The following is an extract from GUT by Guilia Enders 2015, published by Scribe, Pp.129-130
Patients with intestinal disease who also suffer from extreme anxiety or depressive disorders are often recommended anti-depressants by their doctor. However, they are rarely told why, and there is a simple reason for that: No doctor or scientists knows. It was not until they noticed the mood-enhancing effects of these drugs that scientist began to explore the mechanisms behind this phenomenon. They still have to come up with a clear answer. For decades, it was thought to be due to an enhancing effect on the 'happiness hormone' Serotonin. More recently, depression researchers have also begun investigating another possibility - that such drugs may increase the plasticity of the nerves.
After that, nerves react according to well-rehearsed patterns. Patterns that have proved useful in the past are retained; others are rejected as failures. This explains the disappearance not only of the inexplicable fits of laughter and temper tantrums of our teenage years, but also the posters on our bedroom walls. After this age, we find it more difficult to deal with sudden change, but the payback is a more table, calmer disposition. This can also result in negative thought patterns taking root, such as 'I am worthless' or 'Everything I do goes wrong'. The nervous messages from a worried gut can also become embedded in a person's mind. If it is the case that anti-depressants increase neuroplasticity, they may work by loosening up such negative thought patterns. This is most beneficial when accompanied by effective psychotherapy to help patients resist slipping back into old habits.
The American researcher Dr Michael Gershon, takes this line of thought one stage further. He is interested in the possibility of developing effective anti-depressants that only influence the gut and do not have an effect on the brain.
Dr. Gershon's research is not as outlandish as it might first seem. After all, 95% of the Serotonin we produce is manufactured in the cells of our gut, where it has an enormous effect on enabling the nerves to stimulate muscle movement, and acts as an important signalling molecule. If its effects on the gut can be changed, the messages sent from there to the brain would also be changed enormously. This would be particularly useful in treating the sudden onset of severe depression in people whose lives are otherwise fine. Perhaps their gut needs a session on the therapists couch, and their head is not to blame after all.
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A Safe Place For Change by Hugh Crago and Penny Gardner
Book review by Elizabeth Day PhD.
My engagement with this text, as with most texts, commenced from the back. I felt reassured to find in the index trusted thinkers such as Foucault and Rorty, and systems for working with the ‘self’ experience such as Buddhism, along with current and classic thinker-practitioners: Alice Miller, Irvin Yalom, Karen Horney, Babette Rothschild; also Ainsworth, Berg, Rogers, Wilber, White. This, I inferred, was a text that pays its dues. I was mildly disappointed, however, to find no Husserl, Heidegger, or Merleau-Ponty. This omission is not unusual in counselling and therapy texts, though (of which more, later). I enjoyed the implicit irony in index entries such as ‘complainants, see client’ and ‘there and then, see here and now’. And the fact that there were many more references in the index to ‘silence’ than to ‘minimal encouragers’ satisfied me that this was not merely a how-to guide, but a text grounded in its disciplinary roots.
The authors declare this a text intended for first-year counselling and therapy trainees. The title signifies its emphasis (safety) on the training and therapeutic relationship, and the topic sequence takes students through the development of a holding capacity, to exploring (deepening) issues, using techniques (fix v re-parent), challenging the client, coaching, and ending.
The authors have avoided a focus on ‘model-specific skills’, opting instead for common competencies for the ‘competent helper’. They locate their work within the complex matrix of therapeutic orientations and techniques, with interpersonal awareness at the core, and work within the parameters they establish to create a developmental training model.
Right up front the text challenges the trainee to direct the enquiry inward (Ch 1: ‘So you want to help people?’), cautioning that ‘You can’t take a client where you haven’t been yourself (p 5), and it places a research-based and experience-based emphasis on the development of capacities of presence and holding (Ch 2 ‘being there: developing the capacity for holding’) as the ground for effective therapeutic work.
Rather more interpersonal than instrumentalist, the text provides a model of change based, refreshingly, on the therapist’s capacity for being rather than doing (p 10). Here we could add the importance of the client’s capacity for the same, per Beisser’s (1970) paradox: change becomes more possible when first we become how and what we are (in all its perceived unloveliness) before stepping in to how and what we want to be.
