Tuesday, 3 July 2012

Love is a Verb

A colleague of mine recommended the book "The 7 Habits of Highly Effective Families" by Stephen Covey. As a mother of three and wife of one, I'm always interested in anything that is trying to tell me how to improve family relationships and day to day life in general. Not because life is so terrible or because I think we are a particularly dysfunctional family but because family life takes up a lot of space - physically, mentally, and emotionally - and can be a pretty bumpy ride. Ultimately I think I'm looking for reassurance that we are on the right track (at least for some of the time), and also for ideas on how to make the journey smoother.  

So I have decided that this book will be my non-fiction summer read and have only just started but one line has already grabbed my attention; Love is a verb. How true and obvious this may seem and yet, mostly we talk about love as a feeling, something that we have no control over but that just happens to us. I do think that some love does just happen to us and is biologically determined. I'm thinking of infatuation and falling in love. Nobody who has experienced this could deny that it is a feeling, it's powerful and we have no control over it. I think that another biologically determined love can hit us when we become parents, a love born out of instinct to protect and nurture a small human being placed in our care. The thing is that these kind of instinctive and biological loves don't always happen when we want them to and they can fluctuate, sometimes diminish, unless we also make the choice to love. Love as a feeling, however powerful, only becomes meaningful in action.

It would be a shame to be cynical about the feeling of love since it is such a positive and energising phenomenon but in some ways I find it quite liberating to think of love as a choice. If we relied on the feeling of love to keep our relationships going, I think we would set ourselves up for failure. Nobody can always feel love for the people they love. We can always choose to act lovingly though (however hard it may seem at the time!) and acting lovingly in turn will feed and nurture feelings of love. Unfortunately we seem to live in a society which places an unhealthy emphasis on love as an automatic emotion and this creates unrealistic expectations of what it means to be, and stay, in loving relationships. Most obviously this causes difficulties in romantic relationships as once the infatuation stage is over and the power of biology (the drive to have sex with the other person!) no longer sustains the bond, we begin to think that there is something wrong. On that note, I think that the infatuation stage is a highly narcissistic phase in which what you actually love is not the other person but yourself seen through their eyes. In other words, how being with them makes you feel about you. Like someone holding up a mirror that only shows all your positive characteristics. How wonderful and reinforcing that is and no wonder coming out of this phase can be so painful (often forced when you start living together) and the mirror starts to reflect all those hangups and insecurities that we all carry around and take with us in to our relationships, only to be revealed once we are attached enough to let our guard down. That is what makes the act of loving so rewarding though; it opens up the possibility of loving and being loved in spite of our hangups and insecurities. It is also through these relationships and the mirrors they hold up that we can fully discover ourselves, learn and grow as individuals - hopefully shedding a few hangups along the way!

Romantic relationships aside, I think that an expectation of automatic and uncontrollable loving feelings can also cause unnecessary pain and feelings of guilt in parents who may not feel instant love for their child. It doesn't make them bad parents but if they think it does it may impact on their ability to love their child as they will be more at risk of 'opting out' and believing that they haven't got what it takes. Sometimes it takes time to love and the more you do it the easier it gets. Love is a verb.  

Saturday, 9 June 2012

Cosmetically Defected

Around this time every year I am reminded of carrying a specific cosmetic disposition. As the sun comes out and my unaffected skin starts to tan, my Vitiligo becomes more pronounced. I was diagnosed about 12 years ago and have no idea what triggered its onset, though as the psychologist I am, I have my suspicion that a few turbulent years, largely seemingly unaffecting me mentally/emotionally, found another way to make themselves known; through my skin. I am in no doubt that what doesn't manifest in the mind and soul will do so through the body. Vitiligo is simply a non harmful but permanent and progressive condition with the only symptom being depigmentation of the skin. Little is generally known about the condition in terms of causes. Genetics play a part (though I don't know of anyone in my family who is or was affected) and there is also a link to other autoimmune disorders.

I rarely think about my condition these days and have never before tried any treatments as they are often time consuming and have a low success rate. I guess for the majority of the time I don't even 'see' the patches. Nor does my family and the only people who will pass comment or ask questions are the children's friends. There is nothing like innocent and genuine curiosity! Having said that, at this time of year the patches bother me and make me feel self conscious. In early summer there is always the discovery of more white patches and I go through a phase of thinking more about it and wondering whether any medical advances have been made. Usually I don't get any further than that but this year I have and as a result I am now trying a new cream. And of course I am hoping it will work but at the same time I feel a little guilty about spending tax payers' money (this cream is apparently very expensive) on something that is in essence a beauty treatment. It is hard also to know where to draw the line between what is just shallow vanity and what is an acceptable level of care for one's appearance. 

