PPP047: The Talking Cure, Transformation and Being a Little Mad with Professor Gillian Straker & Dr Jacqui Winship

Ellen:     My guests today, and there are two of them, are Professor Gillian Straker and Doctor Jacqui Winship and they're joining me to talk about their new book, The Talking Cure: Normal People, their Hidden Struggles and the Life-Changing Power of Therapy.

Ellen:     Gill is a highly experienced clinical professor in the School of Psychology at Sydney University. She's published widely in psychotherapy and psychology. She's a passionate believer in the transformative power of authentic relating and is firmly of the belief that we are all engaged in psychological struggles that we tend to hide, including from ourselves.

Ellen:     And Jacqui has over 20 years experience as a clinical psychologist, psychotherapist and supervisor to other psychologists. Jacqui works with adults, adolescents and couples and believes in the power of therapy to enable individuals and couples to grow, heal and thrive.

Ellen:     Both are based in Sydney and they're joining me over the airwaves today to talk about their book, psychotherapy, and what we can learn when we pay attention to the dynamics between people and within ourselves. Welcome to you both.

Gillian:  Well, thank you Ellen and thanks for inviting us.

Ellen:     I have been reading your book, The Talking Cure. I was very fortunate to get a pre-released version from Allie at Pan Macmillan, and it is fascinating. I was just saying before we started, that I'm learning so much about the psychoanalytic or psychotherapy itself, which I'll ask you more about and get you to explain to our audience shortly. And about myself and about the inner processes that go on within us and where these might come from and how they might manifest.

Ellen:     I've been really loving it and really appreciate, as someone who's done a bit of writing myself, how well you've walked that line between what we might call psycho-education, which is explaining psychological concepts to people and these are pretty complex concepts and story telling, that makes it engaging and interesting and relatable. Well done for that and I'll start by asking you... Well firstly you open... because the other thing I really enjoy is that you have included a lot of popular culture references in the book, which I think also makes it interesting and engaging. So who, of the two of you, is the film and TV buff?

Gillian:  I would say that in terms of popular references I think that Jacqui has to take the credit for that.

Ellen:     So Jacqui you open... the book opens with a reference to The Sopranos, that iconic TV series. Why The Sopranos?

Jacqui:  Well, actually Gill was the one who came up with the reference to The Sopranos, so I'll credit that back to her. But I guess it was one of the first times in television that we got some sort of insight into a psychotherapy relationship and a difficult and complex one. And it really, I think, allowed people to see how therapy could work for people. I mean in some ways it's a poor example because Tony, the client, ultimately is unhelpable, unchangeable. But he does, along the way, come to various insights or understandings through his relationship with Jennifer Melfi, the therapist in The Sopranos. But I think it sort of helps people to see in a very graphic form and visual form how the therapy helped to reveal what might be going on underneath the surface with Tony. That there was more than what meets the eye, and that understanding unconscious motivations can help to throw light on what's happening in the more observable conscious behaviors.

Ellen:     And when we're talking about therapy in this context, so in your book and in this example in The Sopranos, we're talking about a psychotherapeutic approach that might differ a bit from what some of our audience might have experienced as therapy. What is psychotherapy as you're describing it?

Gillian:  Well, if we go back to The Sopranos, I think one of the interesting things about it is how important the relationship with Melfi becomes, despite the fact that that was certainly not actually what Tony's intention was. And how so many of his issues, which were about power and control and sexualizing, get in fact played out in the relationship with Melfi.

Gillian:  And I suppose that what we're trying to do in relational psychoanalytic psychotherapy specifically, is take the relationship as the unit of analysis, and not just simply the individual and what is inside of them, but how they co-construct a relationship with another person in repetitive patterns. So, sort of the idea that how we might do the relationship in the room is also perhaps how we kind of doing the relationship, so to speak, outside of the room. And it gives you empirical evidence-based data in the space between you. And I suppose that's one of the things that we wanted to put forward is that long term therapy and therapy which is outside of the mainstream, which at the moment would be cognitive behavior therapy or dialectal cognitive behavior therapy both of which already make a great contribution, but that this is evidence-based because the piece of evidence is revealed between the two of you as the therapy unfolds.

