Chapter 12. Glimpses of Processes of Change

In this chapter, I present glimpses of specific processes of change. The examples illustrate the possibilities for psychological transformation that arise from LBT (Linguistic-Based Therapy). Some examples are remarkable in demonstrating aspects of the brain’s capacity for change beyond what psychology traditionally conceived as possible. The examples also highlight the significance of imagination for psychological change and how it can be utilized in therapy. They also exemplify the extensive capacity for change in clients. A common feature among these examples is reducing the client’s contact with sensory images, words, and statements (bio-psychologicalelements) that trigger psychological pain while increasing the connection with mental images that lead to well-being and mastery.

Treatment of Post Traumatic Distress Following Violence

A young person from Northern Norway had experienced life-threatening violence and underwent an extendedhospital stay. He developed persistent and extensive phobic anxiety. The family had to relocate due to the client’sanxiety. The school reached out two years after the violent incident, as previous treatments had not yielded desiredresults. The client experienced flashbacks where they visually relived the violent event. The anxiety was so overwhelming that he didn’t notice if his hands were touching a hot stove, and he perspired to the point of developing a rash on their hands. He had become socially isolated, abandoned their hobbies, could no longer bein shopping centers, and their academic performance had plummeted.

The initial goal of the treatment was to reduce the client’s anxiety. The treatment followed the process described in Chapter 5, the various strategies for change and forms of change described in Chapter 13, and several methods outlined in Chapter 3 in sections 15 to 24. The work led to the cessation of flashbacks and anxiety related to theyouths who had perpetrated the violence. These methods illustrate the significance of the mind-biological elements in the experience of psychological distress, the extensive capacity for change in specific clients, and the importance of imagination in the changes that can be achieved through therapy.

The client was resilient and proud. One of the things that troubled them was that he hadn’t been able to retaliate. He perceived the situation as a defeat. It may sound peculiar, but he felt shame that he had been beaten without being able to fight back, even though there were three of them, and he was caught off guard. It took some time for me to find an approach to the treatment. The client’s statement about their inability to retaliate and perceivedweakness provided a starting point. The following are selected excerpts from the treatment.

• T: Do you have any heroes, such as comic book heroes like Superman or any other superhero? Thequestion turned out to be within the client’s realm of experience. C: Yes.

• T: Great. Have you ever been interested in martial arts? The client had been interested in taekwondo, a Korean martial art.

• T: Okay, let’s see. Imagine if something could make you completely safe and free from being on guard. C:I don’t know. (The client’s immediate anxiety made it difficult to envision a situation without fear). Thetherapist’s early attempt to establish contact with specific mental resources failed.

• T: You don’t know. Does the feeling of being on guard that you have now stem from that situation that happened? C: Yes.

• T: Exactly. Then, imagine that you can see yourself from a distance at school. (Shifts the client’s focus and reduces anxiety). C: Hm (the client’s “Hm” was a signal of agreement. The client can thus change focus). The therapist has provided the client with a dissociated position, seeing oneself from a distance, making it easier to access mental resources.

• T: Can you imagine being 215 centimeters tall with a black belt in taekwondo? (Boosts self-esteem,security, and a sense of mastery). C: Hm. T: You are safe. And one more thing, now you know what willhappen. And you know what you will do in advance (increases security). C: Hm.

• T: And now, you can see yourself from the outside, but this time, you are Superman with a black belt intaekwondo and 215 centimeters tall. You handle the situation with complete superiority. Now, see what happens when you genuinely handle it how you desire. What can you achieve now? C: I defeat all three (confirmation of change).

(The intervention worked. The client gained access to some mental resources).

• T: Now, imagine yourself defeating all three (reinforcing the change). How does that feel? Laughter. It feels much better. It’s pretty easy (confirmation of change).

• T: You are entirely calm (reinforcing statement). C: Hm.

• T: Now, the situation continues. (Prevents the client from stopping and dwelling on the case). T: Howdoes it feel now? C: Hm-

(The client’s tone indicates a somewhat adverse reaction).

• T: Does it feel good? C: Yes. A little laughter (confirmation of the change, but the client’s tone suggestssomething remains. The client still appears unsettled).

Forming a new mental reality through imagination intends to increase emotional distance and reduce the client’s experience of anxiety.

• T: Have you ever watched a Chaplin film? C: Yes.

• T: Imagine that you are now watching a Chaplin film, and you are Chaplin. C: Yes. Slight laughter.

• T: Now, imagine yourself in a black-and-white film of the situation, as if you are Charlie Chaplin, where you handle things in a slightly comical way. You are still 215 centimeters tall with a black belt intaekwondo. How does it look? C: It looks silly. Slight laughter.

• T: It looks silly. C: Some laughter.

(Humor and laughter are signs of greater calm and relaxation, reducing anxiety. Seeing oneself in a film as CharlieChaplin in a violent situation is a powerful visual change. )

• T: And now, imagine one more thing. As soon as they approach, you shrink them down to two centimeters. (This visual change makes the students appear harmless. ) C: Hm.

• T: And then, you dress them in lederhosen and place them on a table 15 meters away, where they dangle their legs, while you remain big, strong, and secure. (An innocuous and slightly ridiculous visual image of apreviously tricky situation reduces anxiety. ) C: Hm. (More laughter) New Test:

• T: How would you feel in that situation now? (Assessing the effect of the intervention). C: I don’t think they would attack me if it were like that. (An affirming statement, but the word “if ” indicates some reservation. )

• T: No, imagine that they don’t dare to. How do you feel then? C: Then I feel good. (Confirming statement).

• T: Then you feel good. See what happens when they don’t dare to attack you. What happens, then? C: Nothing.

• T: Are you feeling good then? C: Hm. When I feel like that, I feel good. (The phrase “When I feel likethat” indicates something remains unresolved. )

The therapist tests again:

• T: How do you feel at school when you walk around with that feeling instead? C: I don’t know. (“I don’t know” indicates some lingering anxiety. )

• T: Is it better to feel that way? C: Probably. (“Probably” is another sign of remaining anxiety. )

• T: Are you still a bit uncertain over there? (Rechecking).

• C: Hm. (The client is very reserved, and “Hm” can mean both yes and no. )

• T: What do you need now? C: I would prefer to have another chance.

• T: You would like another chance? C: Hm.

The statement “another chance” is an unexpected reaction and indicates that the client’s discomfort is linked tosomething other than anxiety. “Another chance” means that the violent incident would have a different outcomewith the client as the winner, even if the client gets hurt.

• T: Okay, imagine that you now get another chance. What happens when you have a new opportunity, and you succeed?

• C: Then it’s completely safe. (The client’s voice is clear. ) Reinforcing the positive experience:

• T: Then you are entirely safe (reinforcing confirmation). Is there anything else happening? (The therapist still needs to understand the statement’s significance fully.

• C: Then I’m the one in court instead.

• T: So you’re the one in court instead of them. How does that feel? C: It feels good.

• T: What does it mean to you to be in court instead of them? C: It means I took them instead of them taking me. And that I took them in self-defense.

• T: Wow, now imagine that you get another chance. C: Hm. And that it’s you who is in court instead of them, and you’re there because of self-defense (reinforcing statement).

• T: See that you receive full support and get acquitted. C: Okay. T: How does it feel now? C: It feels much better.

• T: And then you walk around the world with this feeling. It’s a good feeling. C: Hm.

The client’s discomfort was linked to lost self-esteem and defeat. The ability to shift the focus from anxietyassociated with the situation to the feeling of failure indicates that the original anxiety has been reduced. We aremoving towards a

resolution. The client had also developed anxiety about shopping centers and going into town. I suspected aconnection between the fear of shopping centers and the violent incident, so I investigated further.

• T: Now that you have this excellent and secure feeling with you when you go into town. The clientimmediately responds: Then I feel much better. Then you feel much better. C: Hm.

• T: Imagine that you now have this feeling in the town. You’ve been given a new chance, and you won, and you were acquitted. Is it a good feeling? C: Yes.

