Hi my name’s Fran…
© Fran Miller May 2007
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I trained as a mental health nurse in the late seventies, and had 15 years experience in acute and forensic mental health services. I went on from there to develop as a person-centred counsellor, complementary therapist, trainer and clinical supervisor.
I began my work in dependency 17 years ago. I’ve worked as a practitioner and service manager in the voluntary sector and as a clinical nurse specialist in the NHS.
I still work for the health service, but also independently now with some colleagues as part of a network called the Tao of Recovery and more recently with my own company Homedetox.co.uk
When William and I spoke on the phone and he suggested I present here today I had two reactions. One was: Fantastic, great, perhaps now I can speak with people about the things that concern me. The other: Oh God, I don’t have a PhD and I’m not an academic. But I am some one who spent 15 Years learning first hand about dysfunctional family systems as a child.
Little wonder I went on to make a career from what I’d learned. I don’t believe I’ve taken the career path I have by accident! Many of my colleagues have similar stories to my own. I wonder how many of you, have a childhood CV not dissimilar to mine!
I suppose you could say I’ve looked at dependency every which way, as a body-work therapist as well as a counsellor and some one with experience of work as a mental health nurse. I’ve looked at issues surrounding addiction from an Eastern, as well as a Western perspective, considered biological psychological, social and political aspects of addictive behaviour.
When I began my work, initially with people who used alcohol, I kind of thought I was to be a ‘therapist’ – I have in fact been a student. At that time, I had no idea that I was entering a whole new phase of my life. My work over the past seventeen years has offered me an opportunity to develop a whole new way of understanding myself, functional and less functional relationships and my part in them.
Sitting opposite my clients is like looking in a mirror. Some of my greatest learning has been as a direct result of that, as I’ve taken the issues that arise for me in the course of my work, to my therapists and clinical supervisors over the years. I’ve come to believe that addiction is a human condition, and a condition we can have either with or without awareness. I hope today I can turn you on to my practitioner’s eye view of ‘dependency process’ and my concerns over what I believe I’m seeing at a service delivery level.
So here I am.. The most unlikely Clinical Nurse Specialist you’ll ever meet! Seventeen years in this work and still passionate about what I do! I doubt there could be a more interesting, dynamically fascinating and satisfying way of earning a living!
Oh yes and by the way, my names Fran… I’m a raging co dependant and workaholic! So where does that leave clients who encounter me on their recovery path!
I’ve read some fabulously inspirational books over the years. One of them, resonates with me on a very deep level. It’s The Primal Wound - a transpersonal view of trauma addiction and growth by John Firman and Ann Gila. There are many references in the book, that I can relate to personally and many references that make sense to me in terms of my experience and work with clients.
For the purpose of today I’d like to touch on one of the main concepts: the wound of non-being. Firman and Gila refer to this wounding as an experience common to all of us in the course of our early development. They believe that from our earliest years, as we seek to know who we are, we engage in a process of projection. A process of kind of a looking out there for confirmation and affirmation of ourselves. Indeed we have to project to get feedback about our selves, how else could we know we exist?
Wounding arises as a result of our looking ‘out there’ into the eyes of other people and receiving a distorted reflection, perhaps one of ourselves as unworthy, or, worse still in some instances, an experience of looking out there and receiving no acknowledgement at all. An absence of a empathetic reflection of ourselves, an experience of non being and, related to that, a fear, that in our non being, we are invisible to the people on whom we depend for our very survival.
As such from our very earliest years we are presented with a life long paradox: that of yearning to be seen and heard as we experience ourselves to be , whilst simultaneously managing a need to hide, in an attempt to avoid the risk of being judged, disregarded and potentially abandoned.
From our earliest experiencing, we can be left with an innate fear of abandonment, a fear, that in Firman and Gila’s words, can determine our lives as a desperate unconscious avoidance of non-being, which in turn leads us into patterns of self-denial and addiction.
A tutor of mine once suggested she couldn’t think of an unhealthier place to bring up a child than a family of origin.. I’m pretty sure she was right. Families of origin might be viewed as our induction to the hall of mirrors that is life itself.
Firman and Gila further believe that as we move through our later years responding to the world from our wounding we project again into our environment, and begin a lifelong search for confirmation and affirmation. Our personal and working lives can become a reflection of our need to avoid experiences of ourselves as invisible and unworthy.
