"The world is full of pushing and shoving and people who think they know what everybody else needs. What's really rare and much more important in my opinion, are places where people can feel safe, and content and cared for and begin to gather their strength. When they're ready for the next step, they'll take it. But in order for that to happen we as helpers and rescuers and healers have to learn to bear the anxiety of not knowing when, or even if that step will be taken. We need to understand that wounds which were inflicted over the course of years will not be healed in months."
At two months old, she was abandoned in the wild and left to die. She almost did. Discovered hours from passing, dehydrated by a third of her body weight and emaciated to the point she looked like a kitten half her age, she was taken to a vet and given life saving treatment. For three days she was watched over day and night with fluids and antibiotics until she was declared stable enough to come home with me. There was not much to her. She was a big head, skinny little legs and a belly swollen from starvation. I held her in my hands and my heart hurt because she had been so horribly harmed. She was, essentially, a skeleton with fur.
For the first week, she did nothing but lay in her bed. I would encourage her to eat, and she would, but then she would return to her blankets and curl up and sleep. She had little to no energy. She could not run or jump or climb. She was a kitten, but just barely. She had a significant head tremor which would appear when she was startled or frightened which gave her the appearance of a fluffy bobble toy. She was quiet, aside from a small, cracked meow she gave one day. It sounded hoarse and static-y, like the sound an old fashioned record player would make when you lifted the needle....
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!
Somatising is a controversial defence mechanism for a number of reasons. Overall, somatising is not understood well by many professionals, including psychotherapists, counsellors, and psychologists. Somatising is often confused with hypochondria (a preoccupation with or fear of signs of illness), which though a real mental health issue in it's own right can be misunderstood as a manipulative or silly bid for attention.
In essence, through somatising we fend off a disturbing reality or painful feeling and instead experience it as a physical illness. When the unconscious underlying pain is fully felt and acknowledged, the symptoms of the somatising - the psychosomatic illness, reduce or disappear.
Over time society has become more sophisticated in it's understanding of how mind and body interrelate. It is a mainstream and accepted idea that stress and anxiety can contribute to physical illnesses. Somatising, however, is more complex than this. At Lucid Psychotherapy and Counselling we are influenced by a form of therapy called ISTDP - intensive short term dynamic psychotherapy. According to ISTDP, anxiety or stress per se, does not make us sick. What is crucial is the way, or pathway, through which we experience anxiety. Though nothing in this blog can or should substitute for medical advice, if your experience of physical illness seems to be connected with your degree or anxiety or the anxiety provoking situations in your life, you may be somatising.
Our series on defence mechanisms in counselling and psychotherapy continues with this post on the defence of dissociation.
Compared to some of the other defences, dissociation is less well known amongst the general public, despite it being very common (at least in mild forms.) We dissociate a little bit when we zone out, and become mentally absent from the situation in which we are physically present. The association between our mental presence and physical presence is disrupted - hence dissociation. More severe dissociation can lead to actual physical numbness, inability to feel one's body. As emotional and mental life become seperated, in dissociation we may also not be able to feel our emotions. We may feel unreal, or quite distance from a situation unfolding around us. Another variant of this is de-realisation, in which the situation around us begins to feel unreal, like a dream or a movie.
Like other defences, we use dissociation to distance ourselves from uncomfortable emotions. Often people who dissociate are aware of a link between their anxiety building up, and beginning to dissociate. Possibly the strongest form of dissociation is the controversial diagnosis of dissociative identity disorder, in which parts of one's identity become separated off from other parts. This was once called multiple identity disorder, which would be the topic of a whole other post.
When the client begins to dissociate in a psychotherapy or counselling session it is usually a sign that anxiety has become too intense to tolerate in other ways. Hopefully your psychotherapist or counsellor will notice this, or, it may be helpful to tell your therapist if you notice that you're beginning to dissociate. Most clinicians know basic grounding exercises that they may talk you through at this point, to help you reorient yourself to being aware of your body in the present moment, or perhaps to re-orient yourself to the external reality of the room in which you're sitting at that time, by noticing things such as the walls or the furniture around you. For most people this quickly helps reduce the dissociation, and is a useful practical skill to learn to deal with dissociation in one's daily life.
This is part of a series of posts on defence mechanisms in psychotherapy and counselling. Today we'll tackle the defence mechanism of intellectualisation.
