Book Review: ‘On Becoming A Person’ by Carl Rogers

This book could be summarised into one paragraph, and while it has some good ideas, it is far too repetitive as a book.

Carl Roger’s came up with what he refers to as ‘client-centred therapy,’ which today sounds like something that goes without saying, but in its own time was a fairly radical and novel concept.

His argument is that each individual has innate, self-actualising tendencies towards growth and development. We all want to be the best version of ourselves that we can be, and, given the right environment and support, will strive towards becoming it. We all have a general sense of what is good for us to do, what we want to do, and how we should go about doing it, or becoming it.

This reminds me of a soft understanding of Nietzsche’s ‘will to power’ – that inner, individual will towards growth in things that feel meaningful for us. We all want to improve and ‘actualise’ ourselves as individuals with power and agency over our own lives and becomings.

Since postmodernism, however, the idea of ‘the self’ has received criticism, and it no longer feels so simple to suggest that we are all bounded individuals who know what we want. ‘The self’ is now a much murkier concept, which is made up of bits and pieces of others, our environment, the things that happen to us… So Rogers’s argument that we all just need to allow our ‘true selves’ to develop and grow seems a bit optimistic and simplistic. What exactly is that ‘true self’, and how would we go about finding it?

Anyway, Rogers says that people suffer psychological distress, and come to therapy, when they encounter problems with self-actualisation. Something has prevented them from either getting in touch with their inner self, or from realising its potential for various other reasons.

Therefore, he argues that it is the role of the therapist not to teach the individual how to live, but rather to create an environment in which the individual feels safe to know, listen to, and then act on their inner wants and needs. A fundamental catalyst for helping the individual to do this is an empathetic and non-judgemental relationship with the therapist.

The therapist must be honest and open about themselves and their own feelings (what Rogers calls ‘congruent’, or authentic), which in turn facilitates a trusting and non-judgemental relationship and allows the individual to themselves become open about their inner experiences. After openness comes acceptance, and with acceptance comes fewer defences and therefore more flexibility and responsiveness to the real world and others.

What I liked most about this idea is the emphasis it puts on the special relationship between therapist and client, as one which can be totally free from evaluation. In our other relationships with people in our lives, there is usually some kind of mutuality – we expect things from each other, there is a balance and reciprocity. Therefore, we hold each other to certain standards. Because the relationship between therapist in client is not one of friendship, there is also no real need to evaluate (according to our own standards) the other person’s motives or feelings. The therapist might completely disagree with everything the client says, but because they aren’t friends (or even potential friends), this doesn’t matter at all, and the therapist can, and should, accept entirely whatever it is that the client is saying. This is quite an unnatural relationship, and one that probably wouldn’t arise outside of the therapeutic environment, but it is one that I believe all of us would benefit from. To have someone who can listen to us, and accept us, completely without judgement.  This kind of space and freedom to air our ideas would do all of us a lot of good. It lets us see our ideas without any need to present or sell them to anyone, and thus lets us be truly honest with ourselves. Only when we can be totally honest can we then look at our thoughts objectively, and only then would we be in a strong position to critique them.

Too often when we speak of ourselves or our thoughts and feelings, we are trying to present them in a certain agreeable way, and we might end up persuading even ourselves that these are the best ways forward. When we don’t feel any pressure to ‘sell ourselves’ to even our loved ones or friends (or perhaps especially to those individuals important to us), we can see ourselves as we ‘truly’ (?) are.

Uhoh, I just fell into the ‘true selves’ trap. Which I myself find a little wobbly as a concept… So I’ll probably need to work out that thought in a blog post to come…

First Day as a Mental Health Support Worker

Yesterday I had my first shift as a Support Worker at a Recovery House; it was both exhausting and fascinating.

