On my feelings, and how I make use of them in therapy

images

I have been reflecting  today, on an aspect I consider to be one of the most important parts of my job – my connection to my feelings.

In relevance to my therapeutic framework, my feelings are used as my connection to humanity, and are a part of the way I connect myself with my whole human experience – and hopefully, help my clients to do the same.

I have just come from a final session with a client with whom I had been working for a long time, and feel full of those emotions that endings can bring; happy for my client, that they were feeling ready to embark on the next chapter of their life – sad that I was not going to see them again – excited about what the future might bring for them, armed with their new knowledge of themselves  – proud of the work that we have accomplished together, and many other feelings besides.

At the end of our session I felt that I wanted to give my client a goodbye hug as we parted company. Now, I know that hugging a client is highly contentious issue in therapy. Boundaries (of every kind) are a big deal for us all, in life, and therapy is a place where this is often worked out. As such, as a therapist, I am always extremely aware and  respectful of them. Equally, though, I feel that warmth, empathy, and a sense of humanity are just as important to MY way of practising psychotherapy. I know that it is isn’t that way for every approach to therapy, and every therapist out there – many would see a hug as crossing a boundary too far – so i feel  that I want to explain my reasoning for this.

Firstly, I would like to clarify that I do not hug, or even want to hug, all my clients! It is absolutely NOT a staple part of therapy with me!  I am using this (well considered and deemed appropriate) action as an example of a feeling led intervention on my part. Because  what I do really do in ALL therapy,  is acknowledge and attend to my feelings towards and with my client throughout every part of the therapeutic process. If I have a hunch that my feeling is relevant, and that it would be productive for the therapy to express it, I do so. Once I have become aware of and made sense of it. I usually have a sense that if it is felt strongly enough to want to mention it – it is most likely to be relevant.

After all, one of the fundamental beliefs of psychotherapy is that the therapy room is a microcosm of the client’s world. That is to say that if it goes on the therapy room , it goes on in the client’s life. This principle guides me with my client throughout the entire therapeutic process. I use my feelings as a tool offering me an indescribable sensory glimpse into my client’s world; they can guide me with how the client feels, as well as giving me insight as to how the people around them probably feel towards them – often in a far more accurate way than straight-up verbalising does.

The trouble is, you see, that very thing that often brings us to therapy  – the ‘incongruence’ as Carl Rogers called it – is often a master of disguise. It takes our feelings and it tangles them up, it dresses them up in other things, it makes them hard for us to recognise and understand. It is often hard to talk about feelings, so hard that we get overwhelmed and don’t where to begin when asked about them. (I have very clear memories of my ‘bad old days’ – before I learned how to understand my feelings – simply dissolving into tears whenever my doctor or therapist asked me how I was. The tears were an uncontrolled indicator of how beseiged my poor brain was!)index

A massive part of my training as a therapist was me learning about my own feelings, how they impact on me and those around me, and where they have come from.  This helps me to separate my feelings from those of my client. A huge part of my job involves me and my client untangling and identifying their feelings. We pull them apart from out-dated defence mechanisms they have become welded to, prise them off misguided beliefs, tease them away from ancient narratives and only then we can start working out where they come from and how we can best deal with them. The knowledge I have of my own process with this is invaluable when trying to help my client effectively.

Freud’s initial concept of psychonanalysis was born of his observation of suppressed feelings leading to illness. It led to his ‘discovery’ of the unconscious mind – an idea that had not been considered before he suggested it. Early psychoanalysis was all about making the unconscious conscious, and that premise has not altered vastly over the years. (Sure, I would like to hope that modern therapists do more than that too, but really this constitutes the meat and bones of therapeutic work)

Feelings provide a pathway into the unconscious.They can set off a chain of bodily responses and events that we are quite unaware and out of control of.  Modern neuroscience has given us a a way of literally seeing  them lighting up brain scans -amazingly, we can actually watch the pathways brighten and pulse as the feelings are experienced. We can now see how much more there is going on within our astonishing bodies  than we may have previously been aware of.  What a gift! How Freud would have marvelled at that – although I’m sure that he would have noted that the scans reinforced ideas that he had already posited.

