Jeanine Connor was commissioned to write a monthly column for BACP Therapy Today for 18 months. This regular feature provided an opportunity to share thoughts stemming from therapeutic work and contemporary issues with a wider professional audience. These columns contain an amalgamation of therapeutic experiences. Events and individuals are unrecognisable.

Words are my own, images are copyright free.




First dates

Published in BACP Therapy Today,  July 2015 

Ten years ago I arranged to meet a woman I didn’t know in an unfamiliar part of town. A mutual friend set us up and thought we’d get along. I remember the trepidation as I decided what to wear for our first meeting and the nervous anticipation as I rang her doorbell.  During the hour we spent together I gradually relaxed. The conversation flowed and she seemed interested in getting to know me. She encouraged me to open up in a way that nobody before her had. She was older than me, witty, attractive and dressed in a similar style to my own. We were a good match and our relationship thrived for five years. Did we fall in love? Perhaps a little.

Choosing a therapist can be like choosing a lover and a first session is much like a first date. The introduction might be arranged by a well-meaning friend or the date self-selected from the Internet using whatever criteria seems important at the time. It’s a risk. It’s anxiety provoking. And it can be ever so slightly exciting.

I remember Stanley, an outwardly confident eighteen-year-old full of swagger. He announced his arrival at our first session by hammering so loudly on the door I thought he might punch a hole through it. Once inside, he relaxed onto the couch not waiting to be invited and started chatting almost immediately. Stanley talked about his college course, family, aggression, scrapes with the authorities and the hour flashed by. Stanley shook my hand enthusiastically and swaggered off. I’d found him intriguing and looked forward to us working together. The following week I waited for Stanley and as the minutes ticked by the realization struck me that he wasn’t coming. I tried unsuccessfully to contact him, leaving messages saying I was thinking about him and wondering if he was coming back. He didn’t reply. On reflection, that first session with Stanley had been the therapeutic equivalent of a one-night stand.  He’d charmed me with his stories and faux intimacy but it had all been bluster and our relationship had no future. He wasn’t ready to commit.

Samantha was in her mid-teens and, like Stanley, engaged enthusiastically in our first session. She had many questions; about what therapy is for, how long I’d been a therapist and what I enjoy about my job. Her questions didn’t feel intimidating they felt fair enough, and I was delighted she had the confidence to be so openly curious. The following session Samantha arrived a few minutes late and with much less gusto. She responded monosyllabically to my wonderings about her week and after about seven minutes she fell asleep, a state she occupied for the remainder of the session. During our first meeting Samantha hadn’t told me anything about herself at all. Instead she’d employed a sophisticated form of defense disguised as engagement. Her catatonic state was less subtle and her communication loud and clear. Samantha was testing out levels of intimacy and control that would feel comfortable enough and I needed to respect these if we were going to have a meaningful therapeutic relationship; which we did, for about a year.

First sessions, like first dates, contain a wealth of information about how the relationship is likely to pan out, contained in our feeling response to the other person in the room. It’s mostly a gut instinct that experienced therapists (and serial daters) learn to trust.

Lexi telephoned me prior to our first appointment. She’d read the therapeutic contract on my website and wanted to ‘get a few things straight’. The telephone call left me exhausted and dreading our initial meeting. Lexi was a compact, buttoned-up woman who was always prompt and didn’t take a breath as she recounted her life of woe. She told me she had been let down by countless ‘people like you’ and had low expectations. I remember thinking – ‘I’ll show you; let therapeutic battle commence!’ but what I was feeling, despite the formidable, highly defended woman in the room, was that I really wanted to help her to have a happier and more fulfilling life. And against the odds I did. Lexi and I worked together for a year and she never missed a session. Ours was an intense relationship full of passion and hate but we survived it together and eventually love thrived. When we finally parted, Lexi thanked me for bearing her and I thanked her for allowing me to. It’s always a privilege to be chosen. 




Why dads 

matter

Published in BACP Therapy Today,  June 2015 

We live in a patriarchal society. Yet it remains a sad irony that many young people will not be sending a father’s day card this month because they have no dad they know about to send one too. They might have a father figure in the form of a step-parent or family friend, while a male teacher or counsellor can provide an adequate male role model too. But there is a fundamental difference between a father figure and a dad proper that goes beyond the biological.

I ran a Thinking and Feeling group for 8/9 year olds. Jack was angry because his mum had a new boyfriend and he was angry because he didn’t have a dad. Lenny told the group he was sad because he didn’t see his real dad anymore. Skye said, matter-of-factly, ‘oh I know what that’s like; my dad isn’t my real dad either’. I encouraged the group to consider what a real dad is. Millie knows her dad is her real dad because he’s in photos she has of herself as a baby. Lenka has been DNA tested to prove whether her dad is her real dad and whether her mum is her real mum. The children’s naivety, in an absence of accurate explanation, had left them feeling confused. So we struggled on, trying to make sense of their nonsensical, father-less worlds.

One of the things about dads is that they anchor us and give us a sense of belonging. Even for younger children who are unacquainted with the biology of paternity, there is a recognizable, yet nameless feeling associated with having a dad that is ‘real’ that makes us feel real too.

