Psychotherapy Matters

Last year I attended as I often do, the Open Day of the Australian Psychoanalytical Society. The speakers I hear at their meetings are often the most inspirational I ever hear both in terms of their thoughfulness and the range of learning. On this particular day last year, the Sydney Psychoanalyst Dr. John Mc Lean was on the list of speakers and I know that I have always found listening to him extremely valuable. However, this time I was most sceptical as to whether his topic would be of much interest to me as he was talking about Mythology, Hindu gods and the like. When it comes to those subjects I often turn away but once again I was surprised and found a lot of interest and pleasure in hearing Dr. Mc Lean’s ideas.

If I understand the situation correctly, he has been associated with joint ventures with the Indian Psychoanalytical Society so began to go to art galleries and museums in India. This fostered an interest in the subject, the universality of the Mythology and he has done a lot of thinking regarding the links to psychoanalytic thinking. For the first time ever, I began to get an inkling of the richness involved and got a tiny window into the many gods and the stories surrounding them.

Then over the early part of January this year I have been in Bangkok and in the middle of my trip, visited Cambodia in particular to see the ancient ruins of the temples at Angkor Wat and surrounds. I was most fortunate to have an excellent guide who had been a teacher and had quite extensive knowledge of the stories surrounding the temples- the stories told in the reliefs along many of the walls, the inscriptions, and the statues of the various deities , kings etc. It seems that the religion of the Khmer was largely infulenced by Hindu India with the later addition of Buddhism. The general feeling was of the similarities too of visiting Stone Henge or the ancient ruins in Rome etc.

I still feel most decidely ignorant on the subject but loved various aspects of the temples. The sheer scale and size of some of these temples rightly qualifies for the over used description of “awesome”. I came away quite often speechless after trying to take in the workmanship, the labour over thousands of years and what was clearly the opulence of what once was there. I loved best of all the walls at the smaller and oldest Roulos group of temples that were covered in Sanscrit. Oh to be a Sanscrit scholar who could read these walls- the temples there having been built in the 800′s.

And I loved the stories told in the stone reliefs along walls in Angkor Thom and Angkor Wat where for instance one depicted the thirty-two punishments in hell. And everywhere, as in Bangkok there were Buddahas by the hundred- similar to Italian cities where there are multiple “Mary and Child” or “Christ on the Cross” images.

We humans have clearly always had that universal need to have our gods and dieties; our heaven and hell. I was reminded of a lecture in a subject in my Arts degree many years ago in my most loved subject called “The Morality of Power”. What does religion give us? It gives us rules to live by, someone or something greater than ourselves to believe in, stories that make sense of our world and our lives and, most seductive of all, the promise of an after-life.

I think somehow feeling like we have answers to these matters gives us some sense of having at least some control over our own lives.

On December 12th, some of the former students of the Australian College of Contemporary Somatic Psychotherapy (ACCSP) organized a tribute evening for the Founder and Director of the College, Jeff Barlow. Although the College will continue Jeff has recently decided to discontinue the basic three year course once current students have completed.

Jeff has been fundamental to the training and education of Somatic Psychotherapists in Australia since 1983. He was enormously influential for me in my journey toward working and developing as a psychotherapist. And some of us who were invited, including myself, actually knew and were trained by Jeff long before the establishment of his College.

With only a few exceptions, Jeff has been the main educator of most Melbourne members of the former Australian Association of Somatic Psychotherapists (AASP) – (now amalgamated with the Australian Somatic Integration Association to become ASPA- The Australian Somatic Psychotherapists Association). Jeff also taught a great many of the Sydney members of the former AASP as well and for many years his college was the main source of new members.

It was thought by many that it was well time to express our gratitude to Jeff. Gena Fawns and myself were asked to speak formally on behalf of the many people present.

I spoke of the early years from when I began with the first training in 1984, soon after Jeff arrived back in Australia from his study in England and Europe. I spoke about the fact that over the years what has stood out for me is Jeff’s passion for his work and for providing the very best in the teaching of psychotherapists. Jeff’s scholarship and his generosity in sharing his knowledge and experience has been outstanding, while his persistence in maintaining high standards when many others would have opted for financial gain by lowering their standards, has been exemplary.

And primarily, Jeff’s integrity has meant that his influence on a large number of people has been invaluable and enabled many to reach beyond what they imagined for themselves. I further spoke of Jeff having been instrumental in the founding of our professional Association and also of the former Somatic Therapy Centre- a Co-operative through which many of us worked together for about 13 years.

