Borderline States, Counselling, Dreams, Hope, Mindfullness, Narratives, Psychoanalysis, Psychosis, Psychotherapy, Reflective Practice, Religion, Spirituality, The Inner World, The unconscious, Ways of Being

From certainty to certainty

Paul Tillich in his sermon Faith and Uncertainty comments “When we have left behind all objective probabilities about God and the Christ, and all subjective approximations to God and the Christ, when all preliminary certainties have disappeared , the ultimate certainty may appear to us. And in this certainty, although never secure and never without temptation, we may walk from certainty to certainty.”  (The New Being 1956)

Tillich’s sermon seems to me to be addressing the issue of containment. Something that as a therapist, is an integral part of my work. There are various “techniques” that help containment. Fixed appointment times, the same room, the same length of session time. All these help but what is central is that as a therapist one is consistent-both internally and externally. The external world can change a little without ill effect. But if who one is as a therapist changes, then the containment is threatened. But containment needs some flexibility if it is not to become a strait jacket. (The word “containment” has its roots in the idea of stretchiness or flexibility.) Tillich uses the word “certainty” which must  also allow for some flexibility. We’ve all met the fundamentalist of any shade or opinion whose certainty becomes a strait jacket rather than something more giving and flexible.

In my clinical practice 95% of my work focuses on containment. Or lack of it. (Or at lease a containment that somehow did not provide the balance between flexibility and fixedness.) The parent who was an alcoholic. Or the parent whom work was the all important aspect of their life. The mother who was terrified of her own sexuality and attempted to repress it in her children. The list is long. The mother who had an anxious mother and who herself passes on anxiety to her children. The list is long but all have in common a lack of holding or containing.

Compare these two images. Both show containment but done in such different ways. One restrictive and restraining, The other flexible and attentive.

Tillich suggests that we may have to let go of all our subjective and preliminary certainties in order that ultimate certainty may appear. It holds true for parenting. My mother was a Spock mother who read Spock as if he were the bible. She followed his advice religiously. My mother-in law also read Spock and found his advice useful, but found his assertion that, “Mother knows best. Trust your instincts.”  much more helpful and liberating. From here she could move from certainty to certainty- albeit never entirely without doubts and temptations.The same is true in clinical practice. I can say something important about what is happening in the room between me and my patient. But it is always tentative and equivocal. Which is the paradox at the centre of Tillich’s assertion that In order to find ultimate certainty we have to let go of many to our other cherished certainties. In T.S.Eliot’s words,”We shall not cease from exploration. And the end of all our exploring will be to arrive where we started and know the place for the first time.

This is what good containment offers us. “The chance to drive where we started and know the place for the very first time.”

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

3D Jigsaw

I was talking to somebody recently and trying to describe my counselling work. “It’s a bit like ‘Hide and Seek'” I suggested. Or, at times, like ‘Russian Roulette’. Other times it can feel like ‘Pin the tail on the Donkey'”My friend looked a bit puzzled. I tried for another analogy.”It’s a bit like trying to build a 3D jigsaw. You have  to find a way to keep all the pieces intact whilst trying to build new things onto it.”I wanted to sound clever and quote Freud’s maxims “Where id was, shall ego be.” And that the aim of therapy is to make conscious the unconscious but I wasn’t sure this would help much. “It’s a complicated process that we try to make look simple.” I said. How to explain ideas like Transference and Counter Transference; Splitting; The Paranoid- Schizoid position; Projective Identification and so on. It took me years to get to grips with them ( and I still am)! But despite the complexity of my answer, it was a very good question. What does happen in the counselling room? How does one describe a task so simple and yet so complex?

