‘The Relational Approach’, or ‘Its People Who Fuck You Up And Its People Who Help You Get Better’.

I didn’t wake up one day with a severe shortage of serotonin in my body and all of a sudden, for no obvious reason, become depressed. I have depression because I was abused. Mental illness is caused by trauma. We may be able to explain our feelings broken down to the chemicals which are or aren’t floating around in our body in recommended quantities, however to see mental illness as only a chemical imbalance is to miss the entirely human factor of it. We don’t live in a bubble. We hurt when people hurt us.

Sometimes its not even obvious that we have lived through trauma, for example we may have a disorganised attachment relationship with a parent or carer during our formative years. Sometimes trauma is more obvious: we lose someone close when we are very young, or we are neglected or abused. Whatever trauma may be the cause, mental illness happens when our relationships with people don’t go as well as they could, or sometimes are wildly different to how they should be. I’ve not met a person with a mental illness who can’t relate to at least one trauma in their life. Of course all of us live through some pretty tough shit, but not all of us become mentally ill. That isn’t to say that the tough shit isn’t the main causal factor of mental illness, although its certainly possible that other factors can make some more susceptible and some more resilient.

Mental illness manifests itself relationally too. Whether its our relationship with our self (our ourselves, in some cases), or our relationships with others, mental illness changes things. This is perhaps most markedly apparent in the cluster of traits known as Borderline Personality Disorder. The deep interpersonal difficulties people with this diagnosis experience just screams out the obvious: the problem is rooted in earlier experiences of relationships which were confusing, turbulent, hard to pin down or make any sense of. Now, their own identity is hard to suss out, and their relationships with others swing between idealisation and devaluation. We live what we learn, to simplify it down a little bit.

And just as it is people who fuck us up, it is ultimately people who can help us get better. Medication may or may not help plaster the wound for a while. Motivational posters can get us so far. But what really brings about lasting healing is a positive relationship with an individual, sometimes a friend, sometimes a partner, often a therapist. This relationship is boundaried, unlike the abuse where boundaries were blurred, or discarded entirely. The relationship is consistent, not like the abuse where it could blow hot and then cold, sometimes being told how special you are, sometimes being threatened in order to keep you quiet. And the relationship is transformative, just like the relationship which caused our problems was, but this time the change is for the better.

One of the hardest parts of being a therapist is trying to both convey genuine empathy at just how hopeless and dark things are right now, but also hold the hope that things can get better – for me, I hold this hope not from naive optimism but experience.  I spend most of a session really relating and holding space for just how crappy the emotions unlocked during recovery are. But I also express how much I care about them making it through the darkness, and that I truly believe that the darkness will end, even though it doesn’t feel like it right now. And this is when the relational approach really hits home for me. These sort of words are empty if they are just read in a self-help book or a motivational poster. They are even empty from a therapist, at first. But when they come from someone who you are building a relationship with, they slowly gain a little more weight. Often my therapist has held hope for me. At first I thought he was another do-gooder trying to say nice things. Now I trust him when he says he cares and encourages me to keep on keeping on.

Its not so much what I say but what I do and who I am as a therapist that matters. And that’s why therapy is a long haul process not a quick fix. Short term talking therapies can certainly be helpful, but any lasting change in our lives comes when we form a relationship with someone and are changed by the positive qualities of that relationship. It is both liberating and fills me with a deep sense of responsibility. I don’t have to give the perfect response to everything my clients say. But I do have to be consistent, kind, compassionate, honest, genuine, and all the other qualities which can help them to repair from the damage which occurred earlier in their lives. My job is one long journey in learning about me, how I do relationships, what my weaknesses are, and how to better be in relationship with another so that I help rather than harm them. It’s a journey of a lifetime, and its changing me as well equipping me to provide an environment conducive for others to change.

Why Was I Abused? The Most Pervasive Question With The Most Elusive Answer

Perhaps one of the most agonising questions during the process of recovery from childhood abuse is ‘why?’ Why did they abuse me? Why did this happen to me? To sexually assault a child makes no sense to us, and yet making sense of our experiences feels like the only possible way to recover from them.

But we will never know why. I embarked upon a psychology degree with a hope that my ultimate question of why some adults abuse children would finally be answered. The etiology of sex offenders was my biggest drive, but also my toughest dead end. I realised this is because understanding why someone does something is key to justification and forgiveness. And justification and forgiveness are not available to abusers.

