Wednesday, 30 November 2011

Brilliant Sadness: 'My week with Marilyn'

My week with Marilyn may well turn out to be my favourite film of 2011, and I've seen some all time greats this year.  Michelle Williams' portrayal of the tragic heroine, worshipped and adored but bitterly unhappy and desperately lonely was brilliantly masterful.  I was mesmerised, captivated and transported to the Pinewood Studios and onto the set of Olivier's film The Prince and the Showgirl.

99 minutes passed very quickly, and I found myself pausing to consider for a moment the principal character's pain borne of her double life. 

Only hinted at in the screenplay, Marilyn's childhood was anything but glamorous. Born to a film technician herself afflicted by mental illness, Norma Jean grew up not knowing her father's identity. She was placed in a series of twelve foster homes, and once in an orphanage. Marrying at 16 represented her escape from the care system, and her career took off as a result of some promotional photographs that were taken at the factory she worked at during the war. From factory to photography studio, Norma became Marilyn overnight.

"First I'm trying to convince myself I'm a person. Then, perhaps, I'll convince myself I'm an actress."
Marilyn Monroe

Williams' brilliantly delivered performance was a testament to the journey of a young woman troubled and ravaged by undiagnosed depression and untreated addiction.  The line that she whispers to her co star, 'Shall I be her?  Shall I be Marilyn?' encapsulated the story so simply:  her fans did not know the girl behind the face, nor the sadness underneath the glitz.  It is only in the closing scenes that Olivier finally attests to the fact that he was able to see beneath the facade, and softens as he acknowledges his respect for her work and her inimitable style on set.  Few really knew her, and of those that did, even fewer were able to offer her the tender empathy a little girl lost in a woman's body so desperately craved. 

"I have feelings too. I am still human. All I want is to be loved, for myself."
Marilyn Monroe

Sunday, 27 November 2011

Self Care: Taking Care of Mind and Body

I've been thinking a lot about mindbody or bodymind.  Someone recently asked me what it was that I envisaged holistic treatment to comprise, and I couldn't quite encapsulate my sense of the term as succinctly as I'd like to.  Sometimes, when I leave something to land, the answer emerges organically, and this week provided a timely reminder of that tendency. 

For me, therapy happens in all sorts of ways.  There are therapeutic benefits to a huge variety of activities or pastimes; it is less important what we do to look after ourselves, far more important is whether we remember to make time to do them.  Whilst I spend much of my working week sitting in a therapy room with individuals, couples or families, I appreciate and respect that talking therapy is but one of many ways to address the challenges we face in our lives.

I consider it important, if not vital, that I have my own therapy.  Whilst not all trainings now require it of those seeking to become therapeutically helpful to others, I am glad that I was taught to value the importance of both therapy and supervision and I continue to benefit from both.  It is my hope too, that what helps me, helps my clients.

This week however, I have found myself thinking about self care more generally, and the mindbody aspect resurfaced in my pondering.  Just as I seek to take care of my mind, and my psychological functioning, so too do I seek to maintain my physical body and health.  I do this in different ways, nourishing myself through what I eat and drink, and what I ask and expect from my body in any given day or week.  

I cannot expect all the answers from my therapist, there is work I have to do, and an important part of this is looking after myself between sessions.  My mind and body require equal attention, and must feature prominently in my weekly schedule if I am to achieve anywhere near the required balance to be of service to my clients. 

So, this week I had a massage.  For me, massage is undoubtedly therapeutic.  It may not always be enjoyable, at the time, but the release is restorative and the effects transformative.  I got off the couch feeling an inch taller, and with enhanced clarity.  I had, most importantly, reconnected.  I believe that our bodies quite often hold tension we may not be able to identify or acknowledge, but it is there, and it needs to be addressed, ideally before we become conscious of it.  I don't make an appointment when I'm in dire pain, when I've become immobile; I attend regularly, just as I do therapy.  This ensures that I am fit to work, and in the best possible place to think creatively, and constructively with my clients, without feeling distracted or preoccupied.  In this way, my body may attune to and work alongside my mind, rather than vying for its attention.

Friday, 25 November 2011

The Season to be Jolly? Great Expectations and Glad Tidings

It's that time of year again.  For some, the 'holiday season' is anything but a holiday.  Quite the opposite, in fact.  For those of us in recovery it is often a period during which extra vigilance is called for, and heightened self care essential.