Nell, a woman in her forties, reflected with me on a father-less childhood and a lifetime of not-knowing. She was three when her parents separated and Nell’s father was described by her mother as a wannabee, a dreamer and a weak man who remained living with his mother into adulthood rather than living in the real world. The real world involved being Nell’s dad and he’d opted out. Nell remembered her mother’s words so precisely because they were all that she had of her father. She’d never seen a photograph of him and her memories were depleted. Nell grew up believing she wasn’t good-enough, a certainty instilled in her by her mother’s story. As a consequence, she worked hard and excelled in academia and in her career. But despite her successes, she had never felt like she fitted in and had an enduring sense of not being good-enough. She struggled to get along with female bosses – replicating early maternal rivalry, and felt let down by male ones, mirroring the father who disappointed her. She opted eventually to work freelance, taking care of herself as she had learned to do from a young age. Unsurprisingly, Nell had a history of failed relationships. She chose good-enough men, who she left when they fell in love with her, so as to deny them the opportunity of repeating her father’s abandonment. Nell told me ‘I just don’t know who I am’.

I think about the adults the children in my Thinking and Feeling group will become; perhaps adults like Nell with a fragmented sense of self, endlessly striving for perfection in an imperfect world. Fathers offer an alternative perspective to mothers, as well as support and equilibrium. Children without a dad have a sense of something missing and are likely to internalize that sense so that they feel inadequate too. They blame themselves (or are blamed) for their father’s absence and go on searching for what isn’t there, never really knowing what it is they are hoping to find. Knowing about our real dad helps us to recognize and consolidate our real self. We are a part of them and they are a part of us; biologically, emotionally and psychologically. That’s why dads matter. 

I’m judged therefore I am...
 
Published in BACP Therapy Today,  May 2015 

I recently facilitated a workshop for trainee counsellors and suffered the familiar pangs of anxiety about whether I’d be interesting/knowledgeable/entertaining enough? Although my superego was more disparaging than my audience, I know that they judged me.

At the start of the day we negotiated our group boundaries and the first suggestion was that we strive to be ‘non- judgmental’. I challenged the group to contemplate the term we bandy about so freely, and I challenge you to do the same. What are we asking of each other and of ourselves, and is it even possible? I think the answer is no. It’s in our nature to judge; evolutionary theory supports this, our survival depends on it and anyone who suggests otherwise is misguided. You’re judging me now. You may even go to the bother of sharing your judgments. The positive and polite will go to Therapy Today; the others directly to me; that’s usually what happens. Critical therapists feel shamed into anonymity.

The theme of judgment recurs repeatedly in therapeutic practice. Parents feel judged on their capacity as parents, work/life balance and social status. Children sense judgment on their popularity and appearance. Adolescents perceive judgment on everything. To rehash a familiar flippant phrase, just because you’re feeling judged, it doesn’t mean people aren’t judging you. The fact is, they probably are.

I perceive clinical judgment-making to be an important therapeutic responsibility. I’m carefully attuned to the depressed mother so that I can make judgments about her capacity to care for her children. When she accuses me of judging her as an unfit parent, I tell her truthfully that I’m wondering if she can be a good-enough mother at a time when her struggles are so overwhelming. Much of my work is with adolescents, many of whom feel judged about their lifestyle choices and coping mechanisms. I do my best to comprehend their internal struggles. They tell me that consuming drugs or alcohol or cutting their skin helps to keep them alive. I don’t judge their choices, but I do make judgments about their capacity to keep themselves safe and I say so. Working with children who have been neglected or abused, I’m often asked to share my clinical judgments in meetings and court cases where decisions are made about children’s welfare. I share my judgments honestly and always with the families involved before anyone else. Do these families feel judged? Of course they do, but I assure them that my role is to help to make sense of their situation and communicate their needs so that they may access the support they deserve.

Every therapeutic encounter invites multiple hypotheses about a client’s state of mind, safety, and physical needs. Therapists are trained to be analytical and what is analysis if not a type of judgment?  Not discriminatory or disparaging judgment, but considered, exploratory judgment couched in theory and clinical experience.  

It’s time to rethink judgment and overturn its bad rep‘. To be judged is to be noticed. As a writer, I sit tapping at a keyboard, not knowing if my constructions will ever be enjoyed. When judgment arrives in the form of a letter or comment I know that someone else has had a reaction to something that I did. I’m judged therefore I am! So let’s harbour this notion to support the judged-and-helpless-feeling client. Let us not fool them or ourselves into believing that we are non-judgmental. Instead let us share our judgments honestly, transparently and without shame. I judge you because I have noticed you and had a feeling response to you. I judge you because I care.

Behind the shades of grey

Published in BACP Therapy Today, April 2015 


I read book one of that trilogy when it was first published and shared my thoughts in a column in the December 2012 issue of BACP Children & Young People. At the time the general consensus was that the books were a ‘good thing’ because they revived sexual experimentation and this was seen as liberating for women in particular. I didn’t read anything that questioned the protagonists’ relationship, which I had perceived as dysfunctional and abusive.

 

Since the film’s release there have been varying reviews, including psychosexual psychotherapist Julie Sale’s critique in this journal last month, and so I’m taking the opportunity to revisit, and perhaps refine, the reflections I made previously.

