Category Archives: psychotherapy

Queries Concerning Psychotherapy and Privilege

May 14, 2013 By in branches of psychotherapy, Countertransference, Ethics, Morals & Ethics, narrative therapy, psychotherapy, Quakerism, social justice, The shadow of psychotherapy, What to talk about in therapy Tags: , , , , , , , , , 2 Comments

Every time we ask a question, we are generating a possible version of life. (~ David Epston in Cowley and Springen, 1995 , p. 74)

Friends (Quakers) approach queries as a guide to self-examination, using them not as an outward set of rules, but as a framework within which we assess our convictions and examine, clarify and consider the direction of our life and the life of the community. (~ Philadelphia Yearly Meeting Faith and Practice, page 205)

Does psychoanalytic psychotherapy as a profession make sufficient assessments of conscious and unconscious, explicit and implicit racism, sexism, heteronormativity and bias in all its forms in ourselves and others, and the destructive consequences to all parties?

Do we believe that healthy relatedness demands well-developed empathy, mutuality, and parity? Do we recognize bias in all forms, personal and institutional, implicit and explicit, acknowledged and unacknowledged as a failure of empathy, an objectification of others and as an obstacle to healthy relatedness and psychological well-being?

Do we accept that the conscious and unconscious empathic failures surrounding bias and oppression are certainly a more profound loss for the oppressed, but a loss to all parties nonetheless?

Do we consider Lacan’s and Foucault’s idea of the privileged “Gaze” of the therapist? Do we see ourselves as people who gaze out from inside a dominant narrative, a “regular” story requiring categorization or explanation from all who we see as “different”?

Do we understand the differences between individual prejudice, institutional racism, and unexamined privilege?

Do we examine the narratives of success, of health, of family, of connection, of development that are viewed as “normal” regular, ordinary, usual, and taken for granted as universal by the dominant culture?

How do we take this made-up story about who is “regular” for granted, and wittingly or unwittingly put these narratives forth as better, more important, more normal than others?

Do we examine our own participation in how “othering” or “normaling” stories get disseminated or disrupted? Do we critically examine how the institutions in our culture – media, government, schools, religious institutions, and graduate and post-graduate psychotherapeutic training institutions – inform us as to what is “regular”?

Do we advocate for inclusivity in our psychotherapeutic practice and training institutions? Do we feel an institutional environment, or our own caseloads are sufficiently diverse when in actuality very few of people of color, differently abled, or LGBT people are represented?

Do we recognize that we speak through our inaction as well as our action? ~ Philadelphia Yearly Meeting Faith and Practice

Do we participate in panels, conferences and workshops, peer groups led entirely or predominantly by those in the dominant culture?

How have the dominant stories about race, gender, homosexuality, disability, and class determined and shaped our psychotherapeutic practices and training institutions, fee setting, size and composition of our caseloads, choice of colleagues, and our preferred psychotherapeutic models?

Do we, as psychotherapists ever place ourselves in professional, or social circumstances where we are not in the majority? How might such experiences help us to better empathize with those who carry narrative burdens, who are regularly challenged to explain, defend, or advocate for themselves within the dominant culture, and those who are on the receiving end of bias and oppressive circumstances more often than we are ourselves?

Do we cultivate relationships with adults with whom we have racial, ethnic, cultural, or religious differences outside of the psychotherapeutic setting?

Do we cultivate therapeutic relationships with clients who differ from us in identifiable ways?

What life experiences or personal characteristics, if any, have made you feel “gazed at”: forced to explain, alienated, ignored, misunderstood, distorted, or excluded by most people or by institutions? What circumstances, if any, have you found yourself in where you were instantly and visibly identified as an outsider in someway?

How might these experiences be useful in practicing psychotherapy with a concern for social justice? How might these transitory experiences offer only limited insight into what it is like for a client who lives with more chronic or different forms of oppressive, exclusive, or unjust circumstances?

Do we listen deeply without becoming defensive or competitive when clients friends, or colleagues or people online share experiences of oppression, even if we feel implicated, guilty or uncomfortable?

Are avenues for exploring differences kept open? To what extent do we ignore differences in order to avoid possible conflicts?
~ Philadelphia Yearly Meeting Faith and Practice

Do we allow ourselves and our worldview to be changed by hearing stories of other people’s discomfort, anger, grief and pain from experiences of oppression, exclusion, bias, and prejudice?

Do we monitor ourselves for defensiveness, minimizing over-identification, excessive or non-generative forms of guilt, hopelessness and indifference?

How can racial, gender, sexual/gender identity and/or class differences between therapeutic partners affect the way they tell and hear each others story?

Do we proactively and thoughtfully confront, explore and examine biased narratives when we experience them in our office, with friends and colleagues, and in ourselves?

Do I treat conflict as an opportunity for growth, and address it with careful attention? ~ Philadelphia Yearly Meeting Faith and Practice

What do you worry people will assume about you?

What do you hope people will assume about you?

What do we understand about our clients’ hopes and fears about the assumptions of others?

What assumptions have we made about clients that were inaccurate, injurious, or unrecognized (by us)?

How do we respond when confronted with the inaccuracy or injuriousness of our assumptions?

Am I careful to speak truth as I know it and am I open to truth spoken to me? ~ Philadelphia Yearly Meeting Faith and Practice

Do we consider that there are parts of our client’s stories that are never given words, are essentially deleted, or never even noticed by themselves, by us, or by others because they just don’t fit in with the dominant story, or with our assumptions as psychotherapists?

How can we learn from clients and colleagues who are different from us without making them feel unduly burdened or pressured into teaching and explaining?

Are we mindful that those with experiences of oppression and narrative burden need to protect themselves from scrutiny and the unempathic Gaze of individuals, institutions and environments that are distorting, enraging or exhausting?

Do we condone or assume that narratives of privilege are healthy for privileged people? Do we remind ourselves that none of us are free unless all of us are free?

Do I examine myself for aspects of prejudice that may be buried including beliefs that seem to justify biases based on race, gender, sexual (and gender) identity, disability, class, and feelings of inferiority or superiority? ~ Philadelphia Yearly Meeting Faith and Practice

What is my psychotherapeutic practice doing to help overcome the contemporary psychologically wounding effects of past and present oppression?