The forthcoming festivities can be challenging regardless for those addressing addiction issues, and unaffected 'civilians' alike.  The advertisements conjure up images of happy families in comfortable, warm homes wanting for nothing.  Everyone is having a wonderful time, and interactions are graceful and joyous.  This isn't a reality many of us can relate to easily.

Financial strains are exacerbated by the pressure to purchase, and the emotional barometer can rise seemingly inexplicably as we operate against a background of expectations, both conscious and unconscious.  I like the definition of expectations as premeditated resentments, or scheduled disappointments.  From this view, they resemble something akin to a form of self injury and have the capacity to prompt considerable distress.  

There is a lot to be said for bringing our expectations into awareness, and then into sharper focus, in order to review their usefulness, before letting go of those which are perhaps merely setting us up for later difficulties.  We establish and hang on to expectations of ourselves, and of other people and tend to create these according to unrealistic standards.  

Evaluating our expectations' utility is a precise science, requiring rigorous honesty, in order that we can ascertain what it is that we are holding on to.  We may then assess their utility, as there is a line at which they become less useful to us, associated with our level of attachment to their ultimate outcome.  Living our lives according to 'If X does this, then I will...' places a great deal at risk, and jeopardises our serenity by inhibiting our all important sense of self efficacy.  Fundamentally, we like to believe that we have a handle on the direction of our lives.  Handing the controls over to others through our expectations is detrimental, and possibly damaging.  It is both a cause and a consequence of our fear and is thus viciously self perpetuating.

By seeing our expectations for what they are, we avail ourselves of an opportunity to invest our energies elsewhere, using them more creatively, to strengthen our relationships rather than our defenses to them.  If we must have expectations, we have a duty to communicate them to those implicated in our fantasies.  Just as most of us lack psychic powers, other people aren't generally terribly effective mind readers.

"I do my thing and you do yours.  I am not in this world to live up to your expectations, and you are not in this world to live up to mine.  
You are you, and I am I, and if by chance we find each other, then it is beautiful.  If not, it can't be helped."   
Gestalt Prayer, Fritz Perls 

"There are two ways to be happy: improve your reality, or lower your expectations."   
Jodi Picoult

Thursday, 24 November 2011

Whose identity is it anyway?

Sitting in the reception of a secondary school recently, I was taken back to my own schooldays and reminded of the uniform regulations and their enforcement.  I wore uniform from the day I started at primary school to the day I finished my A Levels.  There was something comfortable about not having to decide what to wear each day, yet a distinct liberation in changing out of school uniform after the school day had finished. 

"When you put on a uniform there are certain inhibitions that you accept". 
David Dwight Eisenhower (34th US President 1953-61)

Uniform impacts very significantly on our sense of identity.  Wearing something we have not designed, and often not been consulted about, communicates something powerful - representing implicit compliance, and a sign of our belonging to something larger than ourselves.  It is a truth universally acknowledged that some uniforms are more attractive than others.  Some, it would appear, have been devised by a colour blind shapeless entity.  Others are fairly unremarkable.  Often, it is not just the uniform but the way in which it is worn that displays someone's sense of identity.  Some may wear their uniform with pride symbolising something about the relationship with the organisation they represent.  Modification, or destruction of a uniform conveys a message of rebellion, or perhaps discomfort.  

Being dressed in a uniform entails a dual identity - that of being an individual, and being part of a group; an organisation, an institution.  Finding a middle way through the conflict this might entail can be tricky. 


Wednesday, 23 November 2011

Twice in a week...

Last week was unusual.  I don't usually make it to North Greenwich, or more specifically, the 02 Arena, twice in 6 days. 

Rihanna's performance on Monday, when it finally began (she was due on stage at 9pm but did not in fact appear until 9.40pm despite an enthusiastic crowd whose attempts to entice her on earlier were impressive in their tireless creativity) was average.  I'd not seen her live before and am not sure I'd rush to book tickets for a future gig.  She was, I thought, rather half hearted about her performance which represents the halfway mark of her UK and Ireland tour. 

Sitting pretty:  in less than six years Rihanna has sold over 15 million albums and over 45 million singles
Her videos have generated over a billion views on youtube

The ATP World Tour by contrast did not disappoint.  In fact, I'd confess that it easily exceeded my expectations.  The 02 makes the perfect venue for indoor tennis.  The doubles contest was fantastically fought both sides of the net.  Ultimately, the pair that have become known as 'Polish power' demonstrated their entitlement beating Llodra and Zimonjic 6-4, 5-7, 11-9. 