 

Fifty Shades of Grey went on general release on Valentine’s Day and is being flaunted as a romantic love story with beautiful actors having lots of erotic sex. Everyone remotely attached to the film has been interviewed and photographed looking sassy and gorgeous. Author ELJ has transformed her image from frumpy, middle-aged mum – ‘Look, I’m just like you!’ – to vampish sex kitten – ‘Hey, you can be just like me!’ All this has made me feel rather queasy. But my overwhelming emotion has been indignation at the widespread ignorance about themes touted in Fifty Shades – the books and the film.

 

The lead actor, Jamie Dornan, got his break in the television drama The Fall, where he played an athletic, sexy, charismatic professional, a counsellor actually, with a disturbing second life. So far, so Fifty Shades. His character was a predator who hunted beautiful young women before tying them up for his own sexual gratification. Again, very Fifty Shades. The Fall challenged the viewer’s perceptions and caused us to ask, ‘How can I be attracted to this man who I know to be depraved?’ But when the character murdered the women he stalked, our desire turned to repulsion. I find Dornan’s casting as Grey quite chilling.

 

For those who still don’t know, Christian Grey is a handsome, charismatic billionaire who is partial to BDSM-style sex. He is a dominator, in and out of bed, who seduces virgin Ana with luxurious dates and expensive gifts. Smitten, Ana takes up the role of sexual submissive and relinquishes control of her life. Christian decides what she wears, who she sees and where she goes. We learn that Christian’s sadistic desire is the result of childhood abuse – an ominous plot line.

 

I recognise the narrative from my work with victims of domestic abuse who tell me their partners want to have them to themselves. They are told to dress attractively to please him and are rarely allowed to see their friends. He earns and controls the money. Some women tell me it’s romantic and chivalrous. I recognise too the justifications: ‘It’s not his fault, he had a terrible upbringing’ and ‘He does it because he loves me’ – a displaced responsibility that saddens me.

 

Arguing that a relationship like Ana and Christian’s is consensual is akin to saying that women who remain in abusive relationships and are beaten or those who dress provocatively and are raped are ‘asking for it’. They are not; the culpability always lies with the perpetrator. Fifty Shades peddles a belief that women fantasise about being dominated by men. Some do, but there is a distinction between fantasy and reality, and it has become blurred. Fifty Shades has reached an adolescent audience, and so has the notion that women want to be physically and psychologically controlled by men. Jokes about domination, sexual abuse and rape have become mainstream. This film legitimises abuse. The sex is just a smokescreen. Take it away and you’re left with manipulation, misuse of power, violence and exploitation.


Not old-fashioned romance but old-fashioned abuse.

Whisteblowing: it’s time to speak up for the sake of our clients

Published in BACP Therapy Today, March 2015 

When the weather is inclement and the evenings short I find myself more aware than usual of what’s in the news. As I write this we are approaching the awards season (I will have been overtaken by events by the time you read this, I know) and there’s an air of anticipation surrounding the nominations for the Oscars, Grammys, Globes, Baftas and Brits, all weeks before the actual awards ceremonies take place, when there’ll be another consignment of frenzy. The entertainment industry likes to honour its heroes. Among the show biz glitz, healthcare industries have been a regular focus of our news too. But they’re not being awarded, rewarded or regaled: quite the opposite in fact.

 

Images of failing services are beamed into our homes, with accompanying narratives about scandal, abuse and exploitation. The names we recognise belong to those who have failed the most vulnerable members of our society. We hear nothing about the successes. Hospitals and GP surgeries deemed inadequate by the Care Quality Commission (CQC) have been named and publicly shamed, while those graded good or above remain anonymous. Waiting times are up, patients are treated in corridors, staff are overworked and underpaid, blah, blah, blah. The names of the worst ‘offenders’ are touted. 


This is the antithesis of what happens in the entertainment industry, where achievement is publicly applauded and ineptitude ignored. I spoke recently to a senior practitioner in occupational health for a large NHS trust. He told me the department is inundated with referrals for mental health clinicians who are on the verge of collapse. They have become a kind of ‘squeezed middle’: pressured by management to treat more patients in less time while quantifying every move on electronic databases that aren’t fit for purpose; pressured too by patients who demand and deserve to be treated according to their needs. I heard that stress, anxiety and depression have seeped into the system so that mental health clinicians are now just as likely as their patients to receive such diagnoses.

 

I also heard about the upsurge in referrals relating to bullying. We hypothesised that the NHS has become a (top) dog eat (under) dog world, with the bullies marking their territory at the top of the tree by nonchalantly pissing on those below them. It seems that individuals with an unconscious desire for power and control are the very people most likely to rise to the top in organisations set up to support the needs of the vulnerable, exploited and abused, so that the system itself becomes abusive. Professionals on the ground feel neglected by supervisors and abandoned by managers who are preoccupied with the business of accounts rather than accounting for the quality of their team’s work. In organisations where numbers matter more than people, clinical safety feels dreadfully precarious.

 

The majority of clinicians who work in the healthcare sector do so because we are passionate about implementing positive change for those entrusted to our care. Could this be the reason that professionals in these industries have so far put up and shut up? But perhaps the wind is changing. We’ve heard in the news that NHS organisations are to be required to appoint guardians to protect whistleblowers from the fallout of speaking up about bullying and clinical safety issues. So I wonder how long it will be before someone, somewhere blows the whistle loud enough for a media kingpin to hear. Lips are pursed, but many remain too depressed to blow. 

