Finding the Elephant in the Room: An AEDP Journey to the Heart of Loss, Presence, and Self
Marc Cecil, Ph.D.
Abstract. Starting with the discovery of an elephant figurine left behind by a dear patient, this paper shares the personal journey of transformation and healing of an AEDP therapist and his patients. While facing a painful loss, the author finds the light of the elephant in the room and discovers the essence of AEDP. Following the quiet strength of the elephant, a metaphorical guide to therapeutic presence and healing, the therapist connects to the map of AEDP and makes room for the pain and joy in his patients as well as in himself. By highlighting the glimmers of transformation, he enables a natural healing and growth process to unfold. Bearing witness to the reality of death and dying, the therapist helps others see the obvious but painful truth in their lives, and also finds his own. With the author’s growing sense of presence and connection to himself and others, his patients find their self-compassion, courage, and wisdom, along with a new sense of wholeness in being alive. Parallel to a new balance developing inside his patients, the therapist finds some of the missing pieces of his own story and the treasures inside himself and others in his life. This discovery reinforces an appreciation of our humanness and unique gifts, many of which are accessible, but others harder to find. Although one journey may end, a new one begins, with a deeper connection to our presence as therapists and people, along with our capacity for transformation and healing. The author holds the hope for other therapists to find the timeless light of loving-kindness and presence within and between our hearts, emboldening new hope of healing loss and aloneness in our lives and around the world.
1 I extend heartfelt thanks to SueAnne Piliero, who has been a bright star guiding me on my AEDP journey, shaping my understanding of this model, while helping me find the light inside myself to do this work with all my heart. I am indebted to Ron Frederick, whose steady encouragement and clarity have been invaluable in helping this light grow and be sustained. I also extend a special thanks to my wife and son for their editorial input and unwavering support. Finally, I am grateful to my courageous patients who have been my best teachers. Patients referred to in this paper have given me their written informed consent for publication of pertinent case material. I have disguised their identity.
Marc Cecil, Ph.D. is a certified AEDP therapist and supervisor. Address correspondence to: Marc Cecil, Ph.D, 65 North Main Street, Rutland, Vermont 05701. Email: mcecilvt@aol.com.
The wound is the place where the light enters you.
~Rumi
A magical gift
A while back, one of my dear psychotherapy patients, Ida, suddenly announced she was moving out of the area and was unsure when she would return. Without my knowledge, Ida left a small figurine of an elephant in my office. The elephant appeared before my eyes one day, as if by magic.
Having been a psychotherapist for more than half of my life, I look forward to the magic that comes out of the healing with people who have endured unimaginable suffering in their lives. There was always plenty of magic with Ida, something we both learned to expect with every breakthrough in her healing. She loved my fondness for elephants, which for me are inspirational as they are known for their capacity for emotional connection, consciousness, and strength, despite the hardships they have suffered. The elephant helped her connect with her strength in the same way they helped connect me to mine.
I remember the day Ida shared her first elephant with me, a much larger one. She arrived for her session a little late that day, but was quite excited, bearing a bronze-like elephant figurine with a small heart-shaped pillow on top. She had just bought it at a yard sale for a dollar and lit up with joy when I displayed it in a prominent place on my mantel. No words were necessary when we looked at the elephant and felt the connection between us, and the pride in the work we were doing together.
Several months before her leaving, I learned about her diagnosis, what her doctors suspected was early Alzheimer’s. It was somewhat ironic that this unforgiving disease would likely rob her of her memory and sense of self she had worked so hard to build over the years. My heart sank. I have a sense of myself like a father in some ways, helping Ida navigate the many storms and losses in her life, but knowing that I can’t always protect her from everything she will face. Through the tears in my eyes, I still feel my loss even now as I felt it back then. Her leaving hits me deep in my heart, similar to the loss of others who have been special in my life, sending pain through the core of who I am and that which I had hoped to be, like losing a part of myself.
Although loss is always around us, it is often difficult to acknowledge its presence. My relationship with loss takes me back to some of my earliest memories, both in and out of the office. Every time I experience it, there is something that changes inside of me. My internal story transforms in some way as I try to make meaning out of it. Sometimes it fits into an old story. Other times, it makes me question whether my story had been correct, driving me to make a revision. 1 With each change, I go to a deeper place within myself, remembering old stories I had forgotten, going beyond their content to a place where I can see more clearly who I was, who I am now, and who I am becoming.
1 Editor’s Note. The author is describing the narrative we write of our lives, and how
successful psychotherapy can help us write a more coherent narrative. It is interesting to speculate, as the author does, that the “coherent narrative” may never be complete and always up for revision.
