Sunday, August 31, 2014

Case #108 - After abuse, the gift of pleasure

Elise plunged right in. She spoke about being molested as a 5 year old girl. This was the first time in her life she had shared this with anyone, and she was in her mid 40's.
After the abuse, she subsequently believed that she had lost her virginity. But when she first had sex with her husband, she realised that in fact that was not the case. However, the burden that she had been carrying since that age impacted on her negatively and in 20 years of marriage, she was not able to enjoy sex with her husband.
As with many victims of sexual assault, she blamed herself - why hadn't she run away? Why didn't she hate the molester more? Why couldn't she let it go? So many things weighed heavily on her. And now, her husband had been having an affair for 5 years, so that increased her sense of burden, and self hatred.
Firstly, I contextualised her experience - many victims find it easier to hate themselves, than the perpetrator. And victims, whether adult or child, get frozen. So I explained a number of things to reassure her that she was not alone in her experience.
She said she would like to be able to find pleasure in sex.
I said - 'won't it be amazing when you get that gift to yourself - you open up the present, and there it is, a lovely source of pleasure that you can access any time'. I was preparing her for this possibility. In NLP this is called future pacing.
I also suggested that she could do a swap - trade the burden she had been carrying, for this pleasurable gift. I said 'how amazing that will be, you get to give away the burden, and you get the gift of pleasure instead'. I introduced the idea of an exchange.
She relayed that after the molestation, she saw the perpetrator, but there was no further abuse. However, strangely from her point of view, she would ask him to give her a lift on his bicycle to her school. She also gave herself a hard time that she was 'using him'. And that she had allowed herself to get somewhat close to him.
This is quite normal, and I reassured her of that. Victims often have some kind of bond with the perpetrator, which defies black and white categories. Bert hellinger speaks at length about this.
I also pointed out that perhaps her 'using him' for lifts was a kind of exchange - a way of 'punishing' him, allowing him to exchange his guilt for 'being used'.
Again, I wanted to introduce this idea of an exchange.
Next I set up a Gestalt experiment: I asked her to select some objects representing different elements - the burden, her hatred, herself, 'the gift' (pleasurable sex), the abuse behaviour, and her husband. I named it 'abuse behaviour' rather than 'the abuser', as it was clear she did not want to hate the perpetrator.
I then facilitated a process: she swapped her anger at herself, for anger at the abuse behaviour. She swapped the burden for the gift.
I then invited her into another Gestalt experiment, involving her having a dialogue with the object representing her husband; she proposed to her husband that if he finished the affair, she would give him her gift - pleasurable sexuality.
If not, she would take it to a new relationship.
She decided she would separate for 6 months, giving him a chance to either finish the other relationship, or decide not to continue with her.
During that time I suggested she practice 'the gift' - pleasuring herself (she had not masturbated before), reading erotic stories, and reading other helpful books on pleasurable sexuality.
The whole process was filled with a great deal of emotion. By the end, she felt very calm and very clear.
In Gestalt we use a term 'organismic self regulation' - basically, a person knows underneath what they need, and they have natural processes of moving towards that. The problem is that old patterns interrupt this movement, getting in the way. So we provide support at key junctures, helping restore this natural organismic flow. Elise was ready for a change in her life, and so all she needed was some assistance in finding how to move in that direction. The clues were all there, and her resources were also all there. She just needed support to form a complete Gestalt - moving from desire and intention, through to action and satsifaction.

