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Thought Potholing

In 1995 I apparently gave a long talk to some meeting or other, after which the content of my talk was published by the BPS Psychotherapy Section. I have no memory whatsoever of giving any talk but I do remember writing the article. It seems worth publishing on this blog, with some updates in terms of the experience with Ian, a much shorter version of the original article as it complements with useful background the Approach to Psychosis sequence I republished some time back: I’ve also tried to reduce the psychobabble, though maybe not enough for everyone’s taste!  I’ve in addition included references to later research that sheds further light on, for example, neuroplasticity and the relationship between trauma and psychotic experiences. This is the fourth of five instalments.

Thinkung thro CulturesIn working with Ian, as described last time, we later discovered that there were two anniversary effects that triggered a resurgence of the hostile voices: these related to two traumatic army experiences whose pain he was never able re-experience and integrate, preferring instead for the voices to get worse at that time of year. It was the lesser of two evils for him, even though it risked relapse and consequent hospitalisation sometimes. What the later discoveries revealed was that the loss of his partner was triggering his awareness of an earlier pool of pain he seemed to know nothing about at that point, and couldn’t bring himself to deal with later even when he knew it was there. Without all this additional information it would have been impossible to make sense of Ian’s psychotic experiences.

We have not come to the end, though, of ways to think through others.

Shweder, in his intriguing book Thinking Through Cultures, continues his list of ways of doing this:

(c) `thinking one’s way out of or beyond the other’, `passing through the other or intellectually transforming him or her . . . into something else . . . by revealing what the life and intentional world of the other has dogmatically hidden away, namely, its own incompleteness’ — `[this] properly comes later, after we have already appreciated what the intentional world of the other powerfully reveals and illuminates, from its special point of view’; and

(d) `a situated and perspectival observer, thinking while there in an alien land or with an alien other, trying to make sense of context-specific experiences’ when `the process of representing the other goes hand-in-hand with a process of portraying one’s own self as part of the process of representing the other, thereby encouraging the open-ended self-reflexive dialogic turn of mind.’

A concrete way of expressing this would be to liken the reality of another person to a cave. I join them in their cave. I notice it has stalactites which I have never seen before in my cave. I say: `My goodness! How interesting! Your cave has pointed things hanging from the roof. I’ve never seen those before. My cave doesn’t have them. I wonder how that has come about.’ The observation of the discrepancy, expressed in this way, involves non-judgemental reflection both on their world and on mine. This would hopefully result in two kinds of learning: we both might learn something about our worlds and a habit of reflection might be acquired or enhanced in one or both of us.

In short, this means that, after mastering the worldview of the other person in its own terms, we may reach a point where we can share the ways our world-views differ, in the hope that this will help us both reflect upon our models of reality and make good any omissions and distortions.

Altamira Cave Painting

Altamira Cave Painting

Another long example might illustrate both these ideas to some degree.

I have drawn on a 30 page long transcript of a sequence of letters for the account given below. What has been omitted therefore far exceeds what has been included. At the time they were written the writer was living in London and planning to move to Hereford. I described this young lady first when I spoke of how her hospitalisation story triggered my own unconscious material.

Dealing with Demons

Mary (19.9.94): `I’m getting quite long bouts of despondency these days. Sometimes I feel OK and I feel I can cope with the voices, but then I just seem to sink and I lose my spirit. I feel I’m never alone because I’m being watched all the time, but I couldn’t be more lonely.

`Time goes so slowly. I do go out for walks but my walks never give me peace of mind or relief, they’re a kind of compulsion — sometimes I think I want to go back home but part of me tells me to keep walking. And some times I can’t leave a particular part of the street or go home until I’ve been given a sign — like three buses going by or two dogs or whatever.’

Me (7.10.94): `Your loneliness is obviously a major source of pain. The pain will feed your demons further and your isolation gives them plenty of growing room. [In using the term `demons’ I am trying to speak of her world using a word that carries both her connotations and my rather different ones: she picks up on this later] . . . . . I feel you need to discuss this as a matter of urgency with anyone who might be able to help – perhaps you are already doing so.’