Gena spoke of the more recent years since Jeff formed his College about 15 years ago and her experience of having been a teacher in the course for seven years. Here is a little of what she had to say:

“…hundreds of students ….. embarked on the three-year journey of experiential, practical and theoretical learning which most of us agree has profoundly changed our lives and our sense of self, and often led to a whole new career-path.… The transformation I have witnessed in students has been a joy and a privilege to be part of. …… Jeff was a great role model in being a teacher who is authentically present, walks his talk with students and does not hide his vulnerability.

The principles of emotional safety, intellectual rigour, and respecting each student’s individual journey are what made the course so valuable, at both a personal and professional level…
Many graduates of the college have said that at seminars by overseas experts they realise how deep their understanding of contemporary theory and research is, thanks to what they learned in the course. And likewise, at skill-based courses, graduates say they realise the robustness of their self-awareness, thanks to their personal therapy and the deep personal learning they were able to integrate during the course……

……. Graduates also say how valuable it was to observe Jeff working therapeutically with individuals and the group as a whole; they feel privileged to have “learned from a master”. Not only did they learn the theories of embodiment and intersubjectivity, but they got to witness and experience these qualities in the way Jeff works and teaches.

Another frequent comment from graduates is how resilient they now feel in their work with clients and in their personal relationships. The experiential process and interpersonal skills they learned, with Jeff and the other teachers, have prepared them well for the challenge of being a psychotherapist.”

Jeff’s input into the basic training of psychotherapists will be sadly missed and the fact that the costs to set up and maintain quality training courses in psychotherapy in Australia are, now-a- days, formidable, is a great indictment on our society.

Psychotherapists of my ilk are frequently talking about “boundaries”- In the first place what are they? Does someone have too rigid or far too pourous boundaries? Why does it matter anyway? Is their sense of self compromised because they don’t have adequate boundaries? Do they continually “give themselves over” to “the other”? Do they never have a real intimate relationship? Do they feel lonely and unable to cope without an enmeshed relationship? Do they ignore crucial “signals” from either their own bodily reactions or their intuition and so find themselves in situations they later regret? Do they somehow always keep others at bay- from getting too close? There is a whole continuum of how people may be affected by boundaries that are either too pourous or too rigid.

Boundaries ideally need to be open enough to allow the other “in” under some circumstances; to be able to empathise with the other; to be able to “see” the other. They also need to allow us to be able to take some risks with another, appreciate where they may be coming from while knowing we can say “No!” and be assertive about what we can or cannot do. If we are strong enough in who we are – in our sense of self- then our boundaries can be elastic enough to make a conscious choice about how much or for how long or in what way we may to some degree “give ourselves over” to the other.

All in all boundaries that are too pourous between ourselves and the “other”, leads to many of the reasons why people seek out therapy. It leads to a loss of self which with some can be almost total. For some there will have been psychotic symptoms as they feel that literally, parts of themselves have been taken over by or into the other. Others find themselves having taken some vital step in their lives even though an “inner voice” told them it was the wrong thing to do. They went ahead because of pressure from outside themselves or out of some “driven- ness” to “do the right thing” or make someone else happy. Others have lived lives with so-called “intimate partners” where they have suffered abuse simply out of their own need to “have someone”.

Some of my self- pshychological colleagues nowadays like to call some forms of this, “pathological accommodation.” And it is true it can be given that name. I like to stay with the simple “giving yourself over to the other.” Of course it arises originally out of deprivation, loss, abuse, the domination of a particular parent or even the fear that the parent will, for one reason or another, not survive if they don’t “accommodate”. If at all possible, the child MUST at all costs to themselves, survive. There are children who have been too young or otherwise unable to accommodate themselves enough to the needs of “the other” and some do not survive. Infants and young children do actually die under some circumstances.

And what about those whose boundaries have to be kept so rigid they cannot allow themselves to have an intimate relationship? This may be the only way they can feel safe or maintain a sense of self. In the end it is the same as boundaries that are too pourous as the basic sense of self is so compromised that intimate contact with the other may threaten their very existence. Being on their own is the price they pay for being able to live life exactly as they need it to be without having to accommodate to the needs, wants or wishes of another. At least they then know who they are and that they exist.

Can psychotherapy help? Most definitely, but psychotherapy of this type under such circumstances is not of the “quick fix” variety. Reclaiming a sense of self is something for the long haul. The way is to find a psychotherapist who will stay with you for the duration of that long haul and one who will help you deal with the pain along the way. The long term result is worth the hard work.

I am not looking at the current market situation from an economical point of view as I am not an economist; however I can recognize panic when I see one.

