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.

 

 

 

 

Giving is taking and taking is giving by Dr Elizabeth McCardell

 

 October 2021

     I very much like the Tibetan meditation of tonglen, which is literally, "giving and taking" or "sending and receiving". It beautifully sums up a gift where the act of giving is the same as the act of receiving, and the act of receiving is the same as the act of giving. There is no difference. Nothing is left out.

      There is nothing worse than those who see the giving of gifts as something obligatory, or those who can’t receive a love-filled gift. I’ve certainly known people like these. I have memories of standing around at Christmas parties where gifts were presented and immediately set aside by certain people. And also those who complain about having to buy gifts for others, seeing the whole process as something somewhat tiresome. In contrast, there are those who take absolute delight in making gifts and giving something chosen because they are delighted by it, as well as delighting in the very process of giving. In the case of the latter, the very act of giving is felt as continuous with receiving so that giving and receiving are the same process, the same transaction of love.

      It got me thinking about how not having a freely given gift received with an open heart feels on an ongoing basis and the idea of suffering moral injury came to mind. A bit extreme, maybe. I note here that moral injury refers to an injury to a person’s moral conscience and values resulting from an act of perceived moral transgression, which produces a profound sense of emotional guilt and shame and sometimes also a sense of betrayal and anger. Not receiving a gift freely given and not giving a gift in a spirit of love somehow gets felt like betrayal. Perhaps I’m conflating too much here, but maybe I’m not. I suspect that this all relates to attachment theory. Attachment theory is a theory about the evolutionary, ethological (where our behaviour is part of our biology) and psychological relationships between people. Such a theory holds that without a good relationship with caregivers, the infant has difficulty growing up as a social being. Give and receiving is integral to the healthy development of a human being. If there is just giving grudgingly and taking, without much interest in the other person, the process of reception is broken and there is little compassionate connection between people. For a little child, this feels like abandonment.

     A child can be given hundreds of presents (presented with stuff, but not given with love), but with little interest in what that child actually wants. The child is treated like a stranger, some generic creature disconnected to anybody. How desperately sad this is. His self worth isn’t recognized by those important others and, quite likely, will come to not be recognized by himself in time. There are grave consequences to this. A person can go through life feeling like he cannot achieve much; like all he can hope for is to function, but not enjoy very much of life.

      I am reminded of a client I had several years ago. She was a fully trained healer,  but didn’t feel she was good enough to work in her field, even though her teachers said her work was very good.  In other words, there was a discrepancy between how she perceived herself and how others perceived her. My aim was to allow her to experience herself in the act of giving through her work as the same as how others experienced her work on themselves. Giving is receiving and receiving is giving in that time of connection and this integral to good healing practices.

      I taught her the principles of tonglen, where her inbreath was breathing in the light of compassion (a visualization exercise), and her outbreath was breathing this compassion to self and others, so that the breath itself gathered herself and others into a single act of giving and receiving. In time, such a practice becomes second nature where self worth is experienced as compassion to self and others. My client, by the way, went on to open her practice and worked successfully in her chosen profession.

             

 

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

 

September 2021

     A few weeks ago, a friend and I went whale watching off Byron Bay. The day started auspiciously enough when we drove out to the dive shop. Things were going well. We arrived in good time and found a car parking spot fairly close by. At the shop we watched a video on what we might see out on the boat, piled in a bus and headed off to The Pass where the boat was launched by a four wheel drive. The plan was to walk through the shallows and climb into the boat, but first the car had to leave the beach. It couldn’t. It was bogged. The tide was coming up, which didn’t look promising. Another 4WD turned up to get the first one out of the shallow water, but, lo that got bogged as well. A small towing truck turned up to help, and successfully pulled the second 4WD out of the shallows. We cheered. Inexplicably, so I thought, the second 4WD and not the truck went back down to retrieve the first car, which by then, was practically drifting away. The first car was saved, and remarkably still driveable, and the second car went back into the shallows to retrieve the trailer that was partially submerged. That was saved and it and all three vehicles headed back up the beach to the road and away. 

     The tide was coming up and the waves were getting bigger as we, an hour later, waded to the boat. We got aboard and started getting really drenched as the waves crashed on top of us, but we decided to continue the planned expedition out to sea. Turtles swam by, dolphins appeared and disappeared and reappeared, and we saw breaching whales rising and diving as we travelled beyond Julian Rocks. We followed them to the edge of the marine park that is out there and delighted in all the life around us. It was truly wonderful.