Questions, and more questions, and questions as yet unformulated.

No answers please.

Deeper questions.

Balancing Act

April 25, 2013 By in Archetype, branches of psychotherapy, Depth psychology, Ecopsychology, New therapists, psychoanalytic theory, psychotherapy Tags: , , , , , ,

Objects fly through the air, stars wheel through the universe. All fall eventually. If we become obsessed with definitively mastering the decline, we are lost. If we achieve peace within the intervals of rising and falling, we find grace.

(Arthur Chandler, On the Symbolism of Juggling: The Moral and Aesthetic Implications of the Mastery of Falling Objects. http://www.juggling.org/papers/symbolism/)

In the minor arcana of the Rider Waite tarot deck, a juggler is depicted, in the act of balancing, exchanging, juggling the flow of energy between two large coins. In more ancient decks, The Juggler (now more commonly titled The Magician) was considered a symbolic entity important enough to be placed in the front of the archetypal gallery of Major Arcana.

The cards are said to represent balance, as a positive action. Reversed, the card implies imbalance, the need to recover the center and rhythms necessary to keep the balls steady and flowing movement through the air between human hands. The message of the Juggler is this:

Learn at first concentration without effort; transform work into play, make every yoke that you have accepted easy, and every burden that you carry light.
(Anonymous, Meditations on the Tarot: A Journey into Christian Hermeticism, p. 8)

The conception of medical, physiological homeostasis permeates psychological diagnosis. Traditional western psychology and psychiatry seek to identify and quantify the archetype of a perfectly balanced mind, as well as create diagnostic codes for all the ever multiplying transient or enduring ways that we can find ourselves out of balance. Even the Diagnostic Manual’s Global Assessment of Functioning Scale (which assigns all human functioning a number between 1 and 100 – 1 equaling imminent death and 100 representing The Perfectly Balanced Human) evokes the archetypal Master Juggler:

100-91 Superior functioning in a wide range of activities, life’s problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. (DSM IV Global Assesment of Functioning Scale – emphasis mine)

And certainly, a preoccupation with the processes of balance, counterbalance and imbalance in all its forms: equivalence, compensation, correspondence, fairness, justice, homeostasis, equilibrium, equality, symmetry, evenness, centeredness, quid pro quo, and tit for tat have been woven into the very fabric of all psychotherapeutic contemplation.

In Freudian thought all dreams, slips and symptoms are potential solutions to states of internal imbalance. The uncoordinated triplet team of consciousness – Id, Ego, Superego – attempt to pass and juggle conflicting needs between each other. One member aggressive and full of appetite, another practical and concerned with working the crowd, and the third, the conscience of the troupe trying to keep the other two in check. A symptom, in this model, is merely one aspect of the self over-correcting for the wild toss of another. The analytic therapist’s job is to help the bickering internal troupe get their act together.

For Jung, dreams, and unconscious phenomena are acts of counterbalance and compensation for whichever stance we have consciously identified with. The Unconscious swings and tilts to balance out whatever it is we believe to be true about ourselves in our waking Conscious life.

In narrative, social and environmental therapies the circle widens. The individual is embedded in a system which is inherently out of balance. Personal imbalance is seen as an extension of and appropriately reactive to injustice, narrative burden, unsustainability, or unconscious guilt stemming from being the un-entitled beneficiary of or hoarding resources without true entitlement.

And each of these seem to me, as always, to be single facets of a still incomplete truth, all of them more incomplete without the others.

An overcommitment to consciously maintaining personal balance creates its own form of disease: A life that is seemingly, superficially never “out of hand” simply banishes chaos to its hidden depths.

A perfectly and consistently balanced human, if one were to exist, would be inert, fixed, stagnant, immobile, inanimate. How monstrously impervious this perfectly balanced human, would be, more of a “thing” than a “who.”

The existential therapies remind us that we are no thing, nothing at all, and that teetering on the brink of meaninglessness, discombobulation and existential dizziness are necessary to apprehend the brevity of our lives, and begin to take real responsibility for our choices and our effect upon each other.

Some ascetic Sadhus, Hindu holy men, spend many years standing on one foot, discovering the balance that can only emerge from negotiating an asymmetrical stance.

Life is inherently out of hand; death, illness, pain, loss, grief, war, disasters natural and man-made, trauma, heartbreak, abuse, cruelty, racism, sexism homophobia and heteronormativity, oppression and injustice in all its forms, including the depletion, exploitation, and hoarding of the earth’s resources. In the face of all that life can throw at you there are times when blatant mental imbalance is the sanest, healthiest most healing response.

We are all embedded in enormous systems, familial, social and planetary, which are also cycling, swinging wildly, falling in and out and passing through imbalance, equilibrium and back again. Living and breathing balance requires and contains imbalance within it.

We will all lose our footing.

No one is impervious. We will all drop the ball.

The universal deadly sin of every routine is The Drop. Dropping is so common in juggling that every performer must come to terms with the inevitable accident that breaks the rhythm of the routine and calls one’s skill into question.
Since drops are inevitable, and even the most accomplished professional jugglers drop in public performance of their routines, one might well ask why a drop should be considered such a disaster.

Part of the reason has to do with the psychological interaction between the audience and the performer….Admiration for the juggler becomes submerged in the more general feeling of wonder at what the human mind and body can accomplish together. It is the overcoming of gravity with style and grace, and produces the kind of internal affirmation that comes with any art or sport done supremely well.

The drop breaks the spell. The audience is reminded of human fallibility when the juggler has to stop and start all over again. Now the creeping doubt has entered everyone’s mind: will the juggler drop again? The second drop confirms this doubt, and the audience now sees only a struggling human being endeavoring to ward off disaster. After the third drop, even the memory of the magic is gone, as both performer and audience only wait for the ordeal to conclude.
(Arthur Chandler, On the Symbolism of Juggling: The Moral and Aesthetic Implications of the Mastery of Falling Objects. http://www.juggling.org/papers/symbolism/)

Extreme imbalance, too many too repetitive “drops” become destructive in their own way. They break down the faith that others have in us, along with our faith in ourselves, our resilience and the world around us.

