As I read this book, I couldn’t help but wonder: if this is the version the lawyers passed, I wonder what the first draft was like. To say it pulls no punches would be to sorely underestimate the book’s systematic dismantling of the British Psychological Society, which is described as poorly governed, opaque, anti-democratic, corrupt and not fit for purpose. Chapter 7 is titled ‘BPS Bullshit’ and gives you an idea of what to expect.

There are four main contributors, with editor David Pilgrim leading from the front; the text sometimes shimmers with barely disguised fury and such is the catalogue of errors, evasion and obfuscation, one can understand why. The book begins by providing an interesting historical context for how the BPS has ended up where it is today. This brief tour of psychological thought and its complex relationship with science and empiricism is fascinating in itself.

Unpicking many aspects of the BPS’s activities, management and leadership, there is one particularly noticeable theme: almost every error is compounded by either the organisation’s inability to see and reflect on it or its wilful lack of action to remedy anything - all further exacerbated by appalling communication.

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It is in the case studies that the point is best made. The two chapters looking at how policy on key issues was developed are disturbing, seeming to be driven by pressure groups and resulting in guidelines that border on polemic.

Sometimes the detail can become incredibly granular and while one can admire the authors’ determination to be meticulous, it can become a little turgid, not helped sometimes by a leaning towards grandiloquence. However, the substance of the book remains truly extraordinary.

I can be quite annoying. In many ways I imagine, but today I’m particularly thinking about how I live in the grey. In the maybe. The master of equivocation. The king of context. My youngest often asks me what my favourite x,y or z is and it is, invariably, ‘I don’t know. It depends.’ Eye roll.

Clients too – they come seeking answers, certainty, a solid sense of direction. I’m afraid they rarely get that from me. When they’re uncertain, that’s where we sit. There’s a lot to be learnt there rather than leaping to easy certainties. Uncertainty is open, conviction is closed.

This is a bit of a recurring theme of mine and I’m sure I’ll return to it.

Or will I?

Who knows

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Anyway, on this occasion I am narrowing it down to a thought I had about how we describe and understand our psychological states. I thought about the DSM-5 and my peculiar allergy to it. I have very little to do with the DSM and I tend not to talk in terms of diagnoses – unless clients bring that into the room of course, then I’m all ears, not least because it’s always interesting to understand why a diagnosis is important or helpful or damaging. But I’m well aware that I implicitly made my decision to largely disregard the DSM quite some time ago – and I’m also aware that it is easier to criticise than to reflect, so I have (briefly) returned to it to address my perhaps unwarranted certainty. It was interesting to read therein:

“The symptoms contained in the respective diagnostic criteria sets do not constitute comprehensive definitions of underlying disorders, which encompass cognitive, emotional, behavourial, and physiological processes that are far more complex than can be described in these brief summaries. Rather, they are intended to summarise characteristic syndromes of signs and symptoms that point to an underlying disorder with a characteristic developmental history, biological and environmental risk factors, neuropsychological and physiological correlates, and typical clinical course.”

This is more embracing of the psycho-social, and of its own limitations, than its reputation suggests. Its contents are more nuanced, the authors are aware of the arguments against it and seek to provide a strong rationale as to why it is how it is.

(However, in seeking to provide this, I wonder if the manual is paradoxically undermined: it has become so broad, so all-encompassing and littered with so many caveats and crossovers as to make it almost meaningless. It simply becomes 947 pages from which anyone can extract anything to meet their particular model or view.)

A more recent conceptual alternative to psychiatric classification rejects the concept of medical diagnosis altogether. The Power Threat Meaning Framework states that:

“The individual does not exist, and cannot be understood, separately from his/her relationships, community and culture; meaning only arises when social, cultural and biological elements combine; and biological capacities cannot be separated from the social and interpersonal environment.

...This PTM Framework...replaces the question at the heart of medicalisation, ‘What is wrong with you?’ with four others: ‘What has happened to you?’...’How did it affect you?’...’What sense did you make of it?’...’What did you have to do to survive?’”

The PTMF is an imperfect document but with admirable ambition. I like that it challenges the stranglehold that diagnosis has on mental illness. Labelling someone with a diagnosis can pathologise the wide range of normal human experience and disregard the societal, systemic and relational context as well as risk classifying very human sadness or anxiety as a symptom of an underlying disorder rather than a reasonable response to life’s challenges.

Even the most well respected and thoroughly embedded of theoretical approaches must be seen in the context of what they exclude as well as what they explain. There are those who challenge Attachment Theory (which I am quite…er…attached to) based on the same principles on which I challenge diagnosis and fete the PTMF. Psychologist Jerome Kagan writes:

“A serious limitation of attachment theory is its failure to recognize the profound influences of social class, gender, ethnicity, and culture on personality development. These factors, independent of a mother’s sensitivity, can be as significant as the quality of the early attachment.”

Therapists must hold everything lightly, even their most darling theoretical certainties, otherwise they will rush to explain, restrict and close down a client’s uniqueness and their uniquely unfolding story.

This is all yet another reason why the therapeutic relationship must, above all, be an authentic, open, human interaction. Simply being seen and heard empathically is powerful and can be a catalyst for change in itself. While theory informs the therapy, it is openness, empathy, warmth and compassion that make change possible.

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Note: I‘m a regular therapist, not someone who works in acute settings, so while I might see – and indeed, have seen - people with all kinds of diagnoses, such as Bipolar Disorder, Borderline Personality Disorder, Depressive Disorders, Schizophrenia, Dissociative Identity Disorder, I do not work in an acute setting, so I am generally able to work cogently with the person in front of me, rather than having to deal with an unfolding acute psychiatric crisis. Those who do work in these settings may well see and use the DSM very differently indeed.

The original study (conducted by Harvard researchers Daniel Simons and Christopher Chabris) perfectly illustrates inattentional blindness: the psychological phenomenon where you completely fail to notice an unexpected, fully visible object because your attention is engaged elsewhere. The audio version being discussed on the radio, meanwhile, demonstrated inattentional deafness.

In case you don’t know it, a brief synopsis of the original experiment: participants watched a brief video of two teams (one wearing white shirts, one wearing black) passing basketballs. They were instructed to count the exact number of passes made only by the team in white. Halfway through the video, a person in a full gorilla suit walked directly into the middle of the players, faced the camera, thumped their chest and walked away. The gorilla was on screen for nine seconds.

Roughly 50% of the participants completely missed the gorilla. When asked if they noticed anything unusual, they confidently said no, and many were stunned or accused the researchers of swapping the tape when shown the video a second time.

