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Section 7
Factors Impacting the Recovery Process (Part 1)

Question 7 | Test | Table of Contents

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In the last section, we discussed overriding obsessive anxiety.  In addition to discussing ways clients can prepare for this technique, we focused on the two steps to overriding obsessive anxiety.  The two steps are exposure and response prevention. 

Clearly your client’s present is inextricably linked to his or her past.  Do you recall Janelle from Section 5: Uncertainty Training?  Janelle was weighed down by regret, pain, and guilt over things that happened decades ago and was therefore  unable to live fully in the present.  Would you agree that as long as Janelle perpetually gazed over her shoulder, she would continue to struggle with anxiety?  Think of your Janelle.  Does your client feel distracted?  Does he or she complain of feeling less alive than he or she is?  Does your client’s past seep into the present and contaminate almost every one of his or her thoughts, feelings, and actions?

In the next two sections, we will discuss Past Redemption.  Our discussion will be identified by the first and second keys to past redemption.  This section will cover the first key to past redemption.  We will also introduce the "Healing Hurts" Technique.  As you read this section, you might consider your anxiety client.  Could he or she benefit from hearing this section, perhaps in a future session? 

♦ The First Key to Past Redemption
First, let’s discuss the first key to past redemption. As you know, buried feelings, especially painful ones, have a high rate of resurrection. I stated to Janelle, "This isn’t my opinion. It’s a fact. Unfinished business takes on a life of its own because the brain remembers incomplete tasks or failures longer than any success or completed activity. It’s technically referred to as the "Zeigarnik effect." When a project or a thought is completed, the brain places it in a special memory.

"The brain no longer gives the project priority or active working status, and bits and pieces of the achieved situation begin to decay. But regrets have no closure. The brain continues to spin the memory trying to come up with ways to fix the mess and move it from active to inactive status. But it can’t - not without our deliberate help. That’s why the first place to begin a journey toward redeeming the past is where it hurts. Healing your hurts, particularly if they run deep, will likely bring closure to many parts of your past. Be aware, however, that healing your hurts is a process of painful self-exploration. Personal growth almost always is. But no matter how painful the process, it’s worth the price."

Before Janelle got too nervous about rummaging through painful memories, I explained why it was necessary.  I stated, "By healing the pain from your past, you will be protecting yourself from repeating the pain in your present - especially in your relationships.  That may sound strange, but we use new relationships as replacement parts for old hurts and old losses. 

"For example, think of a parent or an ex-spouse. Every relationship, in a sense, gives you another chance to resolve issues you didn’t get squared away in the previous one. But if you do not heal your hurts, you’ll never get them squared away. You’ll just continue to repeat relationship problems and replay your pain again and again."
           
♦ Dad's Change of Plans
As I spoke with Janelle, she recalled an infuriating scenario that played itself out on several occasions when she was a child. The issue involved sudden changes in plans that meant missing out on something Janelle was excited about. 

Janelle stated, "Of course, this happens to everyone.  But my dad seemed to have this down to an art form.  It could be as simple as a trip to get ice cream or as involved as a trip to Hawaii.  But it happened all the time.  Many times, just as we would be closing in on whatever it was I was looking forward to, dad would go on another drinking binge.  He’d be gone for days, spend all his money, and come back like it was no big deal.  I got kind of used to it so I started thinking, ‘No harm, no foul, right?’  After all, we can get ice cream tomorrow.  We can go to Hawaii next year." 

As you probably know, the repetition of being deprived of things she looked forward to led Janelle to harboring negative feelings.  I asked Janelle how her reactions as an adult toward similar situations compared with those of when she was a child. 

♦ Charlie's Change of Plans
Janelle stated, "I remember when I first got married, I guess this history came with me and my baggage - and I can’t even remember packing it.  The first time Charlie, my husband, tossed out an idea for changing plans for something I was counting on, I nearly went berserk.  