'Polish Power':  Eighth seeds Fytstenberg & Matkowski gained victory beating second seeds Llodra (France) & Zimonjic (Serbia)

Rafael Nadal and Mardy Fish provided gripping entertainment as the end of the weekend approached.  Playing late into the night, the players held the crowd's undivided attention and inspired plentiful audience participation with articulations of support echoing around the Arena.  Captivated, I spent much of the match which lasted nearly 3 hours, on the edge of my seat, holding my breath with amazement and respect for the skill on show.  Their respective talent was challenged to the max, culminating in a hard fought tie break which concluded play at 11:29pm:  Nadal hung out at the baseline and kept Fish away from the net to beat him 6-2, 3-6, 7-6(3). 

Late night victory:  Second seed and last year's finalist Nadal (Spain) defeated eighth seed Mardy Fish (USA). Nadal hit 18 winners and committed 27 unforced errors overall, compared to 35 winners and 50 errors for Fish.

For me, it was my second visit that was all about an art form.  It was quality entertainment, well worth the ticket price, the not inconsiderable journey and the consequent lack of sleep.   

Thursday, 17 November 2011

What's up Doc?

I was pleased to be invited to contribute to Petrie Hoskyn's show on Sunday afternoon in which she was reviewing an article from last weekend's Observer which had been talking about high functioning alcoholics.

I took the opportunity to think some more about the many functioning addicts and alcoholics I have come to know, both personally and professionally.  Functioning addicts look, after all, very much like you and I.  They continue to function and, as Petrie and I were discussing, they often function very well.  In most areas of their life.  But appearances can be deceiving.  To maintain such an appearance consumes a devastating amount of energy.  Which is usually what prompts such an individual to seek help.  It all works very well, until it doesn't. 

The article highlighted the prevalence of alcohol misuse and dependence amongst professionals, particularly doctors and lawyers.  The medical and legal professionals are well known for their fast pace, work hard-play hard ethos and culture.  They are also two of the most difficult fields in which to admit vulnerability, let alone show weakness. 

I have in recent years come to work with increasing numbers of professionals from all walks of life.  I am well versed in assessing those who have become experts in self assessment, self diagnosis and and self medication.  All too often the wheels of disciplinary action and professional standards have started rolling before such individuals approach me and herein lies the problem that is, I believe, common to anyone addressing an addiction issue:  shame.

Shame feeds denial, and denial feeds shame.  Those unfortunate individuals who might come to be recognised as functioning addicts are not, in fact, functioning, except in the art of deception.  They defend the illusory image that they are fine to such an extent that they may even start to believe it themselves.  Denial is self perpetuating and in order to escape their deep sense of shame, functioning addicts go to extraordinary lengths to keep anyone from guessing that they might have a problem. 

The statistics are frightening, but my fear is that they reveal at best a partial truth.  If it is estimated that somewhere between 15 and 24% those in the legal profession have a problematic relationship with alcohol, this may in fact be far higher because were you to take a straw poll standing in Chancery Lane on a Friday night, chances are you wouldn't get many admitting to having any problem with the amount they drink. 

1 in 15 healthcare professionals is said to develop an addiction problem.  The numbers worry me, as it is a population that have an almost pathological inability to seek help.  And not without reason, either.  There is a woefully inadequate provision of specialist support at present.  All too often, professionals who acknowledge their struggle are sent packing.  What is needed is less hype and more substance.  The right substance, of course. 


Sunday, 13 November 2011

The trick is to keep breath-ing

I have upped my pool sessions this week, and found my mind pondering an insight mid-swim I thought might be equally applicable on dry land (and anywhere else, for that matter). 

Ploughing up and down my lane, it dawned on me that there is perhaps truth that discipline pays dividends, and that sometimes short term pleasure is best placed on hold, in favour of long term gain. 

I swim, on average, 3k on most trips to the pool which is, by most people's standards, a moderate distance.  My only enemies are fatigue and lane invaders.  Breathing is my solution to both problems.

Getting into a steady rhythm is absolutely essential if I am to enjoy any time spent in the water.  What I discovered one afternoon this week was the joy of semi solitary swimming, with undisturbed water and only ripples emanating from the lanes of my fellow pool dwellers.  It was in these conditions that the scene was set for a lesson whose importance I later came to fully understand:  establishing a good routine when things are peaceful is the key to managing more difficult circumstances.  A truth perhaps well known to those of us in recovery, where enduring serenity is commonly attributed at least in part to daily discipline and routine. 

