Diving down by Dr Elizabeth McCardell, M. Couns., PhD

February 2019

     I’ve ordered a full length, upper and lower body rashy for snorkelling and diving purposes. It had to be bought online because I couldn’t find anyone locally who sells them. I have a wetsuit for scuba, but find it cumbersome and too warm for comfort for shallow dives and hovering around on the surface of water. This purchase comes hard on the heels of my January birthday and the confirmation to self that, beside the work I do as a psychotherapist, snorkelling and diving are my favourite activities, along with music, and I want to do a lot more of those.

     As I muse upon these things, I am reminded again of an account told to me by my diving instructor from ten years ago, which in turn triggers a realization that what occurred in that incident, exposes the nature of dreams in a curiously similar fashion, though without the same conditions.  

     My diving instructor and his girlfriend did a dive in the Truk (Chuuk) Lagoon in Micronesia and the girlfriend suffered nitrogen narcosis (also called the “martini effect”) where she lost her entire memory of the dive. Nitrogen narcosis is a temporary condition caused by the effect of gases breathed in under pressure. She couldn’t recall anything of the dive at all. Then one day, eight months later, she said she’d had a dream and she related everything they’d seen together on the Truk dive. Her memory of the dive had returned.

     To me, this account shows the stratospheres of the mind and the usefulness of dreams in bringing knowledge that is not readily accessible by ordinary means but which can be useful in ordinary and therapeutic life.

     I usually ask my clients about their dreams, not only because they prove useful tools in the therapy itself, but they allow me entrance into the unconscious of the person, and their inner truth. (As I write this, I am entranced by the word “en-trance” and its seductive suggestion that the dream draws us both in to a trance state, which feels just about right.)

     Dream interpretation should arise from the dreamer, and not be imposed by dictionaries of dream interpretation, nor from the therapist. The image of a snake may have nothing to do with sexuality, even though a dictionary might say otherwise. It might suggest, or not, the healing powers of injury and suffering, as the symbol of the entwined snakes on the staff, the caduceus (the staff of Hermes), or anything else more relevant for the dreamer.

“The dream,” as Jung puts it, “shows the inner truth and reality of the patient as it really is: not as I conjecture it to be, and not as he would like it to be, but as it is.” (1934)

     I reveal myself when I write of diving down as entering the unconscious, but that interpretation would mean nothing to someone who does not dive or who has no associations in this way. My way of thinking is not universal, and likewise for you.

     Because I both dive and interpret dreams and because I’ve made the association myself, diving down is rich and redolent with meaning for me. Because I operate this way, I’m attracted to certain therapeutic ideas over other ones that speak to me. I am attracted to psychodynamic psychotherapy, and always have been. My first training was in Jungian psychology in the 1970s.  C. G. Jung’s ideas resonated with me and so I engage with him, and others similarly inclined, and continue to think and learn and mull and dive.

     I have colleagues who do not work with dreams at all and see no point in them, seeing the dream as silly and absurd. To those I say, why would we dream, if not to have this as a resource for possible discovery? We all dream and there are  inklings of meaning to be had in exploring them. But, whatever each of us seeks, so that should be the point of any counselling. I seek the healing of the whole person, and so diving is what I do.

“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.

A Therapeutic Conversation by Dr Elizabeth McCardell, M. Couns., PhD

December 2018

     In September this year I travelled to Germany and then to Scotland, particularly around the Isle of Mull. In Germany I met with a couple of Facebook friends for the first time, one of whom is a psychotherapist like myself, the other an artist, like my otherwise self. We talked for hours in a little café called La Boheme in the old town of Heidelberg. This was, for me, a turning point in life and work. I remain in conversational contact with my colleague and he encourages me to new understandings and new readings and has enlivened how I work. I’m delighted by all this, and have been mulling on things ever since.

     In a non-direct way, through talking about Psychodynamic-interpersonal Psychotherapy, which both of us practice, I’ve been introduced to Conversational Psychotherapy, or simply the Conversation Model. It’s filling in my intuitive sense about how I work and how I’ve come to understand the self, and myself. This concept of self, which is a kind of consciousness, has been there all along, largely unarticulated, prompted by my early readings (in the 1970s) of William James and other relational-humanistic psychologists, but the clear statements of the Australian psychiatrist Russell Meares, b. 1936 (son of Ainslie Meares, psychiatrist, hypnotherapist and writer on meditation) has brought it into the clear light for me.

     The self, seen as a dynamical interrelational process, is not an abstract entity somehow separated from environmental encounter, nor known through the immersion of arcane texts; it is a dual process of felt bodily reaction and a dynamic play with inner events that bring about reflective awareness.  The self is ecological and relational and involves a sense of aliveness, of vitality, of well-being, positive feeling (warmth and intimacy), non-linearity, coherence, continuity, temporarily, spatiality, content beyond the immediate present (that is of the possible, the imagined, the remembered), with a sense of ownership, boundedness, agency and a that duality.

