Doing therapy with awareness

Nov  2010  (Note, this is an old article of mine)

     I’m sitting on a balcony overlooking the ocean up in the Tweed shire and watching the sun rise. There is a meringue of clouds on the horizon with bands of coral orange breaking through. The sea is low today, a crinkle of waves.    A bush turkey hurries by. I should be content, but I am only partly. I want to be home with my beloved cat; the home I haven’t been in for nearly 4 weeks. I’ve been travelling overseas, attending a conference in that old city of Heidelberg in Germany, and then enjoying Amsterdam and Iceland on a much needed holiday.

     Here I am on the coast, north of home. Why? I am attending a Gestalt training residential, to deepen and expand my psychotherapeutic skills, and bring to more awareness my own processes.  To be effective as a therapist, it is necessary to understand – and keep up to date – knowledge of the field and understanding of oneself. To do therapy effectively is to be able to separate out the issues that belong to the client and those that come from the therapist, otherwise the actual needs of the client are not heard.

     “Doing therapy with awareness” is a double-meaning-ed title I’ve thought of for me as therapist, and the kind of therapy  work I do with clients. My  work is essentially an existential-phenomenological therapy (of which Gestalt is a part) that aims to bring the client to awareness of how and what they do in their daily experience of life that isn’t nurturing to the uniqueness of who they are, to bring to a closure half-finished emotional business (stuff that gets in the way of change), and to allow them greater access to their capacity to make choices for themselves. What is true for clients, is also true for me as a fellow human being and me as therapist. To be an effective therapist is to practice awareness.

     To be attuned to what is important for a client, I need to be finely attuned to what is important for me. I need to look after myself as much as I encourage my clients to look after themselves. A stressed-out-of-her brain therapist is not able to do her job; she’s ceased to be a therapist, in fact.

     I enjoy the sea, the flux and flow of water and sand turned up and around and wind in all its moods matches my energetic process exactly. Qi gong practice, which I learnt some years ago, also employs this flux and flow. Here there is a strong movement outward followed by a gentle one inward, followed by a strong movement, followed by a gentle one, and so on. Qi gong is an exercise and meditation practice akin to tai chi. The pattern of strong-gentle-strong-gentle is the pattern I follow when working with  clients. It is a rhythm that nurtures and challenges in turn, centering and bringing awareness as it goes on. The Chinese may be wrong in many things, but in this fundamental Taoist truth, I believe they are right. Tao observes the rhythms of nature; a rhythm as natural and as complex as life itself.

Psychotherapy and counselling, in my book, should not be viewed as peculiar goings-on for the unstable, but accessed by anybody wanting aid, support and challenge in order to go about life more fluidly, with greater awareness, astuteness and grit.

    

    

Coming Together by Dr Elizabeth McCardell, M. Couns., PhD

Oct 2010

     The boat slid through satiny water to an infinite edge of sea to the breakers beyond. Overhead ospreys circled; whales glimpsed through laid back leapings and turtles mated far from shore. I wondered about the name “Whitsundays” (for this is where I and a colleague and friend was  last week) and I remembered:  Whitsunday is the other name for the day of Pentecost (the 49^th day after Easter Sunday), the Christian feast when the Holy Spirit descended upon the people and gave them capacity to understand and speak many tongues, join in community, and celebrate the new church. Whitsunday, or White Sunday, is thus called,  for the white ceremonial robes of the celebrants of this feast - appropriate for the white beaches of these islands. Central to the idea of the feast is an ability of people to share things together, to talk and to have a sense of community.

     The Whitsundays are a scattering of approximately 150 handsome islands peeking through the sea between approximately 20° and 21° south latitude off the subtropical central Queensland coast. Captain James Cook found these islands in 1770 and named them ‘the Cumberland Islands’ and their passage, the‘Whitsunday’s Passage,’ because it was the feast of Pentecost when he sailed among them. The Aboriginal tribe, the Ngaro, however, knew and explored the richness of these islands for 8,000 years, paddling in boats made from saplings, bark and fern fronds. I imagine the Ngaro talked of many things.

     Though somewhat a culturally biased account of things, and I do this in deference to other cultural experiences, I am moved to write of the  elegance of this wondrous place as itself a Whitsunday experience: of a place where strangers come together, sharing their disparate experiences in the making contact with one another, and conflating this with what I experience in my clinical practice.

