Freud's Dog, by Dr Elizabeth McCardell, M. Couns., PhD

 

July 2021

       Quite a few years ago I had a client who it seemed didn’t wash often; his hands and, usually bare feet, were dirty and, frankly, he smelled. He wasn’t down and out, he had money and a house with working plumbing, but he just wasn’t aware of personal hygiene. I found it difficult being in the same room with him, having my own thing about cleanliness. I was rather too willing to dismiss him, except for the fact that my cat Paschie, loved him. She would race inside and get on his lap and stay there purring happily. He, in turn, was fond of her. He’d pat and talk gently to her. Through watching this interaction I learned probably more about this man than I could’ve just talking with him, at least in the short term.

     Sigmund Freud acquired a chow dog for his daughter, Anna, and then another for himself  rather late in his life. This dog accompanied him into the therapeutic space and he observed what the dog did in relation to the patients. On one occasion the dog got up during a session and scratched at the door. Sigmund got up and opened the door and said, “You see, he couldn’t stand listening to all that resistance garbage. Now he is coming back to give you a second chance.” (p.76, I. Yalom, The Gift of Therapy)

     The therapeutic space is not empty of personal encounter on a whole range of levels.  The therapist’s idiosyncrasies, whether through the presence of a loved pet animal, the décor of the room, the person of therapist his/herself, is there for the client to engage with, or not. Contrary to what many think of psychoanalysis as a situation that provides a tabula rasa (an empty slate) for the patient to project all the contents of their unconscious onto the therapist in an act of transference, it is becoming clear that even Freud didn’t do this entirely. Freud’s room was filled lushly with Persian carpets, ancient figurines, and books. How could his patients remain unengaged? Traditionally patients had their eyes closed during the therapy, but not when they walked in and out of the room. In modern non-traditional psychoanalysis, bizarrely, the tabula rasa idea attempts to persist. This seems to me to require enormous cognitive calisthenics.

       I am not a psychoanalyst and did the bulk of my training where the therapeutic encounter, the therapeutic conversation is paramount, so I make little attempt to conceal my presence in that encounter. I do dress professionally and don’t wear house clothes; my hair is brushed and I’m neat. My consulting room is comfortable, and idiosyncratic to a degree, but professional looking.  My current cat, Pusski, sometimes comes in, but I always ask my client if this is alright for them.   I need to note that I’m not talking here of self disclosure in the sense of revealing my personal life, except sometimes when directly asked, or if I want to suggest that the client’s worry is more common than they thought. Such disclosure is a therapeutic tool and it is not a self indulgence, nor an attempt to get the client to switch roles with me.  That is unethical. I am talking about the here-and-now of ordinary encounter, found in the interaction of people in their environment.

       Ordinary encounter has many levels to it already. It is interesting that what is an assumed awareness of the things in one’s environment isn’t necessarily so. I have a large Russian toy brown bear called Ruach (Hebrew for spirit, breath, mind) that sits in a corner of the room which not everyone notices. Yes, my clients are mostly preoccupied with their own worries, but seeing, or not, the things in their environment tells me a lot about them: information that comes in handy when I contemplate a therapeutic strategy.

       As Freud’s dog and his Persian carpets created a unique comfortable therapeutic environment and tool for himself and his patients, so my room and the sometime presence of Pusski, is useful for me and my clients. All contribute to a place where healing can happen.

Treating Borderline Personality Disorder by Dr Elizabeth McCardell, M. Couns., PhD

June 2021

     When I first started practicing as a psychotherapist, I had a client who intrigued and confused me. We’d just be getting somewhere (or so I thought) after tumultuous emotional upheavals to a quieter place, when another tsunami of emotions would come battering her. More calm, more intense emotion, more calm…. This went on, over and over, for a couple of years, week after week, to the point that I really didn’t know what to do. I sought advice from other practitioners and they said all I could do was ‘be there for her.’ Somehow this didn’t sit well with me, but maybe, maybe not. 

     This behavioural pattern fits the borderline personality criteria. The core features of borderline personality disorder (BPD) are impulsivity and instability in relationships and mood. Their emotions are intense, erratic and can shift abruptly move from passionate idealisation of the other to contemptuous anger and back again. I experienced all this. One week, I was glorified and worshipped; the next, I was wrong wrong wrong. Neither attribute had any real reference to the me-ness of me.

     People with BPD haven’t got a clear and coherent sense of self. This manifests sometimes in their ideologies, career choices and values. My client, for instance, moved from career to career to career, saying each time that now she’d found what speaks truly to her heart - until the next bout of severe depression swamped her and then the burst of grandiose discovery of something else more appealing.