• T: Imagine that you now walk in town with this feeling, and everyone knows it. C: Yes. (Laughter)

• T: Everyone understands what has happened, that you were acquitted, and that you took them instead. How do you feel now when you go into town this way? Client, emphasizing: Then I feel much better.

• The client’s sense of honor, the need to be the strongest no matter what, and the feeling of social defeat were beyond my original focus.

The therapist here uses several reinforcing statements for change.

• T: How does it feel now that things are much better? C: It’s the feeling of security. And the way I can handle things.

• T: Feel now that you have the feeling of security and that you have that great way of handling it. C: Hm.

• T: What happens when you enter the shopping center with the feeling of security and the knowledge that you can handle it?

• C: Much better.

• T: And now you can envision yourself at school with this feeling of security (transferring security tomultiple situations) and the feeling that you can handle things. C: Hm.

• T: How do you feel at school then? C: Much better. (Laughter)

• T: Then you feel much better. C: Hm.

• T: Feel the excellent sensation of being at school with this feeling in your body. C: Hm.

• T: Does that mean you no longer need to be afraid? And that you can be completely safe? C: Hm.

• T: Feel that you are at school, completely safe. It’s a good feeling. C: Hm.

• T: Now you are in town, completely safe. C: Hm. T: And then you are in the shopping center, completely safe. C: Yes.

• T: Now imagine you have had it this way for two years. So, it has become entirely sure. C: Hm. T: In addition, you have a black belt in karate. C: Hm. T: Wow.

The process continued. There was more to do. Before the violent incident, he had been a confident, tough, strong, and fearless young person with good grades, especially in mathematics. The treatment took three consultations. The client made new friends and resumed his previous hobbies. He could bike again, ride a moped, go to shopping centers, and the anxiety disappeared.

A Mental Killing as a Substitute for a Real Murder

It was the second consultation. “I want to kill one of them,” the client said. The words were spoken with utmostseriousness. I became uncertain. Words of admonition and moralizing would have little effect. The client knew verywell that one should not kill anyone. How should I approach this situation? I became speechless and perplexed. A few seconds passed.

• T: “How would you kill him? ” C: “With a knife. ” The idea seemed premeditated.

• T: “You’re only 14. It might be foolish to have already ruined a part of your life due to violence and thenput yourself in a situation that would lead to many years in prison. ”

The argument seemed irrelevant.

• T: “But maybe you could kill him here and avoid prison. ” For some reason, the client bought into thetherapist’s suggestion.

• C: “Okay. ” I thought it was risky and might have an unfortunate outcome, reinforcing the desire tocommit the actual murder. But I could observe how it developed and proceeded afterward, although I still felt uncertain.

• T: “Okay, imagine that you kill him. ” After a short while, the client signaled that it was done.

• T: “How do you feel now? ”C: “It wasn’t enough. I still want to kill him. ” The word “enough” became a new starting point.

• T: “All right. How often do you have to kill him before you start finding it boring? ”

The question contained a presupposition, a prediction, and a message that the client would become bored after killing him several times.

• C: “Sixteen times. ”T: “Hm. ”

• T: “Imagine that you kill him 16 times here. Give a signal when you’re done but take a short break and think of something ordinary and neutral between each time. ”

Subsequently, the client killed the most violent of the youths 16 times. It took some time. When the client finished, the therapist asked:

• T: “How do you feel now? ” C: “I’m fed up. He’s a jerk, but I don’t bother caring about him anymore. He doesn’t deserve it. He’s nothing. I’m more indifferent. I want to forget the whole guy, but I know he’s afraid of me. He’s a coward. I would have taken him if he had been alone. ”

I breathed a sigh of relief and could continue with the treatment. But what happened here from the neuropsychological understanding of psychological reactions? The client’s inclination and determination to killresult from being in

contact with a range of multimodal mental-biological elements, encompassing emotions and words, statements, or thoughts that also contain emotions.

There was a severe previous physical and now a painful psychological reality underlying the client’s determinationto kill. At the same time, the client must have also had contact with some thoughts that pointed towards not killing.

The fact that the client accepted that he could kill purely mentally aligns with the brain-psychological understanding that physical and mental actions have a mental foundation. This implies that mental killing can have the same effect as killing but without extensive side effects like imprisonment. However, the client’s statement that killing once was not enough was a sign that mental killing was insufficient to reduce the need for revenge ultimately. But mentally killing multiple times led to a weakening of the revenge impulse. At the same time, the client had encountered the thought that after a certain number of times, he would grow tired of killing,which happened after ”killing” one of the adolescents 16 times.

The client’s reactions are in line with how we function daily. We often grow tired when we have done the samething in the same way many times. The same murder carried out 16 times mentally changed the client’s state: fromwanting to kill to not caring about the guy.

This experience opens the possibility of preventing violence through treatment that replaces and reduces contact with internally sensory elements and words and statements that promote violence. At the same time, one must increase the connection with bio-psychological elements encompass emotions and insight, allowing for actions other than violence.

Gambling Addiction

He was 14. The parents contacted their daughter, whom I knew beforehand. Could I help? The boy had become addicted to gambling and was playing on slot machines. At first, he won some money, then lost, and then won a bitagain but ended up losing much more. He played to win it back, and it had gone too far. He had started stealingseveral thousand kroner at home and from his grandparents. The boy understood that it couldn’t continue, but hecouldn’t stop. He had to play whenever he saw a slot machine making sounds and flashing with red, yellow, and green colors.

Moral persuasion had no effect. It turned out that what he couldn’t resist were the flashing bright colors and the hope of winning it back. The solution was to reduce the attractiveness of the slot machine and connect gamblingto

psychological discomfort, loss, lies, and theft. The colors were changed, and the slot machine was dipped in foul-smelling mud. The solution involved mental aversion techniques drawn from behavior therapy, combined withdisconnecting the positive emotions and the bio-psychological elements that anchored the attraction associated with slot machines. This worked. The boy stopped gambling.

Suicidal Tendencies

A depressed client with visual disturbances due to substance abuse consistently displayed signs of experiencing psychological changes. And just when you think you’re on the right track, during a consultation, the client revealssuicidal thoughts. The client was functioning better, but as a therapist, I had overlooked the most fundamental issue: the client’s desire to not live.

It was a wake-up call. I had to change my therapeutic strategy and redirect my focus toward what truly mattered tothe client. I conveyed that if he genuinely meant and had planned to take his own life, I had to immediatelycontact psychiatric services and initiate a “nightmare” to ensure he received prompt help. In this situation, thepublic mental health system had to assume responsibility for his treatment. “We cannot wait a month for you to beevaluated if you genuinely believe you no longer want to live. You need help quickly. ” He had previously seen a psychologist and disliked contacting psychiatric services, partly due to the associated stigma. So, we made anagreement that was reiterated and confirmed several times. He promised not to take his own life in the next four weeks in exchange for me not initiating an extensive process involving psychiatric intervention.

The client continued with the treatment. I did not know if the client would not take his own life. But it likely had some significance for the subsequent course and the client’s mental state that I conveyed the importance, in theongoing treatment, of assisting the client in choosing to live instead of ending his life. My earnest statements thatthe client was valuable not just to himself but also to those close to them possibly contributed to the disappearance of suicidal thoughts during our contact period. The treatment continued. There were still some unresolved issues remaining.

From an Unpleasant to a Positive Hallucination

She was 17 years old and undergoing evaluation after six months of cognitive therapy. The client mentionedliving in a transitional home during the consultation. During the session, the client revealed that she saw herselfsitting on the floor a few meters away with a doll. The doll was larger than her, and she was small. The doll said unpleasant things and ordered her to do things in a stern voice. She experienced a vivid visual hallucinationcombined with auditory hallucinations. I did not assess the client’s condition but asked how she perceived the situation. The hallucination and the doll being larger than her and saying unpleasant things had caused anxiety.

