Sunday, 22 May 2016

Wilhelm Reich, psychoanalyst and scientist



Reich died in jail in America nearly sixty years ago, after having most of his books burnt on the orders of the American government. As a young psychiatrist in Vienna, in the mid - 1920 he had been a brilliant pupil of Sigmund Freud and part of the inner circle in the growing world of psychoanalysis. Many of his ideas are in use today; often unacknowledged However, many distorted idea and rumours were circulated about him and his work during his life and after his death. 

I became interested in Reich's work in my late teens sensing that his connection of the body, energy,  sexuality, repression and political ideology were key. His book Character Analysis showed some of his therapeutic approach; based in the early work of Freud. This book is still recognised as one of the foundations of body psychotherapy; an approach that is coming back in to recognitions neuroscience supports its principles. 

In 1933 he published The Mass Psychology of Fascism and soon after had to flee Hitler; ending up living in the United State. You can listen to a recent radio interview on Reich. Click Here.

After he died, on his orders, all his papers and laboratory notes were all locked away for fifty years. They are now available and at last a film is being made which will give an accurate account of Reich and his ideas using his original notes. The film has been funded through crowdfunding. It has been shot and now money is needed to edit it. They have now got about half the money they need. I have made a small contribution. If you would like to do so then Click Here to go to Crowdfunding Page.

Monday, 20 April 2015

Labels, pathologising or containing?

It seems as if life; both professionally and personally is getting me to think more about labels and pathologies. Generally humanistic therapists are concerned with the uniqueness of each person and want to support them to be open to everything they can without any restriction. Labels; particularly ones that point to a pathology can easily become more important than the person who has the label and with labels can follow formulaic ways of treating the label; not appreciating and seeing the person. However labels can have explanatory power; reduce feelings of chaos and aloneness and stop worse labels being applied. They can contain rather than limit. For example, years ago in schools, children that we now know have dyslexia were just labelled and dismissed as "thick"! It can sometimes be helpful for someone coming to therapy with what, to them, seems like a collection of random symptoms that are signs of failure, to be told that it sounds like they are depressed. What can be named can often be explored and known and transformed. 

Labelling can easily connect to diagnosis and a pull towards a medical model of diagnosis and treatment which ignores the uniqueness of each person's depression for example and give a pseudoauthority to what is little more than prejudice. However, over the years I have become increasingly convinced of the the usefulness of the concept of personality disorder. Anyone who thinks borderline personality disorder doesn't exist has never met one! There are plenty of people in certain professions with narcissistic personality disorders and sadly my professional association, AHPP has been taken over by someone with psychopathic personality disorder. Some research suggested that 5 - 10% of successful corporate CEO's sore highly on test of psychopathy. Of course you cannot convince anyone the have a personality disorder; that is its nature. It is ego-syntonic. However everyone around them knows eventually through their behaviour and how they are treated. 

In many ways, personality disorder is just a name for a cluster of behaviours and attitudes. It is not in the same category as a diagnosis of measles even though people talk of mental health categories in the same way as diseases with real pathogens. It itself personality disorder labels do not have to be more pathologising than an astrologer saying that someone is a "typical Leo" or a homoeopath saying someone is a "Sulphur type" or therapists talking about character structures. Everyone is unique and yet there are universal recurring patterns. I firmly believe that personality disorder can be worked with in therapy and modified and the negative aspects reduced. There are positive aspects to all personality disorders when awareness and moderation are brought to them. Of course the hardest part is for the person to believe they have one but this is not necessary. The label can help guide the therapy and the issues to be worked on in much the same way that character structure can be used as a guide to origins, issues and ways of working. 

I have recently had a client who has now become dominated by a fixed paranoid idea with delusions and possibly hallucinations. They are unshakable in their belief and very difficult to work with. No amount of rational argument or evidence or common sense shakes their belief which fills their life and the sessions. I cannot say if this is paranoid schizophrenia but if does feel very powerful. I also have a client who, with my encouragement, took a test for autism and scored highly. I hope it helps us to understand what they need to give them the means of working around their difficulties in relationships that this explains. No label is ever a sentence if it is held lightly; but it is a starting point, and may be a relief




Sunday, 1 June 2014

Brainspotting

In my time I have been fortunate to see some world-class therapists doing live sessions; James Bugenthal, Hal Stone, Tapas Fleming and Asha Clinton the last two both from the energy psychology world.  For the last four days I have been with another from the same league; David Grand who in 2003 discovered a powerful new form of therapy. David trained as an analyst in the early 80's and in 1993 trained in EMDR (Eye Movement Desensitisation and Reprogramming). He later trained in a body therapy called Somatic Experiencing and combined them to make EMDR less rigid as Natural Flow EMDR. In 2003 he noticed with one client that when she fixated at one point in her visual field she processed new trauma and deepened her processing of other traumas they had worked on for a year all in the space of ten minutes. Brainspotting was born.