     The borderline disorder of self is characterised by a reliance on others (a sort of “you are, therefore, I am”), and a particular sensitivity to signs of rejection and abandonment. They equate individuation with withdrawal of the other and thus they avoid self-expression and self-activation in order to maintain what they see as closeness. When they feel abandoned, rejected, there is an upswelling of intense affect that may manifest as hopelessness, helplessness and rage, and thus the giant wave of seeking closeness to the detriment of developing their own agency begins again.    Some may experience transient psychotic and dissociative symptoms when extra stressed. They are also likely to have high levels of anxiety and engage in self harming behaviours, like binge drinking, cutting (maybe in order to “feel”), suicide attempts, eating disorders, and the like. Such clients, thus, do need support from their practitioners.

    Why do some people suffer in this way? There are a few theories, ranging from neurobiological factors: deficits in sensitivity to the neurotransmitter serotonin and frontal lobe problems (the brain’s frontal lobes are thought to regulate emotions); social factors, such as childhood abuse; to object-relations theory, a psychodynamic approach, that focuses on the way children internalize how they felt about their caregivers (a relational way of thinking). The internalized images (object representations) become part of the person’s ego and influence how the person reacts to the world. 

     Object-relations theory, as a way of understanding our inner world, most appeals to me  probably because I was shaped by these ideas of psychodynamic therapy since the age of about sixteen and it is integral to the way I live and work. Our inner life interests me.

     In object-relations theory, the person with BPD was a  child who experienced and internalized a confusing mix of parental behaviour. They knew love and attention inconsistently given. The child was praised when she achieved scholastically or out on the field, but rejected when she was frightened. In this way, she internalized the disturbed object representations of caregivers. The why of this, relates to the caregivers’ own style of being in the world, their own core sensitivities. These might value achievement over autonomy and individual agency, rewarding dependence over individuation. The child, having such ideas about what it is to be human in the world, modelled by such caregivers, develops an insecure ego that always seeks attachment and always fears being alone but doesn’t have the inner resources to seek enduring and nourishing long term relationships. This is where psychotherapy comes to its own, in the bringing to awareness and activating what  inner resources may be drawn upon when feeling abandoned, is where psychotherapy becomes useful, thus providing much more than mere support. 

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

May 2021

     Some years ago I had a client who believed he was possessed by the devil. He’d been sexually abused by the Roman Catholic parish priest in England as a child and was left with what could’ve otherwise been described as panic attacks that consisted of violent shivering, at various points of his life. He interpreted the shivering as demonic possession. No amount of trying to redefine his symptoms was having any effect at all, and, frankly, I was at a loss as to where to proceed. 

     Then it struck me in the middle of the night, as it often does, that I should propose we prepare for an exorcism.  Having studied Theology and Church rubrics many years ago, I was sort of familiar with what that might look like, but the whole idea filled me with trepidation. I was suggesting something that scared me. What if this experiment went horribly wrong?

     When his next appointment came around, I put my proposal to him. He thought this was a good idea, and so we began identifying the symbolic items that might form part of an exorcism ceremony. Did we need holy water, a cross, a sacred icon? What specifically spoke to him? We went into great detail in the shaping of this ceremony, but part way through that session (the exorcism was to take place at the next appointment), my client sat up and said, “I don’t need to do this anymore. I feel good.  I feel like the devil has left me.”  I breathed a sigh of relief. Thank goodness, I thought. 

     This whole process taught me a fundamental truth, that using experimentation in the therapeutic environment is extraordinarily powerful. It’s a central truth, that experiencing something teaches us much more than merely talking about, or analysing, that something. I’d already known that talking with my client about his symptoms wasn’t changing anything. His anxiety levels remained the same. But taking the path of actually preparing for possibly a life changing event had profound effect.

    What was critical here, was to take the client’s concerns very seriously and to be prepared for entering that space, without flinching. He knew I was serious, and thus he entered the arena of his own anxiety. He owned it, and he knew I was with him where we were safe.

    Experimentation in the therapeutic space needs to be safe and secure and for the therapist to check with the client that the direction chosen feels appropriate. It should also have enough energy within itself to remain interesting to the client. There is no point attempting to go where the client has lost interest, or that the whole thing feels too massive and fills the client with fear. Gently, gently, is the principle.

