This post isn't about some new idea in psychotherapy or counselling, or about the psychology of the social or environmental issues we collectively face. It's about the afternoon that I spent yesterday taking some of my own medicine - a dose of ecotherapy. The first thing I want to say is that it's so strange, that it takes getting a bit sick and run down and feeling like I have to stop running in the rat race, to actually give myself something different.
Weaving through traffic and the unexpected traffic jams, I felt like I was making a prison break. I half expected that some last work commitment or emergency would stop me from getting to the start of the trail I was headed to at the base of the port hills. In hindsight I was actually worried that I'd flake out without a good excuse, and then have to face having sabotaged my own aspiration without even having an external barrier as a justification.
As I began to walk up the gentle (and then steep) uphill start of the trail, this slightly urgent anxiety to escape began to relax as I felt committed to the trail and direction I had selected. Soon this commitment began to shift to excitement and desire to see the view from the next crest of the hillside. I could feel my empty physical and emotional gas tank begin to refill. Pausing often, to turn around look behind, I began to get perspective on the city. No longer a trapping and limiting, stress and anxiety provoking maze through which I madly run, Christchurch had become a sweeping vista.
As I continued to climb, being an ecotherapist, I kept tuning in to the mental and emotional shifts that were happening inside of me. I noticed that as I began to sweat and glow from the climb, I began to feel more robust and confident, feeling my own capacity to work and progress and rise up over my previous foul mood. By the time I had reached the top I had also reached within myself a strong feeling of gratitude. This gratitude was towards myself, for having given myself this experience and worked for it, but also for having the amazing geography of the port hills so close by. The thought occurred to me: "I am made for this." And I think that's true. I, and you, were made to move through landscapes and to work physically, roam, to find new paths, and to trust the instincts of the body rather than a schedule or a fluorescent office environment. I don't happen to believe that a personal deity came along and made this world to suit my needs, but it's a pretty good moment when I spontaneously find myself feeling that evolution made me to enjoy walking, looking out at views, and feeling the wind on my face.
The descent felt less ecstatic, but still important. I'm not going to live the rest of my life (or even much of it) out on a hillside, as much as I can love it for a while. The impulse to escape the city had shifted to a readiness to return, a sense of warmth and tolerance towards the people and activities that I had needed a break from. Descending is not about ecstasy, it is about careful details of placing a foot in such a way that we do not slip or turn an ankle. As much as the details of my life persecute me at times, it was good to feel ready for rather than resistant to the painstaking detailed work of descending.
I'm glad to be able to share this experience with you through this blog post, but I'd like to take this further. A hell of a lot of research and my own experience tell me that those of us who struggle with issues such as anxiety or depression will find this sort of experience at least as beneficial as sitting in a therapy room with me. I look forward to starting up ecotherapy experiences this spring, so stay tuned for that!
When Psychotherapists and Counsellors start their training, usually the first thing that they're taught to do is to listen to what their clients say, and then to give succinct summaries back to the client, so that the client can hear what they've just said, and that they've been heard. In worst case scenarios, this leads to experiences of sitting down with a therapist, pouring out one's heart to them, and hearing back in a some-what parrot-like way, the gist of a the problem for which one so desperately is seeking a solution. Of course, it's important that your Counsellor or Psychotherapist actually does listen to you, and certainly that is better than simply having one's feelings shut down, or covered over by advice. That said, I do think that in a way, therapists still do listen too much.
The reason why I say this, is that we all use the defences that I've written about in previous posts, practically all the time. Furthermore, it is usually the use of some of these defences, that are actually creating the problem in the first place. Frequently, even at the start of a first session, a client's defenses will stop them clearly describing to me what the problem is that they'd like me to help them with. For instance, when I ask during an initial session what the problem is that my client would like me to help them with, they may reply with the defence of projection (of their will) by telling me (indignantly) that their psychiatrist thinks they have a problem! Or they may reply whilst using the defence of withdrawal, telling me about the problem in such a small tone of voice, and without making eye contact, that it's as if they're miles away from me. If we can't clearly agree on what the problem is that we're trying to address through therapy, it's unlikely that we're going to be able to work together effectively on dealing with that problem.
According to intensive short term dynamic psychotherapy (ISTDP), it is our defences that creating our problems, and therefore are hurting us. It's my job to (with the client's permission) to interrupt their automatic and unconscious use of defences. For instance, withdrawal and isolating is often part of what perpetuates depression. By helping a person to see in a session how they withdraw from me by not looking at me, mumbling, or talking in a small tone of voice, I can help them to begin to experiment right there and then with making some of the changes that will help alleviate the depression that they wanted my help with.
