Monthly Archives: February 2006

who do men tell their stories to?

here’s an interesting blog entry by hugo schwyzer on feminism and “liberal white men”. my comment (if you take the trouble to scroll down or search for my name in the post) is about my disagreement regarding hugo’s idea that men should stop “burdening” their women with their stories, and find men to talk to. not that i think men shouldn’t talk to more men – i decidedly wish they would – but i think it’s pointless to make gender a deciding factor regarding who to share our hearts with.

isabella mori
counselling in vancouver

the therapist as a person – pt 2

this is a continuation from an article started a few days ago …

The influence of the therapist’s personality and history on the therapeutic process is recognized in psychoanalysis and is subsumed under the notions of countertransference and counterresistance. However, although psychoanalytic theory recognizes the existence and importance of countertransference, it is not a topic writers of the psychoanalytic persuasion are eager to discuss. The term countertransference is first mentioned by Freud in 1910. Johansen explains that in the controversies over countertransference, there are two main categories of definitions. One sees it strictly as conscious and unconscious responses to the client, the other includes all personal responses to the client, including those that arise out of the therapist’s past.

Many writers insist that countertransference consists of “emotional” and “irrational” responses that interfere with therapist objectivity. Racker, an oft-cited writer on the matter, speaks of countertransference as “psychopathological processes” in the analyst, indeed a form of neurosis, which influences the therapist’s perception and/or interpretation of the unconscious processes of client and therapist in the therapeutic context. Singer contends that countertransference can be grouped into roughly three categories: irrational kindness, irrational hostility, and anxiety reactions. Robertiello & Schoenewolf, in “101 common therapeutic blunders”, a delightful – and sometimes frightening – book of teaching tales, give examples of the following categories: erotic (e.g., “The therapist who feared his sexual feelings”), sadomasochistic (e.g., “The therapist who had to be The Boss”), and narcissistic (e.g., “The vain therapist and the slob”).

Robertiello & Schoenewolf also discuss counterresistance, a phenomenon that other writers often subsume under countertransference. While countertransference can be understood as a type of projection in which, for example, the therapist treats the client as if he were her father, counterresistance can be seen as therapist behaviours which influence the therapeutic process through such “blockings” as (hostile) silence, attempting to change the subject, or otherwise preventing unwanted ideas or feelings from rising to the fore. Counterresistance can result from a therapist’s colluding with the patient’s resistance to explore or work through unpleasant issues but can also originate exclusively from the therapist. Robertiello & Schoenewolf’s tales of counterresistance have titles like “The therapist who denied his own obesity” and “The religious therapist and the atheist”. All of the titles cited speak for themselves as illustrations of some of the types of countertransference and counterresistance that can be found.

Generally, however, countertransference connotes therapist irrationality and unwanted lack of objectivity, even though many writers stress that countertransference can be used productively. Partly because of this connotation, I will avoid the use of the term “countertransference”, preferring in my discussion terms like “the influence of the personal”, “social influence”, etc. If the influence of the personal is not a favourite topic for many writers, social influence is even less so. It appears that when issues of social influence arise, they are frequently decontextualized or dealt with by tokenism. For example, a therapist’s values might indeed be recognized as intruding in the therapeutic process – but implicitly they are HER values. The question of how these values relate to prevailing ethics, politics, or other social contexts, and how THAT influences the therapeutic process is rarely asked.

(stay tuned for the next instalment before the end of this week)

isabella mori
counselling in vancouver

psychiatric medication and weight gain: purple prose vs. intelligent talk

a few days ago, big fat blog referred to a story in prospect magazine about a young woman who underwent psychiatric treatment and “tragically” lost her beauty by gaining weight. if you like purple prose,sexism, sizeism, an outdated concept of beauty and other such nonsense, this prospect article is for you!

far more intelligent and interesting are some of the responses to the article, like this one, posted by sjbrodwall:

From experience I can tell you that most patients’ and parents’ concerns about medication-induced weight gain are far from cosmetic. For most patients, particularly the chronically mentally ill ones, the first med is not going to be the med that turns them back into “themselves”. Maybe not even the second or third. The problem is that while the first, second, and third might not help with the depression (or whatever), they still cause weight gain–weight gain that often doesn’t go away. And we’re not talking a few pounds here, we’re talking about turning average-weight people into fat people.

