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

Not paying attention

lil-liza-jane

The song above is a simple folk song. I’ve listened to Pete Seeger singing it since I was a young teenager. His is the version I have in my head. I sang it in my singing lesson this week. And sang the version I knew. Which is subtly different to the original version. So my teacher played the version she had in front of her, following the notes on the page. I sang the version in my head. And so we kept on getting slightly out of sync. Like tripping over an uneven paving stone. It wasn’t enough to send me flying. But enough to put me off-balance. It spoiled the rhythm of the song. After a few run throughs I sang the song we had in front of us and we were in harmony.

I don’t read music so when I’m having a singing lesson I’m dependent on accurately mimicking the sound my teacher makes. Which works well most of the time. I gather that even if I could sight-read I would need a few goes before I was accurately singing the notes on the page. Even then there is a good deal of room for interpretation.One can leave more or less time between notes. Or linger over one phrase slightly longer than another. All these small changes mean that my version of L’ll Liza Jane can be subtly different to another version. But before I can make changes, I need to know the original.

When I’m teaching students about different states of being, I’m always surprised by their superficial responses. (I mean no criticism! They are still learning their trade and will need to keep very strictly to the script in front of them. Walking before they can run. But an experienced therapist can improvise quickly because we have learned our tunes a long time ago.) I remember an encounter with a patient many years ago. She was a young woman who was admitted to an acute admission ward. We  were all told that she was sexually disinhibited. So, men, protect yourselves! None of us asked what being sexually disinhibited meant. Nor how did anyone know. We accepted the information unquestioningly. She was also thought to be a suicide risk so she had to have a nurse following her at all times. (Again, nobody asked her if she was going to kill herself. We got on with following the tune as we had heard it.)

On one shift I was following her. (The technical term is “specialling”. How ironic!) She went into the woman’s dormitory. I panicked. What should I do? I didn’t want to be alone with her in such a dangerous place. Who could tell what might happen? Equallly I wasn’t allowed to not keep her within arm’s reach. In the end I followed her to the dormitory but lounged against a wall well out of her reach. She left her bed area and went to leave. As she did she turned to me. Kissed me gently on the cheek. Stepped back and said “That’s to teach you not to be afraid of me, Terry.” I learned more in that encounter than in many years of training before or since!

“So,how to bring together words and music? Nurses, along with many other health care staff, are given a lot on information about patients. Some of it is official. “Mabel has an ingrowing toe nail which needs removing”. Much of it unofficial. “She’s an old cow, that one. Watch yourself.” Or “He’s a real sweety.” One’s care is determined much more by the unofficial story than the official one. We are given a particular version of a person’s song and too often fail to check out their version of their song.

In therapy, the risk is as large. My patient begins to sing their song. I listen for a few bars and “know” how the rest of the song goes. I’ve heard this song lots of time before. The danger is that the patient wants to change the last few notes. To put an emphasis on this word or phrase not that one. This changes the entire meaning of the song.(It is, after all, your song to do with as you wish!)  It is a simple song. Deceptively so…

 

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Borderline States, Counselling, Psychoanalysis, Psychotherapy, Reflective Practice, The Inner World, Ways of Being

Dead Man Walking

dead-man-walkingThis is a rather dramatic image for what I am writing about-but it is the best description I can find. No, I am not dying. I have not received a diagnosis that I have a terminal illness. I am between jobs. I am leaving university and going back into practice (assuming my CRB check is ever completed)! Not a major trauma but it is an interesting place to be. I am a ghost. I walked back into my office after two and a half months away and nobody said a word. I walked through the doors, passed several of my colleagues and sat down at my deal. I now knew what a ghost feels like. I thought I was real but it seemed as though I had become invisible in my absence. (In fairness several of my colleagues came and gave me a hug as the morning went on. Which made me feel a bit more real.) But it was an odd experience and a little unnerving. Had anyone noticed that I had been away? Did anyone care? Should I turn round and go home again? Since nobody seemed to see me I couldn’t be missed.