If we are clever, and develop our self-awareness well, we can follow our feelings and create a ‘map’ of where they lead us. Our brains are so magnificent and complex, and (most importantly) malleable, that we can then decide whether we want to continue following that map, or whether we want to try out a new route. This is often a good idea. After all, if the road map keeps leading us to a place we dont want to be in, why would we stay on the same route? Of course, its not always easy. A well trodden in pathway is often easier to take than a new unknown course.

So, back to the hug.

Sensing that perhaps it was something that they felt that they wanted too – and after asking them if it was ok – we hugged our farewell. My client seemed very relieved that I had suggested the hug, saying that it was what they had wanted but that they were unsure of protocol, and did not want to ‘break the rules’. It felt like a good way to end our work, and our hug spoke a thousand words that would have been very hard to say. I’m glad we hugged. (If therapy had been continuing, I would have been interested to explore their feelings surrounding ‘rules’, but thats another story, and tangent I cannot go to right now)so-many-feelings

That hug was full of  feelings that cannot be expressed verbally at the ending of a lengthy and productive piece of work. A long, intimate, intense (at times), relationship had been built. So much stuff had been felt, examined, considered, discussed, played with and understood. Lots more hadn’t been, couldn’t be – after all, we get way more feelings than we know what to do with. All the more reason, in my opinion, to act on the ones we do know what to do with  especially when we instinctively know exactly what to do with them. I just knew that a hug was right, on this occasion, and i took a leap and asked if that was a reciprocal feeling. Turns out it was. It spoke. It said way more than either I or the client could. Stuff that clearly needed to be said, otherwise we wouldn’t have both felt that we needed it. Did it add a new piece on to our ‘neural road maps’? Perhaps. Perhaps it underlined the biggest lesson therapy can possibly give any of us?

That we are human, and that our feelings are a huge part of what make us so, and that we have so many different ways of expressing and using those feelings. Why not make use of them? Paint with the whole palette, not just black and white.

Isn’t that an ultimately positive lesson to take from therapy? Isn’t the ‘incongruence’, the ‘sickness’, the unhappy or uncomfortable feelings that led us into therapy in the first instance, our body (which includes our mind, of course) reminding us that it needs to be used properly and as fully as can be, in order to work well?

I think so.

 

 

 

Advertisements

On Self-Disclosure and why I choose it, as a therapist

index

I feel compelled to write about an issue that was raised in a recent supervision session of mine – the highly contentious counselling issue of ‘self-disclosure’ (in other words – giving the client any of our own personal information) It is an issue of great debate amongst counsellors and psychotherapists, and raises some very strong opinions –mostly negative. After all, original Freudian psychotherapy required the therapist to provide a blank canvas and space for the client to fill with the workings of their unconscious mind. For many years, clients lay down on a couch facing away from the therapist to facilitate this process, whist the therapist said little or nothing throughout the session, but took copious quantities of notes – giving us our therapy stereotype that we all know and (maybe) love, or (sometimes) fear.

I didn’t realise I felt quite as passionately I do about the subject until quite recently, when I started to realise that I was self disclosing reasonably frequently. So with trepidation I cautiously mentioned it to my supervisor, knowing that it was something I had to revisit and explore. I was right to be nervous, as my therapist met my confession  – yes, that was how it felt – with a look of concerned shock and the response that she would never recommend this usually.

2

Here is where one of my character flaws kicked in before I could control it (yes, I own this), and my rebellious streak took over. Seeing her response, I couldn’t stop myself from pushing the envelope, and (maybe exaggerating some) I blurted out “Oh yes, I self-disclose all the time these days!”

Did I say that just to see the look on her face, and make her eyes widen? Did I want to play the disobedient child in order to test her ‘mothering’ skills (she is a relatively new supervisor to me – so it is possible) Am I so used to being provocative, and posing alternative ways of thinking, that I wanted to show her how competent I actually am? Or did I simply want to be completely congruent and own the fact that I am wholly myself in the therapy room – the exact same person as I am whilst out and about in the world?

