Men on the couch

1. Men on the couch Silvia Baba Neal MSc, CTA(P), UKCP Reg 09th of June 2018 Hereford silviababaneal-psychotherapy.co.uk

2. Part I: Biology, culture, relationships • Mental health statistics • Brain/mind • Fear and aggression • Social status • Loneliness • Peer socialisation

3. Self-reflexivity (Barlow Sweet, 2012 Etherignton, 2004) The practice of accounting for and being transparent about how our cultural context and life experiences have shaped our current values, assumptions, biases and prejudices Who is telling the story and whose interest does the story serve ?

4. Emerging themes/metaphors in association with men and masculinity • Dragon: spirit of adventure, strength, soft underbelly • Eye: curiosity, looking outward and looking inward • Butterfly: Transformation, adventure, play • Peacock: Pride, taking one’s space • Car: Play, independence, self-sufficiency • Horse in protective armour: Psychological armour, vulnerability and beauty underneath, sex • Comic mouth/teeth: Speech, humour

5. Masculinities • Part biology, part social construction • Different cultures - different ‘rules’ for masculinity • Honour cultures vs dignity cultures

6. Statistics (Men’s Health Forum) • Suicide is the biggest cause of death of men under 45 • Three thirds of completed suicides are men • Three times times more likely than women to become alcohol dependent • Three times times more likely than women to report frequent drug use • 86 % of violent crime • 95% of prison population • 50% more likely to be sectioned • Lower life satisfaction than women in Government surveys • 73% of adults who ‘go missing’ • 87% of rough sleepers

7. Non-cartesian conception of mind(Dan Siegal)

8. “... a brain is something that is contained within a single skull. A mind only exists within a network. It is the result of the interaction between brains, and it is important not to confuse brains with minds.” David Brooks – The Social Animal (2011)

9. ISSUES THAT COME UP IN MY PRACTICE • Powerlessness • Low status • No identity in a world in which power has shifted • Intrusive thoughts • Poor body image • Unmanageable emotions • Shame • Loneliness • Not safe to be vulnerable

10. Causes of depression and anxiety • Lack of meaningful work • Disconnection from other people • Junk values • Childhood trauma • Low status and lack of respect • No access to nature • Lack of a hopeful and secure future • Epigenetics Hari - Lost connections: Uncovering the real causes of depression 2018

11. Empathisers vs systemisers Simon Baron-Cohen – The Essential Difference, Men, Women and the extreme male brain (2003); Zero degrees of empathy, (2011)

12. “Don't take me for a fool There's a woman inside of me There's one inside of you, too And she don't always do Pretty things” Big Thief - Pretty Things/Capacity (2017)

13. Adrianne Lenker on “Pretty things” "(...) the chorus is something that I like to focus on as a mantra. (...) It comes from a place of wanting to equate femininity with strength. Femininity is not something that is weak or dainty in any way, or pretty even. Femininity is like this energy that is inherent in all things — in men and in women and however you identify. (...) It’s about feeling like a receiver — someone who receives this anger and this fear and ego-driven toxic poisoning — and being able to see beyond all that [aggression]. But the song is also saying that masculinity shouldn’t be equated with violence or aggression. It speaks to both masculine and feminine energies, trying to make some sense of how they can be balanced. In the same sense I could say that there’s a man in me; that I have masculinity in me. But it’s just saying, “OK, that’s there,” but also this is somebody that has been violated and hurt through experiences with men, but she’s really strong and she can see beyond herself. She can see what’s happening and witness it in slow motion like she’s disassociating from herself but at the same time she’s holding this incredible space for humanity, for human beings. That what’s being given to her is this sort of violent energy and she’s taking that toxicity and transmuting it and putting it back into the person, saying that, “I know at your core there’s more, and I am not blind to what’s happening.”

14. The trouble with empathy “…is a spotlight focusing on certain people in the here and now. This makes us care more about them but it leaves us insensitive to the long-term consequences of our acts and blind as well to the suffering of those we do not or cannot empathise with. Empathy is biased, pushing us in the direction of parochialism and racism. It is shortsighted, motivating actions that might make things better in the short term but lead to tragic results in the future. It is innumerate, favouring the one over the many.” Paul Bloom – Against Empathy (2016)

15. Testosterone and agression

16. “Regardless of the context of the violence, its function is often the same; it’s not just practical but performative and designed to ward off potential aggressors as well as eliminating a direct threat.” Daren McGavery – Poverty safary (2017)

17. psycho-social stress Baboons are perfect models for westernized stress-related diseases because “like us they have the luxury of generating psycho-social stress”…”If you’re unhappy it’s because some other baboon has worked very hard to bring that state about. ‘’ Robert Sapolsky - Why zebras don’t get ulcers (2004)

18. aggression and fear “Fear and aggression are not inevitably intertwined – not all fear causes aggression and not all aggression is rooted in fear. Fear typically increases aggression only in those already prone to it; among the subordinate who lack the option for expressing aggression safely fear does the opposite” Robert Sapolsky – Behave (2017)

19. Status syndrome: health implications • Michael Marmot • Whitehall Study I (1867-1976) • Examined 18000 civil servants (all male) • First longitudinal study looking at how high/low status within a hierarchy affects health • The ‘Winston Churchill’ effect • The ‘Oscar’ effect Status Syndrome Michael Marmot – How Your Social Standing Directly Affects Your Health (2004)

