The National Council of Psychotherapists
A Tale of two Students: The Holistic Approach to Therapy
A holistic approach to therapy should be based on rapport, or communication between therapist and client. The approach to establishing rapport must necessarily vary between clients. In this context, I almost wrote ‘needless to say’, but in fact the point is not obvious or trivial. Too many therapists – like too many educators and social workers – are wedded to doctrinaire theories that come between them and their clients, in that they obscure the fact that the client is an individual in his or her own right, with his or her own complex needs and motives that transcend theory or book-learning. A holistic approach to hypnotherapy (and other forms of therapy, including conventional medicine) should take the individual client as its starting point. This means that abstract principles should be subordinated to an awareness of the client’s individuality.
The client will present not only with ‘symptoms’, such as depression, phobias, panic attacks or physical pain, but with his or her particular response to such problems, and with his or her distinctive background and circumstances. Keeping this in view, the therapist should expect a wide range of responses from his clients, even clients with superficially similar conditions. Let us take the hypothetical cases of two university students. Student A is female and studying medicine, Student B is male and studying law. Both are bright and motivated, they come from the same part of the country and have similar educational backgrounds. But both suffer from exam nerves, which have become serious enough for them to seek help from a hypnotherapist.
To the hypnotherapist, these might appear to be two near-identical cases. He might consult a well-thumbed textbook with a section on ‘exam nerves’ and treat his two clients in an identical and fairly perfunctory manner. But that approach would be bad therapy, both because it would be failing to establish rapport with the two clients, and because it would be unlikely to work, except perhaps in the short term. A more holistic therapist would not treat his clients as Students A and B with exam nerves, but as Amanda and Mark with similar symptoms, but underlying problems that might be quite different in nature and origin. Therapeutic theory, and textbook examples, may provide useful guidelines and insights, but they should not be seen as infallible. Or, to put it another way, Amanda and Mark should not be forced to fit textbook models or those models will have no practical use whatever. The therapist’s task is therefore to get to know Amanda and Mark as clients, find out what interests them, what makes them happy or sad, what they believe in (and what they don’t believe in), and what they want to do with their lives.
When the therapist gets to know Amanda and Mark, he finds that while their academic problems are the same, the reasons behind them are quite different, even opposite. Amanda is a perfectionist. She is determined to succeed, but tests herself against standards that she finds impossible to fulfil. She then blames herself for her supposed failure, and believes that her situation is more difficult because she is a woman. Amanda wants to be a cardiologist, but refers repeatedly to her chosen field as male-dominated. Her parents divorced when she was in her early teens; her father left her mother for another woman and has since married again. Amanda misses her father, but also feels deserted by him. She is determined to be different from her mother, who works as a secretary and has had a hard struggle since the divorce. Mark, by contrast, is the son of a barrister who is quite often in the papers. His father pressured him into studying law and he feels that he has to live up to his father’s vision of success, which he finds impossible because he is not interested in his studies. Mark also envies his sister, Sarah, who is now a development worker in Nepal. He believes that because she was a girl, their parents took a more flexible approach to her education and career.
Amanda, therefore, has developed exam nerves because she is ambitious and dedicated – and punishing herself. Mark presents with the same symptoms because he is bored with his studies and feels trapped. They present themselves differently to the therapist as well. Amanda is articulate and confident, but appears to be angry. She is angry with herself, for being nervous, and so letting herself down, but she also expresses anger towards her father and men more generally. Yet it quickly becomes apparent that beneath the surface a lot of her anger is really directed against women (including herself) and the weaknesses she identifies with femininity. She views her mother with contempt as well as pity, and she blames the qualities she identifies as feminine for her inability to compete with the males on her course. As well as exam nerves, she complains of frequent headaches, which have no apparent medical origin.
