An open letter…The margins of therapeutic practice

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To: All practitioners working at, and in, the margins of mainstream structures.

Last year, I presented a paper at The British Association of Dramatherapists’ Annual Conference, exploring the dynamics of visibility between margins and mainstream. I presented and reflected on my work as a therapist in a marginal profession with a marginalised client group, HIV+ gay men. I defended that more must be done to move Dramatherapy and the work that we do as a profession, from the margins, to the mainstream.

I am here now, to challenge and dismiss that assertion, and to accept, embrace, and own my place at, and in, the margins of therapeutic practice.

Some of the most common feedback I receive in my sessions goes like this:

“I was really anxious about this session, but I feel so much better now. I don’t know why.”

“What we did last week really shifted something in me, but I don’t know why or how.”

“At first I thought this was weird, but then it made sense. I don’t know how to explain it.”

Do you notice anything about those statements?

Yes, they all include “I don’t know” why, how, what, etc. And guess what? Most of the time, I don’t know either.

Now, let’s look at this scientifically.

In fact, let’s not. If I wanted to be a scientist I would have studied Psychology or Psychiatry. And not to say anything in particular about those disciplines, but I studied Dramatherapy. And that’s that.

I never had a scientific mind, or enjoyed that process very much. I was always a “feelings” and “energies” type of person. I could always sense things and knew them to be real. Could I prove it? Not really. Did I feel the need to prove it? Not at all. Why? I always felt that an authentic connection between people did not need a piece of paper to validate it.

I read clinical articles sometimes and think “What else is new? Tell me something I don’t already know!” Now, I completely understand and value the process of rigorous methodologies and studies in order to prove something, and create the necessary robustness that a health care profession needs in order to be registered and protected. But I never felt the need to go through those processes myself. I’m currently writing my first clinical article, and the headaches this is giving me are quite something. The idea of finding theories to prove the dynamics of human connection, is frankly stressful. I know, crucify me already!

However, somehow in between the beginning of my training as a Dramatherapist, and my current work almost two years post-graduation, I have found myself trying to be part of the clinical psychology establishment. Me! Of all people! Me, who has always pushed against established ways and systems.

Yes, for the past few years, I have found myself trying to seek the validation of senior clinical teams who demanded evidence-based research for my work and approach, and for years I have endured this fight with openness, poise, and willingness to learn. And yet, I have continued to be on the losing end of that fight, and I have finally understood why: I have been trying, mostly unconsciously, to make a marginal and relatively new therapeutic approach part of the established mainstream. And I have been trying to do this on my own, in my little corner of the Dramatherapy world.

Thus, after a renewed demand that I stop using the term Dramatherapy because there is no evidence-based research for drama as therapy, I finally decided to claim my own boundaries, and respectfully said no. No to this demand! As a registered and protected title, a Dramatherapist IS a therapist, and it is my professional and legal right to use it. Moreover, I will cease to attempt to be part of the mainstream, because, guess what? I doubt Dramatherapy will ever be part of the mainstream therapeutic establishment. And for the first time since I have started studying and practicing this approach, this is perfectly okay. I have experienced this recent situation as a classic case of “I’m not good enough.” Somehow, I have felt inferior to other psychological therapies, and this has been my drive to be part of, to be accepted, and validated by the more established professions in psychology and psychiatry.

And, if I may say so, I sense this is a general feeling amongst the profession. Not consciously, per se, but if I have been experiencing this, I can’t be the only one, right? I still remember a few years ago at the AGM of our professional association, there was a motion to seek out accreditation from the BACP (Counselling and Psychotherapy association), and a member of the community stood up and asked why we needed such a thing, if we were already a registered and accredited profession? I think this has stayed with me until now, because now I get it. Why, indeed? If we are strong, authentic, and boundaried enough in our conduct, why do we need others to tell us what great work we do? And if we don’t think we are good enough, then let’s all look at that, and have a conversation about it.

I can honestly say that it was a rude awakening this week to realise that, actually, I didn’t think I was good enough all these years of studying and practicing. That a part of me carried the belief that Dramatherapy was not good enough. That perhaps other professions had a point of challenging every single one of my moves and decisions. As I was going through my process of awakening this week, this anonymous quote came through on one of my social media feeds:

“Stop asking why they keep doing it and start asking why you keep allowing it.”

And then it all made sense. It’s not just that people keep challenging my profession and training, it’s also that I ALLOWED IT to happen. I kept accepting their authority without question.

No more allowances on this front. I have put in place a healthy boundary: a boundary which whilst remaining open to new ideas and approaches, is also protecting and taking care of my own approach and my sense of growth within it.

By asserting this boundary, I am saying: this is what I do as a Dramatherapist. I use drama to explore the depth of individuals’ emotional experiences, and facilitate the sustainability of long-lasting change and fulfilment in their lives. No more, no less. No comparisons to other professions and approaches. No further explanations. This is it. I experience the value and worth of my training and talents on a daily basis, by the feedback I receive and transformation that I witness. And that is enough for me!

I choose to focus on causes. On people. On human connection. On compassion. On experience. On living, and thriving. And this is my commitment to all my clients, and myself.

 

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Reflexions…On the Duration of Therapy

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I have recently experienced a shift in paradigm, in relation to how I experience therapy. I experienced this in the context of my own personal therapy, and I am currently questioning many aspects of my training and practice – which is both frightening and exciting!