Ellen:     My understanding is that it's a reflection I guess of... so as the therapist you are paying attention to the dynamic that occurs between yourself and the individual who's with you and using that to inform I suppose an understanding of the dynamic that [inaudible 00:06:36] person might be experiencing in the other important relationships in their life. Would that be a summary?

Gillian:  That would be perfect.

Jacqui:  Yes, absolutely. And I guess, within that the therapist is sort of paying attention to what is going on in the client and also in themselves to form hypotheses about what it might be that creates difficulties for the client outside of the room. And then, honing those hypotheses in collaboration with the client because we can never fully know another person's experience, we have to sort of keep mirroring that back to them in a way and getting their response or reaction to it.

Ellen:     So, it's really a process of kind of testing and learning?

Gillian:  Precisely. Exactly. Sort of learning from the patient, which I think is an important key in the book around also breaking down the division between patient and therapist as if all the knowledge is in the therapist, no knowledge in the patient, to try to see what is the knowledge between us. And how can one use that to generalize outside of the room into the world. Yes, it's a process-oriented way of thinking.

Ellen:     And in the book you use what you call case stories, not case studies but case stories, to illustrate. So, for each chapter there is the story of someone who is, from my understanding, an amalgamation of perhaps a number of different clients that you've seen over time or that between you you've seen one way or the other. So the therapist in the stories is an amalgamation and the client is also an amalgamation just to give hypotheticals. Who are these people? Who comes to you for therapy?

Gillian:  If I can just say, you're spot on in terms of the amalgamation in regard to the people we see. But it's actually far beyond that because it's an amalgamation of the people we see, our friends, our families and ourselves. So, it's not just the people we see.

Ellen:     [crosstalk 00:08:54]

Jacqui:  From that we could say that the people we see are normal people, you know. They are people like you and I, who are struggling with issues that we all struggle with to some extent or another. For some people those might be creating more impediments for them in lives than in other cases but the people in our book are not special in some way, they are very much everyman if you like.

Ellen:     And I think that's why I found it so relatable as I was reading it, was that these are stories of people that might be functioning largely very well in a number of different areas of their life. They're professional people, they're parents, they're very capable but as you say Jacqui, there might be just one bit that's going a bit pear-shaped, for want of a better term. They're parents who are struggling with a relationship with a teenager who is acting out or they're young professionals who just started to see a pattern with their relation... you know significant relationships are breaking down and they're trying to understand why.

Gillian:  Exactly. And I mean Ellen, just to add to that, and I know Jacs agrees with me about this, but also the idea of normal because the only normal people are the one's you don't know very well. So you might just think that everybody is just on a continuum, some people might struggle more than others but I don't think there's such a qualitative difference between people with issues that I acknowledge and perhaps are more obvious than people whose issues are more hidden.

Ellen:     I think that's a lovely point. I often refer to people as normal in inverted commas because there really is no such thing as normal is there. We can't talk about average people either. There's no average people, there's just people.

Gillian:  Exactly.

Ellen:     We have similarities and differences.

Ellen:     What was the driving force behind using these case stories as a way to depict the interactions that you might have with a client and to help us to understand this relational psychotherapeutic approach?

Jacqui:  Well, I think that people relate to stories. You can tell them the theory of something but it's really when they can see it played out in a story that they can more deeply and experientially understand it. So that was one of the motivating factors, that we wanted it to be a live learning.

Jacqui:  The other is confidentiality, which both Gill and I take very seriously. That we feel very uncomfortable to tell the stories of real clients in a book.

Jacqui:  The third thing is that we wanted to show a broad range of issues that are quite common to many people that we see. They're not necessarily just representative of one client or patient, but actually representative of the kinds of things that many of us might struggle with. But Gill can tell you a little bit more perhaps about how a book began, because that also explains the use of stories.

Ellen:     I'd love to hear it. What prompted the idea of the book Gill?

Gillian:  Well, I was actually giving my seminars at Sydney Uni and they, at that point, happened over a day so there was a large lunch break. In the morning, the students kept on saying to me, 'Yes, but how does this way of working actually look? What does it look like? What is it?'.

