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

Working with families

One of the shifts that is implicit in my shift as a clinician moving from individual holistic health to the psychological wellbeing of individuals, is that in the latter it is necessary to consider the person’s environment as an organizing principle. In my work as a homeopath I took into consideration the effects of the environment and the person’s own view of reality and their understanding of their environment and I looked for the underlying organizing principle why they found themselves in that environment. This is a fascinating study and one that can point to many inner organizing themes in the person’s psyche.
Yet in psychotherapy, while working with the individual, it is necessary to pay attention to the family structure – or the lack of that – when striving to bring about health and balance in one’s inner world. In homeopathy I did not consider it to be my role to help my clients understand their family structure and their place in it, nor using that matrix of family bonds in relieving them from their underlying anxieties and discomforts, I merely needed that understanding to bring us to a general understanding of the person’s constitutional makeup.
In therapy the inner experience of the person is dependent on the maintaining factors, the environment. (It is called “maintaining”, when the circumstances cause suffering and as long as the person is in that environment, healing is extremely difficult). Bringing light on an experiential level to the inner workings of these relationships I believe I can be of utmost help as a therapist. It is most often true about people that they are in certain environments and relationships for a reason but in many cases the person is tied in that particular situation and has no option to move out of it. So while keeping it in mind that this person has a larger organizing principle in their life that keeps them in that particular unconscious set up, a way to dissolving that discomfort can be through solving the puzzle in their family environment.
A large group of people for whom this is true are children. This is complicated enough for young children who are stuck in abusive or unhealthy circumstances but I find even more excruciating some of the situations of inner and outer conflict and paradox of adolescent life. Adolescents are on the edge – they are still children but they are budding adults. Several clinicians and authors spent their careers working with adolescents and tried to untie the knots of the complex hardships of transition from childhood to adulthood, in this most active phase of individuation. I find it a rewarding thought as a clinician that I might be able to intervene at this juncture of one’s life.
Adolescents have the mental capacity to see the intricacies of mental emotional and relational (interpersonal) life yet they are operating on the platform of the well-tried and familiar childhood. It is often the very parents who admire their children and want the best for them in becoming healthy adults, who keep them back from making those steps and allowing them to detach from them. It is hard to see a loved one leave. Working with families of adolescents is rewarding as I feel I am allowed into the life of people at this intricate time when one (the parent) needs a little whisper of help to let go and the other (adolescent) needs the whisper of encouragement that it is ok to go.

Importance of mother's state during pregnancy

I have been often wondering why the mother’s state of mind during pregnancy is important when prescribing a homeopathic remedy to a child. I have thought and noticed that if the mother had specific traumatic events during pregnancy it must have affected the child and not only in a straightforward manner but also in a more chronic way. This, I have explained, was due to the fact that the mother had a certain predisposition, which corresponded to the trauma or her state of mind during pregnancy and she ought to display it throughout her mothering, not only during pregnancy, thus affecting the child in his or her very essence. This usually brought under my scrutiny clues to whether or not the child reacted to the mother’s state in any observable manner. I often found it did, so I explored the mother’s disposition during pregnancy, tried to see if it had any elements that were unusual for the mother outside of her pregnancy, and included that in the remedy picture for the child.
While this is still relevant and stands true in my homeopathic thinking, I have noted a connection between the underlying logic of including the mother’s state during pregnancy and the child’s constitutional make up. This came through psychoanalytic explorations of the infant’s psychic development.
According to some psychoanalytic theories, the infant is born into the world without a self-concept. The infant does not know about her limitations, physical boundaries and does not have the concept of predicting or expecting future events, like feeding times, hunger, thirst, pain, digestion, urination. All these events and sensations happen to the infant and together with the environment’s response to these events and sensations, the infant slowly but surely starts to develop its own being and understanding of the world.
The mother (or primary care taker) is a crucial being in the infant’s developing self-concept. This is the person, who responds to the infant’s needs, urges, cries, smiles, and tries to read the infant’s bodily signals, most often in an attending fashion. This care taking, thus plays an essential role in the infant’s development, not only in psychosocial and physical development, but also in the very creation of the infant’s self –image. Taking it one step beyond this actual physical care taking during the initial stages of the infant’s life, the mother, as a container and care taker was there for the infant during the pregnancy as well. The mother was the containing environment the infant (the fetus) was surrounded by, received vital signals of life and well being from, and essentially everything that got absorbed into the infant’s being.
This conceptualization of the origins of the developing self, gave me the missing piece I needed to understand the fundamental reason for inquiring about the mother’s state during the pregnancy. With this frame of reference, I can navigate my way easier in the maze of critical and non-critical information a mother can provide the homeopath during the interview for her child. The mother, as the environment, or container plays a crucial role in the creation of the very matrix of the developing self of the fetus and infant, thus providing clues to the personality and remedy picture of the child through her own inner experience and world of vital sensations.