Psychotherapy Matters

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.

The Australian Association of Somatic Psychotherapsits was formed in 1986/7 by a small group of Melbourne and Sydney people who had been teaching and training for three years in a body oriented neo-Reichian approach to psychotherapy. At the time we came up with the title that included the word “Somatic” meaning body-mind. We believed that the word encapsulated our particular niche in the world of psychotherapy. Our prime interest was to work in an integrated way that did not split off body from mind. Our work would not just be “head stuff”- talk that did not connect with the emotions or the body and nor would it be simply “body-work” where no attempt would be made to “make sense” of what was happening.

We all learned to work directly with the body through a very particular kind of massage for therapeutic purposes and also we learned the body “exercises” of Alexander Lowen. But we also learned to “tune in” to the person’s breath and the way they “held” their body or say, tension within their body and to discern typical bodily character types.

And gradually we grew to know that the major factor in whatever type of psychotherapeutic approach one followed, the major force for change was the capacity of the therapist to simply tune into the whole person and to “be there” for the client/patient in a way that communicated complete respect and a willingness to at least try to understand the client/patient from their own perspective on life and themselves.

Some of us came closer and closer to a traditional psychoanalytic/ psychodynamic approach to psychotherapy. We came to know that we had to learn a lot more theory and for that to be incorporated into the training to become a somatic psychotherapist. Many of us went toward learning from the British “object relations” school of psychoanalysis and others moved toward a Self- psychological or Intersubjective view of how to understand the individual mind and/or the relationship between therapist and client that best promotes change and growth.

But all along, we have made very certain that we have always written into our Ethical code of practice the possibility that we may use direct touch or other work with the actual body of the person. Practitioners who belong to other associations will occasionally tell an audience- often in a half whisper- that they have “touched” a client to good effect but I do not believe that there is another psychotherapy association- at least in Australia- that actually covers that possibility in their Ethcial Code. I personally think that is a very serious omission.

Touch and the physical body are integral to us being human. We should not allow some sort of articifical separation just because it may pose all sorts of dilemmas for therapists who have not sufficiently come to terms with their own sexuality so that they do not pose a threat to their clients/patients. Touch is only likely to be a problem when the issues cannot be named and thought about openly.

All that brings me back to my association. In the past few months my association and members of our sister body- The Australian Somatic Integration Association have been working solidly together with the aim of amalgamating. Drawing up a new Constitution and a new Ethcial Code has been an onerous but a rewarding and worthwhile experience. We now feel that we have laid a strong foundation for our new amalgamated association that should come into being in the second half of this year. We will be newly named the Australian Somatic Psychotherapy Association.

2011 is well and truly begun and what a beginning- with floods in my home state of Victoria that followed the Queensland floods and the horrendous catastrophe in Christchurch New Zealand our part of the world is seeming much less safe for us. And even the summer in Victoria has not seemed like a summer at all- after only about two days of 40 degrees we are into Autumn.
It seems to me that difficult times brings out the best and worst in us or in different people. Some find strengths they never knew they had, while for others it is the last straw and they can never again function as they had before. There is a wonderful book that myself and lots of my colleagues read last year called “Wounded by Reality- Understanding and Treating Adult Onset Trauma”. It is written by Ghislaine Boulanger who is a clinical psychologist in New York City and a member of the supervisory and teaching faculty in the Clinical Psychology Program at Teachers College, Columbia University.
Ghislaine writes of the differences between the effects on people who have suffered long term childhood developmental and attachment trauma and those who have been leading perfectly ordinary lives with ordinary coping skills and then been involved in a totally unforeseen and unexpected catastrophe- as for example the twin towers catastrophe in her home town. Ghislaine was very involved in the follow up of such people. I have had her thoughts much in mind when thinking of the help that many people in Christchurch and in the Queensland Lockyer Valley will need in the years to come.
No-one comes through such catastrophes without being a changed person. And it is to be hoped that the rescue workers also are able to get all the help they will need to cope with all that they have seen and heard.
The day to day work of a psychotherapist has similarities even though it is rarely as intense, urgent or confronting in the immediate moment. But many of the people who come to our doorstep have suffered such trauma. Most commonly, psychotherapists are likely to see them some years after the event or events. They have often needed to “just get on with life” after perhaps some initial counselling or debriefing or sharing with fellow sufferers. And for some that will be enough.
However, for others something lingers on and they feel like they are “stuck” or have “never gotten over it” and fortunately some of them come to understand that maybe a psychotherapist could help.
Our job does involve a capacity to sit with the pain of others- we cannot take it away but we can be there to be, at the very least, a witness to what they have been through. Many in the community- friends and family alike- frequently want them to have got “over it”- to “move on” but they can’t. It is understandable that friends and family want that because there is only so much friends and family can do. They are frequently barely holding their own lives together or needing comfort for themselves. On top of all that, constantly dealing with another whose pain is overwhelming is more than they can bear.
To greater or lesser degrees or intensity this is the work of a psychotherapist whether the source is from adult onset trauma or the long term childhood relational trauma.

