NEWSLETTER
2005 Articles
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'God lead us to the slow path; to the joyous insights of the pilgrim; another way of knowing: another way of being.' Michael Leunig from The Prayer Tree
What does the Hakomi method of psychotherapy have to say about the narrative aspect of our lives? When we think of narrative, it is usually about words and language, both inner dialogue and our verbal communications with others.3 Some therapies focus on the words, on what we tell ourselves about ourselves, our lives, and the world we live in. As a psychotherapist I have observed many times that clients have a dual level of meaning.4 They 'know' in a rational mind way, and can tell the story of their lives in a way that supports self-esteem and a positive outlook, even when a contradictory 'story' operates. Or they may use their stories to distance and deceive self and other. Sally, is an intelligent woman. She knows that the abuse that happened to her as a young child was not her fault, she is aware that her mother's craziness did not happen because she was a bad child. Yet Sally constantly struggles with crippling anxiety that she has not done well enough, and when people affirm her she has this deep sense that if they really knew her they would not like her. She writes positive affirmations in her journal, has them up on the bathroom door, says them over and over each night, and yet she cannot shake this feeling of being a bad person. This less coherent, underground narrative haunts her continually. The ghostly narrative has influenced many of her choices and actions and distorted some of her perceptions, thus shaping the course of her life, and her current, conscious story of who she is. Hakomi is a method of psychotherapy that involves self-study in mindfulness. The method allows us to activate early memory patterns that are principally somatic, visual and emotional in nature, and thus discover the ways that we are unconsciously organized around certain issues. Ron Kurtz, the founder of Hakomi, describes how the child is the map-maker.5 Many of the core imprints are formed very early in life, as a result of the relationships and the nature of attunement from others toward the baby and young child.6 The foundation stones of our narratives are formed from the perspective of the child mind, and are greatly influenced by the egocentric, magical, emotional impressions typical of the young child.7 In Hakomi psychotherapy there is recognition that the body and limbic system of the brain hold the imprints of the deeper truth of our lives. This'story' is written into the implicit memory system. It is formed early before words or narrative memory are neurologically possible, and is held in the body, in the cells, the muscles, and the neural circuitry of the right brain and limbic areas.8 9 These memories form the deepest layers of our stories, our longings, our limitations, along with habitual patterns and defensive behaviours. And it is this subterranean layer of information that profoundly influences the nature of our word-based, conscious narratives. And sometimes it is a very different story that lies beneath. Using the mindful, attentive, non-violent techniques of Hakomi we can contact the truth of this deeper embodied 'narrative'. By slowing things down, creating a safe, loving therapeutic relationship, by listening to the intelligence of the body, and honouring what unfolds, we can come to know the deeper truth. We can bring our 'narratives' more into harmony. Symptoms start to make sense. We gain a richer appreciation of past and present experience. Core beliefs can be renegotiated making it possible to transform limiting, automatic patterns. Reconnection with deep meaning and purpose can occur. Self-acceptance and compassion is nurtured and the balance of body, mind and spirit can be restored. As we come to experience our own aliveness, our conscious narratives are likely to change.10 11 In Hakomi the personhood of the therapist is vital to the success of the method. In trainings students are encouraged to develop their own compassionate qualities, study their core beliefs and character patterns, and embody the principles in their work. The therapeutic process is dependant upon the personal attributes of the therapist, which allows them to live the principles in the therapy, enables effective use of skills, and the establishment of a safe, attuned therapeutic alliance. Attachment theory stresses the importance of the caregiving relationship in development, and also in the later 'repair' of early negative imprints and their sequelae.12 The literature on attachment shows how our early relationship experiences influence the manner in which we form the stories of our lives. Those with ambivalent attachments often tell stories that are long and highly emotional, those with avoidant attachments tell stark, brief stories without biographical detail. Children who have experienced trauma have narratives that are disjointed and confused.13 Over time, in the attuned, compassionate relationship of psychotherapy a secure attachment style can emerge, with all the positive benefits for sense of self and relationship ability.14 The narrative begins to change accordingly. Therapeutic change also occurs in unconscious ways, which the client may never articulate. The Hakomi therapist recognizes that meaning making is a vital aspect of human life.15 Discovering the meanings made early in life, exploring the emotions tied up with certain understandings, and reformulating meaning that is more in accord with the person's current values and experience, are all important in the therapeutic session. Sally, in a therapy session, was re-experiencing her child consciousness related to when she was seven years old. She again felt the confusion, terror and pain of her little girl self watching her mother use a sharp knife to cut herself. However, in the session there was a difference. Her compassionate adult self was there to notice, and give a new perspective. The therapist was there also, giving safety, support and affirming the mature wisdom of Sally as adult. In that moment Sally saw so clearly how she as a child was blaming herself, wishing she could be 'more good' in order to 'fix' her mother, and thus bring some order to that frightening, out-of-control situation. Sally, as adult, gave her child-self a missing experience. She 'held' the little girl and told her how it wasn't her fault, acknowledged how scary it was for her, and let her know that she was good, but being good couldn't fix her mother. The 'old narrative' was coming more into line with a new, more realistic and positive story. Over time Sally didn't need the affirmation rituals. She walked with more confidence, and her eyes were less startled and more sparkling. She talked of her crazy mother with feeling and calmness, in a coherent way that had new details, and even humour at times. Some aspects of her therapeutic change she could make sense of and weave into her 'therapy' and life stories. Other aspects, however, I believe were occurring implicitly, below the level of awareness. Changes were likely occurring because of the attuned limbic resonance, the subtext of her story was transforming and new patterns were probably being imprinted in her unconscious memory system. At times of stress for Sally old negative automatic thoughts did filter upwards, but she found she could easily counter them, and the churning in her stomach that used to accompany them had gone. As a Hakomi psychotherapist I am often in awe of the
power of the method to access core issues, and effect deep therapeutic
change. To cite Halko Weiss, a founding Hakomi Trainer, 'Hakomi
becomes an extremely fast and effective method for exploring, processing
and healing one's deepest hurts.'16 I often am
moved and inspired by my relationship with my clients, and by their
stories. I am also aware of the healing power of fully integrating these
experiences and making meaning of them in terms of current life values
