Category Archives: Therapeutic Approaches

A relational vision of human distress

Dr. Joe Hinds, Senior Lecturer at CCCU and practising integrative psychotherapist, discusses the distinction between mental illness and eccentricities, and the appropriateness of mental disorder diagnoses on atypical behaviours.

In 1961 the psychiatrist Thomas Szasz suggested that the concept of mental illness as conceived by the medical profession was vague and unsatisfactory, comparing the assessment of mental disorders with astrology. Indeed, determining the sane from the insane has never been straightforward (Rosenhan, 1973).

Munch’s “The Scream”

Now as then, there is a reliance on prescribed pharmaceuticals to medicate and ‘cure’ people who display out of the ordinary behaviours and beliefs. Where psychiatry once governed, contemporary approaches largely based on psychological rather than psychotherapeutic understandings reinforce the pathologising of experiences. For instance, according to interpretation of the diagnostic criteria of DSM (Diagnostic and Statistical Manual of Mental Disorders), where there was once shyness there is now social anxiety, high-spirited children now have ADHD and where we might observe people with strident differences of opinion we now see them labelled as having conduct disorder. Alongside some appeals against the overtly positive culture in which we are encouraged to participate (“Smile or die” – Ehrenreich, 2009), others have suggested that by strict adherence to the criteria of determining disorders in the DSM (and elsewhere) the concept of happiness is worthy of inclusion as a disorder also.

As a relational psychotherapist, I embrace the simple but important and sometimes difficult arts of listening, empathy, consistency, stillness, and being me in an intimate and emotional therapeutic encounter with another. Interpersonal dynamics, particularly in early life, have much to contribute towards our adult functioning and therefore the role of therapy is to provide a safe and understanding relational space in order to re-address these dynamics. The therapy described here is about demonstrating a genuine humanness and not to hide behind the implementation of techniques or assessment. Why would the person in therapy “Expose their tender under belly if the therapist plays coy and self-protective?” (Whitaker, 1976, p. 329).

In attending to people’s life stories I have found many who have been labelled as having or being something such as borderline personality disorder, bipolar, psychosis, and many others. Whilst undoubtedly these people on occasion may behave in ways that are non-conformist and disconcerting, these behaviours are often the coping strategies (‘symptoms’) of chaotic and often abusive or traumatic life experiences and I am not convinced that categorisation is a necessary nor helpful practice. I have not been tempted to formally evaluate people along any parameter of mental functioning – it is understanding that is needed here not the assessment and removal of symptoms.

“Every human being is born a prince or princess; early experiences convince some that they are frogs, and the rest of the pathological development follows from this” (Berne, 1966, pp. 289-290).

Moreover, the social and cultural conditions of living are increasingly competitive, time pressured, intense, confusing, and, when added to personal experiences of trauma or neglect, may result in increased instances of psychological distress (e.g., 2014 had the highest number [130] of UK adult student suicides: Office for National Statistics). Often the conditions of living are the cause of distress: the ‘problem’ does not necessarily reside within or as part of the individual. In the words of R. D. Laing, the celebrated radical psychiatrist, “Insanity is a perfectly rational adjustment to an insane world”.

Dali’s “The Temptation of Saint Anthony”

Salvador Dali

The difference between being mad and eccentric, and the acceptance of these in society, is often determined by degree of wealth or success: exemplified by creative genius – see Dali and his The Temptation of Saint Anthony above. The very needy or distressed are not seen as such because of their position in society or their acceptance by favourable sections of the population. Paranoia, narcissism and rigid dichotomous thinking (as indicators or symptoms of distress) displayed by elected world leaders, for instance, would attract the attention of health care professionals under very different circumstances.

Yet these characteristics may also be becoming more prevalent in various societies. Democratically elected leaders are after all voted in by sizable minorities who may recognise, applaud and share those characteristics. In addition, our own habitual practices when set against other cultural standards may not seem to be altogether beneficial or rational including the derogatory categorisation of people according to their level of social conformity. The DSM only completely removed the category of homosexuality (“Sexual Orientation Disturbance”) from the list of disorders in 1987. Therefore it becomes increasingly difficult to separate the so called ‘mentally ill’ from the so called ‘mentally well’.

