Counselling, Psychotherapy, Ways of Being, The Inner World, Spirituality, Reflective Practice, Religion

On falling off bikes 2

crashed cyclistPart one of this blog was simply some autobiography about my cycling career. In this  second part I want to think about some of the crashes my patients have had and survived. When my patient implied that I was either mad or brave to continue cycling, it struck me that coming into therapy is much the same. One is seen as either mad or brave. In reality one is neither. At best there is a curiosity about being me. At worst we have therapy because our life is unravelling and we must do something to stop it. Sometimes, of course, the process of therapy feels cruel. One of my patients came to me from another therapist. They wanted a “top up”. (The therapeutic equivalent of proof reading their work?) It quickly became apparent that this patient had many more issues than had come to light in their previous therapy. Our initial sessions were hard on my patient. The story that they thought fitted their life no longer worked. We explored many areas that had not previously been examined. One consequence of this was that they had to rethink who they were.  There have been times when we both wondered if I was being cruel or kind. Should I have left them with the story they had constructed? (My patient’s answer was “No. I want a real story. One that is honest.”) This is where courage is shown. Riding my bike after a crash is not a very big deal. Being willing to trust one’s therapist enough to do the work is a big deal.

I remember another patient who had come out of the Army after 20 years. He found civilian life dull and wanted to go into close protection work. His wife was deeply unhappy about this and their marriage was suffering. We had an initial session where I pointed out that he had both a wife and a mistress- the mistress being the Army. I suggested that he now had to make a choice. He disagreed strongly. He came back the next week saying he had talked things through with his wife who agreed with me. He went on to tell me that he had applied for a civilian job at the local Army camp and was no longer going to do his close protection work. The two sessions were enough. This took a huge amount of courage. Having spent 20 years and more in the Army, to leave it behind was an act of bravery comparable to that which he had shown in the field.

Others are less able or willing to show that kind of courage. I remember one of my patents who had had a succession of marriages and had had affairs throughout. He came wanting to think about his current relationship with a woman who was the love of his life. I asked if he was able to be faithful to her. A very long silence ensued. “No.” he said. “I have not been faithful to her.” I tried to explore why this was the case but he did not want to think about this. He  left after that session and did not return. (Men, in particular, show an odd correlation between success in business and success in their emotional life. I have met a number of very successful business men who have done very well in their field. They have expensive houses, wear well cut suits, have expensive toys etc. but their inner world is empty.)

I suppose that getting back on my bike and riding it took some courage. But coming week after week to see one’s therapist takes another kind of courage. I’ve written before about my poor map reading skills and my capacity for getting lost. (As I get older I panic more easily. As a young man in my 20′s I drove anywhere quite happily. If I got lost, so be it. I’d ask the way. These days I need more certainty.) I do  not want to sound like some Thought for the Day speaker who draws parallels between buying a new car and being Saved. But the metaphor of  journeying- riding, taking risks, exploring, falling off and so on-is a good one for the therapeutic journey.

 

 

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Madness, Mindfullness, The Inner World, Ways of Being

On falling off bikes

crashed cyclist

One of my patients who reads my blogs was asking about my piece on Identity. I had spoken of how pleased I am to be back on a bike. That being a cyclist is an important part of my identity. And I suppose I draw a distinction between being somebody who can ride a bike and somebody who enjoys all the challenges of riding.Which includes coming back from an injury. My last accident has taken me about two years to recover from psychologically. I am now back to 90% of my emotional fitness. There are times when I have to manage my anxiety very actively. If I am going down a steep hill I use my brakes more now than before my crash. But I never could simply put my feet on the handlebars and allow the bike to take me down a 1 in 3 slope.So not much has really changed. My patient’s question took me by surprise because I don’t see cycling as inherently dangerous. I have been riding for 20 years, Ten of those riding into south London twice a day.

