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The concept of the “observer” is well established in science and also in society. It carries the tone of “separate” and “disconnected” and “apart from” what is being observed. This dissociated quality of observation may have its place, but the capacity to observe and have a subjective involvement at the same time is not historically unusual.

The presence of an internal ‘‘observer’’ has been central to ancient Eastern traditions of meditation, yoga, and mindful awareness and has found its way to Western psychotherapy, perhaps because of its ability to bring wisdom and grounding to even the most tumultuous situations. The observer gives the ability to stand back and notice what is happening inside, while experiencing it at the same time. Even the smallest space between experiencing the full power of feelings and ‘‘knowing’’ that they are just feelings allows a person to settle into the reassurance that even a tidal wave of emotion will eventually pass.

The caring observer is a role created through psychodrama in relation to the traits of self-compassion: to evoke a warm embrace of the self; the ability to hold one’s self in kindness through suffering; and the sense of feeling connected to humanity rather than isolated and ashamed. A growing body of research indicates that self-compassion and self-esteem contribute to overall optimism and hopefulness (Neff & Vonk, 2009). In psychodrama, we create the felt sense and experiential engagement with concepts described in research such as that self-compassion is a more stable and enduring trait in positive mood states, and that openness and resilience is a stronger healing agent for depression, anxiety, self-loathing, and self-injurious behaviors.

Psychodrama has several techniques to embody the observing stance that can help someone find stability, or grounding, even in an affectively charged experience of swirling emotions. One such procedure is to have the protagonist pause the emotionally intense action, step outside the dramatic arena, and watch the scene from afar.  He or she becomes a calmer witness who can offer reflection, wisdom, or solace to the self.  Simply watching the scene, versus living in the intensity of it, provides a safe distance and a fresh perspective. 

In the 1990s, Kate Hudgins, PhD, developed a specialized psychodramatic model to treat post-traumatic stress disorder called the Therapeutic Spiral Model. Her model, now used to treat individuals and communities in the frontlines around the globe, casts the role of the Observing Ego (OE) along with various doubles (empathic voices) to create the internal architecture of safety and containment. The OE provides the cognitive container, or the left hemisphere’s presence, to help label events that may be stored in the highly charged, nonverbal memory. The OE helps make sense of the once fragmented experience and weaves it into the colourful and empowering narrative of the trauma survivor (Hudgins, 2002; Hudgins and Toscani, 2013; Lawrence,2011).

ADDING COMPASSION

Buddhist traditions kindle the softheartedness of compassion with prayers or mantras that ask for safety and good fortune for oneself, the community, and the world: a simple act that evokes feelings of tenderness and care for self and others. A recent study from the University of Wisconsin shows that this exercise of well-wishing is akin to weight training in its ability to build ‘‘compassion muscle’’ in the body and mind. The two-week compassion training increased altruistic behavior in participants and increased firing patterns (comparing fMRI) in the inferior parietal cortex, the area associated with empathy, when looking at images of suffering. The compassion training also increased regular activity in the dorsolateral prefrontal cortex and its communication with the nucleus accumbens, brain regions involved in everyday emotion regulation and positive emotions (Weng et al., 2013).

The soothing and therapeutically beneficial qualities of self-compassion have begun to make their way into psychotherapy through programs such as Compassionate Mind Training (see later), mindfulness-based therapies, self-compassion workbooks, and self-forgiveness exercises. One of the leading pioneers in the field of self-compassion—Kristin Neff, PhD, at Texas University—has generated volumes of research on its efficacy in psychotherapy.

She defines self-compassion as having three essential components:

Self-compassion involves treating oneself with kindness versus self-judgment in the face of suffering, pain, or mishaps.

The trait of self-compassion is the understanding that suffering, mistakes, and messiness are part of the human condition rather than something unique and shameful.

Self-compassion involves the element of mindfulness, or an understanding that painful feelings come and go and one doesn’t need to overidentify with them (Neff, 2009; Neff, Kirkpatrick, and Rude, 2006; Neff and Vonk, 2009).

Gilbert and Irons (2004) add the qualities of warmth and wisdom to self-compassion, connecting it to the mammalian caretaking and comfort system. Badenoch (2008, 2011) brings the addition of the warm welcome, suggesting we treat all parts of ourselves—even the parts that are defensive, scared, critical, or cranky—with the open arms of acceptance. She writes, ‘‘Our consistent experience tells us that therapeutic progress accelerates when our patients are able to shift from the stab of self-blame to the embrace of self-compassion’’ (2008, p. 184).

