Tuesday, December 08, 2009

The Power of Connection: Existential Psychotherapy 8

Here I continue with a brief summary of what Dr Irvin D. Yalom suggests as a way of therapy, and indeed a way of living, that overcomes the terror of death through what he terms connection. We have already discussed how through (i) the healing human touch, (ii) empathy and (iii) the power of presence in and through friendship connection may be made with the suffering and dying other. Such “connection”, Yalom argues, overcomes the inevitable gap of estrangement and sheer existential loneliness caused by the inevitability of death.

The Importance of Self-Disclosure:

Another intimate sharing between human beings that is therapeutic is the reality of self-disclosure. For the therapist, this could theoretically be seen as a useful technique that can be acquired and practised. However, such a technique must become more than a technique, it must be genuine and natural and totally unforced. Otherwise it is rendered useless. Let us return to the words of our learned psychiatrist once again:

Because many therapists have trained in traditions that stress the importance of opaqueness and neutrality, friends willing to reveal themselves to one another may, in this regard have an advantage over professional therapists…. Self-disclosure plays a crucial role in the development of intimacy. Generally relationships build by a process of reciprocal self-revelations… (Yalom, p. 131)

Our Values and Actions ripple on through Generations:

It has often been commented that religious people who see life as continuing in some form after this earthly existence are happier and more content souls. However, not having the consolation of religious beliefs need be no hindrance to one’s personal equanimity or sense of acceptance in approaching death as the appreciation and realisation of the on-going ripple effect of one’s actions in the world can lead to similar consolations. How often have we heard people aver that they hope to leave the world a better place than when we entered it? The effects of our good actions ripple out from us and transform to some extent the world in which we lived and moved and had our being. Admittedly, some people have the consolation of living on in their children. However, whether one is married or not, has children or not, real happiness and contentment are literally an inside job, my appreciation of my own meaning and significance in and of myself. If I have valued my real self much, I will also have valued the true and authentic self of every other human being. I will also have sent out positive ripples or vibes which will radiate out further, long after my demise.

Yalom refers to a medieval morality play called Everyman where the eponymous character sought a companion everywhere to accompany him on his lonely road through death and on into the next world. However, everyone turned him down until finally in desperation he found one person only who had the courage to go with him and that was a character called Good Deeds. Let me continue by using the words of our brilliant and inspiring psychiatrist:

… the Christian moral of this morality play: that you can take with you from this world nothing that you have received; you can only take what you have given. A secular interpretation of this drama suggests that rippling – that is the realization of your good deeds, of your virtuous influence on others that persists beyond yourself – may soften the pain and loneliness of the final journey.(Ibid., 134)

The Role of Gratitude to enhance Rippling:

Yalom then recounts an exercise often given by Martin Seligman, one of the leaders of the positive psychology movement, at his workshops. The exercise went something like this: “Think of someone still living to whom you are very thankful, and to whom you have never expressed this gratitude. Sit down and write a letter to that person for ten minutes. Then pair up with someone in the group and share your letter. The final step is that you must, as soon as you possibly can, pay a personal visit to that person.” (My paraphrase of Yalom’s recollection of Seligman’s instructions.)

Discover your own Wisdom:

Yalom rightly traces this advise back to Socrates. The role of the mentor, teacher, facilitator, counsellor or friend, following the Socratic method is to ask pertinent questions which force us to go deeper into ourselves and mine our very own wisdom. In this we must also learn to parent ourselves as we travel the road deathwards.

The Value of Regret:

I shall resist paraphrase here as Yalom’s words are pared to the bare essentials, and this better to quote the man in full:

I often counsel myself and my patients to imagine one or five years ahead and think of the new regrets that will have piled up in that period. Then I pose the question that has real therapeutic crunch: “How can you live now without building new regrets? What do you have to change in your life? (Ibid., pp. 145-146)

Savour the Awakening:

The awakening to which our learned and wise psychotherapist refers is the awakening of the soul to its mortality. The author encourages us to savour it, appreciate it, value it, take advantage of it. Such an awareness helps us to really value the importance of life, of living in the now, because we only live once. We can never repeat our one and only performance. What a pity to waste it!

Monday, December 07, 2009

The Power of Connection: Existential Psychotherapy 7

Given what I said in the last post that we each inhabit a private world known only to ourselves. This, along with our alienation from ourselves and from others, makes up existential loneliness. In short, following Kant and others, especially Freud, Jung and certainly Sartre, we very much make or create our own world, shape and define ourselves, in other words, make our own meaning of it and in it. And then, yes then, we observe it crumble away as we die. This is the very heart of existentialism. What then does Yalom suggest in his psychotherapy? It is to that we now turn.

