Tuesday, January 31, 2012

My Brain Hurts

One of the hazards of being a psychotherapist or counselor is the fact that being regularly exposed to the intimate dilemmas, worries and sufferings of other people brings with it the potential of touching uncomfortably upon your own, personal issues. I had an instance of such discomfort not too long ago when a client was sharing with me the pros and cons of choosing to leave his partner.  It happened that his significant other and he were in a cross-generational relationship involving about the same age difference as myself and my partner. Although they had been married for over ten years, my client was enunciating his reasons for no longer wanting to be in a relationship with a considerably older man.  Many of those reasons were applicable to dissatisfactions that could readily be experienced in my own relationship.

As a therapist you, hopefully, become attuned to the reality that such a situation, sometimes referred to as one evoking counter-transference, presents a risk to both you and your client. The conversation presented a risk to me because I could easily have slipped into an inner focus regarding my own relationship; a risk to my client because I could have lost contact with his thoughts and feelings and, at worse, begin to dispute his thoughts as a covert way of defending my own relationship. I was able to summon the professional responsibility of focusing on his perceptions and feelings, rather than getting lost in my own or being swayed into attempting to influence his choice.

I'm skeptical that maintaining such a position of neutrality is, in fact, humanly possible and suspect that, somehow, my own feelings of being threatened could emerge, despite my professional attempt to put them aside in our conversation. Further, I suspect that the most likely way my own feelings would emerge would be in bending over backwards not to question his reasons for considering ending his relationship. What happened, in fact, was that he decided to leave his partner and I was supportive of his decision.  We moved into considering how he would go about sharing that painful choice. For several days after I experienced reverberations of that conversation; wondering if my partner had the same reservations about our relationship and that some day we would be facing the same crisis.

A quite different situation presented an equal challenge to my own emotional well-being, though more complex than the one I've described, as it invoked both emotional and intellectual issues. A client of mine, who suffers from chronic prostate pain, came across a treatment option involving what is called "paradoxical relaxation". He was impressed by what he had read and asked me if I could explore the approach in order to see if he might employ it as a partial remedy for his own discomfort, which persisted despite the care provided by his medical specialist.

As I began to explore the literature relating to paradoxical relaxation, I experienced personal discomfort. The treatment approach is comparable to the practice of mindfulness; training oneself to focus attention in a relaxed, non-judgmental way on feelings of discomfort, frequently those of chronic pain; simply attending to the discomfort, while breathing deeply and silencing thoughts that drift through one's mind; becoming aware of changes in intensity and place of that discomfort; fostering a detachment from the discomfort.

 I've been comfortable with suggesting mindfulness practice to clients and assisting them in getting started with exploring it. Mindfulness is consonant with meditation and aspects of trance that have formed a part of my approach to counseling for decades. That practice does not have strong emotional reverberations for me; although I, happily, don't suffer from chronic pain or severe, physical discomforts, I've used it myself to help in relaxation, especially before sleep.

Paradoxical relaxation, on the other hand, comes with a more intensive practice and a wider, more ambitious narrative to situate and support its effectiveness. Part of that narrative involves the contention that chronic pain, along with many other physical maladies, frequently arises from bodily tension that is a response to stress; stress that often stems from difficulties in the expression of key emotions, such as fear, shame, sadness and anger; emotions which, if not released, become encapsulated and held in particular postures of the body. It is claimed that the process of holding on to unexpressed emotions is usually the result of repressive, childhood experiences and trauma associated with the emotion in question.

The method of paradoxical relaxation is to focus non-judgmental, even welcoming, attention on the experienced pain and discomfort. Allegedly, that focused attention leads to an awareness of muscular tension, which is a source of the pain or discomfort. The same focused attention is given to that tension, an attention free of thought, desire or judgment; paradoxically, not even trying to relax, but simply being with the tension, which gives it the opportunity to relax. The objective is to return to a stress and tension free state, often identified with that of a baby, nursing at its mother's breast, living in the present, making no differentiation between itself and its environment; a state comparable to the Bhuddist attainment of enlightenment. We are told that mastering the practice of paradoxical relaxation usually takes a daily practice of at least an hour and a half for a period of at least a year and a half. There is some evidence that both mindfulness and paradoxical relaxation are effective in reducing chronic pain and discomfort.

