Self Harm

Our meeting on March 23rd looked at several papers on self harm, with particular emphasis on self harm in adolescents. We learned something about the on line presence of websites and chat rooms dedicated to self harm and frequented by young people. The positive side being a source of support for young people in unbearable pain.  The negative being a peer group which might encourage self harm and could even promote it.

Chapter 3 of Antonia Murphy’s book ‘Out of This World’ discussed the relationship between self harm and suicide. She sees a difference in intentionality though they are both acts of self aggression. People harming themselves generally want to feel more alive whilst those who are suicidal wish to die. We quickly saw a blurred area where the two acts overlap where long term self harm can lead to ‘acquired capability’ of suicide. Both behaviours come, of course,  from psychic pain and we discussed the importance of investigating the pain and its origins by empathic atunement in therapy. Barent Walsh’s paper on Clinical Assessment of Self Injury concentrates on extracting the details of the client’s harmful behaviour in what he calls  ‘respectful curiosity’ , a term which did not sit well with all of us as it implies therapist distance rather than involvement. We were however agreed that seeking detail might make the behaviour feel more real for the client and conveys a willingness to bear this reality collaboratively. The client’s prior experience of other people is likely to have been avoidant or squeamish.

We came up with a very interesting new idea (for most of us) that morbid jealousy is itself a form of self harm stemming from early inadequate attachment –  the pain of feeling unloved  at the same time as feeling unworthy to be loved and re creating this distress in the self inflicted pain of jealousy.

 

Advertisements
Self Harm

Insights from neuro-biology to soul

A presentation for a workshop first given to a BACP workshop in Cardiff ‘Working with soul in counselling and psychotherapy’ in 2017, was shared with the group by the presenter, Dr Peter Bowes.

Peter’s interest is in developing a psychology of spirituality. He works with his understanding that human beings universally need a language we call ‘spiritual’ to speak of their experience. What is the source of that experience? Before we attribute it to an external influence such as ‘Spirit’ or ‘god’, it is responsible to explore it in other ways and certainly in today’s world to do so with awareness of current neuro-biological research.

The Powerpoint presentation used first the work of archaeologists David Lewis-Williams and Steven Mithen to point back to the ‘big bang’ of human evolution which in say a 6 million year history happened say between 60,000 and 10,000 years ago. This relatively short event saw the end of Neanderthals and the continuation of our species, homo sapiens.

These two authors offer different hypotheses. That of David Lewis-Williams points to the displays on the walls of the Lascaux Caves in the Durdogne. He refers to modern understanding of altered states of consciousness (see for example the work of Charles Tart) to illuminate the role of the shaman in these early communities. However, by this time the Neanderthal extinction had happened. The hypothesis is therefore about the capacity developed by homo sapiens that did not occur in the Neanderthals. Mithen uses his Cathedral and Swiss Army knife metaphors to attempt to offer how the increased ‘cognitive fluidity’ demonstrated by the artefacts left behind by the one and not by the other, might have developed. Each had perhaps the discrete areas of intelligence needed for survival but only homo sapiens was able to have the cognitive fluidity that linked these otherwise disparate intelligences together. Thus archaeologists note, for example, the development of increasingly elaborate burial rituals in homo sapiens which do not occur for Neanderthals.

So already questions form for us as to what prompted that development? What ‘drives’ that development? Can that theorising stay within a paradigm that insists there  is not an external power at work or are we driven in our civilisation to posit external forces and hence our religions or posit aliens and the ‘scientific fiction’ culture that develops with it ?

Another construct found more helpful to the author who is a therapist comes for that reference to altered states of consciousness. The shaman whose experience is of such altered states (dreaming say to psychosis as others might define some such experience), has power which inevitably others want to share. The cave paintings are offered by Lewis-Williams as arising out of that shared experience. No attempt to understand humans neurobiologiclly or indeed within any other disciple can be complete without taking cognisance of the universal and comprehensive experience of such altered states. Books such as The Irreducible Mind  (Edward and Emily Williams Kelly)  and The Mystical Mind (d’Aqulla) make strong pleas for and offer in depth evidence for such states.

