All posts by Cedric

57046800 - a road signs eu and brexit and a blue sky

Quelques considérations sur les impacts psychologiques de la crise du Brexit

Le 23 juin, une majorité de l’électorat britannique s’est prononcée en faveur d’un retrait du Royaume-Uni de l’Union Européenne. Au delà des conséquences politiques et économiques immédiates et à long terme, les individus eux-mêmes sont touchés profondément par cet événement sans précédent. Ce court article, à l’usage des pscyhothérapeutes et des personnes intéressées par le sujet, recense quelques données psychologiques avec lesquelles ils doivent dorénavant composer, et se concentre sur les défis qui s’adressent aux citoyens de L’union Européenne vivant en Angleterre.

“En nous” et “autour de nous” : l’effet du contexte sur la personne

Un patient anglais, qui me voit depuis plusieurs années, et qui pense depuis quelques semaines à conclure sa thérapie, me dit : “de toute manière, impossible de prendre pour l’instant une décision dans un sens ou dans l’autre. Avec tout ce bruit dans le pays à propos de partir ou rester, c’est difficile de s’entendre penser”.

Si, dans leur démarche, les thérapeutes se penchent avant tout sur le passé de la personne, tel qu’il se manifeste en eux, il est donc plus que jamais nécessaire d’écouter attentivement ce qui se passe autour de la personne (celle du thérapeute et celle du patient) dans le présent. Cela permettra de prendre en compte l’effet considérable que les mouvements de la société et son discours peuvent avoir sur le psychisme de la personne.

«Je me suis réveillé un matin,

et mon pays avait disparu»

Il est possible de dégager d’ores et déjà, de distinguer deux grandes catégories d’effets, que j’appellerai “appel d’air”, et “écho”. L’appel d’air est lié à la disparition d’une chose prise pour acquise, dont l’absence soudaine crée un vide dans lequel un vécu révolu peut s’engouffrer. L’effet d’écho est lié à l’apparition d’une nouvelle donnée, qui est susceptible de faire écho à des expériences passées.

La disparition d’un environnement sûr crée un appel d’air avec le passé

Un patient Russe, membre du conseil d’administration d’une entreprise privée, me confiait la détresse qu’il avait ressentie immédiatement après la dissolution de L’URSS – “je me suis réveillé un matin, et mon pays avait disparu”. De nombreux témoignages récents sur la manière dont les citoyens de l’UE vivent le Brexit rejoignent celui-ci. Bien que, aujourd’hui, l’Union Européenne existe toujours, elle connait aussi, dans son état de désintégration latente, cette remise en question tant sur le plan de son territoire que sur celui de sa population. Une désintégration qui menace le territoire Britannique lui-même, et qui, quelle que soit leur nationalité, menace ses habitants dans leur personne même.

Cette désintégration s’exprime d’abord dans la sphère du rapport de l’individu au groupe. Un de mes patients m’expliquait avec passion : “j’ai passé ma scolarité dans une classe internationale, j’ai fait un programme d’échange Européen, je travaille ici depuis des années, et je ne m’étais jamais posé de question. On met aujourd’hui en doute, non seulement les conditions de mon séjour ici, mais aussi les fondations de mon éducation. Que va devenir ma génération de jeunes européens ?”

«J’ai à nouveau 10 ans, on m’a volé

mon futur et je ne sais plus quoi faire»

Ce jeune homme a l’impression d’être à la dérive, et son groupe d’appartenance ne lui offre plus de garantie pour le futur. Une situation que beaucoup auront vécue dans le contexte de la cellule familiale à la veille d’une séparation, qu’elle soit amicale ou non. L’appel d’air, ici, se fait avec les mémoires inconscientes liées à cette séparation, et a pour conséquence de remettre au jour un éprouvé qu’on ne sait pas toujours identifier.

Voici une autre illustration de ce phénomène : une jeune femme polonaise, dont les parents ont fui la Pologne communiste des années 80 avant la chute du mur de Berlin, m’explique : “ils ne m’avaient rien dit, pour ne pas que je vende la mèche. J’avais 10 ans et j’aurais sûrement parlé de leurs plans de quitter le pays si j’avais été au courant. Je croyais que nous partions de Pologne pour des vacances dans le bloc de l’Est, et me suis retrouvée à Stuttgart avec des parents qui m’expliquaient calmement que nous ne retournerions plus dans mon pays, et que tout irait mieux ici – ce qui n’a pas été le cas. J’ai émigré en Angleterre à 20 ans, et me revoilà dans la même situation. J’ai à nouveau 10 ans, on m’a volé mon futur et je ne sais plus quoi faire”.

La vulnérabilité actuelle fait écho à une vulnérabilité passée

Les citoyens de l’UE sont maintenant des “migrants”, amalgamés, en nom, avec les réfugiés risquant leur vie en Méditerranée. En faisant son apparition dans le discours social, cette nouvelle donnée amène une refonte, parfois spectaculaire, des relations interpersonnelles. On se regarde parfois de travers, et les amitiés, voire les liens familiaux, en souffrent.

