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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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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Containment 2

I want to continue the idea of containment. I have a softer image .One which speaks of the willingness to allow the other freedom. One which assumes that the recipient wants to be held and is attuned to that holding. I was reflecting today how pleasant it is not to have left a hospital admission in an angry mood. I can look back at my Wycombe experience with a sense of appreciation. The unit- the  staff- contained me. From here I could become content. The words have the same root which has links to the idea of a tenancy or a tenant. Someone who doesn’t own the property but who occupies it by mutual agreement.  The mother doesn’t own the baby. Nor does the baby own the breast. They agree to a shared tenancy.

One of several strands that shaped my feelings about my hospital admissions was a disappointment at the tenancy conditions. I had read the contract in a particular way. It included words like care, nurture, interest, compassion. The other party seemed to have a different tenancy agreement. One that included records, busyness, form filling, box ticking. By the time we had met, it was too late. We both made assumptions about the agreement that would contain us for the near future.

This image is all about being silenced. About a very particular form of containment that is far from desirable from the viewpoint of the individual. It speaks to me of a fear of allowing the other to speak and be heard. It is the way of the bully in any situation where they might be challenged. Be that Brexit, sexual harassment, the  outlawing of opposition parties in politics. Or the voice of the  prisoner or the patient. Theologically and spiritually the idea is the same. The Old Testament prophet Isaiah says “I form the light, and create darkness: I make peace, and create evil: I the LORD do all these things” (Isaiah 45:17) The Creation story in Genesis has a similar idea. God doesn’t only create Light. He creates Darkness-with all its implications. He offers darkness a containment which allows it to live.

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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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Does God dream?

As a counsellor I’m always interested in my patients’ dreams. Freud called them the Royal Road to the Unconscious. I also have an interest in theology and spirituality. A conversation recently left me mentally combining the two and asking “Does God dream?”  Behind that there’s another question “Does God have an unconscious life?” 

In clinical practice I use unconscious material a lot. We think about my patients’ dreams. The Soto vocce asides they make. (In psychosis these are experienced as “voices”. They are a similar phenomenon. Communications that are only partially meant to be publicised.)

The unconscious seems to be akin to the Cloud. It is an undiscriminating storage space with limitless capacity, password protected and safe from external interference. ( I confess to understanding the unconscious far better than the Cloud!)   My other premise is that we are told that Man is made in the image of God. Logically, this should lead us to the thought that God has an unconscious life.

But what is stored in the unconscious? Predominantly those parts of ourselves we deem unacceptable. Those parts that Jung calls our Shadow. We hide our racist thoughts here; our sexual fantasies; our murderous and hateful feelings. And so on. How do we know we have these thoughts? Catch yourself the next time someone cuts you up when driving. Or has the temerity to queue jump. Or to say or do something that leaves you feeling patronised and not-seen.
So where does this leave God? Where does an omnipotent being hide his Shadow? Jung suggests He hides it in plain sight. He uses projection. Brexit seems to me to be a current example. All our social, political and economic woes are due to Brussels. And immigrants. And any “previous government.” Looking inside ourselves is anathema. Who knows what we might find?

Jung suggests that God put all His shadow into Satan, also a son of his. But one who for a number of reasons was not his father’s favourite.  A dynamic not unknown in ordinary non divine families! So any thought or idea that Yahweh couldn’t tolerate was given to Satan to own. (The NetFlix series “Lucifer” plays with this idea very perceptively and amusingly. A kind of “theology lite”!)
If God went into Psychoanalysis we could explore his unconscious life. Which might make many things clear – not least Him!

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Analogue Brain

I was sitting having coffee with a friend who I know is ” good with I.T.” He understands these things. I was struggling to set up another Twitter account. I’d followed all the rules. Pressed all the right buttons. Uttered all the appropriate digital incantations. To no avail. “Here. You have a look. You do this stuff.” He looked at the runes. Waved his digital wand and told me what steps to take. It made no difference. I couldn’t understand a word. He sighed and pronounced judgement ” Your problem is that you have an analogue mind in a digital world.” He’s absolutely right. My brain doesn’t seem to do digital.

I’ve just visited the Tesla museum in Belgrade. We were given a tour with various clever demonstrations. My wife and friends assumed I’d be bored. I wasn’t. I wasn’t engaged enough to be bored. I simply had no framework into which I could put what I was hearing. ( I say this with no sense of ludditism. I should be better informed.) I’m not. Put me in front of a Dali painting and I’ll find a way in. Jackson Pollock’s work is the same. I know how to think about what I’m seeing.

Psychoanalysis is the same. I can work with dreams. I can make sense of my patient’s material however it is communicated. Even if  I feel completely lost in a session, I can think about that state of mind and wonder about it. 

As a teenager I remember my father coming back from a school open day and reporting my headmaster’s indictment of me. He says your head is full of nothing. This was not true. My head was not full of maths, physics and chemistry. It was full of Romeo and Juliet. Of dreams and hopes that could not be contained in a dry formula.

Fifty years on and very little has changed. If    I’m sitting with a patient I’m not good at concise formulations. I can’t build a plan of action based on an initial assessment. I meet my patient as they are on that day in that moment. I’ll wave my hands and say things like ” You know it occurs to me that…” Or ” I think you want me to understand that…”  I worked in a CBT team for a few months. It was not a success. I focussed on all the wrong things. I was supposed to divide my patient into neat proportions and ratios. Anxiety = 60% Depression = 40% Therefore create a plan of action for the depression. I left after a year.

My point is to make a plea for those of us who are digitally challenged. We aren’t being difficult when we can’t make this app. work. We know that a good digital filing system with appropriate passwords is a thing of beauty. It’s just that finding the meaning in Dali seems so much more useful. Or being able to create a well framed interpretation of a patient’s words. Here only analogue will do…

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