and relationships. I have personally found that adding some insights
and questions from Narrative Therapy has enriched the integrating process
of Hakomi. Hakomi is traditionally a method for individuals to become
more and more mindful, and deeply aware of their inner lives, along
with their behavioural and emotional patterns. Some Hakomi therapists
are now expanding the method, adding to the focus on the individual,
inner world, and moving to what is beyond. Hakomi is growing to include
therapeutic work with relationship dynamics,17 18
19spirituality,20 and social systems.21
In this way it is possible to use Hakomi to further enrich the narrative
at all levels of life; personal, relational, spiritual, and social. |
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Over this past year of transformative personal and social change I have been greatly nourished through meeting regularly with each of five friends. In each pairing we share mutual reflections on our lives and its vicissitudes. In each pairing a different Susanna is drawn to life, each relationship drawing forth a uniquely co-created perspective and way of telling the story, the many stories. Each with different details enjoyed and exchanged. Each pairing has its own angles and wisdoms, its own fruits. Each conversation opens to a particular realm unlike any other. Each realm waits for the pair to return to its stream of consciousness. And then again there is the narrative that appears in my personal journal. The story I tell myself; the conversations between different aspects of myself to free me for peaceful sleep. Sturdy Susanna, outraged Susanna, fragile Susanna, wise Susanna, philosophical Susanna, worried Susanna, peaceful Susanna. I tell my family to make sure they burn my journal without reading it if anything happens to me. It is not the full picture, I tell them, I use it to have a winge. My meditation teacher says, 'All imaginings are the invention of the mind. All memories, all constructions of experience, all dialogues.' As a counsellor I am attentive to all of these, these being the focus of the counselling exchange – within a background of affective resonance energized between us. My meditation teacher says,'The goal of meditation is the stilling of the Mind. So Mind withdraws to the back of consciousness. (He demonstrates with a gesture, pulling fingers into a point from between the eyes towards the back of the head.)…. So the Real Self can be experienced directly, which is peace.' Sometimes I (dare to) wonder whether the conversations of counselling and the deep conversations between close friends, are the meditation technique to open the mind, to still the mind, so something else can be experienced directly, the resonant field itself. There is the narrative, the sound, the movement, the story and the meta story. There is the resonant field generated between the counselor and client in which the greater story of the Self can emerge into the light. This can be seen by both, can take shape in the present moment of connection and becomes a springboard for renewal in engaging with life. A line comes to mind from my early religious education;'In the Beginning was the Word. And the Word was with God. And the Word was God'. Currently I am relishing a return to an experiential
training process, that of Hakomi, a body-centered psychotherapy. In
this later stage of my life and professional practise it is good to
loosen again the set pieces in my mind from earlier trainings and become
open to being held in the large narrative of a group process. In particular,
I enjoy pondering the ancient meaning of the word Hakomi which is native
American Hopi for: 'Where Do I Stand in Relation to All The
Realms?' |
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Grief is a normal reaction to loss and in this context refers to the distress resulting from bereavement. It represents a 'complex set of cognitive, emotional and social difficulties that follow the death of a loved one'. 'Individuals vary enormously in the type of grief they experience, its intensity, its duration and their way of expressing it' (Christ et al., 2003, p. 554). Grief can be influenced by a person's age, their stage of development, their gender, a previous history of loss and/or trauma, a history of a major depressive order, and the type of loss they have experienced, (whether it was anticipated, violent or traumatic). In addition, cultural norms and spiritual, religious and philosophical convictions need to be considered. Bereavement refers to the loss of a loved one by death and in its broadest terms encompasses the entire experience of family members and friends in the anticipation, death, and subsequent adjustment to living following the death of a loved one. Bereavement includes the internal psychological processes and adaptation of family members, and expressions and experiences of grief. It also encompasses changes in external circumstances such as alterations in relationships and living arrangements (Christ, et al., 2003). Most grieving people show similar patterns of intense distress, anxiety, yearning, sadness and pre-occupation and these symptoms gradually settles over time (Allumbaugh & Hoyt, 1999). The majority of the population appears to cope effectively with bereavement-related distress and most people do not experience problematic grief or adverse bereavement-related health effects. Some people however, will be so overwhelmed by grief that it becomes 'preoccupying, incapacitating and immobilising for a prolonged period in a way that causes concern to the bereaved person and his or her family' (McKissock & McKissock, 1991, p. 679). Researchers have hypothesised that this small, though significant percentage of the population (approximately 9% - 12%) experience complicated grief, and that these individuals are at greatest risk for adverse health effects (Byrne & Raphael, 1994; Middleton et. al., 1996; Prigerson & Jacobs, 2001). The nature of complicated grief and its relationship to other syndromes and conditions and questions about how complicated grief should be defined, assessed, and classified, are topics of significant and persistent debate (Stroebe et al., 2000). In a recent Report on Bereavement and Grief Research (2004), it was noted that 'there is tremendous variability in perspectives among researchers in bereavement and grief research' (p. 499) and that distinctions between bereavement and grief have been inconsistently maintained in research (p. 498). In addition, there is great diversity in the use of adjectives used to describe variations from normal grief. These adjectives include absent, abnormal, complicated, pathological, distorted, morbid, maladaptive, atypical, intensified and prolonged, unresolved, neurotic, dysfunctional, chronic, delayed, and inhibited. The conceptualisations of complicated grief also differ according to the theoretical approach taken by the investigators (Stroebe, 2000). This definitional and theoretical confusion leads to uncertainty for health care providers and services that endeavour to make sense of the complex and apparently conflicting literature. Notwithstanding these debates, several consistent factors have been identified that may pre-dispose an individual to a complicated grief reaction. These include situational factors related to the death, such as, whether the death was sudden or anticipated; personal factors such as gender and characteristics prior to the death such as the relationship with the deceased, emotional stability, religious beliefs and practices, and self-esteem; and interpersonal factors such as the availability and use of social and emotional support from family, friends and community (Stroebe & Schut, 2001). Other risk factors commonly cited include previous unresolved grief, concurrent crises or a pre-existing psychiatric disorder. In therapy practice, a careful history-taking forms the basis of risk assessment. It is also important to be aware of the range of normal reactions to grief. For example, on a physical level, an individual may experience