July 2009

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Psychotherapy is a strange world.  It claims to help people resolve conflict and change, yet the whole profession is deeply split.  The psychoanalysts, humanists and behaviourists are all convinced their approach is only true one, but when it all boils down, there is more to connect different therapies than to separate them.  While claiming allegiance to a particular modality, most therapists develop their technique and attitude from an eclectic theoretical background and would, I think, agree that the success of therapy does not so much depend on the modality as on the quality of the therapeutic relationship and depth of communication. 

Nevertheless, attempts to bring the different therapeutic disciplines together has been beset with difficulties, so much so that the United Kingdom Council for Psychotherapy has relinquished the effort and claims instead to supports diversity, whatever that means.  Clearly integration is seen as a bridge too far. 

Separation cuts deep into the human society.  It exposes enormous ambivalence.  While we desire to belong, at the same time we wish to also be separate, independent, autonomous.  Donald Winnicott captured the resolution of that dilemma, when he said that the aim of our psychological development is have ‘the confidence to be ourselves in the company of others’.  But the company of others implies belonging to certain professional groups, societies or teams that encompass a particular set of interests or attitudes. 

That immediately introduces a split. If we belong to a certain group, we don’t belong to other groups.  While Pi, in Yann Martel’s wonderful allegory, The Life of Pi, might practice as a Christian, a Moslem and a Hindu, he causes consternation among all three sects.  He must choose; he can’t be all three.  The same seems to apply to the psychotherapies.  Psychoanalysts tend to dismiss cognitive behavioural therapy with ill concealed disdain, yet they would agree that the goal of psychoanalysis is for an understanding that brings about a change in thought and behaviour. 

Even the most inclusive societies seem to demand we make a choice.  This starts early in life.  At the age of 14, I had to decide whether I was going to study arts or sciences.  Later I decided to be a doctor, which meant not dedicating myself to my first love, zoology and ecology.  Then I chose gastroenterology and not neurology.  More devastating in its consequences, although I discovered it was possible to love more than one woman, I had to choose one and abandon the other.  To fudge, to be indecisive or deceptive challenges the social order, even though it might make perfect psychobiological sense. 

So perhaps separation is part of our encultured identity.  Society demands difference, encourages diversity.  There must be something about agreement, sameness that does not lead to progress.  Society is like a shark; if it doesn’t keep moving forward, it dies!  Difference and the anxiety and competition this induces, keeps society alive.  If The Government were not continually being challenged by the opposition, then there would be no recovery.  The only time coalitions thrive is when there is an overwhelming external threat.   

So each of us embodies a certain set of beliefs and attitudes that make us who we are and sets us apart from others.  That is socially acceptable as long as understanding and tolerance exists between groups.  It’s when different groups feel attacked for their beliefs and are forced to adopt adversarial positions and ever more extreme attitudes,  that difficulties ensue. 

Unfortunately psychotherapy, which purports to be the most understanding of professions, is riddled with sectarianism to the detriment of therapists as well as their clients. 

We need to built bridges, not broad bridges that reduce everything to its lowest common denominator, but bridges with a café in the centre of them that facilitate communication and understanding.      

At the last meeting of The Hallam Institute of Psychotherapy on July 1st, Keith Tudor, a Humanistic Psychotherapist and co- founder of  Temenos, a Sheffield group promoting Person Centred Therapy, delivered a seminar entitled Building Bridges over Troubled Waters;  regarding humanistic and psychodynamic psychotherapies. 

train_wreck_at_montparnasse_1895 (Large)A few years ago, while staying in London,  I was coming down the stairs carrying an open suitcase,  but there were more steps than there were at home, I couldn’t see where I was putting my feet and I was preoccupied with anxieties about being away from home.  Three steps above the bottom of the staircase, I stepped out – into nothing – and landed heavily on my left leg, rupturing my quadriceps tendon and rendering me disabled for three months.     

It was an unfortunate accident, but how accidental was it?  On reflection, I realised there  was a trail of causation. 