I arrived for 8am, which was when the night staff give us the hand-over on each individual staying at the house, how their night went, etc. so that we know how everyone is feeling in the morning. Then myself and a colleague went around each room at 9am to say hello to everyone, even if that’s just a sleepy grunt, and give some people their morning medication. The rest of the day was spent checking various inconsistencies (one lady had much less medication left than we would have expected given how much she is supposed to take), or issues (to do with housing, mis-remembered doctors appointments…). We also keep regularly checking-in on everyone, and take notes throughout of everything that happens so that we can then hand over that info to the night staff that will follow us when we leave at 9pm.

One of the most interesting parts of the day for me was shadowing a 1-on-1 chat between my colleague and a service user who had only recently come to the house, and listening to how we first get a sense of the individual joining us – what they are struggling with, what they hope to achieve, what particularly distresses them, and general background information…To be totally honest, the conversation was heartbreaking. What seemed to be the major problem for the service user, apart from her mental health difficulties (which were being relieved somewhat by medication, I think), was her lack of social networks. She said that she had no friend or family member who was there for her outside of the house. The only person ‘in her life’ was her Care Co-Ordinator. That must be so frightfully painfully lonely and horrible. I don’t think many of us can even imagine what it must be like to have literally no one that we could turn to if we were ever in a difficult situation (aunts, friends from school, neighbours…). And, in a cruel turn of fate, it is as if having that support network there is even enough to prevent us from actually needing them. I think that the very fact that we know that they are there, is enough to comfort us and stop us slipping into a spiral wherein we really need to rely on them.

In talking to this woman I suddenly realised how powerful those invisible support networks (and, of course, the less invisible ones that we get joy and love from on a regular basis) are to our mental health and stability. Her affect felt completely hopeless, and I really felt and shared her suffering as I listened to it.

Since the ‘social networks’ box that my colleague ticked seemed to be the major problem, (I must add that I really didn’t like the very obviously ‘structured’ interview style that we were doing, I understand that it is useful to quickly measure and compare over time, but it felt inhumane and insensitive when discussing such intimate difficulties.) – she tried to suggest ‘ways to improve’, such as to hang out in the lounge or kitchen more, and get to know other service users, or join one of the activities that the house runs like yoga or a film night.
These are all great ideas, but, to me it almost felt too soon to ask this lady to ‘get out a bit more’. I would have wanted to talk to her a bit more personally first, try to understand what kinds of things she as an individual could imagine enjoying doing, get a little bit more of a sense of herself first, so that she wouldn’t feel overwhelmed and incompetent while trying to socialise. I say this because she really struggled to even look either of us in the eye during the conversation. Though, actually, trying to socialise could probably only help, and maybe she would be pleasantly surprised by the ease with which everyone seems to get along in the house. So, both efforts could be used at once, I think. And of course my own presence probably didn’t help the conversation, as I was just awkwardly sitting there watching. A genuinely 1-on-1 conversation would have been easier for everyone involved.

So, those were my first day thoughts! I am very very much looking forward to getting comfortable with all the admin-stuff of the house, the millions of forms to fill, and which keys open which doors, etc., so that I can concentrate fully on providing the best possible service to the residents. Will keep you updated.

Book Review: ‘The Body Keeps the Score’ by Bessel van der Kolk

This is a fantastic book about psychiatry, trauma, PTSD, Complex-PTSD, and recovery.

It is rare that a book written for such a wide audience manages to be both accessible and hugely informative. It references (seemingly) all of the relevant and up-to-date research, brings in case studies for more concrete examples and understanding, and keeps the language clear with no unnecessary jargon.

Bessel van der Kolk is a psychiatrist who specialises in trauma and how the environment impacts the body’s physiology. He mounts a very persuasive argument against any kind of mind-body dualism and shows that the things we go through leave marks on our biology, and influence how we approach things in the future.

