Knowing, but not knowing you know by Dr Elizabeth McCardell, M. Couns., PhD

 

June 2023

 On the radio the other day, a football coach was saying that he knew it was time to give up his job as soon as he asked himself the question whether to continue doing it. The question itself implied a sense of the answer, or so he thought.

 This got me thinking about the thing about asking questions as well as the kind of implicit knowledge we have about certain issues before knowing that we know.  I could never answer the question, for instance, put to me by an old mentor of mine, “Did I have any questions I wanted to ask him?” My mind always went blank. It dawned on me, as I was driving home from the beach this morning, that the reason for this was that I didn’t know what I didn’t know and for me to ask a question would be to already know what I didn’t know. I needed the language in order to ask the question, any question.

 People come to me sometimes knowing what their problem is and can easily articulate that, but mostly they come expressing a generalized sense of anxiety about what they  think they don’t know what the problem is. Knowing somehow, without knowing consciously.

There are several kinds of knowing, but broadly two types:  Explicit knowledge and Tacit knowledge. The first is the knowledge we can draw upon whenever we like, and organize according to categories (like, for instance, a plan of how to connect SCUBA equipment in preparation for a dive). Tacit knowledge is the knowledge we have that is difficult to explain; we just have a sense of knowing something (like, knowing just the right time to enter the water). Tacit knowledge increases with experience over time, whereas explicit knowledge must be added to deliberately. Some researchers also talk about Inert knowledge, which is knowing something without understanding it, and there are a number of other kinds and levels of knowledge. I intend to only talk about inert knowledge.

Clients may say, for example, that they know they should be meditating and that they know how to do it. They know that meditation will help their levels of anxiety diminish, and yet they don’t do it. This kind of statement needs be untangled. Sometimes it isn’t a case of actually knowing how meditation feels, but knowing the procedure for getting into a meditative state. Procedural knowledge is like reading a manual and knowing the steps to something, but it’s a knowledge that hasn’t been instilled into experiential and tacit knowledge. It is as though the information is there, but the embodied knowing is absent. In cases like this, I’ll often suggest walking meditation where you put your focus on the sensation of walking over grass or sand, becoming aware of the textures, the dips and rises, beneath your feet, the coolness or warmth of the air around you, the way your jacket feels on your body; in other words, getting your awareness back into bodily experience. You walk slowly, conscious of each and every step. This level of mindful practice becomes a meditation very quickly. Your focus is, and has to be, present with what you’re doing. Sitting meditations can too readily drift off into memories and other distracting thoughts.

Bringing consciousness into that which has been unrealized is a really important tool in the art of healing. Much of this inert knowledge is known but not known. Once the knowledge shifts into embodied knowing, it can alleviate much ungrounded anxiety.

Milton Erickson, a father of clinical hypnotherapy (which I practice, along with psychotherapy and counselling), said this "When someone comes to see you, they always bring their solution with them, only they don't know that they do, so have a very nice time, talking with your client, and help them to find the solution they didn't know they brought with them." It’s the art of coming to know something you know at some level, but haven’t been able to successfully access. It’s the art of using what you know to be able to ask the questions needed for finding your answers.

 

 

 

Somatic OCD: an attempt at quelling anxiety by Dr Elizabeth McCardell, M. Couns., PhD

November 2021 

     When I work with a client with particular issues I think about what they’re going through and set about expanding my understanding of these through extensive reading and research, and I don’t stop, even after the client has moved on. So it is with a particular person who came to see me some time ago where they were obsessed with controlling their breath. I knew that such a somatic (bodily) compulsion was a form of a obsessive compulsive disorder (OCD) that arises originally to quell upwellings of anxiety, but, to be honest, I couldn’t get much of shared sense of what that felt like to the person. I’ve never experienced such a thing.

     Yes, I’ve experienced anxiety; we all have. It’s part of being human. Anxiety is our body’s natural response to stress. It’s a feeling of fear or apprehension about what’s to come. Things like the first day of school, or giving your first speech, or going to a job interview can stir up feelings of nervousness and fear. There’s nothing wrong with us in these circumstances in feeling this way. It’s only when such feelings last a long time and are interfering with our life that the natural response has become an anxiety disorder. You might have sweaty palms, increased heart rate, rapid breathing, restlessness, feeling spaced out, trouble sleeping, difficulties concentrating most of the time. Medication may help, but the source of the condition still needs to be addressed. But, hang on, let’s not go there yet.