Since telling people that I am leaving, my relationship with the university has changed. There is no point in asking about next semester’s teaching. I won’t be there. I don’t need to worry about my timetable. I won’t be there. Sadly there are relationships that I shall lose. I shan’t be there .The people who have looked after me during my time there and who are important to me.(And vice versa) Equally strange is my lack of involvement in my new job. I don’t know how big my caseload will be. I don’t know which surgeries I will belong to-if that’s the ways things still work.It is an uncomfortable situation with so many elements beyond my control. Yet they impinge on my daily life in a significant way. I simply have to stay with the discomfort and occupy myself usefully.

I begin to see how it feels psychically to be in limbo. The work that I do is often with people who are struggling with existential issues. There may be some depression. Some anxiety. Some issues with anger. But these are not the core problems. The core issue is “Who am I? How do I live? What is it that defines me?” These questions may be triggered by relationship difficulties. Or problems at work. But they are existential dilemmas. I remember a patient many years ago who was part of a group a friend and I ran. We used projective techniques to help our patients find new ways to explore their inner lives. We did a series of sessions on masks. The mask we present to the outside world. The mask we show at home. (Fairy tales lend themselves very well to this kind of work. We used Little Red Ridng Hood.We thought about the woodsman as both Eco warrior , defender of the forest but also hardman who hated his work. Two faces of the one person.) After one session I called in to see her. She talked about a recent dream in which she saw herself as faceless. We explored it a little bit and decided one meaning was her own passivity. She had  been a “patient” for so long that she had lost any other identity. She spent most of her day sitting in her armchair either sleeping or watching TV. .She relied on the system to do everything for her. Provide financial support. Diagnose and manage her mental health.Provide her with a limited social life. She had lost touch with the healthy parts of herself that might have galvanised her into more self care. She had become faceless.

She occupied a limbo land. She had lost her past self. A husband. A daughter. Parents etc who needed her. Who gave her a reason to get up in the morning and have some purpose in life. Equally she was not so terribly ill that she needed permanent hospitalisation. She existed in two worlds, with no real investment in either of them.In Kleinian terms she lacked good objects inside her. What she had was a rather flaccid breast that was almost incapable of providing any nourishment. Yet like Harlow’s monkey’s, no matter how unsatisfactory this breast-mother was, she feared it was the best she could hope for. Thus she clung to it tenaciously.

A lot of my work as a counsellor is about helping my patients to find a face that belongs to them. To strengthen the healthy parts of them that will enable them to make their own claim on their future.  I have always found the phrase “Dead Man Walking” utterly cruel and humiliating. It denies hope and smacks too much of a demeaning power game by the system. The person’s humanity is lost. They are only a dead man walking.The film “Bucket List” may have sen about two dead men walking. But they walked outrageously. That was what was missing for my faceless patent .She walked like a zombie. There was no outrage.It is one of the pleasures of clinical work to see a patient leave “outrageously”

My university has set itself what it calls “an outrageous ambition”. It hopes to become on par with the Russell Group of universities .Who knows if it will succeed or not? But it does have an ambition. It is alive. Perhaps that should have been the image at the top of this blog. “Outrageous ambition”. (If I was clever I would find a way to place them adjacent to each other. I shall learn that trick another day. But I think I make my point. Even dead men need an ambition.

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

Out on the edge

Brum cathedral glass I was in Birmingham Cathedral recently and was looking at the stained glass window made by Edward Burne-Jones. In particular the East window which depicts the Ascended Christ. Mostly  I am not an enthusiast of stained glass windows although there are exceptions. (The glass in Coventry Cathedral is beautiful. As is the glass in the Gaudi cathedral in Barcelona.) I spent about ten minutes looking at the window. Enjoying a sit down and just allowing myself to look at the glass in a “mindful” way. (Simply, I allowed myself to experience the window and its context without letting my prejudices get in the way.) I saw the figure of the risen Christ first. He occupies central stage in Burne-Jones’ window. Apparently he is looking down on humanity with compassion. He is surrounded by angels who hold their hands in gestures of prayer or praise. After about ten minutes I noticed a figure on the far left of the portrait (The left if one is looking  up at the image from the floor.) I have no idea who he or she is. I thought of her as female although this gender is neutral. I was shocked by how long it had taken me to see her. My gaze was caught up by the Christ figure who occupies central stage. Yet he needs his companions to give him shape and meaning -certainly in terms of the balance of the window.