One of the most common early by-products of imbalance in intimate personal relationships is resentment. If the spirit of quid pro quo is violated, exploited, or ignored, and the energetic, logistical and personal exchange becomes too chronically lopsided resentment compounds, festers and mutates into toxic contempt, hopelessness, and love-killing exhaustion.

Learning how to make necessary corrections and adjustments to preserve the loving core of intimacy is the work of couples and family therapists: Do I accept and try to accommodate the low ball, hold out for a higher toss, or stop trying to feed my partner the ball in just the way they demand it? Should I ask for more, settle for what I’m getting or give less?

When one member of a family or social system changes their rhythm or their stance – the entire network is thrown out of its precarious homeostasis, everyone reels and teeters. “Change back!!” they seem to cry, as their footholds crumble out from under them. A deeper equilibrium, a truer justice often requires that we mourn the loss of an unjust balance and pass through a period of disorienting imbalance before we find a stance that allows everyone to have some part of their need acknowledged and met.

Our relationships, and perhaps Love itself require some balancing component in order to thrive, and without it, we will too soon reach breaking points, beyond which the old center can never be recovered.

We hold many apparently imbalanced relationships as sacred in the service of growth and nurturance: Parent and child, teacher and student, sponsor and sponsee, therapist and client. There are vast power differentials, discrepancies in knowledge and experience and attention, the most obvious giving flows in one direction. Yet, there are symmetries, larger circles of justice exchange and evenhandedness at play: Someone gave this to me, so I now give it to you. In caring for you, I care for untended aspects of myself.

The mystic symbol of justice, that is equivalence and equation of guilt and punishment. …In its most common form two equal scales balanced symmetrically on either side of a central pivot. A Dictionary of Symbols, J. E. Cirlot

All of our theologies and most of our philosophies circle around cycles of cosmic balance and justice. We construct an evenhanded tit for tat, eye for an eye, the equivalence of opposites: Heaven and Hell, Good and Evil. Alternately we embrace the long view of cyclic karmic justice: what goes around comes around. Souls are weighed and balanced in the afterlife in the mythic psychostasis: in ancient Egyptian cosmology, the human heart is weighed on cosmic scales against the feather of Maat, the goddess of order and justice – while a monster “waits below the scale, ready to devour the unbalanced heart.” (The Book of Symbols The Archive for research in archetypal symbolism pp. 512)

Individual psychological equipoise and the ultimate cosmic balance intersect to complete the hermetic formulae and the Master Juggler’s circuit: As it is above, so it is below. As it is below so it is above, As it was in the beginning, so it will be at the end. As it is within, so it is without.

The therapist, is only supposedly, a skilled juggler and juggling teacher – able to keep many balls in the air, managing their own internal and external challenges to equanimity and flow while incorporating all that the client throws at them, and passing back the ball at the right speed, spin and rhythm so that the client can receive it, polish up their own act, and expand their bag of tricks. Therapists make split second assessments as to whether a client is trapped in sticky bullshit stasis, if they need to pushed off of a false-too-comfortable standpoint – or if they are reeling too near to dangerous overwhelming imbalance requiring all the therapist’s skills to help them stabilize. Young clinicians often wonder, when they have fallen on their asses, in life or in session, if they themselves are stable enough to go forward in the work.

I am no Master Juggler although in session I have learned to keep quite a few balls up in the air. Usually just one or two more than any given client, (although sometimes, admittedly, I must scramble to keep ahead).

Just as the Juggler or magician has had to train and work for along time before attaining the ability of concentration without effort, similarly, he who makes use of the method of analogy on the intellectual plane must have worked much, i.e. to have acquired long experience.
(Anonymous, Meditations on the Tarot: A Journey into Christian Hermeticism, p.10)

I’d better at least look like I’m good at it by now. I’ve been practicing almost everyday for nearly two decades – and perhaps for long stretches I can manage to appear as if it never gets out of hand.

But it does. Of course it does. I get knocked off my pins, blown off my center, lose my flow and rhythm and toss out ill-timed passes with humbling regularity.

The drop is inevitable.

And although I can still be shaken when my act has inadvertently slipped into an ordeal for the most part I have learned to enjoy the momentary peace within intervals of rising and falling.

copyright © 2013 All rights reserved Martha Crawford

Pain/Full

March 22, 2013 By in Chronic pain, Countertransference, Crisis, How therapy works, migraine, pain and psychotherapy, psychotherapy, Self Care, self-revelation, Spoonies, Wellness, What to talk about in therapy Tags: , , , , , , 1 Comment

I grew up in a haunted house with a parent disabled, possessed and ultimately devoured alive by chronic physical pain. One day, Pain, an occasional intrusive visitor, burst its way in, and never ever left. Pain sat with us at the dinner table, rode with us in the car, spent sleepless night in front of the television reclining in barca-lounger, or in a home hospital bed manipulated by magic buttons. Pain spent up all of our financial resources, taught us to walk on eggshells, pressured us to forgive all outbursts and unreason, and garnered the tongue-clicking pity of the neighbors. Eventually, Pain blocked all obvious pathways to warmth, comfort and connection, as cold and dark as a cloud blocking the sun. It took up more and more and more space each passing year – until there was no room for anyone to live with it at all, until there was barely room to move or breathe.

All of us were so used to Pain and the daily incantation of its horror-litany that we grew to hate its oppressive presence. We hardened our hearts, and had no empathy or patience left for it. We were sick of its specter, and sick of its name. We surrendered to its power as it disabled us all. Pain sucked everyone dry, and left nothing behind.

Pain runs in families.

I had my first migraine at age 7. By adolescence it was typical for me to become blind-sick, with an invisible hot metal spike in my eye and throbbing skull, nauseated or vomiting before and after any high-stakes event: A big test, an audition for the school play, a nervous first date, or at the mall choosing matching his and her outfits for the high school dance.

