Creating Art: A four-week long self-study

Art is an important way to express oneself and plays a role in releasing our emotions. I spent four weeks conducting a self-study where I used art as a means of self-expression. There are three steps to this process all of which were documented weekly (each time I expressed myself artistically, the quantity of which varied from week to week. For brevity’s sake, only one instance from each week has been documented and analyzed here).

The steps are as follows:

1.) Assess and record my emotional state

2.) Paint/draw

3.) Assess and record my emotional state (post-expression).

Each of these steps was followed for each artistic experience. One final step is needed to complete this self-study and that is an analysis of each individual painting, each painting experience, and the relationship between the two; each painting chosen from the four weeks will be analyzed here.

The aim of this study is to assess the validity of art as catharsis and to understand aspects of myself that would otherwise go unnoticed.

To assess my emotional state I used the PANAS-X  (Watson,D., & Clark, L, A., 1994)[1] a psychometric tool used to measure positive and negative affect states, as well as four basic negative emotions, three basic positive emotions, and four more complex affective states. Each score has been assessed and those that are of importance for each week will be displayed (pre and post-expression) alongside an analysis of the individual piece.

The PANAS-X uses a nominal 1-5 scale to rate emotions and affect, 1 for very slightly or not at all to 5 for extremely.

Week 1: “Fragmented”

fragmented

Fragmented, self-portrait

In the week leading up to this painting I was feeling sad, lonely, and blaming myself for my feelings of despondency/loneliness. I set the environment by listening to music that reminded me of home –this generated strong feelings of sadness. I did not plan what I was going to paint; I let my creativity flow naturally influenced by my mood and the music.

“Fragmented” is a self-portrait representing how I viewed myself. I am faceless because I no longer knew who I was and I was unable to identify qualifying features of myself (how do I identify myself in relation to a city and culture I have never experienced before, and do not feel at home in). Further I have no eyes because I Was unable to determine what my future looked like, or where I was headed in this city – I am essentially blind, emotionally and mentally. I felt disconnected from myself, and a big part of that feeling stems from the relationships and connections I left behind.

The image is simple yet bold, clearly expressing my inability to identify with the city I am in, or the people in that city. Sandra Turner outlines this feeling in “Encountering what is possible – the impact of role development in facing existential crisis”: “When anything fundamentally threatens our way of being in life, the manner in which we each know ourselves, this becomes an existential threat. This threat potentially brings a loss of a way of life often coupled with a loss of the community to which we have made a commitment. We can no longer act as we normally would and this brings a loss of confidence […]” (Turner, 2002). Although Turner is referring to psychodrama and roles within psychodrama, this sentiment can be applied to my situation.

The act of creation for this piece generated a wealth of emotions – I began crying throughout the process, and found myself still crying post-painting. Staring back at the image of a faceless self I realized how fragmented I truly felt.

After creating this piece I did experience a significant emotional breakthrough, which made it easier to talk about my feelings with my significant other. I was able to understand where I was emotionally and why I was feeling this way. This helped me assess my current life situation and discuss changes I could make in my life to make my transition easier. It opened the pathway of communication about our hometown and it was comforting to know that I was not the only one experiencing these emotions. I had let my emotions completely take over my life, and being able to express how I was feeling allowed me to clear my head, see the bigger picture, and make necessary changes. Not only did the process act as a cathartic experience for me it facilitated continued emotional outlets – by communicating with friends, family and my significant other – I was able to deal more effectively with my emotions, and be more readily able to identify what I was feeling in the moment.

As we can see from the graph below a significant number of negative affects and emotions represented on the PANAS-X were typically experienced at a 1, 2 or 3, more often than at a higher rate. However, those affects that were most strongly felt were more interrelated than others recorded. An overwhelming amount of emotions were centered on dissatisfaction, anger, or blame towards the self, which influenced other significant emotions such as feelings of sadness, loneliness and being downhearted.

It would only make sense that during a time where I was concerned with feeling disconnected and estranged from my self, my friends, and my hometown, I would be experiencing feelings of sadness, dissatisfaction and loneliness more so than I would be experiencing feelings of fear, hostility and guilt. As we can see I did experience these feelings, just to a much lesser extent than the other more salient emotions outlined.

untitled

In comparison to the positive affect scale, I was feeling significantly more negative emotions. If we look at the graph below demonstrating the positive affect, we can see that for the most part my rates were ranging between 1-2, meaning there was no significant differentiation between positive affect states, but there was a significant difference between my negative and positive affect states. The negative emotions I had been feeling did have an effect on my positive emotions influencing the likelihood that I would experience them. For instance, confident, enthusiastic, and happy were all rated at a 1, which is uncharacteristic of my average affect. This indicates that my negative affect significantly influenced not only how I experienced negative emotions, but also how I experienced positive emotions. Since the strength of my negative affect was so strong this actually influenced the likelihood that I would experience positive emotions.

positive1

An important part of this experiment was measuring my affect pre and post expression and comparing the scores. Taking a look at my scores post expression I still ranked experiencing negative emotions and affect more so than positive ones, but to a slightly lower degree. Further, my positive affect increased by 1 point on affects and emotions that had been rated higher in the pre-expression assessment. However, my affect did not change for those scores that were rated lower, possibly because my negative affect was still felt relatively strongly, and possibly because feelings of joyfulness, and cheerfulness were not strongly felt prior to painting. This suggests that the artistic experience did help me emotionally, but it is hard to determine whether it was catharsis or my feelings towards the resulted image that influenced this change in affect.

positive2

These changes suggests that artistic expression does impact affect – it helped me express what I was feeling in a concrete, physical way, which helped facilitate conversation about my feelings.

The change in my negative affect can be explained by my newfound understanding of my emotional and mental state – upon completion of the piece I was able to see the whole picture. After completing the image the reason my negative mood states decreased, in particular feelings of loneliness and downheartedness, is because I was able to put into words how I was feeling and I was able to share these feelings with a confidant. As mentioned before, the painting represents a physical manifestation of my emotions in regards to my self, my relationships and my hometown. As we can see in the graph below, similar to the positive affect scale, not all affects were affected or altered.

negative2

It is of particular interest to note the changes in my feelings of anger, sadness and loneliness – because they all interact with and affect each other. Since the painting experience acted partially as catharsis I was able to express some of these feelings of loneliness and sadness in my image. Once these feelings were expressed I was able to understand them better and the source of these feelings. This of course made it easier to communicate my feelings, which further acted as catharsis.

Limitations to this process include that I cannot determine whether my emotional expression was better facilitated through the music, or if my resulting emotional state was due to painting, listening to music, or a combination of both. Regardless, this process made me introspect a great deal, focusing mainly on my negative emotional state in the previous weeks leading up to the experiment. My emotional state was significantly more potent directly prior to the expression (within 2 hours), but averaged the week prior.

 Week 2:”Floating”

floating

Floating

The process for this particular piece was in contrast to “fragmented” – I did not need music to motivate my emotions or memories, in fact, the expression was very much a result of my environment and current life events. By environment I am referring specifically to my apartment and the influence the rooms and noises outdoors had on my emotional state. The time of day, the activities I was doing at the time (drinking coffee, writing), and the sound of the street mixed with the birds reminded me of home. This made me feel very much at ease, relaxed, and tranquil, and played a significant role in my overall affect. Of course, because I was thinking of home and feeling more connected to my home I undoubtedly experienced negative emotions as well as positive ones – the difference is that the negative emotions were felt less strongly than the positive emotions. For instance, while painting I was focused more on my positive feelings: feeling proud, happy, inspired and so on, than I was on my negative emotions.

As we can see in the graph below the negative affect scale averaged a score of 1, whereas the positive affect scale averaged a 3, which translates to “moderately felt” on the PANAS-X affect scale. It is interesting to note that even though I felt positive emotions and averaged a much higher positive affect than negative, I still felt negative emotions, and these surely impacted the expression of my positive affects.

If I were to have not felt negative emotions to the minor degree that I did (for instance, while I was rating my inspiration, pride and happiness around a 3 or 4, I was simultaneously rating my feelings of loneliness and downheartedness as a 2), my positive affect would not have been affected so greatly. That is, had I rated my loneliness and downheartedness at a 1, my feelings of inspiration, happiness and so forth perhaps would have been rated between a 4-5, making my positive affect much stronger than my negative affect.

negative3

positive3

What we should also consider is how my general positive affect further influenced other aspects of my emotionality. For instance, my ratings on the self-assurance dimension were quite strong as well in comparison to the week prior, where my scores of confidence, pride and strength were around a 1. The average score for the self-assurance dimension was 2.83 (rounded up to a 3), indicating that my positive affect had a significant influence on other dimensions of positive emotions, particularly aspects of self-assurance (my feelings of inspiration and happiness influenced my feelings of confidence and strength of ability).

selfassurance

When we look at the image “floating” itself, we can see each of these positive emotions reflected. The reason this image was so easy for me to paint was because I was feeling very expressive physically, and so it was easy for me to direct that passion and energy into creating this piece. The image displays myself floating with balloons – showing a lack of gravity.

