This article is dedicated to fellow psychotherapists, those who daily choose to accompany their clients on the road to healing, to regaining and strengthening mental health.
Address insomnia as an emergency in psychotherapy. Whether you are working on depression, anxiety, stress, trauma, self-image, or a personality disorder, check the quality of the client's sleep, and if insomnia is present, begin intervention with it.
Four arguments are sufficient to support the recommendation to set combating insomnia as the main therapeutic objective, namely:
- As long as the client suffers from insomnia, the prevailing mood is bad mood and exhaustion, with both mental and physical damage. Although functional, he/she is forced to live in survival mode, using the few energies he/she has to satisfy his/her basic needs, to "live" by running the same patterns of thought and action. He/she may have the will to change these patterns, a will backed up by an awareness of the need for change, but he/she does not have the power to make change possible. Success in therapy is about harmonizing "I want" with "I can".
- Out of the need to survive, he/she uses the same few personal resources automatically. The ones that have proven to be life-saving in his/her history and that are activated with a minimum of effort. You know how rich your client is in this respect. How many personal resources he/she has, and if he/she lacks certain resources, you know he/she can create them. Insomnia, by drying up the mind, blocks access to these resources. Thus, the client is either unaware of their presence or associates their activation with effort and waste of energy. Which energy? That which he/she has in minute doses and which the mind dictates he/she must conserve to live. That's why, although you show him/her the way to these resources, you patiently and gently show him/her how he/she could harness them and help him/her, he/she responds with a simple "I know, but..." because he/she doesn't see the benefit of the resource, but perceives the effort it requires to activate it, and he/she has neither the availability nor the energy for this effort.
- For the client with insomnia, the resistance he/she brings to the therapeutic process, which he/she activates in his/her process of change, is more than psychological resistance. It is a survival mechanism for him/her, and its presence is justified by the need to protect, to live, literally. Insomnia forces the client to use up what little energy he/she has. This is why the brain, and therefore the mind, chooses to satisfy the need to survive between the need to survive and the need to function optimally, to be well. The client has little energy and his/her brain is faced with a choice: it directs this energy towards satisfying the basic needs that guarantee his/her survival, i.e. towards change, which is aimed at well-being but does not guarantee it. The resistance identified as a survival mechanism forces him/her to decide in favor of satisfying the needs that guarantee his/her survival, even if this means accepting the bad mood, even normalizing it.
- Insomnia therapy is a short-term process and progress occurs relatively quickly. In any type of intervention, progress is necessary to motivate the client to be available for their healing process, and to support the changes they prescribe. Combating insomnia involves eliminating the exhaustion that turns into overwhelm during the day. Eliminating it helps the client to move closer to the comfort zone, gradually leaving the survival zone, which helps him/her to gradually increase his/her energy level, and optimizing this level, allows the client, under the guidance of the psychotherapist, to discover the multitude of resources at his/her disposal, to have the energy to harness them, to create new resources, and to help himself/herself to eliminate the resistance that sabotages his/her healing process.
In summary, insomnia drains the client, with exhaustion and the associated bad mood constantly accompanying them. Exhaustion leads to extremely low energy levels, forcing the client to direct what little energy they have towards meeting basic needs, living trapped in survival mode. Much of his/her resources are blocked, including their activation, which requires energy consumption. Resistance appears as a mechanism that guarantees that he/she does not lose the current state, because beyond the bad mood, the alternative is perishing, and between living in a bad mood and perishing, the brain chooses... the bad mood.
By combating insomnia, the energy level is optimized, which allows the client to activate the resources at his/her disposal, make the most of them in the therapeutic process, gradually eliminate mental resistance, accept the need for change, assume and sustain it, unblocking and training the mind.
