Articles on Holistic Therapies

CBT - A Quick Fix ??

When a crisis hits us in our lives we naturally want it to end as soon as possible. We may look into psychotherapy and counselling and see that it takes a bit of time. Then we see that cognitive behavioural therapy (CBT) takes 6 – 8 sessions and it’s an easy choice. Or we have done some psychotherapy but want to be fixed quicker so CBT is an easy choice.
We can come to CBT wanting a one-line ‘magic bullet’ phrase or piece of advice that will undo all our problems. We don’t want the answers to have to do with our behaviour, our body or our feelings, just be cognitive. Those areas are off limits. Our back story can also be off limits ie how we got into this situation. The more that is out of bounds and off limits, the more any solution will be purely partial and won’t last very long. What we are DOING is avoiding. Trying to fix only one aspect of ourselves is like putting a small boat on a big ocean, when the ocean rears up the boat gets smashed and the ocean reasserts itself. In other words, the size and power of the mind and its patterns reasserts itself.
Emotionally we can therefore come to CBT with impatience and anger, born out of desperation, but showing an underlying sense of panic and uncertainty. What we are DOING is treating ourselves and others harshly and impatiently from the panic we feel at the uncertainty we are experiencing.
From this we move into relationships and a therapeutic relationship with a sense of ‘give me the answer, you fix me now’. What we are DOING is assuming someone else has YOUR answer. What we are telling ourselves is ‘I can’t help myself’. What we are also telling a therapist is ‘I’m looking for certainty, I can’t bear the uncertainty I’m feeling and the anxiety it brings’.
We are stuck in the vicious cycle of how we treat ourselves. CBT describes the vicious cycle as ‘What we DO follows from and serves to confirm what we believe’.
In CBT we have to become aware of what we DO first, become aware of our patterns. As we calm down we get in touch with the uncertainty and anxiety and see that we don’t know, YET. Knowing that you don’t know is the beginning of knowing and is the start of the solution. We start to give ourselves the time and space we need to look at what’s happening in us and to take a more full view rather than racing to fix one thing out of panic. As the panic itself subsides we see the same one problem differently already. We then have space to trace the roots of this panic and find the underlying assumptions and the core beliefs they sit on. Albert Ellis, one of the founding father of CBT, said: ‘We are not disturbed simply by our experiences, rather we bring our ability to disturb ourselves to our experiences.’
CBT is not something separate from psychotherapy. CBT’s founding principals are based on the same therapeutic principals. There is just a slightly different emphasis – the importance of DOING something to change it, behaving in new ways. When we change what we do, when we stop avoiding and stop panicing and stop treating ourselves with aggression and impatience, and see that we CAN help ourselves and what that might involve, we can begin to DO things differently.
In summary, we become aware of what we do first, then consider ‘what can I DO’ that would represent an important symbolic change in that behaviour. When we act differently we get different experiences coming back to us and our life changes.
How long that takes depends on what is happening with us. Six to eight sessions may indeed be enough to get through the crisis. It may require more and it may not. It’s like drinking water, if you don’t drink enough you remain thirsty, if you drink too much, you can continue drinking but there is no point. There is a point between these two extremes that is the right ‘enough’ point for YOU. Only you can judge that point from your experience of CBT.

This article was written by Thomas Larkin, psychotherapist working at Mind and Body Works. For more information about Thomas please click here

Introduction to Cognitive Behavioural Therapy (CBT)

“Men are disturbed not by things but by the views which they take of them”

Epictetus

The same event may lead to a range of emotions for different people depending on how the event is interpreted and evaluated. It is, therefore, not events that produce bad feelings but the way these events are appraised. When people hold unrealistic and negative beliefs about themselves or their experiences, an emotional upset will result. If this negative thinking is extreme or persistent, it may lead to an emotional disorder.

“We find either that individuals live creatively and feel that life is worth living or else that they cannot live creatively and are doubtful about the value of living. This variable in human beings is directly related to the quality and quantity of environmental provision at the beginning of each baby’s living experience”.(1974 [1971] : 83)

Attachment Behaviour

Following the work of John Bowlby, it appears that children, who have experienced
satisfactory bonding to primary care-givers, will develop a basic set of rules or core
beliefs which say “People can generally be trusted” (Bowlby 1969). Those who have not experienced satisfactory bonding can have an over-generalised response which says “You cannot trust anyone”. Unwilling separation and loss give rise to many forms of emotional distress and personality disturbance, including anxiety, anger, depression and emotional detachment. Attachment behaviour is held to characterise human beings from the cradle to the grave.