That a central, powerful figure commands our attention is not news. We see it every day in a classroom. A workplace. A hospital ward. The obvious individual gets noticed. As  counsellor part of my work is to see the marginal figures in my patients’ characters. I read a piece recently called “The parts of me I don’t want you to see”. This , of course, is true of the therapist as well as his patients! We are able to hide some parts of ourselves by keeping to strict boundaries. But our patients find us out sooner or later. In the same way that the classic Freudian slip is viewed as an unconscious communication, so we do the same. By our time keeping; our billing; our diary keeping. We show our marginal selves.Which if we can allow this, can enrich the work. I remember being late for an appointment and talking to my patient about this .The response was “So you’re not perfect after all!” I had been put on a pedestal as some kind of perfect therapist. My lateness challenged that view! A good deal of helpful work came out of this error in my timekeeping.

I clearly remember a moment in my own analysis when one of my hidden parts came into view. I knew that my analyst had two daughters. One day I was going to my appointment when a young man came out in his running kit. I mentioned this in my session and commented on his enthusiasm considering that it was pouring down with rain. I said that I assumed it was her son, since  he had come out of their house. The discussion about who he might be and my responses to him opened up a whole area of conflict that provided work for a  long number of sessions. More importantly it allowed me to work on an area of great difficulty  and to be able to move on. His appearance triggered a whole “hidden” part of me. I knew it was there but, like Burne-Jones’ Christ, I was preoccupied with the foreground.

I have had similar experiences with my patients. A chance question takes us into whole areas of previously unexplored territory. We are introduced to family members who have been banished to the margins for a very long time.Yet they form part of the balance  of my patients lives. As a child I used to lie in bed trying to see what I couldn’t see. Or that was how I characterised it! I was aware that there were things on the outer limits of my perception that I knew were there. But I couldn’t name them. I was always struggling to bring them into focus. Then they would be in my range of vision and I would know what they were doing. This is the work of therapy. To bring into our vision those things that are on the periphery. “To make conscious the unconscious” as Freud put it

I now look more closely at stained glass windows. I look for the squirrel hidden in a Saint’s cloak. Or a halo on an angel that is a little lopsided. The old proverb says that the Devil is in the detail. I think that’s unfair. Lots of fascinating life affirming things are also in the detail.

 

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Counselling, Madness, Psychoanalysis, Psychosis, Psychotherapy, Reflective Practice, Religion, Schizophrenia, Spirituality, The Inner World, Ways of Being

War wounds

war woundsI filled in a job application recently. As always I had to list all my illnesses and disabilities from birth to now. I listed what I could recall. I’m not good at these sort of questions. I tend to have an illness, live with it for a time and then forget about it. Occasionally I’ll need to know about it- in which case I usually ask my wife! I came to the section on Mental Health problems. And paused. The question was phrased quite precisely. Are you currently receiving treatment for any Mental Health problems? I could answer, honestly, “No. I am not under treatment for any mental health problems.” (I have had time of work recently due to a short-lived episode of depression. This has now been resolved. I received no treatment-although I was prescribed a course of anti depressants, which I chose not to take.) But my reaction surprised me. I had no problem saying that I had mumps when I was a child. Why should I view depression any differently?