As I focused intently on my breath, I was able to enter a different dimension from which it was possible to feel almost at one with the water.  As I swam, I was aware of my movements but I was also attuned to a sense of moving fluidly and without effort through the water.  No two lengths are ever the same, and whilst I would struggle to remember individual portions of my 120 length swim, I would energetically rebuke any suggestion that distance swimming might ever become boring.  Swimming in this way demands a lot more than appearance might attest and dull moments are rare.  I leave the pool feeling refreshed and revived, my energies having been channelled and directed, they return to me. 

Thursday, 10 November 2011

"If you know what I mean?" Well, I might just...

Discussing intuition with some colleagues who share my interest in the neuroscience of the therapeutic encounter proved to be a good way to spend part of my weekend.  We arrived at a definition whose novelty left a lasting impression and caused me to ponder a while longer - is intuition any more than a summing up of past experience.

"Intuition is the clear comprehension of the whole at once."
Johann Kaspar Lavater  (Swiss Theologian, 1741-1801)

"Intuition is the supra-logic that cuts out all the routine processes of thought and leaps straight from the problem to the answer."  Robert Graves (English poet, 1895-1985)

[in-too-ish-uh'n] noun

Immediate knowledge arrived at without inference or the use of conscious reason. 

Intuition provides us with beliefs that we cannot necessarily justify.

Origins:  from the Latin word 'intueri', which is often roughly translated as meaning 'to look inside' or 'to contemplate'.

As we grappled to discern between instinct and intuition, we likened the latter to instant knowledge which caused me to consider those times when a client has casually said 'do you know what I mean?' requesting confirmation of something far more abstract and uncertain than intellectual knowledge - in the question is an invitation to affirm the connection between us, that I might somehow, mysteriously intuit what it is that they seek to alert me to, so that something that perhaps defies description is known to us both. 

I wonder whether such 'intuition' might underlie many of the 'magical' moments in the therapy room as it becomes explicit, as either therapist or client courageously give voice to facets of their internal worlds.  To me, the risk is justified by the dividends I know can result.   

"You have to leave the city of your comfort and go into the wilderness of your intuition. 
What you'll discover will be wonderful. What you'll discover is yourself."
Alan Alda (American actor b. 1936)

"Intuition can often be a far more powerful searchlight than cold reason."
Betty Williams (Nobel Laureate, b. 1943, Belfast)

Wednesday, 9 November 2011

Changes on the Horizon and how to Manage them

I have been offered an opportunity to become involved with a new venture involving the application of my skills and experience in a new and different context:  Change Management.

"Because things are the way they are, things will not stay as they are."
Bertolt Brecht

Whilst exploring the possibility, it occurred to me that the essence might concern managing attitude to change, rather than change itself.  Things change all the time.  There are those things we have a degree of control over, and there are the many we do not.  Of those we do, we may only be able to moderate certain aspects.  I am interested to test my hypothesis that self management lies at the heart of any wider change, and that this might be improved via attitudinal shift. 
"Change before you have to." Jack Welch

The key to any movement within an attitude held either personally, or more widely, is open mindedness.  The degree to which change is realistic is dictated by the willingness of those who will either instigate it or encounter its effects.  Team buy-in is essential. 

From my initial consideration and perusal of the concept, it strikes me that therapy constantly entails effective change management, as unless someone is prepared to change, transformation will wait in the wings without a cue.  Given my own commitment to change, and development, my first step is now to embrace the possibility of branching out into something new.  I can courageously trust the process. 

Tuesday, 8 November 2011

The dawn of Emo-Logic

The ventromedial prefrontal cortex
 "Emotions have taught mankind to reason."  Marquis De Vauvenargues

Until recently, I was suffering under the (perhaps common) misapprehension that emotions and logic occupy two very separate domains.  The Human Brain Colouring Book highlighted my error, as the anatomical region for deductive logic is in fact the site of some of our most implicit human responses.

The right ventromedial prefrontal cortex houses the part of our brain associated with the regulation of the interaction between cognition and affect in the production of empathic responses.  There is also evidence that hedonic, or pleasure responses emanate from this area of our grey matter, which seems to be of central significance to our capacity to assess whether we like or dislike something, a key role in the construction one's self.  It is here that we store our 'somatic markers' - emotional associations, or associations between mental objects and visceral (bodily) feedback, which we use in natural decision making.

....Just goes to show, there's method in the madness some would ascribe to therapy. 

