Monday, January 26, 2009

The Helping Environment

A Helping Relationship


For those who haven't heard of Carl Rogers, here's a summary of what research has found to be of the most help in counseling: That the client feels that his/her therapist is trustworthy, that the therapist tries to understand them, and that the therapist is being genuine with them.

Techniques and teaching methods alone do not bring about improvement. It's hard to trust the process, if you don't have faith in the person putting you through it. This is true for most relationships, even those that you may not consider personal. Take calling up customer service for help, for instance. If the representative doesn't seem to care about your problem or doesn't seem to understand, you're not likely to have much faith in what they tell you--especially, if like me, you normally find that this type of customer service representative is far more likely to tell you something that causes more harm than good. Not getting enough data will give diagnoses that may be very wrong and don't fit in with the other things the client is experiencing. It's hard to give sensitive information to someone whom you don't trust, even if you know intellectually you should. It's a matter of self-preservation.

But if one has the knowledge, they can tell you what's wrong. And knowing what's wrong is half the battle, right? To such a question, I answer, "Only if the diagnosis makes sense to the one it's being applied to." Though to be honest, I still believe that a diagnostician who doesn't have the client's trust is working under a handicap. Anyway, no diagnosis will help a client to make any significant change to their lifestyle if they don't comprehend it. I can't find my book right now, but I believe it is in John Bradshaw's Healing the Shame that Binds You where the author gives the example of a preschooler being reprimanded for riding their tricycle beyond the corner, after being told several times not to. While the parent was engage in rage, the terrified child looked up and asked, "What is a corner?" No one can follow instructions they can't understand.

Another situation that many people are probably more familiar with: someone is in a very abusive relationship, who really should leave, but doesn't--or if they do leave, they return to it after a while. Most people who have been on the outside looking in, often give up on the person, saying things like, "They want the abuse." "They're idiots." "They're just hopeless." However, what often happens is these people don't leave because they really cannot comprehend how to live differently. Sometimes financial or cultural issues keep them there. Sometimes they don't understand the help they can receive. However, some of them stay because of beliefs that the relationship will change if they just work hard enough at it, or love the person more, or that they are the ones at fault. These people can be pressured into leaving their abusive significant other, but they do it to please those pressuring them, not because they themselves believe the abuser is horrible. In fact, being insulting about the abuser is more than likely to bring out the protective response in them. As long as they see some hope in the relationship, they won't give it up easily. Only they can make that decision and make it stick. After all, if you are demanding them to get out of the relationship, you might appear just as bad as the abuser they are dealing with. That's not to say that you shouldn't tell them that there is something wrong, if they appear open to it. Nor am I saying that you shouldn't interfere if it becomes a matter of life and death. However, when all is said and done, only the person can finally cut those ties.

What has worked the best for me when in such a situation is to emotionally support the person in their decisions and let them know that I am there for them, even though I don't agree with them. Usually when they no longer feel pressured to defend the abuser or the relationship, they are able to make the decisions necessary for their own happiness and there are no "What if I had tried this or that?" regrets to contend with. When all is said and done, they need the support more than they need the problem labelled, though the label can help them to address the problem.

Grossly simplified: diagnosis is not the same as therapy. This is a particularly sore spot for me because as someone who intends to become certified as an art therapist, one of the greatest frustrations I have is getting people to understand that when I speak of doing art therapy, I am not talking about using the client's art to see what's wrong with them--I'm talking about the client using their art, especially the process of making it, as a means towards self-understanding and growth. Yes, it is possible to diagnose certain conditions through artwork. Studies have shown that schizophrenics often draw in a certain manner and that sexually abused children will often exaggerate certain body parts when drawing people. However, studies have also shown that it is what an individual personally attaches to an image that matters when it comes to a therapuetic art process. And non-directive therapuetic artmaking works better in most cases than telling the client what to draw, even though directive artmaking is not without some benefit.

