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.

    

Relationships and the matter of grief

April 2018

     The stages of grief a person goes through after the death of someone known to them are typically described as: Denial, Anger, Bargaining, Depression, and Acceptance, or DABDA. This is the formula taught to medical students and grief counsellors the world over, since it was first described in 1969 by Elisabeth Kübler-Ross in her book On Death and Dying.  DABDA advanced our understanding of the grief process, for sure, and did much to illuminate what had become an embarrassing situation for dying patients and their families alike. Death in our society, after all, is often felt as a somewhat awkward life event, treated in subdued tones behind closed doors. With the advent of research and the institution of counselling sessions for those who have suffered the death of a friend, spouse, parent or child, the five stages of grieving became the bench-mark for not merely understanding the emotional process of facing death, but practically prescribing how it will be.  Non-DABDA responses to death such as relief and or even joyfulness came to be “read” by some as not facing facts, thus practically pathologizing what might be a right response for that person according to the quality of relationship they had with the person who died.

     There really isn’t a “right” way to grieve and we need to recognize this. Loss can be liberating, it can engender sadness and happiness at the same time, it can be felt as desperately sad, it can be felt as not much at all. The rubric of DABDA doesn’t recognize the complexity of relationships, and thus the multiple possibilities of feelings and expressions of loss. This matters because we are often quick to judge those who do not express feelings of loss, as being hard hearted, unsympathetic, robotic – and sometimes impute, wrongly, an intent that may be utterly fanciful (the person wanted the other dead, or maybe they did it, or some such). May not a relationship fluctuate between love and hate? May not a person die in stages and that a final cessation of being be greeted with relief and not grief?  May not the dead person have already been absent for many years (“dead” to family and friends) before their actual passing? Maybe one's spouse died suddenly after a violent argument, or maybe they died just before divorce. One may indeed have felt deep love once, but the release from a profoundly difficult situation may well have elicited plain relief rather than grief. Loss is not always simple and grief may not be always present.

There is considerable social pressure put upon those who experience relief, rather than grief – such is the pressure of the social expectations encapsulated in the DABDA concept – so that they may go on to wonder about the authenticity of their own responses. Perhaps there is something wrong with them, perhaps they ought to feel pain, why don’t they feel pain, they might think.  Those looking on may wonder at this silence of a response and suggest it hides inner turmoil, denial, even depression perhaps, and yet who is to say that there is conflict there at all? The pressure brought to bear from within oneself and from family, friends, and counsellors, can hinder an honest, authentic statement about what is really felt. Maybe, the very act of getting real  with a client or friend about death could liberate actual feelings in the pair of them. The listener can do well to provide that space for deep listening. We really do have to listen to what is actually said and not be too quick to suggest that a response is lacking in some way. Maybe until we do that our judgement is clouded by our own discomfort.

There are no rules to how grief is to be done; there are only responses to the quality of the relationship a person had with the one who has passed. That is what is important here; that is what matters.

Being Real

     I was going to title this piece, “The Personal is the Professional” but realized I wanted to go a bit further into the encounter of therapist and client and beyond that to being real throughout work and beyond.

     I cannot sit back, detached, uninvolved, impenetrable, spouting stock phrases, when I work with a client. I am engaged, I feel, I think, I occasionally share; I act ethically and responsibly as I create a space for the client to speak of what they wish to speak about, and yet I am impartial. This genuine regard for the other flows from my own life choices and how I live my life. I seek an economic, intentional, honesty in my life. If I was duplicitous and led a life of wild debauchery while promoting economy, intentional and ethical honesty, I would be at odds with myself and would come across as a fraud, which indeed I would be. I make mistakes, I don’t know some things, I assume stuff every now and again, I have biases, but I work towards presence and realness in the same way as I encourage my clients to explore.

     There is some difference between how I am in work and outside work. Doing psychotherapy requires particular skills to be employed, just like any other work practice. There are, however, some basic themes running through both.

     I have to be engaged, but I have to be impartial. I cannot declare myself powerful and infallible and yet be open to what is said and not said to me (to listen to the quality of silences between). I need to be able to hear the painful accounts of other’s lives, and yet also be relatively impartial and balanced. Being impartial means setting aside my own ideas of how things work and actually listening acutely to how things are for the other person.

     I need to be inventive and appropriate, in order enrich my encounters (as much for me as being with others). The conversations I have with my clients are not like any other ordinary conversation and therapy is more than conversation, anyway. There may be experimentation, journaling, drawing, music making, dream work (which I do a lot of), hypnosis, building, or not, the transference, challenge, etc. Whereas a conversation with friends and/or family depend heavily on partiality and the mutual feelings from a shared past, the therapeutic relationship doesn’t. In my own life, I’m endlessly experimenting with choices and strategies for the best outcome. In this way, how I am in session and outside is very similar.