 

     How might a person deal with this sense of anxiety interiorly? You might put your focus on such things as blinking, swallowing, tapping your tongue on the roof of your mouth, cracking your knuckles, or noticing how you’re breathing through taking deep breaths and counting them, or any other repetitive behaviour, and in this way you might temporarily quell your anxiety. We are after all always looking for ways to soothe ourselves.

 

     Unfortunately those ways of self soothing can become a problem in themselves and come to be associated with feelings that unless these actions are done, we will be doomed. Thus a cycle of intrusive, unwanted thoughts (obsessions) and

urgent-feeling behaviours to try to stop the thoughts (compulsions) or prevent feared outcomes from occurring is set up. For someone with OCD, the obsessions can centre on or be triggered by a number of things.

 

     In the case of my former client, her anxiety had to do with fear of dying and she had been told by someone, using a mindfulness meditation as a reference point, that when such feelings arose, to focus on taking deep breaths. Very unfortunately, such words of wisdom became a problem in itself. She became hyperaware of the automatic process of breathing, such that she thought that if she lost that concentration on breathing, she would die, and so she took to counting each breath, to keep track of it.

 

     Bringing awareness to the breath or any other somatic activity may be a good mindfulness technique but is clearly counterproductive for someone already preoccupied with their feelings of anxiety. Preoccupation is already a problem, so to add to it just exacerbates it all. It is much better to take the focus away from the compulsion to breath deeply and count each breath and put the client’s attention to what breathing actually achieves: to release and then to take in the new. Most of my focus in my hypnotherapy sessions with OCD clients is on the letting go and relaxing side of things.

 

     It is interesting that the process of breathing out, and letting go, is when the parasympathetic nervous system is happening. It is a quiet “rest and digest” period and helps the body-mind to literally recuperate its energies. The inbreath, the inspiration, is the responsibility of the sympathetic nervous system, that system that stimulates the heart beat and gathers up the body’s resources for flight or fight. OCD feels to the person all about hypervigilance/hyperawareness, thus the therapy needs to enhance just letting go, letting be, and relaxing.

 

 

 

 

Nearly forgotten, but not quite

May 2018.

     Suddenly I realize I’ve practically forgotten the copy deadline for May’s article. It’s after midnight and Friday. Yikes.  I haven’t missed an issue of The Nimbin Good Times since writing for this paper in March 2009, and I can’t start now. So, what to write about?

     I’ve been thinking a lot about intergenerational trauma in recent times as I see the effects frequently among my clients. I have people coming to me with feelings of high anxiety, sleep issues, and accompanying digestive problems that are not easily simply understood from personal histories, per se, but suggest that something more is going on.  Some deep questioning from me often reveals a pattern of anxiety and depression shared by the parents and grandparents of my clients, and often shaped by war experiences and alienation from family at critical times.

     I remember working some years ago, with a man with sleep problems and associated weight issues (weight problems is identified in the literature as being associated with long term insomnia) whose mother experienced bombs going off in London as a little child. She couldn’t trust enough to sleep properly and was, and remains, always on edge and anxious. Her cortisol levels must have been through the roof.

     Cortisol is a hormone that is released in response to stress and is known as the ‘flight or fight hormone’.   It is also associated with maintaining blood pressure, and anti-inflammatory and immune processes. Interestingly, cortisol also works in tandem with the hormone insulin to manage constant blood-sugar levels, so it plays a part in digestion.  High cortisol levels are associated with diabetes, a condition my client also had.

     At an epigenetic level, my client was likely affected by the experiences of his mother a nearly three decades before his birth, and not just from the stories that she may, or may not have told her son. Epigenetics is the study of heritable changes in gene function that do not involve changes in the DNA sequence itself. Bodies don’t forget, it seems, and they hand down the generations their imbalances created by trauma. Trauma upsets nervous systems across the board that impact on the whole health of the descendents.  It becomes critical that those who seek counselling receive it with reference to trauma therapy and not merely symptom control. Good therapy is thus, in my view, a depth psychotherapy that really helps shift those levels of fright-flight-fight reactions to more than manageable levels.  Really good therapy frees up the whole self so that the energy previously captured in iterative anxious responses now becomes available for creative output and innovative work and play practices.  Clinical hypnotherapy is often useful alongside counselling in this process, but that is the client’s choice.

