My Blog
January 2023
Mindfulness & Individual Interiority. December 2022.
A longstanding and esteemed acquaintance has asked me several times in the last twelve months to read Eckhart Tolle’s A New Earth. Quite why, has intrigued me and is something I have been speculating about, but isn’t the subject of this essay.
And so, I dutifully read the book, and surprisingly found myself restless and disconcerted, despite agreeing with many of the ideas presented. Indeed the basic premise that life and possibly even something of the transcendent is to be found in the quiet and luminous vastness of awareness; the idea that thoughts and feelings ebb and flow within this space of awareness and lend it a colour, temperature or general complexion so to speak; the idea that awareness has certain qualities of benevolence and that it is from here that it is possible to observe without being too entangled in the verbal mind. And finally, the suggestion that perhaps it is awareness itself that at its source unites us as living beings, possibly into a single infinite consciousness. Some of these ideas underpin some contemporary psychological therapies such as Mindfulness, Acceptance & Commitment, Internal Family Systems and Compassion Focused Therapies. So why the ennui and annoyance?
There was the authoritarian style of the writing which whilst espousing the dangers of being too caught up in the thinking mind, paradoxically was so conceptually dense that it itself obliterated any space for free association. More fundamentally though, there seemed to be an earnest turning away from the individual in favour of the generic. Tolle’s example of the Lost Ring stands out as an illustration.
Tolle describes visiting a terminally ill woman on a regular basis over the last few weeks of her life. On one occasion he arrived to find her in a state of anguish over the disappearance of a ring bequeathed to her by her grandmother. Tolle tells the reader the ‘quickness of her response and her anger and defensiveness were indications that she had not become present enough’. Tolle proceeds to ask her a series of questions around whether she was in fact diminished by this concrete loss and ‘when she started speaking again, there was a smile on her face, and she seemed at peace’. Tolle continues to talk about some sort of movement towards Being and away from thinking that is apparently synonymous with peace and contentment.
I found myself incensed that this dying woman had been so shut down. I wondered if Tolle’s description of her not being ‘present enough’ was really a projection of his own struggle to think about the anguish of this woman. I wondered what had been suppressed, and whether the anguish may resurface later. I wondered what the anguish was all about. Was it the ring? Was it the losses that the ring symbolised? Or something else? Why had this woman been prevented from coming to know and perhaps work through her grief? This dying woman was shunted away from her own mind and her own life to a generic universal consciousness that Tolle terms spirit and that Tolle had identified as the goal.
And so, somewhat ironically, in the age of artificial intelligence, which perhaps is an apt metaphor, this appears to be what we do in our culture. We are addicted to the generic and turn away from the mess, the multiplicities, the turbulence, and the intrigue that is the individual. Mindfulness is thus at risk of promoting mindlessness in its retreat to the ground of awareness in a solemn pursuit of peace, stillness, and some sort of spirit. Of course, there is value in being able to access this sort of fundamental awareness which Tolle calls ‘Being’, or in the parlance of some contemporary psychological approaches termed the ‘observer mind’, but is it not in the contents and the dynamics within the observer mind that are own lives play out? And what is the cost of bypassing all this? I wonder if the result may be a subtle deadness and boredom at best and the nefarious suppression of the life force, as with Tolle’s terminally ill patient, at worst. Could the observer mind perhaps be most useful when offering a stable point of viewing from which it becomes possible to investigate individual interiority, rather than flee from it?
How mindfulness is made use of in our culture may reflect our cultural preoccupations more broadly. The tendency in the age of identity politics is to be in receipt of one’s subjectivity from outside of the self.
I remember being particularly struck by this one winter evening several years ago when I collected my 4-year-old son from school. He showed me some Lego he had in his pocket. He and his peers often used to sneak Lego into school to show each other and swap. Much of it would get confiscated by the teacher and returned at the end of term. However, the thrill of subterfuge and showing off was simply too tantalising to relinquish. My son solemnly and with an attempt at conviction, told me that his teacher had returned the Lego figure to him that he had taken into school that day because he ‘missed Mummy and it helps me feel safe’. He looked at me questioningly to see whether my bullshit radar had registered anything and went on to reiterate this statement to see whether he could land it a little more convincingly. I asked him if that was what the teacher had said, which it appears she had. My son had disturbingly been presented with a premature explication of his mind. There was I suppose a slim possibility that the teacher’s interpretation bore some truth but for the most part I was doubtful, particularly considering the air of indifference that arose when I attempted to discuss separation anxiety with him in this context. But explaining a child’s or indeed anyone’s supposed behaviour to them in this way runs the risk of contributing to a gradual degradation of a connection to their inner world. In this instance, it was as if a benign and somewhat vulnerable sense of who he might be, was preferable to finding out about him and his recalcitrance. Because not knowing, or put differently, waiting and seeing, heralds the possibility that what is discovered is unpalatable in some way or even incomprehensible.
And so, we are soberly and tediously encouraged to slot into the culturally available explanatory models of human functioning, of mental health diagnostic categories, gender, sexual and political identities and so on, as if there is almost an aversion to individual interiority. Oliver Davis and Tim Dean (2022) note in their book Hatred of Sex for example, the carving up of our relational styles into attachment categories where ambivalence is fundamentally problematised. This is what our culture appears to excel at, the availability of such classifications, of off the shelf identities, and added to this the guidance, the multi-step plans, smart goals and pre-empted journeys and even conversations.
Unfortunately, the psychological therapy industry is not exempt from this. Perusing the writings of a well-known child psychologist recently, I came across some scripts offered for parents to use to increase their emotional connection to their children. Notwithstanding the oddity of talking as a way of listening, the irony of the use of a script to make contact with another was stunning. Another perhaps more subtle example is the collapsing by ‘trauma informed mental health services’ and by various therapeutic approaches, of all emotional distress into trauma sequelae, seductively evading intra-psychic dynamics that may be independent of external factors which then leaves them unexamined, restricting the opportunity for individuals to arrive at some sort of freedom from these processes. It is as if there is a tacit acknowledgement that we can only bear to know our children, and perhaps each other, and indeed ourselves to a certain extent only, or put another way, we want to be alive, only somewhat.
