By Andrés Gottfried.
Ms. María T. attended her first session expressing “deep anguish”, which at times manifested in panic attacks, especially in closed places, since she described a “feeling of lack of air, strong pressure on the chest, agitation, dizziness, fear and the urge to run away“. This situation did not allow her to have, what Ms. T. referred to as “a calm and peaceful life”; at any moment she could be triggered to feel great anguish which she felt in her chest and feet. She said, “I want to be well but I can not, I have no strength”.
In exploringthe actual events of her life, no remarkable facts were identified. When asked what she could attribute the feeling of “deep anguish” to, Ms. T. stated that she was not clear when those long-distressing emotions had begun, and that they had grown over time, especially, on her return to Argentina after having lived in the United States for almost 11 years. She reported that she had married young, had had 2 daughters and had emigrated to the United States with her husband. In that country she had had a good life, but living with her husband was not easy, until she decided to leave him and return to Argentina with her children. It had been 4 years since her return, and her daughters were 20 and 18 years old. In Mendoza, she had a good job and a comfortable life, economically speaking. She did not have a partner; however, it was not a subject that worried her, as she said she felt fine that way.
At the second and third sessions, Längle’s Biographical Method was used, but nothing of relevance to Ms. T. was identified. She did not present any event to which she could attribute such anguish. Her panic had increased. At the end of the third session, the Argentine adaptation (Gottfried, 2016, in press) of the Test of Existential Motivations (TEM) by Längle and Eckhardt (2000) was administered. At the base of the instrument are presented the theoretical contents developed by Längle, which systematizes “Existential Analytical Psychodynamics” (Längle, 2000; Längle, S., 2003; Espinosa 2006) based on the development of “Fundamental Motivations of The Existence” (Längle, 1998a, 1998b, 1999, 2000, 2002, 2003, 2009). The TEM consists of four scales representing each of the Fundamental Motivations of Existence. Each scale is composed of 14 items, with a total of 56 items.
She completed the questionnaire in the waiting room and before leaving, she handed it to the secretary. When evaluating the TEM, it was noted that Ms. T had obtained low scores in all the scales, especially those of the 1st and 2nd Existential Motivation. These scores were below the 25th percentile, which is interpreted as “blocking zone and Coping reactions”. The items of Fundamental Trust (1st MF) with very low scores were: item 2 “I can gladly accept the circumstances in which I live”, item 13 “I feel as if I could lose the floor under my feet”; Item 22 “I feel I have enough space to live”, and item 32 “Insecurity in my life distresses me.” The items of Fundamental Value (2nd MF) with very low scores were: item 20 “I am a sad person” and item 30 “I experience life as a burden”. The questions for further clinical inquiry came naturally: “What distress you,?; What can you not accept that makes you feel life as a burden?, and what makes you feel that you lose the floor from under your feet?”
In the fourth session when talking about her daughters and her relationship with them, suddenly a painful memory came to her mind: “Oh no … I had forgotten … it wasn’t in my mind… I actually had three children. My youngest son, the only male, died very fast with hemolytic uremic syndrome at one year and two months” (with tears in her eyes). She then reported that they buried the baby’s body and the next day, she and her husband decided to move to the United States, retracted the contract of the house they rented, sold their car and paid for the tickets for the trip. Within 15 days of burying her son, she was traveling to Texas with her husband and two daughters. Ms. T reported that her husband never spoke of the “subject” and lived his life “as if nothing had happened.” After Ms. T. named what the center of her anguish meant for her: “the death of her one year-old son“, psychotherapy began from the Längle Method called “Personal Existential Analysis (PEA) “(Längle, 2007; Längle, 1998b; Espinosa, 2006). Ms. T. was asked to describe in detail what had happened since her son became ill until he died. Having to report the events that had been “forgotten” made her come in contact with what had happened to her, connect with her pain and work with the impression contained in her experiences, elaborate them and take a stand in front of them.
Through the phenomenological analysis of t PEA, Ms. T. was able to express the immediate and spontaneous sensations in front of the death of her son: “Nicolás’s death hit me suddenly, I felt totally alone, unprotected, tight… life became a very difficult load to carry“. She felt for her deceased son a “special preference” over his other two daughters, for having had the “same eye color of her father,” whom she had loved very much and had died of a heart attack when she was 17 years. By connecting her only son to her father, attention was focused on her father. Apparently the loss of her son, brought up a previous loss, also very significant. Ms. T. had had a bad relationship with her mother, which was getting worse over time and was cut off at the time of treatment. She remembered her father as someone who gave her security, protection, and containment, and above all had been an important support in her difficulties with her mother and in the difficult time of adolescence. When her father passed away, she left her last year of secondary school to go to work, since she needed money to go live alone. At the time of leaving home, she started a relationship with a man 9 years older, because he seemed a “grown man” and the next year married him.
Ms. T. could see a common reaction to these two losses: “fleeing”. She said: “It was like the floor was constantly falling off, as if small blocks of the floor began to fall into the abyss and I had to jump to the next and the same with the next thing … jump when my father dies, run away from my mother, avoid loneliness and marry the wrong person, jump and flee the death of my son … jump and jump … Run and jump before the floor falls”. Ms. T., in order to survive, reacted automatically by “fleeing and jumping” Her avoidant movement of protection (Längle, 2003) did not allow her to take a stand against the loss of her father and then against the early death of her son. The anguish was worked from the 1st MF (Längle, 1997, Längle, 2005) and 2nd MF in the acquisition of deploying its internal strength to accept and elaborate her “double duel“. In the following sessions, Ms. T.’s primary “fleeing and jumping” reaction was brought together with all the values that she could discover of herself. This integrated emotionality became a force of will, a will anchored in affectivity, which allowed her to find a position, and express herself in a new way in the world and leave the withdrawal. It was apparent that her personality was very similar to her father, who was a serene, strong and secure man. Shad learned how to cope with the difficulties of life from him. She was able to distance herself from her youth reactions to his father’s death, and at the same time realized that she had also been a strong person to endure difficult marriage, to care for and educate her children, to support herself economically in a foreign country, and to have made the right decision to separate from her husband, who reminded her of her mother, as both were derogatory, critical and aggressive.
In the following session returning to the theme of her resemblance to her father, Ms. T. spontaneously offered an observation: “I am as strong as my father“. That gave her enough confidence to be able to be by his own strength in the face of adversity. She felt that she could lean on herself, and at the same time an inner space opened up to confront her panicked states with courage. Her panicked states declined considerably after that date until they disappeared altogether when she decided to go to the cemetery to visit her father to bring him flowers as an act of thanksgiving and to visit her son’s grave to give him a plaque. Ms.T. made a Copernican turn, a movement that went from her father to herself, that is, from the trust characterized by protection, space and support, placed in her father, directed towards her person, becoming herself the center of her inner strength. Feeling strong and secure allowed her to connect with life and freely enjoy what gave her “life to her life” (Längle, 2003), because she felt calm, her floor no longer fell, her existence was strong and firm. As the tango “Volver” written by Alfredo Lepera (Gobello, 1999) and sung by Carlos Gardel says: “I am afraid of the encounter with the past that returns to face my life … … For the traveler who flees, sooner or later stops his walk”.
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