A NEW THERAPEUTIC MODEL: SELF-COMPASSION

Self-compassion is gaining evidence and valour as a construct that enhances positive moods and prosocial behavior and is a robust protective factor against a variety of disorders, including anxiety, depression, rumination, and fear of failure. Higher levels of self-compassion are linked with higher levels of happiness, optimism, curiosity, and connectedness (Neff, 2009). It is also linked with connecting language versus separating language (disowning parts of self) when writing about weaknesses (Neff et al., 2006). Research shows that people with high  self-compassion tend to have courage to venture into new arenas, make mistakes, and pick themselves up again, since they are more likely to offer themselves reassurance. They are also more motivated to learn from intrinsic curiosity and desire for mastery than from performance or competitive goals alone (Neff, 2009).

Like self-esteem, self-compassion correlates with general happiness, optimism, and positive mood states; however, self-compassion holds up where self-esteem falters, since self-compassion is based not on being better than average or achieving a goal but on treating one’s self with friendly regard (Baumeister, Campbell, Krueger, and Vohs, 2005; Neff, 2009; Neff et al., 2006; Neff and Vonk, 2009). After nearly three decades of esteem-building programs, research now tells us that adolescents with high self-esteem are no less likely to turn to alcohol, drugs, bullying, cheating on tests, or engaging in early sexual activity than teenagers with low self-esteem (Baumeister et al., 2005; Neff and McGehee, 2010). Research indicates that self-compassion is a stronger buffer against anxiety when a person is faced with an ego threat than self-esteem, since self-esteem is often contingent upon outcomes and comparing the self to others (Neff and Vonk, 2009).

A study of self-compassion versus global self-esteem found that self-compassion predicted more stable feelings of self-worth and had a negative association with social comparison, public self-consciousness, self-rumination, anger, and the need for cognitive closure compared to self-esteem. Self-esteem is positively associated with narcissism and the need to defend a better-than self-image (Neff and Vonk, 2009).

RELATIONAL PAIRS: INTERNALIZED MODELS

Jacob Levy Moreno, MD (1889–1974), the founder of psychodrama and sociometry, believed that the smallest unit of treatment is two. In other words, we are always ‘‘in relation’’ with the other (Moreno, 1953). His enormous contribution of the social atom is a testament to the power of internalized relationships, or how our social networks can nourish or strain us, stir ambivalence, or be simply neutral. The interpersonal neurobiologist Bonnie Badenoch, PhD, refers (2008, 2011) to empathic and unempathetic relational pairs as neural networks that represent internally what we have experienced relationally.

An example of an empathic pair would be the playful dad and adoring daughter. These two, form an internal working model woven into implicit memory, evoking bodily sensations of lightness and warmth, an involuntary smile, and the bubbling of fond memories. An unempathetic pair might be the angry mother and terrified son, leaving a grown man gripped and speechless when approached by an irritated co-worker. These pairs offer healing pathways for therapists who use psychodrama, art, or expressive therapies to loosen the lockstep of the duo and invite new connections to engender a safer internal world for clients struggling with self-abuse, neglect, or a harsh introject. We can look at self-criticism and self-compassion through the lens of the two-person dynamic to understand the power of internal berating versus internal comfort.

Interestingly, the body doesn’t distinguish between stimuli from the outside versus the push from inside: The physiological effects are the same (Gilbert and Irons, 2004; Gilbert and Procter, 2006; Neff, 2011). Research indicates that kindness from the self kindles the same circuitry as loving-kindness from another, allowing us to feel the glow of connection whether it is coming from an internal support or a friendly neighbour. This warm connection activates the mammalian caretaking system, stimulating a flow of hormones in the oxytocin and opiate family nicknamed the ‘‘social reward system.’’ Oxytocin has historically been named ‘‘the touch hormone,’’ since it is released in large doses when mothers nurse babies to promote touching, cuddling, and bonding. However, science now tells us oxytocin is released in a variety of situations where social signals indicate safety, friendliness, and affiliation. It has an overall calming effect, as it lessens fear, reduces physical pain, lowers cortisol (stress hormone), and creates a general feeling of safety, generosity, confidence, and well-being (Panksepp and Bivens, 2012). Brain studies (fMRI) show that self-compassion lights up the left temporal pole, anterior cingulate, and anterior insula, suggesting that efforts to be self- assuring engage the same regions as expressing empathy and compassion toward others (Badenoch, 2011; Longe et al., 2010).