At its simplest, counselling is all about a relationship. I see my counsellor and we talk to each other. And, hopefully, hear each other. (Not always guaranteed by either side.) Within that framework I then build a picture of my patients’ inner world. Of their early life, their childhood, school, university, work, relationships and so on. I look for the repeating patterns. This week my patient’s world is wonderful and ever more shall be! I remind them that two weeks ago they were suicidally angry and had decided to join a silent order of Buddhist nuns.”Oh! Yes, But that was then. Things  are better now.” My task is to hold both past and present, making a connection between them to help my patient make their own connections. (This is Freud’s “making conscious the unconscious.”) I might then wonder what my patient’s early life had been like. How did his parents relate to each other and to their children? I half know the answer but want to help my patient see their own presenting past ( the past being re enacted in the present). Plus I want to know for myself and my work if my musing is accurate. The idea of therapy is that the model fits the patient. Not the other way round. In this case, my patient came from a home where “today was always a new beginning”,which is less positive than it sounds. “Those who forget their past are doomed to repeat it.” as the philosopher George Santayana put it.

So in this conversation between therapist and patient, all manner of strands are being weaved together. Or, a 3D map of their world is being carefully and jointly built.


Borderline States, Counselling, Dreams, Hope, Mindfullness, Narratives, Reflective Practice, Religion, Spirituality, The Inner World, The unconscious, Ways of Being

Containment 3

Two people suggested that the last two blogs about containment needed a third one to bring them together. This is an attempt doing that. Years ago we used to sing a lovely hymn, “Brother, let me be your servant” it ran thus

“Brother, let me be your servant

Let me be as Christ to you…

I will hold the Christ light for you

In the night-time of your fear.”

It was usually sung for someone who was finding life particularly difficult or painful. A kind of lullaby between the singers and the soothed. It offered a promise of containment. “We can’t take away your pain, but we will do our best not to leave you alone with it.” (A lovely thought albeit one that cannot be totally fulfilled. At some point we are all left alone in the night-time of our fear.) The most we can hope is that the night-time doesn’t last too long. And that somebody is there with us in the morning.

Effective containment is a balance. The child who is frightened of the monster under the bed can only share its parents’ bed for so long. At some point the child has to go back and look under the bed and face the monster. That way they learn to self care. Then, when the next child is scared the monster, they can comfort them.

I remember doing a role play in a workshop. I was playing a husband whose wife of 40 years had just been told that she had six months to live. The other participant was being a counsellor. They listened to me as I expressed my grief, my fury, my fear.  Nodded and made empathic noises. Then said “I understand how you feel.” At this point I nearly had to be forcibly restrained. How could this counsellor who was at least 30 years my junior begin to understand? How dare she have the temerity to say that to me? What did she know of grief, or loss, or suffering? Whether I was in role or out of it, I was furious. She looked ashen, having suffered an unexpected emotional mugging.  What she needed to have done was to demonstrate that she understood. And to show me what it was that she understood. So “You must be feeling very frightened right now” might have helped.  Or even “How are you both feeling at the moment?” I make a point of never telling my patients “I understand.” Because I probably don’t! I’ll ask how they feel. I’ll suggest how I think they’re feeling. I’ll ask “How does that make you feel?” But I won’t tell them I understand.

How does this relate to the previous pieces? My hope is that it highlights that good containment holds both the Light and the Darkness. The Love and the Hate.  When I was lecturing I worried about those students who were devoutly Evangelical. I interviewed one candidate, asking her for her responses to being threatened, verbally abused and generally intimated by a patient who might be severely psychotic. Her response “I’d let the love of Jesus flow into him” worried me. Here was someone who was unable to know her own hatred. This put her at risk. And her colleagues. We did not offer her a place.

I previously quoted Isaiah 45:7 “I form the light and create darkness: I make peace and create evil: I the Lord do all these things.” Containment allows these two to live together and be acknowledged equally. The psychoanalyst, Donald Winnicott wrote “What is a normal child like? Does he just eat and grow and smile sweetly? No, that is not what he is like. The normal chid, if he has confidence in mother and father, pulls out all the stops. In the course of time, he tries out his power to disrupt, to destroy, to frighten, to wear down, to waste, to wangle and to appropriate… At the start he absolutely needs to live in a circle of love and strength if he is not to be too fearful of his own thoughts and… imaginings…”  (Winnicott, Deprivation and Delinquency)

This is containment. This is care. This is nurture. The rest is just nonsense.