Intellectualisation is considered one of the more mature or advanced defence mechanisms, but like the other defence mechanisms, it can still sometimes become unhealthy. When we intellectualise, we rely exclusively on reason, thereby distancing ourselves from or entirely blocking out disturbing feelings or anxiety. It is not merely the use of the intellect, but a "flight into reason", away from pain.
Sometimes the pain that we might avoid through intellectualisation is associated with a difficult decision, in which case the intellectualisation becomes a repeated analysis of the logical aspects of the difficult choice. At times this may be helpful, even of survival value, as we may need to remain "cool headed" and may not always benefit from deciding out of our feelings. However, people who intellectualise a lot tend to not only not decide out of their feelings, but tend to ignore the feelings altogether. This can cause problems. It can cause us to ignore our intuition, to ignore an opportunity to consider what this feeling might be telling us about the most beneficial course of action, can cause us to ignore factoring our happiness (an emotion!) into the decision, and by deactivation our emotional response can reduce our motivation to act on our decision. I read a book (an unfortunately cannot remember which book!) that talked about a true case of a judge who due to a very specific form of brain damage was unable to feel emotions. This judge ended up retiring himself, because he believed that without the input of his emotions his judgement was impaired.
Apart from decision making, intellectualisation can cause us other problems. People who overly rely on intellectualisation can be boring, even if they are smart and knowledgeable. This is because part of what we respond to in other people is their emotions. An interesting idea stripped of emotions often doesn't stay interesting. Related to this, people who intellectualise a lot may become so wedded to analysis that they forget how to play. Without playfulness, our relationships tend to suffer. Humour (considered an even more advanced or mature defence mechanism than intellectualisation) may be the antidote for the dryness of rampant intellectualisation.
Psychotherapists and counsellors should, by virtue of their training, be able to spot intellectualisation in their clients, and work with it constructively. Often, for me this means pointing out to a client that when I asked them what they felt, they told me what they thought, and then inviting them to consider the feeling. Sometimes that may mean exploring the cost of excessive intellectualisation, in terms of loss of intimacy in relationships, or the general loss of aliveness that comes from turning off feelings.
At times however, in the psychotherapy or counselling process, intellectualisation can be helpful. Part of what therapists offer to clients to help deal with emotional overwhelm, may be a set of ideas that give them a safe point to step back into and from which to view the emotional chaos. Sometimes intentionally changing gears into the intellect provides the necessary respite, and helps things to feel safely understandable, so that the client can once again return to the necessary therapeutic task of learning to bear their feelings.
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.
To understand more generally about the concept of defence mechanisms, and how they relate to psychotherapy and counselling, please read prior posts in this series. To learn more about the defence of this post: sexualisation, please read on.
When we use the defence of sexualisation we imbue something (or someone) with sexual significance in order to avoid our anxieties around feelings such as aggression, dependence, or loss. Like other defence mechanisms, there is something remarkable about our capacity to do this. We not only avoid experiencing something painful, but through the pleasure we receive through the sexual association, we may actually be able to make that experience pleasurable. In general, a psychotherapist or counsellor will only confront a client with their defence if it is hurting them. This seems worth pointing out given our propensity to make judgements around sexuality. Sexualisation isn't bad, and is not something to be ashamed about, but sometimes it gets in the way of living a fulfilling life.
To clear up another possible misconception, the defence of sexualisation is quite a different concept from the concern about people (usually children or women) becoming sexualised. According to Duchinsky this different and later use of the term sexualisation developed in the USA in the 80s, to describe a maladaptive form of socialisation which causes a premature entry by the child into adult forms of sexual subjectivity and desire. It seems likely that many of those who have been prematurely sexualised in this later sense of the word will then resort to the use of sexualisation as a defence mechanism, but they are different ideas.
To bring this out of the heady realm of theory, it might be useful to give a couple of common examples of the defence mechanism of sexualisation. Because men are often taught that we must be independent, many of us feel uncomfortable with dependence. But, inescapably, being social animals, we are dependent on others for social connection. When men who are uncomfortable with their need for dependence feel lonely or disconnected they may sexualise this threatening sign of dependence. Instead of seeking out intimate emotional connection, they may go out on the town looking to "get laid" and having the sort of sex that leaves them feeling more empty and alone than ever. (This pattern is not restricted to men, but seems more common in men due to masculine socialisation to be independent.) In extreme form this can result in men (or women) seeking psychotherapy or counselling for sexual addiction or other sexual problems that are really problems with emotional intimacy.
