‘This hid my shadow, my own uncertainty’

Around May of 2020, I had been working for over a year with a woman whose presenting issues were also contributing to a lack of intimacy in her marriage. During one momentous session she declared that she had been able to fondly hug her husband, and the affection had infused their relationship. But after telling me this she seemed to withdraw into herself. It was difficult to get a consistent narrative from her. Instead of exploring this I began to fill the uncertainty, speaking more and offering psychoeducation around reparative relationships. When I finally remarked on the client's emotional withdrawal, she had left the feeling behind and was only able to rationalise. 

Later, as I reflected on the discomfort I felt during the session, I realised that I had been unable to tolerate the fear and uncertainty my client still felt about her marriage. I was keen to reinforce the gains made and normalise the nebulous journey of a repairing relationship. I was placing pressure on myself to find the answer, to make the unknown known.

This was not the first time during my practice as a counselling psychologist that I have found it challenging to remain with uncertainty. Often this has happened during times of transition or turmoil in my own life, such as starting in a new job, relocating, or coping with a personal loss. During a particularly trying time when I was explaining to my supervisor how unanchored I felt from my way of working, she invited me to read Barry Mason's 1993 paper, 'Towards Positions of Safe Uncertainty'. Almost at once I felt I had returned to the comfort and familiarity of home. I felt able to hold my ground again during sessions, not drawn towards some kind of definitive knowing. 

Mason asks if uncertainty offers creativity or paralysis. In my experience I tend to feel more paralysed, and deskilled, when I am placing pressure on myself to move between the long-term unfolding work that I so enjoy, to delivering the short-term, solution focused therapy that can be in such demand. These are the sessions that can leave me with a sense of cognitive dissonance, as my way of working feels out of alignment with my therapeutic principles.

Alternatively, when I am truly open to the uniqueness of the other and able to gently facilitate their journey of self-discovery, understanding appears to bubble up between us without much effort at all. These moments are truly wonderful. Sadly, during the last year, these moments have been occurring less and less.

To keep them safe

During the initial lockdown in March 2020, I tried to make the transition to remote sessions as painless as possible. Maintaining a sense of containment became paramount and I followed guidelines, which were swiftly made available by the BPS, to make sure that my clients would feel secure within the new way of working. Inevitably there were those who were reluctant to transition, not least of all myself, but we were left with little alternative but to give it a try.

During my early reflections on remote therapy, I believed an intrinsic aspect of 'relational' to be missing. I heard myself saying repeatedly to colleagues, 'never will I underestimate the power of simply being in the room with another person'. I began to realise how much I associated presence with humanity. With hindsight, I believe that this was the first point where I began to look for certainty as a means of ensuring connection.

On the surface it was still therapeutic. My clients would bring their issues week by week and I would seemingly use my curiosity to examine them more deeply. However, I sometimes found myself drawing on information they had shared in the past to settle ambiguity or strengthen insecurities. Alternatively, I might engage in some psychoeducation – filling the gap with some concrete knowledge. Arguably, this is no bad thing, and the approach can serve me well in some of my short-term work. But in Mason's safe uncertainty paper, he draws on work from theorists Anderson and Goolishian, who warn of the dangers of understanding the client too quickly. In their view, maintaining an open dialogue can avoid misunderstanding. Without curiosity, we come to understand too quickly and fall into 'premature certainty' (Stewart et al, 1991). I can see now that my curiosity had become directed – covertly directed. I was no longer available in the same way to explore novel experiences in my clients lives. I was using a framework of pre-existing knowledge and understanding to, in my mind, keep them safe.

Reflecting on 'normal'

I hasten to add that this somewhat impaired therapeutic stance wasn't always the way. With my longer-term clients our open and exploratory pattern was preserved, in the main. I was also fortunate that my numbers dropped. This allowed me the space to reflect on my felt sense that something was missing from my work, and it couldn't be just the fault of Zoom.

As I explored my own position, I wondered how I was coping with the changes in the way we were all connecting with and relating to each other. From very early on I had been taking part in a Covid-19 social study for University College London. This study was particularly concerned with mental health and well-being during the pandemic. When I regularly completed the weekly questionnaires during the first lockdown I was forced to reflect on how lucky I was. I was financially secure, I had good friends and family support, and I had a generally optimistic view of our nation's ability to cope. However, I believe this hid my shadow, my own uncertainty that I wasn't able to acknowledge so readily.

On one occasion when I had a driveway-style, socially distanced visit with my daughter and young grandchildren, I was hurt to notice my granddaughters staying close to their mum, as if they were scared of me. It was a truly horrendous feeling of rejection and one that cut more deeply than I gave it credit for. Around the same time, at the funeral of a close relative I felt shunned by family members who chose not to hug me – as guidelines directed at the time.

These experiences had played into my own attachment issues. I was sincerely frightened that my own family would become adrift and there would be a schism between us – hard or even impossible to repair. It was only via a reflexive process that I was able to acknowledge these wounds and begin to reduce the associated paranoia.

'The new normal'… that felt abrasive. I wanted normal or nothing at all. Until it's normal, it won't be okay! Unsurprisingly, whilst having thoughts like this I found it difficult to remain open to uncertainty.

