Thursday, August 20, 2009

Working with the pre-verbal client**

A blogger states:

“Ok, another interesting thing came up - how do you treat pre-verbal trauma? I think most of the stuff I actually remember, I dealt with well both at the time and later in life when reflecting back, but a lot of my general unsettled-ness comes from really early abuse...what can be done about that?”(end quote)

Some suggest that pre-verbal issues are more difficult to treat than a client who has problems from that stage of development where the child has gained mastery of language. (ie verbal issues). My personal view is that this is not the case. It is easier to do psychotherapy with someone who has problems from an age where they did not have language. One could say it is more primitive but those therapists who do not like it may perhaps feel insecure because they cannot do the interpretation of language. To my mind that makes things easier because you are dealing with more obvious and basic communications. It is non-fancy therapy and non sophisticated therapy and that requires the therapist to be non-fancy and sophisticated.

For a therapist working with pre-verbal issues is not hard in the

technical sense but can be hard in the emotional sense

Pre-verbal psychological maladaption means the person has suffered significant disruption to the parent/child relationship before the child has gained substantial mastery of language. Let’s say that is from birth to 18 months of age. This corresponds to what Freud defined as the oral stage of development: 0 - 18 months of age.

This disruption can occur because of obvious neglect or physical abuse of a child. Or it can occur because the child is physically looked after but there is a significant disruption to the attachment between the child and the main parenting figure. This can occur because there is some problem in the child or for some reason the parent is not available to the child. That can be because the parent is significantly effected by drugs or alcohol, is consumed with anxiety or depression, is physically ill and cannot see the child much or for what ever reason is emotionally unavailable to the child.

A minority of adults can just feel this age. It is a natural thing for them.

In attachment theory, for a successful attachment to occur the mother’s Free Child must be involved. In other words she can’t fake it. The newborn is so sensitive it will pick up that mother does not want to (or can’t) attach. If this is the case then the attachment will not happen in a successful way and pre-verbal difficulties will result.

This stage of development is actually divided into two separate stages. The oral sucking stage (0 - 8 months) and the oral biting stage (6 - 18 months).

Oral sucking stage - this is all about the mouth, lips and tongue, sucking, swallowing, passivity and dependency. In adulthood this is typified by cigarette addiction which involves sucking and taking in. The person who smokes cigarettes for these reasons will find it particularly hard to break the addicition. The dependent personality can result from this as can the narcissist and the schizoid personalities. The pleasure principle dominates as does autoeroticism.

Oral biting stage - relevant to teeth gritting and grinding and is about the teeth and jaws as any breast feeding mother will tell you. Biting, eating, destroying, sadism and aggression. Conduct disorders in children and the antisocial personality in adults may manifest from a fixation at this stage of development. This person is not so much into sucking on cigarettes but more into biting as with chewing gum or chewing pencils, finger nails and so forth.

If a client presents with such problems what does one do. The first thing one does is assess the level of regression that the client is capable of. If the client is able to regress significantly then preverbal fixation is a possibility. That is they can regress into their Child ego state to a degree more than the average person can not. They have that ability to be very child like although this can at times be well hidden in their day to day presentation.

The client will have that ability to naturally regress whereas others simply will not. As a result one often ends up working on a mat on the floor with the client. Some clients will naturally gravitate to this and others will not. They will feel a natural need or repulsion to be held and others will not. When doing two chair work they will say thing like. “I have no words or nothing to say”. When working they will naturally put their feet up in the chair or request to sit on the floor. They need of get off the chair and get onto the floor and curl up or lash out in a temper tantrum.

With preverbal clients one has to deal with strong emotions and thus one does things like rage work on a mattress on the floor. Or the client curls up frozen with terror. If one has ever seen such a thing they will know what I am talking about.

Then of course there is rebirthing. Which one can see here.

Unfortunately what happens with many therapeutic techniques is they get commercialised. Rebirthing can be most useful with the client who has conflicts from the first year of life. The client is given the opportunity to simulate their birth. This can either be a wet rebirth in a hot tub or a dry rebirth on the floor.