The games people play

Published in BACP Therapy Today, February 2015

Did you hear the one about the MP caught playing Candy Crush during a Commons committee meeting? He said he’d try not to do it again. For those that don’t know, Candy Crush is an apparently addictive game accessible via mobile app. Players match rows of brightly coloured sweets accompanied by tinkley music. It resembles something designed for a three year old but the typical player is aged 25 – 45. The best selling games of 2014 were FIFA 15 (Xbox 360 rated age 3+), Grand Theft Auto V (PS4 rated 18+) and Minecraft (Xbox 360 rated 7+). Time was that families would sit together and play a board game. Old fashioned perhaps; but Monopoly, in its various guises, remains the best selling game of all time.

 

As ever, cultural trends, fantasies and fears are reflected in my practice. Among my therapeutic resources I have a selection of twenty or so board games. Some have survived from my own childhood while others were sourced from charity shops. When I first set up in private practice I had a few games ‘just in case’ and soon discovered their popularity among clients of all ages. I also realised their therapeutic worth and so my collection grew. 


I recently completed a period of therapy with a girl of 11, an only child who presented as precocious and pseudo-adult. Evie’s parents had strong moral and religious values and placed high emphasis on educational success. Evie was unquestioningly bright but I had a sense of a lost childhood. During our first session, she noticed the games inside a glass-fronted cabinet and told me proudly that she was a ‘Scrabble champion’. Surprisingly then, she opted to play Snakes and Ladders for the duration of her six week therapy. This game is more about luck than skill and can be incredibly tedious. As Evie wriggled about excitedly (like a snake) I commented on her enjoyment of playing, and about the going-ups and going-downs of the game. Evie learned that my observations about the game also signified recognition of her own internal ups and downs.  


Ethan, a boy of 13 struggled to read or write. He’d been terribly neglected and I suspected he’d been abused. He couldn’t make eye-contact or express himself verbally and didn’t like to draw. Ethan selected Junior Monopoly, a game based on the original and designed around a fair with fairground ride assets and ticket booth properties. We played it every session for the duration of Ethan’s therapy. The game has low stakes. You earn £2 pocket money for passing GO and pay to ride the attractions. We spent eight weeks playing together in/on fair ground while reflecting unconsciously on the unfairness of Ethan’s external world.         

Tom was a sullen 18 year old on the brink of exclusion from college and caught up in gang culture, drug use and theft. He noticed my ancient Solitaire and wanted to know what it was. We dipped in and out of playing the game designed to be played alone, together, taking turns under Tom’s instruction to jump over marbles with other marbles, working collaboratively to accomplish a mutual goal.   


The sessions with Evie, Ethan and Tom were often monotonous and I wondered about the value, in monetary as well as therapeutic terms, of what we were doing. But each of them displayed progress in their capacity for reflection and expressed emotion, inside the therapy room and externally. Parents reported calmness where there had been chaos, calamity was replaced with creativity, isolation with connectedness. In short, the therapeutic process had been effective. The games we played together provided consistency, stability and containment and there just isn’t an app for that. 

So this is

Christmas


Published in BACP Therapy Today, December 2014

It’s Chriiistmaaas. Actually, it’s early November but I’ve already heard Noddy Holder’s screeching pronouncement half a dozen times and by the time this goes to print he’ll be laughing all the way to the bank for the 41st consecutive year. Many readers will have decked their halls, stairs and sitting rooms to a festive soundtrack, while others will have opted out depending on the meaning of Christmas where you are. I won’t assume I know what that is, how could I.


When people talk about the true meaning of Christmas we assume they’re referring to Christianity in varying degrees. The nativity is re-enacted in schools across the land where girls as young as three compete for the chance to play Mary. What they understand about the virgin birth and the doll in the feeding trough is contestable but their sing-songing to you and your king (sic) about morning being night (sic) suggests significant confusion. In reality, the true meaning of Christmas is far from cheerful for many families as evidenced by the Office for National Statistics*. There are 20% more deaths in December than any other month, commonly caused by road traffic accidents, fires, falls and poisoning. Women are 12% more likely to be murdered in December while for men the probability increases by 5%. Figures for matricide and infanticide rise by 25% in the two week period between Christmas Eve and Twelfth Night, while there are 33% more incidents of domestic abuse on 25th December alone than on any other day of the year. We know that alcohol is a significant risk factor and consumption is almost double in December (+41%) than in any other month.  These figures make for grim reading but they also illustrate what I already know from my therapeutic practice; everybody’s not having fun.


One young man found his way to therapy in early December suffering from a severe bout of depression. He lost his mother when he was 15. She was killed on Christmas day by her partner who was found guilty of murder. My client’s family encouraged him to focus on his studies and he’d achieved significant academic success. But he described an emptiness that these accomplishments failed to fill as well as a series of unsatisfying relationships with older women at university. My client was tormented by all-things-Christmas and the extended festive period at home was experienced by him as a living hell. I hoped that my metaphorical ‘holding’ would convey something of my understanding of his desire to be mothered.       