Self-compassion is a strong buffer against the ravage of the self-critic, which is often the feed monster in depression, anxiety, eating disorders, and shame-based disorders (Gilbert and Irons, 2004; Gilbert and Procter, 2006; Neff, 2011). A pilot study by Gilbert and Irons (2004) used Compassionate Mind Training (CMT) with a group of highly self-critical people and found significant increases in ability to self-soothe as well as significant reductions in depression, anxiety, self-criticism, shame, inferiority, and submissive behavior. CMT is targeted to reducing shame proneness through viewing self-criticism as a safety mechanism that became part of surviving a harsh or abusive environment. Seeing through a no-fault lens and using compassionate imagery, patients could calm the neurological threat system of the self-to-self attack and slowly soften into the caretaking system of inner kindness.

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In this relational pair model, self-criticism and negative evaluation activate the panic system in the same way a critical attack from others sets off the neurological threat response, releasing cortisol and activating regions of the brain (lateral prefrontal cortex and dorsal anterior cingulate) that trigger error processing and resolution. Gilbert and Procter assert that depression is an example of the internal pair of dominant (hostile attack) and subordinate (submissive, anxious/depressed) response leaving a person feeling helpless, humiliated, and defeated in response to the inner tyrant (2006, p. 358). Based in attachment, people who suffered neglect or abuse in early years of life have not only overdeveloped systems of internal threat but underdeveloped systems of human warmth and caretaking (Gilbert and Procter, 2006; Panksepp, 2009). For example, people with and without bulimia both show the use of food for comfort, but people with bulimia have difficulty generating self-nurturance in nonfood ways (Lehman and Rodin, 1989).

Science tells us that an exercise to engender self-compassion does wonders to wash away the hormones of stress and panic and activate the juices of love and compassion (oxytocin and opiates) that restore feelings of trust, openness, and generosity. This neurological shift from sympathetic threat to parasympathetic safety allows us to relax into social engagement, better immune functioning, clearer thinking, the ability to stay present, and an overall sense of calmness (Porges, 2009).

CREATING THE CARING OBSERVER THROUGH PSYCHODRAMA

The self-compassion exercise (below) was part of Recovery in Motion®, an upbeat psychodrama program designed for substance abuse treatment in a women’s prison in Cleveland Ohio.  Women were often dealing with debilitating self-criticism, self-loathing and rumination, making treatment and participation challenging. The Caring Observer exercise helped create the shift to self-acceptance that paved the way for openness, curiosity and engagement in the other elements of the program.

The Caring Observer is a role created through psychodrama that embodies the traits of reassurance, warmth, and empathy that a person needs to feel ‘‘seen’’ and supported through his or her struggles. The Caring Observer is an endearing member of the observer family, a role slightly more dimensional and relational than the traditional observer, whose job is to be neutral, nonjudgmental, and objective (Hudgins and Toscani, 2013). Using the model of relational pairs, the Caring Observer becomes a friendly companion to the one who suffers, creating a welcoming environment for the person to grow, falter, forgive, muse, and dare to try new things.

These components are helpful: First, most often people can show compassion and caring toward others and lack the ability to show those to themselves (Neff, 2009, 2011; Neff and Vonk, 2009). This is well illustrated in the case of caregiver burnout and compassion fatigue. The protagonist may know well how to generously give empathy to others but be unable to give that same care to herself. In this exercise, her ‘‘other’’ energy is directed onto herself through the use of the second chair. Second, the soft blanket concretizes the nourishing feelings of love and acceptance many of us crave. Most often, participants ‘‘soak’’ in the luxury of the blanket and ease into a benevolent support for themselves. Finally, the Caring Observer must be experienced interpersonally first before it can be generated as an internal role. Therefore, small action structures or warm-ups that build attunement between group members enrich the field of empathic resonance and can give participants the experience of feeling seen and understood that can then be imported into this new role. The warm-up exercises may include the following:

Dyad sharing about a person who treated you with unconditional positive regard, a person who saw you for who you were.

Dyad sharing (on any topic) where the instruction to the listener is to listen with eyes, heart, and body only, allowing the speaker to feel ‘‘felt with’’ simply through the warm embrace of being heard.

A group activity where each person has the opportunity to take the role of a person who really ‘‘gets them’’ and introduces that person to the group. Place an empty chair at the top of a horseshoe and invite members to come up ‘‘as’’ that attuned person and tell the group something about the group member. For example, ‘‘I am Jane’s grandma Ruth and I saw what a bright girl she was’’ The group leader can interview to try an extract more details and invite ‘‘Grandma Ruth’’ to tell Jane directly something she needs to hear.