Cognitive psychologists take the individual’s early experiences as the starting point of many adult distortions of reality. They have revolutionised our knowledge of how we perceive the world and the situations we are in. Negative experiences, upsets, and the prevailing emotional attitudes of the carers, predispose the child to certain problems.

Example:
Someone with a parent or parents who are hard to please may grow up believing that they must always do well if they are to win approval. Such a person will tend to avoid situations in which they fear failure. In this way, they limit their own options. The difficulty may be dormant until life, refusing to play by the distorted rules of the individual, presents realities that cannot be accommodated, either by avoidance or by perfection e.g. making a marriage work, rearing children or progressing in a company.

Cognitive Behavioural Therapy

Cognitive-Behavioural Therapy, devised by A.T. Beck and Albert Ellis, did not gain
acceptance until the late 1970s. Beck gives the name “automatic thoughts” to thoughts and images occurring involuntarily in the stream of consciousness (Beck, 1976). He has described how the type of emotional disorder produced will depend upon the content of the thought. If a person’s automatic thought centres around danger or threat, then anxiety may be produced. If loss is the dominant theme of a person’s thought, depression will result.

Albert Ellis emphasises the role of “irrational beliefs” in emotional disorders
(Ellis, 1962). Irrational beliefs are evaluative beliefs such as: “I should be perfect”,
“If I make a mistake that proves how useless I am”. Such a belief would be extremely harmful because the client would be extremely upset every time he made a mistake and he might, for example, blame other people in order to avoid admitting to it.

Cognitive-Behavioural Therapy theory asserts that thoughts and beliefs are hypotheses which can be shown to be true or false by logic or evidence. The practice follows directly from the theory and involves helping the client to gather evidence that will disprove unrealistic and self-defeating thinking and thereby change it.

The Cognitive-Behavioural Therapy view is that people are not disturbed so much by past events as by the way that these events are viewed in the present. Take, for example, the case of a depressed person who believes that she is worthless. Her depression is not produced by a childhood experience such as her mother telling her that she was useless, but by the fact that she continues to think and believe this.

Ellis (1977) put forward an easily remembered model which explains the relationship between thinking and emotion. It is called the ABC Model:

A = Activating Event
B = Beliefs, thoughts
C = Emotional and behavioural consequences

What this means is that emotional distress and problematic behaviour, C, are the
consequences, not of the events themselves, A, but of the negative inferences and
evaluations of the events, B.

People, who have distorted images of themselves, have an A-C formula, in which A, the bad event, directly causes C, the emotional distress. One task of Cognitive Behavioural Therapy is to persuade the client that it is the bad evaluation B, “negative automatic thought” (NATS) that produces the C.
For example:
A young student teacher, who was in charge of a class of 25 children for a number of months, became very depressed because she was finding it very hard to control them. She felt that she was not in control and that she would make a useless teacher. She became so depressed that she started missing days. When the therapist asked her about the children in the class, it transpired that two of the children, in particular, were causing the disruption.

The therapist then helped her to dispute the logic of her thinking by asking, for example, “How does it follow that you are useless and not in control when it is only 2 out of 25 children that are disruptive? The therapist got the client to carry out tasks to test out or contradict her beliefs by finding out from other teachers if they were having problems also. She discovered that they were and she also learned that the children were both going through a difficult time at home. This client, who was emotionally upset as a result of the event, was able to identify, through Cognitive-Behavioural Therapy:

i) her maladaptive thinking and beliefs
ii) realise the connections between thinking, emotions and behaviour
iii) test out maladaptive thinking and beliefs by examining the evidence
iv) substitute her NATS with more realistic thinking

There are many examples from everyday life which highlight our cognitive distortions:

• All-or-Nothing Thinking: If I don’t do it perfectly, there is no point in doing it at all.
• ‘Should’ Statements: If I respect others, they ‘should’ respect me.
• Over-generalisation: I never get anything right.
• Discounting the positive: OK so I did well at the exam, so what?
• It’s only what is expected of me.
• Jumping to conclusions: I’m no fun, nobody would want me around.
• Magnification This situation is awful. There is nothing I can do about it.
• Personalization/Blaming: The evening didn’t go well. It was my fault.
• I ‘should’ have been more entertaining.

