Deeply poignant, honest and inspiring, Winsome Thomas draws from stories of the people she has treated, most notably the author of Madness: A Memoir, Kate Richards. Heart Hungers will help you uncover the eight fundamental desires that must be met to lead a fulfilling and satisfied life. Read an extract below.
HAPPINESS IS AN ELUSIVE CONCEPT. I prefer the word ‘contentment’ as it conveys a notion of equanimity, peacefulness and acceptance combined with a quiet sense of joy.
I’m a psychologist. No client has come to me saying, ‘Please make me happy.’ Each, however, has come with a degree of distress of one sort or another whether manifesting as depression, anxiety, relationship issues or psychosis. Removal or alleviation of that distress is their desire. Ideally, each would progress to a level of contentment. Not all reach that state but major steps are taken when the deep longings of the heart are attended to. These fundamental desires are what I call the heart hungers.
The following chapters explore in more depth what I mean by ‘heart hungers’, how I’ve experienced them in my own life and describe the deep yearning some clients have brought to therapy. The mix of needs and desires is frequently complex and always unique. Through these stories you will gain insight into what the client seeks and what the therapist brings to the task to enable healing or restoration to occur.
The book’s genesis lies with my former client, Kate Richards.
Kate and I worked together over several years. Her therapy was punctuated from time to time by admission to hospital either after a suicide attempt or an act of severe self-harm. During her absences I would think that she had given up, because therapy can be confronting and challenging. Not everyone can stay the distance. Despite my misgivings Kate always returned, often with a massive new scar.
Over time Kate recovered and stabilised and her life took on a much greater semblance of normality. Throughout her therapy she wrote in the evenings and held down a regular job in medical research during the day. After leaving therapy, Kate wrote Madness: a Memoir, a recollection of her journey from the highs and lows of bipolar disorder to stable health.
She won awards for her book and has been interviewed in a range of public forums. In 2014 she appeared on the ABC television program Compass with other experts in the area of mental health. When the host Geraldine Doogue asked about her therapy, Kate replied that critical to her recovery was my holistic (body, mind and spirit) approach.
This work explains how that therapy, as a result of my training, core beliefs, values and life experience, came into being.
2. What are heart hungers?
As you ought not to attempt to cure the eyes without the head, or the head without the body, so neither ought you attempt to cure the body without the soul. - PLATO
EARLY IN MY CAREER as a psychologist couples came to me for counselling. In my search for information that would broaden and deepen my understanding of their problems I came across a small volume entitled The Intimate Marriage by Howard and Charlotte Clinebell. The Clinebells wrote in the seventies, an era when marriage, rather than partnership, was the prevailing form of committed relationship. They also wrote from a firmly Christian faith-based perspective.
In the book they listed eight basic heart hungers that, in their view, need to be met to a reasonable degree for a marriage to be satisfying. They are as follows:
1. security (from feelings of being accepted and belonging)
2. service (giving love to others, investing one’s life, meeting others’ needs)
3. esteem (feeling valued, recognised, affirmed by the other)
4. enjoyment (sexual, intellectual, recreational, aesthetic, spiritual)
5. love (knowing the other cares – deeply, warmly and dependably)
6. limits (the need for responsibility, dependable routines, respect for reality and rights of others)
7. freedom (the need for autonomy, space, respect for differences)
8. faith (the need for a philosophy of life, values and trust in God)
These propositions made me pause and reflect. Is it really the case that for a marriage or any de facto relationship to thrive, these yearnings need to be satisfied? Could it also be the case that these deep desires need to be met for individuals to feel contented and fulfilled, at least to a significant degree?
I came to the conclusion that these ‘heart hungers’ exist as the deepest needs not just for couples but for all. Absence or disturbance of one or more, especially over a long period of time, is likely to cause considerable distress. In due course I incorporated them into my repertoire of theory and have given them significant attention when dealing with clients. They have become a reference framework in my practice.
Encountering the work of Clinebell and Clinebell was not the first time I had considered which factors contribute to wellbeing. A number of people and theories had previously influenced me. Some I discovered in my undergraduate training and others later. The most significant were Maslow, Yalom and Seligman, each of whom holds an important place in the history of psychology. Their work, together with the Clinebells’ propositions, underpins and informs and frames all the heart hungers and my practice.
In 1943 Maslow in his seminal paper, ‘A Theory of Human Motivation’, proposed that humans are driven by a hierarchy of needs. Those needs, he argued, ascend from the most basic to the most sophisticated; namely,
- physiological needs: breathing, food, clothing, sleep
- safety and security: health, employment, property, family and social stability
- love and belonging: friendship, family, intimacy, sense of connection
- self-esteem: confidence, achievement, respect of others, the need to be a unique individual
- self-actualisation: morality, creativity, spontaneity, acceptance, experience of purpose, meaning and inner potential
There is an overlap between Maslow’s list of needs and the Clinebell heart hungers. And there are many other ways of classifying or analysing the factors that motivate and satisfy.
