Tag Archives: clinical supervision

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

Keeping Secrets

March 4, 2013 By in About Me, Blogging about therapy, Confidentiality, Ethics, How therapy works, Morals & Ethics, self-revelation, Therapuetic privacy Tags: , , , , , , ,

Kalli was the secret-keeper of Maldinga. Every day the people of Maldinga straggled through the woods to the clearing where Kalli’s cottage stood. They came one by one, never in two or threes. And one by one, they told Kalli their secrets.
~ Kate Coombs, The Secret Keeper.

Almost two years ago, when I began to talk to friends, colleagues about writing on-line – I could see it made people uncomfortable.

“How are you going to do that?”

“What if your clients read it?”

“I wouldn’t want my therapist to have a blog.”

At the time, the questions and comments struck me as strange: therapists publish their narratives all the time, in books and journals easily purchased or subscribed to on line. They give presentations in public settings, to other psychotherapists, and to the interested public, often filled with extensive case information and histories, whose names, occupations, sometimes genders and personal details are obscured to protect their client’s confidentiality.

Early one morning Sheld the baker came to the cottage. He gave Kalli a basket of fresh rolls and a copper coin. Then he whispered, “I sell loaves weighing less than full measure.” Kalli nodded and caught his words in her hand. After Sheld went away with a sigh, Kalli opened her hand again. The secret was now a small gray rock, like a stale bread crumb. Kalli went inside and tucked it into one of the hundreds of tiny drawers that lined the walls of her cottage. ~ Kate Coombs, The Secret Keeper.

“But aren’t you supposed to stay anonymous?”

“Why don’t you write under a pseudonym?”

Anonymous? With a secret identity?

You mean like Batman?

Clients have seen me in public spaces in hundreds of different ways: putting out my garbage in my sweat-pants and slippers, sweating with my hair in a headband on my morning run, bickering with a sassy kid at school drop-off, dining with my husband on “date night,” in line buying tickets to see a stupid romantic comedy that I am half ashamed see at all, in my bathing suit on the beaches of Cape Cod, in public restrooms in department stores, looking like a foolish middle-aged woman practicing martial arts in the park, picking up my prescriptions at the pharmacy, and at rallies for causes they disagree or agree with.

Such public encounters reveal things about me clients may not like or feel comfortable with. It has never crossed my mind to try to be anonymous, to disguise myself, or cauterize my own needs or interests outside of the office, or in any public setting.

Anonymous
1: of unknown authorship or origin
2: not named or identified
3: lacking individuality, distinction, or recognizability
~ Merriam Webster

I don’t move through the community in drab camouflage, and I made no vow to live an unidentifiable life.

I am not a traditional Freudian, and have never, at any point in my career, aspired to be a “blank slate.” I don’t think it’s even possible.

Although I try not to intrude my own agenda into my clients’ experience, or make them tend to my needs in anyway, the notion that it is possible to “keep myself out of the room” seems to me a mystifying illusion.

Therapists are always “in the room” whether they admit it or not.

I am not required by my profession to live in anonymity – I am mandated to maintain confidentiality.

When confidential information is used for purposes of professional education, research, or publication, the primary responsibility of the clinical social worker is the protection of the client(s) from possible harm, embarrassment, or exploitation. When extensive material is used for any of these purposes the clinical social worker makes every effort to obtain the informed consent of the client(s) for such use, and will not proceed if the client(s) denies this consent. Whether or not a consent is obtained, every effort will be made to protect the true identity of the client. Any such presentation will be limited to the amount necessary for the professional purpose, and will be shared only with other responsible individuals. ~ New York State Society for Clinical Social Work Code of Ethics

I don’t publish identifying information about any client, or any extensive material about any single case history or study. I have tried to fictionalize cases, and blur out identifying specifics entirely. I have created studies of clients in aggregate, noted typical clusters and trends among the clients I have seen over the years, made note of cultural trends, and tried to use my imagination to put me in the midst of cases that I have never met or heard of. I try to speak about the universalizing aspects of the therapeutic experience, my own therapy, my own experience of the work.

