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Having your cake and eating it

If your style of therapy was a cake, what would it be?

 “Eclectic is like this cake” said my husband, looking at his plate, having eaten most of a piece of ginger cake topped with apple and a sticky toffee sauce. 

It’s got lots of interesting bits on it but it’s not quite as much as the sum of its parts”

 What would an integrative cake look like?  What forms might a gestalt or a psychodynamic cake take?  Here are some ideas as a start to get the juices flowing:

Person centred – a luscious, moist and slightly chewy coffee cake with some rather surprising walnuts and brazil nuts in.

 CBT – a well thought through Victoria sponge, cooked just as Delia instructs, that is delicious for many people, but light on calories and doesn’t last too well.

 Psychoanalytic – this one is well established and is years in the making: a deep rich (and sometimes rather dry) Christmas cake that improves with maturity … and liberal applications of alcohol.

 Relational  - it doesn’t matter what the cake is as long as there are two of them.

 Systematic – in what context is the cake situated? Who gets to eat the cherry on the top?  Is there any left for me?

 TA  - A chocolate mini-roll (or role?) which can provoke different reactions -  "Gimme, gimme!", "Not right before bedtime, darling", or "Maybe just another little sliver".

 Developmental  - let's just start with a very small cup cake….

 NLP – This cake is a map not the territory. Let's explore it with all our senses, let it taste delicious, let the deep chocolate smell waft towards you, let it be wonderfully large, deeply coloured, blazing with candlelight, notice how your taste-buds are starting to water, etc. etc.

 Gestalt – Yes, but what does the cake want to say? Here, now, in this moment?

 Might attempting to integrate this lot lead to indigestion?


If I know where I stand I know who I am


There is a lot of talk about values these days, particularly from politicians with their talk of “hardworking families” and “British values”.  But its hard to know what it really means – or indeed what good it is doing anybody.

For us as individuals, and as part of our families and communities, values are important, because they tell us who we are.  Having a clear set of values enables us to have a clear sense of self, a clear sense of our identity and who we are in the world.  This was demonstrated very clearly to me this weekend, when I went to the funeral of someone who had greatly touched me with her kindness and warmth. 

Everything about the funeral exemplified the values that this friend stood for: the location, the simplicity, the music and readings, and the courage with which each contributor played their part. The eulogy seemed to bring her back with us, beautifully written, full of her sayings and beliefs.  Here was someone who really knew what was important to her, and lived those values.  She didn’t compromise or live to other people’s rules, but lived and loved with a passion that she shared with all those around her.

We get our beliefs and values from many sources.  Some we work out for ourselves, and some we get from other people, often our parents, but also grandparents, uncles and aunts and other significant adults.  Some of these beliefs are handed down through the generations, not always with positive effect.  We pick up values from school, from our friends and colleagues.  Teenage years are a very active time of sorting through values and working out the things that are really important, but this process continues through life.

Part of the work of therapy (and coaching) is to help you become clearer about the values you hold, where these come from, which of these beliefs are really yours, and which beliefs you wish to retain.  For example, I realised that my mother and father had both given me a set of values.  The problem for me was that these values often contradicted each other, they took up a lot of space, and they left little space for what was uniquely me. 

I like drawing, so I found myself expressing this in the picture below


This picture showed me how little space I had, and the conflict between my inherited values.  This then helped me to work towards integrating the historical values from my parents and giving myself more space, by discarding what I did not need or was conflicting, and integrating what was important.  (This integrating process is an important part of Integrative Therapy.)

 With this realisation, another picture emerged (below).  I see this one as integrating different parts of me, bringing in parts from my parents, and a space for me, a heart filled centre, a sense of transcendence, and clear boundaries.

The result of this work has been to help me be clearer about who I am, to say no when this is the best answer, to make decisions, and to know where our boundaries are.   I can filter what others say, chew it over and discard what I don't believe.  I don't have to swallow it whole.

Does any of this resonate with you?  Do you know what your values are?   I will be writing more about how you can explore your own values next week.  In the meantime, why not tell me what you think.  Contact me at:


Do something different for a change

There is a maxim in Neurolinguistic Programming (NLP) that says:

 “ if you always do what you have always done, you will always get what you have always got”

It’s a bit like having a recipe for life  - if you always take the same ingredients, mix them in the same way, cook them in the same oven for the same time and at the same temperature, you have a pretty good chance of producing something very similar.

