Therapy
Getting defensive
05/01/12 10:26
Life is painful.
This would be apparent to anyone who witnessed your emergence into the world. Healthy newborns clench their fists, curl their toes, and scream in shock and agony. Life is a gift, the receipt of which none of us is consulted about in advance.
We each find our own individual ways of managing the pain of being alive. As we grow, and the circumstances of our life change, our methods of coping are continually challenged. Sometimes, we encounter a situation for which we have no established coping strategy. This may happen within minutes of being born, or not until much, much later.
To begin with, newborns have no way of coping with even the most basic challenges of being alive; They are not able to eat, talk, move independently, or even make sense of the signals their eyes, ears, nose, mouth and other body parts send to their brain. They must therefore rely on a parent to cope for them, to make sense of life on their behalf, to digest it and filter it, in order that they might be able to at least take some small parts of it in.
When you were in the womb, your mother breathed the air, ate the food, expelled waste and moved about in the world, filtering what she took in and providing sustenance to you via the umbilical, whilst human-shielding you from the outside world. Once you left the womb, much of this parental 'filtering' continued; your mother continued to provide food for you; changed full nappies for clean ones, and so on.
As well as managing bodily functions, the mother also manages sensations for the baby. If the baby is hungry, or tired, or cold, or something else, she will simply cry out; The mother must make sense of this discomfort and attend to the baby's emotional need. If there is no mother, for any reason, even for a brief period, then the baby is left exposed to the reality of life, 'unfiltered'. If the baby is confused, there is no-one to make sense of things for it. If the baby is hungry, no-one to feed it. If the baby is tired, she must somehow find sleep herself.
Of course, the parent cannot be there all the time. There will inevitably be at least a brief period in which the baby must experience life 'unfiltered'. What, then, does an infant do at these times? The answer is that they erect some sort of shield, or 'defence' to the onslaught of reality. The simplest form of defence might be to simply deny what their senses are telling them. The hunger pain they feel is ignored, and thereby, no longer painful. This works for a while, but cannot work forever. Some defences are more helpful than others. As the child grows, new, more complex forms of defence become possible.
As childhood progresses, children are forced to cope with more and more of life's painful realities; they must manage their own bowel movements, for example. As the tasks of living life become more complex, so too do the defences to life that must sometimes be erected in order to manage the pain of it. A pre-schooler, faced with a room full of unfamiliar faces, may retreat into the comfort of his own intellect, looking away from the curious eyes, downward instead in intense concentration on a lego tower. A toddler, struggling to manage overwhelming and confusing feelings triggered by an absent mother, may become frantically busy, rushing from one activity to another, never allowing the external world to settle, keeping her attention ever-moving, and thereby forever postponing the moment when those dreadful internal feelings must be somehow felt.
When an adult is presented with an experience that is overwhelming, they may be 'traumatised' by it. It is reasonable to consider that trauma can in fact occur at any age, and in fact someone like an infant, with so few defences of their own, might actually be even more suceptible to trauma than an adult. This is indeed the case, although infants and children, with their remarkable capacity to learn and adapt to new situations, seem to recover better from traumas than older adults do.
What, then, is mental illness?
Mental illness, in all its forms, might occur when one or more of an individual's defences is malfunctioning in some way. It may be that the efforts a person is going to, to cope with the pain of reality, are themselves causing needless pain. For example, a person who repeatedly checks and re-checks all the power switches in his house, is doing this to manage a deeper sense of dread, or some otherwise overwhelming notion about himself, or the world. He is arguably suffering more than necessary from the effort of maintaining this defence - more than he would suffer if he had to confront the deeper dread he is afraid to feel.
Or consider a person who manages the pain of loneliness by overeating; he may only be substituting one pain for another delayed-onset form of suffering. Or a person who finds herself simply overcome with sadness; she may have reached a point where some of her defences have ceased to protect her adequately from one or more of the painful truths of life. A man full of barely-contained rage may become violent when he encounters a situation with which he cannot cope. One way or another, the problem relates to reality, and the way in which the person copes with it.
So the next time you are accused of being 'defensive', take it as a compliment. Imagine where you would be without your defences?
This would be apparent to anyone who witnessed your emergence into the world. Healthy newborns clench their fists, curl their toes, and scream in shock and agony. Life is a gift, the receipt of which none of us is consulted about in advance.
