Coincidences (2) …… and causes

 

Coincidences (2) …… and causes
Torrey Orton
April 22, 2013

6 degrees of separation and such matters??

The 6 degrees thing was back in hardcopy sight last week with a few hundred words borrowed from Steve Jones by the Australian Financial Review’s Review (pg. 2R) section on Friday 19, April ’13. It reminded me there is this thing of organic coincidence among us, much closer than many would like to imagine, though increasing the distance as our (advanced?) cultures become more ethnically diverse (which leads directly to DNA diversification, which is good for humanity overall). We are, after all, all out of Africa.

And on they march…coincidences, concurrences (which is a competition for the French!), correlations, co-occurrences – the makings of causes…all the variations on the sense of being in synch with ourselves, others, the world, the multi-verse…Pick your preference if you can; if you can’t, these connections become opportunities for perceived and real dis-connection, being out of synch, feeling out of it.

Sharing house, but a life?

A few days ago one long term patient announced that his girlfriend is house sharing with another patient of mine. What are the chances of that happening? Probably calculable if I can set the parameters, though I couldn’t do the calculation myself. Some of the parameters might be:

·       Prior mental health issue(s), untreated or treated

·       Tertiary education levels

·       Under 35 and over 20

·       Single, and seeking partner

·       Minority backgrounds – race/ethnicity; sexual orientation…

·       Inner suburbs address

·       Share housing

·       Early career in recognised professional field

·       Tertiary educated parents??

These are groupings, presumably linked in some shared way. And if you get enough of them together you have a presumptive causal cluster. Demonstrating it rather than assuming it is the challenge.

But, what possible implication(s) can I draw from the fact of sharing itself, without any presumed other connective effects. So, they happen to share a house. And people share houses with no other connection than the need for sharing (economic/social/and?). These two could not be possible love objects for each other, distinguished as they are by different sexual preferences. Maybe there’s naturally occurring mutual support thru sharing their experiences of therapy with the same therapist…informal quality control reflected back to me as they adjust to our relationship in light of their understanding of it from the other one?? Could be.

Needle, not haystack

This is not a coincidence but a case of finding what I did not know I was looking for. We were wandering along the path in Chamonix towards the Swiss end of town, with Mont Blanc and the Aiguille du Midi across the valley to the right and the local stream just off the path. On our left was a rock face of about 300 meters height forming the base of the lower range facing Mont Blanc. A few ropes were laid down the face from different heights and groups of primary school kids were being instructed in the entry level arts of defying the heights. I grabbed a couple of quick shots of the site and the little scramblers and sent it off to a patient at the time who was struggling to overcome such fears, which she subsequently did…with the slight increase in risk-taking which comes with its acknowledgement by others.

This is evidence of unconscious processes at work, as they often are in the therapy, the scanning for world understanding and the writing parts of my life. Much less so with the Friends of FCC work…or so it seems.

Her past just walked in the door

Then there’s the ex-patient of mine who started her own therapy practice and within a week a facsimile of her PhD candidate self walked in the door, struggling with a similar range of things she had herself back then – doubt, motivational slippage, conflict with supervisors, data collection glitches….normal stuff, except when you are in it; then it’s the pains which assure you the honour of completion is warranted, maybe. Within a couple of days an article had appeared in the New York Times on PhD study challenges, assaying the terrain we had just been revisiting. I passed it on and received a quick acknowledgement of a good fit with her own experience and that of her new patient.                  

And, there are the patients who seem to come in clusters of same-symptoms, same traumas, often over a week or two. This is signalled to me when I start telling one patient of another with similar concerns who I realise in the telling I just saw the day before or the week before. This is probably a case of proximity calling out approximately equal experiences from my recollections of near patients…not that there is a collocation of people and life practices in neat experiential bundles by chance!!!

