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.”

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

I and Thou


I’ve just started reading “I and Thou” by Martin Buber. It’s a poetic piece that is experienced emotionally as much as read intellectually. I started it a very long time ago and gave up on it. This time round I’m entranced. I want to highlight every line. I shall have to be careful or I shall end up wandering round Aylesbury loudly declaiming my favourite parts. (I’ve spent 25 years in psychiatric hospitals and have always enjoyed being able to leave when my shift finished. I do not want to stay there involuntarily so I shall content myself with writing a blog and boring my wife with “Have you heard this?” Or “Buber says this. Isn’t that brilliant?”

Early in his essay, Buber sets out his basic premise; that there are two kinds of relationships: “I and Thou” and “I and It”. My understanding is that we move between these kinds of relationships. We have these two relationships with different things and different people at different times. Buber puts it so ,”Every It is bounded by others. It exists only through being bounded by others. But when Thou is spoken, there is no thing. Thou has no bounds”. I’m not sure I fully understand him but I can give an example of an I=Thou encounter. The first time I saw Rodin’s sculptures I was deeply moved. His John the Baptist and The Prodigal Son moved me nearly to tears. There was something about that first encounter that I’ve never experienced since. I’ve seen theses works a number of times now and still enjoy them. But they have lost some of their impact.  In Buber’s terms, my first encounter was boundless. It was pure experience. There was no attempt at understanding the processes involved. It just WAS… Subsequently my response is a little more measured, a little more bounded. (Perhaps akin to falling in love and being in love.)

Later in his essay Buber has this to say about words, what he calls primary words i.e. “I and Thou”and “I and It”: “Primary words do not describe something that might exist  independently of them, but being spoken they bring about existence.” I’m reminded of the idea in Genesis of God calling the world into existence and this bestowing on it the status of “Thou”. (An idea that chimes with much of the current discussion about environmentalism and our place in the material world.)

What has this to do with therapy? It seems to me that in a therapy session there are “I and Thou” moments and “I and It” moments. Sometimes we are calling into being new life. An insight is gained. Something is understood for the first time. A sacred moment has been shared. (The roots of “Sacred” lie in ideas of ratifying or ordaining. Of validating something or someone. Definitely an “I-Thou”matter.)  These encounters have been described as “moments of meeting” with the association being made to the way a mother plays with her baby, cooing and making eye contact.)

At other times the baby is left to play happily by itself, albeit with mother sitting quietly watching. These moments occur in therapy where the therapist’s role is to be present with patient whilst they play and make their own discoveries. these seem akin to “I-It” moments. As important but less intense.

In both these encounters something is created and bought to life. Something now exists that did not exist before that encounter.

 

 

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

Who are we?

W all love stories. We live in them and through them. Being Robin Hood or the Sleeping Beauty or Heidi.  That’s one of the reasons I enjoy a good radio play. It has better pictures, as somebody observed. Cinema is excellent-so long as I don’t know the story on which a film is based. Then I get cross because the director’s picture of a character is always at odds with mine!

In his book The Amber Spyglass,  Philip Pullman wrote,  “Tell them stories. They need the truth. You must tell them true stories, and everything will be well, just tell them stories.”  A true story was the means by which those in Sheol – (or its “Dark Materials” equivalent) — found their freedom. So many things and people shape the stories we tell ourselves about ourselves. Are we seen as  clever? Or sexy? Or stupid? Are we a “Good” boy or girl? Being “Good” can be quite a curse. I’m never able to be “Bad”. Or my “Badness” is felt to be unspeakably awful and shameful. Thus creating a self censoring super ego that rarely gives me a minute’s peace. (The same is true of “Bad” people. Even terrorists go home at the end of day and play with their children!

Niall Williams writes, “We are our stories. We tell them to stay alive or to keep alive those who only live now in the telling.” History of the Rain . We choose what stories to tell. When I was training to be a psychiatric nurse, I made a point of only telling funny anecdotes about my work. I rarely shared the darkness the so often haunts psychiatric patients. (Imagine spending all day, ever day with voices that only you can hear. Taking to you. Commenting on your actions. Telling you how worthless you are. Telling you to go and kill yourself. Or kill others. These are not the stories that are easily told. Or easily heard. There is a cost in hearing these stories.We might wonder, with Williams, who or what we are keeping alive here.)

So, stories. As a counsellor I spend much of my time hearing people’s stories. Frequently we start with a “What an awful person I am.” Over time it becomes possible to think about the origin of this story. “Well, my husband tells me I’m…” Or “My wife thinks I’m …”  Then we can challenge some o these  stories. I’ll sometimes ask something like “Well, are you lazy?”Or “Is it the case that you never help with the childcare?” Most times my patient reflects that,”No. That’s not entirely true.”

It takes courage to change our story. My story, after all, is Me. That’s who I am. Isn’t it? As part of my training as  a counsellor, I had my own analysis.(There were so many stories to tell! But that, as they say, is another story!) My wife was terrified. Terrified the I’d uncover a different story about her. One that ended with my discovering that I didn’t love her. After 30 years of marriage it is apparent that there was no other story. I loved her then as I do now. And will continue to do because that’s my true story. Which sets me free. And that is one way of understanding my work as a counsellor.To help people tell their stories. To listen to the telling. And to reflect on my experience of that story. My patients are always free to do with my listening as they wish. That is my blessing and my curse as a listener.

