Chiron, Wounded Healer

January 2018

Chiron, Wounded Healer by Dr Elizabeth McCardell, M.Couns., PhD

     Once upon a mythic time, a long time ago, a little immortal centaur with a horse’s head and a male human body was born. His mother was the nymph Philyra and his father Kronos (the half brother of Zeus). His mother took one look at the infant and rejected him. This little boy, named Chiron, was taken and cared for and educated by Apollo and Artemis and he grew up wise and with psychic vision. When he was much older, he was wounded by an arrow dipped in the poison of a hydra fired by Herakles. This wound would not heal and gave him tremendous and inescapable pain. With such came deep compassion for others and healing powers, as well as an exquisite capacity to teach. His pain was so excruciating that Zeus took away his immortality and made him a star in the constellation Sagittarius or Centaurus.

     Chiron is known as the wounded healer. I write of him because he experienced rejection and injury and yet became is a fine model for healers. Many of us in the healing professions know full well that our own experience of pain gives us the ability to sit, in focused awareness, with the troubles of others and begin a collaborative process of healing.

     We are relational beings that contribute to how we negotiate the greater world and understand ourselves.  How we do this originates in our very first relationships and continues throughout life. What was writ in early childhood, though, does not make us who we are now, unless all we have known is the same kind of thing. Depending on the other later experiences and whether those undo the damage of early infant rejection (as with Chiron), we can generally move on and find some happiness elsewhere.  Sometimes however, the old relational patterns are replicated over and over and psychotherapy then becomes a very useful tool in breaking this iterative pattern.

     It shouldn’t be thought that iterative patterns of internalized belief systems are all negative. In fact, the person with such patterns have learned capacities for dealing with issues that show rather amazing strengths, albeit often out of proportion to the situations at hand. The human organism knows its vulnerabilities and seeks to protect them. It’s when such protective mechanisms prevent interactions that are nourishing. All of us have unspoken self-protective strategies that guide our experience within relationships, so therapy isn’t about destroying those strategies, but loosening our dependence on them as well as introducing new strategies that free up our life experiences in healthier ways.

     Patterns of relationships evolve from the primary relationship of infant and primary care giver, as noted above. These are called attachment styles.

      The secure bond between caregiver and child is emotionally charged: there is eye contact, touching, proximal seeking, vocalizations (and later linguistic exchange), etc along with an increasing courage and capacity for the child to explore their environment. So emotional closeness is paradoxically associated with a growing independence and capacity for curiosity, exploring, experimenting, testing other interests and developing self reliance and independence.

     How a person relates is intergenerational, unless some intervention has occurred. Lack of emotional closeness tends to be passed on from generation to generation. It is significant fact that many of my patients come because of lack of a secure sense they experienced in their family of origin. A quick exploration usually shows that this experience was shared down the generations. The wars also contributed to lack of any sense of safety.

     Attachment is a basic human process for a close and intimate relationship between infants and their caregivers. Without  a secure base,  where the primary caregiver  is always anxious, the child tends to develop problems with relating to other people, lack of confidence and distrust.  This is not writ in stone and can be transformed and when transformed can become the tools for budding healers and teachers, as the archetype of Chiron shows us. The work of self awareness, however, is, I believe, necessary for the development of such skills and thus I recommend psychotherapy for healers as well as those we heal.

Re-writing your past in this present

Dec 2017

Re-writing your past in this present by Dr Elizabeth McCardell, M. Couns., PhD

     Irvin Yalom, in his wonderful book, Creatures of a Day, and other tales of psychotherapy, has a chapter called “You Must Give Up Hope for a Better Past,” but in it he notes that the past is continuous with the present and you can rewrite your past whenever you decide to. Therapy is a very good place to do this. Therapy provides set-aside time, space, confidentiality, professionalism, a trained listener who has chosen to listen and be absolutely present for you; it provides safety and the therapist, a skilled use of tools that can re-write the landscape of your history into a more comprehensible, less destructive form. Therapy is like an alchemical crucible where the telling and the hearing are part of the transformative process of re-writing your life story.

     I hear many accounts of lives in my work. I have heard events in people’s lives that no one has ever heard before, that the person never dared tell before.  I am humbled hearing those things said for the very first time as well as knowing that I will remain the only hearer of these things, as I am sworn to silence (with two exceptions) by virtue of my profession. It is times like these that the two of us carry your life (and I do know from my own experience what a relief that is).  I am, though, merely a journeyman beside you, with a map out of the jungles, ragged peaks, and marshes. I will travel with you as long as you wish me to be there and then you can proceed as you wish. You can, of course, hire me once again to walk with you whenever you like.