Irvin Yalom, the celebrated American psychiatrist, two decades after Maslow, provided an arresting alternative framework: an existential approach. He proposed that clients fundamentally grapple with the givens of existence. In his view the four ultimate concerns that we all face and deal with or avoid are:
1. death (its inevitability and the desire to continue to be)
2. freedom (the absence of external structure)
3. existential isolation (‘the tension between our awareness of our absolute isolation and our wish for contact, for protection, our wish to be part of a larger whole’)
4. meaninglessness (and the attempt to find meaning in this life)
Connection, acceptance, freedom and meaning present as common and essential elements in both the Clinebell list of heart hungers and in Yalom’s existential approach.
More recently Martin Seligman stated that happiness can be found through cultivating three dimensions in one’s life; namely,
1. the Pleasant Life, wherein we savour basic pleasures such as companionship, the natural environment and our bodily needs
2. the Good Life, wherein we discover and cultivate our unique virtues and strengths and use them to creatively enhance our lives. The six core virtues are: wisdom and knowledge; courage; love and humanity; justice; temperance and spirituality; and transcendence.
3. the Meaningful Life wherein we find deep fulfilment by creatively employing our unique strengths for a purpose greater than ourselves rather than focusing only on our own pursuit of pleasure
Each approach acknowledges a deep hunger in the human heart for a measure of contentment, a sense of equanimity and a sense of self. Until that hunger for peace of heart and mind is addressed we experience restlessness, anxiety and distress. The mind whirrs. The worry continues. The lethargy remains. The anxiety mounts. The emptiness or ache in the pit of the stomach continues.
Some endure the pain. For others, the level of distress is overwhelming and thoroughly disrupts and disturbs their ability to operate. The key question in each case is: what will bring a sense of wellbeing or equanimity or contentment and restore a sense of normality?
There are no magic wands. Over many years varying therapies have been developed for dealing with the dilemmas and distress that beset clients. The list is long. Some of the most common are as follows: narrative therapy, psychodynamic therapy, Gestalt therapy, mindfulness-based therapy, motivational therapy, psychodrama, reality therapy and relationship counselling. In recent years cognitive behaviour therapy (CBT) and dialectical behaviour therapy (DBT) have been used for a range of issues such as anxiety, depression, personality disorders and some aspects of psychoses. CBT places particular emphasis on addressing the role and contribution of cognition (our thoughts and beliefs) towards our functioning and DBT also incorporates attention to behaviours or actions. The basic premise underlying these approaches is that our emotions result from cognitions and behaviours and can be regulated when both are addressed.
From a therapeutic perspective each of the foregoing therapies principally attends to what one might be thinking, doing or feeling. Each is valid and valuable. In some cases it is essential that they be used in conjunction with appropriate medication. I hold deep respect for the contribution that can be made to stabilising mental and emotional disorders through medication. Without medication, those who suffer from psychotic illness and severe clinical depression would not be in a position to explore the self or to address lifestyle issues. However, medication does not provide the total answer to emotional and mental distress. It is only one part of the picture even if it is a major aspect. Optimal functioning is restored when the mind (thoughts), the body (behaviours) and the heart or spirit are addressed.
When you add or subtract pieces of glass in the bottom of a kaleidoscope you get a different picture and each time you turn the end section a different pattern appears. Similarly, in therapy we need to address every aspect of a life, not just one or some.
It was writers and researchers such as Clinebell and Clinebell, Maslow, Yalom and Seligman who added another dimension and asked different questions; questions that address the wellbeing of the heart or spirit or soul, not just the mind and body.
Almost two decades ago Irvin Yalom asked the profound question, Where is the psychotherapy lexicon that contains such terms as ‘choice’, ‘responsibility’, ‘freedom’, ‘existential isolation’, ‘mortality’, ‘purpose in life’, ‘willing’? Such issues mine the very difficult area of self and operation. So, whether it be Maslow’s hierarchy of needs, Yalom’s existential issues, Seligman’s emphasis on virtues, strengths and meaning or Clinebell and Clinebell’s heart hungers, each addresses the gaps, the pain and the very functioning of the inner life. Their approaches, starting with the wellbeing of the individual, stand in sharp contrast to the medical model of diagnosing an emotional state or a mental or personality disorder and then prescribing treatment.
