Sustainable practice in the impossible profession – Interview with Michael Soth

Sustainable practice in the impossible profession – Interview with Michael Soth

Your workshop ‘the Impossible Profession’ is unique in its concept, what led you to its creation?

There are two separate but linked recognitions which inspired the workshop, and the 2017 article which it is based upon:

1) the essential impossibility at the heart of the therapeutic profession, and

2) the consequent difficulty in sustaining its practice.

Practising therapy has its inherent strains, but what links the two issues is how so much more exhausting and unsustainable the task becomes unless we accept that underlying impossibility.

How can we relax into the impossibility and stay rooted and grounded in it, rather than implicitly fighting against it or trying to escape the feelings of shame, failure and helplessness that are necessarily part and parcel of the impossibility?

After working for about 15 years following my qualification, I came to a point where I questioned a key underlying assumption of my training that I had taken for granted as self-evident: that if only I thoroughly understood and followed the theories and technique I had been taught, and applied them diligently with good intention, warmth and compassion, therapy could be made to work in the majority of cases. My assumption had been that therapy was do-able through applying ‘correct’ theory and technique.

I began to realise that - in spite of my humanistic principles of authentic relating - the application of theories and techniques to the person in front of me implied a 'treatment' paradigm, not unlike the stance that a doctor would take. Although I was using humanistic theories and techniques, and favouring existential values, implicitly I was taking a medical model stance alongside - and confusingly: in conflict with - my humanistic-authentic-dialogical stance.

On the one hand I was trying to create a space for human intersubjective encounter, on the other hand I wanted the therapy to be effective in taking the client - in fairly linear treatment fashion - from an undesirable dysfunctional state towards what I implicitly assumed was a better, more functional state, of wholeness or self-actualisation.

All the precious knowledge, understanding and skills that I had acquired were meant to enable me to effect that desired treatment outcome, but supposedly without taking a superior or objectifying or pathologising doctor position and without having an agenda. That ongoing conflict not only did my head in, it was exhausting and wearing.

In any case, this idea of the competent practitioner, fairly nonchalantly applying theories and techniques, did not match at all my internal reality within the therapeutic position: I was constantly feeling conflicted, torn between different therapeutic impulses, ideas and agendas; I felt caught in endless dilemmas, between conflicting perceptions, contradictory models and sometimes mutually exclusive interventions. I was torn between pressure to make things happen, often quite desperately, on the one hand and on the other hand equally strong inclinations to let things be, based on a reluctance to impose things or force change. The idea that nothing had to happen seemed equally valid, strengthened by the paradoxical principle of change: change happens when we accept what is.

Much of my experience within the therapeutic position was conflicted and uncertain, but I was equally convinced that a competent practitioner would surely be conflict-free – that that was the criterion for competence. I was assuming that with increasing experience I would increasingly become single-minded, certain, and sure of my impact and effectiveness. I was judging myself harshly for failing to live up to that competent doctor position which was spooking around as an ideal in the back of my mind.

Over time, though, I realised that each and every of the linear assumptions I was judging myself by, every notion of what I should do as a therapist, was in conflict with an equally valid opposite truth, and that I was trying to do justice to both of them at the same time. No wonder being a therapist was a fairly effortful, exhausting vocation – like driving a car with one foot each simultaneously on the break and the accelerator.

During those years, the movement towards psychotherapy integration was immensely valuable to me, helping me embrace the profound and often irreconcilable contradictions pervading the therapeutic field. There did not seem to be unquestionable and self-evident ‘truths’, as I had initially assumed – on the contrary: there did not seem to be any principle that was not contradicted by some other therapist or some other approach. The more I could accept the paradoxical nature of my most cherished therapeutic principles, the less compelled and haunted I felt by ideas of the linear do-ability of therapy.

I had heard people quip about therapy as the 'impossible profession', and I found that Freud had made reference to it already in 1937. But eventually I began to take that notion seriously, as an essential feature of the therapeutic endeavour, and wrote a blog on the topic. It then became apparent to me that most counselling and psychotherapy training, especially with its increasingly academic focus, was implicitly fighting against the paradoxical essence of the profession, rather than helping students embrace and relax into the impossibility of the profession.

This also had a big impact on my stance as a supervisor, and what I considered helpful to my supervisees. Rather than adding to their shame for experiencing the impossibility of the profession, for failing to achieve its idealised linear promises, for succumbing to the 'intersubjective mess' (the technical term I started using in order to call a spade a spade), I started to validate their feelings and intuitions of failure (due to therapeutic stuckness and impasse, getting entangled in supposedly countertherapeutic enactments, etc, etc), as accurate manifestations of the underlying impossibility. Rather than redoubling their professional efforts to overcome their sense of failure - through more reading, more CPD, further training, more work on their own process - by embracing and inhabiting the impossibility of their position, paradoxically their work deepened and became more effective and more transformational, as well as more enjoyable and satisfying (at least some of the time).