This little dilemma has reminded me of a course on self-esteem I went on a few years ago. According to research that the speaker referred to, someone's feelings about their appearance is the one single factor that affects self-esteem more than any other factor on its own. Fairly disappointing results in a way since many of us would probably like to think that beauty runs deeper than the skin and what really matters are aspects of life that have little to do with how we look. At the same time these results go a long way in explaining the huge, and still growing, industry around fashion, youth, and beauty. We all want to feel good about ourselves and clearly how we feel about our looks is a strong factor in determining our self-esteem overall. Maybe the problem is not so much that we care about beauty but that we seem to lack the ability to widen our perspective on what is beautiful. Many of us fail to appreciate the beauty of an old woman's wrinkly face where each line tells a story of the life she has lived. Or we find it hard to appreciate and accept that sagging breasts look the way they do because they fulfilled the vital and beautiful task of feeding children. Wouldn't it be great if we could somehow reverse our ideals? We all want long lives, filled with interesting and exciting experiences, and yet we don't want it to show in our faces or bodies. We want the tan but not the wrinkles. Luckily we are moving in the right direction and getting closer to having it all. Maybe it starts with cream for white patches and ends with boob jobs and tummy tucks. Watch this space...  

Thursday, 24 May 2012

The Sound of Silence

As per the Myers Briggs Type Indicator (MBTI), I am an extrovert. This means that I am energised by interacting with others. People who have a preference for extroversion are more likely to 'come alive' when in company and find socialising fairly effortless. We are often low in energy first thing in the morning but gradually feel more alert as we start to interact with people and become involved in communication. According to the MBTI, extroverts are also more noise tolerant than introverts, and can happily work with the TV/radio on in the background. Based on this I think it is fair to say that we live in a world (at least in the west) that favours the extrovert personality type. We are all about communication in every shape and form and for many of us times of reflection and silence are a rare occurrence, and possibly not even something that we really value or see the point of. Despite this, some of the most important interaction happens in silence. An estimated 93% of human communication is non-verbal!

Also, silence plays an important role in psychological therapies. A bit paradoxical as psychotherapy is often referred to as 'the talking cure'. But it is during the silences that the reflection and insight happen. It is also in moments of silence that the therapist can reflect on what is going on and access their internal supervisor. Sometimes these silences can be uncomfortable but then that tells you something too. The task is to figure out what! 

Of course, affection, eye contact, and silence as a therapeutic intervention, still refer to interaction with others and maybe what many of us really neglect, even avoid, is time to be with ourselves. Personally, I know that this is something that I am guilty of. I tend to fill my life and time with people and rarely have moments of silence when I am just with myself. The iphone is a great help! I can be in constant contact through a whole range of means; email, text, phone, Linkedin and Facebook. Never a dull moment. Being the extrovert, this is not really that difficult and doesn't necessarily feel stressful. I think it probably is though. And of course, the MBTI was invented and designed when the options for communication and staying in touch were somewhat more limited.  I'm not sure that any extrovert is able to interact continuously through their waking life without at some point suffering the consequences in the form of stress. A kind of stress that stems from never knowing when the next text, phone call, email, fb comment or friend request is coming your way, followed by a feeling that a response should be near enough immediate - because it can be, not because it is urgent. These frequent interruptions do not just take us away from what we might be in the middle of doing, they also interrupt and interfere with our thoughts. 

I did a course in Mindfulness last year and what I really enjoyed in the sessions was to be able to have uninterrupted thought processes. (I know that that is not really the point of Mindfulness as when doing it 'correctly' you are not supposed to follow your thoughts but rather just notice them whilst bringing your mind back to the present moment). I realised that I live in a state of almost constant anticipation of the next interaction, planned or unplanned. Some of that I'm sure, is due to having young children and therefore expecting to be interrupted at, pretty much, any time. But I don't think that is the whole story. It's all the remote stuff, all the people you are not actually with. Those who you are not having eye contact with or getting a hug from. Those interactions that rely on words. It's like the silence that never happens, even after the friends have gone home and the children to bed.