Building a spectrogram, or an imaginary scale of the harsh critic to allow members to warm up to the topic and to each other. Invite the group to imagine a continuum on the floor from 0 to 100.  Mark each end using paper, scarf, or other item and ask, ‘‘How hard are you on yourself?’’ It helps to demonstrate zero and one hundred.  For example, zero is “If I do something wrong it rolls off my back, no worries whatsoever,” and one hundred is, “I can’t stop beating myself up for days”.  Ask members to stand where they believe they are on the line. Individual members can share aloud, in clusters, or in dyads. Second-step variation: The group leader can ask, ‘‘Where would you like to be on this line?’’ Group members can move to the desired place and speak in the here and now of that spot. For example, ‘Wow, I have a lot of freedom.’’ Generally, group members like to play this one out a bit so they can fully experience what it is like to have the “monkey off their backs”. The group leader can call for a description of bodily sensations, the creation of sculptures, or sentences to bring this new state to life.

ACTION: MEET YOUR CARING OBSERVER

As the group leader, I introduce the idea of a part of ourselves who is always aware, the ‘‘one who knows all you have been through’’ in life. The soft blanket can be passed around or walked around by the group leader so members can ‘‘feel into’’ the concept of caring and self-kindness.

Place two chairs onstage, one slightly behind and angled toward the side of the first. In the second chair goes a soft object, like a blanket, scarf, or cloth that is soothing to the touch.

In the first chair (the chair in front), we imagine the Self sitting, the one who has struggled or endured hardship and is often alone. In the second chair (with the soft fabric) is the Caring Observer, the only one who knows how difficult the journey has been.

The group leader can explain the exercise as one where we take the role of the Caring Observer (the soft chair) to our own self—saying the words we have longed to hear. The group leader can suggest that participants take their time, offering an unrushed generosity to the sensory experience of sitting in the role, breathing deeply, and absorbing the kindness offered by the cozy blanket. This luxury of lingering invites the softer self to emerge.

The leader can offer sentence stems like, ‘‘I am the only one that really knows . . .’’ or simply allow for spontaneity.

This action structure can be done as an empty-chair-style exercise, where participants come up one at a time, or may be expanded to include auxiliaries and role reversals.

Allow plenty of time for psychodramatic sharing, which means members share from their personal touch points rather than giving advice, interpretation, or analysis. The sharing opens the door to deep connections between members and expands the feeling of belonging and commonality, one of the signature traits of self-compassion.

Comments: This exercise has shown excellent results in allowing participants to have the experience of feeling understood and being held in the warmth and positive regard that fosters the healing process. Very often statements like ‘‘It wasn’t your fault!’’ begin to offload the heavy shame and self-loathing that come from abuse (and self-abuse), allowing a person to experience a tenderness for the part of themselves that was harmed. This new self-to-self pathway tames the hot underbrush of the self-blamer and expands into the cooler breathing space of curiosity, openness, acceptance, and love in daily life, the signal of internal safety and neural integration (Siegel, 2010). Taken together, this role-taking exercise sends the baby shoots of self-compassion—which include a softened embrace of the self and the wise observer who knows ‘‘this too shall pass’’—and the  self-acceptance that takes root as participants shift from isolating shame to the blossoming of belonging in a healing circle.

Contraindications: Some participants will have a strong reaction to a compassionate voice, because often a perpetrator uses the seduction of caring in the grooming stage of abuse. In this case, a more neutral tone of the Observing Ego will bring safety and containment. Also, the harsh critic will easily contaminate the role of an observer, so directors can be watchful of forms of criticism slipping into the role. Finally, the Caring Observer exercise can be taken outside of the therapeutic space—participants can recreate this small vignette on their own any time reassurance and warm wisdom is needed.

COMMENTS FROM THE FIELD

Leslie Gray, former Clinical Director of Northeast Reintegration Center states, “When I look back at Recovery in Motion®, I vividly remember you pulling out the fluffy blanket for the Caring Observer exercise, drawing sceptical looks from the women in the groups.  Without fail, I watched how the women softened and shifted, as if by magic, taking in the nourishment and messages to themselves.  This was really extraordinary to watch – as women in prison are often extremely hard on themselves, so this transformation was powerful and memorable. It was always one of my favourite activities.”  (telephone conversation April 11, 2019). 

