All posts by Tammie Fowles

The Handless Maiden: An Open Letter

Recovering from our Wounds, Reclaiming Our Wholeness

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Some time ago I read, “The Handless Maiden,” an old folktale in which the hands of a young girl are chopped off in order to fulfill a bargain with the devil that her father made to attain material wealth.  The girl is devastated by the loss of her hands, and is immediately reassured by her parents that she will be fine, that she doesn’t need her hands because the family in now wealthy and can provide servants to take care of her needs.  She doesn’t need to ‘do’ anything at all because the hands of others will ‘do’ her bidding.

One day, in despair, the young girl wanders into the forest and decides to live there.  While she attains a degree of peace in the wilderness, she soon discovers that she is at risk of starving, as without hands, it’s difficult to feed oneself.  Eventually she discovers a pear tree and is able to sustain herself by biting off the pears within her reach.  The king who owns the pear tree discovers her one morning and captivated by her beauty, decides to take her home with him to his palace and marry her.  The maiden (now queen) lives in the lap of luxury, loved and pampered.  She and the king have a child, and life appears to be as perfect as it possibly can be for a woman with no hands. Still, as hard as she tries to count her many blessings, the maiden still feels empty and dissatisfied, and so risking the dangers of the wilderness once again, she takes her child and disappears into the forest.

Without giving the ending away completely, suffice it to say that eventually she regains her hands after a difficult and courageous journey that ultimately leads her to wholeness.

As I thought about the tale of the handless maiden, it occurred to me that her story was a metaphor for the struggles of so many wounded women whom I’d encountered during my years as a therapist, women who in spite of their limitations, had embarked upon their own courageous journeys in order to reclaim their sense of power and wholeness.  The following is an open letter to this mythic woman, and to every woman who has struggled with loss and limitations and eventually triumphed.

Dear Handless Maiden,
I’ve been thinking about you a great deal recently, admiring your strength, your resilience, your courage, and your triumphs.
Over the years, you have bravely traveled a tremendous distance.  You were an innocent child once, one who seldom complained, accepting the mandates and the stories of your elders, and all too often sacrificing your needs, your power, your perceptions, and your wholeness.   Today, you have moved beyond being a vulnerable and dependent daughter, and have grown into a strong and independent woman.
You’ve bravely moved forward, beyond the comfort and security of both your parents’ home and your husband’s palace, and entered the dark forest, following an unmarked and solitary path that eventually led you back to yourself.  In order to embark upon this journey you were required to let go of the guide wires that both protected and yet imprisoned you, and in taking this risk, you have saved yourself.  How did you muster the courage?
Your wound did not render you permanently helpless, although it easily could have, more than once those whom you loved and trusted gave you permission and encouragement to allow it to do so.  And yet, you refused to allow your wound to become that which most defined you, did not accept that it would lead to a lifetime of suffering, or require that you must become dependant on others for your well-being and safety. You recognized that a life spent being ‘taken care of’ would ultimately become a life of surrender, and would render an incalculable price.
You didn’t settle for creature comforts, safety, and predictability.  Instead you journeyed from unconsciousness into deeper knowing, from innocence to wisdom, from victim to savior, and from vulnerable child to capable woman; one who is ready to take full responsibility for her own life and well being.
I’m wondering what it is that lives within you that enabled you to overcome your suffering, your limitations, and your fears?  What sustained you as you faced the loss of a fundamental part of yourself, and then empowered you to reclaim it?
And now as this portion of your journey has reached its conclusion, I’m wondering how your incredible resilience and strength will continue to serve you?  What do you see your life purpose to be?  What next courageous steps will you take to realize this purpose?  What lessons will you bring with you to assist you in taking these steps?  What wisdom will you offer others as you move bravely forward?

Written by: Tammie Byram Fowles, author of BirthQuake: The Journey to Wholeness

To a Wounded Angel

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Hugo Simberg (1873–1917)

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You’re so brave, so strong, so beautiful,

and you can fly  so high…

I’m so often in awe of you, did you know that?

And believe me when I say to you

that I value you every bit as much

when you’re stooping as when you soar…

Right now, settled on the ground,

with your wings folded down around you,

I think I love you even more…

“Everything happens for a reason,”

good people have told you,

and you’ve done your very best to believe them.

This philosophy offers such comfort and peace.

And in retrospect, when looking back upon my own life,

for the most part, it rings true. 

So much that was painful or disappointing

later proved to serve me.

And I know with all of my heart

that your own hurt can serve you.

But I can’t offer up that “everything happens for a reason” to you.

My throat closes around those words the moment they occur to me,

and bitterness rises up to meet them.

How can there possibly be a reason for innocent children

to be tortured physically, sexually, emotionally or spiritually?

There is no reason that I can accept,

and I’ve long since given up my quest to acquire one.

I refuse to tell you that the devastation that you suffered

as a small child happened for a reason.

What logical reason could there possibly be?

As a therapist, I’ve looked into too many pain filled eyes.

Eyes that reflect a tortured childhood,

eyes that ask why? WHY? WHY?

And you know what?

There never was a ‘why’ that I found acceptable.

Not a single explanation that was ever good enough for me.

And so my weary angel,

I come to you emptied of answers.

I can’t take away your WHY

and replace it with an explanation.

I wish I could.

I want so very much to take your pain away.