Undoubtedly the absence of any of the factors cited by these researchers may be associated with or contribute to depression, anxiety, personality disorders and psychoses but it seems to me that these factors also stand alone in the landscape of human functioning. Depression and anxiety can be alleviated, psychoses and personality disorders can be treated but the heart hungers remain and continue to nag. Until the heart hungers have been addressed, clients are frequently burdened, unnerved, confused and feel off-balance, distressed, unable to cope and out of step with those around them.
At our core we are more than mind or body or emotions: we are soul, self, heart or psyche, or however one wishes to name that inner sense of being which is the seat of our wellbeing or our distress.
Over the centuries philosophers such as Plato and Aristotle and psychologists such as Freud and Jung have recognised that wellbeing of the psyche or soul underpins and forms the essence of our existence and demands our attention. The associated questions of faith, meaning, life, death and relationships they showed as not only central to our wellbeing but fundamental to our identity.
But what do we mean when we use terms such as ‘heart’, ‘soul’, ‘psyche’ or ‘spirit’?
In my view, the self or soul or psyche is the core that develops as a result of the interplay between a range of factors that emanate from body, mind and spirit. In therapeutic terms:
- Attention to the body relates to physical safety and security, health, food, warmth, exercise and rest.
- Attention to the mind relates to thoughts, beliefs and values, appreciation of our gifts and qualities, memories, understandings and ways of using the mind such as with meditation, prayer or mindfulness.
- Attention to the spirit relates to the heart hungers: one’s needs regarding relationships; a sense of meaning and purpose; a sense of one’s gifts; and a sense of what enhances life. Above all, the heart or spirit or soul is the barometer of wellbeing.
When all three modalities (body, mind and spirit) interconnect we develop a true sense of self or identity and the freedom to be that true self, to live authentically.
If one or more of these areas is overwhelmed or affected by trauma, massive stress, illness, conflict, isolation, undue restriction or violence in any of its many manifestations then the self is either damaged, threatened or reduced. Equilibrium, equanimity, confidence and the capacity to operate are minimised.
Therapy is always a journey of discovery with each client learning about the gaps, the hurts, the failures, the confusion and problems in addition to any symptoms of anxiety or depression or mental illness. When the heart hungers are addressed the client finds restoration; they move forward with one or more of the following: new insights, perceptions, understandings, beliefs, stories and/or approaches. The process always encompasses body, mind and spirit until a fresh sense of self emerges.
Over the years I have found some of the most fruitful questions to ask clients are, ‘Tell me about yourself,’ ‘What is important to you?’, ‘What drives you?’, ‘How do you get balance in your life?’ and ‘Who are you?’ I developed a ‘Who am I?’ questionnaire and sometimes ask clients to take it away and fill it out. We discuss it at the next session.
This is how Glenn (who we will see more of in the chapter on love) described his therapeutic journey:
When I was referred to you by my GP the pieces of my life had become fractured, bruised and confused. There was a disconnection between my behaviours, my head, my heart and my spirit. You have helped me to hold the fragmented pieces of my life and enabled me to look at them from a variety of different angles so that I could gain a new perspective. You have helped me to own and embrace the different aspects of my ‘self’ and my journey.
Your counsel, creative illustrative drawings and suggested readings have helped me to put the pieces of my life back together again into a united whole. I faced my workaholic tendencies, my emotional disconnects, my inability to hear what my inner voice was trying to say to me. I had to move from the ‘blame game’ in my circumstances to owning my own issues and primarily, to face the awful truth expressed so clearly by Eckhart Tolle, ‘When you lose touch with stillness, you lose touch with yourself, and when you lose touch with yourself, you lose yourself to the world.’
Thank you, Winsome, for helping to open the way for this exciting ongoing journey of personal growth and developing sense of wholeness.
That is the therapeutic process in a nutshell.
My holistic approach to therapy grew and strengthened over time: it sat easily. Early in my development as a psychologist my supervisor, Patricia Strong, recommended I develop an eclectic approach and not become a one-trick pony. Unlike most psychologists I began that professional journey in my middle years, bringing to it all my previous experiences: careers (education and management), education, travels, marriage, divorce and children. Without that background and maturity or a holistic approach I doubt that I would have been able to deal with some of the more complex issues I’ve seen in my practice.
Being a psychologist differs vastly from many other professions. In my case it was a clear vocation, a calling and not just a career. I entered the graduate diploma in psychology, the fourth year of training, with a firm conviction that counselling would be my path. I had no idea, however, that my career would encompass counselling of cancer patients in palliative care, writing of family reports for the court, mediation, couples counselling and dealing with psychosis as well as the regular stock-in-trade presentations of depression, anxiety and life crises. These extra dimensions arrived unbidden and seemed like opportunities as well as challenges. Early in my training the teachings of the renowned Carl Rogers were introduced. His client-centred approach to therapy calls on the therapist to hold unconditional positive regard for the client, to express his or her own genuine feelings and to extend empathetic understanding. Rogers’ approach resonated strongly with me. I was relatively non-judgemental (or believed I was), cared deeply for others and was prepared to meet them where they were. I had no difficulty whatsoever in embracing a Rogerian approach to therapy.
