Facilitated Intense Catharsis
Appassionato e tempestoso
FACILITATED INTENSE CATHARSIS IS NOT SAFE UNLESS
ALL THE DESCRIBED PREREQUISITES ARE IN PLACE
The extreme
form of externalisation discussed under this heading may only be of interest to a few readers.
The parts which relate to the organisation of facilitated intense catharsis in a group setting
may be of interest to even fewer readers. That being the case, I expect many readers will ask,
why have I included it at all?
Firstly, because
it represents the most comprehensive approach to externalisation, I felt that the book would be
incomplete without it. Secondly, it provides an opportunity to consider safety aspects in relation
to intense catharsis, which can then be applied to any given level of intensity, simply by reducing
their stringency where appropriate. And thirdly, I am quite certain that facilitated intense catharsis
can be a very valuable part of the overall approach to severe emotional distress, if all the conditions
described are fulfilled.
I said under the
previous heading that the first step in damping down the expression of feelings is withholding
or withdrawing any encouragement to let them out. The present heading discusses the deliberate
encouragement of intense catharsis – the very opposite of what has just been discussed.
Importantly, although the descriptions given will often refer to a group environment – which
has certain advantages – the process can also be used as part of individual counselling
work.
I will refer to
those who attend an activity, and receive encouragement to express feelings as intensely as necessary,
as participants; and to those who provide the encouragement as facilitators. The activity itself, as you know, is called facilitated
intense catharsis. None of the ideas presented here are new, of course, but I think they are
well worth revisiting.
I will have quite
a lot to say about facilitated intense catharsis in the following pages. But the first thing I
want to say about it is that it is not necessary unless gentler methods fail. And
the second thing I want to say about it is that it is not safe unless you make it safe.
I do not say these things to disparage it, rather to put it in its place.
And that place,
in my opinion, is a very important one. Because, when gentler and quieter ways of externalising
emotions fail, this way usually succeeds. And when all the prerequisites discussed below are met,
it is at least as safe as crossing the road – and probably safer.
However, although
simple in principle, making it safe requires significant time and effort. At least as much of
each, in fact, as an amateur theatrical production would require. I have written a basic script,
which I have called Prerequisites (below). It isn't a particularly exciting name for a production,
I admit. It could probably do with some embellishment in other ways, too. But at least the Creative
Commons copyright is flexible – and free.
Even when it is
found to be necessary, and made to be safe, it is still very hard work – and it doesn't
suit everybody who might potentially benefit from it. But for those who choose to do this work,
the benefits can be correspondingly considerable.
To make facilitated
intense catharsis available in a group setting, a number of people must work together, in a determined
and organised way. This may sound tedious, but a complex undertaking always involves a fair amount
of unexciting, but necessary, work behind the scenes.
True, there are
quite a few organisations that already provide opportunities for emotional catharsis. But they
usually offer it as part of a broader type of therapy – or sometimes a religious activity.
This introduces a degree of complexity, and sometimes a belief system, which may be counterproductive,
or even downright dangerous, depending on many variables.
Of course, there
is nothing new about intense catharsis. For example, the classical Greek tragedies were written
and performed for the express purpose of encouraging emotional catharsis. And in modern times,
many therapists have encouraged clients to make as much noise as they like, and also to hit something
while they are screaming, swearing and putting violent ideas into words.
Kübler-Ross, in her residential workshops, used to provide a thick rubber
hose, and a supply of telephone books, to facilitate the physical expression of angry feelings
like rage or hatred. While assisting at one of those workshops, I saw a frail, gentle, elderly
lady reduce a large phone book to confetti with a rubber hose, after getting in touch with some
very deep-seated anger.
At other times,
her physical activity was really quite limited. After the session, she felt very much relieved.
She had sore muscles later, of course. I don't know where her strength came from, and neither
did she. That and countless other examples of powerful externalisation have convinced me that
considerable energy is associated with strong emotions.
But is it safe to meddle with such powerful feelings? My answer is, it is safe
if you make it safe – but not otherwise. This answer is based primarily on my own experience
with the process, both as participant and facilitator. During the year I spent training under
Kübler-Ross and her associates, I externalised unfinished business of my own, or facilitated externalisation
by others, for roughly five hundred hours.
During that year,
hundreds of other participants also took part in facilitated intense catharsis. In all that time,
only one significant physical injury came to my attention – and it was due to a fall during
psychodrama, not during intense externalisation. Also, no case of new precipitation or
significant exacerbation of mental or physical illness as a result of the process came to my attention
during that year. And this was a close community, with a very efficient grape vine.
