Therapy
Undertow
06/11/09 12:33
Going to the beach was always something she’d enjoyed, albeit with a little apprehension. Something about the quiet roar of the waves, the occasional spectre of bluebottles, or perhaps the jokes people sometimes make about sharks.
As a child she’d sat and paddled in the wet sand, watched people bake in the sun, and, as she got older, enjoyed wandering up and down the waterline, her eyes combing the foam, flotsam and jetsam that last night’s storm had dislodged from somewhere out to sea.
As an adult, she would swim into the waves, feeling the push and surge against her chest; the shifting sands underfoot. Then one day she found herself being drawn strongly against the flow of the waves. She began to swim back to shore, and the effort tired her all to quickly. Before she knew it, the safe familiarity of the shoreline looked smaller and more distant than she had ever seen it.
She swam and swam, feeling growing shame and dread as she sensed a losing battle with the current. She didn’t want to be one of those foolish-looking people who let the surf get the better of them - she’d always been a confident swimmer. Even as she panted and pulled against the relentless rip, she chuckled at how ridiculous the situation had suddenly become. A surfer paddled over to her. “Are you ok? You need help?” “No,” she puffed irritably. “Maybe I should call the lifeguard,” he said. “I’m fine, I know how to swim,” she countered, and began to stroke harder against the tide.
A lifeguard on a board appeared beside her. “I don’t need help. I’m just caught in a rip I think. I can swim back, just when this lot of waves passes,” she spluttered as another broke over her. The beach was looking so distant now. A wave of sadness rose in her, as she felt the longing to be back on the firm sand.
“Help!” she yelled, and the lifeguard began to pull her onto the board. “Paddle with me back to the shore. When a wave comes, paddle harder,” he stated. Tired as she was, she began to paddle. After a minute or two, she was just so tired. She lay down and rested on the board. “Keep paddling, or I’ll have to leave you behind!” said the lifeguard. “I can’t,” she sobbed. She found herself back in the water, drifting further out to sea. She was crying freely now, certain that this current would not let go of her.
That’s when a voice she could not place began to speak softly to her. “Sometimes this happens. Let the current carry you. Swim with it if you can.” “I’m scared. I’m drowning,” she thought to herself. “You are safe if you don’t struggle.” murmured the weird voice. “Sure, and I’ll get carried out to sea forever,” she mused. “Not forever. for as long as it takes,” sounded the voice.
And so she gave up and let the current take her. Within what seemed like a few seconds, she found herself becalmed. The beach seemed a long way distant, and the rows of waves between her and the sand, but she could only hear a soft murmur of the surf. The current had brought her to deeper water, and she felt a strange peace. The disembodied voice spoke again: “where do you want to go now?”
“Home.”
“Where’s that?”
“Here.”
As a child she’d sat and paddled in the wet sand, watched people bake in the sun, and, as she got older, enjoyed wandering up and down the waterline, her eyes combing the foam, flotsam and jetsam that last night’s storm had dislodged from somewhere out to sea.
As an adult, she would swim into the waves, feeling the push and surge against her chest; the shifting sands underfoot. Then one day she found herself being drawn strongly against the flow of the waves. She began to swim back to shore, and the effort tired her all to quickly. Before she knew it, the safe familiarity of the shoreline looked smaller and more distant than she had ever seen it.
She swam and swam, feeling growing shame and dread as she sensed a losing battle with the current. She didn’t want to be one of those foolish-looking people who let the surf get the better of them - she’d always been a confident swimmer. Even as she panted and pulled against the relentless rip, she chuckled at how ridiculous the situation had suddenly become. A surfer paddled over to her. “Are you ok? You need help?” “No,” she puffed irritably. “Maybe I should call the lifeguard,” he said. “I’m fine, I know how to swim,” she countered, and began to stroke harder against the tide.
A lifeguard on a board appeared beside her. “I don’t need help. I’m just caught in a rip I think. I can swim back, just when this lot of waves passes,” she spluttered as another broke over her. The beach was looking so distant now. A wave of sadness rose in her, as she felt the longing to be back on the firm sand.
“Help!” she yelled, and the lifeguard began to pull her onto the board. “Paddle with me back to the shore. When a wave comes, paddle harder,” he stated. Tired as she was, she began to paddle. After a minute or two, she was just so tired. She lay down and rested on the board. “Keep paddling, or I’ll have to leave you behind!” said the lifeguard. “I can’t,” she sobbed. She found herself back in the water, drifting further out to sea. She was crying freely now, certain that this current would not let go of her.
That’s when a voice she could not place began to speak softly to her. “Sometimes this happens. Let the current carry you. Swim with it if you can.” “I’m scared. I’m drowning,” she thought to herself. “You are safe if you don’t struggle.” murmured the weird voice. “Sure, and I’ll get carried out to sea forever,” she mused. “Not forever. for as long as it takes,” sounded the voice.