a feeling of hollowness in the stomach and tightness in the throat or chest. There can be breathlessness, muscle weakness, a lack of energy, dry mouth and over-sensitivity to noise. Some people may experience a sense of depersonalisation. In addition, there can be many emotional responses to grief. These include anxiety, fear, sadness, anger, guilt, inadequacy, hurt, relief, and loneliness. People who are grieving can also demonstrate many behaviors that can be considered part of the normal response. These can include crying, sleep disturbance, sighing, restlessness and over-activity, appetite disturbances, absentmindedness and social withdrawal. On a mental level there can be disbelief, confusion and pre-occupation. In therapy practice, it is important to be aware of normal responses and risk factors because it is one way of understanding what grief means for a particular individual. The significance of these factors is how they can help to understand what someone might be feeling and experiencing and therefore what support might be offered. However, when risk factors are present with an individual, it does not necessarily mean that their grief response will be abnormal. However, they may need more on-going support and referral. In summary, complicated grief is not indicated by signs or reactions that are different from normal grief, but is characterised by the persistence of these signs and reactions to the extent that the person is unable to take up a satisfying or meaningful life. The majority of studies support a concept of complicated grief reflecting prolonged intense separation distress, preoccupation with images of the deceased and distress or avoidance at reminders (Raphael & Minkov, 1999). However, it is also important to note that in some cultures quite elaborate avoidance practices are used that would be considered the norm for these groups. Whilst there is a lack of evidence for good practice
in bereavement research and counselling services, especially for those
who might be 'at risk' of complicated grief following bereavement,
the implications for clinical practice are that a careful assessment
of the nature of the relationship, the nature of the death, previous
experiences of loss, previous and present coping strategies and access
to social support will remain the cornerstone of client-centered bereavement
counselling. |
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Buddhist Psychotherapists share common approaches to work with grief and loss among their clients. These include:
I would have the client tell me where in the body
the sensation of blocked breath is concentrated when they recall the
loss. Once identified, I would request they draw the shape of the blocked
breath. Then we would commence a mindfulness breathing exercise focusing
on breathing into the part of the body where the breath is not moving.
The assumption in Buddhist psychotherapy is that there is an intimate
connection between body and mind. I believe we store grief in the bodily
cells by constricting breath in that part of the body in an attempt
not to feel the pain of the loss. By restoring breath to this part of
the body through a breathing/meditation process, we bring back life
force and consciousness to the place of 'loss' which is holding
us in a degree of 'stuckness'. As the client continues to
breathe into the area, they will often start to weep slowly. Such a
meditation would continue for up to 20 minutes. At the end of the process,
I would have the client touch the part of the body where the original
blocked breath was experienced and draw how the breath is now flowing.
In the degree to which this breathing intervention has been successful
the second drawing will show a movement from dark to lighter colours,
from contracted to expanded shapes and a movement from irregular to
regular or more flowing lines. Here I am working with the client's attachments
to the lost person or situation which results in aversions or desires.
I will focus on desires here to illustrate. As a result of the loss
the client now experiences a range of missing qualities in his/her life
that previously were projected onto the lost person or situation. They
feel unable to move on because of feelings of emptiness or powerlessness.
I ask the client to name the missing qualities and work with them one
at a time. If, for example, the quality was joy, I would have the client
receive joy from a human or spiritual resource that he/she chooses and
breathe in the joy they receive form this external resource until he/she
can give it to himself/herself. We would continue breathing in joy,
giving the breath a colour, sitting or walking in the gesture of joy,
drawing or making the gesture of joy in clay or a colour medium until
the person feels the new gesture of breathing of joy in their body.
I work using a range of artistic mediums until the new thought/ gesture
of the missing quality is strongly imprinted in the client's body
and mind. I would conclude by brainstorming with the client ways to
enlarge the quality of joy in his/her external life as well. Here I would dialogue with the client to create a
clear understanding of the suffering caused by unskilful attachment
to qualities of a person or situation without taking responsibility
to cultivate those missing qualities in the client's own life.
I would distinguish this from skilful management of loss where one continues
to breathe from a position of equanimity and non-projection. Here the
client can honour the gifts of the person or situation brought to their
life. This leads to the expression of gratitude and the cultivation
of loving-kindness towards self and the other. We work together to create
a ritual to honour the gifts received, for example, 'the essence
of father-soness,' and 'the passion of the lover.' The
client may choose to write a poem, draw or paint, plant a tree or a
rose garden. Always the choice engages the body and mind in activity
so that the new skilful imprint of acting from centredness and equilibrium
is experienced deeply. This work may take several sessions and always works
at the clients pace to assimilate into his/her body and mind the new
processes of breathing, the new skilful thought patterns and the new
experience of meeting his/her own needs rather than projecting these
onto others. |
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'He became aware of the 'function' of the self-object (David), as he explored with the patient the positive,
self-sustaining, self-repairing, and self-regulating nature of the woman's 'moribund' attachment to her son. Once he ceased to promote
decathexis and began to explore the functions of the self-object in the area of affirmation, mirroring, and merger needs, he noted a change
in the ambiance of the treatment and revitalization of the treatment relationship.' In working for many years with people and families experiencing disability, chronic and terminal illnesses and bereavement I have learned the dangers of adhering too steadfastly to one prescribed therapeutic approach. The accumulated interactions with my clients, the transferences and countertransferences we have necessarily encountered together while focusing upon significantly painful losses in their lives together with the periods of their associated despair and pining, have raised for consideration by me, several therapy practice issues in regards to grief and mourning. Fundamentally, I view grief as essentially a universal human response to the loss of a loved one, the loss of an object of attachment or the loss of a place of great significance. I do not view grief from a psychopathological perspective. Rather I prefer to consider grief, bereavement and mourning within an interrelationship and systemic developmental framework. In this regard I am strongly influenced by the work of Ester Shapiro, (1994). I do not believe grief is something done to us, nor that mourning is a condition. Rather both are processes we experience. It helps me to think about these processes as being experienced and expressed, or