I strive to meet my ethical requirements, hyper-vigilant in adherence to the spirit and letter of my ethical mandate. I would never publish anything that would put my clients in harm’s way – that could ever put them at risk to be recognized. And I believe I have done that, at least, successfully.

But is that enough?

Strangely, two years into writing I am revisiting these questions anew, after a synchronicitous cluster of internal and external events, among them several enquiries and comments from other therapists that have made me wonder again why I write. I have been repeatedly asked, and am asking myself about the effects this kind of writing has had on my practice itself and on the clients in my care.

The truth is I just don’t know.

There were so many secrets.
A small boy didn’t like his new baby sitter.
The grocer’s wife had hidden ten gold pieces under a tree root.
A plain girl loved a handsome boy and dared not tell him.
The miller’s son had stolen a coat.
The tailor had left his widowed mother alone and come to Maldinga to seek his fortune.
The mayor’s daughter was sneaking about, keeping company with a young rascal.
~ Kate Coombs, The Secret Keeper.

Publishing my words in public requires clients to trust me even more with their wounds and sorrows and shames.

Most clients have made no mention of it, and I assume have never read my writing, or feel no need to discuss it with me. (If you are one of these, reading this now, and have not brought it up, I hope you will consider this an invitation to address together anything, positive or negative, painful or pleasant, that reading this may activate)

I have told a few clients about it directly, so that they do not feel ambushed or frightened or betrayed by finding out about it in some other manner.

The vast majority of those who have found it or been told of it have expressed positive feelings about it, feel that reading serves as a transitional object between sessions, or gives them access to ideas that may not have entered our therapy directly otherwise.

But that doesn’t mean that it will continue to feel that way. There may, one day, be an essay that agitates, annoys, or distresses. Or words read previously that are experienced differently at a later time, in a different self-state.

I let every client who enters my office know that over the course of treatment I expect to make errors. And although I will always try to protect them from any severe clinical harm, or negligent malpractice I will undoubtedly fail and stagger, causing them pain and discomfort at some point. I may mis-respond, misunderstand, or miss my own blind-spots. I may even re-injure pre-existing wound.

I am sometimes disappointing to both clients, and to myself.

And although I’ve accepted that as inevitable to the mechanisms of the therapeutic process and my own fallibility: it still causes me deep sorrow when it happens, no matter how or where: in or out of the office, on the street, or online.

And as I’ve written about elsewhere ( http://wp.me/p1AOzF-k ) I’ve also learned that powerful therapeutic opportunities for repair, for forgiveness, for re-working, and for corrective experience can lay dormant, almost invisible, curled up within these painful failures.

There is no doubt that publishing my experiences as a therapist, in any format, coupled with my capacity for error and mis-attunement can cause discomfort, and could even potentially disrupt valued therapeutic relationships.

Some have discovered it on their own, and yearn to see themselves in my writing, and feel sorrow that they have not found themselves there. Others, have encountered aspects of my identity, that they do not like, and would rather not know.

Some feel overstimulated, overwhelmed, ashamed at having googled me at all, and try to keep it to themselves – sometimes their dreams have let me know. Still others see themselves in the universalized or imagined scenarios I write about, and hope/fear I am speaking of them specifically.

There are times when we are called to meet deeper obligations that require more from us, beyond the professional guidelines.

Obligations to clients, as well as obligations to ourselves:

I have, and will, make errors in this public space, just as I do in the office.
Even as I scrape off every bit of identifying data, avoid any extensive case discussion, and do my best to disguise all the content, writing about my work carries the capacity to hurt, but hopefully never harm, people and relationships I care deeply about.

I can fail to disguise a reference sufficiently to serve a clients comfort level, or “make up” a scenario too close to one that I have consciously forgotten but remain unconsciously preoccupied with. I can overlook a single word that might sting and intended to edit from an earlier draft. I can leave a client out of a discussion they would want to be included in, or include a reference, no matter how disguised, that activates a sense of exposure.