And so she gave up and let the current take her. Within what seemed like a few seconds, she found herself becalmed. The beach seemed a long way distant, and the rows of waves between her and the sand, but she could only hear a soft murmur of the surf. The current had brought her to deeper water, and she felt a strange peace. The disembodied voice spoke again: “where do you want to go now?”
“Home.”
“Where’s that?”
“Here.”
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Being Framed
26/04/09 20:17
Therapists sometimes talk about the “therapeutic frame”. The term doesn’t refer to being made a scapegoat, or even to the mounting for the therapist’s qualifications up on the wall. The therapeutic frame is the sum total of all the ‘rules’ and ‘limitations’ inherent to the therapy process. The cost of sessions, the availability of the therapist by phone after-hours, the provisions and limits of confidentiality, the regularity of session times, and whether the therapist would also see one of your friends or family, are all part of the therapeutic frame. While some of the aspects of the frame, such as the adherence to rules about confidentiality, are important in themselves, it is also important that the therapeutic frame, once established, remains secure, consistent, and predictable. How do you feel when someone makes an appointment with you, then doesn’t show up? Having a clearly established therapeutic frame allows you, the client, to form clear expectations about your therapist that you can then rely on over time. Every time the frame changes (for example, if your therapist goes on holiday), it falls back upon you and the therapist to spend time re-establishing the frame; time that could have otherwise been spent focussing on you and your problems.
One aspect of the frame that you may find challenging is the lack of information available to you about the therapist. This can be disconcerting, particularly if you don’t trust your therapist to see things from your perspective. You may find it difficult to talk openly when your therapist is not doing the same. One reason most therapists don’t like to discuss themselves in sessions is that it shifts the focus of the conversation onto them, and away from you. Even a small detail, such as knowing that the therapist is feeling a bit tired today, has the potential to affect the flow of the session adversely. For example, knowing your therapist is tired, you may feel more reluctant to show difficult feelings to the therapist in case you tire them out too much. Some therapists ask clients to lie on a couch for this reason: you are lying down, looking at the ceiling, and can’t see the therapist’s face, so you can’t judge how they are feeling about what you are saying, and therefore are less likely to ‘censor’ what you say to avoid distressing them.
Of course, you may quite like the fact that you don’t know what’s going on for your therapist (or you may simply not care!), as it allows you to get on with the work you need to do in session, without having to also deal with their issues. If you are attending therapy, consider how little actual factual information you have about your therapist, and yet how many assumptions you still make about them. These assumptions are actually very important, and useful to be aware of. They will tell you a lot about the assumptions you make about people in general. Many of the ideas, feelings and reactions you have towards your therapist are a reflection of these assumptions. Understanding your reactions to other people and the history behind these reactions is part and parcel of understanding yourself, which is the point of therapy after all.
One aspect of the frame that you may find challenging is the lack of information available to you about the therapist. This can be disconcerting, particularly if you don’t trust your therapist to see things from your perspective. You may find it difficult to talk openly when your therapist is not doing the same. One reason most therapists don’t like to discuss themselves in sessions is that it shifts the focus of the conversation onto them, and away from you. Even a small detail, such as knowing that the therapist is feeling a bit tired today, has the potential to affect the flow of the session adversely. For example, knowing your therapist is tired, you may feel more reluctant to show difficult feelings to the therapist in case you tire them out too much. Some therapists ask clients to lie on a couch for this reason: you are lying down, looking at the ceiling, and can’t see the therapist’s face, so you can’t judge how they are feeling about what you are saying, and therefore are less likely to ‘censor’ what you say to avoid distressing them.
Of course, you may quite like the fact that you don’t know what’s going on for your therapist (or you may simply not care!), as it allows you to get on with the work you need to do in session, without having to also deal with their issues. If you are attending therapy, consider how little actual factual information you have about your therapist, and yet how many assumptions you still make about them. These assumptions are actually very important, and useful to be aware of. They will tell you a lot about the assumptions you make about people in general. Many of the ideas, feelings and reactions you have towards your therapist are a reflection of these assumptions. Understanding your reactions to other people and the history behind these reactions is part and parcel of understanding yourself, which is the point of therapy after all.
"I've always sorted out my problems on my own..."
27/02/09 18:34
If you've reached a point where you are seriously contemplating getting some counselling or therapy, you may be feeling apprehensive about what you could get yourself into. It's difficult to walk into a strange room, with a complete stranger, and talk to them about things you have barely ever talked about out loud, let alone with someone else there. The anonymity of therapy is an important comfort, but there are still a lot of unknown factors: What hidden parts of me might be uncovered? Will I go mad? Will I spend a whole lot of money with little real result? Is there a better way? Can I trust this person to do the right thing by me?
If this is you, I wanted to offer some basic, fairly universal things to consider before you start, and some questions you may want to ask your therapist at your first session.