     There are two exceptions to the confidentiality rules we therapists are required to stick to: your safety and the safety of others, or when I’m required by the courts to impart information. In the case of the latter, I will fight for confidentiality as far as possible.

     As I say, I have heard, and hear often, events in the lives of my clients that have never been said before, and hearing them, will likely never speak of in any identifying way. My lips are sealed.

     Some years ago I heard an old woman, now deceased, tell of things she’d kept under wraps for eighty plus years. She spoke of family, shame, blame, rapes, escapes, homelessness, restitution, travel, education, careers, pleasures, fundamental vulnerabilities and sensitivies, and a desire for her story to be heard, without criticism. The two processes: saying and being heard mattered to the healing of her soul and that’s why she came to me.

     Sometimes it is sufficient once to tell a trusted person stories that have not been told; sometimes, though, the events in lives need much more work than a telling. A re-authoring is needed. The past is rarely ever boxed away and discontinuous with the present. What happens now changes how the past is thought and felt about. Yes, of course, the facts of a  past are history,  but mostly for most of us, the facts are not what disturb us; it is our feelings from that past that can haunt us. This is what can be re-authored; this is where change happens.

     Imagine if you will, you and me walking through the landscape of your past in the present moment talking together. Our walking is a journey of the mind, of the soul. As we walk, we talk and I bring to our therapeutic conversation the tools of my trade. We experiment with ideas, we write and rewrite, I hear your dreams and we traverse the language of the dream to the dream’s heart,  I hear your aspirations and insights and I am changed while you are changing. My journey with you is also transformational for me (do you see now why I love my work?). Here, in this place of now, we discover new vistas, opportunities and new ways of being in the world.  And nothing is ever the same old, same old again. The ghosts have left the room and you can be in the world freer, and happier.

Between Twig and String

November 2017

Between Twig and String by Dr Elizabeth McCardell, M. Couns., PhD

     I like to think of philosophy as that space between nature and artefact, in the in-between of dream and critical thought and a sort of interior witnessing to the very act of making sense of things. It is like the linking of shells with twigs and string into an evocative yet skilful piece that remembers the sea, the grasses and stories therein. Philosophy connects what we know about being in the world with how we might think about this (a how that may be thought of in multiple ways).

     I am, by nature and training, a philosopher and my work as a psychotherapist lends itself well to this. The psychotherapeutic endeavour is a philosophic one, but something with a practical outcome. It is a practical philosophy; a philosophy for life.

     Just as the discipline of philosophy requires a sorting through, of this versus that, so psychotherapy chooses the pathway of authenticity over falsehood: the path that speaks most truly for the client. It is really nice to be part of this sorting process, to be part of the conversation of what matters, and what doesn’t.  I can, after all, suggest an experiment that we find is not suitable in the end, for that particular person, but in there we both discover what matters more right now and so we move on to thinking about things quite differently. Philosophy and psychotherapy is thus less about dead theory than a testing of  a theory that prompts a possible action that may, or may not,  have a useful outcome, but the process of which  shifts our understanding and the formulation of another theory that is itself open to question. A psychophilosophy is about processes and testing and moving knowledge into new realms. It is, thus, not a static thing; it lives.

     The psychophilosophical space is fluid, not fixed. This is a philosophy not of logic and correctness, but messy, like living experience and existence itself. In the end, the choices are those that give strength and meaning for this individual, not some generalized theoretical self, but this living, breathing person, here, now.  

     So many disciplines come into play in this work: formal philosophy, sociology, psychology, physiology and neurology, chemistry, creativity, art, stories, even the mathematics of form and space, with that underlying philosophic turn. These things go together to make something more unique and beautiful than ever.

      This philosophy of existence is at the heart of the kind of psychotherapy I’m interested in, that is, existential psychotherapy. It is not about dark morbid things, though darkness may be explored; it is not cerebral, though it thinks, and feels things through; it is not particularly esoteric, through it sometimes examines and plays with that.  The existential approach confronts the "ultimate concerns" (Tillich) and everything in between: death, endings and beginnings, consequences, freedom, loneliness, responsibility, suffering, meaning and meaninglessness, connections, relationships, power, will, presence, love and the irrepressible drive towards individuation, that is, the realization of the Self.

     Existential philosophy and its handmaiden, existential psychotherapy is, as I say, practical, concrete, positive and flexible. At its heart, it is not fearless, but it courageously journeys into fear itself. There is a purpose here: this is a space of tremendous energy, where transformation happens. Here is where the little bub of the new firebird of alchemy is born.      Being here is supported by the presence of the therapist, who travels with the client all the way, while still maintaining the sturdy string to ordinary life and understanding.

