Description Of A PBSP Therapy Structure Session

By Al Pesso, PBSP Co-Founder

Kathleen, my client, was a fascinating mixture of vulnerability and lurking threat.  Her dark eyes filled quickly with tears, but regularly flashed wordless challenges to me.  Her skepticism was clear at the outset of the program, “I don’t think anything of value can come of just two days of work with you,” she said, and followed that up by telling me that she had been in therapy for eighteen years without any good effect.  She gazed intensely at me as she silently dared me to think I would do any better.  Though the barbs launched from her down-turned mouth and angry eyes fell upon me with chilling effect, I could not ignore the nearly simultaneous expressions of helpless suffering and pleading for relief that leaked out around the rims of her bold hostility.

 We were in a European city where I was launching the first day of a research program on the efficacy of PBSP for use with clients with traumatic histories in conjunction with the university in that city. Four clients with traumatic history had volunteered to be subjects.  Days before, they had each filled out psychological questionnaires and then were placed inside an fMRI scanner to make records of their brain activity as different images were flashed on a screen before them.  This was done to establish a baseline prior to the two days of the workshop with me.  After the workshop they would be asked to fill out a second questionnaire and then be given a second run in the fMRI scanner to see what changes show up in the various brain structures that could be affected by the work.


Kathleen was a very intelligent, talented person who had lived in despair and unhappiness all of her life.  Our work together had a shaky, precarious beginning. Before I begin to make therapeutic interventions, I like to establish a clear contract with the client that she is going to follow her own impulse to heal and will bring the work of a structure (the name we give to the therapeutic process) to a good end.  In a structure we review and illustrate clients’ negative history with the help of role-players or objects chosen by the client to represent the figures in their past.  The purpose of this is to provide a stage where the memories and consequences rising from past failures of maturational needs can become clear and consciously experienced.  Then we can construct a supplementary, symbolic history with alternative, life supporting figures that we call Ideal Mothers, fathers, etc. who, had they been in the client’s life, would have provided the necessary interactions that would have naturally led to a more fulfilling and happier life.

This contract negotiation with Kathleen was fraught with pitfalls.  It soon became clear that her idea of the therapy would be that I would make suggestions and she would follow them.  That smacked of a state of surrender (and disguised passive aggression) on her part and I told her firmly, but gently, that this was not a contract I could agree to.  I said, “If you are following me, then you are not being you.”  I told her that in PBSP the therapist follows the client, trusting that the emotions (felt consciously as affect and unconsciously as sensations in the body) that arose in the work contain the seeds and energy that would result in a healing reorganization of perception and action in the present.

“My contract is to follow your desire,” I said.  She grew silent, her eyes, downcast.  Then she said, “I feel split and it feels kind of strange to speak for one.”

I said, “Everyone has different parts and we will give room for each one.  I assume there is one you with many parts.”

“It seems that a part would never stop crying, and there is another part that sees an ideal world.”  I said, “That is the part that has hope.  There is the part of you that is still longing for something.  I call that the soul, the part that is longing to have it the way it should be.”


“When I was a child there was the crying child.”  I asked her why she was a crying child.  And she said, “I was always sad, worried and afraid.”  “Children are never those things for nothing.” I said, “You must have seen sad things, things that made you worried, and seen things that made you afraid.”

For long moments she looked at the ground, deep in thought and I imagined she was reviewing old images in her mind.

“What’s happening inside?” I asked.

“I remember big people who tried to care for us but had many troubles themselves.”

 “I said, “Do you remember I said in the theory in the beginning when big people have problems we try to solve it ourselves?”  She looked at me and nodded glumly.  “I’m guessing you did that.”

 “Who are the big people?” I asked.

  “Mother, father and grandmother,” she replied

 “Who was the one who needed help themselves?” I asked.

 “All of them.”

 “Even your grandmother?” I wondered aloud.

 She nodded sadly in assent.

 Here she presents a classic example of the negative consequences on a child’s life when significant role figures do not or could not carry out their necessary care-giving responsibilities and have unfulfilled needs themselves.  This is a double whammy.  In PBSP, we call this “Holes In Roles.”

 First, her basic developmental needs are not met and that has negative consequences on her normal maturational processes, which would result in the absence of emotional security or a regular sense of well-being.

 Second, her innate capacity for compassion has been too early awakened and over-stimulated by the sight of suffering loved-ones.  The consequences of this are deep, dark (in the sense of unconscious) and disastrous to her natural inclination to act (without guilt) in her own self-interest. This kind of history is the foundation of a life-long pattern of attending to the needs of others at the expense of neglecting one’s own needs.

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