I believe Firman and Gila’s writings are hugely important. They acknowledge the core issues of addictions that I experience and work with every day, at the often disregarded existential levels. It’s been my experience that these are the levels that clients explore when they engage fully in deep and lasting recovery work. And that these are the levels that good 12 step work addresses.
I’m pretty sure my life has been a reflection of managing my need to hide, and my need to seek a reflection of myself as a person of worth. What do you suppose I’m doing here, speaking to you now ? I’m certainly experiencing that paradox right now. I’m delighted to have this opportunity to speak here but I’m equally horrified by the potential of being judged worthless and found wanting in some way because I don’t meet your expectations.
Dare I look into the hall of mirrors that are your eyes just now !!! Perhaps not! Maybe later! John Powell put’s it well in his book, Why am I afraid to tell you who I am, when he writes “because you may not like me and I am all that I have”.
A quote from Charles Whitfield: “When our alive true self goes into hiding in order to please it’s parent figure, and to survive a false co-dependent self emerges to take it’s place. We thus lose our awareness of our true self, to such an extent that we actually lose awareness of its existence. We lose contact with who we really are. Gradually, we begin to think that we are that false self so that it becomes a habit, and finally an addiction.”
On a personal level I caught myself going into hiding as I was trying to prepare what I wanted to present here today, I caught myself sitting on the floor surrounded by books, looking for excerpts from other people’s work and writings to put across the points I wanted to make.
I felt drunk, binging on words and theories, struggling to simplify and be clear; an uncomfortable experience, but initially, it felt preferable to the horror, of taking the risk of being me, and speaking from the heart in an environment where I fear intellectualisation may be the order of the day.
It was difficult to acknowledge my self as having things to share that may be of interest. If I speak from the heart and you decide that what I say is of little interest or perhaps disregard me altogether, might I be launched back into my wound of non-being?
If I’m honest, yes. I’m pretty sure that despite hundreds of hours of my own therapy, I probably will be, for a short time any way ! What makes my fear any different from the fear my client’s experience when they come to see me?
It’s my belief there’s very little, if any difference. As an experience common to us all the wound of non-being leaves us all liable to addictive forms of behaviour. I don’t believe any of us do what we do for a living by accident. I know for me, my career path has been my initially unconscious attempt to experience myself as visible, and as a person worthy of belonging.
I don’t use substances and alcohol addiction to avoid my fear, but I have developed a means that enables me to manage my fear effectively, what Firman and Gila might refer to as a ‘survival personality’.
Survival personalities and their associated forms of addiction enable us to superficially manage the feelings of fear, worthless and invisibility we experience amid the mixed messages and double binds, reflected back to us by the distorting mirrors of our environments.
In her fabulous book, Beyond Therapy Beyond Science, Ann Wilson Schaef refers to addictions as falling into two main categories: substance addictions are to ingested substances like alcohol and other drugs, while process addictions are things like co-dependency, overwork, gambling, relationship and sex addiction.
I believe we all display traits of addictive behaviour, it’s just that some forms of addiction are more socially encouraged than others. Co dependency is a prime example of process addiction that enables some of us to fulfil our conditions of worth by responding to the needs of others, in a society that actively reinforces us
Take me for instance. I have a rather sophisticated survival personality that is quite acceptable, thank you very much. I can escape the fear of my invisibility and potential abandonment through adopting the socially acceptable role of nurse or therapist. Others, in their attempts to avoid the pain of their wounding, may choose less socially encouraged forms of addiction and the more obvious forms of self-annihilation, associated with substance and alcohol dependencies.
Luckily for me, some of these people adopt the role of ‘client’. Thank goodness for that! I can sit myself in front of one of them, as one of us. Keeping my mortgage paid, safe in the distraction of looking out there. Tell me about your childhood but for heavens sake don’t invite me to tell you about mine!
But if I really look and really listen, what I see and hear seems pretty familiar. The common features of the wounding are there. We are in parallel really. It’s just that some of us have sophisticated survival personalities that enable us to hide like trees in a forest!
Just as my tutor couldn’t think of a worse place to bring up children than a family of origin, I can’t think of a worse place to put the wounded than the workplace! Two years ago I witnessed first hand the power of the workplace as a trigger for and enactment of the wound of non-being very powerfully.
I was working in an agency where a manger had a very unfortunate manner that seemed to trigger extreme responses in people. Some people seemed to be running around trying to please her even to the extent of betraying long-term friendships. I also witnessed an effect in a very self-aware member of staff, a mature very experienced practitioner who had a panic attack after a meeting with this person, something she later disclosed to me had only ever happened to her once before when she was about seven years old.
