Brian Thorne: The Mystical Power of Person Centred Therapy – Hope beyond Despair 2002
I am going to call the therapist Maddy and the client Fiona.
Maddy visits Fiona at home for their sessions. Fiona has other support. Before Maddy’s visit on this particular day, she had already received a couple of other home visits on the medical/assisted living side.
When Maddy arrived, the previous visitor was just leaving. Fiona was extremely agitated and red-faced. She immediately said to Maddy with considerable energy: “I’d like to sack the whole bloody lot of them”.
Maddy asked her what was wrong.
Fiona said that for most of the day, she had been “going crazy” because of a strong itch on her shoulder. Because of the position of the itch, and her unusable arm, she could not scratch it herself.
She had asked the first helper to do it for her. The conversation went something like this:-
Fiona: “I have a dreadful itch on my shoulder. Please, please will you scratch it for me?”
Helper: “Oh, no, I couldn’t do that. It might break the skin or cause an abrasion, and get infected. Sorry.”
She point blank refused to do it.
So did the second helper, giving similar reasons.
So Fiona sat in her chair for hours “going crazy”, tormented by her itch, unable to scratch it, refused help by those who were replacing her dressings and doing her household tasks.
Maddy said (and at this point in Maddy’s and my session, my heart leapt): “Come here, I’ll do it!”
Fiona indicated the spot, and Maddy carefully scratched it, through a piece of cloth to protect the skin. Fiona told her the job was done. Maddy checked her shoulder – not red, no broken skin, fine.
Fiona said “Oh, I could hug you!”. Maddy said “You can if you like!”, so they had a hug.
It was very early in their counselling work together, and Maddy had previously experienced Fiona as holding her at arm’s length, perhaps even “testing” her – making (unfavourable) allusions to Social Services and Fiona’s expectations that Maddy would be coming from a similar place.
Fiona’s whole manner towards Maddy now changed. Maddy experienced her as warm and open, far more willing to connect in relationship. As Maddy left after their session, Fiona said “Come back soon”.
After this incident, Maddy was curious. The reactions of the helpers seemed strange to her, and disturbed her. She wondered what others would think. She ran the details past a few (counsellor) colleagues. She was sufficiently thrown by their responses to bring the whole story to her session with me. She was filled with self doubt and wondering if she had “done something wrong” (even though in her heart of hearts she felt her response to be the right one, for her and for Fiona).
She said peer responses fell into two main categories:-
1. “Well, OF COURSE you gave her a scratch! How ridiculous”
2. “Oh, I don’t think I would have done that. You took a big risk”
One person in the (2) category suggested Maddy had put her entire career at risk. It wasn’t a joke.
So what I want to know is this: when did such a simple human body-body interaction as scratching someone’s shoulder become so fraught? What’s going on?
In political terms (i.e. power analysis):-
Two ways to interpret the helpers’ attitude:-
A. “It’s for your own good”
In other words, we are back to internal locus –v- external locus (all roads lead here). Do I get to decide for me, or does someone else get to decide for me?
Fiona is a competent adult human being. Yes, she is old. Yes, she has lost the use of an arm. So what?
She has made an autonomous choice (to have her shoulder scratched). She just lacks the ability to implement it, because one of her arms does not work.
The helpers’ refusal disrespects Fiona’s autonomy and disempowers her.
It denies her autonomy on a basic human level to decide what does/does not happen to her own body – because she is disabled.
The power rests with the helpers, and they exercise it by refusing to implement Fiona’s clearly expressed decision about what she wants. They decide – in however clear or however unreflective a way – that they know better, and that they have the right to impose their will on Fiona against her wishes.
How is that okay?
How is it logical? The whole point of their presence in Fiona’s life is that they are meant to be enabling her – offering her the ability to lead her life despite her body’s damage.
In my view, the helpers’ behaviour is abusive (please note that I am not commenting on intention here – rather on effect).