«Le climat social actuel favorise donc, en écho avec les vulnérabilité passées, un fonctionnement infantile chez tous ceux qui sont témoins de la crise, et plus encore chez les populations en situation de plus grande vulnérabilité, réelle ou imaginée»

En outre, à l’horizon hypothétique de l’application du fameux article 50, ce groupe nouvellement désigné et singularisé sera également soumis à un contrôle particulier, réservé jusque là aux populations d’autres pays. Entre temps, il devient, comme l’expriment certains journalistes, l’otage de négociations de sortie du Royaume-Uni. Cette nouvelle soumission à un contrôle, cette nouvelle vulnérabilité face à une entité jusqu’ici accueillante et nourrissante, et qui maintenant se comporte comme un parent volatile, feront écho avec des expériences vécues dans l’enfance.

Elles remettront donc au goût du jour une partie des névroses qui y sont liées, en même temps qu’elle redonneront du poids au psychisme archaïque qui règle la vie du tout jeune enfant. En effet, comme celui-ci n’a pas encore acquis suffisamment de resource interne pour gérer l’ambivalence de ses sentiments par rapport à son parent, il doit scinder, dans son esprit, le parent en plusieurs parties nettement distinctes et sans relation apparente entre elles, les bonnes et les mauvaises. Il “dé-intégre” son parent pour ne pas éprouver de confusion, ni sentir qu’il se désintègre lui-même.

«Les citoyens de l’UE touchés par le Brexit

subissent un “double-whammy”.»

Chez l’adulte, tout jugement à l’emporte-pièce (par exemple, “les Brexiters sont tous racistes”, “les Remainers sont tous progressistes”, “les Européens seront déportés”), participera de ce résidu de fonctionnement infantile, où il prendra sa pertinence et son énergie.

Le climat social actuel favorise donc, en écho avec les vulnérabilité passées, un fonctionnement infantile chez tous ceux qui sont témoins de la crise, et plus encore chez les populations en situation de plus grande vulnérabilité, réelle ou imaginée.

En résumé, et pour reprendre une expression anglaise, les citoyens de l’UE touchés par le Brexit subissent un “double-whammy”. La disparition de certitudes met en lien inconfortable des vécus présents et passés, et la mise en exergue d’une vulnérabilité, par sa cristallisation dans le discours social, peut faire régresser l’individu en termes de son fonctionnement psychique.

Plus grave encore est le fait que la notion même d’individu est mise à mal par la polarisation discours et du corps sociaux en un “eux et nous” rigide.

Le “Eux et nous” fait disparaître la personne et menace la relation à l’Autre

Jusqu’à il y a deux semaines, les démarcations entre jeunes et vieux, locaux et “migrants”, riches et pauvres, étaient perçues en principe comme une chose à négocier à l’infini dans le cadre d’un réseau de relation de curiosité mutuelle à l’autre. Ces démarcations acquièrent maintenant un caractère collectif, concret et figé. On semble collectivement baisser les bras et se résoudre officiellement à ce que la différence soit insurmontable. La dynamique de rapprochement incarnée par l’UE se transforme en une dérive aliénante. La frontière du “eux et nous” s’est déplacée : en tant que citoyens de l’UE, nous passons d’un “nous” à un “eux” inconfortable.

Dans ce contexte, il est difficile de s’affranchir du mode de pensée binaire décrit plus haut, et il est aussi devenu plus difficile de voir la personne en tant que telle, plutôt qu’en tant que représentante d’un groupe particulier, dont elle hériterait les caractéristiques par défaut.

Comment vivre la nouvelle donne ?

Nous pouvons aborder cette question sous deux angles. En rapport à l’effet d’écho, qui remet au goût du jour un fonctionnement psychique infantile, il s’agit de se demander comment fonctionner comme adulte en dépit de notre vulnérabilité et de notre dépendance. Pour ce qui est de l’effet d’appel d’air, ou d’anciens souvenirs sont réactivés avec les emotions qui y sont associées, il s’agit de voir comment vivre un deuil.

«L’honnêteté intellectuelle et émotionnelle sont donc deux atouts à cultiver ou à apprendre, pour tous ceux qui ont du mal à penser et sentir au delà des discours qui nous sont offerts par le corps politique et la presse, et relayés par certaines sections du public, britannique ou de l’Union Européenne.»

Rester adulte

Comme décrit plus haut, les jugements à l’emporte-pièce sont une manifestation d’un fonctionnement, où la nuance n’a pas encore la place, et où il convient de classer les choses de manière simple, sans qu’elles ne soient en relation mutuelle. Les bons doivent être totalement bons, et les méchants totalement méchants. Chaque tentative de cloisonner les choses en soi, que ce soit en parlant d'”eux et nous”, ou en niant la complexité des individus de part et d’autre de ces démarcations maintenant cristallisées, doit alors être comprise comme un archaïsme à dépasser. La façon la plus sûre de neutraliser cet archaïsme est de rester curieux par rapport à l’autre, quel qu’il soit, et d’accepter la complexité de ses positions.