And yet, I do find it amazing that it is possible, and really quite special to be in contact with all these people and would not want to be without that. But even more special is being able to be with others in silence. It seems that this is only really possible if you are either with people you are very close to or in a group situation where silence is part of an agreed format. I love the times when all five of us travel in the car, in silence, everyone in their own little world but together at the same time. Until the iphone beeps/rings/vibrates and reminds us that there is a whole world out there. A world that needs me - NOW!

Wednesday, 9 May 2012

Faith and Fishing

I'm lucky to be a member of a film club as cinema trips and a young family is not a match made in heaven and occasionally it's nice to see a movie for and about adults. Last week we saw "Salmon Fishing in The Yemen" with Ewan Macgregor and Kristin Scott Thomas (she was brilliant!). Essentially this was a film about believing in and pursuing an idea that at first glance and at face value appears ludicrous, even immoral. A rich sheik with a love for salmon fishing decides that he wants to transport and plant 10000 fish in man made waters in the middle of the desert. An idea that could be seen as indulgent, hubris laden, lacking in cultural and ethnic consideration. The sheik needless to say comes up against a lot of resistance but continues to believe in his dream and the pursuit of making it real. His hope, apart from being able to indulge his passion on home ground, is to bring east and west closer through this totally OTT project. He talks about fishing as a hobby based on faith, not knowledge. To be a successful fisherman requires faith and patience. You don't know if and when you might get a catch but yet, passionate fishermen will stand in waters for hours waiting and believing that eventually they will strike lucky. Why else would they stand there? Of course some knowledge about salmon, their habits and habitat, the right equipment and bait form a basis for success. But once these things are in place, faith and patience are what is left. Without these attributes having the right equipment becomes redundant. It made me think about psychotherapy and how in some ways it is a bit like fishing. 

Within psychology, a lot of time and effort has been spent on establishing the discipline as a science. During my years at university there was a huge emphasis placed on adopting a 100% scientific approach to what we were being taught. At times it almost felt a bit defensive. And maybe that's the problem. Of course psychology is a science if we by that means the observation, identification, description, experimental investigation, and theoretical explanation of phenomena. We should not feel the need to defend the right of psychology to have scientific status. But we need to move beyond this in the way we apply psychological knowledge as therapeutic practitioners and accept that human processes cannot be explained through a number of theories and formulas. There might always be another variable, hidden from the conscious mind of both the client and the therapist! This means that the same therapeutic intervention will have very different outcomes depending on a number of factors, many of which we will never fully understand. I used to think that one day I would find 'my approach' and kept searching through various courses and CPD events, for this one method that would become my treatment of choice. And don't get me wrong, I have learnt a lot through my searching and some training has been life changing in terms of how I practise (e.g. becoming trained in the application of EMDR). But the more I practise and the more people I meet, the more I'm coming to the realisation that therapy is a process combining science and art, and as such there is no 'one fits all' model for affecting and healing psychological distress. Psychotherapy at its core is about applying scientific knowledge to a process that largely can not be explained scientifically; namely the therapeutic relationship. This requires faith in the power of the relationship and its ability to affect change. Sometimes change happens very quickly, sometimes it takes a long time and it is almost impossible to predict at the beginning which it is going to be. I still struggle with this from time to time, the not knowing what is coming and constantly having to think on my feet, not being able to quantify the elements that make up a successful therapeutic intervention. At times I even feel as if I didn't really do anything.

And yet, it is the lack of certainty and the uniqueness of each individual's journey that make the change, sometimes unexpected when it occurs, so much more exciting to witness. Each time this happens it feels as though it was worth the wait and the sessions when nothing seemed to shift. And I guess that is why we do it, because we believe in the possibility of change, even when it takes time and despite not being able to fully explain or understand the processes underpinning it.   