     I am always interested in that coming to a place of playfulness from the tensions of hardline panic because then the whole being of the self is softened, loosened, and ready for new experiences. The client can then move on to what really excites and motivates them, and, what’s more the memories of difficulties are practically forgotten.  It’s a curious thing, this forgetting, because it is possible to see that there has been fundamental change at a more than cellular level. The whole person is lively, fitter, glowing, and sort of bouncy. What was once a stuck problem story is now recounted with how things once were, with only a little bit of the pain previously experienced.

      Remembering the trauma experienced by an antecedent family member or members helps the client recognize that their own symptoms don’t necessarily reflect anything they themselves have done, or not done, and this fact often contributes to a freeing up from some aspects of the symptoms of anxiety they have felt. It shifts the experiences to a sense of something that can be witnessed as opposed to drowned in. So a chance to speak of such things to a therapist is really useful.

     Another side effect of doing therapy with a counsellor is that the changes experienced translate into changed family dynamics and even family members realign to more healthy choices. Interesting stuff. And now to bed.

    

Anxiety

Anxiety    by Dr Elizabeth McCardell, M. Couns., PhD

    I’ve just realized this is the last Wednesday of the month, the deadline date for contributing articles to the Nimbin Good Times. To say I’m a bit stressed and anxious, is an understatement. I’ve contributed to this fine paper every month since March 2009 and really don’t want to miss an issue, if at all possible.

     Anxiety is my topic, appropriately. What a better way of working than working with material currently experienced.

     At the moment I am participating in an online international conference on the use of hypnosis in the treatment of anxiety. The tools we are adding to our repertoire are extremely useful and are available to any client wishing to work with me. So the matter of anxiety is close to me at other levels too.

     Anxiety has a structure that is pretty well universal. There is an internal voice that repeats messages of fear, danger, maybe lack of ability, that manifest alongside the mental reiterations, a physical component of tightness in the chest, perhaps some breathlessness, palpitations, dry mouth, and the like. The internal voice is quite high pitched, strained, and rapid. The message is not really rational and it repeats itself.

     Anxiety distorts and intensifies normal interaction in the world and with other people, so that our whole selves can feel overwhelmed with emotion and a sense of being out of control. The art then is to change those perceptions.

     For me, at the moment, my stress at needing to get this article written is being accompanied by fear of losing income. Ridiculous, isn’t it. These articles are one of my sources of income, so I have to write them (or at least so I think). At the forefront of my inner chatter are the words, “hurry, hurry, hurry”. There is, though, another voice that is taking the micky out of this and the “hurry, hurry, hurry” is acquiring a sort of sing song chant, “hari rama, rama rama, hari krisna, hari krisna” – and thus the tension is lessened. And here is a key to losing anxious feelings.

     It is impossible to maintain anxiety when other processes are introduced. There is a technique where the therapist suggests  the client writes down the words of stress in very small script. Then the client reads what she/he has written in a normal voice, and then re-reads the script in a very slow, bored voice. Such a technique changes the non-verbal qualities of the inner talk, and even changes how the body feels as the exercise is carried out.

     Neurological research is showing how this is possible. Changing a person’s experience of inner talk actually changes how the body-mind operates. Inner talk is iterative, that is, it has a quality of rumination, where stuff is thought of repeatedly. In terms of neural activity in the brain, the same pathways become entrenched and sometimes pretty difficult to get out of.  Worry that occupies us, occupies us more and more, unless we can break the looping that occurs. Breaking the pattern, as for instance, taking the micky out of the inner story (my “hurry” changed to “hari rama”), or slowing the words of worry down, or singing the story, or speaking the words in an ordinary  voice, have the power to actually disempower the rumination and the looping and thus forge new neural pathways. Breaking the pattern changes the body’s response to what used to be plain old anxiety and increases a relaxed state. The tightness goes, leaving a softness and a sense of being more fluid and easy.

