Journal no 9; 22nd November 2012

This week, another skeleton class, as the dreaded lurgy tightened its grip, squeezing our precious group to the bone; I must admit, I was in two minds about coming in myself, but feeling the commitment to the course had to remain, no matter how crappy I was feeling on the inside, dragged myself in. During check in, other members of the group reported feeling a bit angry and resentful of the fact that, despite their own hardships, they had made it in to the session, whereas the others hadn’t managed to make it their priority. I acknowledged this, and certainly empathised – but was quite aware that actually, that was not how I felt in this situation. Me; I felt proud of myself for having made it in, despite feeling like a sack of dung. Maybe I was in an introverted place, and that is why they were so self-centred, but it did not stop me acknowledging, empathising, and – I think – affirming to the others that it was okay to feel angry. I suppose, with  our knowledge of defence mechanisms, I just knew and understood that their feelings of anger directed outwards, were most probably displaced, and were more about their own frustration at themselves and their own personal struggles with how demanding they are finding the course.

The day was focussed on ‘self’ – more searching back into our own pasts, trying to make sense of our lives – in keeping with these last weeks of studying the psychodynamic approach. On this day, we were given a quote from Michael Jacobs, a leading contemporary psychoanalyst, as a springboard for own reflection;

Part of therapeutic work involves finding expressive language (image, metaphors, narratives, statements, outbursts, drawings, songs, movement etc) for aspects of the impact we have on each other, and aspects of the impact life has on us”

This quote was a revelation for me, in terms of understanding how modern psychodynamic therapy has evolved from the early days of a silent therapist, sitting behind a couch. This emphasises a connection (a continuation of the ideas of Winnicott, Fairbairn and most recently, Hobson) between the therapist and the client – that recognition of our mutual cultural touchstones will strengthen the therapeutic relationship further, building further trust and understanding. In my mind, this fixes the eternal issue for me, when looking at the work of Freud, Jung and the like – the fact that a much clearer picture of the client’s psyche will inevitably emerge, if a strong, trusting, warm relationship is built. The divide that I always perceived between psychodynamic and humanistic approaches is now well and truly broken. One can use psychodynamic theory in a more humanistic way, and reap the benefits of both approaches. Using the past as meat for the dialogue, but engaging with the client in a way that is parallel to that that Carl Rogers defined through his core conditions; Bingo!

To bring the power of this idea home to us, we listened to a piece of music by Shostakovich together, and reported back to each other how it made us feel; what it made us think about. There were many similarities – some said that it made them feel excited and optimistic, think of royalty, grandness. Of course, there were many differences as well in our reactions – after all we are individuals with our own perceptions and frames of reference. But I surmised more similarities. We felt connected by them, just as counsellor and client can, when mutuality is established; a bond created. Knowing that the core theory I am training in is humanistic, I do believe that the connection between counsellor and client is key, the most important element of the relationship. Without this, how could any client could trust the counsellor with their inner most thoughts, feelings, dreams and fears – I know I couldn’t. (Very ‘humanistic’ of me? No! I can be psychodynamic and think this way too! Ha-Ha! Michael Jacobs says so…)

The next few hours were spent looking back on key figures in each of our lives who have had impact on us – not just people, but culture too – films, tv, brands, art, songs, and how they have shaped us. We took a long time to think about this alone, and a long time sharing our thoughts together. The strengthening impact on our group as a result, was HUGE. The level of connection and understanding that sharing of personal reference can achieve really is staggering. Our entire lunch hour was spent reminiscing about mutual songs, films and tv shows we have loved, describing what they mean to us. As a team building exercise, it had a phenomenal effect, but even more than that; it reinforced the importance of an affinity between the counsellor and client, and how culture can be used to express so much, how we all emote through it and personalise it. (I am reminded of my many years of making ‘mix tapes’ in a bid to try to let the recipient know how I was feeling, and equally, the amount of mix tapes I received, in turn)