Thursday, 26 April 2012

Mothers and Daughters

"All women become like their mothers. That's their tragedy. No man does. That's his." (Oscar Wilde)

I am a daughter of a mother and a mother of a daughter. Two of the most important relationships in my life. My mother brings out the best and the worst in me and I believe I do the same to my daughter. As a girl and woman there is something about your relationship with your mother that is highly ambivalent. At one point your life literally depended on her, this is then followed by years of working towards becoming independent from her. Often a struggle for both mother and daughter. How many people haven't you heard say that teenage daughters are much more challenging than teenage boys? When you are born, dependence on the mother is necessary for your development and she is the centre of your world. Little girls are often in awe of their mother and are likely to idealise her. I am frequently being intensely and uncritically observed by my daughter as I get dressed, put make up on, cook, write, or chat with my friends. But I am under no illusion, in a few years this will be replaced by a highly critical attitude where I can do nothing right and on the whole will be seen as right down embarrassing. As you grow up, independence of your mother becomes necessary for healthy and successful development into adulthood. This means that when you are sixteen, the thought of becoming like your mother fills you with dread and every effort is often made not to be like her. It's like you somehow have to reject the whole lot before being able to accept and make your own, the aspects of your mother that are also part of your own personality. Some process!

For me the first stage was easy, both in my role as daughter and in my role as mother. The second part feels so much more complex. I think this may be particularly so for women as opposed to men. Boys seem more likely to grow up, separate from their mum and move on. That's not to say that they can't have a close relationship with her! However, for us girls I think our mothers tend to continue to have a much more significant role in our lives (maybe especially when we become mothers ourselves).   She often continues to be our primary role model and someone we are likely to continue to compare ourselves with. This is a source of pleasure and pain and most likely a life long condition.

As a mother of a young girl I find it hard to get the balance right between acknowledging and empathising with characteristics in my daughter that I see in myself, but without over emphasising our similarities as this could lead to over identification and enmeshment (when two or more people's identity are too tightly wrapped together, preventing them from emotional separateness). It feels like such a big responsibility to know that I'm her primary role model, and as such has a lot of indirect power over how she develops her sense of self. Similarly I sometimes still (!) struggle to 'hold my own' towards, and be emotionally independent  from, my mother. And yes, that is after about a hundred hours of therapy! Which brings me to my next point; it really is no myth that the mother has significant presence in psychological therapy. There are a number of various types of 'symptoms' that seem to figure in the dysfunctional mother/daughter relationships, including over identification and enmeshment, over dependence, unexpressed and expressed anger, jealousy and rivalry, to name but a few.

In some ways I think it boils down to being able to love the child just as she is,  without projecting our own expectations and wishes and in the process fail to see and meet the needs of the person as she really is. Daughters are probably more vulnerable than sons in this respect, as subconsciously we are less likely to compare and identify with boys to the same extent. I think mothers of daughters need to be extra conscious of what is them and what is their daughter in order to enable the daughter to grow up and be her own separate individual. This takes a mother who has a lot of self-insight and is confident in her own right. Someone who doesn't seek affirmation from her daughter or needs her to be in a certain way in order to feel validated. Someone who is happy to be close to, and proud of, their daughter without feeling the need to see their own reflection in her. An ongoing functional relationship also requires a daughter who is willing to accept her mother as less than ideal, whilst at the same time recognising and appreciating that in all likelihood, she did the best that she could based on what was available to her at any given moment in time.

Now THAT is what I call a sales pitch for psychotherapy!

Monday, 16 April 2012

Modesty Above All

I live in Scotland. And love it. The weather may leave a lot to ask for (as I write this it is 3 degrees and snowing outside!), but on the whole I think this country is beautiful, has integrity, and is populated by people who are kind hearted and possess a fantastic sense of humour. However, after living and practising in this country for eight years I have become very familiar with a seemingly culturally determined psychological phenomenon which at times can be frustrating; Scottish people find praise unsettling. Delivering it and receiving it. This also applies to any form of self approval which could - God forbid - mean that you might be proud of yourself. There is a real fear of coming across as showing off or being boastful. Unfortunately I think that this fear at times leads to one neglecting one's own and others' need for affirmation and recognition, which in turn impacts negatively on confidence and feeds a kind of 'not good enough' mentality. As a people the Scots lack confidence. On a larger scale this has implications for the country's lack of belief in their ability to be an independent nation. The absence of a 'winner's attitude' also appears to have a negative impact in the context of sport (no names!). 