Because I cannot take away,

I come to you with a modest offering.

One so small, that I’m humbled as I hold it out to you.

It’s a small stone with one word engraved upon its surface.

The word is AND.

You were hurt very badly

AND yet in spite of the hurt, you’ve grown.

You were deeply wounded

AND still you survived.

You were exposed to the worst in human behavior

AND yet you’ve always tried to give your best.

Your voice was silenced

AND still you’ve heard and responded to the pain of others.

You were touched by evil

AND you’ve chosen to embrace goodness.

You were betrayed

AND still you seek to trust.

You’ve been vulnerable and exposed

AND still you’ve sheltered lost souls with your wings.

Your agony can’t be denied,

but neither my precious friend

can all of the AND’s that are contained within you.

They too have shaped you,

and even as your pain has left you grounded,

the AND’s will surely make up the magic

that will lead you once again to fly.

Take them with you…

Love,

A Fellow Traveler

Written by: Tammie Byram Fowles, author of BirthQuake: The Journey to Wholeness

PERSONALITY AND ILLNESS

“The last place we tend to look for healing is within ourselves.” Wayne Muller

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Medical sociologist, Aaron Antonovsky, after conducting several studies regarding personality characteristics that serve to promote well being, concluded that it’s a sense of coherence within the individual that produces health. This sense of coherence is comprised of three components: (1) comprehensibility, (2) manageability, and (3) meaningfulness.

When we view the world as comprehensible, we perceives it as making sense, possessing some sort of structure, and offering some level of predictability. When we believe the world is manageable, then we feel able for the most part to meet the demands of life, having faith that one way or another we’ll be able to cope with our circumstances. The meaning that we attach to a situation not only effects how we’ll respond to it emotionally, but impacts our physiological responses as well. Antonovsky proposes that when we possess a strong sense of coherence, we tend to view the challenges that confront us as opportunities rather than as threats, consequently minimizing their stressful effects. Research indicates that when we simply anticipate an experience that we expect will be positive, or think about something that makes us feel good, positive changes occur in our bodies as well.

Liz, a lovely and energetic woman with whom I worked had a near fatal heart attack at the age of forty-five. She was lying on a gurney in excruciating pain while emergency workers scrambled to save her life when she was struck by the chilling awareness that she could be dying. Liz wrote:

“You read about it in the paper just about every morning, some middle aged man or women with growing children has died suddenly. It happened all of the time, and now it was happening to me. ‘I’m dying’ I thought in amazement. This is it. I’m no exception. I’m just an obituary in the morning paper in the grand scheme of things. No warning, no second chances, no negotiating or compromising, just over and out.

I had lived my life with such warped priorities, giving far too much weight to deadlines at work, dust on the furniture, and children with dirty fingernails. Right before having my attack, I’d been obsessing over a memo I needed to send to my boss. I’d hardly slept the night before, writing it over and over again in my head. After I sent it off, I was a nervous wreck, imagining that he’d conclude that I hadn’t adequately planned for a very important project that I’d been assigned. Well here I was dying, and I knew beyond a shadow of a doubt that I wasn’t prepared. All of the sudden, that memo and my boss’s approval meant absolutely nothing.

They say you see your life flash before your eyes when you’re dying. Well in a way I did see my life pass before me in snap shots. I watched a replay of Tina slamming the door in tears that morning. I remembered the discouraged look on Patrick’s face the night before when he realized that I hadn’t been listening to him again. I recalled how warm the sun had felt on my skin as I hurried to get into the car, and how I’d never gotten around to watching the morning news with my husband. I thought of a friend who’d listened to me complain over and over and over again of never having enough time. She’d suggested that when I got the chance I should write an essay entitled, ‘When I have the time…’

The recovery process was a time of reckoning for me. Faced with a significantly damaged heart, numerous uncertainties, and borrowed time on my hands, I began to write that essay.

An old friend had brought me in a magazine article stating that the United States had been hit with a potentially deadly epidemic. This malady was said to be one of the top five reasons that people call their doctors, was the culprit behind one of every four health complaints, and was one of the leading causes of early death. What was this terrible affliction? A lack of joy.

My life, a privileged one by even my standards, contained far too much stress and way too few pleasures. The greatest irony was that most of the stress that I now firmly believe led to my heart breaking down, was self-imposed, and the absence of pleasure was related to my own self denial.

I took notes while I read the article. It suggested that in order to experience more joy, I needed to work on patience, unity, agreement, humility, and kindness. I made a commitment that when I left the hospital I would do the following:

  1. I would strive to be more patient. I would take deep breaths, stop behaving as almost every task before me was an emergency, slow down, and ask myself when I started to become agitated or upset, ‘How important is this in the grand scheme of things?’ One brief flashback of the emergency room usually serves to put things in perspective.
  2. I would pay attention to my body by listening to and responding to its’ signals. I would take more time to really connect with other people, concentrating on the moment and being as present as possible. I would spend some time each day in prayer, or meditating, or spending a few moments in nature.
  3. I would work to stop over reacting to those things I had little or no control over and begin to view each experience as an opportunity to learn instead of as a potential threat. In fact, I would make a decision to view the whole of my life as a learning process rather than a race I had to run, or a deadly serious game in which it was important to score the most points possible.
  4. I would try to acknowledge my weaknesses as undeniable aspects of my humanness. When I took the time to fully appreciate how my flesh, (just like the flesh of every other person in the world) was ultimately so very vulnerable, then striving for perfection began to seem ridiculous.
  5. I decided that in the best interest of both my physical, emotional, and spiritual health, I would work on being kinder.”

