– Hello, Doctor.
– Yes, Anonymous, good day. You’re having a day now?
– Yes, I am. It’s half past four.
– Well, let’s get acquainted again. My name is Doctor, and you can call me by my first name. I’m a psychologist, a family psychotherapist, working at the Unknown Institute and running a private practice. One rule I always tell my clients is confidentiality. Everything that happens in our space will remain between us. Your mother was in therapy for a long time, so anything related to her and my knowledge about her concerns only our therapeutic relationship. Consider that I know nothing about your mother in our context, and I will ask you about her because I need your perspective on how you see her, how you feel about her, and so on. Everything concerning us will remain between us, meaning I won’t share anything with your mother.
– Thank you for this. For me, the feeling of safety is very important, and honestly, I have a sense of fear for some reason, but excuse me for interrupting.
– Well, since you mentioned fear, what are you afraid of, Anonymous?
– Trusting, opening up, letting someone into your soul, because those people I let in, I tried to understand where this fear comes from, and those people I let in, maybe I behaved in a way that provoked something, but I received some kind of blow. The blow of people turning away or betraying me, or striking me. Probably so. If this is rephrased, it sounds like for me, safety in therapy is important because I’ve heard different stories from other people where therapists severely traumatized them. Because of this, there’s also fear. But objectively speaking, until you try it yourself, you won’t know. Probably the fear of pain, it’s hard to say. I wanted to open up about this; maybe it was the most frightening thing for me to say, so I decided to speak about it right away.
– When we agreed on therapy, that same evening, probably my psyche worked in such a way that I had a dream. Excuse me, it makes me laugh. In the dream, I was standing in a corridor in Vegas, where I lived with my grandmother, where I spent my entire childhood. My grandmother was sitting in a chair, my mother was standing next to her, my cousin and aunt were in the room. And my grandmother started abusing me, saying, “You’re a failure, nothing will work out for you.” My mother, I’ll speak directly, excuse me, I think you’ve probably heard everything in therapy. She said – your mother is a prostitute, and they all started humiliating me. And I was surprised that so many years had passed, this was long ago in childhood, but it happened often over many years.
– But I experienced this dream as if it were real. And my grandmother’s intonation, the words she said to me, the energy with which it was all conveyed, I felt it all as if it were happening live. But the difference was that she looked as she does now. She’s in London, already elderly, around 80. But her voice, intonation, everything was as it was back then. And what was the difference? That I didn’t take the blow, the abuse, the devaluation this time. In childhood, I didn’t understand, and it strongly affected me. It poisoned me, I had doubts about myself. I’m not confident in myself or somewhere else, it seems. I can stress and get nervous, thinking about whether I’ll be understood in a group, whether I’ll cause irritation, whether I’ll cause dislike. Somewhere, not always, but somewhere I experience this. Won’t there be a conflict with management because I might set my boundaries, somewhere because I won’t do something I’m not obligated to do by my position. So, this time in the dream, I started giving counterarguments, saying no, you’re not right. And everyone in the dream responded to each of her abuses. And the most interesting thing, I turned my head, and in this dream, you were standing there, just observing everything. Afterward, I woke up, thinking, what’s happening? This is like some nonsense from my subconscious or an experience, I don’t even know. Everything came out together.
– Yes, an interesting dream. We’ll continue getting acquainted a bit later, but first, I have a question for you. Over the six minutes of our conversation, you’ve said “excuse me” four times. What are you apologizing for?
– I don’t understand myself. Maybe it’s a sense of insecurity or maybe it’s a habitual form of communication. I spent some time trying to get into a seminary, I went to live in a monastery in Greece. There, to live in peace among each other, say, in a Christian way, in love, mutual respect, in higher values, we learned to advise each other. The older brothers in the monastery learned not to offend the younger ones but to offer advice. The elder, the director of the monastery, taught everyone, and the younger ones showed respect to the older ones, of course, unless something inappropriate happened. And from there, I developed a way of communicating where people ask for forgiveness, somehow, so as not to offend anyone. Maybe something from that has stayed with me. It’s hard to say; I don’t understand myself. Here, I think it’s connected to my inner ugliness, distortion, damage, suppressed anger, fury. I hope that with your help, somehow, it might be possible to untangle this and free myself. As if being healthy is hard to diagnose for oneself. I say all this intuitively, going into myself, trying to reflect on myself.