We each find our own individual ways of managing the pain of being alive. As we grow, and the circumstances of our life change, our methods of coping are continually challenged. Sometimes, we encounter a situation for which we have no established coping strategy. This may happen within minutes of being born, or not until much, much later.
To begin with, newborns have no way of coping with even the most basic challenges of being alive; They are not able to eat, talk, move independently, or even make sense of the signals their eyes, ears, nose, mouth and other body parts send to their brain. They must therefore rely on a parent to cope for them, to make sense of life on their behalf, to digest it and filter it, in order that they might be able to at least take some small parts of it in.
When you were in the womb, your mother breathed the air, ate the food, expelled waste and moved about in the world, filtering what she took in and providing sustenance to you via the umbilical, whilst human-shielding you from the outside world. Once you left the womb, much of this parental 'filtering' continued; your mother continued to provide food for you; changed full nappies for clean ones, and so on.
As well as managing bodily functions, the mother also manages sensations for the baby. If the baby is hungry, or tired, or cold, or something else, she will simply cry out; The mother must make sense of this discomfort and attend to the baby's emotional need. If there is no mother, for any reason, even for a brief period, then the baby is left exposed to the reality of life, 'unfiltered'. If the baby is confused, there is no-one to make sense of things for it. If the baby is hungry, no-one to feed it. If the baby is tired, she must somehow find sleep herself.
Of course, the parent cannot be there all the time. There will inevitably be at least a brief period in which the baby must experience life 'unfiltered'. What, then, does an infant do at these times? The answer is that they erect some sort of shield, or 'defence' to the onslaught of reality. The simplest form of defence might be to simply deny what their senses are telling them. The hunger pain they feel is ignored, and thereby, no longer painful. This works for a while, but cannot work forever. Some defences are more helpful than others. As the child grows, new, more complex forms of defence become possible.
As childhood progresses, children are forced to cope with more and more of life's painful realities; they must manage their own bowel movements, for example. As the tasks of living life become more complex, so too do the defences to life that must sometimes be erected in order to manage the pain of it. A pre-schooler, faced with a room full of unfamiliar faces, may retreat into the comfort of his own intellect, looking away from the curious eyes, downward instead in intense concentration on a lego tower. A toddler, struggling to manage overwhelming and confusing feelings triggered by an absent mother, may become frantically busy, rushing from one activity to another, never allowing the external world to settle, keeping her attention ever-moving, and thereby forever postponing the moment when those dreadful internal feelings must be somehow felt.
When an adult is presented with an experience that is overwhelming, they may be 'traumatised' by it. It is reasonable to consider that trauma can in fact occur at any age, and in fact someone like an infant, with so few defences of their own, might actually be even more suceptible to trauma than an adult. This is indeed the case, although infants and children, with their remarkable capacity to learn and adapt to new situations, seem to recover better from traumas than older adults do.
What, then, is mental illness?
Mental illness, in all its forms, might occur when one or more of an individual's defences is malfunctioning in some way. It may be that the efforts a person is going to, to cope with the pain of reality, are themselves causing needless pain. For example, a person who repeatedly checks and re-checks all the power switches in his house, is doing this to manage a deeper sense of dread, or some otherwise overwhelming notion about himself, or the world. He is arguably suffering more than necessary from the effort of maintaining this defence - more than he would suffer if he had to confront the deeper dread he is afraid to feel.
Or consider a person who manages the pain of loneliness by overeating; he may only be substituting one pain for another delayed-onset form of suffering. Or a person who finds herself simply overcome with sadness; she may have reached a point where some of her defences have ceased to protect her adequately from one or more of the painful truths of life. A man full of barely-contained rage may become violent when he encounters a situation with which he cannot cope. One way or another, the problem relates to reality, and the way in which the person copes with it.
So the next time you are accused of being 'defensive', take it as a compliment. Imagine where you would be without your defences?
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Getting it wrong
05/12/11 13:47
I was lucky enough to be invited to a wedding a couple of weeks ago. As is usually the case, it was a very romantic occasion. There were beautiful people, in a beautiful place, saying beautiful things to one another. I was surprised and moved by the single reading given during the ceremony. I have taken the liberty of reproducing it here:
So if you are questioning a relationship, be it a marriage, a friendship, or something else, ask not what’s going wrong between you and the other person; ask yourself what are going to do with the wrongness that will always be there.