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

Winnie the Pooh

This is a piece about Winnie the Pooh who lived in the 100 Acre Wood where he had lots of friends.: Christopher Robin, Owl, Tigger, Piglet, Eeyore. Kanga and Rabbit. (Have I forgotten anybody?) When they got in a muddle he helped them out and when he got in a muddle, they helped him out. And he needed his friends just as much as they needed him. Which is how all good friendships work.

I want to spend some time getting to know this group of friends and see what we can make of them. Starting with where they live would be a good idea. The psychoanalyst Donald Winnicott observed that “home is where we start from.” So, home for this group is the 100 acre wood. Woods are important places. They represent stability and protection. We all love walking through woods.

But there is also a darker side to woods. Things are killed in woods. Owls, foxes and badgers kill other creatures in order to survive. Along with “All things bright and beautiful” nature is also “red in tooth and claw.” The 100 acre wood will have been no different. And whilst nobody physically dies in Winnie the Pooh, the emotions are there. A depressive Eeyore has to live with the manic Tigger. The young and feckless Roo has to live alongside the elder statesman Owl. As with any family, conflict was unavoidable, and necessary. Much as Tigger would have exasperated Eeyore, the former’s optimism would have offered Eeyore the possibility of Hope. Reciprocally we might think that Tigger could learn that quietness need not always be feared. So the home of 100 Acre Wood was a containing place that could hold both light and shadow. Which is probably as good a definition of “home” as we will come across.

Having looked at the context for the story, it might be interesting to look at some of the characters. My own favourite is the lugubrious Eeyore. He isn’t going to be fooled into thinking that everything is automatically and necessarily going to work out well. This way he can’t be hurt when people let him down. In one of the stories, his house is blown away. He always knew this would happen. Didn’t it always? Yet despite himself, his friends always help him out. Most infuriating. It is as if someone had offered Diogenes a proper home.

Then comes Tigger, ostensibly Eeyore’s polar opposite. Tigger always seems to land on his feet- all four at once. And just as often treads on someone else’s feet in the process. At first sight, he has nothing in common with Eeyore. On a close look, however, he uses bouncing in the same way that Eeyore uses melancholia. Tigger just uses a manic defence to keep at bay his existential anxieties. They are much more alike than either of them might want to admit!

At this point it is worth considering the 100 Acre Wood so that it tells us something about ourselves. “To make conscious the unconscious” as Freud put it. We all have our Tigger moments and our Eeyore moments. We also have our Piglet moments and so on. Depending on many factors we will all have a dominant personality trait. We may be more prone to an Eeyorish depression; a Tiggerish mania or a Rooish dependency. The process of emotional growth is the work of integrating these parts of ourselves in the same way that families have to accommodate children with their differences but who are still part of one family – hard though that is to comprehend at times!

To finish I want to suggest that all these characters reflect Christopher Robin’s inner world. And these in turn all reflect A. A. Milne’s inner world, and ours. In psychoanalytic language they are internal objects and part objects. Or “bits of ourselves” to put it more colloquially. So, when we read Winnie the Pooh we are reading both backwards and forwards. We are reading “forwards” in that we can look at the inner worlds of the characters in the stories. how they relate to each other, their world, themselves. Then we can look “backwards” to Christopher Robin and his world. Then we can look at the world of A. A. Milne and his hopes and dreams. Which begins to make a complex picture seemingly a long way from the simplicity of the 100 Acre Wood. Yet as counsellors and therapists we do this work all the time. Our patients bring themselves to therapy. But they also bring their partners, children, work, friends etc., as well as their relationship with us and all that represents. It is a sort of 3D chess game. It is this dynamic that makes the work so rich and rewarding. Mostly! (Occasionally also deeply frustrating and confusing.)