avoided, in a multitude of different ways. When counselling people who are experiencing grief and mourning, I see my function then as assisting them to make meaning and gain understanding of what they are experiencing within the context of their life, past and present. The terms pathological grief and mourning are mostly used to describe problems with the resolution of grief. Rando (1993) defined pathological, abnormal and unresolved grief as complicated mourning, a term which does not pathologise grief and one which enables personal meanings and choices to arise and develop. Herbert Schlesinger in a chapter titled, 'Technical Problems in Analyzing the Mourning Patient' (Salman Akhtar (ed.), 2001) challenges our counsellor and psychotherapist thinking about the use of the term 'pathological'. He states, 'But let us not resign ourselves to the inevitability of several other objectionable terms such as the oxymoron 'pathological mourning', and the weaker epithets, 'displaced mourning', and 'pseudo mourning'. Why are these usages objectionable? Because they assume there is such a 'thing' as mourning; or to put it more precisely, that mourning is a condition that one could describe with a noun………We must ask what does it do for the patient to go about mourning in this way or what does it do for him to avoid mourning in this way. We must try to understand what the patient gains from his efforts, not just what it costs….. What makes letting go so difficult, what else is put at risk by saying goodbye? Perhaps I have alluded to a sort of clinical disease. But, more accurately, it should be considered a 'disease' of clinicians; one we might refer to as 'hardening of the categories'. We tend to pathologise patient behaviour we disapprove of, give it a bad name, and at least implicitly, urge our patients to stop using it. We would do better to try to understand it than banish it.' (p.130-131). Prior to Freud's writings, bereavement in many cultures around the globe was accepted and acknowledged as a commonplace experience. Bereavement was often understood in socio-cultural and behavioural terms. Freud's writings brought insights to the personal and intrapsychic processes of mourning. Since Freud's influential essay on 'Mourning and Melancholia' (1917) commenced the clinical literature on grief there have been numerous and profound advances in theory in the fields of thanatology (the study of death and dying) and grief and bereavement. When reviewing the collective findings of some of the most significant researchers in the field including Lindermann (1944); Kubler-Ross (1975); Bowlby (1980); Horowitz, Wilner, Marmar and Krupnick (1980); Brayer (1977); Parkes and Weiss (1983); Raphael (1983); Stephenson (1985); Stroebe and Stroebe (1987); Rynearson, (1987); Demi and Miles (1987); Rando (1993); Worden (1991); Hagman (1995), one readily identifies many dimensions which can contribute to an individual's experience of the grief reaction. These aspects may include the individual's family history and internalized family-of-origin relationships, history of previous losses, personality structure and coping style, capacity to make use of existing social supports, the nature of the person's relationship with the deceased and the availability of social supports (Shapiro, p.25). These dimensions form a continuum along which grief reactions can be assessed as more or less severe or prolonged. Herein lies an important therapy practice issue I am always bound to consider – in the context of the person's life, at what point on a continuum do they experience their grief reaction as being either severe or prolonged? Aligned with this, what is my therapeutic assessment of where they're at and how does this inform my interventions? Whilst psychoanalysis has substantially influenced the development of modern grief, bereavement and mourning theory throughout the past century (Jacobs, 1993; Parkes, 1981; Rando, 1993) there has more recently been a growing swell of change in the way we think about and work with grief, bereavement and mourning. George Hagman (2002) in a chapter titled, 'Beyond Decathexis: Toward a New Psychoanalytic Understanding and Treatment of Mourning' (Neimeyer, 2002) provides a clear overview of the psychoanalytic history and contemporary developments in psychoanalytic theory and treatment of grief, bereavement and mourning. Heather Servaty-Seib (2004) cleverly draws connections between three current mourning theories (The Dual Process Model of Coping with Bereavement, Meaning Reconstruction and Loss, and Attachment Theory and Loss) and counselling theories in her article, 'Connections Between Counselling Theories and Current Theories of Grief and Mourning'. In my own work with people and families at the Cottage Hospice, important aspects I remain alert for include distorted and conflicted mourning involving ambivalence (love-hate feelings); unanticipated mourning whereby a person has little or no opportunity to prepare for the loss mentally or psychologically, and complicated and complex mourning which can include earlier losses that haven't been sufficiently grieved and which now have compounded with the most recent loss. Societal, familial, ethnic and community cultural factors also influence and impact upon a person's experience of complicated grief. The members of multidisciplinary teams working in hospitals and palliative care facilities around the country are required to conduct Bereavement Risk Assessments for family members of a deceased person in the facilities within which they work. Working within such a team and facility I conduct these assessments on a weekly basis. Interestingly, the frequency and familiarity of exposure to people's grief reactions has only served to increase my constant alertness for any hidden complicating factors which may impact upon a person's capacity to find their own personal form of resolution of the grief they're experiencing. Resolution is not'the closing of a chapter in life' nor is it about 'moving on'. Rather 'finding resolution' tends to focus upon integrating all of what the dying/death experience involved for the bereaved person. When the work is with a family or even with multiple extended family groups, it incorporates resolutions involving the relational and collaborative self. There is certainly nothing abnormal about the raw feelings, the sense of vulnerability, aloneness and disruption one may encounter when bereaved. Dying, death and all of the associated feeling responses are an integral part of life. Each person's experience of grief and bereavement is indeed very unique and personal. As mentioned earlier what is normal and what is pathological can only be considered in the context of the individual person's specific personality, relationship with the deceased person as well as his or her familial and cultural background (Neimeyer, 2002, p.25). Some other aspects I watch out for in my work with
bereaved clients are: Another therapy practice issue I hold continuously in mind is the effect sustained losses has upon me. What effect does this have upon my own personal and professional life? There are the pragmatic and practical tasks of self-care including maintaining balance in life; incorporating joyful and fun experiences into my daily routine and not taking life too seriously all of the time. I do allow for regular personal time as well as having regular clinical supervision to reflect upon the meaningfulness of the substantial losses I encounter intimately in my work. The opposing effect has certainly impacted upon me – that is, I've grown to truly appreciate so much more in my life…. truly valuing each day and my opportunities to'be' with life in all its aspects. Critically though, how often do counsellors and psychotherapists
review in a healthy manner the cumulative impact of their ongoing exposure
to loss, grief and bereavement? This may be either through the termination
of their clients' counselling contracts, intentionally or otherwise,
or by the very relational and interpersonal nature of the work we do.