I began trying to get to work by car and discovered how pointless it was. I sat in a traffic jam from Woolwich to Camberwell, listening to the time checks come and go on the radio and fuming at everyone and everything. When I arrived at work I had to spend another fifteen minutes driving around trying to find a parking space. I dumped the car and brought a motorbike. A small 125. I have never in my life ridden a motorbike. I had to ask a friend to ride it home for me, so little did I know. I spent some time over a weekend learning the basics. How to start. Stop. Change gear. that was it! My first proper ride was on a Monday morning riding from Woolwich to Camberwell at six in the morning. Then coming back again at three in the afternoon. This lasted until the next Friday evening. I was almost home when the car in front of me stopped unexpectedly. So did I. Via his boot! (I think I broke my collar-bone in the crash.) I sold the motor bike that weekend and soon after brought a push bike. A very useful mountain bike- a Rockhopper Comp. Thereafter I cycled into work for nearly ten years along with a posse of other riders all dodging through the traffic and swearing loudly at our common enemy the motorist. On the whole it was fun. (Perhaps a small part of the pleasure was the adrenaline rush of choosing the best route through the traffic. Of gauging if it was safe to jump these lights or not. Of trying to shave off two minutes from my previous ride time.)

That is a brief history of my cycling career. Every cyclist will recognise it. Any non cyclist will wonder if we are all quite mad-as I  think my patent did. The best answer I could give him on the day of his question was “I don’t want my world to be circumscribed by fear. I do not want my world to shrink because I had a cycling accident.” I still think that is a good answer. There are many things that worry me. Computers worry me. Getting lost in strange cities worries me. The way that nursing is practiced worries me. Our blame culture worries me. But cycling? I’m King of the Road!!

 

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Counselling, Reflective Practice, The Inner World, Ways of Being

A good enough mother

good enough mother

I have been thinking a good deal this week about mothers-both real and “as-if”. I remember reading that over protective parents produce accident prone children. Presumably because more confident parents allow their children to take healthy risks. Arthur Ransome’s quote fits here “Better drowned than duffers. If not duffers won’t drown.” I also like Winnicott’s idea of the “good enough” mother. Presumably one who trusts herself and her children sufficiently to allow them to negotiate their world in their own terms.

The image above is that of a Tiger mother, the mother who ferociously pushes  her child to achieve- and not simply to achieve, but to excel. (The complete opposite of a Winnicottian mother.)  The reason I chose it was rather different. For me it represents the child who can face down their tigers. The child who has been given a good enough start to have a strong sense of their self worth.

A friend has started a blog about leadership. He writes well. You can find him on Twitter @AndrewGBale. The blog I am going to mention is “The Leadership Parable”. In this piece Andrew talks about three levels of leadership. Level one leadership, he suggests, is where nothing goes wrong, but nothing very exciting or different ever happens. Level two leaders are those  who “… when you look back at their areas of responsibility in a few months, have found faster and better ways of doing what they do.”  Then there are those rare creatures who have attained Level three leadership skills. These are those people who “… are able to look beyond what is being done and can see a better vision. A way of achieving transformations in their teams to not only achieve the same things better, but to deliver qualitatively improved results.”

I read his comments and smiled, thinking “How interesting. Very perceptive. Good blog.” And moved on. I am not a manager. Nor, mostly, a leader-although I try to lead my students in my lectures. I am a clinician. So my task is to enable. To facilitate. To enquire. But not to lead. Then I came back to Andrew’s comments and reconsidered them as hall marks of good clinicians. Or good mothers. Or good organisations. I have seen endless nurses* who fit into the level one tier. Nobody dies on their shift. There are few drug errors. Notes are written up on time. Ward rounds are conducted perfectly well. But there is no passion for their work. They do not sit and wonder about what patient A’s voices might mean to them. Then there are level two nurses*. These find quicker ways of organising patient’s notes. Their ward rounds are over quicker. The drug round runs smoothly. PRN medication is always available. Drug charts always written up clearly and neatly. But there is a tendency to see patients as product. They are there to be managed. Ably and competently. But managed.  Level three clinicians are, indeed, rare. These are the one’s whose notes are written -but not in Copperplate. Their care plans are simple. “I will meet C three times a week for 30 minutes.” Their ward rounds will go on because they want to be the best advocate they can be for their patients. They insist on the patient’s voice being heard. They will worry about their patients. they will ask awkward questions. And carry on asking until they get an answer that “fits.” If I’m ever a patient, I know who I want looking after me!