It was through many years of practicing as a supervisor from this perspective, supporting supervisees in deconstructing the persecutory ideas of their traditions and trainings, that I began to link the impossibility of the profession with the sustainability of therapeutic practice.

The more we have recognised the dangers of vicarious traumatisation, the more prevalent advice has become how therapists should protect themselves, should take responsibility for their self-care, strengthen their boundaries and counteract the damaging effects of the therapeutic position.

In contrast to that kind of advice, I'm trying to find ways of processing the experience of the impossibility more deeply, more effectively and in a more embodied way (as most of the sense of impossibility is communicated and engendered nonverbally and pre-reflexively). Rather than closing ourselves off more deliberately, or strengthening our professional boundaries more impenetrably, or creating professional distance more coherently, I have found that therapists can learn to sustain their practice the more they can succumb to the impossibility, and then get curious about that experience in a way that benefits the deepening of the therapeutic process and therefore the client.

Apart from the practical and business aspects of making a living from working as a therapist, I have suggested that there are three underlying psychological issues which affect how many clients a therapist can 'hold' in their practice:

  1. the therapist’s capacity to digest and compost the emotional impact of the therapeutic relationship as bodymind process;
  2. the therapist’s capacity to embrace/inhabit ‘enactment’ as the central paradox of therapy;
  3. how entrenched or flexible the therapist can be in their ‘habitual position’, i.e. their own unconscious relational ‘construction of therapeutic space’;

Each of these is a one-line condensed formulation of what I consider a complex neglected and under-theorised issue in the profession.

The first one relates to the neglected bodymind process of client and therapist in the 'talking therapies' - this imposes limitations on therapy's effectiveness (which - as Allan Schore has insisted - depends mainly on right-brain-to-right-brain attunement). But it also leads to obliviousness and underestimation of how much emotional load the therapist's body ends up carrying and somatising. Without attention to the relational bodymind process we are sitting ducks for overwhelm, vicarious traumatisation and burn-out, or we succumb to implicit distancing manoeuvres which help reduce the impact on the therapist, but at the expense of engagement and effectiveness.

The second issue relates to the decades-old denial of the aforementioned impossibility of the therapeutic profession. Traditionally psychotherapy as a discipline, both in practice and in the training of its students, has been importing an objectifying, linear and academic paradigm from the sciences and particularly the medical model, as I described above for myself. As long as we are not aware of and do not embrace the impossibility we should be experiencing in the therapeutic position, we are adding a whole other unmanageable surplus load of stress and distress into our practice.

The third issue relates to the notion of the 'wounded healer', and how our own wounded subjectivity is necessarily the instrument we are working with. Since the 1950s, the 'countertransference revolution' has given us the basic principles for understanding how the therapist's experience contains information about the client's inner world and unconscious dynamics. However, unless we manage to translate those principles into an everyday application to practice, we are left with an unprocessed and unmetabolised double whammy: both absorbing the client's conflict and on top of that necessarily triggering and exacerbating our own conflicts.

In your workshop synopsis you discuss the therapist’s ‘habitual position’ could you explain more about this and how this impacts the work with clients?

The idea of the ‘habitual position’ is just a consequent application to ourselves as therapists of the kind of ideas, concepts and models which we use to understand any client's habitual patterns.

Whatever therapeutic language we use, there is some concept or term we have to describe fixed patterns of experiencing, feeling, thinking and behaving - what we call 'schemas' in CBT, or scripts in TA. A model of such fixed patterns and defensive structures that includes awareness of bodymind processes is Wilhelm Reich's 'character structures', updated into a comprehensive modern integrative developmental theory by Stephen Johnson through his work on 'character styles', integrating humanistic and psychoanalytic traditions.

A character style is like a protective shield which we have developed as children in response to developmental injury or wounding, designed to protect us both externally from being injured again by others, and internally from experiencing the unresolved left-overs from childhood.

If we apply that kind of thinking to ourselves as therapists, the question is how all the precious knowledge and skills we have gained in therapy training may be feeding into and exacerbating our defensive structures? To what extent has our training challenged and helped us work through our habitual position; and to what extent has it fortified and entrenched it further?

