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Tony Ryle the therapist: A privilege to listen in

Dawn Bennett, 2018. Tony Ryle the therapist: A privilege to listen in. Reformulation, Summer 2018, pp.22-24.

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Annalee Curran and Virginia West spoke at Tony’s Memorial Conference of a supervision session with Tony when he talked with them about giving his client ‘Tom’ a tin of paint. Tom’s therapy is described in Cognitive Analytic Therapy and Borderline Personality Disorder (Ryle, Leighton and Pollock, 1997, pp 62-70), a powerful account of a deprived and abused man who left his home town in the North after trying to protect his mum from an assault by the worst of the many stepfathers who had entered his life. I had the privilege to hear sessions from this therapy as part of my PhD, researching how CAT therapists work with reciprocal role enactments that threaten the therapeutic alliance (Bennett, Parry and Ryle, 2006).

This therapy is one that I have shared with CAT trainees, offering Tony’s eloquent phrases of how he held the despair, maintained hope and was totally on the client’s side. Some will have sat with a group of colleagues on a training day as we have role played a session between Tony and Tom, one of three consecutive sessions when Tom is on the brink of suicide just before the Christmas break. I hoped it would stay with therapists as how we use ourselves safely and how at times there are no techniques or clever words left, just that someone is there and does understand – an authentic presence and a new form of relational experience – not the idealised rescuing care, the ‘pink spectacles’ state on Tom’s diagram but the exit Tony named as Tom being ‘entitled to ordinary needs and possibility’ (Fig 1). I have also drawn on some of Tony’s words from this therapy at the darkest moments with clients who were at the same point as Tom. They were ready to pull away from any potential care as to connect and hope risked being in touch with unbearable neediness. With his words and stance echoing, I hoped they could take what was on offer although it was less than they needed, and deserved. Each time they did. The privilege of hearing the sessions, actually feeling in the room, was more than an internal supervisor. I’d like to share some of the words and perhaps you can gain a sense of the compassion and the heart of Tony’s gift of CAT.

Session 5 begins with Tom saying he won’t be coming next week as he’s decided to kill himself and this central enactment spans three sessions

T: I think what’s happening here, what happened then, what’s happening in you, is that part of you, that is desperately in need of some care, like you said last week, you wish to be held and rocked and allowed to cry, which is understandable. That part of you, when you get any kind of sense of someone being there for you, you are so overwhelmed by the intensity of the feeling that you have to back off. There is such a well of neediness that you can’t risk letting anyone near enough to help you. So you back off and go off to the sand-dunes as if it is the only place to go

P: I disagree

Silence

P: Are we talking about the past or on the ward?

T: The ward, friends, art therapy, me. In all those contexts people are allowed so near and then you break contact

P: I still disagree

T: Are you saying that that was one of the lessons, not to get close to people because they are going to betray you?

P: Yes.

T: ..What about the therapy, you haven’t felt betrayed yet? I hope you won’t be but you may feel it.

Silence

T: Can you risk it?

P: No

T: Why is that more difficult?

P: Because the things I want aren’t going to happen

T: One of problems about the degree of want that you have and degree of need that you have is that it is very hard to know what you could take that is less than you need. In a sense that is what you have to do always, get what you can from people, but nobody ever gets all they want, nobody ever gets everything made up for. […]

Tom left this and two subsequent sessions not sure if he would return and over the Christmas break. He decided, at the last moment,not to drop an electric fire into his bath. He sat and cried (grief behind the rage) then reached out to friends.

P: I’d not realised that I kept people at arm’s length, even Anna and Steve, you know, I really do trust them but even then I’ll keep them out

T: Perhaps you didn’t want to burden them? Enough is enough

P: Yes ... I should trust them more .. I realise how I do protect myself

T: If anyone had noticed your distress, you might have found a better way but no-one did

P: ........my aunt would say there’s something wrong with him and then I heard my mother say ‘what the fuck has he got to worry about’, they were her words, and I thought you fucking cow and I just walked out

T: […]. The story really has two halves: the actual real threats, aggravations, cruelties of your childhood and adolescence and trying to put that right and your right to feel grief and rage about it, .[…] But the second part is how you dealt with that, how it was possible to survive and that is where you learnt, how to keep away certain things, not to risk certain things, to operate on certain terms, that’s what you did with your life in the next eight years which brought you right down, because even when something good started to happen, with your friends, job and all those things, something about you made it impossible for you to get what you really needed from that.

P: I was always right

T: That is a real set up because you fall in love and you feel hopeful and then, unrealistic hopes, it goes wrong and then that’s just more evidence that there is nothing for you ... The struggle of the last time has been our struggle to be allowed to be there for you and despite how awful you felt and it was nearly unmanageable and we nearly lost you. The good news was, there was a bit of you that didn’t let you.... there was just enough to keep something alive in you but something you almost resented, maybe more complicated perhaps to have some conviction and hope when it goes wrong so often

Silence

T: It was good that the person who decided not to kill himself was you not us. There is something in you that can care for you, at the last resort

P: During the week there were so many people that I thought about, that said ‘he’s a nice guy’ and like what you were saying about people only able to give so much, as well, that made so much sense. I’m confused because all these things are starting to make sense and realising that people can only give so much it’s like myself, I can only give so much. […] It is something inside me saying I want to die.....that’s how I felt about myself. Now I feel it is curable, dying isn’t the only way out.

Tom engages and moves forwards but in session 15 as the ending approaches he becomes low. It’s an 18 session CAT, Tony had said he had taken Tom on as others had been wary but as a retired therapist who spent six months abroad, time had been limited.