This demonstrates how I did not feel held back by anything at the time – particularly my emotions. This image represents a sense of free-floating lack of attachment – to my surroundings and to any given situation. I felt so strongly connected with my home that I was spiritually, or emotionally transported to a time and a physiological as well as psychological state reminiscent of those experienced on a similarly positive day in Ottawa. These feelings of floating were also influenced by the fact that I had received positive news, which essentially made me feel “on top of the world”, which is reflected in the image.

After the painting was complete I completed the post PANAS-X and found that the majority of my ratings did not change much from the pre PANAS-X. This can be explained by the fact that I was not experiencing negative emotions or mood states that needed to be altered or shared. Typically, when we experience negative emotions we want to return to baseline – which are neutral or positive mood states. When we experience positive mood states however, we have already achieved what we are aiming for. It makes sense then that my affect did not change much after completing the image.

The only difference between scores was found in the negative affect but was only reflected in the ratings of upset, downhearted and sad – which only changed by 1 point. The reason for these changes can be explained through reflection upon the piece. Although I was still generally in a positive mood state and experiencing feelings of pride and confidence, I was still feeling disconnected from my home and a lack of connection to my current environment. Therefore, upon reflection, I was able to ruminate more on my feelings of sadness and downheartedness in regards to missing my hometown which, generated these feelings even more.

Week 3: “Caught Between Two Worlds”

caught-between-2-worlds

Caught between two worlds

The process for this image was similar to that of floating in that it was very much a product of my emotions motivated by my current emotional state. What I had discovered at this point in my experiment is that the majority of my emotions have been centered on and influenced by my feelings towards my hometown and my strong desire to return home. I have discovered a lack of rootedness, which as Fromm declares, is one of our eight fundamental human needs (Fromm, 1941).

The image presents myself caught between Ottawa on the right, and Halifax on the left. It evokes a strangely calm and serene acceptance, an acceptance that no matter whether I remain in Halifax or return home, I will invariably be caught between both worlds. Should I return home, I would be more content because my roots will surround me, I will be comfortable, and fall back into my regularly occurring routines. However, should I return home, I will also be left with ruminating feelings of loneliness and sadness because the majority of my family will be in Halifax while I am in Ottawa –defeating the purpose of returning home. Should I remain in Halifax I will maintain the feelings of emotional stagnation but remain close with my family – which is incredibly important. My unresolved feelings towards Ottawa will keep me from growing roots in this new city.

Ottawa is painted in much more lively colours than Halifax is – the reason for this being I am much more attached to and drawn to Ottawa than I am to Halifax. The majority of my experience while in Halifax has been very emotional, leaving me feeling sad, lonely and detached much of the time. I am also quite fearful of water and being on boats, which plays into this image. I feel much more grounded in Ottawa hence the choice of parliament to represent Ottawa, whereas I feel very scared, and unsure of my surroundings while in Halifax, hence the use of water as the defining image.

All of the colours in this image work together to demonstrate my current emotional state. Although the colours draw a clear line between right and left dichotomies, and which emotion is felt for which city they are still relatively muted expressions of my feelings. This demonstrates the calmness of my sadness, loneliness and yearning. At this point in time I had been experiencing these and similar emotions and had quite some time to ruminate on them. In fact, the emotions that I had been feeling up to this point in time had essentially petered out. I am still feeling the same emotions just at slightly less intense levels. For instance, the emotions related to Ottawa and yearning to return home is still felt, and the majority of the emotions that I rate more strongly have been expressed each week. If we take a look at the graphs below we can see that I have experienced a mixture between negative and positive affect with a tendency more towards sadness than anything else.

I believe at this point my feelings of positive affect have strengthened, possibly because I have come to terms with my negative feelings. My negative and positive affects will undoubtedly continue to influence each other, but my feelings have calmed to a certain degree.

neg4pos5

As I mentioned the majority of my high ratings were found on the sadness emotion scale, similar to past weeks. Although I was still experiencing feelings of sadness and loneliness I was simultaneously rating my positive affects at more median rates, while my sadness emotions were rated at more median rates as well.

sad

This is the most interesting week so far in regards to my affect. I experienced relatively muted and mixed emotions. I experienced sadness while simultaneously feeling inspired or interested. Which leads me to believe that my emotions do generate creativity, and that by directing them into a productive outlet this facilitates further understanding of said emotions and affect states.

This piece facilitated communication between my partner and myself and I felt even more secure upon completing this image. The security I felt was linked to my desire to return home and the final decision I had made. I have come to realize that environment influences my contentedness, and that I should not be living to fulfill other peoples dreams or wishes.

What I learned throughout this experiment is that my feelings are stemming mainly from one source and are generated through thoughts attached to this source, environments that remind me of my friends, memories attached to Ottawa, and my past experiences. I discovered that I am much more rooted to Ottawa than I had previously thought.

My post expression scores on both negative and positive affect scales did not change significantly enough to graph the results and present them here. I believe that this lack of change is due to the fact that my affect was already so muted; expression in this case did not alter my emotional state much.

 

Week 4:“My Creative Mind”

mycreativemind

My Creative Mind

In the final week of my self-analysis I found that my emotional state from the previous weeks had muted significantly. In the first week of the experiment I was feeling very lonely and downhearted, in fact, I was taking these feelings out on myself and I was blaming myself for feeling such a way. I had led myself to believe that I was feeling negatively towards myself because of internal aspects instead of external aspects.

In this week the majority of my art works were expressive of my own creativity, and very much an appreciation for the evolution of my artwork. Based on the form and colour, you can see a direct change in emotionality. This image in particular is expressive of my creativity and I employed a limited number of colours. The colours that I did use were expressive of calm, contentedness and serenity. The colours elicit a feeling of general calm that has come over me throughout the four weeks. This calm is in direct relation to the resolution of my feelings of loneliness and disconnectedness felt in the first two weeks.

My brain is painted in similar colours as the surrounding image, representing a calm felt at the cerebral level— these feelings of calm emanate throughout my environment but are also felt within myself.

As we can see below my negative and positive affect scales are similar to the preceding week. I was still feeling sadness, downheartedness and loneliness but these were muted in nature. I believe that these feelings were more muted in comparison to previous weeks because I had an opportunity to deal with the underlying issues.

neg6

As we can see my general negative affect was rated quite low with the majority of scores being rated as a 1, and the remaining scores being a 2. When these scores are compared to my positive affect we can see that I was experiencing positive affect more so than negative affect and at greater intensities. Each of the positive affects were closely related to each other – that is, my feelings of inspiration were correlated with my feelings of determination, enthusiasm and strength. These scores had changed from the first two weeks because I dealt with my negative affect throughout the subsequent weeks.

pos6

For this week I felt it was important to show both my sadness emotion scale scores and my serenity emotion scale scores. My sadness emotions were rated lower than the previous weeks, but I was still experiencing feelings of downheartedness and feeling blue, which I believe is due mainly to my missing my friends and hometown.

sad2

In comparison my serenity emotion scale indicates that although I was still experiencing underlying sadness emotions, my serenity emotions were quite high. My feeling of relaxed in particular is important to note. I believe that this emotion was rated so high because although I was still dealing with negative emotions I have come to terms with why I was feeling these emotions, and I developed a plan to alleviate these feelings.

At the beginning of this experiment I was overwhelmed with my emotions and had a difficult time verbalizing the issues I was facing. Now, at the outset of this experiment I have a better understanding of my emotions and their source. This helped alleviate some stress and anxiety.

With the increase in my general positive affect and the decrease in my general negative affect I have been able to mediate my emotions, and have become much more content. Of course, just as the positive affect scale, the emotions rated on the serenity emotion scale are very much interrelated, which could explain why my scores did not differ much. Since my feelings of relaxation were so high so too were my feelings of being at ease and calm. Again, these feelings and the positive affects are interrelated, which could explain why the scores on both scales were rather similar.

serenity

The post expression scores did not differ significantly enough to display here. Although I was feeling lower levels of downheartedness and upset, these changes were not even significant enough to indicate nominally (the changes would have been between .25-.5, and the PANAS-X uses a 1-5 nominal scale). Therefore, although there was a slight difference between scores they were not significant enough to mention.