This was written by Andrew Boyd, who, it turns out, has some equally wise things to say about a number of other areas of life as well.“We're all seeking that special person who is right for us. But if you've been through enough relationships, you begin to suspect there's no right person, just different flavors of wrong. Why is this? Because you yourself are wrong in some way, and you seek out partners who are wrong in some complementary way. But it takes a lot of living to grow fully into your own wrongness. And it isn't until you finally run up against your deepest demons, your unsolvable problems--the ones that make you truly who you are--that you’re ready to find a lifelong mate. Only then do you finally know what you're looking for. You're looking for the wrong person. But not just any wrong person: the right wrong person--someone you lovingly gaze upon and think, "This is the problem I want to have."
I work with individuals, and with couples. In every case, there is a relationship. One of the most common difficulties people seem to encounter is to do with their expectations - their hopes - for the future of their relationships. What many people do not realize is that a relationship is no different to a person: it is riddled with flaws. As with a person, the trick is not to erase or repair the flaws in a relationship, but simply to know them, and find some ways to live with them. A healthy, strong relationship is one in which problems are well known, and accepted by both parties. You can see why this takes a long time to establish, regardless of how ‘compatible’ the two people might be. This is true not only for marriages, but also for other relationships, such as friendships, business partnerships, or even the relationship between a person and their therapist. The key here is not that everything is known, but that at least all the problems are known and accepted. This acceptance does not need to be gracious; it may suffice that one person feels able to say to the other, “I can’t live with your golf obsession any more,” in order to then be able to keep living with it after all. The key here is not neatness, harmony, or even honesty; it is acceptance.
So if you are questioning a relationship, be it a marriage, a friendship, or something else, ask not what’s going wrong between you and the other person; ask yourself what are going to do with the wrongness that will always be there.
The Blanket
13/10/11 14:58
I’m not going to write about an obesity epidemic. I would, however, like to make a couple of observations about weight loss, based on my experiences working with people who are trying to do it. All of their quotes and comments below have been shared anonymously and with permission.
cautionary note: please do not take the following video seriously...
Fact: Most people who try to lose weight, regardless of the method, are unsuccessful. I once researched the issue as part of a doctoral thesis on people’s unsuccessful attempts to change. It turns out, there is a surprisingly large amount of research data on this topic. If you are interested in the area, and would like to read more, you are welcome to contact me. Basically, it seems that most people around the world who set out to lose weight, or in fact try to change anything about themselves, have very little success. There are many explanations for relapse. But consider this: you are the way you are for good reasons. It’s going to be difficult to change the way you are, without at least an equally good set of reasons.
It is just not realistic to declare that you want to lose weight, and then simply begin a weight loss endeavour on that basis. Do you know why you put the weight on in the first place? Or, to put it another way: Why don’t you want to lose weight?
For some people who are overweight, their body shape and other lifestyle elements (such as overeating or inactivity) seem to provide an important, and much needed, source of comfort. I once heard someone refer to their extra weight as ‘my blanket’. For some people, it seems that their excess weight, and the process of eating, makes it easier to hide from other people. Easier to hide the parts that others might reject, such as anger, or neediness, or vulnerability. It may also enable them to feel more protected from other people’s intrusion, their curiosity, or their judgement. So: In order to successfully lose weight, that individual must first work out how they are going to manage their relationships without the comfort and security of their ‘blanket’.
Of course, for many people who are overweight, their weight itself is no comfort at all; it is a source of real and ongoing anguish. By implying that excess weight allows a person to avoid uncomfortable things, I do not wish to deny the equally uncomfortable aspects of being overweight. I also do not deny that there are important medical and physiological factors leading to obesity. However, I believe that anyone setting out to lose weight weight ignores the psychological aspect of their predicament at their peril. There is an even greater source of anguish than being overweight, and to discover it, you only need to talk to someone who has made a transition from being overweight to being in a lower weight range, for example as a result of bariatric surgery. One individual I spoke to referred to it as going “out of the frying pan and into the fire”. For example, she described how she began to lose her temper more often, and in fact had a permanent falling out with her best friend after their first ever fight, which took place after she had lost 25% of her body weight. Glad of her new body shape though she was, she nevertheless longed for (and eventually had to grieve for) the earlier time, when she was better able to hide her feelings and didn’t have to be “so honest” about them with other people. She felt “mortified” that her thoughts and feelings were “spilling out”. She felt like a burden, and feared that all the people who were closest to her, would now be driven away.