With Ida’s leaving, I feel much pain, but also know that if I can allow myself to ride the waves of the emotions arising within me, I will be able to find more strength inside myself, as well as in my patients and others in my life. It makes me look at my journey in a new way as I look at myself and the people I have met in my work. I appreciate the many gifts that have been left behind, gifts I can’t always see but know are there as I feel them in my heart, gifts that reveal our humanness and authenticity, the unique fingerprint of our heart.
I feel honored and privileged to have gotten to know so many courageous people on this journey, who, in the process of helping them, have helped me see myself and to rewrite my story from a place of strength. Although not an easy process, and one that has taken much time to cultivate, I am grateful when it happens as it helps me find the lost parts of myself, and to bring them back home again. When I allow myself to be vulnerable and feel my pain, it helps me see my specialness so I can do this work in a way that is consistent with who I am and my truth.
My intention in writing this paper is to help other therapists become more aware of these gifts, both within their patients and inside themselves. In doing so, I will share my journey of self-discovery and growth in becoming an AEDP therapist, as the use of this model not only helps our patients change but us as well. I will describe how the change inside myself enables me to be more present with my patients as a recursive and parallel process unfolds inside and between us.
The gift of AEDP
Along with many different models of therapy I have learned over the years, my work with Accelerated Experiential Dynamic Psychotherapy (AEDP) has been a gift that has helped me find a new path on a journey where I can connect to myself and others with all of my humanness and heart. AEDP is an experiential and integrative, attachment-focused, and neuroscience-informed model of psychotherapy that has grown out of the groundbreaking work of Diana Fosha (2000). Her approach enables us to see the truth in this rather magical but real phenomenon called transformance, the innate self-righting capacity and resilience within all of us that fosters healing and growth.
AEDP helps me see my patients as not just a disorder or set of symptoms I need to fix, but rather as human beings trying to adapt and survive, where the therapy relationship serves as a safe and rich container with the necessary ingredients for healing and growth. Moreover, AEDP gives us a platform for understanding and intervening in the process of therapeutic transformation and healing.
Following the map of AEDP (Fosha, 2009) enables me to form an internal map where I can connect to my healing capacity and goodness, find my core self, and trust the light in my heart to help others find their own. Although the map is nonlinear, ongoing training and supervision help me develop my ability to know where I am on this journey. In addition to the felt sense in my body (Gendlin, 1982), the ongoing metaprocessing of all aspects of the therapeutic experience confirms moment-to-moment whether we are heading in the right direction, and allows us to adjust our course if needed, for further transformation to unfold.
My intention in psychotherapy is to facilitate a corrective emotional experience (Alexander & French, 1946) for the patient, by bringing myself more deeply into the therapy relationship. I view the patient’s symptoms as a reflection of a system that is out of balance, both internally and externally. This imbalance may have been a way of adapting to and surviving a disruption in early attachment and past trauma. But it is more noticeable now as the demands in life increase, and it becomes apparent that our old ways of reacting are leading to more stress and pain. AEDP is like a healing dance between my patient and me: The steps go back and forth, each of us leading and following. When I allow myself to get out of my head and not assume that the dance should go in a particular direction, it seems to go the best. Because I am with them and they know and feel that, the patient can find the courage to ride the waves of their emotions, eventually, calming down as they know I am with them and can help them get back to shore.
When I connect to the path of AEDP, there is a healing force moving in both directions, allowing me to take in my patient’s specialness despite the pain I feel in my heart for both of us. In some ways, I am a witness to human suffering, my own as well as my patients, while at the same time, a treasure hunter for the gifts inside all of us. In this capacity, I allow myself to feel the pain and let it in the room, helping the patient see that it can be part of their learning and healing. As the patient connects to the light of compassion in my heart, they can begin to find it within themselves, enabling them to feel the warmth inside they have needed to heal and grow.
Like a beautiful flower opening up after a rainstorm, the patient feels more balanced and alive inside as parts of themselves come together and blossom into the unique core self that has always been there (Fosha, 2013; Panksepp & Northoff, 2009). The core self is completely perfect in its humanness and foreshadows the self we are capable of becoming, our optimal future self (Napier, 1990), which is available to guide us now. As the patient stretches their sense of self, we focus on the change inside, as the old beliefs and rules from the past sit sideby-side with the new ones that are emerging and make more sense now (Ecker, Hulley, & Ticic, 2014).
In this moment of noticing the difference between then and now, there is a corrective emotional experience, a merging of ourselves across time where we move out of the stuckness of the past, and the future becomes our present, a new now. As we take in the wonder of what we are creating together and words emerge from our experience, the patient begins to feel whole again, as a new internal working model (Bowlby, 1969) consolidates their sense of self, providing an updated template for transformation and healing, helping sustain the change over time.
Through this process, I feel infused with new energy and generosity of spirit in my work and life, growing stronger every day, enriched by the ever-expanding and loving community around me. It helps me appreciate the sacredness of this healing work, and that it is just as much an art and spiritual journey as it is a science (Deikman,1983; Schore, 2012).