Wednesday, August 27, 2014

Case #107 - Using authority to exit from violence

Kirstie was in a domestic violence relationship
She grew up in a large family; even though her father was away working during part of her childhood, her memories were basically good.
Her husband came from a military family. His father had beaten his mother. His siblings had various problems, including addictions.
Kirstie was a good wife. She worked in the family business. She helped her husband. She helped her inlaws. She was there for everyone - except herself.
Her husband was insecure and controlling, limiting how much she could go out of the house.
Yet, he had had several affairs.
The violence had occurred on a half dozen occasions, but the last incident was fairly recent, and the police were called.
She wanted to separate, but he refused, backed up by his parents.
She told him if the violence occurred again she would leave.
Kirstie had been doing lots of self development courses, reading lots of books, including some on domestic violence. She had been learning self care on a variety of levels. She had been to some group therapy.
Of course, there was lots of emotion as she was relaying her story.
One of the contraindications for therapy is domestic violence. Whilst therapy can be useful to help empower the person in the victim role, it can in some ways make things worse - as the person becomes more independent, the violence may increase, as an attempt to impose control.
So I didn't want to work with feelings, or even behaviours. I didn't want to come up with strategies. I said to Kirstie - what do you want from me?
She said - a direction to head.
I pointed out that she probably had plenty of suggestions from her girlfriends, and that if I was to suggest something to her, she would probably ignore me. She smiled, just faintly, and I knew what i was saying was true.
I tested this out. I asked her point blank - if he beats you again, will you leave?
She paused, baulked, started to cry a little, just faintly shook her head.
This was confirmation that something much more profound was required.
So I wasn't soft, compassionate, understanding, or supportive. That would involve being pulled into a 'sympathy' position, which would not ultimately empower her.
I stepped into my authority role, and told her - 'there is only one thing you can do'.
Now, usually I eschew my authority role, in preference for dialogical communication, or bracketing of myself, to explore the client's reality or their values.
If we had more time, this may have been useful.
But theres very realistic dangers at stake in a domestic violence relationship, and my orientation is more practical.
So I used my authority for dramatic effect, to confront her, and to test out her readiness to truly do something different.
I used polarity theory in Gestalt  - the existence of any one polarity, always implies the other.
She was identified with the victim/powerless/nice girl.
So I said - 'you will have to become like your father in law - a military man'.
I spoke in this way, to use the language of authority - which is in one sense what she was used to responding  to, but I was using for benevolent purpose rather than to hurt her.
I picked up a statue of a patriarch looking guy, and put it in front of her. I directed (notice the authority again) her to come and stand behind the statue, and to 'become him'.
All this authority is setting her up to step into that energetic realm. I asked her to imagine she were a military man. An officer who commanded thousands, sent them into battle. Who was obeyed absolutely, who gave orders, who was willing to sacrifice the lives of others.
She of course found it difficult to occupy this role, but I kept focusing her, showing her how to stand, giving her mental images. At one point she said 'but my father in law is very unhappy'. I said  - this is not about happiness, but about power. Its about you stepping into a role of power. You don't have to stay there, just as long as is necessary, then you can go back to being your nice and caring self.'
I explained how in that role, she wouldnt care about hurting others in her decisions.
This sounds like setting someone up for destructive behaviour. But in fact, for someone like her who is identified with their powerlessness and 'caring', they need a way to step out of so much 'caring' for others, and into a place of 'not caring', so they can act with power to defend themselves.
The one thing her husband was afraid of was her leaving, and thats the one power she wasn't really willing to exercise. To do so would hurt him. So this is an example of a 'strategic' skill, skills which are necessary in life and relationship, just as much as intimate skills are.
She was able to hold this position briefly, then started crying.
So I asked her to sit down.
I explained to her that the things she wanted - better communication, safety, were secondary effects. The first one was finding her power. Without that, there were no bottom lines. She had an identity  as a nice person. To move out of her situation she would have to learn to take on other identities - in this case, the military commander

There may be people who object to me using such violent images. But the irony is, until she could own that ruthless and violent part of herself, she would not be able to truly stand her ground, and be willing to leave him. Until she was willing to do that, she would 'adjust' and put up with anything - probably for a long period. It can take a woman many years to leave a domestic violence relationship.
So I explained to her that she needed to practice this identity every day. To remove her jewellery, to wear masculine clothes when practicing. To really find her authority and power.
And then, when she was fully ready, to plan - strategically - a meeting with her husband where she would step fully into her power, and 'lay down the law'. This is the kind of communication he was used to from his family, and would potentially earn his respect.
It would only be after she was really willing to leave him (i.e. hurt him), step into her power, and deliver him this message, that anything could change.
She agreed.
So in this case, power came first, and everything else came second. Therapy has to be flexible enough to take the approach that is necessary for the situation. To work with her feelings would be inappropriate, when the context was violence. It was necessary to go to that context, and to move her out of her own fixed position, to allow her to gain the respect - and obedience - of her husband.