     It is no random accident that I call this piece “Between Twig and String” for what I’m doing is  attempting to describe the mysterious process of therapy and philosophy itself, for both are art works in the making. Both are intensely creative, and both are in process. For in as much a piece of string links the found objects of shell, stone, and twig, so the making of this simple piece engages the sight, the style, the inclination, the dexterity of artist. And it is subject to time and decay, incorporation of other things, anchored within a framework of sturdy string.

Making friends with what scares you

October 2017

Making friends with what scares you  by Dr Elizabeth McCardell, M. Couns., PhD

     There is nothing wrong with being afraid, nor being anxious about it. Being anxious is our way of warning ourselves that we may  not be quite ready to take on this monster that scares us, nor even know what it is.  Treating the symptoms of anxiety is ok, up to a point, but until we actually begin doing the inner work, the object of our fear, and our anxious response to it, will remain wild and untamed, even if dulled by anti-anxiety medication or held at bay with behavioural distractions, like pinching the tips your fingers, or playing with worry beads, or touching a much loved necklace.

     The art of overcoming fear maybe to befriend it.  By making friends with it, we defuse its power and control over us. This can sometimes be done alone, or with the help of friends, but  it is also really useful talking with and working with a professional. Therapists are trained for this. Such work, it needs to be said, may not be short term (though sometimes it is), but the insights and capacity to choose how you might respond to situations that previously would have you in a panic attack, is well worth it.  Combined hypnotherapy plus counselling is very useful, as is counselling alone. This really is a matter of choice.

     One rather effective way is to give your fear and anxiety a name, and “Anxiety” just wont do it.  Etymologically, the word “anxious” has too much baggage, with its roots found in the 16^th Century. The word referred to "apprehension caused by danger, misfortune, or error, uneasiness of mind respecting some uncertainty," from Latin anxietatem.  This meaning hasn’t changed much. In the DSM 5, anxiety refers to “apprehensive expectation” and worry about various topics and events in a person’s life that are debilitating as it occurs  on more days than not. As that manual puts it: “The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children. 

(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going blank
(4) irritability
(5) muscle tension
(6) sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)”

     Calling Anxiety, that big nasty creature, something else might be really helpful What of the cute names of “Bruce”  or “Poppy” or “Jazzy”?  By the way, I am not  belittling the anxious person (I have sometimes have anxiety, too, after all), I am attempting to point a way to managing the problem and eventually taking away its power.

     Funny names and visual images that make you laugh are good.  Here, I’m reminded of  the work of Judy Horacek, a lovely whimsical  Australian cartoonist, artist,  and writer. Judy drew a  cartoon some years ago of  a horrible monster sitting beside a woman on livingroom couch and a visitor enters the room. The woman looks up and says in words to this effect, “Come  here and meet Kevin, the bête noire from next door.” Kevin’s expression was priceless. Sort of, “What me, the monster? I’ve got a name? What fun.”

     When we identify our anxiety around scary situations (actual and remembered), and give it a name and an identity we have the beginnings of the means to defuse it, and defusing it frees us up marvellously.

     Fear has many forms and should be acknowledged as having an effect on how we manage our lives. Fear can stop us doing what we love and/or get in the way of enjoying it. So working on anxiety should be done gently, with awareness, and slowly, if need be. There is no need to challenge ourselves to do something very unpleasant or uncomfortable just because we want to break through that fear. What is point of increasing anxiety? So, gently, gently. Try painting, music making, writing, and talking with others about the issue, and if you wish, try counselling.

It's completed, or is it?

September 2017

It’s completed, or is it?   by  Dr Elizabeth McCardell, M. Couns., PhD

    Every month I am faced with the problem of how to complete these articles, and it is something that I grapple with in unsureness.

     Beethoven was famously unable to finish his symphonies, and you can certainly hear that. The same closing bars are played over and over again, until, maybe in his exasperation, the piece is ended.

     Then there are writers who somehow cannot write the final paragraph, cannot finish the book and so the project gets hidden away somewhere, half remembered, half forgotten. Less dramatically, there are those whose final paragraph hangs uneasily, without proper resolution, or the words, …to be continued – which is all very well, except for those readers who don’t read any more of this author.

      Leonardo Da Vinci famously said, “A work is never finished, just abandoned.” Maybe, maybe not. Somehow I’m not quite convinced. I think a lot of projects are certainly abandoned and left unfinished and presented as such, but then there are those where final touches really do complete the work.