Conclusion

There is a positive relationship between my use of art as a form of expression and my affect states. Over the four weeks I came to understand my emotional state on a deeper level, and came to understand the root of the majority of my emotions/affects. In assessing my affect state both before and after artistic expression I was able to assess the potential immediate impact the expression had on my mood state. I found that for the most part my mood state did not improve significantly directly after the artistic process, rather that the act of artistic expression acted more as a facilitator for further communication and analysis. Post expression was more oriented towards analyzing the underlying emotion states and how to deal effectively with them.

This four week process was interesting for me to notice the changes in my affect and emotion states, particularly because I found myself dealing primarily with one main issue that had been effecting my mood state for quite some time. I was able to focus on this issue and explore different ways to deal with it, which led to improvements in my overall emotionality.

As an additional effect, I found that painting actually became a source of improved mood and I began seeking it out and looking forward to the opportunity to paint throughout the day. Therefore, there were three main effects: improved mood, catharsis and communication, all of which were interrelated.

Limitations

This is a self-study and therefore lacks external validity. Further, there may be confounding variables (the use of music), which may interfere with our assessment of the usefulness of artistic expression in facilitating catharsis and dealing with emotions. As a final note, this study was based entirely on introspection, which is not easily tested and not entirely reliable.

 

References:

Fromm, E. (1941). Escape from Freedom. New York, NY: Farrar & Rinehart.

Turner, S. (2002). Encountering what is possible –The Impact of Role Development in Facing Existential Crisis. ANZPA journal, vol. 11, 31-37.

Watson, D., & Clark, L, A., (1994). The PANAS-X: Manual for the Positive and Negative Affect Schedule. Retrieved from http://ir.uiowa.edu/psychology_pubs/11/

[1] Permissions to use the PANAS-X were granted me by David Watson. The PANAS-X is copyright David Watson and Lee Anna Clark (1994) at the University of Iowa.

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The Power of Listening

The reason therapy works for so many is because therapists are trained to listen to their clients, and this active listening lets the client feel that they are important and what they have to say is important. When someone accesses therapy it is typically because they have something they need to communicate and have no one in their lives that will listen. This may present itself in different ways; either they have no one who is available to listen, or they feel threatened in some way by the people in their lives – perhaps what they have to say could be misconstrued as damaging to their character, or may be generally embarrassing – but they still need and are seeking help. They are seeking someone to offer an active ear and a non-judgmental, empathetic approach to their situation.

I do not believe that active listening and empathy are limited to therapeutic settings. Typically when laymen think of therapy they imagine a client lying on a couch pouring out their feelings across from a clinician expressing “how does that make you feel?” This is not how all therapy unfolds, and a lot of therapy does not have to be as structured. However, because of this conceptualization of therapy, it is believed that if there is no couch or no closed room, therapy cannot happen. This is not necessarily the case.

I have met with a number of persons who have needed counsel outside of typically identified therapeutic settings, and the same components were present – empathy, non-judgmental attitude and active listening[1]. Empathy and active listening are two very closely related actions which can be combined in order to create empathetic listening, which Burley-Allen characterizes as resisting distractions, noting and acknowledging the speaker’s verbal and non-verbal communication, and being empathetic towards the speaker’s thoughts and feelings (Burley-Allen, 1995).

image-17Interpersonal connectivity : sharing thoughts, feelings and emotions

Stewart and Logan (2002) identified three competencies in developing empathetic listening, which include focusing, encouraging and reflection. All three competencies work together to encourage the speaker to communicate their feelings, issues and desires. It also allows the speaker to feel more at ease while discussing their thoughts. Ender and Newton (2000) demonstrate the importance of paraphrasing the thought and feeling of what the speaker has said in a non-evaluative way, while still interpreting their understanding accurately. This is important because we do not wish to make the speaker feel uncomfortable, or uneasy. We want the speaker to feel able to express him or herself free of judgment, so we must take care to withhold judgment from both thoughts and feelings. This is directly linked to empathetic understanding, which as we know, is the understanding of the clients’ views and experiences from their frame of reference (Ender and Newton, 2000). Cuny, Wilde and Stevens (2012) point out that through empathetic listening and understanding we can help the client/speaker develop personal understanding. Empathetic listening can be used to promote communication, develop cognition and enhance self-concept. Empathetic listening and understanding also promotes a specific attitude which translates to the client as them having worth, and something to offer, which helps develop self-confidence (Cuny, Wilde, & Stevens, 2012).

Stanley Jackson states that “the psychological healer, in particular, is one who listens in order to learn and to understand; and, from the fruits of this listening, he or she develops the basis for reassuring, advising, consoling, comforting, interpreting, explaining or otherwise intervening” (Jackson, 1999). This demonstrates the importance of listening for the counselor, outside of building trust and offering a cathartic experience for the client. Of course, listening is important in assisting the client through catharsis, building trust between client and counselor, and aiding in self-development, esteem and efficacy; but it is also important in understanding the client and situation better. We are unable to help a client without first knowing, and understanding, what it is they need help with. It is true, that listening in and of itself is powerful in facilitating healing for the client; but we must be able to provide further assistance after the fact, through proper application of interventions or therapies.

The most relevant person to mention while discussing the power of listening is of course, Carl Rogers, who championed empathic listening in his client-centered therapy. Rogers identifies the value of empathy in a multitude of ways. First he states that empathy indicates to the recipient that someone cares for, accepts and values who he is as a person (Rogers, 1975). He states that empathy “dissolves alienation.” That is, it breaks down barriers between person and therapist (Rogers, 1975). The analysand in question is requiring attention and care, possibly for issues that may arouse judgment or isolation. Through our use of empathy we no longer see alienation as an option, and we allow the clients to fully express themselves, to fully experience the all too needed catharsis. This of course, leads to better therapeutic results.

There cannot be active listening without empathic understanding; the two go hand in hand, and work in conjunction with each other. By understanding a person more fully through our listening, we pave the way for the client to understand himself in a full or complete way without inhibitions (Rogers, 1975). Rogers indicates that by our full understanding of the client we offer them a way to understand their self, which facilitates congruence (Rogers, 1975).

Rogers and Farson (1987) show that people who are listened to in such an active and sensitive way learn to apply such methods to themselves, and listen with more care and are able to vocalize more precisely how they are feeling and what they are thinking. They identify that there are two essential components to what a speaker is saying; there is the content of the message, and the feeling or attitude, which underlies the content. Both are equally important and must be attended to in order to understand the complete picture, (Rogers, C., & Farson, R., 1987). There are a few ways that we as listeners may attend to these underlying messages: firstly, we must consider the emotions, and respond to the feelings conveyed by the speaker. By our responding to the feelings we acknowledge the speakers emotional state, and offer a space where they may feel safe and able to express themselves. Secondly, we must note all cues; facial expression, verbal cues such as inflection, speech style, and body language. All of these things may work together to let us know more of what the speaker is trying to convey. For instance, a client may wish to express they are feeling hurt, but may fear reprisal and so they may try to mask these feelings. It is our job as listeners to study their body language, facial expressions and tone, all of which may help indicate the underlying emotion the client may be shying away from expressing. In this way, we may respond not only to the content, but also to the underlying emotion, which truly shows the client that we are listening and that we care.

Active listening is an important component of any therapeutic scenario, and can be employed in every interaction with another person. It demonstrates respect, builds trust, and facilitates a relationship between speaker and listener. It tells the speaker that they are valued, and it encourages them to value themselves.

Many consider listening as a passive component in therapy, when in fact it is the most significant component in any therapeutic scenario without which we would not have an understanding of the other person. Listening is a powerful tool, and truly listening leads us to develop healthier, stronger relationships with our clients, and leads our clients to better understand themselves and relationship dynamics. Listening is an all too important tool that we can apply to every scenario, and offer our clients when we find ourselves with nothing but our attentive ears to give.

 

[1] Therapy cannot occur without a licensed practitioner, just the same as art therapy cannot occur without a licensed art therapist. However, we can employ therapeutic methods while counselling our clients in atypical settings (within their homes, at school, on the street).

 

References

Burley-Allen, M. (1995). Listening: The forgotten skill: A self-teaching guide (2nd ed.) New York, NU: John Wiley & Sons, Inc.

Cuny, K, M., Wilde, S, M., & Stevens, A, V. (2012). Using Empathetic Listening to Build Relationships at the Center. In. Yook, E, L. & Atkins-Sayre, W. (Eds.), Communication Centers and Oral Communication Programs in Higher Education. UK: Lexington Books.