What’s particularly fascinating is that people’s eyes physically saw the gorilla; tracking studies show that even people who missed the gorilla looked directly at it for several seconds. The failure wasn’t in the eyes, but in the brain’s cognitive filtering network.

The prefrontal cortex locked onto a specific goal: ‘Count white shirts, ignore black shirts’. The thalamus acted on this instruction by actively dampening the incoming sensory signals that didn’t match the criteria. The brain used its cognitive capacity to focus purely on specific objects.

The thalamus is the primary brain structure that filters sensory information, evaluating incoming signals and determining which ones are important enough to reach conscious awareness and which ones to suppress. The reticular system is responsible for habituation - the process where your brain learns to ignore repetitive, predictable, non-threatening stimuli so you’re not overwhelmed by sensory overload.

The result of all this is the Baader-Meinhof phenomenon. It’s funny because since learning about this phenomenon a few years ago, I see it everywhere.

I saw it with my own eyes

I remember how freaked out I was when I watched a programme years ago (on the BBC perhaps – does anyone remember it?) that threw into doubt the reliability of eyewitness evidence. Really simple experiments showed that different people witnessing the same event saw spectacularly different scenarios unfold.

Indeed, mistaken eyewitness identification is the leading contributing factor in roughly 70% of wrongful convictions later overturned by DNA evidence today. Researchers have also replicated the gorilla experiment framework specifically for crime and security scenarios, with results including:

• In a study, 174 participants were asked to complete an attention-demanding cognitive task while a video containing a physical assault played. 65.5% failed to notice the assault entirely.

• Participants in a study were instructed to jog behind someone and count how many times he touched his head. They ran directly past a staged, highly chaotic physical fight. At night, 65% missed the fight completely; during broad daylight, 44% still failed to notice it.

• In studies testing ‘change blindness’ (where a person changes identity mid-scene), research showed that 37.5% of students and 50.8% of active law enforcement officers failed to notice when a target changed their physical identity or clothing between scenes.

There are many – disturbingly many - more.

The therapy gorilla

So, I hope I have directed your attention, fooled your reticular system and you’re still with me. I am introducing a new gorilla, who I like to call ‘the tenuous link into what I really want to say about psychotherapy gorilla’, into this scene and I invite you to see it. It’s a link predicated on the impossibility of a single known reality, of a common perception, of total understanding. A call for humility in a world of endless possibilities and wholly unconscious filtering of information.

I remember reading, as a psychotherapy student, about Donald Hoffman, a Cognitive Scientist at the University of California. He argued that we are constantly interacting with the infinite so we must, by necessity, limit our interface - but we have mistaken this limited interface for an objective insight into fundamental reality.

Translating this into psychotherapy, I think this tells us that as soon as any theory is applied to an individual, an element of their uniqueness - and thus an opportunity for deep understanding - is destroyed. Laing wrote:

...no psychopathological theory is entirely able to surmount the distortion of the person imposed by its own premisses [sic] even though it may seek to deny these very premisses.

I don’t think any single theory, model, metaphor or symbol can ever do justice to the full range of human experience. No-one has only one true story, as it is constantly open to interpretation, change and both conscious and unconscious influence. At some point, the brain has to make some sense of the infinite amount of information out there: this is the premise of the book Closure, in which the author – philosopher Hilary Lawson - argues that the world itself is a vast, unfiltered openness that is entirely raw and unstructured. Lawson states that humans use language, thought and physical senses to close this openness.

As June Singer says:

When we speak about reality, we can only speak about the portion of reality we perceive, given our experience and the information that is passed to us by the agencies of our culture.

To even think that we can conceptualise a client, a fellow human being with infinite possibilities, in just one way only reflects simply the views, beliefs, science, philosophy and mores of our time. Power, too plays a huge role, in that the powerful in society impose a worldview that the disenfranchised - in fact that all of us - are defined by.

We must try to allow the client the space to gain awareness of themselves, become empowered and to create their own narrative for their life, resisting, as Kagan said, ‘the pervasive human temptation to construct a narrative that matches our preconceptions and unexamined biases, walled off from the messy reality in which all of us - clients, therapists, and researchers alike - have to live’.

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This ambitious book tries to bring much-needed clarity and nuance to the public mental health discourse, especially around stigma. Discrete sections tackling different mental health diagnoses or issues each follow a template that brings plenty of lived experience in alongside theory and social commentary.

My overriding concern is: who is it aimed at? Really it is the sceptics that need to read it but the combative tone – from the title onwards - would quickly put the anti-snowflake crew off, as would the dismissal and ridiculing of their positions throughout. I think we actually need a bridge to facilitate discourse in an attempt to refine discussions in this polarised space.

The book largely holds a judicious biopsychosocial approach to mental illness and there’s a strong basis of relational-developmental theory behind the commentary. Issues such as antidepressant use are treated carefully and even-handedly. However, there are a number of occasions where mental illnesses are talked about as causes of symptoms (eg ‘schizophrenia is possibly the most well-known cause of psychosis’), rather than as labels for certain clusters of symptoms. This is not purely semantics - it goes to the heart of identity and how we relate to mental illness.

However, the book does contain some essential messages, particularly around the power of language to cause harm. The sections around prison, addiction and hospitalisation are excellent, exposing hypocrisies and bringing both humanity and good sense to the discussion.

It is to be hoped the book finds its way into the right hands.

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But I’ve recently been thinking more about whether the value of displaying an element of one’s humanity occasionally as a way of strengthening the therapeutic alliance by equalising the power dynamic, normalising vulnerability, and offering the opportunity to build trust – especially reparative trust that can rise from the ashes of a rupture.

Of course, this can be overdone but my instinctual position is likely to preclude my going too far, I think.

In this spirit, I was reflecting on my recent Substack post where I spoke about meeting clients at their most painful, vulnerable and distressing moments - a stormy passage that is often the only route to calmer seas. I was also talking about the value of art to help us make – and make sense of – that journey.

I reflected in the days following how often art – particularly poetry – has helped me too. Sometimes that poetry is my own, and I submit one of my poems below in the spirit of walking in my clients’ shoes. It relates to one of those painfully transformative life events, after which nothing is ever quite the same again.

I’m not sure if this is a good idea (or a good poem) but this is an experiment in vulnerability so I’m going to put it out there and see. Comments on this choice to share, or the poem, are very welcome.

Busy dying

The switch is thrown and you become a project;
PSA scores, hormone injections, steroids, anticipatory medicine,
DNR forms.

We’re busy.
Moving, organising, calling, planning, researching,
Counting pills, making appointments, planning meals;
Googling
Everything.

Willingly, we exhaust ourselves learning this new language of denial.