Mary (19.9.94): `The voices are continuing to tell me I’m really evil and everyone hates me. They say I look like the devil. I’ve been avoiding going to Church because I feel kind of “unclean” and demonated. When I did go a few weeks ago I got really distressed because during the sermon all those blasphemous thoughts started racing round my head and they were sounding out all over the church and I was terrified I’d be chased out and be ex-communicated, so I had to go back home.

`I feel painfully conscious of my loneliness whenever I attend Mass. And anyway my spirit seems to have died — so I’m getting all confused about whether I still believe or not.’

Me (7.10.94): `To have spiritual problems on top of everything else is very hard indeed. It is not unusual though for someone who has been on the receiving end of so much pain so young to conclude that they are evil. [Here I am trying to blunt the power of her feeling of being evil by contextualising it rather than arguing with it.] Obviously, people’s religious beliefs have to be the result of their own free choices. Perhaps though I could offer one idea from my own “rattle bag.”

`Though people often highlight punishing notions from their spiritual traditions, my own reading of many such traditions and ideologies has led me to a very different conclusion about the ground of being than the Old Testament or fundamentalist Islamic one. The fundamental universal law of all great systems of belief seems to me to be love. [I expanded on this much more in my letter but don’t include it here.]

Mary (14.10.94): `I found your thoughts on spiritual matters very uplifting. I actually felt quite relieved! I was brought up a Catholic — as you know guilt and punishment seem to be central themes of this Religion.

`The impulses to harm myself are becoming a bit more difficult to control recently. It’s happening through the day and not just at night anymore.

`You must think it’s terrible saying this, but the last time I harmed myself (a couple of days ago), I almost enjoyed it. I felt kind of high afterwards, like I’d rid my body of some terrible disease. I saw myself being released from my mental prison, and the voices were with me not against me, they were on my side spurring me on. I felt like an anarchist burning down buildings, whoever joins in becomes your friend — you all support each other. So it was like I was the leader in a violent gang-riot and all these strangers were applauding me as I smashed the windows of the Police-station. For about half-an-hour I was almost triumphant.

`Then I felt sick at what I’d done and how good it had made me feel. I got very depressed and had about three baths that night to try and “cleanse” myself.

`I did feel though that I was releasing evil spirits from inside my body. Sometimes I wonder whether I’m possessed by evil spirits. When you talk about my “inner demons” — is this what you mean? [She was not going to let me fudge this issue any longer!] I get frightened when I start thinking about things like this, so I’d better change the subject.’

 

Illustration by Sandro Botticelli: Dante and Virgil visit the first two Bolgie of the eighth circle (For source of image see link)

Illustration by Sandro Botticelli: Dante and Virgil visit the first two Bolgie of the eighth circle (For source of image see link)

Me (31.10.94): `Because I’m still pressed for time I can really take up at length only the question you raised about demons. This is a tough one to get down on paper. It would be much easier to discuss it face to face.

`I use demons to mean anything that a person experiences as evil and tormenting and by which they sometimes feel driven to do things they do not really want to do. I believe trauma and stress make one vulnerable to demons in this sense. Some people believe demons are spirits outside them: other people believe they are parts of their own being which have turned against them. [I am trying to offer alternative possibilities without implying that she’s mistaken.]

`I do not mind which position a person takes about their origin because from a psychological point of view roughly the same courses of action apply, it seems to me. Emotional pain feeds demons as does self-hatred. Healing emotional wounds and improving my opinion of myself will reduce the hold demons have on me. The worst thing to believe is that the demons are all-powerful, all-knowing and undefeatable. When people believe demons come from outside it is often the case that they also believe those other things about them too. If you believe they are part of you, it’s easier to cut them down to size and realize that they can be controlled, contained, even conquered. . . . .

