The Snowdrop by Dr Elizabeth McCardell, M. Couns., PhD

 August 2022

 

     One of my favourite plants is the snowdrop. It spends most of the year as nothing more than a small swollen bulb underneath the dark earth. Time moves on, day to night to day… seasons change from hot to cooler to cold, rains come and go and come again, and nothing much seems to happen around that patch of ground. Where did I plant the snowdrop bulb again?

      Life goes on, new decisions are arrived at, new choices made, old stuff is left behind, new plans initiated. Change is constantly with us: some we fear, some welcomed, some just thrust upon us and we are forced into making new choices.

      Why, when transformation is happening within us/ for us, do we try and hold it back, to contain it, to try and continue the same old, same old? Why, so often, are we just afraid of change?  Why do we attempt to hold back the inner juices of inevitable shift in our being?

      The little bulb lying silently underneath the dark earth follows its own apparent inchoate primordial process, doing its own thing: growing roots, and preparing an upward thrust through granules of soil out to the sky beyond; much of which we don’t see until little green leaves appear.

      Are we actually any different? Does change in our own life go unnoticed until we find ourselves seemingly suddenly facing unfamiliar new things? Is meeting the sky unfamiliar to the little bulbed one, or is this new stage already known in the fabric of the cells of its being, in its memory of existence itself?

     My feeling is that we, like the little plant, have a deep knowing of the nature of transformation and a deep reverence for it. The stuff of religious ideas is emergent from it. The Christ rising from the dead, the miracles of lamas who transmogrify into rainbows, the mysteries of manifestations are all implicit in our ordinary processes of change.

      What then, the fear? Much of our lives is spent in trying to hold still the unstoppable. Do we not have faith in natural processes? In the Tao of life?

      I like to watch the making of sand mandalas by Tibetan Buddhist monks. Utmost attention is put to each grain of sand rubbed down by vibrations to the patterns forming below. The mandalas are of heavenly architectural buildings representing the dimensions of ourselves. When the “buildings” are made, they are sung over, and then scraped up into a vase and walked down to a river or the sea to be scattered to the beyond. Each act is the letting go of any idea of holding to the unchanged, for all is change, all is flux.

      There is something very beautiful in change. The little plant, now growing strongly, forms buds and then, in the miracle of silence, exquisite white flowers come forth: white blossoms with spots of green and a faint perfume. It is a pretty flower, the snowdrop, but so are we as revelations of beings in the process of becoming.

    Let’s not be frightened of change. We cannot control every aspect of our lives, and neither is there any benefit in attempting to do so. We can simply acknowledge that the changes that we become aware of have been happening anyway outside our consciousness. It is implicit in the nature of being itself. We cannot control the essence of life because it pulses through us. We are like snowdrop bulbs making flowers in the making of new futures.

 

Being Careful What One Says in Therapy by Dr Elizabeth McCardell, M. Couns., PhD

 

July 2022

 I’ve always thought a really good conferences paper would be to present an examination of what not to say in the psychotherapeutic session.  You can really ruin a perfectly good hour by careless talk, and other dodgy contributions. You need to be mindful of your responsibility to prepare the client to re-enter the ordinary world as well as nurture their ongoing healing beyond the hourly session. This means gently disengaging them from the thickness, as it were, of any emotionally charged material through conversation about everyday things. I might, thus, talk about how beautiful the sun feels after really cold, chilly days, or something like that.

 The therapeutic hour has a rich density about it. It is bounded by a greeting at the beginning to a see you next session at the end. In between, though, there is a contained conversation that is therapeutic and driven by the therapeutic capacity to hold the space safely, with confidentiality. It is, as I’ve said, thick and rich, for it is quite unlike any other conversation any of us will have out in the rest of the world.

 Erving Polster wrote a significant book that, in one flash several years ago, gave me an understanding of therapy that I really didn’t have before. His book, From the Radical Centre, The Heart of Gestalt Therapy (2000), had encaptulated, in one sentence something that I’d only intuited, but not articulated. He wrote, in so many words, that therapy is the space between a deep hypnotic trance and a light hypnotic trance and that the continuation of the therapeutic work needs to not only nurture what is learned in that rich space, but not damage it. This accelerated my understanding enormously and, as an offshoot, encouraged me to do a Diploma of Clinical Hypnotherapy on top of my existing Master of Counselling degree. It brought a mindfulness to the doing of therapy and thus a more careful consideration about the words (and actions) I use before, during and around the point of concluding a session. It also delivered greater thoughtfulness about what therapy actually is, something that I continue to mull on umpteen years later.

