Lifespan Integration Therapy: Two Cases By Mandy Roland‐Smith

Introduction

Lifespan Integration (LI) employs a number of protocols, each which uses a timeline of memory cues to heal both developmental deficits and trauma. Each protocol serves to integrate experience and create a more solid sense of self and a more secure attachment style. LI therapists need the skill to choose and perhaps adapt the appropriate protocol to address the developmental or psychological need of the client, coaching appropriate needed responses to help to heal the internal worlds of their clients.

In LI there is a triangular relationship between the client’s adult self, his child‐self‐states and the therapist, who acts to support the client’s own healing, through the building of strong internal relationships between her client’s self‐states. Peggy Pace, who developed LI, thinks that Lifespan Integration accesses specific neural networks and re‐writes them to integrate disowned or forgotten experience by weaving together the components of memory ( thoughts, feelings, imagination and body sensation). She maintains that this is more than a technique and that its success depends on the ability of the therapist to hold a frame, stay grounded and attuned and aware of needed, reparative interventions. In my experience this includes an understanding informed by counter transference feelings and bodily sensations, as well as having a developmental theoretical model and the experience of being a parent. My personal LI therapy gives me a depth of understanding about how the LI process works from the client’s perspective.

Jonquil:

Jonquil came to see me having endured PTSD for a year since she was attacked in her home one afternoon during a burglary, by a man who tied her up and threatened to kill her if she made a noise. Her small daughter was asleep in the next room and Jonquil was terrified that the little girl might wake and call out and the intruder would kill her. The incident ended when Jonquil’s mum had rung the bell, tried her key and then called through the letterbox, at which point the intruder left by the back door and jumped over the fence. He had been caught by the police and was serving a custodial sentence.

Since then she had moved in with her mother and found it hard to go out. She was constantly anxious and hyperaroused, had difficulty sleeping, regular flashbacks and was triggered by the smell of tobacco, which the burglar had smelled of. She had been off sick from work for several months and was questioning whether she would ever feel able to return.

Throughout her therapy Jonquil filled out regular Impact of Events Scale questionnaires before sessions, to measure Post Traumatic Stress Disorder , with scores for avoidance, intrusions and arousal. At the beginning of her first session she scored 75 out of a possible 88. A score of 33 is enough for a probable diagnosis of PTSD. Jonquil and I compiled a cue list of some of the significant moments of the attack and then created a timeline of memory cues to the present day. Tracking the sensations in her body and through repetitions of the timeline, using a modified version of Lifespan Integration’s standard protocol we began the job of convincing the part of her stuck back in time in the horrific event, that it was over and that she and her daughter were safe now.

I saw Jonquil two weeks later. She reported that she was not now getting flashbacks and had managed to sleep a few hours at a time, but was now worrying more that she might meet her attacker and was finding it almost impossible to go out unless she was accompanied. Her IES score was down from 75 to 52, but her avoidance score remained high. This time I emphasised to her imagined younger, terrified self, that she was safe now and that she didn’t have to worry, because it was over and happened a long time ago now. We repeated eight timelines, by which time Jonquil said she felt calmer and felt that she was beginning to understand it was in the past. The sensation in her body was fainter.

Our next meeting was a month later and I was struck by Jonquil’s appearance. Gone was the grey, exhausted woman of the first session. She was smartly dressed, with some lipstick and matching shoes. She reported that she felt much better. She was sleeping through the night and was back at work. Her IES score was down to 44 and the avoidance score was down by 10 points. That session we completed six more timelines. She reported that she felt ‘raging mad’ at the intruder for invading her house and terrorising her so she had lost a year of her life, so I gave her the chance to confront him to get her own back, or to express what had not been possible at the time. She did this, imagining three male friends bursting in and holding him while she hit him with a bat and kicked him, while shouting her outrage at him. She repeated this process again and after that we did one final timeline. Jonquil felt no activation at all when she thought about the worst parts of the attack (her fear that he might kill her daughter). The traumatised part of her, which had been stuck in time, really understood at a cellular level that it was over and they were safe.

I offered her another session and we left it that she would phone if she wanted to see me again. She emailed some weeks later to say she didn’t need to come back as she was fine now, back at work and hoping to move back into her own home in a month, when the tenants left. She sent me a final IES score questionnaire which showed that, although with a final score of 28 she still had some remnants of the trauma, three sessions of LI had been transformational.

Frank:

Frank came to me following the end of a relationship with a girlfriend, the last of many that ended at a point where they seemed to be becoming more serious. This had left him feeling distraught, isolated, unmotivated and suicidally low, self‐harming and thinking about ways to end a life that felt pointless, despite a well‐paid, interesting job and a group of good, longstanding friends. He seemed depleted, his body collapsed and looking as though he could not support himself, but he held my gaze throughout the session and I had a sense of him wanting to be in relationship.
I did a thorough risk assessment in which Frank showed me scratches on his arms where he had self‐harmed. I judged that he was not at immediate risk and asked him about his life. He was born in Germany 31 years ago and when he was three his little family moved to the UK with his new baby sister, to be near his maternal grandmother and for his father’s work as a scientist. Frank’s granny minded him after nursery, then school and in the holidays and he had fond memories of their times together. I had the sense of a loving family and a little boy who was happy and secure.