Gillian:  And I thought, oh my goodness, that is such a wonderful question and how do I actually try to bring this alive to them. So, during the lunch break I started to write the first chapter. And, as Jacqui said, I was quite committed to the idea of therapy being a sacred trust because I really believe that, and not talking about a real, live person but thinking okay what are some of the common dynamics and how might they play out. So I started at that... It started really at lunchtime at Sydney Uni.

Gillian:  But then I sent it out to a number of friends of mine, including Jacqui, and all of them pretty much said the same thing, as well as Jacqui. 'No, you need to make it more alive, you need to put in popular references,' but the only difference being, that Jacqui actually did it. She didn't say to me, 'this is what you should do', she did it. And so I said, 'Well Jacs if you're going to do so much work, you'd better come on board'. Which [inaudible 00:13:44] and lucky for me, and I would say that we've had a really fabulous time and a fun time trying to weave the thing together. So Jacs I think that's how it started, would you agree?

Jacqui:  I would agree, yeah. But in fact, the relationship between the two of us has been a very important part of writing the book and of, in some ways, reflects our focus on relationality in the book itself and in the work that we do.

Ellen:     So this is a really, a living, breathing... I suppose not quite living, breathing, but you know what I mean, example of this emphasis on relationship. That these dynamics that we have between people are happening in so many different levels and in different ways and they touch on our experience of everything that we do including writing a book.

Jacqui:  Yeah, and I think that we can understand our experiences better through relationship, which is part of the psychotherapy process, but I guess it was with Gill and I that we could understand what it was we wanted to say through interacting with each other.

Ellen:     And I think it's wonderful that you've made the experience of writing a book a positive and fun one because as somebody who has written a book before and knowing a lot of other people, for a lot of us it's actually a long and torturous process.

Gillian:  Well, Ellen it was certainly long and I mean there were times when we thought it was quite torturous. Well me particularly when we had to re-write and re-write and re-edit, that was my worst. Jacqui is much more focused on detail in that way than me so we had a good synergy but I think if I were doing this on my own I absolutely know I wouldn't have had the energy to push it through. I do think it was something about being able to laugh about certain things and we wrote it by going away for a series of writing weekends where we could do it pretty intensely, because for neither of us was it our day job. We combined it with enjoyable sojourns in the house of a friend of ours, Caroline and Chris, who made their house near the sea available to us so it became enjoyable on a number of levels to do the job.

Ellen:     Wonderful. And I think it comes through really well that it's whilst some of the topics that you address, the case stories for each chapter, there's some difficult stories in there. And difficult issues at times for people but there's nothing that feels difficult or distressing in the reading of the book. It feels light and engaging but also very thought-provoking. That would be probably my experience of reading it. It just really got me thinking about my family of origins, it's part of what you talk about is the experience of what you learn through dynamics with your parents from infancy really all the way through. And then, how that might play out as you start to engage in your own adult relationships and experience of yourself. It really, really got me thinking. It's hard not to identify a little bit with every one of the stories in there and start asking yourself 'Ooh, is that me? Do I do that? Where might that have come from?'

Jacqui:  And I guess that's certainly what we hoped for Ellen, so it's good to hear that that was your response to reading the book. We hope that everyone would recognize a little piece of themselves in some of what they read and that it would help them to, perhaps, reflect a little more and be a little more interested in their own internal worlds.

Ellen:     And would you say that's one of the goals that you had in writing the book to prompt a little more self-insight perhaps in the reader?

Gillian:  I think definitely Ellen, because I think that, and as you know there are social references and we value social media and so we see that as something valuable and it's here to stay. But also it does encourage a lot of focus on external and on curating an image and on putting something out there as opposed to perhaps a more internal, reflective space which I think that we do find valuable. And we were trying to promote the value of looking inward as well as looking outward and trying to get into a better synergy rather than too much outward looking without enough inward looking. That was the one thing.

Gillian:  The other thing is that there seems to be such a plethora of books around recognize the borderline and how to manage them, walking on eggshells, don't put up with the narcissist, tell the psychopath to take a hike. All of which are helpful and true and we're not going saying them but sometimes it helps to look for the little narcissist or the borderline or even a bit of anti-social in oneself. And start with that rather than projecting it always into the person other than yourself.

