Therapeutic Alliteration

Therapeutic Alliteration

Every argument worth making, it seems, can be summarised in a limited number of words all beginning with the same letter. So here are the Four Ps of Therapeutic Attitude. The last one is A, so I made the middle two either P/A to balance it out.

By the way, the “you” addressed here may be a therapist, but not necessarily. Everyone can bring some therapeutic attitude to the table in whatever relationship they are in. If you are in a position of professional responsibility, then I believe you have a duty to do so. Oh, and first check out Attitude

So here are the four Ps: Position, Posture, Purpose, and Appreciation. That’s P for ‘preciation.

Position

Are you visible? Accessible? Are you in a place in your own life that enables you to park your issues and engage fully in the therapeutic relationship for the allotted time? There is little point in having all the other attributes of a therapist if you are hidden away or beset constantly by other demands. Position can also refer to your “position on issues”. Where are your red lines? I suggest, very simply, “Support the other if you can do so without harming anyone”. If you have read much else of what I have written you will know that I have other red lines; I will not serve the machine, for example. Red lines are relatively static and provide the channels through which Purpose (see below) is directed.

Posture/Appearance

Body posture is both a useful metaphor, and a way to evidence and influence a more internal posture. You need to be upright without being rigid; relaxed without being slumped; alert without being rapacious; responsive without jumping to conclusions or into action. Some aspects of your posture will become evident from your responses. To maintain therapeutic attitude, you need to be located in the real world, but not too subservient to it. Stable, yet poised for movement. How you appear will hopefully inform others as to your position and likely style.

Purpose/ Approach

The purpose of therapy is to enable positive developmental change; enable and encourage, but never force or demand. The agenda arises in – is set and owned by – the other person. Any other would-be influences can be considered part of the environment. If the client has been sent or brought by a third party – then the agenda of that third party is something that you and your patient or client can look at with interest. Someone may come to you with an agenda and that is fine, but you will be curious towards it, and ready for it to change.

Appreciation

Appreciation of the other includes warmth, greeting, acknowledgement (that they are real and valid), acclaim, and humour. There are two keys to appreciation. One is Sensitivity. There is no merit to acclaim, for example, if it is insensitive. Some people are not rewarded by a fanfare, but rather a shy nod. Others will only notice a fanfare and will experience a shy nod as a brush-off or will not notice it at all. The other key to appreciation is genuineness, and it is at the point of appreciation that genuineness is most crucial. It is possible to manufacture Position, Posture, and Purpose and act them out – possibly against the grain, though this will require a good deal of effort – but genuineness must be genuine. Fake genuineness, when detected, simply results in disengagement; if undetected, fake genuineness can be toxic. Therapeutic work, therefore, is a vocation. You do it because you really want to, and because it really matters to you.

TA = P + P(A) + P(A) + A(P)SG . What could be simpler?

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Pebbles and People

Pebbles and People

Whenever let loose on a beach I immediately find myself looking at the ground around me, stooping, and picking up objects for closer examination. Sometimes it is shells or driftwood. Occasionally it is a useful piece of nylon string. But what I find fascinates me most frequently are pebbles.

On the beach at Filey in Yorkshire, about ten years ago it occurred to me that, although I was exercising great discrimination in selecting pebbles, I might just as well shut my eyes and pick up the first one I stumbled across and that single pebble would give me as much satisfaction.

This observation troubled me slightly, and bided its time, quietly fizzing in the very back of my mind until a few months ago on a beach in Pembrokeshire. That idea about “any old pebble” popped up to greet a new niggling observation. I was noticing in myself a sense of affection bordering on love and nostalgia towards the stones I was picking up and, with some reluctance, releasing again to the wild.

Suddenly these were people. Indeed, they were my patients! Do I have a favourite? No, of course not. Is any one not worthy of love? No. Is any of them perfect? No. Do they share features, and yet retain, each of them, a uniqueness? Yes. Do I take a particular interest in some over others, for a time? Yes. Does each of them accompany me for a time and then leave? Yes. And do I have a sense of the number that I can safely carry, and the number that I can examine closely, at any one time? Yes.

Of course the analogy has its limits. Any analogy that is total or complete ceases to be an analogy or of any interest. I do not see myself as of any use to these stones. I don’t expect any of them to be in any kind of predicament that I might be able to help them through. In fact the roles are somewhat reversed. It is more likely that they can help me with my predicament.