`It is hard to convey these ideas in a letter. . . . . I can only say that my own experience of working with people suggests that if a victim of voices can only feel safe enough to work through traumatic pain, the demons will fade to a point where they are no longer a serious problem. Success includes the art of defying them without vilifying them in a supportive environment which facilitates healing and self-esteem.’

Mary (6.11.94): ‘Thank you for explaining what you mean by demons. I am quite confused by what is inside me and what is outside me. I feel that my inner evil is a kind of magnet which pulls in fear and horrible experiences and thoughts etc. — otherwise why would it all keep happening? There must be something about me which attracts even more evil.

`I’m very confused about everything — past and present.’

(17.11.94): “I heard today that I’ve got to go into hospital on December 5th to have an operation. Everything is getting too much. I keep having this feeling of wanting to hide and just let the world carry on and go past for a while.

`And when I’m feeling down like this the voices and everything that goes with them just escalate and I don’t even want to stand up.’

(24.11.94): `My nights are completely controlled by fear. I can’t even describe it. I just get this feeling I’m being hunted and I’m going to hell.’

Me (12.12.94): `I am a bit unclear as to whether this letter will arrive when you are still in hospital or whether you will have come out again by now. I hope you receive it fairly soon and I hope the surgery went ok.

`Because I look upon hell as a state of mind many people experience in this life rather than an exclusively post-mortem penal colony, I believe the torment you experience is already about as bad as it can get short of physical torture. You may feel that you are hunted but hell is where you already are in one sense. It can’t get any worse mentally at least. Don’t let the voices fool you that they can do any worse. You’ve been hit with their best shots and survived! They’ve nothing better in their armoury. If you can hold onto this and build on it you can cut the voices down to their proper size.’ [Again, from within the terms of her world, I was seeking to open out a small consolation, a way of diminishing the power of the voices.]

Mary (16.12.94): `Thank you for your thoughts on the voices and the fear of hell. I do see what you mean, I think I even agree with you — well, I want to agree with you because I really understand what you’re saying and I’ve almost come to think that myself, but I’ve still got a niggling doubt and I do think a lot about the possibility of things being even worse and more nightmarish.’

We both were doing our best to respectfully acknowledge the world the other lived in. It is obvious that neither of us was completely successful, but I think that the effort was none the less worthwhile. Hopefully it helped both of us cultivate our capacity for ‘the open-ended self-reflexive dialogic turn of mind’ Shweder advocates.

The next and last post attempts to pull some remaining threads together.

quote-bishop-berkeley-destroyed-this-world-in-one-volume-octavo-and-nothing-remained-after-his-time-sydney-smith-173569

Source izquotes

Berkling up the Wrong Tree v2

Source of Image: idioms4you

One hour’s reflection is worth seventy years’ pious worship.Mirror 1

Bahá’u’lláh: quoting a hadith in the Kitáb-i-Íqán

It seems a good idea to republish this sequence from almost four years ago to complement the current new sequence on collaborative conversation. This is the fifth of six.. 

Three Crucial Factors

There are at least three other crucial factors in the mind-work process over and above what we have dealt with in the previous posts: Reflection, Relatedness and Relativity. They are qualities that the mind-worker must have from the start. The names for these qualities are used in an existential model of mind-work. (Reflection is also a core quality of the Bahá’í spiritual process and has been discussed at length in other posts on this site, as has consultation which can be fairly described as a process of group reflection.)

Reflection, relativity and relatedness as discussed here are the antidotes to three forces of fixity – drowning, dogmatism and disowning — which I discussed in detail in the article on Collaborative Conversation (a term I borrowed at the time from Anderson and Swim) in Madness Explained mentioned in a previous post. The forces of fixity are common when we function in survival mode. Psychotic experiences in people who need help from Mental Health Services are very threatening. Being in survival mode is therefore very much the norm for many of them. Creating a situation that feels safe is of paramount importance. Otherwise it can be very difficult to mobilise the forces of flexibility.