The Power of Touch:

While Yalom does not go into detail about the power of human touch, he illustrates it beautifully by referring to the wonderful film, written and directed by Ingmar Bergman called Cries and Whispers. It is a Swedish film, made in that language needless to say, which was made in 1972. This film is set in a mansion at the end of the 19th century and is about two sisters who watch over their third sister on her deathbed, torn between fearing she might die and hoping that she will. Here is how Yalom describes the power of this film:
In the film, Agnes, a woman dying in great pain and terror, pleads for some intimate human touch... but neither can bring herself to touch Agnes. Neither has the ability to be intimate with anyone, even themselves, and both shrink away in terror from their dying sister. Only Anna, the housemaid, is willing to hold Agnes, flesh to flesh. (Yalom, p. 123)
I have long believed in the healing power of human touch and of the importance of hugs in our lives. I have experienced, like so many of my fellow human animals its healing power in my own life and in those whom I know and love. It is Anna's embrace that enables Agnes to complete the journey into death. Yalom places this topic of the power of human touch under the heading of empathy. However, I'd prefer to place it under its own title or under the title of intimacy. Be that as it may, we will now turn to the topic of Empathy.


Having spent two years of my life studying psychotherapy, empathy is seen as one of the three central and important core conditions in good psychotherapeutic practice. Indeed, it was Carl Ransom Rogers who pioneered and promoted what he termed the three core conditions of counselling or therapy, viz.,congruence (realness), acceptance and empathy. Here is Rogers himself speaking on the nature of empathy and its centrality to the therapy process:
The third facilitative aspect of the relationship is empathic understanding. This means that the therapist senses accurately the feelings and personal meanings that the client is experiencing and communicates this understanding to the client. When functioning best, the therapist is so much inside the private world of the other that he or she can clarify not only the meanings of which the client is aware but even those just below the level of awareness. This kind of sensitive, active listening is exceedingly rare in our lives. We think we listen, but very rarely do we listen with real understanding, true empathy. Yet listening, of this very special kind, is one of the most potent forces for change that I know. from Carl R. Rogers, Way of Being, Boston: Houghton Mifflin, 1980, p.115-116
Connecting with the anxiety of the Dying:

Through real and authentic human touch which holds, contains, but can never explain the mystery of human life in all its vicissitudes, in all its highs and lows; through the really human experience of empathy, with Yalom we can state that both these realities can heal the frightening gap between the desire for the fullness of life on the one hand and its inevitable extinction on the other. This is the task of both the therapist and the client, the healing or bridging of that frightening gap. During so is at the heart of existential therapy. Let me quote Yalom once again:
You can't connect or offer the dying what Anna does in this film unless you are willing to face your own equivalent fears and join with the other on common ground. To make that sacrifice for the other is the essence of a truly compassionate, empathic act. This willingness to experience one's own pain in concert with another has been a part of the healing traditions, both secular and religious for centuries. Yalom, p. 124
Hence, the power of family, friends and support groups cannot be underestimated.

The Power of Presence:

I have referred to the power of presence in the last post. To be present to and with another is a sacred and graced act, especially if that person is suffering or dying. A good teacher, professor, doctor, psychiatrist or counsellor is really present to his clients. He or she is there with the client, student, patient in the nowness of being, and is not distracted by one thing or another, and certainly is not elsewhere in mind or spirit. We instantly warm to those who are truly present to us. There is no substitute for real presence. We know it immediately we experience it. Let us listen to Yalom again:
One can offer no greater service to someone facing death... than to offer him or her your sheer presence. (Ibid., p. 125)
In all of this connection is paramount, connection with another suffering human being. This very connection is the healing factor. I return yet again to the powerful words of Yalom:
Whether you are a family member, a friend or a therapist, jump in. Get close in anyway that feels appropriate. Speak from your heart. Reveal your own fears. Improvise... Once, decades ago, I was saying goodbye to a patient near death, she asked me to lie next to her on her bed for a while. I did as she requested, and, I believe, offered her comfort. Sheer presence is the greatest gift you can offer anyone facing death (or a physically healthy person in a death panic. (Ibid., 130)

To be continued.

The Power of Connection: Existential Psychotherapy 6

There I was the other day viewing a talent show on RTE 1 which showed the inimitable and still youthful Dana - she of Eurovision fame - judging contestants from Ulster for some all-Ireland competition. I was not really interested in the contestants at all, but was quite taken by the quality of her judging. Several times she either complimented or criticized a contestant on their possession of or lack of what she termed "connection" with the audience. I felt her judgements were excellent, and her own "connection" with the contestants was superb.

Then, I recalled the phraseology of current political, social and economic pundits on the media. They invariably speak of what they term "a disconnect" between the Establishment and the people on the ground - the ordinary "Joe Soap" or punter in the street. Once again there is much sense and not a little wisdom in these criticisms.