L’honnêteté intellectuelle et émotionnelle sont donc deux atouts à cultiver ou à apprendre, pour tous ceux qui se retrouvent à ne plus pouvoir penser ni sentir au delà des discours qui nous sont offerts par le corps politique et la presse, et relayés par certaines sections du public, britannique ou de l’Union Européenne.

«Avec la disparition annoncée du lieu concret, où on se rencontre, c’est une relation dynamique et nuancée à l’autre qui menace de disparaitre, au profit d’une relation concrète par l’intermédiaire du collectif.»

Cette vulnérabilité doit aussi être abordée concrètement, pour la mitiger et la mettre en perspective. Il est possible pour de nombreux résidents de se “régulariser”, de se soutenir mutuellement (des groupes de soutien dédiés apparaissent et grandissent sur Facebook), de faire pression sur leurs élus au niveau municipal, ou encore de prendre des dispositions pour un départ, qui se feraient dans leurs termes.

Faire un deuil

L’effort de rapprochement entre les peuples d’Europe, symbolisé par une des clauses controversées régissant l’Union Européenne depuis 1957, est maintenant en suspens, et peut-être en train de se transformer en un éloignement progressif. Un éloignement vécu comme une aliénation de l’individu par rapport au pays qui l’accueille, mais aussi par rapport à l’Autre. Avec la disparition annoncée du lieu concret, où on se rencontre, c’est une relation dynamique et nuancée à l’autre qui menace de disparaitre, au profit d’une relation concrète par l’intermédiaire du collectif.

La psychiatre Elisabeth Kugler-Ross identifie en 1969 qu’une personne, face à l’annonce d’une maladie terminale, va éprouver une succession d’émotions qu’elle appelle les cinq phases du deuil : Déni, colère, marchandage, dépression, acceptation. Il sera utile d’examiner notre situation sous l’angle de ce modèle.

Dans le déni, la personne, choquée de la nouvelle, va nier la nouvelle réalité et son caractère irréversible. Elle se dit alors : “Il y aura un second référendum, les anglais se sont trompés, rien ne va changer”. Et les citoyens du Royaume Uni, affectés eux aussi et, pour une grande partie, dans ce même déni, feront écho à cette croyance, comme Sadiq Khan cherchant à rassurer les citoyens de l’UE résidant à Londres que rien ne change et qu’ils sont toujours les bienvenus comme hier.

Dans la colère, il y aura des manifestations, des invectives, de la hargne contre le gouvernement, un sentiment d’injustice et d’impuissance bien familier. La relation à l’autre souffre alors que les positions se durcissent.

Dans la phase de marchandage, les positions respectives s’assouplissent à nouveau. On se dit alors que si on satisfait à certaines conditions, la relation pourra survivre. On cherche à acquérir un nouveau passeport, en se disant que cela rétablira les choses, et que cela fera revenir notre relation à nos hôtes à son état d’origine.

Suit alors ce que Kübler-Ross définit comme la phase de dépression. C’est un moment pour se débattre, dans la tristesse, avec un inéluctable qui semble nous dépasser complètement. Il ne sert plus à rien de nier que la relation va disparaître, de se mettre en colère contre son bourreau, ni de chercher à marchander avec lui.

C’est l’arrivée à une phase d’acceptation qui indique alors que la personne est en passe d’avoir fait son deuil de la relation. La dépression fait la place au sentiment d’être prêt à un engagement total et actif avec cette disparition annoncée. Il y a alors un nouveau travail de rapprochement à débuter avec les nouvelles données, internes et externes.

A la recherche d’un nouveau rapprochement

Comme Jean-Paul Sartre l’illustre dans Huis Clos, la mauvaise foi est source de l’incommunicabilité de deux consciences. Il ajoutera plus tard qu’elle est source de toute violence. C’est cette mauvaise foi qui peut nous empêcher de reconnaitre notre liberté de choisir nos positions alors qu’elles paraissent dictées par le collectif, qui fait disparaitre l’autre en tant que personne à connaître. C’est cette même mauvaise foi qui anime les premières étapes du deuil. Une relation de bonne foi à l’autre, sans violence, passe donc par un effort conscient pour dépasser nos fonctionnements infantiles passés, et par un deuil actif d’un passé immédiat.

Tweet about this on TwitterShare on FacebookShare on Google+Share on LinkedInPin on Pinterest
Psychology of risk - cropped

Understanding and working with the psychology of risk in the financial sector

From driving on the streets of London, speaking one’s mind in a challenging situation, to taking a position in the market, taking risks is part of everyday life. Becoming aware of what motivates our positions towards risks in our professional and private spheres enables us to act with greater consideration for ourselves and others, and, in time, to show true leadership.

Tweet about this on TwitterShare on FacebookShare on Google+Share on LinkedInPin on Pinterest
site_image (cropped)

Professional psychological help and support in the heart of London

We live in a time, where constant change is fast becoming the norm: change in society; change in work conditions and circumstances; change in the key relationships that shape our private sphere. This can have a considerable bearing on how we feel in ourselves. It is no surprise that sometimes, the constant demand to adjust to seems to be more than what we can manage with what we know. In my experience, it is beneficial to recognise this and to seek help to find in ourselves the resource we need to live fully. Psychotherapy and counselling helps to engage with the problem with the professional support of a qualified and experienced practitioner.

