I was thinking about whether or not psychotherapists care about people. Many don’t, I suppose.  They’re rather introverted but they still seem every able to help other people become more themselves – which, in my mind, is all you can do.

But it strikes me that there is a difference between caring for people and looking after them. There’s a certain kind of psychotherapist I have often met who seems vey invested in something about who their client should be. These people don’t care. They look after people.

Looking after people, in the sense I am describing here, usually involves inhibiting them in ways that are not available for discussion. It’s often done secretly or coercively and has a relationship with what has become called ‘co-dependence’. In a way it treats them as mad while the person doing the ‘looking after’ is somehow removed from having to look into their motives with the help of someone else. We are not transparent to ourselves: never.

It doesn’t have to be like this. I might ‘look after’ myself, for example; but even in that there’s a sense I am somehow divorced from myself as I do this. I’m selfish to a point that might extend beyond reason.

EMDR and Psychoanalytic Psychotherapy

EMDR and Psychoanalytic Psychotherapy

I thought I might share this: an abstract for a paper at an EMDR conference. It’s a bit glib but I think it says something about how I work, and why.

As EMDR becomes more popular and its application becomes more diverse practitioners may find it helpful to consider some of the ways psychoanalytic therapists have explored therapeutic relationships. Freud’s work with trauma in the 1890s, enthused by his interest in mesmerism, in some ways bore a closer relationship to contemporary EMDR practice than to contemporary psychoanalytic psychotherapy. The metapsychology he developed, although at first-sight complex and sometimes arcane, offers EMDR practitioners a wealth of ways of thinking about their work without departing from the usual protocols.

Perhaps one of Freud’s most interesting discoveries was that the ways therapists think about their work inevitably affects the therapeutic relationship. From cognitive interweaves to decisions about treatment planning, the timing of interventions, the depth of preparation required and how a client should be oriented post-treatment, a psychoanalytic attitude can expand awareness and foster confidence. Freud wrote about ‘wild psychoanalysis’: psychoanalytically informed interventions by doctors, nurses and others who may not have been trained in the full psychoanalytic method.

I will explore the implications of EMDR with a psychoanalytic attitude and look closely at three distinct ways of drawing on psychoanalysis: a form of history taking based on free association which I have found extremely helpful; EMDR as applied to dreams; and considering how our interventions may sometimes be less rational than we imagine.


Cocoon of Addiction: Addiction Treatment to Face the World

I was reminded today of what happens when someone finally seems free of their dependency: they need to confront the source of their anxiety.  An entrenched belief, perhaps; an overwhelming one. Addiction can be a cocoon protecting someone from something they cannot face – addiction treatment, a way of coming to think the unthinkable.

Addiction Treatment
Addiction treatment requires an element of nerve.


What often confuses people is how long addiction treatment can take. Being free of dependency is not the same as stopping, or being abstinent. The desire to use needs to recede; the emotional-intellectual state someone is trying to recreate (the scene they are repeatedly brought back to) needs to diminish in intensity to a point where using is thinkable.

There are three broad phases of addiction treatment: stopping (which involves all that leads to stopping), becoming free of dependency, and then attending to self-esteem. Although the third phase is often also part of the work in the second phase, it can only ever really happen last.

The ideal way to engage with this cocoon, the best form of addiction treatment? Group work plus EMDR, followed by long term psychotherapy.  Too much addiction treatment stops too soon, over-investing in what has been seen as stopping, of a person not wanting to use or in apparent gains in self-esteem.  Shifts can happen quickly, leading to a sudden, powerful sense of gain. It’s often overlooked that this change brings with it all kinds of complications. A personality needs to adjust to the difference in life.

Occasionally treatment ends too soon, or relapse occurs because the depth of often painful feeling achieved when someone no longer needs to use feels like failure.

Addiction treatment takes time and if it doesn’t it will probably fail.

#International Women’s Day

Q: How many men does it take to change a situation?

A: What situation?