It is interesting to think about what function might the pre-empting serve. Is there perhaps a desire to avoid the narcissistic blows that knowledge about the realities of our minds can serve up? Is there some sort of satisfaction or perhaps relief in the pre-empting, in the deadening? And perhaps a satisfaction that comes with a cost to aliveness.
I wonder if we are perhaps too goal or outcome oriented, too knowing of what we think we want, rendering ourselves less available to what we might find out that we do want. Mindfulness and its aims to inhabit a spacious state of Being, may be a case in point here. Maybe outcome orientation is itself for the most part, an impossibility. Maybe outcomes are just that, an emergence of something from something else that perhaps cannot be all too easily predicted or engineered, or indeed arrived at without some sort of antecedent activity. But it appears that waiting and seeing is fundamentally hard to do. And so we do things like nail down our sexuality for example, similarly unnecessarily pre-emptive, and destructive of sexual possibilities And maybe this need to determine, lies behind the desire of so many young people to be famous, to be known at least by others, so that that knowing can then be fed back to the self to almost fill the self as it were, or put slightly differently to fill the unknown and perhaps ultimately unknowable.
I have seen this a fair amount recently with patients presenting to psychological services having previously engaged with some form of contemporary psychological therapy for emotional difficulties, where the goal or the approach, has been to disengage from for example the anxiety and reframe it as ‘just anxiety’, a manifestation of that irksome fight flight mechanism that our evolutionary legacy has lumbered us with, that needs to be leapfrogged over on the way to some more serene state of mindfulness. This is truly helpful on one level in that it lends itself to a sense of universal human struggle in which we all share. But it sanctimoniously obfuscates any exploration of what that anxiety might be about, what might be the messages implicit, or the unconscious conflicts in relation to the perhaps existential or relational particulars of an individual’s life. My sense is that our economic realities have spawned an empirical research obsession which can only ever be about generalities, rather than singularities, but it is the singularity of our experience that we care about and that brings individuals into mental health services. And yet what is offered is often rather generic or formulaic and where there is not a particular encouragement to be interested in one’s distress in any way beyond a superficial understanding en route to the destination of symptom eradication.
I have been astonished by how frequently I have heard patients tell me that despite presenting to psychological therapy services over the years and undertaking various contemporary therapies, that they have never had a ‘talking therapy’, meaning a space to talk freely, to be listened to seriously and attentively, and to explore the meaning of their difficulties in the context of their own singularity. I imagine it may be a state of mindfulness on behalf of clinician and perhaps patient eventually too, that could be a useful starting point from which to venture out on this exploration. It seems a shame to stop here, at a predetermined end point of mindfulness and equanimity because the adventure that is getting to know oneself and one’s passions becomes an opportunity that is missed.
January 2023
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January 2022
Therapy In Person and Online
So what are your thoughts about psychological therapy online? I have been listening to hundreds of responses to this question over the course of the past almost two years and invariably hear the standard ‘it’s not the same’ and various iterations of this. There are also many (patients as well as clinicians) who surprisingly to me, have said ‘it’s fine, there isn’t much of a difference’ or even ‘I prefer it, it is more focused’ and inevitably comments about the convenience aspect. Some NHS operational managers seem to somewhat glowingly describe online therapy as the addition of a new option existing alongside in-person therapies which expand patient choice and accessibility and thus by implication (the disturbingly transactional notion of) ‘customer care’. But NHS therapies are sold as evidence based and if online therapy is, as we are told, an addition to the therapies offered, it might not be unreasonable to interrogate it. In contrast I am aware of one NHS psychotherapy service that has stopped all online working on the grounds that patients cannot be cared for safely. How can we make sense of all of this?
I along with all the rest of us moved to online working at the start of the pandemic with some apprehension about how it would or could work, but also with interest. What would the experience of meeting another so intimately be like over a screen? And my observations have been invaluable to me in learning more about the craft of psychological therapy.
My own experience of undergoing psychoanalytic consultations somehow became slightly less excruciating when we moved from the analytic consulting room to zoom. The experience was still intense, but it was doable, which in the early days of my analytic experience felt like an achievement. Settling into the process over zoom made meeting again in the consulting room bearable, and I have eventually been able to progress to full four times a week analysis in the consulting room and could not contemplate now returning to online meeting, which seems to me now too tantalizingly and frustratingly remote an experience.
I have noticed something similar with my own patients, where the in-person contact has been for some very intense, overwhelmingly so, video work has focused and titrated the contact and thus brought the intensity of the encounter to within a window of tolerance where there is stable ground from which to think and to do the work of therapy. It is as if for some, the in-person contact is too destabilizing for productive work to occur, which online working helps with, until it becomes possible to tolerate in person contact. For some of this group of patients who elected to return to face to face work following online therapy when covid lockdown restrictions were lifted, I was curious as to whether the gains made during online working would be maintained or whether they would be knocked out by the intensity of in person meeting, but interestingly with both myself as an analysand and with my own patients, gains seem to have been maintained enabling more productive in person therapy than was possible prior to moving to online work. This has been a useful discovery which could help some people for whom in-person therapy may initially simply be too overwhelming to be workable.