Reflection, Relatedness and Relativity are the core of the mind-work process. They will need some further explanation. They are what the mind-worker models and what the client can either develop further or discover how to use. If the mind-worker lacks them the process of mind-work is likely to remain locked in unproductive disputes that tend to drive the client further into his private world. The client may or may not demonstrate them at the beginning but should increasingly do so as the mind-work progresses.  The better the mind-worker models them the more likely it is that the client will begin to use them too. These qualities are what consolidate and generalise the process of change. They ensure that the process of mind-work becomes a permanently transformative one. If the client does not develop these abilities there is likely to be no real sustainable progress.

These three capacities combine with the relationship aspects in different ways – trust, containment and authenticity – each of which contributes something special and important to the therapeutic process. They may have an order of importance which is discussed later in that without Trust it may be impossible to develop Containment and without Trust and Containment Authenticity may be impossible. Eventually the client will certainly need to acquire and evince Reflection, Relatedness and Relativity, without which he will never make his own any clarity that comes from the mind-worker.

What, in the Relationship, Makes Change Possible?

The Plane of Authenticity

Clarification and Congruence (see earlier posts) are two sides of a square mind-space, so to speak, which is completed by Reflection and Relativity, two concepts which are also related. The combination constitutes what we might call Authenticity.

Let’s take reflection first. Reflection is the capacity to separate consciousness from its contents (Koestenbaum: 1979). We can step back, inspect and think about our experiences. We become capable of changing our relationship with them and altering their meanings for us. We may have been trapped in a mindset. Through using and acquiring the power of reflection, we do not then replace one “fixation” with another: we are provisional and somewhat tentative in our new commitments which remain fluid in their turn. Just as a mirror is not what it reflects we are not what we think, feel and plan but the capacity to do all those things. Knowing this and being able to act on it frees us up: we are no longer prisoners of our assumptions, models and maps.

The principal focus of reflection in mind-work is often upon our models of reality and upon the experiences which give rise to them and to which they give rise in return. This is especially true of “psychosis.” The capacity to reflect increases the flexibility of our models in the face of conflict and opens us up to new experiences: the adaptation and change that this makes possible enhances the potential usefulness of our models and their connected experiences. It is the antithesis of drowning where we are engulfed in our experiences and sink beneath them.

The ability to reflect, one part of our repertoire of tools for transformation, enables us to achieve our own clarification without depending upon another mind-worker. If a mind-worker does all the reflecting she is just giving people fish: if she can help someone discover how to reflect, she has taught him to fish. In combination with its sister quality, relativity, it becomes a powerful tool indeed. The antidote to chronic dogmatism, another of the forces of fixity, is relativity. Being dogmatic seals us off from new evidence which makes it hard to change our minds even when we are wrong.

It is not surprising that Reflection and Relativity are interconnected. By placing our models and assumptions mentally in brackets or inverted commas, which is a necessary first step towards reflecting upon them, we inevitably acknowledge, at least implicitly, that we have no monopoly on the truth, that we understand and experience the world at best imperfectly from a particular viewpoint or perspective which is only relatively true. This is not the same as saying there is no truth out there and any viewpoint is as good as any other. We refine the usefulness and accuracy of our simulations of reality partly at least through a process of comparing notes with others in consultation or, as I call it here, collaborative conversation.

We can, and as mind-workers we must, become almost as sceptical of our own position as we tend to be of other people’s.  Any other posture is unhelpfully dogmatic in this context. The extent to which I should then explicitly endorse the client’s position is still an issue of debate. Peter Chadwick, for instance, in his book Schizophrenia: a positive perspective, contends that it would not have been at all helpful to him to have staff endorse his beliefs in supernatural influences at the time he was experiencing extreme psychotic phenomena, even though he still holds those beliefs to be valid now that he is well: had they been endorsed by staff at the time he might have killed himself.