Not losing weight is disappointing. But maybe losing it is even more challenging. I admire anyone who sets out to change something about themself, regardless of their degree of eventual success. If you are thinking about changing something about yourself, make sure that you give some thought to the reasons why the change hasn’t occurred already. If you aren’t sure, than you may find changing harder than you expect. I do wish you the best of luck.
cautionary note: please do not take the following video seriously...
Fact: Most people who try to lose weight, regardless of the method, are unsuccessful. I once researched the issue as part of a doctoral thesis on people’s unsuccessful attempts to change. It turns out, there is a surprisingly large amount of research data on this topic. If you are interested in the area, and would like to read more, you are welcome to contact me. Basically, it seems that most people around the world who set out to lose weight, or in fact try to change anything about themselves, have very little success. There are many explanations for relapse. But consider this: you are the way you are for good reasons. It’s going to be difficult to change the way you are, without at least an equally good set of reasons.
It is just not realistic to declare that you want to lose weight, and then simply begin a weight loss endeavour on that basis. Do you know why you put the weight on in the first place? Or, to put it another way: Why don’t you want to lose weight?
For some people who are overweight, their body shape and other lifestyle elements (such as overeating or inactivity) seem to provide an important, and much needed, source of comfort. I once heard someone refer to their extra weight as ‘my blanket’. For some people, it seems that their excess weight, and the process of eating, makes it easier to hide from other people. Easier to hide the parts that others might reject, such as anger, or neediness, or vulnerability. It may also enable them to feel more protected from other people’s intrusion, their curiosity, or their judgement. So: In order to successfully lose weight, that individual must first work out how they are going to manage their relationships without the comfort and security of their ‘blanket’.
Of course, for many people who are overweight, their weight itself is no comfort at all; it is a source of real and ongoing anguish. By implying that excess weight allows a person to avoid uncomfortable things, I do not wish to deny the equally uncomfortable aspects of being overweight. I also do not deny that there are important medical and physiological factors leading to obesity. However, I believe that anyone setting out to lose weight weight ignores the psychological aspect of their predicament at their peril. There is an even greater source of anguish than being overweight, and to discover it, you only need to talk to someone who has made a transition from being overweight to being in a lower weight range, for example as a result of bariatric surgery. One individual I spoke to referred to it as going “out of the frying pan and into the fire”. For example, she described how she began to lose her temper more often, and in fact had a permanent falling out with her best friend after their first ever fight, which took place after she had lost 25% of her body weight. Glad of her new body shape though she was, she nevertheless longed for (and eventually had to grieve for) the earlier time, when she was better able to hide her feelings and didn’t have to be “so honest” about them with other people. She felt “mortified” that her thoughts and feelings were “spilling out”. She felt like a burden, and feared that all the people who were closest to her, would now be driven away.
Not losing weight is disappointing. But maybe losing it is even more challenging. I admire anyone who sets out to change something about themself, regardless of their degree of eventual success. If you are thinking about changing something about yourself, make sure that you give some thought to the reasons why the change hasn’t occurred already. If you aren’t sure, than you may find changing harder than you expect. I do wish you the best of luck.
Four benefits of therapy, before you've even begun
11/08/11 13:05
You may have wondered whether therapy is really helpful to those who do it. According to the Australian Bureau of Statistics, around 45% of people will experience a mental health disorder at some point in their lifetime. About half of these people will experience a mental illness that lasts for more than 12 months. It appears that around 30% of people with a mental illness seek some form of treatment, usually from their GP (this includes medication). Around ten percent of people go to see a psychologist or other therapist.
So what’s the benefit of doing therapy? Answers to this question are many and varied, as it turns out. While it is easy to establish the benefit of a medication such as an antidepressant, it is much trickier to work out if, and how, therapy helps people to recover from their difficulties. If you’re interested in the research about the effectiveness of therapy, you can check out a good review here. There is an excellent group of researchers who continue to investigate the issue here.
