Psychotherapy, uncertain art, uncertain science by Dr Elizabeth McCardell, M. Couns., PhD

 

December 2023

      I used to be an occasionally good university teacher before changing careers 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 14 or so years or so, since then, I’ve worked solely as a psychotherapist. There are similarities to teaching – we want the best for those in 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.

 

 

 

 

Reading Between the Lines by Dr Elizabeth McCardell, M. Couns., PhD

September 2023

  A friend was talking about something important and my response, as it typically is, was Mmm. She said how interesting it is the different kinds of Mmms there are. A non-therapist says Mmm in another way entirely, but therapists have an extra tone to their Mmms. I responded by saying our Mmms are all about reading as much as we can about what we hear. We are gathering information, said and unsaid. We are listening to the semiotics, the layers of meaning-making in not only words, but tone, inflection, posture, gesture, facial expression of the how of the other person, what is said and not said.

 Reading between the lines is important for working with clients whether in person or online. This requires close listening and very good observational skills. Online psychotherapy has an added benefit: of contextualizing the client usually in their own environment – all providing very useful extra information about them as well as adding to our shared communication, and enhanced communication matters enormously.

 Reading between the lines can be described as an intuitive process, even psychic, but, as my friend Peter Nelson in his book, The Way of a Seer, Reflections from a Non-ordinary Life, published 2013, says, psychic knowledge is really just about paying minute attention to all the clues presented to us. Peter is a retired psychologist and social scientist with that acute ability, and we all have it, if we train ourselves. A lot of miscommunication/misinterpretation arises from inattention. The art is thus, to observe, listen, perceive, not only the other person, but ourselves.

 Things not yet consciously known can nevertheless be intuitively felt and manifested in our dreams. Dreamwork is thus a very useful tool to practice. The dreams of our clients and ourselves need to be listened to. Problem stories and their solutions brought into the consulting space may or may not be recognized straightaway, thus our need to pay attention to those things that are often ignored.

 What we therapists often teach our clients is mindfulness. There are numerous ways to become mindful. I sometimes suggest a walking meditation as a means to develop mindfulness. This may consist of walking barefoot on grass or sand or carpet, slowly, feeling the texture of the ground beneath the feet, noticing how one’s body adjusts to the slow walk: the way our toes grip the ground and relaxes, the sensation in our calf muscles, the extension of legs from the knees, and so forth. At the same time, you might feel the coolness of air on your face, breathed, in saturating your whole self with renewed life energy. Your awareness extends to the landscape through which you walk, for your walking meditation mindfully connects you to your environment. Such close awareness reveals previously unrecognized things in the environment: the jewel of dew on a single red leaf, a water-turned stone, something previously unseen, now delighted in.

 The art of mindfulness reduces stress and improves mood. It’s about slowing down, deeply breathing, and engaging all our senses with the environment all around us. As an art it can be extended to everything we do and are, as we go through life.  Learning mindfulness helps us particularly in those situations where we are more reactive than we need to be. For instance, when somebody says something that stirs up old feelings, whether or not they are appropriate, it’s useful to be able to stop lashing out in our reactiveness.

 Practicing mindfulness is valuable for all of us. This skill is most obviously useful when what a client says stirs up old feelings in the therapist and the latter, instead of stopping listening to the client, uses that awareness to further the effectiveness of therapy and then deeper places can be mutually investigated.

 One thing though, mindful listening and reading between the lines, is never learned as a once and forever art. It has to be practiced in every moment, every encounter, with awareness and intention. As such, we have to be vigilant with ourselves, and with our clients, vigilant toward them, but in a spirit of relaxed allowing: allowing whatever arises to simply arise.

“What we perceive depends on how we direct our attention.” (Milton Erickson) by Dr Elizabeth McCardell, M. Couns., PhD

January 2019

     Perception is an interesting thing. Most of the time we see our world as we have become accustomed to seeing it. This is generally useful as it means we are not having to work hard at living life, but can assume a lot of things and then get on with making sense of the novel. 

     Our responses to what we perceive can largely become part of a well-oiled machine, which is not to say that this is necessarily good. In families, old patterns of behaviour in interactions between members and beyond that to interactions with other people who simply remind us of a family member, can be practically set in stone in a destructive manner. For example, a little girl is bossed around by her older sister who has been given the care of the younger one because mother is ill. The older sister has always been angry at having to be “mother” to her sister and forced, more or less, to give up her own childhood. The younger one doesn’t really know any difference. Mum is sort of there, but not as a comforter when she is hurt. “Mother-sister” is unreliable (she’s angry, after all), but who else is there? Father works away, and there is no other family nearby, and so the little one has to depend on this person who feels good/not good. When she grows up, she meets a man who is good and not good. He is familiar, but still not quite known. He behaves unpredictably and erratically, he is there and then he disappears and returns to surprise her, and then goes, and then comes.  Every time the woman meets with her older sister, she feels attacked and sort of depleted. She notices that afterward seeing her sister she eats a lot of sweets even though she isn’t hungry and even though she is now pre-diabetic. She attends psychotherapy sessions and starts to notice the patterns of behaviour in her own life as well as that in the man she’s with. She breaks up with him and at the same time, builds an understanding her sister more. She starts to notice that as her perceptions of that woman’s behaviour change, so are her reactions changing. She doesn’t feel the same imploded feelings so much and doesn’t consume massive amount of  ice cream in the way she used to.

     The process of psychotherapy interrupts not only tired old modes of interaction that are not working, but brings insights that create an ongoing capacity to change how we respond to others in the world. This, though, doesn’t mean everything is hunky-dory. As anyone who has experienced how it is to stop reacting as one has traditionally done within families and other groups, one’s non-reactions disturb the machinery of the family system and certain others can become belligerent and nasty. My suggestion when such things happen is to walk away and leave the antagonist to fight their own shadows. I’m reminded of the martial artist who, when the opponent lunges aggressively at them, simply steps aside. The opponent topples over. Neat.

     In time, the perceptions of other people in response to us change as we change and how they behave towards us changes too. Family and other social systems are not immutable, but fluid and flexible. What once was, doesn’t have to be forever. Our perceptions change according to how we direct our attention, and that changes practically everything.