I really appreciate his double-focus, on both the lives people lead and the actual situations that cause the psychological problems (essentially he takes people’s trauma seriously), and how this impacts their biology. He shows that we would be foolish to ignore either the environmental factors (a term which is far too broad and vague, anyway) and the biological ones. But the direction that his argument goes in (environment influences biology) also suggests that the focus of treatment should be on creating a new safe environments (so: relationships) for the person to heal in; rather than aiming only to fix the biology, which would be treating the consequences and not the cause…

He argues for a participatory approach in the healing process, against the notion of passive ‘patients’ who must be cured by experts, acknowledging that the role individuals take in their recovery has significant impacts on how the recovery goes. This person-centred and identity focus I think is a useful counter to the standardising and universalising biomedical trend, which gives everyone drugs and expects that to be enough to heal them. Drugs are particularly ineffective for curing PTSD and C-PTSD, so I think his expertise in this area is particularly useful and hopefully could be applied to other forms of psychological distress.

Another of the interesting arguments that his book put forward is that to help someone recover from trauma, it sometimes isn’t right (or enough) to simply to get them to open up about it in language first. If their body is still stuck in the ‘fight, flight or freeze’ mode, and gets either excessively stressed or dissociated when remembering the event, it will do no good to keep getting the person to talk about it. The biology will overpower the talk-therapy, and they won’t be able to process it in a calm and reflective manner, and won’t be able to acknowledge that it is now in the past and no longer a threat. This is why he is such a strong advocate for trauma-informed yoga, because he finds that it can be hugely successful in calming down the body (learning to breathe deeply, feel the sensations of your body in the present…) which is the necessary first step before then talking about the traumatic event.
But, he does also believe that it is absolutely necessary to then find words for feelings and events once the individual is in a safe enough feeling-state to do so. Then they can gain some distance and perspective on the event which will help them process it more ‘rationally’, with the more developed and less instinctive parts of the brain.

Here are some quotes from the conclusion that I found particularly interesting:
‘We are fundamentally social creatures – our brains are wired to foster working and playing together. Trauma devastates the social-engagement system and interferes with cooperation, nurturing, and the ability to function as a productive member of the clan. In this book we have seen how many mental health problems, from drug addiction to self-injurious behaviour, start off as attempts to cope with emotions that became unbearable because of a lack of adequate human contact and support.’
‘Our increasing use of drugs to treat these conditions doesn’t address the real issues: What are these patients trying to cope with? What are their internal or external resources? How do they calm themselves down? Do they have caring relationships with their bodies, and what do they do to cultivate a physical sense of power, vitality, and relaxation? … Do they have a sense of purpose? What are they good at? How can we help them feel in charge of their lives?’ (349-350).
‘As long as we feel safely held in the hearts and minds of the people who love us, we will climb mountains and cross deserts and stay up all night to finish projects … But if we feel abandoned, worthless, or invisible, nothing seems to matter. Fear destroys curiosity and playfulness.’ (350)

As someone who wrote their BSc Psychology dissertation on attachment theory, I am very strongly inclined to think that so many of our psychological problems and mental health issues stem from poor attachment system functioning. The reasons can be many (societal, financial, psychological, biological), but if an individual doesn’t feel that they have a ‘secure base’ of loving relationships from which to explore, I think it’s incredibly likely that life will feel a bit too much and not something they can adequately cope with, and any kind of mental health issue might develop…

Why Dora?

In 1905 Sigmund Freud wrote his ‘Fragment of an Analysis of Hysteria (Dora)’, as a case study hoping to substantiate his earlier theory of hysterical symptoms and their psychical/sexual basis.

His chosen case study was Dora, who we now know to be Ida Bauer (1882-1945), and his analysis with her lasted a grand total of 3 months before she ended it.

Ida Bauer

Though I want to be a clinical psychologist, not a psychoanalyst, psychoanalytic theory has contributed major insights for all forms of psychotherapy, so of course I had to read Freud. These days people don’t take everything he said very seriously, but some of his insights have seeped thoroughly into the cultural mindset and are pretty much taken for granted. We all know what a ‘Freudian slip’ is, and aren’t too shocked by the idea that people might unwittingly ‘marry their mothers/fathers’.