Of course, she questioned me further on my statement (after all – what kind of therapist or supervisor wouldn’t?) and I found both all of the above, whilst going along on a train of thought that I hadn’t expected, and that my younger therapist self would have been quite surprised to hear. It took me back to my training;

 

One of my clearest memories of my first counselling placement as a trainee was of the final session I had with my very first long-term client. As you can imagine, this being my first proper job in the field, I was very keen to get things right, and wanted to make sure I did everything properly every step of the way, to the point where my self-awareness was often painful, and often extremely rigorous and perhaps heavy-handed at times. Although I had explicitly mentioned to him (whilst preparing for our ending) that the organisation I worked for did not allow us to accept any gifts, he had brought me one anyway. It was a lump of cheese –  and an extremely nice one too. I was surprised – taken aback, even, and I told him so.

 Why had he brought me a gift when I had clearly told him that he mustn’t, and how on earth did he know that I was such a lover of cheeses? He laughed, and told me that our therapy sessions hadn’t just been about me getting to know him – it had been just as important for him to get to know me, so that he could trust me properly.

He said that he had noticed my eyes widening every time he mentioned cheese in a recipe (he was a real food-lover, and had often discussed what he planned to cook that weekend) and that it had felt important to him knowing that I shared his enthusiasm for this. He explained that he knew that I was not supposed to give too much away about myself, but that he also sensed that I was a bit of a maverick, and that I would probably not mind him breaking the rules on this one harmless instance. That too was an important quality for him to find in a therapist, as he wanted therapy to be a place where he could find his own way in his life from now on, and not be encouraged to necessarily tow the line and keep the status quo.

What had I learned from this experience?

Firstly, that I have clearly got an extremely expressive face (!) and that I am not always aware of what it is doing. (You can take the girl out of drama training but you can’t take the drama training out of the girl, it seems)

Secondly, sometimes things come out sideways for a reason, and that may be because the client finds it important to know certain things about their therapist. Sure, it is most definitely THEIR space, and the disclosure should be kept to a minimum, but it is often important for the client to know they are working with a human being. Even if that human being is a bit (ok, a LOT) of a cheese fan.

Thirdly, when information isn’t given, sometimes the client will fantasize about their therapist, and make up stuff. Ok, so on this occasion my client was right. But, more importantly – there was relevance to his imaginings. He had needed me to be this non conformist for a really good reason, and thank goodness we got a chance to discuss it – albeit in his final session. I would have liked to have spent more time with it, but these things sometimes go like this.

 

I had learned all right. This experience had stayed with me, and (thankfully) helped me to ease up on myself a little. I stopped feeling quite so self-conscious, and a more natural ‘Katrina-type’ counselling style evolved, and continues to do so to this day.

In fact, when I look back on the period between now and then, there have been many, many, factors  and opinions that have contributed towards my therapeutic style, and my way of being with my clients. Discussion, work and experience  with many other therapists: colleagues, trainers, organisations,  clients and supervisors have all helped me to have confidence and belief in myself and both my skills and intuition. They have helped me to understand that I am the tool to be used in the process of change, and that I should trust how effective I am in it, in that moment. Usually if it feels right, there is a reason.

images

Which brings me right back to being present, and the here and now in my own private practice. ME working in the way that feels most right for me and the client. My client, who has chosen me from a vast selection of other private therapists in the area, and who is paying quite a lot of money to make use of ME. So what do I give them, for their money? What else? ME. The real me. Sure, the fifty minutes paid for is their time, and is completely about them, but I do make it clear to them that I am ME in the room with them. I  intermittently choose to share little snippets of information about myself that allow my clients to know I am really human, that I have lived a life that provides me with a broad frame of reference, and if I feel that snippet helps them I am happy to give it.  I do feel that I am working with them for them.  I always have empathy for them. I feel other feelings with them, sure – sometimes for them, about them, always for the benefit of THEIR process. I work humanistically, primarily. This means I am a human being working from the present moment using feelings to understand experience.