Authenticity matters because without it the clarity necessary for effective action and coping is unlikely to become possible. Client and mind-worker could well remain in a warm and sympathetic muddle that leads nowhere. As we will see in a moment though, without the warmth of an accepting relationship, authenticity and its resulting clarity can seem far too dangerous to risk.

Without a clear sense of uncertainty about absolute truth radical authenticity of the kind required here may prove impossible. An example from my own work serves to illustrate this well. A client was convinced the devil had a purpose for him. He was very concerned about whether I believed in the devil or not. He pressed me in almost every session for an answer. In the end, concerned to be congruent, I told him I did not. He broke off mindwork. I reflected on this afterwards. It became apparent to me that I had spoken from a position of dogmatic and unreflecting identification with my views about the devil. It would have been more authentic to acknowledge that, as a fellow human being struggling to make sense of the world, I couldn’t know for sure whether the devil existed or not. I could have shared with him, if he had pushed me further, that I had chosen to operate in my own life on the assumption that the devil did not exist. This would not, I think, have broken the relationship in a way that made further work I possible.

The Plane of Trust

Relativity shares a space with Relatedness. This term was chosen because it began with an ‘r’! Perhaps openness is a better word. Ernesto Spinelli (1st Edition: 1994) uses the expression “ownership.” Either way, along with Warmth, Encouragement (both discussed in earlier posts) and Relativity, it helps develop Trust, a crucial component that the client must eventually bring to the therapeutic process, and along with Empathy, Solidarity and Reflection it helps the client develop the ability to contain, rather than disown or act out, his inner experiences. The relation between Trust and Containment we will return to in a moment.

First of all we need to know what Relatedness is. Relatedness, in this context, is the capacity to consciously acknowledge and relate to what we are experiencing. It is the antidote to disowning, the last of the forces of fixity. It makes us sufficiently accessible to relationships with people and things to learn to accommodate to as well as assimilate experiences, to make appropriate adjustments to our selves or to our circumstances. If we disown parts of experience we become a prey to it, just as Ian was a prey to his repressed pain which turned into hostile or destructive voices. Anything we disown controls us while eluding our influence to change it in any way. What we are open to we can affect even though it may also affect us directly in its turn.

Trust comes first. We need to trust someone sufficiently to feel the strength flow into us from her Solidarity, to be able to know that she understands how we feel but will not therefore dump us or summon undermining and unwanted help, and to see how she feels confident enough to open up to what she feels about us and subject it to careful Reflection.  This is what gives us the opportunity to learn that we can contain our experiences and change our relationship with and understanding of them.

How do we develop Trust?

First of all, we need to feel the warmth of the mind-worker, her unwavering and unconditional valuing of us. Next, we need to sense her relativity, that she knows the incompleteness and inadequacy of her understanding and can suspend judgement and criticism indefinitely until it is really constructive to share (not impose) it. Then, we need to experience her encouragement, which unfailingly rewards our efforts to apply what we have discovered to our problems. Last but by no means least, we need to see her relatedness, her unthreatened openness to all experience, which allows us to become more aware of other dimensions of our own experience.  These things together make it possible for us to trust other people, our experience and ourselves. Without this making and sustaining change becomes almost impossible.

The Plane of Containment

This mind-space comprises empathy, solidarity (both discussed in an earlier post), relatedness and reflection. If someone is standing beside us in our struggles, giving us comfort, understanding what we are going through, and showing an open and reflective attitude to the revelations we share, it helps us to contain what might otherwise be too scary and/or disturbing to contemplate. What we cannot contain, we find it almost impossible to reflect on and process. Containment therefore plays a central role in the therapeutic process.

In our culture we are all too prone to either repression (convincing ourselves we’re not experiencing something when we are) or acting out (expressing whatever we are currently experiencing and ignoring the consequences until it is too late). Containment is the creative third way and a key to change.

An inability to contain experiences of a disturbing nature accounts for much substance abuse, self-harm and dependency on mind-altering subscription drugs. Containment is often not possible outside a set of supportive relationships of the kind I am attempting to describe.

