Pieces of Eight: Stories of Encounter and Tele

By Lorraine Michael

‘Pieces of Eight: Stories of Encounter and Tele’ by Lorraine Michael, is a collection of tales of allure and intrigue from the author’s work in psychotherapy within acute psychiatry. The phrase, ‘Pieces of Eight’, used to refer to the most famous of all forms of pirate coins of treasure is chosen to depict the treasure trove of people, lives and stories – rich, precious, sacred and exquisite! Written in a dramatic, literary story-telling manner, the author demonstrates in living colour the premise of the ‘I-I’ mutual relationship and brings alive and to life the human being who is in the forefront of the work together. In this, she invites us all to examine how we relate to our own existence as well as the existence of others and how we honour, celebrate and restore humanity in each other.

• Language: English
• Publisher: Lorraine Michael
• Release date: Nov 15, 2013
• ISBN: 9781311251534

Lorraine Michael

Lorraine Michael is a passionate therapist and loves her work with people – both individuals and groups across all ages of the lifespan. Her love of the written word sees her writing stories from her travels across the globe. She has a deep affinity with all things Finnish & Polish. She also loves Woody Allen & French movies & loves to laugh with gusto!

Book preview

Foreword

I always cringe a bit when people describe others as ‘brave’ for doing something, but I find no more apposite adjective to describe Lorraine Michael for having produced this book. She has felt confident enough about herself and her therapy to express herself in a way that reveals the rawness of the emotions that therapeutic encounters in mental health can produce in the clinician. Joy, anger, sadness, longing, regret: Lorraine has experienced all these emotions and more, and has chosen to share these with us. In doing so she enlightens us not just about psychodrama and the way it actually works in clinical practice, but also about what it means for both the patient and the clinician.

Elements of this book will be confronting for the reader. But the way in which the stories are told bring a human-ness which will enrich the reader and help them understand more about the joys and angst of clinical psychiatry.

Professor David Castle:

Chair of Psychiatry, University of Melbourne; Consultant Psychiatrist, St. Vincent’s Mental Health Service, Melbourne.

Foreword

Psychiatric inpatient units in the state of Victoria are unusual places in which to find a psychodramatist at work. Yet this form of psychotherapy can offer much when appropriately employed within an inpatient setting, as demonstrated by the work outlined in this book.

‘Pieces of Eight’ offers eight vignettes of the author’s work with individual patients in the inpatient unit of St. Vincent’s Mental Health Service (SVMHS). It began when senior consultant psychiatrists, impressed by the author’s comments at case presentations and discussions, invited her to develop psychodramatic formulations about certain patients to be presented to the treating team. These formulations offered insights, often deeply compelling insights, into the patients as individuals in their own particular worlds. These insights were gained not only by paying close attention to the role or roles the patient might be exhibiting at that point in time - via their manner of interaction with individuals and in groups, their posture, language, gait, dress and etc. - but through the author’s capacity for empathy and an intuitive awareness of the vulnerabilities in the patient’s internal world.

The author’s formulations were of particular value in complex cases where uncertainties existed within the treatment team about what had led to a particular patient’s presentation, especially when this involved factors not easily understood in the pressured setting of a psychiatric inpatient unit.

The author has presented her work at scientific meetings at SVMHS, and at conferences both within Australia and overseas, where her papers were particularly well received.

It is clear to me after ten years of supervising some of the author’s work at SVMHS that she has the capacity to engage with patients at a deep level. Her work has often enabled patients in the safety of one-to-one encounters, to connect with deep, frequently painful emotions, which they may never before have faced, let alone expressed. This can bring relief, even liberation, in cases where there has been fear that expressing these emotions will lead to rejection (a common fear) or loss of control (an equally common fear). Importantly, staff members on inpatient units can also be afraid of the expression of strong emotions by the patient, fearing that such expression will exacerbate the patient’s psychopathology –an understandable anxiety in such a setting. This book demonstrates that exacerbation of psychopathology does not occur when emotional connection and expression occurs within a safe, containing and empathic therapeutic environment. Indeed, the patient may experience enormous relief, not only because of the emotional release, but because their feelings are now known and understood.

This brings me to the two chapters I want to single out for particular comment. Chapter 8 is outstanding for its depiction of psychodramatic intervention at its best. This patient was able - through the work- to reach an understanding of a deeply troubling symptom – a symptom which, in inexperienced hands, could have led to misdiagnosis and mistreatment. The author’s intuitive capacities are nowhere better shown.