It has been wonderful to move back to the consulting room and be together in person. It is also in many ways easier. It is less tiring, there is less need for an iron grip over attention to focus on the small screen and filter out the detritus of the rooms we find ourselves in. There is generally no need to fill in the blanks when the internet connection is disrupted, mid flow that can’t be easily interrupted. And of course, the sensory qualities of being in the physical presence of each other informs our psychological understandings using cues that would be simply unavailable over telephone or video. An example would be the genre of clothing a middle-aged client characteristically wears that seems to express an unconscious phantasy of inhabiting a pre-adolescent possibly latency stage of development as a defense against the unconscious conflict between libidinal and deadening forces in the context of chronic illness and disability as life slowly ebbs away. In person therapy has enabled this to be revealed and the unacknowledged grief for lost years of living and the devastation of illness mourned, and life slowly and painfully rebuilt.
In person therapy is an opportunity for that precious thing we call connection and a contemplation of and experimentation with the connection that gets enacted. I am reminded here by British psychoanalyst Marion Milner who writes so cogently in her book A Life of One’s Own (1934) about her discovery of the effects of spreading out her attention, beyond her body ‘wanting nothing, prepared for anything’, on her experience of her own aliveness. Milner contrasts this with a more habitual narrow attentional focus driven by a relentless mental taskmaster to serve some ultimate purpose that by definition is not in the present, or put another way that closes off, or that deadens something in the here and now. Milner’s open awareness is exactly that which allows us to approach and experience the mind of another. Both Marion Milner and Erich Fromm (the latter in his book Psychoanalysis and Zen Buddhism, 1957) describe the process of spreading attention so that it almost inhabits the mind of another. In this way the analyst (or therapist) joins the patient in their experience of being. But online working requires a driving and a tightening of attention that may occlude and shut off those crucial meanderings of our awareness. We task ourselves with focusing on the image in front of us and the concreteness of the visual, the auditory, trying to put all these domains together but with it all not quite knitting together expansively and fluidly.
And then there is of course the container that is the consulting room. The space within which both parties minds co-exist. The consulting room becomes the space where two minds connect and explore that connection in order to work with potentially problematic ways of relating to parts of the self internally and / or to others in one’s external world. The consulting room has no other role or associations and as such allows the expanding of the mind outside the body for both clinician and client, and this is where we experience an awakening of transference, counter transference or projective identification that is the richness of the material for therapy, and that crucially can be left in the consulting room.
All this leaves the interesting question where actually does the mind exist if such a question can indeed be posed? I wonder if the mind is as much between us, outside of our bodies as it is within us, and within the confines of our skin. It is not inconceivable that the mind is the source of the body (and ergo of each other’s bodies) rather than the other way round. The implication of all of this is that separating minds through separating bodies and indeed rooms when we work remotely, could attenuate or muddy the possibility of taking each other in and of reciprocally affecting each other, precisely through the closing or the narrowing of the aperture of awareness, thus diluting the whole process.
We can now make sense of why some services may have chosen to stop all online working because for some patients, where meeting even remotely is so provocative, without the containing space of the consulting room and the mind of the therapist, these tricky connections can then take on a sense of singularity, amorphousness and precariousness which may feel rather unsafe.
So, to conclude, it appears to me that remote working can take the intensity down and aide engagement with psychological therapy, where in person meetings may be too overwhelming, but for some, where any form of therapeutic encounter at all, be it remote or in person is very overpowering the containing space of the clinical room is critical. For the remainder it appears to me that remote working is not equivalent to in person therapy, but is in fact a less optimal way of working. I would be interested he hear others thoughts on this.
January 2022
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July 2020 - Travel
Since March of this year, life for me has become almost unbearably busy, as I imagine it might be for many. There are the demands of work, home-schooling, supporting vulnerable family members, all without access to the parts of life that replenish the body and soul. Time with friends, exercise, downtime, are for now, all out of reach and yet something profound appears to have happened.
I have noticed a sense of settling, a relinquishing of striving, grasping, pushing ever onwards, almost as if in preparation for death. And with it a sense of benevolence, a sense of deep respect for and responsivity to my being. It is as if I have been forced to encounter the It, that life / death force that Tolstoy’s Ivan Illyich was confronted with during the agony that was the end of his life.
I have wondered what it is that accounts for this, and it appears to me that the change is perhaps in large part, the absence of travel, of travel to work, school runs, my own psychoanalysis, after school activities, training courses and trips abroad. An absence of absurdly flinging myself in a perpetual dual against time across the city, the country and at times the globe. And I have wondered if all this travel is a metaphor for the running away we do from ourselves, for the merciless abandonment of ourselves and of our needs to come home, rest, digest and renew again. And I realise that what we are perhaps beckoned to do now is to come home and assess what our homes are like, homes symbolising our inner worlds and our relationship matrices. For this is perhaps really, all there ever is in the end.
And what is revealed through this assessment is frequently the blithe and ignorant coasting often at high speed, along the crest of the wave of continual movement, of striving, striving to obfuscate some sort of emptiness or shame, or striving simply an old defensive strategy that runs on autopilot. And our enforced homecoming rips this away and forces us to confront and scrutinise all that we do and everywhere we attempt to run to, and to examine that which we repress, overcompensate for, or distract from. None of this of course makes for pleasant viewing, but it is really the only way to come of age, to discern what we really need and what we actually want, and to gently and kindly weave in these formerly shunned parts of ourselves into a much richer tapestry of our being. The frustration and general unpleasantness of the task is rewarded by a peacefulness and energy that illuminates the way forward more than any calculated striving could possibly hope to, and generates a sense of being that is unbounded by the confines of the body, less rigid, defended and cut off and more open and connected to fellow travellers along the way.