     I am wondering if the completion is somehow tied to its context, or to something in the object’s inherent form. This is an entirely intuitive idea and one in which I really do not know its veracity. I think to my practice of painting little birds on the seed pods of the Illawarra Flame Tree. I start with the back and wings and tail and then around the face, and then finally its eyes. It’s the eyes that set the little birds free. The glint in the eyes is the finishing act of the painting. (I swear I am somewhat of an animist.) The form of the pod defines the design character of the bird in the making, and the painting of the eyes is the final act. Bird is already bird and painting merely reveals it.

     Bird is already bird, but a written piece can only ascribe itself to the work, and the genre, as it unfolds.  There is something in the final act that gives it life, or not.

     How, though, to know that the final touches gives life and not just adds to the burden of colour? Again, I intuit this, and of course I could be wrong. If life, then something of  a death of the old and the luxuriant newness of something else.

      In trying to connect my idea to something tangible, I  keep coming back to the words of the old man, Simeon on holding the infant Jesus in his arms, described in a Bach cantata of the same name: Ich habe genug (German). It sums up for me what I’m trying to get at. Ich habe genug is variously translated as “now I have enough,” or “now I have everything,” or even interpreted as “now it is finished because it is complete”. Symbolically, the Christ birth can be seen as the ending of the old way and beginning of the new – which throws a whole different light on completion and finishing. There is a richness and a vulnerability here.

     Perhaps knowing the end is just part of the beginning. A work of art needs to be alive at the start, even as it is a departure from previous works. This means that the artist/writer has to feel connected to it, and not merely attempting to churn out something that might appeal to others but which feels uninteresting to himself.  It is very wearing to make something that doesn’t link  with the artists inner integrity: sort of akin to being part of a production line. How lovely it is, instead, to create from beginning to end something of meaningful delight.

     To begin something of a creation means slipping into the dark lake of the mind, bounded by the banks that shape it, and allowing a certain degree of chaos, confusion and doubt to be present, but to stay with it, and nurture it along, separating out the useful from the non, guided by the moon’s reflection, knowing somehow that here is a life that needs to be revealed, and fearlessly making it so.

Exploring the unconscious for the richness it contains

August 2017

by Dr Elizabeth McCardell, M. Couns., PhD

     While considering what to write on for this month’s article, I came across some notes I made on hypnosis and dream work in depth psychology some years ago and  thought this was the beginning of a worthy something or other. I remember having the beginnings of a thought then about how both hypnosis and dream work share a very rich interior landscape. Such musings led me then to adding qualifications in clinical hypnotherapy to my counselling and psychotherapeutic training and practice.

      I first came into contact with depth psychology when I was 19, and began a ten year study immersion in the field of Jungian Analytical Psychology in both Australia and Switzerland. Since then I’ve trained in several other modalities, but I continue to mull about the unconscious and wonder, as I work, on its flexibility and capacity for fundamentally changing ordinary lives when properly nurtured and tapped into.

     The unconscious mind is a strange place of figures, and feelings, and sliding doors of perceptions that throw up, in the cracks of our existence, meanings that eluded us previously. Here is a kind of trance-scape that is really interesting not only theoretically but also experientially. This I know from my own inner work, as well as academic study. Here is the space where a richness of half known things are found to be much greater than originally thought. It’s sort of like a Tardis, where the interior is vastly bigger that what appears on the outside.

     I remember when I was a child playing a game that involved only traversing the cracks in the pavement on the street where I lived. This often required leaping around gazelle-like to avoid the plain old pavement with no cracks. It required focus, agility, and – at the same time – something of a relaxed stance. This focused-relaxed attitude is likewise what is required to be engaged in by both therapist and client alike in dream work and hypnosis. In order to move beyond the obvious, we have to connect gently to the subtle in order to know better the landscape of our minds.  Hypnosis provides a useful training for that, as does the work done in a counselling psychotherapy. Both take the natural aptitude most of us have for entering this focused-relaxed state and enhances it so that fundamental change can take place.

     None of this magical nor out of the ordinary; indeed most, if not all, of us already know what it feels like. We watch movies, we read books, we write, we listen and play music, we paint or gaze at an art work, we run, cycle, swim, or just wander around gardens or streets and shops in a present, and yet drifting away type of state. We do not lose control, just we do not lose control with hypnosis nor exploring our inner life in therapy, and no one can do things to us that we do not want. We can move in and out of this state at will.

     In therapy and hypnosis there is safety in the  meeting of minds, a rapport, and it is this mutuality that builds not only trust but a deepening of shared therapeutic experience where change happens.