By learning ways in which to correct distorted beliefs, neurotic states can be
corrected and a healthy psychological state can come about. Ways in which clients
learn to challenge their negative thinking is through role-play within the therapy session or as a homework exercise using the ‘triple column technique’.
For example:
Negative thought: I’m useless, I never get anything right.
Distortion: All-or-Nothing
Discounting the positive
Rational Response: I’m human. I’m not useless.
I have achieved very well many times

Cognitive therapy has become an effective treatment for people with emotional
difficulties, psychological problems and personality problems and important advances in both theory and practice have been made (Clark & Fairburn, 1996). For example, it appears that panic sufferers attribute catastrophic interpretations to relatively normal bodily symptoms (Clark, 1986). People who are socially phobic exaggerate the way they perceive others perception of them, based on internal rather than external cues (Clark & wells, 1995) and people with obsessional & compulsive disorders interpret their own thoughts as evidence that they are bad people or responsible for bad things happening (Salkovskis 1985).

One of the aims in Cognitive-Behavioural Therapy is to look at the meaning the client is giving to situations, emotions or biology expressed as the clients ‘negative automatic thoughts’. The concept is that there is a link between particular types of appraising thoughts and particular types of emotions and the influence that they have over our behaviour.

The appraisal danger for example, raises anxiety and primes us for evasive, defensive or other reaction. Loss is likely to invoke sadness and mourning behaviour and unfair is likely to arouse anger and a possible ‘fight’ response. The responses to our appraisals are not necessarily problematic and are often functional i.e. thinking of the dangers of driving can make us better, more careful drivers but when our appraisals become more exaggerated and we begin to see ourselves having an accident, then our emotion of slight functional anxiety becomes one of panic.

The essence of the model is that emotional difficulties begin when the way we see events gets exaggerated beyond the available evidence. These exaggerated ways of
seeing things tend to have negative influences on our feelings and behaviour, in a vicious circle. The cognitive therapist aims to understand, in a highly individualised way, why the client is appraising events in particular ways and why he/she feels the way that they do.

Given that the clients thoughts and emotions about an event may appear “irrational” his/her core beliefs or schemata may show the response as entirely rational.

The Therapeutic Relationship

In cognitive work, the relationship between the therapist and the client is collaborative. They work together as a team to bring about change. There is a mistaken belief that the approach lacks warmth and is therefore not appropriate in a true counselling situation.

However, it is usually therapists who are genuinely concerned to meet the many and
diverse needs of clients who use cognitive behavioural techniques when they feel that the client will benefit from such an approach. This sensitivity to clients needs is at the very heart of good counselling practice so the notion that it lacks warmth is certainly open to argument.

Investigators (Rogers, 1951; Truax 1963) have found that if the therapist shows the following characteristics, a successful outcome is facilitated: genuine warmth,
acceptance and accurate empathy (Beck,1976, p221). Other characteristics in the
relationship which make for a warm encounter are listening, summarizing and reflecting. Such qualities also enable the client and therapist to work together to challenge thoughts and beliefs which are problematic to the client, to enable such challenging work to take place. Cognitive therapy also allows adaptation of the core conditions to maximise their helpfulness to the individual client, for example too much empathy or warmth may be perceived as threatening to, say, a very depressed client, who believes ‘I do not deserve such caring’ or ‘No-one understands me, why is she pretending?’ Hence, the value of a good conceptualisation of the client’s needs, is being able to modify the core conditions accordingly.

The job of the therapist is essentially one of re-parenting i.e. providing a ‘secure base’ where reflection and debate can occur and where one’s most cherished rules can be revised. What is important is that the Cognitive Therapist formulates a useful conceptualisation of the client’s core beliefs or schemata, formed as a result of past experiences, and that they are clearly identified, to allow them to be re-evaluated from the perspective of a free thinking adult, who is now supported within the therapeutic relationship.

