Facilitated Intense Emotional Catharsis, Part 2

(Continued from the previous page)

FACILITATED INTENSE CATHARSIS IS NOT SAFE UNLESS
ALL THE DESCRIBED PREREQUISITES ARE IN PLACE

Methods & Equipment

The Basic Process

Unless already experiencing strong feelings, the participant is encouraged to talk about something which recently caused distress. If no recent example is forthcoming, previous material can be revisited.[91] Using the minimum of words, the facilitator encourages attention to the feelings involved, and then moves the focus to expression of those feelings, using any of the many safe methods available.

Firstly, gentle methods of externalisation such as talking and crying, which were discussed under Gentle Expression, are not redundant here. They are included at every level of intensity. In this case, whenever the feeling being expressed requires it, the repertoire can be expanded to include shouting, screaming, swearing, howling, moaning and any other noises and contortions imaginable, no matter how loud.

That does not mean that any activity at all can be employed. Only methods which are effective for the participant and safe for all concerned are allowed. In practice, this usually means the methods already described under Gentle Expression, and two more techniques which will be described here.

In the first of those extra techniques, a piece of rubber compressor hose, approximately 45 centimetres in length[92] and 4 centimetres in diameter, is used to beat upon something inanimate, to aid in the expression of antipathy. A rubber hose can make a lot of noise, but is not nearly as dangerous as a solid object, if anyone inadvertently gets in the way of it.

I don't actually remember anyone ever being struck by such a hose, but it is possible, so solid objects must not be used. If the hose is too long, incidentally, it can bounce back and hit the person holding it. If this occurs, the hose should be shortened, a centimetre at a time, until its rebound is controlled.

Suitable targets for the rubber hose include a roll of carpet, a log of wood or a plentiful supply of old phone books. A mattress can also be used as a target, but it will wear out quite quickly. The floor is not a suitable target, as the beater's knuckles make contact with it. A log of wood used as a target may need to be covered with carpet, so that splinters do not break off and fly around.

Any other target which can release projectiles must also be modified or avoided. The same principle applies to the rubber hose itself – hence the use of compressor hose, which has a composite construction, including a fibre mesh layer with high tensile strength. But it is still possible for a piece near one end to become loose, in which case that piece must be removed.

If phone books are used as targets for the hose, they shed lots of bits of paper as they disintegrate. But that is not a problem – in fact, it can be very satisfying for the beater. There is a symbolic significance in reducing the object of wrath to shreds.

While a participant is beating with a rubber hose, it is sometimes necessary for the facilitator to provide redirection, if there is a tendency to stray from the target – which could conceivably place other participants at risk of injury.

As previously mentioned, safety directions given by a facilitator are not negotiable – a participant who cannot accept safety directions from the facilitators cannot safely engage in the activity. I have never seen it happen, but as a last resort, the participant would have to be asked to leave.[93]

The other extra method of externalisation, which joins the repertoire when all the prerequisites for facilitated intense catharsis are met, is for the participant to lie on their back on a mattress and "throw a tantrum" – using the voice and tear ducts to good effect at the same time. The rubber hose is not used during this form of expression – and the participant does not turn over to adopt a lateral, prone or hands and knees position (unless mandated by physical illness).

The mattress itself must be sufficiently large, thick and firm to prevent injury due to insufficiently padded contact with the floor. It needs to be much firmer than most mattresses used for sleeping, and should not contain springs, which might break and become dangerous after extended use. It may be necessary to source suitably firm foam first, and then arrange covers.

There must be a facilitator at the head end of the mattress, who must ensure that the participant stays on the mattress and safely away from its edges, as well as maintaining an approximately supine position. As with redirection of a straying beater, these requirements are not negotiable, because they impact on safety. In any other position there is some potential for injury, either to the participant or to others in the vicinity.

The facilitator must scrupulously avoid encroaching on any airspace which could conceivably be reached by the participant's arms, legs or head, to avoid either inhibiting the participant's tantrum behaviour, or being injured. A facilitator who remains alert, focused on the participant and in the correct position – near the head end of the mattress, but not too close to the head – is very unlikely to be struck.

Incidentally, whenever not lying on a mattress, a participant must be in a standing, sitting or kneeling position – otherwise the body, and especially the head, could be injured by contact with the floor. Any tendency to adopt an unsafe position must be quickly noticed by a facilitator, so that the participant can be redirected, usually to a mattress, until less distressed.

Whatever method of externalisation is in use, the participant is provided with encouragement and guidance by a facilitator when and if necessary. Frequently, the sum total of this input is simply the presence of the facilitator nearby. At most other times, input is limited to a few quiet words, or else to entirely non-verbal communication.

