8th February 2018
I was recently lucky enough to be at an event where I got to hear one of the great contemporary existential therapists, Ernesto Spinelli. He challenged modern ideas of therapy which have come to mean a change for the better; an improvement; a medical intervention, when in fact the original Greek meaning, Therapeia, was the attempt to stand beside another.
I can imagine that a client who is in a lot of pain and distress might find it hard to see that my role might be to stand beside them, helping them explore their inner world, rather than trying to facilitate change whereby they will be relieved of their difficult feelings. However, I can also see that if I have an agenda about how the client should be this may not be helpful. The therapy is more effective if I can accept the person as they are and not be the superior one who ‘knows’ what is best for the client.
From this place, the first task of therapy is to assist the client to hear their own voice more truthfully and accurately. Spinelli says for this to happen, the therapist must be ‘an idiot’: asking the most obvious questions. The questioning is more along the lines of ‘what’ and ‘how’ of the client’s experience (description) rather than explaining causes. It is through describing experience that we change. Asking a client how their descriptions are experienced in their body makes it unique and more concrete, and helps facilitate a link to associations and memories.
There then entails the creation of a descriptive narrative about the story told, wherein important themes might begin to emerge. Metaphor may be added in order to be more concrete or accurate about feelings. The process offers a fuller expression of self.
The purpose of this descriptive process is that it allows ownership by the client of their experience. If the client can experience a problem as their own, they are no longer a victim of a problem and their way of being with their problem shifts.
Spinelli goes on to talk about another phase in which the therapist is the ‘the fool’ who gives voice to ‘otherness’; the therapist’s own experience of being in the room which is different from the client’s, and thereby invites the client into some other possibilities. Clients can then begin to see that the issues that brought them to therapy are related to a stance they have adopted towards themselves.
Then there is ‘the executioner’ phase in which the client must consider the wider, more complex world outside of therapy. They have had the opportunity to experience themselves under certain conditions of the therapeutic space, and must now consider whether this can be transposed to the wider world.
29th September 2017
The Body, Psychotherapy, the World
I recently participated in a weekend seminar with the big title of ‘The Body, Psychotherapy, the World’, put on by Processwork UK. I had some big experiences (perhaps for a later blog) but was also reminded of the basics of the work that I do. Two central ingredients: warmth and curiosity. If I do nothing else but this around clients, I believe, I will be setting the groundwork for change to happen.
I don’t remember ‘warmth’ or ‘curiosity’ being discussed with any emphasis during my training as a therapist. Somehow they seem to belong more comfortably in a social context, and don’t quite sound technical enough, medical enough, or professional enough to be constituents of profound and life-altering psychotherapeutic intervention.
And so I am taken back to basics, of how I can be around others, what makes it safe and purposeful for them to dwell inside themselves and somehow share with me what that is like. Once they do that, I can enter the slipstream of their experience and then we are in business.
Warmth and curiosity go a long way because they create a framework for a client to tell, to show, to be seen; for parts of themselves to be revealed that they may have deemed unacceptable, unwanted, disowned or broken to come into the room for re-evaluation. The client can also become warm and curious about themselves, or self-reflective, thereby being able to access inner resources in challenging situations.
15th June 2017
Patterns and breaking them
Therapy is about change. What generally motivates people to come to the consulting room is that they are unhappy, anxious, in pain. Their life is in a place that is not working for them and they do not know how to improve their situation. People often speak of feeling stuck or hopeless. They have tried to make changes but nothing has worked. Often patterns of behaviour (as well as patterns of thinking and feeling) have developed over a long period of time, some of which may be outside of the client’s awareness.
By having the space to talk through or map their subjective experience, clients build up a clearer picture of how and what they are doing, some of which may be directly contributing to the painful, stuck place they are in. With this awareness they are then in a position to decide to do things differently, to change the pattern. This often looks like a re-resourcing of the client. They feel they have more options available to them, and can even, for example, find that new words are coming out of their mouths which take them in a new and unexpected direction. This kind of fluidity, feeling the possibility of not being stuck and the hope that one day life will be different and that they will be happier is very energising. A glimmer of hope can create momentum for further change to happen.