Panic

Cognitive Behavioural Therapy helps the client to come to terms with the manageability of the “worst case” scenarios and the realistic expectation that it is unlikely to happen anyway, for example, many people with panic disorder engage, at times, in “catastrophic thinking” i.e. imagining that the worst is about to happen. In anxiety-provoking situations, they often focus on their physical sensations and may become convinced, not only that a panic attack will occur but, that it will lead to a heart attack.

A panic attack is usually triggered by a negative thought or a frightening daydream.
Once a panic attack develops, your thoughts, feelings and physical symptoms feed each other in a vicious cycle.

Example:
A businessman named Bob spent thousands of pounds having tests. Whenever he felt upset, he’d obsess about some ache or pain, notice a tightness in his chest and become convinced he was dying of heart failure. The results of the tests always proved to be normal. He struggled unsuccessfully for years before he went for Cognitive-Behavioural Therapy.

Bob was asked to put his fear to the test by jogging up and down the hall. In the process he experienced instantaneous relief and agreed to try this at home instead of running to the doctor the next time he felt he was having a heart attack. Several days later, Bob got anxious and felt chest pain but he became so petrified he
couldn’t get out of the chair for fear the slightest movement would trigger a heart attack. Bob’s resistance to testing his fear illustrates how enormously convincing negative thoughts can be, even when they’re absolutely unrealistic. As a way of getting around Bob’s resistance, the therapist suggested that he try very
minimal exercises the next time he felt he was having a heart attack and then try some that were increasingly more demanding.

Between sessions, when he became anxious and felt convinced he was having a heart attack, he took deep breaths, stood up and sat down, walked back and forth across the room, touched his knees, toes and floor, etc. It became clear that he wasn’t having a heart attack. His chest pain and his anxiety vanished. Distorted thoughts, not realistic ones, cause anxiety. It is important at times of stress to look at the normality of one’s feelings and stop adding fear to the feeling, as it is only when one adds fear to their feelings that panic takes over.
 

Shame and Embarrassment

Shame and embarrassment are particularly prominent in people who suffer from social anxiety and panic attacks, as they are particularly sensitive about what people think about them. When a person is feeling ashamed or embarrassed, he usually experiences an intense desire to remove himself from the public view. This way of thinking, for example, “I could never face them again” leads to avoidance and further difficulties. The sufferer can become agoraphobic i.e. afraid of being in situations from which escape might be difficult or in which help might be unavailable if you suddenly had a panic attack.

In Cognitive-Behavioural Therapy, shame and embarrassment can be tackled in
the same way as other emotional problems by verbally disputing the logicality of the
client’s self-devaluation and by setting up behavioural experiments to test out the clients beliefs.

Depression

Therapy seeks to correct the original faulty interpretations and modify the assumption to free the patient to live more fully in the world of reality. According to cognitive theory, psychological disturbances, particularly depression, often begin with the faulty processing of information. This leads to assumptions which lead to irreconcilable and debilitating frustrations.

Example:
Kate came for therapy in a very depressed state after her husband had left her. She felt worthless and a failure. “I should have been able to make my marriage work”, she thought. She stopped going out and started to avoid any social gatherings for fear of negative evaluation by others. She had two sisters who, she felt, were better looking than her and always got more attention. She herself was a perfectionist and a high achiever. This gained her a lot of recognition. She was also a very independent, capable person and she viewed needing support as being incapable and weak. Her father always seemed so dependent on her mother, missing her if she went away for a few days, etc., and she thought becoming dependant on people can make you very unhappy. She was very confused. She did miss her husband but that made her feel weak. What was upsetting her the most was people seeing her as a failure.

During the course of therapy, it became evident, that due to Kate’s unique personal
experiences and life history, she interpreted missing someone, being lonely or needing support as being dependent. As a result of these core beliefs, she lost touch with her husband on an emotional level and, because she felt she was recognised only by her achievements, she feared failure. Her negative automatic thoughts were “I’m useless, I’m worthless”. Failure to make her marriage work made her realise her worst fear.