The situation in Australia seems to me to be much healthier than is the situation in other countries in the world. At least here, according to a report by the banks a couple of weeks ago, (the ABC news) the ordinary person becomes more conservative with their money and tends to save rather than spend. In some other countries people can go the other way round and spend the money that they do not really have.

However, have we gone a bit too conservative? Are we retracting too much? Are we influenced by panic and therefore rush into quick actions that may contribute to an experience of a domino effect?

When we are affected by panic we lose our thinking and are swept by a tsunami wave of emotionality: fear, worry, doom and gloom to name only a few. We can’t hold on to hope. We try desperately to cut our losses, act quickly in order to get rid of the terrible panic feelings and in years to come we may realize that we acted in haste.

We need to remind ourselves to calm down. We can help ourselves by vigorous physical activity, relaxation techniques, breathing and meditation. We can talk to friends or a therapist and work through the panic to restore hope.

A couple of weeks ago I attended the three day conference of the ANZCP- Section of Psychotherapy here in Melbourne. I like these conferences of the psychiatrists who are seeking to do more than just medicate people who come to see them. In recent years I have been to their conference in Hobart and in the Gold Coast. This year I went because they had a big draw card in the person of Dr. Glen Gabbard. Over the years I have read a great deal of Dr. Gabbard’s books on psychotherapy as well as his book on “The Sopranos”, so I was keen to hear him in person.

And Dr. Gabbard was well worth the high conference fee especially when the conference also included such local psychiatrists/ psychotherapists as Dr. Louise Newman and Dr. Ed Harari. I was really impressed with Dr Newman’s capacity to put together and articulate recent findings in neurobiology and attachment as they related to her client population of very disturbed young people. She opened the conference and Dr. Harari ended it on Sunday with a wonderful case study from his work in the Gastroenterology Department at St. Vincent’s Hospital in Melbourne.

Dr Gabbard gave a number of lectures- the first of which was on the research on what actually works in psychotherapy. I may not totally accurately represent what he had to say but what I took away from his lecture was a validation of what we all know in our gut- that the prime “curative” factor is the “alliance” between therapist and client- or we might call it the working relationship.

On themuch debated question of whether we should “zealously pursue” transference related interpretations as our major tool- if I heard correctly what Dr. Gabbard said-the answer is “No”. Contrary to long held psychoanalytic dogma, transference interpretations are really not so much required by our higher functioning clients/ patients. They do just as well with out them and in fact are likely to find them distracting and annoyed that we seem to be narcissistic in constantly wanting to “take everything back to being about you.”

On the other hand, some more disturbed clients with real attachment issues do benefit from transference interpretations. They may do much better if we can very much stay in the present with the two of us who are right there in the room. And in those cases when we do make transference interpretations they have much more impact when they are preceded by a lot of empathic validation of the client.

Somatic Psychotherapists have never believed that transference was the be all and end all of psychotherapy. We do know, though, that working with the relationship between us and using that relationship to elucidate the long held patterns of relating and the way we ourselves contribute to the dynamic between us, can ultimately change problematic psychic processes and even the way the brain (and the body) works.

As is evident from my name and if you talk to me, from my accent, I am one of these people who, many years ago, made Australia their preferred home.

Being a “stranger in a strange land” is not the only reason why people may experience that they do not belong, have feelings of estrangement, alienation and a sense of lack of roots.

These feelings are not felt exclusively by migrants; they may be experienced by people who for some reasons never “fitted in” within their family or school or society. These feelings may be felt also as a result of sudden sweeping changes in life conditions, being a minority, feeling different in whichever way, etc.

Meaningful connections with people allow for the growth of a new root. Just like the new seedling, when in an environment that meets its needs in a good enough way, it grows stronger and stable and with time can withstand the rough winds and variety of weather conditions.

For some people the meaningful connections are not easily established or not possible at all. They may live their lives in social isolation or they may grow bitter and have a sense of being “shrivelled up”
These are some of the issues that are worked through in the therapeutic relationship.

Many people have expressed their views regarding similarities and differences between individual counselling and individual psychotherapy.

So I would like to share my thoughts in this matter as well.
My thoughts are based on my clinical experiences working with both modalities. For me it is important to know the differences between the two because that determines what the client needs from me, what is possible to achieve in the work and what are the limitations of the work.

When I get the sense that I can work from within the relationship between the client and myself, when I can connect the past – what happened in the life of the client there and then, – with their present life in the outside world – what is happening in the here and now between that client and myself, then I have a sense that I am engaging in psychotherapy. In a sense the client is letting me into deeper places and levels in their being. These experiences can be life changing.