 

Tweet about this on TwitterShare on FacebookShare on Google+Share on LinkedInPin on Pinterest
question-marks-psychotherapy

In Brief: what happens during the initial consultation?

People who come to see me for the first time often tell me: “I’ve never done this, what happens now?”. The workings of psychotherapy appear indeed to be shrouded in mystery, which is why I’d like to list a few useful bearings for people who are considering psychotherapy or counselling and haven’t carried out extensive research. I have taken those from a longer article from this blog, which you can find by following this link.

The goal of the initial consultation is to find out if therapist and patient can work together, and if so, how. To do this, I pay attention to what a person tells me, and how they say it to me. At the end of the consultation, I am able to tell the person if psychotherapy could be of benefit to them, and will discuss frequency, term and boundaries.

The “what?”

There are a few direct, specific questions that I like to ask to find out more about the person’s history and current circumstances.

For example, I may ask someone suffering from symptoms of anxiety to describe how they experience them, and what impact they have on their life and their daily functioning. I’ll also be curious about the history of these symptoms: are they a new experience, are they reoccurring? Also, do they seem to be triggered by external factors (such as, for example, an deadline approaching for a performance, being in the same room as a specific person, or being in crowded places) or do they seem to be occurring spontaneously?

I also consider all facts about a person’s earlier life to be a very important source of insight for both patient and therapist, for two reasons: first, it tells me what external factors may have influenced their development during childhood; second, it tells me how the person understands themselves. When I know more about what a person’s life has been like, and how they have this in mind, I have useful, factual information that allow me to decide whether or not it is appropriate to offer to help them through psychotherapy.

The “how?”

Not all of us will have paused and thought about ourselves as a person with a past, present and future. To many people that I have worked with, this even initially looked like “a luxury”. Life indeed seems to afford few opportunities to stop and truly reflect on oneself. And we are often given the message by our parents, friends, colleagues, partners and bosses to “get on with it” and not indulge in “navel-gazing”…

This is why it is not rare that people aren’t really able to tell me much about themselves, even when I ask them specific and precise questions. This is why I pay as much attention to what people tell me to he way they tell me it. And if I find that, in an initial consultation, a person find it difficult to tell me about themselves using words, I will help them to concentrate on this very difficulty, so that they may begin to see themselves more clearly and progress towards a better comprehension and verbalisation of their experience.

I have written an account of such a consultation in a longer version of this article, which you can read here.

What happens at the end of the session?

Before the fifty minutes of the consultation are up, I will tell the person if I can offer to see them for psychotherapy. If they tell me that they would like to start therapy, we then discuss the frequency of the sessions, and whether they want to set a term to their treatment from the outset. Some people also want to set specific goals, which we can discuss, and some will prefer to have free rein to get into whichever area of their life they feel is important in every individual session.

In my experience, my patients benefit most from therapy when they are able to come at least once a week, and the large majority of people choose not to set a term for their engagement in therapy right at the beginning. Some choose to do this later on.

Once I have communicated my policy that I require seven days’ notice for any change of session, the patient and I decide whether or not we will see each other again, and if yes, we make an appointment for the following time. Many people choose to start treatment right away and will set their appointment time and frequency there and then.

 

Tweet about this on TwitterShare on FacebookShare on Google+Share on LinkedInPin on Pinterest
Initial consultation - psychotherapy

Series: “what does a psychotherapy session look like?”

1- The initial consultation

Abstract: People considering psychotherapy and researching the topic and looking online for practitioners are not readily presented with material that will give them a concrete idea of what goes in a session. This is partly a result of the fact that each course of therapy is unique to the individual, and it may even help the therapeutic process. It is however possible and beneficial to publish facts about psychotherapy, that inform while leave enough to the imagination.
The first article in this series is about the initial consultation. I make the point that even though this key session looks more structured and concrete than the sessions that may follow, it is still unique to each individual. Some data is necessary for the therapist to assess a patient's presenting problems and suitability for psychotherapy, but this data can be transmitted and acquired in various - and sometimes surprisingly roundabout ways.

People who come to see me for their first consultation of psychotherapy often say right at the beginning: “I’ve never done this before, what happens now?”. This is not very surprising. We hear more about people’s experiences with their doctors, lawyers or even their plumbers than we hear about their experiences with their therapists. I have even become quite convinced that psychotherapists willingly cultivate an air of mystery around their practice.

«Working with a person’s expectations of a relationship is a key aspect of psychotherapy, and it starts “working” before the protagonists (patient and therapist) have even met.»

If you have indeed been looking for a therapist online and have visited their websites and blogs, you may have noticed that little appears to be said about what exactly goes on in therapy. Therapists write, as do I, about their principles, ethics and theoretical frameworks. They write about how, in general, psychotherapy can help people with certain common ailments such as anxiety and depression, but more rarely about what it is that really forms the interaction of patient and therapist in the fifty minutes of a session.