The research on Carl Rogers' person-center therapy has been so convincing and thorough that almost all schools of therapy promote using it in addition to their methods and philosophies. But how does one foster this trusting and safe environment with a client? Not without a lot of soul searching on the part of therapist. To be able to provide a safe environment to allow the client to explore the dark and scary parts of their own psyche, the therapist has to be able to not only deal calmly with the client's fears and anger, but their own. We are never truly as good about hiding things as we often belief we are. Things slip out at times and if we do not handle those feelings with genuiness, then we give our clients very good reasons to feel at least a little unsafe around us. They will hold back telling us about certain feelings and thoughts to keep the therapist from reacting badly. However, if the therapist also has shown that they believe in the client's abilities to grow and be stronger, then the relationship has another mooring to keep it in place. Likewise, an understanding of the problem as the client experiences it creates yet another mooring.

In a way, the therapuetic relationship is like scaling a cliff with the therapist as a guide and safety line. Both therapist and client has some treacherous terrain and loose rocks to look out for, but a skilled therapist, like a mountain guide, makes sure the safety lines are in place and knows not only how to handle the situation when the client slips, but what to do in the hopefully uncommon situations when both do.


Thursday, January 22, 2009

Symbolism and Imagery


Rituals of Healing: Using Imagery for Health and Wellness by Jeanne Actherberg, Ph.D., Barbara Dossey, R.N., M.S., FAAN, & Leslie Kolkmeier, R.N., Med.

The Power of Symbols by A. "Mandy" Doerr, 


Okay, I'm going to be a little lazy here.  I am going to reprint what I wrote years ago in The Power of Symbols because after rereading it, I realized that I would be hard-pressed to improve it.  (Though I have added a clarification or two as a footnote.)  After the essay, I will write a few paragraphs on the technicalities of imagery.


    Simply said, a symbol is something that represents something else. The letters you are reading now are visual symbols (or physical symbols if you're using a Braille reader) of verbal words which in turn are auditory symbols of concepts, ideas, objects, actions, people, etc. Numbers symbolize relationships and amounts. Individually, letters and numbers are very simple things, but put them together in patterns and manipulate them and you have the ability to communicate the depths of the soul or discover the secrets of the universe.
    Carl Jung would probably have cringed at my discription above, for I included what he termed mere "signs" in my definition of a symbol, in addition to his definition of a word or image that "implies something more than its obvious meaning." (From Man and His Symbols.) I do this because my inner engineer sees no point in the distinction when she is manipulating concepts. My inner poetess does agree with Jung, but finds what the inner engineer comes up with very intriguing and will rarely protest. The inner matriarch, however, will put her foot down if she thinks the other two are getting out of control.
    So despite what my inner engineer thinks, it is still a very good distinction to make. While signs relay only information, symbols affect us on a much deeper level. Quoting from Man and His Symbols again, I give you Jung's explanation:
    It has a wider "unconscious" aspect that is never precisely defined or fully explained. Nor can one hope to define or explain it. As the mind explores the symbol, it is led to ideas that lie beyond the grasp of reason. . . . Because there are innumerable things beyond the range of human understanding, we constantly use symbolic terms to represent concepts that we cannot define or fully comprehend.
    About this time my inner poetess smiles in smug triumph and my inner engineer goes, "That's what you think, buddy." At which point the inner matriarch gives them both cookies and milk and tells them to be quiet for a few moments.
    The point is - a symbol carries not only a meaning, but a set of related meanings, some which may not be apparent at first. Furthermore, there are different sets of meanings that exist for a symbol depending on the context it appears in - just as there are different means for many phrases depending on the context surrounding them. Alter the context just a little and new connections become apparent. Alter too much and it all becomes meaningless.
    "But how can one be sure of the correct context?" asks my inner engineer. To which my inner matriarch answers, (after smacking the back of the engineer's head for talking with a mouth full of cookie crumbs), "By finding the symbolic constants and manipulating them until everything falls into place." My inner engineer then takes a large sip of milk and starts talking excitedly about mathematical atomic models and how they progress over history, until they become better and better at predicting atomic behavior. My inner poetess sets down her cookie and asks, "And how do you know when you have reached the truth of what an atom is really?"
    My engineer blinks and says, "Well, it's impossible to know what an atom is really like because we can't see it. We can only construct mathematical representations that explain the behavior we see through experimentation."
    "Then Jung was right," my poetess says. "Man cannot understand everything. Even you must relinquish the concrete for the symbolic."
    My engineer shrugs. "I'll give you that, but it does show that signs can work the same way as symbols." 
    "I think the mathematical signs you're referring to could also be considered symbols," return my poetess. My inner matriarch hushes both up again before they get into an argument.
    There are symbolic constants that exist through the collective conscious of humankind. They are called symbolic archetypes and we have only begun to meticulously identify them in the past century or so. Many psychologists are rediscovering the power in them and more personal symbols in the transformation and maturing of self - knowledge once widely accepted among ancient cultures. After discovering that man is made up of atoms and their bodies planned through DNA, we are just now starting to appreciate that the human mind is a symbolic entity.
    This should not come as a surprise. The cornerstone of intelligence is the ability to make connections and identify patterns. That is what a symbol is - a concentrated module of connections and patterns. Some of us have just set that part aside in the pursuit of the concrete. Because of the concentrated nature of symbols, they can be very powerful things if used just right. They can explain processes, sway opinions, give direction and even predict certain events.**
    In its own way, science has stumbled across the dual nature of man. The carnal, concrete being and the spiritual, symbol-driven one. Through the use of symbols, we learn to access our spirit - to either use it or abuse it at our whim. Properly harnessed, the spirit is stronger than the body. Studies on survivors show that the factors that determines who will survive and who will not is not their physical attributes, but their emotional and mental ones.
    We as individuals are very much like symbols - we too are much more than what is obvious at first glance.