It would appear that Liz is doing a wonderful job keeping her commitments judging by the healthy glow of her skin, the twinkle in her eyes, and the relaxed, graceful movements of her body.

I recall a winter day long ago when my sister-in-law and brother-in-law dropped by. My sister-in-law was her radiant, cheerful self; however, I was immediately concerned about my brother-in-law who appeared drawn, tired and depressed. I asked him what was wrong. He informed me that they had finally managed to save a few hundred dollars in the bank (they had been struggling financially for years in spite of their very hard work) when they received news that they owed the IRS over two hundred dollars. Once again their savings would be wiped out. “It seems like someone is watching me, just waiting to stomp me back down every time I get my head up,” he complained. My sister-in-law immediately replied, “Did you ever think that maybe someone is watching over you, and that when we could have been in trouble by not having the money to pay the taxes, lo and behold, there it was!” I was struck by the effect of this event on these two very special people. The experience was the same for both, and yet the way it was experienced, was vastly different. It created anxiousness, discouragement, and weariness in one, while it fostered appreciation, gratitude and peace in the other.

Kenneth Pelletier in “Mind as Healer, Mind as Slayer,” points out that between 50 to 80 percent of all diseases have psychosomatic or stress-related origins. According to Pelletier, any disorder is the result of a complex interaction of physical and psychological stress, social factors, the personality of the individual, and his or her inability to adapt adequately to the stressors.

Victor Frankl, in “Man’s Search for Meaning,” recalled the death of a fellow concentration camp prisoner, as he wrote of the deadly effect of losing hope and courage in the camps. The prisoner had confided in Frankl that he had had a prophetic dream which informed him that the camp would be liberated on March 30th. Frankl’s companion was filled with hope. As March 30th grew nearer, the war news remained bleak. It seemed highly unlikely that Frankl and his companions would be free by the promised date. On March 29th, Frankl’s companion suddenly became ill, running a high temperature. On the 30th, the day the prisoner had believed he was to be rescued, he became delirious and lost consciousness. On March 31st, he died.

Frankl believed that the terrible disappointment his friend faced when liberation did not occur had lowered his body’s resistance against infection and consequently allowed him to become victim to illness.

Frankl also pointed out that the death rate in the concentration camp during the week between Christmas and New Years in 1944, dramatically increased beyond all previous experience. The camp physician concluded (and Frankl concurred) that the higher death rate was due to the prisoners’ disappointment and loss of courage. Many of them had hoped that they would be freed and home again by Christmas. When their hopes proved to be in vain, their powers of resistance dropped dramatically and a number of them died. The presence of hope and faith not only provides comfort, it can also save lives.

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©Tammie Byram Fowles, (an excerpt from BirthQuake: The Journey to Wholeness)

THE PATHFINDER

anarule“Our souls grow also through the pain of crisis. In the life of the soul times come when we begin to sense, in some area of our life, the acute pain of unfilfillment. Some neglected or unknown part of oneself presses to be born.” Ann K. Elliot

Gail Sheehy’s insightful book, “Pathfinders,” offers to assist us in overcoming the crises that occur in adult life while also finding our own individual path to well being. Although I doubt that her book accomplished this significant task for all who read it, it certainly provides a very helpful travel guide. Pathfinders, according to Sheehy, fit the following description:

anabull1 The individual must have emerged from a particular path or completed passage with “renewed strength and expanded potential…”
anabull1 The individual must have done a minimum of harm to others during his or her journey.
anabull1 The individual should not be exclusively involved in the service of others but should instead have sought a balance between a purpose outside of him or herself and individual growth.
anabull1 One does not start out as a pathfinder, one becomes a pathfinder.
anabull1 The individual is as committed to his or her inner growth as he or she is to outer achievements.

One of the greatest privileges of being a therapist has been witnessing the making of a Pathfinder. While far from an everyday occurrence in my practice, when the process begins, it’s as wonderful an experience to behold as any I’ve ever encountered. It seems very much like a birth to me, beginning with fear and discomfort, leading into the acutely painful transitionary period, and culminating in bringing forth new perspectives, strengths, and direction.

Survivors of a Birthquake tend to make outstanding Pathfinders. Most have been broken and yet they still stand. They have been afraid, hurt, bewildered, and angry and still they moved on. Many found that their lives had been turned upside down, their identities battered, and their foundations shaken, and still they rebuilt. While they may have lost hope, they were never hopeless. Surviving the Quake requires great strength, and efforts to transcend often lead down a new and unknown path. James Hillman once wrote that, “Victim is the flip side of hero.” It is on this journey toward recovery that many survivors become Pathfinders — transformed from victims to survivors (and hero’s) of their own unique Quake.

“True healing means drawing the circle of our being larger and becoming more inclusive, more capable of loving. In this sense, healing is not for the sick alone, but for all human kind.” Richard Moss

In order to support the struggling seeker, faith must be maintained in the value of the journey. Often this is best achieved through reaching out to others who have been through their own dark forest and have emerged on the other side. From such individuals, the weary traveler learns that he or she is not alone, that others have also felt confused and inadequate, and that still they arrived safely, and stronger than ever before. It’s my belief that those struggling within the uncertain territory of a Quake benefit tremendously from the support of a group. While a personal guide can be helpful, the collective wisdom of others is often the most sustaining through the turbulent process, and when rebirth is achieved, it’s far better to be celebrating with others who stood by you than to be rejoicing alone.