Debilitating depression and anxiety paint pictures of an impoverished life of no hope. When this is overly dominant the client may need the experience of the therapist to carry the possibility of things being different and ask the client to trust them on this. This is where relationship is so key; if the client experiences that the therapist has really heard them and engaged with their pain, this can be the motivation to be open to change.
10th February 2017
Clients often say that something they value about therapy is the opportunity to take an hour out of their week to reflect on their life. It sounds pretty obvious or even easy, but we tend to fill our lives with events, relationships, work and activity. Stopping in order to evaluate, particularly with another person in conversation, less so.
Related to this is the idea that life is understood (by looking) backwards – one can see a train of thoughts or decisions which led in a certain direction that was taken. In therapy, you can view your life as it is lived and therefore there is opportunity for choice and change.
Mindfulness and therapy share some common ground. Mindfulness practice offers the opportunity to observe ones patterns in life as they arise, and choose to do things in a different way. With therapy the process of talking about your life means that you are not only the protagonist you are also the narrator or witness of your own experience, and therefore choosing to do things a different way becomes a possibility.
Sometimes I notice that if there has been a break in the therapy, for example to due holidays being taken, the process of change seems to slow down, and sometimes old patterns start to creep back in. This would appear to be consistent with developments in neuroscience whereby it is observed that pathways are formed in the brain due to our experiences, which might be stressful ones. The process of therapy helps to modify neural activation patterns which have developed, eg around anxiety and depression, and provide new experiences which change these patterns in the brain. However, it is possible that the old patterns can re-emerge if old neural pathways are activated.
16th September 2016
I recently saw a new film called ‘Look At Us Now, Mother’. It is a documentary film made by an award-winning director about her relationship with her critical, narcissistic mother, and how the daughter comes to a place of forgiveness with her mother. In fact, the relationship is now so good that the pair are on tour together with the film, doing Q & A sessions after screenings.
This got me thinking about the role of forgiveness. A lot is spoken about forgiveness being important to letting go of painful situations and relationships, and that holding on to resentment and anger ties one to the perpetrator or scenario. There are many who claim that holding on to grudges and resentment can restrict energy for other, more fulfilling things in life, and can even create illness. Got it.
However, sometimes it seems to me that people may want to jump to forgiveness in order to maintain the status quo and keep difficult feelings shut down. They may be frightened of the consequences of being angry or engaging with their feelings of hurt. They may be concerned that key relationships may break down irrevocably.
Therapy can offer a space to give voice to anger and hurt, recognising that these emotions may be necessary to restore a healthy sense of self and separate from those who have imposed violent or abusive behaviours. A counsellor can bear witness to difficult and painful experience that socially people may shy away from, and may never be acknowledged by those who inflicted the pain. Keeping quiet and pretending that all is well can be a collusion that keeps the victim stuck in old patterns, rather than creating space for new ones.
Once the emotional fire has been allowed to flare up, and plenty of space given to emerging feelings, THEN there may be a place for forgiveness… or it may never come.
14th June 2016
Listening to yourself
One could say that in counselling, the core experience of the client is that of being listened to. Properly. In a social context, people often interrupt each other; a train of thought is not followed through because distractions and diversions arise. Some people seem incapable of listening to others, and constantly want to draw attention back to themselves. Socially, most people will operate a degree of self-censorship for fear of being judged or rejected.
So the focused listening, or attention, of a therapist may be an unusual and possibly healing experience in itself. Add to that the often-mentioned advantage that the therapist is not directly involved in the client’s life, does not need to be taken care of, and offers a safe and accepting environment, then a client may be able to reach into their material more deeply. An effect of this, not always perceptible to someone new to the process, is crucially that the client starts to listen to themselves.