While researching this, you may have come across Irvin Yalom’s lively and thoughtful accounts of existential psychotherapy practice, or perhaps watched three of the old masters, Fritz Perls, Carl Rogers and Albert Ellis, respectively demonstrating in the film “Gloria”, gestalt psychotherapy, person-centred psychotherapy and rational emotive behaviour psychotherapy. A lot has been – and is being – written, and professional journals will abound with what is dryly called “clinical material”, but, unless this material makes its way to paperback or interactive media, there is little chance that someone willing to undertake psychotherapy will be readily presented with it by professionals.

***

Undeniably, there are three upsides to this. First, when therapists stay vague about what happens in a consultation, they give a greater opportunity to the person considering psychotherapy to imagine what it could be like, and then to confront what they have imagined, with what is happening in reality. Working with a person’s expectations of a relationship is a key aspect of psychotherapy, and it starts “working” before the protagonists (patient and therapist) have even met.

«Is it possible to write something that informs, and perhaps inspires, while respecting the frame of mind of the person looking for help, and acknowledging the unique character of each session?»

Second, it is genuinely difficult, and some would argue, unhelpful, to be precise about the course of a session. Sessions are conversations between two people, where one has the function of attending to the other’s needs. And whatever patterns may emerge in a conversation between two people rarely applies neatly as a template for another conversation.

Third, allowing some degree of mystery about psychotherapy is consistent with, and respectful of, the fact that the forces that the individual feel are at play in their psyche may feel like a personal mystery. Psychotherapy aims to help a person develop an interest in this mystery, so that its workings becomes known, so that they can grow beyond the experience of helplessness that often characterises their life before therapy.

The scarcity of material relating to what happens during a session seems to be both unavoidable and beneficial to the unfolding of a person’s psychotherapy. So, is it possible to write something that informs, and perhaps inspires, while respecting the frame of mind of the person looking for help, and acknowledging the unique character of each session?

This series of short articles will attempt to do this. I first aim to address the need presented by many patients in their first session, by giving some bearings about what happens during the initial consultation.

***

This initial consultation is the easiest to describe, as it often appears to follow more of a formula, as there are things that I will be interested with every new person. It is a first contact between patient and psychotherapist, and the aim is for both the therapist to find out if they can help the patient, and for the patient to form an opinion, or at least get a sense if the therapist can help them. At the end of this session, I am in a position to make a recommendation to the person in respect of psychotherapy, and to establish  together what the frequency of the sessions should be, and perhaps the term of the treatment, if this is important for the person at the time.

In this consultation, it is important for me to get an understanding of what is troubling the person who has come to me for help, and to know more about their current circumstances and the history of these troubles and how they fit (or not) in the person’s life story.

«I don’t need to know everything about a person in the first fifty minutes – In fact, it has happened quite a few times that a patient tells me something quite important about themselves much later in their therapy – sometimes, several years after the initial consultation.»

I will be interested in hearing the person’s perception of their life so far, and to see if anything stands out for them in some of the key relationships that contribute to forming one’s personhood, such as parents, siblings, significant relationships at school, college, the workplace, and any other significant setting.

In my experience, this can take many different shapes. Some people choose to tell me stories about themselves and do it with ease, (and sometimes gusto), some like talking about themselves in a less structured way, some have very accurate memories and others quite vague ones. Some people don’t like talking about themselves at all and find it difficult to put into words what it is that they struggle with and what makes them seek help. This is all fine.

Indeed, while it is important that I know some basic facts about a person’s personal history and current circumstances, so that I can establish if psychotherapy is a suitable form of treatment or if the person should be referred to another professional, I don’t need to know everything about a person in the first fifty minutes. In fact, it has happened quite a few times that a patient tells me something quite important about themselves much later in their therapy – sometimes, several years after the initial consultation.

***

I recall a first contact with a young man who seemed to be struggling to answer my questions. Generally, I ask open questions, so that the person has the space and time to give whatever shape they wish to their discourse. It also informs me greatly about their state of being to see how they use the space that I provide for them. I have found that asking too many precise questions right away tends to give impression that psychotherapy is a data collection exercise, where there are right and wrong answers.

This young man would answer my questions in a very vague, perfunctory manner. His childhood was fine, his parents supportive, his partner was nice, he sort of liked his job… it was just that he needed to turn his life around by making a bold decision about where to live and work, and he found himself unable to make this decision, without knowing why. This was all said quite briskly in the first few minutes of the session, and once I was done asking him questions, he looked at me expectantly.

I told him that, on account of how fast he’d run through the story of his life, I had the impression that he didn’t seem to find it worth saying too much about it. He didn’t reply directly, and told me that he just wanted to stop feeling rudderless and indecisive all of the time. I asked him more questions about his experience of indecision. Again, his answers were quite perfunctory. I smiled and made the observation that it seemed that I was more interested in him than he was. He seemed quite puzzled by this, and reiterated that, really, he’d come to see me to sort this particular problem out, and didn’t feel that talking about himself would be helpful at all. As for his childhood, he didn’t remember much before the age of 10 anyway. But he did have some facts about it, which he shared with me.