T: It’s probably hard for you to resent, be angry and disappointed because it has been good but it doesn’t mean it doesn’t hurt you when it stops and there is bound to be for somebody with all the history of loss that you have had, some repetition of loss and some repetition of disappointment and anger. Even though it’s been good, I am also going to leave you. […]I’m saying that if you do feel it you don’t have to suppress the feeling, in a way if you […] don’t allow yourself to feel it, that’s what seems to be the blanket depression. Depression is often not having […] a real feeling, […] so you end up, worse than being sad and worse than being angry, that kind of numbifying blanket

P: Don’t know, it’s like just closing off and feeling lonely

T: But you know what happens after that

P: Yes ….. Worse

T: It always has been a quick way out ...... with those, who care, not let them in earshot

Silence

T: Not surprising, that the old escapes are still there, you’ve used them very thoroughly for years.

….not killing yourself and coming here was only the very first step ...... allowing yourself to be a bit needy. All you have done is turned the corner, you have been going down the same fucking road for 28 years, in a smoke-screen most of the time ... only now can you understand why that happened, you cannot live up to possibility yet. The difference is the direction. Where you were there was nowhere to go but where you are, there is a difficult road to God knows where, but possibilities.....

Silence

T: Do you think that is true?

P: At the moment, don’t feel I can get on with anything

T: I’m giving you a sermon today

Silence

T: What are you thinking? ‘Why don’t you shut up’?

P: No just feel pissed off with it all, I know I am sitting here and saying things and that if I do things, painting and stuff, it does make me feel better but in last few weeks I have not done these things

T: I don’t know, it sounds to me like actual sabotage of the self, the self who was recovering... self who was beginning, of the self you could grow into, sounds to me like some part of you has sowed its destruction and undermined, sabotaged, thrown away, which is the same debate as you’ve had in the bath, on the bridge, basically for a long time, between the possible and destruction, seems like a handing over to the fascist again in your head ... part of you can’t allow you to move on ..........

P: Can understand that ..I will have to fight part of me ....... but I don’t think I intentionally push things away, sometimes I just shut down

T: That is the sand-dunes trap … the cost of shutting down is to lose all touch with self and other people.......... I know it is unintentional. The diagram has always shown you where your unintentional path leads you, you don’t choose it and I do think that coming here has helped you with not choosing that

P: Yes

T: Also worried about the end of it, so one way to deal with that is to shut me out as well and blank out and come here (points to diagram) and that deprives you of this conversation which you can refer to when you’re not here, that’s why it’s important that you feel what you feel when you are here, whether it is cross or whatever because then it’s real, then you can hold onto what is real and argue against that old battering you give yourself and use my arguments to counter the ones that were spoken earlier to you.

Then I heard something that shocked me.

T: I’d also like you to add to your debt by having some money to decorate your flat and when you have finished paying off your arrears you can pay me back

P: Oh no

T: Does that worry you?

P: Yes

I replayed the tape a few times. I emailed Tony who said he had offered Tom a tenner. I thought “So much for this therapy being an excellent example of working with RR enactments.”

T: I am a gambling man to that extent living is very dangerous, I would see you in the autumn, it would be the beginning of a positive spiral, makes it less depressing. If there was a proper hospital service for loans you could get that but there isn’t anymore. I can certainly do it

P: I would have to think about it

T: Yes think about it and let me know next week, it could complicate things but as far as I am concerned I wouldn’t mind taking a small risk, think about it. That would really be another expression of my encouragement to you to give the process a chance, do whatever you can to keep things moving, make a claim even in the face of the undermining voice

Silence

T: How do you feel?

P: How I woke up this morning

T: Steam-rollered, I’ve been working hard on you this morning

P: Yes, feel a bit overwhelmed, like in the session after the bath.

T: Think about it. See you next week

I don’t know if he gave the tenner or a tin of paint but next session Tom returned and it had made him realise how little he gives himself. He had started to decorate his flat. How would we view this? Tony reciprocated,but with awareness? He facilitated an ‘exit’? It was authentic human connection? He was willing Tom to find hope, giving him a pull up, to kick start change?

In addition to his therapy being in the pool of cases I used to derive the CAT model of enactment resolution, Tony worked closely with Glenys Parry, my PhD supervisor and I as we teased out ‘good’ therapist performance. Tony gave hours of his time, wisdom and thought, he reflected on all I raised and worked tirelessly. He was also a task master and he was interested in my life and where work fitted in, he greeted the birth of my second child with a lovely fax, in his (just decipherable) handwriting “To Alice, from Tony, Welcome! Please give your mother a big smile (soon)”. My only regret is serving up a boring pasta carbonara when he travelled up from London to Manchester but he didn’t complain. As many others know he gave so much, created opportunities for many of us, supported and empowered us and I was lucky enough to experience this. I think it was all of this that kept Tom alive.

Acknowledgements

I am grateful to Glenys Parry for help in editing this piece but also for her inspiration and guidance in this research and for conversation both with Tony and about his work. Tom gave permission for his therapy to be used in research and for Tony to publish aspects of his therapy. I hope that he would approve of the sharing of these extracts

References

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

Ryle, A., Leighton, T. and Pollock, P. (1997). Cognitive Analytic Therapy of Borderline Personality Disorder: The Model and the Method. .

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Dawn Bennett, 2018. Tony Ryle the therapist: A privilege to listen in. Reformulation, Summer 2018, pp.22-24.

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