This journal discusses the issues that arise in therapy: anything concerning the human condition. I write when I have something to say, normally about two or three times a week, so drop by for new entries. It is not a substitute for therapy. I do not mention my clients as their personal information is confidential. I hope you find my journal interesting. The views expressed in my journal are my own and not those of Richard Snowdon Counselling Psychotherapy & Psychoanalysis.
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11:03 - 22|01|2008 | Post a comment: email@example.com
Following on from yesterday's thought about the difficulties of listening to the other, of encountering the other in their entirety - I wondered today if we have somehow isolated ourselves in an anxiety of saying and doing the wrong thing so we tend to try and say nothing.
We cannot easily listen to someone telling us of the emptiness inside them, we can not easily listen to their loneliness. Could it be because we fear the loneliness in ourselves?
I have written before about the idea that we could dissipate our pain by sharing our pain in the same way we break bread. (Breaking Bread 09-10-06). Perhaps we may have done this in the beginning of our development as thinking and feeling mammals.
The paintings that we find on the caves of the early homosapiens showed us how they went out and faced the beast, the mammoth, the sabre-toothed tiger, how fearful that must have been for them. Did they dissipate the fear by showing it, by sharing it in a communion of art?
The fear no longer sits with the individual, it is shared collectively, it can enable them to go out and hunt as the group, the fear is not so strong if it is shared.
If we hold a fear of becoming depressed, if we fear being alone and we don?t somehow share that fear, do we not then hold it all in, and is that why we can become anxious?
When someone else does vocalise it, do we find it hard to encounter them and listen because we have become so used to holding things in, we have forgotten how to show and share our feeling.
The personal versus the tool
20:17 - 21|01|2008 | Post a comment: firstname.lastname@example.org
I discovered an article written on the 7th Jan 08 in a magazine aimed at GPs called 'Pulse'. The title of the article was 'QOF depression tool causing over diagnosis.' The article explained that GPs tend to use two assessment tools. One is the Patient Health Questionnaire (PHQ-9), and the other is the Hospital Anxiety and Depression Scale (HADS).
In a study both tools were used on the same number of patients. The PHQ-9 classified twice as many people as moderately to severely depressed, compared with HADS. So in theory GPs who used PHQ-9 and strictly adhered to NICE stepped care model, diagnosed that three quarters of depressed patients would be offered an antidepressant. Half would be offered one if tested via HADS.
The article then moved on to various quotes. One of these stated that they didn't know which one of the tools were wrong. Finally one doctor quoted called the tools 'blunt', he went on to say and warned that GPs often don't act on their findings because they don't really know what to do next. The QOF has unskilled a lot of people - they seem to be forgetting their holistic skills.
Now this is the part of the article that resonated. The idea that people who were GPs and who's training is based in a scientific medical model suddenly find themselves de-skilled by a scientific tool. It is, as the quote suggested, they have become de-skilled as they do not see the individual sat opposite them as a whole. An individual walks into the practising room and says ' I don't feel so good, I am not myself, I am not sleeping, I have no joy in life'. As the GP is listening does he/she have to switch off in that moment and reach for the tool and instead of entering in to a dialogue with the patient, the GP simply asks questions from a sheet of paper. Then they make their diagnosis from that, rather from what the individual sat in front of them was trying to convey.
Is this so hard to do? To listen ? To encounter the whole person, rather than just an aspect. I wonder though if we all suffer from this same issue. Are we de-skilled? Can we enter into a dialogue with the depressed person? Or do we all try and reach for a tool? A piece of information on which we can base an opinion. Are we perhaps afraid of saying the wrong thing in difficult situations so we tend to end up saying nothing.
How do you let go of tools and encounter the individual in their entirety?
11:10 - 23|04|2007
I went out and watched the runners in the London marathon yesterday, and it's the first time I have ever watched a marathon. I often wondered why people found it interesting to watch lots of people running past them, and then I experienced it.
It was that collective experience that I know we all need to have. The atmosphere was one of admiration in the strength of the runners to endure the task. And also that many of the people taking part are on a personal journey and are raising money for chosen charities.
The crowd of course come out to cheer these people on and it was an uplifting experience and I too cheered them on. When runners came past in fancy dress they drew the loudest cheers and waves and they brought a happiness to the crowd.
It makes us happy to see that side of our natures, the side that makes an immense effort to care for another person, and to demonstrate that love and care with action.
It can sometimes be hard work to love and care because it opens us up to the most strongest of feelings. To witness all those people yesterday running for something they believed in and cared for was an affirming experience. It affirms how amazing we can be.
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11:01 - 16|04|2007
I have often found that when I am coming back from the supermarket laden down with shopping, it is when I am nearest to home that I suddenly question whether my aching arms are going to be able to take much more, and the bags then feel so much heavier.
