Psychotherapy, uncertain art, uncertain science

December  2019

by Dr Elizabeth McCardell, M. Couns., PhD

     I used to be an occasionally good university teacher before changing professions to practicing psychotherapy full time. This was over in Perth, Western Australia. We had a syllabus to follow, lectures and tutorials to run and they followed a pretty standard course. For about a dozen years or so, since then, I’ve worked solely as a psychotherapist. There are similarities to teaching – we want the best for those under our care – but the way we go about it is very different. As psychotherapists, we observe and guide the other person(s), and we participate in their lives, aiming to bring forth insights, understanding, different ways of doing things, as well as strengthening their sense that only they are the authors of their lives.

     Psychotherapy is art and science: fumbling, uncertain, creative, experimental; it’s a growing body of psycho-social-spiritual knowledge, it’s an understanding of the dynamics between people; it’s sometimes methodical, ordered, and follows a clear beginning, middle and end; it’s helped by therapist self-awareness (which is very important) and depends on just seeing what is effective and what isn’t, it unfolds, it explores, and it’s not a journey that finishes with the last therapeutic session. It’s part of a life time of self-discovery. Those coming to therapy or counselling or whatever you call it should not expect clear cut outcomes all the time; it’s not an anti-inflammatory pill for the mind, despite what some might tell you. A course of treatment is a dubious way of talking about what is a much more subtle and impactful process. Here is a therapeutic conversation that has goals along the way, but they are reached via improvisation, intuition, acute listening and trial and error.  That is the best therapy, as I and several others see it. Yes, we can strictly follow the protocols of psychotherapeutic schools and models and rituals, but when we do so, we cease to actually listen to what our client is saying in her words, her body, indeed her whole demeanor. When we get caught up in saying the ‘right thing’ we have stopped listening to what is. I fear I have missed quite a number of people as I’ve observed and participated in their therapeutic journeys, by doing exactly this.  For that, I sorry.

     One thing I need to say with regards to  not listening properly to a client is that it forces me to sit with my own discomfort, to tolerate uncertainty and the hoard of ghosts of self doubt, but to also aim to be more present, more sensitive, next time. Erving Yalom says of this that such is a prerequisite for the profession. Ours is a somewhat wobbly profession. We try to steer an even course through uncertain waters, while knowing that this goes against much of  the common perception of what we do. That idea is that what we do follows predictable, measurable pathways but very often it doesn’t work that way, and that’s ok. The outcomes may be quite different from what could’ve expected at the outset.

     Though I speak of such things, I also know that the journey we travel together isn’t without a safety net, well, actually a few safety nets.  Psychotherapists have been trained (in my case, university trained at a post-graduate level), we have experience, we are monitored by a colleague or colleagues in supervision, we participate in ongoing professional and personal development, we are bound by a rubric of ethics, we are insured, we abide by the laws surrounding our practice and, basically, we just care what happens to our clients.

     Ours is a caring profession. We guide, we accompany, we share, but we do so from a fairly objective position. If we did it any other way, both of us would be lost. But in participating with the client in a deeply human way, we allow them, and us, to be changed at the very heart of the therapeutic encounter. This is a rich, wonderful collaboration where both client and therapist are nourished in a journey that  reintroduces  the client to the authorship of their own lives, and that’s good to be part of.

Making the Therapeutic Relationship Real

November 2019

by Dr Elizabeth McCardell, M.Couns, PhD

     Therapy is a unique relationship that is a rich, supportive and useful environment for change. What goes on between therapist and client is, itself, therapeutic and it’s not so much what is said, but how it is said and how it is heard.

     The client is encouraged to speak of those things that may have been unsaid for a lifetime, and those things just thought and worried about. How, though, may this be achieved? In this month’s article, I want to address the tool of therapist self-disclosure. The reason is that it is still a disputed zone, as it were, among therapists and clients.

     Therapist self-disclosure in therapy is when the therapist shares their own personal views or experiences with a client with the purpose of improving that client’s emotional or mental state, as well as possibly normalizing the client’s experiences that may otherwise be felt to be too odd or crazy, while not trivializing them.  Its purpose is to help the client and not meet the needs of the therapist. It should not be used to add to the client’s problems. It may be used to decrease client anxiety, expand their awareness to different viewpoints, and to increase their sense that the therapist is genuine and is there for them, but it is not to be used by a therapist to ‘dump’ their stuff onto their client.

