Bob Chisholm Counselling & Psychotherapy

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10/24/2015

Love is the Question

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What brings people to psychotherapy? Ideally, this is a question that would never be answered in general terms for each person is unique and therapy only becomes meaningful once the client begins to come to terms with his or her uniqueness. The better, indeed essential question is always: "What brings you to therapy?" For only by eliciting reflections based on the actual experience of the client can a strong foundation for therapy be built. As a psychotherapist, then, I avoid making any medical sounding diagnoses precisely because it discourages the development of the self awareness that therapy depends on. Moreover, I don't believe that a medical diagnosis--derived from the Greek, meaning seeing through-- for purely psychological conditions is actually possible. Although I believe that fixed patterns of mental suffering are a reality beyond dispute, the idea that there are discrete disease entities that can account for them has little, if any merit in my view. Still, because there are typical patterns of thought and behaviour for a great range of psychological complaints, having some theoretical understanding of what people commonly experience when they are depressed, anxious or deeply confused is a resource that no therapist can do without. But helping the client to look beyond the symptoms of her particular condition and find the intentional actions that keep that condition in place is what therapy is all about. This almost always involves recalling painful experiences from the past, as well as looking at difficulties and frustrations in the present. And what is often discovered is that at the heart of those frustrations there is often a terrible privation that can be be both mysterious and obvious at the same time. The lack is love.

The idea that getting love is the answer for all the pains and frustrations to the which the self is subject is practically a cliche and every therapist should regard it with deep suspicion. Alas, not all therapists do and many err seriously by seeing themselves as the guardians of their clients' affections. It is common to hear, for instance, of therapists projecting their own material into the client's discontents, imposing their sense of narrative into the living story of their clients. This may be done more or less innocently, but it is almost always done blindly and can only work against the client's need to develop self insight. Perhaps even worse is when therapists explicitly advertise themselves as love doctors who can dispense wisdom and advice for obtaining love and sex. There are certainly good, ethical therapists who deal responsibly with issues relating to sex and relationships. Unfortunately, there are also others who are only too happy to exploit the insecurity of their clients by promising success in love. As we might suspect, this is largely an American phenomenon, but the practice of promising to deliver romantic success happens here, too. The late David Smail, a brilliant psychologist, used to argue that it was a strategy of advanced capitalism to present love as a scarce commodity by convincing people that only the wealthy, famous, intelligent or beautiful are worthy of it. His argument finds validation in psychotherapists who pander to the desperate hopes of the lovelorn by playing on the logic of feeling that a capitalist society promotes. Yet, surely, feeling unworthy of love is nothing new or modern. The complaint of the world has always been that there is never enough love to go around. If some therapists find the shortage of love an opportunity for selling it like snake oil, the problem that therapy will always face is the absence of love. "Why doesn't love happen to me?"; or, even more poignantly, "why didn't love happen in my childhood, when I needed it the most?" are questions that always come up in therapy.   

Of course, seeing love from a position of deprivation is almost certainly to form a distorted idea of it. It's like trying to imagine life on a planet in a distant galaxy. The possibilities may appear endless, but none are open to direct experience. Fortunately, most of us have experienced love in some form or another. And usually those experiences provide essential guidance for our emotional lives. Yet, although almost any form of love does have a transcendent quality, confining our notions of love to our personal experience of it may be misleading, especially if we think that love obtains only in the people or things that stimulate our affections or arouse our desires. Though we may find security in knowing whom and what we love and the reasons why we love them, we may still be mistaken in closing the circle of our love around them. We forget that love begins as an opening and a discovery that enables us to know others--and ourselves--in a way that no other form of knowledge permits. Consumerism does a booming trade by persuading us that love appears only in erotic or sentimental guises and convincing us to dread the possibility of never getting it. But love depends less on objects that provide reliable satisfactions than it does on keeping the heart open to the experience of others.

Those who are advanced on a spiritual path--people we might regard as enlightened--appear almost indiscriminate in the expression of their love. It seems to radiate from them like sunlight. They also seem to know something that the rest of us don't. Their love doesn't need to be gratified--it is already gratified, or rather, perhaps, their love is realised beyond any need to find gratification. Certainly they seem able to give love without receiving it in turn; nor do they seem aggrieved by the lack of reciprocation. But for most of us, love is far more conditional. We are cautious and selective in offering it and we usually offer it only in order to get it. But then, it may be that we really don't see what the enlightened seem to know so clearly. Almost everyone wants love--to give and receive it--but the conditions we impose on it impair our understanding of what love is. And because love leaves us vulnerable to disappointment, we are understandably protective of our affections. So we cling to love as we have experienced it, even when the conditions of that experience may have vanished.

