Williams, B., 2012. Past Hurts and Therapeutic Talent. Reformulation, Winter, pp.39-42.
“It would be professionally suicidal for me to tell my supervisor about my past history” said an embarrassed colleague, who sounded totally convinced. I was concerned, and realised other therapists also believed their credibility would be jeopardised if “too much came out” about them. This led me to think that some exploration of “wounded healing” and professional attitudes towards this could be beneficial. Are these fears justified and what are the implications for CAT? I have set out below some of my findings and conjectures.
Diverse ancient and modern sources find a positive link between woundedness and healing. Asklepios, the Greek god of healing, was said to suffer an incurable wound; the Akkadian poem of the righteous sufferer describes a deity who humbles and denigrates but also heals and enables. Shamanistic healers were chosen for their history of trauma and made to endure suffering as part of their initiation (Merchant 2011). The modern TV series HOUSE portrays a brilliant doctor who walks with a limp, is addicted to pain killers and at times questions his own sanity. Jungian psychotherapists believe that they can best help patients by a process of self-healing and that the therapist is as much in analysis as the client. Change happens through a mutually unconscious process affecting both parties. The client first needs to inflict a wound on the analyst who has to undertake a self review in dealing with this hurt. In the process both therapist and patient undergo a transformation (see below).
Contemporary movements such as Alcoholics Anonymous or Hearing Voices networks emphasise the benefits of having lived through similar experiences to their client population, often to the dismay of professionals who feel that the passion and personal involvement of fellow sufferers can do more harm than good. These arguments are very well documented by White (2001). There is an old joke that therapy is when two people who need help, get it. The purpose of training, then, is to reduce proportionally the amount of help obtained by the therapist. There is some research into therapists’ backgrounds such as Pope’s survey of psychologists in the USA showing that many therapists have personally problematic histories, including sexual abuse. Those who are seen as particularly effective often attribute their therapeutic ability to the problems they have had to confront (Wolgein & Coady,1997). If this is true, why should it be? Explanations usually cite greater empathy; less likelihood of preaching and judging; confidence that problems can be overcome; familiarity with a road travelled and the barriers en route. It is mooted that people who have been wounded are more likely to be drawn to a healing role than those who have “sailed through” life without encountering significant distress. The Jungian view that the patient’s inner healer and the therapist’s wounds both require activation for help to occur seems for its time refreshingly egalitarian and respectful of the client. However, Jung’s model is very complicated and shrouds the process in mysteries involving alchemical processes and innate archetypal structures.
Here is Groesbeck’s (1975) depiction of the process, elaborated from Jung’s original adept-soror diagram.
Twelve steps describe the interplay of different positions back and forth from conscious to unconscious and from mental turmoil to new perspectives and growth.
Contrary to the views expressed by my colleagues, the premise that we have to be hurt in order to heal is compelling and humanity has forged a strong link between wounding and healing as if the one is actually prerequisite for the other. Angela Cotter (2011) describes four types of wounded healer. The first type is the healer who both wounds and heals, like Apollo who kills but yet purifies and heals. The surgeon’s knife could be considered to fall in this category, but originally the idea was that the divine physician was both the sickness and the remedy. For her second category Cotter identifies people who have had near death experiences. Recovery following this and metaphorical rebirth is associated with successful healing (Sanford 1977, quoted Cotter). Also, Cotter argues, the continual exposure to life threatening situations “keeps the experience of being close to death alive”. This is also akin to her third category, the healer who carries a permanent wound, such as the Shaman, or the healer whose empathy is increased by having walked the walk, and so being “more likely to listen than to lay down the law”. The final type of wounded healing that Cotter discusses is about the healer who takes on the wounding of others and “heals through processing it themselves” (see Jung, 1946 ).
What then is a CAT take on wounded healing?
