Plum, I am saddened to learn about the depth of your mother-in-law problems. I have a few thoughts about that, but first I want to say something about ISTDP and your experience with Kristian Nibe.
Dr. Abbass is at Dalhousie University in Halifax, Canada. A couple years ago a Canadian newspaper ran an article mischaracterizing ISTDP as being all about anger. He responded: “In reality the cause of these problems is complex feelings including sadness about broken attachments, rage, guilt about rage. Love and interrupted attachments are the heart of these problems as opposed to just anger.” Nibe's book does not ignore this. In describing ISTDP, he says the first task of therapy is to overcome defense mechanisms that cause a person to repress feelings, i.e., habits like intellectualization, rationalization, denial, displacement, splitting, projection, acting out, and on and on. After the patient can accomplish that, Nibe says the task is then for the patient "to feel through feelings of grief [about a broken attachment], anger, and guilt [about the anger], until one finally reaches the attachment core and feelings of love."
The behavioral impulse of anger is aggression. ISTDP uses the term "portrayal" to describe imagining how one would carry out that aggressive impulse if one were unconstrained by morality, religion, social norms and so on. ISTDP psychiatrist Nat Kuhn has written: "There is nothing intrinsically therapeutic about portrayal. . . . When therapists encourage portrayals without helping the patient to experience the full range of complex feelings (that is, grief, guilt, and love in addition to rage), the results can include dropout, symptom exacerbation, and serious acting out."
I think the genius of ISTDP is its focus on a person becoming aware of and overcoming defense mechanisms so that he or she can do what Sarno preached, namely, become aware of repressed anger. I am not a fan of portrayal because I never found that necessary in order to overcome my decades of TMS and TMS equivalents. Further, I am skeptical about the value, let alone the necessity, of portrayal for reasons based on my understanding of neuroscientist Joseph LeDoux's work regarding how the brain responds to threats--something too complicated to go into here. I think portrayal, properly done in the therapy setting, can have value but not for the reasons ascribed to it by ISTDP theory. (To avoid any misimpression, I have no formal training in ISTDP. ISTDP and the neuroimmunology of persistent pain are only hobbies that fill my abundant free time since I retired ten years ago and that provide a refreshing break from from a long professional career having nothing to do to my hobbies.)
Now to my thoughts regarding your mother-in-law situation. I like what Gabor Maté says about anger. He relies significantly on what he learned about anger from ISTDP therapist (and fellow Canadian) Allen Kalpin but stops short of calling for portrayal. If you have access to Maté's book titled When the Body Says No, I suggest reading pages 269-74. If not, here is what I consider the most important paragraph:
Anger does not require hostile acting out. First and foremost, it is a physiological process to be experienced [a surge of energy and aggressive impulse]. Second, it has cognitive value—it provides essential information. Since anger does not exist in a vacuum, if I feel anger it must be in response to some perception on my part. It may be a response to a loss or the threat of it in a personal relationship, or it may signal a real or threatened invasion of my boundaries. I am greatly empowered without harming anyone if I permit myself to experience the anger [the surge of energy and aggressive impulse] and to contemplate what may have triggered it. Depending on circumstances, I may choose to manifest the anger in some [regulated] way or to let go of it. The key is that I have not repressed the experience of it. I may choose to display my anger as necessary in words or deeds, but I do not need to act out in a driven fashion as uncontrolled rage. Healthy anger leaves the individual, not the unbridled emotion, in charge.”
You cannot control whether your mother-in-law is driven to hurt you and/or your husband, and your anger is a perfectly natural reaction when she does that. The aggressive impulse of anger is automatically triggered when another person threatens the relationship we have with that person or threatens our boundaries. It is a gift of evolution: If our long ago ancestors did not have that behavioral impulse when threatened in a relationship or regarding personal boundaries, they would have been less able to survive than they were. But you can control what you do with your gift of anger. Of course, you don't want to act out in unbridled aggressive fashion. But as you know from Sarno, you also don't want to repress it either. Maté goes further and makes the point that repressing anger can harm your health in all sorts of ways in besides TMS. (Guilt is also a gift of evolution because it helped our long ago ancestors survive, but I won't detour into that.)
So what can you do with your anger? I think Steve Ozanich has it right in The Great Pain Deception. He says there are three choices in dealing with anger. First, burn the anger with physical activity that leaves you too exhausted for aggression. The trouble with this, he says, is that "the root of the problem remains and the seeds of discontent grow back." State differently, after you are over the exhaustion, your memory of your mother-in-law's threatening behavior will remain and have the power to trigger your fight-flight response. Second, face the anger in therapy. Ozanich says: "To feel and talk away anger may be two of the best ways to purge unexpressed energy, but it bypasses forgiveness. Understanding why someone did what they did to us does not necessarily mean we forgive them." Every time you think about what your mother-in-law has done, your fight-flight response is likely to be riled up again. Third, transform the anger by forgiveness and compassion. Ozanich regards that as the only effective solution. I know that can be difficult to do, but as a place to start, I'll mention two points that psychologist Fred Luskin has made about forgiveness. First, forgiveness does not mean that you condone what your mother-in-law did to you or your husband. Second, forgiveness is not for your mother-in-law but rather is for YOU because the result of forgiveness is that your memory of what your mother-in-law did will longer rile you up. Going beyond Luskin, Plum, I know you are familiar with Dr. Hanscom. If you have not seen two recent posts by him on this website's subform titled Mindbody Blogs (was Practitioner's Corner), I urge you
to check them out. One is titled Forgiveness is a Learned Skill - and a Power Move, and is dated March 2, 2020. The other is titled Beyond Forgiveness - Compassion for Those Who Hurt You, and is dated February 23, 2020.
I wish you success in moving forward.
