Sunday, May 20, 2007

Anyone For EBT*....?

You may be aware that there are plans afoot to expand access to psychological therapies in the NHS. This is a Good Thing, in my opinion. You may also be aware that there are plans afoot to ensure that CBT will be pretty much the only therapy on offer. This is a Very Bad Thing in my opinion. Perhaps you already know that. We have had some stimulating discussions on this blog about the pros and cons of CBT. See here and here if you want to catch up.

I have worked with a number of clients who self harm; who will routinely cut themselves as a way of managing a deeper distress than the physical pain of a wound. I have a friend who does this. She is exceptionally bright. She runs a successful business and has a broad CV. She knows more about psychology and psychotherapy than most, including many who work in the field. She invests in her personal development, and has an awareness and intuition that make her a valuable friend. She also cuts herself.

We present to you a joint post, on cutting and soothing, from the perspective of the one who cuts and the one who listens to some of those who cut. Find her words here.

There are a number of techniques that therapists are taught to use with those who cut. These include:

  • Challenging the negative self talk, and replacing it with a positive internal narrative
  • Distraction techniques, like going for a walk or a run
  • Using an elastic band to inflict pain without damage
  • Stabbing a melon with a large knife (!)
  • Taking a bath with aromatherapy oils

These techniques don’t work. I know, because in my early days I have encouraged people to use them and have been dismayed at their lack of effectiveness.

They don’t work, because they absolutely fail to understand the purpose of the cutting. They fail to take account of the simple fact that, for those who do it, cutting soothes. That cutting has an effect on the physiology of the individual, and provides an experience that going for a run or pinging with an elastic band simply can’t replicate.

People don’t cut because they are attention seeking or histrionic. They cut because sometimes it is the only thing that soothes. Everyone who relies on self-harm for comfort has a level of significant internal disorganisation, resulting from either early trauma or lack of attachment in their early years.

This is hard for a therapist. We sit and hear the level of distress, the despair, the hurt and the pain and we feel overwhelmed. We may feel the distress ourselves. We feel pain at watching another in pain. We feel frustrated with ourselves that we cannot relieve it, and then we project that frustration onto the client for not making the techniques work for them. We may feel intolerant at their impotence and at their apparent inability to soothe themselves. We may pick up the projected impotence and feel like a failure at not being able to help. None of this is easy for a therapist.

And so we come up with yet another technique, the purpose of which is to soothe our own feelings of impotence or inadequacy. We Try Hard. It ceases to be about soothing the person in front of us, who is still in despair. The person who cuts knows that they are causing the therapist despair. It hurts them. They know that we are Trying Hard. They leave feeling misunderstood and blamed, confirming a belief that no one can help and they can only find respite through self-harm.

I have found something that sometimes works. It is not a technique. It is not a clever psychological trick. I have learnt that when I walk in their shoes, I start to understand what cutting gives them. I start to understand the primal experience, and recognise that inflicting deep pain on oneself can be physically soothing. It is a very different experience for each person who cuts, and it is not helpful to try to come up with a universal theory to explain the whys. For some people it is about manifesting psychic pain. For some it is about control. For some it is akin to a sexual experience. I have heard people say that it is like having an orgasm, only better. There is no doubt that the physiological experience is as important as the psychological one. Neuropsychologists are starting to research the possibility that cutting releases oxytocin – the same hormone that is released at the point of orgasm. It is possible that cutting performs a function of affect regulation.

So if I could sit alongside the person who is telling me of their pain and their need to cut, if I could walk in their shoes without acting out my own frustration, impotence or discomfort at my own distress, what effect would that have?

We know that to be in the presence of a self-regulating other is soothing in itself. We learn to tolerate our own deep despair by having another tolerate it for us, and show us that it is indeed tolerable. Neuropsychology tells us that when this happens in childhood positive neural pathways are formed, which allow us to continue to soothe ourselves in distressing moments when the other is not there. The secure attachment facilitates the production of oxytocin, serotonin and possibly other neurotransmitters. For those of us who don’t have enough of this experience in childhood, it is hoped that therapy can help us to develop it later in life.