Let me leave the last word to Winnie the Pooh who would have made a very good therapist. He observed “I am not lost for I know where I am. But, however, where I am may be lost”.

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

Whomper asks the best questions


” ‘They’re all so unlike me’ he thought, ‘They have feelings and they see colours and hear sounds and whirl around, but what they feel and see and hear, and why they whirl around doesn’t concern them in the least’.” (Whomper)

“If they can get you asking the wrong questions, they don’t have to worry about answers.” (Thomas Pynchon)

As a counsellor I find myself interested by Pynchon’s observation, because there really are no wrong questions in therapy. Certainly not from the point of view of the patient-  or of the therapist listening to the patient. Within the confines of the 50 minute session, all questions are interesting and important because they are all a form of communication which can lead into other issues. So the simple question about holiday dates has one reply. “I’m away throughout August.” The question could rest there. But the work lies in hearing the unasked thought. Perhaps  “I envy you. A whole month off. Lucky you.”  Or  “But you can’t leave me for a whole month. I need you.”  This can then take us to a conversation about envy, anger, hatred jealousy, abandonment and so on. (As well as a genuine wish that the therapist has an enjoyable holiday!)

Whomper and the other Moomintrolls find themselves affected by a nearby volcano exploding and disrupting their normal lives. (Volcanos are good at that!) The rest of the family seem quite sanguine about events. Not so Whomper who wants to ask all sorts of difficult questions about things and cannot understand why nobody else is as bothered as he is by these events. It is interesting that Jansson gives him the task of worrying because his name, Whomper, carries a sense of  someone who rushes about carelessly, just muddling through. Yet he ask the most interesting questions “What”and”Why”.  when I was lecturing it was common for a shy or diffident student to ask the most interesting question. “But… why do we do this?” Sometimes they almost apologised for asking a “Silly” question. Whomper seems to be doing this. “Why do people do this? What do they feel about things?”

I spent a few years in a very fundamentalist Christian group. I was one of those who always asked the “wrong” questions. I remember saying something one day and being looked at with blank bewilderment. If had spoken in Hebrew or Swahili, I could not have been more marginalised. It wasn’t that I had asked a “wrong” question, it was that I had asked a non-question. The thought processes that lead me to ask my question were inconceivable to the mind of the person to whom I was speaking. (I fairly quickly chose what questions I asked where and when. And  of whom!) For Whomper seems to be encountering something like this. (Perhaps that’s why he’s always in a hurry. So many questions to ask and so many possible answers .And so little time taken to hear the unasked question.)unknown


So unlike Pynchon, I’m not sure there are wrong questions. But that’s the luxury of being a therapist. One is always trying to understand the meaning of the question. To try and understand why “they” have feelings and see colours and hear sounds.


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


advent7All this was a long time ago, I remember,
And I would do it again, but set down
This set down
This: were we led all that way for
Birth or Death? There was a Birth, certainly
We had evidence and no doubt. I had seen birth and death,
But had thought they were different; this Birth was
Hard and bitter agony for us, like Death, our death.
We returned to our places, these Kingdoms,
But no longer at ease here, in the old dispensation,
With an alien people clutching their gods.
I should be glad of another death.

Extract from “Journey of the Magi”



The extract above is from T.S.Eliot’s poem  “Journey of the Magi”. I first heard it when I was at college and it has stayed with me. He captures the struggle of the Magi to  make their journey. These are  not triumphant warriors coming home. These are  men  who are tired. For whom the journey is uncertain. “Were we led all that way for Birth or Death?” That is a question that arises so often in therapy. “What am I doing here? I thought counselling was supposed to make me feel better.  I feel like shit.”

