Defenses

Our best strengths that help us achieve in life are at the same time our worst enemies and most painful weaknesses. Why is that?
In homeopathic case taking I listen to the person's experiences in life and the way they describe these. Often it is clear that the same patterns that create the helpful, positive, unique strength in the person in one end of the spectrum, in one extreme, the same pattern is recognizable at the other end of the spectrum where the person is struggling with the same patterns, qualities, experiences. while the pattern is the same, it can be helpful in one extreme and unhelpful in the other extreme. I think that in psychotherapy we see these as the person's defenses. These are behaviors, patterns, unconscious anxieties and drives that makes the person move and act and protect himself. On the other hand, the same person cannot shed this pattern and behave well other times. The same pattern will create the negative and the unpleasant, as well as the passionate and creative behaviors.

Mindfulness

In discussion with Renee, a Mindfulness therapist in Palo Alto, the question arose about the here-and-now nature of Mindfulness techniques in therapy and the issues that tend to come up in therapy about the patient who names tendencies, recurrent patterns of thinking that are unhealthy and as such the therapist would aim to help the patient create a new, healthier narrative to their story. Often, psychodynamic therapists would explore with the patient the history of the thoughts and shed light onto the unconscious patterns that govern those conscious troubling thoughts. I appreciated Renee's thinking about this issue: the exploration of the patient's mind and body in the here and now sets the stage, creates the space that is needed for the unconscious to find its way to the surface and be cleared off. This way, instead of thinking with the thinking mind about the unconscious, the body gets involved and finding the calm, relaxed state of the unthinking mind allows the contents of the unconscious to surface and clear. The issue can be named, and the body can be invited to access the underlying thinking patterns, taking the thinking out of the equation and allowing the process to happen.
For me, at this juncture the body-mind modalities meet and allow the space to open up in a very real, authentic, close-to-home way. Focusing and Mindfulness techniques are wonderful tools to access the below  the conscious layers.

The story the body tells us as it moves around in the consulting room

The other day  a psychotherapist friend shared a story about one of his patients who came for a session and she talked openly with him but while showed good insight, had peculiar behaviors, like straightening the tissue box on the table, moving her chair and then rearranging the position of the ottoman at her feet. Not only these but she then got up and rearranged the curtain, covering a different part of the window. The therapist observed these actions and when the patient shared that her loved ones have been complaining about her controlling nature, the therapist knew exactly how they felt. The patient seemed completely unaware that her actions of manipulating the environment to her taste and satisfaction seemed like a controlling behavior to others. The therapist shared this story with me as he was wondering what went wrong in this session as his patient did not return anymore after this visit. He concluded that in his comments he “fell for” this patient’s story of being controlling. He, too, just as the patient’s friends and family, assumed that the patient was controlling her environment, manipulating its pieces into a situation that suits her needs, according to her logic without questioning others’ needs and stance. He wondered with me, what would have been a more clinically correct response from his end in this situation. He thought the issue was deeper seated than a control issue but he did not realize it during the session and he felt he got sucked into the interplay this patient has been manifesting with so many other people in her life.

This story made me think of my homeopathic case taking technique, where I follow the person’s body language, not only the hand gestures but also the body’s physical manifestations of the person’s disharmony. I take this therapy patient was showing something with her gestures, actions. In a non-directive case taking method one would have wondered with curiosity what she was doing. Without the judgment that her actions were driven by and leading to a sense of control, one could ask her about the actual actions: “I noticed that you moved those pieces of furniture”… “Tell me more about your thinking and feelings around closing the curtains….” While the person might even come to the conclusion that they want it according to their control, I would even question that: “Please describe that need. What is that about?”

In all situations we tell the underlying story with our word choice and actions. And as I learned in the sensation method case taking, the most relevant part of the story telling is when the words don’t match the story being told. When the body language and actions and behaviors are peculiar. These are the most important times to be non-judgmental, and not only asking this from ourselves but also our patients: do not assume that you do an action because you have been told endless times by your relatives you were controlling. A patient might come to see us and say that their relatives demanded they seek therapy for their controlling behaviors and while the patient on the surface disagrees with these statements, they have internalized this understanding to the degree that they display and judge their own actions as controlling. Yes, if we are curious enough, we can find a gold mine of depth and new understanding beyond the doors that are opened up by simple actions like moving a tissue box in our office.