I have some disagreement with the contention that there ever was or ever could be a human state in which tension and stress are absent. Any living organism exists in tension with its environment and its integrity is eventually is lost through the stresses of living in its environment. In the case of humans, there are indications that stress begins with the fetus in the womb and is not intrinsically connected with the noxious influence of negative thoughts and worries or the differentiation of self from other. The image of the stress-free infant, contentedly nursing at its mother's breast, living without anxiety, is, to me a romantic myth that became a pillar of Freudian psychology. While we may experience powerful moments of feeling stress-free, they remain just that: moments, which, however valuable, do not constitute a transformed state of being.

On the other hand, there are elements in the approach of paradoxical relaxation that have been formative in my own practice: the theory of character armor from Wilhelm Reich, working with embodied parts of the self in Gestalt and the value of meditation, compassion and self-care in Buddhist thought. In addition, it is important to me to continue to grow and to expose myself to new approaches; even though I realize that such exposure can often produce its own discomforts. It's important to me, when I come across a new, interesting way of working to experience a bit of how it feels to make use of that method. Unless I can experientially connect with it in some way, I'm not comfortable suggesting the new approach to clients.

Coming to a better understanding of paradoxical relaxation meant looking for places of stress in my body and encouraging myself to focus on them, even though I am not, currently, particularly bothered by stress. Not surprisingly, if you look for stress and discomfort in your body, you'll almost certainly find it. I know that in times of extreme emotional stress I've had a tendency to somatize that tension in a part of my body. For example, while dealing with the my mother's decline in the years before her death, I developed achalasia, a condition in which the sphincter muscle of the esophagus refuses to relax in order to permit food to pass. Although some specialists in that condition maintain stress is not a factor in its origin, I know from my own experience it is aggravated by stress. Looking for tension in my upper digestive tract seemed a good place to start. In a relaxed state I scanned my body for tension and there it was: a discomfort first experienced in my jaw, then moving downward toward my esophagus.

Further, I could readily see the possibility that such tension, such muscular holding-on and failure to relax, which I experienced with difficulties in swallowing, could involve a physical holding on to a particular unreleased emotion: sadness. Readers of my blog will perceive that sadness is a significant presence in my reflections. Sometimes, when my face is in a relaxed state, people will tell me I look sad, though I'm not feeling sad. There is a very early experience, of which I have not yet spoken, through which sadness could, understandably, have found a place in my body, in my musculature. Certainly, the experience I sometimes have in witnessing something sad, in a circumstance where sadness cannot be appropriately, emotionally expressed, closely resembles the difficulty with swallowing I have experienced in achalasia; swallowing a feeling, which the body resists; just as it has resisted swallowing food. Although my achalasia was largely cured by a surgical intervention, here I was, quite voluntarily, putting myself through some not-very-comfortable feelings, which I would not, otherwise, be experiencing. It represents, I believe, an occupational hazard.

Normally, I tend to be a pragmatist; true to my roots in greatly admiring that clear-headed, common-sense, American psychologist, William James.  I'm a believer in leaving good-enough alone; if it works for you and causes no harm to others, that's great. I have the good fortune to be living a life relatively free of physical and emotional pain. I'm not at all motivated to athletically climb the heights of spiritual or meditative accomplishment. Yet, here I am, courting, looking for and, not surprisingly, discovering, emotional discomfort in the name of growth, as a person and as a helper. No doubt were I actually living with chronic physical or emotional pain, I would be differently motivated to personally pursue techniques such as mindfulness and paradoxical relaxation; perhaps, becoming familiar with those practices now forms a sort of preparation for that possible future.

There is an abundance of research indicating the fact, surprising to many, that subjective perceptions of being happy increase with age well into the nineties. Some psychologists speculate that is due to having learned over the course of a lifetime what individuals and situations provoke discomfort and being more comfortable with avoiding those sources of discomfort. There is a tension between that part of my self which feels that withdrawal, avoiding stress, living in peace, tending my garden and shovelling snow, is what is desirable; another part, more closely associated with my professional life, wants to welcome the discomfort of being challenged; resists resting where I'm comfortable until I come to rest in peace.

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