Depression is often perpetuated by a specific demand that some high standard of personal performance or approval by others must be achieved in order to feel happy. Kate became aware of how she was hurting herself by replaying her past, in other words, because of the way she viewed events. As a result of her core beliefs being clearly identified, she was able to re-evaluate them from the perspective of a free thinking adult, supported within the therapeutic relationship.

Recovery may require new ways of solving practical problems: - goal-setting, problem-solving, assertiveness training and decision making are some of the skills that can be taught in a very structured way within the Cognitive-Behavioural approach but they require commitment and co-operation if they are to have any impact. The therapist works with clients to discover precisely what behaviours clients wish to change and to set specific goals for change. The approach offers a key to survival as much as an option for recovery.

The message throughout therapy is that the real work is a function of what goes on
between sessions as well as within sessions, expressed as a concentration on homework and generalising therapeutic gains across different situations.

Example:

Beck Depression Inventory (B.D.I.) is a self-rating scale which can be given to the
client to rate his/her own emotional, cognitive and physiological aspects of depression and, at the following session, the scoring can be assessed collaboratively with the therapist. It can be a source of encouragement and builds self-esteem for a client who views himself worse than he is. Research has shown that when a person is depressed they can interpret many situations incorrectly. His thoughts are distorted and not based on real fact.

The Daily Mood Log is helpful in enabling clients make the link between their thoughts, feelings and behaviour. This form is structured to allow analysis of what occurs in response to specific upsetting events that happen between sessions. As clients monitor their typical coping behaviours, they become aware of positive strategies as well as self-damaging repetitive behaviours.

Conclusion

Cognitive therapists need to be thoroughly at home working with the emotion, for the emotion itself can be seen as a vital response to events in the world. “If you’re not working with the emotion you’re not where the action is” (Beck 1994).

Cognitive-Behavioural Therapy provides a comprehensive and effective approach to
many emotional problems. It aims to help clients to become aware of what they have been unaware of, overlooking or avoiding e.g. “negative automatic thoughts” and “irrational beliefs” about themselves or their experiences. It transforms their perspectives on their concerns.

BIBLIOGRAPHY

Beck, A.T. (1991) Cognitive Therapy and the Emotional Disorders
New York: Penguin

Boyne, E. (Edited by) (1995) Psychotherapy in Ireland (Revised Edition)
Dublin: The Columba Press.

Burns, D.D. (1999) The Feeling Good Handbook
New York: Plume

Casey, A., Dryden, W., Trower, P. (1999) Cognitive-Behavioural Counselling in
Action. London: Sage

Salkovskis, P.M. (1996) Frontiers of Cognitive Therapy
New York: The Guilford Press

Sanders, D., Wills, F. (2000) Cognitive Therapy – Transforming the Image London: Sage

Kathleen Horne is a counsellor and psychotherapist working at Mind and Body Works. For more details on Kathleen please click here
 

One of the prime benefits of sand therapy is that we see the invisible. It is made visible for us by what the client, who is the designer, has done in the sand tray. Everything is spontaneous three dimensional conscious responses to an inner unconscious voice. Unlike dreams which are often only fleetingly recalled we have a graphic and, if we wish, a photographic record of the inner unconscious material of the client. The arrangements we make in the tray are themselves healing. It is very important to remember this because they do not need your interpretation or mine to be absorbed into the consciousness. Nor do they need interpretation to reorder and balance the psyche. Dreams heal whether we recall them or not and they have their own messages absorbed in our waking life. They are speaking to us in a different language but they are a response to what is going on in our unconscious. Sand therapy heals in the same and even more graphic way.

In dreams the dream is restating, in a different way, what we are not saying in our conscious life. Symbols with exaggerations, archetypes and metaphors recur over and over if we do not pay attention to them in dreams. For example, we have all had recurring dreams and recurring dreams are simply our unconscious saying “pay attention” “listen” “try to understand what I am saying”. And very often, sometimes after many years, the psychic penny drops and we do change something in our life and discover to our amazement that we are not having the recurring dream again. The sand tray, like a dream, does not tell you what you already know but it brings to life and illuminates what has remained hidden, what has been only a fleeting thought perhaps. George Santayana an early 20th century Spanish philosopher, said in his book Person and Places (1981) “those who cannot recall and trace an emotion are doomed to repeat it without understanding”.