The elephant’s light
Elephants are an inspiration to many humans as they are known for their capacity for emotional connection and consciousness (Bradshaw, 2009; Kieper, 2013), a characteristic neuroscience has found present in several other animal species that supports their survival (Panksepp, 2011). Moreover, neuroethology research has also revealed that disrupted attachment and relational trauma have a similar detrimental effect on elephant biology, behavior, and culture as it does on humans (Schore & Bradshaw, 2012).
In considering the implications of this research, I feel the pain of all those who have suffered as a result of our cruelty and inhumanity toward one another, including the elephant, a pain that is always in the room, which we cannot hide so easily. The image of the elephant, for me, is a powerful symbol of strength and courage that can help guide us through the pain. I think of the elephant as connecting us to our life-enhancing emotions, the negative often sitting side-by-side with the positive, but all needed to help us heal and grow.
As I reflect on the pain and loss that is always happening in our lives, and how it relates to transformation and healing in the therapy process, I ponder the familiar metaphor “the elephant in the room.” The everyday use of this expression renders the elephant as something we aren’t talking about or able to see about ourselves even though it might be right in front of us and appear obvious to others. There are several topics in our culture that have a painful ring of truth, which even therapists and those in the helping professions often struggle with, particularly death and dying.
When I think about the elephant in the room as I work, I am aware that what we need most in our healing is what we often find the most difficult to see or hold onto. Although our truth can be painful to see, I think of the elephant as helping us find the parts of ourselves we have been hiding and, in the process, we become whole again. I try to look for the light of the elephant and highlight the moments where the truth begins to shine. The elephant, along with the map of AEDP, is my guiding light to this truth, which help me to not only identify our pain, but also find the humanness and treasures inside us.
The strength of the elephant is within all of us if we can find a way to access it, and then share it with others. The elephant lets us know when there is a pain inside we are not facing, and in some way, helps us connect to it in our heart. When the pain is too much, we try to hide from the elephant inside our heart, but the pain can often be felt in other parts of our body as well (Van der Kolk, 2014). Although it can get very dark at times, it seems impossible to hide completely, as we are trying to hide from ourselves.
The ways we try to hide eventually lead to us disconnecting further from our emotions. Over time, the holes inside our heart get bigger, and new ones form, as our anxiety evolves into fear, guilt turns into shame, anger changes into hatred and hostility, and sadness becomes deep loss and aloneness. The elephant then has a larger presence in the room, becoming even harder to avoid. Although the elephant can help us find the courage to see the pain of our younger self and its hurt parts, it is important for the therapist to proceed slowly and patiently, building a sense of safety inside the patient as they take in the safety within our relationship. In the process, patients develop a clearer separation and differentiation between the present-day adult self and the hurt parts. Like a loving parent, the observing self (Deikman, 1983) is there to hold the younger parts when needed, which enables their transformation and healing.
Through our fierce love (Piliero, 2013, 2018), we can give our patients who are lost and overwhelmed the careful listening and loving-kindness they have always deserved. They can begin to look through our eyes as we see them, and then their own, feeling the safety around them and the strength in the hurt parts they couldn’t see before, connecting through compassion for themselves. Although it can be painful as the patient mourns for the self they had lost and are starting to find, they are then able to understand how these parts helped them to survive. As the patient begins to appreciate these lost parts, new hope and light arise as the patient sees how these parts can help them thrive in present-day life and guide the path toward a brighter future.
In presence
I welcome the elephants in the room and relish the chance to work with them, as they help me create a healing container where I can find the holes of pain inside, while also connecting to my strength. AEDP has taught me to slow my work down, to integrate top-down and bottomup learning, and to heal and grow from the inside out. As I connect to my intuition in an embodied way (Marks-Tarlow, 2012), I hold the pain of my patients with my humanness, colored by the unconditional acceptance and loving-kindness in my heart, while knowing that we are doing this work together, and are not alone in this process.
In AEDP, the primary intervention is the self of the therapist (Piliero, 2015). Having this connection to ourselves allows us to feel more attuned and connected with our patients as a True Other (Fosha, 2005). In AEDP, this phenomenon is called therapeutic presence (Fosha, 2000), a major component of many diverse therapy modalities (Geller, 2012). Fosha describes therapeutic presence as “being inside the patient’s affective world as an other, and the patient’s feeling it and knowing it. In the presence of such a presence, the patient’s world unfolds. This presence – equal parts knowing and wanting to know, being there and wanting to be there – makes it possible to talk to someone else about parts of themselves that are painful and hidden and frightened and dangerous and disorganizing” (Fosha, 2000, p. 29).