We still celebrate our triumphs;
In the summer you walked around the block,
In the autumn you microwaved your tea,
In the winter you got to the toilet on your own,
In the spring you still dressed yourself.
(It took you three hours, we discovered one day)

And now, warmed by the summer sun in a world you’ll never see again,
My heart jumps when you manage to sip your water through a straw
And slump back exhausted.

I remember when the carers came to the house;
Two stoutly-built women jollying you along, calling you by your first name -
I feared the worst.
Then they washed your hair, massaged your scalp,
Soaped and moisturised your cracked feet.
‘That was lovely’, you smiled.

Now, here I sit, still hoping to have all the conversations
We never did. Trying to say ‘I love you’,
Putting my ear close to gather in your words
Stuttering, half-whispered and swallowed,
Lost in the twist of your dry lips.

And then they go a step further and have the courage to share with us, their fellow humans navigating this world and the human condition. They say to us, ‘You don’t have to hide. This is life in all its richness, hope and despair, love and hate, pain and pleasure. Stop hiding beneath the compromising carapace of social norms and embrace it in its rawness and beauty. Live your life, don’t just pass through.’

The day after my trip to London, I opened a new book (incidentally, a joy that never fades) and the first thing I read was this George Eliot quote:

If we had a keen vision and feeling of all ordinary human life, it would be like hearing the grass grow and the squirrel’s heart beat and we should die of that roar which lies on the other side of silence.

Its serendipitous appearance while I was still mulling over everything that the Tracey Emin exhibition had made me think about felt remarkable. It made me reflect on how often this is what therapy is – our client will suddenly hear the roar of life and its impossibilities; all the usual mechanisms to keep everything painful outside of consciousness fail and we can’t look away. Just like being faced with the brutal reality of an Emin (or Bosch or Bacon or Goya or Gilbert & George and countless others) original.

Yes, often therapy is quiet, uneventful, workaday - but sometimes I am the guest at a private view of another person facing those same fears, pain, distress and regrets as the greatest artists. The beauty, the darkness, the impossibility, the wonder. We sit in the intensity together, clear-eyed, the world laid out in front of us in all its rawness.

I find it quite hard to be truly shocked or offended by art in all its forms - maybe that’s partly because it is simply all human life and as therapists we have the privilege of seeing that each day in its unexpurgated version.

I don’t think living at this pitch is sustainable for most people 24/7 - but a visit to an art exhibition (or a play or a poem or a dance performance or a concert…) can be a sure way to bring us into that moment of intense reflection so often found in the therapist’s chair: ‘Are we making the most of our one wild and precious life (as Mary Oliver put it) if we do not allow the terror and the ecstasy to visit us once in a while?’

Art is such a powerful adjunct to therapy and truly vital to life

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I will love you when you are a still day.

I will love you when you are a hurricane.

Clementine von Radics – Mouthful of Forevers *

I’ve been thinking about unconditional love. It is a central tenet of many beliefs around relationships, especially those with our children and romantic partners. It forms the basis of how relationally-developmentally trained therapists see the ideal parent-child relationship - and indeed for many therapists, unconditional positive regard forms the bedrock of the therapeutic relationship.

In short, it is the act of accepting, supporting and loving a person regardless of anything they are or do or say or believe.

I’m sure many partners, husbands, wives, lovers, parents and caregivers believe this is what they offer. I wonder how many truly have. I believe I’ve both offered and received it - and it feels truly remarkable: a validation, a liberation, the zenith of human experience. A tacit acceptance of our human frailties as well as our endless possibilities. An opening of our eyes to what it means to be alive rather than just living.

But really, how possible is it to offer this to any other human? Is unconditional love the Absolute Zero of human relationships – we can get so, so close but will never touch it?

The sad truth, visible every hour of every day, is that children are usually offered a very conditional love – but with the added burden of being told that it’s unconditional. In reality, it’s a love based on good behaviour, on obedience, appropriateness, achievement - and often on suppressing emotions, especially difficult ones.

The conditions of this ‘unconditional’ love are baked into what is expected of them, what is ‘right’. So the child develops in such a way that they learn to reveal only what is expected of them, and over time this fuses so completely with what they reveal and inhabit that they – and anyone else – wouldn’t be able to guess how much more there is to them behind this characterological palimpsest.

Lavinia Gomez writes in her Introduction to Object Relations:

“It is one of the turning points in therapy when the patient comes to the emotional insight that all the love she has captured with so much effort and self-denial was not meant for her as she really was, that the admiration for her beauty and achievements was aimed at this beauty and these achievements and not at the child herself. In therapy, the small and lonely child that is hidden behind her achievements wakes up and asks: ‘What would have happened if I had appeared before you sad, needy, angry, furious? Where would your love have been then? And I was all these things as well. Does this mean that it was not really me you loved, but only what I pretended to be? The well-behaved, reliable, empathic, understanding, and convenient child, who in fact was never a child at all?’”

Of course, society welcomes and approves of precisely those qualities that are often signs of damage, not emotional maturity. How often are children told they should not cry or are silly to cry, or babyish, or not manly, or they will be given something to cry about if they’re not careful, or that they should not cry in order to spare other people’s feelings. Adults who have been made to deny their own fears and griefs will find themselves all too easily engaging in these conspiracies of silence.

Is it even possible?

Back to my initial pondering: is unconditional love even possible? This raises questions from several angles:

Is it possible to love someone completely like this? To love them through everything they do or say, no matter the damage, distress or pain they cause? Will the love not be changed, compromised, damaged?

What even is a person? What is the ‘you’ of ‘I love you’? Is ‘you’ the same today as it was yesterday? As it was 30 years ago? As it was before a trauma, before an illness or disease? If not, what is the essential ‘youness’ that is being loved? What of the ineffable is made concrete enough to be the object of unconditional love? Is unconditional love part projection and therefore partly about the self, not the other?

And who are you actually loving? Is it really better to love despite behaviour, beliefs, character and actions than to love because of those expressions of self? Does this kind of love paradoxically depersonalise the love? ie You are loved anyway, in spite of anything and everything, so any active choices you make, qualities you display or actions you take are of no consequence.

Yes, I’m playing devil’s advocate here, and probably not very convincingly. My innate felt sense around unconditional love is that it is as close as we can get to godliness. (Some might argue that it’s superior, what with godly unconditional love seeming to rely on displaying certain prized behaviours, worshipping another being, repenting sins, being thrown into hell or annihilation if you don’t conform etc. But that’s a discussion for another day.)

I wonder if the desire for unconditional love is really a very human desire for permanent safety: to be loved without the anxiety that you might stop deserving it. That’s a deeply human need. It’s a need that begins in those years of helplessness as a baby and child – who, without other people, can not only not find the food and warmth needed to survive physically but also can not manage the emotional regulation of its inner state in order to survive psychologically. Having no food is one thing, but the existential terror of the total absence of a caregiver is entirely another. Just ask Harlow’s monkeys.