For CAT, I would think that woundedness equates to chronically endured pain and that the ensuing reciprocal role procedures are barriers to therapy unless they have been understood and challenged. With such understanding there would be greater alertness to the client’s invitation to reciprocate or the quicker spotting of enactments arising from similar RRP’s in client and therapist. This can be depicted as follows:-
Wounded Healer SDR. Fig 2
Whilst acknowledging the possible increased motivation and enthusiasm for therapists identifying with client issues, CAT would not see past suffering as an eligibility criterion in therapist selection as suggested by Sedgwick (1994). CAT’s focus is the prevention or repair of ruptures caused by enactments (Bennett, Parry & Ryle, 2006). Whilst all CAT therapists are supposedly aware of their reciprocals through past therapy and supervision, Jung’s warning may be salient.
“No analysis is capable of banishing all unconsciousness forever. The analyst must go on learning endlessly, and never forget that each new case brings new problems to light and thus gives rise to unconscious assumptions that have never before been constellated” (Jung 1951).
Here the role of supervision becomes crucial in spotting enactments and containing the therapist to enable thinking outside the box. However, CAT supervisors may be hampered by strict boundaries sometimes drawn between supervision and therapy, by the supervisee’s wish to appear in a good light, or by time restrictions. Guggenbuhl-Craig comments that the more experienced the therapist, the more skilled s/he becomes in deflecting and denying problems. Similarly, in training, case material is presented so as to attest to the trainee’s competence and obscure shadowy areas. This author suggests that only good friends or partners are likely to provide an effective challenge to therapist difficulties. Only they are trusted to explore the therapist’s blind spots and feelings of shame. In CAT we rely more on the client’s SDR to help us avoid unhealthy collusion, but as a rule neither the client nor the supervisor gets to see the therapist’s SDR.
So whilst on the one hand there seems to be general acknowledgement that past hurts can be assets rather than detrimental to therapeutic endeavours, there also appears to be an opposite set of beliefs that takes away professional credibility from people admitting to problematic histories. In my view this can be described by a CAT dilemma and trap:
As Marx puts it,
“Enough water needs to go under the bridge for supervisor and supervisee to understand the core themes of each other’s style to the point where shared human foibles can be enjoyed, rather than being treated as indications of something more serious that might attract a mutual judgment.“ (Marx 2011)
Fear of judgment and our attempts to avoid it can create a culture of collective avoidance whereby issues are fudged and parallel processes ignored to the detriment of all involved. How can we address this?
Guggenbuhl-Craig suggests there are several therapist hazards to look out for: vicarious living via patients; jealous attacks on spouses; protective diagnoses; spiritual inflation; philosophical arrogance. To combat this, Sedgwick recommends self knowledge in general; checking whether the subjective fantasy is unusual or not for therapist, and noticing the intensity of affect when intervening - that is how and from where the therapist is responding.
CAT has a range of helpful ideas for in- session monitoring and management of roles and state shifts. There is the countertransference assessment tool on the ACAT website and various CPD workshops have been offered, such as embodiment; difficult moments with Tim Sheard. In CAT South, I recently facilitated a workshop where we looked at ways of enhancing recognition of state shifts or evoked RRP’s in session. We made a list of these and discussed a range of exits, coping strategies, and ways to look after ourselves. This work could be carried forward in various ways. We could think about peer support groups to explore our demons and how they manifest in-session. We could have a Reformulation column of cautionary tales where we “fess-up” our RRP generated therapeutic gaffes, and how we dealt with them. We could think about “taboos” and our stance towards different client groups. We could also write about how we have been able to use our past and current hurts to help clients.
Clearly this topic attracts me because of my own problematic history, but I have no way of knowing how far it resonates with the wider CAT membership. It would be good if you could tell me if the topic matters to you, or if you think my concerns are unnecessary. Perhaps you would care to email me or write anonymously to Reformulation? Would you be interested in a questionnaire relevant to the topic?
