Xuanxuan: “But I Can’t” | Internal Family Systems Therapy (4)

中文在文章后半部分

This article was originally written in Chinese by Qin Xiaojie (Counselor and Psychotherapist), and later translated into English with DeepSeek, adhering to the author’s original intent and principles of writing about client stories. The case study presented in this article was shared with the client beforehand and published only after obtaining their written informed consent following their review. To maximize the protection of the client's privacy, all personally identifiable information has been thoroughly anonymized, and certain non-essential details have been fictitiously adapted. This article aims to share knowledge of psychology; no case is uniquely correspondent to any specific individual, and readers are advised not to identify with the content personally.

Author: Qin Xiaojie (Psychotherapist)

Time: 2025 Beijing

From Brokenness to Reconstruction

For two years, Xuanxuan and I established a rhythm of face-to-face sessions in the Beijing consulting room. The path of therapy is never a straight line, especially in the beginning; it often felt like taking three steps forward only to take one step back. During the most difficult periods, her depression would intensify so suddenly that she couldn't attend sessions for a whole month. However, it was a comfort to me when she once shared, "My doctor (in the hospital) said that my overall state is better when I'm in therapy with you, and I should keep coming." As a therapist, this feedback felt like a meaningful validation from a fellow professional. 

Yes, our work was indeed progressing, slowly yet tangibly. The frequency of her suicidal ideation decreased, and she was able to maintain basic life and work functioning during depressive episodes. I had been deeply concerned that her periods of depression—which clouded her ability to work—might put her job at risk. Yet, in an increasingly challenging economic environment in China, she reached a point where she almost no longer needed to take mental health leave. She even began attempting financial planning, developing a more realistic sense of money, and her compulsive shopping gradually lessened. These were crucial safeguards for her and her family's livelihood. It was like plugging the biggest leaks in a boat taking on water—only then could it hope to sail steadily again.

"I Know, But I Can't": The Barrier Between Cognition and Behavior

While these improvements were encouraging, a year since we started, progress on some deeper emotional reactions and behavioral patterns seemed to hit a plateau. "I know, but I can't "—this phrase became the central paradox of our work.

In the early stages of our sessions, Cognitive Behavioral Therapy (CBT) was my primary framework. This is a classic "top-down" intervention—from a neuroscience perspective, it works by engaging the cerebral cortex (especially the rational and logical prefrontal cortex) to regulate and manage the limbic system responsible for emotions and memory. CBT is a structured, relatively fast-acting method. It helped us build a stable cognitive and behavior foundation without directly delving into traumatic memories, which was significantly beneficial in the short term.

Image created with the assistance of Deepseek.

But it also has clear limitations (Xiaojie on Cognitive Behavior Therapy: A Therapist's Honest Take).

As therapy progressed, CBT’s marginal effects diminished, particularly for individuals with significant trauma histories. This is because traumatic experiences are primarily encoded in non-verbal somatic sensations and emotional memories, stored mainly within the brain's limbic system, specifically structures like the amygdala and hippocampus. Adjustments based purely on logic and cognition often fail to reach the core of such trauma. This is also why profound psychological reconstruction (healing) ultimately requires repairing trauma rooted in bodily feelings and emotional memory — it needs a different pathway. Experience is the most direct way to ‘converse’ with the psyche at this level.

Experience: a ‘Dialogue’ with the Limbic System

During a period when Xuanxuan was relatively stable, she was able to be ‘productive’ in her various roles as a mom, a wife, and an employee. She described in one session the technique of ‘harsh words’ as self-talk was quite ‘effective’. For some people, a degree of self-discipline is necessary; we need it. But after more than twenty sessions with her, I recognized this as a sign of activated trauma at play.

In that moment, I didn't praise, question, or directly present my analysis of the roots of this pattern. Instead, I summoned (really tried) my own curiosity to better understand her internal process. I invited her to explore it with me—not through logic reasoning, but by attending to the physical sensations and images that arose.