     It always strikes me as something of a miracle when people from diverse backgrounds can come together and get on so well. I often find myself really enjoying the presence of others so very different to me. Listening deeply, a tool of psychotherapy, isn’t just what makes contact possible, but it is part of it. Such listening situates the practitioner in a place of present-centredness as well as an exquisite awareness of  self in relation to the other person. The co-createdness of the relationship is also heeded and responded to, even played with. There is a dance-like quality to the sharing and with it, a sense of togetherness and  separateness; feeling states that are like the tense and loose states of a boat riding Whitsunday waves.

     On the boat up north, my American psychotherapeutic friend and I encountered many people who showed a delight in talking of their lives to us. These were contacts with people we’ll probably never see again, and yet – in that short time – we came to know quite well. It felt to me that the islands were like a net thrown out, gathering people in  shared experience, yet each maintaining their unique perspective and eager to speak of this to us: a magic of commitment to conversation, a magic of community.

     I imagine that the first Christians felt their commitment to dialogue (listening, receiving, and sharing) as a palpable energy and as a means to generate and hold safe a sense of community. I feel my commitment to dialogue is likewise a means to create a safe therapeutic place where diversity of experience can be expressed without anxiety, held and released when the time is ripe; a place that is the relationship of selves who do not need to agree with each other in order to get on with the work of increasing awareness and discovering in themselves healthy freedom and new ways of being.

     People talking together are like the Whitsunday islands strung together like individual pearls in a necklace of great beauty, and like a necklace, the elements of communication are not glued, but linked by likeness and difference. So, let’s talk!

Medication and Counselling by Dr Elizabeth McCardell, M. Couns., PhD

Sept 2010

     I often hear about people who have been advised to go and get counselling and medication for depression; who go on antidepressants and then decide not to have counselling or psychotherapy as well because they feel better. What they don’t realize is that their problems aren’t going to go away; feeling “better” through medication wont change fundamental things much. The ideal situation involves looking after the whole self, and not just the chemicals in the brain.    

     Antidepressants certainly level a person’s mood, but the highs go as well as the lows. When they are deeply distressed this levelling can be very welcome. Over time, though, not being able to feel much can be quite disturbing. Because we are expressive  responsive beings, the sense of being disengaged can impact greatly on special relationships and even just in everyday encounters. A loved one can feel left out, in some subtle way and the depressed one is not even aware of this happening.  By expressive responsive beings, I am describing the beautiful  lively interplay that occurs in every face to face encounter where each person responds to the other, back and forth. When one person isn’t so engaged – as when their affect is flattened – the other person can feel excluded. This partially  blocked interplay is even more clearly evident when one person has had a stroke and their face is immobilized (as literature on face recognition describes it).

     Another aspect of this is the diminishment of a sense of being able to regulate one’s moods, and not recognizing what moods are within the normal range and what is outside the normal range.

     Several years ago, I knew a woman who had been on antidepressants so long that she no longer knew which of her thoughts and moods were reasonable and which were outside the experience of most of her friends. Any feelings of anger  were attributed by her as requiring increased doses of her medication. This is so topsy turvy and fundamentally wrong.  Psychotherapy would have given her a more accurate sense of what is real and what is imagined. It would have put her in touch with her inner world, giving her awareness of anger as a useful emotion with its own energy for changing the dysfunctional in her world. Instead she felt eruptions of anger as if these feelings came from somewhere else and increasing the medication had the unfortunate effect of deadening her creative encounters with her world even more.

     Antidepressant medication can be useful in cases of prolonged grief, such as sometimes occurs after the death of a beloved, but here again, it should accompany counselling of some kind. Just the chance of talking about the death with someone who will listen deeply is nurturing. A counsellor generally will not shrink away from meeting a person at such a profound place.

     Loss of career, of hope in relationships, of despair, loneliness, and a sense of powerlessness can contribute to feeling depressed. Maybe such depression merits going on medication, but more is needed.  The chance to develop other ways of seeing and instituting fundamental change is an important part of counselling and psychotherapy.  Counselling and psychotherapy moves one’s internal dialogue from societal and family ideas of loss equals failure and all the introjects of “get a grip on yourself,” “put on a stiff upper lip and you’ll get through this,” and “think of the starving millions with greater problems than you”, and so on, to actually finding new and creative ways of being really here in this place, now, with your integrity intact.