     It’s sort of like adding, bit by bit, a titration of a change agent to an existing mindset, like spices to a meal, so that what was once a problem isn’t anymore. The thing about it, though, is that the outcome cannot fully be predicted. It is an experiment, after all, and some experiments fail. That’s the beauty of it, actually. It’s a risk, but it has the potential to radically change things for the client.

     Experiments, in therapy, can be much less dramatic than the one described above. It may simply consist of suggesting the client does gentle breathing exercise, or sounds a note, or starts to dance, or draws a dream, or engages in script therapy, or does some active imagination, or empty chair work, or any other manner of appropriate things, anything that brings a sense of safe supportive engagement in the here and now of experience. It is the trying of something new to see what will happen.  It is the lived experience of something that can sometimes be otherwise a little too abstract and intellectually remote to effectively integrate.

     It is a wonderful privilege for a therapist to be part of a client’s healing journey. Experimenting in that journey brings me delight, especially when I see the lifting of what was previously problematic, smoothing out into acceptance. It’s there in their whole demeanour, they’re relaxed and able to move forward comfortably.

Being Present with Another’s Traumatic Experiences by Dr Elizabeth McCardell, M.Couns., PhD

 

April 2021

     “Trauma is not what happens to you, it’s what happens inside you as a result of what happened to you.” Gabor Mate.

     We all react differently to things that happen to us and what can feel catastrophic to one person may not be felt that way by another. Some people just seem to ride the waves without being too much affected by what they experience. That said, we can misjudge a person’s reaction when all we see is how they are behaving.  A person showing outwards signs of distress may not be in the same degree of shock as the person who is simply sitting staring ahead in silence. The silent one may continue to feel distress many decades after the event, but still not show it. They might be experiencing sleeplessness, nightmares, panic attacks; they might resort to excessive alcohol consumption and taking drugs, or none of these things, but still give the appearance of coping perfectly well.

     I’m reminded of one of my first clients many years ago who came to me because he was feeling suicidal. He’d taken early retirement as an aircraft mechanic and a week after giving up work was suddenly inundated with memories from his time in the air force where his job was flying helicopters picking up bodies during the Vietnam war. He’d kept it ‘together’ throughout his working life after Vietnam, not showing any emotion, just pressing on, doing his job. He maintained a holding position, until he couldn’t anymore.

     The person yelling and sobbing after traumatic events may be coping better than the silent one. Yet we, in our society, judge the former as being more traumatized than the latter. Thinking here of the quick condemnation of Lindy Chamberlain on the tragedy of losing her baby to a dingo at Uluru in 1980. She showed no emotion at all and was judged as being a cold, calculating child killer, when in fact she was frozen in utter shock.

     The Perth psychologist and trauma counselling specialist Michael Tunnicliffe who taught trauma counselling in  my Master of Counselling degree explained that the crying person was already adjusting and adapting to the reality of what they have just experienced. The silent person might be numb, not feeling anything, as if the event did not happen. The silent person has got stuck, as it were, along the path to adjusting and adapting to their new reality.

     Stuckness in shock is felt bodily. Freezing in fear is what animals do (called ‘tonic immobility’), and it is a survival response, but unlike other animals, people can get stuck there.  We do this by repeating our fears in a sort of emotional loop and thus continue the frozen response. If you watch a cat encountering something frightening, they freeze, but then shake it off. Too often we humans recapitulate our fear response by overthinking it. This is where counselling comes to its own. If such a person can talk their experience through, with plenty of emotional and somatic support, then the fear response doesn’t tend to get stuck.

     Peter Levine, a pioneer in trauma therapy, (cf Waking the Tiger, Healing Trauma) notes that certain things can effectively loosen the frozen response. He  might  ask the client to put one hand on their forehead and the other on their chest, or put one hand under their armpit and the other on their upper arm in a kind of self hug. Tapping your whole body or tapping just their hand also works for some people. Such movements contain feelings of panic and lessens the sense of having a hole in a person’s boundaries.

     When the sense of frozenness is old, dance, massage, gentle breathing exercises or vocalizations are  good ways of releasing seized up emotion. For immediate help, just sitting listening with the person speak whatever it is they want to say really helps. The key is, gently does it. What doesn’t help is more exposure to the same sort of traumatic event.

     Just being with a person helps give a sense of safety and containment, which is a beginning to healing.

 

 

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

March 2021

      In wondering what to write about in my monthly articles, I listen to what’s going on around me in order to identify what I sense is what needs to be said. For my article this month, I thought I’d get back to basics and examine what counselling and psychotherapy are as well as that they try to achieve.

