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Protected: the sound of a melting heart

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I never promised you a rose garden

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a6b5cfbe87b90adc58888458745ded5f I love reading, and the last months I have read some good “based on a true story” books that really gave me some wonderful insights into the human mind. I want to write a bit about the wonderful book I never promised you a rose garden, because it really captivated me. It wasn`t just  the fact that it was well written, but it gave such an acute feeling of being there with the main protagonist, that it almost felt like watching 3D-movie. The book has also been shown as a movie, which I have not seen, but I can assure you that the book is really worth it, even if the film wasn`t (generally books give you something that easily might lack in movies, the persons thoughts, ideas and way of seeing the world. You must use your own imagination more).

Here is some information about the author:
Joanne Greenberg (Helen Green is the alias she uses for the book)

“I wrote [I Never Promised You a Rose Garden] as a way of describing mental illness without the romanticisation that it underwent in the sixties and seventies when people were taking LSD to simulate what they thought was a liberating experience. During those days, people often confused creativity with insanity. There is no creativity in madness; madness is the opposite of creativity, although people may be creative in spite of being mentally ill.”
– Joanne Greenberg

I Never Promised You a Rose Garden is a fictionalized depiction of Joanne Greenberg’s treatment experience at Chestnut Lodge Hospital in Rockville, Maryland, during which she was in psychoanalytic treatment with Frieda Fromm-Reichmann. The book takes place in the late 1940s and early 1950s, at a time when Harry Stack Sullivan, Frieda Fromm-Reichmann, and Clara Thompson were establishing the basis for the interpersonal school of psychiatry and psychoanalysis, focusing specifically, though by no means exclusively, on the treatment of schizophrenia.

It is useful to keep in mind that Sullivan and Fromm-Reichmann were by this time renowned for their work with severely regressed patients, some diagnosed as schizophrenic and others who were not so easy to categorize, using nothing in their treatment scheme except psychoanalytically oriented psychotherapy. Though the use of medicating drugs was in its infancy in those days and most psychiatrists were using electroshock therapy, sleep therapy, and other bizarre forms of treatment, both Sullivan and Fromm-Reichmann resisted these practices and treated their patients, as they themselves would have like to be treated were they suffering from a similar state of collapse and confusion–as though what they really needed was someone to talk to.

It should be noted that they apparently enjoyed extraordinary success in their work, if “success” is indeed the right word, by the measure that many of their patients–like Joanne Greenberg herself–eventually left hospital for good, never to return. Today, when there is so much currency about the presumed causes of schizophrenia and other psychotic disorders–that they are genetically determined, for example, and that it is irresponsible to deprive such patients of the drugs that are now available to them–one wonders if it would be possible–indeed, if it would even be permitted–for people like Sullivan and Fromm-Reichmann to work with patients the way they did 50 years ago. Whatever the cause of schizophrenia might be–and nobody, despite what some claim, actually knows what it is–the treatment still depends on people like Frieda Fromm-Reichmann who are willing to sit with them hour after hour, day after day, and year after year for however long it may take to see them through their ordeal. As a young girl, Joanne Greenberg suffered from an ordeal of her own which her family only gradually began to realize was getting worse. At the age of 16 she was taken to Chestnut Lodge Sanitarium in Rockville, Maryland, where Frieda Fromm-Reichmann became her therapist. Her treatment experience lasted from 1948 to 1951. Ms. Greenberg remained in outpatient psychoanalysis with Dr. Fromm-Reichmann until 1955, by which time she was attending college. Their relationship not only served as a vehicle for Joanne Greenberg’s remarkable recovery, but was also the source of a friendship that continued until Frieda Fromm-Reichmann’s death in 1957. In fact, Joanne Greenberg, her mother, and Frieda Fromm-Reichmann had intended to collaborate on a book revolving around Joanne’s treatment experience, but Frieda died before the plan could be executed. A few years later, Joanne decided to publish a book about her experience on her own, an account that many believe demonstrates a measure of courage, literary power, and immediacy that is unparalleled in the literature on this rarefied and near-impenetrable subject.

As every psychoanalyst knows, the success of any treatment experience is never the result of one person, but the consequence of a collaboration between the two principals: a clinician who possesses the sensitivity and unflappability to contain whatever manner of experience a patient is capable of, and a patient who possesses the courage, grace, and determination to face whatever demons her history has dealt her. Clearly, Joanne Greenberg’s account of her trial is the story of two such individuals, and her courage to write such a book is an inspiration to us all, patients and clinicians alike.

In her presentation, Ms. Greenberg spoke informally about her relationship with Frieda Fromm-Reichmann for the first time before a public audience. She used the occasion as an opportunity to revisit her experience at Chestnut Lodge and to share it with those who are endeavoring to work with people who may be suffering a similar ordeal.

The author, Mr. Greenberg, really have a wonderful way of describing her inner life, that makes it all so alive. Sometimes I had to stop and just soak in the words, feeling the pleasure through my spine as I read through them again. There isn`t many books that give me that feeling, but some of the descriptions were so poetic and at the same songs_of_schizophrenia_by_xalineatime intelligent, that I was really moved. The interesting thing is how the work with the therapist is so closely woven together with her experiences. This adds extra spice to the story, there are so many wonderful metaphor, chilling, because you know they were so much more for her when she lived in the schizophrenic confusion. It was real pain, and the blood on the walls were her way of describing it.

