Recently I started the process of becoming a fully fledged EFT or Emotionally Focused Therapist working with couples in distress in a very particular way: a way which helps them recognise how they play out their original attachment histories, and how to repair disconnection. Here is a short video with Dr Sue Johnson with whom I trained to certification level one last year, and Dr Edward Tronick, explaining one of the key factors in why disconnection is so distressing and how healing and soothing reconnection is.
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There's been a long standing debate in the therapy world, about whether to call people who consult us Patients or Therapy Clients.  For a while, as a young therapist, I found myself avoiding the use of "Patient", in an overly zealous attempt to not pathologise whomever came into therapy with me. It was also very much part of working along CBT lines, the primary mode of intervention taught to us at the time, though during our training towards registered psychologist we had to put together our own approach, or at least develop and present a worldview which we based our imagined future selves as practitioners. I was adamant to not follow the more medical model of calling my paying clients "patients", wanting to minimise the formality of our encounters and the possible power differential which may be created by that label.

But as I grew older and wiser and my knowledge base widened over years of sitting with people, doing additional training both for Continuing Professional Development as well as deepening my interest in many other fields which we did not receive in- depth training in(such a embodied psychotherapy, Mindfulness-based approaches, etc), I have come to appreciate what "patient" really means: someone who is suffering. And is it not true that every therapeutic encounter and intervention is about relieving suffering? 

Every person sitting on my coach, is someone who is suffering. So that referring to him or her as a patient actually shows the deepest form of respect and awareness of that. Therapy is not simply a consultation where the therapist dishes out advice and guidelines to live a happy life: in that case "client" would be appropriate. Or if I am approached to coach someone through a life transition or workplace issue, I happily use "client".

But when I talk about patients, it is with a deep awareness of the suffering, the psychological woundedness, and the need for being cared for if not cured in the safety of the therapeutic hour. As therapists we need to be able to hold the space for such suffering to be spoken about and sometimes sit helpless in the face of utter pain, simply witnessing such suffering. I often remind myself of how therapy is really about helping people to tolerate the previous intolerable, to help people distinguish between unavoidable suffering and suffering we inadvertently create for ourselves ironically as we seek relief from pain and suffering.

So yes, I think and talk about people who come to me for therapy as Patients. This has not prevented me from entering the therapy space in a collaborative way, of meeting people as equals. After all, I too, have been a patient on a coach and suffer in similar ways, sometimes simply by being human in an intrinsically unsafe and unpredictable world.

(Another site where I've posted this: https://ronellehartblogspot.wordpress.com/

I've heard it many times: I may even have said it: "Let it go". It's one of those popular psychological phrases which are often quoted, by psychologists and spiritual gurus alike. Many of my therapy clients bemoan the fact: " I can't let it go!" "Please help me to let go", referring usually to some old hurt from the past: the loss of a loved one, an old grievance, a hanging on to an erstwhile lover, even sometimes guilt and shame and self-judgement, and many more.

These seem very diverse, but have  in common how difficult it is to stop thinking about old hurts, how hard it is to stop longing and yearning for a lost love, how to stop that inner voice of judgment and shaming. We all seem to hope that somehow, there is a magical cure, or a trick which will help us to get rid of all which seem to hamper our well-being and sabotage a healthy sense of self, and will enable us to be free to be happy. Stopping IT from interfering with the quality of our lives, seems to be one of the most popular themes of the Self-Help industry.

Many "cures" are proposed and idealised even: I've heard and seen demonstrated several visualisation exercises, where one can imagine IT floating away and out of sight like a little boat of the sea, or a helium filled balloon. Or the often employed exercise of writing IT down and burning the piece of paper (with an incantation or two thrown in). There certainly is some value to these, but probably no lasting relief is really found by imagining "Letting go" of whatever troubles us. I have even heard the expression: "Let go and let God" and while there may be  some sense of comfort in imagining that you are giving IT over to a greater being, even this is not quite effective to change our very human hearts and minds which still ache and long and obsess.