Ender, S, C., & Newton, F, B. (2000). Students Helping Students: A guide for peer educators on college campuses. San Fransisco, CA: Jossey-Bass.

Jackons, S, W. (1999). Care of the Psyche: A history of Psychological Healing, New Haven & London: Yale University Press.

Rogers, Carl. (1975). Empathic: An Unappreciated Way of Being. The Counseling Psychologist. Vol. 5, No. 2-10.

Rogers, C., & Farson, R. (1987). Active Listening. From Communicating in Business Today R.G. Newman, M.A. Danzinger, M. Cohen (eds) D.C. Heath & Company.

Stewart, J., & Logan, C. (2002) Empathetic and dialogic listening. In J. S. Stewart (Ed.), Bridges, not walls: A book about Interpersonal communication. (8th ed., pp. 208-229) Boston, MA: McGraw-Hill.

 

Understanding Schizophrenia

Schizophrenia is a neuropsychiatric disorder most easily defined as a distortion in thought, social behaviour and cognitive functioning. Around 1 % of the world’s population has been diagnosed with schizophrenia. There are a number of theories surrounding the onset of the disorder. Prevalent theories are steeped in the bio-medical model, while other less popular theories stem from a more psycholinguistic approach. The word “schizophrenia” comes from the Greek word “skhizein” meaning to split and “phren” meaning mind (Online Etymology Dictionary); schizophrenia therefore, can be translated as a splitting of the mind. This understanding has confused some individuals who are not necessarily familiar with the symptomatology of the disorder. It should not be confused with dissociative identity disorder, where there is a split between personalities; rather, the split that occurs in schizophrenia is a split between self and reality (how one internally conceptualizes reality).

This confusion does not end with the definition of schizophrenia. Most do not understand the presentation of symptoms, what the symptoms mean, or how to interact with these symptoms. I have witnessed many times, individuals interacting with someone with schizophrenia and not understanding just how to do so – it can be a complicated and at some times frustrating experience, when you do not fully understand the disorder. I am here to outline some major symptoms of schizophrenia, and how they present themselves, along with some ways to interact with clients while they are demonstrating these symptoms.

First, let us differentiate between positive and negative symptoms. Positive symptoms can easily be thought of as additions to a persons’ behaviour or cognition. Common examples of positive symptoms are hallucinations and delusions. Negative symptoms are subtractions from a persons’ normal range of functioning. Common examples of negative symptoms would be blunted affect and alogia.

Now that we have identified positive and negative symptoms we can assess the full range of symptoms presented in persons with schizophrenia[1].

Positive symptoms

Hallucinations and delusions are the most commonly known symptoms of schizophrenia, in fact, most people will not know many symptoms aside from these two.

Hallucinations can manifest in 5 different ways, these being auditory, visual, olfactory, gustatory and tactile. Visual hallucinations are things that are seen by the client which are not there, or that other people cannot see. Auditory hallucinations are characterized by hearing voices that others are unable to hear, tactile hallucinations are characterized by feeling things which are not there, or which other people do not feel. Tasting, or smelling things, which are not present, or that other people do not taste or smell characterizes the final two categories of hallucinations – gustatory and olfactory (American Psychiatric Association, 2013).

Delusions are identified as false beliefs held with strong conviction, regardless of evidence to the contrary. These can be characterized in 4 categories, which are delusions of paranoia, delusions of grandeur, somatic delusions and delusions of reference (American Psychiatric Association, 2013). Paranoid delusions are false beliefs centered on the idea that others are out to get you, or that others are doing things when there is no clear evidence. Delusions of grandeur are centered on the idea that you are important, special or significant outside of the normal realm. For instance, believing you are a religious prophet, or the reincarnation of Christ. Somatic delusions are false beliefs about your body – internally or externally. Delusions of reference are false beliefs that things in the environment are directed towards you, when they are not. For instance, a TV show or radio broadcaster is talking about a certain event, and you believe that this is directed at you specifically.

Disorganized speech, otherwise known as word salad, is characterized by derailment or incoherence in speech (American Psychiatric Association, 2013).

The final positive symptom in schizophrenia is known as catatonia, or catatonic behaviour. This behaviour is characterized by rigidity, stupor, inactivity, mania, or extreme flexibility of limbs, (American Psychiatric Association, 2013).

Negative symptoms

Negative symptoms, as mentioned before, are characterized by a lack of certain behaviour. These are as follows:

Alogia, which is characterized by a difficulty or inability to speak.

Affective flattening (or blunted affect), which is characterized blunted facial expressions, or less lively facial or bodily movements.

Lack of emotion or, the inability to enjoy activities to the same degree as before.

Social isolation, in which the individual spends most of their time away from others, or when they do, it tends to be close family only.

Low energy, in which the individual does not exert a lot of energy, spends most of their time sitting around or sleeping.

Lack of motivation, in which the individual does not have much motivation or interest in life.

Inappropriate social skills or, a lack interest in, or ability in socializing with others

and finally, inability to make friends, in which the individual finds it difficult to make new friends, or keep friends they already have. They may not care for their friends.

There is one more category of symptoms that typically gets ignored when discussing schizophrenia. These are categorized as cognitive symptoms, and refer to difficulties with concentration and thinking.

They are as follows:

  • Disorganized thinking
  • Slow thinking
  • Difficulty understanding
  • Poor concentration
  • Poor memory
  • Difficulty expressing thoughts, and
  • Difficulty integrating thoughts feelings and behaviour

In treating and individual with schizophrenia, understanding the symptoms of the disorder is half the battle. It is not enough to simply be aware of these symptoms, you must too understand their presentation and be able to differentiate between the symptom, and the person. What I mean by this is you must have the ability to separate the person from the expression of the symptom. For instance, a woman experiencing an auditory hallucination may be feeling anxious, or aggressive. She may be feeling attacked, and may yell or swear out loud in response to the hallucination. You may think she is yelling or swearing at you, and you may involve yourself in the situation. This should be avoided. That is not to say that you are not able to communicate with her while she is experiencing these symptoms, but you should avoid centering the conversation on them. The reason I say this is because you are not experiencing the symptom, you are not aware of what exactly is being said. This is based almost entirely on whether or not you have gained the client’s trust. Do not pretend to hear the voices as well – she is able to recognize that you do not hear them. Do not pretend that you know how to make them go away – because when she realizes you are unable to do this, you lose even more trust.

You can ask the client what the voices are saying. I believe that by doing this, you are demonstrating to them that you care, and it opens a window to strengthen the trust that is already there. You can also ask the client if they believe what the voices are saying. If they are able to, ask them to challenge the voices. You can re-direct the negativity into positivity.

Albert Ellis proposed rational emotive behaviour therapy (REBT) in 1955, which is the pioneering cognitive behaviour therapy. The goal of REBT is to challenge thoughts in order to avoid certain behaviours. He proposed an ABCDE model, with A meaning action (activating event) B meaning belief system, C meaning emotional consequence, D meaning disputing and E meaning cognitive/emotional effects of revised beliefs. In a situation such as the one outlined above, we can easily apply this model to the clients’ hallucination. The beauty of REBT is that it involves rationalizing the situation prior to the onset of behaviour. By asking the client to challenge the thought, voice, hallucination, or delusion, we are going straight to the disputing stage of our model. It is perfectly all right for a client to dispute their delusions or hallucinations. In fact, it should be encouraged. By ignoring or trying to avoid the symptoms, we end up encouraging repression, which means that the symptoms will likely return.

You should avoid invalidating their symptoms because though they may not be real to you, they are very real to your client. Invalidating their experience breaks down trust, and creates a divide between you and them.

While interacting with someone with schizophrenia we should always be mindful of our own attitudes and behaviors, specifically while they are being symptomatic. You should avoid teasing or mocking the client’s behaviour. I have witnessed caregivers laugh at a client’s word salad, or mock their catatonic behaviour. There is a misconception that because these individuals are experiencing things outside of the realm of normalcy that they do not understand our behaviour, or do not notice it. This is not true, and you should always be aware of your attitudes, language use, tone, and behaviour.

Experiencing schizophrenic symptoms puts the client in a very vulnerable state. There is a need for trust, without the ability to trust. Not only, will a client with schizophrenia find it more difficult to trust you due to their illness, they will also find it difficult to trust you because they have been taken advantage of so many times before. With that in mind, their delusions hold some truth. It is difficult to give your entire trust to someone else, to give up your power and to rely on someone else’s.