“He abused you because he was abused as a child.” “He abused you because he just couldn’t fight these urges that he wished he didn’t have any longer.” “He abused you because he felt powerless and needed to feel powerful.” “He abused you because he was depressed.” Whatever answer to ‘why’ you might find, they are never going to fulfil the function you hope them to serve. Because the why doesn’t make it ok, the why will never mean you can say “oh, I get why you did what you did, and I forgive you.”

There is no understanding why someone abuses a child. There can be factors which contributed to their actions, but there will never be a reason that we can accept, because accepting a reason means accepting their outlook. The very fact we can’t understand why is what makes us a healthy individual. Despite all that happened to us, we can’t imagine what would cause an adult to put their sexual desires over the welfare of a minor.

My clients are desperate to understand why. Similarly to myself at their point on the journey, the lack of any rational explanation for entirely irrational behaviour often sees them turning in on themselves. If you can’t work out what was wrong with the abuser, the next step can so easily be to assume it is something wrong with you, the victim. Indeed the abuser used this technique to ease their own conscience and to silence you. To a question that is unanswerable, blaming yourself can seem the best way to make sense of your ordeal.

They weren’t bad, I was. I deserved it. I brought it on myself. These are attributions that are so much easier to accept than the alternative. I am not bad, they were. But… they were my parent, friend, priest, carer. How can this be? I didn’t deserve it. But then that means the world isn’t fair and bad things happen to good people. I didn’t bring it on myself, I was a child. But then, again, WHY? The only remedy to the endless questioning of why it happened is the brace acceptance of some of the hardest truths. To stop asking why is to stop putting blame on ourselves and instead to leave the blame at the door of someone who we will never understand – and thank god for that fact.

Ritual Bathing: When Abuse Leaves You Feeling Dirty

Baths have always been a dangerous time for my mental health. Like many survivors, ritual bathing and extreme washing became routine for me. Unlike some survivors, I had no idea this is what was going on for me.

Every Sunday night after I was abused, I would run a bath. There were many justifications I gave to myself for this. One was that the bathroom was the only place with a lock and thus the only room in which I would be able to evade comment from my parents about my apparent closeness to my abuser. Also, it was the night before I went back to school, so it was sensible to wash then, right?

Never when I was in the bath did I have the common thoughts of how dirty I was or how desperately I needed to clean myself. There was no conscious awareness of the motives behind my behaviour. Even as it soon turned to scratching every inch of my body, accruing dead skin under my nails, and not stopping until the marks were ubiquitous, I had no actual idea what I was doing. I rationalised my behaviour creatively: apparently the ancient Romans also scoured themselves clean with instruments like blunt knives. See, I was just being historic.

It was long after the abuse stopped that I realised baths weren’t a good time for me. Firstly, when I was in relationships there was natural concern shown for the fact I exited the bath covered in scratches. Also, the slight telltale sign of ending up suicidal every time I had a bath started to make the connection hard to ignore. In the end I realised that baths are not good for my mental health. Without me knowing, I had been trying to cleanse myself of the bad stuff that happened to me, even though I wasn’t consciously aware of that fact.

Even now baths are hard work. I make sure I have them earlier in the day as my mood is prone to crashing at night. I have to keep control of myself so washing doesn’t become scratching. And I never have alcohol in the bath (depressant + depressant = nightmare). I no longer feel like I am dirty or guilty and yet baths are still a hard time for me. Habitual behaviour can become hard to break free from. Especially when you aren’t even aware that it is a result of your trauma.

Making the connection is certainly the first step to taking control. Being aware of why you are doing something means that you have the power to change your thoughts surrounding the behaviour and therefore over time change the behaviour. It isn’t easy. But especially if the trauma is now over, you can begin to self-soothe and remind yourself that you are an adult now. You are safe now. And as such, the behaviours that used to make sense are not helpful anymore. It doesn’t happen overnight and you don’t always get it right. Sometimes my perception of my recovery is my own downfall – I think I must be well enough to have an evening bath by now, and then I end up lying in a bath drowning in dark thoughts. But step by step it is possible to move away from these behaviours and into healthy new routines.

Ghosting Your Therapist

The recently published article, ‘Why Do I Still Feel Guilty for Ghosting my Therapist‘, got me thinking. As a counsellor, I have an insight into the professional frustration of a client ghosting you. As a client, I have bucket-loads of experience ghosting mental health professionals myself. I realised while mulling this over that it all comes down to the relational aspect of therapy. Back when I was a recurrent ghoster, I had zero positive regard for those who were supposedly trying to help me. The medical model saw me as a problem to be solved, or more easily, to be medicated. Therefore the power imbalance between me – a sedated patient – and the professionals meant that there was no form of relationship taking place. And as such, my borderline traits of being absolutely awful at human interaction played out in my encounters with psychiatrists and nurses. They didn’t seem to have basic respect for me, so I didn’t show any respect for them.

