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


We recently lost one of our dogs. We were walking them in local woods when Hamish caught a scent of something irresistible and off he went. After an hour of calling him we reluctantly came home. A second trip was no more successful and we again came home, since night was coming. The house felt very empty, despite our other dog. In the morning we were told that Hamish had been found and was safely ensconced with a local dog warden. We couldn’t understand why we hadn’t been contacted directly since he had a name tag and contact number. Unfortunately this had come off and we hadn’t realised it. (He now has a new one, securely attached.) He came home none the worse for his night out.

His absence was palpable, even though we have two dogs. He brings an energy to the place-even when he’s asleep.The playwright Tom Stoppard has the line “Death is the absence of presence” in Rosencrantz and Guildenstern. That was how we felt that night. There had been a death and there was now an absence . Happily it was short-lived absence. I began to think about  how this absence due to something lost is often played out in clinical work. Many of my patients come with lost objects. Sometimes living. Sometimes dead. But absent for whatever reason. And this absence always feels like a death. Part of my work as a counsellor is to help my patents find those objects that they have lost. “Lost” here having many meanings. Lost as in misplaced. Lost as in deliberately hidden. Lost as in denied. The effect is the same. Death and the absence of presence. This is not easy work for either of us .It is often painful -although one hopes it is ultimately healing. The discovery of something previously lost is not always a joyful reunion and as a therapist one is not always loved for pointing out the absence. We do the work out of a belief that if something is present, it can be thought about and known. (This may lead to a good death and a proper burial. Or to an incorporating this new object into oneself.)

When I was first thinking of this blog, I intended to end it on that last paragraph. That would have made a neat ending and another “successful” blog. But a friend challenged me recently about  my own lost objects- or those objects that I have temporarily disowned. As therapists we spend a lot of time helping our patients find their own lost objects. This can be a way of denying our own vulnerability. We sit quietly in our therapist chair and comment on what we think is happening. We claim therapeutic immunity from being asked about our lives. Our task, we say primly, is to help you, the patient .We understand your interest but will not satisfy it for you. (Or a variation on that theme.) There  is truth and value in this reply. We are there to help our patients who won’t be helped by hearing about my divorce or my car crash etc. The danger comes when we try to apply therapeutic immunity to ourselves.

As therapists we are as vulnerable as our patients. We know about hurt, loss, grief, rage etc. As well as about joy, pleasure, delight, longing etc. The danger for us is to deny these feelings- particularly those that challenge us and threaten to overwhelm us. Here is where we need friends, partners and the like to remind us of our lost objects and to help us bring them back into consciousness. Mercifully, we are not omnipotent. Much as though it is a fantasy in which we sometimes indulge!sussex-spaniel-1

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

Therapy as prayer

The analyst Mike Eigen wonders if psychotherapy might be seen as a form of prayer. On first reading I was sceptical. Prayer seems to involve a lot of wishes and hopes and a certain amount of intellectual sleight of hand. Or the prayer tradition in which I grew up was like this. Prayer was a divine slot machine. One put one’s money in the machine and back came an answer. It may not have been the answer one wanted, but the get out clause read “The answer may sometimes be ‘No'” Thus most options were covered. How, I wondered, could psychotherapy be a form of prayer? (My patients might have their own answers to that question!) Then I remembered that there are other prayer traditions that pre-date the Evangelical slot machine version. The Orthodox church has long had a tradition of contemplative prayer which may be seen as clearing one’s mind of external concerns so that one can better hear God. A kind of centring down into one’s emotional, psychic depths. that then make thought and understanding possible.

It is at this junction that one can see links between therapy and prayer, particularly given that one root of the word “therapy” has ideas of healing and curing. (Psychotherapy being known as the talking cure.) Prayer makes room for the Other, which philosophically is defined as “the counterpart who defines the self” (Wikipedia) Defining one’s self is a central part of the work of therapy. I could put all my patents under one broad heading. Their headlines might be depression, anger, marital  problems. But at root they all ask “Who am I?” My task as a therapist is to be the Other whom they can use in whatever way they wish. The classic Freudian analyst presents a blank screen onto which the patient can project whatever material they choose. Thus one becomes a lover, a hero, a bastard, a thug, a father, a mother. The list goes on. What links these projections is that they are Other than the patient and can be explored in the transference relationship.

Prayer seems to serve a similar purpose. God can become Judge, Jury, Benevolent father, tyrannical manager. And a lifetime more than these. With skill and practice one can begin to understand why God might be seen as this or that. As Tyrant or Lover. (And this might be where classical theology and classical psychoanalysis meet. In both cases the Object- God or the analyst- does not change. Their task is to hold and contain, thus allowing healing to take place.)

This quote sums up both prayer and therapy for me.