Ellen:     Yeah, a little bit less of what I know, in some circles, they call that othering. That this experience that this is not something that happens to me this is about other people. And realizing, or coming to appreciate that, as you say Gill, we've all got a little bit of those different dynamics, those different attributes. There's bits in us all that, if we really reflect on them, we might not be that comfortable with and I think that comes out in a lot of the stories that you share.

Jacqui:  Yes.

Gillian:  Yes.

Jacqui:  Yes. That the insights can be challenging.

Ellen:     So taking the opportunity I guess then to actually be comfortable, or start to consider those things about ourselves that perhaps we're not that comfortable with or we don't like. And what is that telling us. And I think that is part of what comes through in these stories that, and part of what comes through in your description of the therapeutic process, is that when we find a safe place to explore, a bit of that ourselves that's where we can hopefully make a bit of progress in perhaps repairing those relationships or repairing some discomfort within ourselves.

Gillian:  Because. Sorry Jacs, do you want to go ahead?

Jacqui:  No, you go for it.

Gillian:  I suppose because really what I think gets us into trouble often is not our vulnerabilities but our defenses against us, against ourselves actually. We're defending against ourselves difficult or problematic feelings or we see a bit of a narcissist in ourselves and we feel shamed and we try and push it away. Rather than thinking, well maybe lots of people have this and I can try to think about it and think about how it affects my relationships and try to work on it rather than just actually do the othering and pretend it's only the other and not me.

Gillian:  And I also loved Ellen what you said when you said that you found yourself in a lot of the stories. Because I often say when I'm working with the students if you find that you've got a smorgasbord of diagnoses you're doing fine. If you're stuck in one you've probably got more of an issue going.

Gillian:  I do sort of think that about all of us. That we all have little bits and pieces of ugly feelings or not such good ways of relating or being.

Jacqui:  And I think perhaps, to add to that, that goes to the importance of the psychotherapeutic relationship. That it's one where people can come to feel safe enough to be vulnerable and to look at their own flaws and perhaps, as Gill calls them 'ugly feelings', without fear that they're going to be demonized for them or judged and that sort of allows the space for those to be aired and understood and worked with. Whereas perhaps it's quite hard for people to do that with a friend or with their partner where there are a lot more vested interests and perhaps more of a need to be defensive about those aspects of ourselves.

Ellen:     Yeah, and there are themes of self-compassion in there as well isn't there. This kind of acceptance of the self as just being a human with all the flaws that come with being human and an acceptance that that's okay. But, as you say Jacqui, it can be really hard to do that within relating to the other people in our lives. Because of the dynamic we've created because we don't want to feel judged or feel like admitting that we can be narcissistic at times, it's unacceptable.

Gillian:  And shameful. And I think shame is such a toxic, difficult emotion which is why we do try to talk quite a bit in the book about shame and how it really inhibits one from self-compassion, which would be a much more helpful way to go because then you can really look at it and say okay and it plays out in these particular ways. Because I think we're also trying to say that the same dynamic can play itself out differently so you can feel perhaps easily intruded on. For one person it might go to being exceptionally shy, but another person might defend against it and become rambunctious. It's also looking at the fact that the same internal experience or difficulty can play itself out in multiple ways. I don't know if you would like to add to it Jacs but that's what I was thinking.

Jacqui:  Yeah, I mean I think it's the recognition that there are kind of common issues that perhaps we all struggle with but that there are also, we are also all very unique, and that we express them in very idiosyncratic ways. And there's not a linear trajectory that we can draw from, for example, one childhood experience to one definitive outcome, that it's very complex and influenced by a myriad of different things.

Ellen:     And that I think came through really strongly in the stories because you quite often referenced back to other stories as you discussed a particular individual and their circumstances. I can think of two where there were mothers who were dealing with difficulties in relations with their daughters, or it was their daughters behavior that they had concerns about. And how on the surface that might look like the same scenario of a mother with a daughter who's acting out in some way but the actual dynamics that had lead to that situation, as you explored them, were quite different.

Gillian:  Yes, and I think Ellen, what we were also trying to do was to look at the fact that... I think, first of all, I think mothers, particularly get a bad rap. They really do. And everything will land on the mother and that, it's almost a bit of a stereotype, that it's the intrusive mother and the absent father and you can map that on to anything.