Unfortunately tend people seize on such things and set up places like rebirthing clinics. On a Saturday morning one can wander down to the local rebirthing clinic and get a rebirth if they want. It’s like ordering a hamburger. Obviously the meaning of such a therapeutic process is lost. For the pre-verbal client a few rebirthing experiences can be most therapeutic if correctly placed within the context of the overall treatment of the client.

With pre-verbal clients one is working on a mat on the floor. More noises than words are expressed. One is suggesting to the client things like curling up at home in bed and sucking on their thumb or using dummies or pacifiers as they are known here. (Interesting term that - pacifier). One asks of the client do they tend to suck on their pacifier or bite it. Thus one can gain insight into if they are at the oral sucking or oral biting stage.

Clients can do such “homework” and some have requested that I record a CD (or audio tape as it used to be) reciting bed time stories that a parent would do to a child. I have done this. Of course it would be better if I could do this in real life but the professional organisations and press would immediately sexualise it and thus it can’t happen.

Clients can also use baby food where feeding issues are indicated. The eating of such foods and monitoring the reaction. And finally one of the more prominent methods of working with the pre-verbal client is the holding of them. As with rebirthing this is not done in a mechanical way but has its place in the overall therapeutic process.

In such holding of the client by the therapist the Child ego state of the client gets soothed in a somatic and non-verbal way. A decisive aspect of any such relationship and attachment. Whilst the Child ego state is being soothed the Parent ego state of the client also takes in the soother for future self soothing. In my view one of the more important ways by which the client can develop the ability to self soothe.



  1. How do you always find such interesting stuff to write about?

    I'm surprised to see the Freudian stuff come out in your explanation. Do you really believe in those stages, or are you using it as sort of a shorthand to explain what ages/stages you are talking about?

    RE the linked Mummy do you love me? post - I do sorta wish I could go back to SF (the new counselor is also from the Bay area) just so there would be a lot more options for this stuff. I don't miss the city but I do sorta miss the mindset, where people are able to try anything.

    And funny about this post: one shrink, when things got intense, I kept wishing to stop yelling at me and interpreting, and just give me a hug, hold me. Nothing sexual. But it was at one point a therapy fantasy just to have someone hold me when I no one ever really did. Just once. Of course, this was in one of those situations where I never could say anything like that. I remember it surprised the hell out of me to have such a childish wish.

    I can't believe I'm even confessing that now...that there were therapy things that stirred up emotions in me. Maybe I should be a shrink, maybe I do believe in it a little more than I thought. If I were still in N. California I might be more open to it because people in the profession there are more open to experimenting and trying new things. Around here, it's Freud baby Freud.

  2. Interesting stuff?

    I don't know Sara, it just seems to come into my head.

    I must admit that does seem to be quite a confession for you and now we know one of your early demands. And we know that your AC will do everything to make sure it does not happen.


    Who really cares. The first year of life is obvioulsy very important psychologically. He came up with a theory to explain it. I find it useful. If someone comes up with a better one then that is fine by me.

    It helps my understanding of clients and thus it helps them,

    I am curious at my adversarial response to you.


  3. Heh...great. Here, I have trouble with the classic Freud which is not very understanding of women. I've run into a lot of shrinks for whom "success" with me would be for me to be married with 2.4 children and not working and happy like that. Any other desires I might have are unnatural. Probably with vaginal orgasms thrown in for good measure.

    I guess maybe the problem is their literalness and orthodoxy about it more than the actual framework.

    And yes, it's true that I would go pretty far to keep anyone from seeing that kind of desire, much less acting on it. But I figured, fuck it, it's my anonymous internet site, the place I can admit all that shit, so why not say it.

  4. ...and adversarial-ness? Maybe because of my wording "Do you really believe that" sounded sorta dismissive. Or something like that.

