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One of the supervisees asked why it is so important that the therapist confronts the patient with his discharge of muscle tension via wriggling his feet.
Perhaps the following answer is of help :
Cellar door defense of discharging muscle tension, passivity, ignoring, neglect
Suppose a patient has quit his front door defenses, gets (more) anxious when giving a precise account of an interaction with someone in the C and discharges anxiety via wriggling/tapping his/her feet. Discharging muscle tension via wriggling/tapping feet is a cellar door defense that is automatically put into operation!!!!! In that way some muscle tension in the torso and legs is slightly reduced and, therefore, it has to be repeated again and again. As this whole process is automatically put into operation, the patient (mostly) is not even aware of this particular way of discharging muscle tension and can continue being passive towards physical manifestations of his body and/or continue ignoring, neglecting them. The therapist thus should be aware that after having helped his patient to quit the defense of wriggling/tapping feet, the cellar door defenses of passivity and of ignoring/neglecting should also be focused upon.
Common sense also tells us that when this automatic process is so habitual, we can safely assume that this person has done so for years and that this person also has parasympathetic and cognitive/perceptual manifestations of anxiety. The therapist could take the patient´s wriggling/tapping feet as an Alarm Signal!!!!!!: please pay attention, the patient´s anxiety is most probably unhealthily regulated!!!!!! And don´t forget: the higher the proportion of parasympathetic manifestations, the more there is passivity as a cellar and front door defense!!!!!!Thank you Josette for your post. We of course aim to help our patients have healthy regulation of their anxiety. Patients who discharges via wriggling their feet they often label their anxiety in inaccurate way or they miss linking their response of anxiety to an antecedent feeling. Confronting them with their cellar door defenses of ignoring/neglecting will lead to a healthier regulation of their anxiety.
Yes, many beginner therapists, including myself in the past, will prematurely focus on anxiety with the patient. Assuming the front door is already open, I have learned it is usually better to deal with the cellar door defences and check the patient sees himself or herself as important enough to pay attention to their anxiety in careful and precise way before moving to a focus on anxiety.
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