Mark, by contrast, appears frightened and withdrawn. Many of the answers he gives are monosyllabic and he looks at the ground rather than making eye contact. He seems frightened that he will be shouted at or criticised by male authority figures. Mark is quite obviously frightened of his father, whom he nonetheless admires and would like to emulate. He feels that he is a constant disappointment to his father, and despairs of ever pleasing him. His father is furious with him for doing badly in his first year at university, and this is making Mark even more anxious about his work. By contrast, he is close to his mother and reveals early on that he still has a Teddy Bear, which she gave him when he was a small boy. Mark is nervous with girls, especially the girls on his law course who seem very well organised and confident – and have heard of his father’s prowess as a lawyer. Most of his friends are fellow Rugby players. His father wants him to give up Rugby to concentrate on his studies, but this is the only part of his university life that gives him any pleasure or belief in himself. He has started having panic attacks, which he has told nobody about and only mentions in the third session with the hypnotherapist. These attacks frighten him and make him fear that he is losing his sanity.
Having quickly discovered important differences between Mark and Amanda, the therapist proceeds to treat them differently, that is to say adapt his methods of treatment to their individual needs. Amanda is a sceptic and an ultra-rationalist who has only consulted a hypnotherapist because her flatmate Nicola suggested she ‘give it a go’. Mark, who is more spiritually inclined (although he’d never admit it) read an article on hypnotherapy and decided to consult a therapist as a desperate measure. It is clear that he wants to believe that hypnosis could ‘solve’ his problems. Yet it proves far easier to induce hypnosis in Amanda than in Mark. She becomes compliant, almost submissive, seeming to enjoy the process. Mark, by contrast, puts up emotional barriers and can only be hypnotised when he is pretending to hold onto his Teddy Bear. He also finds breathing exercises helpful, because the panic attacks male him hyperventilate. It is Mark who is in greater need of hypnosis than Amanda. Although she comes across as emotionally cold, she finds it easier to access and describe her emotions than the more outwardly nervous young man.
To treat Amanda and Mark effectively, and communicate with them better, the therapist induces them to examine their outward or more obvious emotional problems first. In the case of Amanda, this means focusing on her anger by encouraging her to talk about it, describe it visually (she also draws it, on one occasion) and act it out, a process which involves on occasions a lot of screaming and abuse – directed at her father, her mother, men (including the therapist), male medics and ultimately herself. Mark, by contrast, needs to focus on his nervousness and sense of being overwhelmed by panic. He acts out one of his panic attacks and reverts to childhood by sucking his thumb. He bursts into tears and expresses his sense of helplessness and his belief that his father will always regard him as a disappointment.
The initial focus on outward or obvious anxieties enables Amanda and Mark to access the deeper emotional problems and fears which are manifesting as headaches, panic attacks and exam nerves. Thus, having expressed her anger, Amanda finds herself able to express the sorrow she has locked inside her. She cries a lot about her parents’ divorce, her love and tenderness towards her father, her sense of being alone and abandoned, and her anxieties about her work. She finds the ability to access this sadness ‘an incredible relief’. Mark, by contrast, finds himself expressing anger. He shakes with rage as he acts out his anger against his father, his sense of being crushed and his hatred for the law course. He says that he never knew he had feelings like that, which is not entirely true; he did know, but has not dared to examine them until consulting a hypnotherapist.
Having helped the two students to peel away their emotional layers and examine underlying conflicts, the therapist looks carefully for details about Amanda and Mark which might provide clues towards resolving some of their difficulties. Crucially, he does not give a direct lead or plant ideas in their minds, but takes up a theme and gives them the chance to develop it. Amanda, for example, reveals that when she was in her teens, she did voluntary work in a school for children with learning difficulties. She enjoyed this work, felt fulfilled by it and smiles when she talks about it, whereas she frowns when she talks about her studies. By talking about her volunteering, Amanda remembers that she likes working with people and that she is good with children. She comes to see that some of the aspects of her character, which she regarded as ‘feminine’ and weak are in fact strengths, and that her attempts to develop strengths that she regards as ‘masculine’ are holding her back. She decides that she does not really want to be a cardiologist at all, but that she could achieve just as much, and be much happier, as a paediatrician.
This realisation makes Amanda happier in herself and more committed to her studies. She no longer believes that she has to prove herself, either as a human being or as a woman, but that she can work towards a career that she will enjoy. I short, she feels able to stop beating up on herself so much and to let go of a lot of her anger. She is less angry with men, for example, because she no longer feels has to prove that she is ‘as good as them or better’, but can develop her skills and qualities as a human being. She talks of seeking a reconciliation with her father at some time in the future – an idea she would not have previously put into words. She reveals that she is no longer plagued with headaches and that she has started meditation.