After such an emotional and powerful morning, combined with my general ‘dung like’ feeling that I have already described, it seemed ok in the afternoon skills session for me to take a step back from baring my own soul. I found myself in a session where my client wanted to talk, no – NEEDED to talk about issues she was having with her marriage, and how her growing self-awareness was impacting on that – an issue close to my own heart in many ways, having been in that position myself. I felt the value of my level of understanding, and responded accordingly, by stepping back from taking my turn to be a ‘talker’ (client) and giving her the whole duration –  a double session effectively. She needed it, and I needed to feel the affirmation that I was useful to her too. I enjoyed the separation of her feelings from my own, despite the similarity of her situation to my experiences. To be honest, my own experiences were completely disconnected from what was going on between us as client and counsellor in the room, it was really only afterwards, on reflection of the session that I even thought about them. Whilst I was with her, in the session, I was focussed on the here and now of what she was saying, HER here and now, and mine was only in relation to her and what she was telling me.  During this long, powerful session, I briefly found myself in a moment where the gestalt ‘empty chair’ technique seemed appropriate to use, but, unsatisfyingly, on trying it, found it did not sit well with the feel of our session – although my approach is definitely humanistic; honest and even a little confrontational (in a gentle way, I hope), I don’t think that I enjoyed the feeling of using that technique. Oh well, lesson learned. The session was good, other than that. – I think I pulled it back!

Which takes me to the end of the day; a short debrief and an early finish. For such a short time, we did a huge amount of work – well, I know I did, and I know that I achieved a huge amount of learning…

 

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journal no 8; 19th November 2012

I arrived for this session feeling somewhat ‘under par’ and was surprised, on arrival, to find that I obviously wasn’t the only one – it transpires that a nasty bug has swept the class, and only 6 of us managed to make it to college. So, a much depleted group checked in, reporting a mixture of feelings – me, being unusually blunt and candid about just how rubbish I was feeling. For some reason, in the car on my journey in I had been overcome with a terrible wave of upset and tearfulness, despite my best efforts to put my ‘chirpy, sociable College hat’ on, and I just felt too upset to pretend I wasn’t – sometimes it is just impossible to carry on, regardless; particularly in an environment where you are being encouraged to be in touch with your feelings, as we are.

So, it was with a level of discomfort that I began the first assignment of the day – a review of psychodynamic theory, and how we have personally related to it. We were given only an hour to get our thoughts down (in preparation for the exam conditions we will face) and I disappeared off to the LRC to place myself in front of a computer, where I could access my notes. The hour flew by in what felt like seconds, and I returned to the class to share my findings with the rest of the (tiny) group. In retrospect, I think that the group size, combined with my already delicate demeanour, made for an extremely intimate and particularly open debrief.

Feeling somewhat vulnerable, yet unafraid to be fully present in the activity (as the level of support that I feel within the group is huge)  I began the next exercise – a set of open ended questions designed to reveal to us what really is lying within our subconscious. *sigh* Well, what can I say? By the end of this exercise I was close to flat on the floor.  I’ll publish this exercise as a separate blog post so you can read how it works, if you want – or breeze over it – whichever…

What a thoroughly depressing set of answers I put forward!  The obvious truth was glaring hard at me; I was sliding – I could feel myself sinking further and further, and I was getting more and more anxious and frightened about it. This feeling had begun a few days before, when I had received some bad news in the post from the welfare support benefits agency. It was probably a bit of a trigger, as the depression that I had been trying so hard to keep at bay for the last few months –certainly since the beginning of this academic year – was hovering around my peripheries, waiting for the moment it could sneak back in and swallow me up again, and it was getting perilously close to finding one.

The practice counselling session that followed on from the quick answer exercise began with me as the talker. I probably made a mistake there – maybe if I had composed myself enough to be the listener, I would have held it together for the rest of the day? No point in wondering about that now though, because I didn’t.

I started talking, and then I started crying, and once I had started crying I found it nearly impossible to stop. All of my fears came out – I told J (my counsellor for this session) about my psychological assessment I had last week, and my fears of an official bipolar diagnosis, and a change to a stronger medication as a result of that. She questioned me as to why I was afraid of that – after all, I hadn’t been so upset when my son was diagnosed last year? I had been relieved that he was finally going to feel better. But on further thinking, I decided that relief was my own – I wouldn’t have to worry so hard if I knew he was being ‘treated’ correctly – just as I felt that those around me wouldn’t have to worry so much about me if I am medicated more heavily than I am currently. But there is a big part of me that is scared that I will never feel happy again if I take these stronger meds. I mean, I know that when I am down I am really down, but at least when I am, what they call, ’hyper’, I feel productive and successful. It may be a somewhat deluded perception of self, but it is preferable to the negative, hopeless, lethargic underachiever that I am the rest of the time. The other big fear that goes with that, is the fear that I will become even more like my Grandma – that I will spend my life suppressed by drugs, and will die lonely, having never truly lived my life, having had a mere existence.

