or Ruling the bends: authorising ourselves to practice
In this post, guest writer Emily Brookes, and Dr Russel Ayling discuss Emily’s experience of ‘bending the rules’, and Russel’s re-thinking of this idea: understanding our bentness, perhaps, or rather, ‘ruling our bends’.
The more I have talked to my psychology friends the more I have come to understand that we all do things professionally that we wouldn’t mention in a job interview. I think it’s fair to say that we all mess up at some point. Perhaps we forget a vital piece of information or maybe we mix up a client’s story with someone else’s. I’m sure that every therapist reading this could, with enough time, recall their own blooper. The intention of this post however, is to go past discussing the common yet forgivable mistake. Rather, my aim is to take what I believe to be a brave step. I wish to discuss some of those things which I would never disclose in a job interview, yet which I do or don’t do on purpose.
I’ll join you in this, Emily, by writing in red. Think of it like a confessional, and me like your psychoanalytic priest-cum-supervisor that you never had. Not that I’m into reparenting …
There are times when it feels like I’m the odd one out. It’s like there are a set of rules or practices that everyone else agrees with and understands that I just don’t get. I feel fuzzy-headed with them. Sometimes it seems like everyone else has read some sort of seminal handbook and I missed the memo. I spoke to a trusted friend and colleague, B, about it. “Maybe” she said, “since you take a pluralistic approach you’re less bound to model-specific protocols. It could be that they just feel less useful”. Perhaps she has a point. I know these are things I feel deep down in my bones, from years of testing out the options.
For sure, there are some things as psychologists that we have to learn how to do, but we also have to interrogate our feelings about them. What does this offer to the client in helping them verbalising their own desires? And us with ours? We probably wouldn’t want our clients to blindly accept our instructions, just as we are right not to want to blindly accept those of our supervisors. Maybe, the aim of a therapeutic training is to make our own ‘rules’, to authorise ourselves to practice, rather than accepting (or resisting) someone else’s authority? I think we find out how to do the former, by doing some of the latter too. But could you be authorising your practice – from deep in your bones?
The first element I feel a disconnect with is diagrammatic formulations. I can honestly say that I have never sat with a client and presented them with a “this is your life” formulation and felt good about it. I either tend to feel frustrated because the client has engaged with the formulation and keeps telling me more information that doesn’t fit well into the diagram. Or, I feel worried because my client appears politely interested but not jumping out of their seat. They are not saying, as one client once delightfully did during a particularly effective ‘reflecting back’ comment, “you hear me my sister!” I guess one could argue that my disconnection with formulation diagrams is because I’m not skilled enough in that area. Yet, being honest, something inside tells me that’s just not it.
How about the idea that the diagrammatic formulation – perhaps like all elements of the frame – is more for the therapist than the client? They’re good as teaching aids in the classroom, but I worry about the idea that we are trying to ‘teach’ our clients. Who are we to ‘know’ what’s in their minds, and what should be in their minds? Clients have spent their lives fitting (or not fitting) boxes, as have therapists. Perhaps they need validation from their therapist (or their supervisors and trainers) that ‘fitting’ isn’t on the side of life. And even if we do teach, and do expect to fit, who says that just because a client isn’t jumping out of their seat with joy at our interpretation, that it hasn’t landed somewhere? Do they really have to let us know that? And should we believe them if they did?
The second guideline I seem to be shirking is the idea that one cannot do good work without a deep and complete formulation. Have you ever read a book and found it has changed you? Have you seen a quote on the internet that has made profound sense? Ever spoken to someone and realised it has altered the way you look at life? In my experience I haven’t needed a sound understanding of (for example) what my core beliefs and rules for living are to find a connection with things and to be moved by them. I’m not saying that formulation is redundant, far from it. What I am saying is that from where I’m sitting, a neat initial formulation doesn’t always seem essential for good therapeutic work.
What is this idealisation of completeness? As if we can know something or someone totally? Again, so many clients have this idea that their identities, their beliefs and their thoughts need to be ‘coherent’. That we need to find a partner to be ‘complete’. Perhaps instead, we need to recognise our inherent lack, that we are born dependent, and fed with and by language from the moment of (and before) our birth. Clients (and trainers) might demand that we know, but our clients really need us not to know, to tolerate uncertainty, ambiguity, and speak through this, in order that they can learn to do that themselves.
I’m well aware however that if I had presented an incomplete formulation in a case-study, one with question marks and which was representative of the “I don’t know” answers my client had given me, I would have failed. The case studies and process reports I see written up for publication always appear to have full and complete formulations. I haven’t read any CBT textbooks which have said “Your client may not be aware of all the elements which trigger their difficulty. Seeing as you have limited time together, it might be worth moving forward with the information you have got”. Is it possible that the textbooks and journal articles sometimes don’t translate into real therapeutic practice?