J’s meeting of future wife D

K and cult colleague J went out to find dinner in Bangkok in the cultish way - begging it from neighbourhood restaurants /cafes. J suggested they ‘find’ the one they would try first by praying for a minute. They did so, and J asked K what God offered and K said there, pointing to a hotel a ways off. J said, “Just what I got”.  And off they went to be waited on by J’s future wife who was in her last hours of a three day employment trial (which she failed). The rest was 20+ years of the deepest marital solidarity which was broken before time by cancer. The cult had gone the way of some bad things well before the untimely cancers seized D.

A bag of lesser treats

·       Our in-laws at Jinks Winery, Tonimbuck, Vic… a classic coincidence which J and I both imagined was going to occur as we got within site of the winery. We’d only been there once before for their elder son’s wedding 3 years ago. We walked in the café door and a few steps inside spied them sitting at the nearest table… as if waiting for us. They weren’t, but also weren’t too surprised we appeared.

·       And there’s the guy in the incinerated fire zone of the Murrindindi fire four years ago whose house at Marysville, Vic. was the only one for a mile around NOT touched by the fires which killed 173. When I called hopefully to see if they were still OK, he said “Yes, and our fire insurance lapsed a week ago”!!

·       And there’s the synch of ‘Mother” coming to my mind in patient M’s discussion of recent developments and she having her dead birth mother coming at the same time to her mind though I was thinking of her step mother…but it’s all part of the total system of her family of origin relationships which cue each other...in her and me.

This matter of therapeutic synch is seriously interesting as a possible member of the coincidence genre. It’s a false coincidence, reflecting rather the coming together of minds that are on a sufficiently shared track, where each other’s stories and roles are firmly enough in mind not to have to be held in mind consciously. So, such synching moments in therapy are expressions or emanations of jointness, and also famously the place in which exactly whose mind is speaking at any moment is a wonder to be validated by checking – the principle activity of maintaining clarified jointness.

The emanations take the early form of premonitions of being in synch, of knowing what the other is thinking/ feeling and hence an example of empathy. In ordinary talk, this premonition is found in the listeners regularly completing the active speaker’s sentences before they do or adding the words the speaker is searching for at appropriate times (e.g. when a felt need to confirm correct attention occurs).

Learner therapist (34)……Not good enough therapist

 

 Learner therapist (34)……Not good enough therapist

Torrey Orton
April 21, 2013

Another of my therapeutic errors…

A year ago I wrote:

I am somewhat obsessively tuned to my mistakes, a commitment moderated by a fairly balanced level of professional self-regard. However, it seems that mistakes continue to occur in sufficient numbers and powers to guarantee the balance falls slightly towards the obsessive side. From my point of view, my reputation is always in danger from my next performance.

And a striking case has arisen, as they do, totally predictable as sessions went on, but avoided by me out of my self-imposed belief that I should always be able to work with anyone and that I am infinitely flexible. Yes, I see the universalising and that I am in the grip of moderate catastrophising, but that’s the price of standards in practice (another argument this, but not now). I pay this price a few times a year in the currency of disturbed sleep and therapeutic relationship crises (in my mind often). Here’s this one:

In brief, he’s a 33 year old in a growingly committed relationship with a woman he characterises as anxious like himself. They are on the verge of cohabiting. But he doesn’t share with her the vitality of his anxiety – that it is persistent, permanent, paralysing – which he deploys like a shield from his deep sense of being notgoodenough. This sense has been unavoidably present to him for 10 years post a major car accident recovery, which took a year of physio and some subsequent therapies through a parade of therapists and psychiatrists of which I am the last, so far, in line.

We’ve been one session a week for three months on an insurance funded therapeutic journey. It was limited to 5 in the first instance and then only after review which I did not do at the time. I had never clearly monitored the conditions of the insurance. So, I was working for free.

He knows his notgoodenough comes from somewhere further back in his past, and has recently acknowledged that father is the obvious source. Father has never been accessible to him nor outreaching for him, though always present… an active, unconscious (?) denial of the son’s existence. Mother appears as the good parent, though almost acknowledgeable as a collusive partner in father’s absent presence. She is also in late stages of thrice recurrent cancers, so seriously compromised as a pathway to the father, or even a discussant of son’s needs.