What is rebirth? I believe that for each person the particulars of this evolutionary process are different. According to Wilfred A. Perterson, “Evolution is the story of stress and conflict, change and adjustment – the unconquerable urge of life to emerge in new forms.” Fundamentally, perhaps, it’s a place where one finally arrives that feels right. You’re born the first time into an unfamiliar place where you have absolutely no control. During your second birth, you’re immediately aware once you’ve made it through the tunnel, that you finally feel at home.

Written by: Tammie Byram Fowles, author of BirthQuake: The Journey to Wholeness

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CALLING FORTH THE SOUL

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“In the last decade of the twentieth century, perhaps in response to the magnitude of our global crisis, spirituality has been coming down to Earth…” (Ronald Miller)

Thomas Moore, best-selling author, philosopher, and psychotherapist, laments that the great malady of the twentieth century has been the loss of soul. Yet his book, “Care Of The Soul: A Guide To Cultivating Depth And Sacredness In Everyday Life,” quickly rose to the bestseller list, indicating that while he might be right about the loss of soul, many twentieth century inhabitants eagerly endeavor to find it.

Moore maintains that when the soul is neglected, rather than simply fading away, it demonstrates its woundedness symptomatically in addictions, obsessions, loss of meaning and violence. Most therapists attempt to isolate or eradicate these symptoms, failing to understand that their roots often lie in our lost wisdom about the soul.

Moore’s understanding of psychotherapy, evolving over more than 15 years of practice and study, has come to involve bringing imagination (which he perceives to be the instrument of the soul) to areas that are devoid of it. It’s Moore’s belief that it is the expression of this void that is manifested by our symptoms.

Further, he notes that in our modern world we’ve separated religion and psychology, spiritual practice and therapy. In his view, spirituality and psychology need to be seen as one. This shift would occur  in a number of ways, one of which would be a commitment to the process of ongoing care of the soul rather than engaging in efforts to cure it.

According to Moore, caring for the soul begins with an observance of how the soul manifests itself and operates, and then responding to what the soul presents. This involves not moving to root out that which the soul expresses and is seen as symptomatic, but to, instead, explore its purpose and value. Moore invites us to regard the soul with an open mind in order to discover the wisdom that can be found in pain as well as the call for changes that are given voice by such symptoms as depression and anxiety.  I’ve have learned both as a psychotherapist and in my own personal life that pain (while I never welcome it) is often a prepatory path that can lead to possibility as my own suffering served  time and time again as a catalyst for growth.

One effective technique Moore shares in caring for the soul is to look with particular attention and receptivity at what the individual is rejecting, and then to speak favorably about that rejected element. For instance, a therapist might point out to a client that in her frantic activity day in and day out, the only thing that seems to allow her to pause and rest are her headaches.  James Hillman points out that at a redemption center, you get something in return for bringing in an item that is often perceived as worthless.  I often suggest to participants of my workshops that they imagine that they have taken a particular problem or difficult circumstance to the redemption center.  I then ask them to consider what they might have received in exchange. Very often, participants are struck by the unrecognized gifts that they’ve acquired during even some of their most painful times.  I recall in particular, a very successful and self-possessed man who shared that after he was injured in an accident and could no longer make his living doing what he had trained long and hard for, he was forced to change occupations.  At first he felt lost and absolutely devastated.   Eventually he went back to school to become a spiritual counselor and maintains that his life has been immeasurably more satisfying since then. Another participant recalled that it was only after suffering from a painful period of depression that she was able to reach out to others and build intimate relationships that she’d never found time for before.  Hilman asserts that by examining these unexpected gifts, “The noisome symptoms of every day can be revalued and their usefulness reclaimed.”

Moore also cautions against splitting experiences into good and bad, maintaining that much soul can be lost in such splitting, and that the soul can be aided in its recovery by reclaiming much of what has been split off. In elaborating on this, Moore turns to a version of the work of Jung’s theory of shadows. Jung believed that there were two kinds of shadows: one consisting of the possibilities in life that are rejected because of certain choices that we’ve made (for example, the person we chose not to be), which is the compensatory shadow; and the other, darker, absolute shadow. The absolute shadow represents the evil existing in the world and within the human heart. Jung believed, and Moore concurs, that the soul can benefit from coming to terms with both kinds of shadow and learning to appreciate even the quirks and perversities of the soul. He adds that sometimes deviation from the usual offers its own special revelation of truth.  Dawn Morkova wrote in, “No Enemies Within” that, “our wholeness is based on reclaiming those aspects of ourselves that, due to our personal circumstances, we’ve had to leave along the way.”

Moore distinguishes between cure and care by pointing out that cure implies the end of trouble, while care offers a sense of ongoing attention. He believes that the approach of psychotherapists would change dramatically if they thought about their work as offering ongoing care rather than a quest for cure.  Moore reminds us that problems and obstacles can offer us opportunities for reflection and discovery that might otherwise be overlooked.