 How we conduct ourselves as therapists really matters. In this article I am focussing on the words we speak, but our actions can damage this relationship.  Talking about oneself too much (a little is therapeutically useful), boundary violations (for example, sexual advances, unnecessary touching, and associated invasive speech), and just plain thoughtless chatter, all have the capacity to absolutely destroy the therapeutic relationship. Right conduct is essential for the containment of the therapeutic experience and a sense that what is learned in that session may be carried on beyond the hour to the rest of the client’s life.

 So, what words might one sensibly not say?  Direct reference to a presenting problem right at the end of the session when in the process of saying goodbye is unhelpful: not least in bringing the client’s attention again to the thing that they are fighting against, making it seductively more attractive. We all know how thoughts about the thing we are trying to give up become like sirens singing to sailors: come hither and taste the forbidden potion. I remember doing periods of fasting and having difficulty because I was preoccupied with the idea of fasting. Abstinence became an obstacle rather than an absence.

 “I guess you won’t want to smoke/drink/play the pokies, doubt yourself anymore,” puts to mind a focus on the thing that you don’t want your mind thinking about. The less one sys about the presenting problem the better right at the end of a session.

 What needs to happen here is a gentle re-introduction to ordinary life, and so I talk about such things as  the weather, or suggest my client has a good cup of something enjoyable,  a hot fragrant bath, a wander around a garden, a visit with friends, or settle down with a good book. The absence of focus on the thing troubling them is the whole point. Healing happens at an unconscious level from the therapeutic work and beyond.

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

      It is timely to write about trauma. After all, we have experienced horrendous floods this year and fires three years prior and many people suffered directly and indirectly the effects of these. On social media many were saying that everybody affected have Post Traumatic Stress Disorder (PTSD). It needs to be said right here, that this isn’t true. Not all who went through these experiences are affected in this way.

     Our responses to threat are primarily instinctive and biological, and secondarily psychological and cognitive. We go into fight, flight, and freeze mode, common to all mammals. First, we enter the arousal cycle. Our muscles tense, as we identify the source of possible danger. Then we enter the mobilization stage where  our bodies begin to produce adrenaline and cortisol, the two primary chemicals that energize us to fight or flee. In the third stage, we discharge this energy by completing the appropriate defensive actions (fighting or fleeing). The fourth and final stage happens when the nervous system, no longer aroused, returns to a state of equilibrium. If we are overwhelmed by the threat and are unable to fight or flee, we instinctively employ the third action plan, the "freezing response”. Here we are in a dissociative state where our minds seem to separate from our body, but we are still highly aroused, setting the stage for high anxiety which may continue for awhile.

     I note here that PTSD is identified as the ongoing experience of trauma lasting more than three months. Less than three months, and this trauma response is identified as Acute Stress Disorder (ASD).  Not all experiences of stressful events become disorders (a very important point here). 

      According to the DSM-IV (a bible of psychiatric diagnoses), for trauma disorder to be diagnosed, the person must experience at least one of five cluster symptoms: recurrent and intrusive distressing recollections, nightmares, flashbacks, intense psychological distress in response to memories or reminders of the trauma, and physiological arousal cued by memories or reminders of the trauma);  three or more of seven  symptoms of persistent avoidance (of memories or reminders of the trauma) and emotional numbing (dissociative or psychogenic amnesia for important parts of the trauma, loss of interest in important activities, feelings of detachment or estrangement from others, restricted range of affect, and a sense of a foreshortened future); and two or more symptoms of increased arousal (sleep difficulties, irritability or outbursts of anger, concentration difficulties, hypervigilance, and an exaggerated startle response).

 

     PTSD doesn’t necessarily occur after ASD and ASD doesn’t necessarily occur after a stress event. Why is this so?  Length of duration may be a consideration, as frequency could be also, but the data is inconclusive. The anxiety response is not the same across all potentially traumatic events. Some events, such as random rape, are transient, while domestic abuse is usually repeated. Hand to hand combat can be transient, but can be repeated many times. Floods and their ongoing destruction go on for a long time, but the time factor isn’t necessarily sufficient to bring on an ongoing trauma response. Other things are at work, and we still really don’t understand everything about this stress response. Some people are more resilient than others, some have better networks and can express their feelings more openly, perhaps.