Friday, August 22, 2014

Case #106 - The thin red line

Jillie started out talking about her marriage. There was very  little sex, and there had been a number of years where her husband was away working for long periods. Now he had returned home.
She had married him for security after some major upheavals in her world, but was not that attracted to him.
So I knew that if her marriage was to last, and to succeed, she would have to be guided by will, rather than by emotion. If there is chemistry, it helps. If there isn't, a good marriage is still possible, but it requires an entirely conscious effort to establish the conditions for intimacy. These conditions were not present in the marriage - in 6 years they had 2 emotionally-based conversations.
I asked her how much she was in the relationship, and how much out. She said 50/50. That indicated that this was a critical juncture, that there was hope, but that something different needed to happen immediately. It indicated the need for input. So that set the tone of the session.
So I asked Jillie to get up, and stand on a line on the floor - the 50/50 line. I asked her which side was which - and I defined the categories - leaving the relationship, or making a quality relationship. I set those polarities, as they made the choice clear. And I didn't want to create a choice of 'stay and nothing change', because that would be to continue the deadness of the relationship, and I did not want to support that.
So then I invited her to step one side - firstly the 'leaving side'.
She reported a number of experiences - fear, excitement, 'freedom', pain. I invited her to step fully into those feelings.
I then asked her to step to the other side - quality relationship. At first she had no idea of what that was, so I defined it again for her - quality relationship and what that might mean, in a few words. She felt stable, peaceful, pleased, balanced, happy, successful.
I took her back to the line. And asked her - 'ok, now if you had to choose, which side?'
She prevaricated. This is the position she is in - unwilling to make choices, staying 'safe' on the line, but meanwhile, dead. This is akin to the passive position that Sartre refers to as 'bad faith'. In Gestalt we are interested in what we call 'existential responsibility', which is a way of living life that involves a sense of choicefulness, rather than being a victim of fate or circumstances.
I could see her unwillingness to step either side.
So I tricked her. I got a coin and told her - heads she leaves, tails she moves to quality relationship.
I was about the flip the coin, and then asked her - which side are you wanting the coin to land?
She said -leaving. So I asked her to step on that side. At least we could 'try out for real' the choice. And get her to experience more fully that side, rather than it just be a fantasy. This is the next phase of our Gestalt experiment.
She said she felt strong and steady. I asked her the specific consequences. And helped her to spell them out - loss of financial security, the impact on her child, and then the impact on her husband - I got her to imagine him there, and see what his response was (sadness, anger etc), and to experience what that was like for her.
For such important decisions its very important to give the person as grounded a sense as possible of the consequences of their choices.
I did not just want to leave it at that though.
One of the features of divorce is that its 'too late', even if the other person changes.
So I said, lets just reverse time for a second, and imagine that just before you step into leaving the relationship, you let your husband know, and his response is 'I will pay whatever price is necessary to build a quality relationship with you'.
This is a dramatic test - just how much she wants to leave, and how much she wants a quality of relationship but doesnt believe that he will come to the party.
This is not just putting words in his mouth, its playing out a scenario when the stakes are high, and the cards are on the table. Sometimes under such circumstances men and women rise to the occasion. I believe its worth giving this a chance.
But she needed help in spelling out what this meant.
I said - what would you ask him for - the list.
She mentioned - he would attend parenting classes, he would get fit, they would have emotionally based conversations once a week, they would go on a family holiday once every 3 months. I said -what about sex? She said - if this happens, I will wholeheartedly give myself to him.
Then I asked her back to the line.
Now, I asked, what side did she want to choose.
Up to this point, I had been neutral, simply facilitating her choices, helping her explore them. My own opinion was irrelevant. I was working to increase her awareness, and therefore capacity to take responsibility for her life. I was facilitating her awareness, working phenomenologically.
Now, she was on the line and she 'couldn't' choose. We hovered there sometime, still no choice.
In a whole series of sessions we might have the luxury of hanging out in that place. But the session was already long, and it was time to draw it to a close.
So rather than leave her there I said - what do you need? She said 'a push'. I said 'so you want my opinion?' She said, 'yes'.
I said 'so you want me to decide your fate?'
I was confronting her with her passivity, and the implications of handing over a decision to me which way to push her.
I asked again - so you really want to hear my opinion? She indicated yes.
This was important - not rushing into giving my 5-bob worth. We all have opinions and we all think them wonderful. But its important to be very careful with clients, as the authority of our opinion as therapist can unduly sway a person, taking away their autonomy.
And, therapy cannot be rigid either. Sometimes, after due exploration, its appropriate to bring in ones own phenomenology. So I decided to do so. I remembered the juncture of a decision about my own divorce. My therapist would not take a position. I wished now they had done so - it would have been helpful for me.
So I told her my opinion, in precise and clear terms.
I believed that she could choose a quality relationship, that if her husband agreed to do anything, she could dictate the terms, which sounded healthy to me. I told her that I saw love as an act of will, and that if she made the choice, she could learn to love him deeply, and create the conditions for intimacy to blossom.
She said - yes, she believed me. It accorded with her deep feelings.
She decided she would do this, and make it a years probation - to be reviewed after that time.
In this way she reached her own integration - to move to a decision, but not to abandon her right to choose the other side. This was a good indication that she had reached her own conclusion.