I couldn’t understand it. I certainly felt the power of it myself very acutely for a time, I found myself experiencing fear, I felt very threatened and uneasy tearful on occasion for no apparent reason, until I stepped back and actually observed the process. This person, probably totally unconsciously (well, lets hope so!) had the unfortunate habit of speaking with a person one day only to totally disregard them the next and a further unfortunate trait of actually closing her eye’s when people spoke with her, if she didn’t like what she was hearing!
I believe she was causing people to perceive themselves as invisible to her through her non-verbal responses. Triggering the wound of non-being and invoking reactions that might be attributed to the distorted projections of the past, associated with transference. It was incredibly powerful; people were quite literally desperate to be acknowledged by this person despite her rudeness, even if it meant a total denial of themselves.
I believe I was witnessing the power of transference and counter-transference in the work place. The wound of non-being was being played out unconsciously with the work place hosting the performance as family of origin.
That’s a pretty graphic example and maybe it’s a rather graphic conclusion, but I think these triggers are there on a much subtler level most of the time, driving co-dependent tendencies in the workplace, and encouraging us to ignore our own well being in pursuit of approval at work.
Maybe in part, this is contributing to the epidemics of workplace stress that seem to be around. What concerns me, are the potential implications of this sort of unconscious process, if our workplace happens to be a substance misuse agency.
Just as I can’t think of a worse place to put the wounded than the workplace, I can’t think of a worse place to employ an active process or co-dependent worker than a substance misuse service!
Like myself many of the people who apply to work in substance misuse services, and what are referred to as the helping professions, do so because they have gained first hand experience of surviving families of origin, where addictive process was very apparent.
Many of us formed our capable survival personalities as a direct response to that experience. Some people go to the pub to get their fix others of us go to work! For people like myself with a co-dependent, chronic overwork, survival personality, the workplace can hold as many triggers for transference and lapse as does a pub for some one who is alcohol dependent.
It seems to me that, with the best will in the world, under increasing pressure to prove ourselves worthy to employers and commissioners, we are falling into patterns that replicate the environments in which clients first experienced themselves as worthless and invisible..
How? Clients encounter staff too busy with their own needs to seek acknowledgement and affirmation from employers and commissioners, to acknowledge them.
Clients know they are regarded as statistics. As workers many of us fear we are turning into glorified administrators attempting to ensure the survival of the agencies we work for. We’ve become so preoccupied with statistics and the need to record how many people we see, the quality of the time we can offer has been compromised.
In many instances, clients look into the mirrors that are the eyes of distracted and stressed workers and, in the absence of authentic empathetic regard, again experience themselves as invisible.
And it’s not just the clients who have become invisible. I know many members of staff, who having felt invisible to their employers have spiralled head long into burnout trying to avoid their feelings of insignificance and invisibility.
There are increasing numbers of staff turning to the use of alcohol, substances and prescribed medication. Some of them, having given their lives to their work, end their careers burned-out or entrenched in the indignity of substance addiction themselves. Quite often cruelly rejected by their peers.
Clients are coming for more and more drugs like methadone to anaesthetize their wounding, and we’re there haring around like hapless drunks amid the paper work trying to avoid ours. The risk is, as individuals with the best will in the world and a genuine desire to help, some of us our out there active in our co dependency, contributing to some pretty unhealthy environments and calling them treatment services. I have concerns that under political drivers we’ve fallen into one of the most prevalent, unhelpful relational dynamics associated with dependency: the Karpman Triangle.
This is a gross over simplification, but for those who may not be familiar with it, the Karpman Triangle is a co dependent relational dynamic, based on one person’s need to resolve their own conflict through actions that control or manage the behaviour of another. A pattern of relating that fosters a need or dependency in another, which later becomes unsustainable, and inevitably leads to chastisement and subsequent rejection.
There’s an excellent example of how the roles of Victim, Rescuer and Persecutor play themselves out in the Alanon leaflet, A Merry Go Round called denial. Primarily attributed to dysfunctional co dependent family systems, the dynamics are often apparent in statements such as “If you don’t do some thing he’ll die” and “after all I’ve done for him”.
These days, these and similar statements can be heard regularly in exchanges between service providers concerned to show effective risk management and positive outcome in treatment services. Political policy, commissioning, and risk management models in these times of litigation seem to be determining therapeutic intervention or some of us would argue determining the lack of it!