There are better ways we could and should be interacting with these clients. It may sound obvious, but the two most important traits are patience and kindness. Due to the combination of cognitive delays and positive/negative symptoms experienced by the client, it is sometimes difficult to make it through a conversation with them. This should not discourage you; in fact, you should seek out any opportunity you have to share a conversation with them. This not only builds trust, but it helps you understand the client more, so that in the future you may be able to differentiate between symptomatic expression and non-symptomatic expression.

Empathy is the most important thing we can offer the client. Carl Rogers explains the importance of empathy in understanding our clients, and in aiding them in their healing process (Rogers, 1951, 1959, 1961, 1974). To be empathetic is also to demonstrate unconditional positive regard, also identified by Rogers as a key factor in successful therapy/treatment (Rogers, 1951, 1959, 1961, 1974).

When communicating with a client with schizophrenia, you should be mindful to communicate with them the same way you would with any other client. Attempt to include them in social activities – they may say they do not want to each time, which is fine, but eventually they may change their mind. What matters, however, is that you made the offer; this shows them that you care.

Understanding schizophrenia is a difficult task, however it is far more difficult to live with it. By attempting to understand, show empathy, and build trust with our clients, we are helping them heal. We are helping them make it through a very difficult disorder. The key to understanding schizophrenia is education and the ability to listen.

References:
American Personnel and Guidance Association. (1974). Carl Rogers’s 1974 lecture on empathy. Retrieved from https://www.youtube.com/watch?v=iMi7uY83z-U&feature=share&list=PL9w3l7GkGUr1yxU4s2PiggyCbOO3XfpRf

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Ellis, Albert. (1957). How To Live with a Neurotic. Oxford, England: Crown Publishers, 1957.

Rogers, Carl. (1951). Client-Centered Therapy: Its Current Practice, Implications and Theory. London: Constable

Rogers, Carl. (1959). A Theory of Therapy, Personality and Interpersonal Relationships as Developed in the Client-centered Framework. In (ed.) S. Koch,Psychology: A Study of a Science. Vol. 3: Formulations of the Person and the Social Context. New York: McGraw Hill.

Rogers, Carl. (1961). On Becoming a Person: A Therapist’s View of Psychotherapy. London: Constable.

Schizophrenia. (n.d). Online Etymology Dictionary. Retrieved from http://www.etymonline.com/index.php?term=schizophrenia

[1]                  It should be noted that not every individual diagnosed with schizophrenia would present all or the same symptoms.

The Role Mozart Plays in Psychodynamic Psychoanalysis

 

Sigmund Freud first introduced psychoanalysis in the 1890s and its basic tenets are as follows:

  • A person’s development is largely determined by forgotten, or repressed events from early childhood,
  • Attitudes, thought and behaviours are influenced by irrational drives found in the unconscious,
  • Conflicts between the unconscious and conscious can manifest in neuroses, and
  • Alleviating neuroses from the unconscious mind is done so by bringing these thoughts, memories and ideas into the conscious mind.

Since the approach was first presented, things have continued to change and evolve, including different schools of thought, and different theories. Psychodynamic psychoanalysis is typically regarded as the least successful/useful form of therapy, particularly due to its founder and his theories and ideas relating to the unconscious mind. Most regard Freud and his theories as hyper-sexualized, and relying too heavily on psychosexual development, and said development as the reason for most if not all neuroses.

The nature of Psychoanalysis is to delve into a person’s psyche, to present to them what the root of the issue is. This makes it so a client who says they are feeling depressed is not given a quick fix, rather, they see what is causing those feelings and focuses on dealing with that, as to avoid the feelings reoccurring. The techniques used are as follows:

  • Anamnesis: recalling past memories and bringing them to the forefront of our minds. The patient is to remember facts, behaviours or emotions related to the occurrence of the symptoms. (By remembering the antecedent of a symptom, we may find the answer for why the symptom presented itself to begin with.)
  • Free Association: The patient is asked to lie on a couch, (in order to create a relaxing state/mood) and is asked to say anything and everything that crosses their mind, without restriction. This act of free association is to allow ourselves to avoid censure, which means we will freely speak of immoral, unethical, neurotic and narcissistic things that cross our minds. By allowing ourselves to freely speak of things, we offer the therapist a way to better understand our condition. This method does not end when the talk stops, rather, it is the therapist’s role to analyze these thoughts, and find the associations between the talk and the condition.

The act of free-association was argued by Freud to be more helpful than anamnesis in bringing thoughts and feelings from the unconscious to the conscious mind. Essentially, through free association, the client is revealing his psyche to the therapist, and his self. So what role does Mozart play in all of this? Music has been found to influence a person’s subjective emotional state (Georgi, R.V., Gobel, M and Gebhardt, S, 2010), effects neocortical structures associated with analysis and synthesis, as well as subcortical structures associated with the processing of both negative and positive stimuli, (Georgi, R.V., Gobel, M and Gebhardt, S, 2010). This supports the idea that music significantly influences mood, and understanding of that mood.

With this in mind, by way of using Mozart throughout the therapy session, then the act of free association may become much easier for the client. By activating emotions, and essentially opening the clients psyche more so than if we were to rely solely on free association, the client may feel more in tune with themselves, and may feel more open to express themselves. It may also help the client understand why they are saying what they are saying –and may be able to “come to a realization” during free association.

Why Mozart in particular? As Norman Doidge points out in his most recent book “The Brain’s Way of Healing”, Mozart’s compositions provide the most continuous sounds that are “easy on the ear,” and it motivates the emotional flow of language (Doidge, N, 2015). Further, the music used in sound therapy enhances the connection between brain areas that process positive reward and the insula, which is involved in paying attention. Music rewires the “noisy” brain, which Doidge defines as an overactive brain that fires neurons senselessly and without direction (Doidge, N, 2015). By re-wiring the brain and these neuronal connections, the brain, and the mind, are quieted and cleared in such a way that enhances clarity, focus and attention. All of which are essential for recalling repressed and unconscious emotions.

Why combine Mozart with psychoanalysis, instead of having patients listen to Mozart outside of therapy? The combination will work in such a way that the client becomes much more open to their past memories and current emotional availability, so that free association will occur with more direction than before. Further, the music will allow the client to be in a more relaxed state, which is essential in free association. Although some have found it necessary to choose one type of therapy, and argue its validity and efficacy, I believe that we should incorporate and rely on more than one form of therapy for the treatment of neurotic symptoms. If music proves therapeutic for some patients, and offers a sort of lucidity, why not pair it with a proven form of therapy, such as psychoanalysis?

 

 

 

 

 

 

 

References.

 

 

Blood AJ, Zatorre RJ, Bermudez P, Evans AC (1999) Emotional responses to pleasant and unpleasant music correlate with activity in paralimbic brain regions. Nature Neuroscience 2, 382-387.

 

 

Blood AJ, Zatorre RJ (2001) Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion. Proceedings of the National Academy of Sciences 98(20), 11818-11823.

 

Brown S, Martinez MJ, Parsons LM (2004) Passive music listening spontaneously engages limbic and paralimbic systems. Neuroreport 15(13), 2033-2037.

Freud, Sigmund. (1895). Studies on Hysteria.

Griffiths TD (2003) The neural processing of complex sounds. In: Perez I, Zatorre RJ (eds.) The cognitive neuroscience of music. Oxford, New York: Oxford University Press, pp 168–177.

Krumhansl CL (1997) An exploratory study of musical emotion an psychophysiology. Canadian Journal of Experimental Psychology 51, 336-352.

McFarland RA, Kennison R (1989) Asymmetry in the relationship between finger temperature changes and emotional state in males. Biofeedback and Self Regulation 14, 281-290.

Nyklicek I, Thayer JF, van Doornen LJP (1997) Cardiorespiratory differentiation of musically-inducted emotions. Journal of Psychophysiology 11, 304-321.

Panksepp J, Bernatzky G (2002) Emotional sounds and the brain: the neuro-affective foundation of musical appreciation. Behavioural Processes 6, 133-155.

 

Schubert E (2001) Continuous measurement of self-report emotional response to music. In: Juslin PN, Sloboda AA (eds.) Music and Emotion. Oxford: Oxford University Press, pp 393–414 Schubert E (2004) Modeling perceived emotion with continuous musical features. Music Perception 21(4), 561-585.

 

Sloboda JA (1991) Music structure and emotional response. Psychology of Music 19, 110-120.

 

Tramo MJ (2001) Music of the Hemispheres. Science 291, 54-56.

 

Vaitl D, Vehrs W, Sternagel S (1993) Prompts – Leitmotiv – Emotionen: Play it again, Richard Wagner. In: Birbaumer N, O ̈ hman A (eds.) The structure of emotion: psychophysiological, cognitive, and clinical aspects. Seattle: Hogrefe and Huber, pp 169–189.