     As a therapeutic tool, therapist self-disclosure should be used with conscious discretion and wisely. It has the potential for losing the client so that they do not wish to return; creating role confusion (who is helping who?); or cooking up a situation where the client and therapist end up just being good friends in the space of the therapy room.

     Used well, it can increase trust and rapport and offer a model for the client. After all, in the counselling situation, we encourage client self-disclosure and sometimes it’s useful for the therapist to lead the way, by example (as psych0-educationalists might).  This is most true in the fields of drug and alcohol counselling, feminist counselling, existential psychotherapy, cognitive behavioural therapy, narrative therapy, gestalt therapy, and other modalities where self-disclosure may be used to reduce the power differential between client and therapist to encourage better sharing.

     The therapist’s theoretical orientation really matters here. Those who disclose (apparently this is about 90% of psychotherapists, according to one study) see it as fitting in the interconnection between therapist and client (as I do). Those who don’t disclose, are more interested in working through the client’s projections, as per the psychoanalysts.

     In psychoanalysis and Jungian-based therapy, therapist self-disclosure is frowned upon, following Freud’s injunction to serve as a mirror and blank screen for clients, freeing them to project their own stuff onto the therapist. Supposed neutrality is seen as important for the analysis of the transference. I personally think such an approach is alienating for many people, including the therapist.

    I remember seeing a client many years ago who had spent thirty years in psychoanalysis in the U.S., with the same therapist. One day, she turned up for her thrice weekly session, and the therapist wasn’t there. He’d disappeared. About a year later, she received a letter from him saying that he’d gotten too tired of working and so had retired. Maybe it would’ve helped if he had said something to her about feeling stressed, tired, and overwhelmed, and then maybe a genuine conversation and genuine change might have been initiated. A bit of therapist self-disclosure might well have helped.

     Real relationality between client and therapist is, I believe, as do many, the agent of change in therapy and understanding the value of relational perspectives (including therapist self-disclosure) helps us do our work effectively.

     Therapist self-disclosure should be direct, brief, focussed and relevant and specific to one’s own experiences/points of view. Used thus, no time is wasted and the necessary therapeutic tension is maintained, creating a good and real change environment.

Psychological Projection

October 2019

 by Dr Elizabeth McCardell, M. Couns., PhD

     Over the past couple of months,  I’ve  been getting abusive phone calls from a stranger projecting a whole lot of stuff on me. Turns out, other innocent people, and writers to this paper, have been getting similar calls from this person (identified by the common phone number). While the abuser isn’t threatening violence, and thus, may not – yet – be charged with the misuse of telecommunications (use of a carriage service to harass or offend), it is nevertheless a bit unnerving. I’ve blocked the number, and advise others to do the same.

     It’s incidents like these that provide useful fodder for articles, such as this one.  The lack of truth to  her ravings point to classic psychological projection and this is an interesting subject.

     What is projection and why do people engage in it?

     Psychological projection is a defence mechanism used to unconsciously  cope with difficult feelings or emotions, positive and negative. This coping mechanism arises essentially from  a person’s Shadow side (as C. G. Jung described it). It usually involves projecting undesirable feelings or emotions onto someone else, rather than admitting to and dealing with the unwanted feelings in oneself. The rants against me were mostly about how I, the privileged one, never listens to the unprivileged. I couldn’t get a word in edgewise in this bombardment of words; there was literally no room for me to speak at all. Droll, eh, and ironic, since I wanted to invite her to come and speak with me directly. This well describes, however, how projection works. This woman can’t listen to anything anyone else says, so she projected this incapacity onto me and I became, in her eyes, the one who cannot listen.

     Psychological projection is common. As Jung says, ‘Everything that is unconscious in ourselves we discover in our neighbour, and we treat him accordingly.’ Such psychic processes are well and truly obvious in everyday life, and politics (!). It is well to remember that projections, like all other defence mechanisms, are an attempt at self-soothing, although destined to failure, because they stir up too many unmanageable emotions, rather than quietening them down in the attacker. Unprovoked attack rarely manifests anything but rejection and resistance in the one attacked. Dialogue is not possible.