How many men publicly say anything in support of women or the situation we continue to live in where women … (fill in the ellipses however you want: there are so many absurdly negative, infuriating choices)? Is it because the kind of men who’d say something have themselves ended up isolated or silenced? Or is that we don’t really care enough. I think it’s mainly the latter.

Most men don’t know how to care and a lot of men just don’t care.

Men: do something. Do something with yourselves, learn how to properly give a f*** and the rest will follow.

Acting Out and the Act of Naming

Acting Out
Acting Out in Paris

People talk about ‘acting out’. Addicts say it to describe what they do that leaves them addicted; psychotherapists say it to describe what a client might do less consciously rather than talk about it, consciously. In either case we’re describing behaviours as symptomatic of dissociated or repressed ‘stuff’. What’s that ‘stuff’?  I’ve written about it here and here where I explore the ‘scenes’ people create when acting out.

Here, however, I need briefly to air my frustration at the way we name the acts of acting out.

In the theatre I love it that I usually find simply, unnamed but identified, Acts I, II, and III. Occasionally I just find Act I, and sometimes an additional Acts IV and V. In psychotherapy, though, especially when we are talking about addiction, we name acts like crazy.

We name the acting out of love 1, loving performed in a certain repetitive way,  as love addiction and create a psychopathology of the ‘love addict’ 2which includes a cause and a treatment. We do the same thing for the ‘codependent’, or the ‘gambler’ and a host of other creations.

These labels can have a place. I call myself a Pole, for example: usually when I feel threatened (reading some James Baldwin this morning re-awoke me to that, after my interest was triggered by Boris Johnson parading the word ‘liberal’ in some freighted, soon to be exploited way, rather like a new British brand of aperitif). To call myself something is a different matter.

This naming of acts seems in step with a tendency I’ve noticed during my time alive, and which probably existed beforehand; but I feel less qualified to comment on matters pre-Tom 3. For example: post-punk, to describe the way my friends and I used to back-comb our hair and listen to bands like the Cure in the late 1970s to early 1980s. We also, of course did many other things, including in my case listening to Duran Duran, going to see plays by Pinter, falling in love with Shakespeare, going hatefully to church, and living in France.

It’s a controlling tendency. One that circumscribes me, draws a circle around me that limits your understanding of me. One that leaves me anxious in the way it short-changes me of  life the world: the less of me that’s there to be known, the less of me there is to be returned to me 4. I need as much as possible to come back to me, or I will only ever know myself as a caricature, and who can survive on that? No wonder I would feel anxious!

This tendency to name acts, to categorise and subcategorise our problems, can create a brittle kind of un-human (not inhuman) understanding; one that looks to understand by pathologising. The phenomena of experience, the dynamism of our lives together 5, are to be understood in terms of their causes, so they can be dealt with. But I’m afraid my experience of life suggests that however much we love theory, and however much it might tell us about forces that might affect us in life, theory is only ever really a listening (reading) exercise 6.

In my various psychotherapies, the ones in which I’ve been able to sit back and let someone else sort out the room beforehand, I’ve gradually managed to let go of a tendency in me to look for a tendency, or a reason, or an underlying cause. Laplanche has some good things to say about this. And I’m not against taking a good look at tendencies.

But there isn’t one underlying cause to explain me; not even a dozen. Not even an army of them. And there’s nothing specific to be done to me that will make me happier, more aware of my life or better able not to repeatedly act out the same old stuff.

All I have learned is that by noticing things with a someone who has a very good ear, who really knows how to listen, you come to notice a lot more in life, manage to stay with the feelings you’ve been avoiding (a psychotherapist needs to be able to hang around with you while this happens without being physically there 7 … something of an art more than a science) and then things change. You learn to better accommodate both yourself, whatever that is,  and the other people, whoever they are, in your life, the broadest sense imaginable of you and not you, so you become gloriously present and not to the exclusion of others. Sometimes it feels like hell, but not as often as you’d imagine. Often it doesn’t.