So this is where my supervision session led me, and where I led my supervisor. I explained to her that I do put myself out there for the purpose of my therapy practice. That I have a regularly updated website, that I use social media regularly, as I feel it is extremely important for me to do so. That I blog about my experiences and disclose on here. That this is how I run my practise, and that it seems to work for me and my clients. She listened, and we agreed it seems that the clients I attract choose me for who I am, and respond to this way of working – in fact, that this is almost certainly why they have been drawn to me in their choosing of their therapist. It can only be, after all – I don’t advertise anywhere else, it’s either online or word of mouth.

Yes, we agreed that maybe it is a little unorthodox in comparison to a traditional way of conducting therapy, but that times are moving on, and that we have to move with them. Modern as the concept seems, I knew that it wasn’t really as new as we thought. When I got home, I found myself revisiting the great Carl Rogers (founder of person centred therapy), and his core conditions, written in 1957 and 1958.

index3

He stated that there are six necessary and sufficient conditions required for therapeutic change:

  1. Therapist–client psychological contact: a relationship between client and therapist must exist, and it must be a relationship in which each person’s perception of the other is important.
  2. Client incongruence: that incongruence exists between the client’s experience and awareness.
  3. Therapist congruence, or genuineness: the therapist is congruent within the therapeutic relationship. The therapist is deeply involved him or herself — they are not “acting”—and they can draw on their own experiences (self-disclosure) to facilitate the relationship.
  4. Therapist unconditional positive regard (UPR): the therapist accepts the client unconditionally, without judgment, disapproval or approval. This facilitates increased self-regard in the client, as they can begin to become aware of experiences in which their view of self-worth was distorted by others.
  5. Therapist empathic understanding: the therapist experiences an empathic understanding of the client’s internal frame of reference. Accurate empathy on the part of the therapist helps the client believe the therapist’s unconditional love for them.
  6. Client perception: that the client perceives, to at least a minimal degree, the therapist’s UPR and empathic understanding.

 

Of course, he summed up succinctly, in 6 phrases, what it has taken me 1500 words and a jam-packed hour of supervision (plus processing time afterwards), to say. But I think he says it quite perfectly, so I have repeated it on here for you to read. It’s how I work, and why I choose to self disclose from time to time.

Because I’m me.

images

On crying. Why do I cry so much?

images

So, I have been crying lately. Often. So what?

Anyone who knows me will know that this is not unusual. I am a tearful sort of person. I cry very easily – my tears appear to be (literally, figuratively, both… who knows?) on tap. My friends and family laugh at me about it. I find something to cry about within virtually every film, tv show, book, song, piece of art, that I come across.

In my case, tears can really be for any emotion; sadness, happiness, frustration, exhilaration, anger, fear, determination, hopefulness, grief, you name a feeling – it will usually make me cry.

What a soggy mess! How – with this spectrum of tearful triggers – do I, or any of those around me, know what I am feeling, exactly? All that can be seen from the outside is a red puffy face and leaky eyes! To which I answer them back with a question – do you need to know? Do ‘they’ – they being the outside world – need to know? Do I want ‘them’ to know?  Well, isn’t Isn’t that what tears are supposed to be for? Letting the outside world know that there are big feelings going on inside?

Perhaps…Sometimes, for me, anyway… It is most important is that I know, surely. The thing I do seem to know, is that the tears seem to flow for me when I generally don’t know what my exact feeling is. Not only that – sometimes, i know that I am not necessarily crying entirely for the thing that started me off. Sometimes, I think, I have just hit old feelings, and triggered the tears again. Sometimes I’m not even really sure if that is the case, even.  Sometimes I’m not sure that the tears are responding to MY feelings at all. Maybe they are someone else’s? Mothers will recognise the feeling of wanting to cry when their child gets hurt. That feeling that they want to deal with the pain for them. Is this a similar bodily response to that?

Hmmm… complicated…

After many years of trying to get to the bottom of this, after having worked (as a client) with many different therapists who used many different psychological approaches, it felt that none of them managed to dive deeply enough into the place my tears originate from. I never really understood why I was such a ‘cry-baby’.