However not everyone wants life changing experiences, needs them, or is capable to delve into the deeper recesses of their selves. These clients come with a presenting problem or issue that they want to resolve, they want something from me that will make it possible to handle or resolve that issue.

For example, a client tells me that he had always been treated unfairly or feels that he had always been taken advantage of.
I then think about what the client has just said and wondering in myself whether the client feels that this treatment is happening with other people in his life in the present and also maybe with me in the room.

I may then ask: “and how is this playing out between you and me” or “maybe you are telling me that I treat you unfairly”. When the client can relate to this question and find the connection between the past experience and how it resonates in the present with me, than I have a sense that we are engaging in psychotherapy.

A question like this becomes irrelevant even impossible to ask when I am engaged in counselling therapy.

I am realizing more and more how touched I am by my work with couples.

I am touched by their struggle to make sense not just of themselves as individuals but themselves as part of a couple.

I am touched by their struggle to understand how their decision in their choice of each other, that once upon a time felt so right could turn upside down to feel so wrong.

Couples put a great degree of work in order to work through their relationship with each other, and within themselves- and they may feel quite challenged by the work.

Sometimes couples come to the realization that separation is the preferred outcome and I am often reminded of a comment made by Warren Colman in his 1993 paper
“Marriage as a psychological container” [in “Psychotherapy With Couples”- .Theory and Practice at the Tavistock Institute of Marital Studies, ed. S. Ruszczynski. London: Karnac Books.]

Colman says that even when the marriage container breaks down and the couple separate, it may be a healthy and fulfilling outcome.

There is no equivalent to such an outcome in individual therapy where the breakdown of the individual container is equivalent to psychotic disintegration.

Recently I came across and re-read a letter I had witten back in 1985 when I took a very small part in a campaign against what some of us thought was draconian legislation proposed by the Victorian Cain Labour government, who seemed to be following through on some left over business from the former Liberal government. This letter and thoughts of that campaign reminded me how my psychotherapy profession was under enormous threat at the time from vested interests who had whet their push for power with a win in earlier times against Scientology.

Our revolt was more than just paranoia that they were also “out to get us” and to stop us practicing. At the time, I was already a social worker but 1 & 1/2 years into the three year basic training to become a psychotherapist. What was absolutely certain at the time, even before this new legislation, with the Act that had come into being to curb Scientologists, we already could not and would not be allowed to call ourselves psychotherapists.

Unless you were a psychologist then, anyone else using the term “psychotherapy” or “psychotherapist”- anything beginning with “psycho” it seemed- to describe their profession or what services they offered, was soon apprised of the fact that they were “in breach of Section 40″ of the then “Psychological Practices Act.” The letters telling you so would come from the “Victorian Psychological Council”.

Fourteen people had already been before the courts and others investigated. The letter sometimes came as a result of a publication where one’s name may have appeared under a listing of “Psychotherapist”. It would say that “this title by an unregistered person constitutes a breach of Section 40″ and that their “practice of psychotherapy may constitute a breach of Section 39.”

And that was the state of the matter even BEFORE the new proposed legislation. Now it appeared as though almost all of the alternative practitioners in a wide range of areas were under threat. I will not here repeat all of my letter (though I will type it up in its entirety soon and put it on my main website). It should be said that about 90% of the bill dealt with setting up the minutae of a whole statutory registration regime for psychologists. BUT about 10% of the bill, in a “couple of broad, vague and all embracing statements seeks to regulate and prevent from operating, hundreds and hundreds of practitioners in a wide range of ‘alternative therapies’ “. Basically it would presribe, through regulation, the practices of almost anyone in the helping professions other than psychologists or psychiatrists.

For the purposes of the Act certain religions and professions would be prescribed. For example Social Workers may have been exempted but it seemed only because as a social worker I would only “assist individuals or groups with adjustment or with emotional or behavioural problems… as a NECESSARY INCIDENT to the ordinary practice of my profession”. In my letter I was outraged that this definition was “describing almost the entire scope of my work” but at the same time calling it a “necessary incident”!!

All this was in the early days of professional psychologists setting themselves up or trying to set themselves up on a par with the medical profession and with a prime aim of gaining medicare subsidies for their members. This they have managed to do anyway, but fortunately, that proposed draconian legislation of 1985 was eventually thrown out and the ACT simply was used to give Statutory Regulation to Psychologists with out regulating others. That alone was a mammoth win for psychologists.