     The self, according to William James (1842-1910) is a duplex of one pole of awareness and another pole of inner events in a dance of self-reflectivity. Consciousness doesn’t always take this form. When we are alarmed or annoyed, reflective awareness is lost. Meares identifies the characteristic consciousness of those damaged by the impacts of the social environment as adualistic. It is reactive and responsive to the brain’s interplay with the environment, without self-reflectiveness. The aim of therapy is to restore, generate, and potentiate that dualistic kind of consciousness that is the self. But this pole of awareness plus a reflective pole of inner events cannot happen by itself. It has to be met, connected with, related to, for the self is part of an ecology. As a part of an ecology, any change in one part affects everything.

     Trauma plays a big part in this disturbance and interruption of the dual process, for it locks the person into reactivity, dullness, and a sense of stuckness. Psychotherapy then becomes very useful in creating a close, safe and supportive environment of reciprocity and engagement as it reconnects a person to themselves and the social environment.

  

     Conversation, as defined in the Oxford English Dictionary, is “the action of living, or having one’s being in a place or among persons”. It isn’t just about talk; it’s engagement and focus upon the shifts, the movements, the waxings, and wanings of this experience, and it is this that lies at the core of the interpersonal therapeutic approach. It is in conversation (in its style, content, context) that we come not only to express what we know but come to know what we don’t yet know.

     Conversational Psychotherapy is directed towards the restoration of a disrupted sense of personal being, or self. It’s interested in the inner life as well as emotions of reaction and building a capacity for self-awareness. An old mentor of mine used to ask me, “And how is the inner life” and such is a very good question for therapists to ask. We should not ignore a person’s perception of their inner life for herein lies tools for healing and strengthening  their capacity for self-reflection and not getting caught up in reactions and adualistic looping, that won’t go away in isolation from conversation.

   So, talking with my friends in the little café near the old bridge of the city of thinkers was not only great fun, but is bringing a greater awareness to my psychotherapeutic practice. Thank you, Jürgen and Aksel.  

An Uncommon Therapy by Dr Elizabeth McCardell, M. Couns, PhD

November 2018

     Uncommon Therapy, the Psychiatric Techniques of Milton H. Erickson, is the title of a book  by Jay Haley on the strategies and practices of Erickson, the father of modern hypnotherapy.  Fundamental to how Erickson worked was just getting to know how the patient thought and interacted in their world, their potential, the things that mattered to them and then utilizing this knowledge in therapy. For him, the patient was unique, first and foremost. He said that the therapist needs to be flexible conceptually and behaviourally to respect, respond, or redirect the patient’s potential to the full benefit of themselves.

     A lot of therapeutic practices are driven by theory and preconceived classifications and notions of what good therapy should be so the perspectives of the therapist tends to dominate where the therapy goes.  I’m thinking here of certain aspects of psychoanalysis, or the medical model and increasingly the health insurance model that utilizes psychiatric classifications of mood and behavioural problems as set entities, or the idea that mere symptom control is sufficient in every situation, or that therapy needs to be swift and superficial all the times, etc. For some  practitioners of these one-size-fits-all therapies, an alternative model based on the fact that each case, each person, is unique tends to be seen as bizarre.

     Erickson (1901-1980), an American psychiatrist and psychotherapist, went elsewhere. He chose a therapeutic approach particular to the individuality of the person before him and worked that way. Unique people require unique therapeutic approaches that utilize their uniqueness and we are all unique. This took the form of traditional sessions in his consulting room, or he insisted a client climb a particular Arizonian peak or visit a botanic garden, or he invited his patient to watch television at a set time each day with his family (shock, horror), or to work in his garden, or home visits, and so on. This was very much uncommon therapy. It was flexible, it listened to the hang-ups, the foibles, the strengths, the frailties, the needs as well as the non-needs of each person and utilized them.  But before doing therapy of this kind, Erickson needed to be with the person’s experience, to listen, to question, to get a feel for the person.

     It is interesting that, in a desire to practically bottle Erickson’s presence and approach, numerous of his followers tried to pin what he did down to a formulation of his style and personality to be imitated by others, as though this was even possible. Erickson, like you, like me, was unique. He lived according to himself. He could not hear tonality in speech and music was dead to him, he was colour blind (able to see only the colour purple), he had been crippled by polio and post-polio syndrome in his 50s, he was talented, flawed, obstinate, highly intelligent, dogged, frail, methodical, practical, scientific even. What he did was listen to what people said and how they said it, he interacted with them (and the therapeutic relationship is critical to effective work), he supported, he created safety, he held back from getting in the way of good therapy and he did what was required. But not always. He sometimes missed the mark, just like all therapists.

     His was an uncommon therapy. He used a more traditional hypnotic induction techniques in his work, but not always. Sometimes he just did an ordinary act differently in order to get a person out of their conditioned, trancelike way of thinking. Sometimes he just talked of ordinary things a patient loved to do, like growing tomatoes that had the effect of reconnecting the person to other parts of their lives and thus initiating their psychological healing. In other words, Erickson played with the known and the unknown and thus stimulated change.

     I like Erickson’s thinking and the freedom he has brought to me through his writing and my contact with therapists trained by him to work according to the me-ness of me, and not as a tired imitation of him, or anybody else. This is what drives me: to meet with my patients where they are and where I am in these unchartered waters of an uncommon therapy and work there effectively.