The one professional I have never ghosted is my therapist. At first, this was simply because contractually I would be obliged to pay for any session I was MIA from. But it didn’t take long for it to be more than just a financial decision to not ghost him. It was a relational one. He was modelling to me boundaries, stability, and open communication. He was clear about timing, and he was up front about holidays and breaks from our routine. There has never been a power imbalance; while I see him as a highly skilled, highly intelligent individual, I also see us as journeying together. He works with me, alongside me. Whereas the medical model repeats the patterns of the trauma of the past, the relational approach heals it. The medical model puts an adult, often male, in control of my life. They have the power, I don’t. It is disempowering, and how has disempowerment ever led to healing? The relational model gives me an adult male who doesn’t have power over me but instead interacts with me healthily. THAT is what can spark healing, the incongruence of that present with my past.

I’ve realised that as a counsellor I am not modelling as healthy a relationship for my clients as my therapist does for me. While I’ve been praised for being very boundaried, I struggle to communicate forthcoming holidays, projecting my own resentment of my therapist ‘abandoning me’ onto my clients. As such, I invite clients to share in this less healthy relationship. It’s still miles healthier than the experiences they are healing from, but that doesn’t mean it’s my best. Self-awareness is the most vital tool  for a a counsellor to provide their very best. So now I’ve realised the importance of what I model, I can take action to make my behaviour even more healthy, and in doing so invite my clients to share in this. It is not just the words and the manner I sit with my clients that affects them, it is how I deal with the banal, with contracting, timekeeping, holiday management. As someone with a previous borderline diagnosis, this can be a little scary to realise. The diagnostic criteria literally stated that I had chronically unstable interpersonal relationships. But now here I am, responsible for modelling stability to my own clients. If this doesn’t show the extent of recovery that is possible then I don’t know what does. That is why I’m a counsellor.

When Your Therapist Takes a Holiday

I recently took my first holiday from being a counsellor. I found it a challenge, not least because of my feelings when my own therapist takes a holiday. See, everyone knows people need holidays. And I understand (especially now!) how taxing being a counsellor is, and I value my therapist as a person so there’s nothing more I wish for him than the ability to rest and recuperate.

But with the warmest intentions in the world, there’s no denying the fact when he goes on holiday it really throws my stability out of the window. It has an impact on me, and that impact, the drowning feeling of being in the stormy ocean without my lifejacket, makes me resent my therapist taking holidays. I mean, his job is to help me, and there he is abandoning me. One second we are progressing in leaps and bounds, the next I have no outlet for a week, or two weeks, or three.

This loss of momentum is certainly what I was aware of in my own client work. I was so grateful for the progress I was making with my clients, and I felt awful to be putting a lack of continuity in the lives of people who really need stability and consistency. I was prepared for them to resent me: I really didn’t mind that because I resented myself. I felt like a bad counsellor, a failure. I projected my own feelings when my therapist takes a holiday onto myself during my holiday.

When I first saw my clients again after the gap I was keen to let them explore how they felt about the break. I wanted them to be able to communicate frustrations if they were frustrated. I wasn’t very surprised to hear that my clients had experienced the break similarly to how I do. They understood my need for a holiday, they wished for me to have a good time of relaxation, but they did feel a bit left in the lurch, and they felt like they were almost back at square one regarding the therapeutic process.

Opening up to a stranger, or opening up at all, is a gradual process, drip by drip, week by week. To have a gap in that can put you into a state of struggling to get back to that level of exposure and trust. It could take a few weeks to build back to where you left off, to be able to disclose in the way you were before. At first I thought this loss of pace was a bad thing. It feels like it as a client when you’ve managed to start talking and then you clam up again. But as with every challenge, it has huge potential for growth.

When I don’t have my therapist to lean on, I have to go back to leaning on myself. In reality, I am the one who gets me through all but one hour per week. It’s me, my strength, resources, will, determination, or sometimes simple stubbornness. But when you’re at therapy you soon start to feel that it’s that one magical hour that it getting you through, not all that grit that kept you alive to the point you first walked into that therapy room. As a counsellor, I am all about how progress is down to my amazing warrior clients not anything special about me, so why then was I suddenly worried about how they would cope without me?

It was a vital time for learning for me and my clients. For me, I remembered that my clients had got through every one of their bad days before they met me – they have unrivalled strength even on their weakest day. For my clients, I hope the lesson was the same. I am here to help them, and I will do my best to support them and provide a conducive environment for change and recovery, but they made it by themselves before and the progress they are making now is them too. I am just the facilitator. It’s them who work the magic. And sometimes when you have no one else to carry you, you realise the magnificence of your own strength.