Moore is far from a solitary voice in the wilderness (so to speak) in regards to the value he places on honoring all dimensions of the self, including our painful regions. David K. Reynolds, in his book, A Thousand Waves: A Sensible Life Style for Sensitive People,” proposes that traditional Western psychotherapy fails to adequately acknowledge the importance of our need for unity among all  aspects of ourselves. Reynolds advocates an Eastern approach, which aims at helping us to honor our natural selves more fully, and more specifically – to help us to become more natural again. He points to the nature of water and suggests we become more like this precious liquid observing that when the weather is warm, water becomes warm, and when it’s cold outside, water too turns cold.  Water doesn’t wish that it was a different temperature, nor does it pretend to be other than it is. It merely accepts its present state and continues to flow. Unlike water, laments Reynolds, people deny reality. They also struggle with their feelings and hamper themselves by focusing on the way things should be or might have been. Water doesn’t fight obstacles, says Reynolds, it simply flows around them, not getting distracted as people so often do by their feelings. Water is flexible and adapts to the particular circumstances it’s in. Water flows at a natural pace. People on the other hand, appear to be dashing around attempting to manipulate their lives or feelings into fitting into their particular notion of how things ought to be or how they wish them to be. Reynolds reminds us that feelings are neither good nor bad, they simply are. The best way to deal with painful feelings according to Reynolds, is to simply recognize them, accept them, and then carry on. Because feelings keep changing, he recommends that an appropriate goal for both therapy and every day life is to: ” …notice and accept these changes in feelings while keeping steadily on about doing the things that will get us where we want to go. Like water does.”

Nietzsche, the German philosopher, made a decision at some point in his life to love his fate. From that point on he responded to whatever happened to him by saying to himself, “this is what I need.” While I fully believe in the tremendous value of Nietzsche’s courageous approach, I’m a long way from being able to adopt it. I question too much, and still carry too much fear. What I have been able to embrace is James Hillman’s recommendation that what ever your experience, “You ask yourself: How does this event bare on soul making.”

©Tammie Byram Fowles, MSW, Ph.D. an excerpt from BirthQuake: The Journey to Wholeness  

The Contributions of Feminist Therapy

psycho4© Tammie Byram Fowles, MSW, Ph.D.

From:  Finding the Forest: Treating Survivors of Trauma Integrating Brief, Holistic, and Narrative Techniques by Tammie Byram Fowles

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“Therapy must be geared to helping the client see that she must be her own rescuer – that the power she longs for is not in someone else but in herself.” Miriam Greenspan

     My work has been significantly influenced by a number of feminist therapists including (but not limited to) Toni Ann Laidlaw, Cheryl Malmo, Joan Turner, Jan Ellis, Diane Lepine, Harriett Goldhor Lerner, Joan Hamerman, Jean Baker Miller, and Miriam Greenspan. I’ve found that what seems to be the universal core of feminist therapy is that clients and therapists are perceived as equal participants and companions in the therapy endeavor.

In her book, A New Approach to Women and Therapy, (1983) Miriam Greenspan explores the impact of both  ‘traditional’ and ‘growth’ therapies on women clients  and provides a thoughtful and articulate description of feminist therapy in action. Included in her analysis are the following assertions:

The therapist’s most essential tool is herself as a person.

     On countless occasions during my years as a therapist I’ve sat speechless with a client, knowing all too well that there are no words that will comfort, justify, or explain the pain away. There have been so many moments when all my years of studying the human psyche and condition still render me helpless to alter a particular circumstance, belief, or feeling. During these times, I am left with only my caring, my understanding, and my faith. While I’m always humbled during these periods, I’m not disempowered. I’m sustained by my belief that in joining another human being in her pain; in being a steady and present witness; in respecting the magnitude and depth of her feelings, while I may not be able to lead her out of her darkness, I can stand beside her.

It’s imperative that therapy be demystified from the beginning in order for clients to achieve a sense of their own power in therapy.

     I was visiting with a very special friend and fellow therapist one day discussing memorable movies we’d seen over the years when she recounted one scene in particular that had struck her. In this scene, the main character is at a rather large party and runs into her therapist who is also attending. She and her therapist chat for a few moments before parting company. A friend approaches the main character and asks her who the woman was that she had been talking to. The heroine responds, “that’s no woman. That’s my therapist!”

This scene serves to illustrate the mystique that therapists often have with their clients. While intellectually our client’s realize that we, too, are imperfect and possess our own challenges and short-comings, they all too often still manage somehow to perceive us as somewhat larger than life. They often look to us to provide answers, direction, and tell them how to fix some aspect of their lives that they perceive as broken. Our responsibility is not to oblige them (even if we could), but rather to assist them in learning to trust in their own power and wisdom.

Expectations of the therapeutic relationship should be overtly stated and mutually agreed upon.

     This doesn’t mean that the therapist explains the rules in which the client is expected to adhere to, but rather that the client and therapist explore their expectations of one another and jointly come to an agreement regarding what each person’s role and responsibilities will be.

Within every symptom, no matter how painful or problematic, there exists a strength.