Happiness is a not a chimera, but it needs to take its place alongside gloom.

As you may have detected, the more I rattle on, the more you learn about me; and that’s the way it should be, surely? Someone I once spent a lot of time in therapy with told me, as I peppered him with questions about who he was, that I’d find out in time; but maybe if I just thought about how, if I’d met him and we were chatting somewhere, it would be a little weird if he told me everything about himself in one go. Point taken. Relationships need to develop over time, sometimes a very long time.

So, you won’t find me telling you, as an act of therapy, that you are a love addict. I won’t be telling you what that means, that we need to do this to sort you out, or where would that leave you. Or us, for that matter? I might suggest thinking about love addiction as an interesting thing to do, that might help you understand some of the ways you have become hooked on the what’s rather than the who’s of your relationships. And if you want to call yourself a love addict that’s a completely different matter. Go for it. Call yourself what you want and that will do you, I’m sure, a lot of good.

Just be cautious of a style of psychotherapy that looks to quickly explain you, or your acting out, your acts, through names, categories or patterns. This act, an acting out, seems suited to a certain kind of heroism in the Obi-Wan Kenobi – Luke Skywalker mould, possibly a masculine thing, when I think about it … that leaves me rather appalled.

Heroism.  Codependence is about heroism, in a way; that we can’t be constant heroes. But that’s another story.

Trauma Work and Scenes

Trauma work and scenes
Don’t get stuck looking for meaning. Let your client tell you what’s going on.

Heidi from Finland asked me if I could give another example of noticing a scene playing out,  and how I worked with that. ‘What’s the relationship between trauma work and scenes?’ she asks. Perhaps I can answer her question and at the same time say something about how I regard working in the transference, why I believe it is so important to work in the present as much as possible, and something about why I find theory helpful.

Imagine a child growing up with a number of siblings. She develops a relationship with her parents where they come to depend on her helping them communicate. She has a difficult relationship with her siblings, who find her controlling,  secretive and somehow, as one of them put it when they spoke as adults, ‘in a different place’.

Thirty years later, when I first worked with Christina, it wasn’t hard to find traces of these early relational dynamics playing out in her life. The work we did underlined for me the important relationship between trauma work and scenes.

What would you do? Let’s forget about trauma work and scenes for a moment and think about what your job as a therapist might be.

Part of your job as a therapist , if you come to work with a person like Christina, is to be as sensitive as possible to the dynamics you might get to know through you relationship with her, which might tell you about what she experienced in her early life. Thinking psychoanalytically that would involve considering the transference, and you own countertransference feelings (although I tend to conflate the two into the transference relationship). Other therapeutic modalities will have their own ways of doing something similar.

Using your intuition, rooted in your emotional relationship with your client, you will then need to help her identify the situations where the traces of her early life seem to be playing out, and to get to the conflicts and emotional struggles she is facing.  The behaviour represented by the ‘scene’ you discover is symptomatic of the way she tried to cope in her early life, and how this affected her.

Don’t be seduced by the obvious scenes. She may well, as Christina was, be a manager at a large company and have developed separate relationships with two senior figures, and be distrusted by the people she manages, who also find her distant. I’ve found various scenes active in people’s lives.

We need to locate the scenes with the most affect – the ones that lie most directly upon the fault-line of her early life trauma (to use a phrase I would like to think about in great detail somewhere else), rather than ‘satellite scenes’, which have something in common with Freud’s ‘screen memories’.

In her relationships your client may also, as Christine was, be very close two two of her children and her husband might end up occupying originally played by her siblings. Scenes can be played in so many different ways. Take these two, with Tom Hiddlestone and Laurence Olivier.

Your job is then to hold in mind the early life behaviour while you explore the current scene with your client, reacting and acting out of all your imagined familiarity with the woman’s past even if you don’t take her there. Try to stay in the present and see what presents itself: where do her associations take you both? What do her feelings suggest? You could ask her, for example, what the sensation she notices inside her, when she describes the current scene in her life you are exploring, seems to say about her.

