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

The formless void

Recently I’ve found myself thinking about words, language, speech etc. I like words. I like the feel of them. As  a nurse, counsellor and lecturer, words have been my stock in trade. Certainly as a counsellor I use words to try and shape what it is my patients bring to the session. I will often use words to try and interpret the feelings in a session. “I think you’re trying to say ….” Or “I wonder if what you’re grappling with is …”  If done well, an interpretation can give  a name to something that was only previously experienced as a feeling. An emotion. Something “without form and void.” waiting for a word (Logos?) to give shape and meaning. This is not always a pleasant process. To discover something that one has kept hidden can be discomforting. The only justification for naming something is that this moves it from the unconscious and unknown to the conscious and known. (This was Freud’s view of psychoanalysis .To make conscious the unconscious.) If something is consciously known, it can be thought about and, hopefully, understood.

We reach places, sometimes, where words aren’t enough. Our bodies tell us their thoughts .We are sad and need a hug. We are tired and need rest. I have spent my professional career |believing” in words and their power. s a therapist I work with my feelings but give them back to my patients in words. I have spent many long years in personal therapy. Again all to do with words.

Various friends are involved in the “alternative” therapy scene Reiki, Alexander technique, Sacro-Cranial work etc. I’ve always quietly humoured these friends and “allowed” them their quirky views about body and spirit-particularly body. So it is with some amusement I find myself seeking out a body therapist. So far I’m pleased and surprised at how much information he gleans from my body about my soul. (I wasn’t really aware of those links. I still think it’s more to do with magic than “real” therapy!)

I began by talking about the value of words. i still hold to that view. But I’m learning that my body also wants to have its say and play its part in shaping the  sometimes formless void of my experience.


.formless void

Borderline States, Counselling, Madness, Mindfullness, Psychoanalysis, Psychotherapy, Reflective Practice, Religion, Spirituality, The Inner World, The unconscious, Ways of Being


The image is of the Narcissus, who, legend tells us, fell in love with his own reflection. What has this to do with this blog? I set up this blog to write psychoanalytically about things that interested me. Over time I have covered quite a range from Jimmy Saville to ISIS. Then in February this year I needed major heart surgery and my gaze shifted inwards. I wrote a few pieces about my struggle to make any sense of my illness but have not written much since. I enjoy writing and am left with left with a problem. Since my focus is still predominantly inwards, do I cease  writing? Or can I say something about the experience of illness and recovery from a psychoanalytic perspective-without becoming narcissistic? I don’t have an answer yet but I’m going to write about me and see where that takes me.

One of the problems with an illness that comes out of nowhere is that there is no preparation time. One minute one is living one’s life quite happily. Suddenly one learns that all is not as it seems. That minor ache turns out to be a symptom of something very serious that has the potential to kill you. Suddenly the clock has struck thirteen and all that went before is questioned. not to mention all that might happen tomorrow. If thirteen can be struck once, then all the rules change. To use my favourite mis-quote from Gatsby “The rock of the world rests firmly on a butterfly’s wing.”

This, of course, is not unique to illness.On a personal level Rape, assault, burglary all challenge our sense of an inviolate self. On a national level, war must do much the same. Our boundaries are nowhere near as reliable as we had thought. The challenge is to find a way to live with the consequences of this boundary violation without losing all sense of self. (I remember when I left hospital commenting that I felt as though I had spent 10 days behind enemy lines, living undercover. By which I think that I meant I had to work very hard to keep my identity secure in a place where there were very few familiar landmarks.)

Freud suggested the idea of Signal anxiety and Primary anxiety. .The function the former being “… an alerting mechanism which forewarns the ego of an impending threat to its equilibrium. Primary anxiety being the emotion which accompanies the dissolution of the ego.” The writer goes on to observe that Primary anxiety may be seen as an inwardly directed form of vigilance. (A Critical dictionary of Psychoanalysis 1968)

Which seems to take us back to mine-and others- experience of anxiety being helpful at some level. Albeit wearing and exhausting at times…


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