I think good enough mothers are level three mothers. Not in a super ego driven way. Not in a Tiger mother way. But in a way that is genuinely interested in their children. (And in the same way that the word “nurse” stands for any clinician, so “Mother” stands for anyone who has a parenting role. A good enough parent wants the best for their children. Is secure enough in herself to let her children play and explore-although this may not always be “safe”. (I remember talking with a patient who had come to see me because of his anxiety was crippling him. His wife had similar issues. They had just had a baby and this was raising their anxiety levels sky high. He said that his wife was very stressed and trying hard to be a proper mother. I mentioned Winnicott’s maxim to him. “Oh Yes. She’s trying so hard to be a ‘ good enough’ mother.” I felt so sad for her. The whole point of Winnicott’s comment is to take the pressure off mothers. “Good enough” is good enough.

My experience of the NHS, Education, Social Work and all allied professions is that it is peopled by individuals who are Tiger driven. Everything they do is fuelled by  a fear of “What will Tiger say if I do this?”  The rapacious Tiger has eaten the Good enough mother. The result seems to be organisations lead by orphans. But orphans who have been duped into believing that Tiger is truly their mother. I think this piece by Brian Patten says all that I been trying to say. It is his piece ProsePoem towards a definition of itself. I think he would be a Winnicottian mother, not a Tiger mother.

 

http://www.all-day-breakfast.com/cannam/poem.html‎

 

*For “nurses” substitute your own profession. The categories are quite flexible.

 

 

 

 

 

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Counselling, The Inner World, Ways of Being

Never let me go?

held by anklesI remember hearing a story by the psychiatrist  R.D.Laing. He recounted an incident where a mother who lived in a multi storey tower block held her young child by his ankles over the balcony. She said to him “See how much I love you. I don’t let you go.” Laing did not comment on what the child made of this! It seems an odd way to demonstrate love. I wonder if the mother wasn’t trying to reassure herself of her love for the child.”See how much I love him. I don’t let him go.” We might wonder to whom she was speaking. Certainly not to anyone who gave her much self esteem. The  imaginary listener sounds very persecutory. And in continual need of being soothed and mollified. It also seems likely that the child’s mother would dearly have liked to drop her accuser from a great height. We can only marvel at the murderous rage she must have spent her life containing. We don’t know what lead this mother to this desperate act. Whatever it was, one hopes she got the help and support she badly needed.

If this mother was referred to psychiatric services today, she would  be Risk assessed to within an inch of her life. Her child would be put on the At Risk register and she would no doubt get lots of visits from Social Services. She might be referred to Parenting classes. She might, even,be offered 6-8 sessions of CBT with a psychology graduate who had read the relevant chapter the night before. (But who had little or no idea about her own neediness. Or Vulnerability. Or Inner world in general.)

In his novel Never Let Me Go, one of Ishiguro’s characters asks “Poor creatures. What did we do to you? With all our schemes and plans?”  This woman might ask the same question. “What did you do to me, with all your schemes and plans?” (Actually, she might better ask “What did you do for me, with all your schemes and plans?” ) One of my favourite writers is Joseph Berke, a psychoanalyst a who is (or certainly was) director of the Arbours Crisis Centre in London. In his paper The Right to be at Risk he comments on this tool called a Risk Assessment. He says very many things of which I thoroughly approve. But, regarding Risk assessments he says “… risk has now become an additional diagnosis. While the ‘Risk Register’ has become a new form of hospital file or pathological or criminal categorisation.” He continues “… diagnoses are not linked with context… we see the decontexualisation of life.”

To return to the Laingian mother, who will spend the time with her to understand what it was she was asking for?  Will anyone be willing or able to listen to her?  To hear her own story and to understand what it was she was asking by her actions? It is much  more likely that she will receive a diagnosis of Personality Disorder- the most damning diagnosis it is possible to be given. It guarantees one will always be pathologised. And, as a consequence nearly all actions, thoughts and behaviours will be dismissed  as Attention seeking. The two go hand in hand. A “P.D.” is, by definition, “attention seeking”. (Curiously, nobody stops to ask why they might want some attention!)