As evolved as most of us fat people here are about the relationship between weight and self esteem, it would behoove everyone to recall that we had to work to accept ourselves, and work hard. When you’re just a teenager and first put on meds for your illness, you’ve got one helluva lot of issues to deal with. First you have the typical issues of self-esteem, peer pressure, etc. that all teenagers deal with. Then your self esteem takes a couple of non-typical, nasty hits–first that you’re crazy enough to have to be medicated, second that the meds make you fat. I think that most of us here can remember how standards were different for us when we were teenagers–just think about the last time you looked back at a picture of yourself when you were young. Think about how fat you felt then, and how thin you look to yourself now. So while 30 pounds might seem like a drop in the bucket to some of us now, this is a major, major weight gain for a teenager, and will have serious and real consequences with regard to how she is treated by her peers and how she feels about herself. On top of the physical appearance problem, there’s also the issue medicated teenagers face about “If I need a medication to be normal, then doesn’t the medication turn me into some who isn’t me? Is normal for me fat, then?”

Teenagers are for many reasons likely to be non-med compliant, and the weight gain really doesn’t help. Being a teenager is hard in and of itself; being a fat one is even harder. Now imagine being a fat teenager who has such serious mental problems that she has to be medicated.If we were talking about a tradeoff between being fat and being happy, that would be one thing. But that’s far from the reality of the situation. It is rarely the case that a person can just start popping pills and be happy, be “cured”, be back to their old selves. Often the pills that cause the weight gain only work partially, and then in addition you have these other problems added to your mental load.

I’ve tried upwards of 15 meds in the course of my depression. The last one I tried got me up to 300 pounds. Despite the fact that it was marginally effective, I decided to stop taking it because the weight gain was too much for me. Yes, cosmetic issues played a part in my decision. I did not like the way I looked. But I also didn’t like the way I felt. I had a harder time getting around. My knees hurt more. I started having fit issues when it came to movie theaters and public transportation. These problems were making my depression worse. Despite the fact that I’ve been involved in the SA movement for over five years, I could not accept this weight gain. It outweighed (cough) any benefits the medication might have had.

I’ve grown angrier and angrier as I’ve seen this issue trivialized here and other places around the web. Many psychiatric patients allow the possibility of weight gain as a side effect to affect our choice of medication. To assume that we are superficial in doing so is to grossly underestimate the complexity of the problem. I am frankly insulted by comments such as these. IMO, they’re not terribly dissimilar from “losing weight is simple–just eat less and exercise more”. I’m not arguing against medication. What I’m trying to do is point out that this issue is far from as simple as many posters here and elsewhere would like for it to be.

isabella mori
counselling in vancouver

curing homosexuality?

back in january i introduced you to daily dose of queer, one of the blogs on gender identity that i like to follow. today they have an interesting article about a pill that some seem to claim might “cure” young men “in danger” of “becoming” homosexual. check it out. i wonder whether the comments i posted there would seem naive to an endocrinologist?

isabella mori
counselling in vancouve

the therapist as a person pt 1

here’s something i wrote a few years ago. it’s still pretty relevant, i think. i’ll post it in installments.

The psychotherapist in context
Personal life, roles and social environment

The vast majority of the literature on psychotherapy deals with therapeutic techniques and theories – the “what” and “how” of a process that is, ostensibly, aimed at ameliorating suffering and/or adjusting the thoughts or behaviours of persons who are in need of (or are deemed by others to be in need of) such ministrations. Much consideration is also given in that literature to one part of the “who” in that process, namely the “patient” (or “client”, which is the identification I will use in this paper), although the scope of those discussions is usually limited to that aspect of the client which constitutes his maladjustment or suffering.

The other part of the “who” is the therapist (and I will use the term “therapist” to stand for a number of mental health professionals, such as psychotherapists, psychiatrists, psychoanalysts, social workers, and counsellors). But just as the client is usually seen only in his role of carrier of maladjustments and sufferings, the therapist is usually seen only in her role of the one who “has” (i.e., owns) the skills and knowledge to deal with those problems. Other aspects of the therapist – her personality, life experience and beliefs, to name but a few – are usually disregarded or touched on only in the briefest manner. However, just as in any relationship, these aspects come to bear quite heavily on the social interchange we call therapy. The lack of attention to these aspects can be illustrated with a few examples from widely used text books on counselling and psychotherapy: Brammer (1985) dedicates 19 out of 163 pages to “Characteristics of helpers”, Egan (1975) spends 2.5 out of 239 pages on “Portrait of a helper”, and in his 390-page text book, Corey (1986) has a 33-page chapter on “The counsellor as a person and as a professional”. Some writers do not touch on the subject at all, notably behaviourists (e.g., Brown, 1977).

This paper attempts to sketch some elements of the influence the person of the therapist has on the therapeutic process. An example of this influence would be a therapist steering a musically inclined client towards attending law school because the therapist harbours great admiration for lawyers but not for musicians. This example also shows that not only does the therapist bring her own personal issues into the therapeutic process, but also her social environment, which, to varying degrees, she shares with the client.