So if the therapist can be a truly self-regulating other alongside the person who cuts, and a holding witness to their pain and distress, this will soothe. And as the relationship strengthens, the attachment will enable the other to internalise the positive object that is the therapist.

There may be time then for techniques. Or perhaps for simply saying “I don’t want you to hurt yourself. I want you to be safe because I care about you.”

I have grave concerns about CBT being the only therapy on offer for people who rely on the NHS. With many clients and issues it simply doesn’t work. With some clients it is positively harmful and reinforces their self blaming pathology. If you want to hear what this is like for users of NHS mental health services, read this excellent post by PatientGuard.

* Elastic Band Therapy


Dandelion said...

"if I could walk in their shoes without acting out my own frustration, impotence or discomfort at my own distress, what effect would that have?"

Oh. My. God. Finally. A therapist who gets it. I think I might die of shock and relief.

Any ideas why this is such a difficult concept for therapists to apply or even grasp, when they themselves profess to practice it? As a "client", it's hard not to take it personally, you know? The arrogance and selfishness of therapists who put their own stuff onto one's experience can often be a re-traumatising experience, you know...It really doesn't seem like too much to ask...

Sorry for the outpouring, but you've hit on a nerve there.

Ms Melancholy said...

Hey Dandelion, the outpouring is fine! I know many, many therapists who can do this. And unfortunately I also know of some who can't because their training has paid scant attention to the importance of the relational dynamic. And all of us have times when the 'counter-transference' (as our feelings are called) is strong and we inadvertently act it out. This is why it is important for therapists to have very good supervision, to have their own therapy and to pay constant attention to regulating themselves whilst in sessions.

There is a time when the relational rupture is therapeutically beneficial, and should be used accordingly in order to heal. But this is useful once the attachment has been made, and in my view we don't make an attachment without having the ability to walk in the other's shoes for quite some time. I think it was Kohut who said that we won't make changes until someone has understood exactly where we are now.

My worry is that CBT pays no attention whatsoever to this process, and if the government has its way this will be the only therapy that those most in need of a relational therapy will have access to.

Thanks for your comments. Much appreciated x

Stray said...

Oh! fab comment Dandelion :) Yes, goodness ... I think I know just what you mean about it being hard not to take it personally!

Ms M - this line is amazing: I think it was Kohut who said that we won't make changes until someone has understood exactly where we are now.

Yes! Bloody hell, yes!

Many apparently destructive behaviours like cutting are a desperate attempt at communication. Often with other parts of our selves as much as others. I believe that the soothing can come as much from the clarity of this communication as any chemical reaction (as if the two could be separate which they clearly aren't).

Action is discourse and discourse is action, and all that.

So, wow, it makes perfect sense that until what the cutting is trying to say has been heard, our subconscious will persist in saying it.


JJ said...

Ms Melancholy, this is such an important subject for people to understand. My thirteen year old son came into my room the other day at bedtime. He said he wanted to talk to me because something had happened to upset him in school. He told me that he had seen a child who was self harming; seen the fresh evidence on the peer's arm, and he felt very upset and wobbly. I think telling me helped, but I didn't really understand much of what it was about for the individual, so found it difficult to explain to him. It's a huge help to hear brave and articulate people discussing this subject.

Ms Melancholy said...

Hey jj, oh, that must be so upsetting for your son. I'm glad he felt able to tell you - we can probably presume that this is the bit that the other boy feels unable to do for whatever reason. Yes, it is important that we talk about this in an upfront, but not a sentimental, way. So often discussion on self-harm becomes awash with unhelpful 'milk and cookies' sympathy. Thanks for your comments.

PS I think it was Kohut who said that we won't make changes until someone has understood exactly where we are now.

I have just looked it up. Kohut was heavily influenced by the humanistic movement, and especially the work of Rogers (he of person centred counselling fame), and would probably credit Rogers as being the first person to stress the therapeutic value of empathy (walking in another's shoes.) Kohut emphasised this (empathy) heavily in his work but maintained his psychoanalytic roots and the importance of transference etc. He was probably the person who first successfully merged psychoanalytic ideas with the values of humanist counselling. Clever man.