T: ”Would it be better if the doll became smaller? ” ”Yes,” the client replied. T: ”Perhaps we should make the doll the size of a regular doll and make you larger, just as you are today? ” The client agreed to this. After a fewinterventions that resulted in her becoming larger and more significant and the doll becoming a regular-sized doll, the therapist asked, T: ”How do you feel now? ” C: ”Much better. ” However, the client added that the doll’s voicewas still unpleasant and stern. T: ”Does the doll have your voice? ” C: ”No, it’s more like my aunt’s voice. ” T: ”Maybe we should replace it with a friendlier voice? ” The client also agreed to this. T: ”Can you recall any voices you find pleasant to listen to? ” C: ”Yes. ” T: ”And is there anyone who says something nice to you? ” C: ”Yes,” the client replied once again. T: ”Imagine now that you are replacing the stern and unpleasant voice with thepleasant voice. And instead of saying unpleasant things, it can say something nice and positive. ” The client carried out the therapist’s interventions by imagining what had been suggested. After a while, the client nodded. Itworked. C: ”How do you feel now? ” The client hesitated. She still experienced some discomfort.

Through several interventions, we gradually gave the doll a warm voice that said pleasant things. Suddenly, the hallucination disappeared, and the client refocused on the therapist, now without anxiety. I continued the treatment as if nothing unnatural had occurred. We did not discuss the hallucination. What happened here? Thewoman’s hallucination, where she felt small and the doll

was large, and it said unpleasant things and commanded her to do something, may not be so uncommon. Theuncommon aspect was that the woman changed the hallucination from feeling small and characterized by powerlessness, lack of control, anxiety, and unwillingness to creating a new hallucination where she had attained a natural size and became the one in control of the situation. Moreover, in the altered hallucination, the doll started saying pleasant things with a warm voice due to a few interventions. It was also remarkable that the hallucination suddenly disappeared once it had been changed. This example does not imply that the client will no longer experience hallucinations.

This experience reveals the possibilities of changing and replacing hallucinations, which means replacing contact with visual and auditory mental elements that evoke anxiety with hallucinations that encompass positive emotionssuch as control, security, and psychological well-being. The example illustrates that in some situations, one can consider the client’s ability to hallucinate as a mental talent and the ability to change their hallucinations as atherapeutic resource. Furthermore, the example demonstrates that the attributes utilized for hallucinating can be employed in the opposite direction to modify and eliminate the hallucinations (Dammen, 2023a).

The unresolved issues required further attention to provide comprehensive treatment for the client. While the focus had shifted towards addressing the immediate concern of suicidal tendencies, it was crucial to delve deeper into the underlying causes of the client’s depression and substance abuse.

Through ongoing therapy sessions, we explored the client’s past experiences, traumas, and emotional struggles. It became evident that the client’s desire to escape from emotional pain had led to substance abuse as a copingmechanism. Understanding the complex interplay between mental health, addiction, and suicidal ideation was vital for developing an effective treatment plan

We employed a multifaceted approach that integrated cognitive-behavioral therapy, trauma-informed care, and addiction counseling. The therapeutic process aimed to empower the client, instill hope, and equip them withhealthy coping mechanisms. We explored alternative ways to manage distressing emotions, such as engaging increative outlets and physical activities and establishing a solid support system.

Additionally, regular assessments of the client’s mental state, including monitoring for signs of relapse or worsening suicidal thoughts, were essential for ensuring their safety and well-being. Collaboration with psychiatric professionals allowed for a comprehensive evaluation of medication options, when necessary, to stabilize the client’s mental health.

As the treatment progressed, the client gradually developed a renewed sense of purpose and resilience. We aimedto help clients rebuild their lives and regain control and fulfillment by addressing the underlying issues andproviding a supportive therapeutic environment.

While the journey toward recovery was ongoing, it was crucial to remain vigilant and responsive to the client’s evolving needs. Open communication, empathy, and a non-judgmental approach formed the foundation of ourtherapeutic alliance. Together, we worked towards cultivating a future where the client could envision a life worth living, free from suicidal tendencies.

This case exemplifies the significance of recognizing and addressing suicidal ideation within a comprehensivetreatment framework. By prioritizing the client’s well-being, collaborating with psychiatric services, and offering atailored approach, we endeavored to provide adequate support in their journey toward healing and renewed hope.

Hypersensitivity and Territory

Most clients have developed hypersensitivity towards thoughts, sensory impressions, and situations or individuals. One characteristic of hypersensitivity is that specific sensory experiences directly affect the emotional center, theamygdala, bypassing the cognitive processing of the frontal cortex. The amygdala, an almond-shaped gland located on both sides of the head near the temporal region, can be described as experiences that go straight ”to the heart” without the individual being able to ”defend” themselves, simultaneously causing discomfort. Hypersensitivity can also be linked to interpreting others’ gazes, vocal tones, statements, and reactions toward oneself. Susceptible clients with low self-esteem may experience intense discomfort related to past and present situations and anticipations of future encounters with people.

The therapeutic task involves reducing sensitivity to sensory impressions and mental elements that lead topsychological discomfort. For specific clients, it is possible to lower sensitivity from a previous level of onehundred to five or ten regarding clear unpleasant impressions. It is also possible to increase the client’s awareness ofsensory experiences that lead to desired emotional reactions in situations previously dominated by unpleasant sensory experiences and to enhance contact with modal and verbal elements that encompass and trigger well-being in cases previously interpreted as uncomfortable. The need for an extensive assessment of the client’ssituation may be minimal in these scenarios. Below is an example of how to reduce the client’s hypersensitivityand pattern of interpretation.

A Young Woman:

• C: I dread every time I have to go home to my parents. I know in advance that I will be criticized or nitpicked, but I can’t protect myself; I just can’t. I either get angry or sad, and I withdraw. I have no defense; everything goes straight into my soul.

• T: Does that mean you can experience something similar in other situations too? C: Yes, with certain friends. They always make jokes at my expense. It’s probably meant to be humorous, but I can’t handle it. So I smile and pretend everything is fine, but it’s not.

• T: Do you think they want to bother you, or is it more of a humorous style? C: It might be funny, but it doesn’t help.

• T: Okay. What is more important to improve, the situation with your parents or with certain friends? C: With my parents.

• T: Then let’s start there. Do you ever feel good or pleasant sometimes? (Here, the client is given a connection to a positive feeling as a starting point for the therapeutic work). C: Yes, often, even with my parents.

• T: Good. Can you remember a situation where you felt beautiful at some point? C: Yes, many times. Ioften feel good, for example, with my children.

• T: Great. That’s a good starting point. How do you react when your children get angry at you or sayyou’re dumb? C: Yes. No, it’s not a problem. They’re just children, and I’m their mother.

• T: That means you don’t take it personally when your children say those things.

• C: Yes. No, it’s normal for them to say that I or Dad is dumb.

• Here, the client is given a situation where she doesn’t react with hypersensitivity. Is it possible to transferthis sense of security to your encounters with your parents?

• C: Yes, or both. They’re adults, so I have to react differently.

• T: Okay, that’s natural. But do you want to respond emotionally so you don’t get upset or angry when you meet your parents, even if they criticize you? C: Yes.

• T: Then we need to do something. Do you know what a territory is? The client, with a slightly self-evident voice: Yes.

• T: A territory protects you because no one should enter the territory without your permission. The client nods.

• T: It is designed so that coming from outside, for example, from your parents, first hits your territory sothat it doesn’t immediately enter your emotions. C: That would be nice, much easier. (The client canimagine something that can protect her, which indicates that the work can continue. )

• T: What should such a territory be made of if it protected you in a way that you could consider whetheryou wanted to let what comes from outside enter your emotions or not? And so that what you didn’t want in your heart would just fall outside the territory and remain there without bothering you, and then itwould be washed away. You can choose what the territory should be made of. It can be a wall, a glass wall, fabric, something armor-like, or something else.

• C: It can’t be glass because it can break. It can’t be a wall either because no one can enter.

• T: You could have a door or a window that allows you to let in what is okay or open to.