Over the years, I have learned to tap into my presence, which I call “quiet strength.” I embody this concept as a place of compassion, courage, and wisdom within myself where I can hold the patient with my heart, making room for the pain alongside our goodness and love, attuned to what I am receiving from them, just as much as what they are receiving from me. I believe when we slow things down in our work and focus moment-to-moment, words are often not needed. Instead, we open up space in our heart for the pain to come forward, be acknowledged and held with compassion and loving-kindness. In the quietness and vulnerability of this space, others receive our humanness and holding, often communicated more through the gentleness in our body and loving-kindness than the content of our words.
In this place, the focus is not on fixing the problem, but rather, our emotional integrity and authenticity, where we make room for the quiet space within and between us, a space where we can give and receive love unconditionally. From this place of being, we can work at our own growing edge as a parallel process is happening in our patients. With a feeling of lightness and groundedness inside, we stay out of our own agenda, and trust the process to unfold naturally in just the right way. The pieces of the puzzle we call the self can then come together, making the issue clearer, and revealing where to focus our efforts. We can then meet the patient in their place of pain, giving them the holding they need, while at the same time, showing them that we see their healing capacity and value as a human being.
We all have a special way of sharing our presence, unique to each person, situation, and relationship. It comes out through the warmth of our face and the delight of our smile, the leaning forward in our chair, the nodding of our head, the tone and soothing sureness of our voice, the softness of our sounds of care and compassion, or perhaps the gaze or tears in our eyes.
In these sweet and precious moments, the rhythm and pacing of the work allow the waves to calm and flow into a natural pause, filling the space with silence, eventually revealing a portal where the lights of dual awareness arise in our consciousness. The quiet stillness inside and between us is both a reminder of our safety and our pain, and how healing can arise out of pain, separating the past from the present, enabling the patient to see a brighter and more hopeful future.
In the present moment, time stops yet expands, opening up our hearts to both love and pain, allowing the love to hold the pain, helping to undo our loss and aloneness, and to find ourselves again. In this sacred space, helping others is not only an act of loving-kindness to them but to us as well. When we dance with the elephant in this healing way, we stretch on the inside and change our relationship with ourselves as we receive the holding and compassion of others, and feel changed by our relationship with them. It is a place where compassion can grow, and the light within us can shine, even if just a small glimmer. In this place, I can make room for the parts I need to listen to, whether my own or those of my patient. Being aware of the change happening within and between us, I look for the glimmers, the moments of transformation where our striving for attachment and balance is active, and the hope of future healing is possible.
As I find the glimmer within myself or see it lighting up in others, I ask my patients to check inside to see what they are noticing in the moment, enabling them to find their elephant, with its quiet strength. A magical dance begins to unfold naturally, both between and within us, healing our hearts with a beautiful song, knowing we are not alone, and that we are accepted and loved unconditionally.
A painful truth
As I sit with Mamie, a sweet, grandmotherly woman in her 80s, I see in her eyes a profound aloneness and fear, the kind I saw a long time ago when she told me about the many years of emotional abuse in her loveless marriage, and not wanting to live any longer. Today, she shares with me that her cancer has spread into her bones, and she is fearing the worst. She tells me that she has not slept much and that it feels like her head has been spinning all day, going from the darkness of wanting to die to the joy of wanting to live, the latter, which she had finally found since her husband’s death.
With tears in her eyes, and the water welling up in my own, I make room for the pain and hold her with my heart, listening to what I am feeling inside, instead of just the words that linger in my ears. And after a while, as the waters begin to calm, I gently inquire, “What is it like for you to share this with me?” Although years ago she may have been surprised by this meta-processing inquiry (Fosha, 2000), and not known what it meant, now she welcomes it as an invitation to share herself in a way that she couldn’t do most of her life and to receive my presence and holding as her therapist. There is a long pause, so I repeat the question, knowing that her hearing can sometimes fail her. She briefly nods as she meets my eyes in the quietness of our sacred space.
In the stillness of the moment, I continue to hold her with the warmth of my smile and my eyes, inviting her in with my head slightly tilted to the right. Finally, our eyes meet again. She tells me that she feels a calming relief as she receives my kindness and compassion. I notice my breathing slowing down as I make space for the strength of my adult self, knowing that the child in both of us feels some comfort in my presence, and is not alone.
As I reflect on this moment, I appreciate how pain and joy can often come in the same breath, the hurt child inside not knowing the difference. But when the child receives the holding of the secure adult, they feel the difference, knowing that someone believes in them and that their presence makes a difference. In this moment, Mamie feels an obvious truth arising out of her pain, the truth that although cancer may eventually take her body, it doesn’t have to take away the connection with herself that this disease and other losses in her life have tried to strip away. She recognizes that she doesn’t have to live in fear and will work with her doctors to figure out the best course of treatment. Mamie begins to see that in spite of the obstacles in front of her, there is still a light to move toward inside herself, letting her know that healing is possible, and that she is not alone on this journey. I feel the light glow more brightly in my heart, as well.