I was initially troubled by chapter 7, ‘Sleeping Beauty.’ It was written immediately after the death of the young patient it depicts. The reader is presented with an outpouring of raw, intense grief, and love for the patient, undiluted, until the epilogue to the chapter, by professional distance or theoretical discussion. The author herself makes a point of noting in the epilogue that she had not been talking or thinking about her patient in the manner depicted before the death.

The chapter conveys an idealization of the patient, which, in my view, requires comment. Idealization involves a defensive manoeuvre of unconscious origin, aimed at defending against conscious awareness of feelings that are experienced as unacceptable, even unbearable. This defensive manoeuvre needs to be considered here not only in terms of the author’s shock and distress at her patient’s death, but also in terms of the interpersonal and systemic factors that operate in organizations. These tend to be particularly powerful in psychiatric settings after the death of a patient. Conjecture about what these dynamics might have been in this case is not appropriate here. What is appropriate is to acknowledge their presence, and suggest that this chapter invites reflection on how each of us might react in such a situation. It is a tribute to the author’s honesty that she has chosen to present this chapter in all its raw intensity.

It is well accepted that psychodramatic psychotherapy is fully compatible with cognitive behavioural therapy (CBT), which is also sometimes practised within inpatient units in Australia. A major advantage of psychodramatic work is that it offers patients the possibility of coming to know, communicate, and express, their feelings. Too often, as alluded to earlier, emotional expression is feared, even in situations where this expression could be most valuable. ‘Pieces of Eight’ may go some way, hopefully a long way, to alleviate such anxieties, allowing psychodramatic psychotherapy to assume its rightful place as a valuable modality of psychotherapeutic treatment within the field of psychiatry.

Dr. Josephine Beatson:

Senior Clinical Advisor Spectrum Personality Disorder Service for Victoria; Consultant Psychiatrist, St. Vincent’s Mental Health Service, Melbourne; Psychoanalytic Psychotherapist, VAPP; Hon. Senior Fellow, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne.

Foreword

It is a great pleasure to invite the reader to an encounter with the thoughts and experiences of a passionate and astute clinician. Lorraine Michael’s immediacy draws her clients to her and elicits a spontaneous response in both. Her ability to interview for role, finding out in a very short period of time the clients’ major concerns is admirable. ‘Pieces of Eight’ is a creative and noble endeavour, demonstrating what can be done when a therapist connects with their client, person to person, without anything in between. Lorraine connects in a very natural and humane fashion with very disturbed people, frightened, often psychotic and in immense pain, who have lost hope of being understood, people in despair. From the very first moment that she meets her client she is interested in them. This interest warms them up to her and to making a connection. Isolation is painful, we all need other people but equally, connecting is painful, especially when coming out of isolation. Having an ‘Other’ there, present, is vital. Lorraine demonstrates the value of companionship in her book. We see how people warm up and come to life, little by little through the relationship they co-create.

You could just read the stories in Part 2 of this book, however that would not do justice to you or the book because the reward is in the immersion of a journey from beginning to end; a journey which reveals the essence of psychodrama in a psychiatric setting. Part 1 really sets the scene for these stories to unfold.

Since the introduction of psychodrama into psychiatry when Dr J. L. Moreno began his own sanatorium in Beacon, New York in 1934, it continues to be used in this field internationally. It takes many years to become a fully accredited psychodrama practitioner. The training is rigorous because the method is powerful. As in surgery, it is important for the surgeon to have a sharp scalpel and the skill to use it. This is also true for the psychodramatist who must be incisive and spontaneous, a clear seer and active listener and must trust in the creative genius of their client.

The ability to encounter the other and enable the encounter was one of Dr Moreno’s prime endeavours. May this book be part of that endeavour.

Sue Daniel:

Director of Psychodrama Institute of Melbourne; International Trainer, Educator and Practitioner of Psychodrama; Consulting Psychologist; Individual and Group Psychotherapist in private practice, East Melbourne; Visiting Professor, Muroran Institute of Technology, Hokkaido, Japan.

Epigraph

I write so that I am not alone….by sharing what is in my Soul, I connect with people all over the world.

Paolo Coelho

Preface

The maxim,

‘who you are as a person and who you are as a therapist are inexorably intertwined’,

is why I am a psychodramatist. I was in my early twenties when I first heard the word ‘psychodrama’. At the time, I was an undergraduate student studying Occupational Therapy at The University of Sydney. Captivated by the mere mention of its name, I began a baptismal journey investigating, inquiring and searching on my own. It was through a book I had purchased about the method that I perchanced upon Invitation to an Encounter, a poem written by Jacob Levy Moreno in 1914, Founder of Psychodrama, Group