If that’s difficult try finding a creative way of getting to what a client’s beliefs about themselves, held in their feelings might be.

I remember asking Christine what it would be like to imagine her feelings, the sensation she had noticed, as an animal. What would it be like? It turned out to be an imaginary animal, the nature of what helped Christine subtly describe how she felt. We imagined what would happen if someone else was given the animal: what would it bring with it as a magical spell to cast upon its owner? What would that owner say about themselves once the spell took hold? ‘I am too overbearing,’ she said – and Christine found herself describing, very emotionally, how she felt she was too overbearing, and what she did to cope with this.

I never mentioned Christine’s childhood. She made a number of connections herself, most of which would have been beyond me; or if I had made them they would have horribly over-simplified the situation.

A conscious awareness of the past, even if it was a reconstruction of the kind of tableaux I used to love seeing as a child at the British museum, resided in me throughout this work. The anchor to the present resided in the client. Between us we found a way of working through something that connected the two.

I intended this as a short note, so I shall end it here. Almost.

Trauma work and scenes … something isn’t finished.

A thought that comes to me having written this relates to the need for a psychotherapist to understand something about theory even if they never talk theoretically with their client or their colleagues. The best psychotherapists and counsellors I know talk about the theory I know only as much as they would their favourite novels or films.

I’m thinking of a printing engineer I used to know who, when called to the site of a problem, would spend some time listening to the machine that seemed to be malfunctioning. This man knew how the machines worked in extraordinary detail. Not only that, he understood the process of printing inside out; and even of publishing. If you spoke to him he could give you a history of a book (from its life as a part of a tree to its place on a shelf in a bookshop) that was so entertaining, and so particular, taking into account the subject of the book, the place in the world it was made, the time it was written, the political circumstances, the kind of transport systems available … and so on. The engineer loved his work.

My point is that when he arrived to mend a machine, all the engineer had to do was listen and he usually had the problem solved quickly. Sometimes he didn’t even have to take the machine apart: the problem lay in the way it was being operated. He knew his theory, and he loved his work, and he could fix a printing machine without once looking at  a circuitry diagram, an operating manual or a service history.

I prefer to work with people like him. Trauma work and scenes: think of yourself as an actor trying to convey the trauma in a play. How would you play a scene? The best actors seem to know a lot about how theatre or cinema work … and if as a psychotherapist you can’t conceive of yourself as playing a part in your client’s dramas, the scene of the psychotherapy, you may be missing a lot. You may even be playing your part without realising it (although I have to say there’s some of this in every psychotherapy I can remember, which I have only been able to get in touch with after the event; and probably some I will never know about).

Trauma work and scenes: I wonder sometimes about my need for repetition.

Scenes in Psychotherapy: Trauma, Enactment & Hanging Out in the Unknown

Scenes in PsychotherapyI thought I should write something about scenes in psychotherapy. Ways of registering these have become fundamental to my work. I find Freud’s scenes, his thinking through scenes, extremely helpful. He writes about a primal scene, and various other kinds of scene, and for someone like myself, who loves certain kinds of cinema, it isn’t too hard to imagine a form of dreamlike scene.

Scenes in the theatre are so different from scenes on the screen. Freud’s psychoanalysis emerged alongside the cinema and without trying to explain this, I would suggest remembering it. The first film studios were being built in 1897; Freud’s Die Traumdeutung (The Interpretation of Dreams) was published in 1899.

Scenes in psychotherapy need to be acted on carefully. Noticing and thinking of a scene, when I am with a client, but not a scene I walk or even talk myself into, as I might if I intruded on a play, (the disastrous consequences of which should tell us something about intruding on our clients) can get something started as a dream can.

