Monday, November 18, 2019

The Bruised Heart: The Importance of Inner Work in Therapy

by Michael Bridges, PhD

One of the great blessings I’ve experienced is that most of my professional life has involved helping people from all walks of life heal through the practice of psychotherapy. While I’ve practiced psychotherapy since I received my PhD in the early 90s, for many years I was also a university professor who did research on what factors brought about a “corrective emotional experience” that helped people change for the better. One of the most important factors is, not surprisingly, the quality of the relationship clients develop with their therapist. However, a factor that may be even more important is the relationship that clients develops in therapy with their own inner world. Research now shows that some of the most healing moments happen when clients move from focusing in therapy on the outer world and shift their attention to their inner world of emotions, sensations, memories and images. This is what I refer to as the “Inner Work” of therapy.

The importance of focusing on this inner world was brought home to me some years ago when I was doing research on what helped people get over betrayals and other attachment injuries in close relationships. I was the therapist for Elizabeth (aspects of the following have been changed to protect the client’s confidentiality), an intelligent and motivated young woman in her thirties who was participating because she was having difficulty letting go of the pain and anger related to an affair. Years before she had found out that her husband of 12 years was having an affair with her best friend. This double betrayal left her so devastated that she eventually left her marriage. She also became so depressed that she entered therapy and for a few months took an antidepressant. After about a year she regained her ability to function and no longer felt depressed. But in our first session she shared that she still thought about her ex several times a week and felt pangs of sadness and anger. She also shared that, although she was a vivacious, intelligent and attractive woman and had no problem finding men to date, whenever she started to become emotionally close, something in her would say, “That’s it!” And she would end the relationship.

Elizabeth had already been in therapy for a year after her divorce and had liked her therapist and felt they made substantial progress that had alleviated her depression. So why was it that, four years later, she still felt she had to shield her heart in a romantic relationship? Instead of continuing to explore her history and go back over the insights she had from her previous therapy, I suggested that, in our second session, she allow me to guide her into her inner world by using a technique developed by the psychologist Eugene Gendlin, called Focusing. This involved having her close her eyes and move out of thoughts and words and to wait for her body to develop a “felt sense” of what was holding her back.

After a few minutes she sighed and placed her hand over her heart and said softly, “It’s like my heart is tender and bruised.  It is like my heart is not saying, “Don’t love.” It is more that it is saying, “Be careful! Be careful.”

In stark contrast to her bruised heart, she also became aware of a sense of energy and strength in her stomach. She smiled as she placed her hand over her stomach and described how she could tell how this felt sense inspired her in her work as a dancer and choreographer and she continued to beam as she described seeing the energy spread down her legs connecting her with people she loved.

I was frankly amazed and delighted by what was Elizabeth was sharing. This, after all, was only our second session! I also think it is important to add that I was not using guided imagery. All what Elizabeth was sharing was coming from her just patiently attending to the sensations, images and associations that were spontaneously arising from her own inner work. We were near the end of our session and, I found myself imagining her standing in that place of strength and light in her stomach and looking up at her bruised heart. Almost on a whim I shared the image with her and she agreed to try it out. What happened next astounded both of us.

As she imagined moving to that place of light and strength in her stomach and gazing up at her heart, the smile slowly faded from her face. Suddenly she leaned forward and put her face in her hands and started sobbing. When she lifted her face up, she was still crying but there was a smile on her face. She was literally smiling through her tears as she shared, “When I looked up…I saw this red, purple bruised heart... but suddenly, there was white light bursting out of it! Like my heart was showing me, I still have so much love to give!”

As profound as this session was for both of us, I don’t want to suggest that Elizabeth shed all her fears surrounding romantic relationships in one session. But she often referred to that session as significant for restoring her faith in her own ability to love. Since this was a research study, our therapy was limited to 14 sessions. But at the end of that time she was feeling much less anxious, had started to date for the first time in over a year, and instead of ruminating about her ex several times a week shared, "I'm really not thinking about him. If I do, it's almost like thinking about a movie I saw a couple years ago. It's not charged the way it was."

If you would like to read a Philadelphia Inquirer article about the research that this article was based on, which includes an interview with Elizabeth, click here:

If you are more scientifically minded or a therapist yourself, the link below leads to a PDF of an article I wrote for The Journal of Clinical Psychology that describes the research in more detail:

Michael R Bridges, Ph.D. has been a psychologist, professor and therapist for over 30 years. Dr. Bridges’ psychotherapy specialties include depression, trauma and anxiety, job stress and career transition. He has experience working with individuals from diverse backgrounds but currently works with many physicians, health-care professionals, attorneys, business professionals, academics and other therapists who function in demanding work environments. He helps clients do their own inner-work using empirically informed methods derived from Internal Family Systems (IFS) therapy, Emotionally Focused and Cognitive Behavioral Therapies. He can be reached at or 215-868-6393.

1 comment:

  1. A beautiful session, Dr. Michael Bridges, maybe transcendent for the client and most validating for the therapist. Thank you for sharing it with us.