In regards to helpful grief and mourning, which Sandra Beuchler in an
article titled 'Necessary and Unnecessary Losses: The Analyst's
Mourning' refers to as 'the well-bourne loss', what are
the therapy practice issues for counsellors and psychotherapists? What
are our own grief issues when the clients we have worked with intimately
die? These are particularly important considerations for those of us
who work in fields of practice in which we experience the loss of clients
on a regular, even daily and weekly basis. |
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Newsletter No. 32 March 2005 |
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PACAWA is now into its second decade of existence. It is growing and developing in stature as indicated in this issue with the four impressive articles written by counsellors and psychotherapists practicing here in Perth. They write from different perspectives about regression in therapy. Regression is most often viewed as an action or an act and a relatively uncomplicated defense mechanism used by animals and humans when they are in a situation of severe stress or sustained anxiety. A child will slip back into a previous developmental stage when tired, hungry or frustrated. Most of us as adults will begin to whine when overly tired, exhausted, or feeling pressured. We witness regression, a phenomenon Freud named, in ourselves and in others. As humans we regress when frustrated by a significant insoluble problem. Perhaps one experienced as no longer tolerable. After all, as humans we are fallible. In a broader, global context Murray Bowen writes eloquently about societal regression in his classic textbook Family Therapy in Clinical Practice. In therapy'regression' may occur as a client returns to a less organised, dependent or childlike state. I find myself challenged when considering how I can give the client what he or she wants or needs whilst continuing to promote their growth and personal development. I do not wish to encourage the restrictive childlike state or helpless dependence. My role and function then is to create a milieu for
new learning and insight. In establishing a safe therapeutic space and
operating within a framework of unconditional positive regard, I need
to respect all of what the client says or does. Robert Hobson reminds
us to always consider that'whatever anyone says it is important'. (Hobson,
1985). The articles in this issue describe and illustrate how each of
the writers as counsellors and psychotherapists do just this. |
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Regression is a large basket of creative possibilities. It is the human capacity to return to earlier ways of responding or versions of self identity and relate as if this is the current reality. Under conditions of stress we can revisit, relive or get lost in other times and ways of being. Aspects of self that were disconnected in an earlier time exist out of awareness and continue to exert a powerful influence over current living. The protective solutions of the past can become a destructive pattern for the now/future conditions. By far the most common manifestations of regression are all around us on a daily basis – read The West Australian, talk to stressed friends, hear the little kid in your own voice when upset. Regressed behaviour can be understood as the consequence of an overwhelmed self insufficiently resourced to meet life's challenges. Through relationship, earlier versions of self can communicate and be engaged with. The experience of being met in the now as the child we once were makes it possible for us to recalibrate earlier/younger views of events and the stance we took, in order to integrate these into a contemporary sense of wholeness. Ultimately it is the adult we now are, forming a respectful relationship with the child self we still carry, that enables the integration. Appreciating regression as a living presence keeps the counsellor open to meeting'who is there'. Which aspect of the client is speaking? The counsellor can connect directly with the person within their interior reality. The client's subjective experience in that moment may be within another time, place, personhood or event to that of ordinary here-and-now reality. These special times of fluidity can enable the'glue' of unifying beliefs to soften and a transformation to a new ordering of meaning is possible. The empathic, non-intrusive, calm warmth of a counsellor can facilitate an experience of wellbeing from which a person can reform their identity and find a basis for reworking constricting life habits in relating to self and other. Regression in this way arises in the course of deep therapy and is part of the healing journey. Such a therapeutic endeavour can be undertaken when the counsellor's steadiness, focus, emotional availability and capacity to relate is in alliance with the client who has sufficient resources, courage and determination to bring the wounded self into relationship. Counsellors don't invent or cause regression
so much as be sensitive to the 'one who is here' and acknowledge
their existence. They engage in dialogue with the person as they present
themselves. In holding both subjective and objective realities the counsellor
can assist the client to discover the connection between the two and
find the gold of integration. Regression without integration can occur in therapy when the counsellor is out of their depth with the destructive aspects of the regressed state, or is not attuned emotionally with the developmental age of the regressed state. Uncontained regression may be the consequence of over-enthusiastic therapy: – moving too fast, too forcefully, too cognitively or too intense a catharsis. Muddle may occur when there is too much self disclosure from the counsellor or insistent interpretation by the counsellor. Short fusing of therapy may also occur with premature simplification of the client's dilemmas. Regular quality professional supervision is the way through. Naturally counsellors are often on a learning edge
with clients in freshly meeting with the client's unique system
of self. Favourite formulaic approaches tempt us towards the security
of known ground. These can affect a lock-out from authentic connection.
The counselling encounter can also trigger out-of-awareness regressed
aspects of the counsellor's self-functioning. Regular supervision
with a more experienced colleague provides the reflective stillness
to clear the relational space of the counsellor and negotiate the territory
of regression as a collaborative work with the client.