Furthermore, if we cannot trust anyone, and perhaps least of all ourselves, we cannot contain what frightens us or threatens to overwhelm us. So perhaps without Trust there is no Containment. And without Trust and Containment, Authenticity will be impossible, I suspect. Any life-lie will seem a tempting port in the storm of life if distrust and disowning rule the mind.

In the next post I will attempt to pull this all together.

Enlightenment

Enlightenment v2For links to the sources of the pictures see guillotine and mill.

It seems a good idea to republish this sequence from almost four years ago to complement the current new sequence on collaborative conversation. This is the fourth of six.

Many people have grappled with defining what mind-workers ought to do. Two “orts” emerge as favourites: rapport, as described by Carl Rogers, and support, as outlined by David Smail. My idea of the mind-working process starts from but does not end there. We will also have to consider other factors of crucial importance if the client is going to be able to take over and keep going the process of transformation for himself. These factors will be described in more detail in the next post: I’ll be using terms rooted in existential therapy but the key underlying concept is present in a strong form in my Faith tradition.

The Rogerian Triad

Carl Rogers

First there is the old faithful – the so-called Therapeutic Triad! I have used the word ‘therapist’ here because it is the one Rogers chooses. I’ve mentioned my doubts about the word in an earlier post of this sequence.

The Therapeutic Triad of Carl Rogers consists of genuineness (or congruence), empathy and warmth (or unconditional positive regard). Though it is very well known it perhaps needs a brief comment here. Carl Rogers in 1957 described the core conditions required of the mind-worker. To be genuine the therapist must be “freely and deeply ” herself. The therapist must also find herself experiencing “a warm acceptance of each aspect of the client’s experience as being a part of that client” if she is to experience “unconditional positive regard.” Empathy is “to sense the client’s private world as if it were your own.” For this to be effective the client must perceive “the acceptance and empathy which the therapist experiences for him.”

This triad can be summarised as Rapport, one of the “orts” which the mind-worker must bring to the mind-work to make the existential processes possible. This is what the mind-worker brings to the relationship but does not expect the client to apply to his own life.

(Incidentally, I will be using “he” or “we” for a client and “she” for a mind-worker in order to be politically correct, to avoid awkward constructions such as “(s)he” or him/her and to increase the likelihood of our reading at least some of these words from a client’s perspective.) If these qualities were not seen by the client to be present the mind-work would never get going. Rapport may often do no more than make change possible.

Smail’s Triad

Then there is the relatively new one on the block which takes things a bit further.This other “ort”, which can be labeled “Support”, is the Smail Triad, which he introduces in his book “How To Survive Without Psychotherapy” (1996). This is less widely known and will need a bit more introduction. It consists of Encouragement, Solidarity (or Comfort) and Clarification.

Warmth and Encouragement are related but not identical. Encouragement is essential. Smail defines this as:

. . . any kind of influence brought to bear by the therapist on the patient (sic) to try actively to make a difference to the factors that are causing him or her distress.

(A feature of so-called “psychosis” is passivity in the face of experience: encouragement is therefore very important in this context. Also such people have typically been facing deeply discouraging experiences for many years.) By encouragement the mind-worker responds positively to the efforts of her client to apply what he has discovered in mind-work. Praise is, for me, a key component.

Solidarity is, according to Smail, “one of the most potently therapeutic experiences to be had,” even though in itself it changes nothing. It is derived from sharing your deepest fears and most shameful secrets with a ‘valued other’ who does not immediately heap blame or scorn upon you, but who instead listens patiently and sympathetically to what you have to say.

It is something one human being gives to another by uncritically and supportively, but not blindly, standing beside him in his difficulties. It should but perhaps does not go without saying that this does not mean leaping in and drowning in there with him.

In the words of Smail (page 213):

Solidarity with others is both one of the most significant and, all things considered, the most available forms of power for ‘ordinary’ people.

