An interview with Michael in preparation of this CPD workshop "Sustainable practice in the 'impossible profession'?" organised by the Wimbledon Guild
Your workshop "Sustainable practice in 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. It seemed obvious that – if I wanted to earn my fee - some desperately urgent change or shift in the client needed to to be effected by me, but the idea that nothing had to happen (or be made 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 – it seemed obvious 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, altogether more non-chalant and confident. 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 brake and on 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 consensual 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 post 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. But the therapeutic position requires a kind of vulnerability and sensitivity which is at odds with protecting oneself.
In contrast to that kind of advice oriented towards self-protection, I'm trying to find ways of processing the therapist’s 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/case load:
- the therapist’s capacity to digest and compost the emotional impact of the therapeutic relationship as bodymind process;
- the therapist’s capacity to embrace/inhabit ‘enactment’ as the central paradox of therapy – implying the impossibility of the profession
- 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, and beyond that on access to the dissociated implicit patterns laid down in the brain stem). 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 physical 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 very 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 heart of the impossibility lies in the paradox of enactment – that the healing of the client’s wounding in and through therapy becomes fully available only in the enactment of that wounding in and through therapy.
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 – I summarise this in the more jargon-free statement: the client’s conflict becomes the therapist’s conflict. However, unless we manage to translate those principles into an everyday application to practice, we are left with an unprocessed and unmetabolised double whammy: we are both empathic to and absorbing the client's conflict and on top of that we are necessarily having our own conflicts triggered and exacerbated.
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, what kind of habitual routines and mechanisms are in place to shield and guard us? How does our habitual therapeutic position dfend and protect us? The question then 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, plus 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 and the impossibility of the profession. 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 evacuated and 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 that 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 embodied 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
What are the emotional/psychological factors that limit a thriving practice for therapists (and helping professionals generally)?
- If you're interested, enrol now for my experiential workshop in London (Wimbledon) on December 7 - places are still available: bit.ly/2VUVxkI
- Most CPD workshops on this topic focus on the actual business skills needed, or your own ambivalence about charging money (self-worth).
- The decisive factor for making a living as therapist: what’s the EMOTIONAL cost of the therapeutic position in an ‘impossible profession’?
- How do relational dilemmas inherent in therapy affect therapists’ well-being? How do we absorb, process and compost emotional material?
- How does the particular intricacy of each client-therapist relationship hook into the therapist’s ‘habitual position’ and become exhausting?
- Therapy as impossible profession is potentially exhausting ALL the time, but this becomes most obvious around frame and money negotiations
- The impossibility of therapy manifests in meta-level struggles: whether, how, why therapy works (or doesn't) and its frame and boundaries.
- How to answer the question whether the client’s investment into therapy will be useful & worth it? Somewhere between priceless and useless
- How to then work out the level of fees? How to you present that to clients (esp. those who expect to pay by the minute, as for a lawyer)?
- How do you respond to clients’ challenges to your sincerity: “You only care about me because of the money I pay you?” – and is it true?
- How to respond to clients who accuse you of ‘emotional prostitution’? Or protest against their dependency on a professional ‘selling love’?
- How do you deal with clients’ requests for reductions in fees or changes to weekly frequency of sessions which are inconvenient to you?
- When clients think about terminating, to what extent do you think about their process or the income you stand to lose (it does happen!)?
- How to handle clients ‘getting worse’ as necessary part of the process - how do you communicate that to them, and negotiate the fall-out?
- How to respond to breaks in the working alliance& thresholds in the process which manifest as ambivalence in the client&their commitment?
- When clients complain, how to deeply understand THEIR perception and experience of therapy-what unconscious constructions may be involved?
- How to negotiate arrangements that are safe, consistent and reliable AND doing justice to the client’s needs, requirements and situation?
- How to get beyond simplistic frames/business models borrowed from other professions? Find a practice that suits you & the work of therapy?
- How to process the subliminal bodymind impact of the therapeutic relationship on yourself, including vicarious traumatisation?
- How to inhabit your own wounds when they get touched upon by the client’s process? What if being a therapist IS part of your wounding?
- Harold Searles suggested 70 years ago: one of the most difficult issues of therapy is the therapist’s mother transference onto the client.
- The bodymind process of therapist’s ‘habitual position’ (how they inhabit ther. position) is most critical factor in sustainable practice
- How therapists ‘construct’ therapy un/consciously through lens of their own childhood scenario affects sustainability of their practice
- The therapist’s ‘habitual position’ is a mixture of their character style, relational patterns, own therapy & training & supervision/CPD.
- The therapist’s ‘habitual position’: how fully can I engage the inevitable and necessary conflicts of therapy, and how do I process these?
- As a therapist I need to fully & openly engage the client's conflicts intersubjectively; my mirror neurons ensure that I will absorb these
- Processing the conflicts I engage & absorb depends on ‘implicit relational knowing’ = my bodymind process = my embodiment as a therapist
- How can I generate spontaneous AND reflective, embodied AND imaginative space to maximise the processing of intersubjective conflict?
- The more aware I can be of subliminal communications & reactions, the more likely I can process them more comprehensively & consciously
- How can an understanding of the paradoxical nature of therapeutic enactments create more space within the therapeutic position?