These early months and years are where the craving is forged. Before we have language for love, we have a body that knows what it feels like when love is either present or withdrawn. To love is to be witnessed; to be witnessed is to exist. The certainty of unconditional love is the ideal state that frees us to live to our fullest.

Perhaps the closest humans come to the feeling of unconditional love is in relationships where they feel fully known and still chosen. This requires vulnerability to a sometimes terrifying level – the huge risk of showing who you are and risking losing the love you crave because of it. The security it produces when you are accepted in that state, however, is qualitatively different from putting on a performance. It’s not ‘I am safe because they don’t know the worst of me’, it’s ‘I am safe because they do”.

We want to be loved without limit, without condition, forever. What is perhaps more realistic – and actually more meaningful – is having a love that is finite, conditional and temporary - but that chooses, again and again, to show up anyway. That choice, made consciously with full knowledge of the conditions, is arguably more powerful than the truly unconditional version would be: a love that cannot be withdrawn requires no courage - but a love that could be withdrawn and isn’t - that is a daily act of will and an extraordinary act of love.

I’m finding it hard to draw neat conclusions. So I won’t. Instead I will seek solace in the words of writers and poets, who are always the people to go to for the essence of everything. Firstly, Tolstoy (in Anna Karenina): ‘I always loved you, and if one loves anyone, one loves the whole person, just as they are and not as one would like them to be.” But as Rilke says, it’s not easy: ‘For one human being to love another: that is perhaps the most difficult task of all, the ultimate, the last test and proof, the work for which all other work is but preparation.’

And finally, one of my favourite poets, Emily Dickinson: ‘That Love is all there is, is all we know of Love’.

Maybe it’s this simple. We offer as close to unconditional love as we can. And we hope someone offers it to us in return.

*https://wordsfortheyear.com/2014/11/29/mouthful-of-forevers-by-clementine-von-radics/

Quietly challenging convention, this book is a largely academic tome with a jacket design straight out of the mainstream. It contains scores of references but no in-text citations; it has no chapters, headings or sub-headings but weaves together an incredible range of disparate themes; the print is large and generously spaced, making it a thicker book than its 50,000 words need – but leaving plenty of room for your inevitable marginalia.

It is also, undoubtedly, compelling. The author takes psychoanalytic ideas and runs with them – sometimes very far indeed. He is in no rush to reach definitive conclusions, preferring to study issues from many perspectives and never settling for a single narrative – a reflection perhaps of the way every sexual encounter, like every therapeutic relationship, is its own unique story full of infinite permutations and motivations.

Sometimes when reaching for ideas, he

overstretches and we find ourselves in the realms of anecdote and supposition, while at other times he disappears on long journeys into esoterica. But then there are instances where there is so much wisdom packed into a few lines, it made me want to show it to every therapist I know.

Of course, sex is never just sex and this book uses case studies, psychoanalytic theory, research, science and the arts to explore why this is the case. I defy anyone to read this and not to learn something extraordinary about the history of sexual practices and to have their minds opened to the intriguing meanings behind our sexual encounters.

I believe the act of writing in itself opens up thought and demands clarity. It requires internal reflection and a process of working through, which may help clarify things in your mind. What’s going on, what shifted during the session, what was their stuff, what was yours, what was co-created in the intersubjective space? Sometimes you have to work hard to tease out what was happening and to find the words to articulate the unique moment.

And when I say writing, I mean the old-fashioned way. A substantial body of research demonstrates that handwriting engages a broader network of brain regions, including sensory processing and memory, which leads to better retention and comprehension.

It’s far too easy to type information out without processing its meaning (aka cognitive offloading). Handwriting is inevitably slower (unless you’re a terrible typist), which encourages you to summarise and consolidate the information in your own words. This necessarily refined encapsulation should lead to a deeper understanding and encoding of the material. We may recommend this kind of slowing down, reflection and articulation to clients – for example, writing a journal or a letter to someone – so why not take some of our own medicine?

It’s not all about content either. The act of writing cements the memory of the client and allows me to recall them, their story, our relationship - and even the less tangible sense of their presence in the room - as I sit down opposite them. Anyone who knows me in the outside world will not recognise this: my memory can be suspect. As it is so different in my work, I can only think that writing – as combined with the uniquely focused concentration on another human and the often intense nature of the connection – is a factor.

I think writing notes also helps to get a broader sense of the session beyond the literal and to see the transference, the projection, the projective identification. Sometimes this happens straight away, sometimes after some percolation, and sometimes only when you have supervision and the reluctant lightbulb above your head lights up with the energy of a new perspective.

The act of writing also creates space to make links between clients. Is there a theme running across sessions and, if so, why? Maybe I’m bringing something unconsciously that I need to become aware of.

Also practically, there is no way I could maximise the value of my supervision without using notes to remind me of the key moments and questions, anomalies, queries etc. The therapist asking the question in the Therapy Today article says, ‘so far, I haven’t forgotten anything important’. But how do they know? I think that’s a question that also plays a large part in my maintaining my current note-taking process.

Apart from the assessment, I would never take notes in session. I had a therapist who did this once and I found it impossible not to ask what she wrote every time. This potential to break the contact and the flow far outweighs the value of scribbling down a quick word, I think.

PS

When I was thinking about this, I happened to be reading a little about Bion (about whom I know far too little: a situation that needs rectifying), but I understand he had an entirely different approach to client work, predicated upon the exact opposite of what I am trying to achieve with note writing - so there may be different note-taking approaches according to different theories or schools of analysis. Bion instructed analysts to enter each session with their mind as free as possible of the patient’s history or the previous session’s events. He believed that relying on memory would lead the analysts to look for what was already known or expected, rather than being open to the new experience unfolding in the here and now. Similarly the analyst should avoid any desire for results, cure or even understanding. Such desires, he felt, interfere with impartial observation and can lead the analyst to steer the session towards a preconceived outcome, rather than allowing the client’s process to evolve naturally. As I say, I know little of Bion and I’m happy to be corrected and educated if my interpretation is incorrect.

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There is great pleasure in helping a client to understand something that is going on for them. Something that perhaps hasn’t been obvious, but with time, patience and interpretation based on sound theoretical principles, all the pieces come together and a valid and viable narrative emerges. This understanding can alleviate anxiety, shame and confusion, it can play a huge role in the client understanding and being compassionate to themselves and their story, and it can become the platform on which changes can be made.