Bearing witness
Although a challenging process for those who have been through great pain in their lives and have learned to be wary of closeness, the healing can start through slow and careful staying in the moment with the internal emotional experience, while at the same time being present with the holding and quiet strength of the other. With each glimmer of internal feeling and accepting the other’s external holding, patients can then begin to feel the holding and compassion for themselves as they shine their own warm, loving light on the pain inside. It is empowering to witness the transformation and healing that is possible as patients open up to the core of themselves and the strength they find inside. The strength has always been there, but for many, it can be difficult to access. It hurts to notice the pain, but there is also great relief.
Past events or memories can then come to the surface, either conscious or unconsciously stored in our bodies, that we associate with these disconnected parts and the loss of self. Some of these parts may be obvious where something terrible happened to ourselves or someone close to us. Others may not have been so obvious at the time, as it was “just the way things were in our family,” or within a particular relationship. Through therapy, these events can take on new meaning: It becomes clearer that we needed something we did not get, which left a sense of aloneness and holes in our heart, causing us to hide our pain in silence the best we could.
In the process, the parts of us that we needed to hide begin to come out of the holes, finding life again. The holes close up and transform, no longer feeding on the pain and shame, as the parts see the strength that was hiding and blend with the strength that was always there. With the help of a True Other (Fosha, 2005), holding us with their presence, a corrective emotional experience (Alexander & French, 1946) can occur, undoing some of the loss and aloneness. The strands of our internal beliefs and truths can then get untangled, either disconnected or reconnected in the right way. The new strands of the truths that are arising begin to weave the holes together, becoming an even stronger part of our inner fabric, like a beautiful tapestry illustrating the story of who we are and have always been.
When I think about my patient, Debbie, a lovely and gentle woman in midlife, I cry inside when I sense the loss she is feeling around the death of her son, the deepest pain a parent can feel. I am aware of my pain and fear as she shares what she is going through in her life now and in the past. I slow down and comfort myself inside as her tears flow, her crying turns to wails of pain, and she lowers her face into her hands, covering her eyes to hide from the shame inside.
Although fearful of this dark place, I find the courage to welcome her tears and hold them with her, so she won’t have to be alone in her pain, and I won’t have to be alone with my own. I don’t say a lot of words, only a few utterances of comfort. I wait quietly, feeling my presence and the love in my heart, staying with her the best I can, in what seems like a bottomless pit, until she can feel my holding, and begin to allow her elephant of strength to guide her out of the hole inside.
I hold Debbie with my loving-kindness, bearing witness to her pain, as we ride the waves of her profound loss and sadness together. I feel my quiet strength as I welcome her tears, and I have the faith that she will be able to ride out the storm and find her strength again. Although more storms are in the forecast, I feel grateful that she knows I am with her now, and that she can finally feel some relief and healing. As she raises her head and finds the kindness in my eyes, Debbie shares with me that she feels her son’s strength, and it is helping her to find her own. In my heart, I hold the hope – that a seed of self-compassion is starting to grow within her, as I feel it within myself.
As Debbie tunes into her son’s strength, she begins to see that the pain of his loss is starting to back off some even though it is still in the room. She recognizes that she can honor her son by sharing what she is learning with others who may be dealing with loss, helping to stop this painful cycle in both her life and others. Feeling my own tears and the magic in this transformational moment, I am aware of Debbie’s courage and strength sitting alongside the deep shame that she didn’t do enough to help her son, or her brother whom she tragically lost many years earlier when she was a child. But, in the moment, she remembers the special times she had with her son over the years, the love and joy flowing both ways, although the loss and sadness is still present. Debbie realizes her own obvious truth that she can still hold her son in her heart, honoring his strength and love, as well as her own, now celebrating the value and beauty of life that can accompany the pain of the loss.
I am mindful that when we can accompany our patients to these dark places, it helps us to listen to our own pain and to shine a light of compassion onto ourselves. Even when feelings of shame, failure or badness come alongside, we can balance the pain with the joy, knowing now that we can connect to the inner elephant of strength and find our way back home.
In the arms of a stranger
When I can be present with my inner elephant and quiet strength, I have the understanding that we all have the capacity to find our own. I hold the hope, like the beam of a lighthouse shining through the clouds, guiding our way home in a storm, helping us find the courage to feel again and heal. With this hope, I envision the elephant leading all the lost parts of ourselves out of the fog, meeting up with the core self where the adult feels their strength, knows their truth, and sees the path ahead more clearly.
We can then feel greater trust in ourselves, having the confidence to let go of the burdens we have carried and deal with the challenges we are facing, as well as those we have yet to meet. We can feel the holding by our adult self in addition to the holding and loving-kindness of others who care about us. With a connection to our core self, represented by the image of the future self we are capable of becoming, we can ride the waves that come with the storms and find the light of joy again when they pass. Although we may realize it is up to us to face the challenges ahead, we can now do so with the knowledge inside that we are loved and are not alone.
