S
Safety. Secure Base, Self-Harm, Sex
Safety
“Being able to feel safe with other people is probably the single most important aspect of mental health: safe connections are fundamental to meaning and satisfying lives.”
Bessel Van Der Kolk (The Body Keeps the Score, p92) is right.
If ‘Feeling Safe’ is not the first priority of therapy then it doesn’t much matter what number two is. But safety is subjective.
For some people ‘safety’ in therapy means a feeling that they can say anything without being dismissed or rejected. For others safety means the absence of an obligation to protect the therapist from their feelings. For some, safety is purely physical: they can sit in a room with someone without fearing attack or abuse.
In practice, though, safety is a fluid thing. Some subjects feel safe, some don’t. Some days feel safe, some less so. And if therapy feels too safe it can discourage the pursuit of the tougher terrain. A mixture is necessary: you feel safe enough to explore what you need, but not so safe as to feel the kind of comfort you might feel with your best friend, for instance.
As a tutor in my training would often say, we want “one foot in the river, the other on the shore”.
Secure Base
One sunny day, on a lawn surrounded by woodlands, two families are having picnics some distance away from each other. Sammie, 5, has finished his snacks and wants to explore. By complete coincidence, Sadie, sitting with her family some way away, has the same idea.
Sammie goes wandering in the woods, playing hide and seek with himself, even on one occasion going and chatting to other families on the lawn. Sadie, though, contents herself with only the immediate lawn to entertain herself.
This is the essence of John Bowlby’s famous conception of The Secure Base (1988). Sammie has a secure base. Sadie doesn’t.
A secure base means an island of return which we know is consistent, predictable and safe whenever we need it. If we have it, we can explore the world in the knowledge we can always return to base. If this island is not secure, though – if we feel it has a chance of floating away or vanishing altogether – then it needs us to keep our eye on it so that if we see it beginning to float we can run straight back to it.
Sammie knows his parents won’t leave the picnic blanket until he comes back. Even if one of them comes out to play with him, one will remain behind. So he can explore all he likes, because he knows he can find his way back. Sadie doesn’t have that experience: she fears her parents may decide to move into the shade while she’s gone, which might panic her as she may think they’ve left the park without her. So she needs to keep an eye on them.
A therapist needs to provide a secure base: one that says “wherever you go with this exploration, or however you react, I’ll still be here”. That’s why having a consistent time each week rather than improvising or chopping and changing is generally preferable, particularly for clients like Sadie.
But sometimes therapists, like parents, have spasms of unreliability. They’re late for a session, say, or maybe forget altogether, or they become ill and need some time off at no notice. How the client responds to these rare but inevitable human frailties is very instructive.
Self-Harm
Self-harm usually means cutting. Alcoholism, substance abuse and eating disorders would also count as self-harm to many people but in therapy contexts self-harm most often mean cutting. For many, self-harm feels like the worst life can be for someone; training therapists fear the moment when their first client tells them they are doing it.
But it depends. As with many of the subjects in this glossary, the key two questions are: what’s the meaning, and what does it emotionally feel like to do it?
Self-harm can be about punishment: “I feel so useless I deserve pain to make me think better and work harder”.
Self-harm can be about release: “I feel so much pain inside me but thank God I can now feel it physically and be able to point to it and say ‘there it is’”.
Self-harm can feel life-saving: “I sometimes feel I want to die so when I’m harming myself I know I can carry on living.”
Self-harm can be about communicating: “I am frightened all the time but I can’t tell anyone; if they glimpse the marks someone might see and try to help me”.
Self-harm is not something for a therapist to be frightened of, however disturbing it can sometimes be to listen to. It is something to be respected, understood and worked through.
Sex
Oscar Wilde said that everything is about sex apart from sex which is about power.
Sex or, more specifically, our relationship with sex is one of the core topics which can reveal fundamental truths about who we are and what we feel. This applies whether we have lots of sex or none, whether we’re vanilla or kinky, married or single, exploratory or cautious. More often than not, if one considers ones attitude to sex (we always find it doesn’t match the expectation, let’s say) we’ll notice a parallel attitude when it comes to food, or money, or some other important element of our lives.
The capacity to talk about sex with ones therapist frequently parallels ones relationship to the topic itself: it feels like an act of intimacy that can only be broached after a long and gentle period of trust, or something to get to immediately but then burns out almost as soon.
So when you talk about sex to your therapist, notice how you went about it and how it felt. That may tell you as much as the content itself. Like sex, therapy is often a bit about the act, but a lot more about the relationship from which it springs.
Next Week: S (Part 2)
‘Splitting’, Stress, Suicidality / Suicidal Ideation, Swearing