I can misread how I will be read, or mis-read.

And, as always, our best intentions can diverge from their real outcomes.

One day, in Kate Coombs lovely children’s story, the Secret Keeper turns cold and tired from keeping so many secrets, and stops answering the knocks on the door from the burdened villagers. With their encouragement and participation, she discovers a way to transform the heavy, hard secrets, into meadowlarks, butterflies and rose petals. These re-formed, transfigured, secrets are released publicly, before the gathered village, deepening the both Secret Keepers connection to the village at large, the villagers understanding of each other.

I don’t write or publish to market, practice-build, to make money, or for professional reputation: and although I don’t write for my clients, I always write with them in mind. I believe they are absolutely entitled to read anything I have written, if they so choose, and hold me accountable for it.

I publish what I write because I believe in what I do, and believe that being transparent is necessary to empower clients as full and equal participants in a process that is too often cloaked in disempowering mystification.

I write because I am full to bursting. I have spent so many years hearing stories that have whitened my hair, broken my heart, vicariously and directly traumatized me, inspired and consoled me. Stories such as these can fill your drawers, accumulating until they turn cold and heavy.

I write to ethically make use of what I have experienced and absorbed, and learned vicariously from others – and if I did not, I suspect I could sink into a vast ocean, a sea of other peoples’ pain and trauma, triumph and intimacy, joy and loss.

I write to let other practitioners and younger clinicians know what life in this field feels like, to share some of what I have learned, and to transform some of what I have held as single secrets, as individual stories, into something that can be released to the larger community to help us all understand each other better, and the culture and era we are embedded in.

I write to wrest meaning from it all.

I will stumble and I will mis-step, and I will do all that I can to make reparation.

But writing itself has become an integral, essential part of my practice.

I write to continue working, so that I can keep on keeping secrets.

copyright © 2013
All rights reserved Martha Crawford

Strange Dreams

February 9, 2013 By in Depth psychology, Dream work, Ecotherapy, psychoanalytic theory, Shadow Tags: , , , , , 2 Comments

You know those nights, when you’re sleeping, and it’s totally dark, and absolutely silent, and you don’t dream, and there’s only blackness, and this is the reason, it’s because on those nights you’ve gone away. On those nights, you’re in someone else’s dream, you’re busy in someone else’s dream.

Some things are just pictures, they’re scenes before your eyes.
Don’t look now, I’m right behind you.

~ Laurie Anderson, Someone Else’s Dream, lyrics

The first time it happened was early in my career, too early for me to know or understand the phenomenon well – and certainly too early to trust it.

I was working in milieu therapy, a day treatment unit, where several hundred “severely and persistently” mentally ill adults came each day to receive their medication and case management, group therapy, art therapy and rehabilitation.

I dreamed that I was wearing a police officer’s uniform, and one of my clients was begging me to spank him, while he masturbated.

I was startled by the dream, it felt different in tone and quality from my “usual dreams” whatever that meant.

I explored it in my own therapy extensively – looking at the countertransferential sadistic and aggressive impulses that emerge when working with clients who have difficulty containing their own aggression. I considered the power and class differentials between me and my stigmatized, disempowered clients, and tried to examine my privilege and the authority, authoritarian, and social control functions that I was expected to serve on the treatment unit. I explored my personal, familial and historical associations to the specific client, to police officers, to spanking, and to domination and submission.

I explored my own sexual fantasy life – but, the sexualized aspects of the dream somehow felt off: a dream could have shed light on power/authority issues without sexualizing it.

But, the sexual nature of the dream just didn’t feel like my kind of kink.

The next week, the dreamed of client came in for an awake, daytime session and confessed that he had been embarrassed to tell me that he had been having masturbatory fantasies about me for sometime. He imagined me, dressed up as a police woman spanking him.

I felt enormous relief. The strange bits of the dream weren’t mine. The dream was about my role on the unit, and also about the ways I had been subtly, unconsciously pulled by this specific client to “police” and monitor his compliance and program attendance in ways that were stimulating to him, perhaps over-stimulating to him, and which made perfect sense with the clients history of sexual and physical abuse.