     Helen Gahagan Douglas in The Eleanor Roosevelt We Remember, reflected, “Would Eleanor Roosevelt have had to struggle to overcome this tortuous shyness if she had grown up secure in the knowledge that she was a beautiful girl? If she hadn’t struggled so earnestly, would she have been so sensitive to the struggles of others? Would a beautiful Eleanor Roosevelt have escaped from the confinements of the mid-Victorian drawing room society in which she was reared? Would a beautiful Eleanor Roosevelt have wanted to escape? Would a beautiful Eleanor Roosevelt have had the same need to be, to do?”  (Douglas,1963)

Perhaps Eleanor would have still achieved all that she was to accomplish in her lifetime, beautiful or not; however, it’s been reported that Eleanor herself confided that her insecurity about her looks often motivated her to work harder.

“In “Legacy of The Heart: The Spiritual Advantages of a Painful Childhood, (Muller, 1992) Wayne Muller notes that those who’ve suffered in childhood, while bearing painful scars, invariably exhibit exceptional strengths; including remarkable insight, creativity, and a profound inner wisdom. He challenges such individuals not to perceive themselves as broken and damaged, nor to eliminate parts of themselves, but rather to strive to reawaken that which is wise, whole, and strong within them. In working with victims of childhood trauma, he observed that while still haunted by their past, they also develop an acute sensitivity to others as well as a tendency to seek beauty, love and peace. Muller reflects, “seen through this lens, family sorrow is not only a painful wound to be endured, analyzed and treated. It may in fact become a seed that gives birth to our spiritual healing and awakening.

It’s been my experience that this is often the case with survivors of childhood trauma. While not all such individuals with whom I’ve worked possess the characteristics Muller so respectfully describes, I’m so often struck by the strength and depth of survivors.   Each client has brought to therapy unique skills and abilities fostered to a significant degree by the very pain she sought to escape.

Muller assures the reader that suffering and pain are not exceptions to the human condition. Instead, they are inevitable threads in the tapestry of life. He cautions us not to become trapped by memories of childhood suffering, thus allowing the suffering to become the one thing that is the truest about our lives. He also points out that many of us would prefer to explain our hurt rather than feel it. He advises that we accept the pain we are given and identify the lessons it will inevitably teach if we only look and listen, particularly to the wisdom contained within the depths of our own souls.

While I don’t under any circumstances wish to minimize the pain of another, nor suggest that he or she be grateful for suffering, I do believe that in order to empower another, it’s important that the value of all experiences in a person’s life be acknowledged. While there are many experiences I would have adamantly refused to struggle with in my own life had I been given the choice, to deny the value of the message in spite of how painful the lesson or unwelcome the messenger, only serves to add insult to injury. If one has no choice but to toil on a particular path, at the very least – claim every available compensation along the way. ”

In the introduction of Healing Voices: Feminist Approaches To Therapy With Women, therapists, Tony Ann Laidlaw and Cheryl Malmo, (1990) assert that feminist therapists welcome their clients’ inquiries about the therapist’s values, methods and orientations. They also:

anabull1  At appropriate times share about their own experiences in order to assist their clients;
anabull1 Encourage their clients to take an active part in making decisions about the course of therapy;
anabull1 Allow the client final say over the content of a session, the choice of method, and the pacing of therapeutic work.

Self Disclosure

The degree of therapist self-disclosure is an area in which a wide range of opinions exist. For some, personal information should not be provided by the therapist to the client in almost any circumstances. Others firmly maintain that some personal information is not only acceptable at times, but advisable. I find myself agreeing with the latter. In order for a true therapeutic relationship to develop, in my opinion, therapist and client generally must achieve some level of intimacy. I don’t believe that such intimacy can exist without the therapist sharing some limited aspects of his or her own life at times. Carl Rogers urged therapists to be genuine. How can one be genuine when conscientiously hiding all personal aspects of oneself? When a client asks if I am frustrated with them and I say that I am not (after all, therapists should never experience anger toward a client) when in fact I am frustrated, I’m not only being disrespectful, I am inflicting damage. When a client observes that I look like I have had a hard day, and I deny that I have, when in fact, the day has been extremely difficult, I have become a liar to someone whose trust is extremely important. This doesn’t mean that I should proceed to describe my day to the client, but that I merely acknowledge that the client’s observation is a perceptive and accurate one.

Lenore E. A. Walker, in her piece, “A feminist Therapist Views The Case” from “Women as Therapists, (1990) provides an overview of the guiding principles of feminist therapy, including:

anabull1 Egalitarian relationships between clients and therapists serve as a model for women to take personal responsibility to develop egalitarian relationships with others instead of the more traditional passive, dependent female role. While it is excepted that the therapist knows more in terms of psychology, the client knows herself better. That knowledge is as critical as the therapist’s skills to make the therapy relationship succeed.
anabull1 The feminist therapist focuses on the enhancement of women’s strengths rather than remediation of their weaknesses.
anabull1 The feminist model is nonpathology-oriented and non-victim blaming.
anabull1 Feminist therapists accept and validate their clients feelings. They are also more self-disclosing than other therapists as they remove the we-they barrier between women therapists and their clients. This limited reciprocity is a feminist goal that is believed to enhance the relationship.

Milton Erikson spoke often of the importance of joining with our clients. It’s difficult from my perspective to accomplish this if we are placed somewhere above our clients and often out of their reach. To truly understand another, we must be willing to get close enough to really see; we miss much when keeping back a safe distance. Perhaps, in part, the distance is recommended because it is not possible to observe imperfections and vulnerabilities close up without risking our own being exposed from time to time. Therapists need not be perfect in order to be effective; in fact, they don’t even need to be smarter.