The Felt Sense: A Bit "Woo-woo" Indeed

"Where in your body do these 'harsh words' you just mentioned live?" I asked.

"Here, in my chest," she said, pointing to it.

"What do these words look like?" I asked.

"Like a cassette tape, playing on a loop." She answered.

"Good. Now, imagine taking that tape out of the player. Replace it with a new tape. This new one has recordings of kindness, gratitude, and love." I guided.

She began to frown. Her body grew stiff, her breathing rapid. Sitting across from her, the stagnation I observed resonated with a thick, almost physical, resistance. My body tensed up a little as well. However, I kept my silence, in hope that she just needed a little more time. But unexpectedly, she said, "I can't... I can't put that tape in."

I sat back, the weight of the moment settling on me with the realization of just how arduous this work of trauma repair truly was. This wasn't the only time this happened in our therapy room.

Self-praise was impossible. Many sessions with clients start with their own reflection of their week. One time, after Xuanxuan summarized her week, I noticed her progress. "That's truly wonderful. Before, you'd only realize after placing the order. Now you mention you can put items in the shopping cart first. I believe that's a difficult shift, and you've done really well." Sitting opposite me, it was as if she didn't hear my words. To help her internalize this positive feedback and build her capacity for self-praise, I gently asked if she could repeat the words back to me. Yet, all she could say was, "I was just fulfilling my responsibility." “Still, it’s not an easy progress. Are you proud of yourself, even just a little?” I tried again. “No.” She replied, fast and firm. Can you imagine how that felt for me, sitting across from her? Yes, this was the therapist's countertransference—I felt a flicker of frustration and even impatience.

For between-session therapeutic practices, I suggested she practice self-encouragement: writing down one small success each day and placing it in a jar. Although she expressed willingness, she never followed through. So, during one session, I placed a tea caddy on the table and invited her to write a note and put it in right then. She sat across from me and said, "I can't." We tried a few times; she wouldn't pick up the pen, let alone write or place anything inside. The room grew very quiet. She fell silent, and I allowed myself to sit in that silence, feeling my own confusion and discouragement but not get carried away by them.

My intention was to gently pull her a little up from the bottom of that well. But as we began, I was once again confronted with just how deep that well was, and how arduous the deep layer of healing process truly would be. I needed other tools.

Shared Space, Different Work: Client and Therapist

As the therapist, I stood on the safe shore, equipped with theoretical maps that clearly showed the route to the other side. Like with my other client, Rose, (Rose's Breakthrough | Internal Family Systems Therapy (2)), Xuanxuan was the one in the boat, battered by the towering waves of depressive and manic episodes. Her entire will was focused on clinging to the gunwale, fighting the nausea just to survive. Steering a course was a luxury far beyond her reach.

In my work with Xuanxuan, I repeatedly reviewed and revised her treatment plan with my supervisors in Australia and China, while continually deepening my foundational therapy skills and learning other therapeutic techniques.

I proposed to Xuanxuan that we incorporate more experiential methods into our work. She was willing to try. It was through these experiential approaches, specifically utilizing the core concept of "Parts" from Internal Family Systems (IFS) therapy, that we finally managed to break through the impasse.

The key to unlocking this profound impasse came from an unexpected place: the language of 'Parts' in IFS. In the next article, we'll explore how understanding and empathizing with each piece of herself began a slow, tender process of reassembly.

This article is the second installment in the series about the therapy client Xuanxuan, and fourth article in the series on Internal Family Systems (IFS) Therapy by Qin Xiaojie. For the beginning of Xuanxuan's therapeutic journey and her initial state, please refer to the first article: Xuanxuan's Polarized Life | Internal Family Systems Therapy (3). This article was written in Chinese by the therapist and later translated into English using DeepSeek. It is published with the client's consent, adhering to the author’s original intent and principles of writing about client stories.