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Counselling, Dreams, Hope, Psychoanalysis, Psychosis, Psychotherapy, Reflective Practice, Religion, The Inner World, The unconscious, Ways of Being

Pain Management

Pain Management

I lay no claim to any particular skills in pain management. My experience has been of the past three months. In November 2017 I had planned surgery for a total knee replacement. I think I underestimated how difficult I would find it. There was the constant pain. Day and Night. I couldn’t find an effective pain killer. Then the inconvenience of not being able to drive. Or, much more of a loss, not being able to cycle anywhere. I became used to taxis for the shortest journey. The loss of independence was not something I managed well. At the time of writing it feels that I might be getting better. The pain is diminishing and I can drive- a mixed blessing!

The writer Henri Nouwen said “When we honestly ask ourselves which person in our lives means the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand.”

I was talking with one of my patients recently about what it means to be human. How did he know, he mused, that I wasn’t a robot programmed to respond in an appropriate way to his conversation. I don’t think I’m a robot but his question was interesting. My thinking is that whilst I try to respond empathically, I also try to link unconscious materials and make links between the past and the present. I also will bring the focus onto myself using my experience of my patient to think about how our relationship might reflect their other relationships. I like to think this is beyond a robot’s abilities.A large part of the work of therapy is achieved in the relationship between the therapist and their patient. if this is a good match, then risks can be taken; challenges made and help offered.

Nouwen talks about the value of feeling cared about( of knowing that one is valued. This is at the heart of all healthy relationships- including that of counsellor and patient. ( This is one difference between seeing me or answering an on line CBT questionnaire!)

So, what can I learn from my past months of pain? One lesson has been the value of feeling loved and cared for by my wife. And a great deal of sympathetic support from my friends. I also came to learn to appreciate and recognise the good things I have Inside me. My pain has not, mostly, been too awful physically. Emotionally it has been difficult at times.)I would not do well if I were seriously disabled.)

As a counsellor I see people who are in emotional pain due to any number of causes often beginning in childhood. My work here is to help them find a way of talking about things that have long been buried. For most of my patients this is a slow process. They begin with a sadrightforwad narrative about their life. “I’m married. I have 2 children. My husband loves me. So why do I feel so lonely all the time?” Another story is “My wife and i are separated at the moment. I love her to bits and our kids. i couldn’t bear it if anything happened to them. But i have problems with anger. A red mist comes down and i’ll lash out at anyone. The wife. The kids. It doesn’t matter who. She says she’s not coming back. i don’t blame her. But i miss her.” Tears often follow this introduction. From here we walk together quietly and carefully, trying to see the underlying story. An anxious and depressed mother and Grandmother so often leave the next generation as damaged as themselves. Violent father’s who “don’t take “no shit from no-one”all too often produce sons who have never learned how to expired need .Or vulnerability. So they lash out. With awful consequences. Then the work goes on and we talk about self worth. About allowing oneself to be vulnerable. i point out the ways in which they are taking a huge risk by coming to see me! And add that, so far, the risk has paid off. That in my room, they are seen and acknowledged in their own right as Persons.
So, just as being hugged, loved and held can help with physical pain so the same process can help with the healing of emotional paiPain Management

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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.

 

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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”.

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

Certainty

There was  a discussion recently on Facebook about a newly found translation of the KJV bible. The academic involved claimed that this new manuscript showed how much of the text had been edited to support particular political doctrines and ideas. The discussion that followed was, inevitably, about the  nature of biblical authority. Is it a case of “God said it. I believe it. That settles it”? Or a case of  “The words of God in the words of man”? The discussion lasted a few days  before moving on to something else. Probably a discussion about giant pandas or the Amazon rain forest.  At the same time a Quaker friend wrote a piece about certainty and religious faith.  She had disagreed with somebody who had wanted it to be the case that faith banished doubt. My friend’s point was that this was not the purpose of faith. Its task is to provide a framework to think about life and its vicissitudes, not to provide an answer to every conundrum. It is a familiar and important argument.

In his paper “Mourning and Melancholia” Freud commented that in mourning what was important was not whom someone had lost, but what. This thought has stayed with me. I spent my 20’s and 30’s  defining myself as Christian, albeit in varying ways – but mostly Evangelical. (That wish for certainty was pervasive.) Then I began psychotherapy and allowed myself to look behind some of my locked doors. What did I think about Jesus, the Church, Evangelicalism, things Charismatic etc? I discovered that I thought all sorts of things that I hadn’t allowed myself to think! Now in my 60’s I am happily agnostic as far as religious faith is concerned. I’m probably agnostic about many things. It’s a position I feel very comfortable with. It’s particularly helpful as a counsellor where I spend much of my time simply holding someone in my mind. I choose to suspend judgement about almost everything. One of my patients commented,”This feels so weird. It’s the only place where I don’t have to defend what I say or think. You’re just interested in the fact that I do think such and such.” My experience of therapy from both sides of the couch is that this is the only stance one can take. The only certainty is that there is no certainty, which makes this work so rich and rewarding. On a good day. On a bad day a small part of me longs to be back in my warm fundamentalist womb being effortlessly nourished by a divine umbilical cord. But we are not meant to spend our lives in any kind of womb. We are meant to be outside exploring and discovering. Endlessly asking “Why”

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