Wow! Rollo May or Irvin Yalom would probably have a ball dealing with my overwhelming existential angst that this personal setback, combined with the shock and realisation that some psychodynamically orientated introspection  has brought on, but I felt quite guilty that I put this much onto a fellow student. It was probably too much for her to deal with – I could feel her instinct as my friend (within the group) even though she was my counsellor (within this setting), and she was struggling with her inbuilt desire to rescue me, to make it better. Credit to her, though, she resisted well.

The level of upset within me was indescribable – even after the session stopped, I couldn’t stop crying – it was that really deep, really snotty and wheezy kind of crying (you know, that Juliet Stevenson did so well in ‘truly, madly, deeply’ – remember that? I’ve never seen such realistic, hard crying on a film since then) and the inbuilt instinct to close my eyes and sleep after that, was close to overpowering me through the process group and the supervision part of the afternoon. I am extremely embarrassed to say that I even answered a question with “I don’t know” – a phrase you will not hear me offer very often (I am someone who generally has an opinion, or wants to offer input to most discussions) but I really did feel completely spent – a bit broken, even. I couldn’t concentrate – even now, writing this journal the next day I am finding it hard to concentrate.

Still, it is done now; my bad day is over – I may still feel the remnants, but the journal is written – I can put this to bed, and hope that this Thursday’s extra workshop goes better for me. It will, I am sure; it has to!

 

 

 

Journal no 7; 12th November 2012

This week, we spent our morning studying ‘Hobson’s conversational model’ ,  (Robert Hobson, an English psychotherapist  born 1920-died 1999) which has been more recently called a  ‘psychodynamic -interpersonal approach’ to therapy.

At the core of this approach is the concept of self by William James, the philosopher, who said that;

(1) All thought is owned by some personal self;

(2) All thought, as experienced by human consciousness, is constantly in flux and never static;

(3) There is an on-going continuity of thought, as it moves from one object to another, constantly comprising shifting focus and context

(4) Thought typically deals with objects different from and independent of consciousness itself, so that two minds can experience common objects

(5) Consciousness takes an interest in particular objects, choosing to focus on them rather than on others

In my opinion, these concepts naturally lend themselves as cornerstones for a therapeutic process – although it is one that Hobson was ‘unwilling to present as a fixed and definitive set of ideas. To me, it is about fluidity, flux and flexibility, about the process of change – and for that reason, I really resonate with this. (In fact I would say that in reading his ideas on the page, it seemed to articulate all my intuitive thoughts on the essence of the counselling process)

The approach was originally called ‘conversational’ because of the emphasis on the use of language. Hobson stated that the therapist and client have a ‘special friendship’ – therapy, and the therapist  can build this relationship through developing a mutual ‘feeling language’ . The therapist can be with the client ‘together in their aloneness’, thereby helping the client through the development of this relationship and the healing power of ‘being there’ with them (echoing several other attachment theories, to me – I recall Fairbairn and Bowlby talking of rebuilding insecure attachments)

Hobson holds true the fundamental notions of psychodynamic theory; that people repeat destructive relationship patterns from the past, that we all use defence mechanisms to shield ourselves from difficult internal feelings, memories and desires, that our problems can stem from unresolved developmental tasks, that we have a need for secure emotional attachments and that the therapist in working with these issues must be aware of transference and counter transference occurring. Yet to me, it seems that his approach bridges the gap between traditional psychoanalysis, where the therapist is at a distance from the process – abstaining from any self- disclosure or impacting their own personality on the therapy – and humanistic approaches, where the therapist is almost as much a part of the process as the client; where the relationship is the key which unlocks the therapy. The concept of ‘aloneness’ is undoubtedly an existential issue, which requires warmth and compassion in discussion, and imposes personality on all who discuss it. I feel it is this concept of the therapist being integral, as an individual, to the process, that brings the psychodynamic approach up to date – shedding the image of a cigar smoking doctor, holding a notebook, sitting behind a client on a couch, saying very little, and I like that it does that.