Gillian:  While that is true, to some extent and it plays out, parents, on the whole, do the absolute best they can usually. I mean you do get some terrible, abusive parents but not too many and I think that... I mean one of the questions you asked us, which I thought was interesting, that if parents are thinking about their children, what should they avoid. And what I really thought that through, because we talked about it before, before we've met with you. For me, it's around the fact that it's usually not a behavior but there's some issue, conflict, trauma unresolved within the parents that then gets externalized and played out outside of an awareness. Which is why it's sometimes so slippery and difficult and why that one chapter is called 'Why's my child a monster when I tried so hard.' It's absolutely true.

Gillian:  So, that's on the one hand and then on the other, when we're looking at issues it is the nurture and the environment but there is also the constitution. I do think some people are born with a greater predisposition to anxiety or depression. Then I also think that the atmosphere of our times is really important. And I think we are in unsettled times. With the new generation and climate change, all the conflicts that are building up; North Korea, the Middle East, Brexit. I don't think people are completely unaffected by the in general instability and insecurity. I think very importantly which has been perhaps underestimated sometimes, is choice. We do make choices. We're not just a blank slate and I think even children have a crossroads where they can go down that path or that path. And yes they're being nudged perhaps by nurture and their predisposition to go A but they're also making a choice and sometimes they will make a choice to B in a surprising way. So, I think we wanted to bring that up as well.

Jacqui:  Yeah, and I guess to add to that. The important thing in many of the stories that we tell in this book is to highlight how, when there is more self-awareness of our unconscious patterns or relational dynamics that people play out then there is a heightened capacity to choose. You're no longer just blindly doing something, you can actually exercise choice about how you're going to respond to that.

Ellen:     Yes, so it's more complex than... Because what prompted my question to you in preparation for this was, as a mother myself and I've got two boys who are ten and seven, and I know a lot of parents and I know a lot of the anxiety that comes along with parenting. And again, you mentioned the circumstances of our times Gill, and I think that is one of the areas where social media is perhaps not as helpful in that tendency to escalate distress or anxieties around 'Am I getting parenting right?', again in inverted comma's. But, as I was reading I thought there could be a lot of people. Because in each of these stories it does relate back to the individual's experience of growing up and what had happened in their childhood and their relationships with primary carers, usually parents, and how this might have shaped a pattern of behavior, as you say Jacqui, that's largely unconscious. And then reading as a parent, thinking oh my god, what am I doing that is going to screw my children up?

Jacqui:  And actually, you know I laughed, when I read that question, when you sent through your brief Ellen, and said 'What would we say to a parent whose worried they might screw up their children later in life?' And my immediate response was welcome to the club.

Ellen:     Again, a bit of self-compassion it's just a normal part of being human.

Jacqui:  Because both Gill and I are parents ourselves and we know how difficult it is to always get it right and all we can do is the best that we can and I think most parents do have good intent. Very few parents look at their baby lying in the crib and think I really want to screw your life up. Most of them have only the best of intentions but we're also all prisoners of our own history's and we can't always get it right.

Jacqui:  And I'm often comforted by the words of the famous pediatrician and psychoanalyst, Donald Winnicott, who said, we only have to be good enough as a parent to, pretty much, do a good enough job so that our children can be productive and happy in the world. But we can't guarantee that they're not going to also have their own issues and dynamics that stem from their experiences with us as we do from our own experiences with our own parents.

Ellen:     Yeah, that makes perfect sense. And I think too, I love that quote that you can only be enough and do enough because that's something that I remind myself too as a parent. I'm doing my best that's all I can do.

Ellen:     But also Gill, you mention there of just how many complicating factors there are in these situations. That yes, there is this dynamic that may play out, but that is one part, as Gill... sorry Jacqui you said, that can come also from our own experience so there's almost a multi-generational thing that can happen here. But environmental context, social context and the choice that we have as well. Even, Gill as you said, the children that get choice, they still get the option to decide how they're going to respond to something perhaps not necessarily with a lot of cognitive awareness, but it's there and certainly as we go into adulthood we get a lot of option and choice so it's not so much that hopefully what we're doing as parents is going to [crosstalk 00:31:55]

Gillian:  Well, you know I often say to parents there's one way and only one way to do parenting and then people look alarmed and then I say and that's the wrong way.