And to me that’s a very nice idea – it gives me the sense that I know what is going to happen, that I’m in control, that the world is safe.  This sense of safety and protection is important to me.  It was how I kept myself safe as a child, and how I have negotiated new situations as an adult.

But from time to time we need to change, and want to change.  I know from my own history that sometimes I really want to experience  something different, to escape from the way I see the world, and to break down some of the rules that I have been living by.

 I first learnt about doing things differently when I broke up with someone (let’s call him Tim) whom I absolutely adored – but hardly knew.  He was a recovering alcoholic, an artist, and one of the most entrancing looking people I had ever met.  He took me to AA meetings, which drew me in with their openness, and a sort of glamour in their intensity (and the fact that there were several well known people in the group).  But then I went to an Al-Anon meeting – a group of those who live with alcoholics, their family, their partners and friends.

 This wasn’t glamorous at all – quite the opposite.  I remember a small and grubby room, where some rather drained looking people sat round a table and we were challenged to look at ourselves, and why we were attracted to an addict, and what was missing in our lives.  It was extremely uncomfortable, and I didn’t go again, but it made a deep impression on me.  I had already started to sense a feeling of addiction to Tim, not being able to say goodbye, wanting to phone him at all hours of the night, wanting something from him that he just couldn’t give me.

 With the wisdom of hindsight and psychotherapy training, I can see that I was deep in a projection of my unmet parental needs, someone to be both father and mother to me.  Tim could sense that I wanted something from him that he couldn’t give me – though he expressed it in terms of a future family life.  So we ended the relationship , but I was left with what felt like an addictive need to see and talk to him.   I knew I needed to change this, to let it go, but how?

 I decided I needed to teach myself to think differently, and to do this, I would start doing up to three things differently each day and see how this worked.  I would keep a journal, and write about my feelings.  Each morning I wrote freely, covering some three sides of A4  with whatever was in my had.  In the evening I wrote about on what had worked during the day, and what I felt grateful for.

 I started by noticing where I had choices.  Coming out of the flat for example, did I cross at the first traffic lights (as I always did) or walk a little further to the ones by the tube station ( as I always did on my way home).    I looked at my clothing choices.  I looked at who I was spending time with.  I didn’t try and do it all at once, but tried doing one thing different each day, and noticing how that was, and then building up from there.

 I’m very short-sighted, and my glasses or contact lenses are vital to me.  I experimented with walking around without my glasses, and found I could see a great deal more than I thought I could.  I started to enjoy walking along my street, noticing what I could see, rather than worrying about what I couldn’t.  Fortunately I discovered I could see moving cars quite easily.

 By doing things differently and capturing my feelings through writing I gradually started to reduce my dependence on Tim.  It was so important that I noticed how I was feeling, what was working, and see what was there, rather than what wasn’t.  By feeling gratitude each night for what I had, I started to replace a little bit of what had been missing from my childhood.   With each bit that I put in place, my dependence and pain around Tim reduced, until eventually.  I could start to see him more as himself, and start to accept that he wasn’t the right person for me.

 Doing things differently is still a conscious strategy for me, as I go through psychotherapy training.  Sometimes I try and break too many rules at once and find myself adrift and unhappy.  When this happens, my journal and my own therapy are vital to keep some sense of safety and containment.  I don't always keep a journal, but It is becoming increasingly clear to me that writing is an essential safeguard in any sort of change work. 

 It is important to remember that the rules that we live by, the rules we have created for ourselves, were made by us to keep ourselves safe.  We made these rules for ourselves when small, and working out how to survive, attract love and attention, or otherwise negotiate our family.    As get older we can find that they may well now be making our lives overly rigid, and limited, but they had a purpose then, for us as children.  It is our task, as we grow older and no longer need all these rules, to find ways to identify them, grow through them, and shed those that restrict us, so that we can find ways to grow through them, to live our lives fully and freely. 

 “Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us. We ask ourselves, 'Who am I to be brilliant, gorgeous, talented, fabulous?' Actually, who are you not to be? You are a child of God. Your playing small does not serve the world. There is nothing enlightened about shrinking so that other people won't feel insecure around you. We are all meant to shine, as children do. We were born to make manifest the glory of God that is within us. It's not just in some of us; it's in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others.”