We were taught
to make it safe, and we did. Much safer than playing football, certainly. Safety is not the only
important aspect of facilitated intense catharsis, of course – but it is the most important.
It must be integrated with every aspect of the process. For this reason, I am going to describe
the process entirely in terms of the prerequisites that make it safe.
Prerequisites
To make sure that
vigorous catharsis is both safe and effective for all concerned, various prerequisites must be
met. They also apply, though to a lesser extent, to the less vigorous forms of externalisation
previously described. Under Playing Safely, I mentioned the essential principles, saying that
externalisation must be done
in a safe
way, in a safe place, at an agreed time and with the permission and co-operation of everyone who
is directly or indirectly affected.
That statement is designed with brevity in mind, and does not attempt to
include details of practical procedures. To expand on it, and to discuss those procedures, I have
chosen five headings which are derived from it, but which use different words. The principles
themselves, however, are not changed at all. Here are the five headings:
·
Administration
·
Participants
·
Facilitators
·
Methods & Equipment
·
Time and Place
Administration
I will say very
little about administration here. It pops in and out of the picture under all the other headings,
doing what is necessary, always available, but never in the way – which is, by the way,
exactly my idea of good administration. Incidentally, in the text, I often refer to the administration
as "the organisers", and to what they organise as "the activity".
Among its many
responsibilities, the administration has to find the venue, arrange public liability insurance,
negotiate agreements with participants, employees and volunteers, and deal with all the financial
aspects. I will not go into the details of these matters, but they are all essential. So the administration,
which gets passing mentions in the text, has a very large and important task in reality.
Participants
The minimum number
of participants is one, but there is an advantage in having a larger number. The feelings expressed
by one person often trigger unfinished business in others. Kübler-Ross often used to work with
around a hundred participants, and four to six facilitators. Those workshops were very noisy –
in the Mozartian sense previously mentioned.
A formal registration
procedure for prospective participants is essential, to avoid missing one or more of the necessary
steps. The main issues which must be addressed before any person participates in facilitated intense
catharsis are information, assessment and agreement. Each of these applies
to both participants and organisers, but not necessarily symmetrically.
Information
Prospective participants
need to be given information about the activity, so that they will know what to expect
and (equally important) what will be expected of them. This allows them to make informed choices.
The necessary information could be provided by word of mouth, holding
a meeting, or providing a brochure – but preferably all three.
It is particularly
important that each participant understands that the process is both physically and emotionally
tiring, and that emotions will come to the surface which may well cause increased distress until
they have been worked through. The participant must be willing to accept these aspects of the
work. Otherwise, it should not be attempted.
Next, the participants
need to provide certain information about themselves to the organisers, so that they can
be assessed for suitability. This is necessary for the safety of the individual participant, and
sometimes also for the safety of others who will be present. It could be collected by questionnaire,
interview, medical report or a combination of these.
The design of
questionnaires and medical report forms would be a matter for the organisers, but examples might
be sourced from health care providers. Ideally, the screening process should be managed by a mental
health care professional. Where this is not possible, a medical report on all participants would
be advisable.
Conditions relevant to the assessment process include both physical and
mental illnesses. Activities like those described below under Methods and Equipment are physically
very demanding. The powerful emotions driving the activity ensure that it will usually be both
vigorous and prolonged. The degree of effort involved may not be noticed in the heat of the moment
– but its results will probably be felt later.
In the case of
healthy participants, muscular discomfort is all that is likely to occur as a result of such activities.
In some cases, other soft tissues might also become inflamed. However, people affected by any
significant illness should always consult their doctor in advance, and provide a medical report
to the organisers. There are some conditions which make vigorous exercise potentially life threatening.
The commonest
condition requiring caution is probably ischaemic heart disease (often loosely called angina)
in which the blood supply to the heart muscle is restricted. In combination with extreme exertion,
this can precipitate a dangerous arrhythmia (fast or irregular heartbeat). A person with known
ischaemic heart disease should already have a cardiologist, who can advise about the activities
which may safely be undertaken. Any other person who is not accustomed to regular vigorous exercise
should be advised to have a medical checkup and report before participating.
It is not only
physical illness that can be worsened by facilitated intense catharsis. Anyone prone to manic
or hypomanic mood states runs some risk of precipitating an episode by engaging
in extreme forms of catharsis. This risk is very much lower if the illness is well controlled
at the time.
Even then, careful
observation is necessary. That is simply because the release of distressing emotions sometimes
causes a natural mood elevation in the aftermath of the session, which may be enough, in some
cases, to trigger an acute manic or hypomanic episode. This might be delayed in some cases.