It is strange how that occurs, and I have found that people who are coming out of a difficult time, when perhaps they felt the weight of responsibility heavy on their shoulders and then they see a light at the end of the tunnel, that it is in that moment they speak of an anxiety. The anxiety that now you know your almost home, somehow your just not going to make it, your not going to have an opportunity to rest.
Perhaps when someone goes through a very stressful time, they may not notice the heaviness, or that they were becoming depressed by the situation. To recognise the situation and to finally talk about the situation always lightens the burden.
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Face to face
15:17 - 11|04|2007
When a person contemplates coming into counselling or therapy part of that contemplation must be based in the desire to change. Therefore there may be an aspect of the person's personality that makes them unhappy. So the desire for counselling and therapy could be based in a desire to change who you are.
Yet that is perhaps one of the first hurdles in counselling and therapy, that moment when you face who you are, and we don't always want to have to come face to face with ourselves.
However it is precisely at that moment when we face the facts of being what we are, that then changes what we are.
21:19 - 10|04|2007
I watched the program The Bible Revolution on channel 4 last night, it was about the lives of John Wycliffe, William Tyndale and Thomas Cranmer.
The presenter of the program spoke about how the lives of these men shaped the way we speak and use language in England today. At that time in history the English church did not want the people to be able to read the bible because they felt that if they could read the bible for themselves then they could start thinking for themselves. It was this that the church needed to be suppressed and so this was what those three men were fighting against. The presenter at the end of the program said that the translation of the bible into English then gave men and women the freedom to choose.
So the church at that time were trying to supress certain people from thinking. If you deny someone access to language, you deny choice, you have control, and can dictate how they should think.
Yet this attitude has not been buried in the past, it still exists today.
It can be that an individual who comes into counselling and therapy has been fighting their own revolution as they try and break away from an idea that has been imposed upon them by a significant other. If a person is not given the freedom to think for themselves how can they have the freedom to express themselves?
If a person has been told in a suppressive negative environment: 'this is who you are and this is how you should think'. Have they not become a prisoner of the other's language?
The individual who comes into counselling and therapy is trying to break out of that language, a language which has become foreign to them. In counselling and therapy they are trying to translate their own lives into their own tongue.
That fight to be free and to choose is onward going.
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10:55 - 30|03|2007
Following on from yesterdays thoughts about knowing what we want because we know what other people want. It made me think about the phrase 'I know what's best for you'. Which could also mean 'I know what you want' Or another aspect of that is 'I know what I want you to want so I need you to want it'
In relationships this dynamic could lead to one partner exerting control over the other, which could lead to frustration for the recipient. The frustration could be based in feelings of inadequacies, due to not being able to live up to the expectation or demand of the other.
The recipient could feel trapped in the relationship because they have unintentionally become dependent on the other as they do not know how to want. They have not been given the space to find things out for themselves or to make mistakes. Then they can become insecure and more dependent.
Yet the desire to discover what it is to be oneself is a fundamental part of human nature. An individual who is thwarted in this by the other may find themselves acting out on the frustration as they do not feel they can communicate their need to the other.
It is this acting out of frustration that can often bring an individual into counselling and therapy, as the individual wishes to understand why they do what they do. Counselling and therapy helps the individual to reach the source of their frustration and understand how it impacts on their behaviour.
Reaching the source and understanding what it means will dissipate the need to act out.
People know what they want because they know what other people want. This idea was being bounced around in a conversation I was involved in last night. The conversation was mainly about advertising and commerce.
The idea of the conversation was that advertisers developed 'wants' and then sold the idea to the public and the public buys it. Then if people think that other people want the product they will want it to. I think that was the gist of the conversation.
Today I started thinking about the 'want' and that the 'want' has to already exist. The advertising agency don't create the 'want', they recognising it and know how to manipulate it.
So there is a relationship that goes on within us with regard to how we think about how the other thinks and feels. In a need to belong and to feel secure in the group an individual may map themselves to the idea of the needs of the other and following on from that the individual would find that they wanted what the other wants. If we all want the same thing we would be harmonious. If a person wants what only they want they are seen as being selfish. So to want something for yourself can on one level be seen as antisocial by the group you inhabit. The group of course can be the family, the social, the work, and of course society as a whole. By fitting into our little groups we fit into society.
Surely then it must be a struggle for people to sometimes know what they want, if they believe they only want what the other wants. Ironically then the need to belong and feel secure could lead the poor individual into an alienation of themselves.
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The transforming insect
17:04 - 26|03|2007
I watched the film 'Pan's Labyrinth' last night and there was a scene where the little girl first sees an insect crawling out of a stone. The insect had the impact of making me feel slightly squeamish, but the girl character in the film likes the insect, and then later on when the insect is in her room at night and crawls up her bed towards her, she smiles and asks the insect if it is a fairy. The insect looked nothing like a fairy, but as the girl shows the insect a picture of a fairy then it transforms into one.