When I think of Will, a gentle, soft-spoken man in his early sixties, I connect to what I have learned from him over the years. I think of how our patients trust us to hold them, and how in turn, they begin to trust themselves. As we begin our work together one day, I see in Will’s face and body a sense of tension and defeat we both know so well. He shares that he is dealing with the loss of a patient he works with as a home health worker who took his own life just a few days earlier. It is hitting him hard, along with the Rolodex of losses he had experienced throughout his life, as well as his times of darkness when he questioned whether life was worth living. We work slowly, giving him a lot of space, deliberately bringing him into his body at every chance, as he has learned over the years to hide from the pain that has been so much a part of his life.
Will then remembers the loss of a man, a stranger, who died in his arms when he was first starting his career as a nurse more than 30 years ago. Then, as if the two events happened simultaneously, he goes to the memory of losing his father when he was only eight years old, feeling so alone himself, as his father, during his final breaths of life, was also being held in the arms of a stranger. Now, remembering the avalanche of traumatic events in his life that followed, the disconnection from himself and a lifetime of victimization, and then, self-abuse coming from the shame he held inside.
Tuning into my presence in the moment, I feel the pain this man has carried alone, and, although I also feel the pain of my aloneness, it helps me to know more about what he needs and to make room for his pain. I hold him tightly in my arms in my mind as he connects to the child inside who has been stuck in the hole of his deep aloneness. He allows himself to stay with his pain as we ride the waves together. Eventually as the waves calm, he feels the separation between his adult and child selves. Then, like the sun shining through the clouds after a storm, he starts to connect to the joy of his childhood and the love of his parents whom he lost many years ago. As he starts to remember more, Will gets closer to his own child, holding him in his pain, while at the same time, taking in my holding of his adult self, feeling the joy in the moment, knowing now that the love he felt was real.
In a way, he is getting to know himself again, the young child that had been lost who has been trying to find his way back home. We stay with that feeling of connection and the love toward himself, the child, that had been missing for so many years. Giving him a lot of space and lingering in the moment, Will starts to feel like the child is finally back home again, now in the arms of his secure adult self who is at his side, a stranger in some ways that his child always knew was there, but didn’t know how to find. He is aware of his father’s presence now as well, and Will is no longer afraid of losing him if he allows himself to feel and grieve, which he was fearful of doing for so many years. I am right there with him, celebrating his joy as he feels my pride alongside his own, knowing now that he can deal with the loss in his life in a different way, the fear no longer dominating his thoughts, but yet, feeling much more protected inside.
I see the calmness and warmth flow through his body, like his sense of self arising from a deep sleep, knowing now the obvious truth that he deserves to be loved. Although he isn’t emoting outwardly with tears, the transformation is no less significant. He is integrating himself now, coming out of the past so he can meet his present-day self, and, in the process, feeling less alone. Will realizes that even though his father is no longer physically present, he is still very much alive in his heart. In the process, he feels more of his own wholeness and presence. He now sees that what he has been through has made him into the person he is today, and what others see and love about him.
As I feel the courage and wisdom of this extraordinary man, I imagine the journey we are all on and how easy it is to get lost when others leave us. There is the recognition that when we can feel compassion for ourselves, the light inside can begin to shine again, helping us find our way back home. As we touch the core of ourselves that has always been there, we recognize our value inside, a big part of our quiet strength and presence. We now know we can trust what we feel, and it is our truth. We now understand that we are whole and alive, and can live again, even when those close to us have passed, and the time ahead is much less than the time behind us.
A grateful breath
As I rest in the comfort of my bed, I breathe through my CPAP, a cumbersome but life- saving machine that delivers a steady flow of air for those of us with sleep apnea, a disorder where a person stops breathing several times while trying to sleep. As I breathe in the air flowing through the hose hanging down from my nose, I feel grateful for being able to sleep more restfully and to be alive. I imagine that I am the elephant before I drift off to sleep. I feel happy that I am giving my elephant a chance to rest on this journey, replenishing the compassion for myself so I can be present for my patients and others in my life.
I thank the elephant for being with me on this journey and pray we can continue to work together. I know that I don’t have to hide from the elephant, and it is there to help me find the compassion to hold my pain, as well as that of others. It is important for me to feel this pain, along with the hope and joy, as it enables me to do my work in a way that honors my truth and purpose. I feel good knowing that I can have the elephant at my side and share him with my patients so they can find their own, allowing us to grow and transform together.
As I feel this transformation, I am aware that there is still an elephant in the room I am reluctant to see. I look a little closer, and I see my mother coming out of the shadows, along with some of the others I have lost over the years. Although I want to feel happy about this reunion of sorts, I feel more anxious and fearful instead. I realize in the moment that the message I am receiving is something I have known for a long time, but it is hard for me to see. It is a fear of death—my mortality and the mortality of others. It is a fear I faced with my mother over and over again when I was growing up. It is a fear I face with my patients now when they deal with their losses and the loss of themselves. It is a fear I face as my hair turns the grayness of an elephant, and my legs no longer carry me with the swiftness of my youth.