It took a long time (and needless to say, many tears), but I finally found one therapist who was unafraid to not just dive, but to hang around around and tread water with me and my tears. This was something absolutely nobody from my personal life could do. Think about it – could you just sit there and let a person you love cry and sob, and sob and cry, without trying to stop them and make them feel better? Its not a failing on the part of my people – it’s just the kind of messy thing that only a therapist (or someone else quite separate from one’s life) can help a person with (and in my experience, not all of them can do it, either). Thankfully, this one wasn’t afraid to.

So, by observing this very process, I slowly discovered that I have a tendency to unconsciously use tears as a defense mechanism. They tell those around me to stop, slow down, don’t push any harder; “Look, I’m upset, I’m crying, do you want make things any worse?”

The tears are my body and psyche working together to find a way to keep me protected from pain; “Look how fragile I am already – don’t go deeper, I can’t take it!” Possibly another ‘ancient caveman’ reason why children cry more easily than adults (apart from the more obvious and often discussed social conditioning which they have not yet received, telling them to ‘be strong’) – because their little bodies are not only more fragile, but their emotional muscle has not yet developed – they need protecting.

In my case, this actually makes a lot of sense. I was quite a physically poorly kind of kid –  I hit most branches of the childhood illness tree, had some health conditions that I sense made other kids wary of me, even a little afraid, at times.  My Mum has often told me of the times she was worried about me not making it through with this, that, or the other condition. As an adult – yes, I still am physically, the proud owner of several ongoing health issues (which I manage, on the whole, quite successfully), and am also proud to say that I have had some really close calls and have ‘cheated’ death several times. Another time, another blog post for that stuff… The point I am getting to, is that, although I may still physically be a bit on the delicate side – emotionally I know I have built muscle on muscle over the years. I am not ‘bigging myself up’ when I say I know I know how to cope with a lot of mental weight. I have simply been well trained for it, is all! (There is a very good reason it takes a long time to train for this profession!)

So, as anyone with a basic knowledge of psychology will tell you, the problem with defense mechanisms is that they sometimes outgrow their usefulness. Our preprogrammed self automatically goes to the standard response, regardless of how suitable it has now become to our current circumstances. Is this what I am doing when I cry? Am I reverting back to the pre-programmed self of my youth? Keeping my (what my brain thinks is) ‘still developing’ psyche safe from whatever assault is about to be thrown at it?

Yes. Partly. Although this does feel sort of right, it also doesn’t feel wholly correct. Because if this were the case, why do I still cry when I’m on my own sometimes? (Yes, I do – I’m owning that here on this public forum!)

These tears, these solitary tears, actually feel more confusing to me than any others. These tears have no direct antagonist, only myself and my inner world. These tears feels more tangly and mixed up than any others to me. They are harder to name feelings for, and often, the feelings and the tears pass through me so fast and with such fluidity that I can’t hold onto them for long enough to work them out.

What I do know about the tears, is that they hold those feelings – those uncertain, unnamed and unnameable, indescribable yet very very real and felt feelings – and they help them to move through me. They stop me feeling trapped in an unnameable hard to understand place. I shed the tears, and often (mostly) I shed the feeling. And that feels good.

Moving through feelings is a sign of emotional health. When we feel stuck in a feeling, we feel stuck in our life. Many of my clients seem to echo the ‘stuck’ feeling when they first come for treatment. So many repeated behavioural patterns can be manifestations of this ‘stuckness’. Addictions, behaviours, compulsions – they can all be ways our bodies and minds  sometimes work to overcompensate for an outgrown defense which is keeping us stuck in an area of our life. My job is to help them through whatever is causing them to feel stuck. To get the feelings flowing again.  Because once that starts happening again, we generally begin to start feeling better.

I guess that is why I love crying. And I love that therapist for letting me cry with her, for never trying to stop me. Because letting the crying happen is the only way to move through and feel better. Sometimes it takes a lot of tears because there is a lot to move through. I guess that could be why I am still crying, years later? Maybe I am crying my way through the old stuff, maybe I am crying for new things I am picking up along my way, and maybe I have no idea why I am crying at all? And that’s okay. It’s definitely okay to cry. In fact, more than okay – positively great to cry.