     Counselling is recommended for specific issues and situations, such as addiction or grief, and takes place over weeks to several months. Psychotherapy, on the other hand, explores issues in greater depth and takes account of past issues and patterns of behaviour that might be contributing to present day problems. This level of therapy takes place over a much longer period. There are many cross overs between counselling and psychotherapy, so what I shall say here, describes them both.

     In my own practice, I am always curious about a client’s past, their family history and family dynamics, relationships past and present, and when they can identify particular difficulties arising and how they dealt with them. I also want to know how well they sleep, the how and when of feelings of anxiety, moodiness, sense of calm and contentment, excitement, and so on. These give me significant clues as to how to proceed.

     So, what is the main function of counselling/psychotherapy? It is to help clients come to know their own strengths, discover what is preventing them from using those strengths, and clarify the kind of person they want to be. They are encouraged to honestly examine  their behaviour and lifestyle as well as learn how to make decisions to modify the quality of their life.

     This is collaborative work, and there are no magic solutions. The pathway for successful counselling/psychotherapy arises from the quality of the therapeutic relationship that, when it is working well, offers support and warmth as well as challenge and confrontation. The latter is sometimes really necessary if old patterns have a chance of being released.

     Contrary to certain  popular ideas, the counsellor/psychotherapist works hard. It may look as though we are just sitting there having a chat with the client. We are, on the contrary, very focussed as we listen, and draw upon our extensive studies and experience of human dynamics and behaviour; ours is a knowledge that takes account of human development, abnormal psychology, social and individual behaviour, neurology, sociology, cultural ideas, and the like. Central to what we do together is the keeping in confidentiality of what is said to us. Those of us who are very experienced have practically heard it all (or so we generally think), so the client doesn’t need to withhold anything. The greater the sense of safety, the more the client feels they are able to speak, and the therapist do their work.

     Another tool that the counsellor/psychotherapist brings to the therapeutic situation is an ability to set aside their own assumptions and beliefs. This is called epoche. It means the therapist is present in a better state of clarity, with little agenda of their own, except to encourage a great easefulness for the client. It is in order to be able to practice our profession with this clarity that it is encouraged by most training institutions that therapists receive therapy of their own.  I began my therapeutic career in the 70s when I studied Jungian psychology (even though I didn’t practice as a therapist for many years) and began serious self reflection through psychotherapy. This continued for many many years. I wrote my Master of Counselling degree dissertation on the subject of therapists who receive therapy. There I noted that such a strategy not only gives insight into one’s self, our relationships, and our style of being in the world, but served as an apprenticeship into this field. All of which makes for good therapy.

     

     Probably the most effective tool in counselling/psychotherapy is the knowledge that the therapist will tailor their work according to the individual client. There is no one-size-fits-all approach. As Jung says, there are as many therapies as there are clients. We work together in the process of your healing and are thus, as therapists, a therapeutic person.

“Hearing” Others by Dr Elizabeth McCardell, M. Couns., PhD

 

February 2021

      I’m  intrigued by the way in which we  get a sense of unseen other people through the narrative of the people talking directly with us. In literary terms, this is known as narrative empathy and it may because my first degree was a major in English Literature, that the idea fascinates me on several levels.

      A while ago, I was listening to a man describing a few ex-girlfriends and I could barely get any real sense of the personhood of these women. It dawned on me that my feelings of disquiet had a lot to do with this man’s own lack of a sense of the “otherness” of the women. If they were characters in a novel, they would be like wraiths, with no substance. We speak, after all, much as we experience.

      We fill in, with our imaginations and felt sense, what we think is going on in another person’s mind when we listen to them speak or write or otherwise depict, the object of their interest. If a person’s focus is on outward appearances, as it was with the man described above, we get very little information on what these other people are actually like. It’s sort of like flicking through a Vogue magazine where women are objectified; nothing more, nothing less.

     This man, who did not have a real sense of the subjective nature of his ex-girlfriends’ experiences, could not understand the effect his actions had on them and the not knowing caused him and, presumably them, real distress. His lack of empathy seemed to be generated by an unawareness of the subjective presence of others. This, I think, was the result of being thrust into an adult world when he was still a child. We develop much of our capacity for empathy though peer contact in a casual environment where ideas of relationship are tried and tested and tried again, and he didn’t have much of this. He was forced to grow up too quickly.

     Getting a sense of how others are feeling is a sign of emotional intelligence and it is the capacity for empathy. Not “hearing” how others are feeling means that they don’t really get a sense of what they themselves are feeling. This is not to say they have no feelings, but rather can’t identify what’s going on within themselves and in the behaviour of others and have difficulty adjusting their behaviour to make space for others’ responses. There is a clinical word for this personality trait: Alexithymia, and being a  trait, it is possible to learn, to heighten, awareness of the feelings of self and others.