Marianne Williamson, A Return to Love: Reflections on the Principles of "A Course in Miracles"


Psychotherapy: How do we know it’s working?

I have been lucky (or unlucky) enough to work with several very good psychotherapists and none has shown any apparent interest in evaluating the effect the therapy was having. This might reflect a value base that therapy isn’t about people changing, but being more themselves. Or it might be because no one has asked them how they know it is working.

 I come from a background of measuring change and developing tools such as the Outcome Startm,  so for me it seems an obvious question.  It is a question that is being asked more and more frequently.

 As I client I want to know whether my investment in time and money is worth it. As a therapist, I am curious about the journeys my clients travel along as they connect more deeply with themselves.  Therapists working as part of a service, with many clients need some form of measurement that can be summarised to show the nature of the impact the service is having, and where and with whom it is most effective. As a profession it is essential to show how useful we are to public health.

 What is it that you would be measuring?  If I reflect on my own experience in therapy, I entered therapy feeling lost, feeling distressed at the loss of a parent and a partner, and having difficulties with relationships.  Through these different episodes of therapy I have noticed changes in myself – a sense of direction, a greater ease in getting to know people, feeling more at ease with myself for more of the time.  Other people have commented on my being more relaxed and easier to get on with.  These are changes that matter to me.

 Measurement tools are developed by going through a process of finding out which changes are valued by clients and practitioners, and then summarising them in some form.  The most widely used tools take the form of questionnaires, such as PHQ9, GAD7, and CORE.

PHQ9 consists of nine questions which together build a picture of the clients level of depression: the higher the number at the end, the higher the depression.  It is used at the start and end of therapy (or at intervals during the course of the work).  GAD7 consists of seven questions focusing on anxiety.  These two questionnaires are used widely in the NHS.  CORE is a broader tool with 34 questions about how the client has been feeling over the previous week, covering subjective well-being, problems/symptoms, life functioning and risk/harm, to produce a picture of what they term the level of current psychological global distress (from 'healthy' to 'severe').

These three tools are all designed to create an ‘objective’ picture of where the client is at any particular time, and generate easily summarized numbers.  However PHQ9 and GAD7 both focus on symptoms, i.e. the show problems getting smaller rather than the emergence of different ways of thinking and being.

The Recovery Star takes a different approach.  This looks at the client’s life as a whole and sets out a journey of recovery, with a clear sense of what recovery looks like, so that you can see where you are, and what the next step might be.  It is based on your subjective experience of the issue, rather than an objective measure, i.e., it isn’t the severity of your depression that matters, but how you relate to it and manage with it.  The importance for me is that the Recovery Star charts a journey through awareness to an increasing sense of self, an increasing capacity to reflect and learn, and increasing independence and purpose.

However formal tools are not always necessary.  It is normal practice to agree some goals of therapy at the start.  One approach is to explore what achieving these might feel, look and sound like – what it would feel like, for example, to have a sense of purpose, how I might know that I was finding making relationships easier. These early thoughts can then be reviewed at a later date. One therapist I know says he always asks his clients how they will know they are ready to finish –  easier to ask than to answer!

Outcome measurement is easier when goals are very specific, which means that it is easier to measure the effects of focused short-term work.  In long-term work goals change and deepen as you travel a journey together, making a tool like the Recovery Star possibly more helpful.

There are dangers in trying to measure too much: long-term therapy has many ups and downs, long periods where nothing seems to happen, and times which are very painful.  In my experience these difficult, or plain boring times have usually been important stages on the way to growth and change.  The timing of reviews and expectation of change therefore is important – it needs to match the work.  If you are working over a long term period, such as two years, it might make sense to review after an initial phase of say three months and then revisit after a year or eighteen months, whilst noting client and therapist observations along the way.

Whether working short or long term I suggest that there is always scope for the client and therapist to reflect and note change together, whether positive or negative, and that this reflection in itself, is a constructive element of the work.







Wild Therapy by Nick Totton Book review

Nick Totton has written this book to make explicit the link between therapy and the environmental crisis  that we face.  He starts from the premise that we have domesticated ourselves, over centuries, and lost, for much of the time our connection to the wild, to the "other than human" and "more than human" that share this planet with us.  This not only leads to distress and ill health but also enables us to live in a way that is exacerbating the crisis and making it increasingly unavoidable.  He regards therapists as having a unique responsibility in helping people to reconnect with the "wild" and recognises that this is a challenge, as much of therapy has been regimented and regulated, to protect clients, and increasingly, to protect therapists from litigation.