Consider asking yourself:
- If therapy is about change, what parts do I want to remain the same?
- Do I want someone to help me help myself, or do I want someone to tell me what to do?
- How will I know that the therapy is working?
- How long do I want this therapy to last?
- What will I do if I think the therapy isn't helping?
- What sacrifices am I prepared to make in order for the therapy to work?
Consider asking your therapist:
- Do you have regular supervision? Would you be talking about me with your supervisor?
- Do you do any other professional development?
- Have you ever had therapy?
- What do you do with your notes?
- Do you use a particular approach, and if so, what is it called?
- Are there any types of client who you usually don't work with, and where do you refer those people on to?
You may also want to sit down and come up with some different questions of your own. If you are feeling depressed, for example, you may want to ask for more specific information about depression, or whether your therapist can recommend any good books on the topic.
Therapy is difficult, often in ways that you don't expect. It is also very rewarding, when it is working well. If you are just starting therapy, I wish you the very best, and commend your bravery in trying something new.
Why "Why change"?
25/05/08 17:43
This phrase reflects the central philosophy of my practice: people don’t need to know how to change; they just need to know why they haven't. Sometimes, people don’t really need to change at all - they just need to know why things are the way they are. Many schools of clinical psychology, such as cognitive therapy, solution-focussed therapy, schema-focussed therapy, or narrative therapy, are designed to provide you with a system to bring about change. What these models don’t really offer is a rationale for why that change should occur in the first place.
The most widely used reference among Clinical Psychologists is the American Psychiatric Association’s Diagnostic and Statistical Manual, currently in its 4th edition. It is typically referred to as the DSM-IV. The DSM-IV lists every mental illness, and describing each one in detail. This is an important guide, because it sets out universal definitions for illnesses such as depression, schizophrenia, and autism, so that psychologists in Sydney, London, or Mongolia can identify it using the same criteria. One of the main criticisms of the DSM-IV is that it is “atheoretical”. This means that it describes the illness, but does not provide any information about why has occurred. For example, the DSM-IV lists detailed criteria for the diagnosis of depression, describing symptoms such as depressed mood, sleep difficulty, and loss of interest in pleasurable activities. Yet no information is provided about why the person may be experiencing these symptoms. By comparison, other medical texts will describe not only the symptoms of the illness (say, coughing, runny nose, headache for the common cold), but also the cause of these symptoms (viral infection).
Most people know what they want to be different in their lives. Depressed people want to be happier. Anxious people want to be calmer. How does it help a sad person to be told that they need to be happy? A person who wants to quit smoking doesn't need to know how to quit; they already know: just stop smonking! What they need to know is WHY they find it so hard to stop. Once they know that, they will be able to find a way to quit on their own. It’s not my job to decide for them what needs to change, or even how they can go about making that change: my job is to do what the DSM-IV doesn’t: to help you understand WHY you feel the way they do, and help you answer the most difficult question: why change?
A lightbulb moment
31/03/08 17:41
Q: "How many Psychologists does it take to change a lightbulb?"
A: "Only one, but the lightbulb has to want to change".
Do you know anyone who needs to see a Psychologist? I sometimes get phone calls from concerned friends and relatives asking me to work with someone they know "...who really needs to talk to someone". The first question I ask is how the friend feels about it: do they agree that there is a problem, and do they agree that talking to a Psychologist will help? Often, the motivation to change actually sits outside the person who has the 'problem'.
Doctors do not have this problem to the same degree, because most medical treatment is done 'to' or 'on' their patient. Your surgeon does not need you to help him make the incision! But for psychologists, the patient must be an active partner in the treatment process; rather than me doing it 'to' you, we must do it together. This subtle difference actually has huge implications for the whole process. When you go to the GP, how often are asked about your motivation to attend? When was the last time your doctor invited you to comment on your diagnosis? For psychologists, your active involvement, through contributing your own ideas and efforts, is essential for changes to occur, and is the only way ensure they last.
So, if you have a friend in need, who is a friend indeed, then you may simply have to wait and watch while they work out what they want to do about their difficulties. If you want someone to change, first consider if they want the change as much as you do.
Doctors do not have this problem to the same degree, because most medical treatment is done 'to' or 'on' their patient. Your surgeon does not need you to help him make the incision! But for psychologists, the patient must be an active partner in the treatment process; rather than me doing it 'to' you, we must do it together. This subtle difference actually has huge implications for the whole process. When you go to the GP, how often are asked about your motivation to attend? When was the last time your doctor invited you to comment on your diagnosis? For psychologists, your active involvement, through contributing your own ideas and efforts, is essential for changes to occur, and is the only way ensure they last.
So, if you have a friend in need, who is a friend indeed, then you may simply have to wait and watch while they work out what they want to do about their difficulties. If you want someone to change, first consider if they want the change as much as you do.