Gillian:  Once you can accept that you're going to make mistakes and that it's inevitable I think that it's kind of helpful because you're less hard on yourself and less anxious and tense therefore. And the other thing that you were talking... You know just to complicate it even further I think we so often underestimate the influence of siblings, and we underestimate the influence of school and teachers and what's happening in the playground. You know, the parents, in particularly the mothers get bad raps but there are just so many other factors that really push upon the outcome for one's children and for oneself that we can't fully account for.

Ellen:     Yeah, and we can't be responsible for either or feel the pressure and anxiety about feeling responsible for.

Gillian:  Exactly, yes.

Ellen:     In the introduction to the book you do offer some commentary on I suppose the state of mental health and our mental health system. I'd love you to expand on that for our listeners if you could.

Gillian:  Jacs do you want to talk about the various diagnoses because I think you were talking...

Jacqui:  Well, yeah. I mean one of the things is that there has been an increasing move towards diagnosing behaviors so even if you look at the DSM, the diagnostic manual that we use there's been a proliferation of diagnoses and so there are new words to describe and diagnose behaviors or conditions that there weren't twenty or thirty years ago.

Jacqui:  I think that the impact of that is to see many variants of behavior as being some kind of illness or to promote a bit of an us and them mentality. Where those with a diagnosis and those of us without, rather than holding a broader spectrum of wellness really. There's a focus on mental health and the illness aspects of it rather than focusing on how we can promote well-being more generally. I can say that.

Jacqui:  The other thing is that, in terms of responses to a government responses or programs, then yes it is a good thing that in Australia people can access some funding for, to see a psychologist but it's limited to ten sessions. Which really focuses the field on the short term response to what I think are often very complex issues. Of course, that's driven by budgets and costs and it isn't necessarily what's going to be in the best interests of people. But I'm sure Gill would have lots more to say about this so I'll let her continue from there.

Gillian:  Well, just to add to what Jacqui was saying about the diagnoses. Because diagnoses we treat as if they are an actual entity, a thing, but in fact they're not. There are huge fashions in diagnoses, there can be a fashion which sweeps a five year period where schizoid personality disorder is the most popular diagnosis or for example, schizophrenia is diagnosed more frequently in the United States than it might be in England. Homosexuality was considered to be a pathology until very recently and then was actually dropped from the DSM. They really are descriptive labels rather than entities and I think sometimes we can forget that a bit. That's the one thing I would want to say. Which isn't to say that sometimes having a shorthand, something descriptive can help, but not if you use it to confine people and box them in rather than to try to increase their degrees of freedom.

Gillian:  And then picking up on what Jacqui said, and I am quite passionate about this actually, and this does flow in fact from the book in terms of what writing the book taught me. It's to try to focus more on mental well-being as a lifestyle choice. Because if you think about it we go to pilates or yoga or people exercise or they look at their diets, they cut out this, they cut out that. We've got wonderful lifestyle choices; no smoking, trying to limit drinking, trying to limit sugar intake. Which will have a massive impact on medicare in terms of prevention saving money.

Gillian:  I would say that if we could look at a focus on thinking about ourselves, our styles of relating and our ways of being in the world in terms of trans-generational transmission of difficulties and also in terms of children growing up. And start seeing the value of prevention, although it looks as though it's costing a lot, and in one way it is. In another way, if you say okay but then there's going to be fewer teenage suicides, fewer self-harm people, fewer admissions to hospital because we are seeing, thinking about mental health as well-being and as a lifestyle choice. That's the way I go with it.

Ellen:     And I think that's such a wonderful point Gill. That's something that I'm personally very passionate about, and it's been part of the driving force of having this podcast, is to be able to, I suppose, to spread the word of well-being in that positive sense and in a psychological sense so that we can help to try and prevent maybe some of the struggles that people have.

Ellen:     I think it is taking that longer term view and I often get, I probably drives my husband bonkers, because we'll hear on the radio, or we'll hear in media about issues of mental health and mental health this and mental health that and so often, even when we're using the term we're actually talking about mental ill-health. We're not talking about mental health at all.