** When I refer to predictions, I mean as a mathematical model predicts behavior.  Those who have been keeping track of the recent fMRI research or read the science headlines, have probabling already seen the articles about areas of the brain becoming activated when it anticipates needing those areas.  Also, many IQ tests rely on our ability to predict the next symbol in a series.  In fact, some people insist that prediction is a major part of intelligence.  Probably a really good example of what I am talking about is one of the basis of Isaac Asimov's Foundation series, specifically the concept of psychohistory as a mathematical science.

Okay, now on to the terminology and such of imagery in a healthcare setting.  I must apologize, but after reading everything, I decided I would be better served with a vocabulary list, then an essay on imagery.  I sort of consider imagery as the practical application of symbolism.  I could share some of the data I've found in the past on the effectiveness of visualization exercises and such, I suppose.  However, this is already pretty long. 


Types of Imagery

Receptive Imagery - images the come into the mind of their own accord and not consciously created.

Active Imagery - images consciously and deliberately created.

Concrete Imagery - technically correct (or real-life) images.  Sometimes referred to as biologically correct imagery.

Symbolic Imagery - images that represent something else in a symbolic way.

Process Imagery - imaging step by step to the final goal.  Often uses concrete imagery.

End State Imagery - images that represent the final healed state of the individual.

General Healing Imagery - images that are involved in the healing process without being part of the process or end state imagery.

Preverbal Imagery - images that have more of a connection with the physical body than language can express.  Can include other senses such as touch and hearing.

Transpersonal Imagery - images that represent connections to other people or another power outside of one's self.

Package Imagery - imagery created by someone else to use in an exercise.

Customized Imagery - imagery created specifically by the person using it, which is unique to them.


Chapter 5 and 6 of Rituals of Healing cover things like relaxation exercizes and and creating your own imagery.  On pages 77 and 78, it discussed the Imagery Assessment Tool (IAT) for determining the dynamics of a patient's imagery.  There is also a list of conditions where imagery often becomes of limited usefulness, such as an inability to concentrate because of depression, pain or medication being taken; lack of motivation and/or time; or an intense need to please others with the images, instead of accepting what comes to mind.

Sunday, January 18, 2009

I create art too.

I have put up some of my art for sale. Feel free to look at it and send your friends to it.

Original Art -
Prints -
Merchandise -

Carl Rogers

A brief background summary by A. Doerr

[Sources used: On Becoming a Person by Carl Rogers (Preface, Introduction, and Chapter 1); Wikipedia Entry on Carl Rogers; and "WE OVERCAME THEIR TRADITIONS, WE OVERCAME THEIR FAITH" by Dr. William Coulson.]