When I hear a dream told to me I do my best not to get in the way of what is being said, and instead to try and keep both the ordinariness and craziness in mind without rationalising them. An interpretation of a dream is an engagement with dream-logic (as you might find in a book such as Lewis Carol’s Alice in Wonderland), something that tries to propagate the outlandishness of an encounter with the unconscious, rather than something that tries to ‘make sense’, defying the logic I have been presented with.

If you watch a film like Jacques Rivette’s Histoire de Marie et Julien you’ll see the kind of thing I am thinking of. This is a film with a very clear logic, as I find in all of Rivette’s films. But as with most of his films, I found myself watching it more than once before I could appreciate it. Then, suddenly, all was clear, and extraordinarily so. There are films by Rivette that have bored me to sleep out of what appeared to be their obliqueness before I suddenly came alive at a viewing (L’Amour par terre, [Love On the Ground] took five viewings before it came alive, during the fifth, to the extent I wondered if I were watching a different film). Each viewing was a re-introduction to a way of thinking, a way of doing things, a way of feeling, that I had somehow failed to comprehend before.

And how many times, I wonder, have I done this with my clients? Not understood because I have failed to pay attention; because I have remained as good as dead to the life in front of me.

I am always reminded: what doesn’t seem to make sense may make sense eventually, as long as I stay with what is in front of me (and then inside me), without trying to hold onto it, crush it, pick it apart or understand it. Forcing an understanding is a particularly terrible kind of violation. 1 My experience of working with people who have been told they are psychotic has shown me that some individuals crave an understanding which is usually withheld from them because of a psychiatrist’s, psychologist’s or psychotherapist’s desire to make sense of them. If they receive understanding, in the way I eventually understood Rivette’s films, I have seen people described as psychotic relax into life, and come together. A theory of psychosis, I could say, might be the hammer which splits off or keeps split, the very person it seeks to understand.

All of which takes me back to near where I began: noticing and remembering scenes in psychotherapy, especially when I believe the kinds of scene cinema 2 can give us, (where I cannot intervene unless I go to the extreme of cutting up the scene, taking some scissors to a length of celluloid, or these days re-arranging the pixels of  a digital production), might take us to places  we may never otherwise know.

In cinema you cannot intrude in a scene; in theatre you can but the effects are unpredictable, usually undesirable and, unless you have been invited in some way to do so go against what has been intended. Interrupt scenes in psychotherapy at your peril, and always understand that your interruption will be traumatic for your client. Remember what Hegel had to say about interruptions: the bud disappears when the blossom breaks through, etc.

This piece about scenes in psychotherapy has become an account of interruptions. Of interrupting a client mid-scene, and of being interrupted by a client’s scene (scenes in psychotherapy as moments of meeting, as they say). If we want to work with trauma something must interrupt us before it interrupts a client. We must withhold our making sense of something until it has deranged us sufficiently for us to not be lost in our own general sense of life, usually where our craziness remains hidden, deferred or displaced. A Jungian might write about a certain kind of intermingling. Heimann (1950) 3 wrote how counter-transference feelings might help us explore beyond what we immediately know.

Let me offer an example. I was working with a man, Adam, who arrived at a session in great distress. He had been travelling with his partner, Craig, a man of the same age, after a period of unhappiness between them. It had seemed that their situation was improved, although not dramatically so, but certainly to the point where a weekend away together in one of Europe’s oldest cities did not seem like foolish idea. On the first evening, however, they had found themselves shouting at each other in a cinema’s packed public bar. The argument grew more and more heated until the two started to fight and they were ejected from the building.  ‘It was as if’, Adam told me, ‘we were back in New York.’

The couple, of a similar age, had lived in New York for several years before their financial situation led them to take up residence in Adam’s mother’s home. I was aware of the many difficulties the couple had faced then and was drawn to try and explore the situation in terms of what we believed we had started to work through together.

What helped the two, though, arose instead out of something that we noticed about the particular scenes of New York and where they were living at the time of the trip abroad: London. Adam wondered what it had been about the cinema where they rowed that had triggered the exchange that was so reminiscent of their heated public rows, on occasions leading to physical fights, in New York.