Any severe depressive
disorder would likewise preclude this work until the condition is stabilised, as a natural lowering
of mood may occur when painful feelings have been brought into consciousness but have not yet
been resolved. This might trigger a severe depressive episode in some cases.
There are also
potential risks associated with psychoses and personality disorders, which are difficult to predict.
The advice of the person's doctor and/or psychiatrist would be essential in all such cases. In
many cases, increased risk of adverse effects and decreased likelihood of benefit would indicate
exclusion.
There may be occasions
when significant medical or psychiatric history is known but not disclosed – or perhaps
has been forgotten. A participant's unsuitability might then not be discovered until after the
activity had commenced. This could necessitate urgent medical or psychiatric review. Depending
on the severity of the condition, the participant might then need to withdraw from the activity.
Assessment
There is only
a very little to say about assessment, but it is very important. On the basis of the information
available to them, as mentioned above, participants assess the activity and decide whether to
proceed with an application. And on the basis of the information provided by them, the participants
are assessed by the organisers, who decide whether to accept their applications. Both sides of
this assessment process are absolutely essential.
Agreement
Prospective participants
who are assessed as suitable then have a very important choice to consider. If they are to proceed,
they must make a commitment to co-operate with the facilitators, and especially to accept safety directions from them. This cannot be negotiated – it is an absolute
requirement. There are other matters requiring agreement between participants and organisers,
which I will discuss fairly soon, but none is as important as this one.
The agreement
of each prospective participant to comply with safety directions is usually adhered to. If it
were not, the participant would have to be asked to leave. But co-operative participants are overwhelmingly
the norm – and they themselves create an atmosphere in which troublesome tendencies simply
do not flourish. Indeed, the participants are usually just as determined to prevent problems as
the facilitators themselves are.
Although that is the most important agreement,
it is not the only one that is necessary. Here is a list of suggested agreements for prospective
participants to enter into, including the one already mentioned:
· to accept safety directions from facilitators (this is the most important agreement)
· to attend in a satisfactory state of health, and free of the influence of any non-prescribed
drugs or alcohol
· to report any changes in the previously disclosed medical or psychiatric conditions to a facilitator
· to maintain complete confidentiality about anything which is overheard (it should not even be discussed with the owner of the information,
unless raised by them)
· to behave non-judgmentally as regards disclosures made by other participants, even if unable
to refrain from judgmental thoughts about them
· to
use the same (allocated and identified) rubber hose at all times, so that it cannot pose a cross
infection risk
· to
report any contamination of the environment by blood or other potential hazards to a facilitator
immediately
In addition to a list of agreements such as
the one given above, a formal consent procedure must be followed. It is true that the participants
imply their willingness to be involved, by attending the activity. However, informed, explicit,
written consent is also necessary, and must form part of the registration process. The exact procedure
varies with time and place, so it will need to be researched during the preparations. It is essential
that the consent procedure complies with local regulations, otherwise it will be ineffectual.
All the requirements mentioned above, along
with any others added by the organisers (or their legal advisers) need to be explained to each
participant, and must be properly understood before they are accepted. The participant's agreement
should then be given in writing as well as verbally. This may all seem rather officious, but quite
apart from its legal necessity, it is really the only way of being sure that the essentials are
understood by all concerned.
There is still one aspect of agreement that
I have not discussed under the present heading, and that is permission. Unless the participants
are convinced that they have the permission of the facilitators to express their feelings, and
also give themselves permission to do so, little progress will be made. This will have
been explained in the information given to participants as part of the registration process. The
reminder "give yourself permission" is also popular with facilitators during the activity.
Facilitators
As with participants,
the minimum number of facilitators is one. However, the number of participants actively encouraged
to externalise at one time should not exceed the number of facilitators present. Of course,
the number externalising intensely without active encouragement may sometimes exceed the
number of facilitators. That cannot be helped.
When more than
one facilitator is present, it is necessary that one of them acts as the director of the session.
Occasionally, a procedural decision will be necessary during the activity, and it is not practicable
to hold a meeting and take a vote at such a time. The director should be an experienced facilitator
who is trusted by the other facilitators present.
The director and
the other facilitators must obviously be chosen by the organisers, who will presumably be influenced
by qualities such as those suggested below. All facilitators must agree
to accept the leadership of the director, and specifically to cease acting as a facilitator if
the director considers this to be necessary.
They must also be in satisfactory mental and
physical health, agree to disclose relevant medical or psychiatric conditions, maintain complete
confidentiality and attend the activity free of the influence of non-prescribed drugs or alcohol.
If any participants are minors, a police check will be required in many jurisdictions. In some
jurisdictions, this may be required regardless of the age of the participants.