Caroline said...

The joint posting has a depth of power that has covered me with hope. Not for me. I'm not even sure who for. Just hope.

(I can not formulate my words out of fear that I will say too much)


trousers said...

Excellent writing Ms M. I'm off to read its counterpart in a minute. I'm a little frustrated about this because I went to an excellent event which looked at self-harm from a number of points of view and had a couple of speakers who were quite inspiring (my frustration is that this was a couple of years ago and so I can't give a coherent summary, the notes I took are at work as well).

It does seem to be a case where the less stigma is attached to self-harm (generally and concerning the individual who self-harms) the better. A basic point but one which is often overlooked or disagreed with. If the stigma is replaced by calm and empathy....well that leads on to the good points that you're making here.

Anonymous said...

My best friend, whose life ended in suicide, cut regularly. Her therapists went Freudian on her, her docs tried meds, none of it worked. The first time I saw the scars, I freaked. Later, I saw her do it, and could see the release and relief in her. I don't cut (but I'm a recovering anorexic, so self-harm isn't exactly a foreign concept), and I've struggled to find a good therapist for years (I think I have one now). And I've seen too many therapists whose work is more about themselves and their own problems than their clients. Glad to find this site and the great ideas here.

Badger said...

Wow... oh how I wish you were my therapist.

I have lots to say, I am just not sure if I am brave enough..... yet.

Badger x

Dandelion said...

Well, if I could just outpour a little more...

I don't think it is amazingly clever at all. I think it is stating the bleedin' obvious, if you'll pardon my french.

Therapists, even psychoanalytic ones bang on about the trauma involved in having a parent who can't/won't engage or empathise with you. So why is it so hard for them to practice what they preach? Talk about hypocritical. They should all be hung for the hurt that they do to already vulnerable people. Arrogant, ignorant bunch of do-gooders. And if they had any respect for their clients, they'd take it on board when we make this suggestion, even if they're too thick to work it out for themselves.

And I don't feel very forgiving, because this is hardly rocket science. It makes me sick to see people patting themselves or eachother on the back for this. What a crock!

Effing bunch of idiots (Not you).

Ok. That feels better. Thanks Ms M

PatientGuard said...

Hello Ms M

I just got my article written weaving back into yours and Strays.

I was so busy cheeking people with insights on another part of the web.

Flinging laughs and severe warmths...

I might have had a go yesterday but I have powerful flashbacks-like-stuff bombing me and have to work through it regularly to get back to the present ...So I was in the dynamite shitbin head mode yesterday ..

Luckily the Tear-God came and showed me a way to float out of my eyes back into Life ..

I'm glad Stray talked about herself. You can love people for that .. - that's the way for us all to share hells and make a campfire where its all acceptable ..Well at least its what some of Service Users are doing on the web now ..

TTT Tribal Talk Therapy ...

Many Warmths to you all

Silvis Rivers ..

Ms Melancholy said...

Stray my lovely, I missed you there! But thanks for that last line

until what the cutting is trying to say has been heard, our subconscious will persist in saying it.

you have summed up precisely what I wanted to say.

Hey lovely Caroline, you don't have to say too much. What you have said is just right x

Hey trousers-who-now-has-a-blog, (go and visit everyone!) Yes, the stigma thing makes sense, although I have never thought about it in quite those terms before. I think we need to normalise all of our experiences before we can fully integrate them, so perhaps what we need to do as therapists is normalise cutting as a coping mechanism but without entrenching it, if that makes sense. Thanks for your comments. Hope your hangover is better!

Hi emi, thanks for dropping by. I think I would like to mention here that in my experience most people who cut or self harm are not doing it out of a desire to end their life. Although of course there will be some who do. I hope your recovery continues x

Hey Badger, big hugs! xxx

Hey Dandelion, wow, please feel free! I felt a little tug there to defend my profession, but I don't think I really need to do I. Sounds like someone has really rocked your boat though. Ruptures can be very useful. Shan't say anymore. Take good care x

Hey Silvis, your elastic band therapy post is great, and I hope people have read it as a result of Stray and I. I shall keep an eye out for your next.

share hells, and make a campfire where it is all acceptable

what a great metaphor! See you again.

trousers said...