Dreams, when understood, help you to become comfortable with the person you are - tomorrow, next week, next year because that will always be the person you were. Part of that person will always be with you. Part of being grown up psychologically, is knowing that we own all of our parts. It is so very easy when somebody has done, or we have done something terrible or that we are not proud of, to say to ourselves or to other people “well if you really knew me you’d know that that’s not really me”. It is. It is us because the sand tray and dreams help show us that we own all of our parts. They point to blind spots, very important, very necessary for us to see.

It might be useful to look at a brief history of sand therapy at this point. Dora Kalff is considered the mother of sand therapy as we know it, but she was preceded and influenced by psychologist Margaret Lowenfeld. However, the beginnings of sand therapy actually go back to H. G. Wells (2004) with a book call ‘Floor Games’. This came about in an interesting fashion. Being as creative as H G Wells was, he was inordinately annoyed at what he thought were the only kind of toys available for children to play with when his boys were young. He set about being the accumulator of what we use today and what we call today archetypal figures – lots of animals - domestic and wild, lots of different kinds of people - people that looked like postmen, sailors etc. and in some instances, had to have them made. In the book he describes how his children flourished under this and what exciting journeys they undertook with this material. This book was read by a psychologist called Margaret Lowenfeld and she thought it would be great to do this in a pit of sand and she literally organised in her little laboratory where she had children come and be observed what we would call sand boxes and the children would climb in. And when she would ask them what sort of things they had done and what they meant they would invariably come up with “well this is my world” or something like that and so she named this World Technique (Lowenfeld, 1979). She presented a paper on it to a Jungian conference which was held in Zurich quite a long time after. What Dora Kalff (1980) learnt from Margaret Lowenfeld was enormous. Margaret Lowenfeld presented her findings at the psychological conference of analytical psychology in Zurich while Dora Kalff was a young Jungian analyst. Dora became quite fascinated in the possibilities in the World Technique and, I might add, Jung himself was also fascinated and encouraged her to develop her take on it, which she did with great success and began lecturing around the world.

I first came across Dora Kalff at University of Southern California in the late 1960’s where somebody had suggested that I go and hear one of her lectures and explained that she had some fascinating theories. I did and never looked back. What she adheres to in all of her work is some basic Jungian criteria. For instance there are three layers of conscious and unconsciousness. There was a personal conscious and that is what we each are aware of now in our present and in the past. There is a personal unconscious what we are not aware of but what is unique to each of us now and in the past. And then there is the collective unconscious, which is the shared unconscious of mankind and is an important layer of the psyche containing the collective contents. This is where the archetypes spring from, for example man’s universal need for religion, the good mother and the wise old man. All of these things are necessary in almost every culture, every place and every time. So we have to assume this theory, which was posited by Jung, and has more or less been taken on board now because there is so much material that archaeologists and anthropologists have unearthed, that there is a double validation of it. These things are shown in dreams but certainly not as graphically as they are shown in the sand tray.

In the sand tray you can almost see, if you know a little bit about the client’s background, what they are operating from and the fact that the sand tray is also graphically divided into areas that represent the past, present and future and also the conscious and unconsciousness. It helps us to really get a view into the person who comes to us for some sort of help and the ability to help them on a very deep level. I want to reiterate again that the trays themselves are healing. If you never said a word to the client they would be experiencing great healing by what they were doing because they would see very graphically, in a different language, just as dreams are a different language, what was going on and what could go on for them.

The sand tray also has a lot of shadow material in it. There will be figures in the tray that represent shadow aspects of the client. The shadow is an un-adapted unconscious. Most Western civilisations overdevelop the conscious side of the person and Jungian therapy is based on loosening the contents of the unconscious. We owe a great debt here to Jung’s interest in Eastern and African civilisations where the unconscious is much more apparent to those civilisations. This loosening is principally applicable to those persons who have over developed consciousness functioning. The persona is the well adapted conscious. In other words, if you are here you are doing something right. If you are functioning you are doing something right. It is not the whole person but it means something is doing well and it is important for the client to see this in a variety of ways. Jungian study is the study of the psychic life of man and our prime interest is really in the development of the whole person. That means the integration of the conscious with the unconscious.