But…

Such is the pleasure of a satisfying intervention and a coherent narrative that I’m starting to think that sometimes, those interpretations can come a little too easily – especially those common interpretative tropes that we’ve all heard – and probably uttered - before.

I was thinking about this the other day regarding clients who are always busy, going from one activity to the next, never a moment to think. The conventional therapist response is ‘Oh, so what are you running away from?’, with the implication that it’s either their emotions or existential despair, or a bit of both. But what if that is just how they operate? Where they feel at their most content and fulfilled? What if they’re not hiding from anything? That’s perfectly possible too. But I think there’s a danger that therapists feel the need to earn their fee, to demonstrate their knowledge, to evidence forward movement - and this can come out in the overwhelming need to interpret, to make very visible progress.

Another common interpretative trope is when clients are late. I can’t tell you how many times I’ve heard people say something about the client obviously not valuing themselves highly enough to invest their time and effort in themselves; or they’re unconsciously sabotaging therapy or expressing resistance to it. Obviously there can be practical elements to lateness – the car broke down, the traffic was bad etc – but even taking a relational-developmental stance, one can interpret it differently: what if it’s actually, ‘For the first time in my life, I feel safe enough with another human that I can take their presence for granted and know that I will not be punished by the withdrawal of affection, even if I push them and invite censure.’ So instead of worrying that we’re facilitating a dereliction of self-care and reinforcing low self-esteem, we’re actually experiencing the positive consequences of a reparative relationship and the client’s first ever experience of having a secure attachment.

I wonder if it might also be a hangover from training, where tutors would perhaps throw these pithy challenges out just to make nascent trainee therapists think again, to learn to look through a more interpretative lens, to consider unconscious drives, transference and relational patterns. But our responses to those challenges, which can make us feel all wise and knowledgeable if we impress the tutor, perhaps become too easily part of the way therapists, once qualified, operate.

I was thinking about some other interpretation tropes that, for me, are overused and too easy to reach for and I came up with:

Anger is a defence against sadness. This is such a common one, and I’ve used it myself. And, of course, it’s also often right. But not always. Yes, anger can be a usefully accessible emotion – as well as one powered by shame at having feelings of vulnerability or sadness – but it can also be perfectly valid in itself. Not only valid, but crucial. We are doing our clients a disservice if we do not see the possibility of anger as a primary emotion, even though it may be more comfortable for us to sit with clients’ anger-as-sadness rather than anger-as-rage.

Another common one is looking at the parental relationship for the answer to every emotional, behavioral and relational challenge the client is experiencing. Now, when, like me, you’ve spent four years training in relational-developmental/psychodynamic theories (and when Alice Miller’s The Drama of Being A Child was the book that propelled you to train), that’s an easy trap to fall into. But we really shouldn’t, for a number of reasons: for one, the developmental environment also always has a number of other important relationships beside the parents; secondly, the current environment can offer its own substantial stressors; thirdly, systemic factors play a part; and fourthly, genetics/temperament will also play a significant role.

On top of that, we must bear in mind that whenever you try to fit the unique complexities of a human into a theoretical box, you are badly letting your client down.

One other common trope I can think of, which feels regularly over-simplified, is shadow projection, which dictates that traits you dislike in others are a reflection of something you dislike in yourself, something you have disowned (your Jungian shadow).

I’m sure there are many more.

It goes without saying, I hope, that good therapy requires a nuanced, individual approach where the therapist must be willing to sit in the not-knowing and the confusion sometimes, not always reach for the safety of an interpretation that has the reassurance of familiarity but not the rigour required to explain the uniquely complex and contradictory human being in front of you.

I have had the good fortune to write book reviews for Therapy Today, and occasionally for The New Psychotherapist, over the past few years. Apart from the pleasure of writing them, it’s also been a great way to find new books that I maybe otherwise wouldn’t have come across. I thought maybe you would like to find out a little about some of these books too, so I will publish the occasional review of relatively recent books over the coming weeks and months. Do let me know if you know the book too and what your views are.

Outrageous Reason: madness & race in Britain & empire, 1780-2020 - Peter Barham

I defy anyone to read this book without it making their blood boil at the sheer inhumanity on display in the name of mental health. The book demands that the reader fundamentally reconsiders the lens through which they see and understand the world when it comes to madness and race. Using meticulously researched stories of key figures, the author gradually builds the case that racism exists deeply, systemically and inescapably in the UK today, with its roots firmly in Britain’s colonial past.

For generations, colonial and post-colonial Britain has marginalised, incarcerated and controlled those who are not part of the ruling class, and this continues to echo through the psychiatric system to this very day. While individual stories of those caught in the crosshairs of 18^th, 19^th and 20^th century colonial oppression exemplify the explicit racism at play at the time, the later case studies detailing recent appalling cases of systemic violence amply demonstrate how racism has become deeply ingrained, unacknowledged – and, indeed, flatly denied.

From the horrific story of the slave ship, the Zorg, through the Jamaican lunatic asylums and the British Raj, all the way to 21^st century London, the author draws a thread that pulls together how power, race and class intersect to maintain systems of oppression that we, as mental health professionals are a part of, like it or not.

Psychiatric concepts and practice have not only dehumanised racialised people and justified their oppression for hundreds of years but have also been actively weaponised. The individual stories demonstrate the agonising impossibility of escaping from psychiatric pathologisation that is based on unacknowledged systemic racism – as true today as it was two hundred years ago.

When people in abusive relationships continue to return to the source of the abuse, most people are utterly perplexed. Similarly, when children defend their abusive or neglectful parents to the hilt, it can feel like incomprehensible, wilful ignorance.

Therapists will be confronted with both of these scenarios, the latter being extremely common. Any time a new client says ‘I had a wonderful childhood,’ a therapist’s ears prick up. And no, that’s not because we’re looking to foist false narratives on happy childhoods (they do exist), but because when we allow space and safety and security for defences to drop, the truth is often very different. The defence is what kept the child alive – psychologically, if not literally – but the defence is now woefully out of date, and the consequences of it are often why people find themselves picking up the phone to a therapist.

This is not an article about the nature of abusive relationships and nor is it an article about getting out of them. I also want to acknowledge that there are a number of very real, tangible, here-and-now reasons that people stay put, such as: fully-justified fear at the consequences of leaving; intimidation; cultural norms; lack of resources; children. Leaving an abusive relationship is incredibly hard and dangerous. Similarly, a child usually needs its parents in order to survive. So they find a way to tolerate what happens to them.

However, the psychological machinations run deeper.