Barbara worked as an NHS clinical psychologist for about 35 years and is a CAT supervisor and psychotherapist. In Adult Education, she taught courses on counselling skills and developing peer- support groups. The wound she derived from her childhood rebuke “whenever Barbara opens her mouth, she puts her foot in it”, led to her feeling continually challenged about what can be voiced, as this article attests. This article is a summary of her IRRAPT dissertation (Williams, 2012)
Bennett, D, Parry, G & Ryle, A. (2006). Resolving threats to the therapeutic alliance in cognitive analytic therapy of borderline personality disorder; a task analysis. Psychology and Psychotherapy: Theory, Research and Practice. 79, 395-418
Cotter, A (2011), The Wounded Healer on Television. Jungian and post Jungian reflections. Chapter 6- Limping the way to wholeness. Wounded feeling and feeling wounded, in Hockley and Gardner (eds) Routlege
Groesbeck, C. Jess (1975). The archetypal Image of the Wounded Healer” J. Analytical Psychology 20, 122-145
Guggenbuhl-Craig, A. (1971), Power in the Helping Professions, Dallas TX, Spring Publications
Jung, C.G. (1946). The Psychology of the Transference. In The Practice of Psychotherapy. 1966. 2nd ed. the Collected works of C.G.Jung, Vol. 16, Routledge
Jung, C.G. 1951 Fundamental questions of Psychotherapy ibid
Marx, R. (December 2011), Relational Supervision: Drawing on Cognitive Analytic Frameworks. Psychology and Psychotherapy, Theory Research and Practice 84 (4) 406-421
Merchant, J. (2011). Shamans and Analysts: new Insights on the Wounded Healer. Routledge
Sanford, J, (1977.) Healing and Wholeness. NY. Paulist Press
Sedgwick, D, (1994). The Wounded Healer: Countertransference from a Jungian Perspective, Routledge
White, W. (2000). The history of recovered people as wounded healers: ll. The era of professionalisation and specialisation. Alcoholism Treatment Quarterly 18 (2), 1-25
Williams, Barbara W (2012 ) Can Cognitive Analytic Therapy contribute to Concepts of the “Wounded Healer”? Unpublished Dissertation
Wolgein C & Coady N, (1997). Good Therapists’ Beliefs About the Development of their Helping Ability The Clinical Supervisor 15, issue 2
Comment on James Turnerâ€™s article on Verbal and Pictorial Metaphor in CAT
Hughes, R., 2011. Comment on James Turnerâ€™s article on Verbal and Pictorial Metaphor in CAT. Reformulation, Winter, pp.24-25.
Book Review: Post Existentialism and the Psychological Therapies: Towards a therapy without foundations
Pollard, R., 2012. Book Review: Post Existentialism and the Psychological Therapies: Towards a therapy without foundations. Reformulation, Winter, p.43.
CAT in the NHS: Changes as a result of the Health and Social Care Act 2012 and the future of CAT
Vesey, R., 2012. CAT in the NHS: Changes as a result of the Health and Social Care Act 2012 and the future of CAT. Reformulation, Winter, pp.6-9.
Cognitive Analytic Therapy & Dysphagia: using CAT relational mapping when teams canâ€™t swallow our recommendations
Colomb, E. and Lloyd, J., 2012. Cognitive Analytic Therapy & Dysphagia: using CAT relational mapping when teams canâ€™t swallow our recommendations. Reformulation, Winter, pp.24-27.
Concerning the Future of CAT and Other Relational Therapies
Dunn, M. and Dunn, S., 2012. Concerning the Future of CAT and Other Relational Therapies. Reformulation, Winter, pp.10-13.
Exploring whether the 6 Part Story Method is a valuable tool to identify victims of bullying in people with Downâ€™s Syndrome
Pettit, A., 2012. Exploring whether the 6 Part Story Method is a valuable tool to identify victims of bullying in people with Downâ€™s Syndrome. Reformulation, Winter, pp.28-34.
Relationships in Microcosm in Cognitive Analytic Therapy: Based on a workshop given at the 2012 ACAT Conference in Manchester
Hepple, J., 2012. Relationships in Microcosm in Cognitive Analytic Therapy: Based on a workshop given at the 2012 ACAT Conference in Manchester. Reformulation, Winter, pp.35-38.
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