'In a moment of frustration, I leant forward, locked eyes with her and said: Kate, I'm afraid I don't buy it"'
'It's a cold, bright, winter's day and I'm sitting on a tightly upholstered sofa, opposite my client, a diminutive 80-year-old lady, who is tightly clutching a tissue and staring at me, wide-eyed, from under her many layers of woolens. Silence. The clock is ticking on the mantelpiece and my heart is racing.
Kate had just been telling me how, following the death of her husband, she was struggling to cope with her lifelong agoraphobia and depression - all reported through the observations of others. "The doctor told me when she gave me the medication and the children tell me I'm depressed too, so I must be, mustn't I?"
Yet, as we talked, she had also revealed another narrative - one of extraordinary resilience and resourcefulness. In a moment of frustration, I lent forward, locked my eyes with her and said: "Kate, I'm afraid I don't buy it." A stare, a blink. "I think it is maybe only others who think you can't cope."
Needless to say, I took this moment to supervision. I am still not sure what prompted me to be so direct. As soon as the words left my mouth and she made her small "Oh" in response, I experienced a post-climatic rush of doubt. Was this too much? But I know that, in that exact moment, I was passionately committed to creating something new for Kate.
It can be hard as a caregiver, family member or professional to transcend the visible signs of frailty when we see them in others and to resist assuming the role of a rescuer. Freud ridiculously believed that older people were not able to make effective use of therapy: Erikson argued that the final stage of life is about integrating past, present and future to merely find acceptance of the life that has been lived. I would argue that, even in very old age, it is still possible, indeed crucial, to actively challenge long-held life narratives and dare to write new ones. This moment with Kate allowed me to see that apparent fragility does not mean that we avoid challenge, as long as it is held gently and appropriately.
I think we can find a balance between treading carefully and providing an environment where challenge and active discourse can happen. if we can only engage in surface-level, inauthentic talk, we are missing the magic of what happens when two people really meet. I could have said "Hmm, I know things are very hard for you at the moment", or even made a gentle reflection: "You feel unable to cope". But I certainly wouldn't have been authentic (I was frustrated as hell), and I'm not sure I would have been serving Kate terribly well, as this is what everyone else seemed to be telling her. We can value our clients' frailties while allowing them to depart from the norm of their experience.
Sadly, there is no happily-ever-after denouement. In our three remaining sessions, we had planned to reflect on the coping mechanisms Kate had devised many years before, which had worked for her, to try to find some confidence in her own abilities. The day before the next session, I had a voice message from her daughter: Kate was feeling unwell and wouldn't be up to our next session. The following week, another message: "The doctor feels the counselling isn't a good idea for her as it is bringing up things that are difficult. Thank you, but she doesn't want to have any more sessions."
My hope is that we had a least challenged together the construct that she 'couldn't cope' and re- imagined it as 'I can find my own ways of coping', but I can't know for sure. However, this moment serves as a constant guide and touchstone for me if I think I am retreating into 'tea and tissues' with clients who seem to be vulnerable, particularly those who are profoundly old and infirm. My plea is that we all consider when we might be filtering or making allowances based on our own perception of a client's weakness. it is, of course, and illusion, and the pull to rescue is powerful. Yet we all confront the realities of our own lives when we close the door on our counselling room - a poorly relative, a challenging child, a marriage in trouble. We all cross the boundary from "I'm ok" to "I'm not ok" in the blink of an eye.'
Extract from article by Helen Kewell a humanistic counsellor in private practice in Sussex and who also volunteers as a counsellor and supervisor for Cruse Bereavement Care. Her book, Living Well and dying Well: tales of counselling older people, will be published this month by PCCS Books. Article pub in Therapy Today: March 2019: Vol 30: Issue 2
'I went home knowing that I was no longer having to cope on my own'
"The doctors came across the cancer tumour in his lungs by chance. My husband has chronic obstructive pulmonary disease and we had taken him into hospital because of that. It was a moment of utter disbelief and total shock. We were told there was absolutely nothing that could be done, that we should go home, put everything in order and basically just wait.
Our minds were in turmoil, trying to come to terms with the news. I began to feel desperate for someone to talk to. Our families live quite some distance from us and I didn't want to burden them. I didn't feel I could speak to my husband as it only upset us both. So I bottled things up. My husband had nurtured and supported me throughout our marriage and, all of a sudden, our roles had changed.