When he was seven there was a catastrophe. Frank’s mum and three year old sister, en route to collect him from school, were killed in a collision with a lorry. His father seems to have been unable to cope and a few months later married a colleague, a cold woman, who was unkind to Frank. Father seems to have handed over responsibility for his son and had little to do with him. In addition, Frank lost touch with his granny and all of his mother’s family. After that there was another house move and when Frank was just nine, a new halfsister was born. Just over a year later another half‐sister arrived. Frank started at a new secondary school and lost touch with his old friends. By the age of fifteen Frank had the job of carer for his half‐siblings at the expense of his own friendships and interests. He told me he was resentful of both his sisters and his parents, but that he never argued with them, fearing that he would be ignored or told off for being selfish and lose what acceptance he had in the family.

I thought about the trauma of losing his mum and sister through sudden death and of losing his father and his grandparents and cousins from father’s response to his own traumatic loss. It was not surprising that Frank would be afraid of becoming close to potential partners give the trauma of such sudden, unbearable loss: nor that he was depressed, given the years of feeling alone, used, unsupported, invisible, unimportant and in pain. It seemed that only he had made himself into an adaptive shell to help him survive his sad situation.

I told him about LI and explained the theory to him. Perhaps because he was biddable and adaptive, or perhaps because he was impressed by my explanation, we agreed to meet weekly and to alternate LI with talking sessions and booked in LI sessions that would last up to an hour and a half.

Our first three LI sessions focussed on the sudden death of his mother and sister using standard protocol. LI works in the body with memories held in the body‐mind system and Frank’s memory of being taken home and seeing his father sobbing evoked a sensation in the base of his abdomen and a tightness in his chest, with difficulty breathing. I asked him to imagine going back in time and taking his young self out of the distressing scene, comforting and telling him he was sorry that little Frank had felt so sad and his mummy had left in that way; that it was over and, because children blame themselves for things that go wrong, that he was not to blame for anything that happened back then. We then proved to this young self state that he was grown up now, by repeating the timeline of cues to bring him into the here and now. In LI there is part of a protocol that requires the client’s current self to ask the young self‐state if he has any questions. In Frank’s case, during one of the early timelines, his younger self asked if his mum and sister would be coming back tomorrow, demonstrating that at the time of this memory he had not understood what had happened to them and illustrating clearly how parts of us get stuck in time, dissociated from current reality.

By the end of the first session, during which more memories around the trauma surfaced,

Frank did not feel so activated in his body when he recalled the events surrounding his mum’s disappearance. And when he came a fortnight later he reported more memories and some thoughts that had come up. He recalled his teacher hugging him he hadn’t known why; and he remembered his granny had been crying and how upsetting this had felt. New memories were being integrated and a fuller narrative of what had happened was being built and along with this came good memories that he had forgotten.

Over the next few sessions we continued to work on the traumatic loss, both to reduce the

trauma and to reinforce the attachment between the adult self‐state and the lost child‐self. Using the timeline of memory cues, we worked to heal the effects of his father’s withdrawal and the loss of his grandparents, as well as the sensed betrayal of his father’s swift new relationship. I coached loving and reassuring interventions from Frank’s adult self to his younger self state, telling his child self that there was nothing wrong with him that made his granny leave and his dad stop caring for him and get a new mother who was unkind; and that he was precious and important. Importantly, I coached Frank to hold and comfort his little self, telling him was OK now that his grown‐up self was with him and loved him; and we proved to this young self‐state, through the use of the repeated timeline of memory cues, that the traumatic time was long past and that he was not alone now. Lifespan Integration is a powerful and immediate way to heal trauma and internal ruptured attachments and Frank reported that he felt both calmer and that the events of his early life were now part of a story, rather than live events.

Frank’s depression and ambivalence about the responsibility he had at work led us to work on the teen years when he had too much responsibility for his siblings. His body‐mind system took us from a recent shameful meeting with his boss back to memories of feeling neglected, overwhelmed and resentful about having to be a child minder at fourteen, when he wanted to be with his own friends. Added to this he felt rage at the lack of gratitude shown by his parents for both the tasks he undertook and the cost to himself. So over several sessions we used LI to imaginally go back in time into several scenes and give him the chance to tell his parents exactly what he felt about this. His younger self‐state was supported by his adult self to express his hurt and anger in whatever way he needed to; then I coached him (the adult Frank) to imagine playing football, practicing bowling and interacting with his younger self in ways that fathers and teenage sons typically enjoy together. And then, by leading Frank through his timeline of memory images, we proved to his teen self that these past events happened long ago and that he was grown up now. Through the repetitions of the timeline, a strong connection was forged between Frank’s hopeless child self and his loving, protective adult self. By the end of each session Frank felt more secure.