For the sake of context, I studied and trained to become a Dramatherapist for 3 years. One of the requirements of that training was that I needed to be in personal therapy throughout that period of time. This included group and individual therapy. Both of those experiences were long-term: I spent 30 weeks in group therapy, and the remaining 120 or so weeks were spent in individual therapy.  Say what you will, but that is a lot of time to be spent in continuous self-reflection and processing of emotional and behavioural dynamics.

Combined with that experience, is my own experience of my tutors and lecturers, and even of available research, whose presentation of clinical case studies seemed to always feature long-term cases. I am not saying that the content only featured those cases, but the ones who stuck with me were often of long-term therapeutic relationships.

And I must admit, that up until this recent challenge to the paradigm I was following, I wasn’t even aware I was following such a paradigm. This paradigm entailed that effective, long-lasting, and authentic healing therapeutic relationships, could only occur in the context of long-term therapy. No one ever told or taught me this, but somehow, through the experiences of my training and studying, I had unconsciously adopted this as dogma. Even though most of my clinical experiences as a therapist have been facilitating short-term interventions! But I recognise now, that I always had this longing to “find” a client with whom I could work with for years. I still do. And I will probably be able to have that experience at some point in the future.

But this is not a debate between long- and short-term therapy. This is simply an awakening, a new perspective, and the curiosity to see where this may lead.

It is very poignant that the first question someone submitted to my “Ask the Dramatherapist…” feature was about uncovering old wounds and the potential negative effects of such actions in a therapeutic setting. I wrote in that post that, often, old wounds are uncovered unexpectedly. That dealing with something here, will trigger or awaken something else over there. And that we won’t know that will happen, until it happens.

This is what happened to me recently. I received some life-changing news in May 2016 and decided to go back to therapy to process the information and its manifested and potential effects on my life moving forward. In the process of doing this, a very painful and traumatic memory re-emerged from the depths of my unconscious and demanded to be processed for the first time in two decades. I had not planned this at all. In fact, I had “worked” so hard at keeping it hidden that not even the intense psychological process of studying Dramatherapy for 3 years had come close to unblock or shift certain life experiences. They were carefully and deeply locked, hidden, and mostly forgotten. The psychological split and disassociation around this experience were very effective.

But then, May 2016 happened. And many “problems” became irrelevant. I was able to finish many chapters, close many stories, and retire old roles that had overstayed their position in the spotlight. Many layers were peeled, which left the core exposed. I felt incredible relief at this purge of old personal narratives, but felt equally apprehensive about the core. I had never addressed it, let alone give it a voice, or time and space. Now, I can easily run away from something if its presence is faint or mild, but if it’s staring me right in the face, I tend to just go for it.

And so, in open and honest discussions with my therapist, I decided to engage in intense trauma work, using a technique and approach called EMDR (Eye Movement Desensitisation and Reprocessing), often used with PTSD to reduce the long-lasting effects of distressing memories, by engaging the brain’s natural adaptive information processing mechanisms, thereby relieving present symptoms. In EMDR, in careful agreement with the therapist, the client chooses a, or the most, painful memory they have about a specific event, and reconnects to the feelings it created, the messages it produced, and the effects it had. Whilst recalling all of this, the client receives one of several bilateral sensory inputs, such as side to side eye movements. I will let you conduct further research on this, if you are interested.

The main point, however, is that through EMDR, I was able to experience the memory differently, in the sense that the feelings it created, the messages it produced, and the effects it had, changed. Not dramatically, not completely, but they changed. And this shift has had a profound effect. And for Dramatherapists reading this, as well as other professionals working with psychodynamic approaches, you will hopefully understand when I say that I cannot explain what the shift was. Only that there was a shift, and that I feel different, lighter, and more relieved. Somewhere in my unconscious, the perspective of this event changed. And this happened within 8 weeks of treatment.

The week after a particularly intense session, I sat down with my therapist and she asked me where I would like to go next. And even though she didn’t verbalise the different options, as a therapist myself, I felt what they were: to stop or to continue. And this is where my paradigm shift happened.

I knew I could continue. I could choose more memories – and trust me, there are a ton of them now! – and continue to follow that process. But like I said earlier, there was something different in me. Reprocessing that particular memory had shifted how I perceived other memories, how I perceived myself and my role in my own life.

We had purposefully agreed to meet two weeks after the intense session, so that I would have time to process it, by simply living my life. And as I started living my life more openly, freely, and emotionally, I realised that I was okay. At least, for now. And that, right now, I didn’t need to continue reprocessing memories, even though I could. And this stopped me in my tracks: I could continue, but I didn’t need to. I didn’t need to continue with this therapeutic relationship, because, right now, my catharsis was enough. And I didn’t need to continue to prod, analyse, investigate, explore. In fact, I didn’t want to. I had spent two decades trapped by something I couldn’t even recognise, and now that something was no longer there. All I wanted, correction, all I want, right now, is to simply live my life. To start new chapters, new stories, and allow new roles to take centre stage.

This is not a defence of anything in particular, simply a sharing about a shift in perspective. That therapy doesn’t always need to be long-term. That profound catharsis and change can actually occur within a short period of time, and that both experiences can be equally valid.

This is a commitment to follow my curiosity in what feels like a brave new world to me: could my Dramatherapy practice enable this as well? What can I do to be more effective in my efforts to facilitate long-lasting change in the context of short-term therapy interventions?