Our habitual position as a therapist is therefore an amalgamation of our original character style as a person which we bring to therapy training in the first place, and whatever habits we have acquired through training in terms of our stance as a therapist and our default thinking and behaving as a therapist, i.e. our preferred theories and techniques.

Just as any habitual structure offers protective advantages whilst limiting our responsiveness and engagement with life, our habitual position as a therapist offers both the advantages of a reliable structure and therapeutic identity as well as generating taken-for-granted autopilot limitations to the kind of therapeutic space we are able to offer.

On an abstract level, our habitual position manifests as certain theoretical dogmatisms, or as an avoidance of contradictory theories; or as an attachment to linear ideas which protect us from paradoxical experience. On a relational level, it manifests as a habitual stance or fixed therapeutic position we take, rather than experiencing fluidly and flexibly a variety of relational modalities, which we are able to inhabit in response to a particular client and the resulting dynamic we are engaged with.

These are the disadvantages of a too partial, limiting and fixed habitual position for the client and their process. But on a deeper level, our habitual position as a therapist has detrimental effects on ourselves, too. Our habitual position is, of course, rooted in our own childhood wounds, which are being triggered – by each client in their own idiosyncratic ways - regardless whether our reflective awareness takes care of them or not.

For many of us, training and working as a therapist replicates our position in our original family, where we were the sensitive receptacles of the unacknowledged or repressed emotional dynamics in the family system. For many of us, whatever counselling or therapy training we engage in as adults constitutes our second training - our first occurred in our original families, and we carry both the skills as well as the scars of that training into adulthood.

Working as therapists we then find ourselves back in the position of being exquisitely attuned and susceptible to unconscious and unspoken dynamics, often without being given the permission or power to name them, address them or challenge them. Within the therapeutic position, we find ourselves experiencing helplessness and uncertainty, alongside all the client’s unwanted feelings. In deep psychotherapy, the client’s regression evokes and triggers our own. Many therapists suffer from being willing sponges for toxic material which clients evacuate into them, whilst exhorting themselves and redoubling their efforts to be empathically present for their clients.

So should being a therapist carry a health warning?

It goes without saying that these dynamics are not conducive to the therapist well-being as a professional, nor as a person. So, yes, the therapeutic position should carry a health warning.

Nearly all therapists I meet as students or supervisees are well-intentioned, dedicated practitioners - but sometimes I am reminded of soldiers being sent into the battlefield with insufficient equipment.

Corresponding to the three issues I mentioned above, across the profession we could make efforts to strengthen and update the equipment:

- bringing more awareness to the bodymind process of inhabiting the therapeutic position

- formulating the therapeutic position as inherently conflicted and paradoxical, by embracing the sense of its underlying impossibility, rather than chasing our tail with linear expectations which are inimical to our discipline

- learning to pay attention to how the client's conflicts become the therapist's, and how to process the countertransference experience of the impossibility, in the service of the deepening process

What do you hope that delegates will be able to take away from your CPD day with us?

From past experience, I find that most practising therapists experience relief from understanding that deep engagement with the client inevitably takes us into conflicted unconscious realms of the psyche - most therapists know this in their bones, anyway, but the feedback I often receive is that people leave with more clarity around the 'inevitable' bit.

To appreciate our internal experience of conflict, uncertainty, failure and helplessness in the therapeutic position as a parallel process which carries profound information about the client and the co-created process between us, opens the door to embracing the impossibility at the heart of our work. Many therapists find that a permission-giving and liberating experience, which puts their practice on its paradoxical feet, rather than puts their heads in the idealised clouds. That does not immediately make things easier, but at least it offers a graspable end of that string which is the tangled ball of our confused and fragmented profession, full of transgenerational conflicts we have inherited all the way down from Freud.

 

In bullet-point summary, here are some of the things that participants might take away:

  • a cross-modality formulation of the client's internal conflict as the starting point for the therapeutic relationship and how that impacts the therapist
  • a generic formulation and appreciation of how the client's conflict necessarily becomes the therapist's conflict
  • some consequent articulation and embracing of the impossibility of the therapeutic position
  • some reflection on the many ways in which we deny, defend ourselves and react against that impossibility
  • some glimpse of our habitual positions as therapists and communities of practitioners and some curiosity about them
  • the beginnings of a bodymind procedure of processing our individual experience of the impossibility in the service of the client's process
  • a sense of the kind of fluidity and flexibility between relational modalities, as well as between theories and techniques, which is required as one foundation of a sustainable practice

 

 

 

By | 2018-05-25T01:42:44+00:00 May 9th, 2018|Michael's Psychotherapy CPD Blog|0 Comments

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