Accidents are often caused by mistakes, lapses in concentration or errors in perception resulting in behaviour that is clumsy or inappropriate.  Our expectations of what might happen are not only determined by what we really see or hear, but by habit – what usually happens.  Most of what happens in our lives is familiar, we go through it on auto-pilot.  We see what we expect to see, hear what we expect to hear, as long as things proceed on cue, we don’t think about what we’re doing; we just do it. 

Our thoughts and actions are so conditioned by experience that for the most part, we don’t have to pay much attention.  Training and experience have set up circuits that cause us to react automatically to a whole variety of familiar circumstances.  To take a current example, Roger Federer is a tennis playing automaton for much of his game.  Hard wired into his brain is an extensive repertoire of responses to every possible nuance of court conditions, ball trajectory, his opponents method of play, the state of the game, the weather;  he reacts without thinking and can produce the perfect cross court volley in the right situation.  He functions in the moment; things only go wrong if he regrets the last shot and worries about the next.  But for most of us, life is not a tennis match, everyday life always throws up the unexpected and unless we are alert and paying attention and able to adapt our responses, we can all too easily assume the expected and cause an ‘accident’. 

Our focus is more likely to be distracted if we are tired, upset and preoccupied about something else.  If our mind is not on the job, we ignore the cues, we expect something to be there but it isn’t.  So if we are in charge of a dangerous machine, operating equipment at work or driving a car, or even just walking down the stairs, we are more likely to make a mistake and have an accident.  My mind was so distracted by domestic worries, I was not focussed on being ‘in London’ and so my legs behaved as if I was coming down the stairs at home. 

Accidents do not always occur because of lapses or distractions.  Emotion can play its part. Desire is not only a potent cause of distraction but can make us take the most enormous risks.  Fury has to be satisfied no matter the consequences.  Guilt or shame can induce a wish for punishment or even injury and death, that is often expressed in the most foolhardy and dangerous behaviour. 

Just as we all possess an instinct for self preservation, so there is a much darker side, an urge to self destruction.  Among the various manifestations of this death wish are overindulgence in alcohol or drug abuse.  Many people use drugs or alcohol to achieve a state of oblivion, so releasing them from the normal inhibitions and calculations over risk.  I used to belong to the Night Climbers of Cambridge.  After a heavy night in the pub, my friends and I would go out and, completely unprotected by ropes or pegs, climb up the walls of the colleges, clamber over roofs and leap from one building to another.  What was that about; a confirmation of the immortality of youth, an urge for self destruction, or a desperate attempt to attract a pretty girl? 

Accidents often have a trajectory, a trail of consequences, stemming from a single  decision made for the wrong reasons and leading in some cases to injury or death.  So when a  woman accepts the invitation of her boss to dinner, drinks too much, has sex with him and then has to drive fifty miles back home in the middle of the night, all the components, tiredness, preoccupation, fear, guilt, self disgust and being in charge of a lethal machine, are assembled for a major accident.        

Accidents also have a purpose.  If you are injured, then you don’t need to do something you don’t want to, to take an exam, have an awkward meeting, take a difficult decision or own up.  The accident does the job for you, extricates you from an impossible situation, and at the same time, recruits the love and care your spouse, family and friends.   

For me, my accident allowed me time out from external distractions while providing the time and space to relax, rest, feel the confidence of being cared for at home and finish my book.  In time my tendon mended and so, for a while, did the connections with my family.

barn_owl_flying_1 (Large)Where the reeds meet the meadow,

By the longer shades of day,

Pale as scalded milk, you ghost by  

weave arabesques in still air,  

your faint heart scans for signs of life   

the fluorescent tag of fear. 

Then you twist on folded wings,

turn on a tussock, drop, reach,    

close and fly  away to the barn

to devour, digest and spit out the bones.


And where the bracken is defended

by walls of stone, above the first blush of heather,

and the late surrender of the cotton grass,

as rustic as oat meal, you patrol your expanses,

conceal your intent with patches of white,

keep to dead ground,  row swift then glide

with certainty through a rising dawn,

your face impassive as a clock, as,

driven by instinct  born of empty hunger,

you hover, pounce and feast in the sedge.

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