It seems to me that dynamic vibrant specialist intervention is disappearing as the balance of therapeutic relationship heads further and further towards staff being required to take ‘responsibility for clients’ rather than demonstrating a responsibility to them.
I believe these co dependent dynamics are driving staff and the agencies towards burnout. In many instances clients are attending services that seem to be showing features of intoxication as a result of the stressors associated with co dependency.
The following quote by Aldous Huxley was given to me by a senior probation officer who plainly sees, and has real concerns about, the process intoxication he witnesses in the agencies.
“We get drunk on our work. Like our alcoholic brothers, we have blackouts; we forget important dates and names; we have hangovers, exhaustion, and health problems. We need the `fix’ of the work .It gives us the temporary illusion that everything is ok. It takes more and more work to give us that illusion. From a distance, it looks respectable. But the disease goes deep, affects us at every level and makes a mockery of our lives and those we love.”
Wasn’t it Carl Jung who said healing couldn’t be found in the seat of the original dysfunction? I’m concerned that as a society we seem to have embraced co-dependency as a social norm, and now, under the political drivers of the National Treatment Agency, potentially as a model for intervention! Are we sure that the drivers determining treatment provision aren’t covert manifestations of the Karpman dynamics?
What is the difference in a family member having an expectation that I should ‘sort out’ a relative who’s behaviour is disrupting the family and the NTA or the courts expecting me to involve myself in decreasing the risk of offending.
I fail to see the difference between rescuing as it’s referred to in Karpman dynamic and arrest referral schemes, or the difference in perceiving people as victims fostering a dependency and long term Methadone prescribing. Who’s needs are being met by the kinds of intervention that we offer to clients?
There’s a moral dilemma in suggesting we are offering a client-centred service when it’s plain that commissioning is very much geared towards safer communities and reducing the risk of offending. And there’s a further moral dilemma when our need to demonstrate effectiveness to ensure the survival of our agencies pervades the integrity of the services we offer.
I wonder if we will see dramatic turn around in what’s considered ‘therapeutic’ or ‘value for money’ as the ten year strategy draws to a close, perhaps confirming, and again reflective of co dependent dynamics, that we’ve fostered a dependency in service users that has now become unsustainable. I have real concerns that as service providers we are caught in the same potentially chaotic, self destructive patterns as our clients.
Who’s in denial here? And what are the implications for clients if these dynamics remain un addressed in the agencies? Those of us who are familiar with the Karpman dynamic know only too well that left unaddressed in families of origin, they perpetuate rather than alleviate addictive cycles. I believe it’s becoming increasingly difficult for clients to find healthy services, with healthy staff who can offer them the uncluttered space they need to take the risk of being fully seen and fully heard.
Here’s an interesting anecdote from a fabulous member of staff who used to use opiates himself years ago. After a busy day of running up and down stairs handing out methadone prescriptions he turned to me and said, “They used to lock me up for dealing this stuff Fran, now they pay me!”
Pretty scary stuff! So, who are these agencies, and services that are so unhealthy and perpetuating addictive systems in the name of treatment. Well here’s the crunch: the agencies, the services are pretty much just buildings. But potentially, they’re the places where we as individuals come together, perhaps grouped in what Firman and Gila refer to as unifying centres, attempting to reinforce our sophisticated survival personalities. In their words: “Whenever we are bonded to a constricting unifying centre, a very curious thing happens we enter a trance”.
They refer to it as a survival trance where unfoldment of authentic personality is derailed. I suppose that begs the question. If we are derailed as service providers, how can we hope to support clients in their recovery. A feature of dysfunctional systems is that they are closed systems; that’s how they ensure their survival.
God forbid that anyone break the ‘no talking rule’. I had a desperate need to do that in my family of origin, perhaps in my transference, that’s what I’m doing here today. So, what might cause us to continue on this The Merry Go Round called Denial? Probably the same features of fear and ambivalence that we attribute so readily to clients; maybe our desperate unconscious avoidance of non being. After all, if we don’t meet with the expectations of others we may be rejected and ultimately abandoned.
As it was for me wrestling my need to hide in books and other people’s work in preparing for today, so it for staff and clients in the agencies. It’s risky to be fully seen and fully heard. Committing to the recovery of my true self might require me to tell you who I am. And why am I really afraid to tell you who I am, because in our trance’s we may be projecting our wounding each other’s way!