The facilitator's role should be formalised
by a written agreement. This may be more complex if they are paid employees, as local employment
regulations will have to be complied with. However, volunteers also need to negotiate a clear
agreement with those organising the activity, and local regulations may be relevant to this agreement
also.
I mentioned earlier
that the facilitators provide more than just encouragement. They bring considerable personal resources
to a dedicated helping role, which includes encouraging, guiding and educating the participants,
and especially, keeping them safe while they do their work. The facilitators are thus critical
to both the safety and efficacy of the venture.
Not everyone is
suitable for this role. Tertiary qualifications in some aspect of health care are certainly no
guarantee of suitability. Some facilitators might come from a mental health background, but many
will not. It is an essentially practical task, and the best preparation for it is experience –
experience of life, experience as a participant, and supervised experience as a facilitator.
However, together
with such preparation, certain qualities are very important in a facilitator. I will describe
the main qualities that I see as necessary for the role under six headings – personality,
attitudes, knowledge, skills, experience and focus. Of course, some qualities might
have an entry under more than one heading – and others might not fit very neatly under any.
Personality
In general terms,
personality refers to a person's individual way of being, acting, reacting and relating. It excludes
the universal characteristics of Homo sapiens, and it also excludes most innate and acquired qualities
of a physical or intellectual nature (though it may be influenced by them). Consequently, it is
primarily the result of emotional and social attributes.
Because personality
is such a broad quality, it can often influence, or be influenced by, other qualities –
especially attitudes. In fact, a good case could be made for including attitudes within personality.
Also because personality is such a broad quality, the few comments I am going to make about it
will be dwarfed by the magnitude of their subject. However, I hope this will not render them completely
invisible.
One aspect of
personality which is very important to the role of facilitator is a deep seated and sincere urge
to help. This is related to the qualities of sympathy, empathy and compassion, which were
excluded from membership of the propathy club, earlier in the book – but are not expected
to receive quite such short shrift in my Philosophical Musings.
Another very important
quality is the ability to remain calm (and not just superficially) while all hell breaks
loose. It is necessary for a facilitator to maintain a congruent equanimity in the face of rage, terror, despair etc. Not to do so
would tend to contradict the first premise of the activity – that the sharing of any
feeling is not only acceptable in every way, but is in fact strongly encouraged as an essential
part of the process.
In other words,
just as the participants must give themselves permission to share feelings, the facilitators must
give the participants permission to share feelings. And this permission will be interpreted as
specious, if any communication from a facilitator, whether verbal or non-verbal, suggests that
anything about the sharing of feelings is not OK.
Congruent equanimity
is not really feasible if the emotions being expressed cause great distress to the facilitator.
Consequently, most people need to have done a lot of work on their own pool of pain before they
are capable of acting in this role. Perhaps there are exceptions, but for practical purposes I
think this quality should at least be tested by working as a participant – which will also
help to develop it further.
I would like to
include a non-judgmental attitude here, as an essential aspect of the personality of a
facilitator – but I accept that, logically, it belongs under the next heading. However,
the ability to actually be non-judgmental – and therefore to show it congruently – probably
does have a foot in the personality camp. So I am going to put it under both headings. If that
is an honour, it deserves it. It is probably the most important of all the essential qualities
that a facilitator needs.
Attitudes
As promised, here
is the repetition. The only essential attitude for a facilitator to possess is the non-judgmental
attitude mentioned above. Importantly, as I hinted there, it must be more than skin deep. And
it will be very clear, from a facilitator's non-verbal output during a session, just how deep,
or shallow, this attitude is.
If you do not
have a non-judgmental attitude, the best way to grow one is to externalise as much as possible
of your own pool of pain, and evaluate that process as you go along. It is mainly guilt, shame
and beliefs, largely laid down during childhood, which keep judgmental attitudes alive. You will
like being free of them – and so will everyone you know.
There are other
attitudes which are helpful, though not essential. Like all attitudes, they will shine like a
beacon, via non-verbal signals, to anyone who is working with their feelings. These other attitudes
include:
· the
attitude that the activity itself is worth doing
· the
attitude that the participant really can discover – and release – the contents of
their pool of pain
· the
attitude that there is no such thing as a feeling which is too bad to share – or too painful
to let go of
· the
attitude that life keeps getting better and better as the painful emotions are left behind
· the
attitude that goodness exists within all people – and can find its way to the surface if
given the chance
I am sure you
can think of plenty of others. But the only absolutely essential attitude is the non-judgmental
one.