This brings me in a roundabout way to the title of the post. Psychotherapists and counsellors need to do more than just listen. Sometimes actually helping a client is to interrupt them, and help them to begin to express the emotion that they need to deal with, rather than spin around helplessly getting nowhere because they're using a defence without even realising it. I'm not suggesting a tactless of callous form of therapy. To skillfully interrupt a client's defence in the right way at the right time is an act of caring, and healing. The people who come to me for therapy usually don't know the technical information about defences and different styles of therapy, but they can feel the sense of relief when their use of defences has been interrupted and they can actually feel themselves again, and begin to choose a more healthy way of relating.
Continuing this series of posts on defence mechanisms in counselling and psychotherapy, today we'll look at the manic defence. For more information on defence mechanisms, check out the first post in this series.
Very broadly, the manic defence is an attempt to do things or think things quickly, to create a sense of busyness that shuts out unpleasant feelings. More specifically, often the feelings that are being shut out are feelings of powerlessness or hoplessness, which are often being shut out with the contradictory feelings of euphoria, goal oriented activity, and control or mastery. Like other defence mechanisms, there really is an intelligence to this, it is very hard to feel hopeless whilst energetically pursuing a meaningful goal. It works. In my opinion the manic defence is also one of the most widespread defences, at least in Western culture where being busy and constantly doing are a virtue.
For many people powerlessness and hopelessness in the extreme can manifest as depression, including lack of energy and pervasive sadness or numbness. The manic defence is often thought of as a defence against depression, though many consider the manic defence to be different from bipolar - or what was once called manic-depression.
In the psychotherapy or counselling process I most often notice the manic defence when a client talks a lot. In particular, when the client's talk is tangential, and is a response to us beginning to talk about painful feelings. When appropriate, I might notice this with a client, by saying something like: "Do you notice that just now as painful feelings began to rise up, you began to get anxious, and you distanced yourself from these feelings by talking fast and changing the topic?" In such a situation, with a client who is ready and willing to work on their defence mechanisms, it may be an act of kindness for the psychotherapist to actually interrupt their client's torrent of words and to help them see their manic defence in action. Thought it may be painful in the short term, experiencing painful feelings rather than shutting them down through mania may at times be a better long term choice. The cost of overusing the manic defence can be exhaustion, spiralling anxiety (because the problems are not dealt with), and difficulty connecting emotionally with others.
For those who are actively working with their own defences of mania and busyness, mindfulness can be an effective practice. Usually this will start with moments of mindfulness in the psychotherapy room, such as the above example when the psychotherapist helps the client to be mindful of their reaction to painful emotions in the moment. Some may take up mindfulness practice in their daily life. By just noticing and not amplifying the flow of thoughts, over time the thoughts slow down, and the usual experience is relief at the lifting of a burden that couldn't even be fully recognised until it lifted. Mindfulness practices that involve being still (rather than for instance walking mindfulness practice) have the advantage of creating physical as well as mental stillness, which further helps with the manic defence.
An interesting Australian article here discusses use of the manic defence by mental health professionals. An example given in the article is the use of antidepressants by GPs and psychiatrists to treat depression. Here the response is to do something, to prescribe something that stimulates rather than to deal with the painful feeling directly. Though I cannot personally comment on prescribing, and don't discourage use of antidepressants, this article is thought provoking. Amongst psychologists, psychotherapists, and counsellors, I see the manic defence at work at times, when the clinician out of a sense of helplessness or anxiety throws behavioural tasks or exercise at a client. Once again, though behavioural interventions aren't bad (I use lots of them myself), when they are being given to clients as a reaction to the clinicians own anxiety, I believe that the client on some level can feel the emotional disconnect, and is affected by it.
A recent research study summarised here in Science Daily has found mindfulness based cognitive behavioural therapy to be more effective than ongoing use of antidepressants to reduce the risk of people relapsing into depression. This is a significant finding, because four fifths of people who suffer from an episode of depression will relapse into another episode at some point in their life.
To be fair, the differences between mindfulness based therapy and medications was not statistically significant. However, even if the two treatments are equally effective, as might well be the case, this will still be significant for many people. Many people do not like to take psychiatric medication, either due to side-effects of the medication, or due to a wish to be pro-active rather than relaying on a pill. The alternative, that of doing eight 2.25 hour long group sessions, with the option of four sessions of follow up over the two years, is not onerous. Furthermore, some participants reported feeling empowered by learning mindfulness skills - something I've never heard in relation to taking medication.
Whilst both options can be effective, it's nice to hear alternatives to medication validated, as well as the transformative power of mindfulness.