[Gareth]

Benjamin,

Well, here is my update. It has been quite an eventful month since I last wrote here. I will also post this on the open forum as perhaps some of the insights might be of use to people who are even newer to the whole therapy thing than me.

I keep coming back here because it was your ideas that first significantly helped me, and provided a basis for my further thinking. I do hope that the following will be of interest to you. You did ask me to let you know how things were going and which therapies I found useful, so here it is!

I have now had some counselling, psychotherapy, and Cognitive Behavioural Therapy, and to me it seems that the most unhelpful part of seeking help is that practitioners are often in polar disagreement over certain very fundamental issues about treatment. I have done extensive and exhaustive reading and research into the ways that the mental health profession would describe, categorise and treat the thing that is wrong with me. At least for my symptoms, there seem to be two communities of thought ñ quite opposed to each other in belief and approach. The ìlifestyleî community and the ìtherapyî community. After seeing a little of the work of each of them, my main impression of the past two months or so is that it seems to be a terrible shame that there is not a more integrated approach.

Up until Friday of last week, the outline of my week was four sessions of work; two with a trainee psychotherapist from the Association of Independent Psychotherapists, one session with a counsellor, and one with a Cognitive Behavioural Therapist. I quickly reduced these sessions to only 2 weekly sessions with my psychotherapist, for the reasons outlined here.

Counselling for me was a volatile experience. Having never really opened up to a stranger before, and finding the stranger that I was talking to so easy to talk to, and finding that I had so much to say, the process was a major head and heart rush in the initial weeks. To make it worse, I was only able to see my counsellor once a week, so would attend a session and then be emotionally in turmoil for 7 days, irritable and jumpy, the equivalent of a flooded river that has its waters released for a second and then pegged back by a dam almost immediately. The sessions had unexpected and powerful effects as a result of her being so overwhelmingly caring and compassionate. Given that my problem seems to be the chronic suppression of emotions since the age of about 14; the hands-on, emotive style of counselling was a good first step ñ it was the beginning of feeling. If my emotional life had ended at 14, which seems to be the case, then perhaps this was the re-awakening of some kind of new emotional lifeÖ applying electricity to the body of a zombie.

After 5 sessions with my counsellor I began to see a CBT therapist once a week and a psychotherapist twice a week. My impression of the work with my counsellor is that we were already beginning to go around in circles, concentrating too much on the here and now and how I was ìcopingî day to day. So I essentially replaced the work with the counsellor with the psychotherapist, and my focus came down to that and the CBT work.

My psychotherapist is less immediately compassionate. She is not concerned with how I am coping day to day ñ she seems instead to want me to reveal my true self, to her and to myself, and slowly and gently she is trying to make me experience emotion and therefore relieve the weight of suppressed trauma that has been pressing down on my psyche for many years. She seems to have a ìtechniqueî, even down to practised facial expressions, ways of moving her body and hands in response to particular things I express, and also, more importantly, certain beliefs in certain concepts that leak out of her into our discourse. I find this a fascinating process. It is very interesting to me the extent to which the client needs to ìsign-upî to their therapistís beliefs in order to get the most out of the process. If I did not believe that the events of my childhood had affected me in some very fundamental ways, and that by the release of my trauma through talking and experiencing emotion related to the past, then there would be no point in me turning up to talk to my therapist.

After the explosion of emotion in those first weeks of counselling, psychotherapy was a good next step. I was feeling pretty raw, and taking things down a notch on the emotional front, and employing a more diluted, less messy, more structured approach with the psychotherapist has been useful. My therapist seems to find me interesting and surprising (there are many raised eyebrows, wry smiles and surprised pauses), and I get the sense that she enjoys our sessions. I think I am enjoying them, until I leave, and then I begin to feel the things that we have been talking about. The real work is done outside of the room, and the next day after a session is usually awful, where I am adrift in a tumultuous ocean of unresolved feelings. The end results of this process always seem to be about what you donít expect, rather than what you do.

I have also had some sessions of Cognitive Behavioural Therapy, which, to be blunt, I found quite useless. I wonder if this is because of the ìlightnessî of the approach, (by that I mean it seems to have no meat on its bones), or that I was unlucky in my choice of therapist, but I have to admit that I was disappointed that CBT was not the holy grail of symptom tacklers that it claims to be. Cognitive Therapy was alluring and seductive to me, as someone disturbed by anxiety symptoms to the point of concentrating on them singularly. There are claims made that the therapy will be able tell you what is wrong with you, and secondly it claims to be able to control what is wrong with you to such an extent that you get your life back to a stable state. The further claims of the CBT profession is that misconceptions about it being all technique and no compassion, and that the CBT therapist will not be particularly emotionally supportive to their client, are misfounded. My experience of CBT is that these claims are completely founded in truth. However I am also aware that this is probably more to do with the individual practitioner than it is the practice itself.