At this point, I’d like to introduce Ronald Fairbairn, who was a Scottish psychiatrist and psychoanalyst and a key figure in the founding of the object relations school. He was a pivotal – if sometimes a little overlooked - figure in the fundamental shift in psychoanalysis from Freud’s drive theory, where humans are seen as fundamentally pleasure-seeking, to object relations theory, where humans are seen as fundamentally object-seeking. So our deepest motivations are in seeking to form relationships (with objects, which, confusingly, means people) rather than simply to discharge instinctual drives. Object relations was the forerunner and foundation for the more well-known attachment theory of Bowlby and Ainsworth.

Fairbairn posited that when a parent is rejecting, the child’s need for love and security remains unsatisfied. Rather than turning away, the child becomes even more fixated and dependent on the rejecting parent. This is because the child’s survival - both physical and psychological - depends on maintaining some form of attachment, even if it is to a harmful or neglectful caregiver. The more the parent rejects, the more desperate the child’s need becomes, leading to a powerful, sometimes lifelong, attachment to the bad object.

To cope with the pain of rejection and the impossibility of acknowledging that the needed parent is also the source of pain, the child employs a psychological defence called splitting. This involves dividing the parent (and the child’s own experience) into good and bad parts. The intolerable aspects - neglect, abuse, rejection - are dissociated and forced into the unconscious. This protects the child’s conscious ego from overwhelming distress and allows the child to maintain an idealised image of the parent, preserving hope for love and attachment.

Despite experiencing abuse or neglect from a parent, a child’s attachment to that parent endures. The child internalises both the bad object - the parent who rejects them - and the exciting object - the parent who occasionally provides hope or affection. Deep within the child’s unconscious, there remains an ongoing drive to mend and resolve these internalised relationships, which frequently leads to repeating similar patterns in relationships later in life. While the rejecting part of the parental object is split off, the exciting object part, however negligible, creates excitement in the child, because it promises the libidinal ego that love is just around the corner.

Fairbairn’s model helps explain why individuals may remain attached to abusive partners or repeat self-destructive relational patterns – or remain convinced that a childhood dominated by unhealthy parenting is actually idyllic. The splitting defence and dissociation allow the person to avoid conscious awareness of the pain, but the internalised dynamics continue to shape behaviour and emotional life. This is why so many clients will say, ‘I don’t know why I keep doing this, but…’

Greenberg & Mitchell wrote: “The child needs the parent so he integrates his relations with him on a suffering masochistic basis…The emptier the real exchange, the greater his devotion to the promising yet depriving features of his parents which he has internalised and seeks within... The individual’s perception of reality is filtered through these sub-selves or part-object identifications, and all the world becomes a stage on which to act out or re-enact these powerful internal object relationships.”

Now we can see human behaviour, no matter how futile or self-destructive it can be, as ‘a desperate attempt to salvage attachment to frustrating but needed objects, real or internalised.’ (Celani). And desperate is the word: it creates a longing for an object to love and be loved by, to see and be seen by. Fairbairn originally termed splitting as The Moral Defence, where the individual blamed the self for the failure of the object.

It is perhaps now easier to see why abuse in relationships is so insidious. It acts on patterns already present but unconscious. So where a partner is caring and romantic one day and cold or abusive the next, the promise of love feels always just within reach. The small acts of kindness or love can seem bigger than they really are because although they occur infrequently, they tap into the hope of something different.

The abused or neglected child works so hard to maintain the parents’ positive image that you can see how this might translate in adulthood not only to toleration of abuse but actually sometimes an effort to be the abuser’s healer or saviour.

It’s also not a big leap to see how the child who concludes that they are bad instead of facing into their parents’ cruelty could become the adults who feels like they deserve the abuse – and the abusive partner will, of course, exploit that.

As relational therapists, our role is to provide the relationship and environment that makes it psychologically safe for the client to see clearly, to drop their defences, to experience and move through the pain of the reality, and to find compassion for themselves as both child and adult, and to try and help them break those patterns of relating that have dominated for so long.

A final note for therapists and trainees: Fairbairn has a lot to offer, I think. However, his writing is not always easy to follow, and nor are his theoretical proclamations always consistent and uncontradictory. Fortunately, someone with considerably more brains and patience than I possess has deciphered his work: I heartily recommend David Celani’s ‘Fairbairn’s Object Relations Theory in the Clinical Setting’, which is a brilliant explanation of his work and its relevance. I note he has written a subsequent book – ‘Ronald Fairbairn: a Contemporary Introduction’, which I haven’t read but I imagine is similarly valuable.

I was at a poetry event a few weeks ago where Joelle Taylor, Salena Godden, Henry Normal and Lemn Sissay all read their work. Such a disparate group of poets but such a powerful evening of words, emotions, courage, connection and joy.

I left the event in an entirely different state to when I arrived, and as I sat in the car trying to let it all percolate through, I thought about how poetry – and art in general – can reach us like nothing else. In ten seconds, I can read a short poem and be momentarily transformed. The awe of a moment of perfect connection with what someone else has written, of suddenly feeling perfectly understood, of knowing you’re not alone in the universe: feelings that good therapy can provide.

Occasionally clients bring me poems, songs or art. Sometimes other people’s because it spoke so loudly to them and encapsulated something for them beyond conventional language; but also sometimes their own work – and what a privilege that is. I never ask for it because it’s not my place to do so, but when they show me, I am very aware that they are allowing themselves to be seen by me, trusting me to see and accept them and their complexities in ways that reach beyond conventional conversation and into the very essence of who they are.

I recently came across a wonderful poet called Tishani Doshi, whose poem Amor Mundi begins like this:

For years I’d throw myself at a rock
and say, Catch! I’d see a hole and try
to shapeshift into it.

How many of us, and our clients, have known this feeling and have worked hard to change the narrative? But here a poet bypasses the chapters in therapy books, the theorists’ musings, the weekly sessions, the neuroscience. Instead she captures a facet of human nature in 21 simple words. (Read the whole poem here https://www.the-tls.com/literature/original-poems-literature/amor-mundi-original-poem-tishani-doshi)

Another favourite of mine is the short but devastatingly perfect Separation by WS Merwin:

Your absence has gone through me

Like thread through a needle.

Everything I do is stitched with its colour.

Access to some way of artistic self-expression is so important for so many people – just a way to articulate something that has resisted articulation; to help someone else understand what they’re feeling on a visceral, emotional level; to say through art what they just can’t say out loud. As Heaney wrote: ‘Between my finger and my thumb / The squat pen rests. / I’ll dig with it.’

I know a poem won’t solve anything on its own, it won’t banish a condition completely, it is unlikely to provide a life-changing epiphany. But it can change our perspective, especially around how we see ourselves, how we see the world, and how we see where we fit into that world. I see Failing and Flying by Jack Gilbert like that: https://poets.org/poem/failing-and-flying

Poems slow time and allow us to refocus – the very antithesis of seeking that familiar, frantically passive distraction from our screens and their inchoate snippets of barren vacuity.