So how does therapy help with the lack of love? Certainly not by preaching the virtues of universal love, no more than by shilling the benefits of romantic love. But because love is essential to human experience, it must remain open to personal enquiry. This may not only involve examining the client's personal history of sadness and disappointment; it also involves an imaginative exploration of how love can be meaningful in the terms that her life experience furnishes. Love really is the answer for so many of the pains that people suffer. But sometimes therapy is the place to begin to address the question. 

 

   
  

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10/9/2015

Mad to be Normal

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I have tried to be cautious about making pronouncements concerning events in the news, but the recent mass murder in Oregon deserves attention because of the proclaimed linkage of this atrocity with the apparent mental illness of the killer. The gunman, whom the authorities are reluctant to name for fear of giving him a sort warped celebrity, appears to have been a disaffected loner whose inner life was dominated by visions of wanton slaughter before he decided to act out his fantasy. Authorities, journalists and even Presidential candidates have been quick to identify mental illness as a contributing cause of the rampage, as only a madman would ever dream of committing such a horrible crime. It does seem obvious that the murderer was seriously disturbed, for his crime was as senseless as it was dreadful. Even so, it is impossible to say exactly what mental illness he was he suffering from, as no one, not even the members of his family, knew what he was feeling and thinking before he went out on his spree of murder. Still, although any diagnosis can only be speculative, I suspect we will be hearing many opinions from experts who will lend scientific authority to the widespread belief that the killer was indeed suffering from a mental illness. Such discussions will hardly be constructive or enlightening, however, if they only address the mental condition of the killer and say nothing about the legal and social contexts which made the crime possible. But only by looking at the atrocity from these perspectives can there be any hope of understanding it and preventing other such incidents in the future. By demanding consideration of these factors, I am not attempting to excuse the murderer or suggest that he was not seriously disturbed. But a society that continues to make guns easily available to anyone after repeated incidents of mass murder can hardly pretend to bear no responsibility for the slaughter. Unfortunately, it is also easy to foresee that those deemed mentally ill will suffer unfair suspicion because of the actions of a few individuals with whom they may have nothing in common except for a psychiatric diagnosis. Because a psychiatric label might seem to offer insight into the mind of the killer, entirely innocent people may become scapegoats for crimes for which society itself deserves much of the blame. Meanwhile, a far greater psychopathology escapes the scrutiny it deserves.

The madness begins with laws that allow dangerous firearms to be so widely available. The US enshrines the right to own and bear arms in the Second Amendment of the Constitution. This provision was originally intended to give citizens a measure of protection against the possibility of state tyranny. Since then, however, the idea that guns are basic and necessary instruments for protecting individual liberty has become one of the unchallengeable convictions of the American Right. There is also a certain shameless defiance in this belief in the sanctity of gun ownership which was exemplified by Governor Rick Perry of Texas who, after the Sandy Hook Primary School massacre in Connecticut, invited gun manufacturers from that state to relocate to Texas where they would be more warmly welcomed. Of course, gun makers themselves do all they can to further their interests by pushing a fanatically extreme interpretation of Second Amendment rights, chiefly through the National Rifle Association, a powerful lobbying group that categorically opposes any restrictions on the right to own firearms. In some states such as Texas, every adult, no matter what his background or criminal history, is free to buy a gun with no questions asked. Readers who are not American may not fully appreciate the number of homicides that occur in the US, even excluding the wholesale murders that are committed by mass murderers on rampages (in fact, these count for a very small percentage of total gun deaths). But comparisons help to throw light on the matter. In 2013, there were 537 murders committed in the UK, which may seem an appallingly high number. But in the same year in the US there were over 14,000 murders. Texas alone contributed 1133 murders to the total count (California, however, came first among US states with 1745). Appalling as these numbers are, no less sickening are some of the individual circumstances of deaths caused by guns. In this week's news, for example, there is a report out of Tennessee about the killing of an eight year old girl by an eleven year old boy. He is alleged to have shot her because she refused to show him her puppies. Yet in spite of many such incidents and the staggeringly high number of homicides in the country, the NRA continues to maintain that gun ownership is the best defence against crime. In truth, the NRA's influence in Congress should be regarded as a crime in itself.      

