Why psychotherapy must start with birth

We are moving towards a seasonal change which Americans call “Fall” and in Britain we name “Autumn”. The Garden Therapy Space now has small, light green apples falling onto the wildflowers and indenting the sandy soil.

Through the changes in light, particularly for clients in the evening, the drawing in and fading daylight catches our attention. Similarly, the ‘early bird’ clients, prior to their commute or busy working days in homes or offices, sense the air temperature at 8am is distinctly cooler, with the smell of the garden holding the damp in the atmosphere.

Within the anticipation of seasonal change, nature’s work appears to be slowing down. But look carefully and it is obvious that the cycle brings in yet more productivity.

Something is happening. It may just be where our attention is directed and how we interpret the change. The pre-frontal cortex in the brain develops in the first five years of life, it gives us the opportunity and the burden to sense the future. Learning to live with our awareness of the transience of time is the concern of temporal integration.

With my clients, our work, focuses (indirectly) on three major aspects of time as uncertainty, impermanence and death.

In late Autumn and Winter as the garden dies back and down, with stalk structures and foliage collapsing to the ground, the decay can be troublesome for many. The clients who are disturbed by this want it to be tidied and cleared, to appear tended. The textured softness in browns and blacks and mottled leaves now disintegrating as mulch. Clients usually first contact me when in chaos and crisis.

Certainly, loss and renewal is occurring deep within our human body perpetually. Often invisible or disregarded. Age is conspicuous and alarming for some. I now see greater numbers of young people and adults in their twenties and thirties who are confused and disoriented relationally, unsure of what is real. So much seems messy.

But what about healing change? The wondrous process that is occurring time and time again. In therapy, I emphasise the growth and development of that which is below the surface, so that every session is felt and embodied and deliberate attention given to the subtle and positive changes. I expect every session to end better for my client than when it started.

Clients in therapy are engaging in a process of integrating their unconscious knowing with their conscious noticing. They become acutely aware that nothing can be certain except change. So we learn how to develop our capacity to influence our own state changes. To be responsive and not reactive.
When we are held and contained in the fluids and shaping of the uterus, we begin life with the experience of being. The cells, embryo to foetus, are nurtured, viable within the aliveness of the woman.
Once we were inside, and then we had to be outside. We begin as if one, undifferentiated. The offspring’s emergence at birth reveals our physical, bodily separateness and increases our vulnerability in exposure to constant risk.

The individual has needs.

So we must begin working for a living! Our lungs must be active for us to take in the oxygen and exhale. That first cry is a signal.

Someone has to be attentive and responsive to all those needs. The baby gives voice to the unintegrated sensory input by crying. New parents and parents of any ‘new’ infant will now spend many moments, minutes and hour by hour interpreting the cry as a signal of need.

This is the essence of interpersonal integration. It is a vital way in which our brains’ hardwiring to connect, enables us to know of our existence. It becomes the foundation, the grounding of our survival and thriving. A famous English paediatrician and psychoanalyst D. W. Winnicott said there is no such thing as a baby, only a mother (caregiver ) with a baby.

We need others.

In the initial, formative assessment (and on an ongoing basis), my collaboration with clients is indeed mindful of our earliest relationships. Our present experience is brain based on all that was learned and assimilated unconsciously through the body. The carer with this baby is creating and forming human connection that will be logged in the brain of the baby. Attunement can only be achieved by the interpersonal relationship(s) being consistent and in Winnicott’s phrase “good enough”.

So therapy is based upon getting on the same wavelength. Just as a sensitive and capable carer of the baby must make effort , time and time again in giving compassionate attention. The baby requires the learning opportunity for how to feel satisfied, be relieved of discomfort or pains and sense comfort and soothing, The adults and the environment stimulate and so the carer also creates conditions for rest , relaxation and sleep.

In psychotherapy processing that is now referred to as ‘bottom up’, the physiological changes and the detail and nuance of how a client senses and observes their own bodily sensations and the feelings of emotion are critically important. Thoughts and words can form descriptions and the client makes interpretations and links to the stories of their past (top down).

In our sessions we use clinical hypnosis and visualisation, positive mental rehearsal, yoga on the chair or floor, movement and exercises, talking and listening, massage on the table with oil to skin or on the futon fully clothed for sensory awareness in thai yoga massage. The body and the brain are not divisible. For the majority of my clients, they have realised it is no longer enough to sit in a chair and just talk. Why? Because they already know what they know!

With sustained and thoughtful carer action repeated over time, there is development for constructive recovery after failure or mistakes. The youngster finds adaptation, flexible responses and recovery. This is a lifelong learning in relationships. Be it at work with peers, socially with friends or within the home and family. Couples relationship therapy is always about mistake and reparation and how to self regulate based on knowing the difference between needs and wants and how to communicate these. The brain has a complex array of associations to relationships from before birth.

In Australia and the USA , The Virtual Infant Parenting Programme (VIP) which involves a baby simulator that cries when it needs to be fed, winded, rocked or needs a nappy change also tracks if the carer is supporting the head and holding the pretend baby safely and securely. This is the grounding of our psychological safety in the embodiment of sensing that we matter.

Disappointments and delayed gratification become tolerable and not overwhelming if the child is in a consistently safe (emotionally and physically) environment of care. Gradually, independence to explore, create, destroy, play and invent happens again and again with skills and confidence.

Our life’s work can then be about how we find meaning and purpose, value in the preciousness of life itself. We are never alone although we may experience loneliness. Anxiety and depression could be thought of as states which some people become entrenched in and do not know how to extricate from.
All of this is therapy.

The roots of human resilience are to be found in the sense of being understood by another. This is where we can return to the word ‘grounded’. We exist in the mentalisation, in the body, mind, brain of someone else who communicates our survival and thriving (existence) is of immense importance. We find ourselves through being with others.

My approach to psychotherapy is that the body cannot be ignored. Indeed I believe the success and efficacy of an integrative therapy is because the body is given validation holistically in the ‘holding’ of the relationship. Mind, brain and body are always in change. Becoming and being grounded again and again is therefore an imperative.

In therapy, grounding can be ‘discovered’ within the professional relationship. Also, there are many strategies and techniques which I can teach for a client to learn or relearn, revise and develop to reinstate belief and feeling more in control of that which can be influenced.

Work with PTSD demonstrates that sensorimotor and mindfulness – oriented interventions for trauma are necessary. It is not sufficient or helpful to keep talking about the past! EMDR (eye movement desensitisation and reprocessing) also requires the client is familiar and confident in being able to change state to being ‘grounded in the present’. It doesn’t matter that it can take time to do this, because life depends on feeling safe within one’s body. Suicide can seem like the only option without help to reclaim the body, mind and brain function.

Just like the garden, much is happening that may be forgotten about or dormant, or waiting to be discovered. On a water jug in the Garden Therapy Space office, the design is of flowers, tree branches and birds. The bird appears to be singing the words “There is no such thing as the wrong time, there is no such thing as the right time”. A garland of letters from one bird to another reads “There is only time”.

Watch and wait, the garden bulbs will surface to flower, before you know it.

A great read is Why Love Matters by Sue Gerhardt.

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