For example - the CBT therapist I saw asked me some questions about my past but didnít seem particularly interested in it once he realised that I had not experienced physical or sexual abuse or parental bereavement. We spoke briefly about the concept of ìtraumaî (at my prompt) and he was fairly dismissive of this, in fact quite dismissive of any emotional involvement in my symptoms whatsoever. He stated that he did not believe what happened to me as a child could qualify as trauma, that it wasnít enough of a dysfunctional situation (despite the fact that my parents fought loudly for years from when I was 10 years old, often keeping me awake and fearful, my father left when I was 13, when I was 15 my mother attempted suicide as a result of me continuing to see my father against her wishes, I found her body and thought she was dead, and I then dragged her through 3 years of her nervous breakdowns and depression, completely alone). It has taken me a long time to get to the point where I could admit that these circumstances were enough to cause my recent anxiety symptoms. The last thing I needed was someone telling me that I didnít qualify and I was merely a ìworrierî!

I come back to my point about subscribing to the therapistís beliefs to get something out of the process. In order for me to try CBT out properly, I had to go to the sessions abandoning any thought of any emotional work that needed to be done, and that I now knew had to be done. I was therefore going into the room to treat only one side of myself; my conscious mind, my lifestyle, my thought processes. This is the end felt disingenuous and something that I could do on my own, for my particular problem. I understand that many people would not feel the same, and that it will all become a matter of emphasis. This is where I began to daydream of a truly integrated approach.

The most useful message that I got from the CBT is that alongside all the soul-searching and emotional work, recovery is also about a daily practice ñ it is about lifestyle changes and doing the little things (doing them well and doing them often) that can go a long way to making you feel more prepared and more focused to challenge the real emotional work that needs to be done (i.e. the emotional work). The problem with the CBT approach is that they seem to be telling you that these daily practices (deep relaxation, exercise, improved self-talk, challenging distorted thinking) ARE the real work.

Surely the integrative approach is to see a therapist who will teach you techniques of symptom management initially, work a little on your conscious mind, and then begin the real emotional work with you, and provide regular reviews on the practice of the lifestyle techniques while the real work of psychoanalysis is on-going. They will in effect coach you through your difficulties, but in a way that places the primary emphasis on working through the core emotional issues. This surely is treating the whole problem, and therefore treating the whole person? Everyone could benefit from relaxing more, exercising more, learning about the cognitive processes of their conscious mind ñ the end result of all of these things is a freeing up of energy which can be used on the process of a proper self-examination, and in the final analysis, a releasing of trauma from the mind/body.

While the processes of CBT are not enough, I also do not believe it is enough to be just sat down on a psychotherapistís couch and immediately to launch into an in-depth examination of the self. The therapist simply does not know enough about who you are, how you live your life, your levels of physical health, the things that you believe in (not just about yourself but about the world in general), and also, does not know what you believe about the processes that you actually engaged in. You wouldnít go to a tarot card reader if you didnít believe in or understand tarot cards, so why do we go to psychotherapist without a true understanding of the process, and without a discussion with the psychotherapist about what we do or do not believe when we initially sit down? The therapist, or coach, has a responsibility to make the process much less of a ìdark artî, and treat people, at least initially, on the basis of the clients beliefs rather than their own. Somehow we are expected to trust in the innate correctness of the therapistís ideas. There is an arrogance there that I feel could be diluted successfully to make the process more effective in its initial stages.

I guess what I am talking about here is an in-depth psychoanalytic process that includes elements of cognitive behavioural therapy, at least at the start, rather than a cognitive approach that seems to be attempting to ìtag onî psychoanalytic work and emotional support to the end, once the individualís primary symptoms may be in recession. Both therapies seem back-to-front to me. Instead of the ìtop-downî or ìbottom-upî method, how about a ìparallel lineî approach?

For me, through exercise and meditation, and, bizarrely and most unexpectedly, gardening, I have found some kind of beginning of an inner peace amongst the chaos of my emotional and mental turmoil. It is the practise of finding the thing that will help you that I believe needs to be taught in this ìcoachingî ñ through painstaking trial and error if necessary. Action and involvement are the routes to happiness. Inaction and procrastination are the devils that we must defeat, and the antithesis of a proper emotional examination of the self.

The most staggering and in some ways beautiful thing about this whole breakdown/recovery thing, is how joined-up it all is, and when you are on the receiving end of some kind of extreme high or extreme low, and you are able to relate it to what has gone before, all you can do is stand back and observe the wonder and beauty of the mind/body, conscious/subconscious doing its thing. At some points I have felt like the 12 year-old version of myself, staring in wonder and awe at the internal workings of a grandfather clock, trying to decipher the complexities of it, but the turning of the cogs in the foreground getting in the way and obscuring my view of the real workings behind.

