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.


A Memoir of the Future

Today this begins:

‘Wilfred Bion will deliver a paper on the effects of our aggressive tendencies, dreams as resistance to overwhelming odds, and dreams as a source of the future.

‘Reports of Mr Bion’s death have in fact been premature. He has been alive and living well, very well, for the last few decades, contemplating a virus analogous to a computer virus which would infect oil (Dreams, he says, are the new oil). His preoccupation with intense darkness has led him to follow with trepidation the fate of the Labour Party, the popularity of Donald Trump and falling sales of the iPhone (the newsworthiness of which signifies, as much as anything else, a crashing lack of reverie).

‘Reverie. I shall pick up on this in the future as much as anything else.

‘Reverie. We don’t dream the same and when we do dream our dreams are not taken seriously. Even a dream book (my father’s was one of the few things he left to me) would do better than the National Curriculum, Internships and what I hear about best practice in psychotherapy. All of the institutions, people, places I look to to help dreams become thoughts, become actions, become something in the world … what are they? Distracted? Disinterested? I think about schools and I don’t even get the teacher from The Wall, more a hazy picture of rows of women and men standing in front of children with an iPhone in their hand. Distracted. Texting without realising they are in the middle of children’s dreams and their job is to help carry dreams forward.

‘Teachers, bosses, psychotherapists need to be Dream Positive. There is an aggressive attempt underway to take away the night, to have us never ending working, or unable to sleep in our anxiety, to stop dreams happening, and for anyone who dreams to be left on their own with their dreams … to ensure nobody is there to hold dreams together with reality, so it all goes mad.

‘Mr Bion will present his paper in the future.

‘Mr Bion reports that dreams are taken seriously as a serious threat to the future. He notes certain repetitions in this piece with interest (for example in seriously and serious in the previous sentence) and wonders what that’s about).

Freezing: People Who Survive Like Matadors

It’s one of the privileges of my middle age, to be able to think about things in ways that once upon a time would have possibly driven me crazy, or into one vice or another. It did feel like that: vices, things that clamped onto me – rather more than anything that would shock someone. I couldn’t move. I somehow froze.
        Probably that’s something to do with fear. Fear freezes some of us; and it freezes in different ways. I was always able to think like crazy while I was stuck to the spot, clamped down, and a lot of good came out of that. I couldn’t have run if I tried. At other times I seemed to wipe myself out: erased myself (you can call it dissociation). A lot of good came out of that, too.
        If your way of avoiding danger keeps you somehow almost standing still in life (even if you’re not entirely there) so you don’t escape through flight and find yourself dislocated, lost, or you don’t resort to fight and smash it all up, perhaps you can keep going without accumulating the losses some people experience. There’s always damage to the people, the real world, around you, but if you avoid the worst extremes of narcissism, as freezers survive like matadors, and some of us get carried away with that, and you don’t in the end get gored, there’s a chance you’ll have a life to look back on where one thing more clearly leads to another. Maybe there’s more to do to make amends but less to reconcile.
        Freezers stay close to life and death, as close as you can imagine. Once you learn how to thaw, or not to freeze, at least most of the time, it’s really rather wonderful.

Stop it (The Labour Party)

Labour Party MPs: it would be possible for everything happening within the Labour party to occur without destroying your party’s credibility and abandoning Britain to your far better organised, rather more at ease with themselves, political foes.
        Jeremy Corbyn, tomorrow morning get on a box on the corner of a street and shout yourself speechless about the things you say you believe in.  Angela Eagle, make a defiant nest at the top of Nelson’s column and dive down all day on the things you find aberrant. Owen Smith … you look like  the verger from Dad’s Army and seem to have begun behaving like him.
        Stop it.
        Once you’ve each done all of this, which is what you were elected to do, and what you are paid to do, go and pull each other to pieces in private. Or check in at Charter and we’ll sort you out.

All of your efforts to make me understandable

Every time you try to describe me, you simplify me. You limit me. Immediately I am no longer me (not, perhaps that I would do any better). The only kind of truth that will ever reveal as much of me, of you, as would a lifetime of getting to know each other, is in poetry; and then, perhaps it could even be more.