I believe that to take the risk of daring to know ourselves, and each other fully we need to be able to encounter uncluttered environments that can offer a reflection of ourselves as the amazing beings we are. We need to encounter environments, or what Firman and Gala’s refer to as ‘authentic unifying centres’ that can empathetically reflect our image as people of worth and intrinsic value despite some of the crazy things we do sometimes.
I’m lucky, I’ve begun, quite literally, to make it my business to surround myself with like-minded people committed to the recovery of themselves. I trust them to tell me with respect when I’ve nodded off, when I’m marauding around in my trance displaying features of a chaotic, hapless drunk! They help me stay awake to the potential I have to contribute to unhealthy work environments, which display features not dissimilar to those of my family of origin. With each other’s support I reckon we are probably becoming more adept at observing ourselves with amusement, rather than condemnation. Well, on a good day anyway! And it feels good. And it feels fabulous to be able to offer that environment to clients.
So, is what’s out there ‘treatment’? Or might we be compounding the original ‘wounding’ in the name of treatment? I’ll leave it with you. For me, I believe projection and addiction to be a human condition learned in response to the unavoidable wound of non-being.
I further believe that as our wound of non-being projects itself into our chosen form of process or substance addiction. It becomes manifest in political policy, the workplace and treatment agencies, eventually to be laid at the feet of clients, with a suggestion that it is they, the clients or the organizations, that need to change rather than ourselves.
Where are we as individuals in this? Might we as workers be mirroring that familiar cycle we observe in our clients, that of seeking refuge from our selves in addiction, needing more and more to get the same effect as tolerance increases and eventually hitting rock bottom and burning out as the habit becomes unsustainable?
Look again at the points on the continuum. Might what you read below the line also be manifestations of the pressure we subject ourselves to in the workplace? How can I not break the no-talking rule after hearing reports of a mum being called into school two weeks after her little boy started there, to be informed by a very stressed teacher that her son had attention deficit disorder!
This little boy is five years old! How frightening is that? What are the implications for him, if he inherits a label of attention deficit disorder? Can we be sure that he isn’t inheriting the projections of an overworked, stressed teacher, who’s attention to him has become unsustainable?
But there again, acting as hosts for our transference and projections, maybe these chaotic work places are giving us a gift, the opportunity we need to rouse ourselves from our trance, to learn to take back our projections and instead pick up the challenge of learning to value ourselves.
How tragic if as a result of having a closed narrow view we limit the possibilities of really getting unhooked and hooking into a far more exciting vision for our selves and other people! How sad if in grouping together to reinforce our survival personalities we loose the potential to know and experience ourselves, and others as amazing in our flawed humaneness!
I believe recovery to be a life’s work of trying to maintain awareness, and stay awake amid the constant invitations we encounter to loose sight of ourselves, and fall asleep. A commitment to managing the tenuous balance between our need to hide, and our unconscious tendencies to project.
No reference to awareness would be complete without mentioning the work of Anthony Demello. His book, Awareness, offers a fabulously funny, humanistic and inspiring mirror for people who dare to look into it.
A risk of doing a presentation like this, is that it can be fraught with sweeping generalizations and inevitable projections. I know what I’ve presented here today, has been. I’m not suggesting that all people in the caring professions are co-dependent or that all services are unhealthy. There are some fabulous projects out there, some dedicated practitioners working with awareness playing an important role in supporting the recovery of others.
But in their book, The Addictive Organization, Ann Wilson Schaef and Diane Fassel suggest: “If people quit playing the co-dependent role, addictions could not survive… Addicts have to have the collusion of co-dependents to maintain their closed addictive system.”
I feel such a fraud, standing here saying these things. People sitting out there, who know me, know full well that I struggle constantly with my chronic overworking. Maybe in breaking the no-talking rule here, I’ll be able to free myself of my own personal groundhog day, that of finding myself needing to suggest that the emperor is in fact naked, whilst others seem to be admiring his new clothes !
Maybe I’ll move on from the work I do now, but in a way I hope not, because there couldn’t be a more amazing and rewarding way of earning a living. The clients I encounter on my journey to know myself help me grow. Maybe I should be paying them! If I’m bound by a limited vision of myself where does that leave clients who encounter me on their journey to know themselves?
I’ve just caught my self-muttering the immortal words Never Again as I type this! How many times have I heard the very same words from my clients! Maybe there’s no escape! Even with awareness!
God grant me the serenity! And God grant my therapist and Clinical Supervisor the same!
by www.homedetox.co.uk .