An adolescent attended a short period of psychotherapy. She said nothing and barely moved. Often she allowed her head to drop forwards as if detached from her body. She slept deeply for most of the session most weeks. Being in her presence felt bleak and disturbing and I experienced the silent sessions as a deadly part of my week. I knew from the referral that the girl’s father had hung himself on New Year’s Day. My client gave me a sense of what it must have felt like to discover her father’s lifeless corpse and to bear a physical memory of that experience in her own body.   


I work therapeutically with young people in residential care and for most of them Christmas is a cruel reminder of everything they have lost. It’s a time for family; but they are alienated. A time for presents; but they receive a generic token. A time for extravagance; but they reside in underfunded institutions. A time for parties; but they receive few invites.  The tendency for these children to act-out at Christmas proliferates dramatically. Reprimands, restraints and runaways escalate as the young people demonstrate their desire to be contained, nurtured and loved ‘the same as everyone else’ – a meagre wish I hear often. 


So I urge you to be mindful of the true meaning of Christmas for each of your clients as you say goodbye for the holidays. Before the festive greetings fall unbidden from your lips take a moment to consider what the next two weeks might be like for them. Yes it’s Christmas, but I’m certain everybody’s not having fun.

*Statistics obtained from Office for National Statistics http://www.ons.gov.uk


Personal 

disclosures

Published in BACP Therapy Today, November 2014

I’ve been interviewed three times this week. Enquiries were made, in varying degrees of interrogation, about my professional and personal experiences, my age, marital and parental status as well as whether or not I smoke or like Iggy Azalea. The impromptu interviews came about during therapy sessions and my adolescent interviewers were not easily gratified. Individual counsellors and psychotherapists have their own rules about personal disclosure which are informed by their modality and individual inclination. Very few, especially of those working with young people, occupy the traditionally psychoanalytic blank slate, and mercifully few share everything. So how do we inhabit a space that feels comfortable on the personal disclosure continuum?

Working from my therapy room at home, clients often enquire about the rest of the house. These are simple enough questions which I answer willingly to illustrate the therapeutic boundaries. Some clients want to know why we can’t sit in the garden (obscured by an opaque window) on a sunny day, and I have to work harder to explain about physical and therapeutic containment. I hear about previous counsellors, real or fantasised, who invited clients to accompany them on dog walks, smoked with them and offered a lift home. I’m judged harshly against my unboundaried predecessors and accused of not caring, if I did I’d let the session run over when my client arrives late. I try to explain that the opposite is true; I care very much about my client and also about honesty, reliability and integrity.   

When I’m asked about my own life (or not) during a therapy session it always tells me something about my client. One young man was particularly interrogational. He’d grown up in the care system with a belief that decisions were made for and about him rather than with his consent. He’d witnessed domestic abuse as a child and been raped during adolescence. He’d suffered a lifetime of intrusion so obviously his questioning felt intrusive as he projected these experiences onto me. He told me it wasn’t fair that I wanted to know all about him while he knew nothing about me. I commented that his therapy was supposed to be about him but he wasn’t satisfied. In fact he was really un-fucking satisfied and I knew he wouldn’t come back after session one if I didn’t change tack. So I attempted to negotiate. I said it made good sense for him to work out if he thought I could help him and in order to do that he needed to know about me. He visibly relaxed but held onto a healthy dose of scepticism, wanting to know why I was a psychotherapist dealing with other people’s shit. Could I deal with his shit was the implied anxiety but it was too soon for smart interpretation.

I’ve realised that what I’m willing to share is what’s on my CV, information that’s readily available via Google to anyone who can spell my name. Nowadays we call this public domain information and I’m comfortable with it being known. But to simply provide facts-and-figures type stuff to clients without facilitating exploration is to miss a trick. The questions are always more revealing than the answers.  I was asked during my training, fourteen years ago in case you’re asking, how I could be a child psychotherapist when I didn’t have my own children. In response I wondered aloud if a male gynaecologist would be judged on his lack of a vagina. He wouldn’t. It’s insulting and ignorant. Reproductive assemblages do not influence medical aptitude anymore than parental status influences therapeutic ability. The most important thing is a capacity to empathise, both with my client’s experiences and with their curiosity about mine. So I’m always willing to explore why it matters if my parents are alive, whether or not they abused me, or if I’ve ever taken MDMA. I don’t share anything that my clients couldn’t find out for themselves and that becomes more bearable as they learn to understand that I mean what I say; the sessions really are all about them.   

Thinking about dying

Published in BACP Therapy Today, October 2014

I live in a small town close to a slightly larger town in a semi-rural part of the UK. Yet despite my whereabouts, I can’t travel far without passing an impromptu shrine apparently marking the site of a recent fatality, forcing personal loss into the public domain. I write this piece in the wake of the actor Robin Williams’ suicide with images bombarding our screens of floral tributes outside his Californian home, on the Hollywood Walk of Fame and at various film locations around the US. Meanwhile, social media is awash with homages to the ‘acting genius’ mostly from people who never met him.  There is no escaping Public Displays of Grief (capital letters merited) the most striking example of which followed the death of Princess Diana in 1997. Images of waist deep stacks of bouquets remain indelible in the minds of all who witnessed them. This seemed to set a precedent and signify a new cultural norm; but to what end?