That was when I began to understand, many years, before I began to study Jung, that my own dreams about clients were not merely about my individual psyche.

I told my therapist excitedly about my new realization and he responded:

“Be careful.”

Be careful of what, I wondered? It seemed to me that I was in greater “danger” or getting pulled more deeply into some destructive authoritarian enactment, scolding or punishing, or chastising a client who could feel too stimulated by it if I hadn’t had the dream.

The dream had clearly protected me, and the client. Surfaced a dynamic, an unconscious currency, an exchange that was already present, but unspoken, unacknowledged.

The dream itself wasn’t the danger.

“If a dream shows me what sort of mistake I am making, it gives me an opportunity to correct my attitude, which is always an advantage”
~ C. G. Jung, Dreams

I left a long message on my therapist’s answering machine after that session, certainly too long, trying to shake off the undermining caution, and the traditional psychoanalytic models of dream theory that we had both been indoctrinated into

The various psychoanalytic branches which grow off of Freud’s ego psychological tree view dreams as subjective and individualized experiences, as a portal to unconscious conflicts which are about the clients personal history – and the conflicts from the past which have been transferred onto the therapist or other loved ones. And an analyst’s dreams could only reveal something about the analyst’s individual, private psyche, and transferences. If an analyst were to dream about a client, it would speak to their countertransference, the aspects of their own historical conflicts, or perhaps a dangerous over-identification, activated and constellated in the treatment.

I don’t know about your dreams. But mine are sort of hackneyed. Same thing, night after night. Just…repetitive. And the color is really bad – And the themes are just – infantile. And you always get what you want – And that’s just not the way life is…
~ Laurie Anderson Talk Normal, lyrics

There was another, more minor dispute about dreams a year or so later. Another one of “those” dreams – this time a strange dream I had about my therapist:

I was in his home, sitting on the treatment couch. His wife, as I imagined her, was nearby. A daughter, a son, and five month old baby boy. I sat and played with the baby boy while others went about their business around me, not interacting with me. The dream itself had little emotion attached to it, I was neither happy, nor distressed, perhaps a little bored, but enjoying the baby enough. Yet, in the dream, and afterward, I wondered why I was there, and worried that I was intruding on the scene.

Again, of course, I explored the dream extensively: as a transferential wish to have siblings, to be a part of his family, to be parented by him. To be trusted and invaluable member of his inner circle. I considered whether or not this tiny baby was an extension of my self, perhaps my inner child, that I wanted to be responsible for, as I was seated, held by the sofa now in the middle of his living room.

Four months later, he informed me that he would be taking a leave for a few weeks. Shorter notice than his usual vacation at an odd time.

“Are you about to have a baby? Is this a parental leave?” I asked.

Yes, he admitted, a boy.

I expressed my happiness and congratulations. But, I had a question:

“Do you remember that dream I had a while back? About you having a new baby boy?”

Yes, he said.

“Was your wife, by any chance, 5 months pregnant at the time?”

Yes.

“Did you think about that then? Did my dream seem strange or uncanny to you? Because I remember saying that it felt like a weird dream for me to have – and I worked very hard to try to understand how it might have been about me! But, now I see, it was also about you – or about us both!

Yes. He had thought of that.

“Well it would be very helpful to me if the next time that happens that you just let me know so we can sort it out. Maybe in a previous session I was sensing that you were internally preparing for the birth of your son, I’ve known you through other parental leaves, and I – or maybe both of us – felt that I was intruding on that scene. And you sort of left me trying to take responsibility for the whole unconscious scenario by myself.”

Fair enough, he promised.