And so as autumn approaches, the new term heralds and this enforced halting threatens to unravel, I notice an unwillingness to return to the relentless movement that characterised life before March. I hear the almost audible whispers of the woods, the hills, the meadows, and the wildlife therein, coaxing me to tarry a while, maybe even a long while. And so, as the summer draws to a close I have spent hours in the woods luxuriating in the friendship offered by the wild. A friendship that does not encroach, that allows solitude and freedom and ultimately life. I have delighted in meandering through woodland, cradled by the soft and accommodating but firm and dependable earth underfoot, aware that I am surrounded by an abundance of aliveness in every direction. Oh the thrill of basking in the coolness of the pale green light reflected by the trees, affably and generously protected from the brutality of the sun’s heat by the ever eager to help sycamore family, whilst bedazzled by the beauty and dare I say vanity of the oaks. They too will offer some shade and a place to rest but not at the cost of their own glory. I have been captivated by the solemnity, the earnestness and the absurdity of the self-conscious antics of the woodland squirrels as they alternate between darting about and coming to a sudden halt, as if starring in some sort of action thriller. I am overtaken by the suspense, and drawn into the drama, wondering where and what it might be. I have witnessed a bird that I could not identify follow a group of similar birds exhorting them frantically all the while as if wanting to warn them of something. The group of birds looked at this bird dismissively and slightly pityingly and slowly walked away, the first bird following them all the while squawking furiously. I have stopped to bear witness to a squashed snail trodden somehow underfoot and have been stopped completely by the grace and unadulterated splendour of a myriad of white butterflies fluttering around me, my joy instantaneous. And I have wondered quite why it is all so compelling. My sense is that it is deeper than relaxation alone. I believe it is the wildness of life in all its mystery, that pulsates all of existence including my own that has compelled and excited me for now. The aliveness of the woods, of the landscape, is quite possibly the aliveness in all of us. In stripping away the shackles of endless movement and overactivity I have been forced to meet with it face to face and have found myself drawn into an intriguing and illuminating conversation. And reminiscent of Henry David Thoreau in his extraordinary book Walden, I sense that from sojourning here for a time, emerges a reorientation and a re-energisation in the direction of one’s life. The task now is to stay open and connected to this fundamental life force whilst picking up the reins of daily living once more.
July 2020
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April 2019
Depression: A Mind that Stands Alone
‘I didn’t know I had depression’, or ‘I now realise I’ve got depression’ is a statement I have heard many times over the years from folks seeking psychological therapy. When pressed about what is meant by that, I often hear illness type explanations, ‘depression is a thing, don’t you know?’ Generally by the time we have reached the end of the therapeutic process, depression ceases to be a biomedical thing but instead a perfectly normal response to a range of imperfect at times almost sickening life experiences.
But what is it, in its essence? Well I’d like to propose my take on it, based on my own experiences and those of the hundreds of clients I have been privileged to bear witness to over the years.
Depression can be carved up in a myriad of different ways, and indeed it is. Depression – a prolonged sense of sadness and hopelessness alongside a blunted capacity for pleasure. A dopamine slump obstructing energised vitality and wreaking havoc on sleep, appetite, libido and motivation, i.e. potency in the world of the living. A heritable, genetic anomaly. A chronic elevation of inflammatory markers. A negatively biased, self-focused difficult to control thinking style. An inevitable outcome of disenfranchisement, marginalisation and structural / political oppression. None of these cut to the core so far as I am concerned.
My 3 year old son captured the knub of how I understand depression several months ago when he and I were discussing over breakfast one morning our plans for the weekend. We chatted about going away for the weekend, and he turned to me and asked ‘will you be coming with?.... cos otherwise I will fall out of the world’. And it struck me, that that is it. A desperate and horrifying and terrifying sense of falling alone out of the world into the dark abyss, complete with feeling turned upside down and inside out.
But why? I understand this experience as a reflection of a mind that feels alone and unheld, unembedded in the mind of an other. From our conception all the way through our infancy and indeed beyond, we require that our minds, our essences, are noticed, deeply cared for, tuned into, responded to and held respectfully and lovingly by another mind, quite literally snuggled inside another mind. It is this form of connection that is gradually internalised, leading to an ability to self regulate through an enduring sense of connection and safeness. Somewhat more technically, these early relational experiences become imprinted into the neural fibres of the developing brain resulting into the cultivation of connections within prefrontal brain regions, responsible for calming, soothing, inhibition of impulsivity and associated executive skills such as planning, perspective taking, empathy, inferencing, problem solving and creativity. These are the brain regions that can be seen on fMRI imaging to tone down our threat processing brain regions and indeed those of others. These affiliative pathways so called because they reflect the quality of our early connections, constitute our emotional regulation capacities. And it is when this embeddness of mind, has not happened very well, when a developing mind has been abandoned, that a mind stands alone. And a mind that stands alone can function well, even very well, when the going is good, but is vulnerable to sheer terror when things go wrong, when we experience losses, griefs and some of the inevitable injuries life serves up.
And during such times an unembedded mind is often a frantic one, writhing, resisting, twisting and turning, endlessly analysing, predicting, threatening, suppressing, critiquing and attacking, often reflecting the internalisation of earlier difficult relationship dynamics. The mind that stands alone echoes into the dark abyss ad infinitum until those echoes turn back inwards enshrouding the mind in a cloak of horrors, leading to a sense of banishment and entrapment in a black hole of utter aloneness and terror, from which the capacity to reach out to life, to others requires monumental almost superhuman effort. A mind that stands alone however, is not just disconnected from other minds, but also from itself. In its attempts to escape and resist itself it loses a sense of anchorage, and groundedness within itself leading to an odd sense of disconnection from oneself, hence the feeling of being ‘in bits’.