Berke ends his paper with these points:

De-patholgise Risk. Avoid Labelling and categorisation.

Re-contextualise the risk. Containing relationships are an essential part of this process.

Soak up projections. Digest them. Don’t pass them back to the person struggling with difficult impulses or feelings.

Encourage benign introjections.

Post Script

As I was writing this blog, I realised it is Mothers Day in the UK. And that I am not writing a piece about flowers, butterflies, chocolates and the like. I am also aware that this is a more than averagely technical blog.  I apologise for these sins of omission and commission but hope that there are still enough good things here for everyone to gain something nourishing.

 

 

 

 

 

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Madness, Psychosis, Reflective Practice, Religion, Spirituality, The Inner World, Ways of Being

Bits of myself part 3

penny farthingIf you are still reading, thank you. This is the final part of the trilogy. (Shorter than “Hobbit” although with fewer special effects!) I have  been writing about identity. Or should that be Identity as a proper noun. I think it should be. A proper noun “refers to a unique identity” according to Wikipedia.” Identity” certainly refers to a unique identity. One of my favourite scenes is in The Crucible where John Proctor will not put his name to his false confession. When asked why, he cries “It is my name! Because I cannot have another in my life!” Whenever I hear that line, I never know whether I want to cheer or cry. Or both. It moves me beyond words. Proctor is a man who is aware of his identity.He knows he committed adultery. He is under no illusions about who he is. But he is desperately trying to make reparation. His identity is that of an ordinary man. He is no saint. But Salem seems unable to live with ambiguity or ambivalence. (Which might take us back to  Saint Paul, struggling with being human and all that implies.)

I have always been fascinated by the concerts in Auschwitz. The guards would listen to the prisoners playing beautiful music. And then send them to the gas chambers. Then go home to their wives and families. Play with their children. Pet their dogs. And so on. And repeat the same behaviour tomorrow. I assume that the guards in Guantanamo do the same. Or those who water-board prisoners in the name of National Security. My point being that we are very skilled at separating off parts of our identity.I can happily torture people because my life “”is hid with Obama in America in Guantanamo bay”.

The work of therapy, as Freud pointed out, is not to make us happy. But to make the unconscious, conscious. Thus part of the work of therapy might be to allow the Auschwitz guard to understand what the “Other” means to him. What it so terrifying about this Other that it must be destroyed? To allow the psychiatric nurse to understand what part of themselves might be being secluded? To let John Proctor think about the meaning of his affair with Abigail.

This blog has been about Identity. I have put in a link to a song from my adolescence. It is by The Dave Clark Five. Listening to it again I’m struck by its energy. And its musical naivety. But the lyrics apply to our inner life as well as our outer life.

Here is the Dave Clark Five link. Despite its naivety, it still sounds brilliant. At least to me.

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Counselling, Religion, Schizophrenia, Spirituality, The Inner World, Ways of Being

Bits of myself part 2

penny farthingThis follows my earlier thoughts and takes the idea of identity a bit further. I wrote earlier how much getting back to cycling has allowed me to regain a part of  myself that I thought I had had to give up. If I saw  cyclist out on a ride I felt guilty, sad and annoyed. Why wasn’t I out there? (I even tried a session of hypnosis to overcome my anxiety. I don’t think it worked-unless it was a particularly slow release style, taking a year to achieve something.) One serious test will come tomorrow when I do a 75 mile charity ride around the Chilterns. (Hence blogging today!)

I have had several conversations with my patients about identity. How parents who divorce can mean important stories get lost. Similarly when parents die, all sorts of bits of us die with them. They are no longer here to be able to ask “What happened when…?” One patient put it that it was like having a jigsaw puzzle that would forever remain incomplete. But unlike a game, this puzzle was their life story which was incomplete. So the work of mourning the death of parents is a doubled piece of work. Part of my past is gone. As is part of my future. Both feel lost.”In my beginning is my end… in my end is my beginning” wrote Eliot.