On an individual level I am often struck by the extent to which people suffer from low self-esteem. I'm aware that my view may be influenced by seeing this through a clinician's eyes, working with a population who are struggling in some way. However, I do believe that there is something about the way in which Scottish people have been brought up that predisposes them to low self-esteem. There is a strong emphasis on learning to 'get on with it', life is hard and the sooner you get used to that the better. I think that for generations this has served as a sort of protective attitude whereby people learn to be realistic, not expecting too much and  hence reducing the risk of disappointment. I'm not sure it has the desired effect. When life gets tough we feel disappointed, possibly even gutted . This is a natural response and not one that can be avoided through some sort of 'hardening' treatment. On the contrary, it is through accepting our feelings of disappointment, whilst  knowing and believing in our ability to get through the hard times, that we can be successful in the face of adversity.  Simply pretending that we are immune to disappointment will only leave us with a feeling of resignation and the belief that we need to lower our expectations even further. Not exactly a winner's attitude! 

The 'hardening' philosophy (which I'm sure exists not only in Scotland and is also not the only style present in Scotland!) manifests itself through a very non-indulgent parenting style where good behaviour brings a neutral or no response, and 'bad' behaviour an overly negative response. When children are not brought up to take pride in themselves and who they are or what they achieve, it has a negative impact on their sense of self and self-esteem. This in turn has a direct effect on their ability to cope when life gets tough, as self-esteem  lies at the heart of resilience; people with low self-esteem are less psychologically resilient.  As parents and adults we can bring the next generation up to be confident and resilient, not through protecting them from disappointment, but by encouraging them to express their disappointment, validating their feelings, and helping them to develop positive coping skills. Expressing our own pride, in ourselves and others, would seem like a good starting point. But then, that could be interpreted as boasting.

Tuesday, 3 April 2012

A Professional Lifeline

My job is interesting. And surprisingly to some people, I don't always find my work difficult, and I don't usually find it hard to leave it behind mentally or emotionally at the end of the day. Most of the time. Yesterday was different. By lunch time I had felt anger towards a client (something that brings up all sorts of issues around transference and counter transference), phoned a GP to notify of another client's suicide risk, and been told by an employer that they were no longer going to fund treatment for someone who in my mind really needs and benefits from the sessions here but has no means of paying for them themselves.

It was with relief and positive anticipation that I sat down to join in our group supervision session yesterday evening. Once a month the five of us who work clinically at The Keil Centre, meet together with an external psychologist for clinical supervision. It's a fairly informal event and we take turns in bringing 'material' to discuss. For me clinical supervision serves as a kind of professional lifeline. It offers the opportunity to reflect on cases and clients in depth, to explore my own feelings and reactions in relation to the issues clients bring, and to further my skills and techniques as a practitioner. All in a supportive and nonjudgmental setting. In many ways the process of supervision mimics the process of therapy. The supervisor's role is to facilitate, guide and support professional and personal development and learning. I say 'personal' because I think that in our job it is not possible to develop professionally without developing on a personal level too. At the end of the day, our biggest asset in doing our job is ourselves. Of course we need theories and techniques but without an ability to ground these in ourselves and make them 'our own', we are unlikely to be able to apply them effectively with clients, as the basis for all successful therapy lies in the therapeutic relationship between the therapist and the individual.  

I would suggest that this is true for many professionals where the main objective involves facilitating healing, growth and learning. I'm thinking of professions such as teachers, social workers, medical doctors, nurses, and care assistants. The basis for successfully being able to help people, whether teaching children to read or treating patients for medical conditions, is a trusting relationship built on mutual respect and an understanding of what each party brings to the process. Sometimes a strong emphasis on the teacher-pupil/expert-patient dynamic gets in the way of optimal learning/treatment because it stops us from meeting people where they are, leading to gaps in the perception of where they should be and how to get there. In order for us to meet people where they are, we as professionals, need to be aware of, and comfortable with, our own vulnerabilities and limitations.  Professional/Clinical Supervision is an effective tool in enabling reflective practise which limits the extent to which our own 'stuff' gets in the way of meeting people where they are, maximising our ability to deliver what we set out to deliver, whether in the field of teaching or medicine. In addition, supervision plays the very important role of offering support and building resilience. As most of my work is carried out on a one to one, it can be a lonely place to be professionally. Nobody actually sees what you do (apart from the client) and supervision is as close as it gets to colleagues gaining an insight into how you work. This can be challenging and revealing but also very affirming. There is something very powerful about sharing with, and listening to, others (but then I would say that!). It has an energising effect and that energy strengthens coping. In short I would say that it is often through clinical supervision that I am reminded of why I do the job that I do. And it really is a very interesting job.