This is an important and delightful book.  The author says from the start that he intends to enable the reader to forage, to meander along a path exploring interesting ideas and voices to right and left, and his pages are full of a wide range of voices from all over the world, inclduing fascinating tales from anthropologists describing the "wild mind" and its collapse in the face of "civilisation".  In the first part of the book he explores what wild and wilderness mean, and how our relationship to the wild has changed, and how we percieve the wild now.  Underlying this is a path exploring how humans have become separate from the wild, how we have strived to simplify complexity though domestication, and what we have lost in the process of separation.  

The later chapters look at the role of therapy and therapists in supporting the process of reconnecting, and the challenges this presents to an individual therapist - here he brings in his own experiences, as well as the voices of others and the author as a person starts to appear on the pages.

What can I do about climate change?

A gigantic iceberg looms ahead, clearly visble from the bridge.  With binoculars the crew and passengers can make out the different colours of ice, the intricate shapes, and more than anything else, its enormous size.  Even those without binoculars can see it - that is, if they are looking straight ahead.  The captain roars " full steam ahead!" 

" but sir, we will crash - its almost too late to avoid it already! We must change our course!" come the gasps around him and from passengers straining to climb through the barricaded entrances to the bridge.

"Nonsense" he says, "we will be fine - this is a very strong ship, we have always managed these things before.  Anyway we have a right of way through this passage - if we dont go this way someone else will and we will be left behind.  Icebergs arent a problem"

Panic starts to spread.  People rush for the lifeboats.  But there arent enough - no one ever thought the ship would need them.  The first class passengers decide that there are prpbably enough for them, as long as the second class and steerage passengers can be distracted and kept out of the way.  Before long fighting is widespread as people scrabble for their one chance of survival.

 A hackneyed metaphor maybe, but one that speaks to me.  Where are the lifeboats for the farmers seeing their livelihoods disappear in the mountains of chile, or in the drylands of the sahel and Sub Sahara?  Or island peoples such as the much quoted Maldives, literally disappearing beneath rising sea levels.  Even we here in the relatively safe UK are experiencing some very strange weather, with a wet and cold spring that has decimated bee populations (and subsequently fruit crops) and a summer with widespread and continuous flooding.  But are we taking it seriously?  It doesnt feel like it.  

I used to live in Oxford, and maybe that is one place where there is a huge amount of awareness and activity and mutual support for people trying to change their lives and live in planet friendly ways.  Now I live in a wealthy Yorkshire town, full of people (like myself) who have moved there because its so nice and has wonderful state schools for the kids.  Its a lovely place to live - but it is a haven of consumption, large cars and a feeling that the world is just fine here.  Its hard to remember that there is a world outside, to which we are connected, and that nothing very much is changing.

It's as if we are on that ship, its full steam ahead, and we have said yes, the icebergs there, but it wont really happen and if it does, we will be ok, and settled back down to enjoying a nice game of backgammon (or in my case playing the fiddle).  Maybe some people are saying - yes its there but there is nothing we can do about it so we may as well enjoy ourselves whilst we can.  Others know they will be ok, because they know they deserve place on that lifeboat - after all they have worked hard to be able to afford a first class ticket..... Others trust the captain, and his view that the ship is strong enough to meet and overcome any obstacle.

I feel I'm one of those people who are sitting anxiously, looking out, seeing what will happen, worrying about how the steerage passengers will cope, but not doing anything or knowing what to do.  I might have gone up to the bridge to try and say something and lend my voices to those asking the captain to change course, but I didnt feel very convincing and I didnt know what else to say, so I gave up.  And worried.

So how do I - and others gain a sense of power?  For me the biggest block to action is feeling that I dont have any power.  I know the answer is quite simply to get involved in something, join with others, and get something going.  And I have done that a bit over the last three years.  But it is easy to be dismayed by the high level failures, such as Copenhagen and most recently at Rio, and wonder what on earth can be done.

Round us the big issue is wind farms - and being in favour of these (generally) puts me in a small minority.  But I cant see the objectors being any keener on a fracking exploration, or open cast mining if that was to come our way.  Ill end for now on that note.

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