Counselling, Psychoanalysis, Psychotherapy, The Inner World, Ways of Being

Li’l Lisa Jane

lil-liza-janeThis is a follow on from last week’s piece about simple songs. Someone replied to the last piece by commenting that her song got heard much better by her therapist than by her husband. (Not a unique experience!) This left me wondering…as a therapist I try to hear my patients’ songs without letting my own intrude too much. I’m interested in how our songs work together. Some songs fit my taste much better than others. But I’m not here to comment on my musical tastes. My task is to hear you singing and to try to understand your song. (I remember a patient many years ago whose only song was one of seduction.I was terrified! This left me completely unable to hear the song behind the song. What she needed me to hear was her loneliness. Her fear of intimacy. Her inability to make a healthy marriage. I failed her by not being able to listen properly. All I heard was my own racing pulse!)

One of the challenges of a marriage is to be able to listen to our partner’s song. To add to it. To blend in with it to make a new tune. Sometimes this is easy. If we both think Li’l Lisa Jane is the world’s greatest piece of music ever written, there is no conflict. The problems come when I am sick of Lisa Jane and want to move on somewhere else. In therapy my work is to get to understand the appeal of Lisa Jane. It may be the song your father sang to you when you were small and wanted comforting. It may be the song that you used for your first solo performance. It may be many things for you. As your therapist my task is to be able to understand the various shades of meaning associated with Lisa Jane. And to wonder if you are feeling such and such right now. And to think about what is happening in the session that triggers this response. Then to try to find a context for this behaviour .To help my patient think about other times when Lisa Jane becomes important. Line by line we can understand the various meanings of the song.

This all sounds very glib and easy. All I have to do for 50 minutes is to sit and hear your song. Make a couple of observations and end the session on time. If only… sitting listening to Lisa Jane for 50 minutes week after week is not easy. I, too, will grow to hate the song. I will resent not being able to have a voice. To be excluded from joining in with you. to be disallowed from making any changes to the words or the tune. But as the therapist, this too is part of my job. To bear Lisa Jane every week until a time comes when I am invited to change the record. Or you sing a different version of your making. (This is Winnicott’s  realm of magic / religion /play / fantasy.A fabulous place where all things are possible.)

As a therapist I hear all manner of songs. Songs of Love. Hate .Desire.Guilt. Sorrow. Joy. Whilst I may not be comfortable with some, all are welcome. Because any song has meaning. The meaning you give it and, thereby, share with me.

 

 

 

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

The trouble with armour.

As all good knights, warriors, etc know, one should never enter a dragon’s den without armour. Be that the old-fashioned clunky sort that weighs a ton, slows you down and restricts your vision. Or a capacity to create magic of some kind. A spell to disappear; a spell to dazzle your opponent; a spell to send them to sleep for a time.The list is endless. Each of us has their own preferred method of defence. These are fine when facing a dragon or similar creature. In the counselling room, they are unhelpful.

I mentioned earlier that I am not in the habit of devouring my patients. Nor do I defend my gold with my fiery breath. But my patients don’t really believe this. At least not initially. So they come to me and use all their armour to protect themselves. I’ve been seduced. Charmed. Threatened. Cajoled.Coaxed. Ignored. The list is very long. The aim is to keep me at arm’s length. Because these are the armours my patients habitually wear. (I did consider putting up a notice saying “Please leave your armour at the door.” Then thought better of it!)

The armour can only come off when the person in front of me thinks they are safe. Sometimes armour comes off after two or three visits. Sometimes it stays on for the duration of our time together. There is no rule with these things. Armour of all kinds is a mixed blessing. Certainly it can protect from assaults. It can also trap the user inside. Chain mail from head to foot is excellent in armed conflict against a similarly clad opponent. It is most inconvenient in an office! Spells of enchantment. Invisibility. Flying. All have their place. But tend to make it difficult to see you. Talk with you. Build a real relationship with you- because neither of us knows what is true.

As a counsellor my task is not to strip you naked and leave you cold, afraid and exposed.My task is to point out today’s defence. Help you think about why you’ve chosen it. To ask what purpose it  might serve. To bring to your attention that you are, in fact, wearing a suit of armour which might be affecting your activities. (It’s amazingly easy for some people to forget they are wearing armour when they come to see me.)

So, next time you come to see me, consider my notice inviting you to leave your armour at the door. Then we can talk about the you that wants and needs so much protection. (And the armour will be waiting for you when you leave…_

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

Mizpah

People enter dragon;s dens in a variety of ways, if we are to believe the stories we’ve read and heard. The thief sneaks in quietly. The adventurer brags in. The maiden comes in shaking. A similar process takes place when people come into my counselling room. Some come in and spend several minutes enquiring about my week; my health; my bowels; my bank balance. To which I will always reply “Fine. Thank you” Other people come in showing off their armour and daring me to comment on it.(Sometimes I do. Sometimes I don’t. I haven’t got an armour policy!) Others come in convinced that I am going to devour them. (I find that a poor way to keep patients, so tend not to eat them.) The same is true for leaving. Some simply pay me. Get up. and go. Some want to stay a little longer and ask about homework. (There never is any. I don’t “do” homework.) Others want to shake my hand and wish me a good week. None of these comings or goings is Right or Wrong .They are simply indicators of how people manage dragons-and therapists. And as  a therapist I note these comings in and going outs with interest. As do all watchful dragons.

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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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