Here is where I come to more existential insights into life as I continue to meditate and contemplate the words of Dr Irvin D Yalom, a wonderful contemporary psychiatrist and existential psychotherapist. Let's examine and explore what is meant by "connection."

As a teacher, I feel and believe that I truly understand what both Dana and Irvin D. Yalom are saying. When I was a young teacher, I can remember hearing a senior colleague refer to what he believed was the most important factor that went to make up a good teacher - he called that factor "presence." He'd say something like: "That young man/woman will make a good teacher: they have presence."

After some thirty years in the main-stream classrooms I am retraining as a Resource Teacher which means that I am now teaching boys with Asperger's Syndrome, Autism, ADHD, Dyspraxia, Dyslexia and Mild and Moderate General Learning Difficulties. Now, most of these classes are either one-to-one, groups of two or three or at most groups of six. To become a Resource Teacher one needs to be able to really connect with these pupils. It can never simply be a question of knowing one's subject. One needs a deep empathy with one's students, a real ability to connect with the student who most times will be struggling to understand whatever the curricular area being covered is. Indeed he or she may be struggle to "connect" with the world if they are autistic or in any other way disabled. How much greater the struggle would be if the teacher was unable to "connect."

Enough illustrations and examples. Let's get to the reflections on the nature of "connection" and "dis-connection." I will continue these reflections by following quite closely the musings of Irvin D. Yalom. Let's begin.

Human Connectedness:

Yalom avers that we human beings are, from our very conception, hardwired to connect with others of our species. In our very essence and in our existence we are creatures designed to connect. All psychological studies show convincingly, if indeed we did need to be convinced, that intimate relationships are a sine qua non for happiness. In other words the desire for "connection" or "connectedness" is at the heart of our very nature. However, that many in our modern world feel "cut off", isolated or disconnected goes without saying also. They feel that their very nature is thwarted, twisted and suffocated - use whatever metaphor you wish. We can call this the existential experience of alienation if we wish. In this regard we are very much an "unfinished" work of art.

Death: The Greatest Disconnect:

One cannot speak about existentialism without discussing the reality of death. Death is always an issue in any philosophical discussions, never mind existential ones. However, there is also the reality of dying to cope with, too. Indeed, very few of us mind death in the sense that if it is an eternal dreamless sleep, akin to our state of non-existence before our conception or birth, then it may indeed be quite attractive. Dying on the other hand we dread because it may be painful in many ways: physically, obviously and psychically as we let go our strong desire to live, our strong desire to reach out and connect. In short, dying is the breaking of connection - indeed the extinction of all connection or possibility thereof. I have long subscribed to the contemporary psychological truth that the real repression in modern life is not sex but rather death and indeed dying. Everywhere one looks life proclaims the power and beauty of living, the desire to live life to the full with all its endless possibilities. We drink all this in - along with the myth of possessions and power and success.

Yalom quotes another of my favourite authors on Buddhism - that is, Sogyal Rinpoche. This quotation is worth reflecting on here:
When we finally know we are dying, and all other sentient beings are dying with us, we start to have a burning, almost heartbreaking sense of the fragility and preciousness of each moment and each being, and from this can grow a deep, clear, limitless compassion for all beings. (Quoted Yalom, p. 115)
And so when we comes to therapy, or indeed when we face any crisis in our lives, we are caught in a quandary which at its existential base, no matter what the crisis is, is a conflict between the desire to survive versus the threat of ultimate extinction. This is essentially what all existential literature and drama is about. The ways the ordinary soul deals with its mortality are as follows: Denial, Diversion, Displacement. Denial can be seen all around us: even when a person is faced with a terminal illness, almost the first reaction is that of denial: this cannot be happening to me! Displacement is where the person displaces death anxiety onto minor concerns - "Oh, I could not do that, it is too risky or dangerous," etc. Diversion is where the person gets involved in this, that or the other activity, and let's include all addictions here, to obliterate the thoughts of extinction.

Let me quote Yalom directly again:
Dying, however, is lonely, the loneliest event of life. Dying not only separates you from others, but also exposes you to a second, even more frightening form of loneliness: separation from the world itself. (Op.cit., 119)
Yalom goes on to declare that there are two kinds of loneliness linked with this contention: (i)everyday and (ii) existential loneliness. The first requires no elucidation here, while the second refers our being born into a world not one of us asked to see, being "thrown" out into it, and having to reach out from our own little world of self into that world shared with others. We also have to exit from that world alone, break the ties we have painfully made over the years of our earthly existence. Not alone that, but we each inhabit a private world known only to ourselves. All of this makes up existential loneliness. In short, following Kant and others, especially Freud, Jung and certainly Sartre, we very much make or create our own world, make our own meaning in it. And then, yes then, we observe it crumble away as we die. This is the very heart of existentialism.

To be continued.