The authors make no claim to be exhaustive; rather, they situate their arguments within a broader field of research and enjoin readers to learn more about a given area, through the device of breakout boxes – ‘Read more’ and ‘Think about it’ – positioned at strategic points in the chapters.
The text progresses its argument through sometimes exquisite examples of client-therapist dialogue, exemplifying right at the point where a student may be struggling to imagine the abstract notions into applied practice. It directly addresses its reader. This is sometimes conversational: ‘at this point, some of you are probably wondering … and that’s a fair comment’ (p 153), sometimes presumptuously: ‘Relax! You’re not expected to perceive such deep-level connections…not at this stage, anyway’. In all these ways it engages readers in the learning process.
I enjoyed the confident challenges to industry assumptions around advice-giving (there’s a time and place), use of I-statements (over-emphasis on this can irritate clients, and miss the point), closed and ‘why’ questions (there’s a time and place); and a refusal to be prescriptive or to labour through the various micro-skills as though they were the alpha and the omega of therapy.
The text’s historical-consciousness around key terms is of great use to first-year students who generally struggle to make sense of the differences between counselling and psychotherapy, psychotherapy and psychology, patients and clients. Counselling and psychotherapy are here distinguished by their orientations: counselling is defined as a content orientated ‘problem-focused approach’ and psychotherapy as a process orientated ‘relational approach’, with allowance that each can include aspects of the other.
Impressed that on the very first page the authors invite critical engagement with the text – ‘We welcome questioning of the positions we have taken here’ – and in the spirit of that invitation, I make the following comments on two matters – the helper model, and the philosophical heart of therapy.
I cannot get comfortable with the ‘helper’ orientation, so usefully problematised in the first chapter but deployed throughout. The designation of therapy as a ‘helping’ profession became ingrained perhaps from the widespread adoption of Egan’s ‘Skilled Helper’ model. I find the notion reduces the therapeutic orientation to some kind of first aid, and is implicitly problem-oriented. While that may be the case sometimes, I see the therapeutic role pertaining more to an orientation of enquiry. Donna Orange’s (2012) recent coinage ‘clinical hospitality’ may yet get definitional traction in the field, though its evocation of the clinic and the hospital is still far from the philosophical roots of her own training. This relates to my next point.
The authors state up front that their concern is with the practical component of counsellor training, based on their perception that students ‘overwhelmingly prefer textbooks that are clear and direct in their language’, and that acknowledge difficulties faced by beginners (p vii).
Inevitably such choices have to be considered when writing texts for disciplines that blend theory with application. And inevitably one choice excludes others. At a time (now) and place (Australia) where the empirical end of the research spectrum is the current locus for what passes as evidence-based research, there is a heightened need for counselling and therapy to emerge as a discipline distinct from the science-derived systems of psychology.
Far from being the disdained bastard child of a medical model, counselling and therapy at least in their humanistic, postmodern, intersubjective incarnations, are twin inheritors of a venerable philosophical lineage: Husserl, Heidegger, Merleau-Ponty, and its offshoots of literary, sociological and poststructural theories of self, and of discourse. Moreover the bedrock practices of presence and awareness pre-date Husserl and trace back through centuries of phenomenological enquiry. I consider it a great asset for students to be introduced to the deep intellectual and ontological roots that inform the relational and change elements of their practice. And I am confident that this can be done without frightening the horses.
In an endnote to Chapter 5 we get:
‘Indeed it may be that all therapeutic models converge on core principles that are indistinguishable from those acknowledged within most major spiritual traditions…what …Wilber calls the ‘perennial philosophy”
(p 228). I appreciated this and would have welcomed a chapter on it.
In the broader context of the endeavor of this text, however, and the training model it presents, my comments here are offered as engagements with its thinking mind, rather than contradictions of those choices. I would recommend the text to first-year students as a sound companion to learning how the art of therapy starts with self enquiry.
Beisser, A. (1970). The Paradoxical Theory of Change, in J. Fagan & I. Shepherd, eds. (1970/1971), Gestalt Therapy Now,
New York, Harper.
Orange, D. (2012). The Suffering Stranger: Hermeneutics for Everyday Clinical Practice. New York: Routledge.
Dr Elizabeth Day is a contributing member of the Psychotherapy and Counselling Journal of Australia
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What people say is often very different to what
they think or feel.