– For example, I practiced judo as a child and observed interesting things. Guys who had normal fathers in the family, they would go into competitions absolutely confident and just crush everyone. It was incredible energy. I couldn’t even get close to that mentally because I had to deal with so much insecurity inside me. Maybe I overestimate the role of a father in the family, or maybe I always sought one, and somehow my judo coach replaced the figure of a father who was absent. Because I spent my entire childhood with my grandmother, who had a very authoritative character. Definitely, we’ll touch on this again. In short, it’s quite a mess. Maybe I’m dramatizing too much. Yes. And it’s uncomfortable for me to talk about this. I’m complexing about revealing this. I’m afraid to reveal this. Not just because I feel vulnerable, but I don’t know how to explain why else. I feel triggered by this. Doctor it triggers me, really. And it even shakes me inside. Painfully. I’m touching on some heavy things for myself. But intuitively and sensibly, it seems to me that beneath the surface I can reach with my mind, there’s much more. It’s like something smells terribly bad, like some kind of decay. Some kind of sore spot that resonates strongly. I’m speaking figuratively.
– Now, you used the phrase “inner ugliness” in your monologue. Do you consider yourself ugly?
– Partly, yes. And I don’t know why. Maybe because I was deeply instilled with this in childhood. Or because I’m personally rolled out as a person. Deeply inside, actually. And also because I see some ugliness in myself. Not because I believe it exists or want to see it, but because it does. I think it exists. Compared to healthy people who have a different mindset, different energy, a different spirit. They shine, they’re light, warm. Probably, in comparison, people who have worked through their issues, freed themselves through therapy.
– And what do you understand by your ugliness? How do you perceive or understand it?
– Probably through the prism of a person’s inner integrity, harmony with oneself, harmony with people, harmony with the world around. I don’t have that. Inside me, there’s mainly fury. My main emotion is fury and suppressed anger. Although, when I lived in the monastery, conversations with the Igumen, dedication to monastic life, generally, it somehow corrected me and touched me. There, they don’t deal with therapy, say, in some sense, they deal with other things. And somewhere, yes, you asked how I characterize myself or what growth I see for myself, living with negative emotions, pain. Maybe it’s resentment, I don’t know, not resentment, but some kind of constant fire scream of fury.
– Now, I reformulate it, and you tell me if it’s correct or not. I reformulate it from you: I consider myself ugly because my main negative emotion is fury and suppressed anger. Also, I hear that this might sound strange or awkward when heard from the outside, and I understand this, and I need to show courage to just reveal it and open up, and thank you for your patience. Maybe I believed this deeply in childhood, living with my grandmother, who told me about it every day, and it’s strongly ingrained in me, sitting like a tumor in my brain, with something sadomasochistic, where I might harm myself against my will. I don’t know how to explain it. “. right?
– Right.
– You’ve mentioned your grandmother and her message several times. What was the main message from your grandmother in childhood?
– Yes. Now, I’ll try to remember. Or let me say what comes to mind first, but maybe that’s how it should be done? I don’t know, just how to do it correctly or incorrectly. Ugly, failure, lazy, slacker. I just don’t want to use a non-censored version of the words she used, out of respect for your age Doctor.
– You can use the exact words because it’s a more accurate way to convey emotions.
– Further, my grandmother’s message to me was: ugly, failure, be damned, may you die, your mother is a whore, your father, who died, thank God he died like a fucking pig, and I hope and wish you fucking bloody shit fuck die soon enough too. Poor your unfortunate wife, slacker, fucking little gay asshole, may you never have a wife you little fuck. May you fucking die, may your head be smashed against the wall so that brains fly out. What else? And all other forms of abuse in that character. I don’t know, over the years of my life, you could write a whole book on it. A guide to abuse for grandmothers.
– You’re telling me this and smiling.
– Nervous shift. This is pain, just pain.
– How do you feel this pain?
– Somewhere in the chest, in the soul, inside, in the chest area maybe. It seems like the trachea passes through here somewhere. Where or how, you asked? I don’t know how.
– I asked where you feel this pain.
– Yes, in the chest area, inside, within myself.
– Have you ever worked with a psychologist or psychotherapist before?
– No, this is the first time.
– This is the first time?
– Yes. I’m a tough case, haha.
– A tough case?
– I think so, based on your previous question. Why, I don’t know why I think so.
– Again, what did you think based on my question?
– Yes, that I have a tough case, that I am a bad case.
– What made you think that? That you assigned this thought to me, that I have a tough case?
– Yes.
– What made you think that?
– Probably my fear that you might refuse to work with me, that it’s hard with me. Or something else. Incurable. Damaged. Something like that.
– Try saying this phrase from the first person. Doctor, I’m afraid you’ll refuse to work with me.