"Where you look affects how you feel" and your field of vision contains the traumas and fixating on them in the right way allows pure therapy; the processing of the traumas at the level of the limbic cortex, the mid-brain and the brain-stem. This is where all deep change happens because this is where traumatic patterns are stored; way below the neocortex and conscious narrative about what happened. I feel as if I have been witnessing therapy laid bare; the core processes happening before my eyes. I witnessed a session of only about 40 minutes where a person who had absolutely no sense of smell from the age of three, when her grandmother forced her to drink some terrible chemical as a way of stopping her from crying; recovered her sense of smell and came out of a state of frozen terror and dissociation.  The requirement is a very highly attuned therapist; attuned both to the relationship and the neurobiology of the client, and getting the right spots for the brain/body to use its own healing abilities to process the trauma and put it where it belongs; in the past so that the person can be more fully alive and present now and recover a sense that had been completely shut down. The hardest part to teach is mindful, empathic attuned presence on the part of the therapist.

Psychotherapy and neurobiology are coming together; not in a cold scientific way but affirming the central humanistic principles of trust in the process, empathy and deep mindful presence. I feel so priviledged and excited to be part of such a live profession as psychotherapy

Thursday, 20 February 2014

Ego, self and regression .

The spiritual world usually has hardly a good word to say about the ego; it is the source of all selfishness and greed. By contrast, the therapy world constantly faces people who have a "weak ego" and tries to strengthen it.  Ken Wilber's map of pre-personal, personal and transpersonal neatly sorts this out as belonging to different aspects of the spectrum of consciousness and his book No Boundary is a simple exposition of the expanding definitions of the self. It is clear that the problem is with the identification with the ego not the ego itself.

The ego is the seat of identity; not necessarily in a very fundamental sense but rather like a passport; it gives some useful information but it isn't exactly the whole story. We all have an everyday identity and ordinary life would be intolerable without one. The ego is also the part of us which can deal with the world in a practical sense; mediating between the "reality principle" on the one hand and the internal world of desires and fears on the other. Our desires may say "chocolate cake now!"; our fears or superego may say "that's not a good diet" and our ego may say; "I'll make a salad for main course and I'll check the cupboard and, if I have the ingredients, bake a chocolate cake for tea later this afternoon.".

Where there isn't enough ego strength then we are prey to terror and regression. The world becomes a frightening place which can easily overwhelm us. It is amazing how strongly people can regress to a place where they cannot function at all. I have seen one person do this recently just from having less structure and finding themselves alone. Adverse, but not life-threatening, situations, can also provoke regression to a primitive child-like place or to desperation and black-and-white thinking.

In therapy which includes a transpersonal dimension, such as tantric psychotherapy; there is work to do in strengthening the ego by reducing past trauma (which weakens the ego) using methods from energy psychology as well as unconditional warmth, empathy and creating a coherent narrative of life. However, tantric psychotherapy using body and energy methods, breathing and touch, supports the move beyond the small self of the conscious mind to the spaciousness of the body and the energy system and towards dissolving into the universe. This is who we really are. It is a quick trip around the spectrum of consciousness.

Sunday, 24 November 2013

Object-relations; relating to an object

I always thought that object relations was an odd term for that vast development of psychoanalytic theory that happened after the war. Some time later, I realised that the word “object” is used in the grammatical sense as in subject-verb-object! It developed our understanding of how our internal world is created by taking in, not just experiences but the relationship and above all the other person who was also present. It need not be a complete person but a fragment or an aspect or a distortion or an entity or an archetype that connects to the experience.  These inner people and fragments can then have a life of their own in a dance of dramas which attempt to control the person. Some parts are more conscious, some more benign, some nasty, some work away hidden in the background. All this internal noise keeps the person from developing a solid enough part to keep the rest in order. The process needs to be like turning a mob in to a committee with a strong enough chairperson or facilitator to draw on each member’s skill and point of view, but not to let anyone dominate or take over.

Self-help literature and much of the stuff I see on Facebook as useful quotes in interpersonal matters assumes that there is some sort of internal order and that the committee may need some help but all its members are known and can at least sit down together. What is needed is to strengthen the role of the chairperson or facilitator.