I finally arrived at a point where my work was becoming unrewarding and I was beginning to doubt my capability as a practitioner. I knew that I wasn't acting outside my competence but I was inhibiting the depth of the work I was offering. Something had to change.

Letting go

Once again, I returned to the safe uncertainty paper. The paper talks of falling into the trap of getting it right and suggests that we can make the mistake of seeing the word 'solution' in absolute terms, which can be unhelpful. I immediately recognised that I was doing exactly that. My own anxieties were compromising my work and I was offering, as the paper terms it, 'safe certainty' (Mason, 1993, p.194).

As I once again absorbed the essence of Mason's paper, I felt a shift in my body, a physical sense of letting go. I was reminded that emerging possibilities were where my sights should be, if anywhere at all. At last, a return to a position of 'safe uncertainty' had potential.

I was keen to see what else could support me in my desire to hold on to uncertainty. I found an online article from 2019 by Michael R. Jackson PhD, an American psychologist. The paper is aimed at trainees who are finding it difficult to cope with uncertainty in unstructured therapy. When drawing on his own experience, Dr Jackson recalled having a theoretical insight associated with existential therapy, this being that "every act in life, and in psychotherapy, is, in some sense, a 'leap of faith' a 'jump from being into non-being'." When able to occupy such a position there is no offer of solution: it becomes all about how we cope with uncertainty.

I strengthened his idea with some thinking from Emmy van Deurzen, who reminded me that therapists aren't predominantly there to support and encourage but to enable the client to 'think through the unthinkable' (van Duerzen, 2002, p.26). I was also grateful for her reference to the need for humility, noting that "Socrates's definition of the wise man as 'he who knows that he does not know' provides a suitable standard for the basic attitude of the existential practitioner" (p.27).

Of further help was the notion of the 'inherent strength of the client' (Jackson, 2019). I was reminded of how little in terms of intervention a therapist actually needs to provide. What is more important is the client's readiness to receive the intervention and their own motivation for change. I was prompted to meet the client 'where they're at'.

Bridging the gap

Now I have returned to a practice which allows for safe uncertainty, those spontaneous moments of insight that seemed to be tailing off in 2020 have become a more regular occurrence in my work again. I am able to trust that my clients can hold onto 'not knowing' from the other end of the internet connection without necessarily feeling abandoned or neglected. Whilst I still believe I am not able to offer my full humanity within remote therapy, I have had experiences that suggest that this gap can be bridged by attentiveness and resisting the urge to understand too hastily.

I also strive to offer less of myself within my CBT-informed practice, being reminded by my supervisor of the collaborative nature of this work. Within focused or structured work there can be plenty of space for not knowing. The more freedom given to the client to describe their issues and find solutions using their own style of meaning making, the more likely any gains will be maintained.

No doubt, the experience of holding, losing and regaining a position of safe uncertainty will continue to be a challenge. But I'll approach that with reflexive practice. I'll constantly review my client work, never settling long in a place of comfort or ease. If a client starts to feel like 'easier work' then I am likely avoiding or missing something. And after the trials of the last year, I'll be mindful of Kierkegaard's quote:

"He who is educated by dread is educated by possibility… When such a person, therefore, goes out from the school of possibility, and knows more thoroughly than a child knows the alphabet that he can demand of life absolutely nothing, and that terror, perdition, annihilation, dwell next door to every man, and has learned the profitable lesson that every dread which alarms may the next instant become a fact, he will then interpret reality differently, he will extol reality, and even when it rests upon him heavily he will remember that after all it is far, far lighter than the possibility was. (139f)." (Kierkegaard [1848] (1944), in Lowenthal, D. and Snell, R., 2003, p.18).

Dr Sharon O'Driscoll CPsychol

Counselling Psychologist

BPS accredited

HCPC registered

[email protected]

References

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

Anderson, H., and Goolishian, H. (1990). Beyond cybernetics: comments on Atkinson, B. and Heath, A. 'Further thoughts on second-order family therapy'. Family Process, 29, 157- 163.

Anderson, H., and Goolishian, H. (1992). Therapeutic process as social construction in McNamee, S and Gergen, K (Eds). Therapy as Social Construction. Sage: London.

Jackson, M.R. (2019). What Do I Say Now? Coping with Uncertainty in Unstructured Therapy. Psychotherapy.net, viewed 18 February 2021, https://www.psychotherapy.net/article/what-do-i-say.

Kierkegaard, S. (1944) [1848]. The concept of Dread (trans Lowry,W.). Princeton, NJ: Princeton University Press. In: Lowenthal, D,. & Snell, R. (2003). Post-modernism For Psychoptherapists, A Critical Reader. Routledge: Hove.

Mason, B. (1993). Towards positions of safe uncertainty. Human Systems: The Journal of Systemic Consultation and Management, 4 (3-4), 189-200.

Stewart, K., Valentine, L., and Amundsen, J. (1991). The battle for definition: the problem with (the problem). Journal of Strategic and Systemic Therapies. 10, 21-31.

Van Deurzen, E. (2002). Existential Counselling & Psychotherapy in Practice. Sage: London.