Still, as much as I strive towards equality in my work with clients, realistically, the relationship inherently possesses certain characteristics that prevent it from being firmly based in equality. As Deborah Lot points out in her wonderful book, In Session: The Bond Between Women and Their Therapists, (1999) when describing her own experiences as well as those of other women in therapy, “We found the very structure of the therapeutic relationship problematic. It was inherently unequal: We needed our therapists more than they needed us, they were much more important to us than we were to them, and the whole alliance was sustained by our paying considerable fees.”

No matter how much we might genuinely wish it were not so, there is a very real power differential that exists in therapy. To deny it doesn’t make it go away. What becomes absolutely essential is that we use our power respectfully and responsibly.

Janet O’Hare and Katy Taylor in the book, Women Changing Therapy, (Robbins and Siegel, 1985) provide a number of insights and recommendations for working with victims of sexual abuse including:

A controlling therapist is too much like the abuser to be helpful.

     We often threaten survivors when we assume control of the therapeutic process.  Many Survivors have been told what to do for much of their lives, and voluntarily surrendering now to the mandates of yet another feels all too often uncomfortably familiar. Survivors need to be empowered to act in their own best interests, to make their own decisions, and communicate their needs effectively. Attempting to acquire these abilities in the presence of a controlling “expert” is hardly conducive to producing these results.

The client must be encouraged to recognize her own strengths.

     Often survivors of abuse are acutely aware of their inadequacies and have little faith in their ability to heal.  When fostering hope it’s important that the therapist focus on and strive to develop strengths and resources rather than honing in on and seeking to remediate inadequacies. In fact, many of the tendencies that survivors (and some therapists) perceive as weaknesses are in fact just the opposite – assets to be recognized and appreciated.

The therapist must honor the client’s unique healing process and allow the healing to proceed at the client’s own pace.

     Not being controlling doesn’t necessarily translate into being non-directive. In operating from a brief treatment perspective it’s absolute necessary that the therapist remain active and willing to provide direction. Still, from my perspective, therapists should serve as guides and facilitators when working with survivors. When one engages the services of a guide while embarking on a journey, it’s ultimately the role of the one to be guided to determine the destination, the limits of the distance to be traveled, the stops along the way, and the overall pace. It is the guides responsibility to meet the objectives of the guided.

References:

Broedy, Claire (1984). Women therapists working with women. New York: Springer.

Collier, Helen (1982). Counseling Women: A guide for therapists. New York: The Free Press.

Douglas, Helen Gahagan (1963).  The Eleanor Roosevelt We Remember.  New York: Hill & Wang.

Duerk, Judith (1989). Circles of stones: Woman’s journey to herself. San Diego, CA: Lura Media Press.

Greenspan, M. (1983).  A New Approach to Women and Therapy: How psychotherapy fails women—and what they can do about It. New York: McGraw Hill Companies.

Herman, Judith (1992). Trauma and Recovery. New York: Basic Books.

Laidlaw, Toni Ann and Cheryl Malmo (1990).  Healing Voices: Feminist approaches to therapy with women. San Francisco: Jossey-Bass

Lott, Deborah A.  (1999). In Session: The bond between women and their therapists.  New York: W. H. Freeman.

Miller, Jean Baker (1976). Toward a new psychology of women. Boston: Beacon Press.

Muller, Wayne (1992). Legacy of the Heart: The spiritual advantages of a painful childhood. New York: Fireside.

Robbins, Joan and Rachel Siegel, eds. (1985). Women changing therapy: New assessments, values, and strategies in feminist therapy. New York: Harrington Park Press, Inc.

Rogers, Annie (1995).  A Shining Affliction: a story of harm and healing in psychotherapy. New York: Viking.

Walker, Lenore (1990)  A Feminist Therapist Views the Case.  In Dorothy W. Cantor (Ed.),  Women as Therapists,  (pp. 78-79).  New York:  Springer Publishing Company.

Worell, Judith (1992).  Feminist Perspectives in Therapy: An empowerment model for women. New York: Wiley.

anarule

GUIDING PRINCIPLES

© Tammie Byram Fowles, MSW, Ph.D.

From:  Finding the Forest: Treating Survivors of Trauma Integrating Brief, Holistic, and Narrative Techniques by Tammie Byram Fowles

     In considering what I’ve learned over the years that has most served to guide me, I believe that the following principles have significantly shaped my work.

The relationship between therapist and client is not exactly a partnership after all.

     It’s the therapist’s job to serve the client. Determining goals and (with assistance) destination, becomes in my view, the responsibility and right of the client, while the therapist develops the road map so to speak. How can we promote autonomy and independence if we insist on steering the course? If the process of therapy were likened to that of a journey across the ocean, then from my perspective, the individual served would be the captain while the therapist faithfully navigated.

A therapist should be a visionary while remaining grounded in the present.

     Although it’s important that we remain focused on the facts at hand, possessing a clear vision for which we strive is of equal value. Webster’s dictionary defines a visionary as, “a dreamer; one who tends to accept fancied things as facts; one who is not a realist.” My personal definition reads, “one who believes in possibilities; one who is not immobilized by the realities of the present but pushes forward to transform ‘fancies’ into facts.” When a client tells me, “I can’t”, the visionary in me might respond, “You just haven’t yet”. When I hear, “It will never happen to me,” I’m likely to reply, “It hasn’t happened yet.” We must believe in possibilities, and our language should consistently reflect faith in our client’s abilities to transcend their limitations and achieve their goals.