It was as if my prayers were answered when I read in the local paper about an organisation offering places in group therapy for people affected by cancer.
Attending my first group session, I met five complete strangers, but, as the weeks went on, I went home knowing that I was no longer having to cope on my own. As the weeks progressed our friendships grew and we all felt confident enough to open up and discuss things that we could not talk about with anyone else. We found most of us were feeling/thinking similarly. We all felt we were being selfish in wanting to talk about how the cancer was affecting us, as carers. What is going to happen to me? How do I cope? It sounds selfish even now, but that's what I needed and I got reassurance from the group and the counsellors that it was OK to think of myself. I was scared -what would life be like without him? I wanted someone to help me through this, to wrap their arms around me and tell me it was going to be all right.
Our two counsellors were absolutely amazing: they were patient, understanding and had an ability to know what to discuss and how to get us to express our fears and concerns and put them into perspective.
Up until week nine of the sessions, I'd joined in all the discussions, but my reason for being there had never felt real. I hadn't accepted my husband's diagnosis and the ultimate consequences of it. That week we participated in a mindfulness session. Almost immediately I felt my whole body relax in a way I'd never felt before. I didn't want it to end; I wanted to stay in this happy, carefree place forever. As the therapist brought us out of it, all my pent-up emotions came out too. It was the first time I'd cried, and it was then that the reality of what was happening and why I was there hit home. And all of a sudden, it all made sense, I knew what I needed to do; my mind was no longer full of cotton wool. Everything I'd learned from the weeks of counselling and discussion clicked into place. This was my turning point.
The course went on for 12 weeks and it that time we laughed a lot, cried a lot, spoke honestly and reached our personal targets. For me, that was to be able to talk about the situation without getting emotional and to feel confident that I would be able to see this thing through to the bitter end, and beyond. We are all still strong friends, still supporting each other and there for each other when things get tough.
If I hadn't accessed this group, I really don't know what sort of state I would be in now. It changed me completely. People say that I am more confident; my husband says he knows now that I will be OK when he has gone. I think he is proud of me. I now say how I feel and I think I am more open, more caring, less critical and more honest - all because of counselling".
Extract from Therapy Today; February 219: Vol 30: Issue 1. The author of the article was a client with We Hear You (WHY), a charity in Somerset that provides free professional counselling to anyone who has been affected by cancer of any other life-threatening condition. For more information, visit www.wehearyou.org.uk.
The need to be like others
"The third need of the developing self Kohut called the twinship or alter ego need. He thought that children need to know that they share important characteristics with one or both of their parents, that they are not too different from the world into which they have been born. If this need is met, the growing person develops a sense of belonging, of communal status. If this need is not adequately met, children are in danger of feeling that in some basic way they are not like other people, that they are somehow strange and don't fit in.
For much of his career, Kohut had thought that the self could most usefully be understood as having only two components - the grandiose-exhibitionistic and the idealised parental imago. He added the twinship need late in his career and consequently wrote less about it. For our purposes, it is enough to note that it's part of the self. It will be helpful to us in our effort to understand certain transferences."
Note: In February's blog we will look at how these three needs that we have featured over the last three months if adequately met develop a healthy self.
Extract from "Between Therapist and Client; The New Relationship by Michael Kahn. Pub . A.W.H. Freeman/Holt Paperback c 1991 and 1997
The need to idealise
"A second strong need of the developing self is the need for what Kohut called an idealised parental imago. It is important that the child can believe that at least one parent is powerful, calm, and confident. If this need is fulfilled, the child can count on help from that powerful, knowledgeable, and calm person in the face of an external world too complex for a youngster to comprehend and internal events too chaotic and frightening for an immature ego to deal with.
Here, too, parents must sometimes fail. No parent is omnipotent or omniscient, and from time to time that fact will reveal itself even to a young child. And the child who has had repeated opportunities to identify with power and knowledge will be able to discover, when the failures come, some power and knowledge of her own. Thus, bit by bit, through the process of transmuting internalisation, the child will come to see herself as powerful and to feel confident of her ability to cope both with the external world and with inevitable internal conflicts and pressures. This confidence is a key part of the self.