What are the Voices Saying?

Schizophrenia is one of the most misunderstood disorders of the mind; it presents differently for most people, and there are a number of different symptoms outside of the most commonly known delusions and hallucinations. Due to this misunderstanding, a number of treatment methods are bypassed to subdue the client, or “quiet” the symptoms. Although medication can be helpful to many, both atypical and typical antipsychotics have a number of severe side effects that may cause more damage than help (Leucht et al., 2009/Stroup & Marder, 2013/McKim, 2007). Of course, the best approach to any mental illness is the incorporation of both medication and therapy, but sadly, this is not always the case. Typical psychotherapy is sometimes regarded as fruitless in regards to treating schizophrenia, possibly because there are a significant amount of symptoms that could “get in the way” of a therapy session. However, R.D. Laing was very successful in treating individuals with schizophrenia through therapy (Laing, 1960), and by implementing a very humanistic approach, through his use of compassion for the client. I believe that this approach should be revisited, and when dealing with hallucinations and delusions in particular, we should be asking the client and ourselves “what are the voices saying?”

Typically, the response to a delusional thought or hallucination is to either 1.) get rid of it or 2.) play into it. Neither is the proper response. If we do not know where this delusion is coming from, how will we be able to properly treat it? We won’t be doing anything other than taking a shot in the dark. By asking the client what the voice is saying, we get a closer look into their psyche, and a closer look into the root of the problem. Understandably parents wish to separate themselves from their child’s mental illness; they do not wish to be blamed for it. Freud was, however, correct in identifying the impact parents have (genetically and environmentally) on the child’s development (Freud, 1918/1923/1949). Early childhood experiences are undeniably, a contributing factor to any mental illness and we should not be ignoring this impact.

How we were treated in our childhood (by parents, peers, other adults), has a significant impact on how we view ourselves, and by extension how we behave. For an individual with schizophrenia, these memories and experiences are quite possibly repressed, and just now, manifesting in negative, neurotic ways. For instance, a client who is hearing a persecutory voice telling them they are worthless, ugly, or that they do everything wrong/can’t do anything right, is a client who quite likely has heard these phrases prior to the onset of symptoms. I have discussed in a previous article the impact a disintegrated self has on the psyche, so too has Laing (Laing, 1960). This inability to integrate certain aspects into the self (memories, experiences, aspects of personality), will present themselves later in the form of symptoms. For those with schizophrenia, this typically manifests in hallucinations and delusions.

By way of simply knowing what the voices are saying, we are able to perform psychoanalysis successfully. Instead of shying away from treating schizophrenia with therapy, we should be approaching it the same as any other mental disorder. Let me give an example.

A young woman, aged 26, has been experiencing delusions for the past year and a half. She is hearing voices telling her that she will “never amount to anything” and “without me you’re worthless.” These voices are of course, very distressing to her, and cause a significant amount of anxiety and worry, which leads to depressive feelings. She begins to believe these voices, and her lifestyle changes significantly from “normal” functioning prior to the onset of symptoms, to a disorganized, chaotic, and dysfunctional lifestyle. She finds it difficult to get out of bed, to eat properly, to get dressed –all of which are simple, everyday tasks most of us are able to perform without thinking consciously about it. This is because she is focused on the voices, combating them, and struggling so hard to repress them.

If we were to ask her “what are the voices saying?” we could discover the source. These thoughts have been repressed for some time, and perhaps, they originate from previous feelings of self-worth (or lack thereof). If we analyze and assess the clients’ history (childhood and beyond), we may get a better understanding of where these thoughts are coming from. It is normal for each of us, from time to time, to have negative thoughts about the self – but do we not also understand, with a little introspection, to some degree where they are coming from?

Say for instance, we were to discover, through our analysis, that all throughout her childhood her parents verbally and physically abused her. When she went into school it was difficult for her to make friends, and she was teased and bullied all throughout middle and high school. She tried her best to ignore this negativity, in an attempt to “survive” her years in school until graduation. This is of course, a very extreme case, however, by ignoring and repressing these negative thoughts and behaviours, they resurface later.

In order to combat these thoughts and experiences properly, we should be counseling, and employing cognitive behavioral therapy (CBT) (Beck, 1967). By counseling, I am referring particularly to counseling parent-child relationships (should this be found to be one of the main sources of negativity). By communicating our feelings, and working through the negativity instead of keeping it inside and ruminating about it, we are more likely to deal effectively with the source. This should not be the only resource we rely on for combating these delusions. We should also be employing CBT – challenging thoughts and behaviours.

By getting to the root of the problem, that is, the source of these thoughts and voices, we can address them directly. We can ask the source (parent, friend, teacher etcetera), why. We may also be able to determine that this is not a fundamental aspect of the clients’ personality. They are in fact not worthless, or ugly, and whatever else the voices may be saying. The first step is of course to confront the source, and the next step is to combat the continuing voices. Just because we have addressed the source does not mean the voices will dissipate. We must change the way in which we think, because this thought pattern, although separate from our selves, has become somewhat integrated into the self. We are able to combat these thoughts and change them, through CBT – by using exercises and homework. These must be taken seriously in order to experience change, because we are trying to alter negative thought patterns that have been with the client since childhood or beyond. As we know, it is very difficult to break a habit, so too is it difficult to break a thought cycle.

Therefore, we must confront those with schizophrenia not as helpless and beyond cure. Instead, we should confront these clients with compassion and new ways of understanding their illness. For many, these thoughts will represent something very real to them. These thoughts should be regarded as a manifestation of repressed thoughts, experiences and memories. As Freud has taught us, when we understand the impact a memory has on an individual, we are able to treat it effectively (Freud, 1895). Even just speaking of the source is cathartic. Instead of ignoring the voices, and repressing them even more, we should be asking what are they saying, and what does this mean?

 

References:

 

Beck, A.T. (1967). The diagnosis and management of depression. Philadelphia, PA: University of Pennsylvania Press. ISBN 0-8122-7674-4

Freud, Sigmund., & Breuer, Josef. (1955). Studies on Hysteria. (James Strachey, Trans.). London: Hogarth press. (Original work published 1895).

Freud, Sigmund. (1918). “From the History of an Infantile Neurosis”, reprinted in Peter GayThe Freud Reader (London: Vintage, 1995).

Freud, Sigmund. (1927). The Ego and the Id. (Joan Riviere, Trans.). London: Hogarth Press (original work published 1923).

Freud, Sigmund.(1989). An Outline of Psycho-Analysis. (James Strachey, Trans.). New York: Norton & Company. (Original work published 1949).

Laing, R.D. (1960).The Divided Self: An Existential Study in Sanity and Madness. Harmondsworth: Penguin

Leucht, S., Corves, C., Arbter, D., Engel, R.R., Li,C., & Davis, J.M. (2009). Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet, 373 (9657): 31-41. doi: 10.1016/S0140-6736(08)61764-X.

McKim, W. (2007). Psychomotor Stimulants. Drugs and behaviour: An Introduction to behaviour pharmacology. Pearson Prentice Hall.

Stroup TS, and Marder S. (2013). Pharmacotherapy for schizophrenia: Acute and maintenance phase treatment. Retrieved from http://www.uptodate.com/contents/pharmacotherapy-for-schizophrenia-acute-and-maintenance-phase-treatment

 

 

 

 

 

 

Inside: Dr. Harlene Anderson

Dr. Harlene Anderson is a well recognized leader in the field of marriage and family therapy, and is internationally recognized for her leading role in the development of a postmodern collaborative approach to psychotherapy. She has applied this collaborative approach to education, research and consultation. She received her B.S. and M.A. at the University of Houston, and her Ph.D. in Psychology with a specialization in Marriage and Family therapy, at Union Institute and University, in Ohio. Dr. Anderson holds a number of editorial board positions including founding editor of International Journal of Collaborative Practices (2009-present), and advisory editor of Family Process (1992-present). Dr. Anderson’s most recent positions include founding member and faculty at Houston Galveston Institute (1978-present), founding member and board of directors at Taos Institute (1993-present) and founding member and principal partner at Access Success International (2002-present). She is the recipient of a number of awards which reflect her contributions to the field, including the Texas Association for Marriage and Family Therapy award for Lifetime Achievement in 1997, and the American Academy of Family Therapy Award for Distinguished Contribution to Family Therapy Theory and Practice, in 2008.

Below is a brief interview conducted by Taylor Bourassa with Dr. Anderson. For those who are interested in learning more, I will provide a list of references at the end of the interview.