 “It provided modelling and training to do something that is still foreign for me. Importantly, it provided a space to try to TAKE IN what I was saying to myself and swallow the thoughts, allowing them to land and take root in the core of my being.”  Nancy L., participant, (Toledo). 

“It’s useful in family therapy because family members can share their true thoughts and feelings in psychodrama when they can’t through traditional talk therapy. The creativity unblocks a side of the brain,” Hayley Whiteman, family therapist in Akron, Ohio. 

SUMMARY

Feeling ‘‘seen’’ and ‘‘felt with’’ is the soul food that nourishes us as humans and taps the brain’s hormonal sweet spots as we attune to ourselves and others. The Caring Observer can become a permanent companion, a built-in set of eyes that can be our witness and ally, a warm hand at our backs that fosters friendly acceptance, loving kindness, and humour to carry us through difficult times. This internal attachment system is switched on through a variety of practices such as loving-kindness meditations, mindfulness skills, activities of the Caring Observer, and social connections that feel safe and secure enough to become part of internal reserves.

REFERENCES

Badenoch, B. (2008). Being a brain-wise therapist: A practical guide to interpersonal neurobiology. New York, NY: Norton.

Badenoch, B. (2011). The brain-savvy therapist’s workbook. New York, NY: Norton.

Baumeister, R., Campbell, J., Krueger, J., & Vohs, K. (2005, January). Exploding the self-esteem myth. Scientific American, 292(1), 84–91.

Gilbert, P., & Irons, C. (2004). A pilot exploration of the use of compassionate images in a group of self-critical people. Memory, 12(4), 507–516.

Gilbert, P., & Procter, S. (2006). Compassionate Mind Training for people with high shame and self-criticism: Overview and pilot study of a group therapy approach. Clinical Psychology and Psychotherapy, 13, 353–379.

Hudgins, K. (2002). Experiential treatment for PTSD: The Therapeutic Spiral Model. New York, NY: Springer.

Hudgins, K., & Toscani, F. (2013). Healing world trauma with the Therapeutic Spiral Model: Psychodramatic stories from the frontlines. London, UK: Jessica Kingsley.

Lawrence, C. (2011, March 8). The architecture of mindfulness: Integrating the Therapeutic Spiral Model and interpersonal neurobiology. Retrieved from http://www.drkatehudgins.com

Lehman, A., Rodin, J., (1989).  Styles of Nurturance and disordered eating. Journal of Consulting and Clinical Psychology. 57(1): 117–122.

Longe, O., Maratos, F., Gilbert, P., Evans, G., Volker, F., Rockliff, F., & Rippon, G. (2010). Having a word with yourself: Neural correlates of self-criticism and self-reassurance. Neuro Image, 49(2), 1849–1856.

Moreno, J. (1953). Who shall survive? McLean, VA: Royal Publishing Company.

Neff, K. (2009). The role of self-compassion in development: A healthier way to relate to oneself. Human Development, 52, 211–214.

Neff, K. (2011). Self-compassion. New York, NY: HarperCollins.

Neff, K., Kirkpatrick, K., & Rude, S. (2007). Journal of Research in Personality. 41, 139–154.

Neff, K., & McGehee, P. (2010). Self-compassion and psychological resilience among adolescents and young adults. Self and Identity, 9, 225–240.

Neff, K., & Vonk, R. (2009). Self-compassion versus global self-esteem: Two different ways of relating to oneself. Journal of Personality, 77(1), 23–50.

Panksepp, J. (2009). Brain emotional systems and qualities of mental life, from  Animal models of affect to implications for psychotherapeutics. New York, NY: Norton.

Panksepp, J., & Bivens, L. (2012). The Archeology of mind: Neuroevolutionary  Origins of human emotions. New York, NY: Norton.

Porges, S. (2009). Reciprocal influences between body and brain in the perception and expression of affect: Healing power of emotion. New York, NY: Norton.

Siegel, D. (2010). Mindful therapist: A clinician’s guide to mindsight and neural integration. New York, NY: Norton.

Weng, H., Fox, A., Shackman, A., Stodola, D., Caldwell, J., Olson, . . . Davidson, R. (2013). Compassion training alters altruism and neural responses to suffering. Psychological Science, 24(5), 1171–1180

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This has been an excerpt from The Neuropsychotherapist Volume 7 Issue 5 – for the complete article and more interesting content, please subscribe to our website.

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