However for some people this is not true and their object relations which get put out on to the world is not one of other people, but of parts of people and sometimes functions and may change chaotically. Every baby and small child needs a secure base to operate from and return to regularly for emotional top-ups. If someone has the secure base projected on to them, they cease to be a person and become a function - a thing, a sort of slot-machine which is supposed to produce the goods when the button is pressed. This really is an object relation and no amount of non-violent communication methods, or dialogue or skilled help will change that in to a human relationship because that implies a sort of symmetry; two people together trying to sort things out.  This symmetry implies the loss of the function and that to the small baby part, is abandonment and death. This is the basis of much personality disorder where the whole issue is the impossibility of real human relating in the face of the demands of the most primitive parts of the psyche for security or admiration rather than real relating with its messy compromises. Self-help and sensible advice need a good-enough self which can at least begin to take in the reality of other people as autonomous beings not things.

Sunday, 1 September 2013

PD - The Elephant in the Room

All humanistic therapists are suspicious of labels for people. The infinite complexity and marvel of a person can't be captured in any word, label or concept. Labels can easily also freeze time and imply that people can't change;  attract judgements and create hierarchy. However, the skilful use of words can help us to understand ourselves and others and communicate some of this understanding.
There are three related words which can be very helpful and are often not understood; particularly in the world of personal development. They can easily be lost into the world of psychiatry or clinical psychology. They are neurosis; personality disorder and psychosis and I want to briefly write about each.

Neurotic behaviour is simply when someone seems to not be able to learn from their experiences. They do the same unhelpful thing over and over again with the same unhappy results. Everyone makes many mistakes in their lives; neurosis prevents us from learning from them. It has a stuck and repetitive quality. Something is behind the behaviour and the failure to learn, which is not fully known and operates in the background - the subconscious. It is likely to be past fears and needs that now are not fully conscious. Neurotic behaviours simply doesn't work very well at making a life of relaxation, pleasure, intimacy, creativity and ease. All basic requirements of human beings.  Some behaviours can be seen as addictive but are fairly easily acknowledged as unhelpful. Often it is seen as "just the way I am" ; as if people can't change. But people can always change, neural pathways in the brain can be re-wired. Neurosis is almost always accompanied, and may be primarily signalled by either anxiety or, often the long term effect of constant anxiety; depression. Anxiety is "fear spread thin"; a sense of vigilance and arousal as if there is some immediate danger. The danger is unknown and the anxiety can often move from one focus to the other. Sometimes the anxiety itself is pushed in to the body and becomes physical illness. About one in ten people will have anxiety and a similar number depression at some time in their lives. People with a lot of neurotic behaviours can easily be labelled, but I hope not dismissed, as neurotic.  At its heart neurosis is a failing attempt to manage discomfort and dis-ease; some feedback and reflection can often allow the person to acknowledge the neurotic aspects of themselves and begin the process of healing; by the twin paths of removing the traumas that are behind the neurosis and learning and practising new behaviours which help them get more of what they really need in life.

Psychosis by contrast involves parts of the person which are not in contact with consensual reality and which either create fear or lead to behaviours which are ineffective or unhelpful to the person. They cannot be easily confronted by new information or feedback and are more deeply buried in the unconscious rather than the subconscious. They often have a quality of dominating a person's life leading to dramatic changes; though sometimes they have a contained psychotic part with an unshakable belief which does not usually totally dominate their life. As all people have different parts of their whole personality it is possible to have a psychotic part which can be contained. People who are actively psychotic need sanctuary; safe places where they are protected, supported and loved until the parts more able to deal with the ordinary world can get stronger. Rarely, they may benefit from some medication. Unfortunately in our society; the idea of an asylum; a safe place has largely gone and been replaced by chemical prisons which may sometimes be the only option but which often block any process of healing and re-connection. There are one or two conditions (perhaps schizophrenia and bi-polar disorder which each affect about 1% of people) where there may be an organic component and medication may be the best; just as a diabetic may need insulin to function.