As this part of the self grows and matures through childhood into adolescence and beyond, it develops indispensable capacities. First, it is the repository of the ideals by which life is guided. Second, it exercises control over the impulses, enabling one to use them rather than to be overrun by them. Third, it develops the capacity for self-soothing in times of stress and pain.
We might pause here and note that all therapists know the importance of the capacity to soothe oneself. Many clients, perhaps most, lack this ability to a significant degree. Painful events happen to everyone. Everyone sometimes experiences anxiety and almost everyone sometimes experiences guilt or shame. The question is how a person responds to these experiences. According to Kohut, people who have successfully internalised a calm, parental figure will expeditiously and quietly soothe themselves, deal with the situation, and go on. Many of our clients (and many of us), however, suffer prolonged, sometimes very prolonged discomfort.
Finally, Kohut believed, the "higher" aspects of their personality - humour, empathy, creativity, and wisdom - come from a successfully internalised experience of an idealised parental imago.
Here the danger is that the child cannot idealise either parent. Perhaps the parents are locked into a pattern of denigrating each other before the child, or they may have such serious behavior problems that it is painfully obvious to the child that they simply are not candidates for idealisation. The child will then have no opportunity to develop this part of the self. Kohut taught that when we meet people who seem to take no joy in life, to have no capacity to be inspired and little vitality, we may be seeing evidence that a need for an idealised parental imago was not met".
Extract from "Between Therapist and Client - The New Relationship" by Michael Kahn. pub W.H. Freeman and Company c 1991 and 1997
The developmental theory of self psychology
'In Kohut's view, three strong needs must be fulfilled if the self is to develop fully: the need to be "mirrored", the need to idealise and the need to be like others.
The need to be mirrored
The first need to arise is what Kohut called the gandiose-exhibitionistic need. Children need to be shown by one or both parents that they are special, wonderful, and welcome, that it is a great pleasure to have them around. Kohut taught that children learn how their parents value them not through anything the parents specifically say or do but through the most subtle of cues: gesture, expression, tone of voice. And presumably the message can be conveyed in varying degrees. To the parental message of delight in the child Kohut gave the name mirroring. The child looks to the parent for the answer to "Mirror, mirror on the wall, who's the most wonderful of them all?" If, a reasonable percentage of the time, the mirror replies, "You are, my wonderful child," the grandiose-exhibitionistic need is met.
Now, no parent can possibly be the perfect mirror all the time, and Kohut says, that's a good thing for the child. Inevitably the parent will sometimes fail to provide adequate mirroring. If that failure doesn't happen too often or too traumatically, it provides the child with an opportunity. Children who have been well mirrored many, many times can draw on the memory of those experiences and thus discover an ability to get along without the mirror - at least for a brief time, at least once in a while. And when that happens, they discover that at least for a brief time, at least once in a while, they can be their own mirror. Kohut called this a "transmuting internalisaton, by which he meant that children seize the opportunity of the selves and, as a result, change something basic in their self. His way of describing that change was to say that bit by bit the child adds structures to the developing self. By structures Kohut referred to the adaptive and satisying functions of the self. Gradually, as the child grows and develops, these transmuting internalisations and the structures they create add up to one important aspect of a strong and cohesive self. Now the grandiose-exhibitionistic needs are no longer primitive. Children who have been well mirrored no longer ask or care if they are the most wonderful on of all. they know that they are attractive and likable people, no matter what messages they may get from the outside world. Their self-esteem is firmly rooted, presumably forever.
If the parents are too disturbed or too preoccupied with questions of their own self-esteem, however, the child never gets enough of those early positive messages. The grandiose-exhibitionistic needs are traumatically frustrated and then repressed because it is too painful to be in touch with them when the child has no hope that they will ever be gratified.
Psychoanalytic theory teaches that one of the costs of repressing an important need is that the need does not become integrated into the developing personality. The need is walled off from the ego, and because the ego is the part of the personality that orchestrates integration and appropriate maturation, the need remains in its primitive form. This is the fate of grandiose-exhibitionistic needs that are not gratified. The person, then, is likely to suffer from insecurity and feelings of worthlessness, interrupted on occasion by surges of unrealistic grandiosity and, in some cases, maladaptive boasting when these powerful needs for mirroring burst momentarily through the barrier of repression and futilely strive for some crumbs of gratification. Thus a necessary structure of the self in stunted.'