Sometimes this can have the result of solidifying an experience or feeling. For example, a client hearing themselves week after week, recounting a painful experience, may finally hear themselves, notice the pain they are enduring and decide to take a different course of action. If they hadn’t heard themselves with this clarity then they might continue to repeat the painful scenario.
Sometimes the externalisation of inner experience can turn up surprises. In speaking and being heard, a client may see themselves in a new light. They may sink into their experience more deeply and find new and unexpected material lying therein.
This sense of being listened to can also allow people to become less entrenched in a position. Once they have given voice to their top-line thoughts and feelings, they may then be able to access a less conscious, perhaps more suppressed viewpoint which challenges their dominant, and more known, position. This can be a very healing and growthful place for clients.
One of the gifts of the therapist is that they listen in to what is not being said, or become drawn to places that the client may have glossed over. This gentle reorientation can genuinely offer a client new perspectives or a deeper understanding.
28th January 2016
Captive to our thoughts
Many clients use the term ‘over-thinking’ to describe the problem they are having in their lives. It amounts to not being able to turn off their brain which is spewing out negative self-beliefs and ideas. Despite the fact that people invariably know that these thoughts are distorted, inaccurate or at the very least destructive, they feel captive to them. They feel somehow compelled to listen to these thoughts and are unable to dismiss them.
A typical description of this problem by clients is having a long list of things that are not right about themselves and their lives. This turn over and over in their mind in some kind of attempt to correct/make good these many problems. Of course nothing is resolved by this activity, only a headache.
Increasingly Mindfulness meditation is favoured by many people as a way of coping with these thoughts and putting things back into perspective. I will regularly recommend Headspace, Simply Being and other Mindfulness Apps for smartphones, which can be a useful tool in coping with this challenge.
The intervention of therapy can operate like an interruption to this process. Slowing down to take a look at the contents of the over-thinking with another person can operate as a buffer when they return. Instead of churning the thoughts around and around, there is the possibility of a introducing a new perspective which is not convinced by the thoughts. The thoughts are no longer permitted to have free reign; another view has been aligned with and thereby the client is somewhat released from the thought tyranny.
3rd December 2015
We are told that 1 in 4 people will develop a mental health issue over their lifetime. That is a lot of us! Celebrities are coming out of the woodwork to share their own stories of struggles with anxiety and depression, and well-being is on the agenda in workplaces, schools, colleges as well as the media.
So if most of us will struggle with our mental health at some point or another, why do we find it so hard to talk about? Why can’t we be open with others about how we are low, down, going to our therapist, taking anti-depressants? Physical health is firmly on the agenda: we complain of headaches, stomach cramps, aches and pains; we openly tell people we have a doctor’s appointment, we are on anti-biotics etc
What’s the difference: Physical health, mental health? Is it that sharing our feelings of vulnerability is intolerable? Do we assume that others will judge us unfavourably for admitting openly what most of us might keep hidden? Do we still see vulnerability as a weakness, rather than just another inevitable trait of being human? In fact mental health and physical health are closely interlinked. When we are physically low, we often don’t feel positive and energised about life. When our mental health is challenged, our physical health is also affected for example through sleep problems, eating problems, drug and alcohol use.
I would like to think that counselling and psychotherapy not only provide a safe place for people to break the loneliness and silence of mental health concerns, but also that the profession can affect the wider culture. Once people feel they have had the chance to share their experiences of anxiety and depression in a therapeutic context, and realise they have not been judged, they may be able to speak about the mental health more openly, encouraging others to do the same. We may finally break the taboo.
10th September 2015
What’s awareness got to do with anything? People turn up for therapy because they’re unhappy with an aspect of themselves, their lives, their relationships. They are looking for something to change. Often people show up in the hope that they can change the behaviour of someone else; if only the other person could be different THEN they’d be happy. A lesson quickly learned is that we can never change other people. We can change ourselves and by doing so things (and people) shift around us.