     Other techniques are useful too. One technique  is remembering the tools we used to use to relax ourselves and learning to incorporate these tools when feeling stressed. For me, writing has this power. As I write this article, I feel more settled. Swimming is another means for me.

     A year or two ago, I had a client with a particular form of anxiety. I wont say what it was about, but I discovered she had a great love of running, down by the sea. In the hypnosis sessions, I “ran” with her in the wind, for in invoking such a scenario, she was able to enter into a deeply relaxed and yet aware state (which is what hypnosis is anyway); a state she was able to evoke whenever she needed to. The inner iterative voice lost its power and her whole demeanour changed in an enduring way. From week one to week three, her face was no longer pinched, her breathing was easy, and her skin glowed.  Along with these changes was a shift in how she worked with the people in her world and how she saw herself. She lost her belief that she was a weak/bad/anxious person. She become confident and looked it. Really fundamental changes occurred.

     Anxiety has a lot of energy connected to it. Unlocking that energy in a creative and helpful way can release and relieve a person very deeply so that they can live more fully and more easily in the world.

Finding order in chaos by Dr Elizabeth McCardell, M. Counselling, PhD

Feb 2011 

     Does anyone remember the child’s game of fiddlesticks? You held in your hand a collection of different coloured sticks (mine were plastic), let them go, and then chose one to lift out of the small piece of chaos each stick until all were removed from the pile. If I remember correctly, you chose all sticks of the same colour, until these were removed. There might also have been a component of the game where each colour was worth more or fewer points than the others. It was a game of skill.

     I have clients who come in to see me, overwhelmed with choices: where to go now, which course to take, how to quell an all embracing anxiety about the multiplicity of things.  They’d reached a point of stuckness; a sense that no choice is possible among the many choices. At the heart of this is a knowing that there many many possibilities, an excitement that beckons, but a tremendous anxiety usually concerning the “rightness” of a decision about to be made.

     Like a game of fiddlesticks you can fiddle around putting off making a decision, or you can deliberately pick up a stick and lever off each stick one at a time methodically, noting as you do, what is more important to you, and what can be cleared away without too much thought. It is usually no more complicated than this. A life is a long time (though, of course, how long, few actually know). In a life it is possible (and happens practically always) to take many “wrong” turns before you realize what it is that really matters to you and what it is that you decide to devote the rest of your time to.

     Anxiety in the face of making a decision is a peculiar admixture of emotions. There is a surge of excitement and a sense of confusion; there is sometimes gut pain, often sweating, a tingling, a rootlessness, a feeling that your heart has dropped to your feet, and an idea that you cannot make a move, because at the edge of it all is a sense that you are near annihilation. Anxiety in bits and pieces is quite normal and a part of life. It is when you feel anxious all the time and when it gets in the way of doing what needs to be done that maybe a call to a therapist is a good idea.

     Anxiety is the “fear and trembling” before a new encounter. It comes to the fore when we challenge our old self-world relationship and doing things in the same old way. Feeling anxious, though, when identified positively as an excitement rather than negatively as a disorder, has the wonderful power of changing how we are in the world, of allowing us to embrace life more fully.

     Artists know well anxiety and a sense of being in chaos. They choose to occupy the “anxious space” for although feelings of insecurity, over sensitivity, and abandonment come with the deal, as it were, they embrace the “divine madness” for the extraordinary charge that comes with creation. Creation, as the Old Testament book of Genesis in the Bible describes it, is a process of separating from chaos (‘the earth was without form and void’), night and day, darkness and light. This process, though, cannot be forced: it is necessary to listen to the movements within. This does not mean that you wait until the spirit moves you, but that you respond to the often inchoate “voices” within, and slowly or swiftly as is required create by a process of separation, this from that, that from this till what you have made excites you.

     Anxiety is embraced by artists and can be likewise an energetic source that others can draw upon in the course of daily life.

     If I take one course of action, will I have to abandon all the others?  Yes, but just for now.

     The art and skill of fiddlesticks is to attend fully to each stick as you lever it up and add it to your pile of possibilities beside you. In sorting through the chaos an art of life that excites you becomes clearer. Sometimes this is just plain and rather dull old work; sometimes your heart soars with elation. Choosing is a skill that can be learned and anxiety can be a useful tool in getting you started. 


Copyright @ 2013 Dr Elizabeth McCardell