Tuesday, August 19, 2014

Case #105 - Leaning and pushing

Patty brought the issue of 'stability', as in, she wanted more of it. In trying to understand what this meant for her, she mentioned that she often felt tired, but at the same time, she couldn't really rest well. As I talked about this with her, I not see much emotion going across her face. I asked about this, but she was not aware of her blankness.
This happened several times, each time I would comment on what I saw. This is what we call phenomenological reporting - the observation of the obvious.
Then she started to tear up, I invited her to breathe, and asked how she felt. She reported just a little sadness.
I could see that it was hard for her to 'let down' - a somatic term which indicates letting go both emotionally and physically.
So I suggested an experiment - she would lean against me.
In this way I was offering her a relational experience of 'someone else' being stable for her, so she could allow herself to go more into her emotions. This could potentially give her a source of strength which she could then draw into herself, and at the same time, allow her to go more safely into her feeling
This worked for a little while, she cried a bit, and indicated a blockage on her back. So I put my hand there - as support - and she felt that pain release.
However, I could tell there was some kind of limit, she wasn't letting herself go further.
She reported a sense of 'having to rely on myself'. So I followed that sense, invited her to sit up, and she said - 'I can't fully trust men'.
In Gestalt we always invite someone to make general statements into personal ones - the 'I-thou'.
So I said - 'I am a man, tell me that directly'.
She was reluctant, but I insisted on personalising it.
Then she said - 'its my first husband'.
So that made it clear. She explained how she had put up with a lot of very bad and disrespectful behaviour from him, and had never said anything. So she was angry at herself - she was squeezing her fists tightly.
I then invited her to 'put him on the pillow', and talk to him.
She did not find it easy to do so. She was so used to blaming herself. She needed help from me to frame up statements to him in the format: 'I am angry that you…'. She had for a very long time been angry at herself that she had allowed his bad behaviour.
In Gestalt we refer to energy which is directed at self rather than other as 'Retroflection'.
Her body was habituated to doing this.
So I provided more support for her to direct the energy towards him, by changing her 'I am angry I allowed myself…' statements into 'I am angry that you did…' statements.
She did spontaneously start hitting the pillow. But not terribly hard, and her voice was still somewhat soft.
She clearly found it difficult to really let go her anger.
However, she reported feeling more breathing space, which indicated that she was letting go.
She talked about a male friend of hers who was very nice to her…but she wasn't so nice to him.
So I brought the focus to her and I. I said, 'I care about you' - and she agreed she could take that in a little - because I was the 'good man'.
I also said - 'but like all men, I can also be a selfish man'. This is offering her the experience of polarity - both in the same person, rather than split into 'good guys and bad guys'.
It was hard for her to take that in.
So I invited her to another experiment. I took one of her hands in mine, and said 'can you feel my caring?'. She was passive at first, but I asked her to squeeze my hand - an active participation in accepting caring. (and addresses the problem of what Sartre calls 'bad faith' - a passive way of not choosing in life).
Then I asked her to push her other hand against my other hand. So both hands were doing two different things.
I invited her to make two statements to me:
'I accept your caring'
'I push away your selfishness'
The second statement we amended to  'I won't allow your selfishness to hurt me'
In this way, we were able to contain both elements of relationship - self protection, and openness and nourishment. For a long time she had been pushing men away, but then feeling starved for nourishment, and not able to enter into relationship.
This provided for her the experience of integration, and the ability to hold both elements of relationship.
She reported feeling much more breathing space, and a new sense of how she could be with a man.