Fortunately, Great Britain does not suffer the infatuation with guns that America does. But even without easy access to firearms, horrifying rampages such as the massacre in Dunblane still happen here, even if they are not nearly as frequent as on the other side of the Atlantic. So why do some people act out their violent fantasies? This raises psychological and social questions, rather than legal and political ones. But as I said before, getting into the mind of a mass murderer without knowing much about him strikes me as a dubious undertaking. What is more open to general consideration is how violence and murder as represented in such popular entertainments as television, movies and video games might contribute to the fantasy life of a killer. This is an old debate that still divides opinion among social scientists, but from a Buddhist perspective there really is no argument. The law of karma asserts that the cultivation of any attitude, be it harmful or benign, produces consequences that will follow accordingly, if not entirely predictably. This does not, of course, mean that every kid who plays Grand Theft Auto will go on to become a violent criminal, as other factors will usually counteract the urge to violence that such entertainments foment. Much the same dynamic can be observed in violent pornography. Although most men who view violent porn do not become sex offenders, a susceptible minority of them find it a powerful stimulus to sexual assault. But even when an unskilful intention does not lead to an actual crime, Buddhism would still insist that intentionally arousing any harmful passion in order to take pleasure in it is to perpetuate a chain of negative karma, even if the agent has no awareness of being enchained and suffers no immediate consequences from his actions. Moreover, this is not a solitary matter that only affects the person who carries a particular karmic disposition. Karma can spread to others like shared good fortune or a contagious disease. And though it depends on causes and conditions that are not easily analysed, karma presents experience as an apparent destiny beyond which we struggle to see. For karma creates the world and assigns a place in it to each of us; or rather, it appears to, for karma is the fabric from of which all our illusions are woven.

The idea of shared karma may be particularly illuminating for a crime such as mass murder. While a mass killer is probably acting out of blind hatred for people he might not know at all, beneath that emotion there is almost certainly a great deal of fear. Moreover, it may not be particularly personal fear, but may have more to do with a social climate in which fear predominates. I remember once going to a sporting goods store in Texas to buy some camping equipment. I was astonished to see how many customers there were at the gun counter, all looking to purchase powerful handguns. These were not guns made for sport; they were made to kill people. So just who did these gun buyers expect to shoot? Governor Perry is worth quoting here. "When a criminal breaks into your home, I'll let the liberals call the lawyer. I'm going to call [the American gun maker] Smith and Wesson." Perry, then, has more faith in guns as a source of security than in the rule of law. Nor is he alone among American politicians in holding such a view. Recently, the billionaire Republican candidate for president, Donald Trump, expressed his views on the mass murder in Oregon. Noting that "there are a lot of sick people out there", Trump suggested that if the teachers at the community college where the massacre occurred had been armed "[they] would have been a helluva lot better off." Another Republican candidate, Ben Carson, said that he wouldn't have stood by idly when the gunman was going on his rampage. Presumably, he would have been packing his Smith and Wesson. At present, Carson and Trump are the leading contenders for the Republican nomination. Although Trump, Carson and Perry would not be diagnosed as mentally ill (though perhaps Trump would score high on a test for narcissistic personality disorder), they are seriously deluded in believing that the unrestricted use of fire arms will make people safer. And for people who are desperately insecure to begin with, the wildly irrational beliefs of powerful public figures who make laws and influence public attitudes will have a particularly toxic effect. When powerful people proclaim that having a gun and being ready to use it should be regarded as responsible citizenship, especially in a popular culture which celebrates violence as a means of resolving conflict, small wonder that both murder and mass murder have become routine occurrences. The idea then that horrors such as the Oregon massacre are due solely to the individual pathologies of a few "sick people out there"is to overlook the social context of the massacre. Seen from that perspective, it was far more normal than people realise.

 


                    

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10/2/2015

Therapeutic Competence

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I  am happy to report that I recently passed the BACP competency test. But because the test has a pass rate of around 93%  my achievement can hardly be called exceptional. Still,  it is noteworthy in that it helps to secure my status as a member of the largest body of counsellors and psychotherapists in the UK.  I have actually been a BACP member ever since I began training as a counsellor and therapist and perhaps like most people who have joined, I see membership as a useful credential in plying my trade.  But I also believe in the BACP's mission to uphold ethical standards for our profession. For counselling and psychotherapy depend on the therapist's ethical commitment to the psychological welfare of clients; any practitioner who violates that trust by exploiting the vulnerability of clients for his own personal gratification should not be practising at all.  But the BACP does more than try to uphold ethical standards for the profession. It also attempts to inculcate methods of good practice for which the competency test serves as a standard.  There are some essential tasks such as record keeping, therapeutic contracts, and above all, client confidentiality, which all  practitioners should understand and manage responsibly and the BACP is right to insist on their importance. But beyond these things, I wonder what constitutes good practice and wonder even more how it can be tested.  I don't doubt the possibility of learning to be a good therapist. Indeed, learning to be a therapist is a necessity, though I believe it can only be learned through experience, not by didactic teaching methods that are more likely to inhibit the intuitiveness and spontaneity which I believe are essential for therapy. But if these essential skills can only be learned and not really taught, how can they be tested?

