Screwtape therapists
“The Enemy [God] allows this disappointment to occur on the threshold of every human endeavour. It occurs when the boy who has been enchanted in the nursery by Stories from the Odyssey buckles down to really learning Greek.
It occurs when lovers have got married and begin the real task of learning to live together. In every department of life, it makes the transition from dreaming aspiration to laborious doing.” (Lewis 1942)
My main professional career was as a psychiatric nurse. I was involved in mental health work for some thirty years. From the start, I was interested in going “behind the scenes” of psychiatry. I wanted to know who this person was who I was nursing. I never cared much for diagnostic labels, preferring R.D. Laing and the Black Papers in Psychiatry to ICD 500 and the latest shiny material from our drug reps. I came to share Laing’s view of things “There is a great deal of pain in life, and perhaps the only pain that can be avoided is the pain that comes from trying to avoid pain. ” (R.D.Laing)
This view was not always seen as “helpful”. It was not part of a nurse’s role to try to understand my patient. We were there to give out the medication to help them manage their psychotic voices. To help them with their delusional beliefs by giving them their prescribed drugs. It was not our task to try and find a shared meaning about the function of their psychotic voices. Nor to try and unpack whatever lay behind their delusions. Some nurses tried to do this. Mostly the system made it very difficult to find enough time to sit with a patient long enough and often enough to do any kind of talking work. (In the nearly thirty years since it was published Menzies’ work on Organisational defences still stands as true.)
In time I began to create spaces for myself in which I could do the kind of work I enjoyed. I became a Community Psychiatric Nurse who left me free to run my timetable. I would table in slots where I could spend an hour with some of my patients “doing therapy.” This did not go unnoticed or unremarked. I was talking to a junior doctor one day and introduced myself. “Ah! You’re the nurse who does psychotherapy.” Pause. “I’d be careful if I were you!” I never got round to asking what it was I was doing that was so dangerous.
I then took this work further and negotiated a role for myself as an Honorary therapist in the Trust’s psychotherapy department. I spent an afternoon a week there, listening to the staff’s concerns about how they felt the wider Trust perceived their department. (There were high levels of paranoid anxiety.) In time I was allowed to take on a couple of patients for once-a-week
psychotherapy
. More of this later. I’m now going to make a small but important digression.
I’ve recently seen the new Marvel D.C.film “Capt. Marvel.” I spent the first 50 minutes wondering if I was going to leave. It’s nothing but special effect after special effect and a bewildering array of flashbacks, flash-forwards, fights and explosions. All leaving me, at least, irked, bewildered and confused. Who was the goodie here? Was that a real cat or a shape-changer in the form of a cat. (Shape-changers are an important part of this film. In some ways, it’s a good model for psychotherapy. How does one find a clear route through the multiple selves with which our patients present themselves?)
After a while, I settled down, shook off my irritation and enjoyed the film. It concerns Carol Danvers, a former member of the United States Air Force who is transformed into Captain Marvel, a Kree warrior who is fighting to save her people from the Skrulls who are set on world domination. At some point in her journeying Carol Danvers develops a “ fist of power”. Her right hand possesses and can harness great force.
Throughout the film, she uses this to protect herself and others. Until in one sequence she discovers that her power can be taken from by others- notably the Skrulls. Ownership of her power is a theme that runs throughout the film. She is constantly challenged to own her power. To believe that it is hers and that she is potent. Her control is sporadic and is mainly used when in an extreme emotional state. Thus in a duel with one of her Skrull enemies she loses her power. She is mocked by the Skull warrior for being so easy to disarm. What others have given her, he reminds her, others can take away. At this point, she finds her power. She believes in her strength and potency. From this comes a new ability to use her power with both hands. Inch by inch she defeats her opponent, now being able to use her power on her terms. (This film needs a good feminist critique!)
