Aylesbury, Dreams, Hope, Mindfullness, Psychoanalysis, Psychotherapy, Spirituality, The Inner World, Ways of Being

Freud goes gardening

As all good gardeners know, we are supposed to plant in threes or fives. This blog is my third “planting”. Five seemed too many given the amount of time we spend in our real and metaphorical gardens. As with all good work, I’ll begin in the here and now. I came in from the garden the other day feeling rather disgruntled. “How did you get on?” asked my wife. “Did you get lots of things done?” I grunted a reply and she carried on typing. I began my blog, I was disgruntled because I’d  spent several hours outside with nothing much to show for it. I’d dug up a couple  of clumps of couch grass and removed yards of convolvulus . But no “Wow!” moments. Just plodding away at routine maintenance. The chief thing I’d done was to plant some bulbs for later this summer. Neatly labelled: “Summer bulbs. Misc.” (I keep careful gardening notes, as you can see!) And at this point I’m going to risk sounding like ‘Thought for the Day’ by using this anecdote as a jumping off point to talk again about the garden as an image for that which I’m going to call “soul”.

I had somebody come to see me recently. He had a number of issues from his youth which he needed to resolve. He talked. I listened, and I made some observations en route. At the end of the session he commented that this had been helpful. He’d talked about more issues that he’d planned to and felt relieved. I asked him if he wanted to come  back. He thought for a moment and said “No. This session had been helpful enough.”  I wasn’t persuaded that he had resolved the underlying difficulties but it was his choice. Others stay much longer. With these patients I can spend a lot of time double digging, removing the entrenched weeds and trying to see what lies buried beneath years of bad planting and poor care. There is a satisfaction to this kind of work, although at times it feels like hard labour! Hard labour with no “wow!” factors to mitigate it. I remember one patient who spent two and a half years with me. Each session seemed to last forever. I did not look forward to seeing her. (It was probably mutual!) We met faithfully each week, seemingly getting nowhere new. Then, suddenly, six months before the end of her course, something shifted. In her. In me, I’m not sure. But new growth started to emerge. Like those early buds in spring. I think we did more work in the final six months than in the previous two years. Asked her why she had stayed when so often our work felt fruitless, she commented that she trusted the process- and me! We both learned a lot from that therapy.

The link here is, I think, about patience. My miscellaneous summer bulbs will flower in due time. I’ve done the preparatory work. Now I have to leave them alone and “trust the process”.  I find it hard , at times, not to want an instant result. I was discussing two of my patients recently with my supervisor. I complained that I was running out of ideas on how to help them. She commented on my sense of frustration, underpinned by a certain crossness. “I’ve been working with this one for several years. And still we go over the same ground, week in, week out. Then they complain at me that we seem to be spending a lot of time going over old material!” The indignation in my voice could have been heard throughout the town! She was sympathetic and reminded me of Bion’s maxim that one should approach a therapy session with neither memory nor desire. It’s a quote I knew but had lost sight of in these cases. She reminded me that it was not my task to make my patients better. My function is to manage the process and, thereby, help my patients towards their solutions. I’ve taken her reminder to heart and feel more relaxed and less irritated.

As a gardener I can’t make my plants grow. All I can do is to provide the right conditions for any given plant. The rest is, mostly, outside my control, which sometimes comes as a great relief and sometimes exasperates me. Just like my patients!

 

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Counselling, Mindfullness, Psychoanalysis, Psychotherapy, Reflective Practice, The Inner World, The unconscious, Ways of Being

The Expert 2

The expert

I finished yesterday’s blog with a quote from Bion to the effect that the therapist should enter their session with their patient with neither memory or desire or expectation of outcome. That takes some doing! I have lost track of the number of times my patients have confounded my expectations- both positively and negatively. Patients whom I thought would stay for at least a year leave unexpectedly after a month. Patients whom I knew would gain nothing from seeing me stay for a year or more and take a huge amount from the work. Sessions where I have been in fear and trembling of the attack I knew would come prove me wrong. And vice versa. In a week I move from being invaluable, generous and understanding to being greedy, rapacious and useless. Which proves the value of Bion’s maxim.

It is a rule that I’m learning to practice. To “trust the process”. To believe that between us, me and my patient can come to a shared understanding in the session of what it is that I am required to know. (As usual it’s this point at which I mildly envy my CBT colleagues who have a fixed programme which they can follow.) Working my way has advantages and disadvantages. As a nurse it meant that I never could write a “proper” Care Plan because I always worked with the transference-  which was unpredictable. It also made my teaching slightly difficult for similar reasons. I still can’t write a lesson plan with learning outcomes etc. I taught in the transference. (A way of working that took some of my students a long time to get to grips with. Some never did.)

How does this relate to Consultants, Experts etc? For me the Expert is the one who is comfortable with not-knowing. The one who can respond to a question with an honest answer and not bludgeon me with their knowledge. (My G.Ps are brilliant examples of how to listen to their patient.) Why does it matter if I’m heard or not? Because not being heard invalidates me. It wipes me out and reduces me to a set of symptoms that only they can fix.(As you might imagine, I am not necessarily a “good” patient.I expect from others what I try to practice myself. Certainly in the clinical realm.)

The picture above picks up the idea of an expert.The climber has reached a peak with hard work, skill and endurance. And has earned the right to enjoy the view. But the number of unclimbed peaks still outnumbers the one on which he stands. That knowledge should keep all of us humble-no matter how expert we consider ourselves.

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Psychoanalysis, Psychotherapy, Reflective Practice, The Inner World, The unconscious, Ways of Being

The Expert

In the space of a week I have had the dubious pleasure of seeing two consultant cardiologists in two different hospitals. In one case I wished that I had had some kind of lethal weapon with me. Or had been taught to kill just using a biro and some lip salve. Bond et al would have known how to do it quickly and efficiently. (His companion would have offered no resistance after his mentor had been so dispatched.) Sadly I was unable to act out my fantasy-which may have been a good thing. I’m still ambivalent on this point. What made me so angry was his attitude. I offered some opinions about my health and suggested that some of my symptoms were probably side effects of some of my medication. “How do you know that?” “Well, I researched the drugs on the web. And read the information sheet that comes with them. These suggest that what I have are side effects.”

“Everything can be found on the Internet these days.” was the response.

I felt like a five-year old who has said something clever in class but who has been firmly put in his place by the teacher and told not to be clever again. The Consultant then proceeded to outline the treatment programme he planned for my heart, which would happen next week. that said the “conversation” was finished and I was dismissed. (Sadly this only repeated my previous experience as an in-patient at Papworth. It felt that everyone looking after me would have been happier if my heart could be nursed apart from the rest of me. Then the surgeons could do their clever technical stuff without me getting in the way.)

My next encounter was in a local cardiac unit. Full marks to the team for being fun, human and interested in me as a whole person and not just a cardiac case. Even the Consultant was reasonably human-to a point. He had his regime in mind and was not going to be deflected from it. When I refused to take a drug he wanted me to have, he was not happy. But conceded that I could make this choice. Again I felt reduced to the level of a five-year old being told “Don’t argue. Daddy knows best.” (He might. I acknowledge his skill. But it is still my body. I have to suffer the side effects, not him. And I will not be railroaded into a course of action that feels damaging.)

The psychoanalyst Wilfred Bion said  of Desires: The psychoanalyst can start by avoiding… Desires for results, `cure’ or even understanding must not be allowed to proliferate.” I will take this idea further in the next blog.

 

The expert

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