Through young adulthood I was sick more often than not: 18-20 violent, nauseating migraines a month.

In Pain’s clutches there is no room for anything else, no comfort, no connection, no conversation. It hurts to talk, to open my eyes, to listen, to breathe. Clothes hurt, light hurts, sounds hurt, smells hurt, the throbbing of my heart beat hurts. There is nothing but Pain.

But more often than not, Pain would pack its bags and slip away before morning, like a one night stand – as if it had never been there at all. I was ready to start the day as if I had not spent the previous 24 or 48 hours nauseated, throwing up, dozing in-between waves of pain on the cool tile of the bathroom floor, the street light burning through my eyelids as it seeped in under the crack of the closed door.

I was actually getting off easy compared to what I knew Pain was capable of. I was able to have friends, to work, to fall in love and sustain a relationship, (although early in our relationship my now husband worried that I had bulimia because of my constant nocturnal nausea). I could read, play, study, live as long as I did it in between headaches.

No doctor ever asked about it. If I did mention that I thought I might have migraines, they responded that it was common and suggested that I try some product over the counter.

I assumed it was normal. It was how it always had been for me.

At 30, my first social work position, required me to have an employee physical. The agency MD noticed I had ticked the “headaches” box and conducted an earnest assessment.

“Eighteen to twenty a month!” she exclaimed. “And you’ve never had any treatment?!?”

Treatment? What are you talking about? What for?

“Most people do not spend 20 nights each month in severe pain throwing up in the dark!”

The new fangled medication she prescribed for me twenty years ago to spray up my nose made me throw up immediately. I decided on the spot that medical treatment was ridiculous if this was the best they had to offer. I deepened my mediation practice, sought out acupuncture, took Feverfew, B supplement, magnesium, yoga practice, Qi gong, Food eliminations. I reduced my migraine load to 9-12 a month.

I thought it was a miracle. I felt cured.
Better than I had ever hoped for.

The only time I saw my condition in the popular culture was in old re-runs of my favorite sitcom from childhood. “Frank, take me home, I have a sick headache!” Darren Steven’s overwhelmed mother would whine, the back of her hand pressed dramatically to her forehead after Samantha and Esmarelda had let their magic loose in her presence. Like the Bewitched script writers, I associated migraine disease with weakness, manipulation, psychosomatic illness.

So I had headaches a lot. There were hundreds pain reliever/headache commercials on TV. Other people could cope it seemed, why not me?

Early in my practice, I could get through most of my work hours. A couple of times a month, I would excuse myself from session, to be sick, and then return to the client and resume the work.

Like a cat hiding its symptoms, I’d sit in session, grateful to focus on the client’s narrative instead of the mounting pain, the excruciatingly searing light emitting from the 60 watt light bulbs, the hypersensitivity to the smell of the therapist’s perfume in the adjoining office.

A few times a month I would have to cancel out and reschedule my day all together. My therapist never did this. Never once in over a decade together had he cancelled out at the last minute due to illness. I did it regularly. For years I was ashamed to admit to my clients what had kept me out of the office. I fobbed it off on flu, tummy bugs, bad colds, “coming down with something” I worried about treatments disrupted, the precarious appearance of my emotional fortitude and reliability as I teetered on the brink of disability:

“I feel another sick-headache coming on Take me home Frank!”

The rare but most shameful moments occurred when I couldn’t/can’t make it through a session. The session begins with a manageable amount of low-grade pain, which suddenly escalates, or an intrusive visual aura partially blinds me letting me know I am mere minutes away from Pain’s explosive arrival, and I need to stop suddenly.

Pain has cut clients off mid-thought, when I realize that the line has been crossed between manageable Pain, and Pain that has possessed me:

“I am so very sorry, I need to stop. I get severe migraines, and I can’t always predict when they will strike. I’m so so sorry to leave you hanging like this – but I think the most responsible thing for me to do now is stop. I hope we can reschedule, and I won’t charge you for this session, or the next one so we can talk about what this leaves you with.”

The client looks stricken, worried, fearful that they caused my headache. They rush out gathering their things and offering well wishes over their shoulder. I cannot get their distressed faces out of my mind or shake the guilt of having abandoned them as I sit, face buried in my hands, slumped and Pain-drunk on the long, smelly, flickering-florescent subway ride home.

When it cracks and I am myself again, I send a note, letting them know I am all right and not to worry – and schedule a time to talk about what happened, what it was like to see me vulnerable, to feel abandoned, what it activates from their past, and how it changes our dynamic going forward.

It took a long time for me to figure out, on my own, that certain clients, in certain self-states, could communicate to me through a migraine – that Pain could sometimes serve as a somatic countertransference, surfacing latent content in the session.

One man, kind, charming, intelligent talented, and highly anxious left me puking into my wastepaper basket immediately after session, several weeks in a row. I monitored my food triggers- no obvious culprit. I changed his session time – to the early afternoon, to the first session of the day – still it continued. I enjoyed him, cared about him, felt touched by his struggles, and courage. Yet, somehow, unconsciously, he was making me sick. Others wondered if I should keep working with him, but had no impulse to abandon him – I was used to this. When the anxiety, illness and chaos that he was struggling to repress finally erupted into a psychotic/depressive break, my somatic countertransferential symptoms disappeared entirely and forever, and we went on to work together for many years, forming a deep and treasured therapeutic alliance.

I don’t know if I have more clients with chronic pain conditions than other therapists, if I assess for it more, or if its manifestations sit with me more intensely.

I have clients who live through, with, and in spite of pain far more severe and disabling than mine: chronic cluster headaches, spinal injury, chronic severe nerve pain, endomitriosis, permanently disabling bone injuries, fibromyalgia, rheumatoid arthritis, inflammatory diseases, autoimmune illness.

Am I therapist that is “good with” pain related issues?

There is no easy answer to how well therapists treat cases that activate our core conflicts. I suspect that I am simultaneously my best, and my worst with these cases.

I’ve seen clients, spend years, even decades like myself, ignoring, denying, hiding, carrying on, prematurely resigned, certain that their pain load, as excruciating, untreated, and disabling as it is, is immutable.