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文章由作者秦小杰（心理咨询师，心理治疗师）用中文写作，后经deepseek翻译成英文，秉持：写作初心和来访咨询故事写作原则。 本文中所涉及的个案分享，先发送给来访者，经其阅读后获取书面知情同意后发表。为最大限度保护来访者隐私，所有个人识别信息再进行深度匿名化处理，并已对部分非核心情节进行虚构改编。本文旨在分享心理学知识，任何案例均不具备唯一对应性，请勿对号入座。

作者：秦小杰 (心理治疗师，心理咨询师)

时间：2025年北京

裂痕中的微光：在破碎与重建之间

两年间，我与璇璇在北京的咨询室里，建立起一种有节奏的面对面工作关系。咨询的轨迹从来不是一条直线，尤其在初期，常常是走三步、退一步。最艰难时，她会因抑郁突然加剧而整月咨询也没来。然而，令我欣慰的是，有一次她告诉我：“医生说，我在你这里做咨询的时候，整个人的状态要好一些，让我坚持来。” 作为一名咨询师，这是来自同行的，我最珍视的肯定。

是的，我们的工作确实在缓慢而真实地推进。她的自杀意念出现的频率降低了，在抑郁期也能维持基本的生活与工作功能。在日益严峻的中国经济环境下，我曾深深担忧她因无法履行工作职责而失业，经过心理咨询，她几乎不再需要请心理精神科病假；她甚至开始尝试财务规划，对金钱有了更真实的感知，购物行为也逐渐减少。这对她和家人的生活是至关重要的保障。这就像一艘漏水的船，先堵上最大的漏洞，才可能继续平稳航行。

“我知道，但我做不到”：横亘在认知与行为之间的壁垒

这些改善都可喜可贺，但一些更深层的情绪反应和行为模式的改善，咨询在一年多后，似乎进入了平台期。“我知道，但我做不到”——这句话成为我们工作中最大的悖论。

在我们合作初期，认知行为疗法(CBT)是我使用的主要框架。这是一种典型的“自上而下”的干预——从神经科学的角度看，即是通过调动大脑皮层（尤其是负责理性与逻辑的“前额叶”）来调节和管理负责情绪和记忆的边缘系统。CBT是一种结构化、见效相对迅速的方法，它帮助我们在不直接深入创伤记忆的情况下，先建立起稳定的认知基础和行为修缮，这在短期内收益显著。

但它也有着明显的局限（心理咨询师的坦白局：跟认知行为治疗的那几年) 。

随着咨询的进展，CBT边际效应递减，特别是一部分经历过较多创伤的群体，因为创伤体验主要被编码在非语言的躯体感受和情绪记忆中时，主要存储于大脑的“边缘系统”，尤其是其中的“杏仁核”和“海马体”，仅凭逻辑认知的调整，往往难以触及核心。这也是为什么，深层次的心重建，实际是在更深层的、根植于躯体感受与情绪记忆的创伤修复，它需要不同的路径去触及——体验，则是一种最直接跟这个层次进行心灵对话的方式。

体验：是大脑边缘系统的对话方式

在她状态相对稳定的一段时期，某次会谈中，我们回顾她近期的自我管理方式。她描述自己如何用尖锐的、近乎惩罚性的内在语言不断驱策自己前行。从表面上看，这种自我鞭策仿佛是一种高度自律；对许多人而言，适度的自我要求也确是功能良好的表现。但与她工作二十余次积累的直觉告诉我，这并非普通的自律——这是一种创伤被激活的生存状态。

那一刻，我没有称赞或质疑她，也没有直接分析这些模式背后的成因。我调整了自己，从好奇的角度出发，邀请她再次体验这个过程，并同时分享给我。

体验：是有点“神叨叨”的

“你刚刚说的‘这些刻薄的话’，在身体哪里住着？”我问。

“在胸口这里。”她指着自己的胸口。

“这些话长的样子是什么？”我问。

“像一盘磁带，一直在播放。”她回答到。

“很好。现在，想象你把这盘磁带从播放器里取出来。换一盘磁带，这个新的磁带上，都是温柔、感激和带着爱的录音。”我引导到。

她开始皱眉头，身体变得僵硬，呼吸急促。我在对面能感受到那种卡顿的状态，也将我的气一下叼了起来。那一刻，我选择了乐观，保持着沉默，相信她的内心只是需要一些时间。但出乎意料的是，她说：“我做不到…这个磁带放不进去。”