Further to my last piece regarding the amalgamation of my own professional association- the Australian Association of Somatic Psychotherapists (AASP) with the Australian Somatic Integration Association (ASIA)- I want to let you know that we have gone an important step further. On May 22nd both associations met at the same venue in Syndey- primarily for our own separate Annual General Meetings and joint meetings before and after. The agenda for each meeting was almost identical with the major business to pass Special Resolutions to amalgamate. This is what has occurred and the bureaucratic process is now in train to make it offical. We should be a newly incorporated body early in July and will have our first Annual General Meeting in Melbourne in September at a joint conference under the new name of the Australian Somatic Psychotherapists Association (ASPA).
Our conference theme and title will be:
“REBIRTH AND RENEWAL: The New Baby is Home – Creating the environment for growth and development within the family of somatic psychotherapy and the wider community.”
The conference this year will be very much an “in house” event where we hope to have quite a few of our members including the “younger generation” present papers that can be an inspiration on which to build our future.

The future of somatic psychotherapy as it is represented by our associations is, I believe, at some sort of cross roads so we need new thinking from our newer members. On the one hand we will now have a new strong constitution and ethical code to set a firm basis for our future growth. We also have an enormously strong belief in the value of the work we do and of the training that we have all had and, as well, the on-going professional requirements that enable us and support us to do the work that we do with our clients.

Additionally, the fact that our associations are founding and constituent members of the Psychotherapy and Counsellors Federation of Australia (PACFA) has been an important factor in giving us substantial legitimacy and the possibility of a “bigger” voice in the community. Now, as well, that membership means that we have the first of some real public recognition. Our clients who subscribe to Medibank Private, will now be able to can gain rebates when they come to see our members who are on the PACFA Register [and who will also be eligible to be on the National Register (ARCAP)]. PACFA expects that other private health funds will also soon accept our members as eligible for rebates for their clients.

The other side of the coin, as I see it, is that our theories and concepts on which our training was based from the 1980′s is now becoming more and more mainstream. My sense is that, unless our members begin to put themselves forward- in producing and presenting papers, research and workshops at conferences and also writing books, then we could easily be seen in future as having “missed the boat.”

The prime interest of most of our members in the past- and I include myself in this- has been simply to do the clinical work. We love the clinical work with our clients. Few of us are academically inclined even though, the likes of myself, have gone off and got an academic Masters’ qualification. We have not been out there promoting our work or ourselves- we have not been lobbying politicians and promoting our “evidence- based” “proof” that our methods work. Psychoanalysts and psychotherapists have traditionally been clinicians and not researchers or academics so we are not alone there.

The difficulties have many aspects. There is a great deal more interest in the somatic ramifications of trauma and so more and more clinicialns are using these terms and concepts that have been integral to our work. Mostly though, as I see it, they believe that the somatic knowledge and work does not require them ever to work “hands on”. With many of our clients we also would not work “hands on” but sometimes it is required to do the “real” work that is needed.
And our training allows us to negotiate that sort of relationship and to think together about the intersubjective or transferential issues involved and to help the client integrate their experience from the past with the reality of the present.

Another aspect that has been a major stumbling blocks to mainstream acceptance of our work, harks back to the very foundation stone of our work. Our training courses are almost always in private colleges and because the training is so long and so difficult only small numbers are attracted and our courses are never money making propositions. And for that and other reasons it is almost impossible to fill the requirements to get colleges officially accredited or their courses approved so that students can get “offical degrees” or have their fees susidised. The amount of work and bureaucratic requirements and money to make that happen means that one needs an independent sourse of finance.

The option has been to seat the courses in an established University. But that avenue has also proved almost impossible. To find a University that would accept, as a legitimate and essential “subject” of a degree, what we consider to be the prime constituent of the training to become a psychoanalyst or psychotherapist is really difficult. That is, the requirement that, along with the academic learning and the skills practise, the training to be a psychotherapist or a psychoanalyst requires that the “student/ trainee” undergo and participate in their own journey of psychothereutic exploration- usually at the very least on a weekly basis and sometimes requiring twice, three or four times weekly in the case of psychoanalysic trainees and- they must continue that over a period of years alongside the academic course. The universities just do not “get it” and anyway would struggle to make such a requirement mandatory much less “assessable” since it is such a private journey.

But this is the essential difference between a psychotherapist/ analyst and another professional with only an academic degree such as psychology. Psychotherapists know that with only an academic and theoretical knowledge one can only go to a certain depth with one’s clients. For many clients this will be adequate but if the client requires us to be able to sit and stay with them in all the depths of their psyche then we ourselves must have explored our own depths. Those who make the choice for psychotherapy choose a very hard journey just as we who are practitioners chose an arduous but life changing journey to do the work.