A blog entry about work at a high school

This was a blog entry at the Adolescent Counseling Services blog on 2/13/2012

By: Ildiko Ran
On-Campus Counseling Program Intern at Menlo-Atherton High School

“I feel so much better that I got all that off my chest. I can go back to class now” – said one of my clients after a session when she unloaded the overwhelming stress that surrounds her everyday life. She keeps up the appearances, her impeccable school performance and her friendships, yet she appreciates the oasis, the safe place where she can be truly herself, which she found in this unexpected place: my quiet office nested among the busy guidance counselors’ offices.

I started as a trainee at Menlo Atherton High School in 2010 and returned for a second year as an intern. I love working with teenagers and the diverse population of this school has given me ample opportunity to see and work through many different problems and circumstances with teens and their families.

Working with teenagers is a challenge that can be greatly rewarding: their everyday experience is on the verge between childhood and adulthood – if they feel lost, it can be devastating for them and their families. When counselors listen to them without an agenda other than keeping them safe and helping them finding their own way, it can be an empowering experience for teens. I appreciate the opportunity that I can provide this service to my clients day after day.

As an ACS counselor, I fill up most of my days seeing clients, who come weekly for several months, some for the whole school year. In fact I have two students who decided to continue with me for the second consecutive year. There is also ample opportunity in our on-campus work to check in with students who are in various crisis situations – suicidal thoughts, angry outbursts, urge to run away from home, or being devastated over a loss of a loved one– are among situation I have dealt with in the past year.

As part of the teens’ treatment I usually meet with their parents a couple of times. These meetings are very different from the sessions with the teens: it includes psycho-education and parenting information. In exchange for their insights about their children, I encourage them to continue parenting with the love they feel, armored with some understanding of their adolescents’ needs.

Our ACS office doors are always open (when we are not sitting in session with clients), so students are familiar with the ACS counselors. “No, it is not mandated. No, it is not punishment. It is your decision to show up. Once you commit to it, the only way to make it work if you are serious about it.” – I often repeat these cautions and clarifications.

I enjoy seeing my clients engaged in their sessions, taking it seriously, appreciating the time they spend thinking about their own feelings, thoughts and actions, in an honest, open way. Teenagers call us adults out on our phony behaviors and in return they really appreciate when we do the same for them. Not only am I happy to see that I can be helpful for my students but sometimes I sense an inward smiley feeling that I have honored my own high school teachers and counselors who did just that for me – genuine, respectful relating. Teens can do wonders with it.

Ildiko interns with Adolescent Counseling Services’ On-Campus Counseling Program. Through this program, ACS provides free counseling to students and their family members at 9 schools in Santa Clara and San Mateo Counties.

For more information about the On-Campus Counseling Program, please visit our website: http://www.acs-teens.org/programs/campus_counseling.php

Core work

The Pilates and yoga world talks about the core as a fundamental element of the health of the human body. In yogic tradition the bandhas are the energetic equivalent to the core, and in Pilates one focuses on the inner muscles that underlie the superficial ones and have essential role in the healthy holding of the body and containing the inner organs. The whole body’s alignment and ability to move in an effective and sustainable way depends on this core. When you work out, practice asanas in yoga or strengthen your core muscles in Pilates, you are working on this core.
In psychoanalytic therapy there is something very similar happening. Dependent on the health of the structure of the psyche- - just as dependent on your body’s health in physical exercise – you will need to recreate the structure by recognizing, finding, strengthening and maintaining your core, your inner self. Throughout our lives we have gone through many experiences that have had strong impact on us. These impacts shape our core understanding of who we are. Who we are is in relation to others. Thus others, or the outside environment affects who we are at our core. This core develops throughout our lives, some stages of life having more permanent effects and some less important or less lasting ones.
About the psychic core it is said that it has been influenced a great deal in early childhood when our original interpersonal patterns were shaped, formed, molded and established. This can happen later in life as well, especially if we go through some traumatic influences. These traumas - whether in the word’s most often used sense, when something traumatic happened to us, but it is also true for other, major influences that leave permanent marks on us.
Again, the parallel with the physical body, we can say that our physical build gets created and recreated by such events as playing a certain sport or musical instrument for an extended period of time, or using our body regularly in a certain way, like driving. For women pregnancy, childbirth and breastfeeding can have similar long lasting effects on their bodies. The examples are endless and they surround us all the time.
The same way it happens to our inner psychic core as well. It gets molded and shaped throughout life’s interpersonal experiences. We internalize and process those experiences and some of them stay with us as our own.
The process of psychotherapy – as I see it – is a process similar to a Pilates or yoga training. The instructor – or the therapist – looks very closely at the minute manifestations of the person’s inner workings. We listen, or look, and observe. Soon a picture of manifestations clarifies a view of the inner core, and the therapist takes that inner core and helps the client rearrange their view of reality in a way that will be healthier, will induce less suffering and will clear the way to free flow of psychic energy, libido – as some call it – or the person’s capacity to live a fuller life.
The core of the personality is that inner container that needs to be strong enough to maintain its essential ingredients, on which the outer manifestations depend. These are not only the person’s behaviors, thought and actions, but their very details of their personality and interpersonal communications. The work is done at this core level. When it is out of alignment, it causes many unhealthy manifestations, and the process of bringing it back to alignment needs to be very gentle, precise and nonjudgmental. That is the only way that its well established ways will allow to loosen up, to shift and to heal.

