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

The shape of things

I have just watched “The Shape of Water” Guillermo de Torro’s new film. I was initially rather baffled by what I thought of it. Lush, lovely, moving, interesting but how did the various themes fit together. How to reconcile the central love story between the mute janitor, Elsa, and the Creature and the back story of the Cold War. What I began to understand was what happens when Difference is encountered. Be that the difference between  spoken words and sign language:between Gay and Straight or East and West. In each of these cases, de Torro shows how much we fear the Other. From this fear comes  a wish to destroy and kill it because we do not trust what we do not understand.  De Torro’s film shows what happens when someone is willing to take a chance and trust the Other. (What follows is at first a kind of death but from this comes Life.)

As a counsellor I was also struck by how profoundly true de Torro’s film is in relation to the inner world. We fear the unknown in ourselves. When a patient brings a dream to a session it is fascinating to see where this takes us. (Dreams being the royal road to the unconscious,, as Freud put it.) Give time and space to think about the dream and its possible meaning and much rich material is gleaned from the unconscious. Material which can be upsetting and unnerving at times, leaving one thinking,  “Is this really me? I don’t want to have to see this as part of me. It is so far from the Me I think I know.”  (This recognition is one of the themes of de Torro’s film.) Yet until we can see, know and accept those hidden parts of ourselves, we are not really able to live fully or so it seems to me!

Another of Freud’s dictums was that the point of psychoanalysis was to bring into consciousness the unconscious which allows us to think about it and understand it. (Thereby detoxifying it.) This willingness to accept the Other is often achieved at some cost. It can be a  shock to be presented with a part of ourselves that like Torre’s creature, seems utterly different to us. Yet take the risk and meet it, and new worlds open up.

 

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

Principalities and Powers

Saint Paul wrote that we wrestle not against flesh and blood but against principalities and powers,

This seems to be one way of thinking about the way values seem to get embedded. Whenever I assess a man for Anger Management there will be generations of men behind him sharing their values and instilling in him a view of how men behave and conduct themselves. Usually these values include emotional and physical abuse as a way of enforcing a power structure. These men then grow up with a view of themselves as needing to be ” hard”. Hard on their children and hard on their wives. Sometimes the control is physical, sometimes emotional. But always about control.

Similarly when I assess a woman who has come for help with anxiety or depression, there will be mothers and grandmothers who instil a view of a woman’s place and function. This will be that they are there primarily to serve their husband or children. ( To serve. Not to complement or share, but to serve. As one patient put it, her task was to help her husband become the man she saw that he could be!)

Saint Paul understood his battle to be with the spiritual forces that he thought lay behind everyday life and society. He saw these values as demonic and anti Life..

Looking at the Brexit decision, I’m almost inclined to follow him.

In broad terms, he had a point. Violence, rage, crippling anxiety and depression are anti Life. Which might be one way of characterising the demonic. That which is anti Life. Which begs the question of “Why?” Why does a man come to believe that violence is the only way to live? Where does he decide that hitting his wife and children are good ways to live?

Where does a woman decide that her task is to sacrifice all for her husband/ father/ family?

It seems that there is an alternative value system that ensnares us in its thinking. I recognise it in myself. My wife works full time in a job that she enjoys and which is demanding. I’m retired and work fewer hours. But if we run out of something at home, my all too frequent reaction is ” Why hasn’t Jenny done the shopping?” (I do try to remind myself that I am quite capable of going shopping.) And I consider myself to be a modern man. Some values run deep!

So how to understand the principalities and powers at work here? Much of the difficulty seems to stem from a sense of insecurity. I’ve yet to meet a man for whom Anger was a problem who was able to value himself very much. In all the men I’ve worked with, there was an underlying sense of low self worth. ” I’m just thick. I’m only fit to be a navvy” is how several of my men have put it. And even on the building sites, there’s no respite. Any comment on their work, justified or otherwise, is experienced as criticism. Any criticism wipes out their entire being, confirming their view that they are indeed ” only fit to be a fucking navvy.” Take this away and it’s hardly surprising that violence erupts in some form. If my self esteem is so fragile, then anyone or anything that threatens that will be met with an extreme response.

With depressed and anxious women self esteem also seems to be involved but in more subtle ways. We know how misogynistic our society can be. A woman’s place is still in the home. No matter how many important decisions she makes at work, a woman can still be undone if she forgets the milk! ( I wonder who does the shopping for Theresa May? I remember David Cameron shopping in Aylesbury. A large, black SUV parked illegally at the top of our street. No parking ticket was issued! His bodyguards got out first, followed by Cameron as he did a bit of shopping in Aylesbury. An everyday trip to the shops such as we all do.)

Women still see themselves as being subservient to men. The patient who told me she saw her task as helping her husband to be the man she thought he could be, was expressing a maxim from her mother and grandmother- which is usually as far back as records go. In this case all three generations had seen their marriages fail as the men they had chosen turned out to have agendas that didn’t match those of their wives. In each case the present generation managed to instil the message ” Do as I say and ignore what you see.” with no good outcomes.

We seem to be back to principalities and powers. Of powerful unseen forces shaping successive generations and influencing behaviour and values. Perhaps one way of characterising the work of the therapist is that we speak Truth to Power.

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