MsM, you've summed up nicely what I was getting at, and as I recall was very much what the best speaker at the aforementioned event practiced. Mind you this was a CPN who hears voices which for him was also perfectly normal until he started his training and realised that if the DSM criteria had been applied to him then he would have been liable to be placed under section. I wouldn't necessarily say this put him in a better situation to deal with the specifics of the topic at hand, but surely gave him a clearer handle on it in terms of normalisation.

(As for my hangover - it was disconcertingly mild given that I tottered home after dawn had broken)

trousers said...

Oops, 'scuse that incredibly badly constructed and overly long sentence.

Dandelion said...

I felt a little tug there to defend my profession, but I don't think I really need to do I.

Nope. You can't be held responsible. But I would say it is an argument for better evidence-based regulation, even if we need to redefine what counts as evidence.

Dandelion said...

ps At least actual doctors are committed to the first principle of "do no harm". It sounds to me like "rupture" is another word for "thoughtless re-traumatisation", and I just don't think that's ok.

Stray said...

I just wanted to chip in to say that I think there is a whole world of difference between a rupture and a 'thoughtless re-traumatisation'.

My understanding is that ruptures occur in relationship when someone behaves in a way which is (negatively) surprising to us.

Given that therapists cannot be perfect, omniscient, utterly consistent beings, it is inevitable that there will be ruptures in the therapeutic relationship, because there are limits to their ability to help, hold, hear and know us.

My own experience has been that generally ruptures have occurred around my own inner conflicts: in particular the battle between the desire to make my needs explicit and the instinct to minimise my needs in order to make me more palatable to others. I have a habit of communicating very unclearly around certain issues - I will state that something is not important to me "hey therapist, read this email if you get a chance before the session, but no worries if you don't" when actually it feels vital. Then I'll be angry with my therapist because they didn't read my mind. *sigh*

Whilst yes, that does touch a nerve for me (and then some), and it feels like a huge threat to my relationship with this person, and they don't care about me and blah blah blah, I don't think it's a failing on the therapist's part! I would go so far as to say that I believe I have had re-traumatising experiences in therapy, and they were really very different from the normal ruptures in relationship.

The unpleasant reality is that every day we have interactions with people in which we are negatively surprised by the other person's response. If we don't learn to adjust our own internal world to accommodate that situation and, if possible, learn from it, then the world will always be a scary and uncomfortable place to live in.

There are some inadequate therapists out there, no doubt, and some arrogant ones, and some dogmatic ones ... and a lot of bloody good ones as well. I don't think 'frequency / occurrence of ruptures' is a stick by which they can be measured - ruptures are just a part of therapy, and the most we can hope for is a therapist who is open minded, patient and creative in exploring them, and who can somehow convey to us that all is not lost in the moments when we feel desperately disappointed by them.


Ms Melancholy said...

Hey Dandelion,, it sounds to me like you have probably had a bad experience somewhere. I am a bit loathed for this thread to get caught up in attacking bad therapists, however. I would like to say though, that the rupture is precisely where good therapy happens. Without ruptures, all we have is 'milk and cookies' - "everything you do and say is fine" - and that turns out to be one damn expensive waste of your time. Why would you want to pay good money for someone to actively collude with your defenses? You pay your therapist to say the things that your friends won't. However, re-traumatisation happens when the therapist does this unconsciously rather than using the process consciously and empathically.

It is not my place to probe into your experience here. Suffice to say that our experiences in therapy often mirror our experiences in life, and can be very healing if we have the courage to explore them.

Reading the Signs said...