Saturday, August 16, 2014

Case #104 - A sensitive young woman

Lucy brought the issue of her sensitivity. What I noticed was her smiling a lot. I asked if she felt happy…and then, what kind of things gave her pleasure, and brought her happiness. Although this gave me some information, it didn't seem to connect up with the issue she brought, so I left it. Sometimes figures of interest such as these may be useful - later in the session, or at other times.
She had done some other therapy work, and read a book recently, that gave her the idea that her problem was over sensitivity. She was also concerned with this in regards to meeting men. She was a young woman who was easily affected by friendship with men - she would soon find herself at the point of wanting to move into an intimate relationship. But she wondered if her sensitivity meant that she moved too quickly, and mistook the signs on the part of the man. Her relationships had not lasted that long, and she wondered if her sensitivity was contributing to the lack of success in engaging in a deepening relationship.
She started telling me a number of stories - about experiences with young men, that hadn't been successful, about a diagnosis that a practitioner had made about blockages in her system, and she started to tell me some other matters to do with her parents, and her unfinished feelings in relation to them.
Although all these stories could have been relevant, I felt a sense of widening circles - too much to grasp, too many images, too much information. In Gestalt we work to ground, focus, and find 'one figure' to work with in a session.
So I interrupted her (an important therapeutic skill), and told her I was getting lost, and wanted to bring the dialogue back to the present, and to focus on the issue she brought. Sometimes other, more relevant figures arise in the course of such story telling, but in this case, it simply generated too many other possibilities, none of which seemed to have more energy.
So I invited her back to the 'here and now, I and thou' - a core focus in relational Gestalt.
I asked her to notice her sensitivity with me, and tell me about that. I expected her to say something about herself, but instead she talked about something she noticed in me - what she described as my loneliness.
Now, this wasn't something I was directly in touch with, at that moment. But in Gestalt, in contemporary terms, we prefer not to label such a thing 'projection'. Because it always has a grain of truth, and there's more valuable dialogue to be had by taking it at face value.
So I looked at my own experience, and shared that although I wasn't immediately in touch with my loneliness, its true I did experience it from time to time travelling, and in many ways, my coping process involved simply putting it aside, pushing it away.
I asked what her own response was to that perception - she said she felt some pity. I asked about the impact on her - she wanted to give me a hug.
Now this was useful to deconstruct. Whilst I may indeed like a hug, especially in relation to any feeling of loneliness I have, what was valuable was to see her process - focusing her sensitivity on the other person, and moving away from herself. I highlighted this, bringing it to her awareness. What was noteworthy was that her sensitivity was finely tuned to the other, but not herself. I pointed out that sometimes my response to someone in pain was to want to offer a hug - but that was more to do with the fact thats what I would like in that place, than necessarily being true for them. I pointed out that by moving away from her experience, she created an unbalanced transaction, in one sense, almost invasive.
So I asked her to 'step back over the fence', and notice her experience - focus her sensitivity on herself.
This was a major realisation for her, and gave her a great deal of valuable information about what tended to go wrong for her in relationship, and what she could do differently.
I also outlined how from a Gestalt point of view, her sensitivity wasnt something to be 'changed', but owned and embraced - the more she knew about herself in that place, the more fully she could bring her uniqueness into relationship with a man, knowing the strengths and limitations of it.

