Therapy as Machine

I think people would be surprised how often psychotherapy acts as a machine to serve people up, back to the world, as apparently less-troubled participants in the social scene they previously inhabited. Good psychotherapy will no doubt make life harder for you before it ever makes it easier. It won’t necessarily make you more productive or happier. If you’re lucky it might make these things more likely to happen, if it shows you how conflicted your life has become, and helps you understand how you’ve bound yourself into life unhappily – but there’s a lot that needs to go on which is beyond understanding.

The Body, Skyped

I sometimes use online technology when I speak to clients. Something like Skype, I believe, which is secure. But I only use it rarely. It’s similar with the telephone, which I use when I have to.

Screen-based communication and telephone calls offer particular emotional experiences: the odd flatness and disrupted movement of an image of you, or of me, on a screen which somehow seems out of step with your voice that I might even hear more clearly on the telephone; and of course there’s the intensity of the telephone. The intimacy. On the phone I hold you up against me, right up close to my ear, and without the sight of your face I attend to your voice and your breath in a way I never normally would – or could.

The person I speak to on the telephone, or on a screen is never the same person I meet face to face, in the flesh. You meet me, and I meet you mediated by many things, not only what happens in us after we notice each other. On the telephone, on a screen, you and I meet something more of a ghost, much of what I’d say is ‘really you’, and vice versa, apparently lost when I meet you partially reassembled, digitally, at a distance.

When you were a child did you ever speak to someone down a plastic cup telephone, or one made out of cans, connected by string you and your correspondent pulled tight?

All of the time we engage with experiences of people that defy what we understand when someone says: I’m here. None of us ever really knows entirely what’s ‘here’. There is no ‘entirely’, of course, apart from in what I would wish to circumscribe. There is only that I believe you are in front of me, with your undetectable memories, fantasies, and residues of dreams I shall never know; all of the thoughts and feelings you cannot put into words and which are lost to me apart from in whatever I detect when you experience them: maybe the way that you breathe, or your eyelid flickers.

And of course there’s all that happens when you out there become you in me: what happens when I perceive someone. I was recently reminded of this at a screening of a film I particularly loved, only to find the person who had watched it with me hated it: a film happens in me. It was as if we’d been watching different films.

There’s a strange conflict in psychotherapy. As we continue to recognise the importance of working with the whole body, that speech is only one aspect of a relationship, therapists seem to be developing more and more ways of having relationships that are less physical.

Are we making relationships possible for clients who would normally remain isolated and disconnected, or are we creating very particular forms of relationships, the particularities of which we fail to recognise; or even impossible relationships, where virtual contact becomes counter-productive, or limiting, restricting a client from finding ‘real’ contact in the world close to them?

 

Something in Me

While I was writing that last post on Dusty Springfield I remembered something I sometimes say to my clients. If you go to see a film, where’s it happening? Some people get straight into this, others remain a little baffled. Thinking about the question clearly and sometimes slowly enough to get to an answer is an exercise in itself – you wade through assumptions, things you haven’t considered, and whatever feels intuitively right or wrong. Then you get to a thought: it’s happening in you. If I watch a film, it’s happening in me. That’s why we can see different things in the same film: whatever I go to watch is seen in the company of me and my whole life, all my thoughts, feelings and unknowns. There’s the rubble of my unconscious and the summit of my achievements.  Something that happens may take place outside me – but it happens in me. Something that goes on, that’s something in me.

Narcissistic Feed

I’ve been thinking about narcissism lately and ended up watching Now, Voyager yesterday and selected excerpts form the Alien films this morning. None of this ran together in the way I have just written it until I began writing the words ‘narcissistic feed’, but there we go.
       Narcissism isn’t necessarily a bad thing: thinking about what you like to eat, wear, say and do; if I didn’t I would, in an awful sense, disappear. There’d be nothing of me on show and no return from that in the world to give me a sense of having a life that’s mine. Of course narcissism can be overdone and, from time to time, most of us overdo it – unless we underdo it, which I might come to at another time: underdo as in written our of life or written over someone else, no doubt a particularly egregious narcissist.  We forget that we don’t actually know better than other people, or that we know them half as well as we might imagine. All kinds of narcissism rely on a feed from the outside world, from the kind of ‘that’s a nice hat’ comment to the more disturbing ‘you’re mine’ behaviour which characterises those egregious types I mentioned.
       If you want to see what happens when narcissism becomes a difficult thing watch what happens to Charlotte Vale, or the crew of the Nostromo in Alien. Narcissists take a dim view of those around them trying to assert themselves: it interrupts the feed. Charlotte or Kane could have stayed in their cabins, but instead they went looking for adventure.
       Differentiation, the move from a ‘we’ to an ‘I’, recognising the other, will always in some way be worrying (not being comfortable as an ‘I’ leaves you feeling anxious). You know you’ve got a problem when someone insists on ‘we’, not necessarily if they get worried about the ‘I’ … we all do that.
       The ‘I’ demands a leap into the unknown unless I believe, secretly, we really are always a we, inseparable and conjoined. Wilfred Bion wrote about Experiences in Groups, not ‘experiences of groups’. Groups are an experience rather than an entity – as  The Three Musketeers would have done well to remember.
       I got worried about something like this yesterday. When I was a boy hooked on watching Sunday afternoon matinee films Now, Voyager had only existed for thirty years … rather like the relationship between now and another film I love: Withnail and I. And so I was reminded that I am 50 again. The ‘we’ of Tom Tomaszewski, me in all of my incarnations, still hasn’t quite become used to this ‘I’, the 50-year old one.