A good friend of mine who has been a trainer and psychotherapist for years, tells me that my concern is pointless. "Everybody knows you can't test these things, " she agreed. "But the BACP need to have something in place to show their concern about the competence of therapists. Basically, you just need to tell them what they want to hear." Indeed, this is what everyone seems to believe, even, I suspect, the good people of the BACP. But what nobody seems to want to admit is that pre-scripting the therapeutic encounter as the competency test does, actually  blunts the fine edge of discrimination that every therapist should always be striving to hone. The problem begins with the typical  case studies that the test uses. It is not that these case studies are unrealistic; it is that they are all too typical. For in order for therapy to be truly effective the therapist has to see beyond the signs and symptoms of any given condition and find the human subject, the actual person with his/her unique life experiences who is suffering from it.  Although the BACP advice is generally sound, it often has the effect of freezing the therapist's deeper, more intuitive responses that make such a discovery possible. When, for example, a severely depressed person comes in complaining of a feeling of hopelessness, the BACP advises a risk assessment for suicide. People do, of course, contemplate suicide in the depths of severe depression and a responsible therapist will always be alert to that danger. But how exactly should such an assessment be conducted? Direct questioning would work well for some clients, but others would respond better to a less overt approach. Although it might be comforting  to believe that there are right and wrong ways of doing something as important as a risk assessment, the truth is it all depends on the characteristics and needs of the client. 

In fact, the competence of the therapist goes far beyond making an accurate risk assessment of the client, as even the BACP test recognises. But it also goes beyond following a check list of do's and don't's of therapeutic practice, which the test does seem to encourage.  For what psychotherapy involves is a unique form of communication of personal experience that remains bravely open to the mystery of being.  I have quoted R.D. Laing  before about this, but it bears repeating here: "Psychotherapy must be an obstinate attempt by two people to recover the wholeness of being human through the relationship between them." It begins then, with the self experience of both parties, but the primary concern must be for the client.  And as it progresses, therapy develops ever deepening levels of trust which become manifest through the close and sympathetic attention of the therapist. Even so, it is somewhat mysterious how a successful therapeutic relationship develops. I have heard some therapists say that unconditional love is the hidden factor behind all successful therapy, but I don't agree. If anything, it is the highly conditional nature of therapy that gives it a certain potent urgency which helps to bring about positive change in the client. For it is within the limits and conditions of the therapeutic encounter that the client may not only confront painful truths, but also might discover better possibilities for himself. But there is no way of knowing what will happen in advance of the fact.  

Perhaps more than ever, therapy is under pressure to justify itself as an effective form of treatment which is why so much emphasis is placed on the presentation of evidence that will confirm its value. Thus we hear so much about "evidence based therapy" as kind of a guarantee of therapeutic effectiveness. Yet, though research into the effectiveness of therapy is a valid and necessary undertaking,, there can be no guaranteed outcome for any individual case. Still, what research does reveal is that it is the strength of the therapeutic relationship that is the best indicator of successful therapy. But establishing a strong therapeutic relationship is more of an art than a science and depends crucially on the awareness, intuition and communication skills of the therapist.. Focussing on the world experience of the client, a good therapist will be able to establish a bond of trust which makes  a deeper exploration of the client's experience possible. But given the infinite possibilities of individual experience, we must always ask how this can be done.

In my experience, it is listening that counts as the single most important skill that a therapist can possess. Although this might seem to be nothing more than the therapist keeping his mouth shut, listening in therapy is actually much more dynamic than it might appear . This is not to suggest that the therapist should ever be trying to prompt the client's responses by employing a cunning strategy of silence. On the contrary, it means that the client's speech should be met with keen attention that is both open to surprises, as well as alert to inconsistencies. For the client.  knowing that the therapist is listening sympathetically can feel like being held and supported in the loneliness of self consciousness. Still, a client usually needs some indication that he is actually being heard, which means the therapist's responses, both verbal and gestural, must be well timed and skilfully expressed. But this does not mean that it will always  be "appropriate" according to the protocols laid down by some code of therapy. I once attended a workshop conducted by a psychotherapist I regard as a master, in which he shocked some members of the audience by saying that sometimes it is necessary to be extremely blunt with a client in terms will be readily understood. "Quit fucking about, mate, you're wasting my time and yours," he recalled once saying to a client who was avoiding the issue at hand. This was, to be sure, a daring gambit and any therapist who would employ such bluntness carelessly would certainly be erring grievously. But another friend of mine made an excellent point about how to judge the matter. "Within some very fundamental ethical boundaries, it basically comes down to connecting with the client in a way that feels natural to them. And then, anything goes." This requires more than competence; it requires  attentiveness and compassion. And it can only be tested in each therapeutic situation.
 




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    Bob Chisholm is a counsellor and psychotherapist with a particular interest in Buddhist psychology

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