The homeopathic principle

The homeopathic principle states that an organism is trying to express, or excel it's dysfunction. The best way to help this effort is to aid the process of expressing or excelling. If the body is trying to get rid of some poison (in food poisoning), the best remedy that one can offer to the person is something that will aide the excelling process, i.e. something that will take over the body's effort to expell the disturbing substance and as a result will give the opportunity to relax and recover for the body.
The other day I was thinking that psychodynamic therapy is very much in line with this thinking. There are psychotherapies that are more aligned wit the allopathic thinking, which is based on the theory that the problem needs to be fixed, stopped, cleared up. While the intention is good, and is often effective, the medications stop the body's (and mind's) natural process of elimination. They go against, they fight the body (and the mind and the person). They prove the body (mind, person) wrong and they teach the body (.., ...) how to do it better, how to be more effective. While it is a fine idea to do this, this often meets resistance in the person. In the body. In the mind.
The idea in homeopathy is well documented and I do not intend to recite that theory. For me this is a new idea when it is translated into the world of psychotherapy:
the approach in psychotherapy I am prone to is an expression of the individual, a ways of finding the root cause of the problem in the very experience of the person. While the therapist is encouraging the patient to talk about their view of their problem, their relationships and their experiences, these form some themes for the person. Their unconscious experience is coming to the surface in some form of conscious manifestation. It is not always a solution per se to the problems the person is facing. it is often a revisiting process of one's experience, a retelling of one's stories and in this process of expression one finds the healing, the reorganization of the unconscious self experience into a more balanced self image. Healing happens, as in homeopathic theories, through this expression of one's imbalance. The sheer telling of the story in a therapeutic environment and in the presence of the expert guidance of a therapist the story, the expression transforms into the vehicle of healing.
This is in parallel with homeopathic theory and the same forces are seen in action. In this lies the body's and mind's own self-healing power. The encouragement for expression is the key to healing. The faith in the process is the art of the therapist.

Grounding the relationship

Bodily sensations and the work focusing around these can keep the “talk therapy” wonderfully grounded. Most often patients seeking psychotherapeutic help don’t expect to do anything but think hard and build theories that will explain their turmoil and sorrow. A big part of a therapist’s job is to calm down this expectation and allow some space for some relaxed mindful work to take place. The unconscious part of the work is really important, it is like the soil feeding the conscious mind. If the soil is rich and has the capacity to provide nurturance it creates the potential for growth and healthy being. But more often than not when we try really hard to help ourselves to feel better, we create more constriction and obstacle to a healthy flow of consciousness. I have found that even if the patient is not yet ready to focus on their bodily sensations and their whole-body state (instead of purely thinking mode), my focus on my bodiy awareness of the situation is often calming and centering. The soil is created by my awareness of the situation and the plant is allowed to grow. It is first an observation where patient and therapist discuss the looks and qualities of the plant. Then, while I am holding the space for the soil to be recognized, the patient will gradually become more aware of its existence and then will join me in admiring it, feeling it, sensing it, and eventually exploring it on an experiential level. This is a process that I wish to embrace and nurture this year in my work. I invite you to join in. I am looking forward to an abundance of interaction with people who find this work fascinating, on any level – email exchanges, forums and personal interactions. Please do stay or get in touch!
Ildiko
Ildiko@innerexperience.com