Utilizing time creatively and flexibly should not remain a good idea to be implemented as often as possible (or when demanded by managed care), but rather a standard by which the conscientious therapist consistently operates.

     This is far from a novel idea and has been suggested by many of our mentors. The creative and flexible use of time places a premium on the needs of the client versus the convenience of the therapist. The 50 minute once-per-week format is much more conducive to a predictable schedule for the therapist rather than being what might best meet the unique requirements of the client. For one client, 50 minutes once per week eventually shifting to every other week might make sense. Another client may need one-100 minute session on a bi-monthly basis; while still another benefits from one thirty minute session per month.

     For years the typical contract between client and therapist was that the pair would work on specific issues and once the problems were resolved they would “terminate” their work together. Thus the relationship existed for a finite period of time. Countless novice therapists (including myself) were informed that an integral component of therapy involved working from the beginning towards termination. I’m humbly proposing that it’s not necessarily so that the client and therapist need to be always working towards termination. Instead, the proposal that the relationship between client and therapist might be viewed as intermittent (involving periodic visits)is far more realistic to me. When are we ever truly finished before death? Rather than saying goodbye forever, a common and often traumatic practice in therapy, how about if the relationship were not to officially terminate at all? What if the client and therapist contracted to do a specific piece of work, mutually agreeing that when the goal has been completed they will part ways but with the understanding that the therapist will be available at some point in the future should the client require further assistance. What truly amazes me is that not too many years ago this was a novel idea.

There is no ultimate formula for providing the best possible treatment to all clients.

     Each client is unique, with differing needs, motivational levels, and resources. In order to meet the various needs of the clients whom we serve, we must be prepared to be flexible, creative and responsive to the varying needs and perspectives of our clients.

Therapists must never presume to have all the answers.

     Our client’s generally want answers from us, and sometimes we’re fortunate enough to be in a position to deliver. They expect wisdom, too, and many of us do everything in our power to oblige them. Still, as the late psychotherapist, Sheldon Kopp, gently and sagely reminds us, “In the world of adults, there are no mothers and fathers, only brothers and sisters.” While we can act as guides and facilitators, I think that it’s important that we not forget what most of us know deep down in our hearts, and that is, that we are all struggle in one way or another in the stew together. We shouldn’t inflict our values and personal opinions on our clients. When we offer advice, we may want to consider that the price our clients may pay (in addition to dollars and cents) is of far greater value–and that is their autonomy. It’s flattering to be made larger than life, to be sought for our knowledge, and professional expertise. It’s enormously gratifying to know that those who seek us out do so very often with a significant degree of faith in our abilities. Faith is defined in part by Webster’s dictionary as, ”…trust and confidence in another…” We must never violate the trust and confidence placed in us. When we even imply that we know for certain what is best for another human being, then we do exactly that – we violate their trust and confidence. We can never truly know what is best for another in spite of our ideas from time to time to the contrary.

The client, not the therapist, is ultimately responsible for change.

     Clients (and some therapists) need to be informed that while therapy may be part of the solution, by itself, it’s seldom the answer. While it’s common practice for therapists to hand clients forms that outline certain key responsibilities of the client such as that the client will pay on time and give a 24 hour notice prior to cancellation. I have never seen a form outlining expectations such as that the client will be expected to work on their goals outside of the therapists office, complete agreed upon homework assignments, and be expected to assess their progress.

We can present, point out, clarify, encourage; but we should never dictate.

     I recall a client who I referred to a psychiatrist for a consultation. The psychiatrist told her in no uncertain terms that she must leave her husband and that until she did, she would be wasting her time in therapy. The client canceled her next three sessions with me and her depression deepened. I was furious. How could this doctor possibly know after a brief meeting that this woman should terminate her 14-year marriage? What if the psychiatrist was right and that she should leave her husband? What if, however, the woman was in no position at the time to act upon this reality? If she cannot leave him for real or imagined reasons at this time, does this mean that therapy is useless? What if the therapy were aimed at assisting her in acquiring the resources she will need to possess in order to carry out any decision she might make?

A Dedication…

I dedicate this book to you,

the wounded angels.

who have courageously

shared with me your stories…

You have touched my life in ways that

I can’t possibly express,

and that you cannot imagine…

I have wept in your presence

in spite of the years of training

that cautioned me to be objective,

and to be still,

and to hide myself from you

while at the same time drawing you out…

They taught me that you were damaged

and that I would need to fix you…

I learned from you

that while you might be wounded,

you were still beautiful

and wise, and whole…

possessing healing tools of your own…

You so often believed

that yours was a story of pain,

of despair, and of failure…

Together we discovered that yours

was a story of courage, of survival,

of strength, and of hope…

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To Participants of a Workshop on the Treatment of Bulimia

Dear Colleagues,
You’ve asked me to discuss the treatment of Bulimia. I must confess that initially, I was somewhat daunted by the task. Where do I begin? First of all, I suggest that we review the stories we’ve been told about the bulimic individual. According to psychotherapist, Christopher Fairburn, her average age is 23.5 years; her attitudes toward her shape and weight are considered to be grossly abnormal; her eating habits are markedly disturbed and have been for several years, although her weight remains within the normal range. Continue reading