• C: No, I think it must be plexiglass. Then I can see outside and have an overview of the situation while it can’t be shattered. And in addition, I can protect myself, but there must be a door so I can come out and let others in when I’m ready.

The client constructs a visual fantasy that can protect her.

• T: Great, that sounds good. Now imagine that you have this territory; what happens to you then? C: If I’m confident that I can protect myself and at the same time decide what I want to let into my heart and what I shouldn’t take personally, then it’s beautiful. Then I know I can protect myself even before I meet them.

• T: Wow, that sounds great. What happens next when you feel that way? C: What do you mean?

• T: When you feel so secure in the situation and in advance as you do now, does it impact other things? C:Yes. I become calmer because I know I can protect myself if I wish to.

• T: Wow. Great. Would you like to have the same ability to protect yourself and not take things personally as you have now, but with your friends? C: Yes, that would be nice. It would make things much more manageable.

• T: Okay, let’s see. Feel that wonderful feeling of having a fantastic territory that can protect you. And then you can borrow that feeling over there with your friends. The client smiles. C: No, there’s no problem; it becomes funny. But I don’t know. Fredrik can say certain things will still be uncomfortable but less painful.

I will conclude the presentation here. The client’s final statement indicated that there was more work to be done but also that positive changes had occurred, and that the client had acquired a strategy she could use to protect herselfand reduce her hypersensitivity.

This story is quite typical. Sometimes, additional work is needed to build the client’s self-confidence and establish astable and secure emotional foundation before applying the territory method. Other times, this is sufficient,resulting in the client managing comments from family and others with greater resilience and less vulnerability.

Indifference as a Therapeutic Resource

”Indifference” is rarely associated with anything positive, but sometimes indifference is needed. I had a new client, a burned-out, anxious, and stressed daycare center director. She was highly skilled, caring, and dedicated to her work. She took responsibility for everything, followed up on everything, solved everyone’s problems, andstill felt guilty for everything she couldn’t accomplish.

She also brought unresolved issues home on weekdays and weekends. It became too much. She slept poorly, experienced anxiety, and eventually broke down, resulting in sick leave and being alone. Her partner had left. Could I help? I became uncertain. The problem seemed complex. It was relatively early in my career as a therapist. I could try, but I couldn’t guarantee anything. The client accepted the situation.

I managed to reduce the woman’s anxiety, but it wasn’t enough. During treatment, I discovered that she became emotionally invested in everything, even small things. It occurred to me that she might have needed the ability to become less emotionally involved and develop a greater capacity for indifference. This would allow her to differentiate between what she should take responsibility for and what she could relinquish or delegate to others. The woman agreed but felt unable to change the pattern.

What now? I administered a test and asked the woman to think of something she was indifferent towards. It didn’t work. She became emotionally invested in everything she looked at or engaged with. She went ”all in,” even for relatively insignificant things. I asked her to think about the middle matchstick in a matchbox to establish a sense ofindifference, which seemed neutral. But no. The woman became very interested: ”And then there’s the middle one, too, right? ” Second attempt. I asked about her relationship to a cubic meter of air somewhere in the sky. Herreaction was immediate. She said, ”A cubic meter of air, that means it contains a certain amount of oxygen, CO2,and greenhouse gases. ” The engagement grew again. Finally, I asked the client to think about a place in outer space with a complete vacuum, in other words, nothingness. It was too much even for this client. Instead ofengagement, she connected with a feeling of indifference. When asked how she experienced the feeling ofindifference, she replied that it was as if something heavy had lifted from her shoulders and that she felt a completely neutral and indifferent sensation.

• T: “Imagine if you had that feeling of indifference at work; what would happen then? ” C: “It would become easier. I wouldn’t have to take care of everything; I could let others take responsibility and relax. And when I’m at home, I would be pleasant, someone others could talk to. ”

The further work involved anchoring the client’s ability to be less emotionally involved. It worked. However, there was still plenty of engagement left. It turned out that this was where the problem lay. There were no more serious issues to address. The client left happily after two sessions. A few months later, she returned satisfied withsome minor adjustments. The feeling of burnout was gone, and she had returned to work. The job was functioning excellently, and several employees had taken on more responsibility. In the meantime, she had found a new partner and was pregnant.

I have worked with several clients who have needed a greater capacity for indifference. While some need less emotional involvement at work, others require it with friends who dominate their attention, and some need to reduce their attraction to a partner who either belittles or suppresses them. Being indifferent is crucial in many situations, far more often than most people realize. In linguistic brain therapy (LBT), clients’ extensive capacityfor engagement is understood because of their connection with specific mental elements that encompass their emotions. Similarly, the feeling of indifference is understood because of reduced contact with cognitive factorsthat led to exhausting engagement and increased contact with mental elements that fostered more remarkableindifference. These elements can be accessed and activated during treatment.

When harnessed as a therapeutic resource, indifference offers a profound shift in perspective for clients like the one I described earlier. Individuals can alleviate stress, prevent burnout, and reclaim a sense of balance in their lives by detaching emotionally from every minor detail and prioritizing what truly matters. Indifference allowsthem to delegate tasks, trust others to take responsibility, and create healthier boundaries between work and personal life.

Understanding the transformative power of indifference expands the therapeutic toolkit. By exploring and integrating this concept into treatment approaches, therapists can empower their clients to navigate various lifedomains more effectively. Recognizing that indifference is not inherently harmful but rather a tool for self-preservation and emotional well-being opens new avenues for personal growth and resilience.

As therapists, we must continue to explore and embrace unconventional therapeutic resources like indifference. Bydoing so, we can assist clients in navigating the complexities of their lives, fostering positive change, and enabling them to thrive in an increasingly demanding world.

Invisibility as a Mental Resource

She was a skilled and hardworking teacher with high competence and great care for her students, but she had become burned out and had to take sick leave. We worked on several mental and pedagogical challenges. Throughout the treatment, she reconnected with her pedagogical abilities and regained her mental resilience, eventually returning to work.

After a relatively short period on the job, she reached out again. Teaching went smoothly in most classes, but she expended much energy and felt exhausted when teaching a particular class, she dreaded. Things were going well, but she believed one student had developed animosity toward her and constantly criticized or questioned her. Wherever she was in the classroom and regardless of which other students she interacted with, she alwaysvisualized this student in her mind. The student was alert, articulate, confident, and attractive, occupying a central position in the class. The client couldn’t mentally remove the student’s presence and noticed she was becomingtired again, requiring another sick leave. The statement, ”I envision her all the time, and I feel like she’s watching me and following me constantly,” became the key to a solution.

I asked her how she would feel if that student wasn’t in the class, which is a reasonably logical intervention. When something is uncomfortable, it’s logical to remove the discomfort. The client smiled. Without the student,the class and teaching would be excellent, and she would feel good. She could focus on the other students as she desired. However, she added, truthfully, ”You can’t just kick out bright, critical, and articulate students in the Norwegian school system, even if they are unpleasant. ” I asked, ”But would it be better if she were invisible since you still see her even when your back is turned to her? ” She nodded. ”That would be wonderful. ”

It occurred to me that since the teacher ”visualized the student all the time,” indicating a mental visual talent, thisapproach might work: ”Imagine that you have an invisibility cloak. And when you place it over the student, shebecomes completely invisible to you, allowing you to focus on teaching and the other students. ”

The teacher expressed that it would be beneficial. Through simple interventions, we created a mental experience inwhich the student was given an invisibility cloak, resulting in her becoming entirely invisible. It workedexcellently, with a touch of humor. The student became invisible, and the client could concentrate on the other students and the subject matter. She found the situation quite amusing. Additionally, she regained her joy of teaching.

”That’s great; it worked well. But does it happen that the young lady occasionally asks relevant and insightful questions that are not unpleasant? ” I inquired. She confirmed this could also occur but perceived everything the student said as unpleasant and critical.

