Counselling, Supervision, Training, Research, Teaching, Writing. Providing therapeutic services to the people of East Lancashire and beyond.

Sunday, 27 January 2013

Book Review: The Examined Life by Stephen Grosz

This little book of case studies has created a buzz in the small world of counselling and psychotherapy. It's been reviewed by the Guardian here, by the Observer here and by Rory of here. Chapters have also been broadcast on BBC Radio Four's Book of the Week and can still be heard on the Marsden Therapy Podbean page here.

I'll start my review by mentioning a major reservation I have about the book in respect of client confidentiality. I accept that Grosz has protected the anonymity of his clients by changing names and details. I don't know how well disguised his clients are or whether they would recognise their private tribulations within the pages of his book. I don't know whether Grosz obtained consent from his clients or if  his clients knew when they attended psychotherapy that Grosz was collecting stories for a future publication.Maybe Grosz didn't know that either. It's a mistake to think that anonymity is the same as confidentiality. Whilst anonymity protects the identity of the client, the principle of confidentiality guards not only the client's identity but - within limits - everything the client says. Of course one of the book's selling points is that it provides an insight into the private world of psychotherapy, but I remained uneasy as I read these very personal case histories, transformed into very beautiful stories.

The book itself contains thirty-one brief chapters in which the author considers both the process of psychotherapy and the lives of his clients. With deep understanding he reflects on what he finds there, pointing out the unconscious motivations behind human behaviour, showing how apparently irrational choices make sense in the wider context of early experience and the need to protect the individual from something much worse. So jealousy protects us from the fear of being abandoned and paranoia guards us against the fear of being alone. Sometimes Grosz's conclusions are ingenious, sometimes speculative, but always thought provoking. There is great wisdom and humanity in this book. Reading the book as a counsellor I was inspired and encouraged to keep listening to my clients and to continue helping them to tell their stories.  

Wednesday, 23 January 2013

Suicide Prevention in Blackburn with Darwen

I attended a mini conference on suicide prevention at Blackburn Town Hall yesterday. There were representatives from a range of health and social services. I was there with a couple of colleagues from Blackburn College. I noticed that my old employer, The National Probation Service, was missing, which was a shame given that the workshop I attended was on reducing the risk of suicide within the criminal justice system.

The aim of the event was to consider how Blackburn with Darwen Borough Council and our own organisations might respond to The National Suicide Strategy. In workshops we discussed how we could work together to reduce the number of suicides in our town and the dreadful impact that each of those has on our community.

The first speaker was Chief Superintendent Bob Eastwood, Lancashire Constabulary Divisional Commander responsible for policing in East Lancashire. He spoke movingly about a colleague who had committed suicide and the impact of their death on family, friends and colleagues. It was pretty clear that Chief Superintendent Eastwood had been deeply affected by this and by the numerous incidents he'd attended at which someone had taken their own life. The impact of suicide ripples out across society. The other startling point made by Mr Eastwood was that sometimes all of his on-duty officers are engaged looking for or attending to suicidal people. He explained that suicide is traumatic and preventing suicide has significant resource implications for his organisation. 

The next speaker was Emma Thompson, the Borough's population health analyst. She gave a presentation on suicide as a global, national and local problem. In Blackburn with Darwen there were 18 suicides across the Borough in 2010 - thirteen of those were male and five were female. On examining the figures for suicide in Blackburn over the last ten years a number of features emerge. She said that most were under the age of 45, 75% were male, 27% were single, 34% lived alone and 70% could be defined as 'white British'.

In the workshop I attended on suicide and the criminal justice system it became clear that the police are struggling to cope with their role as first responders. Often their appearance exacerbates the situation. A Chief Inspector said his officers really struggled with non-statutory offenders specifically and with distressed and suicidal people in general. He said there was a pressing need for speedy assessment and for a referral pathway. We thought there was a place for volunteers in supporting suicidal people, but the work would be complex and challenging.

Living Works talked to us about the suicide prevention training they offered. They offered three major programmes:

  • suicideTalk - awareness raising,  one or two hours duration, groups of 30 to 50
  • safeTalk - a step up from suicideTalk, a programme designed to give people the confidence to talk about suicide with people at risk.
  • ASIST ... a two day course involving role play, designed to give people the skills to work with suicidal people based on the principles of connecting, understanding and assisting.
The aim of Living Works is to create a network of helpers in the community. They said 'help seeking' is encouraged by open, honest and direct talk about suicide. They also said that the relationship between the helper and the suicidal person is key! The presentation ended on a positive note: 'No matter how despairing someone feels there is always a reason to live'.