     Some, but not all depression serves a purpose: it tells us when we are out of kilter with our uniqueness; when we are not fulfilling our individual lives in ways truer to ourselves. Some depression is actually more chemical than psychological (endogenous depression), but here again, just going on medication is insufficient.  Dialogue in counselling is very useful, in bringing awareness to feelings and thoughts about feelings, as well as interactive communication with others.

Ghost Catching with a Dress

Nov 2013.

     I'd watched a video of a very beautiful conversation among therapists and others talking on the death of mothers. The phrase ‘ghost catching with a dress’ came up in relation to finding clothing, letters, and treasured objects belonging to mothers who had died. I was very moved by the image, for I have such items from my own mother. Indeed, most of the crockery and utensils I use on a daily basis were from the cupboards of my mother. Hanging in my wardrobe is a red coat my mother made herself of the lining of officer’s coats during the war, there are gloves she made,  and there is a dress she fashioned from silk that I only very vaguely remember her wearing to a party once or twice. She was an extraordinary seamstress; a skill I entirely lack.

     Ghost catching with a dress is, for me, the catching of glimpses of my mother’s life and story and those others I have known and loved. Glimpses sewn into the gossamer of memory – sometimes poignant and painful, sometimes sweet and tender. 

     Life, death. What are these? When people talk of death, premature or after a long rich life, like my mother’s, I wonder yet again, what it all means.

     The taking of one’s own life, throws another angle into the mix. There are many therapists who express deep concern for those who contemplate their own death, and while I too am disturbed by this, I am brought yet again to the existential place that I face on a daily basis: What of life, what of death?  I cannot see those who contemplate taking their own life as a sign of mental illness. I cannot, for the same reason that I acknowledge death as intrinsic to life and life intrinsic to death. What gets thrown up into the air like wind in fallen leaves, is the integral mystery of existence itself. I cannot sweep this knowledge, this subtle awareness I have, into a neat pile to be put discretely into the rubbish bin. This is the greatest mystery I know of. Death is not a medical problem and suicide is not a medical condition. Death is, as life is, and relationships are.

     What is caught in suicide are ghost catchers of clothes, of toys, bric a brac, books and letters; of the tears in memories, of  hearts broken, of anger, resentment, bewilderment, lots of questions unanswered. These are perhaps more poignant than even the caught ghosts of those who died a normal death.

     I have had friends who have died by their own hand and know something of the strangeness of this. One man, I had shared a meal with only a fortnight before he gassed himself.  Was I partly to blame? I could not think so, for as the ghosts in cloth unravelled after the funeral, the threads emerged of a life of disconnect, of  feelings of alienation and lostness.  This poor friend could not speak of what he suffered and it is here that my feelings are stirred, and it is now here that I offer myself as a therapist to hear and share the burden of pain.

     Death, and life, are touched by the living in a fluid process and grief and loss are felt as those we’ve loved move into another dimension. It is not so much the death bit that shakes me, but the threads of life that are not always seen and understood; threads that need, somehow, to be shaped into a dress to catch the ghosts of real flesh and blood people in our stories, recollections, and a need for some kind of farewell. We living need to let go and yet to remember and to let go and yet to recollect. Our grief is not to be discarded mindlessly, but to be brought into the fabric of our life to enrich us and also, mysteriously, give us the courage to let go, let be that majesty that is  life.

Therapy as Magic Realism by Dr Elizabeth McCardell, M. Couns., PhD

August 2018

I had a friend, Tom, who I met at university when both of us were doing our PhD. He being far more organized than I. finished writing his thesis a couple of years before me. The locus of his work was on the magic realism in the early writings of Jorge Luis Borges (1899-1986), the Argentinian author.

Tom’s PhD thesis was examined and passed with flying colours. We spoke once, at the completion of it, and then he disappeared, literally. I couldn’t find any information about where he went; even his  parents and brother had no clue. No death notices, no life notices, nothing.

In a fantastical effort to discern where he went, I scattered, upside down, a set of animal druid cards. In that set are two blank cards, there to encourage its users to create a couple of animal narratives of their own. The two blank cards came up. I picked up a third, and it was “the fox”. The fox is an elusive being, known for hiding among grasses, and disappearing when he wants. I felt then that Tom just didn’t want to be found, and no online searches could unearth anything. There are, it seems, three men with the same name, but none of them living in our time frame.

How extraordinary, really, that his fox-like disappearance fits so well with the nature of his academic work!  He, or rather I, made a myth from him simply being/not being there.