Mark knows that he hates his law course and does not really want to be a lawyer like his father, but he has not been allowed to consider anything else. On one occasion, however, he reveals that he enjoyed being in the Corps when he was at school. Gentle questioning reveals that as a boy he had wanted to join the Army and that he would still like to do so, not only for the military training and possible fighting, but also for the peacekeeping, the sense of adventure and the regimental traditions. His father, who is a human rights ‘expert’ and a stalwart peace campaigner, disapproved of Mark’s ambition and squashed it with scornful rhetoric. Mark realises that he is now an adult and a fit young man. He can pursue a military career if he wishes, that there is nothing his father can do to stop him and that the idea that he had fewer choices than his sister is an illusion. This realisation makes him feel less deferential towards his father. He also realises that if he joins the Army after university he doesn’t have to study law and can switch to history. Mark makes inquiries about both history and the Army, which bring a positive response. His panic attacks diminish and he becomes more poised in his appearance and more articulate in his speech. He reveals that he is also less nervous with girls.
When Mark abandons the law for the Army, he is wounded by his father’s anger and disapproval. But he is less afraid of his father, partly because he is able to access his feelings of anger. Amanda finds greater happiness in herself and her studies because she is less angry and more able to access tender feelings – including tender feelings towards children, which have led her towards paediatrics.
Amanda and Mark have both benefited from a holistic approach to therapy. The hypnotherapist’s aim has not been to provide a total ‘cure’, or pretend that his therapy will solve all problems in living, whether ‘internal’ emotional problems or ‘external’ problems in relationships with others, such as family members, friends or authority figures. The ‘internal’ and ‘external’ issues are of course closely related and part of the therapeutic process is to enable the client to connect the two. Indeed the most important words associated with holistic therapy are probably ‘enable’ and ‘equip’. The therapist enables his clients to look at their situations from different angles and explore underlying truths, beneath the level of ‘normal’ consciousness. He equips them to confront sources of anxiety, stress or pain, and to alter their perceptions and goals if doing so will improve their lives. Holistic therapy invites clients to map out their emotions and then use the map to guide them in their everyday lives.
Rapport between client and therapist is central to any meaningful, let alone holistic, approach to therapy. But rapport should not be confused with immediate friendship or instant attraction. If anything, it is more like falling in love (although it is not to be confused with romantic or erotic feelings!). People who fall in love are often indifferent or hostile to each other when they first meet, but they grow together as their relationship develops. Rapport is built up or accumulated in the same way, but for different reasons and with quite different goals in mind.
The development of rapport between therapist and client can mean that both have to examine their underlying prejudice. Amanda, for example, does not warm to the therapist because she regards him as a representative of ‘male domination’ and because she is sceptical about hypnotherapy anyway. The therapist does not warm to Amanda because she expresses left-wing feminist views and carries a copy of The Guardian, a newspaper he detests. As they interact, Amanda develops a ‘softer’ view of men, and hence a softer view of women and herself. She decides that many of her political views were projections of her anger and self-doubt. She tires of The Guardian. The therapist, in turn, makes himself look beneath Amanda’s political utterances (and even newspaper choice!) so that he may see them as expressions of vulnerability at one level, and at another as expressions of valid complaint. Amanda has, after all, been deserted by the most important man in her life, her father, who has treated her mother shabbily. Her mother has faced disadvantages because she is a divorced woman. Realising that Amanda has reason to be angry enables the therapist to put Amanda’s political rhetoric in perspective. He begins to warm towards her and learn from her, and the process becomes reciprocal. By the end of the treatment, they both understand each other better, as well as better understanding themselves.
I cite this example to show that rapport need not be instant, but often evolves and should deepen during the period of treatment. There are occasions where, for temperamental or other reasons, rapport does not develop and the therapeutic relationship fails. In those cases, it is wise for the therapist to recommend a change – if the alternative is lack of progress, or even conflict between therapist and client. The therapist should not be arrogant enough to suppose that his methods, approach and temperament will suit everybody. On the other hand, he has a professional duty to be flexible in his approach and to attempt rapport with clients from a wide range of backgrounds and in a wide range of situations.