So what to do when doing anything at all seems an impossibility? Well perhaps the first thing to do is nothing. All the frenetic activity of a mind that stands alone may be conceptualised as resistance, an attempt to escape, abandon itself once again. And these activities are exhausting as well as harmful. Putting the proverbial stick down, and then second accompanying oneself, bearing witness to one’s suffering with tenderness leads one home to the quiet part of the self that can observe and contain what it observes. That kernel of spirit within. This is the start of a sense of friendship and integration between disparate parts of the self, the start of connection and of groundedness. Strengthening this observer self through inhabiting it can lead to an opening to the compassion emanating from this deepest self. Compassion that embodies a deep wisdom, strength and courage and a heartfelt desire for health in the fullest sense. Compassion that can encourage a bit of movement, perhaps getting out of bed and slowly into the world again, perhaps some measured risk taking in terms of possibly connecting with others and maybe some alternative perspectives on things. Opening to the quiet and compassion of the observer self also connects one to that universal indivisible spark of humanity present in us all stretching forever backwards and forwards in time for all eternity and thus collapses rigid labels, identities, judgements and so forth that separate us from each other. Thus through accessing, resting in and slowly strengthening the timeless, compassionate, observer mind, our deepest spirit within, we can begin the journey to reconnecting to both ourselves and each other so that our minds no longer freefall alone in the darkness.
April 2019.
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Jan 2019. Submitted to Clinical Psychology Forum.
A Suggested Redefinition of Clinical Psychology
Over the recent Christmas break I and my partner took our pre-school age son to the park to play some footie. Whilst we were ambling over the green we spotted a rather delightful puppy and found ourselves orienting towards it to say hello. The puppy’s caretaker for the afternoon very sweetly picked up the dog and asked if my son wanted to stroke it. My son shyly declined. He preferred to observe from somewhat of a distance and wasn’t ready for a close encounter. Inevitably moments later, boredom arose and my son scampered off in the direction of the football pitch, followed by my partner. Feeling somewhat obliged to hang around for a bit and dispel even momentarily, some of the chap’s evident loneliness in exchange for his kindness towards my son, I chatted for a while. I learnt a great deal about the state of our nation. And it was not welcome news.
The man treated me to his views about the diversity in our country as reflected in the range of punters in the playground. Children. I was chilled. He launched into his political views against globalisation and the ‘left wing liberals who are a danger to themselves and everyone around them’. Naively I was stunned by the regressive nature of these ideas and by the assertion that he represents part of a wider political mainstream. I was dispirited by the sub text of hatred, anger and mistrust. And I was particularly struck by how I almost never come across first hand, proponents of extreme right wing ideologies. How is it that I only encounter proponents of left wing as it were, socio-political viewpoints? And then it occurred to me the health or otherwise of our society is reflected in the magnitude and the nature of the space between us, between the right and the left wing in this instance.
I was keenly aware that I was repelled by this man, my brain had rapidly sorted him into an other, a ‘not like me’ and my instinct was to move away from him. It took energy to see the vulnerable and fearful child within him and offer the respect and care that the compassionate and skilful part of me wanted to offer. And therein lies the problem. We have evolved to engage in fight or flight (or at times even freeze) behaviours in response to threat. And that is in part why we have the societal divide that we have. The challenge for Clinical Psychology is to move beyond the clinical, beyond the individual to lead the way in helping our societies understand the implicit biases our evolutionary heritage has endowed us, the unconscious defences we engage in and the evolved action tendencies our social mentalities recruit in our minds and bodies. And that I argue is a task we are failing categorically. And the implications could be catastrophic.
My sense is that this reflects a fundamental confusion in the profession about our identity and role. For example, my own Clinical Psychology training some years ago espoused ideas around scientist-practitioner models and so forth, but never really clarified in application to what. We were implicitly taught about dimensional rather than categorical models of human experience but were explicitly taught assessment, formulation and ‘disorder specific’ treatment protocols. The very term clinical psychology, a biomedical one, reflects assumptions around the distinction between health and disease. Naturally the focus was on the latter, sliding reflection on social, cultural, political, economic and anthropological practices swiftly out of focus. The course I attended nurtured a reputation around academic rigour and excellence, which I argue masked a fundamental sense of deficiency at its core. My experience of clinical training was that aside from some valuable aspects of the course, there was by and large a fundamental sense of emptiness, an absence of content at the heart of the enterprise. It was a shame that I found myself so busy jumping obediently through the various hoops to respond to the boredom and disappointment I experienced, in the form of constructive feedback. I imagine most training courses are largely similar and examination of teaching schedules that recent trainees have shared with me suggest that there have been no dramatic changes. So here we find ourselves in cultural crises with Clinical Psychology silent, impotent.
I argue that we need to reflect on the nature of our profession itself. I propose that we widen our aperture of analysis beyond clinical problems to psychological processes as they occur in our experience of living as evolved relational beings in ever changing societies on this fragile planet. We need to start taking ourselves and our responsibility towards the societies we live in seriously. Clinical Psychology routinely offering psychological perspectives in the form of social and cultural analyses would be invaluable. Facilitating the integration of psychological thinking into schools, teacher training and medical training would also be a good start in increasing psychological literacy, in creating as Paul Gilbert terms ‘psychologically hygienic’ environments for young people to develop in and in unifying body and mind in understanding health and illness. Wouldn’t it be wonderful if the man I met in the park on Boxing Day was aware of our evolved tendencies towards categorising, ‘othering’ and prejudice? Or if he could consider the possibility of unconscious projection? Or if he was aware that the contents of his mental flow was but one option colouring the purity of his consciousness.