He can do anger at two things: his parents, but especially his father, and me if I suggest he “out” his admittedly socially phobic obsessions and compulsions to anyone, but especially his girlfriend. When angry he presents clearly as powerful – language strong (f bombing) and posture strike ready. Outing is part of a process of exposure which is a widely accepted ingredient of anxiety and addictive therapies, and one I’ve used in a wide variety of situations with workable effectiveness for patients of many sorts. I said as much to him in roughly the following words:

The principle reason for encouraging self-outing of any kind is to reduce the burden of the un-outed secret(s) which, for lack of psycho-spiritual-relational air, fester in the paranoid richness of the dark holding bay of the self. At this point it was a crucial move because we were going around in circles and the only talking place for this was therapy.

There exists alongside the phobic persona a competent, though self-doubting, one with a wide range of social and potentially professional skills, and with better than average verbal skills, both spoken and written. He is supposed (psychiatric report) to have done CBT for self-doubt, but shows little retention. He’s devoted to the latest manual driven self-improvement thingy about social phobia – very CBTish in style. He hasn’t been able to stick with any such processes or related tracking of moods over the three months, though getting started a couple of times. He’s swamped by the daily flux of his fears, and amplifies them at each session by arriving late and leaving early, starting to notice the approaching self-imposed departure time 30 minutes into the session.

Because of his intense resistance to raising his phobia with his girlfriend or selected workmates and his increasingly reported despair about the phobia (expressed in spontaneously written emails capturing the daily experience), I felt trapped and ineffective and looking to reduce it by stopping our work and handing him on to someone appropriate.

I had not confronted him with this thought, but he could have been aware of my doubt from my unwillingness to add another session to the present once a week. He has history for losing therapists because they cannot / will not fit into his workplace secrecy regime which requires him to do nothing in work time (even if lunch) which might invite a question from colleagues or management about what he’s doing.

I did not feel that I had the time or mood flexibility to respond usefully to his needs. At the same time, progressively over the preceding two weeks, I found myself under a rapidly increasing load of high need patients. It takes a while for me to notice I’m close to not coping, but I’m getting better at it. This is a significant straw in this story, and this camel’s back was bending. With this case I was feeling like death and actually surrounded by long term patients considering themselves as candidates for death. My decision to discontinue our work came off a base of having done similar things at very high pressure times of near overwhelm over the decades of my organisational development practice, both here and in China.

A few days ago we had our first session since my coming to the conclusions above about my needs and his. He walked in and started immediately with his doubts about how we were going, beating me to the task. Within 20 minutes we had agreed that I would find him an alternative therapist within the day and pass that option back to him, which I did. He was a bit angry that he had once again lost a start on therapy which happened partly because he did not demand at intake that the proposed therapist (in this case, me) work outside normal hours. Some of the other lost therapists had parted for similar reasons, he said.

I think from the backside of my failed effort that it is principally a result of insufficient checking with the patient about how things were going for him. Checking is about the only antidote to letting things amble along when they really aren’t ambling much at all. And it is not as if I don’t check regularly. But maybe it is that I check somewhat less regularly than I think and that rigorous attention to checking (putting it explicitly on every session’s agenda) would reveal a pattern that somewhat more diffident checking occurs with more diffident patient experiences – and it’s my diffidence I’m talking about here. My failure to check the insurance requirements for continued payment are party to my self-deception or avoidance.

As I said at the start: “my self-imposed belief that I should always be able to work with anyone and that I am infinitely flexible”  may facilitate my not taking seriously some recurrent but slight evidence that things are not getting very far or very well, though they continue! As so often in development matters, awareness is all except when it isn’t enough, as in this case. I know exactly what that self-monitoring awareness feels like from my commitment over the last 6 weeks to raising my performance in aikido weapons practice to both a higher intensity and greater regularity. The subject is always close to the front of mind, including when I choose to not make the required effort.

For the moment it is clear that my reputation to myself as an aikido practitioner is more important than my professional one!!