”Then we have to do something magical,” said the therapist. ”Imagine that every time this student asks relevantquestions and says something positive, she becomes visible like a regular student. And then you see her as an interested, capable, and ordinary student whom you will teach and who contributes something. ” The client nodded. The therapist continued, ”Otherwise, the student is invisible to you, so you can focus on the others. ” The clientnodded again.

The client and I repeated the process several times through simple interventions. She realized again that the student was invisible when she entered the classroom. Still, when the student contributed something constructive,she became visible again, allowing the teacher to be present for that student as she was for the others. We thenreinforced certain other qualities that she needed. The consultation was over.

After a couple of days, the teacher contacted me by phone. It worked. She had discovered that the teenage girl was attentive, engaged, and critical, but she was indeed an excellent and friendly student with whom she hadstarted to connect. And she experienced that this had changed her situation as a teacher and her relationship with teaching in the class.

What happened here? The same thing as in most other examples described. We reduce contact with mentalelements that harbor unpleasant emotions and establish a connection with mental elements that contain positive emotions. The slightly peculiar but logical aspect is that we generate a mental representation in which thepreviously ”unpleasant” student becomes invisible. This was done based on the teacher’s statement that she ”saw the student in her mind’s eye. ”

Thus, it was not the physically present student who was the problem, but rather the teacher’s mentalrepresentations of the student, i. e. , the psychological material, the modal and verbal elements that had beenformed through teaching and dominated the teacher’s focus in the class. The issue was the teacher’s sensitivity and ability to create mentally unpleasant representations. The fact that the teacher felt she ”saw” the student even when she had her back turned is, in LBT an expression of a mental talent that can be described as the ability to ”see” something internally that is not physically present. From there, it is a relatively short step to create a newmental representation of an invisibility cloak that makes the student invisible.

The ability to make others invisible in the sense that we are not aware of them is a common trait that we often overlook. Anything that we are not currently focused on is, in a way, invisible, although it can become visible again when we shift our focus. The difference from ordinary invisibility is that the visual representations of this student were so intensely unpleasant that they dominated the teacher’s emotional state and her internal gaze, regardless of what else she focused on. We formed new representations through specific interventions, not bystopping or preventing anything, but by utilizing the teacher’s mental capacity to create a positive, unique mentalexperience. We crafted a new mental narrative encompassing positive emotions and a sense of mastery.

It was unnecessary to examine the client’s overall personality to find the underlying causes of her reaction pattern.

When Lifestyle Sustains Mental Distress

He was a highly skilled, well-respected, and mentally sharp teacher at a secondary school, pursuing a new law education while working full-time. Additionally, he experienced anxiety, depressive tendencies, and hypochondriacal inclinations. At each consultation, he entered the office heavily burdened by anxiety and depression, firmly convinced that he was seriously ill and had a brain tumor, despite functioning exceptionally well intellectually. And after each consultation, he left the office happier, more secure, and more satisfied afterapproximately 90 minutes. Nevertheless, he returned for the next consultation just as heavy-hearted and anxious asbefore, believing he was seriously ill and had brain damage. This pattern repeated itself four to five times.

It was unusual. Only once before had I experienced a client returning with the same mental distress after one ormore consultations. Something must have happened between the consultations that led to the persistence of mental distress, but what? He had around 15 cubic meters of books and journals on psychiatry, medicine, andhealth supplements. Every day, after finishing work, he immersed himself in this literature. Therefore, I asked theclient to stop reading medical literature and health supplement books to investigate how this could affect him mentally. He promised to stop, but when he returned next time, he was just as burdened and anxious as before. He hadn’t managed to do it.

That’s when I did something I never do otherwise. I commanded the client to pack up all his medical professional literature, set it aside, and stop reading health supplement literature. It was an order. The client has yet to return. After a few months, he contacted me again. The anxiety, mental tendencies, and concerns about the brain tumor disappeared relatively quickly. He had been ripe for change. He reached out again because he was soon to retire and worried about transitioning into the ranks of retirees. He wanted to prepare himself for his new existence mentally.

His persistent reading of medical literature sustained the client’s anxiety and hypochondriacal tendencies. Every day, he sought answers to his questions about brain tumors and a scientific understanding of his symptoms. Every week, he learned something about brain diseases and other illnesses, and every day, he interpreted his emotionaland cognitive reactions as signs of something serious.

When he packed away his medical library, he had to engage in and focus on other things. That’s when the workwe had done in therapy started to take effect. I also confirmed that if clients returned to the next consultation withthe same level of anxiety as in the previous one, something must have happened between the talks.

Based on the neuroscientific understanding of psychological change, the client produced and reinforced the mental-biological elements that contained psychological discomfort, resulting in him having less and less contactwith the positive changes that had occurred in therapy.

Psychological Change Through Alteration of X-ray Images

This is an example of the method called ”fantastic fantasies. ” The fantasy begins with something familiar or known to the client. In this case, an X-ray machine. Modifying the client’s imagery is more accessible by starting with something familiar. The client knew what an X-ray machine was and how it worked. The starting point forthe fantasy was the client’s desire for less anxiety and increased ability to cope with a situation.

T: ”You know what an X-ray machine is? ” The client may think, ”What a silly question,” but answers yes. T: ”Butthis one is a bit different and magical. ” The word ”magical” can create curiosity while also allowing for the possibility of what was previously impossible becoming possible. Imagine a color X-ray machine set to take an image of where in your body you feel the psychological discomfort and how that discomfort looks. ”

The client nods. The client envisions themselves entering the X-ray machine and having an image taken showingthe discomfort in their body. Based on the therapist’s verbal intervention, the client engages in a mental process.

T: ”The X-ray machine is magical in that it demagnetizes your discomfort, causing the unpleasant feelings to disappear from your body and remain on the X-ray image. ” The client nods and visualizes what the therapistsuggests.

The therapist provides a verbal intervention that disconnects some unpleasant mental-biological elements from theclient’s psychological state. No clients have claimed that this is impossible. They willingly “buy into” this fantasyand carry out the mental process. The client is then instructed to step out of and away from the X-ray machine,now free of uncomfortable feelings, and to stop only when they are “outside the radiation of the X-ray machine”and then look at the X-ray image from a distance. The therapist uses words that the client is familiar with, such as “take an image,” “move away from the machine and the uncomfortable radiation,” and “turn around and view the color X-ray image from a distance. ” However, there is no guarantee that the client can carry out the mentalprocess as the therapist suggests. We may receive a signal of refusal. But this time, it works.

T: “Look at the X-ray image. Where in your body is the discomfort located? ”

Clients usually respond with the head, throat, chest, shoulders, heart region, solar plexus, or stomach. For some,the discomfort is felt throughout the entire body. Others say that the discomfort is in both the stomach and the head. Some express uncertainty about the discomfort’s appearance, while others describe it as a black or dark mass inthe abdomen or something angular. Some say the image is stationary, while others say it moves. Some describe the feeling as a hard nut or a clenched fist, while others say it feels like carrying a heavy burden on their shoulders. What is common among nearly all clients is that the psychological discomfort is perceived as something dark,often brown, dark gray, or black. Some add that there is also a bit of light or some colors in the image. This usually indicates the presence of something psychologically positive in the situation. It is also common for clients to want to eliminate the discomfort. The client’s perception of something being dark implies that they have a visual mental, or mental-biological element that anchors the unpleasant feeling of “darkness,” which causes theclient’s discomfort or anxiety. The clients’ reactions provide an illustrative example of the connection between inner visual experiences and emotions.

T: “You are the artist of your life. Imagine if it were possible to remove the unpleasant elements in the picture orreplace the discomfort with a better feeling. What would you most like to do with those parts of the image that you want to change or eliminate?

‘Art’ is associated with freedom, creativity, and the ability to choose. This statement aims to open to new solutions and reduce resistance or ‘no-it-is-not-possible’ signals. There are as many suggestions from clients on how they can alter or remove the discomfort in the X-ray image as there are clients. Some suggestions are recurring. Manywant to burn or discard the discomfort or the entire picture. However, I suggest first bleaching the image to make the darkness disappear. And for bleaching, we use chlorine. Already, this leads some clients to express that they feel better.