Here's a suggestion: what if you just "Let it BE"? Yes, just stop wanting IT to not be present. Quite a radical idea, I thought, when I first encountered this approach. How is it to simply just relax into radically accepting whatever IT is that you so want to get rid of: that intrusive thought, that painful memory, that harsh inner voice which evokes such distress?

Paradoxically, letting IT be exactly as it is, can be the first step toward unhooking ourselves from it. It's only when we can look at what is going on within, that there is any hope for change. So inquiring directly into the nature of whatever It is, in a mindful way, may interrupt the striving to get rid of it. The attention and energy given to try and not feel what is simply very human, often keeps the unwanted thought, memory, emotion right in place. Ironically we cannot "let go" in the sense of putting down our "baggage" and catching the next train out, another commonly used metaphor in psychology. We cannot excise parts of our brain: that's what it would take to get rid of that which we don't want to have within.

But once we know the exact nature of the unwanted IT, once we can look at IT with self-compassion and without the urgency to get rid of IT, we can learn to not pay the same amount of attention to IT. To  notice IT, to honour IT, but to intentionally shift our focus, so that new neural pathways can develop in our brain, and the once feared and unwanted IT slowly recedes into the background of our being. That is what "Letting Be" looks like.

Not easy, not a quick-fix either. But with the guidance of a trusted therapist, it is possible to learn to live with that which previously was intolerable. 

I almost always hear this: “We don’t communicate!” when a couple sits on the couch across from me. After infidelity or some other betrayal, this is the most often cited reason that brings couples to therapy. Training to become a psychologist, this is also the focus of many marital therapy interventions: to teach couples how to communicate.

So, imagine their surprise when I gently say: “Oh yes you do. But maybe what you are communicating is the cause of distress in this relationship. Maybe what you are communication is disconnection. And maybe we can together find out what this is all about”.

In fact, it is impossible to not communicate: we are always communicating something: even (and probably especially!) when we don’t say a word. Postures, facial expressions, eye contact, physical orientation in space, all “speak” volumes. And it’s usually these non-verbal clues which are picked up by our nervous systems; those are the messages which we respond to at a gut level.

I may at that point ask them to just notice how they sit in relation to another. (I have a small couch in my rooms, so that it’s almost impossible for two adult bodies to not touch when they sit side by side on it). And it is quite satisfying to see that shift: from being focused on the other person (and usually their shortcomings) to just noticing how much each communicates simply by how they are holding their own bodies in relation to one another: are they allowing physical contact, are they sitting as far apart as possible, do they hold their bodies in rigid poses even when touching? And to start becoming aware of how much it all says about how they feel in the moment.

Couples (or at least one of the two) are usually poised to start a long verbal rant of dissatisfaction and complaints and injuries, done to them by the other. So, to suddenly be alerted to what may be going on inside oneself, can be quite disconcerting. It’s not something that most of us know how to do. Some of us learn very early on in life how to not show and say how we feel, in order to preserve our attachment bond with our mother, or our primary caretaker. This results in a developing our default way of being in the world, and will translate into certain communication styles in our adult attachment relationship.

This change in focus can be the beginning of a different awareness in each of the partners: to start taking notice of what is going on inside themselves, within the relationship space. I don’t believe that relationship counselling can be effective without this shift.

Simply teaching verbal communication skills may help a little, but not before people are aware of what is really going on inside themselves, and what is evoked for them in a particular relationship dynamic. Then there is the possibility that they could learn to communicate that more effectively, and congruently.

One of the reasons people enter therapy, is to learn to control their emotions. Some people even state that at the outset: “I want to learn to control my anger”, or “I need to control my anxiety”, or “My husband says I need to control my insecurity”, or some variation on the above. Or else, in the therapy process, it becomes clear that the patient believes that he or she needs to control their emotions: one sees that quite early sometimes when people struggle to retain their composure, or swallow away inevitable tears and even apologise for crying.

