Medium 9781912573233

The Gossamer Thread

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This book is a memoir of the author's professional life as a psychologist and psychotherapist. It shows his progression from a hard-nosed behaviour therapist with a strong commitment to science to a psychodynamic therapist with an interest in narrative. Along the way he shows the way the main schools of psychotherapy (behavioural, cognitive, psychodynamic) work, drawing on case material from his professional practice. He shows the mistakes he made and the lessons he eventually learned from his patients. His focus on clinical cases enables readers to see psychotherapy in operation and get drawn into the ups and downs of trying to help some fascinating and often tricky people who rarely conform to what is expected of them.The book is free of jargon and can be enjoyed without any prior knowledge of psychology or psychotherapy. It is designed to entertain and inform the general readership about the mysterious world of psychotherapy, what goes on behind the consulting room door. It will be of particular interest to the increasing number of people who encounter psychotherapy either through their own experience of seeking help or the experiences of family and friends or through reading of popular books such as those of Oliver James and Irving Yalom.It should also prove invaluable for those interested in training as a clinical psychologist, counsellor or psychotherapist.

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Preface

ePub

PREFACE

“That's the typical guff you psychologists spout!” Kevin glares at me across the low table that divides us. I'm startled. What have I said? Kevin is convinced that the person in the flat above him stomps noisily across the floor whenever Kevin switches on his television. It's a deliberate act of provocation according to him.

“Are you sure?” I'd said, unwisely I now realize.

Kevin snorted. Of course he was. The man hated him.

“Might it not have been a coincidence?” I enquired. Tactfully, I thought.

Kevin shook his head angrily at my stupidity. “I know he does it.”

It was then that I spouted my typical psychological guff. What I'd said was that Kevin could test out the hypothesis by keeping careful records of when the stomping occurred and if it did coincide with his switching on the TV, then he would be proved right. If not, it would be a coincidence. Kevin is a scientist so I thought he'd appreciate the idea. But he was having none of it.

 

Section I: Getting my Hands Dirty

ePub

SECTION I

GETTING MY HANDS DIRTY

A blond, curly-haired, slightly chubby 17-year-old boy sits by a squat, black telephone staring out of the top-floor latticed window of a grand house on the Berkshire/Surrey borders. The telephone is the old-fashioned sort with a circular chrome dial that has letters on it as well as numbers and requires a hard tug to make it move. The phone does not ring and the boy appears not to be interested in it. In fact, the vacancy of his gaze, his casual, slumped posture, the occasional, irregular drumming of his fingers on the window-seat, suggest that he is entirely caught up with his internal world and that the external world is, for the moment, lost to him. Were he to take in what is in his immediate vision, he would see a square, gravel forecourt below, temporarily empty of cars, leading to a drive that bifurcates in front of what, in the summer, is a sumptuous rose-garden but is now a long parcel of dark earth. There is a small cottage beyond and, everywhere to his left and right, stands the gaunt tracery of trees and bushes that make up the extensive grounds. If he were to open the window, lean out and look to his left, he would just see the top of a tennis court. And if he were to look to the right, he might catch a glimpse of Rosie, his brother's foul-tempered horse, in the field beyond the hedge. And if he had been looking out of a window on the other side of the house, he would see manicured lawns, neat, cultivated flower-beds, a rectangular swimming pool dormant under a grey plastic cover, and an expansive view across fields and woods unimpeded by another house or building. It would remind him, if he needed reminding, that he was a privileged child, the son of rich and successful parents, on the brink of what he hopes will be a glittering career.

 

Section II: Microbes in the Vast Universe

ePub

SECTION II

MICROBES IN THE VAST UNIVERSE

“I sometimes wonder,” says Angie, speaking very carefully as though the exact words were crucial, “if I could get taken over by the Devil. Like in The Exorcist.” She looks at me and there are tears coursing down her cheeks. I feel moved by her evident distress. “Do you believe in the Devil?” she asks.

“No. But you do. Is that what you're saying?”

“No. I don't know. I don't know what I believe any more.”

Angie continues to cry. I do not know what to say. We are in a small side room of a GP surgery in Harborne, Birmingham. I have been invited to work here by one of the doctors as their visiting psychologist and behaviour therapist. It has been four months and I am beginning to build up a caseload of patients. Angie is one. This is our second session.

Angie is 30, married with two very young children. She had worked as a dental receptionist but now stays at home to look after the children. Keith, her husband, works on the North Sea oil rigs. He is away from home for long stretches of time, as he is now. The GP referred Angie to me because she had become depressed a few months after the birth of her second child. He had diagnosed post-natal depression and suggested antidepressants. But Angie had refused medication. He had been seeing her supportively when she told him about the horrific fantasies that had first appeared after the birth of her second child. Angie confessed that she had awful thoughts about killing her children.