In your book, the final chapter on God has become the most unexpectedly interesting for me. This idea of releasing ourselves to a higher power that has our very best intentions at heart, of actually glimpsing moments of a larger force at work in our lives, leading and nurturing us, has become a guiding idea for me throughout the entire process. I have actually seen my own versions of the unexplainable phenomena that you talk about in the book, similar to the experience you describe when you felt the arms of your mother around you. Instances of inexplicable and powerful guidance and reassurance that make me believe in things I have never believed in before and that have given me strength to go on.

Dreams have become a very important part of that as well. I unfortunately donít tend to remember my dreams, but received a telling and powerful message from my subconscious a few weeks ago in a dream. The story is as follows.

In a counselling session I had spoken with my counsellor about ìbreaking downî and what this meant to me, how it might manifest itself, and whether I could allow myself to do it. My counsellor wondered how I felt about ìbreaking down in order to break through.î The idea has always terrified me. In my conscious mind, breaking down means losing everything. After the session, my wife and I went away for the weekend. I was in a foul mood for the entire weekend, constantly feeling on the edge of snapping, irritable with everything, jabbing myself with anger at the world, not wanting to participate in the fun. I told my wife that it was in fact her attitude that was ruining our weekend, and used her shamelessly as a convenient shiny surface onto which to project my misery. In a fit of self-pity I ruined our weekend away, but only realised this days later. I have made my apologies.

On the Sunday night, for some reason I chose to re-read the chapter in your book about God. I didnít sleep a wink that night, tossing and turning in angst and fear, feeling the very worst of my symptoms throughout the night. In the morning I had the breakdown that I think had been coming for some time. In my sleep deprived state, at the moment I pulled myself from bed, the whole universe and everything in it, most importantly my own mind, seemed black, broken and forever ruined. I became convinced of the irredeemable nature of my own deep insanity, and the fact that I had brought it all on myself, how my own actions were entirely to blame, and how it was I who had destroyed my own life. There was no way out, no way back, I was a lost cause, and I should resign myself to never having the life that I want, to having lost my chance for peace. I physically and mentally collapsed, alone and petrified, with nowhere left to run to.

I was on the floor of my bedroom, shaking, crying, staring into the jaws of the bottomless pit of my own despair. Without thinking consciously of what I had been reading the previous evening, I for the first time in my life prayed to a God that I have never believed in. I screamed at God, bemoaning the unfairness of my situation, demanding to be given my chance, the same chance everyone else gets, to live a happy life, and begging for some intervention to pull me through. Finally, drained, I sat quietly on the end of my bed, numb and empty.

I went to work and dragged myself through the day. That night I slept well and dreamt. My dream was that I had been given the task of teaching a group of people how to swim the English Channel. The activity in itself holds no significance to me personally, Iím not a strong swimmer, nor do I have any particular interest in swimming or fear of water or anything ñ swimming the channel is just something that I imagine would be terribly difficult.

The key part of the dream was my detailed and thorough explanation to the people whom I was teaching that, although this would be the hardest thing they had ever done, that there was one important thing that they must remember. That halfway across the channel, in some of the deepest, darkest, and most ferocious of waters, there stands a sturdy wooden pole, firm and solid, vertically embedded deep into the ocean bed down below. This was to be their resting point. They must find it, they must cling to it, they must breathe and regain their strength, and then they would be ready to face the final exhausting and painful swim to the shores of France. A neat little message from my subconscious that the respite I was craving was on its way perhaps? That all I needed to do was swim on, rest, and then swim on, and that an end is indeed off in the distance, and that end point is in fact land, the most stable of all things on earth.

Writing this Iíve only just realised something. I am going on holiday to France in July, a destination I have never chosen before and has never particularly interested me. I wonder where the choice of that destination came from.

Gareth

[Benjamin Fry]

Gareth,

Without fear of contradiction I think I can say that you have a gift that should not be wasted. You combine in your writing everything that you hope for from a therapist; research, knowledge, skill, balance, openness, compassion and inspiration. Your summary is useful, informative, personal, moving and was a delight to read.

I suspect that your conclusions about therapy are largely correct. I personally like to work with both the ìtop-downî and ìbottom-upî, with a key emphasis (especially for television) on taking action and not just talking. Gardening is a great example. Getting oneís hands in the earth is the perfect metaphor for finding the kind of solid roots that anxiety feels like the opposite of (you describe land as the most stable of all things on earth).

You might consider submitting this piece of writing to magazines and newspapers that cover these sorts of issues. I think your research and balanced conclusions would interest many people who struggle to find the help they need. You might find some personal satisfaction from writing about these issues that would help you to feel more professionally rewarded.

Iím glad you had the resources and courage to experiment to discover your optimum process. Many people donít think to do so, or canít, or just donít bother, which is a shame.