How can a therapist be with another seeking to improve their well-being? I went to discuss this recently with colleague.
- This is a revised presentation I made to the British Psychological Society (BPS), Eastern Branch, in Cambridge, September 2019.
“I want to explain what I think I do as a therapist. The approach to my practice has been changed in recent years by the ideas of Dan Siegel, Stephen Porges, Allan Schore and Bessel van der Kolk, amongst others.
I am not a neuro-scientist. I am a translator. I need to know enough science to help others interpret their experiences in order to adapt and make changes in their lives. My shortage of detailed knowledge of biology and neurology is moderated by the use of metaphor and illustration.
It pays me to avoid complexity and technicality, in favour of the digestible. I want people to have enough information to act differently, and with growing confidence. I want to be accurate – but if I have to choose – I’d prefer to know I helped some-one make a change. To minimise mistakes, I advocate SMALL safe experiments even if it means following a scenic routine to change.
What are the ideas that have influenced me?
Dan Siegel asks us to consider several facets of Mind and to follow several neuro-biological principles. He says that Mind comprises:
- an embodied and relational phenomenon, to use the jargon. We have a body and its parts relate one to another. This is our inner world. We exist in relationships outside our physical body as well. Many become part of our ‘mind’. The impact of caretakers on children demonstrate this only too well.
- a subjective experience. It appears we cannot know an ’objective reality’ because observing ourselves changes what is seen. However, we can sense things and this means we develop a ‘subjective’ or very personal experience of ourselves.
- consciousness: all internal and external experiences bundle together to create a complex awareness of ourselves. It leads us to being able to wonder who we are.
- information processing capacities: these make us a self-organising manager persistently looking for meaning.
- an ability to self-organise: we do this by regulating and directing our energy within our bodies and toward, or away from, other people, living things and things.
When all these elements work together, the mind can monitor and modify itself. It is regulated and regulating in a relaxed way.
Generally speaking, Siegal says the person who is thriving will demonstrate an ‘integrated mind’. This process of ‘integration’ involves linkage of each of those elements, as listed above. The ever-changing result is a degree of flexibility, self-confidence and strong, resilient relationships.
When the processes are not integrated, the tendency is toward reactivity – an unthinking and spontaneous reaction – to people and events. Without the smooth flow of energy between our thoughts, actions, feelings and sensations, we can become chaotic or rigid. I will add another set of extreme responses: our tendency to catastrophise or cope by ritualising our behaviour to give the appearance of coping or being safe.
Most authors I listed in my references – see the Powerpoint presentation – appear to assert that the mind emerges from essentially unspoken connections. We can talk through connections – that’s what I am wanting to do right now – but we do not ‘know’ all that is emerging. Fortunately, most of us can show some empathy and this should minimise any damage to ourselves and other people as these subterranean passages are carved out.
Therapy can improve our ability to notice what we are ‘carving’ as we move toward a ‘new normal’; tomorrow’s destination.
Now, in practice, how do these ideas impact on what I do? What therapeutic exercises build ‘integrated minds’? How might therapy inoculate therapist and client against chaos, rigidity, catastrophising and ritualising?
A primary intention is to widen any available the Window of Tolerance (WOT). Mine, my ‘client’s, people in my client’s life etc. How can that be done? By:
- small safe experiments that increase awareness of the ‘unknown unknowns’ (see the Johari Window).
- improving communication within the brain and body – from our left to our right, from back to front and up and down. Body Scanning plays an helpful role in fostering this improvement.
- improving our confidence and self-confidence through linking memories, experience, including sensation, and cognitions (thoughts in our head). Visualisation and practice do this.
- recording the results of ‘safe experiments’ so the story of our life – our ‘narrative’ – can lead to a re-writing of the tale. This is necessary when the key ‘plot’ in that story comes into question after, say, a death, separation, divorce. The same applies when we explore new close, if not intimate, relationships. Trauma of different shapes and sizes can disrupt our ability to write a continuing and coherent story. This process goes beyond just knowing something in our memory. It involves sensing it, feeling it and tasting it with the help our ‘inner narrator’.
- acting on outcomes discussed in my consulting room is essential to change – talking is not enough. We can adapt to a new context in which we are operating and that is achieved only by action and taking the consequences. This assumes a high degree of trust between therapist and client as they both practice doing their ‘own thing’.”
In my actual presentation, I went on to illustrate how this had worked already – using case examples. I am not including this material here, but there is a slide summarising my own view of the outcomes.
NOW, if you have ever been in my consulting room with me. What do YOU think I did?! Want to tell me?