     It could be said that the psychological projection expressed by our caller was something of an almost Herculean effort to haul back some control of her ailing and fragile sense of self. Why else would a person repeatedly ring strangers to yell at them?

     In psychological terms, ownership of one’s projections is part of the healing of the whole self. Jung was very clear about this. His whole psychology was one that promoted individuation. Our task is to recognize the subjective origin of our projections, withdraw them from the outside world and to integrate this element of our personal into conscious awareness.

     To be clear, individuation is the transformative process whereby the personal and collective unconscious is brought into consciousness, and what belongs to oneself is recognized as separate from what belongs to others. The business of psychological projection is actually quite useful for it identifies the unowned areas in our lives, thus giving a signpost to what needs to be worked on within ourselves.

Overcoming fear through focused body movement

September 2019

by  Dr Elizabeth McCardell, M. Couns., PhD 
 

     In Germany in the 1920s to the 40s some very innovative work was going on that traversed psychotherapy and body work. Dancers, gymnasts, massage therapists and other body workers were in conversation with psychoanalysts and psychologists (including C. G. Jung) and these conversations were the seed to recognizing that no psychological problem exists without a bodily response and no psychological/emotional problem exists outside a bodily experience. It is curious, therefore, that the two forms of therapy then went off in separate directions. Psychotherapy started to think of itself as entirely to do with the mind and social domain, and physical work as having nothing much to do with feelings and thoughts. Both had got caught up in a mechanical way of doing things. I’m talking mainstream here; alternative modalities didn’t lose track of the whole embodied self.

     It is interesting that the severe anxiety response particularly in post-traumatic stress disorder is being our entré into more holistic approaches to healing. Anxiety is a fear response, a flight-freeze-fight response that stirs up adrenalin, causes cortisol levels to soar, saturates the blood with higher levels of glucose and more white blood cells, hyperventilation, saturates the mind with recurring thoughts and imaginings, stirs stomach discomfort, gives us a dry mouth, makes us feel we can’t escape,  etc. Imagine being in a sustained fear response lasting days, maybe years. Fear is crippling, and those consumed by it tend not to venture far.

     In the 80s a Tai Chi practitioner friend was involved in a study with a group of elderly people with a fear of falling, Many had already fallen several times and broken bones. My friend was hired to teach the group some simple Tai Chi exercises. The more they exercised in this flowing fluid way, the less fear was experienced. Fear of falling, and interestingly, other fears went away.

     Exercise is good, but I think there is more to what was going on here.  I have two main thoughts on the matter. Focused body movement matters.  Tai Chi is a mindful, focussed form of exercise. Mindfulness is now a tool in psychotherapy. When you are aware of what you’re doing, your thoughts are no longer on your anxiety.

     My other thought is that mindful physical exercise expands our perceptual strengths and capacities. Most of us have a dominant sensory perception, where the less dominant ones are not paid much attention.  When one perception shapes a person’s experience in a fairly exclusive way, negotiating the greater world can be compromised. Think of someone who practically exclusively gets around using just what they can see as a means of knowing what is there and how it must feel to meet the unseen, unexpected whatever. It would be scary.

     We usually talk of only five sensations: sight, hearing, taste, smell, and touch, but there is another: proprioception. Proprioception, also known as kinaesthetic sense, is the sense of self body movement and position in relation to space and other things. Developing proprioception can be very beneficial for people who have an over developed sense of sight (maybe they spend all day on their phones). When fear arises from encountering the unknown (which is always there) – eg not being able to see into a dark room – having a strong body knowing, that is, a better proprioceptive sense, can give greater security, because presences and absences can often be felt actually in the body. You don’t have to see everything to feel secure.

     Focussed exercises, like those in the martial arts, where you are aware of your own sense of balance, your core fulcrum, as it were, the slowness or speed of your body movement, the grace of an arm, perhaps an unsteadiness of a leg, your breath, your sweat, expand your sense of safety and confident engagement in the world. It’s also great fun.

     As one of the early German body practitioners who worked alongside a psychotherapist, said, the therapeutic work is speeded up when patients do both focussed body work and psychotherapy. I encourage my clients in the pursuit of both for their healing.