• Then I ask if there are any colors that the client likes, colors that evoke a sense of safety, well-being, orcontrol. Almost everyone responds with yellow, orange, blue, or green. Some say red, but red can also be associated with discomfort and anxiety. Interestingly, most clients would replace the unpleasant colors in the image with a primary color. Some prefer a pastel color. Some want just one color, others wish forseveral, and some say they want a feeling of white. Some say, ‘I don’t know. ’ In that case, we need toapproach the problems from a different angle.

• T: ‘Imagine that you are the artist of your life’ (conscious repetition) and that colors flow in there, or you paint the picture with colors that give you a good feeling where there used to be something dark andunpleasant. Which colors would you use, and how does it feel when you have achieved this? ’ The client isgiven some time. ‘I feel better,’ the client may say. T: ‘Notice if there is anything else in the X-ray imagethat you want to change. Then imagine making those changes you desire and the image transforming into a neutral or positive one. ’

Once the client confirms that they have carried out the therapist’s instructions, the therapist continues:

• T: ‘Now, imagine entering the X-ray machine again, but the emotions are demagnetized oppositely this time. The beautiful colors and feelings that are now on the X-ray image fill you exactly as much as youdesire, especially in the places where there used to be something unpleasant. ’ Pause. The client works. C: ‘Yes. ’

• T: ‘When you remove something uncomfortable from your body, a vacuum creates a space that needs tobe filled with something positive; otherwise, some of the discomforts may return. ’ Clients find thislogical. T: ‘How does it feel when you achieve this? ’ Often, the client smiles and expresses that they feel much better.

I use the phrase ‘when you achieve this,’ not ‘if you achieve this. ’ The word ‘when’ implies that it simply happens on its own, while ‘it’ allows for the possibility that it may not work—the term ‘when’ encompasses a presupposition, a prediction that something will happen.

It is important not to dwell on the client’s discomfort. If anything remains, the process is repeated. Then the client can experience how they feel when they achieve what they desire, with the beautiful colors within them. It may benecessary to go through the process a couple of times. The X-ray image changes with each new cycle. The colorsoften become more beautiful, unpleasant parts of the image become smaller, and any remaining discomfort shifts toa different location in the body. The method is quite entertaining. Mentally, the same thing happens as in the other examples. Some mental-biological elements that hold unpleasant feelings are altered or disengaged, while positively charged mental-biological elements with positive emotions and psychological well-being are connectedand replace the previous discomfort. The method is often part of a longer process of change. In these processes, the client focuses on the narrative. In contrast, the therapist focuses on both the record, the mental elements the client engages with, and the mental processes the client undergoes.

Transformation through submodal changes

I have occasionally conducted mental experiments with my students. In this example, I combine the techniques ofdissociation and submodal adjustments, derived from neuro-linguistic programming, with narrative therapy,focusing on changing narratives.

Teacher to students:

• T: Close your eyes and imagine you can “see” a person you like or feel happy about. Notice whether theperson you visualize in your mind is in color or black and white and whether they are close or far away. Feel the sensation you have when you see this person within you. The person you are now thinking ofshould only be associated with something positive. If not, you must choose another person.

When I ask the students how the person they care about appears in their mind, most respond that the person is incolor and stands quite close, sometimes right beside them. They connect with an internal image that holds positiveemotions. Then, I give them new instructions.

• T: Now, imagine that the person you care about walks backward and disappears behind a house. Feel the sensation you have when they disappear.

Several students appear more serious, and some even look a bit sadder. When asked how they feel now, the answers are unanimous. The good feeling they had a moment ago has diminished. Some have a neutral feeling, while others feel sad. As I don’t want them to remain unhappy, I provide them with a new intervention.

T: Imagine now that the person you care about returns but is placed slightly to the side, not between me as the lecturer and yourself. This way, you can focus on the person you care about instead of me and the lecture. Some grasp the point and smile.

What’s happening here? Initially, I helped the students connect with a positive feeling (a positive mental element)by allowing them to visualize someone they care about internally. Then, I altered the positive sense by introducing anew internal image where the person they care about disappears behind a house. As a result, a psychological shiftoccurred, leading them to connect with a less positive feeling. Since I want to make the students comfortable, Iprovide them with a new intervention that brings back the person they care about. This means they regain the connection with the positive sense.

Through my interventions, the students have embarked on an emotional journey characterized by several psychological shifts. Such emotional journeys occur continuously in everyday life as individuals sporadically shift their focus from neutral to positive to negative to neutral experiences, and so on, often changing moodswithout fully understanding why. In narrative therapy, we control clients’ psychological shifts by systematicallyconnecting them with experiences associated with positive emotions as a starting point for the change process.

When red represents discomfort

The starting point is that the therapist wants to assess and change the uncomfortable feeling of restlessness the client is experiencing.

• T: The feeling you have now, is it something you sense or something you see?

• It’s both something I sense and something I see. Okay, is there any color associated with it? Yes, it’s red. An intense experience of red can trigger anxiety for some. C: It’s uncomfortable. It’s too intense. T:Imagine that it was possible to fade the intense red to become more pastel-like and lighter. What happens when you achieve that? C: It becomes less intense. It doesn’t hurt as much. T: Now imagine adding new colors that you like or make you feel calm. What color or colors could they be? C: Blue and green. T: What happens when you add blue or green to the image? It becomes cooler. I feel more in control, you know. T: Is that okay? Yes

The client’s reactions indicate that emotional changes have occurred because the intense red feeling associated with discomfort in a specific situation has been replaced by colors the client has a positive connection with, such as blue and green. Changes in the way a client perceptually experiences a crisis often lead to emotional changes.

The client’s reactions indicate that emotional changes have occurred because the intense red feeling associated with discomfort in a specific situation has been replaced by colors the client has a positive connection with, such as blue and green. Changes in the way a client perceptually experiences a crisis often led to emotional changes.

Client reactions are private, but the fact that internal sensory experiences trigger emotions and that emotions canbe altered by changing those inner sensory experiences through treatment is a characteristic of human nature. You often feel a bit happier when you receive a text message with a smiling emoji (although some may feel irritated). You may feel less satisfied if you receive a frowning or thumbs-down emoji in response to a message. The sameapplies to colors. A stored experience perceived as dark elicits a different reaction than if the same experience isassociated with something bright. In narrative therapy, clients transform their internal uncomfortable sensory experiences into more positive ones through the therapist’s interventions.

Psychological transformation and activation of desired qualities

There is a high likelihood that the qualities the client needs to handle a difficult situation have been experienced inthe past. While calmness may be associated with one problem, resilience may be linked to another, and mentalstrength to a third. Additionally, at some point, the client must have experienced a sense of control, self-confidence, assertiveness, pride, decision-making ability, and the capacity to stand up for what is essential. It is also likely that the client could cope with setbacks, even if that ability is not present today. If available in the currentsituation, these qualities would improve psychological well-being. This implies that the client possesses stored psychological material in the form of memories that contain the emotional resources and reactions needed today.

Therefore, the therapist investigates the qualities and psychological material the client requires to manage, reduce,or eliminate their psychological distress. The client is then asked to think of a situation where they possessed thedesired quality and to take note of what they see and feel. The purpose is to connect the client and the rates and emotional reactions they require today.

When the client signals that they have connected with the desired quality, they are instructed to observe themselves from an external perspective in the challenging situation and to notice what happens when theyborrow those desired qualities in that problematic situation.

Once the client can envision themselves handling the uncomfortable situation with these qualities, they are asked to imagine themselves being in that situation and experiencing it from within. Experiencing a problem from within, or associating, means that the client sees the situation and their hands but not their own eyes. If the client now experiences an uncomfortable situation with the desired qualities, it indicates positive changes have occurred. If this experience is still uncomfortable, it signifies that more work needs to be done. Often, clients will require several qualities to navigate a difficult situation. The same procedure is repeated for each desired quality, workingon one quality at a time.