      I particularly like working with people who, till now, have felt stuck in repetitive habits, negative ways of thinking, and bogged down with worry, anxiety, and a sense of unfulfillment. The artist, the writer, the musician facing the perpetual  blank canvas, or page or unliberating musical silence are perfect candidates for hypnosis and/or the depth psychology of dream work. I know this not only from working with such people, but through my own experiences facing similar sorts of things. There is a great beauty in the release of such blockages and the making of art, the release of iterative habit, and repetitive thought processes. This, by way, is felt as much by me as my clients. I enjoy my work and I bow my head humbly to the courage of those who journey with me.

Self Care

July 2017

Self Care by Dr Elizabeth McCardell, M. Couns., PhD

     I care about you. How often have we who care, heard this said to us? I suspect, not often enough. And yet hearing it is medicine for the soul. It is pretty hard working in the caring professions (nurses, doctors, paramedics, counsellors, psychotherapists, psychologists, social workers, vets, etc) without receiving some gentleness and care words, or even just someone to hear what we have to say. We tend to push on doing what we feel we must do, even when we begin showing signs of compassion fatigue, or its more chronic form, vicarious traumatization, which is the cumulative effect of an a more than empathic engagement with our client’s traumatic material to the point of feeling really hurt ourselves. We sometimes care a bit too much and for too long. Empathy is our greatest asset as well as possibly our greatest liability.

      Compassion fatigue may not become chronic and may not bleed into feelings of vicarious traumatisation and may not eventuate ultimately in burnout, if we ask for help early and practice necessary self care. Burnout is literally a feeling of running on empty. It is characterized by exhaustion, depersonalization (which is disengagement or detachment from the world around us) and lessened feeling of self efficacy.

     Compassion fatigue is like a sort of catching of the other person’s emotions as we might catch their flu infections and in this vulnerable state we risk over-identifying with them and may seek to rescue or protect them beyond the calling of our jobs, on the one hand, or avoid them altogether (thus not doing our job properly). Absenteeism, low morale, job dissatisfaction, depression, nightmares, intrusive imagery, irritability, difficulty forming intimate relationships, high levels of stress, and, sometimes, substance abuse are all signs of empathy gone to the point of profound fatigue.

     I’ve known a few people (counsellors, doctors, paramedics, etc) who have chronically over cared to the point of vicarious traumatization  and, actually, burnout. These are people who pushed themselves just too far to the next client in need (and maybe they forgot they are human), without a break, without asking for help, without practicing any self care at all. Their capacity to do their job just wasn’t there anymore. Now some cannot work at all, while others have pushed on still and now teach their profession. The lecturer in trauma counselling at  the University of Notre Dame, Fremantle, where I did my Master of Counselling degree  those several years ago showed all the signs of burnout. He was so strung out that he lived on a diet of Coca-Cola and black coffee and cigarettes, despite recent major heart surgery. He talked fast. without intonation, without engagement with us, like a dead man talking.

     We do not need to get to the point of overload. We can learn to manage our work-after work life so that we do not succumb to compassion fatigue and the more intransigent vicarious traumatization and burnout. One of the ways is to seek counselling not only when we are feeling fragile, but as a regular component of our working life.  This shouldn’t be seen as a luxury, but as a necessity.  Getting counselling, or the longer term psychotherapy, is entering a safe place where what is said isn’t disclosed to anyone. This is a confidential space where strategies for coping are learned, but more than this, here is somewhere to simply say the things that need to be said and be heard by someone, like myself, who cares.

     Work-related stress in high empathy occupations has a physical impact on us as well as an emotional impact and self care therefore needs to  have a physical component as well. Cardio exercise, swimming, qi gong, yoga, dance, music making, and a nutritious clean diet are good. Practicing the quiet of meditation, mindful contemplation, slow walking in nature, gardening, massages and smelling flowers may nourish us.

     Let us not forget ourselves in the caring dynamic. Caring for others, needs to begin with self care. In this way, we can maintain throughout our working lives, the sense of purpose that got us into the caring professions in the first place.

Paper delivered to clinicians 22nd June 2017

Elizabeth McCardell, June 2017

Exploring an approach to restoring reciprocity in the relationship of therapist and patient in depressed patients with blunted facial expressiveness

     In therapy there is not me and not you, but us, as Neville Symington put it.

     In here there is usually connection, contact and relationship. And when you look at a therapeutic pair (as through a one way mirror, or on a video) you can see a kind of dance, where mirroring of movement and facial expression and phrase sharing takes place.

     The body is a sensitive “sounding-board” in which every emotion reverberates both within and between us, at least in the normal course of an encounter, as William James put it (1884). Emotions are literally e-motions, that is, a movement between what is felt and displayed and what is visible in expression (Fuchs and Koch, 2014). Between people, there is in the facial, gestural and postural expression of a feeling a bodily resonance that feeds back into the feeling itself, but which also induces processes of interaffectivity: my expression is affected by your expression which affects my expression, and so forth. Thus I experience the kinetics and intensity of your emotions through my own bodily kinaesthesia and sensation. 