In the meantime I thought I’d list four ways that therapy helps you, before you even attend your first session:
1. The waiting-list effect.
It turns out that just knowing that help is on the way is helpful. The anticipation of therapy can probably improve your symptoms by around 10%, when we average out the different results of research in this area. I did my own research in this area, using people in Sydney who were waiting for group therapy for anxiety, and found that some individuals’ symptoms improved as much as 40% while they were on the program’s waiting list. Just the act of making an appointment can lead to an improvement of your situation.
2. A space is created.
Many people with depression, anxiety, or other psychological difficulties lead cluttered lives, which allow them little time for reflection on how they are feeling. It makes sense to try to avoid focussing on your problems if they seem overwhelming, insurmountable, or just make you feel down or defective. The process of seeking help of some sort for your difficulties forces you to confront the issue. It is only when you do this that you will discover two truths. The first is: most problems are much smaller when you look at them up close. The second is: the person who is in the best position to make changes in your life is you. When you start to tackle your problem front-on, the issue begins to shrink, and you also begin to grapple with the issue yourself (rather than leaving it up to others). By the time therapy starts, this process is well underway.
3. Others get involved.
Therapy is a confidential process, but many people starting out will put the word out somewhere that they are ‘seeking help’ at some point along the way. Often, this involves contacting a close or trusted friend to seek advice or a recommendation. Even if you don’t intend it, this process brings you a little closer to the people around you, and subtly changes the relationships you have, in a healthier direction. The experience of sharing your experience with others, even if it’s just the practice receptionist, is itself therapeutic.
4. Re-evaluation begins.
Therapy takes time, costs money, and is inherently emotionally challenging. In order to begin the process, you have to re-evaluate your priorities, and put your own feelings and needs ahead of other issues that might have otherwise taken precedence. It seems logical that putting your own personal needs first is a healthy thing to do. Getting yourself into a financial and practical position to undertake therapy has the added benefit of getting your own needs higher up on the list of what’s really important.
When it does get underway, good therapy takes some of these initial changes, and expands on them, bringing you more and more into a space where you understand yourself and those around you better, take better care of yourself, and feel more hopeful about the things taking place in your life. This process also continues after therapy sessions have finished. It’s important to understand that you are the main mechanism of change in the therapy process. The therapist’s job is to do him or herself out of a job. It’s your life, after all.
So what’s the benefit of doing therapy? Answers to this question are many and varied, as it turns out. While it is easy to establish the benefit of a medication such as an antidepressant, it is much trickier to work out if, and how, therapy helps people to recover from their difficulties. If you’re interested in the research about the effectiveness of therapy, you can check out a good review here. There is an excellent group of researchers who continue to investigate the issue here.
In the meantime I thought I’d list four ways that therapy helps you, before you even attend your first session:
1. The waiting-list effect.
It turns out that just knowing that help is on the way is helpful. The anticipation of therapy can probably improve your symptoms by around 10%, when we average out the different results of research in this area. I did my own research in this area, using people in Sydney who were waiting for group therapy for anxiety, and found that some individuals’ symptoms improved as much as 40% while they were on the program’s waiting list. Just the act of making an appointment can lead to an improvement of your situation.
2. A space is created.
Many people with depression, anxiety, or other psychological difficulties lead cluttered lives, which allow them little time for reflection on how they are feeling. It makes sense to try to avoid focussing on your problems if they seem overwhelming, insurmountable, or just make you feel down or defective. The process of seeking help of some sort for your difficulties forces you to confront the issue. It is only when you do this that you will discover two truths. The first is: most problems are much smaller when you look at them up close. The second is: the person who is in the best position to make changes in your life is you. When you start to tackle your problem front-on, the issue begins to shrink, and you also begin to grapple with the issue yourself (rather than leaving it up to others). By the time therapy starts, this process is well underway.
3. Others get involved.
Therapy is a confidential process, but many people starting out will put the word out somewhere that they are ‘seeking help’ at some point along the way. Often, this involves contacting a close or trusted friend to seek advice or a recommendation. Even if you don’t intend it, this process brings you a little closer to the people around you, and subtly changes the relationships you have, in a healthier direction. The experience of sharing your experience with others, even if it’s just the practice receptionist, is itself therapeutic.