“Before you can live a part of you has to die. You have to let go of what could have been, how you should have acted and what you wish you would have said differently. You have to accept that you can’t change the past experiences, opinions of others at that moment in time or outcomes from their choices or yours. When you finally recognize that truth then you will understand the true meaning of forgiveness of yourself and others. From this point you will finally be free.”
― Shannon L. Aldertherapy as prayer


Mad as hell

As I sit and write this blog I can hear my heart pounding away. It sounds like the noise made by young men who have their car stereo on maximum bass. The whole car vibrates. That’s how my heart feels and sounds. I sit with a patient in the quietness of my treatment room and long for a radio in the background. Or some white noise. Just to neutralise the sound I think my heart is making and which I’m sure they can also hear. (So far none of my patients have commented on it and I haven’t found the courage to mention it to them. Perhaps I should put a note on the bottom of my bills. “Dear patient, the noise you may well be able to hear in this session is my heart. Do not  be alarmed. I am not about to have a heart attack in the session. It can be spoken about!”)

And I’m furious. Nobody consulted me. Nobody said “Terry. We’re going to give you a very unusual heart condition. It affects 3 people per 100,000 of the population. But you have been chosen.”


“Because that’s the way it goes.”

Well, no thank you. There must be deserving people out there who could make good use of such a “gift”.  Some people who are thoroughly bad, cruel and nasty. Or people who would welcome the chance to demonstrate their faith and commitment. (I don’t think I’m the former and I’ve done the latter far too often.)

If one reads Facebook it’s full of people posting their positive thoughts and messages. One such runs “A child is like a butterfly in the wind. Some can fly higher than others but each one flies the best it can…” It’s as though we’re scared of anger, fury, ire and that whole family. A friend is doing a Positive Psychology degree and complains frequently of this same phenomenon. Anger etc are seen as “bad”-bad intrinsically and bad morally. One’s glass should always be half full, seems to be the message of the moment. I love the sequence in the film Network where Howard Beale has had enough of everything and declares “We’re mad as hell and we’re not going to take it.”

Which brings me to my point. Sometimes we have to be as mad as hell .To rage against the dying of the light. It’s only that energy that gets us out of bed in the morning.

Here is brief reminder of Howard Beale’s rant.

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

The Expert 2

The expert

I finished yesterday’s blog with a quote from Bion to the effect that the therapist should enter their session with their patient with neither memory or desire or expectation of outcome. That takes some doing! I have lost track of the number of times my patients have confounded my expectations- both positively and negatively. Patients whom I thought would stay for at least a year leave unexpectedly after a month. Patients whom I knew would gain nothing from seeing me stay for a year or more and take a huge amount from the work. Sessions where I have been in fear and trembling of the attack I knew would come prove me wrong. And vice versa. In a week I move from being invaluable, generous and understanding to being greedy, rapacious and useless. Which proves the value of Bion’s maxim.

It is a rule that I’m learning to practice. To “trust the process”. To believe that between us, me and my patient can come to a shared understanding in the session of what it is that I am required to know. (As usual it’s this point at which I mildly envy my CBT colleagues who have a fixed programme which they can follow.) Working my way has advantages and disadvantages. As a nurse it meant that I never could write a “proper” Care Plan because I always worked with the transference-  which was unpredictable. It also made my teaching slightly difficult for similar reasons. I still can’t write a lesson plan with learning outcomes etc. I taught in the transference. (A way of working that took some of my students a long time to get to grips with. Some never did.)

How does this relate to Consultants, Experts etc? For me the Expert is the one who is comfortable with not-knowing. The one who can respond to a question with an honest answer and not bludgeon me with their knowledge. (My G.Ps are brilliant examples of how to listen to their patient.) Why does it matter if I’m heard or not? Because not being heard invalidates me. It wipes me out and reduces me to a set of symptoms that only they can fix.(As you might imagine, I am not necessarily a “good” patient.I expect from others what I try to practice myself. Certainly in the clinical realm.)

The picture above picks up the idea of an expert.The climber has reached a peak with hard work, skill and endurance. And has earned the right to enjoy the view. But the number of unclimbed peaks still outnumbers the one on which he stands. That knowledge should keep all of us humble-no matter how expert we consider ourselves.

Psychoanalysis, Psychotherapy, Reflective Practice, The Inner World, The unconscious, Ways of Being

The Expert

In the space of a week I have had the dubious pleasure of seeing two consultant cardiologists in two different hospitals. In one case I wished that I had had some kind of lethal weapon with me. Or had been taught to kill just using a biro and some lip salve. Bond et al would have known how to do it quickly and efficiently. (His companion would have offered no resistance after his mentor had been so dispatched.) Sadly I was unable to act out my fantasy-which may have been a good thing. I’m still ambivalent on this point. What made me so angry was his attitude. I offered some opinions about my health and suggested that some of my symptoms were probably side effects of some of my medication. “How do you know that?” “Well, I researched the drugs on the web. And read the information sheet that comes with them. These suggest that what I have are side effects.”

“Everything can be found on the Internet these days.” was the response.

I felt like a five-year old who has said something clever in class but who has been firmly put in his place by the teacher and told not to be clever again. The Consultant then proceeded to outline the treatment programme he planned for my heart, which would happen next week. that said the “conversation” was finished and I was dismissed. (Sadly this only repeated my previous experience as an in-patient at Papworth. It felt that everyone looking after me would have been happier if my heart could be nursed apart from the rest of me. Then the surgeons could do their clever technical stuff without me getting in the way.)