When we accept anger just as it is, then we can change.

Today I felt a familiar sensation rising in my chest. My pulse raised, my muscles tensed. My fists and jaw clenched. It’s not uncommon, it’s a feeing we all feel. But then I did something much less common. I thought to myself, ‘I am angry.’

When unchecked emotion becomes conscious cognition, there is a space for a change. The first internal voice to attend to my revelation tried to soothe the situation. “Anger isn’t going to get you anywhere, only make you feel worse. This is not a big deal in the grand scheme of things,” the voice chided.

But the counsellor in me soon took a different tack. Keen to not minimise my emotion but rather welcome it and recognise its cause and its validity, the second voice offered, “it’s ok to be angry. It’s a natural reaction to this situation. All emotions are ok, they just tell us things.”

It was in this moment that I suddenly understood one of the most quoted phrases of Carl Rogers, a phrase I had hitherto found intriguingly puzzling.

“The curious paradox is that when I accept myself just as I am, then I can change.”

I’ve always been a fighter, a hands on problem solver. If I want a change I go after it with tenacity. No acceptance, just defiant determination.

When the counsellor voice in me attended to my anger, I immediately felt the anger subside. It wasn’t the voice that tried to soothe and coerce myself away from anger which depleted my anger, it was the voice that said, ‘yeah, I get you, I’d be angry too in this situation. Anger is ok right now.’ And so I saw in attending to myself what Rogers learned in attending to a lifetime of clients.

All my thoughts were trying to do was apply a little bit of mindfulness. I didn’t mean to therapise myself, I was just trying to non-judgementally allow myself to be in this moment. It’s amazing what a little loving-kindness towards the self can do. And it’s amazing what accepting feelings, even the ones we’ve been taught are ‘bad’ can lead to. Now I’m beginning to understand. When we accept our emotions just as they are, then they can change.

Recovery is not linear

Perhaps one of the most frustrating truths about recovery is that it isn’t linear. It is not a straight path from A to B, and actually I’m not entirely sure that B even exists. The B you have at one point may be a B you later realise you’ll never attain, but there’s no harm in dreaming big. The B you have at one point may one day be your new A; sometimes we don’t dream big enough.

In fact, ‘recovery’ might be a misleading misnomer in itself. There is no final recovered self who is as if the trauma had never happened at all. Recovery doesn’t mean you lose the memories, the lessons, or the triggers. You don’t even lose the hurt. (But it can diminish greatly.) Recovery isn’t being the you you were before all the shit happened. Recovery is being the best you possible in spite of the shit that happened.

But even the path to that best you is wobbly. You don’t just keep getting better without any stumbles and falls. But just because the darkness is back and the memories hurt again doesn’t mean the progress is lost. My therapist uses an analogy of a pile of sand. You can’t keep building the pile higher and higher without at times it fracturing under the weight, the foundations widening, the sand falling. Has all the progress been lost? The new sand added has not left the pile, it just looks different now. And it may look smaller, but it is stronger, it has a more solid base.

Recovery is a lot like that. Some days, weeks, even months can be dark and ouchie and we can wonder what on earth has happened to our journey. But then the sun comes out again, and slowly we pick up the pieces, and the lessons from before are not lost. Not only that, new lessons are learned. And all that growth we experienced before, it’s still there. Our sand pile doesn’t stand as tall right away, but it’s built on more solid foundations. Those foundations can never be taken away from us. Our lessons aren’t forgotten just because things have got difficult again.

I try to be very realistic in the expectations I give to my clients. I have always believed in dreaming big, but promising the impossible helps no one. Things will get hard again, and being prepared for that is one of the best ways to dissipate the chaos that the next low brings. I am also realistic with myself when I see a client making heart-warming progress. It does fill with pride, in me, in them, in the process. But I don’t allow myself to think that the first escaping from the darkness means that clouds will never hide the sun again.

Recovery is not linear, it is a lifelong process. That’s why I am not just a therapist but also a client. That’s why I am helping others while also still getting help myself. It’s not weakness, or ineptitude, but a bold recognition of the fact that there is no ultimate destination, no fixed me. Instead there is a journey. And while I am able to hold others hands along the way, sometimes I still need that person holding mine. I hope all people I help on this journey feel as comfortable reaching out for help no matter how ‘recovered’ they see themselves as being. I am no different to my clients, I might be just a little further along the way, with a lesson or two to share. And that’s ok.