B. “It’s for my own good or to cover my back” (ironic, huh?)
When I was quite small, our family went for a walk in a local park. My grandparents were there. My grandmother went nowhere without her gloves. She dropped one. She asked me to pick it up. I refused. They called me rude and unhelpful, and wanted to punish me. My mother defended me. She understood my reality – the soft, cold texture of the glove fabric was horrible to me, it creeped me out. I felt a strong physical aversion to picking it up, and I could not bring myself to do it. But I was too young and too frightened to voice this.
So if someone asks me to do something, and I have an inward “no”, fine. I have a right to respect my own process and my own needs, and sometimes that will conflict with the needs of others. If one of the helpers had said “I would like to help you, and I have a great fear of touch, so I am not going to”, okay. (Maybe with an added “but I’ll find someone else to help you”).
But that does not seem to be the case here. Their refusal – and the support that has from Maddy’s peers – appears rather to arise from a perception that it might not be SAFE or ALLOWED to say yes.
Again, this is about external locus. The helpers have handed over the standing to make this decision to perceived external authorities. Maybe their agencies have a “no touch” rule (clearly not the case for the dressing-changer). Lots do. Maybe it’s not a specific handing over, more a general perception about our culture and about “risk”.
i.e. We have created a society in which these helpers experience it as potentially dangerous to offer Fiona what she has asked for. A simple consensual physical act between competent adults to relieve discomfort is perceived as too risky.
And where not one person sees it this way, multiple people do.
And actually, as Maddy identified herself, she WAS running a risk – at the very least, of the disapproval and adverse judgements she did in fact encounter.
What the hell are we playing at? Do we seriously want a society where people are too scared to scratch someone’s back? And with good reason?
In relational terms:-
Fiona asks for a simple human act that she needs and wants. Her request is for the other person to DO something – take a relational step towards her. This requires empathy, immediacy and spontaneity. It requires an element of daring and risk, as stepping forward into relationship always does. It requires that we take each other seriously as human beings, and that we value each other and express this in action.
The helpers won’t take this step forward. They withhold the relationship Fiona has requested. This promotes distance and disconnection, and inhibits trust.
Maddy takes the step forwards, and then so too does her relationship with Fiona. Fiona begins to connect with her and trust her.
This is the essence and beating heart of therapy. Sometimes it goes with changing a dressing, sometimes it goes with listening to another person talk about how they were raped as a small child, sometimes it goes with scratching a back. What matters is to be there, and to be real and human in relationship. With love and with respect for the other person as an equal and profoundly valuable being.
There’s shed loads of evidence, and there has been for years. What works, therapeutically speaking, is both extraordinarily simple and extraordinarily complex: RELATIONSHIP. We move, learn, grow, lead fuller and happier lives, when we are able to connect with others in loving relationship. I’m not going to set out the evidence here – this is not that kind of article. Take my word for it. Or, better yet, go research it and see for yourself. Or, better yet, go with your own intuitive sense of what’s true. Internal locus.
Therapy works when the therapist is able to offer loving relationship. Loving relationship is – of course – in part about intention. However, it’s also always in the eye – or rather heart – of the receiver. If you don’t feel loved, you’re not – at least not in a way that works for you, which is the only way that matters.
For Fiona, loving relationship in that moment was a scratched back. Maddy offered that to her. Good on you, Maddy. I personally will fight to the last ditch for your and Fiona’s right to make this decision in the moment, in your relationship – because that is where it belongs.
Someone whose opinion I do not respect has suggested that injustice and mistakes are no reason to “abolish” rules or systems (she rather skates over the possibility of re-examination or revision, rather than abolition, because polarization suits her argument). She has suggested this would amount to “throwing out the baby with the bathwater”. Actually, I think injustice and mistakes are A VERY GOOD REASON for throwing out the rules/systems which allow and perpetuate them – and indeed any rule/system-based approach to the world, because everything is always specific, and can be understood and meaningfully responded to only in context.
This “baby” needs to go. Indeed, I think it might be time for it to grow up and take some responsibility for itself……….
“The disappearance of a sense of responsibility is the most far-reaching consequence of submission to authority.”