Responsiveness to the person who is relating from a younger sense of self is informed by an understanding of the client's developmental level, psychological state, meaning-making systems, personality structure and ego strength. The observing self may be present reporting to the counsellor about the inner young self, or the young self may speak directly to the counsellor. The person may be in the grip of a preverbal state which has no language or thinking and yet is full of meaning and affect. When there is an arrest in development the client may present as a small person disguised in an adult body with adult language. Or the client who reveals a wise adult functioning only in session and in the remainder of life lives the world view of a five year old. These meetings with clients are very different in quality to a generally integrated person revisiting a disconnected aspect of self, who has consciousness of the whole and can move between with awareness. Different again is the absence of 'adult' or 'executive self'; where there are shifts of self state between defensive, coping aspects or core aspects without a coordinating consciousness. There may be no inner sense of self, no capacity for mindfulness nor language for the inner experience. Repetitive acting out of early learned ways of being may be the prison without parole. It is a shocking experience as a counsellor to realize a client is traveling simultaneously in two realities - when severe traumatic past events and their aftermath are operating in the here and now, woven through ordinary reality, sometimes differentiated (as intrusive breakthroughs) and sometimes not. Formulaic therapy will miss these nuances. The counsellor
is continuously challenged to catch the moment, attune to 'who
is here' and engage with respect, sensitivity and humanness whilst
holding awareness of a bigger picture of the client as a whole person.? |
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I can't remember when I first heard of the term PTSD. I was certainly aware of it in the late '80's and the early '90's when working closely with the mining industry. Along with a colleague, I would venture out onto mine sites, having being urgently called upon to respond to a 'critical incident'. The thinking at this time was to get there as soon as possible to 'debrief' the workers, talk them through the incident and so hopefully prevent PTSD. Often there were one or two men who did not want to participate, even though they were told they had to. I often think back now and reflect on what their reluctance was. Did they fear opening a can of worms in a formal debriefing? Was it a safe place to open up? Did they already have PTSD? Did more talking only exacerbate their negative pre-existing experiences? In speaking with colleagues there was the growing realization that many of our clients had experienced multiple traumas over a long period of time. I recall being asked to talk with a mine supervisor after a fatality. This man had declined to be part of the formal debriefing but was open to meeting with me in his small demountable office where he had taken refuge. Amidst many tears he told me this was the fifth fatality he had been involved in and couldn't take it anymore. Many of those who were part of the debriefings did seem to move on in life and remain in the workforce. However, there was always a small percentage who struggled to come to terms with their experiences, seemingly unable to move on in life again, often sheltering in the refuge of alcohol and or drugs. Again the question, 'What was different with those who didn't seem to move on?' In co-facilitating a women's domestic violence group, the scenario of multiple and long standing traumas was again recognised. Many of the women felt safe enough to acknowledge the emotional reality of their physical and psychological abuse. For some participants the sense was that it wasn't safe, especially if they had experienced multiple traumas, not just in their adult relationships, but from very early in childhood. Around this time I found it useful to consider PTSD as existing on a full continuum. Some clients barely met the DSM criteria, whilst others met all the criteria. Interestingly, many men participating in Domestic Violence groups (as perpetrators) have also experienced multiple traumas such as childhood abuse (most often physical or sexual abuse), adult violence through service in the military or police, and as paramedics or emergency workers. Was their controlling and abusive behaviour a means to keep safe? In counselling with the veteran community it was recognised that well over half the clients, veterans and their partners, had experienced multiple traumas (unpublished survey); childhood and war trauma for the veterans, and childhood and very often spouse abuse for the partners. It would have been fair to surmise that the majority of the veterans had been diagnosed with PTSD, or in the process of being diagnosed. Very often the counselling was concurrent with anti-depressant/anxiety medication. I have been continually enlightened by the work of Van der Kolk and Babette Rothschild who have long had the wisdom and foresight to acknowledge the body and the concept of somatic memory. Their work, particularly 'The Body Remembers' and 'The Body Keeps the Score', acknowledged that 'talk' therapy was important but that it was only part of what was needed in helping clients move beyond PTSD. I value Van der Kolk's belief that 'As long as people don't feel their bodies, we're wasting our time and theirs trying to do psychotherapy'. The emergence of therapies such as Eye Movement Desensitization and Reprocessing (EMDR) and Emotional Freeing Technique (EFT) sought to redress this mind-body imbalance. For many clients the use of these more body centred therapies has been life saving, enabling them to leave behind the 'demons' of PTSD. For veterans a focus on the body through yoga and group exercise has been found to improve the general health of participants in a structured program. Increasingly, our understanding of PTSD has been informed by Neuro imaging. As a counsellor, acknowledging the physical reality of PTSD has often been useful for many clients as they try to understand what has happened to them. They aren't 'mad', 'stupid' or 'weak'. For many, this knowledge and increased understanding assists them in letting go of their guilt and shame. In reflecting on the above experiences several aspects of trauma stand out. The first is that there is a very physical aspect to trauma. Our body remembers and seeks to adapt, often in ways perceived by others to be very disruptive and debilitating. The second is that many clients have experienced multiple traumas over a long period of time, very often in both childhood and adulthood. Again I put on my wondering hat and ask what the implications for me are in my therapeutic practice. The first is that clients need to feel safe to tell their story, especially as it may be a story full of sadness, fear and shame from years of different trauma experiences. Creating a safe space and listening are still the fundamentals of counselling. Another implication is that I consider PTSD on a continuum, not as a discrete psychiatric condition as per the DSM. The implications of this are that I need to listen carefully to all clients, regardless of presenting issues, always aware of possible trauma. The temptation is to only consider and work with the most recent incident or issues. Within a safe space I may need to consider earlier life experiences and explore how these have been handled and what meaning the client has for them. My final thought is to maintain what I call a reflective or 'wondering' stance and so see counselling as only one aspect of the healing process. Putting aside my professional bias for talk therapy and mind focus (as a counselling psychologist), I'm left wondering how I might respond to the belief that 'the body remembers'? I acknowledge the ideas and support of Suzie Herberte,
Senior Counsellor with the Domestic Violence Advocacy and Referral Service. |