     When I was studying couples counselling in my Master of Counselling course we did a lot of practice runs working with people who were not “hearing” the perspectives of the other person they were in a relationship with. We had them do a bit of play acting whereby each had to pretend to be the other person, saying the words they’d heard the other say. This simple task quickly gave each person a felt sense of the other person and a bit of an awareness of other lives, other sensibilities, other perspectives.

     A study needs to be done to investigate how such a technique changes the quality of “voice” in a person’s narrative accounts of others. The quality of “voice” after all changes the capacity to “hear” another person, other people. When we speak of others, what we know of ourselves and how we perceive the other lives of the people we speak of, is reflected in the quality of our narratives. To speak of others without feeling something of what another is feeling is to speak as if “tone deaf”: there is sound, but not much content.  To “hear” another allows us to speak of them in a deeper, fuller way. The man I mentioned above, could well benefit from psychotherapy, if he ever should wish it. The purpose of therapy here would be to learn how to fill out a life with reciprocated relationships that feel good, by recognizing the felt being of others. That makes for a life among others rich and fulfilling.

 

 

Can Hypnosis Retrieve Memory? by Dr Elizabeth McCardell, M. Couns., PhD

 

January 2021

       Every now and again, I get requests from potential clients to help them remember something they’ve forgotten using hypnosis. I generally say I don’t do this sort of thing. There are three reasons for this, and I say so to these people. One is that memory isn’t a large, permanent and possibly accessible storehouse of information, nor is it a recording device; two, hypnosis isn’t a searchlight into such a storehouse;, and three, hypnosis wrongly done can plant false memories, and I’m uninterested in doing that.

     Memory is already a distortion of experience since it is an internal representation of an event and not the event itself. No amount of uncovering bits of information through hypnosis will get to an absolute truth. What hypnosis might do is allow a person to think about a situation or event differently, and this is useful therapeutically, but as a possibly inviolate forensic tool it is generally not admissible in the court of law, with few exceptions. It should be remembered that hypnosis isn’t a powerful tool to recover accurate memories under a variety of conditions including accurate memories as far back as birth or even past lives. You may get glimpses of ideas, but that’s about it.

     Digging into memory using hypnosis, it has been found through years of considerable research, is as susceptible to the problems of distortion and confabulation as any other method of trying to remember something. It would be unethical of me to use hypnosis to fulfill someone’s desire for memory recovery, and I won’t recommend any other practitioner who might claim to do this dubious thing.

     My interest as a clinical hypnotherapist, as opposed to a forensic hypnotist is the loosening up of rigid ideas about oneself. I use hypnotherapy as an adjunct to my psychotherapeutic practice, but only by client choice.  I am a psychotherapist first and foremost, and my participation in my clients’ healing is my actual interest in the field.

     I have helped some clients find missing objects, but not by directing them to that object. I know from personal experience that when something is missing I am more likely to find it when I’m not concentrating on looking for it. It’s when my attention is elsewhere that I can find pointers to the lost thing. When preparing for exams, I used to play difficult fugues on the piano and in this way solve the mathematical problems by approaching the issues from other directions. This, to me, is a far more interesting way of approaching difficulties.

     This loosened therapeutic direction, valuable as it is as I use it, actually also points to the inherent danger of trying to hypnotise someone in order to direct them to actual memory. A hypnotised person’s openness to suggestions, as well as an expectation that hypnosis will work, sets the stage for possible confabulation. Memory is easily contaminated by a whole range of things (just like a crime scene), including the very desire for hypnosis to uncover truth. If you believe something will work, you are most likely to believe the veracity of the something. In court cases where hypnosis is used to trigger memories (real or not), the person is likely to say they are more than one hundred percent sure that such and such is true. This is a red flag. Nobody can be so sure of anything. I note that I avoid such directiedness by saying something like, “Maybe you will find it; maybe you won’t, and that’s alright.” I try to avoid direct statements of any kind, as I do not wish to create stories for the other person.

     By avoiding direct statements during a hypnotherapeutic session, I also avoid client resistance, which is just more inflexibility to a much more fluid approach to life. Loosening anxiety around a problem has the capacity for releasing a person from the problem itself, and that matters enormously.

    So, hypnosis is an unreliable means for uncovering things unremembered, but it’s a wonderful tool for learning to think outside the box; it is a doorway to greater creativity and self confidence.