Carl Rogers was the fourth of six children from a relatively well-to-do and affectionate family. His parents were very protective and created a very rigid religious environment to raise their children in to keep them uncorrupted by worldly things. To this extent, the family moved to a farm when he was twelve. There his father, a prosperous business man, farmed as a hobby and the children were encouraged to do the same. On the upside, this installed Rogers with a strong conscience and gave him a strong animal science background. On the downside, this upbringing convinced Rogers that people were inherently good and that strict religious systems were harmful to an individual's personal development.

This last belief was further strengthened after he changed from a degree in agriculture to history and joining the ministry. He felt that he was being indoctrinated more than taught. In 1922, Rogers went with a Christian student group to France and Germany after World War I. It was then that he was exposed to the concept that very honest and good people can believe very different things. After further religious study, he became convinced that it was "a horrible thing to have to profess a set of beliefs, in order to remain in one's profession." (Rogers, 1961, p 8) This eventually lead him to becoming a children's counselor and then a very successful psychologist when it came to dealing with neurotic patients.

If we to inject the generation cycle theory put forth in the book Generations by William Strauss and Neil Howe, we can easily place Rogers in the G.I. Generation due to his birth. The quote from Wikipedia that states: "[a]ll of them entering midlife were aggressive advocates of technological progress, economic prosperity, social harmony, and public optimism" does fit Rogers a great deal. He was very optimist about human nature and social harmony. However, perhaps due to his very protective upbringing, Rogers also shares many traits of those in the Silent Generation, advocating "fairness and the politics of inclusion, irrepressible in the wake of failure."

I've included this sociological information to help explain Rogers' fame and infamy. Peter Kramer's posthumous introduction to Roger's book On Becoming a Person mentions that in some ways, Rogers was what Isaiah Berlin would call a "hedgehog"--he knew one thing, but he knew it so well that it became his world. Most of Rogers ideas were good and are still in use today, especially his push to get the field of psychology to rely more on scientific methods and studies, but his own work was mostly for neurotics. His success there was worthy of the fame he received. It was when he tried to apply his theories to people who weren't neurotic that things fell apart.

To quote Neils Bohr: "An expert is a person who avoids small error as he sweeps on to the grand fallacy." Rogers' grand fallacy was the IHM Nuns controversy. Dr. William Coulson, an assistant of Carl Rogers who was personally involved in this experiement, has spoken on the subject with much honesty and clarity. Though, like Rogers, the "all or nothing" thought distortion sometimes raises its head. Though I'm not really sure if it is them actually, or the people who are presenting their work to prove their own agenda. It is my impression that the cause of this disaster in the field of psychology was based on the following factors:

1) Rogers did not stop to consider how his own issues were being triggered. After all, the Catholic school acted much in the way his own mother did towards him and his siblings. Of course, the feedback from the progressive faction of the IHM only helped to feed his biases by suggesting that things did need to be changed. However, even though a lot of something can be bad, that doesn't mean that any bit of it of all is also bad. In fact, some of it may actually be necessary.

2) Rogers believed that all people were good. As Maslow said, there was great danger in his assumption that there weren't paranoids, psychopaths or other destructive people that would mess things up for him.

3) Rogers' own belief that people should ultimately be their own authority backfired on him. In his assumption that all people were inherently good, it had never occurred to him that not everyone had a conscience as well-defined as his, even though Abraham Maslow warned him of the evil that can exist and the failure of his methods when Maslow tried to use it with his own students. So, while the encounter groups ran by Rogers and those who were afraid of Rogers no one wandered into sexual misconduct, other facilitators were not as restrained. In fact, Rogers and Coulson were unaware that of "the reports of seductions in psychotherapy, which became virtually routine in California."

Coulson summarizes this backfiring better than I could: Rogers didn't get people involved in sex games, but he couldn't prevent his followers from doing it, because all he could say was, "Well, I don't do that." Then his followers would say, "Well, of course you don't do that, because you grew up in an earlier era; but we do, and it's marvelous: you have set us free to be ourselves and not carbon copies of you."