More recent research and thinking by Iain McGilchrist in The Master and His Emissary explores the operations and functions of the left and right brain hemispheres and the manner in which each half facilitates and inhibits the other. Again developmentally one might wonder about the need for such difference and sameness and what drives it to occur.

There is, of course, a vast amount of research and literature about these themes. Peter’s aim for this presentation in the context of soul in counselling and supervision is to draw attention to the wondering that happens when considering the apparent ‘big bang’ development in the growth of homo sapiens.

The work of Jaak Panskepp, who sadly died last year, detailed in his The Archaeology of the Mind, brings contribution from his neuro-biological research to our awareness. Acknowledging the plasticity of the mind/brain, he shows the existence of primary, secondary and tertiary brain areas. In the primary sub cortical area, he demonstrates the existence of seven primary affects to which he looks for the origins of our survival as a species and the dynamic that drives our evolution linking to the most fundamental of these affects, that of SEEKING. The capitals denote that this affect is not that we normally associate with our emotions. Further more, Sandra Paulsen, demonstrates that these affects can be damaged by our early attachment processes and that damaged, they can be ‘reset’.

However, returning to the purpose of the presentation, bowing before the extraordinary nature of the human being who is our client, should surely caution us from a profoundly left brain driven belief that we can know what is wrong with them and that by instruction such as that offered often by cognitive behavioural therapies to our tertiary level brain processes – a top down understanding- the desired changes can take place. Neuro-biological research is suggesting or showing to us that ‘bottom up’ processes are essential and that of Panskepp in particular must invite our attention to the conditions that are necessary such that change at primary processing levels takes place. We already know for example that EMDR stumbled upon those conditions some 25 plus years ago and only now is the neuro-biological research beginning to show us why this might be so.

Fundamentally, if we were to ‘know’ what those conditions are, then as therapists we might consider ourselves morally and ethically bound to create them for our clients. This observation will change the way psychotherapy is delivered in the near future.

St Augustine (354-430 AD) sagely observed years ago “Thou hast made us for Thyself, O Lord, and our heart is restless until it finds its rest in Thee.”

Perhaps then we need as therapists to so value and love our clients that we hear more sensitively their experience of their world in their mind/brains with wonder and willingness to learn of the experiences of others. We may be more willing to comprehend the mystery of that experience that needs the language of spirituality, and to listen with awe to the breadth of those expressions. Each of us can be said to be creatures seeking, and that dynamic finds its source in those of our clients as well as our in our selves. What greater respect can we demonstrate? Are we witnesses to the emergence of soul?

Insights from neuro-biology to soul

Vulnerability

At today’s Fells and Dales meeting we used a TED talk by Brene Brown to stimulate further discussion about shame and newer discussion on vulnerability.
Vulnerability requires courage to be willing to be emotionally exposed, unsure or seen by another. The reward is the possibility of connectedness and furthermore ‘it is the birth place of creativity,innovation and change’.
There was general agreement that supervision is most effective when supervisor and supervisee are willing to be vulnerable together. In this environment, creative exploration of new territory becomes possible.
The extent to which a counsellor should show vulnerability in a therapy session seemed to be more nuanced. Sharing uncertainty or disclosing our own vulnerable experiences can be a way of connecting. It might also create what Brene Brown calls ‘Me too’ and reduces any client fantasy that the counsellor is infallible. With many clients, our honesty about not knowing where the therapy will go or if it will help is enabling for the client. Others need to feel something of our experience, and steadiness to enable them to feel hope. This lead us to think about clients who have unrealistic hopes – hope to be rescued for example. We identified that ‘learned helplessness’ can be seen as an adaptive behaviour created to avoid change. It is therefore distinct from vulnerability .
We recognised that becoming vulnerable can be excruciatingly painful and even in a safe environment it is natural to be tentative and  reveal oneself in small steps. We discussed some of the faces of our own vulnerabilities – the pain of being seen (and therefore judged), the pain of being unseen and over looked, the feeling when we let people down, of not being good enough.
Shame and vulnerability and guilt inevitably tangle together and fester in secrecy.
‘Guilt expects punishment while shame expects abandonment’. Guilt comes from a cognitive process while shame is embodied. We were cheered by the good news that ‘The antidote to shame is empathy’.

