As Ellen noted above, imagining crushing mother’ skull is an element of ISTDP. In ISTDP, this is called a portrayal. But there is a lot more to portrayals than imagining crushing mother’s skull. ISTDP psychiatrist Nat Kuhn, MD, wrote about that in his book
Intensive Short-Term Dynamic Psychotherapy: A Reference. As is obvious from what he said, his target audience for the book is other psychotherapists. He wrote:
“In portrayal, the patient imagines playing out the impulse associated with some feeling. . . . There is nothing intrinsically therapeutic about a portrayal. Many patients have elaborate revenge fantasies which only worsen their difficulties by reinforcing unconscious guilt, in turn fostering additional self-sabotage. When therapists encourage portrayals without first mobilizing unconscious feelings and/or without helping the patient to experience the entire range of complex feelings (that is, grief, guilt, and love, in addition to rage), the results can include dropout, symptom exacerbation, and potentially acting out. . . . When guilt is not experienced, symptoms will worsen rather than improve.”
Kuhn explains that the phrase “complex feelings” means “a mixture of positive feelings (e.g., love or appreciation) and negative feelings (generally anger).” Portrayal of the entire range of complex feelings would go something like this: (1) you feel angry at a person you love, (2) you feel grief (or sadness) about the less-than-desired status of your relationship with that person, (3) you feel guilty about having gotten angry at him or her, and (4) you realize that despite your anger you do indeed feel love for him or her.
I am not a therapist, let alone an ISTDP therapist. I’m just an old guy who overcame more than half a century of various forms of TMS and TMS equivalents. Sarno’s chief psychologist, Arlene Feinblatt, helped him design his treatment program, and she was trained in ISTDP. That motivated me to read the main texts on ISTDP, like Kuhn’s book. For what it is (or is not) worth Dianna-M, I will offer a couple thoughts about your journaling portrayals.
First, as Kuhn noted, unconscious guilt can make the portrayer’s situation worse. It has been said that guilt is the most painful of the core ISTDP emotions and therefore is often deeply repressed. Congratulations on being able to feel guilty about your anger. It is good that you don’t repress the guilt.
Second, given what Kuhn wrote, I wonder whether it might be helpful if your journaling were to go beyond portraying your anger and include portraying your guilt. Conscious anger carries a behavioral impulse of aggressive action toward the object of your anger, while guilt carries a behavioral impulse to repair the relationship damage caused by your anger if possible—to reach out and apologize, comfort the object of the anger. How about writing about that behavioral impulse? Beyond portraying not just anger but also guilt, I wonder if it might be helpful if your journaling were to include portraying your grief or sadness about the status of your relationship with the object of your anger and, above all, include portraying your love for the object of your anger.
