Fantasy vs reality..

The joy of postmodern therapy, for both clients and therapists is in how a postmodern approach gives value to inspiration, creativity and the imagination. For we seek to recast the future and the past in ways that enable, and no longer disable. For us, the concept of mental illness as a loss of contact with reality, begs the question - whose reality? And that question has to be asked, because it places power at the core of diagnosis. If reality is to a large extent constructed, and if people arrive with different versions of reality, and if someone imposes their version of reality over the other person's...things like this really bother postmodern therapists. Because we are of course, seeking to enable our clients to transform their view of reality. 

One of my core tasks is to help my clients reclaim power, to reconstruct their identity, and to become aware of other possibilities - their power to make changes. To do this I need to merrily sidestep the knee jerk conclusions based on binary oppositions, and, notice the power dynamics in this client's situation. 

In postmodern therapy fantasy isn't a problem, fantasy can be piggybacked into becoming an intervention; the question 'what do you suppose...' is an invitation to the sandbox, to liminality, to use fantasy, to ask what if...

Such questions about the prevalence of binary oppositions and the invisibility of power dynamics don't seem to bother the psychodynamic therapist who will say:

"We become well by relating to what is here; we become ill by relating to our fantasies." Jon Frederickson"

I don't disagree, but such statements about facing what is here, can inadvertently cause a lot of unnecessary suffering. 

My patient’s reluctance to reveal her problem turned out to be a gift. Her fear of revealing her problem pointed to her fear of depending on me; it revealed her rejected longing for an embrace. Her depression said no to the life she was living, pointing to the yes she was afraid to be. I accepted the resistance she feared I would reject. In this mutual acceptance, the grief flows as a lie dissolves: the lie that we are not lovable. Jon Frederickson. 

But Jon - how did she understand what happened?

Back to fantasy, or rather, the art of engaging imagination. Fantasy is incredibly powerful, a person's irrational and intrusive thoughts can so disable him, that he can no longer eat or drink, and can only shake in fear because if he gets it wrong, he is certain it will cause something catastrophic to happen. Truth doesn't set him free. He already knows that his thoughts are crazy, adding a fear of mental 'illness'. Now he has more fear and this time he knows the problem is him - fear of his mental state! Telling him, 'its only thoughts ' can't help him. His thoughts are too powerful.

What will help is if others accept the truth of his fear, and the power of thoughts. This enables real contact between people, and trust to develop, and perhaps a reparative relationship (!) will help over time. But I don't see relationship as the key.  

We only have only six sessions..

Contact with his reality has to be made from the language of his reality.

And his language is fantasy.

So, how do I use fantasy?

Let's start with the most practical of all SFBT questions "on a scale of...." I used to really struggle with the scaling question. The scaling question makes us sound all CBT when we explain it. But, this is useful because certain powerful fund holders love CBT! So we will forever describe it as if it is a worthy companion to the GAD 7, or PHQ.  I prefer to work with complex and emergency cases. Clients attending such services don't have to pay for therapy, but I need a wage. So I don't argue when sfbt is described as goal setting, exceptions, miracle question, scaling' - as if SFBT is a magic machine, akin to a medical procedure.

But at first, those scaling questions did not come naturally. So, what changed, or rather what enabled me to use the scaling question? 

Basically I started plugging client metaphors into the scale. 

Using metaphors is non-standard, non-canon, and crosses into the domain of Narrative therapy, and 'clean language'. 

And it could sound like this. 

"If you had got this, let's say if you were at a ten, where ten is perfectly able to get through all this. What would you be like, what's a version of you at a ten, like"?

This is 'miracle question lite'. But instead of sfbt Brief style, this question is not requesting a concrete, 'granular description. Instead it is a 'clean language' question, seeking the quality of an experience.

For example:

Me: "What would you need to be  like<pause> to be more the version of you who has got this?"

Client: "Ooo, the version where I've got this? <pause> I'd be more Swans!"

Me: "Wow, OK - so if being perfectly Swans is a ten, what number do you put yourself at now?...< note, therapist doesn't need to know what being more Swans means>

Client: "How Swans am I right now? Not much. <pause> about a 2...

Me: 2, OK <positive inflection to tone of voice and facial expression. I sound pleased> so <pause> how come you are not at a zero, I mean what is it about you that means you have that much Swans already?

Client: Well, that's a really hard question! But, yes I am still digging into the edge of awareness, imaginary, fantastical realms. I'm not giving up...I sound determined, and dramatic, and I frighten myself! Swans are scary, and powerful. loud too. But in a safe way! <laugh>

Yes, I'm talking about me, and I love these kinds of scaling questions with clients, their answers are rich and express so much emotion, image, feelings; insight. A scaling question with an image, or sound, or...anything, can be a wondrous thing! 

It is, of course, a key...

A key for the person to open up memories, dreams and reflections that give clues as to how they are already doing what they need to do - and can now focus on being more...

More Swans!

Some forms of therapy have a distressing habit of placing the problem in the person.

The problem is accidently - or purposefully - allowed to be interpreted as a reflection of the person's identity. 

Clients arrive with statements about themselves that begin with "I am"...and that particular I am is often a condemnation, almost an insult, 'I am....anxious, depressed, ADHD', unable to do anything right'. 

And I'm not saying that you are not, but the only thing we know for sure is that everything changes. And the present way of thinking, feeling, seeing describes the landscape, not your whole life, not even your future life. 

I'd probably ask you what kind of, X this not so good is - so you become the owner of the definition, rather than the proof of someone else's pet theory. I'd ask how it affects you, what are it's habits, so it becomes a something that has come to live in your life, because I have no rational reasons to believe that it defines all of you.

In my scaling question, I'm saying tell me who or what you know yourself to be, and want to be more of for the next part of this journey...My role isn't to enlighten you, I'm not here to cure, or change you. 

I'm just a catalyst.

Ok, as I write this, thoughts about Eros are fermenting and clarifying...

In my next post I will take a look at the process of sublimation, revisiting 'the reparative relationship '!