Talking It Over
By George Gillson MD PhD CCFP
Continuing on with October’s theme of Mental Wellbeing I’m going to discuss Counselling in this post. At EvolveWell, this service is offered by Phil Herrington, RPC (Registered Professional Counsellor). I had the pleasure of chatting with Phil a few weeks ago about his training and the approaches he uses to help people sort through the issues they might be facing such as depression, anxiety, relationships and generally trying to cope with the challenging times life throws our way.
I’ll talk about his counselling methods in due course, but I wanted to first give you a taste of Phil’s philosophy. He talks about the idea of intentional living versus unintentional living. To Phil, living intentionally means being aware of what’s going on at any given moment and realizing that you are in control: you can observe your own process when you are in a tough, emotionally charged situation: you figure out what’s needed and are able to get through the challenge. Furthermore, you learn from, and take responsibility for, your mistakes. Living intentionally gives you resilience. It’s meta-thinking: thinking about your thinking.
On the other hand, living unintentionally means that you might careen from one bad, maybe even awful, experience to another without learning, without being able to change course. “Management” is an old, quirky romantic comedy featuring Jennifer Aniston (Sue) and Steve Zahn (Mike) which basically chronicles the evolution of a somewhat turbulent love affair between two dysfunctional people. (Spoiler alert: It has a marvellously cheesy romantic ending!) At one point though, Sue tells Mike that he has to stop going through life like an “unguided missile”. I think that’s an apt simile to describe unintentional living. You plow through life leaving a trail of destruction in your wake. Phil wants to help clients live intentionally.
Phil also mentioned that we need to gain the ability to look deeply and clearly at whatever happens as opposed to looking “through a glass darkly” (1 Corinthians 13:12) and having an obscure, imperfect view of things as they actually are.
We had a fascinating discussion around anxiety: Phil views our day-to-day anxiety level as a barometer of how we manage ourselves emotionally and maintains that anxiety arises from complex, suppressed emotions. Typically, in a dysfunctional family, a child learns that certain emotions are not to be expressed and will carry this habit into adulthood. That child might also develop a punishing inner critic who haunts them into adulthood, reading potential disaster into every situation and breeding fearfulness. Phil’s goal in therapy is to help a client to recognize a pattern or patterns and access the buried emotion(s). I think he likens it to teaching someone with a fear of fire to learn to edge close enough to enjoy its benefits without burning up.
We’ll look more closely inside Phil’s “toolbox” in a bit and briefly discuss two of the counselling methods he uses: Transactional Analysis and ISTDP or Intensive Short-Term Dynamic Psychotherapy. But first I’ll preface that discussion with a quick look at Classical Freudian Psychotherapy.
Classical Freudian Psychotherapy
Freud theorized that the way people behaved was dictated by the balance between three components of their personality: the ID or emotional/irrational component, the Ego or rational component, and the Superego or Moral component. Freud thought that a pathological balance was established by early adverse/warped interactions with one’s parent(s). The therapist’s job was to understand the three components and foster transference of the patient’s past negative experiences into the therapeutic relationship, bringing the subconscious into conscious awareness and hopefully triggering a cathartic release of negative emotions. A classical therapeutic relationship could span 5 to 7 years, take hundreds of hours and cost thousands of dollars.
One of the main criticisms of CFP was a lack of underlying scientific rigor. Nevertheless, there have been many useful offshoots from Freud’s work that are still used today but a discussion of them is out of the scope of this article.
Transactional Analysis (TA) was introduced in 1957 by Eric Berne, MD. This was preceded by fifteen years of conventional psychoanalytic training during which Berne also challenged Freud’s theories and studied the work of other therapists. Berne revolutionized psychotherapy by defining the “transaction” as a basic unit of human interaction in which one person initiates a call by saying something and the other person answers (sort of like playing poker). Transactional Analysis was a way of systematically studying these interactions.
Berne postulated that each person operates in one of three ego states at any given moment: Child, Parent and Adult. Berne defined an ego state as “a consistent pattern of feeling and experience directly related to a corresponding consistent pattern of behavior.”
In therapy, transactions are observed and analyzed to eventually determine which ego state the client is operating from, either as a preferred mode or possibly a default state under stress (this latter is my take on it). Attention is paid to the content of the transaction but also how the words are delivered (accompanying body language, facial expressions, tone, emphasis on certain words, and so forth).
Like Freud, Berne felt that clients presented with problems created by internalization of “toxic parenting”: harsh criticism, too much control, too little freedom to explore, too little positive affirmation. Clients wound up with too little reasoning Adult in their mix, if you will. The goal of TA therapy is presumably to help the client to be able to operate primarily in that reasoned Adult state.
TA has been criticized for focusing too much on content and not enough on understanding. In its defense, it was based on observable data gathered by noted researchers such as Wilder Penfield at McGill University. The ego states appear to be actual, not theoretical, and represent stored emotional memories along with factual memories and new information that comes along day-by-day.
In any event, Phil Hetherington was formally trained in TA, used it for more than a decade with good success but eventually found that there were some clients he simply couldn’t help, at which point he began to look at other therapeutic approaches. Eventually he discovered Intensive Short Term Dynamic Psychotherapy and after three years of training he began to employ it in his practice without discarding TA as a therapeutic tool.
Intensive Short Term Dynamic Psychotherapy (ISTDP)
When he is engaging in ISTDP, Phil initially will ask the client what problem or concern they need help with and then proceeds to ask questions about the problem, gently attempting to uncover what suppressed emotions might be at the root of the problem. In the course of the discussion, the client might use defenses which are gently challenged. The therapist pays careful attention to the nature of any anxiety that arises during this process (it’s not The Spanish Inquisition!).
ISTDP uses the concepts of Type 1 and Type 2 anxiety. Type 1 is “mobilized” anxiety involving striated muscle (mostly the muscles we can see) and regulated by the sympathetic nervous system, under conscious control. It manifests as fidgeting, foot tapping, jaw movements, tightness in the abdomen. It’s energy with no place to go. Type 2 is “immobilized” anxiety involving smooth muscle, regulated by the parasympathetic nervous system and characterized by nausea, migraines, brain fog/unclear thinking, vagueness and dissociation from the body.
Phil teaches people to recognize the type of anxiety they are manifesting and helps them to access the feelings beneath it and move themselves back into their body where they have more conscious control (you can’t tell your liver to relax). He’s also a great believer in exercise and says the gymnasium is “the best antidepressant in the marketplace”. It’s a way to dissipate pent-up emotional energy. He encourages people to join him in a scientific- or detective-type quest to understand themselves better: to awaken their curiosity and to see the price they are paying for buried emotions.
As touched on earlier, Phil sees anxiety as being common in people who have developed a very critical inner voice due to adverse childhood experiences/criticism. An innocent statement to such an adult can be perceived as a threat that might culminate in loss of relationship. It can cut to the bone. To the child in all of us, loss of relationship is primal and life-threatening.
Phil also thinks that chronic anxiety is very biochemically depleting and can eventually draw us down into low-energy depression. Hence clients presenting with depression might be at the end of a trail of anxiety rooted in suppressed emotions.
The hallmark of ISTPD is that it is intended to be efficient, resolving issues with fewer sessions compared to other approaches. It is also intended to stick, leaving the client with tools they can use going forward.
The bottom line here is that no matter what, Phil has a very non-judgemental, welcoming, easy going and sensible approach to healing and works with anyone regardless of their spiritual/philosophical beliefs. He’s an intuitive, gentle person with a wealth of experience and is an asset to the EvolveWell Clinic.