 

Oedipus

Oedipus is not about a young man who wants to sleep with his mother and kill his father. It’s about someone whose parents’ secrets are always there to threaten him. In the end his blindness destroys him. Oedipus is to blame yourself for your parents’ crimes.

For Now

I’m realising, more than ever, that there are things my mother taught me, and left for me to discover, which were not for the time I found them, or she gave them to me. That was confusing. They’re for now, I believe she meant it that way.

Noticing Changes in #Psychotherapy

People often write about change in psychotherapy. Fewer people seem to write about how changes are noticed and acted upon, especially in clinical teams. This piece is written for people working in teams and tries to suggest a few things about accountability among clinical groups.
        When you see something that you believe someone has missed it can feel alarming. (I’ve heard it can also be gratifying.) There’s a kind of noticing which can either be constructive or divisive, depending on how it’s approached, and it goes like this: someone (a therapist, a  counsellor, a nurse; let’s not get too hung up on titles right now) is responsible for a client, perhaps something goes wrong or a situation deteriorates, or nothing seems to be happening, and another person is invited in (hopefully by the first person) to take a look at that client as well. I’ve experienced this from both sides.
       
At worst, the person being called in might see what they call negligence.  Negligence happens and is probably as likely as ever to happen now, although I won’t get into that here (if you’re interested, I imagine all would be revealed rather quickly if you watched Ken Loach’s latest film and then read some Adorno on administrative culture). More often I imagine that what might be regarded by the second person as having been ‘missed’ by the first person has actually been subject to one of, broadly speaking, three kinds of process.
        The first person may have been aware of what has been ‘missed’ but chosen to approach it in a way that does not seem immediately obvious to the second (process one); or it could have been seen and not considered as important as the second person believes it to be (who may or may not be right in believing this – either way, this is process two); or it could have been become perceptible as a result of the way the first person has worked, but remained undetectable, immediately, to him or her, such are the defences at play (process three).
        There’s much I would say about the first two categories of process listed above. It’s the third, however, that I want to say some more about here. If you have some kind of affinity to what’s usually called ‘psychoanalytic’ work then the third category is possibly one that you never let slip out of mind. But I think any experienced clinician, in fact anyone who’s had the regular experience of joining in with work someone else has begun, might recognise that some things will never be immediately perceptible to the people who begin to make them knowable.
        Good clinical work is work from which something emerges over time. This calls for a kind of continuity in which accountability is isolated, as far as possible, from blame – where it’s sought after by the person accepting it, rather thrust upon them as part of a move to account for what apparently hasn’t happened, with no acknowledgement of ‘yet’.
        The idea that clinical work can predictably happen in the time we would like to allocate to it is of course most seductive. Given the ways in which clients live their lives, how treatment is paid for, and how therapists work it’s almost too much to bear, to think that the most useful thing in someone’s treatment may be happening only unrecognisably so. But holding onto the idea that perhaps something hasn’t happened yet, and that some clinicians are going to complete what they see as their work without perhaps feeling with their client the greater sense of achievement that comes with a life ‘turning around’ calls for a rare and special kind of collaborative work.
        Supervision and cooperation must hold strong without starting to become steely. Experience needs to be contained without being restricted or constricted; growth needs to happen while being shaped as little as possible by containing forces (directive work needs at some point to give way to a client finding his or her own direction).
        Plato  (the Timaeus), Heidegger (Was heißt Denken?, 1954 [What is Called Thinking?, trans. 1968]), Bion (Container and Contained, 1962) and Derrida (Sauf le Nom, 1993 [On the Name, trans. 1995]) wrote about this. Still, it seems somehow to so often become forgotten.
        And of course I am not suggesting that certain other important things be forgotten, like looking closely at what is evident to everyone involved and making sure certain parameters are not exceeded: the ones written into the ethical codes we subscribe to and the bottom lines relating to the forms of treatment or engagement we begin. It would be a mistake, however, to believe these things are always decided beforehand, in another place, such as a room inhabited by a UKCP ethics committee. Things begun in those places have a life of their own, too.