I tried so hard to help my mother because I didn’t want to lose her and be alone. I felt my mother’s pain as if it were my own. I allow the tears of my pain to flow as I remember her in later years lying comatose in a hospital bed, not being able to help her. That little boy is present now as I speak to him from my heart as his future self, with my mother listening, reassuring him that he did the best he could, and it wasn’t his responsibility to save her. I tell him that he grew up to be a kind and humble man and cannot save everyone, as many are helping now and are working together I can see him looking at me with love in his eyes, as I feel his strength then and my own now.
I feel my mother’s presence as she hugs my little-boy self and my adult self and tells us that she is at peace and is watching over us, along with the others I have lost through the years. I realize I don’t have to fear death and can accept it as part of life. I take a grateful breath, knowing that if I die before I awake, it does not mean my work will stop. I recognize my obvious truth that it will just be another beginning, and what I give to others will live on in their hearts, and in the hearts of all those they touch, ensuring that neither they nor I will ever be forgotten and be alone. Moreover, I know now that I can help people who are living with pain and suffering to find a way to live again, and to neither fear death, or see it as the only way to relieve their pain.
When I can find my quiet strength and hold someone in a heartfelt and loving way, I try to find a part of myself which guides me in giving my patients and others in my life what they needed that they never had, or was not enough. I remember my child within, and together, we help them hold their own, enabling them to find meaning in their life again, while helping me to know my own.
Ida’s spot
At this moment, I feel a chill on the back of my neck and remember another Ida in my life, my first one. This Ida is a very special woman who was like a second mother to me. She was much more than the help my father hired to do the chores my mother didn’t have the strength to do, and would stay with my brother and me when my parents were away. Like an angel in our lives, Ida gave my mother the friendship and counsel she needed. At night when she tucked me in, she showed me how to share my gratefulness and prayers for others, yet always giving me the love and protection I needed, and I never felt alone.
And then, one day, my heart felt heavy, and I was alone. Ida wasn’t there anymore, and I didn’t know why. I remember her having to work full-time for another family and needing the time to take care of her own, as my brother and I were more self-sufficient by then, and supposedly didn’t need her anymore. It bothered me that Ida never said goodbye. I didn’t feel like I was getting the whole story, and I felt the loss and aloneness without her presence. I was angry and thought that my parents did not care about my feelings, even though I know now they were probably hiding and protecting their own. My world was not the same anymore, suddenly changing my sense of safety and trust inside, once again driving me to revise my story and hide my feelings, as I had learned earlier in my life.
Over the years, I felt the pain of Ida’s leaving, and buried her loss deep in my heart, not wanting to feel it. I can still sense her special kiss on the back of my neck, a place she never wanted me to forget, which she called “Ida’s spot.” As I feel the warmth of my hand on this spot, I remember Ida’s kiss and the sweet smell of the Juicy Fruit gum she often chewed. I hear her soft words of reassurance, and I know that I have never forgotten her love and care, even though I had tried to hide it over the years so I could protect it – and protect myself. Now I can bring it out into the light as I hold that little boy and tell him with compassion and warmth that his feelings are important, that he always deserved to be loved, and is loved now.
In this moment with myself, I feel Ida’s magic and can feel the pain in this little boy beginning to dissipate. I realize the obvious truth that my feelings are important, and it is safe to express them. I know now that when you love someone and feel them in your heart, they will always be with you in some way. Even when they leave us, we never forget the truth about what this person meant to us or what we meant to them, a truth that is often too painful to see or feel when suddenly faced with the reality of our loss and aloneness.
As I feel Ida’s kiss, I hear her loving voice telling my mother and me, with my child self in my arms, that I am safe now and can trust myself. I feel my goodness and know that she is with my parents and brother, and others that I have lost, but is still there for me. I know now that Ida is always with me in some way as I face new challenges in my life and celebrate my successes. I now accept Ida’s leaving, somehow knowing that people come into and leave our lives for a reason.
Conclusion: A work of hearts
As the sun rises to a new day, I thank the elephant for shining the light on my pain, which helped me to find my first Ida, my surrogate mother, and to find myself again. When I make room for the loss, I can feel the aloneness. But if I think about what my inner child needs, and the love I have received from many people in my life, I now know that I have the strength inside for myself and for those who can feel my holding in their heart. I accept loss as part of life and no longer have to fight against it or to deny its existence to feel safe, as doing so stops me from living. I accept myself and live each day rather than worrying about dying, whether it is me, a patient, or others in my life.