David Smail

For people with a label of psychosis it is significantly less available and we should not underestimate the corrosive effects of that unavailability upon a person’s well-being. Solidarity is also what stops the praise and encouragement from being experienced as patronising. The mind-worker stands alongside, not above, the client. To feel that we are not alone in our troubles and that some one appreciates our efforts has a power to keep us going and bring about success that should not be underestimated.

Though Solidarity and Empathy have much in common they also are not the same thing. Solidarity involves standing with somebody as he struggles to act. Though it implies the mind-worker knows how the client feels, solidarity also implies action whereas empathy might only sit nearby and commiserate with how difficult it must feel.

Clarification is also crucial. People in distress are often confused. Simple questions and straightforward feedback are often all that is needed to dispel the fog. Sometimes another map of the world needs to be gradually introduced, again as a colleague and fellow human being, not as a superior being from her pedestal.

Smail (page 42) feels that there is,

. . . in principle at least, not a great deal of difficulty in arriving at an acceptable account of how people come to be as they are and what are the origins of their distress. Where difficulties do arise is in knowing what is to be done with this information. The idea that ‘insight’ leads automatically to cure, while figuring largely in many patients’ expectations, has long been recognised to be problematic by therapists.

The glib assumption, that to be clear is to be able to change, places an unrealistic degree of responsibility upon the client. Part of Smail’s solution is to emphasise solidarity and encouragement: the rest of what he stresses may be summarised under the idea of taking proper account of the power of environment in creating and alleviating difficulties. The extent to which an oppressive environment cannot be changed sets limits on the degree of change we can bring about.

For me, the physical environment within which the mind functions can be both outside (society, unemployment, lack of cash, poor housing etc) and inside (brain structure, chemistry, hormones etc) the individual. The degree to which these variables can operate effectively to bring about change is affected by environment, but that is a topic too large for present consideration.

Transferring Ownership

The process of clarification provides us with the easiest bridge from the “orts” to the factors we mentioned earlier which enable the client to keep the transformation process going because the client has to have more ownership of clarification than of the other qualities in these groups of three.

Support, even in the context of a good rapport, can only make change possible but it doesn’t tell us how to make sure it will happen in the first place and then continue in the right direction in the absence of the mind-worker. These qualities do not become the instruments the client will use himself to bring about change nor are they the results of changes taking place. They are composed of the essential prerequisites that make positive change processes possible within a relationship. With the possible exception of clarification, if the client lacks them, he does not need to develop them if he does not wish to. However, he needs to sense most of them in the mind-worker.

The Good Samaritan

The Good Samaritan

It perhaps goes without saying that most of these characteristics of the relationship, such as warmth, empathy, honesty, encouragement and solidarity are also emphasised in many spiritual traditions as essential to a proper relationship with other people. The golden rule, which recommends that we treat others as we would ourselves wish to be treated, occurs over and over again across the world transcending barriers of language and culture.

The characteristics I will be discussing in the next post helped me combine practical insights specifically drawn from the Bahá’í Faith with the processes of therapeutic practice. They are key to someone’s being able to carry on the work after the mind-worker has gone.

The English Teacher’s Wife

It seems a good idea to republish this sequence from almost four years ago to complement the current new sequence on collaborative conversation. This is the third of six.

The Importance of Motivation

What perhaps is also worth mentioning is that if Ian had not been desperate to get rid of the voices he probably would not have bothered doing anything I suggested.

P.: What I’m picking up is that, initially, you didn’t have much trust in me and you wondered what on earth I was up to. You didn’t really believe in what I was suggesting you should do.

I.: No.

P.: So, in a sense, why do you think you tried it? And why do you think you stuck with it?

I.: Desperate. I wanted to get better, you see? I didn’t want to go on the way I was going. So, I was desperate. So, I tried what you were telling me to do. It was worth a try. It was something I hadn’t tried before. And it was something new, you know? And it worked.

P.: Were you surprised it worked?

I.: I was very surprised it worked.

P.: Right.