Magic realism is a genre of literary fiction characterized by the matter-of-fact inclusion of the richness of a  psychological imaginary into an otherwise realistic and ordinary framework. Tom’s life had that quality: he  showed me how to use a computer by playing with it, we ate meals together, we walked the campus together, and he tripped while walking downhill, somersaulted mid-air, and landed on his feet like a finely tuned cat, while I, on a different evening fell and broke both hands. We got on well and once he celebrated passing his PhD, he disappeared.

Magic realism situates itself neatly in the discourse of psychotherapy. I note here that I am not talking of magical thinking. Magical thinking is defined as believing that one event happens as a result of another without a plausible link of causation. This is unconscious thinking.  Magic realism, on the contrary, is an actual  and conscious tool in literature and, I suggest, in psychotherapy in order to engage a person more richly in a life not fully lived.

Active imagination, as practiced by Jungians and others, including me, could be said to be a  magic realism tool, and  is used as a bridge between the conscious and unconscious mind. It is  a method for visualizing and fleshing out unconscious issues  by drawing upon the imagination. This is a very useful tool and has the capacity to build meaning, new memories and connection in the field in which the client lives.

Much of what we do, as psychotherapists, is pragmatic and here and now, and yet it merges the ordinary subtly into landscapes of the imagination and dreams, for a purpose. The mind, decorated with elaborations of enriched memory, becomes a luminous space of possibilities and our exploration of these, transforms ordinary reality.  This is why I ask my clients what they love to do, and whether they paint, play music, write, dance. I want to know what magic they engage in and how can we use that for their healing.

There can be a danger in the making myth of life events, but properly and ethically handled, it is a very powerful tool.  I think once more of Borges’ writing and his emphasis on containment and playful control of words and sentences. Nothing is wasted and nothing slops over into a messy unconsciousness, and yet …   And so, with Borges I say, “I know what the Greeks do not know, incertitude”  for the bridge between this world and the world of the imagination is always open and what is learned in this here-and-now world and the imaginary is always magical and very real.

Dispelling Dream Clouds

July 2018.

     Most of us, most of the time, are caught up in clouds of anxiety, thoughts, memories, feelings of shame… general inner noise. These clouds whirr around us in a vortex of “what ifs”, “should I”, “and then”… making us increasingly confused. A lot of my work is about sorting through these clouds and making real what needs to be real, and releasing what is inessential, and thus freeing my clients from much unnecessary anxiety.

     The making real is grounding the something into a tangible form; something that can be worked with, and something rich with actual possibilities.

     In my own life in recent times I spent months of wanting, of craving, to travel again to Europe, mulling, thinking, planning, changing those plans, mulling, dwelling on, dispelling: essentially caught up in swirling clouds of possibilities. And then, a mid-September conference in Heidelberg, Germany beckoned (a time of Autumnal cooling and dancing red-bronze leaves and ripened berries), and I thought maybe I will/maybe I wont go, and so the churning continued. Then in the middle of one night, clarity came: go to the conference, and then work the rest of the journey out from that point. I registered with the conference people and booked my accommodation, and then a few days later, booked my plane flights.

     In this time of observing my own inner processes and noticing with clearer insight the processes of my clients, I began again thinking of the Tibetan Buddhist cosmology, or three planes of existence (trailokya): the desire realm (Kāmaloka), the form realm  (Rūpaloka), and the formless realm  (Arūpaloka). Of particular interest in so far as this article is concerned is the desire realm. Here, is populated with lurid hell beings, of demons, ravenously hungry ghosts who can never be satisfied, demi-gods, animals and humans, all in a state of suffering.

     I can see elements of Kāmaloka in the horribly confusing and tormenting psychological states some clients bring to our sessions together; states dominated by anxiety, fear, self doubt, shame, and longing.  I certainly can identify aspects of it in myself.  Until they are identified, spoken about, even written about, they just undermine our capacity to move on in our relationships, our jobs, our life.

     This work has parallels in the Buddhist practice of dream yoga, or Milam. Dream yoga  is, in essence, the art of bringing consciousness into the dream state and learning to observe and control the dream, and then be free of it. Working with the unconscious (from where dreams arise) is a fundamental tool of psychodynamic psychotherapy and that work is about bring consciousness to ordinary and unordinary life. I’ve certainly noticed this in my own personal work, begun decades ago. I used to write my dreams down in journals and over the years collected dozens of them (big handwriting). I notice the quality of my dreams changed as I brought the light of conscious awareness to them. I also noticed that I was becoming aware that I was dreaming while asleep, and that I could change the course of dreams.  And then came an awareness that I didn’t need to dream quite as much as previously and also that I understood the meaning of the dreams I had with greater clarity.