Fearing failure, sensing rage

I’m afraid this will be a bit of a ramble, a kind of a hack through some thoughts of failure, of watching a TV interview of a sportsman from the 1970s and then one last week, of media training, of war, of politics, of anger, of disconnection and of fear. I haven’t time to concoct a proper playing out for them, but something about them needs to be said right now, rather than me carrying them, and feeling angry as I carry them. So here we go. Failure. I’m admitting it from the start.
        Failure is a disconnection, and usually a painful one. In my work as a psychotherapist I see reality failures each day. Reality being life being lived now, experienced in the present. People experience moments in life as if they were, in more respects than they need to be, not just echoes of the past but replays of past moments attached to things going on in the present. They feel fear or anger as powerfully as those emotions were first felt in response to an event in the past, not the one happening now.  The fall in love – again. And again. And the same thing happens. All of us, we in some way fail to find clean connections to reality: ones unsullied by detritus from the past. And we keep on doing this until someone points it out; and then usually we dismiss them. Outside intervention fails.
        Recently there have been a couple of spectacular failures: the English football team losing to Iceland, and the Remain side failing to convince half the country of the chaos and aggression that would be unleashed by an ‘out’ vote’ (the destructive spiral of hate crimes, political implosions and financial crises).
        What can I do here to describe the things which, with hindsight, seemed to predict failure to me? What can I do, because I did predict how these things would fall.
        I had a very strong feeling that England would lose their football match, not because I know anything about football – it’s about twenty years since I saw a game – but because the day before the game with Iceland I caught sight of an interview with one of the English players. In the manner of many sporting professionals he seemed oddly encapsulated, neutered, tedious and predictable. He’d ironed himself out.
        If I turn my mind to a sport I know far better, cricket, I’ve always been interested in how the teams with the best interviewees usually win. Free spirits, non-compliant people, win things as long as they accept there is some kind of law they can’t go beyond (and or that they need a strong captain or manager). Shane Warne stretched that to the limit but as a player he always seemed to have some kind of respect for the laws of cricket. That English footballer I saw, something in him had been milled down. He’d gone from porridge oats to Ready Brek. There was a level of deceit to him, seemingly utterly anodyne, that felt as if it couldn’t been true. How do you turn that off, that castrated plodding? And where did his anger go at being so horribly circumscribed? How could that not lead to the clumsiness, lack of coordination and deflation of that game?
        Media training disconnects. It sets people up to fail. What’s it like, I wonder, to talk about yourself and your team-mates when it feels as if (or perhaps it’s the case that) your speech has been rewritten by somebody else? What’s the effect of that? Anxiety, almost certainly. Maybe a false calm. A veneer of solidity.
        People who succeed feel themselves, or have experiences where they can feel themselves, as often as they can. If they can’t, then in some way they start to fail, to come apart. Under pressure that doesn’t play out well.
        Maybe watch interviews of sports stars from the 1970s if you want to succeed. Ignore media training (if you’re unlucky enough to have it thrust on you). Make the occasional gaff, be yourself and know not just your limits, but the limits.
        That’s football.
        Brexit, then. Speakers from one side of the argument during the referendum seemed to avoid and attack facts. They focused on ‘project fear’ and ‘taking control’. They tapped into an aggressive, destructive surge – Gove in particular, orchestrating what felt such a symphony of hate. Or perhaps you only feel that keenly if your name or your skin marks you out s a possible object of hate. Polish vermin, for example. It seems now I am a rat?
        Leave. If something makes people feel much better in themselves, especially if they were feeling unbearably bad to begin with, you try getting between them and it. Leave. Think of leave as a drug, leave as a cigarette, leave as a glass of beer and Brexit makes sense. How long have packets of cigarettes carried messages saying smoking kills? And how many people still smoke? It makes sense as long as you don’t deny how angry British people were not just at the time of the referendum but at others, and how at those others they weren’t allowed to let it out.
        Well it’s out. Leave. And Boris Johnson and Michael Gove are doing their media training thing, glossed and strangely confectionary, so I imagine they’re done for now. People need somebody to remind them, or even show them, how angry they are. Gove and Johnson do. Jeremy Corbyn does. That strange paleness, that prickling in the fingers, those raised shoulders and shortness of breath; that headache, that sleepless night, that slamming of the door by mistake. That treading on the foot. That push. That shove.
      We used to have wars closer to home. Then we found ways to have them and forget them. Now they’re coming home again, I fear, unless we find ways of calling them before they begin. No more media training, please. No more gloss. Politicians need to show us how to get angry and sports players need to show us how to compete – sometimes brutally, but inside the rules. Within the law.


Fantasy Island II / Brexit

I’ve listened to people justifying voting to leave, and all I’ve heard are fantasies, curious projections and strange assertions of calm.
        A socialist politician renowned for her work with refugees was shot dead last week by a far-right fanatic. The markets are falling, and many people I know are scared because they see a man like Nigel Farage (who wants to relax gun control, who last week stood in front of a poster even people in his own campaign team criticised for its fascist associations) getting air time on TV. Whatever people on the right imagine when they see Jeremy Corbyn on TV I doubt it comes  with a soundtrack of distant jackboots marching. Although I have to say that even some people I thought I knew well seem deaf to that.
        I don’t feel calm.
        Would I leave my children for five minutes with Johnson, Gove or Farage? No. Voting to leave means you have, and for the foreseeable future. Your children’s future in their hands and if not our lives, then the lives of whoever become scapegoats now Europe’s out of the way, in the balance.