Of course, all such behaviour is an invaluable source of information to the therapist about someone’s way of being in the world. And hopefully the therapy client will learn that the therapeutic space is safe enough to express all kinds of emotions. But even when someone has relaxed into being able to express whatever emotion is present, it remains a challenge to help them realise that the key to healing is not learning to control emotions, but to allow the emotion to simply be deeply and viscerally felt, and to learn to use the information from the mind and the body which an emotion is trying to convey.

The greatest obstacle to allowing an emotion simply to be felt, is that we judge some emotions to be bad. In fact, any emotion which causes physiological discomfort seems to be labelled “bad”. This may be a moralistic issue: harmful behaviour fuelled by certain emotions may be judged harshly by families and societies and religious dogma, and so the emotion itself becomes labelled as bad or good. Anger is a good example of this: despite it being a very important and strength giving emotion, it gets confused with aggressive behaviour, and is often unwanted and feared.

It is true that emotions like fear, sadness and anger are uncomfortable and cause central nervous arousal which is felt in our bodies as unpleasant, and protracted experiencing of these states can be stressful. The impulse to want to control and therefore minimise these are understandable, but the simple reality that no emotion is “bad” can already be a powerful intervention.

Learning to simply become aware of the emotion, to become curious about why it is there, to let it find its natural expression in the visceral experience as it arises in our body and awareness, is the beginning of healing.

This is at the center of a more mindful approach to working with emotions: in fact, distress tolerance is a key skill which is taught in Dialectical Behavioral Therapy, developed for treatment of Borderline Personality Disorder.

Controlling emotions does not work as a long term strategy. Knowing that an emotion is a temporary state which can be tolerated, understood and expressed effectively, and learning to simply sit with an emotion with curiosity, openness, and mindful awareness is in itself a worthy therapeutic goal.

I have been rereading an old favourite of mine: A wonderfully wise book by James Hollis, a Jungian analyst and teacher living in the US: “The Middle Passage: From Misery to Meaning in Midlife”. This is a truly remarkable book, and I have referred patients to this and other of his books. Rereading it again, I was reminded about how true it is that we tend to burden the other in our relationships and particularly marriages with the task of making our (often unconscious) dreams come true.  One of the biggest issues in failed marriages is the simmering resentment we eventually experience towards the other because they don’t fulfill that ideal.  This happens when two people  give up on their own individuation in service to the unconscious demand on each other to stay as they are to preserve a particular relationship dynamic.

Individuation is the process of becoming fully our individual, separate selves, with increasing awareness of what is true and real for us, and taking self responsibility for our development as we continue living our lives within the inevitable limits which fate brings. But when we surrender our inner truth to another’s agenda, as is so often required by socially accepted roles and rites in relationships, we do not live our own lives in an examined and aware way, and it often takes a failing relationship, to wake us up.

A relationship crisis can therefore be a first sign of the need to inquire into what is really going on for us. As Mr Hollis reminds us in this book: our intimate relationships can never be better than the relationship we have with ourselves. “All relationships, therefore, are symptomatic of the state of our inner life, and no relationship can be better than our relationship to our own unconscious”(p 47)

I think that these are incredibly true and powerful words: for all our relationships: with intimate others, with family and our own children, with friends and colleagues.

So the ultimate challenge then is to be able to look at ourselves, and ask the hard questions about what is going on inside of us and how it informs our thoughts and feelings, and behaviours , in stead of blaming or shaming the other party, or even(prematurely) severing ties.

Not easy, but possible. Sometimes it takes repeated failures or heartache to force us into doing this work:  when we lose lovers and friends, when we clash with work colleagues, and our relationships with family members and even our own children become fraught with tension, it can be the beginning of our own journey into becoming more self aware, self responsible, more grown-up, more fully ourselves. Ironically it is only when this happens, that we can have good relationships. This is why it is worthwhile to invest time and effort and in the case of therapy, money, into becoming familiar with ourselves, and learning to have a good relationship with ourselves. That is the ultimate gift to ourselves and others.