The Magi responded to a sign which they saw as significant. They were unsure what it signified, but they understood it to be important. The same is often true of my patients. They see a sign. A difficult marriage or relationship. Tensions  at work.  Perhaps feelings of depression and anxiety. These are read as signs. Signs that need to be attended to and understood. We only know that the Magi came from the East following a star. Bethlehem was an unknown destination. The  parallels to clinical work are obvious. We start from a different place. Frequently the place of our beginnings. Our place of birth. Those earliest moments of conception, pregnancy and birth which seem so far from our current places. Yet each time I see a patient we end up back at their beginning. The men whose fathers leave months after  their birth. The men whose mothers abandon them. The women who feel overwhelmed by their father’s expectations  of them. This is where the journey has begun. This is what has shaped their life to date. The woman who has had  six children with six different men. And each of her children taken into “care”. The successful business man who always has a lover whom visits regularly.  Whose wife pretends not to know and not to mind. These journeys are more like death than birth.

The biblical account of the Wise Men is only found in Matthew’s gospel. He places this visit at the end of his genealogies “The book of the generation of Jesus Christ, the son of David, the son of Abraham…” (Matt. 1:1) Matthew is telling his readers their history. As counsellors we don’t share your histories but  nonetheless draw on them in our work. (Unlike Athena who emerged fully armed from the skull of Zeus we have learned our histories the hard way with journeys that seem to have made the Magi’s travels look easy!) We share our patient’s journeys in many ways.We, to, have slept badly at times and have wondered where our journey will take us. To birth or to death?

My aim is to write more about Journeyings. Meanwhile I shall end with some Advent music. Enjoy, as they say!

Counselling, Mindfullness, Psychotherapy, The Inner World, The unconscious, Uncategorized, Ways of Being

10 Miles to go

A friend and I completed a 100 mile cycle ride yesterday. It was hard work! But enjoyable-if you like that sort of  thing! We managed to achieve Gold medal standard in our age group by finishing in seven hours. We had not set out with any expectations of  doing anything more than completing the ride before sunset! The medals were a huge boost to tired legs and sore backsides. We climbed a total of 3,000 feet in those seven hours. And alternately cursed, smiled, wept depending on where we were at any given point in the ride.

The hardest part came after 90 miles. There was a sign proclaiming “10 miles to go.” We whooped with excitement. A mere 10 miles. No problem! A few minutes later my friend turned to me and said “You know what that means, don’t you?” “Yes,” I said. “It means we’ve still got another 40 minutes riding to do.” For a short time our euphoria vanished in the face of how much work was still left. We carried on pedalling and, eventually passed over Marlow bridge and in to the finishing area, got our times and medals and gave each other a High Five, grinning like a pair of Cheshire cats.

As a mental health nurse I was always taught that the most dangerous point in the recovery of someone who is depressed, is not the acute phase. Mostly they are too depressed to act out in any way at all. The crisis comes when they are getting better. I’d always taken this as axiomatic. A useful piece of clinical data when managing somebody who is depressed. That remains true.  Until yesterday, however, I had never really experienced that maxim first hand. We’d ridden 90 miles. We’d got up at six in the morning, loaded the bikes, parked the car, signed in and set off on the ride. We griped, complained smiled etc. Then we  got to the “almost there” mark and nearly threw our bikes away and called a taxi .I’m pleased we didn’t. (And  “Thank You”to all my friends who sent “Bravo” messages.They are much appreciated.

Whilst being ill is horrible, one knows where one is in a strange way. Hair falling out? Blame the chemo. Depressed. Blame the divorce. Dropping things? Blame the arthritis. One gains much justified support and sympathy an acute phase. The problems begin with recovery. One’s life is no longer in immediate danger. The expectation is that one can resume normal duties-albeit in a graded way. It is this stage that is the most demanding. Having come so far, that final 10 miles seems so near yet so far. Small wonder that this is the danger phase in so many illnesses. As it was on our ride. Hope had been kindled followed by the almost overwhelming realisation of how much effort was still required of us.

Once more I’ve had practice teach me the real meaning of theory. But on reflection, I’m still pleased they told us we only had another 10 miles left. If only because it made the 5 mile marker all the sweeter.


10 miles to go