So, what does Capt. Marvel have to do with psychotherapy? The brief for this piece was to write something to a new therapist or a younger version of me. I wrote earlier that my main career has been as a psychiatric nurse. Albeit one with interest in analytic psychotherapy. I was comfortable in my nursing work. My identity was established. This allowed me to work well with some very challenging patients. So, when I went to the psychotherapy department, it was as Terry Burridge, a psychiatric nurse. The problem was that like Carol Danvers; I found myself disempowered. My control of my skills was sporadic. Sometimes I felt potent and effective. At other times I felt useless and unskilled. What was I doing amongst all these powerful psychotherapists? I was just a young child pretending to be a grown-up. I didn’t belong here. So there were times when I could control and use my power. Times when I felt it had been taken away from me by others. It was not an altogether enjoyable time. Like Carol Danvers, I often felt disappointed in myself.
I remember my first psychotherapy patient. He was not particularly difficult to work with. A young man with some issues around depression and anxiety who had I seen him in my nursing role, I would have managed very well. He was rewarding to work with. Or should have been. The trouble was, I wasn’t now a nurse. I was a Psychotherapist (with a capital P!) This meant I had to “do” psychotherapy with him.
Whatever that was!
I remember sitting in my treatment room talking with him. All around the room I heard psychotherapy’s ancestral voices. In one corner I heard Freud telling me that my patient’s issue was the conflict between his id and his superego. Klein joined in from another corner telling me this was all about the primal scene. Winnicott chimed in behind me reminding me to find about whether he had had a good enough mother. This chorus was orchestrated, in my mind, by the departmental manager whom I felt had a very low opinion of my skills. It was a miserable experience for me. I don’t know what my patient made of me!
This went on for some weeks until one day I consciously exorcised these ghosts. I sat in my chair and banished each of them from my room. “ This is my patient. I am his therapist. We will do things on my terms. For Good or for Ill. Thank You all for your contribution. Now ‘Get Out’!” There were problems with the work — problems which now I could manage much better and think about more creatively. I had, like Carol Danvers, found my power in both my fists. I was not going to allow myself to be disempowered again. Or not by my fears and anxieties at least. Val Wosket has this to say about the therapeutic use of self.
“As clinicians and researchers more frequently argue that the primary vehicle of change is the quality of the relationship between therapist and client (Cooper 2004; Mearns and Cooper 2005), so interest in the therapist’s use of self has grown. As a consequence, a discernible degree of attention has moved from examining the techniques that may account for the change to studying what it is about individual therapists that make them able to effect change – more who, rather than what is effective (Aveline 2005; Hemmings 2008).” (Wosket 2017)
This, of course, was what I had to learn. In my nursing mode, I knew who I was and how to make the best use of “me”. It worked well and helped me through some difficult situations. Many dangerous confrontations were defused because my patient knew me and, fundamentally, trusted me. Even if at that moment he wanted to kill me. (It wouldn’t have been personal, I’m sure!) As a wannabe therapist, I lost myself in a maze of theory, aspiration and uncertainty.
So, my message to my earlier self. To any therapist just starting on the journey is, remember you are your greatest asset. This extract from the film is pertinent.
“[holds up her fists]
Carol Danvers: What is the point of giving me these if you don’t want me to use them?
Yon-Rogg: I want you to use them. The Supreme Intelligence gave me the responsibility of showing you how to use them.Carol Danvers: I know how.
Yon-Rogg: Well if that were true, you could’ve knocked me down without them. Control your impulses.
[he points to her hands and then her head]
Yon-Rogg: Stop using this, and start using this. I want you to be the best version of yourself.”
This sums up =my paper. “I want you to be the best version of yourself.”
Bibliography
Lewis, C.S. The Screwtape Letters Geoffrey Blis 1942
Wosket, V. The Therapeutic Use of Self Routledge 2017
Marvel.Com Captain Marvel 2019
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Terry is a qualified Counsellor, based in Aylesbury, United Kingdom.
With a commitment to mental health, Mr Burridge provides services in English, including Counselling.
Mr Burridge has expertise in Anger Management Issues, Anxiety Disorders and Depression.
Click here to schedule a session with Mr Burridge.
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