But do they talk to me? Yes.

What makes these pebbles like people to me? What is it they share?

A pebble’s character is shaped by two things: their inherent material, and their experience. Each stone is made of a material which may be soft, hard, brittle, porous. These features, in turn, have their distant origin in constituent and experience – their chemical makeup and the terrible forces that gave birth. There may also be a fault line, or a sheering plane due to differing materials joining. And then there is the tossing and churning, the action of water, and jostling with their fellows which has brought them to their current shape. The interaction of these two broad sets of influences is important. Some will have been more or less resilient to this abrasion. Others may have seemed impenetrable until they split after a sharp tap, to reveal a hollow interior. And then this, in turn, was smoothed and adapted. And some may have been brought here from elsewhere, finding themselves in the company of other shapes and colours.

I found myself moved by the stories of these stones. And by the fact that, yes, some of them caught my eye – bright colours or a wet shine – but that I could pick any one of them, take an equal interest in it and enjoy its company – for a time.

Ultimately, of course, the analogy relaxes its grip and we fall back into our respective places. I turn to my human companion, perhaps compare notes, and move on.

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Transference: A reflection on not being the Other

Transference happens. We could argue about how much, exactly how, and whether the name is right, but that would be pointless. The point is that we can, at times, react towards another person as though they were not who they actually are (friend, boss, shop assistant etc), but an important other from our own past or distant lives.

Some of us do it more than others. Some people seem almost to do nothing else. It can be trivial, but it can also seriously hamper relationships and personal development. People who enter therapy and are likely to be doing so exactly because they do have problems with their relationships and their personal development. They may be expected to be particularly prone to this type of relating. For this reason, therapists need to be adept at managing the situation.
                                                                                                                                                          Therapy encourages transference by 1) establishing a particular kind of relationship which has inherent in it a degree of asymmetry, and then 2) having as its remit the exploration of areas in which the patient or client is unconfident or unskilled and which evoke earlier relationships. Some styles of therapy may further encourage this by their use of silence and by developing what has been called the “frustration tension”.
                                                                                                                                                                  The therapist cannot simply dismiss the confusion by saying, for example, “Stop it. Don’t be ridiculous! I’m not you mother!” They have to keep it going enough for it to be seen, understood, and worked with. It would be unforgivable, though, if the therapist were to encourage or consolidate the confusion, by continuing to play the part and recapitulate the original trauma.
                                                                                                                                                                      In other words – and here I am getting to the crux of it – the therapist has to be able to be enough of all these others (these fathers, mothers, lovers, siblings etc) to be plausible to the client’s unconscious whilst manifestly NOT being these people. In a sense, they need to be able to be any number of people whilst emphatically not being them.
                                                                                                                                                                           Not being should perhaps have a hyphen, because this activity of not-being is different to a simple absence. As in the mind-experiment of trying to not think of a pink giraffe, not-being to a large extent draws attention towards being. Not-being subsumes a degree of being. In a sense, it flirts with being. Think, for example, of the counsellor whose skill set should include knowing how one might take the session deeper, in order to not-do so. Or the doctor who is required to be able to prescribe a medication before their decision to not-do so can take on significance. The mountain guide must know what would be a reckless action in order to be saved from carrying it out.
                                                                                                                                                            Adding to this, the therapist must also be genuinely themselves and 100% present whilst in a way leaving much of themselves outside the room: bringing their skills, attention, and beneficial intent into the room – giving them a voice – yet leaving their own factual lives outside. They have to remember the right things. They have to remember who they are without the constant rehearsal of self-revelation and, whilst stripped in this way, they have to not-accept the roles and characteristics transferred within the therapeutic relationship.
                                                                                                                                                            Therapists, then, if they are to be therapists rather than functionaries, have to be sufficiently capable and supported to perform this balancing act; a balancing that includes things repeatedly touched upon in Being With and Saying Goodbye such as equipoise, believing whilst suspending belief, uncertainty, and paradox. The space between being and not being (which I have here called not-being) is what Winnicott might have termed a “potential space”. It is there yet not-there; the essential ambiguity needed for the play that is therapy.
                                                                                                                                                                    Do think, reply, discuss. Here, or @afwesty via Twitter