I began to wonder about this and discovered that there is a sense of shame around emotional problems. I dislike the terms mental illness and mental health problems. They medicalise distress.  If I am depressed, I want to know why. If I am psychotic, I want to know the meaning of my psychosis. What might I be defending against that needs such a drastic response? I have spent a number of years in therapy. I found it helpful and healing. Many of my friends shake their heads and say something g like “I don’t want to know what’s in my cellar.” Or attic. Or shed. (Choose your locked room.) I find this strange. If I know what is in my cellar, I have nothing to fear from it. It’s there because I haven’t got round to throwing it away. Or I think I might want it some day. It’s not there as a prisoner. Or a forgotten orphan. So why would I have a sense of unease about declaring any emotional problems I might have encountered?

I live near Stoke Mandeville hospital which has its spinal injuries unit. It is not uncommon to see people in wheel chairs around town. There appears to be no sense of shame attached to them. Getting aground is more complicated than if one is able-bodied. But that’s an issue for town planners. Not a destigmatisng campaign. We now have the Paralympics where  athletes with some kind of disability compete. One sees all manner of physical injury on display. Artificial limbs abound. The key message seems to be one of “Look at what we can do. Not what we can’t do.” Soldiers come back from wars with their wounds. Frequently they are given medals for their bravery. This  seems to be less prevalent in the realm of mental health. I have yet to see anyone given an MBE for their bravery in combat with schizophrenia. Or depression. Or mania.

The dictionary definition of shame is interesting and revealing. The OED gives this as part of its entry “The painful emotion arising from the consciousness of something dishonouring, ridiculous, or indecorous in one’s own conduct… fear of offence against propriety or decency…” It also has roots in a sense of guilt or disgrace. How sad! Rather like blaming someone for walking on a hidden mine and losing their legs. In what way are they to blame?

in my thinking about this blog, one image that came constantly to mind was that of Christ’s stigmata. These wounds were displayed when it was helpful to others to so do. When they gave hope reassurance, comfort. (John 20:27)  There seems no sense that he was ashamed of his wounds. Rather the contrary if one takes a view that Christ’s death was redemptive. So, maybe it’s time that we can allow our emotional battle scars to be displayed. “Wear your poppy with pride” was the slogan for supporting survivors of armed conflict. It was a successful slogan. I wonder what a Mental Health flower might be? A rose because it is impossible to  separate the thorns from the flower? A Lenten Rose because it will grow and flower in seemingly inhospitable times?  Perhaps we should commission the RHS to create a Mental Health flower. What would you ask them to create?

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

In the Way

ridgeway

I’ve just been walking my two dogs along the Ridgeway. It is a lovely old walk with some breathtaking, heart lifting views. (And walking through the English countryside on a June morning is hard to beat.) Wikipedia tells me that people have been using this path for some 5,000 years which makes it feel all the more special. (I would like to think that my own direct ancestors walked this path since my family come from Bucks as far as records go back. Whether they did or not, it still adds an extra layer of appreciation for the route.) The walk left me thinking about Ways-and all the phrases linked to this. Being in the Way; The Quaker Way; The Marxist Way; Rights of Way. The list is long. But all convey a feeling of movement. Of going from one place to another. And of Travelling rather than Arriving.

A friend was telling me the story of a university that spent a lot of money organising its campus. After a while it became obvious that the students were, literally, voting with their feet. The carefully laid down organisational routes were ignored as the students made their own Way across the campus. (As one who has spent the past seven years in Higher Education - a misnomer? –  I am well aware of the difference between Institutional ideas about paths and student / staff ideas. The same extends to the provision of Mental Health services. I read the other day that the Recovery Model is intended to put the patient at the centre of the process, not the psychiatrist. (We need a ‘model’ to tell us this?) There seems to be an issue here about whose way is being walked. And who determines what one chooses to look at en route. I love walking in woods. I rejoice in  an old gnarled tree, bent over by the wind. I love the sight of Beech trees just coming into leaf. Equally I am enthralled by an unexpected vista. A view that suddenly appears from “nowhere”. It is the variety that is fascinating.