I have been doing couples therapy for as long as I have been a therapist, and over the years have created a way of working which has had a moderate success rate, using principles taught but also intuited  by years of training and doing the work. I have seen how deeply people long for love: for connection, to be heard and seen and and accepted as they are. That is what emotional nourishment consist of, and what is almost always lacking in a marriage or relationship which is in trouble.  Sometimes it is too late to learn to reconnect: too many hurts, too much distance, too many individual emotional issues which had come in the way. But for couples who can identify the unhappiness or dissatisfaction (which is usually the beginnings of disconnection) in time,  couples counselling can be fruitful and lead to an enriched relationship. This video introduces and explains an effective and well researched approach to working with couples, and shows the direction in which I am developing my further skills as a therapist. This approach fits perfectly with how I have been working, and with how I see relationships and love and connection, and the importance there-of in our lives


http://www.mindbodygreen.com/0-14364/how-to-make-love-last-in-the-age-of-instant-gratification-dr-sue-johnson.html

Most people come into therapy with the wish to “just be happy”. But what does it mean to be happy? And is it even possible to “just be happy”?

On the Self Help shelves in bookstores there is a proliferation of books which guarantee a more successful, better, more fulfilling, but especially happier life. These books reflect our wish for happiness, and our unease with suffering, pain, discomfort, uncertainty.Of course, I am not advocating that we should suffer unnecessarily, nor am I saying that self help books are of no value. But I have to admit: when I see titles making promises that if only a certain number of easy steps are followed, all will be well and you will have found true happiness, my therapist heart sinks. Real suffering requires real inquiry and time spent, with a therapist, finding out what is going on: not a checklist, questionnaire, or twenty positive self affirmations in your mirror every morning.

There are no quick fixes. Of course some issues are more easily resolved, and sometimes reading books and getting information that way can make a huge difference in our understanding and experience of what is going on for us. But usually our unhappiness is there for a reason: whether it is part of a normal response to an abnormal environment or event(such as trauma), and/or whether it rises from within us as a response to our own particular history. Our unhappinesses are usually  unique to our particular lives and requires telling about and inquiring into.This is done best in the presence of another who can hear and see and witness and guide and comment and ask questions, and ultimately help us become aware of what is going on and what is causing us to feel unhappy. Therapy can help us explore and try out new emotional, behavioural, mental: in other words psychological, alternatives, which help us to be normally unhappy, in stead of pathologically unhappy. Freud once famously said: ‘The aim of psychoanalysis is to relieve people of their neurotic unhappiness so that they can be normally unhappy”. I smiled when I read that first, even though at first glance it sounds pretty pessimistic.( Neurosis, by the way, is a general term “applied to a variety of mild disorders or conditions that are characterized by anxiety and phobias that don’t involve any altered senses of reality and don’t effect the entire personality”. http://www.alleydog.com/glossary/definition.php?term=Neuroses#ixzz2RGxTrr2 )

But when we are neurotically unhappy, it means that we are unable, because of unhealthy ways of experiencing our emotions and thoughts, to be resilient in the face of what happens to us in life. In therapy we can learn to inquire into those ways of feeling and thinking and behaving which get in the way of being able to experience if not ecstatic happiness, then an ease of being, or a sense of general wellbeing. In therapy we learn new ways to respond to our inner impulses and outer triggers in ways which enable us to have good relationships with others and ourselves, to feel generally good, calm, resourceful and satisfied, and able to take on the task of growing up and becoming more fully who we are.

This general sense of ease and wellbeing is as good as it gets. Being able to cope with what life throws at us in a way which fits our relationships and personalities and circumstances so that we don’t make the sometimes unavoidable suffering worse, is as good as it gets. Living an aware life, a life in touch with what goes on inside, does not guarantee permanent happiness: it does bring though a sense of self responsibility, of autonomy, and being one’s own person. Not happy shiny always, but alive and responsive to the world.
Original post here: http://ronellehartblogspot.wordpress.com/2013/04/24/as-good-as-it-gets/