The quality of the facilitator's non-verbal communication is of critical importance at all times – for example, a slight change of facial expression when a participant shares some information could easily be construed as disapproval. Added to the participant's existing diffidence about self-disclosure, this might be enough to halt the externalisation process in its tracks.

FACILITATED INTENSE CATHARSIS IS NOT SAFE UNLESS
ALL THE DESCRIBED PREREQUISITES ARE IN PLACE

Complications

What might go wrong during the procedures described – and what is necessary to keep the practice safe for all concerned? The most essential needs for safety are the careful screening of participants, the careful choice of facilitators and the absolute requirement that participants must comply with safety directions from facilitators. These issues have all been discussed above.

Almost everything else that has been discussed above also has some bearing on safety. Most of the regulation of the process, however, is provided by example, aided considerably by the fact that the participants are invariably there to free themselves of pain – not to create trouble for themselves or others. The facilitators, and also any participants who have prior experience of the method, create a non-verbal atmosphere of mutual respect, tolerance and kindness. In this atmosphere, deliberate violence, whether to self or others, is most unlikely.

However, the slightest tendency towards unsafe behaviour must immediately elicit redirection by a facilitator on safety grounds. In most cases, the participant should be directed to return to the log or mattress and to work on externalisation of the current feelings, using the safe methods provided. The availability of safe methods of externalisation is the key here, as it provides a safe outlet for the very feelings which were motivating the previous unsafe behaviour.

While it is possible that a participant might not accept the directions given, it is also true that every person present is there because of a strong determination to make things better – not worse. Any seriously antisocial behaviour is therefore most unlikely. In fact, I think it would be far more likely to occur at a bus stop, or a cinema. Certainly I have never come across any such thing during EEEEs work, regardless of its intensity.

Agreement to attend unaffected by drug or alcohol use was mentioned under Participants. With the exception of prescribed medication, which should at least be of some benefit and is sometimes essential, the EEEEs method should not be attempted under the influence of drugs or alcohol. Not only are emotional perceptions likely to be distorted, but insight gained as a result of the process may well be diminished – or even completely inaccurate.

That is not to say that EEEEs work has nothing to offer to drug users. Almost all drug users suffer great emotional pain, which is often the main thing motivating their use of drugs. The relief obtained from their drug use is, unfortunately, temporary – and comes at a price far higher than the street value of the drugs.[94] EEEEs work would give far more relief, with less candy but no poison (see previous footnote). However, participants should be drug free, or nearly so, while doing the work.

The transitional distress around the time of closure and departure, and the repercussions which sometimes occur after that, are not really complications, but rather normal responses. These issues, although peripherally related to the current heading, have their own headings below.

FACILITATED INTENSE CATHARSIS IS NOT SAFE UNLESS
ALL THE DESCRIBED PREREQUISITES ARE IN PLACE

Infection Control

This heading admittedly has no direct relevance to emotions, but I have decided to include it because facilitated intense catharsis is so often carried out in a group setting. It seems to me a great pity to reduce the benefit of such an activity by bringing home a new illness – especially if it is a serious one. However, if you are not involved in organising group activities, you may wish to skip this heading.

Whenever a number of people gather in one place, it is possible for infectious conditions to be transmitted between them. This can occur either directly or indirectly. As one obvious example, if more than one person has an accessible scratch, graze, laceration or ulcer, and at least one of them is infectious, then various serious infections, including hepatitis B, hepatitis C and HIV, could be transferred.

This type of cross infection is possible whenever a body fluid such as blood, containing the infectious agent, contacts non-intact skin or mucous membrane – or sometimes, intact mucous membrane. In some cases, an amount of blood or other body fluid too small to see may be sufficient to transfer infection.

Although the original source of infections like these is usually a person, the immediate source can be a different person, or an inanimate object, in cases where either has previously become contaminated. Such contamination may involve a number of intermediate steps. For example, an infectious person could be scratched by a damaged door handle, leaving some blood on it.

The next person to use the door could get a little blood on their fingers, but not be scratched – and might then work with the nearest rubber hose (though that is strictly forbidden). The owner of that hose could later hold it in perfectly healthy hands, and subsequently rub or scratch an itchy eye. This is a very roundabout way to contract a life threatening infection – but that will be no consolation to the person who gets sick.

The above example may give the impression that cross infection is almost inevitable – but nothing could be further from the truth. The risk can be brought very close to zero, if the appropriate precautions are taken. And those precautions are not complicated or difficult – they are, in fact, just basic hygiene – which should be known by every child at school.