Grief is a deeply personal emotional state, so the desire to demonstrate it publicly seems paradoxical. Perhaps the laying of floral tributes externalises, and therefore splits-off, those feelings of personal grief that are too painful to contain.  Maybe the shared mourning of a celebrity creates a socially acceptable outlet for the expression of individual loss, discouraged in our typically buttoned-up society.

We have heard much about Robin Williams’ struggle with depression which is in contrast with the more familiar face of the ‘comic legend’. Millions of people identify with this and with the urge to self-harm or to attempt suicide.  When someone takes their own life, opinion rages and those who do so are branded as brave and tormented or insensitive and selfish.  And all this in the context of another debate currently being contested in the public sphere; that of assisted dying. The associated moral, ethical and legal considerations are too vast for the constraints of this column, but they do highlight issues which cannot be avoided; issues about how we manage death, personally, publicly and in practice.  

Benjamin Franklin wrote in 1789: ‘In this world nothing can be said to be certain, except death and taxes.’ Death is certain of course, but the where and when and how is rarely known about in advance. How could we live with certainties about our own demise despite knowing, cognitively, that we and our loved ones are mortal? Some of our patients have fewer unknowns; those who live with terminal illness, their own or their families’, and those who are contemplating assisted dying or suicide. This raises a further paradox in that although these issues are in the public domain, personal suffering too frequently remains hidden – few spoke about Robin Williams’ depression prior to it being cited as the cause of his death.

I have worked therapeutically with many patients for whom death is an ‘alive’ reality. Their ages and circumstances vary enormously but all are beset by physical and/or psychological pain, often accompanied by a heavy dose of shame. Talking helps. Having a space to verbalise fears, fantasies, what-ifs and if-onlys helps. Not being judged, persuaded, discouraged or emotionally blackmailed helps. Humour helps. Of course I have an urge to keep my patients alive physically, but the crux of my work is to facilitate psychological aliveness. I have witnessed transformation in the most fragile individuals as they gradually become more robust. I have rejoiced as, after numerous overdoses, a patient begins to make alternative, safer choices to manage their despair. I have reflected on life after death with children whose parents have completed suicide and who thought there was no alternative for them. I have explored treatment choices and decisions to terminate treatment with those who are terminally ill. I have helped manage the psychological ache of termination. One very ill young man summed up our work with a metaphor: ‘There’s a tonne of bricks hanging over me. You haven’t taken them away, but you’ve climbed under here with me and are helping me hold the weight. I’m ready now. I’m ready to go.’


Seeds of hope

and potential


Published in BACP Therapy Today, July 2014

The 70th anniversary of the D-Day landings, the beginning of the end of World War II, was commemorated on 6th June. While 4th August marks the centenary of the outbreak of WWI. Summer 2014 has a distinctly commemorative feel. Until a few years ago, my knowledge about WWI consisted of sketchy memories of war poetry I’d studied reluctantly at school. So it was with some ambivalence that I took the opportunity to visit the Somme area of France. During my stay I became immersed in history, desperate to improve my meagre understanding of the atrocities of WWI. I visited countless cemeteries and gazed with awe at immaculate row upon immaculate row of war graves. What I found most striking about the Somme was its vastness and its immense beauty. It is truly breathtaking how vile and bloody battlefields have been transformed into the serenely exquisite memorials that stand in their place today. The experience of bearing witness to this was the epitome of poignancy.

And of course there are poppies.

Papaver rhoeas (field poppy) has an innate capacity for survival. Every flower head contains over 1000 seeds, each with the potential to become a new plant. Those seeds, once dispersed, lie dormant in fields and craters until they are disturbed and exposed to light. Perhaps this is why the poppy has long, literary associations with sleep, oblivion and homoeroticism. One hundred years ago the Western Front was reduced to mud and trenches. But when fighting ceased, hidden seeds germinated creating miraculous swathes of red poppies. Their colour mimicked the bloodshed and the Royal British Legion adopted the poppy as its ubiquitous emblem.

There is much symbolism in the imagery of war that feels pertinent to my therapeutic work. Often when I meet families they tell me about the battles at home, the fighting, futility and hopelessness. They express despair and despondency. They describe separation and splitting without hope of reconciliation. I hear about verbal attacks and abuse as well as physical assault, rape and violence. Some clients describe the internal war raging within them, and the tireless fight against psychological demons that are an omnipresent enemy. It is human instinct to turn away, not to listen or want to learn about other people’s bitter experiences, just as some people turn away from images of conflict. But therapists in practice have a different instinct which encompasses a desire to hear our client’s stories and visualise their awful realities. We are curious and empathic. We can hear the unspeakable and we do ponder the unthinkable. And we are rewarded with the opportunity to facilitate change, to awaken the latent hope that we know must be hidden somewhere beneath the hopeless devastation that our clients share with us.