Monday, August 11, 2014

Case #103 - Disciplining Ms Spontaneous

Molly wanted to establish a more regular meditation practice. She was very keen to do so, but, as with many people, found that she would do it for a while, then get out of the rhythm.
I asked for specifics - how often, when, and for how long. She wanted to do one hour, twice a day - in the morning, and the evening.
I asked about her schedule. She did not have a schedule. She worked for herself, her time was open, and every day was different.
This was going to be difficult! Given that she clearly had such a preference for spontaneity, I was interested in her family context, which is often what sets our personal style.
This is what we call a Field question in Gestalt - an interest in the setting of the field and its influence. Deeper patterns tend to come from that place, and its important to enquire about this, as otherwise immediate and behavioural interventions are likely not to stick.
She had a number of brothers and sisters, and grew up in a rural environment. Both parents worked. So there was a very tight schedule. Her father would wake, often sometime around 4.30am, get up, cook lunches for all the children, get them up, and then help her mother feed the kids breakfast. They would then head out with their mother who was a school teacher.
She talked about how when she had an exam her father would wake her earlier to study, but as soon as he was gone she would go back to sleep until it was time to get up for school.
This gave a clear indication that any role I had in being helpful and 'waking her up' to do something - even  in her own interest - was just as likely to be sabotaged by her desire of the moment.
So I knew there had to be some sense for her of working for a result - if it was my direction, it wouldn't work. She had to feel full ownership. I decided that one way to do this would be for her to feel like she was 'paying the price' of getting the result (of regular meditation). It wasn't going to be a 'free' or 'easy' answer, and would have to involve some kind of explicit sacrifice on her part. Otherwise, she 'wants it all' - her freedom, and a regular practice. Things don't usually work like that.
But I also had to find a way that she could retain a sense of control, and spontaneity, so I didn't think that a regular time frame would work.
My solution was this. I proposed to her that everything has a cost. And if she wanted this result, she had to be willing to pay the price.
In this way I prepped her for being willing to pay a cost.
I asked if she was open to 'paying' for the result. She agreed.
I then suggested that she 'pay' by exchanging a meditation session for a meal - that is, until she had completed her morning practice, and evening practice, she wouldn't eat her meal.
This gave her a sense of 'paying' for the meal with the meditation - displacing her focus away from 'having to' keep a meditation discipline, and using her hunger as a motivator instead. Hunger is something fairly stable, it returns each day, and doesnt have to be worked at, so anchoring it as a reference point provided a point of stability in her otherwise chaotic schedule.
It also allowed her to vary the time when she did her practice, satisfying her need for spontaneity.
In Gestalt, as in Ericksonian approaches, we try to use the client's resources, find things which fit in their unique style, and introduce tasks which are integrative, rather than pushing against resistance.

Friday, August 8, 2014

Case #102 - A pleasurable reward

Martha was depressed. The family business was not something she was very interested in; she didn't want to go to work, but felt guilty when she didn't. She went in and out of a dark depression, a general lack of motivation, and had considered going on medication. She had tried therapy, but the counselling was 'just chatting' and didn't help. She wanted help to get into doing a regular meditation practice, but she had no schedule, and could not get a regular rhythm going.
Firstly, I made it clear that, while I thought the spiritual practice could be very helpful, I beleived that she did need to do psychological work, and that both were in fact important. I subsequently made some efforts to find a good therapist to refer her to. I think that the spiritual solution is an excellent one, but do not believe it is generally enough on its own, just as I think the psychological approach has its limitations as well, and can be supported by spiritual practices.
So next we looked at her situation. I asked about her meditation practice. She said she used a guided visualisation tape, but that it didn't work very well.
Its important to have a spiritual practice that you enjoy and that really fits for you. So the first thing I suggested was that she find a really good meditation practice. Whilst guided visualisations can be relaxing, they are not necessarily spiritual in the sense of connecting in some kind of transcendent way, accessing a state which is beyond mind and emotion.
I asked the spiritual framework that had meaning to her - its important to find the client's philosophical reference point (if they have one). It was Buddhism. I then asked what specific teacher had meaning for her. This is not always the case, but its a useful resource to identify. She named one. I asked if she would be willing to go to that teacher and ask for a meditation practice. She agreed.
The next issue was a regular schedule. This is a problem for many people. For her it was exacerbated by her depression, and by the fact she had no fixed or regularly schedule in her life.
The problem in depression is generally a lack of pleasure (amidst other core aspects of course). So I proposed to her that she give herself a 'reward' every time she meditated. I asked her how long and how often she would like to meditate for; she said twice a day, half hour each time. So next I looked for a reward that would be meaningful and easily accessible.
I asked about her interests - the things she enjoyed learning about - they were spiritual matters, and psychological ones.
I talked about how I enjoyed watching videos of people talking about these subjects, and enquired if that would also be pleasurable for her. She agreed. So I proposed that she give herself a reward after each meditation, by spending some time watching one of those videos - that she would line up ahead of time.
This process involved addressing the spiritual by using a range of psychological interventions. One was eliciting resources in her field. Another was grounding her interests in a way that was tailored to her needs. Finally, I used some behavioural elements to support her goals.
Gestalt can work on relational and existential levels. However, it is also flexible, such that it can be employed - as with many therapies - to help a person achieve healthy goals.