«This young man’s apparent inability to talk to me about himself during the initial consultation was a live, “here-and-now” illustration of how he had been shaped by his earlier life.»

He explained that he was the youngest of three siblings, who had been born quite close together. His parents argued a lot throughout his childhood, and began separating when he was eleven. They divorced when he was eighteen after a protracted custody battle that involved both children needing to “take sides”. He also told me that, after offering his mother constant emotional support throughout his late childhood and early teens, he had chosen to stop doing so for his own sake.

It became apparent to him that his inability to make big decisions in the present was consistent with his earlier experience of his parents involving him in their own. On the one hand, he was to act like an adult by supporting his mother and then choosing which parent he would live with. On the other hand, he felt he was being treated as a child because those decisions were being imposed upon him. If his parents had taken an interest in him, they would have understood that all that he wanted was for them to make up ask him how he was.

So, this young man’s apparent inability to talk to me about himself during the initial consultation was a live, “here-and-now” illustration of how he had been shaped by his earlier life. It showed clearly that it was new for him that anyone should take an interest in his person. His reluctance to take the lead in the session also illustrated that, for him, there wasn’t a positive experience of taking the lead in his life, and he wondered whether he would one day be able to do so.

On the day of his last session, five months later, as I was waiting for him to ring the doorbell, I received a call from him. He was at the airport, about to board a plane for New Zealand. He had wanted to have his last session over the phone, saying with humour that it was “so that we are both certain that I’m going to get on that plane!” He was able to muster the resolve that had eluded him for so long, and moved  there to live and work.

***

As a conclusion to this short article about the initial consultation, I would like to stress that there is no set, perfect way to go about it, neither for the patient, nor for the therapist. My aim is to offer my patient a space, where they can tell me about themselves and start to see themselves with a greater degree of clarity. This initial consultation shouldn’t be something for patient or therapist to “pass with flying colours”. It is about being curious about the other, in a way that leaves them the space to say what matters to them, or if words are not available to them at the time, to show me with their actions what is holding them back in their life.

Tweet about this on TwitterShare on FacebookShare on Google+Share on LinkedInPin on Pinterest
Psychotherapy and Counselling on skype

Psychotherapy on Skype

I offer psychotherapy and counselling consultations on Skype. Some of the people who see me regularly sometimes use Skype to ensure that, wherever they may be in the world, they  can keep to regular appointments. Skype offers a greater depth of communication than the phone, because it is possible to convey a greater array of non-verbal cues (which for over 95% of all of our communications).

As per the words of some of my patients, “it works”. This means that they think and feel that they still receive what they need from a consultation that is conducted via this method of communication. However, is it possible, as a rule, to engage meaningfully with the process of psychotherapy on Skype (or even on the phone), whether the sessions are all or partly held via this medium?

Is therapy on Skype “real therapy”?

While developing this medium for my practice, I have carried out research into how it affects the therapist, the patient, and the therapeutic relationship. I wrote a short paper and gave a lecture on this topic at the Multilingual Psychotherapy Centre. You may read a short summary here.

I have noticed that, when using Skype, some of the traditional boundaries of psychotherapy are blurred. First, it is no longer just the patient visiting the therapist: the two parties physically see into each other’s spaces (rooms, offices) and are therefore invited into each other’s worlds. Second, both parties can see a “selfie” thumbnail superimposed upon the image of the other, like a moving stamp onto a moving postcard. And third, patient and therapist seem to become talking heads to each other, which begs the question of Skype being a watered-down version of its face-to-face counterpart.

These challenges are real, but my my experience of Skype is that it does not create new problems for therapy – it only highlights essential aspects of the human encounter, which become lines of inquiry in the therapy, and therefore means of helping the patient become conscious of themselves.

Indeed, therapists are always figuratively invited into the patient’s inner world – Skype makes it concrete. Similarly, we always see a reflection of ourselves in the other (this is supported by neurological research into the phenomenon of mirror neurons), and again, Skype makes it concrete. Finally, communicating via Skype helpfully brings into conscious focus the challenge that true relationship represents.

In short, I have found that, for all the challenges that it presents, Skype is a meaningful medium for psychotherapy, especially when it is combined with face-to-face sessions.

 

Tweet about this on TwitterShare on FacebookShare on Google+Share on LinkedInPin on Pinterest
outcomes

Addressing Anxiety through Psychotherapy

Anxiety is one way to respond to an external event that we see as a threat. In a state of anxiety, some of our physical and mental functions are heightened so that we are able effectively to confront what is threatening us, or to escape it. This is referred to as the “fight-or-flight response”. As such, it has been essential to our survival as a species, and continues to serve us in situations of severe danger.

