Tags
Book Review, CBT, John Marzillier, Psychological Therapies, Psychotherapy, The Gossamer Thread: My Life As A Psychotherapist
The Gossamer Thread and The Boundless Ocean
I thoroughly appreciated John Marzillier’s wonderful book on psychological therapy, as the reading of it caused deep reflection which led me into many fields. Not least of which is the whole relationship we have with the reflective activity of reading itself. Doors open, horizons widen, intense emotional experiences and thoughtful, reasoned self-questioning occurs; ideas become developed or discarded; change happens.
I most value those books, fiction or non-fiction, which take me into these areas.
Marzillier’s beautifully titled book explores his own development in the field of psychological therapy, and the development of particular therapeutic approaches, as much as it also explores his successful or less than successful experiences with clients, suitably anonymised, and often with stories changed, to also protect the confidential integrity of the client’s story, in case a former client reads and thinks ‘that is me!’
John Marzillier almost stumbled into clinical work by default, beginning to work using behavioural techniques – a very reductive, lab-rat approach (or so it seems to this reader) in the late 60s and early 70s. The model, it seems, was heavily based on physiology and learned behaviours, biased towards large scale statistical ‘objective’ scientific studies, and drew much of its methodology from observed animal behaviour. However, Marzillier was beginning to feel uneasy, as ’something’ was missing in this approach, and almost by instinct he found himself, through a more dynamic engaged relationship with individual clients, drawn to exploring thought processes and even gaining curiosity about ‘back stories’
In fact, he was moving closer to embracing the role of the relationship between client and practitioner as integral to treatment. The ‘relational field’ approach though was still in the future for his work. This is a concept central within psychotherapeutic and psychoanalytical approaches, but was barely engaged with by the more ‘impartial’ scientific observational ideology of the behavioural approach.
He began to formally train in a then new discipline, cognitive therapy, examining the internal thought processes, the scripts and dialogues which run through our heads. Cognitive therapy of course, in tandem with the earlier behavioural approach, became mainstream as Cognitive Behavioural Therapy (CBT)
My sense, reading this book is that perhaps Marzillier was always as much an artist as a scientist, and therefore, by his own nature, more likely to find that any approach which has fairly set protocols, and a fairly rigid methodology might quickly begin to seem as if it were missing something. It seems to me that no one method or approach, in this field, is ever going to be successful with all people, at all times. What the left brain approach lacks is the imaginative gestalt, the whole-person poetry of the various strands of ‘relational’ right brain methods. Science versus art of psyche.
Marzillier ended up having a kind of revelation, listening to a lecture given by Dorothy Rowe, well-known for her work in the field of depression, about the centrality of core belief and how it can become entwined with one’s very identity. A belief may be useful or destructive, but even a self-destructive and painful core belief can provide the security of comfort – a reinforcements of the sense of self. To LOSE, for example, the certainly that life is meaningless or you yourself are worthless and bad things happen to you because you are worthless can be a frightening change too far – though a belief may or may not be a helpful one to an individual, – and may or may not be right, it is YOURS. We all struggle with complex responses to being WRONG
His process of progression from scientific certainty, where the steps are known, and the methods can be approached sequentially, so that the method, not the person employing the method ‘makes’ the cure, eventually led him to the uncharted, waters of the mysterious ‘unknown’ of other, and the personal, uncertain route of that more narrative, right brain approach. I had a sense of the psychodynamic psychotherapist (a further training in this followed) like a boat in the middle of an ocean, lacking a map, with destination unknown, steering by instinct, feeling, sense, gut reaction on a journey of trust with his client. This sort of work comes closer to the relationships we have with ‘the others that are not self’ as we move through life. There are forms and structures, rough maps and sketched instructions which guide us, but the relationship between self and any other is something like a dance, which though the steps may be known, veers off into something jazzy, freeform, improvisational. Things may go horribly wrong, and the dancers fall over, step on each others’ toes – but they may also get to a dazzling, inventive, dynamic place with their dance.
Later, his journey takes him into analysis, to experience the procedure from the other side. He is as thoughtful about himself as an analysand, as he is about his patients, teasing out his sense of the process, and his resistance
As Marzillian points out, there are difficulties in psychoanalysis being properly verified by the statistical tools – because it is not dealing in certainties, but in ambiguities – the subjectivity of the practitioner is always within the encounter. There is not a set protocol of method, session to session, with set aims and objectives. This is the very real challenge of that therapy. It seems to me that IF the practitioner is both skilful, and congruent , on some deep level, with the client, the work can be amazing, profound, transformational. It is about much more than the client being free of the ‘symptom’ which brought them into treatment, and about much more than the client being ‘made well’ by the method – or by the therapist using ‘the method’. Instead, there is the possibility of (like with any authentic human encounter), both participants stepping into ‘meaning’ An epiphany of sorts, if you will. The big problem of course, is that it always beset around by those IFS.
Like that other wonderful writer in this field – the humanistic, existentialist psychotherapist Irvin D Yalom, Marzillier is steeped with a sense of art, awareness of metaphor, the poetic. He often illustrates by using literary allusion – literature is indeed a potent source helping us to understand the depth and vitality of human experience.
Marzillier also writes not only with warmth, clarity and authenticity – but with a fine 
sense of the absurd humour that is to be found in even the most serious places.
What is also utterly compelling about this journey Marzillier takes the reader through, is that he is a man who accepts the confusions, the hesitations, the contradictions within any ‘method’ No wonder he embarked on so many trainings, with that recognition that any one party line is too reductive and fixed to capture human exchanges in all their complexity
Or, as he more cogently puts it
If I have learned anything from a lifetime career as a psychotherapist, it is that there is no universal truth, that everyone is different, and that you, the reader, should take what I or anyone else tells you about psychotherapy with a large pinch of salt
The Gossamer Thread Amazon UK
The Gossamer Thread Amazon USA
This sounds absolutely fascinating. I’m also reassured by the quote as to a lay person it seems that to help someone you need to understand so many different strands of events/behaviours/sense of self, etc. that the task is enormous!
I like the fact that he is so ‘un-guru-like’ and presents what he does/did as work in progress, being very respectful of his clients, and questioning rather than assuming some sort of unchallengeable knowledge about another person
Yes, yes, and yes! Very interesting.
And as my brother, the physician, told me once: “Patients tell me all the time about how various drugs or treatments are or are not working. Or what their unusual response is to a drug or treatment. The best I can say is, ‘OK,’ and use what they tell me going forward. I cannot tell them that they cannot be having that response or side effect, because it is their experience.” Enter the physician as artist.
With psychotherapy, more so than most other areas of medicine, it’s easier to see it as an art. Did he mention anything about changing the mind through meditation?
That’s not there – the book is a sort of autobiography of his life in the field and I guess he had probably stopped practising before meditation practice became examined and the practice of mindfulness started being seen as mainstream tools for better living outside their connection to a spiritual practice. In some ways cognitive therapy touched one aspect of what meditation does – that observation of what is arising to get a wider less reactive sense of oneself, except that CT of course is a very precisely honed in doing thing.