  5. I really smiled reading this post and I will share why...

    1. With my last but one T I really wanted to do all my talking sat on the floor. It felt so much better for me. I felt I could talk more. We did occaisionally, but I could never bring myself to actually ask if we could do all of our sessions sat on the floor, though I did want to ask. I feel so much more comfy sitting on the floor. In fact I liked sitting with my knees up to my chest and my arms wrapped around my legs.

    2. The child in me mainly comes out when it is just me and my dogs. I have taught them to play hide and seek and most nights I will play this game with them. Also I tease them and they enjoy it. I pretend I cant see them and call out their name and they will go all giddy fun. And I also hide under the duvet and they will try and get me to appear. Oh I could go on and on about the games we play. They were teasing me tonight as rather than bring the ball back to me, they kept running off with it!

    3. I must say my image of a 're-birthing' exercise is that it is cultish. I just cant see what it achieves except messing with peoples minds. I dont mean that as a rejection of what you say, I am just stating my prejudicism.

    4. When I am really fed up with life I just hide under my duvet and shut the world out. I dont do it often and it is something I am not sure I like that I do it, because my mother used to do it a lot.

    5. {Sara, that you have shared what you have, makes me feel like I too will share more.} My last T but one gave me a hug once. Well actually twice. There was one part of me that liked it, but another part of me felt extremely suspicious, that it was a weapon to be held against me. Let me explain. After the first hug, after that if I had say, clammed up in a session, he would ask me what I wanted. Yes I wanted a hug sometimes, but he wanted me to ask for it. I could tell - cos I could read him - and he would eventually have this slight smirk on his face. He knew I wanted some soothing but I had to ask for it. Because of that there was no way I was going to ask for it. I know this was the 'game' being played out because the last time I saw him, at the end, he didnt ask me what I wanted, he asked me if I wanted a hug. He had been trying to persuade me to continue seeing him and I felt that it was his way of using a hug as a 'hook' to make me stay. He had that same smirk on his face. I am not cheap. I replied to him I dont know. He asked me again and I did succumb, though afterward I felt annoyed at myself. I felt I was soothing him with the hug.

    6. I find it hard to visualise how a forty year old adult would be helped by eating baby food, sucking their thumb or whatever a baby does. The past is gone. I am not sure i find it more odd, or more scarey.

  6. Yes Sara,
    Freud 's views were mysoginistic, or at least we were told they were.
    For more on this see

    To my mind he is a theorist. Thus he makes up stories (theories) about people. Like every other theorist does. Some allow me to understand people and thus assist me in my assitance to them.

    Good on you for staing (confessing) what you would not normally state.


  7. Hi Kahless,

    Well that is a good contract for finding another therapist should you ever seek the services of one. Ask him/her if you can sit on the floor whilst you work. If they say yes then go back for a second time.

    As with so many of these psychological methods they can become cultish. Unfortunately people can then think poorly of the method when it of course has nothing to do with the method but instead how people are using it and for what motive.

    When I was in California and doing training in rebirthing and body therapies I would say that the therapeutic methods were being used that way. I wouldn’t call them a cult but rebirthing as a technique was not being used in the context of an overall therapeutic relationship at all.

    At the training institute I was at people would go through rebirths and some would have no therapy contract at all. Mind you they changed the theory so that they could do that. I even heard some people would report memories of their actual births that they claimed they could now remember because of their rebirthing experience.

    I never questioned any of that. I beleive they believed they could remember such things. I didn’t believe that they could recall such a thing but I was not there to argue but to learn, which I did. And of course it was a different era then and so professional practices were much less stringent. But as there was often no treatment contracts there was no professional practices or ethics to be followed anyway. There were plenty of semi naked and naked bodies at times and I am sure some of the participants engaged in extra activities out side sessions. But that was the CULTure of it. So if I have ever been involved with a cult that was my time I suppose.

    40 years old sucking pacifiers and so forth? Why not? If they get some gain from it what is the problem. Odd or scary? I would get you to put the pacifier in the empty chair and talk to it.

    Hope you are having a good day my friend