Perhaps one of the most challenging but significant of tasks is to engage with those who’s politics we find distasteful. If we consider compassion as central to Clinical Psychology and define compassion as the willingness to engage with suffering, with skill and wisdom for the purpose of alleviation and prevention of harm, then it is encumbent on us to move out of our echo chambers and towards those we instinctively recoil from. Paul Gilbert brilliantly articulates this in describing that which we dislike as an inherent inhibitor of compassion, but that which is paradoxically most in need of compassion. I am reminded here of Jo Berry, daughter of Sir Anthony Berry killed in the 1984 IRA bombing at the Conservative Party conference in Brighton’s Grand Hotel. Jo described a growing awareness shortly after her father’s murder that she wanted to meet his killer, simply to understand him. After his early release from prison under the terms of the Good Friday agreement Jo and Pat arranged to meet. Pat describes their first meeting as one where he arrived prepared to meet Jo steeped in his politics by way of justification. Pat described how being listened to with what he described as ‘acute attention’ without judgement, being accorded dignity, shattered something within him. Jo described how just when she concluded that there would not be a second meeting Pat stated ‘I don’t know who I am anymore…. How can I help you with your pain and grief?’ Being truly seen, held, for the purpose of understanding, was transformational. It facilitated as Pat describes the dropping of his political guise and propelled him towards the unknown, a mutually constructed unknown, where Jo and Pat later developed their Forgiveness Project and Building Bridges charity targeting violence in areas of conflict. So maybe we don’t need to have the solutions up front, maybe just moving towards the ‘other’, with openness, curiosity, respect, is in and of itself a creative process. One which transforms all of us, thus reducing and changing the nature of the space between two sides, so that we are able to come together to construct common values and goals and to co operate in working towards those whilst honouring the differences between us. This is our task. Our futures depend on it. And who knows where it will take us.
Jan 2019. Submitted to Clinical Psychology Forum.
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October 2017
Time
I would like to invite you to think about your relationship with time. What is the nature of your relationship? Do you indeed have a relationship with time? If so, are you by and large the subject or the object in the relationship? Have you noticed changes in the ways you and time relate to each other as you move through your life?
My relationship with time is generally reasonable with a rumbling undercurrent of unease. This unease is at times dormant and at other times thunders its way to my awareness. As a child however, I found myself frequently delighted by time. The changing of the seasons and the quality of light, from the autumnal dusks, to the early summer dawns, were quietly but frankly rapturous. Those together with all the associated fragrances of woody, burning leaves, freshly cut grass, the smell of heat mixed with suntan lotion of yesteryear, all joyous, almost celebratory. The sounds, from the rain sodden traffic on a murky winters night, to the spring lawnmowers out in force, to the thundering motorbikes on a lazy hazy summer weekend heralded that ever thrilling gift of life, the movement of time, and with it the changing seasons and all the possibilities within.
Our relationship is still at times heady, but infrequently. As the years have passed I often feel bullied by time and kicked along the grinding punishing routine, sometimes in multiple directions. When I am particularly exhausted it is more a feeling of being dragged by time and pulled against my will, simply too fast. I am no longer the subject. And then there are the odd days, illness, annual leave for example where time relaxes, magnanimously waits for me to catch up and lets me have a go at being the subject for a change. These empty days often fill me with even more unease. Of course, it is not just the odd days, it is also the odd moments, those in between times, meal times, domestic tasks, travel, when time seems to on these occasions, grudgingly relinquish control, again pointing the finger to me to take the helm and start directing things for once.
And it is in these moments that plans are borne, and trajectories set and reconfigured. So how is this relevant to you? Well, how we interact with our time is central to contemporary psychological treatments for depression.
At the most fundamental cognitive behavioural level, planning our schedules with mastery and pleasure focused activities may interrupt depressive inertia and cycles of ruminative self-torture, and jump start those dopamine engines of vitality again. The positive psychology domain would extend this type of intervention to include activities which play to one’s ‘signature strengths’ as well as activities that generate a wide range of positive emotions. Csikszentmihalyi identified flow as particularly key to our experience of positive emotionality or well being. He describes flow as almost a sweet spot that exists on the continuum between boredom and stress, a state of complete absorption, where task challenge and skill level are matched, leading to a self-perpetuating state of engagement where a sense of self and indeed of time disappears. It is often reasonably demanding creative tasks or physical activities that induce that exhilarating sense of flow. Another of my favourites is Dan Siegel’s healthy mind platter. Dan suggests taking some control of time to incorporate somewhat of a balance of seven daily essential activities to fuel our mental health, defined by Dan as integration of mind, body and social context. These activities include focus time, play time, connecting time, physical time, reflective time in, down time and sleep time. I would not recommend getting caught up in trying to fit all these in on a daily basis, but to bear these in mind when thinking about the general balance of your life, perhaps on a week to week basis.
All these interventions however useful, presuppose that your time will allow you to take the reins. What if your life is configured by events and forces that stretch back in space and time perhaps outside of your control? And now you find yourself living out old and somewhat unchosen trajectories. Moreover, how do we shore up our relationship with time, knowing that as it passes, life takes on an increasing sense of urgency? How do we live well whilst aware that time is quite simply, running out?
The first thing would be to foster an appreciation that all of us find ourselves here in these mortal bodies, in spaces and times that we have not chosen. Most of us were unable to significantly shape the trajectories of our lives from the privileged but powerless positions of childhood and adolescence, and that where we find ourselves in adulthood is, in the words of Paul Gilbert, generally not our fault and worthy of our compassion. Simply being gentler with ourselves for not creating the time to do this or that, or indeed for not creating this or that particular life. Releasing the burden of self criticism can reintegrate the brain and mind to enable the generation of solutions to problems and deficits in how we feel we are using our time, and the courage and the will to implement change, so we do not ‘accumulate’ in the words of existentialist Irvin Yalom ‘further regrets’. The second comes from an acceptance and commitment therapy perspective and involves the clarification of our values and then living these values as best we can, however the circumstances of our lives. There is tremendous congruence and satisfaction to be earned here.