I also wish I had had a therapist that practised what you speak about. My experience is that it's hard for many therapists to bear the idea that there may be no solution. This is where CBT, which is completely results-orientated, is going to fail those who are more than anything else in need of someone who is prepared to be alongside.
Why is there a sense that this is so rare, especially now? Old-school therapists may have got other things wrong, but I think they had more time, were less strung out. The therapists I know (well, two of them) are, like so many others, trying to pack too much into their lives, feeling that they are failing their clients, their families, themselves, constantly trying to meet some kind of target. Another therapist I know seems to send everyone away with a clutch of affirmations and begins the day with a formidable Gratitude list.
If I ever feel moved to look for a therapist again I will have a badge made that says "Just Walk With Me".

Paul said...

Add up all the coping mechanisms that people use:- Alcohol, cigarettes, anti-depressants, sleeping tablets, beta-blockers, food supplements, alternative therapies, pampering weekends, religious fundamentalism, chocolate, comfort eating, dieting, life-styling, life-coaching, personal trainers, retail-therapy, road-rage, violence, verbal abuse, soft-drugs, hard-drugs, solvent abuse, therapy.

It must mean something?

Paul said...

Stray - "Many apparently destructive behaviours like cutting are a desperate attempt at communication. Often with other parts of our selves as much as others."

You're so right - We so much want and need to understand ourselves, to understand others, and to have them understand us - to make sense of a world that at times is beyond understanding.
And all we have to do it, is language, with all its imprecision and inadequacies.
Empathy then seems a far more important ability than the understanding of neural pathways and hormonal imbalances - A recognition that we are all different, and yet all the same.

bindi said...

Thanks Miss M and Stray for showing us the healing potential of empathy. The other thing that really struck me is how difficult the process is for one individual to truly develop empathy for another. The self reflexiveness required for empathy is not really something many of us

bindi said...

... understand or just do naturally.

(sorry, not sure why it was cut off).

PatientGuard said...

Grief's Royality :

I suppose in blood
I'd put it like this
Don't tell me to shut up
For what I missed

Don't tell me how mom or dad
And other mistakes should never
Bleed out of my arm or wrist

Get in the boat in my heart

Lets travel my history veins
Secure the compass of squeal
And Real

You just help me , cry
My terrible pains..

How about the tear-sail
With the large eye ?

Let it wind-razor and rip
And the half of me
Dumbed and numbed
Coded to fail

Just help me therapist

Dilute the blood
Let it clear in my eyes
Of grey and shale

Help me for years to let it drip ..


As far as I am concerned there is a major taboo against showing "develpomental griefs" because in essence when released they are critical of family ands social "care"s ytems which bury the individual's pain and unmet needs ..

You are lucky if you ever develop the language (and emotional repretoire) for this given the state of health services in the UK

The UK mental health systems are emotional burial systems and the uncomfortable corpse of social lies and denial haunts..Boy does it haunt on the groups I am on - !

Dandelion said...

Wo Ms Mel. Good answer. And thank you for it.

I'm not trying to attack bad therapists, but I do attack the idea that for a therapist to walk in a client's shoes without acting out their own stuff is anything more than a blindingly obvious, bare minimum requirement, therapeutically prior to any transferential benefits that may be possible.

It's not amazingly clever at all, I wouldn't say. It might take some effort to actually do, and I'd applaud that, but therapists do get paid, on the whole.

Also I do not like that when a gazillion clients ask their therapist for empathy, well, they've obviously had a bad experience (doh! why else would they be in therapy...), yet when a therapist suggests it's a good thing and it works, then suddenly it becomes a really amazing clever idea. D'you see where I'm coming from?

Also, if I may add, the notion of a therapist's empathy is totally orthogonal to the question of whether they agree with the client all or any or some of the time. Or not. That's a totally separate issue, to my mind, and I don't think it's helpful to muddle them up.

Dandelion said...

One doesn't need to negate one's own viewpoint or feelings, or wisdom in order to have empathy.

Believing that one does leads to a defensive avoidance of empathy, which I think is re-traumatising. I can understand it, but it's damaging. And therapists shouldn't damage people really, I don't think. That's all

Ms Melancholy said...

Hey Signs, you say

My experience is that it's hard for many therapists to bear the idea that there may be no solution.