– Doctor, I’m afraid you’ll refuse to work with me.
– Try saying it a bit differently. Doctor, I’m afraid you’ll refuse, decline me.
– Doctor, I’m afraid you’ll refuse, decline me.
– Where do you feel more fear, in the first version or the second?
– Probably in the second. Doctor, refusing me and refusing to work with me are different in the core. Probably more personal contact is if you’ll refuse me.
– I’ll discuss some organizational aspects of our work. What is therapy? Therapy is working with the psyche. The psyche is, if we speak colloquially, part of our consciousness, possibly even all of our consciousness in the structure of personality.
The psyche determines behavioral reactions
Doctor
– The psyche is honestly connected with emotional experiences, essentially emotions are part of the psyche. And the psyche is a combination of the higher nervous system, brain, personality. There isn’t a universally accepted definition of the psyche. If you google it, there will be many different definitions of what the psyche is. In any case, the psyche, if we speak simply, determines our behavioral reactions and life scenario. Working with the psyche is painstaking work because, if you’ve ever been to a gym or fitness center, you know that to make changes in the body on a physical level, you need to go regularly, two or three times a week. Because if you go once a month, there will be no changes. With the psyche, it’s exactly the same. Therefore, regularity is important in therapy. If you miss our meetings for some reason, there will be a setback. The optimal schedule is once a week. I sometimes allow clients to meet every two weeks, depending on their financial capabilities. Less often, because less often it would not be therapy but just occasional consultations, which would have little influence on changes in the psyche. Sometimes I recommend meeting twice a week. So, evaluate your financial, organizational, and household capabilities, and we’ll choose the frequency of our meetings. Ideally, once a week. It’s desirable if we always meet on the same day at the same time. But this will be understandable and useful for you. You will always set aside this day for our meeting. Sometimes we’ll adjust because if I have seminars or you have trips or business trips, that’s also acceptable. We’ll discuss and adjust. But ideally, it’s always best if we have a reserved day and time. You told me you work until 15:30, so 16:30 GMT is acceptable for you.
– Yes, even 16:00 is fine. This suits me. Thank you very much for this.
– Yes. Now, I’ll think about what else. Periodically, I’ll give you homework.
– This is great.
– You can do the homework or not. If you don’t do it, it’s your responsibility. At the same time, I’ll ask why you didn’t do it. What else? After our meetings, it’s desirable to give yourself time to assimilate what you’ll be dealing with in our sessions. What does assimilation time mean? It means that after the session, after our work, you won’t immediately turn on the TV or talk to anyone; instead, you’ll spend some time alone, about 30 minutes, to digest what happened. Sometimes you’ll need more time for this, but you’ll feel it yourself.
– Great.
– Yes, Anonymous, what about? Why are you smiling?
– Yes, because I’m glad there’s hope and joy from some anticipation. I know we’re seeing each other for the first time, and it might not be clear why I’m sitting and smiling. Maybe so. But I’m glad this opportunity has come, that it exists, that I’m in it, that some horizon is unfolding. What I desire, what I’m looking for. And that you’re meeting me and describing a picture of a possible future where something in me will start changing for the better. Generally, I’m glad about this perspective. That’s why I’m smiling from a sense of joy. That’s the thing.
– Yes, thank you. I’ll periodically ask you questions during our work about your reactions. This question is specifically about your awareness of your emotional experience and external expression. So, when you smiled, I asked what your smile was about. You said it was a smile of joy. You said you don’t know why you apologize, maybe it’s just a habit from when you were in the monastery. And this is important because it’s important to understand what drives me at any given moment when I say or do something.
It’s important to understand what drives me at any given moment when I say or do something.
Doctor
– Because when you say “excuse me,” I’ll immediately ask why. I’ve been in the space of the Orthodox paradigm, and I know that many dialogues start with the phrase “forgive me.” “Forgive me, Lord” or “forgive me, brother,” “forgive me, sister.” And I understand it that way. But we’re in a slightly different paradigm, so I’ll always ask you about this. Or periodically. Do you have excess weight?
– Yes, I do. I want to tell you something. My weight was 130 kg. Here in Monaco, I started going to the gym, put myself on a diet, and I’ve stuck to it, and now I’m down to 114 kg, and it’s gradually decreasing. And already, say, a month ago and now, I see that my face has slimmed down, everything has slimmed down. My wife says, “Wow, you’ve finally taken care of yourself, and you look younger and better.” But I still have excess weight.
– When did you start gaining weight?