4) There was several older nuns and priests looking into feminism and other social reforms who neglected to provide any real guidance to their students, who were lead to believe that they would receive sound guidance. So instead of being liberated, the students were actually abandoned. Granted the studies about the human brain not being fully developed until age 26 probably weren't available at that time and the leaders didn't quite comprehend that their charges were still developing judgment skills.

5) The popularity of humanism was at its height and coupled with drug use in many cases. While Rogers had troubles with even putting soda pop in his body as a young adult, I wouldn't be at all surprised if some of his followers considered drug use as a means to overcome obstacles to being one's self.

6) California is not really a place to find "normal people" in large numbers. (I was borned there and live only a few years there and even I can't claim to be a "normal" person.) Rogers probably should have been suspicious when he couldn't get the same study to work in Wisconsin because the participants kept dropping out when they realized what was going on. Instead, he found a group willing to invite him in to do this. That in itself should have been a red flag. However, I will not judge him on that matter, considering the fact that humans have a wonderful tendency to ignore red flags and I have done it a time or time myself.

Even though this became a total failure as an attempt to improve the lives of the nun, it did eventually improve and support the ethical guidelines for psychologists. Counselling students are now taught that it is unethical to try to change a client's religious beliefs, to have sexual interactions with the client, and to be aware of one's own issues enough to know when they should refer a client to a professional without the same issues. Rogers did realize his own folly. So, while he did fall into Bohr's definition as an "expert", he and the field of psychology did learn from his mistakes.

From now on, I will be focusing more on what Rogers got right. Having accepting his human fraility, I will start on his brilliance.

Friday, January 16, 2009

Essay on the purpose and basics of rituals

Essay on the purpose and basics of rituals

A. Doerr


Based on the text: Rituals of Healing: Using Imagery for Health and Wellness by Jeanne Actherberg, Ph.D., Barbara Dossey, R.N., M.S., FAAN, & Leslie Kolkmeier, R.N., Med. 


For the intents and purposes of this essay, I will define a "ritual" as a planned set of symbolic actions.   Otherwise, I am going to end up writing a treatise and I don't want to.  As you will notice, I'm not being extremely scholarly about this essay, either.  If we're going to talk about the ways rituals help us, then I might as well explain the one I am performing right now.  One of my rituals is to take material that I read and see how it integrates into my already acquired knowledge and personal experiences.  I am what some call an "experiential learner".  My ritual of ingesting information by using it in the form of an original writing, organizing it in some way, or just finding a practical use for it in my own life, helps me to retain and understand the information better.  This is really the purpose of rituals--to help.  Whether by controlling anxiety through organization, recognizing achievement, dictating social actions to make things go smoother, or creating social bonds, rituals are usually established as a helpful mechanism for life's changes and challenges. 


In general, a ritual has three major phases to it--separation, transition and return.  I was first introduced to the structure of rituals when I was taking my bereavement class as an undergrad.  It fits for funerals, weddings, commencement ceremonies, inaugurations and even my little ritual here.  In all cases, a significant amount of planning is involved.

Separation can be either voluntary (such as becoming a graduate or a bride) or non-voluntary (such as a griever of a loved one who died).  In this phase, the major participants of the ritual become marked as different from the rest of society.  While mostly symbolic, this separation can also be a physical one.  In many cases physical separation serves a purpose.  Grieving, depressed and ill people need to conserve their energies to deal with their tribulation.  Graduates, engaged couples, presidents elect and students like myself need time to organize and plan without distractions. 

Transition is the formal part of the ritual where the participants change from their former lives to their new lives.  The grieving say goodbye to the deceased.  The bride and groom become wife and husband.  The undergrad becomes the graduate.  In other cultures, a child becomes and adult.  And I become more educated.


Return is the re-entry into daily life as dictated by the new social role.  In my case, it is the sharing of my knowledge with others.   However, my "re-entry" is atypical in its shortness.  For most rituals, the return to daily life can take a while as the person adjusts to their new life.