Key References

Szasz, T. (2011). The myth of mental illness: 50 years later. The Psychiatrist, 35, 179-182.
Whitaker, C. (1976).The hindrance of theory in clinical work. In, P. J. Guerin (Ed.) Family therapy: Theory and practice (pp. 317-329). New York: Gardener Press.
Laing, R. D. (1965). The divided self. Harmondsworth, Middlesex: Pelican Books.
Berne E. (1966). Principles of group treatment. New York: Oxford University Press
Rosenhan D. L. et al (1973). On Being Sane in Insane Places. Science, 179, 250-258
Ehrenreich, B. (2010). Smile or Die: How Positive Thinking Fooled America and the World. London: Granta

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Comfort Dogs and the Spiritual Experience

Nicole Holt, research assistant to Dr. Liz Spruin, has been exploring the use of dogs for rehabilitation and wellbeing, and the benefits that ‘comfort dogs’ can provide

In America, a new role for dogs has been created called “comfort dogs”. These dogs and their handlers regularly go out into the community and interact with people at churches, schools, nursing homes, hospitals, and various social events throughout the community. The label “comfort dog” was suggested by the Lutheran Church Charities organization in Northbrook, Illinois, going on to write that ‘[comfort dogs] share the mercy and compassion of Jesus Christ with…people’.

While compassionate engagement with the community is commendable, some have argued that this work focuses on vulnerable individuals, particularly when the same individuals might be asked for financial donations. There is a wider issue about the safety and welfare of the dogs involved, but so far no substantiated reports of (mis)treatment have emerged.

However, though it is important to note criticisms of the scheme, we should also consider some of the benefits. For instance, these dogs are also used all around the United States to help people in disaster response situations. One also has to applaud the creative use of such animals, as dogs can be a calming influence on individuals who are in need of comfort. It might also be the case that the dogs are able to gain comfort for the people whom they are helping, leading to a mutual benefit.

Moreover, there have been several case studies, alongside anecdotal evidence, demonstrating that engaging with dogs can help reduce stress and anxiety (Holder, 2013; O’Neill-Stephens, 2011; Wells, 2009). Also, many people, for one reason or another, are not in a situation that allows them to own dogs or simply interact with animals. So, just for a few hours, people can have the benefit of connecting with dogs, which contributes to health and well-being, helping people feel connected with a creature who makes no judgement. As long as a religious organisation is subtle rather than forceful in presenting their own beliefs, and are keeping compassion at the centre of their interactions, then it is easy to see the positives in this initiative.

As we rapidly push forward implementing using dogs in the courtroom, ‘comfort dogs’ provide food for thought about the many roles which dogs can potentially play in society.

To find out more about comfort dogs please follow this link to their website: Immanuel Lutheran Ministries

References

Holder, C. (2013) ‘All Dogs Go To Court: the Impact of Court Facility Dogs as Comfort for Child Witnesses on a Defendant’s Right to a Fair Trial’ Hous. L. Rev., 50, pp.1155.

O’Neill-Stephens, E. (2011) ‘Courthouse Facility Dogs.’ [Online] Available at: http://www.courthousedogs.com/starting_news.html (Accessed 14th Septemeber 2016)

Wells, D. (2009) ‘The effects of animals on human health and well‐being.’ Journal of social issues, 65(3), 523-543.

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The Horse as a Therapist’s Assistant

Philosophers and practitioners alike have recognised that humankind has had a long and enduring relationship with all things natural. Jung had suggested that our over-civilised selves could do with some re-wilding! One route to this is to re-connect with our animal brethren, and for those who have suffered psychological trauma, a more specific approach is through animal-assisted therapy. While many animals provide comfort at a simple psychological and physiological level as ‘companions’, others elicit different responses and experiences. Compare, for instance, being in the company of a whale or goldfish. In the company of a large animal, it is possible that a sense of awe triggers regression to development periods that reflect similar relational experiences during childhood, which enables a process of resolution and self-development. Moreover, people with severe trauma or those for whom talking is difficult, such as young children and people with autism, non-linguistic and embodied communication may be more important. Animals are able to ‘read’ these signals and respond and interact in a way that is perceived by many as safe and therapeutic.

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In particular, the use of horses for aiding recovery from trauma, typically Equine Assisted Therapy, has been gaining some interest and practice recently. A forthcoming chapter in a book addressing various forms of outdoor therapy, Ecotherapy: Theory, Research and Practice edited by Martin Jordan and Joe Hinds, details the ideas, benefits and practice behind Equine Assisted Therapy.

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The horse encourages people to act and behave in a way consistent with their actual thoughts and feelings (congruence), which may potentially be overlooked or under-developed within the counselling room. The horse responds with honesty and without a hidden agenda reacting to the internal world of the person, regardless of their efforts to conceal it.

Direct experiences with a large animal can produce a sense of perceived mutual understanding – there is a substitution of verbal cognitive communication for a basic or primal communication that is symbolic and directly dictates behaviour. The human response to a large animal will often be attuned to its physical presence and its movements and may, through the tactile, embodied and physical quality of the animal encounter, enhance important unexpressed emotions and build relational aspects of the self that have been thwarted or under-developed. Martin Clunes the actor experiences this directly in the video below:

In short, these experiences can prompt authentic moments, whereby the statement ‘actions speak louder than words’ has added significance.

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