AS a group, we spent a long time discussing our inbuilt need to feel some kind of resolution from the counselling interview – that as keen students; heads exploding with theory, we are unconsciously striving to apply that theory and to see some kind of progress being made, for our own satisfaction and the consolidation of our learning. However this is not necessarily what is always going to happen, and often it is just not necessary – the process in itself is enough, and trust and faith in the long term power of the process and respect for the client’s autonomy in their own change is vital, and must be remembered. Often, we are so engrossed in the story being presented, that we forget about the process itself. Supervision is the place where we need to take our reflections on the session, and use our supervisor to help us clarify the power of the process as much as the theory and story. Hobson’s model exemplifies this beautifully.

Luckily for me, I had only recently watched a video of myself counselling, (and bizarrely, fortuitously, one where the volume was very poor) and so I had a slightly more objective view of my own experience of the counselling process to draw from. Because of the poor volume, I had paid extra attention to the body language used, the intonation in voices, shifts in rhythm and the overall feel of the session, and in my reflection I felt my eyes being truly opened to my own abilities as a counsellor. I saw so many areas for improvement, and so many new areas for future work. The benefit of reflection like this is huge, again highlighting the importance and huge gains to be made from supervision. The supervisor is the third person in the relationship, providing that objectivity of someone from the outside looking in – vital and so valuable!

I don’t know whether I was invigorated or intoxicated by this idea, but (in retrospect, foolishly) I put myself forward to be recorded again in the afternoon, and let the whole class watch my abilities as a counsellor on the big screen – an exercise in studying ‘the process’. Why, why, why??? BACP Self care – lesson to be learnt, K, you are not a natural extrovert! Why do I feel the need to constantly push myself forward towards other people with my own personal learning? Firstly, allowing myself to be counselled in front of the whole class during the last lesson of last year, then blogging this journal, then doing this??? Is it for the adrenaline rush? Cos I feel so awful afterwards, having done it – but then I am well aware that I like making myself feel uncomfortable, as I am secretly pleased with myself for having pushed myself through the pain. Ooooh, this really is stuff for my therapy – I’m hearing echoes of the eating disorder inner voice coming back “punish, punish, take control,” as well as the overactive superego, my family telling me ”don’t be shy,” and Fairbairn’s internal saboteur; setting myself up for criticism and failure, some external punishment for my internal self- hater.

Sadly, the crash after I did this, did exactly what the saboteur wanted – set me up to fall, and I felt myself crashing after that – not that anyone around me would have known – well, I may have been slightly quieter outwardly, but I know that I do a very good acting job – I have been perfecting it for nearly forty years now!  The rest of the afternoon was a blur to me, and that evening, and the next day too. It is only now, two days later, that I feel able to write about it, and I still don’t understand it.  More exploration  needed, plainly…

 

journal no 6; 5th november 2012

A recap on all the psychodynamic practitioners we have looked at this term, to begin with;

FREUD –  levels of consciousness (unconscious, preconscious, conscious). Structure of personality (id, ego, superego) Pleasure principle and reality principle, defence mechanisms, dream analysis, free association, transference and counter transference, psychosexual stages of development (oral, anal, phallic, latent, genital)

JUNG – analytical psychology, archetypes – animus, anima etc, shadow, personality types – thinking, feeling, Intuiting, sensing, transcendental meaning, individuation – spiritual growth, synchronicity, collective unconscious, personas

KLEIN – attachment theory, child analysis, splitting – good breast, bad breast, object relations, depressive and schizoid positions, play therapy

WINNICOTT – ‘good enough mother’, ego splitting, transitional objects, art/ drawings, nursing triangle, space between, focus on environment and relationship with it

FAIRBAIRN – object relations, driven by attachment, working beyond transference, creates real relationship with client, internal saboteur, attacking/resisting object and exciting/disappointing object, attachment with self is important re attachment to others

BOWLBY – attachment, mother-child, separation, secure base, loss, attachment styles – secure, avoidant, ambivelant,

ERIKSON – psychosocial stages, identity crisis, identity achievement, moratorium, foreclosure, identity diffusion