Ellen:     In workshops I'm running in workplaces, when I talk about these topics I reflect to people and say, 'Look, when I say the term mental health, what comes to mind?' and I'll get a list of symptoms and diagnoses and struggles. And I say, 'Is that really mental health?'. If I asked you to say 'What is physical health? What would you say?'. Then they say fitness and strength and all of those positive terms so being able to hopefully get to a point, and I think this goes to what you were mentioning Jacqui, that having a diagnosis is almost a prerequisite now to get the help that you need and yet it's such a short way of thinking about mental health as something that we should be seeking to achieve. I'd love it if we got to a day where people just went to see a psychologist for the insight that it gives and to boost their well-being and to make sure that they're on track rather than having to get to a point where they feel that something's gone fundamentally wrong.

Jacqui:  Yeah, we would love it too Ellen.

Ellen:     We're all talking the same language.

Gillian:  Yes, we are. And trying very much to promote that. If you think about it even when writing an exam sometimes to go from 50 to 70 is not as difficult as going from 75 to 85. Yet think about the society, think about the contribution if we could think about trying to actually get that extra possibility which, for me if I think about mental well-being, what does it involve? Well, I think for me it involves connection, big time, and there's so much research now showing that depression is linked to lack of connection. It involves agency and again we were told listeners that all of that connected to depression.

Jacqui:  Choice.

Gillian:  But I think it also involves things like making a contribution and altruism. If you are promoting mental health, and really meaning mental health now and not mental ill-health, and also seeking meaning as the fourth one. I was thinking the three C's and the fourth one. Before you can promote that as an atmosphere of the society, I think that you will be promoting a much better emotionally and mentally happy... not only happy... I hesitate to use the word happy and then I think well why not. A population that's invested in well-being and not just invested in only me. I think mental well-being is moving away from only me to thinking about we in a really meaningful way.

Ellen:     Yeah, I think they're excellent points and I agree wholeheartedly. Particularly, with one of my favorite topics to talk about is the role of meaning and purpose in life and what that does to contribute to our sense of well-being and happiness and contentment. But also when I'm out talking in workplaces, drive and motivation and productivity and those things that have a positive, flow-on effect as well. And getting into that positive well-being spiral, which we do get the opportunity to do through our work, but not always depending on probably a lot of the stuff that has a lot more to do with your realm of expertise around the relational dynamics that occur in workplaces.

Gillian:  Ellen, it's so important you've said that because I really do think that these dynamics play out hugely in the workplace because if you would ask me to reduce, and it is reducing, the two drivers for all of us as human beings it would be the axis of power and the axis of initimacy. And it's namely the axis of intimacy that we're dealing with in the book because we're dealing with familial and love relationships and romances and all of that. But in the workplace you're dealing with the other aspect of it which is the axis of power and I think those two dimensions are the two dimensions where we are liable to co-construct difficult and problematic relationships. Because in our families of origin we have to deal not only with intimacy and closeness, but we also have to deal with authority structure self-appearance and how we relate to that and also majorly translated to how do we deal with our siblings, colleagues and how do we deal with our parents authority's in the workplace.

Ellen:     Ummm. I'm going to go and investigate a bit more into the axis of power because that does sound very informative especially for the work that I do. Yet we often talk about in workplaces how managing is often like parenting and, those sort of structures, they do parallel our experience of relationships in our family lives and our other important relationships.

Ellen:     I think there's one other question that I'd really like to ask you both before we finish up. That is, because this has got me thinking in a quite fascinating, and I've been reading the book and reading the stories. Is what's it actually like to be a psychotherapist using this approach because you are playing a much bigger part in some ways. My understanding, and again I'm not a therapeutic psychologist, but a lot of us are taught that we don't play a part in this, it's not about the therapist, that we're separate, it's all about the client. But using this approach the therapist does actually have a really important role to play. Far more [inaudible 00:44:39] role, so what's it actually like to live and breathe that?

Jacqui:  Well, certainly the therapist and the hoover therapist is integral and the [inaudible 00:44:48] because it's a relationship and the relationship always involves two people. It's looking at what emerges in that but I'd say for myself that certainly it is an honor, I guess, to be so up close and intimate with somebody else's story and their vulnerability. We're in a very privileged position to be able to share in those stories. And not to say that it isn't sometimes hard and confronting and people can be difficult, but really it is a very special kind of relationship to have with a person and to be so privy to the intricacies of their lives and their stories.