The poppy would make a fitting emblem for therapy, or rather for clients in therapy. Not because of its connotations of bloodshed and oblivion but for its extraordinary robustness and its potential to endure suffering, regenerate and survive even the most ferocious experiences. Within each of our clients there are minute seeds of hope and potential. There is also an innate instinct to survive, emotionally and psychologically as well as physically. When our clients come to us, the seeds of hope are often dormant and buried deep within. Our role is to unearth them (sometimes by shaking things up a little!) We shed light by illuminating our client’s realities; their strengths and difficulties, what can change and what is unchangeable. We fertilise their potential with care and attention. We bear witness as the seeds flourish and our clients emerge psychologically and emotionally more robust, ready to survive and shape the future.

So as we commemorate the two World Wars this summer, let us also be reminded, in the symbolism of the poppy, of our client’s battles and of the journeys we accompany them on through devastation, depression and dormancy to something alive and hopeful. This summer, and always, let us remember them all. 

Facebook in therapy

Published in BACP Therapy Today, June 2014


My reputation for blaming gaming for the rise in ASD and ADHD is based on a distortion of my article ‘Where Lunatics Prosper’ (¹). I maintain that children living in an environment furnished with chaos and violence are likely to present as chaotic and violent or emotionally shut-off and socially isolated and I remain troubled by the popularity of 18+ games in under 18s. However, the rumpus surrounding my previous article focused on a misunderstanding of my thoughts. I explored off-screen chaos and violence too but it was my reference to the computer generated stuff that got people’s goat.  Those in the gaming camp felt illegitimately attacked, while the anti-gaming posse jumped on the overcrowded bandwagon pedalling the notion that the internet is the root of all evil. And that seems to be a theme; technology fuels the terrifying headlines while external reality remains worryingly unthought-about.  


Take Facebook, now in its 10th anniversary year. Conversations I’ve had with adults about it usually go one of two ways. Either (a) they prohibit access to under-13-year-olds because it’s illegal. Or (b) they prohibit access to over-13-year-olds because it’s unsafe. Both perspectives demonise technology and shut down thinking. There is a third position; the perilously uninformed one of turning a blind eye. Those who ban Facebook ignorantly assume that prohibition will alleviate the much-hyped problems associated with it. It won’t; children will just keep shtum.

 

I don’t understand why the 13+ age restriction is clung to so vehemently by adults who veto Facebook yet turn a blind eye to children as young as 5 playing 18+ games. Have you seen those games? They contain violence and sex, sometimes violent sex, all in graphic technicolour. They have a chat function too so while your child’s avatar is killing and having sex s/he can link up with ‘friends’ who are killing and having sex too. Their online friends might be of similar age or they might be over 18s playing perfectly legitimately. Is that comforting? The paradox is that the main reasons cited for prohibiting young people from accessing Facebook are fears about cyber-bullying and sexual grooming. Warning: these risks exist outside Facebook. And anyway, the 13+ age restriction has nothing to do with safeguarding and everything to do with US advertising laws in relation to minors. Surely everyone knows that?


Consumer reports estimate that of Facebook’s 900 million+ users, 8 million are under-13 and 6 million are under-10(²). These figures are likely to be underestimated because many under-13s are too scared (or too savvy) to own up. I don’t think it will be long before Facebook lowers their age restriction and there is talk of linking children’s profiles to those of their parents. That’s an interesting proposal; making children’s online safety the responsibility of their parents and carers. I wonder if it will catch on.   


One boy I talked to was being bullied via Facebook. He finally told his dad who threatened to report him to the Police because he was only 11! Will this boy stop using Facebook? – Probably not. Will he confide in his father if he gets into a sticky situation online again? – Ditto. Meanwhile, a 12-year-old told me she’d used her mother’s login details to access Facebook and ‘see what people were up to’. She found sexually explicit messages between her mother and a family friend as well as photos of them semi-naked. It’s impossible to un-know something like that or to un-see those images. She knew she’d be in trouble if she admitted using Facebook but she did admit it to me during a therapy session and we were able to think it through together.


Lots of young people ‘bring’ Facebook to therapy, sometimes literally. In these examples, as in countless others, Facebook isn’t really the concern; it’s simply the vehicle of expression for real-life issues such as bullying, betrayal, secrecy and sexuality. Is this an appropriate use of therapy? Totally. Why? Because the client has asked for help to explore something that’s troubling them in a non-judgemental, safe, thoughtful and contained way and that’s exactly what I seek to do. 

 

1.    Where Lunatics Prosper, bacp Children & Young People, September 2011

2.    Consumer report figure quoted in BBC News Technology, 4 June 2012

The human need for connection

Published in BACP Therapy Today, May 2014

We don’t get a second chance to make a first impression. This paradigm runs through my mind as I write my first column for Therapy Today. A quick glance left and you will notice a new name (mine) in the familiar slot. In practice, we learn a lot from first impressions of new clients. I arranged a first session with 15 year old Henry who’d been described by school and parents as un-teachable, unreachable and uncommunicative. Henry’s father ‘forgot’ to bring him and I sat in my therapy room thinking about Henry in his absence. When I did eventually meet him I was able to state honestly that I had held him in mind. He struggled, unsurprisingly, to comprehend this or to communicate his thoughts and feelings. Nevertheless, he attended ten therapy sessions where he experienced being in the presence of an attentive other and something shifted. He began spending time with his family instead of in his room. He invited a friend home for the first time in eight years and his academic performance improved dramatically. I was informed that therapy had done its magic!  I think the ‘magic’ encompassed what Winnicott termed ‘maternal preoccupation’¹ which can feel quite magical.  

