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.

 

Having Fun and Self-care by Dr Elizabeth McCardell, M. Couns., Ph

January 2022

     Many years ago now, I was asked by a trainer in one of my classes when I was learning to be a psychotherapist what I did for fun. This seemingly frivolous question is actually extremely important. Unless we therapists can enjoy our recreation and have fun, our professional lives are very short. The burn-out rate among therapists is very high. About half have to leave the profession because of mental exhaustion, which leaves many open to debilitating breakdown in emotional and physical health, and relationships. Those that press on without relief, experience high rates of depression, feelings of depersonalization and cynicism which naturally impacts on the quality of the therapeutic relationship itself. This problem, of course, isn’t just confined to psychotherapists; all of us in the helping professions can be affected by burn-out: a fact now being especially highlighted by the ongoing effects of the covid19 pandemic.

      I’ve written about the need for therapists to receive regular clinical supervision and personal therapy, if that is desired, and I may have mentioned that we really do need to maintain membership of a professional psychological and/or counselling organization in which professional ethics are paramount, and the required  adjunct professional liability insurance to keep us on track and provide a safety net in the unlikely event of a client deciding  to sue us, but what I want to write about in this article is not what happens when we press on beyond our personal limits, but return the focus to fun and a happy means of creative letting go. Without a pressure valve, all of us simply wear out.

      Those of us who are continuing to work effectively enjoy our lives, and our relationship with clients is benefitted. All the successful therapists I know integrate self-care into their daily lives. Some of these people have been in the profession for a very long time. A mentor of mine, a psychologist with over fifty years experience, lives and works in Fremantle, Western Australia and rides his bicycle at 3am in the morning,  swims in the ocean, and does qi gong. This man is one of the funniest, and most relaxed human beings I know. He is also one of the best therapists around. I do some professional development with him fortnightly.

      My friend and colleague in Germany, and a specialist in drug and alcohol counselling, walks in nature beside the River Rhine with his little dog bounding in the waters beside him. He, like my mentor, is a really funny, playful guy. These therapists are  compassionate, generous, clear minded, direct, intelligent, knowledgeable and very skilful in what they do with clients, fellow therapists, and everybody else. Salt of the earth, you could say.

    Other therapist friends dance, play the didgeridoo in the forest - listening for an echo – fish from boats out at sea, surf, garden, cook, sew tapestries, create paintings. They are nourished in engagements and they integrate playing into their ordinary, and thus extraordinary lives.

      What do I do for fun? I love the water. I swim, snorkel, dive (free and scuba), kayak and all that lovely watery stuff. I have a large selection of fins, for all kinds of activities (I’m an Emelda Marcos of swim fins!) I’ve even added deep water aerobics to the mix; an activity that makes me laugh. There’s something intrinsically very silly about comporting oneself through the water with hands held above one’s head or propelling oneself like some water beetle or small lizard flat out swimming, or engaging in deep water running, or any of the other sometimes challenging exercises It’s play, with a purpose. The beauty of it all is that when I’m doing it, I am only doing it. This is really important because when I’m doing therapy I only need to be doing therapy. My presence, body and mind, needs to be entirely on the therapeutic endeavour. If I were to work beyond my own psychological capacity, without respite, I know that I would be joining the 50% of exhausted therapists who, by rights, shouldn’t be working at all.

     And so, I swim, laugh, play

 

 

 

Playfulness in Therapy by Dr Elizabeth McCardell, M. Couns., PhD

December 2021

     Sometimes the therapeutic conversation gets heavy and stuck and it’s clear that talking about it won’t loosen it up. Something else is required.

     I have a little red and white striped string covered ball that I keep in my room. Sometimes I’ll pick it up and throw it to my client. Usually it meets them with delight and they’ll throw it back and a little game begins. The whole atmosphere lifts and we laugh in our play. Sometimes the game releases tears amidst the laughter. Sometimes this is all that was needed to shift the sense of stuckness and to open the therapeutic conversation to move it to another level.

     I have been interested in how this happens between people for a very long time. In fact I called my PhD thesis Catching the Ball: constructing the reciprocity of embodiment (available for reading through the thesis repository of Murdoch University, Western Australia) for the easy interactions that arises in non-serious and unconscious engagement between ourselves and ourselves and our environment. The subtleties of this connection is not only intriguing but also very beautiful. There is flow, inhibition of flow, non-awareness and awareness: receiving and letting go, and interestingly all happening at the same time. Think, if you will, of a person throwing a ball, and the other person preparing to catch it, some of  the ligaments and muscles in the bodies of both players are extended and some are retracted in preparation for the next throw/catch. This physical engagement mirrors the conversation between people: we speak, we listen, we prepare to speak again. There is give and take and give….

     What arises in these little burst of playfulness in therapy should not be confused with the speciality of play therapy. That is quite different and is usually done with children. The Australian Psychological Society defines play therapy as ‘a powerful  means of joining with the innate, creative, non-verbal capacities of children in order to engage and work therapeutically with them. It is a developmentally appropriate, evidence-based method of counselling younger clients.’  What I am writing right now is just plain old playfulness that happens to arise between people within and outside the therapeutic situation. I also note that I do not do play therapy as I mostly work with adults, leaving child psychotherapy to those who specialize in it.

      Playfulness, of course, isn’t just throwing a ball back and forth, it can arise in verbal humour, facial expression, mimicry, or anything else that is light, funny and spontaneous. Planning on playfulness will likely fall flat.

    Playfulness can release a client’s resistance to change. Playful silliness can create a sense of safety in the encounter with the therapist, and allows the client to relax and lose their tight anxiety, which is not a bad thing. Laughter is part of playfulness and that encourages the expression of a sense of togetherness. Another beautiful thing about playfulness is that, in that looseness, it allows us to reframe therapy – and beyond therapy to  experience life as entertaining, intellectually stimulating and interesting, such that we are better able to happily encounter complexity, without panicking.

     Another side effect of playfulness is that it opens us to creative engagement in our world, including an increased desire for physical activity and the endorphins that are generated therein (excellent for healing depression).  After we’ve engaged in little bouts of silliness a client often goes away to once again make music, paint and write, after sometimes years of creative drought.

      I’m reminded of the use of laughter medicine in hospital settings, a delightful therapy begun by Patch Adams, an American medical doctor who is interested in healing the whole self and self in community. His Gesundheit (health) Institute  has people going into hospitals dressed as clowns to share fun and laughter with their patients. Perhaps that might be entertaining, but actually I don’t much like the structured play of clowns and anyway, playfulness doesn’t need to be an all stops out fanfare. A little bit of silly playfulness goes a long way, from the here and now of the therapeutic encounter to softening the edges of ordinary life.

 

 

 

 

 

 

 

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

November 2021 

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

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

 

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

 

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

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

 

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

 

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

 

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