The final speaker was Shirley Goodhew, Public Health Development Manager for NHS Blackburn with Darwen, speaking about risk factors for suicide: job loss, debt, social isolation, bereavement (especially for older people), family breakdown and imprisonment. Clearly a key risk factor for suicide was LOSS in its many forms. She said stigma and bullying are aggravating factors.

I left the conference feeling that agencies in the Borough had a long way to go if they were ever to work together effectively to safe-guard those at risk of suicide; but I left feeling that I had a part to play and I intend to book myself onto a Living Works training programme as soon as possible because, as the Chief Inspector said, 'Every life matters'.

Sunday, 20 January 2013

Some thoughts on Leon Benjamin's 'Building brand me?'

Leon Benjamin, a blogger at Winning by Sharing has posted an excellent presentation, How do I build brand me?, on Slideshare. It contains some very useful and (for me) timely advice on social media networking and prompted me to add the following (now, slightly edited) comment:

Thanks Leon, seeing your blog and Slideshare has been timely for me. I spend a lot of time sharing links, writing posts and creating resources for my students and to build my reputation as a counsellor who is passionate, committed and knowledgeable about the profession of counselling. I have evidence from students, clients and colleagues that this is successful, but your blog and presentation has helped me to be patient, focus on the process rather than the outcome and to remember that influence cannot always be measured by immediate reactions and change. In fact these principles apply as much to client work in counselling as they do to my involvement with social media. And the fact that I am now thinking, 'This could make a good blog post' shows how much I have begun to think in terms of creation, curation and sharing. Best wishes, @MarsdenTherapy

So, here I am creating the very post I mentioned in my comment. I think this is an example of why I like social media and its networking potential. I'll make a list:
  • I have Tweeted the link to Leon's blog on my Twitter feed to alert my followers to something interesting I've found on the Web. I'm particularly thinking of those followers who are also colleagues at the University Centre, Blackburn College and interested in developing Open Educational Resources (OERs) and using social media to engage learners.
  • I have followed Leon on Twitter, 'liked' his Facebook page, added his blog to my feed, added his blog to my newsletter on and subscribed to his Slideshares. So I'm now 'connected' and have expanded my network. He may or may not subscribe to any of my social media sites but either way I'm going to be notified whenever he uploads content.
  • Finally here I am embedding Leon's content in my own site and adding my own reactions. For me this is fun but it's also learning.
So, I shall continue giving time and attention to my social media accounts. It's fun to create and curate; it enables me to connect with colleagues from across the world; I'm able to engage with different opinions and experiences, new ideas and research; it develops my writing and critical thinking skills; and builds my reputation as a counsellor, supervisor and teacher who is working at being authentic and is certainly passionate about his work ... 

Now ... I need to add this to my blog and post a link on Twitter ...

Wednesday, 16 January 2013

Reflections on Bradshaw and Toxic Shame

With some trepidation and for the third time in my career I entered counselling  before Christmas. My counsellor is an advocate of ‘inner child work’ and recommended this John Bradshaw book. I’ve read Bradshaw before because fifteen years ago, when I was training to be a counsellor, ‘healing the wounded child’ was very much in vogue. When I read Bradshaw the first time around I was not impressed. It seemed superficial, quasi-religious and a cobbling together of numerous therapeutic models and techniques. Those objections largely remain. I’m not in sympathy with Bradshaw’s twelve-step approach, his patronising of gay people, his theocentric world-view or his conservative beliefs about sex . The biggest sticking point, however, is Bradshaw’s view of shame.

Bradshaw says that shame is toxic or demonic. In other words, the thoughts, feelings and behviours of individuals repeatedly shamed in early life become shame-based. Shame becomes part of the individual’s identity. Shame is the belief that, ‘I am a flawed human being’. Whilst I agree with Bradshaw's idea of toxic shame and I like the idea of shame as demonic, I struggle with Bradshaw’s corresponding idea of ‘healthy shame’. He argues that the shame we feel when contemplating a wicked act stops us doing wicked things. I can accept that anticipatory guilt serves as a useful emotion helping to keep us out of gaol, but a shame-based reaction seems over the top, harmful and destructive. Is it healthy to feel shame in Tesco at the thought of eating a grape from the bunch you haven’t yet paid for?

Despite these reservations I gave Bradshaw my best attention. I found his exploration of toxic shame in part one of the book illuminating and I could relate to what he was saying. But as he described shame in all its forms and identified the ways shame is passed down the generations and internalised, I began to feel pretty miserable.

In chapter one Bradshaw argues that to combat toxic shame - the belief that I am a flawed human being -  an individual creates a false self to escape his or her shame laden identity. In chapter two Bradshaw expands on his view of shame, describing how it manifests at different stages in an individual's development. It’s in this chapter that his views on gay people  -  he identifies 'normal' children and gay and lesbian children - feel patronising.