Having said that, it must be admitted that the hygiene measures to prevent cross infection by blood and other body fluids were greatly neglected until the discovery of HIV/AIDS – which, though far from being the only example, raised awareness of this method of transmission very greatly.[95] Anyway, I will briefly mention the main principles of infection control in a general community setting.[96]

The first principle is to apply all the basic cross infection precautions universally. If you wait until you know of a person with a transmissible infection before you practise good hygiene, the first person you know of with such an infection will probably be yourself. And by that time, there may be many other cases – most of which were also preventable.

The second principle, in very general terms, is to know how transfer can occur, and use that knowledge to prevent it from occurring. In the case of transmission by blood, probably the most important (but not the only) precaution is to cover any areas of damaged skin with a dressing capable of preventing infectious material from getting in or out. I will not consider other examples here, except to say that, unless you know the exceptions, it is best to treat every body fluid, and every body surface or cavity, as possible opportunities for transmission.

In the case of respiratory tract infections, there is something to be said for affected people wearing surgical masks to reduce the dissemination of infectious droplets.[97] This almost certainly reduces the risk of infecting others – some of whom might become much more severely ill than the person donating the infection. It is common practice in Japan, but has been very slow to catch on elsewhere.

When masks are not worn, the next best practice is to remain at least one metre away from other people, and cover every cough or sneeze, so that droplets are not sprayed so widely. Handwashing, as below, and safe disposal of tissues, are also necessary, in order to reduce environmental contamination.

Handwashing is the third principle. It is perhaps rather boring, but nevertheless critically important. An alcohol based lotion designed to provide an equivalent effect is an alternative means of cleaning the hands, and is often more convenient. The main times to clean the hands are after touching anything which could transfer infective material to them, and before touching anything which needs to be kept clean.

A very few examples of the former situation are after coughing, sneezing, nose-blowing, attending to a wound, going to the toilet or handling objects which may not be clean. A very few examples of the latter situation are before touching the nose, mouth or eyes, attending to a wound, preparing or eating food, or handling objects which will later be used by others.

The fourth principle is to clean the environment routinely, at suitable intervals, and also to remove any known contamination promptly and effectively. This needs to be interpreted broadly, to include, for example, ensuring that any food, beverages, utensils or other objects provided are free of infective or toxic material. Local public health authorities should be approached for more specific advice about all this.

Attention to these four principles makes cross infection during everyday activities much less likely. However, for best results, both dressings and cleanup should be done by someone with first aid or similar training. Although the procedures themselves are simple, there are plenty of ways to render them ineffective – even with the best intentions. Also, good infection control is not a substitute for recommended immunisations.

Apart from the general principles mentioned above, there are also some precautions particular to our current context. One of these relates to the possibility of contamination of the lengths of rubber hose used when externalising antipathy. Using the hose very vigorously can sometimes cause skin abrasion, but another possible source of contamination would be an existing breach in the skin, which had not been covered immediately.

To prevent cross infection via rubber hoses, each participant should be provided with their own hose, clearly labelled with their name – and must only use that one. The cost of each hose, incidentally, is trivial if the tubing is bought in bulk.

It must always be remembered that a hose (or anything else) which looks clean is not necessarily safe. As mentioned above, an invisible amount of blood can transmit some infections, especially hepatitis B. Also, the residues of other body fluids may not be easily seen, especially at the cut ends of the hose.

The body fluids likely to be produced during externalisation are sweat, tears, saliva, nasal secretions and sputum. Unless they are bloodstained, these fluids are not, at the time of writing (2008) considered to be significant modes of transmission for the three viruses mentioned above. Some of them can, however, transmit various other infections – for example, conjunctivitis or influenza.

In the case of the mattresses used during externalisation, the basic principle is not to continue using a mattress if it becomes contaminated. It is also not wise to borrow mattresses which are in domestic use at other times, although suitable mattress covers would reduce the risks associated with prior contamination. Practical issues of decontamination of mattresses or their covers should be discussed with local public health or infection control authorities, as various methods exist and preferences vary with place and time.

Exclusion of persons suffering from infections which pose a public health risk, such as open tuberculosis, is also important. This is a complex issue, and regulations vary with time and place. The person's doctor, with the help of local public health or infection control authorities, should be consulted about this.

FACILITATED INTENSE CATHARSIS IS NOT SAFE UNLESS
ALL THE DESCRIBED PREREQUISITES ARE IN PLACE

Closure and Departure

When a session of facilitated intense catharsis comes to an end, some transitional activities are necessary before the participants return to the "normal" world. Otherwise, the sudden change from the exhausting and disturbing actions and feelings experienced during the session, to the activities of daily life – and the behaviour of "normal" people – can be quite a shock. Transitional activities also allow time for the acute edge of any repercussions (discussed below) to settle down.