I have seen Pain annihilate people, drive them into a permanent haze of narcotic dependency and abuse, make them wish they were dead, or drive them to consider killing themselves to escape.

I’ve watched Pain eat relationships alive and suck their bones. It destroys by obliterating our ability to experience other people or even one’s own Self. At its worst, it doesn’t permit the experience of anything other than Pain itself.

I’ve also watched people move into states of conscious acceptance that Pain is permanent, and unescapable, and sometimes through that surrender, they discover how to survive and thrive.

When I sit with clients trapped in its jaws, I am terrified it will chew them up slowly, in front of me. My office transforms into the haunted house of my past. My own brushes with a near disabling pain condition rears its head. My demon-pain-fears, past and present whisper in my ears, terrorizing me.

These are the most harrowing countertransferences that I face. Yet, cognitively, I know that everyone one will and must forge their own, unique relationship with Pain.

There have been times I have chosen to disclose my circumstance, in order recuse myself from the illusion of objectivity, and allow my client to protect themselves from my own Pain-fear. A decade ago, a young client with chronic pain (who I had seen for many years for other issues) contemplated a surgical intervention that I was too tragically familiar with from my family history.

“Listen: I know that this is a very important decision and I want to support you in making whatever choice you feel you need to make for yourself. But, I have to let you know, it will be very hard over the next few months for me to separate my own experiences with this procedure from our discussion. I had a family member who had this very same procedure many times, with increasingly bad outcomes each time. I know that this is not objective data – that I am drawing on a sample of one, and it offers no statistical significance to help you figure out what you need to do. I have seen only the worst outcomes, not the best. So, that being said: I plan on doing my best to support you through this – but I need you to know that I hold biases that are specific to me – and if it ever feels like it’s getting in the way of hearing your own reason and intuition about this, please, I’ll need you call me out on it. If you see me very uncomfortable or looking fearful or worried, I just want you to be clear that it is about my history – and not about my approval or disapproval of your decision.”

The client ultimately chose to go ahead with the surgery, and we were able to stay close and connected through the pre-operative period, the surgery, the recovery and its aftermath.

And there are times that calling out my client’s Pain-blind-spots have helped me to see my own.

After years of feeling that I was functioning “well enough” with my 9 to 12 incapacitating headache days a month, my cancelled/rescheduled sessions, and my wellness practices – I heard myself confronting a chronic pain client on his resignation and encouraging him to find a reputable pain clinic that offered real treatment – not just narcotic pain medications.

“Your anger and fear that the pain will never go away entirely, are blocking you from exploring any avenue that could reduce your pain, and give you more of your life back!”

And then I thought to myself:
Ah yes, well then. Pots calling kettles, physicians healing themselves, doses of my own medicine and all that…

I googled “NYC headache specialists neurology” immediately after the session. I’d had chronic migraines since childhood. I was now over 40. I had never seen a neurologist in my life.

Two things had changed that made those 9-12 sick days or nights no longer acceptable. I began waking up ambushed by Pain in the morning. It snuck in as I slept – and it was staying longer – sometimes for days consecutively – violating all rules of migraine-hood as I knew them.

And I had become a parent.

A baby sleeping on you while you are in a Pain-stupor can be sweet and comforting. Trying to get two toddlers out of wet bathing suits, and diaper-changed under bright lighting in a noisy, crowded locker room after baby swim classes half-blind, in level 8 pain, and throwing up in garbage cans on the street while pushing a double stroller home is a nightmare.

I heard myself begging my kids to “be good” to “be quiet” because Mommy’s head hurt very badly. I heard the irritation and exhaustion in my voice 9-12 days and evenings out of the month as I scattered eggshells on the floor for them to walk on. I heard my kids ask, when they didn’t see me: “Is mommy throwing up again?” and watched them play Family: “I’ll be the mommy and lay down in a dark room!” I heard the voices and whispers that had haunted the house of my childhood. It now seemed a terrifying and real possibility that it could all happen again.

I found an excellent neurologist. With some trepidation, I went forward to try Botox – which paralyzes my scalp and back of my neck. (The standard protocol is to do the forehead and brow muscles too – which I opt out of. Being able to look worried, furrow my eyebrows and lift them happy surprise is three quarters of what is required of me professionally. )

Botox brought incredible relief -(and I have a very youthful scalp!) the number of headaches were not reduced, the severity was: no more nausea, and Pain took up much less square footage. I still had the accompanying neurological symptoms: occasional aura and visual distortions, agitation and irritability, light, sound and smell sensitivity, fatigue, dry mouth, word-loss, garbled speech.

Over time, I added preventative medication, as well as the medication needed to stop a migraine in its tracks. I still eat medicinally and mindfully, practice meditation, and martial arts based energy work, I still use natural remedies whenever possible, take supplements to support neurovascular health, and draw on the support of alternative medicines. My migraine load, for the past four years or so is down to 4-6 a month. For now. Some months I am entirely migraine free. I haven’t missed whole days of work, and only occasionally need to cancel a late night session.

My journey has been from alternative and wellness modalities, to deepening my use of allopathic support. I have had many clients who have traveled the opposite path – traditional western medicine maxed out its offerings, or proved to be harmful or useless and engaging in alternative methods of treatment and self-care and wellness has been able to carry them farther.

Three years ago, Pain reared up and threatened to consume yet another client, with no prior warning, in the form of chronic cluster headaches – which bring with them some of the most severe, acute physical pain that human beings can endure. For a full year I watched a woman I cared about being sadistically, demonically tortured by Pain at its most hateful, explosive and destructive. Neither of us knew that she would survive if or if Pain could be successfully controlled. My own fears surely led me to make many errors. There were times as I watched her collapsing, her sense of self slipping away that I flailed and clutched too tightly, acted out my agitated panic, and probably compounding her sudden violent disability with my own urgencies. I could not sit at a distance, with naive certainty that “everything would get better.” I was not able to be inherently calm or soothing. I was afraid with her.