– I started gaining weight when I went to Greece to live in a Russian monastery. That’s where it started. Someone says it’s because the lifestyle is sedentary, because of obedience or the work I did, which was as a kitchen assistant. There’s very little movement, but it’s very stressful, dynamic, and tense. There were many experiences, stress, and so on.
Analysis of A’s psychological state and potential areas for therapeutic focus
1. Deeply ingrained negative self-image: A repeatedly refers to his “inner ugliness” and expresses a belief that he is fundamentally flawed. This stems from childhood experiences, particularly his grandmother’s verbal abuse.
2. Suppressed anger and fury: A identifies these as his primary emotions, suggesting unresolved trauma and a need for healthy emotional expression.
3. Fear of vulnerability and trust issues: A expresses anxiety about opening up in therapy, fearing potential harm or betrayal.
4. Apologetic behavior: Frequent use of “excuse me” indicates low self-esteem and a fear of taking up space or asserting himself.
5. Complex family dynamics: Difficult relationships with his grandmother, absent father, and “prostitute” mother have shaped A’s worldview and self-perception.
6. Weight gain and body image issues: Started during a stressful period in a monastery, potentially linked to emotional eating and lack of self-care.
7. Spiritual seeking: Past experiences in monasteries and seminaries suggest a search for meaning and belonging.
Therapeutic Approaches and Suggestions:
1. Trauma-Informed Therapy: Address childhood abuse and neglect to process unresolved emotions and reframe negative self-beliefs.
2. Cognitive Behavioral Therapy (CBT):
– Challenge and restructure negative self-talk and core beliefs about being “ugly” or a “failure”
– Develop healthier coping mechanisms for stress and emotional regulation
3. Psychodynamic Approach:
– Explore early relationships and their impact on current patterns
– Work through transference issues, as A may project past experiences onto the therapist
4. Mindfulness and Self-Compassion:
– Practice mindfulness to increase awareness of emotions and bodily sensations
– Develop self-compassion to counter harsh self-judgment
5. Anger Management:
– Teach healthy ways to express and process anger
– Explore the roots of suppressed fury and its impact on daily life
6. Body-Focused Work:
– Address the mind-body connection, particularly around weight gain
– Develop a holistic approach to physical and emotional well-being
7. Assertiveness Training:
– Build skills for healthy boundary-setting and self-expression
– Reduce apologetic behavior and increase self-confidence
8. Existential Therapy:
– Explore questions of meaning and purpose, integrating spiritual experiences
– Develop a more cohesive sense of self and life direction
Areas for Growth:
1. Self-acceptance: Moving from self-loathing to self-compassion and a more balanced self-view.
2. Emotional regulation: Learning to identify, express, and manage emotions, particularly anger, in healthy ways.
3. Interpersonal skills: Developing trust, assertiveness, and authentic self-expression in relationships.
4. Integration of past experiences: Making sense of religious/spiritual experiences and family history.
5. Mind-body connection: Addressing the relationship between emotional states and physical health/weight.
6. Building resilience: Developing coping skills and a stronger sense of self to navigate life challenges.
The D should focus on creating a safe, non-judgmental space for A to explore these issues. Given his fear of vulnerability, building trust will be crucial. Regular check-ins about the therapeutic relationship and process will be important. The therapist should also be prepared for potential intense emotional experiences as A begins to process long-suppressed feelings and memories.
By addressing these core issues and utilizing a multi-faceted therapeutic approach, A can work towards greater self-acceptance, emotional balance, and overall well-being. The journey may be challenging, but with consistent work and support, significant positive change is possible.
Key therapeutic techniques and approaches that could be particularly relevant and helpful for A situation:
1. Genogram Construction:
This structural family therapy technique involves creating a visual representation of A’s family relationships across multiple generations. It would be especially useful given the complex family dynamics he described, including his relationship with his grandmother, absent father, and mother.
How to apply:
– Draw a family tree diagram with A, including his parents, grandparents, and other significant family members
– Use different symbols and lines to represent relationships, conflicts, and emotional bonds
– Discuss patterns that emerge, such as intergenerational trauma or recurring relationship dynamics
This technique helps identify family patterns and provides insight into how past relationships may be influencing current behaviors and emotions.
2. Inner Child Work
Given A’s descriptions of childhood trauma and negative messaging from his grandmother, inner child work could be very beneficial.
How to apply:
– Guide A through visualizations to connect with his younger self
– Encourage dialogue between his adult self and inner child
– Practice nurturing and reparenting exercises to heal childhood wounds
– Use empty chair techniques to have conversations with internalized critical voices (like his grandmother’s)
This approach helps process unresolved childhood trauma and develop self-compassion.