To be continued in December's blog
Extract from "Between Therapist and Client - The New Relationship" , by Michael Kahn. pub W. H. Freeman/Holt Paperback c 1991 & 1997.
The Long Bag We Drag Behind Us
"It's an old Gnostic tradition that we don't invent things, we just remember. The Europeans I know of who remember the dark side best are Robert Louis Stevenson, Joseph Conrad, and Carl Jung. I'll call up a few of their ideas and add a few thoughts of my own.
Let's talk about the personal shadow first. When we were one or two years old we had what we might visualise as a 360-degree personality. Energy radiated out from all parts of our body and all parts of our psyche. A child running is a living globe of energy. We had a ball of energy, all right; but one day we noticed that our parents didn't like certain parts of that ball. They said things like: "Can't you be still?" Or "It isn't nice to try and kill your brother." Behind us we have an invisible bag, and the part of us our parents don't like, we, to keep our parents' love, put it in the bag. By the time we go to school our bag is quite large. Then our teachers have their say: "Good children don't get angry over such little things." So we take our anger and put it in the bag. By the time my brother and I were twelve in Madison, Minnesota we were known as "the nice Bly boys." Our bags were already a mile long.
Then we do a lot of bag-stuffing in high school. This time it's no longer the evil grownups that pressure us, but people our own age. So the student's paranoia about grownups can be misplaced. I lied all through high school automatically to try to be more like the basketball players. Any part of myself that was a little slow went into the bags. My sons are going through the process now; I watched my daughters, who were older, experience it. I noticed with dismay how much they put into the bag, but there was nothing their mother or I could do about it. Often my daughters seemed to make their decision on the issue of fashion and collective ideas of beauty, and they suffered as much damage from other girls as they did from men.
So I maintain that out of a round globe of energy the twenty-year-old ends up with a slice. We'll imagine a man who has a thin slice left - the rest is in the bag - and we'll imagine that he meets a woman; let's say they are both twenty four. She has a thin, elegant slice left. They join each other in a ceremony, and this union of two slices is called marriage. Even together the two do not make up one person! Marriage when the bag is large entails loneliness during the honeymoon for that very reason. Of course we all lie about it. "How is your honeymoon?" "Wonderful, how's yours?".
Different cultures fill the bag with different contents. In Christian culture sexuality usually goes in the bag. With it goes much spontaneity.
Marie Louise von Franz warns us, on the other hand, not to sentimentalise primitive cultures by assuming that they have no bag at all. She says in effect that they have a different but sometimes even larger bag. They may put individuality into the bag, or inventiveness. What anthropologists know as "participation mystique", or a "mysterious communal mind", sounds lovely, but it can mean that tribal members all know exactly the same thing and no one knows anything else. It's possible that bags for all human beings are about the same size.
We spend our life until we're twenty deciding what parts of ourself to put in the bag, and we spend the rest of our lives trying to get them out again. Sometimes retrieving them feels impossible, as if the bag were sealed. Suppose the bag remains sealed - what happens then? A great nineteenth-century story has an idea about that. One night Robert Louis Stevenson woke up and told his wife a it of a dream he'd just had. She urged him to write it down; he did, and it became "Dr Jekyll and Mr Hyde". The nice side of the personality becomes, in our idealistic culture, nicer and nicer. The Western man may be a liberal doctor, for example, always thinking about the good of others. Morally and ethically he is wonderful. But the substance in the bag takes on a personality of its own; it can't be ignored. The story says that the substance locked in the bag appears one day somewhere else in the city. The substance in the bag feels angry, and when you see it it is shaped like and ape, and moves like an ape.
The story says then that when we put a part of ourselves in the bag it regresses. It de-evolves toward barbarism. Suppose a young man seals a bag at twenty and then waits fifteen or twenty years before he opens it again. What will he find? Sadly, the sexuality, the wildness, the impulsiveness, the anger, the freedom he put in have all regressed; they are not only primitive in mood, they are hostile to the person who opens the bag. The man who opens his bag at forty-five or the woman who opens her bag rightly feels fear. She glances up and sees the shadow of an ape passing along the alley wall; anyone seeing that would be frightened.