Psychological Transformation through “Hospitalization”

Sometimes clients express difficulty in getting rid of an unpleasant feeling, describing it as a lump in the stomach, chest, or throat, and find that the other methods are insufficient. This indicates that the client is connected to akinesthetic material that anchors their discomfort. Change can be created through a dramatic and fantasticalimagination in such cases. We have several options. Here’s one: First, the therapist checks if the client is open to asomewhat unusual fantasy. In this example, the client has given a positive response.

T: We need to do something drastic here. Imagine the following: You are admitted to the hospital. We havebrought in specialists in this exact type of operation, along with a team of the best doctors and nurses. Youundergo surgery, the unpleasant lump is removed and discarded, and you are beautifully stitched up without leaving any scars. In place of the discomfort, fresh tissue, security, and well-being emerge. You will be taken good care of. And when you wake up from anesthesia, the discomfort is gone. Several positive changes may occur after a successful operation.

Silence. The client works mentally and nods when finished the fantasy.

• T: How do you feel now when everything is working as it should?

• T: How do you feel now? C: Much better. The pain is not as intense anymore. (Sometimes additionaladjustments may be necessary).

What is happening here?

The intervention is in line with the client’s linguistic and emotional logic.

The client’s statement about lumping the stomach describes how they experience their emotions and contact withsomething familiar, namely an unpleasant feeling. One seemingly dramatic but logical for some clients, way to remove a lump in the stomach is through surgery. The purpose of mentioning a “team of

the country’s best doctors” is to instill a sense of security in the client, creating an image and belief that the operation will go well. All clients have a relationship with hospitals and surgeries, and most believe that competentdoctors can remove a lump in the stomach without significant issues, which is subsequently destroyed or discarded. The term “anesthesia” is used to prevent the client from resisting what happens during the operation (in theconsultation) and to enable them to entrust the responsibility to the experts. I have used this intervention with numerous clients. The clients agree: they feel better. They go through a mental journey. Some find it a bit crazy,but it works, and it doesn’t matter if it seems odd. Some report that something remains, and the lump returns, but it is smaller now and less uncomfortable. The client’s reaction indicates that there is more work to be done. Sometimes the client is “readmitted,” and a new, more minor operation is performed. Other times, a milderapproach can be applied. Another intervention involves the client, based on the therapist’s interventions, “seeing” the lump from a distance and then reducing its size, moving it further away, or bolting it to a wall, preventing it from returning. The latter is sometimes necessary since clients often express that the lump or discomfort returns,albeit milder. The psychological change also involves logic. The notion that we bolt a problem removed from thebody to something logically gives the client a sense that the problem cannot return.

In the mental world, anything is possible. Sometimes Velcro is enough. Other times the lump of discomfort needs to dissolve in water or be sent out into space like a projectile. There are as many solutions to remove psychological distress as there are clients. For detailed information, refer to the method “Fantastic Fantasies” in Chapter 13.

Anxiety and Monkfish

Musicians, dancers, and actors – as well as others – can experience intense and paralyzing anxiety that hinderstheir ability to excel in concerts, theater, ballet performances, or other high-pressure situations. Often, the result is that they cannot perform as well as they are capable of due to the pressure of expectations. Performance anxiety can be far more distressing than non-performing artists can imagine. Some musicians are most afraid of the verything they love the most, such as performing. And many ask themselves: Is it worth it?

The anxiety can occur several months before a concert or premiere and is highly visible to friends and loved ones. In their well-intentioned and caring manner, they often remark: “You’re so talented, it will go well. Why are youso anxious? You know what you’re doing. It’s not a big deal. ”

These well-meaning statements can amplify anxiety because they focus the individual’s attention on what they perceive as difficult. The result can be increased pressure. I advise students and colleagues against making these types of comments. “You’re so talented” is rarely a helpful statement when someone is experiencing anxiety. Additionally, the recipient of the statement may feel conflicted. On the one hand, they are plagued by anxiety, doubt, and uncertainty. On the other hand, they may feel foolish for not understanding the fear is unnecessary. The question “Why are you so unsure? ” invites an explanation, but if one is to justify something unpleasant, it mustbe done with something equally or even more unpleasant. The saying “the one who digs in the dirt finds more of it” rings true here. The statement “It’s not a big deal” immediately triggers associations with what is dangerous for susceptible individuals. They relate to the substance and the word “dangerous” rather than “not. ” These statements can lead to an increased connection with psychological distress and further lock the individual’s focus on anxiety-provoking thoughts.

The first goal in this situation is to redirect the client’s focus to something unrelated to discomfort. If I see an anxiety-dominated music student just before a concert, I might say: “Do you like monkfish? ” Few people know what monkfish is besides that it is a type of fish. No one associates anxiety when they hear that statement. And they will shift their focus from the concert to something unrelated to anxiety, resulting in a different feeling. It is notuncommon for them to think I am a little eccentric. But that’s okay. It helps them elevate their mental state and become more confident. In addition, many find something humorous in the situation. It’s difficult to be afraid andlaugh at the same time. At this moment, they are often receptive to an intervention that provides a sense of security. In some cases, they become calmer. And when they step onto the stage immediately afterward, they havea greater sense of control than they did ten minutes ago.

The principle of change in this example is that any shift in focus leads to an emotional change unless the underlying feeling of anxiety is so intense that it overrides the new focus. If this is the case, more robust methods must be employed if the client still experiences anxiety.

When Fog Lies Between the Musician and the Sheet Music

During a lecture on performance preparation, a violinist shared that he could not read the sheet music before anupcoming class where he had to perform.

The student was experiencing anxiety, and he described it as if there was fog between him and the music stand. The statement “fog in front of the sheet music” indicated that the student had an internal visual experience of fogand that the visual element of “fog in front of the sheet music” triggered his anxiety response. There was nothingwrong with the student’s vision; he could see perfectly well.

The logical and simple solution was to remove the fog, which aligns with the MRI tradition principles that emphasize taking the client’s statements at face value and understanding them as expressions of emotionalexperiences. In this case, the client had transformed a feeling of unease when it came to playing into a visualmental-biological element of “fog in front of the sheet music” that encompassed the same feeling of unease.

As a teacher, I asked the student how the fog could disappear, and he correctly responded, “When the sun shines on it, and a cool breeze comes. ” Through specific interventions, we established a mental sun that illuminated the fog. Additionally, in line with the student’s understanding, we introduced a cool breeze. According to his internal logic, the student had no trouble imagining this and suddenly said, “Now the fog is gone. I can see the sheet music. ” The student was very pleased, and later he performed for the class without anxiety, which is a situationthat most students perceive as anxiety-provoking. It is challenging to perform perfectly for critical experts with the same or even more excellent skills.

There was more work to be done, but the dominant immediate feeling of anxiety was triggered by the inability to see the sheet music. The simple solution involved replacing the client’s connection with the visual bio-psychicelements that prevented the student from seeing the sheet music with visual elements that enabled him to see it.

All changes in LBT (Logical and Brief Therapy) are based on the same understanding outlined here. Below, I describe a parallel example with a slightly different perspective.

When everything was just black,

A pianist said she would audition for a job but couldn’t read the sheet music because everything seemed black. She felt that the notes were so close together that she couldn’t distinguish them from each other. Other pianists nodded. The problem seemed to be familiar. Once again, I took the client’s statements literally. What do you dologically when something is so close together that it’s

impossible to separate things? You separate them (see the logical and opposite method, chapter 13). I asked thestudent to imagine the sheet music as a rubber band. Then I attached the rubber band to one wall in the auditoriumand pulled the rubber band, i. e. , the sheet music, to the other wall. Then the student said: “Hey, now there’s too much distance between the notes, so much that I have to turn my head for each new staff line. ” I replied, “Okay, then I’ll move back toward the wall where the sheet music is attached, and you tell me to stop when there’s exactlythe right distance between the notes. ” The student nodded. Approximately 40 centimeters from the wall, thestudent said, “Stop. ” Now there was just the proper distance between the notes for her to have a clear overview and read the music without any problems. If not for laughter, there was undoubtedly much humor in the auditorium.