     Merleau-Ponty (1962) describes  it this way,

     “The communication or comprehension of gestures comes about through the       reciprocity of my intentions and the gestures of others, of my gestures and the intentions discernible in the conduct of other people. It is as if the other person's intentions inhabited my body and mine his”.

     I can best illustrate this using the möbius strip. There is here a chiasm of reciprocity

     The möbius strip, that mathematical morphological idea that describes a two dimensional surface , a loop with a single twist, where surface A, when followed around becomes surface B, also beautifully describes, symbolically, the therapeutic relationship: not you, not me, but us. There is here not two surfaces, but one expressed two ways.

     I often use the möbius strip as a model to illustrate the nature of reciprocity, as it provides a useful and graphic account of the chiasm of relationships. In what I am exploring here is something that is poorly understood and needs, I think, much more work.

     Right now, I’ll do something I did in my doctoral thesis (2001. Then, as now, I shall attempt an examination of an embodied account of reciprocity by resorting to its study by an examination of absence, by what is not there, in order to better comprehend what might be there.

     With the PhD thesis, I wanted to examine the cognitive and non-cognitive realm of relationships within self, self-others, and self-environment, and so  I employed a method used by astronomers whereby the existence of as yet unseen cosmic entities is theorized to exist by the behaviour of surrounding cosmic entities. It’s a method that then allowed me to discover, to a degree things like memory, perception of time,  interconnections of behaviour and culture, relationship of body movement and intention, etc, through the examination of neurological disorders of Tourettes, Parkinsons Disease, Asperger’s . Absence helped point to presence. 

     As then, so now, I am moved to attempt to know more of human reciprocity in the therapeutic encounter by noticing what happens when the other person presents as somehow unengaged in that dance of reciprocity. I shall use the flatness of facial expression and its accompanying detachment and feelings of joylessness as the sign of this.

     Blunted affect, or as it sometimes called, anhedonia (where there is no felt pleasure in life: passive joylessness and dreariness, discouragement, dejection, lack of zest), can be found in a range of psychiatric conditions including mood disorders, schizophrenia and post traumatic stress disorder, and so on, as well as the influence of long term use of some antidepressants.

     The lack of felt pleasure is manifest in facial expression, slowed down body movement, and unengaged posture. Coupled with these signs is a growing felt sense of isolation and detachment from the lives of other people. The reciprocity between people is lacking. The “us-ness” is impoverished.

     I shall only speak about clinical depression as the kind of clients I most see are those with depression. 

     My personal reactions to the client with blunted affect are thrown into a certain degree of confusion. I am not as able to respond to the person in front of me, because many of the familiar cues are absent. The give and take of mirroring, as the dance of interaction is blunted. What is happening and how can I move this along somehow?

     I am remembering here of Jarrah, a 33 year old woman I saw for 6 weekly sessions last year. Jarrah’s mother rang me to make an appointment for Jarrah. She said her daughter has anxiety, depression and OCD. I asked then to speak to Jarrah about times and dates. Jarrah enthusiastically responded and so we organized a time for the first session.

     Jarrah presented with that familiar waxy look and lack of motility in the give and take of my relationship with her. She described feeling isolated, and dead inside. She would smile as an actor might, without engagement of herself and me, and which I felt repelled by, without fully understanding why. 

     Jarrah was 33, a reluctant mother and one where her deep depression began when she became pregnant while traveling overseas.  Her own mother had been severely traumatized by her Dutch parents who were absent much of the time during the war and by their war-time experiences. For her anxiety, Jarrah’s mother took valium. Her father was similarly damaged by his post-war family life in Holland and is now alcoholic and living alone. Jarrah, growing up with anxious parents, was fundamentally deprived of a sound and secure attachment with her primary caregiver, that is her mother. Whenever Jarrah sought comfort from her mother, Mum gave her valium. This continued throughout life. Jarrah wanted closeness, but her mother pushed her away and medicalized her need.

    Jarrah is single and lives on her own and with her young son. Her 9 year old son spends a lot of time being mothered by his father’s mother. Her son seems to be getting reasonable and stable support with the grandmother.