Return to Fantasy Island

I voted today, having waded through a flood outside the polling station which would have put an eel off, I’d have thought. I am however more man than eel (although Freud, a very important man to me, spent much of his life thinking about eels, so there’s some eel in me … my book on psychoanalysis as a footnote to the study of eels will have to wait). All night, rain of Biblical proportions. All week, and the weeks before, lies and bullshit and coruscating moments of insight to the state of this pumped up nation.
        What I’ve heard and seen most are fantasies of leaving. Of an Exodus to a promised land that doesn’t exist other than in the discredited rhetoric of some third-rate politicians. Of a future, like a sad little pink eel, in the clammy hands of Boris Johnson … and you may do what you will imagining the fate of that little eel.
        It’s all an exit strategy. It’s all too much. It’s the mid-life crisis of (mainly) desperate men. I’m interested in who’s going to hang around and clean up the mess. A mess of the last twenty years, and many more before that. Look around us at the effects of lies on the scale of Blair’s weapons of mass destruction, of his rationale for expansion in higher education; and of his (or at least his administration’s) immigration policies that seemed to arrive like ghosts in the night. What was that about?
        Defence, education and immigration. Blair and his crew butchered the last of the truth in all three to the extent that Johnson and Gove can dismiss experts as if they were flies.  And Cameron?  Cameron. He with his piggy intent, somehow Blairite, more Blaire-lite … but with ‘austerity’. A more toxic bucket of filth tossed at the British public – as it has been across the world. A choice to create wealth by inflicting pain upon the most vulnerable. You’d think there was a pervert residing at the exchequer.
        And there was Clegg, awfully but briefly.
        This referendum is about immigration and emigration, and little else. Coming and going. Leaving a sinking ship for fantasy island, again. It happens horribly regularly in politics when the chips are down. Good luck if you’re on the lifeboat rowing into the sunset (be careful Boris doesn’t push you overboard when he finds the rations are running low). If you’re staying here can we have all hands to the pumps, please?
        The problem is that, whatever happens, at the same time nobody’s going anywhere. What is it about eels?


Out of a Book

I was reading Elizabeth Bowen’s essay Out of a Book, and wondering (as I often do … sometimes I wish so badly for the spontaneity of my seven-year-old self and for what he’d be doing, having read that essay, right now. Up a tree maybe? Making something out of sticks in a wood, with bits of string and wire. Drawing … which became the eventual move to writing … as a last resort … enough …) why I had decided to find that essay this morning, quite out of the blue (looking back over this sentence I think I need a typographical convention for over-long parenthetical wondering). I finished reading it, which is the trick, not to let the wondering disconnect me from the reading, just to stay in it, and of course it came to me, written as it was:

The apparent choices of art are nothing but addictions

Out of a Book, 1946

I was going back to the same old thing.
        Addiction isn’t necessarily a bad thing. Usually it is. Most usually it comes about as a way of coping when someone starts to feel overwhelmed and hasn’t really had the best advice. Falstaff, rather than Shakespeare, for example; a good reason not to get lost in a character, but to read really closely.
        So what do I learn from this, speaking as someone who likes to learn as much as possible about life? Perhaps Bowen gives me a very good idea of where my life has come from. As a child I read so much: some things, even, that I have no idea what I took from them. I read Kafka at a really weirdly young age because my mother, who’d started an OU course in literature, left a copy of his short stories lying around with what looked like a picture of a beetle on the front. As it happened my primary school playground seemed to attract a lot of stag beetles, so I was drawn to that book as much as I was to the other one that always seemed to be lying around, a compendium of photos of the dark side of the moon. But that’s for another time.
        This week I have a story, Heidi’s Advertisements (or the return of the Mouse Folk) published in Minor Literatures,  a piece of writing that cleaves from Josephine the Singer, or The Mouse Folk, Kafka’s last storySo I imagine reading Bowen’s essay again has much to do with that.
        And it could also be connected to the fact I woke up wondering how much, in my imagination, I still identify with Spock, the Nimoy version, from Star Trek. He was half human, and I’ve been thinking about my humanity … and in many ways, growing up with a father as intensely foreign as mine, that was how I started to feel. Not entirely human; and that’s never entirely left me. More than that though, which is after all a little psychological, I look around me, especially at work, and I think Im wise not to forget about how utterly obsessed I was with Start Trek. It isn’t just books that shape our lives in the ways Bowen suggests (and she doesn’t limit life to books, either, she just loves them).

I may see, for instance, a road running uphill, a skyline, a figure coming slowly over the hill – the approach of the figure is momentous, accompanied by fear or rapture or fear of rapture or a rapture of fear. But who and how is this? Am I sure this is not a figure out of a book?

Out of a Book, 1946

Well …


Mood Altering Substances: Shakespeare & Frank O’Hara

I was on my way to meet a friend for lunch yesterday and realised my mood had spiralled downwards after a run of irritating things. Tuesday had been patchy to rotten, yesterday morning was rotten to patchy, both in spite of (or perhaps exacerbated by) some lovely moments. Then a colleague showed me a picture of a kiss. I told her about a kiss I’d seen yesterday: Tom Hiddlestone as Henry V kissing the French princess. I wish I could show a link here but perhaps it’s best left to the imagination, and Shakespeare, to whom I think the actors somehow managed to remain faithful:


Kissing her

You have witchcraft in your lips, Kate: there is more eloquence in a sugar touch of them than in the tongues of the French council; and they should sooner persuade Harry of England than a general petition of monarchs.

That got me back on my feet. I then found some Frank O’Hara:

Having a Coke With You

And love healed all. I felt free to enjoy lunch with my friend.