I now realize that my child-self who had to hide his voice to avoid the pain of loss is starting to find his voice again in the strong adult he has become. I can see the obvious truth that I am not alone any longer in dealing with loss. Now, I can be there for myself in a different way by making space for the pain, while at the same time, feeling the closeness of those I have lost, but still allowing others to be there for me. In this place, I can separate my caring from the loss and don’t have to feel responsible for fixing the pain of others. I can be there for all those I touch with an open heart, helping them see that feeling the pain in their life can also help them remember their joy, and, in the long run, to remember who they are at their core, and that those they have lost, still live in their heart.
Finding the elephant in the room helps us access the truth inside ourselves and those we touch, letting them know that we are holding the hope, even when they cannot see it themselves. The elephant is a reminder that we already have everything inside that we need, and it has always been there, and will be in the future. When we find the elephant, we can see ourselves more clearly, helping us recognize our value and uniqueness, being alive and present in a way we could not feel before. But to do so, we need to accept that the pain is also present in ourselves as well as in our patients, enabling the light of transformation to shine, and the wounds to heal inside both of us.
I hope that my journey will be a reminder of the transformation happening within you, dear reader, as your patients change, and how this awareness is an integral part of your growth as an AEDP therapist and human being, as well as what makes this approach and the work you do so special. Let this work of hearts be a magical elixir helping you find the courage to heal, allowing yourself to look at old stories you have hidden or forgotten. It will help you revise your story where the shame of any secrets will come out of the darkness where it grows, and into the light where the wound can shrink and heal. Let this new place enable you to find yourself again, awakening the value and meaning of your life, helping to break the cycle of trauma, knowing that the loss will always be in our life, but the trauma doesn’t have to accompany it.
Let the elephant remind us that if we lead with and follow our heart, it will take us to a timeless place inside where the future meets the past, allowing us to see the truth now of who we have always been. In this space, we will not only change ourselves but can live in a way that is right for us. As we travel down this path, we will uncover even more treasures, finding at last, the obvious truth that we can make a difference, yet knowing we already have.
References
Alexander, F. & French, T. M., et al. (1946). Psychoanalytic therapy: Principles and application. Ronald Press.
Bowlby, J. (1969). Attachment and loss. Vol. 1. Attachment. Basic Books.
Bradshaw, G. A. (2009). Elephants on the edge: What elephants teach us about humanity. Yale University Press.
Deikman, A. J. (1983). The observing self: Mysticism and psychotherapy. Beacon Press.
Ecker, B., Hulley, L., & Ticic, R. (2014). Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation. Routledge.
Fosha, D. (2000). The transforming power of affect: A model for accelerated change. Basic Books.
Fosha, D. (2005). Emotion, true self, true other, core state: Toward a clinical theory of affective change process. Psychoanalytic Review, 92, 513-551.
Fosha, D. (2009). Emotion and recognition at work: Energy, vitality, pleasure, truth, desire & the emergent phenomenology of transformational experience. In D. Fosha, D. Siegel, D. & M. F. Solomon (Eds.), The healing power of emotion: Affective neuroscience, development & clinical practice (pp.172-203). Norton.
Fosha, D (2013). A heaven in a wild flower: Self, dissociation, and treatment in the context of the neurobiological core self. Psychoanalytic Inquiry. 33 (5), 496-523.
Geller, S. M., & Greenberg, L. S. (2012). Therapeutic presence: A mindful approach to effective Therapy. American Psychological Association.
Gendlin, E. T. (1982). Focusing (2nd Ed.). Bantam Books.
Keiper, C. N. (2013). Do elephants have souls? The New Atlantis, 38, 10-70. Marks-Tarlow, T. (2012). Clinical intuition in psychotherapy: The neurobiology of embodied Response. Norton.
Napier, N. J. (1990). Recreating your self: Building self-esteem through imaging and selfhypnosis. Norton.
Panksepp, J. (2011). The basic emotional circuits of mammalian brains: Do animals have affective lives? Journal of Neuroscience Biobehavioral Review. 35 (9), 1791-1804.
Panksepp, J., & Northoff, G. (2009). The trans-species core SELF: The emergence of active cultural and neuro-ecological agents through self-related processing within subcortical-cortical midline networks. Consciousness and Cognition, 18, 193-215.
Piliero, S. (2013). AEDP Essential Skills 1 Course Handouts. Presented in Boston, MA.
Piliero, S. (2018, November). Transform trauma through fierce love: Using the therapist’s bold, embodied presence. Presented at AEDP New England, Lexington, MA.
Schore, A. N. (Ed.) (2012). The science of the art of psychotherapy. Norton.
Schore, A. N., & Bradshaw, G. (2012). How elephants are opening doors: Developmental neuroethology, attachment, and social context. In A.
Schore (Ed.), The science of the art of psychotherapy (pp. 243-258). Norton.
Van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.