I have been in holiday mode for some time though the holiday period has been a mixed one this year- lovely to have some quiet time but also terrible to hear on the radio or watch on the television terrible disasters- some in countries in the wider world so much more impoverished than we are in Australia. But Australians and especially Queenslanders have been suffering as well in raging flood waters. Some have horrendous stories to tell and dreadful images to live with. For many individuals it will have been a life changing experience. We can have some confidence that Australians in general will get a lot more help than the many thousands in those impoverished countries like Haiti or Pakistan or Sri Lanka but we must not underestimate the suffering of each and every person.

I am reminded of how often people coming to see me wonder if they are “suitable” for psychotherapy. They doubt that their “issues” or “problems” are “bad enough” when they know that other people in the world suffer or have suffered far more privation or traumas than have they. Often they feel at one level as if they may be being “self indulgent” or should just “pull up their socks and get on with it”.

Rather than exaggerate their suffering, I often find that the very people who say this are the ones who I think have shown amazing resilience in the face of awful things happening in their lives. They have indeed, found ways of “getting on with life”- they have often, consciously or unconsciously, made big important decisions about how they must be in the world just in order to survive- either or both physically, psychologically or emotionally.

And survive they have- many have found a career, a paying job, formed relationships and created families. They have lived well in spite of the traumas that have occurred in their lives. Now they have turned up on my doorstep often because something has triggered memories or flashbacks to the trauma or traumas.

For others, their coping mechanisms have now become a problem in themselves and they seek my help- for example they became dependent on drink or drugs or maybe they had to learn to dissociate and cut themselves off in some way- or perhaps they cannot understand why they have gone through life chronically depressed.

Others perhaps at long last, feel strong enough in the world to “catch up with themselves”- to go back and think about and integrate the part or parts of themselves they left behind- the self who was in the position to have had to make those survival decisions so long ago.

And we can only hope that all those involved in these latest disasters are able to find the help they need right now and also far into the future. First and foremost they will need practical help and information and to know that they are not forgotten.

Some will need much time and space for debriefing and some will respond to counsellors right now. But others will need someone to talk to in a few weeks, a few months or even a few years down the track. Some will close right down and it may be years later before they can tolerate any opening up of their wounds. Hopefully they can then find the “someone to talk to” and the help they will need.

I have now been working as a psychotherapist for many years- since 1986. In all that time I have had hundreds of people find their way to my door thinking that what I have to offer may be what they need. Many have gone away after the interview and have never come back again; for whatever reason, I have not made the sort of connection with them that enabled them to stay. Sometimes it may be that I personally am not a good fit for them, perhaps the way I present what I do does not seem right for them, maybe my fees are too high, maybe it is just not the right time in their lives for the sort of work it seems to them that I do. Mostly we never know why someone leaves and does not come back. With some of course, we decide together, on the spot, that someone else may be a better fit for them or for the sort of therapy they are looking for- others we never know.

Why me, why now- is a common question that needs to be asked when someone arrives; and for psychotherapy, the fit is everything. I may not be the right person for them at this time in their lives but I may be down the track- or it can be the other way round. Sometimes we can do some work together but they cannot stay with me to go further. And it may well be that they need something that is just not in my personality to give them. And sometimes it takes a few sessions or a few months or even a year or two before someone feels safe enough to stay and deal with the deepest issues that trouble them. And all the time the issue of whether or not I am right for them may be a subject for discussion between us- or we hope that it is- for this relationship will mirror and reflect relationships in the world.