I.: It seemed so simple. All that eight years, you know? All the trouble, all the Sections [i.e. compulsory detentions under the Mental Health Act 1983], and all the rest of it, and all the time in hospital and all the talking didn’t count for nothing. Then all of a sudden it just seemed to click! And it come together.

P.: Made sense and gave you relief?

I.: It did give me relief, yeh.

It made very little sense to him beforehand. This is true for a great many people. The more engulfed they are by their experiences the less sense a mind-work approach makes to them. Only desperation or an equivalent motivation will drive them to try what we suggest to them. In Ian’s case we were lucky that he got some results before he gave up trying.

The Balance of Pain and Gain

There was also the issue of the pain involved.

P.: So you think that the pain you experienced as a result of sorting this out was a price worth paying for now having sorted it out?

I.: Yes. It was well worth paying. I didn’t think so at the time. I wanted to stop it, you know? Because it hurt too much.

This was not true later. When he was dying some years later of emphysema and heart failure, I visited him in the hospice and asked him the same question. We had worked on other deeper pain by then. He had changed his mind. The pain was not worth the gain he said then. He had learned to manage the voices by dealing with the pain when they got too bad and he had learned to manage the pain of difficult anniversaries by allowing the voices to surface again more strongly. The torment of the voices at those times was preferable to the pain, anguish and guilt he would otherwise experience. This makes it imperative to consider carefully whether we have the person’s informed consent before we use the depth approach.

The Limitations of Diagnostic Labels

Also interesting is the point he made that the problems he discovered were different from what he thought they would be.

I.:. . . . the questions you asked were painful. And I didn’t want to answer them.

P.: And you didn’t see the point of answering them either, did you?

I.: No, I didn’t see the point in answering them because I didn’t recognise myself that the problem lay there. But once I could see where the problem was I could bargain with the voices.

P.: Yeh. And you had to know where the problem lay, roughly before you could bargain with them?

I.: And talking to you showed me where the problem was. So, I was able to deal with the voices in a positive way.

P.: But before you had gone through this whole process there was no way you would have realised that the problems were what they turned out to be.

I.: No. I thought it was just schizophrenia.

A Welcome Corrective

A Welcome Corrective

P.: And that was the end of it.

I.: And that was the end of it. I was schizophrenic and that was it. And I had nothing to look forward to except hospital and more medication. And I couldn’t stand the thought of that, you know? So that jumping under a train was looking very attractive. But it doesn’t look attractive now.

P.: Because life seems to have more to offer?

I.: Yeh.

Nonetheless in our subsequent conversations he oscillated between talking about his thoughts/feelings/voices and his illness.

What perhaps matters most is not whether these ways of describing a problem are true or false but whether they are useful or useless to the person at the time. Psychosis is too complex a phenomenon to be successfully explained in our present state of knowledge. My problem with the medical model is not that it is always completely wrong but that it is all too often offered as the only explanation when other explanations would be more useful to the person concerned.

Sleep and Food

Naturally, there are other factors that have a part to play in psychotic experiences and a person’s capacity to cope effectively with them. For example, Ian talked of his need for sleep and food.

He said, ‘Now I come back off the holiday. I was quite well for about a couple of weeks . . ..: . . . and then I went downhill very quickly because [the voices] wouldn’t let me sleep and I stopped eating. And I got very weak, you know. And the voices become louder and more persistent. And I started to believe them.’

We probably all know how important sufficient sleep and good food is for mental health, especially for people suffering from this type of problem. The physical and social environment is also extremely important. However, I am not attempting here a comprehensive list of such factors. That would be too ambitious. I’m trying to give a sense of what constitutes an optimal approach for someone seeking to use conversations to help those who are struggling with these potentially disabling phenomena we call psychosis. The recovery model as a whole package depends upon many other things also being in place such as, where needed, social support, training, education, a spiritual perspective and work.

Perhaps next time we should look more closely at the ingredients of collaborative conversation.

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