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”

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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

The Future of Psychotherapy

Peter Bowes introduced the UKCP Conference theme ‘The future of Psychotherapy’. He is to give a one hour workshop from the perspective of a trauma psychotherapist. He asked the group to watch and consider two TED talks on UTube and consider two questions;
1. What is it that each of us believes we are dong as a therapist when in touch with presentations of our clients that point to attachment issues?
2. And when we do what we do, how do we think change takes place?

The first TED talk featured Fin Williams who referred to her personal story that she had absorbed, which was probably an outcome of her parents’ self-perceptions and self-narratives and that those stories had shaped her development. She related how being aware of her own story eventually enabled her to think of herself differently and positively. She also told how she was then able to recall the positive memories of her parenting which had previously remained ‘out of sight’. Fin’s talk ended with her imploring the audience, to write their own narratives of their stories and share them with another trusted friend.

The second TED talk was one of many on UTube by Dan Siegel. He reviewed an aspect of disorganised attachment in five minutes by means of an anecdote of a father telling his son to brush his teeth. This father experienced an eruption of rage when challenged by an attempt at autonomy by his son to not be so instructed. In this presentation, Dan noted how a triggered rage shut down the father’s pre-frontal cortex and how that response might escalate and then lead to an attack on the child. He noted how mirrors neurons would have communicated in both directions the unconscious perceptions and read by both father and son with the concomitant emotions arising for both from the activated neural paths laid down by earlier attachment processes. The father is re-traumatised and the son traumatised (not for the first time one may assume!).

Each of the group courageously then wondered about how they thought as therapists about their client presentations. We challenged ourselves to wonder how we thought that change like that narrated by Fin Williams takes place. It was not easy for us to more beyond change of thinking for the client at first before moving into the awareness that change of feeling was essential. We probably agreed together that therapy required as a sine qua non an authentic unconditional positive regard in which the experience of the client is validated. Dan Siegel’s framework of neuro-biologically informed construal of what happens between human beings requires acknowledgement and awareness of the reality of mirror neurons however and thus the demand upon us as therapists to engage fully and genuinely in a relationship of love of the other. This brings also the demand on us to continuously develop acute sensitive empathic awareness of the other and the capacity and ability to sense whether that awareness is of the therapists feelings or those of the client. Any unacknowledged inauthenticity will be communicated through the activity of ‘mirror neurons’.

The discussion concluded with us thinking about the future of psychotherapy. It is possible that neuro-biological research may lead us to become more aware of the conditions that allow the brain to change and for the ability to reflect on one’s own inner world to develop. Thus self – regulation and personal resilience, deficient due to inadequate attachment processes, might be re-discovered and reformed at a fundamental neurological level. If we do get to understand the conditions that enable that brain change would we not ‘have to’ do what we can to bring about those conditions?

Authors and books mentioned were:
Ecker, Ticic and Hulley, Unlocking the Emotional Brain
Panksepp and Biven, The Archeology of the Mind
Lanious, Paulsen and Corrigan, Neurobiology and the Treatment of Traumatic Dissociation. Towards and Embodied Self.

The Future of Psychotherapy

Is the analyst central to the process of therapy?

How do we use dreams?

In our September meeting, we explored the transference that occurs between therapist and client which, put simply, involves the client projecting onto the therapist feelings about significant figures in their own past. The therapist’s counter-transference is their response to those feelings and can be a useful tool in the therapy.

The article we read was entitled: “Mapping the landscape: Levels of transference Interpretation” by Priscilla Roth from the international journal of psychoanalysis, 82:533-543, 2001

The article looked at transference in a deeper and more complex way and defined four different levels of transference which may be used in the psycho-analytic process and which are considered key to that way of working.  These levels were summarized at the beginning of the article as ranging from:

“ interpretations that point to links between current events in the analysis and events from the patient’s history, through interpretations that link events in the patient’s external life to the patient’s often unconscious phantasies about the analyst and the analysis, to interpretations that focus on the use of the analyst and the analytic situation to enact unconscious phantasy configurations, sometimes pulling the analyst into the enactment”.

We grappled to understand these concepts and how they would operate, in particular the phantasy “configurations”. a  It was helpful that four consecutive sessions of the analysis of a client were presented and demonstrated how the level of interpretation could shift as the level of understanding on the part of both analyst and patient deepened also.

We did, however, have some reservations. We questioned whether the analyst was always such a central figure for the client but could at times be more tangential without this being a form of defensiveness on the part of the client/patient!

We also prefer the more person-centred notion that it is preferable for the client to make sense of their experience

before the therapist offers an interpretation. We had some distrust of the certainty shown by the analyst in the way interpretations are stated and given to the client almost as fact while respecting that this method is based on extensive training and clearly can be effective with long-term clients

who are being seen three, four or five times a week.

The article also contained a fascinating analysis of a dream which was seen as an integral part of the therapeutic process and did yield some rich material.

That led to a brief discussion of how we all work with client’s dreams in different ways, two of us liking the gestalt notion of each part of a dream representing something about the client.

As always, we had a useful sharing of views and support for each other.

Rosemary Pitt, Fells and Dales Counsellors

Is the analyst central to the process of therapy?

Gender Dysphoria in Counselling

For the early April FellsandDales Counsellors, Arlene Istar Lev’s book, Transgender Emergence, (Therapeutic Guidelines for working with Gender-variant People and Their Families, Haworth Clinical Practical Press, 2004,) provided background reading. Chapter 6 explores ‘Learning to Listen to Gender Narratives.

Peter, who provided this material for this CPD session, presented some of his experience in previous years of clients with gender dysphoria. He shared the experience he had had of being disoriented and his experience of considerable incongruence within himself.

The Lev chapter was significantly helpful in its description of three approaches that others have noted are commonly identifiable:

  • Client struggling with Gender-Dysphoria feelings
  • Clients seeking Medical Treatments
  • Clients presenting with Family-Related issues.

Lev’s research and survey of therapists experience includes therefore that the client’s ‘transsexual narrative’ might be the basis for ‘diagnosis and treatment’ and that that narrative contains certain basic criteria without which the term transsexual cannot be valid. These are (p.213):

  • Non erotic cross-dressing and cross-gender behaviours, interests, and expression starting at a young age
  • Disgust regarding genitalia and secondary sex characteristics with a desire to change or remove them
  • And an ability to “pass the real-life test” which includes full-time living in the new gender, often including paid employment or full-time school attendance and proof of legal paperwork changes.

The group members were aware that clients who knew about these themes whether or not they meet the criteria do, if for example they are seeking medical treatment and gender reassignment in particular, will demonstrate compliance by dissembling or lying.

The group were also able to share various experiences with clients where the complexities of our own conditioning, when faced with gender ambiguities, bring about uncertainty and difficulty in listening empathically to our clients. Clients, of course, are likely to sense our uncertainty, and possibly therefore intuit that their own agenda is not going to be met, or register discomfort and give meaning to  it that confirms their repeated experience of not being listened to by professionals.

The chapter, it was acknowledged, does provide very helpful analysis of what may be in the room with us. It would therefore be of  great benefit for reading in preparation should we be fortunate enough to know that gender dysphoric issues were to be  presented. It is possible that such preparation might enable us as therapists to stand on firmer ground from which to observe the array of themes, characteristics, and personalities that are in the room with us. It is possible that such preparation might permit us to really be listening to the client, perhaps to different ego states, maybe to evident mental health issues, and therefore be better able to explore client history objectively without the tangle of counter -transferential responses that otherwise can destabilise us.

Gender Dysphoria in Counselling