Read more

Tweet about this on TwitterShare on FacebookShare on Google+Share on LinkedInPin on Pinterest
Couples therapy and counselling

Individual psychotherapy for relationship problems and couples psychotherapy

What makes for a well-functioning, ultimately successful relationship? It’s up to every couple to find out what works for them. This “finding out together” is a vital part of being in a relationship. One could even say that it is the relationship.

However, sometimes communication and intimacy get lost, and situations become stuck. Any deadlock can affect both partners and perhaps children or dependents, and often threatens the existence of the relationship.

Read more

Tweet about this on TwitterShare on FacebookShare on Google+Share on LinkedInPin on Pinterest
reform mind

Article review – Peter Fonagy on psychotherapy in the NHS

Article review – Peter Fonagy on psychotherapy in the NHS

I am reading Martin Pollecoff”s interview of Peter Fonagy in the Psychotherapist, the magazine of the United Kingdom Council for Psychotherapy, of which I am a member, and find myself resonating with Pollecoff’s concern that “in IAPT (increasing access to psychological Therapies) you have people who have been through a year’s training with no therapy of their own. I am concern about the political shift between the therapist and the client. It’s a model in which the expert, who is OK, is treating the poor client.There is something wrong there for me”.In my view, Peter Fonagy is absolutely right to point out that the medical model has failed in the provision of adequate mental health services to a broad public, and that the IAPT initiative is a way to   Address this failure. But I don’t feel that in this interview he answers the interviewers’s questions with total clarity. Fonagy says that the psychoanalytical model is the best way to understand how the mind works and how a person can heal. He also describes three essential elements in psychotherapy (the working alliance, mentalisation and compassion). In my experience of practising psychotherapy in London, all three elements are totally contingent upon the relationship between the patient and therapist, and I feel it can only be beneficial to the patient if the practitioner has experienced these elements in a relationship with a confirmed practitioner for a significant amount of time.

Fonagy says “you have to be robust”, and in my view this comes as a result of the practitioner having tested out the solidity and healing potential of a working alliance, not as a result of a short one year training. Generally, it is my experience that the patients who come to see me at my London practices will only ever go as far as I have been myself. If there is something that I cannot negotiate within myself, then  it follows that I cannot help my patient negotiate this corner for themselves. Fonagy has gone through intensive analysis himself, and I am surprised to see that he remains quite vague when discussing the essential aspect of practitioner therapy with Pollecoff.

Tweet about this on TwitterShare on FacebookShare on Google+Share on LinkedInPin on Pinterest
http://www.dreamstime.com/royalty-free-stock-photo-mixing-paints-background-image21615125

Integrative psychotherapy and coaching – how do the two mix?

Integrative psychotherapy and coaching – how do the two mix?

As published in the Autumn edition of the Newsletter for the Association of Integrative Coach-Therapist Professionals (AICTP)
Coaching interventions in psychotherapy: challenges to the transferential relationship

As I was looking for inspiration to write this short piece about how we can draw upon our coaching skills as psychotherapists, I noticed a thought-provoking comment on the AICTP discussion thread “How do you manage movement between disciplines when using an integrative coach-therapy approach?” A participant described how he had decided to challenge his client, who was “reluctant to make external decisions and changes” so that she would get out of the comfort zone of her inner exploration, and suggested moving from counselling to coaching.

It is quite a common assumption (which I have seen expressed even by the most senior practitioners of counselling and psychotherapy in London) that coaching is future-oriented and psychotherapy about the past, and that coaching is about the outer world, and psychotherapy about one’s inner world. If we choose to accept the assumptions as the truth, then it follows quite naturally that there is a line in psychotherapy that the therapist and his or her client need to cross together when the focus of the work shifts away from the inner life and the processing of unmet childhood needs, and towards achieving life goals within a partnership of equals. The participant’s comment on the AICTP thread describes a situation when it is the therapist who takes the initiative of introducing the coaching perspective in order to shift the focus of the work.

I have also frequently observed in  my practice that it can be the client who requests that the therapist intervene as a coach. This can be the case when clients feel particularly stuck in their therapy, or are particularly anxious for their lives to change in a way that they can control. I noticed that people who suffer from addictions and who experience repeated relapses will from time to time ask for a directive, solution-focused approach.

What is then supposed to change when we make coaching interventions in psychotherapy or move the relationship on and away from therapy, towards coaching? If coaching is about the future-external and therapy the past-internal, are the corresponding ways of working respectively dictated by concrete goals, and by the inner process unfolding in the person? And if so, what is the effectiveness and appropriateness of  doing so, and what are the pitfalls?

What are the appropriateness and possible pitfalls of switching between therapy and coaching?

One of my patients[1], a woman in her late thirties who has been in twice-weekly therapy with me for the past three years, has been constantly frustrated by her inability to build lasting relationships. She was also unsure whether she should seek a same-sex or heterosexual relationship, and her inability to decide has caused her great frustration. During the early stages of her therapy she was able to discover, accept and act on a sexual appetite, which she had perceived as non-existent since her early teens. As a result of this, she had several same-sex encounters, sometimes resulting into brief and casual sexual relationships. She also formed an ambivalent attachment to a man of her age, who already had children from a previous marriage.