The archetype of the shadow is extremely interesting. In Jungian terms the shadow is the part of ourselves we don’t want to know and usually its parts that are not compatible with our self image with our awareness of who and what we think we are. We usually repress those bits into our unconscious. Intense dislikes are often shadow material and shadow projections are when we see in our own negative qualities that we particularly dislike in others. Countries often will project shadows onto other countries and say while mentioning any nationality by saying “I don’t like ... because....” and invariably there is a core of that in the country themselves. It is an opposite of what they like to think they are. It is only because the psyche is so close to us that psychology has been discovered so late. We only have, by and large, psychological facts to explain psychological facts. It is again worth repeating that the only way you can become aware of shadow is to become more aware of yourself. As far back as 400BC Sun Tzu in The Art of War (1944) said “if you know yourself and you know your enemy you need not fear the results of a thousand battles. If you know neither the enemy nor yourself you will succumb in every battle” That is particularly applicable to the battle that we all live with virtually every day with the shadow side of ourselves. The shadow is not confined to adults. Children themselves can very much be victims of shadow materials. The shy “shrinking violet” child talks of hate of the more aggressive or streetwise outgoing child, while the outgoing child makes fun of and bullies the quieter child. It is the fear of what we are not, the fear of what we don’t know that is so important.

Dreams as custodians of sleep was Freud’s first working hypothesis. In his second hypothesis that all dreams are wish fulfilments, he was led to the idea of a censor that he claimed everyone possesses, and Freudian psychology gets past that censor. Jung did not believe in a censor but assumed the dream meant what it said, but in a very different and uninhibited way. We now know, thanks to encephalograms, that we dream several times a night even if we wake up convinced that we have not had a dream. I have to wonder if this is not the censor factor at work. The wonderful thing about the sand tray is that there are no censors. Creating the sand tray is basically an introverted act. The exposition in explaining the narrative is an extroverted act. If the child or adult is capable of a lot of exposition that does not mean we back them into a corner and ask them intrusive questions but rather encourage them to talk about the tray as a story and then to, occasionally, ask what a particular figure/animal might mean? If I ask a child, “what does this animal mean to you?” he/she is apt to reply “that animal understands me” or “I can talk to them better than to humans”. The symbolism is powerful here in giving another road into the innermost world or feeling of that child/adult.

I have talked a bit about the making of the tray being healing. Deeply introverted and particularly tense people tend to relax. Hyperactive almost hysterical clients tend to quieten down. Three dimensional reality is a calming effect in itself. It is particularly effective in reaching clients who over verbalise, rationalise or intellectualise and, of course, the opposite clients, those who have trouble verbalising at all or who are afraid of their own voice or been denied their own voice. Intuitives can benefit from the concreteness of the process as it tends to slow them down and ground then and again the therapist listens with as little of their verbalisation as possible. After the sand tray is finished the therapist may ask the client to tell the story of it or may ask relevant questions to illicit the client’s comments and associations. The therapist can begin to speak of something suggested by the tray, though that’s often better done in a subsequent session so as not to inhibit the client in future sessions. The therapist is able to evaluate the picture in the light of what they know of the client and of Jungian symbolism and any archetypal amplification they suggest themselves. Again, the therapist does not offer this information at this time and does not press for association or confront the client in any way. Interpretations can imply value judgements. The aim of sand therapy is to offer really free protected space, devoid of rules and in safe circumstances. The only criteria for sand therapy is that everything must be put in the tray or on the tray, in other words it can be put on the edges and held up with blue tack or in the tray. Also, the client is reassured that they can take as many objects as they want and they can take as few as they want and until they tell you the tray is finished they can go back and get more. It is also often significant what the client leaves in the basket that they use to collect their figures. Sometimes they leave two or three items and then it becomes an interesting puzzle for the therapist to test his/her knowledge to figure out what is going on by what is being left.