My next encounter was in a local cardiac unit. Full marks to the team for being fun, human and interested in me as a whole person and not just a cardiac case. Even the Consultant was reasonably human-to a point. He had his regime in mind and was not going to be deflected from it. When I refused to take a drug he wanted me to have, he was not happy. But conceded that I could make this choice. Again I felt reduced to the level of a five-year old being told “Don’t argue. Daddy knows best.” (He might. I acknowledge his skill. But it is still my body. I have to suffer the side effects, not him. And I will not be railroaded into a course of action that feels damaging.)

The psychoanalyst Wilfred Bion said  of Desires: The psychoanalyst can start by avoiding… Desires for results, `cure’ or even understanding must not be allowed to proliferate.” I will take this idea further in the next blog.


The expert

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

History or His Story? 2

historyThis piece will take the History / His Story split into the clinical world and look at the nature of stories. Churchill observed that “History is always written by the winners.” This holds good in the personal realm as well as the public one. I see many patients who come with a version of  their history written by the “winning” part of their psyche .This is often a highly edited version of their history written by a depressed part of them. Or by a part desperate to continue a story about their idyllic childhood. People do have lovely, happy, good enough childhoods. These people, however, do not usually end up in a succession of damaging relationships with partners who seem set on destroying them. Nor do they try to commit suicide, get involved in abusing drugs and alcohol or have multiple sexual partners. (It is always an uncomfortable moment when I bring together the stories my patients tell me about their blissful childhood and the biography they tell me week after week. Two worlds collide and tears often follow.)

The original sense of “History” was not of a recording of events per se. I “did” the Tudors and the Stuarts at ‘O’ level and learned almost nothing that seemed important about them. I don’t know if Henry VIII was a good man or not. I have no idea what kind of man James 1st might have been. I learned the dates of their reigns but nothing much else. This kind of history seems soulless to me. The original meaning of “History” is that of a narrative, a story. This meaning in its turn is linked with the idea of a wise man using stories to discover a truth – much  more akin to stories in counselling. There is rarely one overarching story in therapeutic work. One can say “Yes. That was abusive” or “That must have felt unfair.” One cannot give an overall meaning to a history. Any event has to be visited and re-visited to begin to come to terms with it. This then has to fit into the rest of the story of my patient’s life. This is the benefit of long-term work. One can work through the issues that are problematic and resolve them.

How do these two blogs fit? I said that I found the idea of History being written as His Story problematic. It imposes one overarching interpretation on history. History as God working His purpose out. God is behind the major events in our world and is using them to teach and train His people. (I’m not sure how one is supposed to react if one doesn’t see oneself as fitting into this category.) As I said earlier, if I was a displaced [person living in a refuge camp I’m not sure how much comfort I would draw from a fantasy that this was, somehow, the will of God.)

So I think I’ll carry writing and thinking of History as just that. History. Not His Story. It means more uncertainty. More muddles. But that’s where I think I’ll find truth along with my patients.

Counselling, Madness, Religion, The Inner World, The unconscious, Ways of Being

History or His Story? 1.

We were sitting chatting in the pub last night. It was the monthly meeting of our A&E group. A&E standing for both Accident and Emergency and Ale and Exegesis.The name came out of the idea of a casualty department which deals with crises because there was a feeling that the church is in crisis, needing some interventions fast.  Plus the idea of good beer and good conversation out of which might come some ideas for local interventions. That, then, is the history of the group. At some point we began to talk about the state of the world-  as one often does after a few beers. We looked at the ebb and flow of power and influence held by different groups at different times in history. It seems hard to grasp the ways in which power shifts. (This is one of the drawbacks of living with 24 hour news. Something happens in one part of the world and the rest of us are bombarded with images, opinions and commentary with so little time to think.) Groups appear for a time, hit the headlines and then disappear from the media because something more exciting has happened.

The conversation moved on and we began to talk about justice, leadership, power, democracy etc. The big ideas. The question was asked about how God fitted into this process. “Well” said someone “the bible says that rulers are appointed by God. One way of saying that is to write ‘ History’ as ‘His Story’.God is in control.” I have numerous problems with this view. I love in the UK in a parliamentary democracy. I have work, a house, a circle of friends. I am not persecuted because I belong to the wrong tribe. Or because someone else wants my land. When the General Election finally arrives I shall not have to worry about armed soldiers implicitly threatening me. On this basis the idea of the government etc being appointed by God seems fine. Move me a few thousand miles East and my world looks very different. I could be living in a refugee camp with 10,000 others. If I was a woman in this context I would fear being raped. My children would not go to school each day. My husband would not have work. Why? Because God has appointed ruler who despises my tribe. Or my race. Or my religion. Or all three. I’m not sure I find that kind of God very appealing. Still less His appointed representatives.

In part 2 I will link this to the personal, inner world.