I said, “Imagine that the notes you’re practicing for the audition look exactly like this. What happens then? ” Thestudent replied, “Then I can read the notes without problems. ” I asked, “Imagine that you can do it; how does it feelnow? ” The student replied, “Totally fine. ” “There’s no problem anymore. ” And at that moment, there were indeedno more problems. The visual experience of not being able to distinguish the notes from each other was the cause ofthe student’s immediate anxiety. When she could see the notes separated from each other, the problem was solved. This means that the problem is solved only for a while. There’s likely more work, but the student completed andmastered the audition. What’s happening here? The same is in the example of “fog in front of the sheet music. ”The student had contact with a visual element that caused anxiety because the staff lines were black. This opticalmodal element of “black” and “too close together,” which led to unease, was then replaced with another visual modal element through an intervention. This new element allowed the student to see the notes separated from each other and thus transparent. What I took away from this experience was that some mental issues are solely a resultof the modal elements that the client has contact with, and not all problems have an underlying or more dramatic cause that needs to be changed. However, there may still be more to do if the goal is expanded to enable thestudent to perform future concerts without anxiety.

Fear of authority

The client had a fear of authority. She felt she was sitting in a corner with a desk in front of her. The boss, a ratherlarge and corpulent man, stood in front of the desk, pointing to the papers in front of her while criticizing the workthat had been done. She felt trapped, without the possibility of getting away, and she experienced anxiety.

I was curious to know if this was solely her perception of the situation or if it was how things were. However, it could have been more critical. I had to relate to the woman’s experience and narrative. Based on the neuroscientific understanding, the woman’s anxiety resulted from contact with visual, kinesthetic, and auditorymental elements associated with unease. These elements needed to be changed to reduce the client’s anxiety towards the boss. Through specific interventions, the woman mentally moved the boss approximately 15 metersfurther away in her inner visual image. We imagined shrinking the boss in fantasy to about 2 centimeters tall and dressing him in plastic lederhosen with reindeer suspenders and a Tyrolean hat with badges. Additionally, weplaced the boss on a table where he dangled his legs. Then I examined the woman’s emotional state when she saw the boss this way. The anxiety had disappeared. Instead, she perceived the boss as harmless, slightly humorous, and somewhat ridiculous.

“But maybe it’s not so favorable for the boss to appear ridiculous? Perhaps it’s okay to have a certain level of respectfor the boss,” said the therapist, to which the woman agreed. Further interventions moved the boss closer butremained about two meters away from the woman’s desk. He had regained his regular attire and nearly his original height. The client expressed that the boss should be smaller than her. She was approximately 165 centimeters tall, so that the boss could be around 160 centimeters. Then something happened. The woman’sperception of the boss changed. Suddenly, he was perceived as an ordinary and friendly man who told her what todo, as bosses should, and he did so with a familiar voice.

The woman’s fear of authority was not solely directed at the boss. She had a fear of authority figures in general. The source of the more general fear of authority stemmed from specific experiences during her childhood and adolescence. We then worked on uncomfortable experiences with her father, which had led to the fear of authority, a fear that had been triggered with full force by her boss. Through my interventions, the psychological or, more precisely, the mental-biological material that anchored the client’s fear of authority was changed and replacedwith psychological material that encompassed ordinary reactions and an intensity that corresponded to the actual severity of the situation.

Suicide Attempt

I was at the cabin when I received a phone call around 2:00 a. m. The client was attempting suicide. She had lefther friends and was standing in a lake with the water reaching her waist. During our conversation, she graduallyemerged from the water and looked back into it. I understood that this happened several times because the sound of the waves diminished and then grew louder. After an hour of conversation, she reached land and walked towardsthe cabin. I was at my cabin by chance, and she lived only a few miles down the valley. We agreed to meet in the village the next day. I then contacted the police and her family.

The following day, I traveled down the valley and gathered the following information: No specific externalcircumstances led to the suicide attempt. The student was with friends but felt mentally unwell; she went outsideand walked through the forest for about forty-five minutes until she reached the lake. The probable cause was thediscontinuation of Sipramil without collaboration with a psychologist or psychiatrist.

The initial conversation occurred at a local café and lasted three hours. She felt fine and had no problems the next day. This continued for a week. The psychological discomfort returned to some extent but with a reduced sense of distress. The client had been prescribed higher doses of Sipramil and Sobril but received no follow-up treatment.

The second conversation, after the vacation

She expressed that she was slightly better than before, not focused on suicide, but still not well. She had given up hope of ever getting better. Current situation: the client is tired and broken down, with minimal self-confidence and a strong sense of guilt. She is marked by resignation and dreads the new academic year. I strongly encourage the client to contact the university’s health services to discuss the situation with a psychologist. I also suggest contacting a psychologist outside of the university if the Student Welfare Organization has limited capacity. Thestudent is not highly motivated. She had gained little benefit from previous sessions with psychologists andpsychiatrists, which she found “controlling. ” I understand that she will not reach out and receive confirmation of it.

She wants to continue our sessions. We start immediately, and the conversation lasts for approximately 90 minutes.

There is no assessment or evaluation of the client’s situation. I explore the client’s experience of psychological discomfort while attempting to recall positive experiences and resourceful situations from the past. Part of her anxiety is related to whether she will handle the academic workload in the upcoming year. I suggest she postponesome exams, but she wants to try it. Afterward, we work on psychological strengthening, elevating the mood, and increasing access to positive resources and energy. It works. The client’s psychological state improves during the conversation, and laughter becomes more prominent.

To ensure that the client does not attempt suicide again, I initially offer two sessions per week. I propose that shecontacts me immediately if anything mentally challenging arises, regardless of the time. She confirms herwillingness to do so. She leaves the office feeling much better than when she arrived.

From my notes after the conversation:

The client’s reactions to the conversation indicate that she benefits from our contact and that it leads to change. I am cautiously optimistic for now. However, the client needs follow-up, and I need help understanding her current psychological state.

Subsequent Conversation

The client returns a couple of days later. She is a different person. She laughs, is joyful, and is fully present. Icheck in on how she is doing. She is doing well, with no problems. I am somewhat amazed and tested the waters, but we no longer have anything to work on. The issues have been resolved, and she hasn’t taken any additionalmedication. She smiles and appears relaxed. I try to delve deeper, but it proves unnecessary. The conversationconcludes after 30 minutes. Before she leaves, I encourage her to reach out immediately if anything resurfaces. She promises to do so. I am still somewhat surprised. She is an entirely different person from when I spoke to her directly after the suicide attempt. I asked her if she would have taken her own life if I hadn’t answered the phone at the cabin. Her simple answer is “Yes. ” She leaves. Perhaps there are lingering issues, but the psychologicaltransformation over a few conversations is almost staggering. I later encounter her multiple times over the years. She greets me kindly, and everything is still going well. When I see her with others, she doesn’t acknowledge me. That is not uncommon. Few want to reveal that they have had contact with someone who works with mental health, even though more than 50 percent of a class may seek help for psychological challenges. One aspect of the treatment is that I employ the method of fantastic fantasies, and we work through humorous, often slightly absurd,and resource-activating mental imagery more extensively than usual.

Conclusion

This chapter provides glimpses into processes that led to emotional transformations. Several of these glimpses are drawn from longer treatments. These processes have in common that verbal interventions from the therapistresulted in new positive narratives that were characterized by greater psychological well-being and mastery than those that perpetuated the mental distress.

Many of the glimpses contain spectacular fantasies beyond what is possible to experience in the real world. The tendency is that those mentally stunning elements prepare for psychological change. These examples alsoillustrate how easily one can achieve psychological change in therapy and the significance of imagination and language in altering emotions and mental distress. Furthermore, the glimpses demonstrate how the mere use ofwords can activate clients’ own inner resources and contribute to their healing process. mental resources and utilize them to alleviate mental pain.