This part of the therapy went on for several months, addressing the low self‐esteem and hopelessness of his over‐burdened teen self through a combination of LI standard protocol and depression protocol, including attachment repair work to coach more self‐compassion in his internal relationships; and to grow parts of him up and help him feel that he was important and worthwhile. He started to do things that teens do, going to clubs and festivals with people who were younger than himself. He seemed to enjoy spending time with his best friend’s dad, who came round to help him with DIY jobs. I regarded this as progress, as he made up for what he had missed as a teen. I noticed that as time went on Frank talked about his manager with less fear and anger and their relationship became more equal, with Frank able to put forward ideas and feel appreciated and more confident. He still became angry and hurt when he felt he was dismissed or unvalued and we would use his body‐mind to take us to the right part of his history to heal more of his interior world.

Throughout this time Frank had steered clear of relationships with women. He knew he was scared of rejection and abandonment; and although the fear of abandonment was less than it had been, he retained a need to stay safe by staying on his own, constantly confirming his negative belief that people always leave you in the end. I mentioned this as a dynamic between us and reassured him that I would not be ending with him until he felt he wished to leave. We used a specific LI protocol, targeting the sensations in his body as he tracked his relationships up through time. Within a few timelines, Frank could see clearly what happened in relationships, how this pattern had evolved and what his part was in the ambivalence that helped lead to the eventual breakdown of his sexual relationships. He understood that he was re‐creating situations that echoed the loss of his mother and little sister, each time cementing his belief that people leave you, so it is not safe to trust and give yourself to them. His choice of partners mirrored that of his father in choosing a cold woman who seemed incapable of love or compassion for a bereaved little boy. Frank’s women were career minded, or just in it for a sexual fling. While this suited the scared, defended part of him, it left him starved for love and real connection.

This paved the way for more healing, with another session on the death of his mum, while I coached that it can be safe to trust some women, who wouldn’t leave him and that his grown up self could judge when it was OK. Then we had several sessions of LI on times in his life when he had felt bullied, used or discounted by his step‐mother while his dad stood by. We targeted his body sensation and he came up with memories of being picked on unfairly, punished disproportionately and withdrawing either into himself or his room. I coached him in his imagination to stand up to her and help his younger self do whatever he was unable to do at the time of this abuse. Imaginally Frank’s adult self could tell his step‐mother to stop and could stand up for his squashed child self. After a few timelines, during which his timeline cues brought up memories of a similar hue or theme, his child‐self took delight in tying her up and leaving her while he went out for a game of football. In the next session, his thirteen year old self made her and his father wash up every item of cutlery and crockery in the house.

Frank was generally enjoying life and spending times with his friends and was feeling more coherent and grown up, taking good care of himself, but he was still avoiding women and sometimes felt very down. Using standard protocol we targeted an early memory of his real mum being impatient with him when he went to her for a cuddle and some love, while she attended to his tiny baby sister. I realised I had overlooked this early event, having fallen into Frank’s polarised view of his life as perfect before his mum and sister died and awful afterwards. I coached Frank to tell his little self that his mummy did love him and he hadn’t done anything wrong, that she was just tired and she shouldn’t have been cross with him. Frank told his small self that he loved him and he was special and that Frank would always take notice of him and comfort him when he was hurt or sad. Then we proved to this sad little child that it was over and that he was part of Frank, who loved and cared for him. Again, the memories on Frank’s cue list were not the events that came up when I read his cues to him. Instead, more incidents of hurts and rejections and longing were recalled. When Frank took his little self into his current life I coached him to spend time with this small child, playing with him and enjoying spending time together.

Soon after this, Frank said that he felt he was ready to finish therapy. He said he felt open to the idea of a relationship and that it didn’t scare him anymore, but that for the time being he was content on his own. He had a close group of friends he socialised with and a number of interests that he enjoyed. He had been promoted and was enjoying the responsibility and challenge this presented, and he felt able to genuinely care for himself. So we fixed a date to end and at the end of his last session he gave me a huge hug and left with a light step.

The whole therapy had taken 19 months, with breaks for holidays. Discussing it with my supervisor, I reflected that conventional therapy with someone with this amount of early loss might have taken several years and not brought about such deep change.

Please note that these case studies are based on real clients, but names, history and some details have been changed to protect confidentiality. Clients have agreed that material may be used in education and training.

Mandy Roland‐Smith is a Senior Accredited BACP Counsellor/Psychotherapist working as a university counsellor and in private practice; and a HCPC Art Therapist. She is an approved Lifespan Integration consultant and teaches Level 1 Lifespan Integration in the UK.

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