Another patient comes into my room but feels permanently absent. I find myself puzzled about where their real life is lived. (I don’t think they know the answer.) Much of our work together seems to be about “real making”. Yeats spoke of seeing “…in all poor foolish things that only live a day, Eternal beauty wandering on her way.” My patient reminds  me of this line. So  much of what is presented in the room consists of “poor foolish things that only live a day”. Or that is how my patient regards themselves and their material. The work is, I think, to allow them to find Eternal beauty. Something robust, valued and sure.

I have spoken before of my roots in Evangelical Christianity. I remember many texts, lines and thoughts from the bible. Some helpful, some less so. A conversation with one my patients recently reminded of a comment made by Saint Paul. He is writing to the church in Collosse and tells them ” For ye are dead and your life is hid with Christ in God.” (Coll.3:3) For more years than I want to remember this was held up as a statement of True spirituality. Paul makes a similar statement in Galatians “I have been crucified with Christ; and it is no longer I who live, but Christ lives in me…” (Gal.2:20) As a good believer I tried to think myself into this position. “Not I, but Christ.” It was hard work. I kept on getting in the way! Following a session with one of my patients I found myself re-visiting these thoughts from Saint Paul. I discovered that I was annoyed with the apostle. “He’s hiding” I realised. “He doesn’t much like or know the person he is. His life is at least three times removed. There is Paul. Whose life is hidden in Christ. Who in turn is hidden in the Trinity. The most floridly psychotic schizophrenic could not be much more cut off from himself. Therapeutic with Paul around his self image and self value would be fascinating. Very hard work. Infuriating. Exasperating. But fascinating. I think the work would take a long time…

I stil have more to write and am aware that 500 words makes for comfortable reading. Much more and patience begins to wane. So, I’ll write part 3 in a little while. If anyone is still reading!

 

 

 

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The Inner World, Ways of Being

Bits of myself Part 1

penny farthingFor many years I have defined myself as a cyclist. That’s not the whole of me, but it has always been important. It gives me exercise, makes friends, allows me to go exploring. And even if I get lost, I seem to panic much less on a bike. I’ll find a signpost that reads “Aylesbury 20 miles” and think “Drat! Should have turned left back at that junction. Hey! Ho! Another hour of riding.” And off I set. This was what I did until about two years ago when I had a serious accident. Fortunately I was out with my club or else I might not be writing this piece. I came into a left hand bend where the camber dropped to the right. I panicked, thinking I was going to drift out into the face of any oncoming traffic. So I braked. Hard. Which with disc brakes is not good. I recovered about 10 minutes later, sitting shivering on the roadside with my friends anxiously looking after me. I tried to move and found that this was not sensible. I had broken my wrist in three places and also my hip. I was not going anywhere very fast! An ambulance came and took me to our local hospital. The ambulance crew were great as were my club mates. (I had the mixed joys of being given Gas and Air in the ambulance. In the end I chose the pain as the lesser of two evils!) I was repaired and left hospital-prematurely! My physical recovery took some months but with excellent physio help and a large dose of bloody mindedness, I got back to reasonable mobility. After a year I could go to the gym and train again with minimal pain. But cycling outside on a real bike terrified me. i still remember riding a few miles to work, fighting the urge to vomit and trying to not mind the churning anxiety in my stomach. I did ride in a few times but eventually found excuses to take the car.

This year I am back on the road. I am doing a 75 mile ride on Sunday and have ridden around the county on some long forgotten routes. Not quite 75 miles but some rides nonetheless. (I’d offer to blog about it on Sunday but suspect that won’t happen!) I am still slightly nervous about riding but it no longer cripples me. i want to ride. I can rise. (I thought I’d typed “ride” but “rise” fits just as well!) I am so pleased! If this was a cycling blog, I’d probably finish here. Pleased with myself and promising to upgrade you on my performances throughout the coming season.This is not a cycling blog, however. It is a counselling blog-sort of! (Psychoanalytic thinking about things that interest me, as the blurb says.)

So, I want to think about identity…which I will do in part 2 of this piece.

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