"A mind all logic is like a knife all blade.  It makes the hand bleed that uses it."
Rabindranath Tagore

Monday, 7 November 2011

"Delicious Autumn!" (George Eliot)

The weather has, it seems, finally caught up with the date.  It's got colder.  We're in November, after all.  This time of year holds a very special appeal and evokes a plethora of memories, bringing to mind previous transitions as the nights draw in faster. 

Walking through the fallen leaves caused me to think that whilst Spring is the season most strongly associated with change, there is nothing stopping any of us shedding things we no longer want, or need, at any time of the year. 

"Autumn is a second spring when every leaf is a flower."  Albert Camus

"Winter is an etching, spring a watercolor, summer an oil painting and autumn a mosaic of them all."  Stanley Horowitz

Friday, 4 November 2011

What did it cost you to be you today?

Swiftly adding up my daily coffee, lunch, 'quickly-pop into the second-hand bookshop' tally one afternoon earlier this week, it occurred to me that such a total might represent what it cost to be me that day.  It is quite unlikely that anyone else spent the exact amount of money on exactly the same purchases.  How we spend our money reflects something about ourselves, and speaks of our character, personality, priorities, and identity.  It later dawned on me that we make countless decisions each and every day that 'cost' us something.  With any choice comes a loss, though we might not explicitly conceive of it in these terms. 

"First say to yourself what you would be; and then do what you have to do."  Epictetus

What have the decisions you have made today cost you?  What did they entail today?  What might they entail tomorrow, and looking ahead?  Being 'ourself' whomsoever that might be, entails a cost.  We are constantly shaping ourselves, and making decisions perhaps without even knowing we are doing it - all of our actions and omissions have an impression that lasts beyond the moment in which it occurs.  Unless we attend to this nuanced process, the price we pay for the identity whose evolution we invest in might cost us more than we envisage... 

"Before I can tell my life what I want to do with it, I must listen to my life telling me who I am."
Parker J. Palmer

"Our achievements of today are but the sum total of our thoughts of yesterday. You are today where the thoughts of yesterday have brought you and you will be tomorrow where the thoughts of today take you."
Blaise Pascal

Wednesday, 2 November 2011

Where is the Love?

Working with couples is something of a passion for me.  Even when there’s no passion any more.  In fact, that’s when they’re most likely to turn up.  Working with more than one person in the room is always a challenge.  But the rewards can be very high.  For everyone sitting in a chair. 

Moving forwards does not, for every couple, mean staying together, and rebuilding their relationship.  I have been privy to some very hard decisions and a great many tears have been shed in the room whilst clients have together acknowledged that a relationship has come to the end of the road.  But taking these steps with each other has made the difference.  Whilst, with insight, the relationship cannot continue as it has been, vitally something shifts to enable something to emerge where respect is possible.   
When working with couples, and families, it is imperative that I take risks.  Staying within my own comfort zone is unlikely to help anyone.  I find myself playing difficult cards, and hopping lightly between different, sometimes conflicting roles.  I position myself very precisely, and do so deliberately.  At some points it is useful for me to temporarily join the systems that I am introduced to, at others it may prove vital for me to resist the temptation to do so, in order to retain a bird’s eye view of what it is that is happening.  All the time, I am locating myself in the midst of complex dynamics which may have developed over years.
I have skills at my disposal born of trainings I have undertaken to equip me to work in this way, but above and beyond anything I can read in any book (and there are many excellent books written on working with couples and families), is my felt sense.  Somewhere between the narratives I hear, and my cognitive response to that, is an internal response to what is happening in the room, and this is probably the most useful asset I have.  This is what helps shape my interventions, what I say, and when I say it.  By tuning and in and listening both to what I am being told, but also to what I’m not hearing, I am able to offer myself in service to everyone in the room.  This will often involve holding different opinions, histories and agenda.  To find my way I may have to make difficult observations, ask challenging questions.  My mission is not to provoke, but rather to probe.  Working with couples is rarely a fairytale but an effective therapy may make it possible to cut through scripts authored, edited, continued and replayed by their unhappy characters, so that the story might have a different ending.     
I see my role as witness and facilitator of a process that is unique to the couple.  They hold the roadmap and select their destination, but I may well enable them to see the weather conditions before they get stranded in a snow storm.  Hurt people hurt people, and this is never truer than when things break down with people we have loved.  Attending therapy can bring the temperature down, and diffuse some of the tension that can sway couples off course and cause them to get stuck in anger, resentment and vindictiveness.  By having a safe space in which things can be looked at for what they actually are, rather than what they have been, or may become, truths can emerge and possibilities explored.  One possibility may be that there are numerous truths.