I agree, by the way. I think we are hooking up into the 'life coaching/cbt' culture, where everyone wants an answer, wants it snappy, and doesn't want to really explore their interior life and tolerate the fact that maybe life is just pretty hard sometimes. The process is stressy for therapist and client. I am becoming more and more intolerant of CBT for exactly this reason. Lovely pics of the isles, by the way.

Hi there Paul, sometimes people come to therapy saying that they just want to get to know themselves a bit better. My heart soars, and I know we are in for a stimulating and interesting exploration. I honestly think that is all that we can do.

Ah Bindi, the self reflective capacity is precisely what therapists strive to develop, and what sometimes eludes us however much we invest. You are right, that it doesn't necessarily come naturally or easily to us.

Wow Patientguard, I think as a culture we cannot deal with it, and I think this is why our mental health services are so impoverished. I feel sad about this, because I know that there are many, many good people working in mental health and this is not what they would wish for.

Hey Dandelion, you say

but I do attack the idea that for a therapist to walk in a client's shoes without acting out their own stuff is anything more than a blindingly obvious, bare minimum requirement,

I really do agree with you here. This is why I am so despairing of the prevalence of CBT and cognitive psychology generally: firstly, CBT places no value whatsoever on the importance of empathy as a requirement for successful therapy; secondly, CBT practitioners are not required to pay any attention whatsoever to the process of the relationship or reflect on their own practice with regard to the relational dynamic. This makes it far more likely that they will unconsciously act stuff out, and be unable to repair the rupture when it happens.

Hey, do you think it's possible we are starting to agree here??!

trousers said...

Some good, thought provoking stuff here. Excellent thread.

Ms Melancholy said...

Hey Trousers, yes, thanks for your contributions. I think it is truly wonderful that we have this arena (blogging) for these kind of discussions. I just wish I had more time to really get round all of the blogs that inspire me.

PatientGuard said...

Today was a good day to savage NIMHE's ankles in my blog article and connect it up to "superficial" therapy EBT approaches with the help of my my friend and Service User co-alligator who is developing some stuff about Govt thrusts to "modernise" services for learning disability folk (see his lethal no screwing around blog at : )

I even managed to bite CSIP and few Mental Health charities who are rapidly turning themselvesw into super businesses and funding-wolves hanging around we Service Users cattle ..

Beware some of us User-cattle have fitted chromium canines - we too are modernsiing ...

Growwwwwlllllll .. Mooooo ..

Warm regards to everyone ...


anticant said...

I find this post, and many of the comments, deeply troubling for several reasons.

First, that so many people seem to have had bad experiences with insensitive therapists. I don't want to 'attack' the latter, but I do deplore them. I wonder who they are, and how they managed to slip through the training net? Also, what kind of supervisors they have? A counsellor who wasn't aware that empathy is one of the prime requirements of the trade wouldn't have been allowed to qualify in the 1980s, when I did my training.

I was struck by the remark that "there are things your therapist says to you that stay with you forever". That is true, and it is the measure of the responsibility which therapists bear to their clients.

As to self-damaging behaviour, my belief is that everything we do is with the aim of making us more comfortable - to feel better, at least in the short term. Just as we all do things "for the best" as we conceive it, even though we may be grievously mistaken, so we follow faulty behaviour patterns which are in fact self-destructive because we have learned them as the "best" coping mechanism at some point in our lives, and don't know anything better. It is the therapist's task to help us identify, and to start practising, better solutions.

Sorry if these reflections seem inadequate - it would take a long essay to do justice to your moving and insightful post, Ms. M.

Anonymous said...

I am currently having CBT with a CPN, I seem to be the first person she has tested her skills on... I am not enjoying it, we seem to be concentrating on one thing every two weeks going round in circles and I am finidng that we are dragging a lot of stuff up that I don't wish to talk about at the appointments.

Emma said...

CBT worries me, mainly because of the small amount of training some of them are given, I am led to believe they can become a therapist after a 16 weeks course or something of similiar scares me that the NHS thinks this is an answer to the every expanding mental health problems we seem to suffering from.