“Enlightening an interpretation on the subjective level…may be entirely worthless when a vitally important relationship is the content and cause of the conflict. Here the dream content must be related to the real object. ~ C.G. Jung, Dreams

Many many years later, following a weekend which involved a very emotional and excruciatingly painful crisis involving my family of origin, a client of mine reported this excerpted dream (with permission) which she had herself after the previous Thursday session:

“You were motioning me to wait – but this guy started to upset you.  I thought you’d tell him to stop going through your papers (they were certificates, I think, of your degrees or licenses or something). Instead, your emotions quickly escalated and you started yelling / pleading with him to stop – and you screamed ‘what are you doing! you’re ruining my life’ He was completely in control of upsetting you.

You sat down across from me, legs curled in and started crying out of control.  I couldn’t help but to cry as well – seeing you in so much pain. You were destroyed.  I think I tried to hug you but you were a broken, small, mangled version of yourself.

There was a pause in the dream. I’m telling you about the dream that I just had (above)- and how upsetting it was for me because it was so strange but midway through, it’s abundantly clear that you’re not listening.  You’re going through your papers.

I stopped talking mid-sentence and waited. You looked up at me and I asked you if you’re listening – if you’re with me.  but you weren’t. So I got up to leave, undramatically. but really very upset. And I said “I can’t do this.” you just watched and didn’t stop me.  I left without looking back.”

Her “strange” double dream not only anticipated my unexpressed concern with a crisis that was about to erupt, the distress I had been in – it showed me the ways in which I could re-injure the client, abandon her and damage our alliance if I chose to hide behind my professional papers, degrees and certificates.

We began by exploring her associations and history, her relationship with her wounded parent, and her personal subjective assumptions about the dream – I started slowly, as, frankly, I did not want to expose the details of a personal conflict that felt still vulnerable and I did not want to burden the client or require that she take care of a “small broken” version of myself. Neither did I want to abandon her behind a professional stance that exempted me from my responsibility for my own unconscious processes as they influenced the treatment relationship.

As we were about to move on, just as the subject was changing, I summoned my courage:

“So, listen, there may also be another component in the dream. You’ve been going through a very intense time, and I know that you have been really needing me lately, and whenever we feel we need someone, we watch them very closely. I am wondering if this dream may also be about me in someway… After our session on Thursday, I had a family emergency/crisis which flared up, and I think, I did, over the weekend feel quite small and broken and I did cry a great deal like in your dream. I wonder if you were reading the signs in me, maybe in the same way you learned to at home, to anticipate an upcoming crisis. And then, the second part of the dream expresses your fear that I could deny your astute perceptions of me, and just pretend that nothing ever happened. Kids learn to read their parents like the weather, and maybe you were reading me, and feeling my own storm coming on, and then expecting that I would just act like you hadn’t felt anything real about me.”

“Yes”, she said, breathing more deeply.
“I must have felt something coming on. I always had to do that at home, and my family would act like I was crazy.”

More deep, relieving breaths.

“Are you ok?” she asked.

“Yep.” I answered, “I take good care of myself.”

“It must be left to the analyst to decide how far he, himself, is the patient’s real problem” ~C.G. Jung, Dreams

In some therapeutic relationships, dreams become the transitional play-space where the patient and the therapists’ unconscious processes communicate and play with each other, telling us both about the aspects of the therapeutic relationship that we have consciously missed.

I’ve learned to trust my dream life, and my clients dream lives as they sense and sort through the unconscious processes that exist as a dynamic in relationship to others, to the systems we live in, to the culture and communities we embed ourselves in.

“That is to say, I take dreams as diagnostically valuable facts”
~ C.G. Jung, Dreams

I once dreamed about a client who was unable to tolerate weekly therapy and had terminated abruptly:

I walk down the streets of the city through various familiar neighborhoods and the client pops up randomly, here and there, as if they are making brief, cameo appearances -walking on the sidewalk next to me, coming out of a store, standing at the cross walk as I pass – in a movie that is about something else.

I realized upon waking that I needed to let the client come in as needed, pop up, pop-in, and not try to force them to into my story-board of weekly standing appointments.

Certainly there are many dreams that emerge entirely from our personal unconscious, our unprocessed conflicts alone, calling attention to our history of past traumas, losses and misattunements.