Gillian:  I would totally agree with that. For me it's a huge privilege to actually be in that kind of position of trust and I think it's something that one has to take really seriously about confidentiality and not being careless about how one might talk about patients which is why we've got stories, not case histories in that way. I think there's also quite a lot of responsibility when people are very, very distressed and you might be worried about them and their states of mind. If they're feeling suicidal or you're worrying about people covering over the pain through addiction, so there is at times a lot of responsibility. But I certainly wouldn't swap my job for anything and I totally agree with Jacqui that there is something extremely privileged and rewarding about it.

Gillian:  There was something else I wanted to say it's slipped out of my mind, but hopefully it will actually come back.

Ellen:     It will come back. And I do get the impression that this is not the kind of therapeutic... that part of this is lived experience for you as the therapist. That it's an accumulation of all of these interactions, and the knowledge and the wisdom and the experience that comes from that that's going to contribute to the next interaction with a client. That it's not something that we could jump into easily as a fairly unexperienced therapist.

Gillian:  I've remembered what I wanted to say.

Ellen:     Oh good.

Gillian:  Which is my challenge. Look, I do think that the particular modalities where it is important for the therapist to step back. So what you're referring to is a different modality which I think those it's probably appropriate, but I think the idea that a therapist can be neutral for me would have perhaps, in my view, gone out of fashion with Heisenberg's Principle of Uncertainty. By which one means, he was looking at atoms and was seeing how the tiniest atom was influenced by an observer. If an atom is influenced by an observer how on earth do we actually think that a person is not going to be influenced. So I think the idea of neutrality doesn't stand up. If it doesn't stand up then I think that there's a responsibility, not just, as I said the responsibility towards the patient but there's a responsibility to keeping yourself well-honed.

Gillian:  Which is why I think that therapists should periodically drop back into their own therapy and they should most definitely continue all the time to be in peer group supervision or to seek consultation if they've got a particularly difficult person that they're working with. So that you're not just getting fooled into thinking, well because I'm reacting to this person that means that my reaction is a fact. Rather than, what really might I be contributing and am I co-constructing what is happening. But you're right when you're saying that the way of working is really an accumulation of experience, including life experience, so yes something about that that's important.

Jacqui:  Yeah, and I think maybe what that sparked off in me is just the thought there's a lot of focus on psychology as a science, and certainly there's something to be said for that, but I think in this kind of psychotherapy it is also an art and that you've got to find the balance between those two things.

Ellen:     [crosstalk 00:49:29]

Gillian:  Sorry Ellen, just adding to that because I think that if you think about it as human beings we are influenced by the tiniest biochemistry. Let's face it if our biochemistry goes out of whack, for whatever reason, our hormones, or if we don't have enough serotonin, we seriously find ourselves in an altered state but we're influenced by that. Plus, then huge things like ideology, religion, music, family, school, politics and everything in between. That I think to have a truly scientific way of reducing that will lead to exactly that; a reduction and not necessarily in our interests.

Gillian:  At the same time it's odd that there isn't... it's a bit like, in the hand of Gods, like bridge, every hand you play is unique but there would be a general kind of way of thinking about it in the general kind of [inaudible 00:50:31] You know that's how I see it.

Gillian:  And going back to the fact that this kind of therapy is often criticized as not being evidence-based yet I would argue that the evidence is there in the behavior in the room, if one wants to actually go to evidence.

Ellen:     So, it really is walking a wonderful line of... between that art and science that you mentioned Jacqui and taking into account all of the wonderful complexities of what it is to be human.

Jacqui:  That's right.

Ellen:     Thank you both so much for today. I haveve thoroughly enjoyed our conversation and I have learnt a lot. I hope that it has both encouraged our wonderful listeners to get hold of a copy of your book which does... is released in June of 2019 through Pan Macmillan so it will be available in all good book stores and online. I will link to the book and to some of the other resources that we've mentioned over the course of today's conversation in the show notes. But I really do appreciate your time, your input, your insights and I hope that everyone walks away from this feeling a little more well.

Gillian:  Thank you. Was lovely to meet you. Bye now.