Was that what was needed? It was frankly all that I had to give. I knew what it was to be neurologically altered, to be unable to think clearly, to post-traumatically avoid any potential trigger, to have my senses Pain-distorted and to be surrounded by Pain on all sides. I knew how cold it could be when the Pain-cloud blocked out the sun. I don’t know how she or I could have gotten through that year together if Pain hadn’t taught me how to stay with her.

It was an unfathomably brutal and traumatizing year for her before the cycle cracked – and a year that made me re-encounter all of my own worst fears on a near daily basis in and out of the office.

But even as it was happening, and certainly once her pain was finally controlled, I was extraordinarily grateful to be reminded of what my relationship to Pain was good for.

Pain becomes bearable, meaningful only when we can discover how to make it of use.

Pain can sever relatedness, but it can also blast open a portal to connection. It reminds us of our own vulnerability, our mortality, and our powerlessness as an inherent aspect of our humanity. Pain can teach us how to be tender to others, and can lay a foundation for empathy, and intimacy to flourish.

Several months ago, my son, to whom I am not biologically related, developed recognizable symptoms: His coat hood pulled over his face, his thumb inserted into his left eye-socket – he complained that the subway lights would make him throw up, and retreated to a dark room to sleep two or three afternoons a week, sometimes missing school off and on for several months.

I knew what to do. We eliminated common food triggers, found him an acupuncturist, and pediatric neurologist headache specialist to confirm the diagnosis.

“Common conditions are common” the headache specialist said when I enquired about the nature/nurture questions that live in the heart of all adoptive families. “But because you have migraines, you were able to identify it quickly and get him care. Many kids go for years and years, or through their entire lives, without ever knowing what is happening to them or that there is help available.”

Don’t I know it.

Pain’s bestows the capacity to recognize its presence and to be moved to alleviate it in others.

Pain can destroy, no doubt. I still sometimes hate its guts and it can still scare the shit out of me.

But I’ve grown to also feel grateful for its dark gifts, and surrender to its teachings, as it has guided me, and others, toward unfamiliar routes to connection, relationship and love.

Last week, I had a whopper. My son, curled up with me, and began rubbing my head.

“Right there, right Mommy?” he clucked. “That’s the worst spot, I know. Don’t worry, you don’t have to explain. I know just exactly where it hurts…”

copyright © 2013 All rights reserved Martha Crawford

The Wrong Road

January 13, 2013 By in Archetype, Decision making, Depth psychology, New therapists, psychotherapy, Shadow Tags: , , , ,

“So what do you think is the right thing to do?”

“So should I leave him?”

“Should I take the job?”

“So are you saying I should tell my mother this?

There is one, simple, correct therapeutic answer to all of these questions:

“What the hell do I know?
What am I? A fortune teller?”

It is true that over the past two decades I’ve had a chance to watch a lot of people make a lot of decisions and I have borne some witness to the outcomes.

There have been trends, there are some patterns that emerge. I do have a sense, an impulse about the kinds of decisions will lead to conflict and chaos, or those that may make life more stable and comfortable.

There are statistical truths. But no one can tell you where one individual’s choices will place them along the statistical spread.

And in my experience, the worst outcomes from bad decisions emerge when bad decisions become cumulative.

It is generally true, perhaps, that impulsive, drunken Las Vegas wedding-chapel marriages between strangers are generally not successful – and if you were consulting with me – and if you paused the evenings revelry long enough to place a long-distance call for an urgent phone session and I picked up the phone (this has never happened and would never happen) I would undoubtedly express my concerns. I would encourage you to slow down, sober up, and think about it tomorrow – remind you that it is a decision that doesn’t have to be made tonight, and I would try to understand what lurks behind the intense urgency.

But always with the same caveat:

What the hell do I know?
Perhaps you’ll be divorced in a month, perhaps they will take you for everything you own, or perhaps, you’ll be married happily and prosperously for 50 years.

Chances may be slim mind you, but its possible.

If your intuition is pressing you forward despite all reservations – you will likely go ahead no matter what I say and meet your fate on the road ahead.

Perhaps this is the best or the worst choice imaginable, and either way it could change your life forever. Maybe it is the very wrongness of it that makes it a necessity. Maybe you in fact need to experience the terrible and awesome intersection of fate and free-will in order to face your destiny.

Such fateful decisions and dangerous trials loom at the heart of every myth and fairy-tale:

“Hansel, since you asked: I think you need to proceed with caution if you are planning to nibble nibble on that candy housekin like a little mousekin. And, you should talk to your sister, Gretel about it as well. Of course you are starved and abandoned – but, in my experience such candy houses are generally built by cannibalistic witches who use them to fatten children up for dinner – so be prepared. You do have other, more prudent options: you can collect kindling and try to fish from the nearby brook.”

“But what the hell do I know? Perhaps by surviving this witch, and finding a way to recognize and protect yourself from the Dark, Toxic mother, the archetypal Sow Who Eats Her Own Piglets you will be able to at least hear the song bird of your own psyche leading you back home, to your loving father. You’ll have to make your own choice, and encounter your own destiny. I’ll be here to back you up whatever choice you make.”

Some of the greatest saints and heroes of myth and scripture headed down the wrong road.

And there was no stopping them:

Before he became Saint Paul, he was a political assassin known as Saul, who set off down the road to Damascus “breathing out threatenings and slaughter against the disciples of the Lord” (King James Bible Acts 9)

And as he set off down the wrong road of murderous intent, Paul met his moment of grace:

“And as he journeyed, he came near Damascus: and suddenly there shined round about him a light from heaven and he fell to the earth, and heard a voice saying unto him, Saul, Saul, why persecutest thou me? (King James Bible Acts 9)

An instructor who introduced me to Jungian thought once advised me with regard to a “problematic” case:

“You have to be careful not to take anyone’s Road to Damascus away from them”

Oedipus, on the other hand, did everything he possibly could to mitigate his fate. He tried to make the safest, most self-and-other preserving choices imaginable:

In spite of his beloved parents’ denials and their attempts to protect his royal inheritance, Oedipus struggles with a persistent nagging suspicion that he has been adopted. He decides to seek the guidance of the Oracle at Delphi to uncover the truth.