     It was, though, getting really late, and so it was decided to return to shore. And so we did. I was hungry, weak with hunger actually, having had only a light breakfast many hours before, so on getting out of the boat I promptly fell into the water. It seems this was serendipity at work for we could  not eat at a particular Japanese restaurant as planned, or in fact anywhere in Byron because I was drenched; socially unacceptably wet all over.

    Now it turns out that this restaurant that we couldn’t go to was the same one visited by a Sydney man and his two sons on the same day around the same time. This little family, it turns out had the covid19 virus. If we had been there, we would have had to be in quarantine for two weeks; or worse, we could’ve got sick. Getting too wet effectively saved us from that happening.

     Serendipity, finding the fortunate while not even trying, feels like a gift. I certainly am very glad of it, but…

     It is easy at such times to try to read much more into such things than may be there. I am, by nature, not inclined to do so. I do not appeal to divine interventions nor other grand schemers, preferring, instead, to determine what I need to do at the time and more or less accept things as they arise and deal with them thoughtfully. I see life as an experiment where we do not really know the outcomes, but where we can explore, test, and examine what happens next. There is life and there is death, for sure, and we are capable of making choices, but there are also things that happen serendipitously. What happened for me could well have been caused by nothing more than an inadequate and too early breakfast. Maybe.

Serendipity, or not, our task, my task, is to act with awareness; to be present and conscious in this beautiful world we are part of, and to be responsible for self, and others as fellow free agents.

 

 

 

 

Projections, Dispassion and Equanimity by Dr Elizabeth McCardell, M. Couns., PhD

 August 2021

     Imagine you are watching a rather intense movie with a group of people and one of them sneezes. Immediately your attention is drawn away from the screen and you return to the present moment with someone saying, “ssshhh, or bless you”. In that moment you are aware of your surroundings: the darkness of the room, the layout of chairs, the faces of the crowd and then your attention is back with the movie. The interruption is nothing more than a brief thing that soon passes, like the upwelling of wind in the trees outside.

     Then you are with a very angry member of your household accusing you of things you know you didn’t do, but they did. You listen to them rage at you, but you take a breath and recognize that their raised temper is their issue, not yours. You recognize that they are attempting to use you as a screen for their own projections, but you feel calm and composed and let them carry on until they lose interest or you simply walk away.

     Then there is a child not doing what you want them to, but instead of screaming at them, you watch your breath and a passing surge of anger, breathe out and – creating space – become mindful of yourself and the situation and calmly choose a different strategy in being with the little one. You might decide to talk with him about what was going on when both of you are happy and calm, or not.

     When we are caught up in the drama of it all and we react with anger we risk losing friendships, burning bridges, damaging our relations with children and partners, and fuelling the fires of our own discomfort and when they get too hot, we often project our antagonisms onto other people, thus repeating the reactive process.

     In an equanimical space of calm, we can learn new ways of being. In that space, the projections of others feel like nothing more than pictures on a screen that we can respond to, or not, without automatic reaction. Here we are able to see what’s happening and why, and we can care about the other dispassionately (caring and not caring at the same time), and we become more resilient.

     Caring, but not caring is to be dispassionate. It isn’t detachment; on the contrary, it is a deep engagement, a loving that isn’t arrogant nor aloof, nor self indulgent. It is a state of being mindful, without discriminating thoughts. From a dispassionate place we can choose right actions, right words as needed by the person and the situation.

     We have choices. We can react in irritation, return anger with anger, or we can let that all pass. This doesn’t mean that we become passive and let things just happen to us, nor allow others to continue to abuse us. We can choose to speak up, and do whatever is actually required of us, or not. Our words and actions then come from a place of deeper understanding than mere reactivity.

     Reactivity often comes from a place of feeling out of control, but sometimes it is habitual and a habit that developed within our family system: all the members of the family operated this way. We can choose to continue to behave like this, or break the cycle and do and be something different, something kinder to our own and others mental health.  Rage doesn’t do us any good if that’s all we do.

     We can learn to maintain mental calmness, composure, and evenness of temper, especially in difficult situations. This is what equanimity is.  Equanimity brings us the pause to recognize we are wanting things to go a certain way and highlights our resistance to feeling out of control.  Knowing when and what to let go of gives us peace as well as a better capacity to speak with other gently, firmly and caringly.

     Mindfulness is key to all this. When we learn to monitor our reactions, slow them down through watching the breath, we have a means to the gift of equanimity.

 

 

 

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.