I believe that probably the key to living well is to maintain a clear eyed awareness of the end of our time. This can be difficult to stomach but if approached, will elucidate for us our most fundamental priorities and our deepest joys, and will helpfully prune away life sapping irrelevances. Face to face with the end of our time, it is often everything that already is, that is enough. The beauty of our natural world, the solace of our connections to each other and the sacred nature of the function that each of us brings to the world. The type of closeness to time that paradoxically confers a sense of timelessness, and in so doing allows for the expression of our spirit. But how much of our life is spent avoiding the finite nature of our time? And how do we do that? Overworking? Chasing fame? Wealth? Material things? Fortifying political or other forms of tribal allegiances? Sensual pleasures? Indecision and lack of commitment in case that closes off possibilities and seemingly shrinks the life we have? The illusion that we are anything other than transient I would argue may feel somewhat easier in the immediate term, but will likely leak out as malaise, discontent, inauthenticity or a sense of directionlessness in other areas of life. I believe that it also affords time an opportunity to bully us mercilessly towards unnecessary tasks that in the cold light of death mean little if anything at all. My sense is that sharpening my recognition of the realities of time will allow me freedom from some of the angst that ensues from the conflict between my simultaneous awareness of mortality alongside the delusion that time will stretch infinitely onwards and upwards. And in so doing, maybe it will allow me to develop a little more reciprocity in my relationship with time. Maybe even to make friends with it somewhat. Whereby I assert my refusal to be bullied into unnecessaries and my right to direct time a little more strategically, but where I also recognise the control time has over my life and respect the value that brings. I am hoping that herein may lie more ease, more contentment and maybe even, a little more rest.
Oct 2017
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April 2017
I Just Want To Be Happy
I just want to be happy
Is the response I so often hear in answer to my question
What are your goals for therapy?
Inwardly I groan
That everything and nothing word
Bearer of false promises
Happiness, I ask, what do you mean by that?
How will you know when you have arrived?
As if it is some sort of terminus
Usually tantalisingly and tauntingly just beyond the horizon.
It is the corporate target cloaked in retribution for our failure to meet
The government agenda mandated for us to be striving for
And green papers and white papers
Deceptively occluding social factors endemic to misery
And those ever cynically punitive measures for failure to meet targets
Amply supported by the great wheel of capitalism turning again and again
Spewing out
More and more
Of what we need to be happy
To start living.
Happiness, a pre requisite for employment so the economists inform us
For the good life
A badge of success
Of achievement
Of the perfected life, home, body, mind, self.
A life and a self created and lived,
in the words of Susie Orbach, from the outside.
To present to the world
And back again to the self.
But what if happiness is not a pot of magic at the end of the rainbow,
but a multi-textured process that moves through us as we live?
What if we dropped the word happiness altogether?
And instead allowed for the multiplicity of feelings that arise
In response to living as attendant to life as we can.
Those feelings that are at times ambiguous
Necessarily complex, messy mixtures of the painful and joyous
Like the almost unbearable and exquisite, sadness- laced pleasure of sensing the spring sunset and knowing at the same time, that this and indeed I, will in time be gone forever
Like the privilege of sharing the pain of another and co inhabiting for a brief time their space in the world
Like an almost sacred sense of awe that arises when bearing witness to the sacrifices made by one for another, that melts into a wish to bow down in worship
Like the angst, the devotion, the relentlessness of child raising, that process that diamond- polishes the soul towards an ability to serve the humanity in all.
And that carefree sense of childhood immortality enshrined in memories of exhilarating and endless summer days
That shatters with
the realisation of mortality and at once plunges one to deeper forms of being,
now imperfect but, richer forms of what some might call happiness.
Feelings of grief, of sadness, of rage that give birth to love, connection, congruence and courage
Feelings that we may not even have words for
Feelings that are not particularly hyperbolic but just alright
With even those being simply alright.
What if true happiness is not attainable, nor even meaningful in adulthood, alongside the recognition of the fragility and finitude of life?
Alongside the suffering that living entails?
And that it is this that connects us all to each other.
What if instead we could in dropping the cruel self talk, simply aim for a sort of alive, authentic alrightness?
That like the kaleidoscopes of our childhoods continuously forms new patterns of experience
New colours
And new vibrancies
Some of these breathtaking
Some jarring
And some alright.
And taking the pressure off ourselves for not arriving at the magic land of happiness through the knowledge that shit simply happens
Being mortal is tough
And our culture adds to the toughness, particularly for those of us at the margins of society.
Alright and awake to life might just be enough
Knowing that it is only in the surrender to all of living, that takes us where we need to go
And where an imperfect sort of contentment and at times, even a sense of the sublime is to be found
Sometimes fleetingly, sometimes longer lasting
But always impermanentAlways precious.
April 2017
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Christmas 2016
Silence
I have recently noticed how the City Centre has become increasingly busier and noisier over the past few weeks in the run up to Christmas. I have witnessed multiple conversations going on simultaneously where people are talking and texting and snapchatting, and expressing themselves in ever increasing volumes, in the hope of being seen, but where no one seems to be listening, or even seeing the other any more than fleetingly. And it makes me wonder what about silence? Wouldn’t it be helpful to intentionally cultivate silence from time to time? Of course this is the business of meditation, but that isn’t something we are all able to or indeed willing to commit to. What I mean is silence as something of value during our day to day lives whether in interactions with others or indeed with ourselves.
Silence that nebulous thing that feels empty, like an act of omission, but that paradoxically can be an act of generosity, a gift to the other or indeed to oneself. Silence brings possibilities to join with another on their own terms in their experience, and to allow them to in turn experience themselves as felt by another. Silence communicates an open door, open possibilities, a refusal to close down into and collude with known categories or projections in either direction. It is a space for not knowing, for experimentation and for discovery in the context of safeness. A relational space between people that ultimately fosters the emergence of the finest versions of what it means to be human. With oneself silence can similarly be an act of commission, almost defiance, a refusal to be drawn into those voices of judgement and self sabotage, those voices that diminish us. It is a space that transforms automatic pilot mindlessness into intentionality, an act of being with oneself with the quality of empathy and dare I say it compassion, a word that is so tiresomely over used these days. Silence with oneself can be I believe the birthplace of optimism and creative possibility, even and maybe particularly, in the darkest of times.