Books are books, people are people, and the unconscious is … unconscious! The lovely, frustrating thing about the unconscious is that it isn’t to be known. That’s what defences are for: to protect us from what we can’t or won’t know. Lacan says that the client comes to the therapist, demanding that they are the one ‘supposed to know’. Our job is not to be seduced into that demand, but to hold the position of not knowing, so that there is space, in the frustration that ensues, for the client’s desire to appear. Winnicott is great on this – he suggests that interpretations have to be imperfect, in order that the client can give up the quest for perfection in the therapist, and indeed in themselves.
The third ‘no no’ I frequently engage in is swearing (sorry mum). My employee handbook states that swearing is inappropriate and must not be engaged in. I’m under the impression it could lead to a warning and with repeated use, dismissal. Yet behind closed doors with my lovely and foul-mouthed clients I have been known to drop the f-bomb. Sometimes nothing quite puts emotion into words like “that sounds absolutely f*cking sh*t”. Although I’m not quite sure he was referring to such profanity I believe that Rogers is behind me all the way on this one. For me, a good obscenity communicates empathy and a realness in the relationship that “hard time” doesn’t quite convey.
Therapists are not judges, we’re not here to moralise on client’s language use. Indeed, it’s very important that clients can see that language is all we have to represent ourselves and our desires, however imperfectly, and to explore the possibilities and impossibilities in that. How can we understand our client’s communications, if we can’t join them in their linguistic play, and be curious together about that? The very idea that a word can be ‘forbidden’, is up for a lot of analysis!
My fourth and perhaps “worst” confession is that yes, I very much want to help my clients, but that I’m also in it for me. The reason I get up and go to work in the morning, the reason I have dedicated uncountable hours to writing my final portfolio, the reason I spent an enormous amount of money on training isn’t all for my client. I like the connection I feel in the room with clients. I like it when I can inspire them towards change and I like it because it makes me feel good. I think it’s important to recognise that I’m in it for me for many reasons. One of these is that there are certain clients I can’t work with because when I do I just don’t get from my job what I want to. Actually, I get a lot of pain and frustration and an agonising sense of inadequacy. I don’t want to go to work and dread seeing my clients. The instinct part of me says that this is totally understandable and okay, who would want this? But the practical part would never dream of admitting this to my superiors. Surely as a professional with sufficient knowledge and experience in the area you ‘should’ be able to work with anybody? That is your job, after all.
Desire! Clients want to feel better, and so do we. What other rewards are there? There are plenty of jobs that psychology graduates could do to get rich quick, although a few celebrity therapists do manage that, many of us earn enough to get by very comfortably. So maybe we love it, and love to hate it too? I remember sharing my ideas with my own analyst that she must get so bored of me saying the same things, blah blah, and she said ‘maybe I enjoy it’. For me, therapy is about how to enjoy life better – and therapist and client are in that together. Sure, we need to learn about the way we get pleasure and unpleasure, and I think it’s important to work with people we don’t like, especially when we’re training. These days though, if there’s a client I really can’t find a way of enjoying, I reckon I should probably pass them to someone who can. Our inadequacy is something for our own analysis, rather than making it our client’s problem.
And whilst I’m really bearing all – ever tried poking fun at a client? Obviously as with any intervention this is only helpful in the right moment with the right client. Individuals might repeatedly say they cannot do something. It is impossible for them. They’re just not that sort of person. They’re not clever enough, not brave enough, not good looking enough. Ask them if they’d do it for a billion pounds. It changes things! I guess I could argue the intervention from an ACT values stance. Would I have written it into a process report – I think not. BUT IT WORKS!
Sarcasm is one of the most delightful interventions when the relationship can take it. I recently spent a session with a client talking very deeply and meaningfully about his fantasies about being dead. Towards the end of the session, he shared that his girlfriend talked so much about her dead father, and he felt quite jealous. I said, without thinking about it, ‘well, you definitely can’t compete with that alive then, can you?’. I would defend that interpretation – to death!
So is it just me being a bit creative with the guidelines occasionally? Are other people still following hunches which they cannot quite explain where they came from? Are others working with both the textbook and the practicalities of their service or team? My inkling is that we are.
Oh sure, but the beauty of a psychoanalytic approach for me is that we have a way of thinking about our unconscious motives, and those of our clients. Our own analysis and supervision is precisely for these times – where we find ourselves doing something that feels ‘wrong’ that we can’t quite account for, and perhaps can’t quite stop doing! As a supervisor, analyst and person, it’s so important that I can open up dialogue on these things, rather than closing it down. This gets me through a world and a job that can sometimes feel very punishing, and helps me not act out that punishment in my own work – not all the time, anyway! I’d love to hear more from our readers about their hunches, no-nos and secret rule breaking too – there’s so much life in them!
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