He then observed that in New York and at that time in London (they had been living in London for some time when he first saw me) Craig had been in psychotherapy, and even though their relationship had often been difficult it had only been when my Craig was in psychotherapy that their relationship had grown so violent.

I found myself on the verge of drawing Adam to think about what Craig might be going through, based on his own experiences; or of asking him whether he feared Craig’s psychotherapy might endanger their relationship. Fortunately Adam interjected: the scene in London and the scene in New York reminded him of one when he was a teenager, living with his mother. His father had died when he was a young teenager.

Adam grew very emotional and remembered how his mother would not talk to him about a relationship that seemed to be developing, the first since his father’s death,  with a man he had never seen or met. He had overheard her speaking to him on the telephone, arranging to meet him, and this was almost exactly what he had heard Craig doing with his psychotherapist. He realised the extent of his jealousy towards Craig’s therapist and the traumatic effect of his mother’s silence about her relationship. He noticed that Craig’s shame at seeing a psychotherapist reminded him very much of the feelings he had experienced in his mother: he had never thought she might be ashamed to see a man she later went on to marry. She had always spoken about wanting to protect Adam, in case the new relationship had not worked out.

The truth, at least what Adam felt to be his emotional truth, suddenly made sense to him. I could feel, as he sat and thought about what he had just described, in a state of deep sadness and then anger during which he had repeatedly punched the side of the armchair he sat on, that something had shifted in him.

This seems to have been be the case. We continued to work for some time, occasionally using EMDR to explore and bring into the world his rage, an awareness of the transgenerational shame in his family, and the diverse roots of his feelings in his very early life.

Scenes in psychotherapy are usually not things to be interrupted and explained in the therapy room. Just as remaining with the obscure intensity of a dream, with its uncertainties and incongruities, can lead us to get something from it in ways we may never at first be able to comprehend, staying with the sometimes worrying scenes our clients may desperately want explained might bring us to an awareness of things beyond reason. Aetiology is born out of anxiety, but so can be an honest encounter with the unknown: the only way I can imagine that truth can be told. I’m talking here about poetic truth, the greater truth a poem, or a certain kind of film, or for that matter a dream can give us.

Scenes in psychotherapy: dreams, films, stories and other accounts of things I will never really see. Scenes in psychotherapy: opportunities to listen and engage with a logic which has been beyond me. Scenes in psychotherapy: places where things can come together.

Imperfection is Desirable

Imperfection is desirable in so many ways. A child cannot survive a perfect parent, because a perfect parent is impossible. A perfect parent is a lie. A perfect person is a lie. Perfection is never true, unless we live in a kind of a machine; in which case we would quickly discover that perfection has cracks in it. Scuffs, weird moments, oddly striking almost ugly profiles or face-ons.

You can’t get turned on by perfection. Perfection could never move, and perfection could never tolerate me, or you. Imperfection is so very desirable, so close to ugliness can even be extraordinarily sensuous, alive to pleasure when perfection can only remain transfixed by its own beauty: narcissus, frightened of a hair falling out of place.

Why are the Stock Markets Crashing?

Stock market ‘carnage’ is an effect of addiction. Addiction affects all areas of life. In many ways it is life: unavoidable, like colds, getting old, and death. All we can do is understand it better and learn to live with it; and if we do we will be less anxious. If we are less anxious we will better be ourselves without trying to draw on things outside ourselves to make us feel better.

If you borrow to invest you are effectively drawing off nothing, and with low interest rates investors have been doing exactly that. Now there is a fear of interest rates rising investors are scrambling to deal with their debt-chains.

The stock market crash: it’s an emotional thing. Don’t get caught up in being rational if you want to make sense of it. It doesn’t make sense: it makes chaos, which is what addiction does. Addiction is a drive towards extinction, to non-presence. Freud called it the death drive. It’s overwhelming. It’s what’s happen if you are eaten up by anxiety.