 

     Several studies have found that low cortisol levels in the acute aftermath of the stressful event and an elevated resting heart rate shortly afterwards tend to result in a stronger and more sustained stress reaction, which is hypothesized to contribute to the development of PTSD. Also an extensive prior history of psychiatric problems and/or substance abuse may make  a person  particularly vulnerable to the development of PTSD. Prior traumatic history also contributes to the development of a stress disorder.

 

     So how we live our life now matters in terms of how we respond to stressful events. Now is the time to communicate and connect with others and learn to manage our issues without abusing alcohol and drugs. Working through our anxieties and concerns through counselling is really useful in preventing the development of the debilitating conditions of ASD and PTSD because they are not inevitable. Therapy for existing trauma really does matter.

 

 

 

 

 

Caring for Ourselves by Dr Elizabeth McCardell, M. Couns., PhD

May 2022

      Suddenly I discover that I've nearly missed the copy deadline for the May issue of the Nimbin Good Times newspaper. Suddenly I realize that the month of April is coming to an end. What a very strange time this has been.  I went to Perth for a fortnight's holiday and lots of lovely snorkeling in the Indian Ocean and actually missed my flight home, thinking my flight was scheduled for Saturday when it was meant to be Friday. I, for the first time in my life, had to rebook a flight. Yikes! I flew on Sunday night, and arrived on the Gold Coast on Monday morning and resumed working on Tuesday.

      I'd gone to Perth for a much needed break. It had been a whole year since my last one and, frankly, I was exhausted. The floods here in Lismore broke my heart. True, I was not directly affected, living and working as I do in the hills above the cbd, but some people lost their houses and their businesses and that affected me because of my caring of them.

      I heard the calling for counsellors, but I knew I was not in any fit state to offer my assistance beyond what I was already doing. I continued, after all, seeing my clients between the floods and afterwards. I just knew there wasn't more in the tank, as it were. In aircraft problems, we are told to attend to our own oxygen needs before attending to those people around us. We cannot help anybody if we are starved of oxygen. This is true for those of us in the helping professions. We cannot help others unless we are ourselves are ok. There is nothing intrinsically selfish here. We all matter.

      I remember seeing a well trained naturopath some years ago who didn't feel worthy enough to work in her field. She cared, as she said, too much for her potential clients and not enough for herself. I only did one session with her, which was all that was needed. We did a powerful Tibetan meditation called Tonglen together. This is a meditation for loving compassion towards others and self. The central message is that all of us matter, all of us. There is no one excluded in this act of compassion. Tonglen consists of breathing in universal love and breathing out this love for self and other.  I was delighted to find that this client went on to open a very successful clinical practice. She has since moved away from the district.

      We cannot work beyond our capacities. There is only just so much that we can offer others before our inner resources are exhausted. Kindness to self means we can continue to offer kindness to others. Now this doesn't mean too much self indulgence. We do need to balance our own needs with needs of others. We do need to be honest to self and others, and self reflective. If someone is not honest with us, we need to speak up, but in a manner that isn't designed to hurt them. We need, I think, to understand our own motivations in our communications with others. Again, the Tibetan meditation is useful here. We, individually, are within the human community. Our actions need to be clear and non-manipulative. We cannot force our help upon others, and neither should we force our agendas on others. Self knowledge is integral to self care, I'm suggesting. Such  knowledge is incremental throughout life. We learn about ourselves as we learn about others and each lesson learned is subject to change over time.

      The beauty of counselling and psychotherapy is that we come to know our strengths and our limits to the expression of these strengths and thereby find ways to nurture ourselves in environments that bring us joy and healing. I have a passion, as many people know, for swimming and snorkeling in the sea. My perfect holiday is doing just this. I forgot the date of my flight home because I was busy gliding through turquoise waters, but I'm here now, and ready to listen to anyone wanting to talk.  

 

 

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

 

April 2022

  Kintsugi, or Kintsukuroi, is an old Japanese art of repairing broken pottery with gold or other metals so that the reconnected ceramic pieces celebrate the breaking, repairing and transformative process of becoming something even more beautiful. The name kintsugi means “golden joinery” and the healing in the gleams of gold, if I may put it this way, emphasizes the fractures instead of hiding them.

That which was broken has the possibility of becoming something beautiful, but only if we do not try to conceal our anguish. Our lives are continually changing, continually being broken and repaired. We tend to want to dump everything of our lives when dramatic changes are thrust upon us, which is understandable, but the saving of the pieces of our lives as well as the memories and the instances of delight of the vessels that contained us before the devastation help the rebuilding, the re-making of us.