But when I read this case I was horrified. So much of it felt completely wrong, misguided, and to a truly dangerous extent. I felt overwhelmingly sorry for Dora having to listen to him and having to suffer his arrogant and all-knowing tone, disregarding her account of the events and her experience of her problems so entirely.

Reading the case made me vow to be a better, more open-minded, flexible, clinical psychologist in the future, and make sure that no client is ever treated so badly as Dora was by Freud. The case of Dora is also an example of something else I feel very strongly about – the problem that society seems to have with believing women’s accounts of sexual assault and trauma. I will write a separate post about that issue, but alongside my work as a psychologist I always want to work at improving the situation of sexual assault survivors, and finding ways that we can better listen to their experiences and learn how to help them.

Back to the case.
While there is a lot that is still worthy of interest in the study, i.e. the psychosomatic explanation of her physical symptoms, and his first explanation of transference; I think mainly the study is interesting in a ‘how not to be a psychologist’ way.

Freud was called in by Dora’s father to treat his daughter of her hysterical symptoms. Freud understood Dora’s physical symptoms as stemming from unresolved psychical and sexual trauma, which he first posited as resulting from Dora’s father’s friend (Herr K) declaring his love to Dora and trying to kiss her when she was 14. This was especially traumatic because Dora’s father was having an affair with Herr K’s wife (Frau K), and so Dora’s father joined Herr K in denying that the sexual assault ever happened in the first place, because in supporting Herr K he would himself be allowed to continue his illicit affair with Frau K. Dora’s father essentially chose his new mistress over his daughter.
Hearing this story we are probably likely to agree that his situation would cause Dora some distress, which of course could reveal itself as physical symptoms! (I like the case for how it connects the psychological with the physical). But Freud twists it further and further, unable to let Dora remain ‘innocent’ in the events. He says that she was only negatively affected by the proposition from Herr K because she actually loved him, and was pleased by his advances. Freud writes: ‘That was surely a situation that should have produced a clear sensation of sexual excitement in a fourteen-year-old girl who had never been touched by a man.’ (452).

Oh really!

Because Freud can’t believe that Dora wouldn’t have been sexually excited by Herr K’s advances, he claims that ‘affective reversal’ must have happened, which served to hide her enjoyment of the situation. He goes on to say that Dora was complicit in wanting Herr K’s affection, because she actually had homosexual feelings for Frau K (linked to her wanting to be Frau K and gain her father’s affection), and then even adds himself into the mix and says that Dora had sexual feelings for him too which was why she disagreed with his interpretation of the events and her underlying issues.

Another frustrating part of the case: Freud even has the temerity to write, ‘I shall pass over the details which proved all these hypotheses completely correct…’ and then just expects us to take his word for it.

But, unfortunately, though he seems to me to get all of Dora’s ‘motives’ wrong, I think his suggestion that physical illnesses can sometimes have a psychological motive to be an interesting one. I am not wholly against the idea that at least some of her physical symptoms were cries for help or attention, in a world where no one seemed to be taking her account of the events seriously. No one believed her when she said she wasn’t sexually attracted to Herr K, Frau K, her father, and Freud. Instead they (mainly Freud) fabricated all sorts of elaborate sexual fantasies for her, and made it impossible for her to deny any of them. In that kind of situation it seems to make intuitive sense that she might have developed some kinds of physical ailments which might have been ‘medically unexplained’. If words can’t speak for her, perhaps her body might be able to?

So when Freud writes: ‘illness becomes the only weapon with which she can assert herself in life’ (466), I can’t help but agree with him, but I think he was horribly and painfully clueless about what Dora might have been trying to assert. She clearly found that the case too, and I hope we are now as a world much better at listening to women and taking their trauma stories and physical complaints seriously.