Vulnerability

Out of this World -Suicide Examined

The Fells and Dales Counsellors group met on August 4th 2017 to discuss a chapter from a book entitled “Out of this world- suicide examined” by Antonia Murphy (Karnak, 2017). This text is a mix of theory and personal experience as the author’s sister killed herself in 1983 aged only 27.

The main thesis is that the act of suicide almost always carries within it an aggressive intent, whether or not this is conscious, and also is an acting out of a fantasy and so demonstrates what she calls ” a delusory aspect”. Indeed the author identifies 5 different types of fantasy, namely (1)the merging fantasy which she suggests underlies all the fantasies where death is seen as a return to a peaceful, womb-like state and the body is killed off as it frustrates or disappoints this euphoric dream. Then (2) the revenge fantasy which the author feels her sister acted out, where the person is preoccupied with the impact the suicide will have on others. (3)acting out a form of self-punishment where there is a strong element of guilt and self blame

(4) an elimination fantasy where “the actual body is experienced as something mad or bad and has to be destroyed for the self to survive”  and (5) the dicing with death fantasy or deadly risk-taking where the person is “both trying to attract and attack the care of the Other” .

She also describes a fantasy which she thinks of as embodying “the deadly heart of the matter”- the delusion that the person will survive the suicide and so be able to witness its potentially devastating impact. She Continue reading “Out of this World -Suicide Examined”

Out of this World -Suicide Examined

Stabilisation strategies

At the July  meeting of Fells and Dales Counsellors we considered the chapter Stabilisation Basics from the book, Neurobiology and Treatment of Traumatic Dissociation: Towards an Embodied Self, Lanius, Paulsen  and Corrigan, Springer Publishing Company, 2014

The stated purpose of giving this material was to prompt sharing about what each of the group recognised they did with clients to facilitate change. The context of the chapter was dissociated clients and their presentation of different ego states as an outcome of trauma in early life in particular and coupled with other traumatic experiences in life.

The discussion included reflections on the theme of meeting the client ‘where they are’ with unconditional positive regard on the one hand and sharing with the client our experience of them and offering education and understanding about the need to create and feel safe in the room and relationship on the other.

We recognised developments in the way in which we approach therapy and the therapeutic relationship and our shared awareness of the move towards perception of the ’embodied self’ and working with visceral somatic experience. Since many clients are not practised at such awareness it follows that facilitating that awareness is the responsibility of the therapist?

We noted that the focus of our chapter being dissociation and the different ego states that can result initially seemed specialised but then noted that creation of a safe place and good enough relationship for therapeutic work was the same. The ‘tools’ were recognisably the same and we were able to review and share what we each brought to that work.

We perhaps also recognised that the future of psychotherapy includes more realisation of ‘bottom up’ processes than the current tendency to focus in the NHS more on top down cognitive processes. If we know how brain processes change, and that a ‘safe place’ and ‘good enough’ relationship are core to that process, then are we not ethically and professionally bound to take responsibility to enable clients to experience calm in order  for change to take place?

Stabilisation strategies

Fragile Process

At the May 2017 ‘Fells & Dales’ meeting, we welcomed a new BACP-accredited member to the group, and discussed the paper on ‘Fragile Process’ by Margaret Warner (2011?) from the Illinois School of Professional Psychology.

