Down and dirty

by Colm O’ Doherty

I don’t think I have ever heard the word in my 47 years of training and working in psychotherapy (having closed my practice in December, 2022). Nor do I remember ever reading the word in any of the many books and articles I have read during that time.

HUMILITY

The client
I have heard and used words like “sacred” or “special” or “privileged to be doing this work.” These words may carry a hint or a whiff of the H word, but there is a kind of glow to them about which “humility” knows nothing. In relationship to the work of psychotherapy I have clients to thank for introducing me, not just to this word, but to the disposition and felt experience of humility, firstly and primarily on their part, and out of that on my part.

So, what does this word, “humility” mean? The dictionary tells us that it means “meek” or “modest” (like “meek and humble of heart”). It can evoke the image, if not the memory, of knowing your place and keeping the head down, of not getting above your station. But a definition is not my starting point. I am choosing to write about the experience, and it is the experience in long-term psychotherapeutic work, with the therapeutic relationship having been well established. So rather than start with a definition, I hope we can come to an understanding of the meaning of the word humility in the context of the work of psychotherapy.

Psychotherapy can be understood as a seeking out of, or a journey towards, truth. The clients’ journey will almost inevitably have started long before the first meeting with the psychotherapist. The decision to make an initial appointment is a landmark moment in such a journey.The acknowledgement of needing help and a realisation of not being able to make it alone is a vital and courageous step towards facing their disturbing truth. There are usually many twists and turns along the way during the course of the therapy, with each challenge revealing yet another bloody mountain to be scaled or valley to be crawled down into, each more exhausting than the previous one. Sometimes the clients will make this journey while sitting on their chair, as they struggle emotionally, and often physically, towards another layer of feared truth. At times this struggle may bring them to their knees; they may drop onto the ground (in Latin: humus), down and dirty, as they wrestle with the excruciating pain of revealing to themselves a truth that they know that they have never known, andhavenever wanted to know. This is not just about remembering, about the mind going back to some half-forgotten memory of awfulness. This can be a physical, visceral, body-mind-soul breakthrough into the deepest dark recesses of their being, as they try to bare and bear the “unbareable” and unbearable, because it is (delete truth) their truth. These clients, whether on a chair or on the floor, have chosen to do this in front of another human being because somehow or other they know that this has to be witnessed. This may happen within a single session or may well take a number of sessions over a period of time. Whatever was unknown has to become known, whatever was secret has to be seen, whatever was unbearable has to be borne, has to be survived. To go to such a place in themselves can be excruciating, and to do so in the presence of this other, this witness, brings with it even further risk and cost for the clients: the possibility of unspeakable shame, of it being just far too much, of not wanting to be seen or met, of utter and devastating aloneness.

To choose to engage in a journey of such cost and risk requires that the clients put truth before any other value. It entails loss of dignity, forever tussling with the fear of being judged and rejected, being seen in utter physical and emotional vulnerability, no matter how disgusting this may appear to them or to the other, doubting the wisdom and worth of having started out on this journey, and the terror of getting lost in hopelessness and despair. To enter into and open themselves up to such a process, to get down and dirty in letting go and dropping onto the ground,as they dare approach these darkest of places in themselves, in both memory and experience, is humility embodied, incarnated, and lived, not just defined. It is a humility that is able to face and fight the awful terror of utter humiliation. And I think that it is only humility that can fuel the courage that is called upon as the client continues to meet all that could obstruct or divert that journey towards truth as it becomes the truth for the first time.

The psychotherapist
But let me not finish here. This humility on the part of the client can engender and require a humility in the psychotherapist. As I have noted at the beginning, “the privilege of doing this work” has a whiff of humility about it, but the humility I have been referring to does not deal in whiffs!

What about the truth of the psychotherapist in meeting, and in responding to, the truth of the clients? Clients will go to places that they may not want to go to, and that I, as their psychotherapist, may also not want them to go. It may be too frightening; there is the danger and fear of retraumatising, or the clients’ pain may be too much for me to witness or bear.What may such pain “bare” in me? The quality of holding that this work can call on may require courage on my part, courage to allow myself to be brought into territory without any clear, or even unclear, path or track. Dare I allow myself to become lost and unknowing, or grope into despair toward finding a way through? Can I let myself not know, and maybe even risk saying: “I do not know; I do not know what to say; I do not know what to do” – and do this, not as an admission of hopelessness but in a spirit of truth, believing that the way ahead is not simply up to me, that waiting with the client in unknowing, and trusting the truth of being lost, can help firm up the ground between us. This has nothing to do with pretending or letting on, nor is it any sort of clever tactic. Rather this entails a letting go that springs from a deep trust in the creative and courageous nature of the therapeutic journey already travelled with the client, and draws on a courage that is founded on humility on the part of the psychotherapist.

Wider perspective
Up to this point I have been looking at the disposition of humility in the context of the dynamic between client and psychotherapist. Before finishing I wish to refer briefly to two aspects of the disposition of humility not specifically engendered within the immediate psychotherapeutic relationship, but that may well inform that experience.

Firstly, there is my place within the wider community in which the clients are living, being one person among many who may be in regular contact with them. I do bring to my work whatever skills and understanding I have been taught and have learned over the years from trainers, trainees and clients; I bring my desire and commitment to being caring, attentive and loving towards my clients. And I also bring an awareness that there have been, and often continues to be, many more people devoted to their well-being – people who have been keeping them company, possibly over many years, through times and troubles about which I may never get to hear. So, while not an insignificant one, I am, nevertheless,one. I do have my place and it is alongside others with their caring, love and support, offering my contribution together with theirs.

And secondly, there may yet be a wider context. Depending on the personal belief system and spirituality of the psychotherapist, there may be an entrusting of my work to a holding of a different and greater order. Many spiritual traditions refer to some nature of an overarching caring presence – a World Spirit or Anima Mundi, a Life Force or Energy, a Providence or God. Such apresence can be thought of in terms of offering a holding to all that happens, not just within the human context but in all of the universe. So, the holding that is offered by the psychotherapist can be considered as participating in a way in this all-embracing holding, making present a tiny moment of this dynamic. And moreover, the holding that can at times test the courage and ability of the psychotherapist, can itself be thought of as being held within an all-enfolding supportive holding by this greater presence. This in no way can be allowed to compromise the obligation on the psychotherapist to work to the highest professional standards, and to take responsibility for the quality of holding offered to the client. But to see theholding work of the psychotherapist within this greater horizon, to entrust it to such a presence, and to trust that it actually belongs within such a perspective, can be a most humbling experience.

Colm O’Doherty started his training in 1974, he began his full-time psychotherapy practice as Director of Dundalk Counselling Centre in 1992, and moved to the Creative Counselling Centre, Dun Laoghaire, (later to become The Institute of Creative Counselling and Psychotherapy), 1996 to 2011. He worked in private practice in Ballina, Co. Tipperary since then, until retiring in 2021.

IAHIP 2023 - INSIDE OUT 99 - Spring 2023