Hello Dr. Harlene Anderson, I appreciate your taking the time to conduct this interview with me. Before we proceed to questions about your career, and your contributions to the field, I would like to acquaint my readers with you. Could you give us some insight into how your career began? What about Psychology interested you so that motivated you to dedicate your life’s work to the field?

Very simply that as long as I can remember I have always wanted to help people in one way or another – I came from a very generous family with parents who always noticed people who needed help and provided it or found the resources as best they could.

You are a leading figure in family and marriage therapy, but before we delve into all of your contributions to both therapies, could you elaborate on why you chose this area of specialization? Was there a particular catalyst that helped you make your decision?

By serendipity. I began a position in the Pediatric Department at the Un. of Texas Medical School in Galveston, TX. As soon as I arrived on campus, I began hearing about something called family therapy – always spoken about with a lot of enthusiasm. I had never heard of family therapy in my undergraduate (BS) or graduate (MA) psychology program. I enrolled in a family therapy course to find out what all the buzz was about. In the first session, I realized that I found something that I didn’t know I had been looking for – and the beginnings of a new language, that upon reflection, to make sense of some of my previous professional experiences.

Dr. Harold Goolishian and yourself developed collaborative therapy. This approach is quite interesting, and offers more flexibility within therapy sessions, offering the client more control, and more breathing room. To me, this approach is reminiscent of Carl Rogers’ client-centered approach. Would you say that this therapy was influenced by Rogers’ humanistic approach in any way?

I am often asked this question. I was not influenced by Rogers as his work was not part of my graduate program. There are some similarities and definitely some distinctions. Please refer your readers to and article that elaborates on this response:

Anderson, H. (2001) Postmodern collaborative and person-centered therapies: What would Carl Rogers say? Journal of Family Therapy. 23:339-360.

Could you elaborate on the structure of this approach, and its typical process?

A response to this question requires a lot of elaboration. The approach, rather than being based in techniques and methods, is based in what I call a “philosophical stance.” The stance is based in postmodern and related premises (social construction theory, contemporary hermeneutic philosophy, and some theories of language and dialogue. The premises are based in a strong focus on knowledge and language as relational and generative rather than as static and representative. The stance has several interrelated features that combined serve as an action-orienting guide. This belief/value framework influences the way that therapists and other professionals think about the people they work with, themselves, and what they do together. Each person or group of people we meet with in our work is viewed as a new unique encounter that calls forth a unique relationship and process.

It is interesting to note that this approach does not rely on DSM diagnostic criteria for diagnosing and treating individuals. Is there any specific reason this was determined as a necessary part of the approach?

The approach was originally developed in the psychiatry department of a medical school, and its roots date back to the later 1950s, so it was developed within a medical model of diagnoses and treatment. My colleagues and I took notice of how “patients” were treated as a diagnosis, and not a unique person. In other words, the diagnosis was sitting in front of them, not a unique human being – so what was familiar was noticed and sought. The novelty and nuances of the person and their unique situation/circumstances were not seen nor heard. In other words, the familiar blinded seeing and hearing the unfamiliar.

 Stemming from the decision to not rely on the DSM, would you also say that medication then, is not relied on as heavily as it is in other approaches? Would you agree that medication is necessary for treating some symptoms, but the over-reliance on medication may in fact, damage the client more so than help them?

Of course, sometimes medications are helpful.

Stepping away from the collaborative approach for a moment, you are a co-founder of the Galveston Family Institute at the Houston Galveston Institute. What was it like developing and contributing to such an important resource for mental health professionals?

It was then and is now very stimulating – provides various forums and colleagues within and with whom to be in conversation with – to reflect on and challenge ideas and practices.

Since the institute has been established, you have continued to contribute significantly to the field, through writing, workshops and conferences. One interesting event I need to mention is the International summer institute. What are some of the activities and workshops one would typically experience while attending this weeklong learning conference?

The International Summer Institute (ISI) is a collaborative learning community in action. It is week of immersion in collaborative-dialogic practices. Participants come from various professional, cultural and language contexts. The various focuses of the week are influenced by participants’ interests and agendas – there is always a combination of focus on the application of the ideas and practices in therapy, education, research, consulting/coaching and organizations.

There is a balance of plenary/didactic presentations, conversation clusters to discuss the presentations and etc, self-organize dialogue spaces around topics participants want to delve into more, experiential exercises and demonstrations of the practice with clients during the week. There is ample time for people to network, continue to talk and share about ideas and practices, and to enjoy the culture, food, etc of the Mexican Mayan Riviera.

We pay careful attention in selecting the venue for the ISI as physical space and ambience a critical part of “setting the stage” for a collaborative learning community. There is always a rich mixture of participants – some quite experienced professors and researchers, some who are mainly practitioners (though teaching and research are practices), some with little experienced either professionally or with the ideas and practices, and some students. My colleagues and I find that heterogeneity in learning groups invites a richer learning experience, and the participants echo this in their evaluations.

For more information, please refer your readers to: http://harleneanderson.org/isi2016.html

Your writing is some of the most compelling I have had the opportunity to read. One article in particular that is of interest to me is Some Notes on Listening, Hearing and Speaking And the Relationship to Dialogue in which you demonstrate the importance of communication, and having a space for dialogue. This is so fundamental to therapy. In this article you say: “Wittgenstein talked of relationship and conversation going hand-in hand: the kinds of conversations that we have with each other inform and form the kinds of relationships we have with each other and vice versa.” This demonstrates the importance of developing a therapeutic alliance with your client. Would you argue that the most essential aspect of successful therapy is this therapist-client relationship? And that this relationship stems predominantly from the way we listen to and act towards the client?

I think that the relationship is important, and I think most research that accesses client voices/feedback agrees. The way we meet and greet, and the way we respond with others is critical to the relationship. The relationship is not something that is created at the beginning of the engagement, but something that must be attended to throughout.

 You mention that most unsuccessful therapy was due to the client not feeling as though they had been heard. Would you propose that listening skills could, and should be taught to therapists, in order to offer a more successful therapy experience for clients?

Not necessarily “listening skills” but the notion of responsive listening . Please refer your readers to the work of psychologist/philosopher John Shotter and literary critic/philosopher Mikhail Bakhtin.

I like to ask this of all persons I interview, as a closing statement more so than anything. If you were to give future Psychologists one piece of advice, what would it be?

Hold what you think you might now in “parentheses”. In other words, always be a reflective practitioner: be questioning of inherited knowledge, be careful of the risks of generalizing, and have an awareness of the importance of the local knowledge (the resources–customs, culture, language, history, beliefs, etc,) that each person we work with brings with them to our encounter. We are always both a momentary and transitional ‘host’ and ‘guest’ in the lives of the people we work with.

Taylor, thank you for your interest in my work and for this opportunity to respond to your questions. I send my warmest greetings to you and your readers.

Selected References: 

Anderson, H., Goolishian, H., & Winderman, L. (1986) Problem determined systems: Towards transformation in family therapy. Journal of Strategic and Systemic Therapies. 5(4):1-13.

Anderson, H. (1987) Therapeutic impasses: A break-down in conversation. A presentation at Grand Rounds, Department of Psychiatry, Massachusetts General Hospital Boston, MA. April 1986 and at the Society for Family Therapy Research, Boston, MA, October, 1986.

Anderson, H. & Goolishian, H. (1988) Human systems as linguistic systems: Evolving ideas about the implications for theory and practice. Family Process 27:371-393.

Anderson, H. & Goolishian, H. (1992) The client is the expert: A not-knowing approach to therapy. In S. McNamee & K.J. Gergen (Eds.) Therapy as Social Construction. Sage Publications: Newbury Park, CA.

Anderson, H. & Swim, S. (1993) Learning as collaborative conversation: Combining the student’s and the teacher’s expertise. Human Systems: The Journal of Systemic Consultation and Management. 4:145-160.

Anderson, H. (1994) Rethinking family therapy: A delicate balance. Journal of Marital and Family Therapy. 20(2):145-150.

Anderson, H. (1998) Collaborative learning communities. In. S. McNamee & J.K. Gergen (Eds.). Relational Responsibility. Sage Publications: Newbury Park, CA. Anderson, H. (1997) Conversation, Language, and Possibilities: A Postmodern Approach to Therapy. New York: Basic Books.

Anderson, H. (1999) Reimagining family therapy: Reflections on Minuchin’s invisible family. Journal of Marital and Family Therapy. 25(1):1-8.

Anderson, H. (2000) Supervision as a collaborative learning community. American Association for Marriage and Family Therapy Supervision Bulletin. Fall 2000:7-10.

Anderson, H. (2000) Becoming a postmodern collaborative therapist: a clinical and theoretical journey. Pat I. Journal of the Texas Association for Marriage and Family Therapy. 3(1):5-12.