Therapy, however, entails much more than holding unconditional positive regard for the client. Listening, nodding one’s head, affirming the client and waiting for him or her to work it all out as they tell their story is just part of the mix. Even though a good deal of that goes on the therapist also brings a vast amount of knowledge regarding methodologies, strategies and research while maintaining clear and firm boundaries and exercising neutrality as far as possible. You need to know when to be still, when to intervene and explore, when to clarify or challenge and when to wait and consider. You need a great deal of compassion, patience and focus. Strong analytical skills never go astray. In sum, you bring yourself: your whole self, including your beliefs, your values and your understanding of the world and people. Genuineness and authenticity underpin the client–therapist relationship. That’s the starting point.
I bring to each therapeutic relationship my unique self. What you see is what you get; no game playing, no pretending. The integrity and honesty of the relationship is where you and I begin – that is what creates the foundation for the work. If there is no sense that I am for real, there can be no trust and without trust there can be no therapeutic growth and healing.
Therapists need to be relatively whole, stable and intelligent people. Experience, compassion, insight and intelligence are the essential qualities that each brings to the therapeutic table.
Henri Nouwen, the twentieth century priest and teacher, expressed the opinion that we can only fully encounter the pain and suffering of others when we have experienced that pain ourselves. He also maintained that ‘for a compassionate person nothing human is alien: no joy and no sorrow, no way of living or of dying.’
I already had half a lifetime of experience under my belt when I began my fourth year of training. Careers, travel, education, significant people and events, family life and spirituality had all influenced me and had determined to a large extent the way that I would work. So I shall share some of these markers as they relate to each heart hunger. In my practice I have come to the task not only as a qualified and experienced clinician but also as a woman who has known the longings and needs of the heart. Like the velveteen rabbit of storybook fame I’m ‘real’ because I’ve experienced life’s highs and lows. My life journey is as authentic as that of each of my clients. It is that history that informs my work with compassion, empathy and insight.
My life, like everyone’s, has been punctuated by gift and loss, joy and pain. I was blessed with intelligence and good mental and physical health. I have learned how to be courageous, to withstand loss, to overcome adversity and be true to myself. For some, grief is never resolved, resilience and strength seem elusive, new ways of being are harder won. Some people are more robust than others. Some lives are more complex than others. But for everyone, heart hungers, whether met fully, partially or not at all, demand attention.
Usually clients have come to my practice with a referral from their doctor or lawyer, or a friend has suggested they see me. After gathering basic details I usually ask, ‘How can I help you?’ or ‘What brings you here?’ Often the client is so burdened that they hardly know where to begin. I encourage them to start wherever they wish. Therapy is like a jigsaw puzzle; you can start with the colours, the matching pieces, the border or the faces but eventually the picture forms.
Rarely does a client present with just one issue and rarely is there just one heart hunger that needs to be explored and addressed. Part of the skill lies in discerning what is hidden or buried, sometimes even from the client’s own consciousness. The presenting problem is not always the real problem.
In general, the picture emerges fairly quickly. Initially the client feels better for having shared their story in a safe, confidential and trusted environment with someone who demonstrates empathy and insight. Or, as one client recently said, “You’re actually engaged with me.” She seemed a little surprised.
The therapeutic journey involves immense trust. My job is to enable healing to occur through joint reflection that promotes insight, understanding and appropriate changes. I can go no faster or slower than my client. Progress can only occur through the client‘s desire, capacity and willingness to undertake and persevere with each step. My client must sustain energy, commitment and engagement. Some give up and don’t return. I undertake serious soul-searching when that occurs but understand that I cannot be all things to all clients. Some gain just enough to fly on their own even though I might desire greater strength on their part.
In the following chapters I have used the stories of clients to illustrate the significance and meaning of each heart hunger as I see it. The vignettes contain a complex range of elements and issues but I selected each, with the permission of the client, because their story closely reflected one of the major heart hungers.
The therapeutic journey for each took many twists and turns before resolution emerged. Some clients came in and out of therapy. Each break revealed another aspect of their life pattern or story or enabled significant processing to occur and with each return the unspoken contract was ‘I trust you to take me another step forward.’
As Ernesto Spinelli so accurately wrote, the retelling of client stories or therapeutic narratives are ‘twice-told tales’. They are ‘highly selective “fictions”…told from the perspective of one, highly biased, participant in a shared experience.’
In each case I have done my best to stay true to the story and to reveal the intricacies of the process while preserving the client’s anonymity, save the last case, where the client gave me full permission to use her real name.
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