4. Re-evaluation begins.
Therapy takes time, costs money, and is inherently emotionally challenging. In order to begin the process, you have to re-evaluate your priorities, and put your own feelings and needs ahead of other issues that might have otherwise taken precedence. It seems logical that putting your own personal needs first is a healthy thing to do. Getting yourself into a financial and practical position to undertake therapy has the added benefit of getting your own needs higher up on the list of what’s really important.
When it does get underway, good therapy takes some of these initial changes, and expands on them, bringing you more and more into a space where you understand yourself and those around you better, take better care of yourself, and feel more hopeful about the things taking place in your life. This process also continues after therapy sessions have finished. It’s important to understand that you are the main mechanism of change in the therapy process. The therapist’s job is to do him or herself out of a job. It’s your life, after all.
A Strange Situation
16/03/11 18:34
There are essentially two opposing forces at work inside us all. The first is a drive for exploration, adventure, growth, change. If you ever find yourself feeling bored or trapped, this drive is probably at work. The second driving force is for safety, comfort, stability, reassurance. Homesickness is probably the simplest manifestation of this.
There is perhaps a fantasy that we all share, of being able to satisfy both of these forces at the same time: the phrase “and they lived happily ever after” might reflect this. In reality, most of us spend much of our lives striving to manage an uneasy balance between security and exploration. The branch of Psychological research and practice that is most concerned with this balance is called “Attachment Theory.”
Attachment theory seems to be undergoing a bit of a renaissance at the moment, particularly in a growing movement generally referred to as ‘Attachment Parenting’; you can read a bit more about attachment parenting here and here. Basically, the idea is that you should parent your kids in a way that ensures they have access to you when they need it. In my experience, nearly all parents aspire to a strong bond with their children, but some struggle to achieve it. Thinking about the security of your attachment to your kids can help you form a bond with your kids, but can equally confront you with the nature of your own attachments to your parents, partner or other people over the years. If you watch the video above, consider what feelings are stirred up inside you when the child’s mother leaves the room?
Similarly, most people who seek therapy for depression or anxiety want to form a good working relationship with their therapist, but this does not always occur. In the ‘strange situation’ clip above, I think the second phase of the test, when the mother is gone and the stranger comes in to try to comfort the child, is a simple but powerful model of what happens when someone begins therapy for the first time. Most people I’ve encountered find at least the start of therapy to be very difficult. When you think about that in terms of attachment, it makes perfect sense. Therapy is truly a strange situation. If you can persevere with it, then you and the therapist will be able to work together, using your emotional responses to the process to understand your own attachments, and how other connections in your life may or may not be secure.
There is perhaps a fantasy that we all share, of being able to satisfy both of these forces at the same time: the phrase “and they lived happily ever after” might reflect this. In reality, most of us spend much of our lives striving to manage an uneasy balance between security and exploration. The branch of Psychological research and practice that is most concerned with this balance is called “Attachment Theory.”
Attachment theory seems to be undergoing a bit of a renaissance at the moment, particularly in a growing movement generally referred to as ‘Attachment Parenting’; you can read a bit more about attachment parenting here and here. Basically, the idea is that you should parent your kids in a way that ensures they have access to you when they need it. In my experience, nearly all parents aspire to a strong bond with their children, but some struggle to achieve it. Thinking about the security of your attachment to your kids can help you form a bond with your kids, but can equally confront you with the nature of your own attachments to your parents, partner or other people over the years. If you watch the video above, consider what feelings are stirred up inside you when the child’s mother leaves the room?
Similarly, most people who seek therapy for depression or anxiety want to form a good working relationship with their therapist, but this does not always occur. In the ‘strange situation’ clip above, I think the second phase of the test, when the mother is gone and the stranger comes in to try to comfort the child, is a simple but powerful model of what happens when someone begins therapy for the first time. Most people I’ve encountered find at least the start of therapy to be very difficult. When you think about that in terms of attachment, it makes perfect sense. Therapy is truly a strange situation. If you can persevere with it, then you and the therapist will be able to work together, using your emotional responses to the process to understand your own attachments, and how other connections in your life may or may not be secure.
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, she 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, she 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.”
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 describes 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 smoking! 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 the therapist's job to decide for them what needs to change, or even how they can go about making that change: the therapist's 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.