And if you find the right poem (or work of art, piece of music, film), I think there’s another impact: it reveals the possibilities and beauty inherent in life itself. Sometimes, some writing is so astonishing, so brand new that it is thrilling, revivifying, a testament to the remarkableness of human beings and the beauty within us. This doesn’t happen often of course, but when it does – what a joy.

For me, the most recent occurrence is my scandalously late introduction to Seamus Heaney. What that man can do with words is nothing short of staggering. If the human race can produce something this exquisite, surely there has to be hope for us all. (My current Heaney favourites include Postscript, Follower, Mid-term Break, The Grauballe Man and Glanmore Sonnets II.)

I wonder if a poem can sometimes reawaken us to a sense of wonder that becomes all too easily crushed as we get older and life batters us a little – or a lot. A wonder that exists in all of us to begin with, as babies and children in this astonishing world. As a therapist, the moments when clients are able to look up and see wonder again in a world that has been all too cruel and bleak are truly rewarding. Sometimes poetry can take us there too.

I could paste poems into this article all day long. Researching it has taken weeks because I just kept reading poems instead of writing this. But I’ll finish with one from Lucille Clifton – a poem full of fortitude, pride, joy, and the triumph of the human spirit in adversity. Sometimes our clients just need to know that they can make it through, and I hope poems like this can be a small part of building the belief that it’s possible.

won’t you celebrate with me

won’t you celebrate with me

what i have shaped into

a kind of life? i had no model.

born in babylon

both nonwhite and woman

what did i see to be except myself?

i made it up

here on this bridge between

starshine and clay,

my one hand holding tight

my other hand; come celebrate

with me that everyday

something has tried to kill me

and has failed.

It can be quite hard to communicate with a baby. While crying, babbling and other noises can give us an idea, and we in turn can respond with different noises and tones (as well as words which don’t yet mean anything), we are not speaking to one another, not sharing mutually-understood language. As any parent will tell you, it can all be very frustrating.

But these first few months of life also represent a brief period where the baby’s thoughts, sensations and feelings are not captured and shaped by the restrictions of language. They live a raw experience, unmediated – and unrestrained – by the meaning that language creates.

Psychoanalyst Daniel Stern captures the exquisite paradox that language delivers: it is both a liberator and a jailer as the infant, ‘ gains entrance into a wider cultural membership, but at the risk of losing the force and wholeness of original experience’. Stern also points out that language does not simply exist either within the individual or out there in the world but it exists purely as ‘we meanings’.

I would add to that not only are there ‘we meanings’ but that these same meanings change with every utterance and every thought, making it ever harder to pin down a true symbiosis of meaning. In this context, maybe we should re-evaluate those pre-verbal interactions and attunements of baby and caregiver as being much more capable of pure connection and understanding than words allow because they are uninhibited by the restrictions of language and the reification of the infinitude of conscious experiences.

And what are the implications for adult patients in the therapy room? Words, of course, are important – it is, for many of us, ‘talk therapy’ after all. However, we will also often look well beyond the presenting issue, to understand how a client’s history is being relived in the present - in other words to focus on their process, not just their content. To circumnavigate the obstruction of language. ‘Don’t chase the facts,’ said my supervisor once, when discussing a client who was running rings around me with stories that became ever-more far-fetched.

As therapists, we are listening out for developmental patterns and attachment schemas that are still being played out. The therapeutic experience can evoke, and in the end contain, good and bad feelings, disturbing thoughts and deleterious behaviours. Through the re-enactment with the client (or perhaps enactment for the first time) of the caregiver’s empathic attunement with their infant selves, the best therapeutic work can be done.

In the ideal scenario (a rare beast indeed), according to theorist Anna Aragno, the therapist works towards an empathy that allows client and therapist to transcend separateness and to communicate benevolent interest, acceptance, compassion, tolerance, respect, forbearance, understanding, closeness, separateness...a sense of total safety in being seen.

All this requires the therapist to reach beyond words to the emotional sense of the client’s experience. Beyond the restrictions and premature reifications of language. Reaching back to that pre-verbal state where understanding can be entirely unobfuscated by language and can reach a purity of connection that is powerfully reparative.

So much is demanded of trainees, not only in academic excellence, skills development and wholesale psychological upheaval - but also in costs, including hidden ones.

The training I took, and many take, is to Masters level. This enables accreditation with the UKCP (UK Council for Psychotherapy). One of the many compulsory hurdles that has to be leapt is to acquire 450 hours of client work via placements. These hours are provided F.O.C.

Now, no-one is advocating (I don’t think) for trainees to get paid £60/hr from day one. But the extent of this free labour is astounding in cold, hard numbers. If a trainee were to be paid for their placement hours at £60/hour, that equates to £27,000. So on top of tuition fees (£15,000-£40,000), compulsory therapy (160 hours minimum at £50/hour is £8,000) compulsory supervision, books and travel, you are also sacrificing at least a day’s work time each week in order to fulfil your placement obligations – and giving up that £27,000 of potential earnings.

The tricky part, though, is that all of these costly components are critical for a trainee to learn the theory and the practice in a safe, supportive environment. You can’t just drop one because it’s expensive. Personal therapy, incredibly, isn’t compulsory on all courses but I strongly believe it should be. Supervision is vital. Placements are where you really begin to learn your trade (and often are the only way that organisations can offer therapy to people who need it but can’t afford private rates, which raises its own ethical questions about accessibility to therapy).

But is it any wonder that so much of the profession looks and sounds the same? It’s the people who can afford it – or who have the social capital that enables access to family money or manageable lending/debt. It’s not that white, middle class people are necessarily the best therapists but they are the ones who can afford to train and, as a client pointed out to me recently: when your therapists, your tutors and your supervisors are all representatives of this cultural hegemony, no wonder those who don’t look or sound the same can feel like the industry is not within their reach.

I have been wondering if this realisation was behind my uneasiness around the Oxford Trauma Conference I attended recently. The sessions were, largely, brilliant. The learning was second-to-none. The calibre and reputations of the speakers was amazing – all the big names.

But that’s perhaps the problem. These big names come at a price: this was an expensive conference that was very much focused on the celebrity gatekeepers of psychotherapy theory and practice. The venues were huge, the amount of delegates was vast, but when speakers come on to the stage to cheering, whooping and general adulation…call me a bit too British, but that felt cringey in the extreme.

Don’t get me wrong – these people are brilliant; I was enriched and inspired. But it feels like a closed shop. This particular event feels like the product of a system that begins decades before – and is still in play now. If we want some different people at the top, we have to find a way to include different people on the first rung. It’s a conundrum that feels impossible to solve.