But she continued to berate her inability to “get started in earnest” and remained deeply dissatisfied at the “sterile” nature of her encounters and longs for a steady partner, with whom he would be able to settle down and have a family.

A few months ago I took the initiative of introducing goal-oriented work in one of her sessions with me. Rather than reflecting back her helplessness, her frustration and her anxiety, I decided to help her articulate and clarify her hitherto vague thinking about what needed to be done concretely to start looking for suitable partners and making herself available to be found.

As I expected, the first part of the conversation resembled a game of “why-don’t-you-yes-but” game (Berne, 1971), but instead of reaching the conclusion of mutual defeat described by Berne (the therapist runs out of suggestions and the client demonstrates that there is nothing that she can do to change), she trailed off and eventually said to me: “it feels quite weird, you coaching me like this. I know why you’re doing it but I don’t think my problem is about that”. I ventured “it feels weird to be coached when you don’t actually know what you want”. She agreed completely with my statement. This allowed us to explore how ambivalent she was towards her sexuality, arriving at the conclusion that in her mind, having a sexually satisfying relationship and a relationship in which she could thrive and find meaning in seemed mutually exclusive.

This proved to be a watershed moment, as she fully realised that her ambivalent position towards creating relationships exactly mirrored her mother’s own ambivalence towards her family, manifested by a series of affairs that were never spoken of in the family. My client had known that this mirroring existed in the way she conducted herself in her life. But until it only ‘landed’ when it was made real and tangible as a manifestation in her therapy. She was able to relate emotionally and intellectually to an past-internal item on the basis of a failure to progress on a future-external one.

What is at the heart of Coaching?

My decision to change my stance and become more inquisitive, active and even risking suggestions by asking such questions as “…and have you thought of doing x?” momentarily changed the dynamic of the relationship. As I fostered her taking ownership of the problem, she became aware that her problem was not so much in her inability to take appropriate action, but to know for sure what it was that she needed to do in the first place.

In my view, the heart of coaching lies more in the process where two parties reach a clear contract about the boundaries, means, general purpose and outcomes of the coaching session, than in the set of actions that the coach agrees to hold the coachee accountable for. With the above example I hope to have shown that by making interventions that challenge the client by bringing up her outer world and goal-directed activity in a space that is in principle dedicated to the exploration of her inner world, we can draw from essential aspects of the contracting process in coaching in order to create awareness.

However, before seriously considering experimenting with a coaching intervention I had to identify and reflect on all the aspects on my own countertransference of helplessness and frustration, lest my intervention be an acting out.

This is what has I am in the process of exploring with another patient, a young man who has come to me because he currently lacks the vision and confidence to plan and execute a change of careers. He was referred to me by his GP, after suffering a series of panic attacks.

This young man is expressly asking me to coach him, but wants a coach who has the “sensitivity of a psychotherapist”. He explained in the initial consultation that his parents would react very strongly if they knew that he is seeing a therapist, and that they have very strong prejudices against psychotherapy. This is why he chose to speak to a coach. He told me that he knew that it was likely he needed to work on himself, but that his priority would be to create concrete actions. It seems that he is asking me to focus on concrete actions and remain “sensitive” to the way that he feels in himself. All the material that he brought to the session was linked to his family and his relationship with his partner.

At the end of the consultation I recommended that he consider psychotherapy above coaching, and bring to the therapeutic space any concrete problem that he wished to explore, and that he could set a short-term review deadline to make an informed decision about what he felt would suit him best. I told him that by agreeing to coach him I would enter into a contract that perpetuated his childhood experience, where his inner life would be in full view but not the focus of my attention. I also felt – but did not tell him – that he was setting up a transferential situation where I would get and experience close to his childhood’s, which was to feel a frustration at not being able to engage with him as he genuinely needed.

The healing process in therapy and coaching

With both clinical examples I hope to have shown that it is possible, to some effect, to change one’s stance towards a client to either help raise awareness. However, in my experience, this change of stance should be clearly “called” (by the client or the therapist) and it should function within, and not instead of, the transferential relationship. With this in mind, it would seem that the assumption that seemed to underpin the comment on the thread is incorrect because it posits that therapy and coaching work only in succession, not in unison.

The essentially ambivalent position of the therapist (as a separate person and a recipient of various projections and transferences) is, I feel, brought in sharper contrast when the therapist is also a coach. I would like to suggest that in person of the coach-therapist, the client is seeking the clear line that may exist between the past and the present, the outer and the inner. If we do not give due consideration to the transferential factors that arise out of this situation, we run the risk of facilitating an inner split when we act as if that line were really there. As integrative coach-therapists, we need to ensure that we facilitate integration in the person, not splitting. It is my view that the client always knows what is good for them, but that the vagueness of the cues they give us (their requests for different modes of intervention, and our countertransferential feelings) is commensurate to the vagueness of this self knowledge. It us up to us to tolerate this vagueness and help the client connect meaningfully with their own healing process.

Tweet about this on TwitterShare on FacebookShare on Google+Share on LinkedInPin on Pinterest