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Three events have impacted my life in extraordinary ways over the past 10 years. Each of them has had a profound effect personally and have collectively contributed to significant changes in the way I practice as a psychotherapist and counsellor, and I might add when I conduct the occasional church service, as I am want to do from time to time. In February 1997 I attended the Level 2 Intensive training in Narrative Therapy with Michael White in Adelaide. I had done the Level 1 training two years previously. Level 2 comprises 8-9 participants; includes huge slabs of time sharing ideas, and offers the opportunity for each of the participants to have a one hour taped interview with Michael, with the remaining participants becoming a reflective team for the session. I was the only male in the group of international participants, and I had been feeling challenged about who I was as a man and how to honour myself as a man. When it was my turn these were the issues about which I talked with Michael. I was very involved in my story about how my dad had stopped kissing me at 7 years of age, and was really warming up to my resentment about that, when Michael said to me, 'Do you mean to tell me that your father, from his cultural background, continued to kiss you till you were 7? Did your friend's dads kiss them till they were 7?' I was thoroughly blown out by these questions! At a personal level I became aware of how quickly I blame. I also became aware of how little I actually knew about my heritage through my father. Since then my wife and I have made a trip to Scotland, have seen the house where dad was born and where he grew up, and have met some cousins I didn't know existed. Professionally it has challenged me to reframe removing the blame wherever possible. I became very aware that the God I had grown up with was very judgemental! In November 2002 I had a quadruple heart bypass operation. That I had a serious heart condition at all was a complete surprise to me. I was after all a regular swimmer – everyday in spring, summer and autumn at Hillarys and then twice a week during the other 6 months in a heated outdoor pool. My doctors now assure me I was one who would have dropped dead as no one would have initially looked at my heart. My own GP missed it!. I saw a surgeon on the Wednesday and had the operation the following Monday, 11th November, Remembrance Day. I have since described the experience of the operation as 'meeting God'. It was very much like that for me. I had 5 days to come to terms with the fact that I might die. When I entered hospital on the Sunday afternoon I was remarkably peaceful and I am one of the lucky ones who have no memory of anything after the first pre-op, till they were ready to shift me out of Intensive Care 36 hours later. What I have discovered is that my arthritis medication masked the heart pain until I had a reaction to the medication and stopped it. The impact of all of this has been profound. The learning continues to be 'If something is to be done, do it now! We never know when a crisis might arrive. We just don't know from one moment to the next'! The terrible devastation that is currently being experienced in South East Asia as a result of the tsunami reinforces this truth for me. At home I am even more obsessive about mess. In my workplace I feel empowered to call it as it is much sooner. Once there is a relationship, and sometimes as a way in to forming a relationship, I call it as I see it, warts and all. I am much more interested in helping the client to find their life now! I recently had a client who works in a zero drug and alcohol tolerance workplace. He had already been sprung for recreational drug use and now he'd been sprung for alcohol. He was a young guy, and I made the assumption that if I was lucky I had his attention for at most one hour. So I say to him things like, 'What sort of idiot are you? Do you like shooting yourself in the foot?' He replies, 'Jeez you lay it on thick don't you?', and I say, 'So you want me to piss in your pocket?'. And he says, 'No I don't. This job is really important to me and I want you to give it to me straight.' He lasted the hour and I have no doubt if he ever gets into a scrape he'll remember our encounter. You never know he might even come and ask me to be his wedding celebrant someday! Before my 'encounter with God', I would never have been so 'in his face'. The third experience was quite different again from the other two. Since its inception and until recently I have been a member, and sometimes Chairperson of the Uniting Churches Committee of Discipline in WA. I retired at the last Synod. At about the time I was contemplating this step I was approached out of the blue to become one of the two Chaplains on the planning committee for the Uniting Church in Australia's National Christian Youth Convention in Perth in 2007. I was completely caught unaware. Why would the youth of the Uniting Church want a 68 year old man for that role? They said that what they wanted was an older man and woman who were wise, to be elders of the tribe. They do not want us to be burdened by any of the many tasks. They want us available to be the listening ear and the appropriate word of wise counsel for the committee members. I am incredibly moved by this. This has challenged me to respect the fact that I am a 68 old man and that for many people I am wise, even though I am a minister. It challenges me to remember that wisdom is a gift, and when we have it there is a tremendous responsibility to use it respectfully. It challenges me to not get wrapped up in my own stories, and to open to the stories of my clients. It challenges me to see the wisdom in clients even as they have responded to it in me. These three significant events have brought forth
other learning. When people say to me, 'What sort of a counsellor
or psychotherapist are you?', the best answer I can give is that
I am eclectic. I have been trained or had significant exposure in Psychodrama,
Transactional Analysis, Systems Theory and Group Process, PET, NLP,
Narrative and probably others, and that I realise that in most instances
it isn't the method or theory which is important – it's
the practitioner. It is who I am, and how I am. It is our 'Being'
that is often the facilitating agent. People are either attracted to
us or they are not. The connection is where it starts. |
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A great deal of what might be called by a psychiatrist 'regression' is a person's natural attempt at self-healing. [Joseph Berke 1971] Jack's eyes widen and he catches his breath. 'Then one day they put me in the car with a... a red suitcase. And we drove a long way.' Jack pauses, and looks at me intently. I notice one tear forming in the corner of one eye. I nod once, slowly. 'Yes', I say. Jack closes his eyes and continues with voice a little unsteady. 'I remember I was very tired when we got out of the car, and my legs were heavy, like they didn't want to walk. And my stomach was hurting'. Jack pauses, eyes still closed. He shifts in his chair, and rubs his stomach slowly. 'It was nearly dark. There was a long path, and a big door, and a lady with a blue dress. She took the red suitcase and...' Jack's voice falters and he opens his eyes again, the tears starting to spill over. 'And they. They left…' His breathing shifts again. 'I thought this was the home' he weeps. 