 

We began by considering what we understand ‘fragile process’ to mean, and how prevalent this is amongst our clients  –  whether aspects of fragile process are frequently displayed, or whether it is a specific phenomenon experienced by relatively few.  It was agreed that it is closely related to early attachments and a client’s past experience of being understood (or not).  The discussion focussed on what we as therapists are empathising with :-  content or process?  –  what is actually being expressed, or what we sense might be difficult to express?  –   or what might be felt but for which words have not yet been found?  In other words, communicating with that which is fragile.  For example, we might empathise with the emotion a client appears to be suppressing, or with the client’s need to suppress it.  We also asked ourselves if we give evenly suspended attention to all that a client is experiencing, and the extent to which we are necessarily selective in our responses.  It was a salutary lesson to be reminded that clients might not feel properly heard by us, when we pride ourselves on being good listeners!  As Margaret Warner says, ‘Clients usually need more than an accepting presence.’  They crave our accurate understanding, and the validation of their experience, to help them to see that they have a right to have it (a recurring theme of Warner’s).

 

One of our members was able to recount first-hand experience of meeting Margaret Warner, describing the very slow, considered pace of her talking (and presumably her way of working with clients), thereby allowing herself time and space to pay meticulously close attention to her client’s moment-by moment experiencing, and an apparent ability to empathise with all of it, and modelling the ‘non-intrusive empathic relationship’ with which she concludes the paper.

 

As an interesting side-issue, we wondered whether clients might detect a ‘fragile process’ in us, and whether they sense a need to protect us, or to protect themselves from us?

 

We concluded by reflecting on how fraught a therapist’s task is, and asking ‘Who would do it?’!

 

 

Fragile Process

Verbal and Non-Verbal Communications

A reflection on the role of the unspoken elements of communication and on the dimensions of verbal communication beyond the literal meaning of words. 

Westland, G. Considerations on Communications – both Verbal and Non-Verbal in Body Psychotherapy (2009) Movement and Dance Psychotherapy 4:2: 121- 134.

The theme of the meeting of the Fells and Dales Counsellors was based around this paper by Gill Westland that focused on verbal and non-verbal communication.  Although this paper was written through the lens of a body psychotherapists we explored the relevance within our own therapeutic modalities.

This paper opened with the notion that communication and experience involves a verbal element and a non-verbal element.  Both have equal value in therapy.  The paper went on to reflect on language and how it is used to convey emotional communication to try to elucidate our inner world or conversely how language can serve as a defence against therapeutic contact with our inner pain and distress.  There is emphasis beyond the verbal meaning of words to the ‘energy’ communicated, the pitch, the tone and the context that surrounds the verbal and that this carries meaning.  Members of the group related this to Roger’s  – ‘Music beneath the words’.

The paper then went on to explore how aspects of our neural  systems might influence elements of our communication and how we may refer to these within therapeutic settings.  Westland notes the ‘dance’ between left and right hemispheres processes that may manifest as a client moving between factual (left-brain) and what Westland considers more unconscious, inner-process (right-brain).  This is also apparent between the sympathetic (arousing emotions such as rage and frustration) and parasympathetic (calming emotions such as sadness and joy) routes of the autonomic nervous system (ANS) and is useful in working with what Westland terms as therapeutic presence and resonance.

The discussions that emerged through the meeting were varied.

In one thread we further explored the way in which the left and right hemispheres influence the way we perceive and interact in different relational encounters and several interesting texts were noted Ian McGillorist The Master and his Emissary (Left and Right Brain).

We pondered on whether it was possible to offer interactions with clients that may help to build more balance between left and right processes and in emotional regulation or whether this tip-toed into leading clients or presenting an agenda in our work.  There was a shared sense that while we strive for those moments of resonance, we appreciate it is not always possible.  Questions then surfaced around whether the duration of work (mostly with the increasing need to adopt more focused-based approaches) would impact on the ability to truly achieve resonance/presence in the way described by Westland.

This left us with the on-going question of whether we align to a client’s stated verbal goals or whether we should address emerging needs that arise on a more subtle level in therapy, that are perhaps less consciously noted by the client themselves – particularly if working to a designated time scale?

Verbal and Non-Verbal Communications