3. Cognitive Restructuring
To address A negative self-perception and beliefs about being “ugly” or a “failure”.
How to apply:
– Identify automatic negative thoughts and core beliefs
– Examine evidence for and against these beliefs
– Develop more balanced, realistic alternative thoughts
– Practice reframing negative self-talk
This CBT technique helps challenge and modify unhelpful thought patterns that contribute to low self-esteem and emotional distress.
4. Emotion Regulation Techniques
To help A manage his suppressed anger and “fury”.
How to apply:
– Teach mindfulness practices for observing emotions without judgment
– Introduce breathing exercises and progressive muscle relaxation
– Practice naming and accepting emotions
– Develop healthy outlets for expressing anger safely
These skills help process intense emotions and reduce their overwhelming impact.
5. Narrative Therapy Techniques
To help A reframe his life story and identity beyond the negative messages he internalized.
How to apply:
– Externalize problems (e.g. “the anger” instead of “my anger”)
– Identify unique outcomes or exceptions to problem-saturated stories
– Develop a preferred narrative that aligns with A’s values and strengths
– Use letter-writing exercises to different parts of self or significant others
This approach empowers A to see himself as separate from his problems and author a new, more empowering life story.
6. Body-Oriented Techniques
Given A’s mention of where he feels pain physically and his weight concerns.
How to apply:
– Practice body scan meditations to increase somatic awareness
– Explore the connection between emotions and physical sensations
– Use movement or gesture to express feelings that are hard to verbalize
– Incorporate gentle yoga or stretching to release tension
These techniques help integrate mind-body healing and process emotions stored in the body.
7. Attachment-Based Interventions
To address A’s relational patterns and fear of trusting others.
How to apply:
– Explore early attachment experiences and how they shape current relationships
– Practice building secure attachment within the therapeutic relationship
– Use role-play to practice healthy communication and boundary-setting
– Develop strategies for self-soothing and regulating emotions in relationships
This approach helps heal relational trauma and develop more secure attachment patterns.
8. Existential Techniques
To explore A’s search for meaning and spiritual journey.
How to apply:
– Discuss A’s values and what gives his life meaning
– Explore concepts of personal responsibility and choice
– Use Socratic questioning to deepen self-reflection
– Incorporate elements of logotherapy to find meaning in suffering
These techniques can help A integrate his spiritual experiences and find a sense of purpose.
9. Gradual Exposure and Desensitization
To address A’s fears around therapy and opening up.
How to apply:
– Create a hierarchy of feared situations in therapy
– Gradually expose A to mildly anxiety-provoking topics, building up tolerance
– Use relaxation techniques during exposure to manage anxiety
– Process and celebrate each step of progress
This approach helps build confidence and reduce anxiety around vulnerability in therapy.
10. Psychoeducation
To help A understand the therapy process and normalize his experiences.
How to apply:
– Explain relevant psychological concepts (e.g. trauma responses, attachment styles)
– Provide information on how therapy works and what to expect
– Discuss the mind-body connection and impact of stress on physical health
– Offer resources for further learning between sessions
This technique empowers A with knowledge and reduces stigma around his struggles.
By integrating these various approaches, the therapist can create a comprehensive treatment plan tailored to A’s unique needs, addressing his trauma history, negative self-perception, relationship patterns, and spiritual journey. The key is to apply these techniques flexibly, always attuning to A’s responses and adjusting the approach as needed.
Key Themes:
1. Trust and safety in the therapeutic relationship
2. Childhood trauma and emotional abuse
3. Self-esteem and self-image issues
4. Suppressed anger and emotional regulation
5. Religious/spiritual influences
6. Body image and weight concerns
7. Family dynamics and absent father figure
8. Fear of rejection and abandonment
Potential Questions for Exploration:
1. “You mentioned feeling ‘triggered’ by our interaction. Can you describe what that triggering feeling is like in your body?”
2. “What do you imagine might happen if you fully expressed your anger instead of suppressing it?”
3. “How do you think your grandmother’s words have shaped your view of yourself and your potential?”
4. “In what ways did your time in the monastery impact your sense of self-worth and belonging?”
5. “What does the concept of ‘inner ugliness’ mean to you? Where do you think this belief originated?”
6. “How might your relationship with food and your body relate to your emotional experiences?”
7. “What qualities do you imagine a ‘normal’ father would have provided? How might we work on nurturing some of those qualities within yourself?”
8. “If you could speak to your younger self who endured your grandmother’s abuse, what would you want to tell him?”