If you are somewhat interested in the psychology of the mind, this will NOT be a disappointment!

http://www.goodreads.com/book/show/45220.I_Never_Promised_You_a_Rose_Garden

http://www.sparknotes.com/lit/rosegarden/

 

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My work as a psychologist

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Freud with his couch

Therapy has for most people been associated with something mystical. Before I started with psychology myself, I also had my mental images of it, and knew about the standard Freudian couch where you simply said whatever you wanted. I`ve heard about Freud, and knew you probably had to talk about your childhood, but had no idea how a typical therapist or patient looked like.

For people who haven`t been in therapy, it is often still a mystery. A lot of my friend have asked me, isn`t it hard to hear about so many horrible things, every day? But it’s basically what we all do, every day, anyway. We see films, listen to our friends, read books and watch news about what`s going on. Of course, we don´t have the “obligation” to do something about that, so people might feel that it`s different, but I promise you, a therapist is not more than a personal trainer cheering the clients on. We always stand by our patients sides when something needs to be done or untangled.

Even if I am a therapist, I still love to go to therapy or supervision myself. I don`t respond to the words, but simply to the fact that I talk with a human being about myself. It’s good to have someone there, who just say “it truly sounds like you had a rough time”.

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What do you talk about in therapy?

This might still be a bit vague. You might think: Well, that`s fine: But what do you exactly DO in those 45 minutes? To make it more concrete, I will try to write a bit more of what therapists do in therapy. Since we can`t talk about patients, I must underline that I don`t describe any patients of mine.

Of course there will be variations in how we work and approach problems, but I always have some basics that underlie everything I do: Respect, curiosity and an attitude of “everything is possible”. I truly believe that, no matter how far someone has fallen, with motivation and hard work, nothing can´t be done.

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People come to therapy for all kinds of reasons

A typical morning for me is getting to work, looking through my calendar and appointments or maybe attending a meeting if its monday or Wednesday. Normally I have about four sessions every day, with people who have a variety of diagnosis. If we have our first meeting, I have to go through some standard questions, but mostly I try to get a description of the problem as they see it. Sometime I also give them some surveys that should be filled out before the next session, but personally I prefer to not use too much time on those, as I find talking to people and hearing their story more important.

people have a variety of problems
people have a variety of problems

In addition, people might get a bit annoyed if everything is about answering questions on papers. I also explain why they have to answer them: So that we can choose a treatment that fits people who generally score the same on those surveys. And of course, if they have a diagnosis where medications is necessary, I can`t ignore that. For very depressed, bipolar people, AD/HD or people with psychosis, conversations might not be what we focus on in the beginning. Sometimes I contact a doctor so that we can secure basics like sleep. For some people, collecting energy will be the first thing we do. It’s can be saying no to people who drain energy, working with attitudes about how perfect everything must be, or simply making a schedule where they put in healthy food, physical activities and “alone-time”. Some people worry a lot, and then the goal might be to set up experiments where those worries are put to the test. For example, people with panic attacks, might worry about fainting in public, and after a while they start to avoid situations that they feel are dangerous. An example that I actually saw on television, was a woman afraid of hurting kids if she had a knife in her hand.

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Using eye movements to reduce fear

After a while, she stopped using knives, and even made sure to lock them in. She also developed a fear where she worried she might accidentally kill someone while driving. After a while she simply stopped driving, because she didn`t want to take any risks. The therapy for her was rather concrete: She had to expose herself to what she feared, like being in the area where kids could be WHILE she carried a knife, and drive a car where people could potentially be hurt, without turning back to check if she had run over people.

I work mostly with traumatized people and people with personality disorders. I usually follow a model where I first focus on collecting energy, before we work with specific traumas that give them flashbacks, nightmares and disrupt them in their daily lives. I use EMDR for this work, which is basically using eye movements while thinking about traumatic memories. I ask them to bring forward a memory that scares them, and to think about the worst part of it. Then they keep that picture in their mind’s eye, while following specific movements I do with my fingers. I monitor their discomfort on a scale from 1-10, where 10 is the worst discomfort they have ever felt, and 0 is completely calm, and keep doing the finger movement until they feel calm. I will write more about EMDR later, but it the main point is that afterwards, it`s easier to live with what happened. People have described it as “earlier I felt the past was as real now as then and now it feels like it`s finally behind me”.

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How to say goodbye

The last “phase” is to talk about ending therapy. We go through the work we have done, and talk about how it will be to say goodbye. This is important, because separations is something a lot struggle with. I must make sure that people don’t feel abandoned, that they can take with them some part of what they learnt in their hearts. I have also talked to a therapist once, and when I feel especially low, I still hear her voice saying: “Take care of yourself, dear”. I say this to my clients: If you take some of what you have learnt here with you, I am happy. I also say that they can contact me later, if they need to. It’s just a way of saying that goodbye is just “Now you can continue on your own. I wish I could walk every step of the journey with you, and in my heart, I will”.

A lot of my jobs is actually just being there. Far too many think they aren`t good enough. It doesn`t matter how many times they have been told or have read that they have worth, it still FEELS like they haven`t. Sometimes its all about stating the obvious; I see how kind-hearted they are (most people are really wonderful), how hard they try, how much suffering they had to go through, and remind them off this, when they think they are terrible people. Therapy is about never leaving, and making sure that they never give up.

I truly care about my clients. When they manage to do something good for themselves, I cheer them on and feel real joy for them. When they change, it feels like magic. It gives me hope, because no matter how bad the past has been, there is nothing that can`t be achieved.

Protected: The sound of reconstruction

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