Wednesday, August 6, 2014

Case #101 - The compassionate no!

Wendy lived with her husband, and mother in law. Her children were grown, and her mother in law had Alzheimer's. Her issue was that she wanted to cultivate her spirituality by being more compassionate to her mother in law - Joan, but she couldn't stand the way that Joan bossed her around and tried to control things in the house.
So firstly I explored the contextual issues - there was a 'should' in there: 'she is old and has Alzheimer's, so I should be nice to her'.
I asked where these shoulds came from - there is always a source.
Wendy said that it was both social and family sources where she received these messages.
So the first thing I did was to help her differentiate between social injunctions and spiritual values. It can be easy for the two areas to become conflated, leading to cognitive confusion, emotional gridlock, and neither psychological nor spiritual health.
I gave the metaphor of the law and ethics - sometimes they coincided, and sometimes a legal action may not be ethical, and visa versa.
I then introduced the idea that it was possible to both state limits, and also have compassion - i.e. to say no with compassion. And that in fact, unless Wendy learned to have compassion for herself, she wouldn't be able to really practice it with anyone else.
We set up a scenario, and then Wendy practiced this.
She felt enormous relief at  escaping from the pressure of the shoulds, being able to say no without feeling guilty, and at the same time, being able to practice the compassion that she aspired to.
This is an example of working with spiritual values, bringing a psychological lens to bear. There are clearly standard therapeutic issues here- differentiation from family, identifying her own authority, being able to sort out whats right for her and whats not.
At the same time, the spiritual aspirations are important to support - and the therapeutic process can offer a fairly unique way of helping a person realise their values in practice. This is aided by both cognitive processes which help clarity, as well as embodied experiments which give a chance to find out, in a safe setting, ways to integrate both spiritual ideals, and interpersonal boundaries.

Saturday, August 2, 2014

Case #100 - What's the point?

Jill asked - what is the purpose of existence? This is a large spiritual question, and certainly one that is important at some point for most people.
I have my views on the matter, but this was an instance where I did not want to share them in that moment. Firstly, that sets me up as an authority, and I don't believe I have any greater real knowledge of the question than anyone else.
Secondly, my interest is in starting with the ground of what the client thinks. They will have some kind of cosmology, some kind of framework of beliefs, even if its within atheism or agnosticism. Its important to elicit these beliefs, to draw them out of the client. Sometimes they are a little unclear, in which case an active questioning and open listening process is of support to help them identify what they do believe. Others will have well worn or very strong beliefs about these questions.
'It depends' very much on the client and where they are at as to what a useful dialogue will be. It may be necessary to help them clarify their own belief system. It may be to assist them to deconstruct inherited or old belief systems, in order to find out what currently fits for them. Or, it may be to offer them some of my beliefs, for them to 'try them on for size', helping them to clarify their own beliefs - perhaps in opposition to mine.
Jill did outline some of her beliefs about the purpose of life. I agreed in most part with her, but disagreed in some aspects. I brought forward my differences, not in an argumentative or antagonistic way, but as part of creating a dialogue around the subject. I supported her to weigh what I was saying, to find what fitted for her, and to see where she may be open to or interested in expanding her current belief system, or in confronting places of inconsistency or rigidity.
In this way, we can use the context of the therapeutic dialogue to work with such cognitive content - around a topic which can easily get abstract and ungrounded. So its also useful after such an interchange to find the implications for this in the clients life, including in the here and now. This helps ground the process.

© Lifeworks 2012


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