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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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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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.

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

Containment 1

I’ve just had a short stay in hospital for knee replacement surgery. It’s  a disconcertingly quick process, once you’re admitted. I was admitted on Thursday and discharged home by the Sunday. Out with the old and in with the new. Literally. This was my third hospital visit over several years and the first one that was planned. The previous two had been crisis admissions. I don’t do well as a  patient – particularly as one who has been a nurse for most of his professional life. My overall recollection of my two previous admissions was of a gap between “hard” medical skills and the “soft” nursing ones. Between  the “male” skills of surgery and the “female” roles of nursing. I remember one nurse observing of me (to me) that “we’re all ill in our own way.” She was right. I’m not good as a patient. I’m far too impatient and independently minded. I hate being stuck in bed. I fear a loss of autonomy. My defence against existential anxiety is to become difficult and demanding. It’s a way of reminding myself – and everyone else –  that I will deal with this situation in my own terms. And if those terms don’t accord with your terms, well, so be it. Which means I’m never going to be “that nice man in bed 12”.

This admission was a markedly better experience. In part because I’d had a lot of time to prepare myself. I had a list of coping strategies. Chief of which was “Be nice to the nurses”! I was and it paid off. I could relax and allow myself to be cared for. Which created a virtuous therapeutic circle. I was content and contained.

The image at the top of this blog gave me a lot to think about. I Googled “Containment” expecting to find images of holding. A mother feeding her baby. A parent and child walking hand in hand.  Holding and held.  Instead I found a number of images like the one I chose. I thought about using another gentler image but opted to stay with the violent image that Google gave me. I wondered why? Partly on the basis of my two previous admissions. Partly on my own experience of being in analysis and also of my clinical work as a nurse and a therapist.

Psychiatric nurses don’t get many boxes of chocolates from grateful patients. In 25 years I got one box! I was reminded of this when I left Papworth hospital. I dutifully brought a box of chocolates. “Oh. Chocolates. How nice.” was the distinctly lackluster response. “I’ll put them with the rest.” It was a fair response. I was expressing my hate not my love.

“Damn”, I thought, “nice Adult nurses always get nice chocolates from grateful patients.” In  Mental Health this was not the way of things. We didn’t get “nice” patients nor did we expect to be “nice”. We expected to keep our patients safe. If that meant restraining them and forcibly medicating them, well then that was what we did. We contained them.

My two previous admissions highlighted this difference. The nurses expected to be liked. Why wouldn’t they? They were there to make us better and we were supposed to be suitably appreciative. So why wasn’t I being appreciative? I was being well looked after. My medication arrived on time and when I needed it. I was constantly monitored by a machine that bleeped if I even sneezed. I had drains, catheters, fluids and drips. All conspiring to keep me alive. So why my ingratitude? Mostly because I wasn’t contained. Nobody was asking me how I felt about having nearly died. Nobody asked me why I wasn’t eating or drinking enough. I was simply put on a fluid balance chart.

So the picture above sums up my first two experiences, My rage, fear, hatred couldn’t be borne. So I felt gagged. And murderously angry. Which I evidently conveyed. Powerfully.

 

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

Cathedrals

 

I came across this comment by the Anglican mystic Evelyn Underhill. She is writing about beauty:

“So, too, all who are sensitive to beauty know the almost agonising sense of revelation its sudden impact brings – the abrupt disclosure of the  mountain summit, the wild cherry tree in blossom, the crowning moment of a great concerto, witnessing to another beauty beyond sense… when we take it seriously, it suggests that we are essentially spiritual as well as natural creatures.” (The Spiritual Life)

I find myself uncomfortable with this idea. I acknowledge the sense of the numinous that we meet at times and places. I remember being moved to tears the first time I saw Rodin’s sculpture of the Prodigal Son. But what moved me was its humanity. Nothing to do with the Divine. I can listen to a great concerto, see a moving play, look at a landscape and be  moved. And be challenged to think about my life, its purpose and meaning. But I do not necessarily intuit the Divine in this.

Speaking of religion, Freud noted that:

“The psychoanalysis of individual human beings, however, teaches us with quite special insistence that the God of each of them is formed in the likeness of his father, that his personal relation to God depends on his relation to his father in the flesh and oscillates and changes along with that relation, and that at bottom God is nothing other than an exalted father.”

I find Underhill’s view one that demeans humanity and our creativity. I dislike the gothic cathedrals that, in my experience, seek to dominate man and propagate a view that reduces us to nothingness in the face of the grandeur of the Divine. I have no wish to be involved with a God who subjugates humanity. Following Freud, one has to wonder at the forces and influences that shaped the  inner world of the architects of the buildings. Robert Louis Stevenson wrote  “I never weary of great churches. It is my favourite kind of mountain scenery. Mankind was never so happily inspired as when it made a cathedral.”    For the most part I disagree.  There are cathedrals that inspire. Liverpool’s Catholic cathedral is one. Its light, its space and potential offer me a feeling of celebration and creativity. I always  want to dance when I’m there. Gaudi’s cathedral in Barcelona has a similar impact.

My point here is not to criticise gothic cathedrals per se. Coleridge saw them as “infinity made imaginable”. Perhaps he was right. For me, I prefer the image of an exalted father to be one of a father who can sing and dance with his children and teach them to celebrate life. I do not want to exalt a father who is remote, distant and intimidating.

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

Spiderman meets Allah

 

I recently watched the latest Spiderman film Homecoming. I was slightly disappointed by it. I enjoyed the Toby McGuire versions. I think because he portrayed more of the conflict he felt about being Spiderman. It seems to me that Tom Holland plays it as a teenager having huge fun as Spiderman but not really having to work overmuch about the implications of this role. But i’m a counsellor versed in psychoanalytic theory, so I may be expecting too much from the film! Although having so said, “Homecoming” does give a good portrayal of Peter Parker’s oedipal conflict .Tony Stark is an excellent father figure whom the young Spiderman has to deal with.

The piece of dialogue that struck me forcibly is this one. Peter wants his Spiderman suit back from Tony Stark who has confiscated it. (Castration anxiety anyone?)

Spiderman “I’m nothing without that suit.”

Tony Stark “If you’re nothing without the suit, you shouldn’t have it.”

(There is a lovely irony here since Tony Stark invented IronMan as his superhero alter ego. He needs his Ironman suit as much as Peter Parker but is unable or unwilling to recognise this need.)

I watched Homecoming around the time of the terrorist attack in Barcelona. The question of “suits” came to mind. As Spiderman Peter Parker can achieve all sorts of things that he cannot do as an ordinary adolescent. He needs to become Spiderman. (There are important questions here about potency and identity.) Like so many other people I wondered how a person can ram a truck into a group of people enjoying an evening out. (And at the risk of death by parenthesis, there are issues of envy here. How dare you be enjoying yourself when I’m not!) Could plain Mouassa Oukabir have driven his car into a group of people, aiming to kill as many as possible. Perhaps not. But as a disciple of a particular Iman, Abdelbaki Es Satty, Oukabir had a suit to wear. Like Peter Parker, it gave him an identity as a perverse “Superhero.” Presumably his version of Islam gave Es Satty a similar kind of suit.

In the closing scenes of Homecoming Peter is offered a brand new Spiderman suit, which he refuses, much to Tony Stark’s bemusement. “That was a test, right?”asks Peter. “Of course”replies Stark. So Peter Parker goes back to  being your average, friendly neighbourhood Spiderman. It seems he has found a way to resolve some of the issues he has with Tony Stark. And, more importantly, with himself. One wishes that “radical Islam” and all its kind could make a similar resolution.

 

 

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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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