So over the years I have seen many people for single interviews, a couple of sessions, or for a few weeks or for a few months. Then there are many who I have seen for a year, or two or three- usually weekly- sometimes more often. Hopefully most of them have got what they needed for that time in their lives and for that part of their journey. It may be all the therapy they ever do in their lives or they may sooner or later move onto another therapist- just as many come to me having been with other therapists in the past. There may also be those who have left after that amount of time and have been disappointed with me- they have not got from our work together what they wanted or needed. Some can stay and speak about all that negativity and sometimes we can move forward again together- but sometimes not- feeling so negative can be too much for some so they leave rather than speak about how they feel. Sometimes they are repeating past patterns of behaviour but for whatever reason the time they have spent in therapy with me is finished.

And for a small number- where the fit is right- the work can go on for many years. The deepest work for those who have suffered long term relational trauma, can only be done in the context of a long term, on-going, reliable, robust and often intense relationship. It is easy for outsiders to be cynical about this sort of therapy- equating it to the Woody Allen scenario and scoffing about dependency. It is true that we, as psychotherapists work with dependency. Far better perhaps to be dependent on a psychotherapist for many years and gradually work toward individuation and independence than to have ruined your health with a dependency on alcohol, cigarettes or drugs; or to got through life feeling totally at odds with yourself.

And it is a fact that the issues that some people have to or want to or need to deal with in order to just cope in life- let alone lead a fulfilling life- takes time- often a long time. Some need the sort of relationship they did not have as a child and we have to sort of “re- grow” them through those stages of development that somehow became distorted or damaged for them. Some have never before allowed themselves to be dependent on anyone- their way of coping has been to be super independent so trusting another at all is something they have to learn.

And after all these years of working I live in awe of the few people who have been able to do this sort of work. Perhaps they were so desperate that they felt they had no choice but they did do it. Maybe it was because I myself had to do that level of therapeutic work myself that I appreciate so much the courage of those who do take that path. They have often done so without the help of medication because of early bad experiences when medication was offered as their only alternative. I admire their fighting spirit on behalf of themselves- to find eventually a life of internal freedom- the hard way.

Lately- perhaps because I had been on holiday myself- I have been thinking quite a lot about absence and separation and their relationship to grief and loss. As psychotherapists we are constantly helping people deal with such issues. Actual separations, both physical and emotional, in infancy or young childhood- from the primary caregiver- frequently lie at the base of relationship and coping issues that many people have and for which they come to therapy.

Of course outcomes of loss are multi determined and everyone who loses a parent in whatever way it is, does not have the same problems in later life. Much depends on the relationship prior to the loss, the type of loss or separation, the age of the infant and the help that the child gets with the loss at the time, the other care takers who are available and of course the length and severity of the loss.

In extreme situations, it is particularly painful for some adults when a relationship breaks up. For some it is totally unbearable that the loved one- a partner or a person with whom they have fallen in love- decides that they want to finish the relationship. Not to be able to see, to talk with or in other ways feel close to the loved one is so horrendous that some do not even want to live any more.

They become completely obsessed and preoccupied with thinking about the loved one and with trying to tease out precisely what went wrong and what must they do to make the loved one want them again. Such a state often goes along with them having idealised the loved one and now they are totally devasted. They are driven to distraction and to suicidal thoughts with the prospect of the loss- better to die they think than to live without their loved one. And some do or at least make the attempt.

It is my belief that these and other extreme feelings as well as lighter versions of them that many of us experience, come out of early loss of the loved parent. Sometimes the losses that make future stability so difficult are those that could be termed emotional absence- a parent who just could not “be there” at all for the child and/or could not see the child as a separate little being with its own needs and life to live. Or the loss may be as extreme as the death of the parent, but prolonged absences due to hospitalisation can also bring problems later on.

I have come to understand that the obsessive thinking and preoccupation with the loved one is the way in which the infant, child and now the adult attempts to keep the loved one alive in their own mind. Better even to have angry thoughts about the loved one than to have a void.

Of course there are many versions of the above and many ways in which people respond to absences. Some can let themselves know about the pain of absence others just shut down or shut off any feelings about an absence- that way they can get on with life and at least survive. Some even avoid allowing themselves ever to get close enough to anyone for absences to seem any problem at all and a sub-group of these people turn to drugs, alcohol or other addictions because dependence on those substances seem safer than people.

I was asked the other day what was PACFA and why was our association a member of that body. PACFA, or more properly the Psychotherapy and Counselling Federation of Australia grew out of a series of meetings between many of the people in Australia who were teachers of psychotherapy and counselling. These people eventually formed an association called the Society of Counselling and Psychotherapy Educators (SCAPE) and themselves are now members of PACFA -after it had been decided to set up an umbrella association of associations.