There is a formula for finding out the age of a hedgerow. Hooper’s law,  which says that to age a hedge we count the number of different species found over a 100′ stretch and multiply this number by 100 (why  multiply by 100 I have no idea!) So a hedge with five different species will have begun life in the sixteenth century.  I find something similar in clinical work.A given conglomeration of material suggest how long these patterns have been in place. And how deep-rooted they are. Which gives some indication of how important they are. An oak of several hundred years standing is more pivotal than some ivy climbing it.

Walking  along a Way provides a useful metaphor for clinical work. One day is never the same as the previous one. Each time I see things differently. Depending on the light, the shade, the wind or the rain. Sometimes my attention is caught by one thing, sometimes something different will catch me. The pleasure is in the unexpected. I find the same to be true in clinical work. No two sessions are the same. No matter how long a patient has been with me, we still see new things, depending on where we are standing at the time.Again, this for me is one of the pleasure of psychoanalytic work .I begin a session in silence and allow my patient to begin. From here we walk, seeing what we can notice. We are, together, in the Way.

The link is to a reading of Robert Frost’s poem “The rRoad Not Taken”-  for obvious reasons.

 

 

 

 

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

Therapy and Archaeology

Archaeology

I visited the Ashmolean museum in Oxford today. I spent about an hour looking at some of the exhibits. I’m not usually a lover of museums etc but I decided to give myself permission to visit and see what caught my attention. I found myself reading about currency, restoration, weaving and a host of other things. (Those who  have been there will know how much there is to see.) One tool that archaeologists use is Multispectral Imaging (MSI) Quoting from the blurb, this is “… a technique used to help read difficult texts. By shining different types of light onto an object, faded  or obscured writing can suddenly become clear.” As an analytically trained clinician I found this fascinating. Something hidden from view becomes clear in light. And from this, clarity, meaning and understanding can be found.  Not only does this technique make a small piece of knowledge comprehensible, it also allows this information to be given a context. Freud made a similar point in The interpretation of Dreams, when he commented

“[The] analytic work of construction, or, if it is preferred, of reconstruction [of the patients forgotten years], resembles to a great extent an archaeologist’s excavation of some dwelling place that has been destroyed and buried or of some ancient edifice… Just as the archaeologist builds up the walls of a building from the foundations that have remained standing, determines the number and position of the columns from depressions in the floor, and reconstructs the mural decorations and paintings from the remains found in the debris, so does the analyst proceed when he draws his inferences from fragments of memories, from the associations and from the behaviour of the subject of the analysis. Both of them have an undisputed right to reconstruct by means of supplementing and combining the surviving remains. Both of them, moreover, are subject to many of the same difficulties and sources of error”.

I was fortunate enough to be able to spend a long time in therapy and analysis, seeing someone four or five times a week for a number of years. One feature of this kind of work is that one does engage in psychic archaeology. I know my ruins; my different civilisations; my wars and famines. I know my victories and my defeats. And some of the reasons for both. I have a sense of the subterranean workings of my unconscious.  Depending on my mood I use this knowledge creatively to help myself. Other times I choose to ignore it because I do not want the burden of self-knowledge. The same is true of all civilisations and cultures.

I worry about the rise of short-term therapy. My fear is that it can become Blairite. The fantasy that a sound bite and a reassuring smile can solve complex problems when these problems have roots going down into aeons past. I know that much can be accomplished in ten sessions. A good deal can be achieved in two-as I know well. But thee is much to be said for steadily uncovering the different layers and , together, constructing the past. All one can do in ten sessions is to signpost possible artefacts and leave the patent to make of them what they can.

One story I read about in the Ashmolean concerned a painting.  On using light it became apparent that there was a hidden image. The painting was of a saint who in the original was holding up a communion wafer. At some time this was painted over. The restoration team had to decide tether to leave it  hidden or uncover it. Eventually they chose to leave it hidden but with a picture next for showing it. This seemed a good solution. It also stands for the work of therapy. (Or nursing. Or counselling. Or all forms of therapeutic work. Prayer and meditation are also useful tools!) Sometimes we choose to leave the hidden as hidden. But with the knowledge that there is another story. Which is just as important and fascinating.

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