     I need to be real in who and how I am. Irvin Yalom asserts that the gift a therapist brings is her/his own humanity and this allows deeper and deepening encounters. With this process an intimacy builds that is born from a solid bond of trust. It is in this space that a client’s intimate revelations can be spoken of, felt through and through, cried with, and be responded to by the therapist in an attitude of actual empathy.

     The personal is the professional and the professional is the personal. This is a truism, but there is risk here. The therapist needs to be able to finish at the end of the working day, prepare a meal, relax, exercise, socialize, or whatever, and get on with their own life; in essence to “forget” the other lives shared during the day. To maintain a professional integrity – being true in work with others, requires a right intention for the same in a therapist’s ordinary life. If they are at odds, then, I think, the practitioner is in trouble. This is one very good reason to maintain a practice of regular clinical supervision and peer conversation. The therapeutic work only works when the therapist healthily maintains connections with others outside their work. We’re human, after all.

      Aiming to shoot straight the arrow of integrity, mindfulness and realness through work and beyond suits me, because I like the imagery of the archer and I aim to be an archer of life.

Charcot and Me

February 2018

     When I have any dental treatment I have nitrous oxide. I have had so much extensive dental work over my life time that now I cannot bear to have fingers and instruments in my mouth at all while in ordinary consciousness. And thus I receive nitrous oxide, otherwise known as laughing gas. I am not amused, by the way, more really interested in the kind of consciousness I experience. In fact I use the experience to examine the levels of awareness: of having a sense of being in a particular place, of body sensations, of what is going on between my dentist and his assistant, of his accounts of travels through India or scuba diving trips and the way in which he speaks of these things, of my own feelings and thoughts,  as well as my  discursive processes, and my detachment from all of these. I am intrigued that I am able to follow everything that is said and remember it, even though much of the time I am in an altered state of consciousness.

     It is these layers of awareness that interests me and is a primary reason I am motivated to work in my profession. I like exploring the edges of consciousness and noticing how each level and kind of awareness has the capacity to effect change in myself and others.

     Naturally I do not use nitrous oxide in my work, I am a mere psychotherapist with no access to the stuff, but the space of therapy itself is anyway a thick and rich one where focus and comfort  (cum forte, Latin for  “with strength”) are both employed to create a healing place. I am reminded here of Erv Polster’s comment that therapy occurs in the spaces between a light hypnotic trance and a deep one (From the Radical Centre, 1999).  Some have spoken of it as a crucible and the work an alchemy, some see it as a play with reverie, but I am keen to view it as a really valuable place where consciousness is not only explored but used to bring very particular awareness of lives as lived. There is in here an acute feistiness that may be effectively nurtured. And I’m speaking here of a normal counselling session that may, or may not, also employ hypnosis.

     I do do hypnosis when specifically requested to by my clients (it costs a bit more than a psychotherapeutic/counselling session mainly because it is intentionally more focused, much like a psychic lathe). Hypnosis is a state that deliberately explores the levels of consciousness as a particular tool. It should be noted here that not all personal health and relational issues are particularly helped by hypnosis but when it is useful both the client and the therapist have a unique access to both our personal and collective unconscious so that problem behaviours, iterative thoughts, sleeplessness, and so on may disappear, or be reduced.

       So why the title, “Charcot and Me”? I came to be thinking about such things while re-reading Charcot, the Clinician: The Tuesday Lessons: Excerpts from Nine Case Presentations on General Neurology Delivered at the Salpetriere Hospital in 1887-88 (translated and published in 1987) which explored levels of awareness in relation to psychopathology and being intrigued yet again that present at these lectures were the luminaries of Babinski, Gilles de la Tourette, Pierre Janet, Freud and William James, among others: all thinkers and clinicians that literally shaped neurology, psychology and body-mind philosophy into what we know today. 

     Reading this material is kind of like attending a gathering of family and friends. Old ideas are chewed over and the good bits relished, while the bad spat out (politely, under a neatly placed napkin).

     The business of consciousness and the exploration of levels of awareness is as much part of my life as it was theirs. Last year, when I bought this book on Charcot’s Tuesday lectures, I took a photograph of myself holding it up, calling my photo: “Charcot and me”, for it is as much a source of useful knowledge as connection with my intellectual genealogy and I have a certain fondness for the man.

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.