As extreme exhaustion is very likely, the first activity might well be a brief guided relaxation, while the participants find a more restful use for the mattresses, or perhaps the floor. Very brief educational input relating to the EEEEs process itself is an alternative activity while participants rest. However, when more than a few of the participants are snoring, the lecture has probably gone on long enough.

If it has not already been done, information about follow-up options should also be provided at this time. If it has been discussed previously, this is a good time to include a reminder about it. Follow-up is discussed under the next heading.

In many (perhaps most) countries, once the participants are a little rested, there is a tendency for every person present to hug every other person present – sometimes more than once. As previously mentioned, this would usually be counterproductive during the externalisation process. In the transitional phase, however, it has significant benefits, and should be suggested by a facilitator if it does not occur spontaneously.

It is unlikely, in this environment, that the least handsome or glamorous participants would be passed over, while others exchanged hugs. However, if that did occur, it should be noted by the facilitators, who could then restore the balance. (In doing so, they would also be modelling appropriate behaviour, which would inevitably be copied by various participants.)

As mentioned earlier, a hug can provide non-verbal evidence of non-judgmental acceptance, which can be very valuable to those participants (usually all of them) who have been working with shame or guilt during the session. It also has the beneficial effect of moving the focus from intense personal feelings back to everyday social interactions.

Perhaps a hug also allows the exchange of beneficial interpersonal things which cannot be seen or measured. This, of course, cannot be proved – but then, it cannot be disproved, either. It can certainly be suspected, though – as many people do. In any event, hugs in all directions tend to create a good atmosphere, resulting in a relatively calm group of participants.

It does not usually take long before there is a general feeling of readiness to depart. Daily living activities can usually be resumed remarkably soon after intense catharsis. But if not, then tea and biscuits could be a suitable device for finding a little more time to acclimatise before departure.

There may be a participant who appears to need help with transport home, or perhaps continuing support until reunited with friends or family. One or more participants who are not in a state of distress will usually undertake this task. If not, it falls to one or more of the facilitators – whose job is not finished until all participants have been returned to a safe state.

Follow-up

Many participants will not require any specific follow-up after the activity, which may simply represent one aspect of a broader approach to their own emotional healing or personal growth. Others will have a range of options, perhaps including formal counselling, already in place. However, some participants may be in need of ongoing support, and may not know of any suitable options.

Sometimes, the organisation providing the activity will also be a provider of other services, which might include ongoing support groups, evening or weekend externalisation sessions, or individual counselling. However, when this is not the case, it should still be possible for participants to contact the organisers for advice about the availability of such services from other providers. At the very least, a participant who is experiencing severe difficulties should be advised to seek medical review.

FACILITATED INTENSE CATHARSIS IS NOT SAFE UNLESS
ALL THE DESCRIBED PREREQUISITES ARE IN PLACE

Time and Place

Apart from convenience, there are only two really important points about the timing of intense catharsis. First, there must be sufficient time after the end of the session for participants to rest, both physically and emotionally, before returning to work or engaging in any other demanding activity. And second, if an important examination, or some similar challenge, is approaching, it is probably best to avoid very intense catharsis for some weeks, or even months, beforehand. However, the need to postpone catharsis would need to be balanced against the need for release of pent up emotions, in any given case.

The choice of venue is a little more complex. The physical requirements are very simple, but are also very important. The room to be used must be in a safe state of repair (including access and exits). It must comply with local fire and other safety regulations. It must be large enough to accommodate the number of participants and facilitators who will be attending. And it must be capable of being secured sufficiently to prevent unwanted visitors from entering or watching through windows.

Permission to use the room for this harmless but very noisy purpose must be obtained from the owner or agent. Permission to make noise must also be obtained from any neighbours who will be affected by it. Neglecting either of these essentials is certain to cause problems, and could even stop the activity.

The room should be simply equipped with mattresses, tissues and some means of energetic expression of antipathy, as discussed under Methods and Equipment above. Seats should be available around the edges of the room. Access to toilets should not require leaving the safe environment of the venue.

There should be a notice placed on the outside of the door, such as GRIEF COUNSELLING IN PROGRESS. Details including a phone number could be added, in case the person reading the sign is interested in future sessions. Even better, a person could be available outside the room, to explain the activity if anyone enquires. In some locations, the presence of security personnel may also be necessary.

In practice, however, it should not be particularly difficult to find a venue. Community centres and church halls can often be used for this purpose, after the method has been fully explained. Residential workshops can often be accommodated in religious retreats or seminar centres.