As I’ve said. above, that which was broken has the capacity of becoming something beautiful, but only if we do not try to conceal our anguish. It is perfectly understandable that we want to press on and rebuild our lives as if nothing was broken. Try as we might, however, the pain remains until it is literally visited and transformed.

Compare the repair of broken pottery with invisible superglue, where the vessel looks sort of ok, but nevertheless retains at a hairline level evidence of a break, with the outright golden repair of metal in the joins between ceramic pieces. The first declares itself as a shadow of its former past, while the other says, effectively, “Here I am, I’ve experienced damage in my life, but now I am even more extraordinary than before. I am empowered by my experiences and I can participate in the lives of others, and myself, with deeper authenticity.”

This metaphor of healing has huge implications for us in the healing professions. Our knowing of our own pain  can become the tool of our empathic capacity to enter in the healing of others. If we do not acknowledge our own pain, our injury, but pretend to know everything there is about trauma and healing, we, paradoxically, cannot actually heal. A cognitive understanding of emotional injury really is no substitute for the participation in one’s own therapeutic healing. Get therapy, if you feel you need it.

Post-traumatic stress injury isn’t inevitable after dramatic and life-altering events, like the recent devastating floods in northern New South Wales and Queensland, Australia.  After going through a traumatic event, it’s natural to experience some emotional repercussions. Anxiety, fearfulness, irritability, and numbness are all normal feelings that may arise in the wake of a trauma, but in most cases, these feelings will subside as time goes on.  I note here, that fear and stress are vital to a person’s safety as they trigger physiological “fight-or-flight” responses that help us be protected from harm.

For those with post-traumatic stress disorder, or PTSD, these symptoms of anxiety, fearfulness, irritability, and numbness persist, and sometimes intensify over a two, or more, month period. A characteristic of PTSD are avoidant behaviours, such as an endeavour to avoid talking about the traumatic event, or to stay away from places or things that remind them of the incident, but this strategy backfires. It’s like trying to apply superglue to the broken pieces, in an endeavour to hide from feeling frazzled, while feeling even more anxious than before. Talking with someone in a safe, confidential environment is a useful step in the healing of the person.

In the therapeutic supportive conversation, insights into positives – like, for instance, ordinary people helping one another, people saving animals and animals saving us, even just a flower floating by, or noticing the subtle shifts in interests in special activities, like music, gardening, painting – can be part of the gold melding the broken bits into something new.

Kintsugi is a playful art, and art in the making of something new from the broken old. It is, literally, golden joinery, golden healing.

 

 

Remembering and Creating Memories by Dr Elizabeth McCardell, M. Couns., PhD

March 2022

    A friend of mine remembers when he was a little child, his mother talking about the croaking frog they were hearing that morning and then being taken outside to look at it. It was huge, gigantic, massive, the size of a small elephant.

     I remember a Zeppelin airship flying over our house, even though they ceased to fly decades before I was born and they didn’t fly in Australia at all.

   Someone I know has an apparent memory of having sex with his mother. Maybe this actually happened, or maybe it didn’t. Gathering the evidence around such a memory requires much more than relying on a memory reconstruction. It requires close examination of the behaviour of actual people and circumstances and possible situations. Again, maybe it happened, but maybe it didn’t. What is important here is knowing that memory is not to be relied upon as a complete and authentic record of past possible events.

   Memory is not a useful tool for determining actual history and so any technique for digging out possible memories can’t be relied upon as the sole means of determining truth – which is why I refuse to pretend to do any so called repressed memory work using hypnosis. I do not want to participate in the making of  false memories. It is significant that hypnosis came into disrepute over this very thing. Once upon a time hypnosis was used to “prove” the authenticity of an event and used in a court of law as evidence. This was until sufficient research had been done to discredit the supposed revelation of repressed memories through this method, unfortunately dragging down with it, the whole reputation of hypnosis as useful adjunct in psychotherapy. Very fortunately, hypnotherapy is returning to being recognized as useful in psychotherapy for other purposes, and not as an excavator of the past.

     We are creating memories all the time in an attempt to make sense of our life. Memories, as I’ve said already, are not necessarily a record of past situations. Sometimes they are a way to explain things that are poorly comprehended in the first place. A little child sees things, as all little beings do, from a small person’s perspective. They are little in a big world. Grasping at meaning from a perspective that is really limited requires piecing together bits of information from around them. Some of these bits of information could be things half heard and barely understood (like the story of the frog), things seen in books and on screen, some could come from other experiences, and so on. My apparent Zeppelin sighting I realize now came from a book on dirigibles and balloons that my father used to read to us melded into recurring dreams I had and reconstituted as an actual event. The situation of being little, of course, is actually true for all of us as we endeavour to negotiate the complexities of the vast world we live in. At least, though, we adults are generally better able to sort out what is probable and what isn’t – although maybe I’m too optimistic here, given the extraordinary rise in conspiracy theories.