 

Section III: Getting Personal

ePub

SECTION III

GETTING PERSONAL

Some years ago one of my daughters gave me a book called Shrink Rap featuring jokey cartoons about psychologists and psychotherapists. A recurring cartoon was of a defenceless patient lying on a couch being listened to (or not) by a small, bearded, middle-aged man who, if there was dialogue, is shown speaking with a heavy Viennese accent. This popular image of psychotherapy is one of the many legacies that Freud has left us. Even today, some 70 years after Freud's death, most people see psychotherapy as Freudian psychoanalysis, the patient lying on a couch, the therapist a silent, inscrutable, European-looking, older man who seems excessively interested in his patient's early sex life.

Simple, stereotyped, negative, and highly distorted views can be remarkably persistent even among those who should know better. In the late 1980s the vast majority of academic psychologists, with a few rare exceptions, regarded psychoanalysis as at best an old-fashioned, outmoded therapy and at worst a form of deception. Their view was no different from that of the cartoonists: the sadly deluded patient lies on a couch, day in, day out, year after year, while the hidden analyst makes portentous, ridiculous interpretations about entirely hypothetical and unverifiable psychic processes. No benefit could come from this approach, it was believed. This view was bolstered by various critiques of psychoanalytical psychotherapy claiming to show it was no better than placebo. But for academic psychologists their major objection was theoretical. Freud's ideas about the workings of the mind were, in the dispassionate language of modern science, arrant nonsense. His “hydraulic model”, for example, in which unconscious sexual drives build up until they somehow overflowed into the psyche, causing neurotic symptoms, was pseudo-scientific, 19th century thinking at its worst. The division of the mind into the holy trinity of id, ego and superego could not be sustained given what we knew of the workings of the brain. The idea that there were stages of development, oral, anal, pre-genital and genital, and that adults can get neurotically fixated at a certain stage, did not fit with modern research into child development. The various psychic processes that Freud had elaborated—repression, resistance, denial, displacement, projection, introjection—were regarded as little better than mumbo jumbo. In other words, academic psychologists saw psychoanalysis as fundamentally unscientific. Its theoretical concepts did not meet the Popperian criterion of falsifiability, namely that scientific hypotheses should be capable of being disproved by evidence. Hypothetical mental processes that acted unconsciously on the person are difficult, many thought impossible, to put to experimental test. Take psychological defences. Freud had suggested that when a significant intrapsychic conflict is exposed, say, in a therapy session, the patient will unconsciously defend against acknowledging it because it is too frightening to do so. They may staunchly deny that they have any such feeling (anger, lust, jealousy, love, whatever it might be). This defence is known, appropriately enough, as denial. The analyst however knows better. But how then, the academic psychologist asked, can one test out the truth of the analyst's assertion? If the analyst's hypothesis is true about the unconscious feeling, the patient denies it. If it is false, it is also denied. Heads the analyst wins; tails the patient loses. The concept of denial, as with many other psychoanalytic concepts that are unconscious, is incapable of being scientifically disconfirmed for this reason.1

 

Section IV: So it Goes

ePub

SECTION IV

SO IT GOES

For all my professional life, I had been a scientist. The letters after my name, MSc and PhD, attested to my credentials as such. But ever since 1964, when I ventured to write my first scientific essay on Tinbergen's A Study of Instinct, I had never felt like one. In the 20 years since I graduated I had adopted the persona of the scientist without being fully committed to it. I published articles in scientific journals. I spoke the language of hypothesis testing and experimental design. I was familiar with all the major statistical tests. I carried out both between-groups and single-case research studies. I had presented my work at scientific conferences. But in the consulting room, the place I felt most at home, the scientist persona slipped and in its place there was a person, a human being, eager to understand and to use whatever skills I had to help the patients out of the impasse they found themselves in.

It was a precept of both behaviour therapy and cognitive therapy that the therapist should be a scientist at all times, even in the consulting room. An idea about what was wrong with a patient was a hypothesis and therapy was a way of testing it experimentally. An agoraphobic is presumed to be anxious about leaving her home, a place of safety. The anxiety is never properly tested as the patient refuses to go out. If this hypothesis is correct, then taking the patient out should lead to an initial increase in anxiety and a subsequent decrease, which is what often happens. A depressed man is hypothesized to have irrational, distorted, and negative thinking that underpins his depressed mood. Using a thought record sheet, this hypothesis can be tested and the results confirm or disconfirm it. Where such thoughts exist, as they do in many depressed people, then changing the thinking should result in changing the mood. Again this often happens. This, it is argued by CBT therapists, is science in operation. But the more I thought about this, the less I was convinced. Suppose an agoraphobic patient is taken outside in a behavioural programme but despite repeated treatments, her anxiety fails to decrease. Does this once and for all disconfirm the hypothesis that exposure treatments will lead to anxiety reduction? No. The therapist looks for reasons. Perhaps the patient has developed an internal ritual, a phrase or mantra that enables her to switch off from the anxiety thereby not allowing the feelings to be properly processed. Or, like Mrs. Hewittson from the Dog Kennel Hill estate, she gains too much from her agoraphobic way of life to give it up. Or there is another factor in her anxiety that has thus far remained undetected, a global feeling of insecurity perhaps stemming from a highly anxious childhood that remains powerful whether or not she is away from home. There are too many variables in psychotherapy for it to be anything like a scientific experiment.

 

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