; you've opened
direct communication with the symptom. If these efforts can give you trouble, they
can definitely take it away.
One last bit of holding on can be distressing far out of proportion to its impact.
Some people find that the exercises have worked. Their symptoms have all but
disappeared, but the last little patch of psoriasis will not go away; the herpes
continues to recur, very mildly and occasionally; the warts that once covered your
hand have left an enclave on the edge of one finger. The best thing you can do now is
accept, even value, this as a nostalgic souvenir of bad times and as a reminder of all
you've done to help yourself. It's not a sign of failure but a last vestige of your
experience, like the scar left by a disease or accident. You've domesticated what was
once a wild beast and you can take pleasure in living with something that once
threatened and tormented you. Think of it as a museum exhibit, preserved in a glass
case, to be visited and pondered on a Sunday afternoon.
An important idea that reappears throughout this book is that we often get into
trouble – including skin trouble – by replaying events and relationships of our long-
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ago past. As I've suggested here, such repetitions can throw up roadblocks to
treatment. One particularly important kind of repetition, the relationship that
develops between sufferers and those who are supposed to help them, is important
enough for its own chapter.
lxxvii R.R.Greenson, The Technique and Practice of Psychoanalysis, (New York: International Universities
Press, 1967).
15.Ghosts: Have They Handcuffed Your Doctors?
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15 Ghosts:
Have They Handcuffed Your Doctors?
When skin patients come to see me, they have almost always been through a number
of other doctors, from family physicians to superspecialists, in search of a cure. My
role is often not to replace medical therapy but to make it more effective – to remove
barriers so my patients can benefit from their doctors' skills. This frequently means
exorcising ghosts.
These ghosts inhabit the twilight zone of the mind, where past and present meet
and mingle. They are the shadows of fathers, mothers and other all-important
persons as they were experienced very early in life. Just as unfinished business from
childhood often generates or aggravates today's skin symptoms, these ghosts can
intrude on, influence, even dominate today's relationships.
The technical term for the "ghost" effect is transference, and like resistance, it
has been studied extensively by psychotherapists. Freud noted early in his work that
his patients transferred their childhood feelings about parents to him and reacted to
him as if he were the father or mother of long ago. He became convinced that
transference could complicate therapy and raise resistance but also generate insight
and change. Transference makes it possible to reexperience the buried feelings of
yesterday openly and directly.lxxviii
Ghosts intrude into all our lives in familiar, minor ways, such as the new
acquaintance or coworker whom you like lavishly or resent unreasonably at first
sight. You can often trace your reaction to the fact that he or she reminds you of
someone from the past. You're actually reacting to your old girlfriend or your cousin
Anne, not the personality of this person you hardly know.
Intimate relationships can be formed and destroyed under the influence of
ghosts.
In the lives of people whose early years did not meet their needs, ghosts are
likely to be particularly powerful. One person after another is cast as the cold,
withholding father or the smothering mother, with the hope that this time they'll
come through as they did not in the past. Like all efforts to rewrite history, it is
doomed to fail.
Relationships with doctors are a fertile ground for ghosts. Your illne