That scene demonstrated very clearly how we perceive reality and how we shape our reality. If you watch the film you too have a choice, you can believe the insect transforms itself into the fairy and leads the girl into another world, or you can see a little girl transforming an insect into a fairy and taking herself off into another world.
The director is showing us something very real in the film regarding reality and he uses trauma as his vehicle. For when a person, child or adult is in touch with trauma, the way to survive that is to cut yourself off, and in a sense create another reality.
In the real world when a person experiences trauma and survives, they still suffer the effects, life in a sense can not go back to normal. Is this because the individual has been in touch with two realities and so how do they return to what was once experienced as 'normal'.
When you have faced a different reality how do you learn to come back ?
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The blue silk dress
I went to see a Russian production of Chekhov's 'Platonov' at the weekend as I'd heard it was an impressive production. I think this was due to the great company of actors, but I think it was also to do with the design of the set. It was an elaborate one, on three levels, the ground level had a pool representing the lake. Indeed seeing actors diving in and out of the water and making their entrance and exits in this way was a theatrical delight.
However there came a point for me during the production when two actors on the ground level of the stage were involved in a strong emotional scene with each other, but my attention could not remain with the actors, and therefore could not remain with the emotion they were trying to convey, because the other actors were moving about on the second and third level. On the third and top level, there was a female actor in a blue silk gown silently dancing and spinning around.
I wondered if the director had intentionally meant to distract the audience from having to experience strong emotion, because if he had just left the two actors on stage alone to deliver the emotional dialogue then of course the audience would of experienced only that.
The director therefore gave the audience an escape, via the distraction of silent actors moving around the set. We could see two actors producing an emotional piece, but if it became uncomfortable we could look elsewhere on the stage and imagine ourselves in the room upstairs dancing, or in the dinning room eating.
If I think about it now perhaps that is what the director was trying to say, that in life there is suffering and yet we do not want to have to face it or look at it. In Chekhov plays you can often see a characters life falling apart as he sit at the dinner table with his friends, and yet the friends are oblivious.
So when I watch the play, do I keep my attention focused on the main drama or do I look up and away at the dancing actor spinning in her blue silk dress. That is the question then, where do we look?
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23:11 - 16|03|2007
The film Factory girl has just been released and there has been a lot of talk about Andy Warhol in the media and I remembered reading something he said once about change. 'They say that time changes things, but you actually have to change them yourself'.
Time does change things and I think that most people often feel an anxiety around change, I have covered this theme many times in my writing. For some individuals change produces such an anxiety that it immboilises, and in that sense the individual is unable to fulfill that part of Warhol's quote, to change things for themselves. Being unable to change can lead onto feelings of helplessness and depression.
When a person becomes depressed implementing change becomes even more difficult. When you're in a depression and you read a quote like Warhol's, it can tap into so much stuff.
Depression can make you feel guilty that you can't make the changes, you can think that everyone else is able to implement change effortlessly. There can be feelings of anger or resentment, a belief that things cannot be changed, or will not change. Or there can be resignation, a depressed person could read Warhol's quote and think that they can't make changes and so time won't change a thing'.
So the depression grows. Yet change can occur, if the depressed person can begin to talk about the characteristics of their depression and not hold it to themselves but speak it, that is a change.
What we do
10:48 - 15|03|2007
'We are what we repeatedly do'. So said Aristotle. No doubt Aristotle elaborated on this theme, and as I think about it I realise it is a central theme in counselling and therapy. Individuals come into therapy because what they are repeatedly doing is impacting on them in a way which causes stress, anxiety, depression, apathy, anger, and all the other emotions that present themselves in the counselling/therapy room.
Counselling and therapy looks at repetition and helps the individual look at repetiton. So if Aristotle is correct and we are what we repeatedly do, then the counselling/therapy process helps the individual change that negative repetition and enables the individual to become more congruent with themselves and their behaviour.
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11:13 - 12|03|2007
I have been wondering what it means to be content in life, how that is a goal, or an ideal, invariably in a conversation when you may be asked: ' What do you want from life'. The reply can often be: 'I want to be content in life'
As I look at the word content I can also see its other meaning. Firstly the idea of being content in life implies a state of equilibrium, for example a person who is content perhaps would not describe themselves as being ecstatic in life, or dejected. Content is to be satisfied with what you have.
Now the word is also used to described the content of something, or something that is contained within, like the contents of a book.
So if I play around with the word I could come to the conclusion that for a person to be content in life they will have to be satisfied with the contents. It is what we, or others put into the book of our lives that will shape us.
If then it is a healthy goal to want to be content in life and there is a difficulty in reaching that state then it will become necessary to look at the content.