A more common example of the defence of sexualisation amongst women can arise in women who have been taught in one way or another that women are weak and men are powerful. Such women, being afraid of powerful or aggressive men, may sexualise this fear to the point where they instead feel attracted to powerful or aggressive men. Another side effect of this is feeling understandably envious of the power that men are perceived to (and may actually) have. This form of sexualisation is actually the basis of Freud's much maligned and misunderstood concept of penis envy, which (depending on how you interpret Freud) can be seen as a sympathetic and understanding view of the terrible impact on women of patriarchy. Women (or less frequently men) who sexualise in this way often come to psychotherapy or counselling having had a string of very painful relationships with men.
Most of us find talking about sex uncomfortable, perhaps especially if we're talking about a difficulty that relates to our experience of sex and desire. This means that often in therapy I've noticed that clients talk about everything other than sex. Therapists may be hesitant to ask about sex, out of fear of this being interpreted as dirty or seductive or leading by their clients. On the other hand, because of many of our shyness about discussing sex, if a therapist doesn't ask, often a client won't talk about sex. It's difficult. In couple's therapy, talking about sex can be particularly complicated, as sometimes the sexual topic that one couple feels they need to bring up, is the source of great shame for the other. There is no easy fix for this, but having a therapist who feels comfortable talking about sex, does help.
This is the last in a series of posts on the relational approach to psychotherapy and counselling for common mental health issues. This post covers anxiety issues.
Like other mental health issues, there are different approaches to dealing with anxiety. The medical approach has it's advantages, but as anyone who has become hooked on sedating or anxiety reducing medication can tell you, it is not without its risks. Another approach, that of mindfulness based treatment for anxiety issues, can be very effective. By learning to control our attention through mindfulness, we can empower ourselves to regulate our physiological anxiety responses, and to deal more effectively with anxious thoughts. Neither of these approaches, however, deals with the relational context of our anxiety.
Our experience of panic, generalised, or specific anxieties is often triggered by relationship with others. In particular, we may be anxious of conflict with others, being vulnerable with others, around displaying certain emotions, or around intimacy in general. With the guidance of a psychotherapist or counsellor, we may be able to approach whatever our personal forbidden territory is, that anxiety keeps us away from. Usually when we approach this territory, we discover that it is not what we thought it is, and we can begin to get more familiar and comfortable with the anxiety provoking situation in our relationships.
In particular, as a therapist, I would watch for moments when a client re-enacts an anxiety driven pattern with me, their therapist. For instance, a person who goes to an old pattern of care-taking in relationships, when feeling anxious, will probably do that with me, their therapist, sooner or later. Working with these moments when the issue is "live" between therapist and client can be some of the most potent opportunities for healing and transformation.
Please let me know what you think about this, and stay tuned for further posts on other topics.
Recently I’ve been noticing how feeling tired or drained doesn’t always relate to how much sleep I’ve had. There can be days where I’ve slept in and gotten at least 9 hours sleep consistently to ensure that I’m paying off my sleep debt, as I like to call it, and I can still feel tired and low energy, as if I’ve had only 6 hours sleep. So what’s going on? Is there more to tiredness than just our physical needs?
Although I know that feeling tired is influenced by more than how well we’ve been taking care of our physical body, I often forget that psychological and emotional factors can completely outweigh the physical. I find it fascinating that feeling stressed about getting everything done and worried that everything won’t get done in time, really can make us feel really tired. It’s like a protest from our bodies about the state of our lives.
The other day I noticed my drained, low energy and decided to sit mindfully for a while to see if that made any difference – I didn’t have time for a nap and I often can’t manage them anyway. So I sat mindfully for 30 minutes and afterwards I noticed a significant increase my energy levels. It’s pretty incredible that sitting mindfully, doing nothing fancy other than paying attention to our self and surrounds in a non-judging way, can really transform how we feel. So next time you notice you’re feeling tired and drained, maybe sitting mindfully somewhere quiet for a while could really help ease this feeling, making your day that much more enjoyable.
Posted by Selina Clare.