Healing rituals have a few other commonalities.  The first part if the "naming" of the problem.  Talk to any person who has finally gotten a diagnosis for an illness, and you will find that a sense of empowerment and relief often comes with it.  (I had a friend who used to tell me that I was the only person she knew, who was happy to find out I was clinically depressed.)  There are obviously some exceptions to this, but in general it is true.  However, the naming of the problem must come from someone the person trusts or it's not going to help at all.  (Like the fictional Dr. House who refuses to believe that he has lupus.)  In a way this is the medical part of the separation ritual.  By having a name for your problem, you become part of a definite and separate subgroup from the rest of society.  Part of the transistion phase of a healing ritual includes many common steps of recovery, helping the participant to live a healthier life.  Effective healing rituals help to create stronger support systems for the participant, making the return to daily life a more stable one.

Saturday, January 03, 2009

Self-made class

Extracurricular Reading in Mental Well-Being
Spring 2009 - First 8 weeks
A. Doerr

Goal: To consider the implications of Carl Rogers’ view of psychotherapy and explore the use of healing rituals as they are presented to the nursing field.

Basically, both of these books have been waiting for me to get round to reading them. I chose to do these two together because the combination is a balance of theory and application. The dates listed are the completion deadlines for each set of assignments. Supplemental reading is not mandatory, but we’re talking about me here, so it’s pretty much a given. Essays will be posted on Diary and ritual work will be summarized to protect privacy. Images may possibly be scanned and also posted. Readers of the blog are more than welcome to follow along themselves, and civilized questions and comments are more than welcomed.

Books: On Becoming a Person by Carl R. Rogers
Rituals of Healing: Using Imagery for Health and Wellness by Jeanne Actherberg, Ph.D., Barbara Dossey, R.N., M.S., FAAN, & Leslie Kolkmeier, R.N., Med.

Week 1 - 1/16/09
Reading: Rogers - Intro, Preface and Chapter 1 “Speaking Personally”
Actherberg, et al - Chapters 1 & 2 “The Healing System”
Assignments: Essay on Rogers’s reputation and background
Essay on the purpose and basics of rituals

Week 2 - 1/23/09
Reading: Rogers - Chapters 2, 3, & 4 “How Can I Be of Help?”
Actherberg, et al - Chapters 3, 4, & 5 “Connecting Body-Mind-Spirit”
Assignments: Essay on the characteristics of a helping relationship
Essay on imagery and symbolism

Week 3 - 1/30/09
Reading: Rogers - Chapters 5, 6, & 7 “The Process of Becoming a Person”
Actherberg, et al - Chapters 6, 7, 8, 9, 10, 11, 12, & 13 “Anxiety, Pain and Procedures”
Assignments: Essay on what it means to become a person
Do a “diary symptom chart” (p 98) for the week

Week 4 - 2/6/09
Reading: Rogers - Chapters 8 & 9 “A Philosophy of Persons”
Actherberg, et al - Chapters 14 & 15 “Healthy Breath”
Supplemental Reading: The Palette of Breath - Facts About Breathing by Lauren Robbins
Assignments: Essay on being a fully functional person
Create and use a personal breathing ritual; chart its effectiveness; and critique the process and your participation in it

Week 5 - 2/13/09
Reading: Rogers - Chapters 10, 11, &12 “. . . Research . . .”
Actherberg, et al - Chapters 16, 17, 18, 19 & 20 “Healthy Heart”
Assignments: Discuss the implications of the person centered approach in research
Based on the diary symptom chart, create a ritual for your most significant health concern and evaluate the ritual using the imagery assessment tool on pages 77 & 78.

Week 6 - 2/20/09
Reading: Rogers - Chapters 13, 14, & 15 (Education)
Actherberg, et al - Chapters 21, 22, 23, & 24 “Healthy Abdomen and
Reproductive System”
Assignments: Essay on person-centered education
1st week of full ritual with diary entries

Week 7 - 2/27/09
Reading: Rogers - Chapters 16, 17, 18 & 19 (Interpersonal)
Actherberg, et al - Chapters 25, 26, & 27 “Healthy Immune System”
Assignments: Discuss the aspects of interpersonal interactions
2nd week of full ritual with diary entries

Week 8 - 3/6/09
Reading: Rogers - Chapters 20 & 21 “The Behavioral Sciences and the Person”
Actherberg, et al - Chapters 28, 29, 30, & 31 “Peaceful Dying”
Assignments: Essay on personhood and behavioral science
Ritual reflection paper