21. Stress changes genes and immunity George M. Slavic and Steven Cole – The emerging field of human social genomics (2013)

22. Epigenetics George M. Slavic and Steven Cole – The emerging field of human social genomics, 2013

23. ATTACHMENT ”Touch me, only touch me with your finger”, the young boy pleaded. The child’s mother was astonished. “Why? ” she asked. “I’m not here”, the boy cried. “Touch me, Mother so that I may be here” (attributed to Coleridge)

24. Socialisation: Guy code • Children see gender everywhere. • Sex segregation in children’s friendship is universal • Boys’ friendships are generally more stable than girls’ • Their rules of friendship accommodate competition and conflict • Typical boy-to-boy talk delivers blunt reminders of what a boy should be • They feel they must cover up their sadness and confusion about plummeting self-esteem.” • Cooperation among boys is common • Intimate emotional exchanges, but these are often obscured by jokes Apter Passing Judgment: Praise and Blame in Everyday Life (2018)

25. L0neliness (Cacioppo and Patrick, 2008) • Risk factor leading to chronic illness and early death • As bad for health as lack of exercise, smoking, drinking • Cellular inflammation – linked to cancer, premature aging and depression (Bullmore, 2018) • Shorter telomeres (Blackburn and Epel, 2017) • Chronically high levels of stress hormone • Less efficient healing functions such as sleep/cellular repair • Impaired ability to self-regulateand employ pro-social behaviours (Porges, 2011) • Cognitive impairment (paranoia, negative bias)

26. Part II – Clinical applications • Working relationally • Psychotherapy – an erotic relationship • Boundaries from a chaos theory perspective • Metacommunicative transactions • Working with the erotic

27. Relational principles When we engage with a client’s mind, both client and therapist change at neural, cellular and genetic level Cozolino (2010); Kandel (2006); Schore, (2004)

28. Relational principles • Two-person psychology (Stark, 1999) • Mutuality: openness to being affected by and affecting another person • Co-regulation of affect • Power with (contracts and flexibility) • Co-creativity (Tudor and Summers, 2014) • Embodiment • Multiple meanings • Tolerating uncertainty • Flexible boundaries

29. “A metacommunication is an intervention that utilizes the therapist's countertransference in the here and now of the therapy together with exploration of the here- and-now process of the therapy in a collaborative engagementwith the client so as to explore the relational significance for the client of what is occurring in the therapy.” Widdowson, Metacommunicative transactions (2011)

30. Metacommunicative transactions • Contract for a relational focus early in the work (Yalom, 2001; Cornell, 1986) • Timing: consider the strength of the therapeutic alliance and client’s capacity • Contraindications: clients might find therapist’s subjectivity too overwhelming

31. Metacommunicative transactions • Attitude of curiosity and spirit of inquiry • Observation and description NOT interpretation • Bracketing assumptions • Disclosure about the act of disclosure • Listening to oneself on a second channel • Being aware of relational impulses: to rescue, prosecute, feel victimized (Karpman, 1968) • Spontaneity: images, stories, humour, metaphor • Owning our statements • Providing feedback • Willing to disclose feeling stuck/lost/unsure etc. • Commenting on the mutual experience

32. Woody Allen: I realize it’s just transference doctor but these days, I’m madly in love with you. Woman Analyst: Just transference! With legs like mine you think it’s just transference?

33. Psychotherapy is an erotic relationship “The erotic implies transgression into the sacred and the profane, into the secret, into the closest possible intimate contact. The erotic, therefore, takes us from where we feel safe and secure and places us full square into what is uncomfortable and exciting. It is the area of the unknown where innovation can come into being—links can be loosened or forged. In this way it takes analytic work away from the predictable exchange of associations and interpretations.” Mann - Psychotherapy: An Erotic Relationship: Transference and Countertransference Passions (1997, p. 66)

34. THERAPIST’S EROTIC SUBJECTIVITY • Therapists bring their erotic subjectivity to the therapy setting (it not all reactive countertrasference – David Mann, 1997) • The erotic pervades most if not all therapeutic encounters and is largely a positive and transformational influence • Beware of the ‘Ewww! factor’ (Muriel Dimen) • Disowning and denying erotic feelings is dangerous • Better not share erotic fantasies with the client ... • …but dare to acknowledge and discuss erotic feelings in supervision

35. Fractal boundaries

36. The therapeutic dyad as coupled oscillators • Working at the edge of chaos • The dyad is more than the sum of its parts • Brain functions become co-ordinated • Mirror neurons • Shared rhythm • Fractal (open) boundaries

37. “we need open discussions of actual cases, which is how all the other aspects of psychotherapy are taught. The supervisors who guide therapists need to be able to discuss their own, real experiences of powerful sexual attraction. Baur - Sex in the therapy hour (2014, p163-164)

38. Working with the erotic • Encourage verbal exploration of uncomfortable thoughts, feelings, even sexual fantasies • Emphasise talking not doing • Normalize the presence of the erotic • Don’t pathologise or blame • Deal with attempts to catch the therapist off-guard and de-professionalize the relationship in a compassionate, non-shaming way • Tolerate your own arousal and/or disgust, fear etc. • Discuss with a trusted colleague

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