A little more time was spent recapping Erik Erikson, as we hadn’t looked at him in about a year. Here are his stages of psychosocial development;

1. Infancy: Birth to 18 Months

Ego Development Outcome: Trust vs. Mistrust
Basic strength: Drive and Hope

2. Early Childhood: 18 Months to 3 Years

Ego Development Outcome: Autonomy vs. Shame
Basic Strengths: Self-control, Courage, and Will

3. Play Age: 3 to 5 Years

Ego Development Outcome: Initiative vs. Guilt
Basic Strength: Purpose

4. School Age: 6 to 12 Years

Ego Development Outcome: Industry vs. Inferiority
Basic Strengths: Method and Competence

5. Adolescence: 12 to 18 Years

Ego Development Outcome: Identity vs. Role Confusion
Basic Strengths: Devotion and Fidelity

6. Young Adulthood: 18 to 35

Ego Development Outcome: Intimacy and Solidarity vs. Isolation
Basic Strengths: Affiliation and Love

7. Middle Adulthood: 35 to 55 or 65

Ego Development Outcome: Generativity vs. Self- absorption or Stagnation
Basic Strengths: Production and Care

8. Late Adulthood: 55 or 65 to Death

Ego Development Outcome: Integrity vs. Despair
Basic Strengths: Wisdom

 

So, what do Erikson theories mean for me? I’m bang on cue, according to him. At 38 years old, having been divorced at age 35, I leave the young adulthood stage having been focussed on intimacy with my husband (I met him at 18) and  the solidarity of my family, and finding myself very much dealing with the issue of isolation as a result of having been unsuccessful in that  stage. Nowadays my focus is now firmly on my career (hence this training), and finding meaning in my life through what I do, and how much I contribute to society. At times, when I feel that I am not succeeding with that, I do find myself feeling as though I am stagnating, and that my self- absorption is my undoing. But of course, that is the peril of doing this course; there is a fine line between self- awareness and self- absorption, one that is easily crossed from time to time, and I have to be aware of that and the social consequences that brings as well.  Oh, I would love to talk psychological theory all day and night with whoever would listen to me (my poor children bear the brunt of that, I’m afraid – we often joke that they know more about Freud and Jung than most adults three times their age do), but I know that it must come across as boring and self-obsessed. Good thing, I am not married any more, really, because I can’t see how the strongest marriage could survive this kind of scrutiny!

Although I feel that there can’t be many relationships that can cope with a shake up this violent – I honestly do think that my children and I are coping better as a family unit, for it. I hope that my bringing them up with these ideas consciously  in their psyches helps them with their understanding of the world. They are between the school age and adolescence life stages, and I spend a lot of time advising them on the ‘pack mentality’ of their peers, and their fears of inferiority. The ‘moratorium’ that Erikson defined, where the adolescent goes through a period of withdrawing from responsibilities is well and truly happening in this house! It is hard to deal with, but I really do think it would be harder if I had to deal with a husband who refused to understand it as well (my ex husband thought that most psychological theories were patronising and ‘airy fairy’, not realising he, himself was a walking text book case study!)

Too much time spent talking about that stuff – the afternoon was spent being videoed in counselling skills practise, as part of our assessment process. How was that?  Horrendous! Nobody likes looking at themselves on tape, do they? Let alone people who have piled on over two stone in a year? I looked like a chubby middle aged jewish woman – which I suppose is what I am, really – but blimey – I have never EVER thought of myself in that way before, and to see myself in that way is erm, sobering to say the least. Oh well, diet tomorrow…

Jokes aside though, the taping of the counselling session was fun – it was good to see beyond my cringing, and note what sort of counselling skills I used. I hadn’t realised what an expressive face I have! To watch my face change through the session is almost akin to watching a mime – I think I need to work on toning that down a bit – hard, when it’s a completely unconscious process, though. There are many changes to be made; it is a process I would very much like to do again, perhaps towards the end of the course, to see if I do manage to change and evolve my style. As Erikson himself said, “There is in every child at every stage a new miracle of vigorous unfolding.” –  a metaphor for the continuing evolution of personality over time – after all, we are not ‘complete’ by the time we are 5 or 12 years old. We continue to evolve throughout life (and so will our counselling skills, hopefully)…