'I thought they'd brought me here to kill me'. He holds his stomach with both hands, and starts to sob. I wait, making occasional very soft 'yes' sounds. After a few minutes, Jack's sobs subside. When his breathing and movements indicate that the intense peak of pain has settled, I nod again, and ask 'then what happened?' His voice now higher, his breath shaky, Jack's words are now coming much more slowly, the language much simpler. He tells me, slowly, painfully, of his parents leaving him at this place, without looking at him or speaking to him. Of the 'blue lady' taking him to a bed, stripping his clothes off, and washing him with a rough cloth. Of a 'yucky drink' and a sleepless night in a cold bed. Of men coming to get him in the cold grey morning; of being held down, naked, on a moving bed. And finally—Jack's face contorts, his nose starts to run heavily, and he seems to choke on the words—of big lights, sharp smells, and people in white sheets trying to put a mask on his face. Again Jack sobs, more deeply this time, holding his stomach more tightly. Again I wait, again the occasional very soft'yes' sounds. When Jack's sobs lessen and his breathing and movement indicate that this intense peak of pain has also settled, I nod again, and ask, 'What else?' The process continues, slow, painful and intense. Jack is five. His short life so far has been 'a nightmare' with a violent and schizophrenic mother, a largely absent father and little contact with the outside world. He has seen something on TV recently about gas masks and ovens. A month ago his father told him matter-of-factly that if he didn't stop provoking his mother they'd have no choice but to put him in a home. Held down in this cold stark room, Jack is certain he has failed some kind of test and this is the place where they kill bad children. He fights, he says, 'as hard as hard as I can'. He twists in the chair and holds his hands to his face. 'I can't breathe', he chokes, 'but I keep fighting'. 'People are shouting, and pushing the mask at me and I keep fighting as hard as I can, I don't want to die.' Thrashing wildly, he feels his elbow connect with soft flesh: a fist crashes into his face, he tastes blood, and he gives up the struggle. The last thing he remembers is saying 'I'm sorry, Daddy' before he loses consciousness. Here Jack lets out a howl, and his words disintegrate into racking sobs. For the next five or so minutes, I don't fully understand what Jack is saying. His shaky breath, his tears and his defensive movements tell me he is experiencing considerable distress. The smallness of his voice, the shocked and stricken quality of his facial expressions, and the small flailing movements of his hands tell me that he is feeling very young, frightened and defenseless. But I don't understand his words until later in the session. This is partly because by now Jack is crouched behind his chair, his voice muffled by the tears, his blocked nose and his large hands, which continue to cover his face. Partly I don't immediately understand this part of the story because he is now speaking in German. This event took place in Germany, forty-five years ago¹. As his distress has increased, as the memory of this terrifying ordeal has became more real and immediately present to him, Jack has reverted to his native language – a language he hasn't spoken since his family moved to Australia three months after the event he is remembering today. Jack is an intelligent competent adult man—and in this moment his entire being appears to be centred in the experience of the very small, very distressed, very vulnerable and frightened five year old he once was. Jack is experiencing a form of what is often described as 'regression'. Ferenczi² called this very common experience 'emotional reliving'. Other practitioners, depending on their background and orientation, might describe it as a 'revisiting' or 're-experiencing' of a previous developmental state. Common to these various descriptions is the notion of a shift in our physical, emotional and cognitive experience of time: an aspect of the past is being experienced in the present moment. For Jack, as for many clients, the prospect of reconnecting with any 'aspect of the past' was frightening. And rationally so. For Jack,'childhood' meant 'fear and pain'. His'decision' (at five) to close off/separate from intense fear and pain constituted a profoundly rational a 'lose myself' and to spend the rest of his childhood in a 'numbed-out' state. Reconnection with these feelings thus meant nothing less than a reconnection with an utter and terrifying loss of 'self'. However by his 50's Jack was also painfully aware that the safety afforded by his emotional'shutdown' exacted a price in his adult life. In learning to 'lose himself', Jack lost presence. He became shy, introverted and distrusting of others. In adulthood, he found intimate relationships difficult, social interaction painful and assertive communication with'authority figures' almost impossible. Jack came to therapy when the pain of staying 'lost' became greater than the pain of reconnection. After the initial deep emotional release, Jack spent the next few sessions exploring a newly integrated sense of himself: 'getting to know the five year old' as he put it. In time he started reporting new levels of self-awareness and self-care (swimming, choosing 'nice' food and pleasurable activities). In our last meeting, he told me of a post-therapy 'celebration' he had planned –a visit to Disneyworld. Jack described as 'like coming home' the opportunity to re-experience - that is, to experience differently -- his distressed 'inner five-year-old'. In taking his time to sit with an emotional space that had previously felt dangerous and uncontrollable, Jack allowed his 'regressive' experience in the therapy room to provide a valuable and healing sense of catharsis and integration. Stories like Jack's teach us that regressive moments in therapy do not mean a loss of self. In fact, properly managed, these moments can be profoundly illuminating and helpful to our clients' therapeutic goals. If we as therapists can provide safety and groundedness in the therapy room and in the therapeutic relationship, then we can mirror for the client the safety and groundedness that will bring him 'home'. 1 As Jack discovered later, the 'home' was a hospital, the 'blue lady' was a nurse and the 'gas mask' was an anaesthetic. His parents had taken him to the hospital to have his tonsils out. They had said nothing to him, they told him later, so that he 'wouldn't get frightened'. The 'crash' he felt into his face was the blow of a doctor — whose genitals Jack's small elbow had connected with during the struggle. 2 cited in Leys, Ruth. (2000) Trauma: A Genealogy. Chicago: University of Chicago Press. 3 see amongst others, Van der Kolk, B.A. (1994) The Body Keeps the Score: Memory and the evolving psychobiology of post traumatic stress Harvard Review of Psychiatry, Vol. 1 pp 253-265; Scaer. (2001) The Body Bears the Burden: Trauma, Dissociation and Disease New York: HMP; Rothschild, Babette.(2000) The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment New York: Norton. [Names and identifying aspects have been altered
and approval by the client received for publication of this case study] |
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The
narratives that we create about our identities, our place in community
and the world, our beliefs and values, our continuity through time,
and our sense of moving into the future, are profoundly important
to our stability and well-being.1 These narratives are
co-creations between the individual person and those with whom he
or she is in relationship. Some aspects of narrative are shared
within a particular culture or family, and other aspects are unique
to an individual.2
The precise processes used by Buddhist Psychotherapists would
vary depending on the western psychological framework in which they
had their primary training
such as cognitive behaviourism, family systems, or the psychoanalytic.
Buddhist psychotherapy is a marriage in some respects of western
psychologies and Buddhist psychology so it has a variety of clinical
applications. For the purposes of this brief article, I will illustrate
how I, as a Buddhist influenced somatic psychotherapist, would work
with grief and loss.
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Selected articles published in PACAWA News are subsequently posted on the PACAWA website. All articles have been subjected to editing processes. However, the opinions expressed in these articles are not necessarily those of the Editorial Board or Management Committee of PACAWA. PACAWA makes no claim that
information contained in these articles is accurate, nor accepts liability
for any action arising out of information contained in these articles.
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© Copyright Pychotherapists and Counsellors Association of
Western Australia (Inc) 2005 |