The Oracle apparently ignores his question and tells him instead that he is destined to “Mate with [his] own mother, and shed/With [his] own hands the blood of [his] own sire.”

Desperate to avoid his foretold fate, Oedipus leaves Corinth, believing that Polybus and Merope are indeed his only parents and that, once away from them, he will never harm them.

On the road to Thebes, he unknowingly meets Laius, his biological father. Unaware of each other’s identities, they quarrel over whose chariot has right-of-way. King Laius moves to strike the insolent youth with his heavy scepter, but Oedipus throws him down from the chariot and kills him, thus fulfilling the first part of the oracle’s prophecy.

And we all know what happens after that… poor man.

Oedipus made the most loving decision possible based on the data at hand – (although perhaps ignoring his own intuition that insisted he was adopted, driving his consultation with the oracle in the first place)

And he too, met his fate on the road.

I have no way of knowing if you are setting off on the road to Damascus or the road to Thebes when you find yourself at the crossroads of a potentially fateful decision.

The blatantly obvious Good decision, the choice motivated by the best intentions can lead to hell.

And the wrong road can lead to an encounter with Grace.

Both possibilities and their opposites exist.

There is no telling.

Whatever “wisdom” I may have accrued, I make no predictions.

I cannot seal your fate. I am no Oracle.

I can listen with you for the “tells” that your own intuition sends out. I can voice my own intuitions and sensations about what may lie down either path. I can help you prepare for what you may encounter. I can stay by your side, and help you respond in alignment to who it is you mean to be.

But, such choices will always be your own.

And listen to this:

Perhaps it is the very process of trying to make the “right” decision – the judgements we create against or in favor of what we perceive as a “good” or a “bad” outcome – that causes our fear and suffering.

Suppose there no merely good or bad option.

Perhaps there is only:
A decision and the consequences, -anticipated and unanticipated – that flow from it.

Light and darkness are always mixed up together. Good and bad luck too.

Darkness can never be avoided. It is present, in some form, in every choice we will ever make.

The question is how will we respond when it emerges.

As therapists, it is easy to be seduced into wanting to protect the people in our care from their own choices. To watch someone making a complicating, challenging mess-making choice can make us yearn to redirect and intervene. We wish we could “stop” it, and help them to make “better choices”

But, sometimes the hard road is the only road where we will meet ourselves.

And we must always bear in mind that everyone simply chooses the road they need to choose. Most often, we make the only choice we know how to make.

One of my kids favorite folk tales is found nestled in a popular children’s book:
Zen Shorts by John J. Muth.

The Farmers Luck is an ancient Taoist tale in which a wise farmer encounters many twists of fate. His horse runs away and the neighbors cluck: “Such bad luck!” And the farmer responds: “Maybe…”

The horse returns with a wild herd, and the neighbors cheer: “Such good luck!” and the farmer responds: “Maybe…”

His son breaks his leg and the neighbors cluck.. and the farmer responds “Maybe…”

Officials come to draft his son into the army, and the broken leg exempts him. And the neighbors cheer…

Maybe.

There is no right road. There is no wrong road.

But what the hell do I know?

Maybe, our task at the crossroads is simply to tolerate the Maybe.

copyright © 2013
All rights reserved Martha Crawford

Four Dreams and the East Wind

October 11, 2012 By in Dream work, Ecotherapy, psychotherapy, Psychotherapy and climate change, Self Care Tags: , , , ,

It is not at all farfetched to compare weather with human life, for few things in our universe are so identical. We are born mysteriously into the world, very much like clouds, and we disappear back into the world just as clouds disintegrate into the atmosphere from which they came. The sky is as changing as human passions, and as spiritual in its ways as our own emotions.
(~ Eric Sloane’s Book of Storms)

Surprising, uncanny things blow in with the east wind.

There are crystalline moments when the air is thick with sudden, disorienting clarity and just a whiff of dread.

Lightening bolt eurekas. Startling updrafts from the deep.

Moments when we just know: that change is mandatory and imminent, that it is time to leave the job, or the marriage, that today is our lucky day, that we are suddenly, incontrovertibly heading in a new direction.

I watch my clients struggle with such moments of bolt awakening – wondering if it wouldn’t just be easier to fall back asleep.

I’ve watched too many resist, fight, ignore, self-medicate, dodge, weave and try to serpentine out of the inner callings to face their fears or to shake up their sense of identity, or to consider something important they have long ignored.

The first dream:
A sociology class requires that I design an experiment. I would like to design one that tests for responses to warm and cold environments and decor in therapy offices. The professor hates my idea and will have none of it. He slams down a sheet with the words SAVE THE WHALES and GREENPEACE on them.
“Do this!” he says “Look at this!”
I begin yelling:
“This is not my idea, not my way! I am trying to make my idea work! I want to do what I want to do! Not what you tell me to do!”

When your psyche asserts itself, it can send you on journeys that you had no intention of ever undertaking.

We all resist in our own way, no one really wants to take on the increased responsibilities of becoming more aware of ourselves or the world around us.

Avoidance is ultimately a costly choice – symptoms emerge, hopelessness, cynicism, boredom, anxiety and depression take hold. The sense of purpose drains out of life.

Suffering is too often the only warning we will heed before correcting our course.

“The business man goes his way despite the weather, more so each day. Instead of adapting himself to the weather his goal is to ignore it… If you want to attract a crowd on a busy street corner, just stand there and look at the sky. So few of us look aloft at all that within a few minutes a crowed will have gathered, staring with you.” (~ Eric Sloane’s Book of Storms)

Many of us have lost the awareness of the ways the weather effects our mood, affect and conduct – and similarly, most modern-minded people are dismissive of their nighttime dreams as random electrical neurological processes, detritus from the day, meaningless nonsense, instigated by rich food eaten before bed, or worse, implanted by televisions left on while falling asleep.

Dreams are an essential element of the atmosphere we move through, and learning to listen to your dream life is like becoming weather wise.