    

     I asked Jarrah what her obsessive compulsive disorder looked like. Interestingly it consisted of checking her body when she was dressing and also checking her body when preparing food in the kitchen. She avoided the kitchen because it became extremely tedious having to check her body repeatedly. I was curious about whether Jarrah had thoughts of suiciding in the presence of kitchen knives, but did not ask this directly. It seemed that suicidal thoughts were not there. It was the iterative nature of the OCD that was the problem. Checking her body repeatedly was like not having much connection with being embodied; like having a concept of a body without any intrinsic knowing of being bodied.

     What was it like for me being with Jarrah and her feelings of anhedonia? How was it for me to sit with a woman who was so unengaged at an embodied level, in the therapeutic conversation, with someone not in emotional affective exchange? Frankly, it was hard.  I found my mind wandering and theorizing and staying engaged was quite hard work. It was as though the centre was not holding, as Yeats puts it. I felt in my body somehow set adrift.

     And so I theorized some kind of healing and I suspect now, at least, that my desire for a solution may well have lacked sensitivity and understanding given the nature of my patient’s long standing problems. I felt also a bit pressured by the sense that I didn’t have much time to work with her.

     During the 3^rd session I suggested she resume swimming (she had been a competitive swimmer), doing yoga and dance (activities she loves). I proposed these to her to loosen her body and get moving. The explanation I gave her was about endorphins, and the like, but I knew from my doctoral work that there is more going on than just simply moving. There is patterning and mirroring and shaping that impels reciprocity between people and it is this that healing takes place.

    By the 5^th session, Jarrah presented as more engaged and her facial movement of affectivity was more noticeable.  There was more mirroring between us, her facial muscles were relaxed and there was little evidence of the false smile of theatre, and the dialogue between us was more fluid and natural than previously.

     Unfortunately, her  medicalized “story” of depression of her life, reinforced by her mother, kicked in once again and on the 6^th and final session, Jarrah said she couldn’t afford to come any more and her mother said she needed to resume seeing her psychiatrist, and so that’s what she would do.

     I sometimes see Jarrah on the streets of Lismore. She has her waxy complexion and her stilted smile back again, which is quite disheartening.

------

     In most social encounters there are two cycles of embodied affectivity which become intertwined, thus continuously modifying each subject's approach and response. This complex process may be regarded as the bodily basis of empathy and social understanding: a dance where each person feels connected to the other. This happens very quickly and happens to connect each person  also to the perceptions of themselves. There is a feedback loop happening here.

     When a person doesn’t feel connected, there is, along with a constriction, a rigidity, a sort of missing tension-flow modulation, a numbness, an affective depersonalization.  The deeply depressed are no longer capable of being moved and affected by things, situations or other persons. They complain of indifference, a “feeling of not feeling” and of not being able to sympathize with anyone anymore.  They  feel disconnected from the world and they lose their participation in the interaffective space that we normally share with  others.

     In  a  rather splendid book by Jonathan Cole (1999), called About Face where he writes of a  condition called the möbius syndrome, Cole captures first person accounts of what it feels like not to be engaged in the dance of reciprocity.

     Named after Paul Julius Möbius, a German neurologist, in 1888 and not the möbius strip it permits a neat coalescence of ideas surrounding that give and take of reciprocity.

     The Möbius Syndrome is a rare neurological disorder characterized by weakness or palsy of multiple cranial nerves. This means the fluidity and flexibility of facial expression is absent.  It is an extreme condition, for sure, but what is expressed by those with the condition tells us a lot about what might be happening with the deeply depressed client.

     People with möbius syndrome feel disengaged and unable to read the emotions of others. As a patient of Cole puts it, “Mostly I think I exist in my sub-conscious or preconscious mind,” but [I do not feel real as an embodied self.] In other words the very capacity to be responsive to the other is permitting a theory of mind that is more than an idea or concept of one’s own mind and the minds of others. It is a theory of mind that requires a psycho-socio engagement, and not merely an abstract thought. I’m intrigued by this and wonder if a self-other disembodied self is possibly like being in a trance state.

     I’ll leave that out there, and return to the thesis of engagement: a not you, a not me, but an us.

     Feelings and emotions enliven us, but when they are cut off from experience a whole range of  embodied processes are reduced, and as they are reduced so the person enters a state of isolation.  The greater the sense of isolation, the greater the break in possible reciprocity  between self and therapist and other relationships.

     Intrinsic to intercorporeality and thus relationality is having a sense of agency and thus being able to respond to the other person. When this capacity to respond is diminished and meaningful encounter is less present then we need to find ways to reconnect ourselves and those we work with.

     I suggested to Jarrah swimming, yoga and dance because these are activities that gives her pleasure. I do not think that these activities would be universally useful and that reconnecting affectivity would have to be tailored to the individual. I do not, also suggest that these activities need to be done in the psychotherapeutic session, but are more usefully to be used as homework.