I think we could say that most males in our culture put their feminine side or interior woman into the bag. When they begin, perhaps around thirty-five or forty, trying to get in touch with their feminine side again, she may the by then truly hostile to them. The same man may experience in the meantime much hostility from women in the outer world. The rule seems to be: the outside has to be like the inside. That's the way it is on this globe. If a woman, wanting to be approved for her femininity, has put her masculine side or her internal male into the bag, she may find that twenty years later he will be hostile to her. Moreover he may be unfeeling and brutal in his criticism. She's in a spot. Finding a hostile man to live with would give her someone to blame, and take away the pressure, but that wouldn't help the problem of the closed bag. In the meantime, she is liable to sense a double rejection, from the male inside and the male outside. There's a lot of grief in this whole thing.
Every part of our personality that we do not love will become hostile to us. We could add that it may move to a distant place and begin a revolt against us as well. A lot of the trouble Shakespeare's kings experience blossoms in that sentence. Hotspur "in Wales" rebels against the King. Shakespeare's poetry is marvelously sensitive to the danger of these inner revolts. Always the king at the centre is endangered".
Extract from "A Little Book on the Human Shadow" by Robert Bly. Edited by William Booth. Pub. Harper Collins:1998
'My taking the piss didn't bother or offend the counsellor. She let me joke around. She wasn't uncomfortable sitting in the room with me, even if I was'
'I was 19 when I was first referred to therapy by my GP. I was sleeping on a friend's sofa, unemployed and not in education a NEET, only the term hadn't yet been invented. My GP clearly recognised I was at a point of personal crisis. She asked if I would speak to a counsellor who worked at the practice, who she said might be able to help me. She led me down the corridor, knocked on a door and introduced me.
I was surprised to see the counsellor was wearing jeans and a pair of trainers with a luminous green dragon design on the sides. It was a total contrast with the smart, formal dress of the GP. I was intrigued. I assumed she must be a little bit of a rebel. A couple of days later, I attended my first appointment.
Her room wasn't like the GP's. There was a desk with a computer, and shelves with books, but there was no sign of medical equipment. In fact, the room looked quite cosy. I half expected her to offer me a cup of tea when she invited me to sit down. We sat away from the desk, of soft chairs, opposite each other, with a small table between us.
I was very nervous and responded defensively when she asked me to complete what I now know was a Clinical Outcomes Routine Evaluation (CORE) assessment. Being a rebel from a working-class background, where statutory services were viewed with caution and suspicion, I refused to answer any of the questions on the form. It was just a case of, 'You don't trust and you don't tell'. And anyway, I'd never considered how I felt before; nobody has ever asked me.
She didn't insist. She just put the assessment form gently to one side. On the table there was a bowl full of glass and stone pebbles. I assumed they were for decoration. She asked me if I would like to choose a pebble that represented me or how I felt. I thought this was a laugh - I didn't feel like a chuffing pebble! However, I decided to play along. I rummaged around in the bowl and found a small dark stone at the bottom and declared. 'This is me.'
It wasn't that I didn't understand the purpose of the exercise; it was more that I wasn't used to relating in this way. I felt uncomfortable because I couldn't speak this language. I couldn't draw meaning or identify with it, so I mocked her attempt to connect with me. Looking back on it now, I can see I was desperate for help and finding it hard to identify my distress and articulate it. Behind the mockery, I was vulnerable and acutely depressed, but my taking the piss didn't bother or offend the counsellor. She let me joke around. She wasn't uncomfortable sitting in the room with me, even if I was. She didn't insist on using her language or ways of expression, and it was this that helped me feel at ease with her and kept me coming back to appointments.
Today, in my own practice, I am mindful of the young working-class woman I once was. I see similar reticence and alienation in my young clients. I try to help them find their own words to express themselves, so they too can come to recognise their power and autonomy.
My therapist with the green dragon trainers was genuinely interested in me. She took notice of me, acknowledged my feelings, believed in me and affirmed me - things that had been very lacking in my life up until then. This was my first experience of professional counselling and it helped me trust and return to counselling some years later, and to train as a counsellor'.
Article by Katy Woodger a person-centred therapist and supervisor. Published in Therapy Today; July 2018: Vol 29. Issue 6