But in the past fifteen years of recording my own dreams, my dreams of clients, and my client’s dreams, it has become obvious to me that dreams serve many other functions as well.

Last night I had that dream again. I dreamed I had to take a test In a Dairy Queen on another planet. And then I looked around And there was this woman… She was writing it all down. And she was laughing. She was laughing her head off. And I said: Hey! Give me that pen! ~ Laurie Anderson Talk Normal, lyrics

I’ve come to think of dreaming as a natural, sensory and relational phenomenon, a means of digesting and incorporating our unconscious perceptions: dreams solve problems, anticipate transitions, highlight things we have overlooked, prepare us for dangers, help us communicate to each other, tell us what issues our psyche is working on in the background, reveal what lives and moves out of our awareness, point out imbalances in our relationships and environments, and extrapolate/project future outcomes from the current trends in the patterns we are embedded in personally, relationally, systemically, and globally.

All of nature talks to me. If I could just figure out what it was trying to tell me. Listen!
~ Laurie Anderson, Sharkey`s Day, lyrics

Many clients in the weeks before 9/11 reported dreams of the like that I have not experienced since. I had been enrolled in a Depth Psychology class studying Jung at an institute in the city, and everyone in the class was asked to keep a dream journal for ourselves, and for all our clients’ dreams. The week before the attack on the World Trade Center, we read aloud from our journals: Strangely, there were many dreams within dreams: of kamikaze jets flying down the streets of the city, of giant tornadoes coming “from the east” which destroyed tall buildings killing hundreds of people, dreams of four giant bombs dropped from the sky but the fourth one doesn’t explode. And those were just my clients. Other classmates’ journals contained surprisingly similar themes and images: lost pilots, building explosions and collapses, one classmate’s client dreamed of turning over the Tower card from the tarot deck.

We wondered together what violent shift was present in the environment that could be reflected in the community’s dreams.

Perhaps any random sample of dreams reported at any given time would contain similar imagery.

I don’t deny the statistical realities of probability or chance.

But I haven’t been privy to a similar thematic thread since.

And I would damn sure brace myself if I was.

Some say our empire is passing as all empires do. And others haven’t a clue what time it is or where it goes or even where the clock is.
And oh, the majesty of dreams, an unstoppable train, different colored woodlands. Freedom of speech and sex with strangers
~ Laurie Anderson, Another Day in America, lyrics

I’ve had dreams, for example, where one highly/overly intuitive client critiques my treatment of another client with a highly/overly developed thinking function: the dream itself offering me excellent insight and supervision into both of the clients undeveloped bits and the functions that I am called upon to strengthen in each of them.

Sometimes I share dreams that have been helpful to me in a case with the client.

Sometimes I don’t.

And another interesting “strange dream” phenomena, which I have experienced many times – A client and I dream a similar sounding dream, the day or two before session, from different vantage points: A dream of a terrible storm in a steep valley, me looking from the ridge of the hill, the client looking at the clouds coming over the high tree-line. A dream with the client swimming against the current, tiring in the water looking up at a woman in a small boat, and me, in a small canoe trying to figure out how to pull a drowing client safely on board.

The dual dream content itself is usually fairly obvious, and takes little work to interpret, but the synchronistic phenomena itself has come to represent to me a kind of alchemical consolidation of the therapeutic relationship itself.

Our unconscious lives have found themselves in the same place, in the same time, working on the same problems, from different perspectives.

I don’t claim that this is science.

Nor do I believe it to be magic.

I remain agnostic as to the ultimate causes or explanations for such synchronistic and unconscious experiences.

But, to the degree that the function of dreaming remains mysterious, and unknown, perhaps we can only approach such mysteries with faith.

And to learn how our dream lives, whatever their origin or function, can serve to deepen our connections to each other and the world around us.

There was this man…And there was this road…
And if only I could remember these dreams…
I know they’re trying to tell me…something.

Ooooeee. Strange dreams.
Strange dreams

~ Laurie Anderson, Sharkey`s Day, lyrics

copyright © 2013
All rights reserved Martha Crawford

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