   What I’ve found is the bringing concrete reality, through clearer insight, and tangible actions like keeping notes, or requesting actual documents, or preparing an action, dispels the dream clouds.

   Developing consciousness in dreaming begins with the learning to know that we are dreaming, and then, gradually working towards shaping what we dream, and then the art of lucid dreaming and travelling via the dream horse to anywhere we wish, or nowhere at all.

     The dream state in Buddhism refers not only to rapid eye movement dreaming in sleep, but to the arising of phenomena itself in every day life. In The Tibetan Book of the Dead, the account of the stages we pass through from life to death, from this moment to that moment, is the exploration of the bardo state (the “in-between”). The bardo describes the transitional, liminal state. This is a rich place of engagement, whether conscious or not, not an empty space. It is in here, however, that the silence of awareness is possible.

     The progression of sleep and dream yoga is something like this: first you learn how to remember your dreams; then you learn how to wake up in them; then you train your mind in the dream; then you learn how to stay awake in dreamless sleep.  All the while you are taking the insights from the night and transposing them into the day.  Not only are you transforming the night into meditation, but you begin to transform your life.  You start to wake up, in the spiritual sense.

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

June 2018

     I have a friend who when confronted by a single sight of something fabricates a whole story around it, filling in details that seemingly come out of nowhere. For example, he and I were driving together through the forest around here and came upon a woman hitchhiking at a really awkward corner where there was no way we could pick her up, so we kept on going. A few minutes later my friend came up with a whole story about this woman where she was escaping from a horrible marriage where the man beat her. I said, we don’t know that, her car might’ve broken down, or she might’ve hitchhiked there and now was wanting to leave, or maybe prefers to hitchhike, or any other unknown reason.

     Making up stories is less about doing it for the fun as attempts to see things according to a pre-existing idea, experience, or hypothesis about human situations in ways that do not consider alternative possibilities. This is known as cognitive bias, or confirmation bias. The single idea is elaborated on in order to see it in recognizable ways.  My friend concocted his story to fit something familiar to himself.

     I need to add some background here. My friend was visiting a relative who also lives here whose marriage had broken down. He had also spoken to me of the imminent divorce of a young Perth friend of his (a young woman he helped rear). So, marriage breakdowns were very much on his mind. The random encounter of a woman on the side of a forest road was made to fit a pattern and situation that was preoccupying him.

     This is fairly common tendency that is quite useful when trying to make sense of the behaviour of other people when we don’t know the full story as it allows for a seeding of empathy for others in the community and it is a time saving exercise. It is one, however, that is open to misuse. When we construct a story around a single observed fact about a behaviour, we risk stereotyping others with our own bias.

      The psychotherapist has to deliberately abandon cognitive biases. For a therapist to run with a preconceived idea is to not listen to what is actually being presented. Indeed, we are trained to put aside our preconceptions, to suspend our beliefs about how the world and its inhabitants “should” be according to our own worldview, so as to hear how the other person actually operates in the world. This is what we call epoché. If we, in this profession, don’t suspend our judgement, we are no good to anybody.

     Effective therapy begins with the close hearing of the texture and resonance of voice, the words chosen, whole body demeanour, the capacity for listening, their willingness to enter the therapeutic conversation, the heaviness or lightness of being (too heavy, too light), avoidance, confrontation, repeated accounts, and so on. We need a sensitivity to be present with the person with us, and a not too ready desire for resolution. We have to hold back solutions, because if we go in with what we consider good solutions without having actually understood where the person is coming from, then we have effectively lost them. We also need to be able to say we don’t know sometimes and even to enter the dark place of ignorance and sit with it to see what emerges.

     There is something of the scientist in the epoché, but only in the sense that here practiced dispassionate detachment is actually being very present, caring, and listening deeply to the other person. What must be realized though that to achieve it, we have to know our own mind, with its predilections, biases, assumptions and this means that to practice psychotherapy we should (at least as I and many others see it) have experience of our own therapy and also engage in regular supervision. We need a clarity of vision and self awareness to be good at what we do and this practice of bringing awareness to our own lives needs to be continued throughout our whole working life.