In this case, the preference of lawyers over musicians might also occur in the social environment common to client and therapist – and we must also note that because the therapist may have higher social status in this environment than does the client, her values might weigh heavier than the client’s. In the title of this paper, I speak not only of the “personal” (i.e. private) aspects of the therapist but also of her roles (in our example, she might have taken on the role of an adviser). Roles can be seen as expressions of accommodating the personal (i.e., “private”) aspects of the therapist, of her interactions with the client, and of social conditions and demands.

Thus, one aim of my discussion is to pay attention to the particularity of the person of the therapist and not only to the universality of skills and theories which can be learned by all; and to pay attention to the subjectivity of the therapist and perhaps to lessen the emphasis of the objectivity she is often admonished to preserve, sometimes at all costs. Another aim is to attempt to make explicit the interplay between social environments and therapists’ personal needs and attitudes.

(a continuation of this article can be found here)

isabella mori
counselling in vancouver

today: ice

hi everyone

you may have noticed that i haven’t posted very much these last few days. i am busy contemplating moving my blog somewhere else, that’s why.

in the meantime, i do not wish to leave you un-entertained. so here’s some interesting tidbits. they’re all about ice.

why? how does that tie in to a blog that’s generally concerned with psychotherapy and the … errr … let’s say “interesting” experience of being a human primate?

how about this one? curiosity. curiosity is one of the main reasons why i’m a psychotherapist. it’s also one of the reasons why people come to see me. they want to investigate what’s going on, what’s underneath and between the layers that everyone can see.

so … ice … yes, ice is one of those strange layers. it can seem so impenetrable. and scary. and hard to get at if you don’ thave the right tools. but then all you need is some warmth …

here we go:

ice worms

bacteria in toilet bowls? try ice cubes!

The collapse of a giant ice shelf in Antarctica has revealed a thriving ecosystem half a mile below the sea. Despite near freezing and sunless conditions, a community of clams and a thin layer of bacterial mats are flourishing in undersea sediments. More?

isabella mori
counselling in vancouver

about words

word again – the broken word;
deep in the stomach it sits
and is afraid:
so little has it been out in the open,
and it will look shabby and disoriented when it surfaces.
it creeps up into brain, eyes and hands
and makes the passages tremble,
stirs the memory of tears behind the eyes,
shakes the hands,
but only inside
(nobody sees).

and word thinks,
what if –
what if i’m a volcano?
and it asks,
what if –
what if i’m a song?
as it sticks to and disappears in the roof of the mouth
like a voice hurled into the empty space of a church deserted by its believers

but word cannot, would not help it,
word zigzags its sounds, its thoughts, its pictures through
the huge cave of a human being
– is it more than a fly in a glass, captured?
word cannot, would not care because word
it must
zigzag, stagger, roam
endlessly it seems, and without aim;
yes – it is a fly captured, a moth drunk with artificial light,
a bird lost in a human house,
and it must
it must
out –

word needs contact with air,
it must breathe, fly, multiply and decay,
it must oxidize, must gather rust, it must rot,
it must become compost.
it must turn stones into water.

word: a feeble worm in the pit of a soul
must uncoil, make its way
into the world
and turn stones into water.

isabella mori
counselling in vancouver

more on sexual identity: asexuality

one of the sexual orientations that seems to often fall between the cracks in the discussion on sexual identity is asexuality. some people have no sexual desire, or no desire to act on it. whether there is something “wrong” with that or not is a matter of controversy. be that as it may, more people than one would think (about 1% of the population, according to new scientist) see themselves as asexual, and that’s enough for me to count that as a sexual orientation.

here’s a clip from AVEN, the asexuality visibility and education network:

The important distinction between sexual and asexual people is that sexual people’s attractions tend to include the desire for sex, whereas asexual desires tend toward other kinds of intimacy. Of course, sexual people can form asexual relationships and attractions and asexual people can realize that they are asexual or become asexual after they have had sexual experiences or even when they are involved in a sexual relationship.

partly because since this orientation flies so much under the radar, it is also, like most invisible phenomena, not entirely acceptable in our society. (of course another reason is that sexuality is such an easy hook for anyone who wants anything – so understandably, nobody wants to give up this great tool of manipulation). this invisibility and lack of acceptance only adds to the difficulty in relationships where only one of the partners is asexual.

what are the solutions in such situations? as an incorrigible polyanna, i think that there are solutions to just about everything. but how easy are they to find, and how can they be put in practice? i think of one of my all-time favourite books, alice walker’s the temple of my familiar, where such a situation slowly, over many, many painful years, turns into a loving friendship; or of the french solution, where it’s quite acceptable for people to be married and have other relationships on the side.

isabella mori
counselling in vancouver