Anderson, H. (2003). A postmodern collaborative approach to theraphy: Broadening the possibilities of clients and therapists. In Ethically challenged professions: Enabling innovation and diversity in psychotherapy and counseling. In Y. Bates & R. House (Eds.). PCCS Books: Herefordshisre, UK.

Anderson, H. (2005). Myths about not knowing. Family Process, 44, 497–502.

Anderson, H. & Gehart, D. (Eds.). (2007). Collaborative practice: Relationships and conversations that make a difference. New York: Routledge.

Anderson, H. & Jensen, P. (Eds.). (2007. Innovations in the reflecting process: The inspiration of Tom Andersen. London: Karnac Books.

Anderson, H., Cooperrider, D.,  Gergen,M, Gergen, K., McNamee, S.,  Watkins, J M., and Whitney, D. (2008). The Appreciative Organization. Taos Institute Publications.

Anderson, H. (2008). Collaborative therapy. In K. B. Jordon (Ed.), The theory reference guide: a quick resource for expert and novice mental health professionals. Hauppauge, NY: Nova Science Publishers.

Anderson, H. (2009). Collaborative practice: Relationships and conversations that make a difference. In J. Bray & M. Stanton (Eds.). The Wiley handbook of family psychology. (pp.300-313).

Anderson, H. (2012). Collaborative practice: A way of being ‘with’. Psychotherapy and  Politics International. 10, 1002.

Anderson, H. (2012). Collaborative relationships and dialogic conversations: Ideas for a relationally responsive therapy. Family Process. 52(1): 8-24.

Anderson, H. (2014). Rethinking psychotherapy: Collaborative-dialogue. Psychology Aotearoa. Auckland, New Zealand: 6(2): 87-92. November 2014.

Anderson, H. (2014). Tips for how to have a good assistant. Silver Fox Advisors. http://silverfox.org/content.php?page=2014_September_Newsletter.

Anderson, H. (2014). Collaborative-dialogue based research as everyday practice: Questioning our myths. In G. Simon & A. Chard, Eds. Systemic Inquiry: Innovations in Reflexive Practice Research. www.eicpress.com: Everything is Connected Press.

Anderson, H. (2015). Collaborative therapy. In Sage Encyclopedia of Theory of Counseling and Psychotherapy. (E. Neukrug, Ed.). Thousand Oaks, CA: Sage Publishing.

Websites:

http://www.taosinstitute.net/

http://www.talkhgi.org/

 http://www.harleneanderson.org/index.html

Understanding Empathy: Where do we go from here?

Now that we have given an outline of our understanding of empathy and the impact it has in a therapeutic setting, what should we do with this information?

Firstly, we should ask ourselves if we do indeed display empathy. It is okay if the answer to that question is no, and for some that may be the case. It is better to know that you are not displaying empathy than to go on thinking you are, all the while providing a sub-par therapeutic atmosphere for your clients.

The next step then, is to determine the method by which we learn to empathize. Some argue that empathy is something we are born with, but I believe that we all have the tendency toward empathy, we simply choose –whether consciously or not – to do away with it. Acting empathetically can prove difficult when you do not have a relationship with the person, or you are dealing with your own troubles. It is most difficult however, when you have never been shown yourself. This is often the case. We live in a society, especially now, that shies away from intimacy, and emotional expression. We are taught briefly in school that “active listening” is the best way to be heard, but as we grow older we begin acting selfishly, we start looking for our turn in the conversation, rather than listening to and reacting to what our companion is saying. We briefly address their points, and then delve right into what we have been ruminating about while we impatiently await our turn.

This undoubtedly results in animosity and feelings of invalidation. It can be a frightening, and anxious experience to share a part of yourself with another person. There is the looming fear of judgment; the fear that what has to be said will change the relationship dynamic. Because of these two things, people often hold back the things they want to say. This of course, leads the individual to ruminate upon their feelings, which in turn motivates somatic symptoms, as well as more pathological mental symptoms to develop. In order to avoid such things from occurring, we must learn how to be empathetic.

Rogers gives us the best example of what it means to be empathetic, as well as the best evidence for our ability to learn empathy (Rogers, 1951, 1959, 1974). He mentions in his lecture on empathy, that what he found most helpful when he was unable to provide the client with any active assistance was to actively listen, and to truly hear what the client was saying. He found this to be the most helpful passive approach to therapy (1974). Harlene Anderson notes in her article “Some Notes on Listening, Hearing and Speaking And the Relationship to Dialogue” that: “clients say they want to be listened to and heard. In the majority of my conversation with clients about their experience of therapy and whether it was helpful, the most common factor in unsuccessful therapies was not being listened to or heard” (Anderson, 2003). If this is what clients are saying, then we should be listening.

Learning how to be empathetic.

This is somewhat of a daunting task, considering the society in which we are living. I have talked before about how our relationships are very shallow means-end relationships, and this has essentially conditioned us to act very selfishly. This is expressed through our conversation styles, our impatience with each other and our inability to truly listen and feel what others are feeling. It would be too much of a commitment to begin discussing all the ways these attitudes are presented throughout society, so I will avoid such a digression. However, it should be noted that our connectivity can be feigned through slacktivism, and shallow social interactions (attending movies, or shopping centers are just a few examples). This is of course, not to say that we should not be allowing ourselves less intimate interactions, in fact, these lay the groundwork for any substantial relationship we are to have. What I am saying however is that our reliance on these interactions is what causes us to have an inability to delve below surface level.

How can we learn something like empathy? I propose a sort of conditioning. To begin with, we must force ourselves to be empathetic in every situation we encounter, even those that are shallow by nature. Empathy should not be forced in situations in which it is not warranted. What I mean to say here is that you should not seek out opportunities to be empathetic, rather, you should be ready to be empathetic in every situation. Part of empathy is not forcing someone to express themselves if they do not feel it is necessary. By preparing yourself to be empathetic, you are on the way to realizing it.

To give you an example, imagine you are walking through the mall with your friend. She mentions she wants to buy a new dress, and she sees one in the shop window that she really likes. Instead of a typical response which may run something like: “I like that dress too, I am also looking for a new dress because I have a party to attend,” keep the focus on her, mention that you think the dress would look good on her, and ask her why she is looking for a new dress. Do not mention yourself or your interests. This shows her I heard what you said, and I would like to know more. It builds trust, and confidence in your friend. It shows her that what she has to say is important, and that you are listening to what she has to say. It may seem simple, and though this is a very shallow exchange with little emotional weight, you are paving the way for future intimacy.

This sort of exchange not only allows your friend to feel more comfortable and more trusting, it also conditions you to act in a more empathetic way whenever possible. Empathy is not only meant for therapy.

Some things to consider as you teach yourself to become more empathetic:

  • practice active listening
  • delve below surface level whenever possible
  • paraphrase what the person has said, and validate what they have said
  • do not interject with solutions to problems, or with your own input
  • whenever possible, steer the conversation towards the other, if you are finding it difficult to listen and you find yourself waiting for your turn let the other person know.
  • Be as honest and as accepting as possible

By practicing all 6 items on our list daily, it will become second nature to you. You will find it much easier to be empathetic, and you will not have to think about it. Empathy should be incorporated into our everyday lives, as well as into therapy. By conditioning ourselves to act in such a way we may also encourage others to do so, which of course, can only produce positive results.

Empathy is a difficult concept for some. We feel as though we are being empathetic, yet our thoughts are straying, our eyes are wandering, or we are inadvertently invalidating the feelings of others. By practicing empathy, and becoming more empathetic we allow ourselves to grow, and we allow others to grow, in a positive and healthy environment. Empathy is such an essential tool in the therapy kit, and it should be used as often as possible, whether you believe you have the skill or not.

 

References:

American Personnel and Guidance Association. (1974). Carl Rogers’s 1974 lecture on empathy. Retrieved from https://www.youtube.com/watch?v=iMi7uY83z-U&feature=share&list=PL9w3l7GkGUr1yxU4s2PiggyCbOO3XfpRf

Anderson, H. (2003). Eight Annual Open Dialogue Conference: What is Helpful in Treatment Dialogue? Tornio, Finland.

Rogers, Carl. (1951). Client-Centered Therapy: Its Current Practice, Implications and Theory. London: Constable. ISBN 1-84119-840-4.

 

Rogers, Carl. (1959). A Theory of Therapy, Personality and Interpersonal Relationships as Developed in the Client-centered Framework. In (ed.) S. Koch,Psychology: A Study of a Science. Vol. 3: Formulations of the Person and the Social Context. New York: McGraw Hill.