I like his idea about the toxically shamed becoming either 'more than human' (ie perfect and superior) or 'less than human' (ie flawed and defective). I remember an offender I once worked with who protected himself from the truth of his awful crime and the judgement of others by assuming an attitude of self-abasement. Bradshaw describes this as 'grandiosity' and says, "It can appear as narcissistic self-enlargement or worm-like helplessness" (41).

Bradshaw expands on his idea of the false self. He says, "To be severed and alienated within oneself also creates a sense of unreality. One may have an all-pervasive sense of never quite belonging, of being on the outside looking in. The condition of inner alienation and isolation is also pervaded by a low-grade chronic depression. This has to do with the sadness of losing one's authentic self. Perhaps the deepest and most devastating aspect of neurotic shame is the rejection of the self by the self" (34).

The cobbling together of multiple theories is much in evidence here. Bradshaw borrows from NLP, CBT, the psycho-dynamic approach and from humanistic psychology. He refers to Seligman's 'learned helplessness'  as well as Harry Stack Sullivan, Alice Miller and Scott Peck. Does this amount to theoretical incoherence? It’s what might be called a kitchen sink approach to the problem of shame. My reaction was to visit Amazon at regular intervals to buy the books Bradshaw was referencing. I concluded that these ideas might be better appreciated in the original context.

Bradshaw links toxic shame to the discourse on 'being' v 'doing'. He says the false self necessitates a life based on externals - doing and achieving - whilst 'being' depends on the inner life. Bradshaw quotes (or misquotes)  scripture: 'The kingdom of heaven is within' [Luke 17:21].

Chapter three is a long chapter in which Bradshaw writes about the family system as a source of shame. He describes how shame is passed down the generations and illustrates this with a composite 'client' called Max (an 'Everyman' of toxic shame).

There is an interesting section on 'families as social systems' which I think I have read before and stored away. It formed the basis of what I was saying to a recent client about his situation. In particular the principle of dynamic homeostasis: "whenever a part of the system is out of balance, the rest of the members of the system will try and bring it into balance" (52). Bradshaw goes on to write about 'shame-based family rules' and lists them (62-63). He also writes about shame as a state of being and describes the three steps that lead to internalised or toxic shame:
  1. Identification with shame-based models [parents, family structures, roles, rules] and the carrying of unexpressed shame
  2. The trauma of abandonment - shame binding all one's feelings, needs and drives
  3. The interconnection and magnification of visual memories or scenes and the retaining of shaming auditory and kinaesthetic imprints (64).
Bradshaw writes (68) about children being sensitive to the needs of parents: 'By taking on the role of supplying his shame-based parent's narcissistic gratification, the child secures love and and a sense of being needed and not abandoned'. Paradoxically the child is actually abandoned since his or her needs are no longer being met. I was reminded at this point of Ferenzci's writing on the 'Wise Baby' syndrome. Bradshaw certainly provides a good description of abandonment trauma and its many manifestations.

Bradshaw says something interesting about emotions (1) they monitor our basic needs, and (2) they give us energy to act (Bradshaw uses the term e-motion, 'energy in motion'). He says our true sense of self depends on feeling authentic feelings; but when our feelings are shame-bound (marked by internalise shame) instead of real feelings we experience scripted feelings – we have to ask ourselves ‘How should I feel?’ I can identify with this.When I started counsellor training in 1997 I was was cut off from my feelings and how others felt was purely guess work!

In chapter four Bradshaw identifies the various ways we cope with toxic shame, the various covers we have, which he refers to, in the Freudian tradition, as primary and secondary ego defences. He goes on to list them, but I shall refer you to page 104 of the book.

In part two - 'Recovery and Uncovery Process' – things take a more positive turn and my mood began life. To begin with Bradshaw invites readers to join a twelve-stop programme or see a therapist as a means of 'coming out'. I have difficulty accepting the principles underpinning the twelve-step programme as advocated by Bradshaw. As an agnostic I have difficulty with the 'higher power' stuff found in the twelve steps and 'God however I understand it' doesn't quite work for me. 

I know this is controversial and the Twelve Steps has helped millions, but suppose I choose the natural world as my higher power. In step seven of a twelve step programme I'm expected to ask my higher power for help to correct my shortcomings. So whatever none-Godlike alternative I choose I am expected to imbue that choice with Godlike qualities. That doesn't fit for me. More generally I do not share Bradshaw’s theo-centric view of things or attribute moral agency to the universe as he does. It's part of an existential view of things: we exist in a universe that is morally neutral and without inherent purpose; our task is to find purpose and meaning.

Things really pick up in chapter seven. Bradshaw writes about corrective work. He tells us about grief work and there's a nice guided trance on meeting our inner child. He writes about corrective experiences (eg a network of male friends to correct the lack of a positive male influence as a child). He also uses the NLP collapsing anchors technique to help add resources and transform memories of toxic shame. I have begun listing toxic shame-based memories and my friend Jean Clements has agreed to use her EMDR skills on each of them.