     What may be valuable is an aware embodied shaping of what is said in the session. I don’t mean phony modelling of facial expression, or words, or anything as obtrusive as this, but  bringing a deeper understanding of what an embodied reciprocity looks like in the therapeutic encounter and somehow bringing this knowledge into some concrete form within the therapeutic encounter, in session. Neuro-linguistic programming uses this idea in the conscious therapeutic use of identifying how a patient operates in the world: kinaesthetically, auditorily,  and visually. NLP is, unfortunately frequently rather clumsily done, and is a bit too obvious for my liking.

     The us of the therapeutic encounter is a fertile ground that needs much more understanding in terms of process, and in terms of a process that can become more than description to a therapeutic tool in itself. This is in here an indwelling of the deep structure of a more than linguistic exchange and an exploration of healing at the heart of a depth psychology of embodiment.

References

Cole, Jonathan (1999) About Face, The MIT Press, Cambridge, Massachusetts.

James, W. (1884). What is an emotion? Mind 9, 188–205. doi: 10.1093/mind/os-IX.34.188

Fuchs, Thomas and Sabine C. Koch (2014) Embodied affectivity: on moving and being moved, Hypothesis and Theory Article, published 06 June 2014, fsyg-05-00508.pdf

McCardell, Elizabeth Eve (2001) Catching the Ball: Constructing the Reciprocity of Embodiment,  PhD thesis, Murdoch University, Western Australia.

Merleau-Ponty, M. (1962). The Phenomenology of Perception. New York, NY: Humanities Press.

Thinking about Human Reciprocity

June 2017

      There is a rare neurological disorder known as the möbius syndrome which is characterized by a facial weakness whereby those with the possibly genetic condition cannot smile, frown, purse the lips, raise the eyebrows, or close the eyelids. There are other bodily abnormalities as well, but the facial ones are more relevant to what I want to explore here. The lack of facial mobility gives the impression of a blankness of presence.

     The condition is named after Paul Julius Möbius, a neurologist who first described the syndrome in 1888.  Having a blankness of presence is confusing to other people, because in most human interactions there is a reciprocal dance of mirrored expression and when one person isn’t responding to the dance, the other has nothing much to go on, and communication breaks down.

     A similar state of affairs sometimes occurs in severe clinical depression and schizophrenia and other such conditions, and also as an unfortunate consequence of  long term use of taking certain antidepressants and antipsychotics. But there is more going on here than a flattening of facial expression (a sort of pastiness, a dullness of facial mobility), there is also a coupling of blunted affect where the person isn’t feeling very much about anything or anyone, coupled with a dulled vocal range.  As with the people suffering with the möbius syndrome, they have a profound sense of social isolation, and  not much of  a sense of other people having their own realities, except as an abstract idea. This is easy to understand because it is in  the act of mutual responsivity that there is a reciprocity which connects us.  In that mobile engagement there is a you and an I and an us.

     We respond to each other, we share our thoughts, and to some extent, our feelings, but we get many of our cues about what is being shared by what we are seeing, as well as hearing, concerning the other person. When in the presence of a person not very readable, we have little to go on, so communication breaks down and as this happens the unreadable feels  more and more excluded.

     Interestingly, or I find it so, at the same time in history as the identification of the  möbius syndrome (actually 30 years previously, in 1858) a mathematician and astronomer named Ferdinand Möbius came up a mathematical morphological figure that describes a looped surface with one continual side. This figure is known as the möbius strip, named after him. It is a loop with a single twist to it, so that when you follow surface A all around you end up on surface B. In other words the usual two apparent surfaces of  a loop, when followed around turns out to be a single surface. 

     The graphic artist, M. C. Escher (1898-1972) endlessly played with the möbius strip in drawing apparently impossible stairs and buildings where up becomes down, and so forth. Continuous looping is used in industry, in recording tapes, in knitting, and other places. It’s a really useful idea, and a beautiful one. You’d think, almost, that the möbius strip and the syndrome came out of the same idea, except for the fact that they were described by actual people, sharing the same surname. Both, though, are very useful in provide a metaphor for connection and conversation and the consequence of breakdown to the interconnection. Surface A (you) and Surface B (I) become us when both of us have the means to actively engage in connection. The problem of healing the other, and self, in order to vivify connection then becomes crucial, and finding a way for this to happen becomes essential. The therapeutic conversation is a very good place to start this. As we know, really, healing starts in the presence of an active listener and one trained to move beyond the level of appearances. 

      You could say, the point of meeting then allows you to be responsive to me and me responsive to you and thus awakening feelings of inner aliveness and reconnection to one’s own self as a member of a community.