The second dream: ;
I am at the same school in a class with kinder professor. He takes, what in my view, is a too strict, too extreme existentialist model – the past does not exist and has no further influence. There is only the present – and the course you set for the future of your community and the world by what actions you perform right now. I suggest that both reflection and action, both past influences and present choices must be taken into account, as well as deep responsibility for the consequences of our actions – predictable or not. He entertains my idea respectfully and as a result I am eager to listen more deeply.

Sailors, farmers and perhaps some pilots still know – not from the meteorological reports – but from the smell of the air, the feel of their bones and scars, the direction of the wind, the color of sky, the waves on the water – what to hope for, what to prepare for, what to brace for, what to fear.

Old sailors’ rhymes, weather folklore, almanacs relied on weather-mindedness, and an observational and intuitive awareness, a kind of dialogue with the world around us.

The Wooly Bear caterpillar, and the width of his central brown fuzzy band accurately forecasts how severe or mild the coming winters will be. Katydids and crickets react to the weather more quickly and accurately than thermometers.

But for the uninitiated, the chirp of the katydids, the ache in their knees, the subtle scent in the wind and the halo around the moon – if they are noticed at all – appear to be totally random, unconnected events creating no obvious narrative, no discernible through-line: merely nonsensical bits of data indicative of nothing.

Like the Wooly Bear’s coat, and chirping of the insects, dreams tell us about our own internal conditions, and how the internal winds of change will impact our energies, our mission and sense of purpose, our life tasks, our characters, and our fates.

The smallest adjustments in our inner atmosphere can create turbulence. Such windshifts always, absolutely always, involve facing some fear, the break down of some no-longer-necessary-defense, and are the cumulative result of a thousands of imperceptible shifts in thinking, behavior, experience, until some critical mass has been reached and the front beneath the previous way of life gives way.

Better sooner than later, I’ve learned.

When we are arrogant enough to assert our own agendas and ignore the weather and the rumblings on the horizon the scenario eventually goes unbearably stale, or worse, erupts or implodes without advanced preparation. Having something unsustainable forcibly torn out of our white-knuckled grip hurts far far more than proactively releasing it when it is still healthy to do so.

For the Navajo, it was the wind, that brought the Holy People, human and four-legged, from speechless existence in the underworlds to life on the earth’s surface and gave them language, thought and leadership.
(~ The Book Of Symbols – The Archive for research in archetypal symbolism)

Not that such updrafts actually lead to perpetual sunny skies and balmy weather.

Fat chance.

More often than not, they involve a rush of clarity and optimism, gathering momentum and confirmation, followed by a daunting challenge, an unforeseen enemy (usually ourselves but not always), a ridiculous amount of effort, flat out exhaustion, even some wretched, self-fulfilling complaining about feeling burdened and misunderstood. As the pressure climbs, maybe even a stormy, irritable tantrum or two.

The third dream:
I have a male roommate who has filled our apartment with piles of dusty books:
‘Where did you get these books?” I ask.
“I don’t know” he says, “I never opened them. It’s too late in the semester now I can’t bear to look.”

I build and install shelves for all the books to be treated respectfully, and to be integrated into the room. When all is done there remains a pile of unshelved science books about plants, animals and climate studies. I toss the books behind the couch.
The roommate admires the way I can “just toss stuff away like it was never there.”
I wake agitated.

Our unconscious moves through and works upon us as surely as the weather.

Of course, I am just idealistically and existentially inclined enough to believe that when my internal weather report changes it does change everything. Just as I assume that the even minor-seeming transformations in anyone, you included, can effect everyone’s reality, (mine included) as well as the collective realities of the planet and the interconnected universe itself.

The impressive thing about our dreaming lives, and the wind and weather for that matter, is that they will perform their cyclic and compensatory functions whether we actually pay attention or not. They go on of themselves, regardless of whether we think they are worthy our regard.

The dreams recounted here took place on vacation, over four consecutive nights. I recorded them, as part of my regular psychospiritual hygiene, quickly forgot them as I did not feel at all like “working,” at anything. I spent no time amplifying them or analyzing them, and didn’t look back at them until a week or so ago.

During the daylight hours in between, I went on long runs and bike rides, meditated in the woods, explored the seashore, and hiked in wildlife sanctuaries and wilderness areas. I got a strange hankering to learn more about bird watching. I felt filled with sorrow at explaining to my children that so much of the wildlife we had seen, from osprey to horseshoe crabs, to monarch butterflies to codfish, to humpback whales were endangered or threatened, I swelled to bursting with a sense of gratitude for the fresh air in my lungs and the sea breezes, and the view of the Milky Way at night. I opened up a conversation with my husband about our sense of urban disconnection from our food sources, the effects of climate change and consumption on the world around us, and a desire to make a commitment to improve our household’s relationship with nature, to accept and face the new and coming realities for good and ill, and deepen our families sense of wellness and interconnection at the same time. I got a notion in my head to investigate ecopsychologal writings, an area I had only vaguely heard of and know little about.

The fourth dream:
I am about to fail an earth sciences class that I never showed up for. I meet with a department head – a plump, pretty older woman with curly white hair. She is wearing purple. She is kind, but I don’t quite see her face. She understands immediately, with little explanation from me, what has happened and what I need. I am assuming that I will be scolded for letting this go so long – but, she even seems to understand that this is painful and anxiety provoking and seems to think it is natural to have waited and avoided it for a time. She is not urgent or worried. I am impressed by her authority, compassion, power and intelligence. She is the author of some amazing body of work in a field that I am not familiar with. I am very grateful to her, and surprised that she has more compassion for my circumstance and my anxiety than I have for myself. I had felt guilty and ashamed that I had ignored it for so long, and her kindness and understanding makes me feel how upsetting it has been to have this looming over me unaddressed. She says I can meet the requirement a different way, in my own way, it doesn’t have to be strictly through the science department, or the political science department, but I do have to meet the requirement. It is mandatory.

The wind changes sometimes.
And it changes us with it.
We can accept, or we can resist,
and most likely we will do both alternately and repeatedly.

But we will all have to meet the requirement, one way or another.

copyright © 2012
All rights reserved Martha Crawford

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