I have been with my therapist for since February and seen her weekly since then, I find it hard to believe that someone who has not had all the relevant training of walking in their shoes to coin you phrase, has very little insight to what people are suffering from.

Sorry for the long sentence but I think I know what I mean.

I just don't think CBT is right for everyone and by offering it in the way that they are it could affect the "real" therapists in the long run, i.e picking up the pieces.

I firmly believe that my therapist couldn't have helped me like she did if she hadn't aired all her own demons first...xx

Excellent post by the way!!

Emma said...

Please accept my apologies for not previewing that post, I have just read it back and the grammar and spelling are atrocious...xx

Dandelion said...

Hey, do you think it's possible we are starting to agree here??!

You sound surprised...?! I think we kind of do agree, but I also sort of think that CBT makes no claims to offer empathy, whereas other things certainly seem to. And others still (psychodynamic approach for eg) can lead to the implicit expectation of empathy, when in fact that is unrealistic, and thence to disappointment and distress.

Forgot to say before that I thought Stray's comment was wicked, and also, Emma, don't you mean "atroshus"?

PatientGuard said...

Meanwhile back in the satire razor zone, a Flash movie was posted onto my Blog by a bloody cheeky contributor User-shark to do justice to the rotating prize winning "Distractor" .....

It does work if you tweak the bottom left corner ..

I am going to do a report later over on (US) where I "report" for my part of the UK about MH services .

Stray the brill and Ms Melan will be linked to for sure .. We are positive insight-umbilicals. We will be born again ..Kind of...Tripleting over our wisdoms ...

You know, we Users are not polite to the Services who do little good for some of our broken tribes and we know many who are just dead ...


Final Solution Therapy ..

Today I was in thick of it showing off my film (and cheeking people) about narrative mental health "Lifebooking". I was amongst other Users and a few staff ... I love other Users - they are teddies with a straight tongue sometimes ..

One staff who de-forked HER tongue (and had a very wide knowledge) admitted there is hardly any therapy for people (locally) who have just come out of core crisis and who are discharged back to the GP's care .

Hell ....There is not even Elastic Band Therapy for them

But abandonment void therapy AVT is what they are offered .. It has a bad service delivery record though

Yeah.....Like Zero ....

Its a paradox because the more you get of it the sicker you get ..And you move towards crisis again ..

No-one can hear your heart in a void ....

I need a good bark at the moment and the garden fence looks good to bite ...

See you all later ...

Boris said...

Thanks for that. Very informative.

By the way, does nail biting REALLY count as self harm?


anticant said...

Ask Gordon Brown.

Ms Melancholy said...

Hey anticant, I share your concerns about empathy - or lack of it - as a core requirement of our practice. I wonder if the current fad for solution focused therapy, CBT, brief therapy etc has caused us to lose our focus on the quality of the relationship and the value of having another really see where we are at. I blame capitalism. (That last bit was only a half joke, by the way.)

Hey alison, thanks for taking the time to comment. I don't feel it's my place to comment on the therapy that you are having. However, I would tell any client that it is helpful for them to take ownership of the process, and that might mean sharing your concerns about therapeutic direction. And of course, it might be a good thing to talk about the things that you don't want to talk about! Hope you find the courage to do whatever you need to do.

Hi emma, you say

I firmly believe that my therapist couldn't have helped me like she did if she hadn't aired all her own demons first

I happen to agree with you. We go with people to difficult places, because it doesn't frighten us to be there. It doesn't frighten us, because we have been there for ourselves. It is easy sometimes to use cognitive techniques as a way of avoiding the pain of the difficult places. Which ultimately is self defeating. Thanks for your comments.

PS You don't get marks deducted for bad spelling or grammar here!

Hey Dandelion, well, maybe just a tiny bit suprised! Don't you think it's so much more fun when we disagree?!

Hey PatientGuard, thanks for the stream of consciousness. You always make me smile x

Hi lovely Boris, only if you swallow the nail, I think x

anticant ;) xxx

Lynn said...

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