当时，引导她更换磁带的初衷，是想帮她从这口深井里往上拉一点。但她内心某个沉重的部分却将她牢牢钉在原地，这让我再次真切体会到，这场心灵救援的工程是何等艰难。

这种情况不止一次的在我们的咨询室里发生。

我跟来访的咨询，常会以他们回顾当周的生活工作开始。一次，璇璇总结了下她一周的生活工作状态，我看到了她的进步。“真棒，以前你都下完单了才反应过来。今天你提到，你现在可以先把东西放到购物框里了，我相信这是很难的一个转变，你做的很好。”她坐在对面，仿佛听不到我说的话，为了增强她自我赞美的能力。我请她复述我讲的肯定，她却只能说：“我只是尽到了责任而已。”“这也是很不容易的事情，你有没有一丝的自豪？”我再次尝试。“没有。”她快速而坚定的回答到。你可以想象坐在对面的我是何种心情吗？是的，这是咨询师的反移情——我不理解为何复述会如此困难，甚至感到些许沮丧和不耐烦。

我也给她布置过“作业”进行自我鼓励：将每天做好的小事写下来放入罐中。尽管她表示愿意尝试，却从未完成。于是有一次，我在咨询中直接放置了一个茶叶罐，邀请她当场写下一张纸条放入。她坐在对面，说：“我做不到”。我们尝试了几次，她都不拿笔，我写字，更别提往里放了。咨询室里，变得很安静，她不讲话，我也允许自己在不语中感受自己的困惑和沮丧。

每次我使劲把璇璇往上拉时，她内心有一个部分都用绝对力量保持这原地不动。在这几幕场景中，我都在跟一个“严厉的监督者”交锋（一个战略性的失误），并且屡战屡败。这个部分并非理性的自我管理，而是她在童年为应对一个有家庭暴力的环境，所分裂出的一个保护部分，此刻正被熟悉的压力再次唤醒。深层次的疗愈的过程是多么的艰巨（要看到心理咨询工作的效果，必须我和璇璇初次碰面时，那种支离破碎的状态为起点，请先阅读：来访旋旋：高功能外表下的双相风暴与咨询困局｜内在家庭系统治疗（3)），我应该需要用别的工具。

同在一个空间：咨询师和来访的体验和功课并不同

我，做为一名咨询师，站在安全的岸上，凭借理论地图，能清晰地指出去往彼岸的航线。跟我的另一位来访蕊芬一样，在黑暗中，她看不到路（来访蕊芬：从黑暗到光明的意向转变）。而旋旋，她是那艘在情绪惊涛骇浪中几近倾覆的小船的亲历者，抑郁期和躁狂期的巨浪一次次将她淹没，她的全部意志都用于紧抓船舷、对抗呕吐感以求生存，无力奢谈航向。

跟璇璇的咨询，我多次跟我澳洲的督导师、国内的督导都复盘修改她的咨询方案，并且不断加深自己的咨询基础技能和其他咨询技巧的学习。逐渐的，我跟璇璇提议，之后用更多体验的方式工作，她愿意尝试。而这种体验方式，我就使用了“内在家庭治疗（IFS)” 的最核心的“部分”得意突破瓶颈，下一篇章，我会详细阐述。

此文是“来访璇璇咨询故事”的第二篇，为“内在家庭系统治疗（IFS）文章系列-秦小杰著”的第四篇。璇璇的咨询起点以及状态请见第一篇，来访旋旋：高功能外表下的双相风暴与咨询困局｜内在家庭系统治疗（3）。作者用中文写作，后经Deepseek翻译成英文。经来访同意后发表，秉持咨询故事写作初心的原则。