The most interesting third term is personality disorder. This is the elephant in the room; the hidden iceberg which is all around us. Some studies suggest up to one in ten people have a personality disorder.  There are about ten recognisable varieties of personality disorder. Many are characterised by withdrawn, detached, fearful or eccentric behaviours and may be distressing for those who have to try and relate to them. However there are some personality disorders characterised by lack of empathy for others and severe disturbance in interpersonal functioning. The two largest of these are Narcissistic and Borderline Personality Disorders. They, like most personality disorders, are egosyntonic which means that nobody goes to a therapist and says that they have a personality disorder. Friends or a partner may push them to a therapist. Anyone who has worked, particularly in industries like finance, law, the theatre, politics will have come across people who are almost impossible to deal with and leave a trail of wounding and destruction behind them. It is very unconscious and has some of the characteristics of a psychosis in its disconnectedness from aspects of consensual reality and their unavailability for feedback and discussion. It is as if their relating is completely beyond all reflection. Unlike neurosis, they often are not troubled by high levels of anxiety or depression. In fact it is a sign of progress in therapy when they feel such things.

Our society rewards financial and career success so some forms of personality disorder can get considerable rewards for the effects for their personality disorder. One study found higher levels of three personality disorders in executives than in patients in Broadmoor secure psychiatric hospital. This is likely to be true for, for example psychopathic personality disorder, as being ruthless in business is likely to lead to success, at least in the short to medium term.  In some ways all personality disorders exist between neurosis and psychosis but they are a different to both while containing elements of both. Some, like borderline personality disorder have overt anxiety but often they do not. They exist with a degree of certainty which eliminates anxiety. This certainty and the interpersonal behaviours that it promotes, is damaging and confusing for those around. One of the best books on living with someone with Borderline Personality Disorder is subtitled "walking on eggshells" from the experience of what it is like being around someone with sudden and violent mood swings and an unstable sense of self.  Those around someone with Narcissistic Personality Disorder are being called on to admire and/or serve the other. Being an admirer or a servant is never very satisfying if you actually want intimacy; you are always either a resource or a threat as a narcissist lives mostly in their own world and can never really see or emphasise with another. For narcissists, ageing is often particularly difficult and they are prone to develop addictions later in life if the possibility of success is no longer enough of a drug.  For borderline personality disorder the intensity of their dramas exacts a big price on their body and they burn out or have to quieten down. Both are living with a weak ego which is always threatened by the world and swings between fear of abandonment and fear of engulfment and annihilation.

Personality disorder is the elephant in the room; an elephant which may be trashing the furniture. I'd rather such labels didn't exist but the disorders certainly do with varying degrees of severity.  At one end of the scale of severity is idiosyncrasies and interesting personality types and character structures; at the severe end are desperate people unable to function at all in the world of other people and of real relationships.  Psychotherapy certainly works with personality disorders but it is more or less impossible unless they can come to the realisation that they have one and it is often slow, steady work.

Monday, 1 April 2013

On Tickling and being excited

Over the years I have come across several clients where being tickled has been a major trauma.  It meant having their boundaries crossed and their body and excitement taken over without any means of stopping it. If later they indicate that the did not like or want this, then it is received as if they cannot take a joke or dislike fun.

Having one's body at the mercy of another unasked is of course traumatic as in sexual abuse, but with tickling it is also the deliberate manipulation of their excitement into a place where it goes over from pleasure, excitement and fun to invasion and fear or even terror as the object of  fear is within - the effects of excess excitement on the system.

It may be in  such families it is just one example of not being listened to and lack of empathic attunement by caregivers. It is an exercise of power over which starts as fun with but leads to an objectification of the other with the refusal of recognition of the traumatic impact. The victim is invited to laugh it off as well.

It is part of the normal adult interaction with babies to play with their excitement and give an experience of the thrill of some danger with the return to safety. This is often done by throwing the baby or small child in the air and catching them.  I gather than men are more likely to let go than women and perhaps the role of the man is to expose the child to increasing risk as part of growth and adventure. However this is done within the frame of attunement and modulation of the level of excitement and the reality of the return to safety with a cuddle as they are caught.

With body psychotherapy with adults the question of what constitutes too much activation is harder to gauge. I remember many years ago a trainer saying to us that if you want to increase the flow of the river you need to increase the height of the banks; this was in the context of general working with energy. The general point is that the container of the therapy has to be strong enough to support the appropriate abandonment of safety in that moment with a certainty of return to earth; safety and the possibility of re-integration at a higher level with increasing ego-structure. We can only grow when we risk we can only know the strength of what we can test.

With tickling it is the child's weaker sense of self and their relative powerlessness along with the lack of attunement and empathy which is so destructive. Not being listened to and taken seriously afterwards, and often a sense of being played with, compounds the trauma. Tickling is one of the first self-other interactions which is why you cannot tickle yourself and can be formative or destructive.  If in doubt about your abilities to judge another; don't tickle!