Limitations in ASR
Most folks like to hide their flaws. But when it comes to therapy, knowing what a modality can’t do is as important as knowing what it can do. Where does ASR struggle? Let me tell you.
ASR leverages the leadership of Self to engage both internal distress and external relational dynamics. Many therapies leverage Self leadership- CBT, IFS, EFT, you name it. However, what do you do when there is no Self to work with?
I’m not talking about trauma in this regard. Even a collapsed Self generally has enough substance for a skilled therapist to engage in therapy. (See the article on build the Leadership of Self.) What I’m talking about is when you can’t find the Self at all.
Where does this occur? Here are client presentations I’ve encountered so far.
Dissociative disorders are unique as clients may literally have no memory of what occurs when dissociated or even what preceded the episode that may have triggered it. For one particularly troubling client of mine, this was the crux of the issue. After some extensive research, I was able to find the right treatment facility where they could monitor my client 24/7. They discovered the client had Dissociative Identity Disorder. Once the problem was identified, the work shifted. The Self became more aware and connected to the dissociated and disconnected parts and ASR worked great. I was able to work with whichever part presented, whether the Self and or the part. But before that framework was found and unlocked, it was hard to know where to work because the client literally had no accessible memories of problematic behaviors.
Psychotic episodes are also particularly challenging. I had a client who was bipolar with psychotic features. They had suffered a particular severe psychotic episode and remained in that state for several months which resulted in multiple stays in inpatient facilities. The Self wasn’t accessible at all during this time. Even in the process of recovery, their distorted memories and the constructed meanings they clung to in order to explain their experience and soothe themselves meant little to know actual work was able to be done.
Mania, which can show up in bipolar or as its own particular issue, can also be tricky as the Self is lost in solving puzzles, seeing patterns, and overcome with a sense of grandiosity and euphoria. Grounding the Self into the present can be difficult depending on its intensity, as the function of the manic state is to help the Self compulsively solve real or imagined “solvable” issues as placeholders for the chronic one(s) that has no answer.
In these cases, once stabilized and the Self is accessible, ASR works great. But during activations of these issues, the Self is lost somewhere within and finding access points to do work can be very difficult.
To be fair, I don’t know of any other modalities that are able to effectively create change with clients in these states. Medication can be a primary stabilizing factor that can assist the Self in remaining present. Making appropriate referrals for stabilization can also greatly increase your ability to work with clients.
Do you know of a modality that is effective with clients when there is no Self available to work with? If so, please let me know! I’d love to discover how they do it.