Unsurprisingly, it all turned out to be a little bit more complicated than that – in so many ways.

One of the most important things you learn as you begin to move from theory into practice is that the situations where theory translates directly into practice, where the spirit of Bowlby or Winnicott or Kohut (insert favourite theorist here) magically transmits healing vibes to the client, who makes a miraculous recovery, are vanishingly rare.

This is because humans are an impossibly complex interaction between biological systems, genetic information, environmental influences, unconscious processes and conscious experience.

Psychiatrist and neuroscientist Dan Siegel said in a recent talk I attended that in neuroscientific terms, we need to remember that a baby is born with its brain stem developed, limbic system underway, and pre-frontal cortex non-existent. So it follows that the brain stem is the ultimate source of innate temperament, which the other two areas have to adapt around.

Ed Tronick explains that two infants will respond to his famous Still Face experiment very differently, and that may simply be the nature of their cortisol system. One will respond with very high cortisol and one very low. So they experience the same event very differently – one frightened and one calm. [NB If you’ve never seen the Still Face experiment, Google it. I’ve seen it scores of times and it never stops being a deeply painful, utterly invaluable, watch.]

Equally, one person may respond to a life-threatening trauma with the feeling that after this awful experience, life simply isn’t worth living; while another may feel so lucky and glad to be alive that they become determined to live life as fully as possible.

This demonstrates that there is so much more happening in our minds and bodies – and beyond - than simply the influence of our immediate environmental experience. There are implications as a result of our endocrine system, our genetic make-up, epigenetic influences, gastrointestinal system and more. Outside of the body, family, community and cultural practices and norms will have an impact too.

Intrapsychically, babies are constantly making meaning of the unique way their bodies interact with the world and its infinite variables (without language and symbols, babies have a necessarily somaticised experience of themselves in the world). They will also be encoding implicit memory during the last trimester of pregnancy and for around two years of life, which will become an unconscious, implicit part of who they are. Meanwhile temperament will define how a baby quickly reinforces small, random variations of sensitivity, creating and strengthening neural connections that quickly become well-worn pathways and patterns, despite a potentially very small initial input or variation.

So to sit in a chair opposite these former babies as an adult and think we can know, understand and heal them according to a blanket set of rules or a fixed model of trauma is absurd.

Indeed, when working with trauma, it is only ever one element of the psychological make-up of the person in front of you, and it’s never the whole story. As therapists, we must understand everything that goes around it – the before, the after, the temperament, the relationships, the unique meaning-making of the individual and so on.

I suppose this is why I work in the way I do, which is usually long-term and at depth – because humans are infinitely complex and need to be seen and understood in all of their complexity – or as much as we can manage. We can, of course, do amazing work with our clients – but only from a position of realism and humility. No-one ever really fully knows anyone.

‘So, am I an onion or am I a bird’s nest?’

Not an easy question to answer in a therapy session, as you might imagine. But an important one.

The question was prompted by a discussion I have fairly often with clients, especially those who are really trying to unpick who they are and where they fit. At its most essential, it is the age-old question of nature v nurture. We are wondering together: ‘is my self, the essence of who I am, built up through my experiences and relationships over days, weeks, months, years and decades (bird’s nest), or is there a core, true self at the heart of it all that we’re trying to uncover by peeling away the layers of confusion, expectation, societal and familial norms?’

As you will learn over the course of these posts, I am an inveterate fence-sitter. Give me black and white and I’ll make grey. As a therapist, I don’t think this is a bad place to be. If we cannot be open to everything, what might we miss? And how can we understand a client’s unique experience, which may differ hugely from our own?

To put it in unnecessarily long words, I tend to take a post-modern social-constructivist position, believing in no single objective truth but a multitude of subjective realities. By definition, this negates the possibility of the 100% core self, waiting to be unveiled.

June Singer says:

Finite human beings can hardly do more than beam their small searchlights into the great yawning darkness… We can only speak about the portion of reality we perceive, given our experience and the information that is passed to us by the agencies of our culture.

While I like her searchlight metaphor, I believe the ‘yawning darkness’ is not full of reality waiting to be perceived but rather is a darkness full of endless possibilities, each unique to an individual’s perception in that moment. Put together, these perceptions can create echoes of universal experience.

I don’t think knowledge reflects an ontological reality I believe certainty is impossible, all narratives are contextual and knowledge is relational. Hilary Lawson’s Closure theory says that the whole world is open ‘and it is we who close it through our stories’.

This approach aligns with my standpoint as an integrative psychotherapist. I believe each individual’s interpretation of reality – their unique experience of themselves and others - must be created out of their own particular system of internalised self- and object-representations. These representations can only be formed in the dual world of external and internal relationship, where each affects the other.

However, I find it impossible to believe (and most people and research would agree) that there isn’t a nature element to our beings, a temperament that is innate. So these two elements must remain in balance. It is perhaps in the multiple layers of inter-related complexity that we find enough stability that we may have the comfort of knowing ourselves and enough lability that allows for change, discovery and growth.

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This is a Substack for anyone interested in the human condition. Ostensibly for people in and around therapy - therapists, psychologists, psychiatrists, trainees, patients, clients – but actually for anyone who has ever asked, ‘I wonder why I’m like this?’.

However, this is not a place to come to for answers. This is a place for exploring questions. I’m rather inclined to believe that in therapy, as in life, definitive answers are rather hard to come by.

I’m the sort of person who finds grey where others see black and white, who answers the question ‘Is it X or Y’?’ with ‘Have you thought about Z?’, and who says ‘I don’t know’ more than any reasonable therapist ought.

In these posts, sometimes I’ll think about what works and what doesn’t, what theory rings true and why, and how our clients are our best teachers. One of my focuses is to write about what I wish I knew when I was starting out – not so much to provide a set of certainties and answers but more to know what the right questions might be, and how best, as a new therapist especially, to create the space for the client to find their own answers.

I hope sometimes I’ll be able to use my knowledge and experience to pass on to others. I also hope sometimes people will spot my ignorance and pass on their knowledge and experience to me. The longer you practise as a therapist, the more you realise how little you know – a humbling but incredibly exciting place to be.

There will probably be poetry and quotes and maybe other arty stuff too, as I’m inclined to believe that the arts can sometimes teach us far more than 50 minutes with a therapist ever could. But let’s see how we go. I’d like to think I’ll approach this as I approach a session – with a clear mind, no preconceptions, and deep curiosity.

Anyway, have a read. If you’d like to engage, I’d be delighted.

Very important note: Any case studies or references to clients are entirely fictionalised accounts based on the types of experiences clients bring to sessions.