When we can connect on a collective level or with many archetypal and mythological motifs we also must recognise that those arising out of our own culture are easier to recognise. The Orang Asli, which is the name given to all the aboriginal tribes in Malaysia and which means original man, and one of the tribes which I worked with called Mah Meri say that ”you cannot understand the myths of Malaysia unless you spend two years as a baby strapped to your mother’s back”. It is something important to take on board now that we, here in Ireland, have become much more multicultural country and we have many more people here for a variety of reasons both because of the EU and because of asylum. I have worked with clients who were husband and wife where the wife is from a South American country and the husband is from a very literate and creative country and the only way they communicate is through English: he does not speak her language and she, likewise does not speak his language. But English is not their first language and I have found the psychic misunderstandings which go on with them are tremendous. By them both doing a few sand trays it is amazing how the communication has improved. Because they are both extremely sophisticated and because they did not come to me to do sand trays but rather to have it as a peripheral tool in their own problems as a couple, I could explain a little bit more to them about what certain things in the tray might mean, which I would not do under normal circumstances. It really has been quite magical and an extremely interesting experience for me because I have never had that particular situation.

I’d like to talk about a motif that has often appeared in the trays. Because it has often appeared I began to write down various things that clients from teenagers to adults have had to say about it to give an example of why the personal interpretation must always take precedence over the archetypal. Trains often appear in sand therapy and here are some of the things I have heard spoken about them. “It gets me from where I am”. “It makes strange noises in my head”. “tunnels, safety, womb”. “They remind me of snakes.” “Speedy lurching, shaking, losing my footing,” and again, “haunting, whistle, olden times.” Then more, “death, being cocooned and no escape,” and “ the world looks flat from trains”. While others say “ I feel I am in a semi sealed box as I walk from one carriage to another” and still more “I feel as though I am walking through my life” and, one of the more interesting ones, “I see the engine going around a curve and think it is the furies of hell pulling my life along”. These are all good examples of why the personal interpretation must always take precedence over the archetypal. And the same is true with dreams. We have a situation in dreams where someone will “excuse” the content and I use the word advisably, on the grounds of the fact that “I was watching a television programme and a man was chasing another man down a lane with a knife” Well, that’s true, but it is also true that the conscious mind, not to even mention the unconscious, sees thousands of symbols every day: walking down the street, in the shop, driving in the car, all situations with different objects and people. The unconscious in the dream and the unconscious in the sand tray chooses the symbols it needs to express its unconscious, unspoken thought and that’s why it is critically important to take the person’s interpretations. It’s why dream books are useless. It’s why “off the peg” interpretation is useless. Let’s take the man who dreams of the knife or puts the knife in the tray. What is the knife in his life? Is he a butcher? Does he work as a chef? Did his brother accidently stab him with a knife when he was a child? The personal interpretation is vital to him to experience and therefore give voice to and ultimately release the held emotion surrounding this symbol secreted deep in the unconscious. It does not mean that the knowledge of the archetypal and the knowledge of the symbolic are not important, it is another string to the therapist’s bow and it is crucially important. But the therapist must remember with both dreams and the sand tray that the personal, that is how something is for the client and their life, takes precedence before you can even begin to help them.

I would like to finish this article with one of my favourite quotes by Marie Louise von Franz, who was an eminent Psychoanalyst and the youngest of the circle around Jung, and who wrote extensively on dreams and on symbolism.
“Dreams never tell you what you already know, they always point to a blind spot, it’s like being able to look at your own back” (2008)

I think that is a wonderful thing to remember both in dreams and in sand therapy.

Dr June Atherton, B,Sc., M.A. Psych. PhD., MIACP, is President of the International Jungian Sandtherapy Association and Visiting Professor in Jungian Studies at the State University of St. Petersburg, Russia.

References:
Kalff, D. (1980) Sandplay, A Psychotherapeutic Approach to the Psyche, Boston: Sligo Press
Lowenfeld, M. (1979) The World Technique, London, Boston: Allen and Unwin (published posthumously)
Santayana, G. (1981) Person and Places, New York: Scribner
Sun Tzu. (1944) The Art of War, Harrisburg Pa: Military Service Publication Co.
von Franz, M.L. (2008) The Way of the Dream - Dr Marie Louise von Franz in conversation with Fraser Boa, Santa Cruz: Marion Woodman Foundation
Wells, H.G. (2004) Floor Games, Kansas: Temenos Publishing Co.
 

This article is reprinted with kind permission of June Atherton and was originally printed in Inside Out, the Journal of the Irish Association of Humanistic and Integrative Psychotherapy in Issue 59, Autumn 2009.