Therapy fulfils a human need for connectedness. It does other things too but the relationship is fundamental and evidence supports this. By connectedness I mean actual, in-the-moment connectedness. It feels nice to be with someone who wants to be with you. When we are, we often face each other, attuned to each other’s facial expressions and micro-communications. We listen and we hear what is said and what is implied. We recall previous shared conversations and experiences. We laugh, we cry. We experience things together, at the same time and we hope we will do it again.

Well sometimes it’s like that. Sometimes I meet people and within moments their eyes glaze over as if they’re not really present, not connected with me at all. I perceive a twitching in their hyperactive fingers that aren’t used to staying still for so many seconds. Temptation gets the better of them and within minutes they are checking their phone to see if anyone has texted or tweeted or updated their status. ‘What about my status? ‘What about what I’m doing?  Right here, right now!’ I want to yell as I metaphorically wave my arms in their vacant faces. I don’t want to jump up and down to gain their attention; why should I? But I have a need to be attended to, to reassure myself that I am cared about. That’s what Henry and all our other clients need too. They need to feel attended to and connected and cared about.

I witness a miserable lack of connectedness happening to all kinds of people in all kinds of places. Doctors review patients by staring at computer screens, avoiding eye contact with the person in the room. Highly skilled and highly paid professionals idle away meetings tapping on phones secreted under their notebooks. Counselling sessions are interrupted by the all-too-familiar ‘ping’ that serves to inform client [or in some cases counsellor!] that someone, somewhere else, has just uploaded a picture of their dinner. People like Henry experience this too. It’s the antithesis of maternal preoccupation, the epitome of un-connectedness and it’s depressing.  

Therapy offers the possibility of a real, live person who is totally preoccupied with just you. Little wonder that some clients, adolescents in particular, find this baffling, especially if their earliest experience of being mothered was less than good-enough. It is the norm for most of my young clients to have hundreds of online ‘connections’ but the idea of being connected with someone whose primary concern is them for almost an hour can feel alien. But it can also feel exquisite. That sense of feeling connected, once they are attuned to it, can indeed be magical.

In my first column for CCYP two years ago I quoted from T.S. Eliot’s Little Gidding – ‘the end is where we start from’. In this first column for Therapy Today I am again borrowing from literature. The opening of Ruth Ozeki’s novel A Tale for the Time Being contains the following: ‘A time being is someone who lives in time, and that means you, and me, and every one of us who is, or was, or ever will be’.  As therapists we are attuned to the here-and-now of our client sessions; the relationship in time between the two beings in the room and in the transference as well as the ‘ghosts’ of many other beings from our client’s internal and external worlds. But we must be mindful, particularly in first sessions, that our clients may not have experienced being attended to, as infants or adults, in the way that we attend to them. They may need time to adjust to this kind of connectedness. And when they do, it will feel magical. 

  1. Winnicott, D. (1956) Primary Maternal Preoccupation, London, Hogarth

Reflecting on... 

Ann 

(unpublished) 

The Ken Loach film I, Daniel Blake portrays the stark reality of poverty and need for its two central characters. Daniel can’t meet the requirements for Job Seekers Allowance because his cardiac consultant deems him unfit for work. But he is ineligible for disability support because a health assessor judges him too well to claim. Single mother Katie is rehoused in an unfamiliar part of the country. As a consequence, she takes the wrong bus, misses her signing-on slot and receives a financial sanction. She can’t afford to heat her damp, dark flat and is reliant on food-banks to feed herself and her two young children.

Daniel and Katie have stayed with me, but I’ve also been reflecting on Ann.

Ann works at the benefit office amongst a staff team depicted as hard-hearted jobsworths. They do what they are paid to do without deviation or emotional involvement, but Ann is different. She demonstrates empathy and understanding, offers support and kindness and is disciplined for it by a faceless manager who warns her to play by the rules and not get involved. I recognise Ann and identify with her predicament.       

The benefit office segments feel familiar. They depict what happens in any number of organisations where ‘service users’ find themselves caught between a rock and a hard place, this benefit or that, one service or another. Clients slip through nets, their mental-health deteriorates, sometimes they die. 

The way to hang onto those precious jobs is to tick the box, not get involved and not ask questions, especially about the inadequacies of the system.


Resources are diminishing in correlation with rising demands and tightened referral criteria. Professionals debate the origin of the problem – It’s environmental! No it’s health! No it’s education! – in order to gate-keep and protect their own workload. There is no time or inclination to think or work together. Stretched community counsellors hammer at the door of tier three services where stricter gatekeepers reside. Clients are admitted if there is a crisis, if not, the wait will be long. Once inside, there is pressure to get them out, until they are re-referred. Most services seem to operate a revolving door.

Serious incidents are increasing. Staff burnout and turnover is high. The way to protect yourself is to be an automaton, turn up, tick the box, discharge the client. Repeat. Thankfully, there are some of us who are still willing to get emotionally involved, to accept complex clients onto our case loads and bend the rules to protect their well-being, often risking our own in the process. We are the Anns of the services. Our clients deserve us to be more Ann.