      The less information we have, the less we have to test the authenticity of something and the more likely we are to incorporate the flimsily known into what we think we know, creating a world view replete with false memories. This is essentially the way cults operate: the known world is deliberately limited to a tight and restrictive community. Before long, the most vulnerable among the group start remembering abuses that may, or may not, have actually occurred and so cling to the group more and more.

    Everything needs to be tested. Nothing should be believed simply because someone has said if you remember it, that it happened. Maybe it did; maybe it didn’t. A memory can be changed, rethought, examined, played with, measured with the feeling status of things, but not relied upon to be necessarily a strict re-membering (re-putting together) of the past. Gather as much information you can and test your memory. In the end, though, maybe your reconstruction is real, but maybe it isn’t.

Opposition in Psychotherapy by Dr Elizabeth McCardell, M. Couns., PhD

February 2022

      Sometimes, not often, a person comes for therapy who is uninterested in allowing me to do my job. They have a fixed idea about what I should be doing. They tell me they don’t want to share their history; they just want me to “fix” what’s troubling them. I tell them that I can’t possibly know what to do from a description of their symptoms and nothing else; I need to have a fuller  sense of where they’ve come from and something of their current life, ideas, things that make them happy, as well as points of distress. Psychotherapy isn’t like prescribing a pill for a condition. Taking a careful and thorough history really matters.

   Psychotherapy is a collaborative enterprise. It isn’t me doing stuff to you; it is me listening and guiding you to another way of looking at the issues that are causing difficulties, and working with you so that life is easier for you.

      As I’ve said, sometimes, very rarely, a person comes for therapy but from the outset doesn’t want to tell me anything about themselves. I remember when I was learning my art, I had a client that when I said I’m interested in understanding her, she said, “I don’t want you to know anything about me.” What was I supposed to do with her, and why was she there?

      Another person reported irritation with me when asked about her past. She couldn’t see a purpose in my questions. For her, my investigation didn’t fulfill her objectives. I replied, they fulfilled mine. I was the one trying to understand  her. She may well have felt that her resistance to my inquiries was realistic, but really it wasn’t. There was more: she missed sessions and she was late paying my fee. I realized there was a mismatch at work and we needed to drop the whole thing. Not everyone can work together. It’s also probable that she wasn’t ready to actually do psychotherapy at all.  Everything has a season, as they say.

     It is important for therapy that a strong working alliance is developed and if the client resents the therapeutic strategy taken by the therapist, then no alliance can actually develop.

     Note here, that I prefer not to use the word ‘resistance’. The reason for this is that that term developed out of Freudian psychoanalysis where  power relations between therapist and client are intrinsic to that purpose of therapy. Psychological resistance is seen by psychoanalysts as a case of clients clinging to their disease at an unconscious level in defence against the parent-therapist (using the concept of transference as what is seen to go on between therapist and client). That idea, I think, is flawed and suggests the therapist always knows what is going on, and the client is always just oblivious. Therapy, as far as I and many others see it, is much more horizontal than that hierarchical model. We are two people working together, both relatively capable of choice making.

     Opposition in therapy may not be aimed at a disagreement concerning the therapeutic strategy adopted by the psychotherapist. Sometimes it arises from an opposition to specific techniques used in session, or non-compliance with agreed exercises (for instance, collecting dreams, keeping a journal, or some other homework) or a dislike of words or phrases used by the therapist, or resistant body language, or repeated non-attendance at planned sessions. Sometimes it manifests in other ways. A client might not want to talk about certain things and will change the subject repeatedly when those subjects come up. Sometimes their objections manifest in not paying the session fee, or delaying it for longer than is polite. All these need to be properly addressed by the therapist and client, and not left to insidiously rupture the therapeutic alliance. When they are effectively addressed by both psychotherapist and client, then two things can happen: a strengthening of the therapeutic relationship resulting in an intrinsic healing, or total rupture.  Sometimes total rupture is the only way, but that depends on the choices we make. It’s ideal that both parties agree to what happens next, as good communication is essential in an effective therapeutic transaction.