But silence of course is not always benign. There is the cold silence of disapproval, of friendship withheld. There is the cowardly silence of bystander apathy, voiceless, motionless, in the face of cruelty to another. Within oneself there is the silence that symbolises neglect of one’s suffering or a refusal to acknowledge the courage, generosity or success that has been achieved. And there is the burning silence of shame, of submission, within and between each other. This is the silence of darkness, the silence that closes, crushes and deadens, the silence of disconnection. What I am referring to is the silence that symbolises presence, connection, in psychological terms we might call this attunement. A prerequisite for secure attachment, that appears to be the birthplace of emotional and interpersonal flourishing across the lifespan.
So one of my new year’s resolutions, is to cultivate more discrimination of the different forms of silence and to offer more of the silence of presence, both in relation to myself and to others. And as I was rushing round amidst all the noise doing the last few bits of present buying before the holidays I noticed I was joined by hundreds of others in the final frenetic dash round the shops, all saying things like ‘I think she’ll like …. And he’ll like….’, and I thought, the holiday season transforms us all into givers who take joy in gifting to the other. How wonderful.
Christmas 2016
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‘October 2016'. Appeared in Clinical Psychology Forum April 2017.
Reflections on Contemporary Clinical Psychology
I have recently been fortunate enough to be able to take a year off work for maternity leave. Our generous UK maternity leave has afforded me time and mental space away from work, such that when I returned to work 6 months ago after almost 10 years practice post qualification, I felt unsure about what to ‘do’ with clients, how to treat, conceptualise or even assess the difficulties they presented with. I quickly came to the realisation that the models and approaches at the forefront of my mind that had hitherto scaffolded my conceptualisations and interventions with clients had become hazy, clunky and less accessible. I was aware that before I went on leave there was an automaticity and fluidity in my interactions with these models and approaches, such that they informed or more accurately dictated all my clinical work. But starting work again post mat leave, they were less available to me and I wasn’t sure I wanted to work in that way anymore anyway. Coupled with this was a more fervent commitment than ever to the tasks of clinical psychology, arguably brought about by the sharpening of existential concerns and values that emerge with shaping a new life in this strange universe, whilst moving up a generation in the life cycle myself and coming closer to my own end. So my first months back at work involved a coupling of renewed enthusiasm for the vocation with a sense of beginning all over again, a sense of uncertainty over how can I be helpful to the folks that come along so troubled and so lost to our services.
So I threw myself back into reading both old and new material, and frustratingly slower than colleagues assured me, the models and protocols all came back to me, only now seemed at times blindspot-inducing, rigid and distancing. I have also had a few experiences over recent months where I have felt a sense of grasping, of searching for an understanding with a client, and have made some sort of statement or other, not of central significance to me, but the client has responded by saying ‘absolutely, that’s it, you’ve hit the nail on the head’, leaving me absolutely flummoxed. So all this has made me think all over again, what actually is it that is helpful to our clients? What actually is it that is helpful about clinical psychology as delivered in our generation, in our society? Because speaking to clients they rarely mention or even remember model driven protocols but often something else entirely. Something that usually takes me by surprise.
And so I have been thinking that maybe what I need to do is draw on psychological principles almost from scratch in understanding the difficulties clients present with, and in developing an intervention. And, this is key to me, to hold these principles lightly and with humility, to see around them and beyond. To remember that (at least in adult primary care) we are simply individuals whose life paths have briefly converged for one of us to help the other along theirs with more courage, ease, vitality, kindness, connection, integration or whatever it is that is needed.
But I observe and read all around me a deferential commitment and allegiance to models and approaches, and schools and protocols with associated jargon and formulae, and I wonder actually if we might be missing a trick here. For perhaps the disadvantages are two fold. First we run the risk of closing down our vision, our minds and our hearts in a way. So it becomes harder to truly meet our clients in the fullness of their humanity and enable them to truly meet themselves. But second in setting up clinical psychology in this way, in constructing clinical psychology in terms of different therapeutic approaches we lock ourselves into working directly with clinical problems in clinical settings. And then inevitably we face the questions; how can we influence changes in society using the tools we have? How can we help workplaces, schools, parents, governmental bodies, the media etc. become for example less brutal, more compassionate? Clinging steadfastly to therapy models and approaches to me seems to make this endeavour a very difficult bottom up approach. I would like to see training courses continue to enable trainees to take a bottom up clinical approach, indeed a range of therapeutic approaches, but crucially also equip trainees for the top down thinking that may more readily address societal needs. This would look like teaching around the fundamentals of evolutionary biopsychology, neuroscience, neuropsychology, epigenetics, attachment, developmental psychology, positive psychology, existentialism, epistemology, the historical development of our profession, all the way back to ancient philosophers, contemplative approaches, the psychology of social and political functioning and much more. In a sense training programs with tighter links between academic and clinical (therapy based) psychology, with an emphasis on understanding underlying (philosophical / cultural) premises. This would enable graduating clinicians to, in the world of shrinking NHS opportunities for clinical psychologists, develop roles to contribute and shape social discourse such that clinicians then don’t need to find ways of bring this or that therapy into this or that domain but that instead clinicians facilitate the mobilisation of change from within. Change that is more nuanced and more powerful than simply bringing in such and such a therapeutic model to this or that arena. An obvious example is Susie Orbach and the Dove Campaign. To me it is simply not enough for training programs to offer teaching in therapy approaches. It is time for training courses to go back to first principles, to begin the process of reconstructing clinical psychology in ways that truly reflect the history and breadth of the field to better address our problems in living at the level of the individual, the social, cultural and the political.
‘October 2016'. Appeared in Clinical Psychology Forum April 2017.
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