So what is this process of changing oneself?
Cognitive Behavioural Therapy (CBT) focuses on behaviour change through changing habitual (negative) thought patterns. As a client, you will be encouraged to identify the thoughts and belief systems that contribute to your feelings of unhappiness. The thought patterns themselves will be examined and challenged, and you will then find that this alters your behaviour, and you start to feel better about yourself. This is a way of directly confronting ‘the problem’ head on and trying to change it. Makes sense.
Psychoanalytic therapy has more emphasis on tackling deep-seated, unconscious patterns of the client’s inner world which are revealed largely through how they relate to the therapist. These patterns are believed to have developed during childhood, and may well have gone unchallenged into adulthood. Through taking time to explore and understand their inner ‘map’, the client can then begin to make changes.
Other forms of therapy will take a view that a key component of the work is developing awareness, for example awareness of what you are thinking or feeling, how you are behaving, what is going on in your body and how you are relating to others and the environment around you.
Ironically, this attention to awareness is not done in order to change anything, but to highlight what is already there. By the counsellor listening carefully and reflecting back, the client is thereby able to see and understand their life more clearly, including areas where they are not paying attention and have less awareness. This is the real meat of the work, and is surprisingly transformative. Somehow this process activates the client’s resources which will in turn allow growth and change to happen. The counsellor has helped the client to accept who they are and how they are, and this in turn opens up new possibilities.
10th June 2015
I see a lot of people in my practice who are in the active phase of parenting young children. This is not an easy time. Tiredness is ever present, and the lack of time and space to process your own experience is a challenge. People say that coming to parenting later in life is in some ways harder; perhaps having less energy than in more youthful years, and the adjustment of having had your own independent life taken away and being replaced with the relentless care needed by young children is not easy.
The possibilities for feeling that you have got it wrong or should have done better are endless with the task of parenting. We are all too aware of how problems in childhood are linked to difficult teenager years, and potential anxiety and depression in adulthood. The thought that as a parent the ‘mistakes’ you make could be creating the seeds of such unhappiness is intolerable. Much harder to step back and congratulate yourself on what is going well, and counter the fear by accepting that you won’t get it all right but it will be good enough.
Coming to therapy at this time might feel a bit self-indulgent and perhaps not the best use of limited time and resources. However, the opportunity to step back for an hour a week and have focused attention on yourself, can provide space to think about how you are with parenting, how you are with yourself, and offer possibilities for reflection and change. It is very tempting to think that giving more and more to others is the way through difficult situations. Sometimes the person you need to give more to is yourself.
29th April 2015
I found myself talking to a client the other day, trying to bring attention to the feeling content of an experience, rather than the transactional, common day content. This could be described as ‘emotional texture’. Therapy encourages this kind of self-reflection, and it can take some getting used to when you first come to therapy as a client. So often we forget to look within; the world presents us with a constant array of stimulants and with the digital age we can entertain ourselves 24 hours a day, without a thought to what is going on inside ourselves.
Here comes the BUT…we pay a price for that. Depression and anxiety are prevalent throughout the Western world (and beyond); mental health has now taken over physical health as the main reason why people go ‘off sick’ from work in the UK; loneliness is endemic in society and public welfare services are overwhelmed with demand. Demand for what? For attention. For help. For connection. For an opportunity to start to feel better and more in control of life.
Counselling and therapy are certainly not the panacea for all ills. (Another) BUT they do provide a space in which people can focus on themselves and get to sort out what is working in their life and what isn’t; what is important and what isn’t; where they might be giving themselves a hard time or where they are in some emotional pain.
Attention to emotional texture is an opportunity to not just be pushed around by life. It offers the possiblity to cease operating in ways that are little understood or have become embedded over time with no current life value. It can be painful, scary, feel shameful and exposing, but the rewards are great. We are social creatures. Something in the act of speaking from a place a bit unknown, a bit hidden, a bit invisible to another human being in a trusted and safe space is empowering and potent.