The meetings and the formation of PACFA were moves toward self-regulation of the professions of counselling and psychotherapy. The people at the original meetings were very concerned about the fact that, as it currently stood, any person could put up their shingle and call themselves a counsellor or a psychotherapist- irrespective of whether they had been trained well or, in fact had any training at all. They also had a strong belief that psychotherapy and counselling should be seen as distinct and separate professions from psychology or psychiatry needing special training, practice standards, ethics and other requirements.

The early meetings had in attendance a very broad spectrum of educators of counsellors and psychotherapists. By definition, the very fact that they were there, meant that they considered they actually did train people in those professions and that they believed that specific training was required. The “cowboys” at the totally irresponsible end were not there. Even so there was a huge diversity in what members thought was good enough training.

And much of that diversity of thinking still stands. There were big differences regarding how much theory, how much experiential learning, how much personal individual counselling, psychotherapy or psychoanalysis would be required of students and then, how much or how frequent was the amount of supervision that would be required of the new and experienced therapists and counsellors.

PACFA had to start with absolute minimum standards so as to be able to encompass all the disparate groups. Over time they have gradually moved to raise standards and requirements of training. There have also been ongoing tensions between those who want to emphasise the commmon base of practice between all groups and those who have thought the standards were too low and perhaps want to differentiate themselves from other groups within PACFA.

The journey has been very difficult but culminated last year in the formation of an Australian national Register of Counsellors and Psychotherapists. (ARCAP). This Register will gradually become the “gold standard” of some sort of assurance on whether or not the counsellor or psychotherapist you might be seeing professionally, has actually been trained for their job. If the person you are seeing does not belong to an association that is represented on A.R.C.A.P then you would want to be asking some questions about the person’s training and professional regulation.

Having just spent last Monday listening to Dr. Norman Doidge give a series of lectures on the plasticity of the brain, I have been reinvigorated with this line of thinking. Dr. Doidge and other neuroscientists have been coming much more regularly to Australia since Allan Schore first came in 1999. Dr. Doidge is most particularly interested in the scientific evidence regarding the plasticity of the brain. He is also interested in how psychotherapy works and its relationship to neuroplasticity.

Our brains can continue to change even into very old age. We are not doomed to have only the death of our neurones after we pass the age of 25! People can change, minds can grow and change in many ways including through the psychotherapy process. Long held emotional blocks and patterns of behaviour that have prohibited forming good relationships and living a fulfilling life can change. Psychotherapists have always known this but now we have the proof. Of course if it had not always been so, then psychologists, psychotherapists, psychoanalysts and many others in the helping professions would have been out of a job long ago.

Dr. Doidge was very reaffirming of the work of Sigmund Freud and early psychoanalysis. He believes that Freud was onto something when he saw his patients for six days every week. He calls it “immersion learning”. Making real change to the neural connections in the brain takes time and really concentrated and consistent effort. Speaking of the neuronal connections in the brain, Dr.Doidge sums up the critical concepts in a few pithy phrases: “Neurones that fire together, wire together”; “neurones that fire apart, wire apart” and “neurones out of synch. fail to link”. He also makes much use of the reality of the notion – “use it or lose it”- whatever we reinforce in our brains takes up space and leaves less space for other connections and pathways.
Those phrases are worth remembering when we fill our minds with negative thoughts about ourselves. We have to work at building useful neuronal connections in our brains.

Of particular interest to us as psychotherapists are his words about the ways in which plasticity works- especially with those who have suffered adult onset trauma or long term relational trauma. He first makes the point that when any neuronal circuit is reactivated it is then open to change. And then, because psychotherapy can offer an environment that is safe, early or previously dormant pathways in the brain can be unmasked. They may perhaps be pathways that were once present before the trauma and these can be opened up to give new possibilities for living in the present. And while these old pathways can be enlivened or changed, psychotherapy can also begin to create new pathways; new ways to think, feel or behave.

If you want to read more about these ideas, Dr. Doidge’s book “The Brain That Changes Itself” is extremely readable. I also noted that on Page 8 of the Melbourne AGE newspaper today (September 3rd 2010) is a story of the use now in rehabilitation of a technique for dealing with “complex regional pain syndrome”- ways of tricking the brain into change. This technique is one of a number which Dr. Doidge explored the origins of its development and wrote about in his book.