Chapter eight is about integrating disowned parts. It covers ‘Voice Dialogue Work’, ‘Owning Projections’ and Virginia Satir’s famous ‘Parts Party’ from her book, Your Many Faces, which has been ordered from Amazon this very night. Chapter nine is entitled 'Confronting and Changing Your Toxic Inner Voices' and begins with an interesting account of the 'fantasy bond'.

When refering to the ‘fantasy bond’ Bradshaw is using the work of Robert Firestone. Basically the notion that one's parents are uncaring is unacceptable to a child. In order to survive the child  idealises the parent and turns himself into the 'bad guy' (201). Bradshaw uses a metaphor to clarify what he means. He says the fantasy bond is like a mirage in the desert: 'It gives the child the illusion there is nourishment and support in his life' (201). Years later when the child leaves his parents the fantasy bond is set up internally - the voice of the scolding parent is given the task of shaming and re-shaming the child. As Firestone says, 'The child incorporates "the attitudes the parents held when they felt the most rejecting and angry. The daughter or son incorporates feelings of loathing and degradation that lie behind their statements"' (201).This is powerful stuff!

On page 203 Bradshaw brings in CBT and Beck's idea of 'selective abstraction' - maintaining ones focus on a particular group of automatic thoughts to the exclusion of all other thoughts. There follows a series of exercises on identifying and challenging the inner critic, including the thought stoppers technique (208) and positive affirmations (219). He goes to provide a useful list of cognitive distortions based on the work of Albert Ellis and Aaron Beck. I like the observation that Bradshaw makes here: 'You imagine that people feel as bad about you as you do about yourself' (213). I also like an excellent analogy he uses between shame-based egocentric thinking and terrible tooth ache: when you have tooth ache you become 'tooth-centric'.

Chapter ten is entitled: 'Choosing to Love and Forgive Yourself for Your Mistakes' (223) and includes advice on giving yourself 'time and attention', becoming assertive, reframing mistakes and mindfulness (the habit of awareness). These are short chapters with Bradshaw’s Christian thinking looming large once more. In chapter eleven Bradshaw writes about toxic shame in relationships, suggesting that: 'Intimacy is the number one problem resulting from internalised shame' (235) and, ‘There is no greater potential for painful shame than rejection' (247)

In part three - Spiritual Awakening - the Discovery Process – Bradshaw argues that true release from shame-based thinking can only come when there is a spiritual awakening in the person. Bradshaw goes on to  explain why shame hangs around sex. He talks about shameless sex and de-personalised sex, which he thinks is 'using people for enjoyment' (though if this is consensual and mutual, why is that a problem?). He argues for sexual relations characterised by the I-thou relationship of Martin Buber. This seems a fairly conservative, family-values approach to sex. Is it not possible to have a mixture of life-sustaining, long-term I-thou relationships and shame-free no-strings attached mutually enjoyable sex?

So the book ends with the return of Bradshaw's religious tone and I ended the book with the feeling, 'this isn't for me'. But that's a generalisation. Actually, whilst parts of the book were irksome, other parts were incredibly helpful to me in my personal development work and I intend to read the book again and spend even more time on the exercises Bradshaw has included. I would certainly recommend it to others (and have done) but I'm also looking forward to reading the many books Bradshas refers to as he rolls along, and which now form a tidy pile on my coffee table, because they may give me the detail and the coherence I'm after.

Bradshaw, J. (2005) Healing the Shame That Binds You, Deerfield Beach, Florida, BCI Books.

Friday, 4 January 2013

Sapolsky on Depression

Here we have an excellent video from Stanford University in which Professor Robert Sapolsky lectures on the biology and psychology of depression. He argues that major depression is the most severe of diseases afflicting mankind. He examines its causality, rooting major depression in biology (genes, hormones and neuro-transmitters) and psychology (referring to Freud's Mourning and Melencholia and Seligman's work on learned helplessness), He concludes that stress is a trigger for depression, with those of us genetically vulnerable particularly susceptible to depression, initially as a reaction to significant life events and trauma and then as part of a cycling depressive disorder.

Wednesday, 2 January 2013

Visualisation in Person Centred Counselling - The Approach of David Rennie 3 of 3

Here is my third and final screencast on the Person Centred Approach of David Rennie. Here I outline his use of visualisation - were the counsellor (if appropriate) shares the visual images and metaphors evoked  in him or her by the client's story. Rennie suggests this can lead to 'vertical development' - a deeper exploration of the client's material as he or she pauses to reflect on what the counsellor has offered and how it relates to their recollection of the experience.