"We were going out to eat - a big weekend splurge for grad students - when he suggested a different restaurant than the one we had previously decided upon. 'How could you even suggest going to Hamburger Hamlet?! We already decided we would eat at Green Street, and I’ve been looking forward to this all week.  You said you wanted to go there. I can’t believe this!  I know exactly what I want to have, and now you want to deprive me of it?!?'

"I can still remember Charlie’s face when I said this.  He was stunned, probably thinking steam would soon start shooting out of my ears like a gasket ready to blow.  My new husband surely thought he had married a temperamental woman that could be totally thrown by a simple suggestion. Charlie began to get upset, and I had gone over the edge of becoming a major jerk.  What was happening to me?"  

As you know, the pain from Janelle’s past was suddenly more painful than she ever wanted to admit.  If your client was wounded by betrayal from a friend in his or her past and that pain has never been healed, that client is likely to become highly sensitive to signs of betrayal in present friendships.  

Does he or she read into innocent behavior motives that aren’t really there?  Why?  Could it be because of unfinished business, and painful, buried feelings?  Unconsciously, clients like Janelle look for relationships which never fail to somehow erase pain from the past.  Would you agree that the end result is typically disappointment?  

By the way, when this pattern of trying to heal the past through current relationships develops, clients will have created a much bigger problem.  In addition to anxiety, clients may no longer relate to people, but only to what they represent, which in turn causes additional anxiety.  In other words, the new person in a client’s life will not really be the object of their feelings.  

Would you agree that these relationships become what he or she symbolizes - an opportunity to work through the issues they had with someone else?

♦ Technique:  Healing Hurts
I suggested to Janelle a Cognitive Behavior Therapy technique for healing hurts. 
1. I stated, "First, begin by reviewing your personal history and make note of any memories you have of feeling abandoned or neglected.  Give this serious consideration. Use a notepad to record your thoughts.  Are there people from your past you blame for not being there for you? Who are they and what do you blame them for?"
2. Next, I stated, "Consider ways that these painful memories may still be impacting your present. How do they determine the choices you make?  Finally, ask yourself what is keeping you from forgiving whoever is involved in your painful memories (a parent, a friend, etc.)."  

Could forgiveness be a productive way for your client to release resentment?  How might your client find ways to forgive?

In this section, we discussed the first key to past redemption.  We also introduced the "Healing Hurts" CBT Technique.

In the next section, we will discuss the second key to past redemption.  As you will see, the second key to past redemption is restitution.  We will also discuss living in the present.

- Nakamura, B. J. Pestle, S. L., & Chorpita, B. F. (2009). Differential Sequencing of Cognitive-Behavioral Techniques for Reducing Child and Adolescent Anxiety. Journal of Cognitive Psychotherapy, 23(2), 114-135.
- Stallard, P., Taylor, G., Anderson, R., Daniels, H., Simpson, N., Phillips, R., & Skryabina, E. (2014). The prevention of anxiety in children through school-based interventions: study protocol for a 24-month follow-up of the PACES project. Trials, 15(1), 1-6.
Reviewed 2023

Peer-Reviewed Journal Article References:
Chan, K. K. S., & Lam, C. B. (2018). The impact of familial expressed emotion on clinical and personal recovery among patients with psychiatric disorders: The mediating roles of self-stigma content and process. American Journal of Orthopsychiatry, 88(6), 626–635.

Garverich, S., Prener, C. G., Guyer, M. E., & Lincoln, A. K. (2020). What matters: Factors impacting the recovery process among outpatient mental health service users. Psychiatric Rehabilitation Journal. Advance online publication.

Petros, R., & Solomon, P. (2020). Examining factors associated with perceived recovery among users of wellness recovery action plan.Psychiatric Rehabilitation Journal, 43(2), 132–139.

QUESTION 7
What are the three steps in the "Healing Hurts" CBT technique? To select and enter your answer go to Test.

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