Knowledge
Knowledge is,
in many ways, the least important heading. This is not rocket science, after all. It is far more
important – to survival as well as happiness – than rocket science, but it is not
a knowledge-intensive discipline. A basic understanding of emotions is the main knowledge that
is needed. This might have been gained during childhood, or later in life. Some of it may come
from study, but its application is mainly practical.
Obviously, it
is also essential to be well versed in the methods of externalisation to be used, and especially
how to keep participants safe while using them. This will be discussed under Methods and Equipment.
At least one of the facilitators should also be trained in first aid (which of course includes
skills as well as knowledge) even though accident or illness during the activity is uncommon,
and almost always minor. A first aid kit, and a telephone, should also be available.
When assessing
participants for suitability, someone with knowledge of clinical psychology or psychiatry should
ideally be involved. This person need not be a facilitator, though. If such a person is not available,
a medical report on each participant provides a partial solution.
Skills
I mentioned the
methods of externalisation under Knowledge, but those methods also include a small but important
element of skill. However, the main skills that a facilitator needs are communication skills. These, as previously mentioned, are outside the scope of this
book, but I will mention two aspects of communication here. The first is
an ability to provide necessary input with minimal interruption. For example, a single word or
a slight gesture can easily encourage continued expression, or point out that something is missing.
On the other hand, a whole sentence tends to wake up the participant's intellect – which
will be very useful for the next E, but is more often a liability during this one.
The second particularly
important communication skill is the ability to make routine use of all input and output channels
simultaneously – with the outputs all being congruent. This is a tall order. Indeed, it
is impossible to achieve by artifice alone; and it is especially likely to fail when something
less than the whole truth is being communicated.
In that situation
– which is not uncommon when working with vulnerable clients – a number of factors
influence the result. Careful attention to the nuts and bolts of the communication process, as
a routine and effortless habit, is just the beginning. Some familiarity with one's own pool of
pain is also essential.
Adding the regular
practice of non-judgmental self-awareness, as previously discussed, should gradually result in
a modicum of self knowledge. That in turn makes it possible for something less than the whole,
mercilessly unvarnished truth to be communicated without causing conflict in the mind of the communicator.
And that in turn makes it reasonably likely that the communication will be made congruently
via all channels.
Some may question
the need to communicate less than the whole truth. After all, brutally unfiltered honesty will
usually result in congruent communication, without requiring any special skills. But it is better
for the participant to choose the rate at which the truth is explored, rather than suddenly being
interred beneath an uninvited mountain of it. And to avoid that, it is sometimes necessary to
save part of the truth for later.
Experience
The most important
specific experience needed is previous and recurrent experience as a participant
in facilitated intense catharsis. This has also been mentioned under other headings. It is simply
essential to have experience of the method, if you intend to facilitate the process yourself.
In this context, one practice is worth a thousand words. After that, experience working as a facilitator,
initially under supervision, will provide further learning opportunities for as long as it is
done.
There is not very
much that can be said about the general aspects of experience, except that they are very important
here – as they are in any field of endeavour. Life comes with experience as a non-optional
extra, but I think some sorts are particularly applicable to work as a facilitator.
Working in fields
such as (but not limited to) mental health care, dementia care, hospice care, or education is
likely to be very useful. So is living in a refugee camp or a prison, going through a divorce,
suffering a bereavement or losing a job or business. In other words, any experience involving
the emotions can be useful background training for a facilitator.
Focus
A facilitator
must give undivided attention to the participant working on feelings. Also, the majority of facilitators
must remain in role until the last participant has left. Assuming a willingness to do the job,
the only threat to this focus is the facilitator's own unfinished business.
Triggering of
a facilitator's own unfinished business is not an infrequent occurrence, because the work being
done by the participants subjects everyone in the room to a wide range of powerful stimuli. However,
whatever is triggered cannot always be dealt with immediately.
Depending on its
nature, an emerging issue might be dealt with by deferring it to a later occasion, working on
it briefly with another facilitator, continuing the activity as a participant or withdrawing from
part or all of the remaining duration of the activity. This would be determined by the director.
Externalisation by a facilitator during the activity must always be managed, because working as
a facilitator requires a clear and steady focus on the participant. Like a medical or surgical
procedure, it cannot simply be interrupted at random.
The above possibilities
should cause little or no disruption as long as all the facilitators have previously done considerable
personal growth work – and continue to do this work as and when necessary. Without that
essential preparation, most people would find the role of facilitator too painful, fulfil it very
badly, or (most likely) both.
This topic is continued on the next page (EEEEs
4)
FACILITATED INTENSE CATHARSIS IS
NOT SAFE UNLESS
ALL THE DESCRIBED PREREQUISITES ARE IN PLACE
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