An interview by Silvia Baba Neal
Margaret Landale is an integrative psychotherapist who has a deep interest in trauma and embodiment. I caught up with Margaret during the Relational TA Conference as I was very curious to learn more
about her background, her style of working and the place of mindfulness practice in psychotherapy. I found Margaret a very engaging and generous partner in conversation and I was most intrigued about Margaret’s critique of complex PTSD as a unifying paradigm and the proliferation of ‘techniques’ to work with trauma.
Silvia: Listening to your keynote speech I really got a strong sense of how you work and the sort of clinical issues that are coming up in your work at the moment. What I would be interested in finding out – if it isn’t too big a question – I was wondering about your professional journey to this particular focus – the body. Was it there from the beginning or something that you ‘grew’ into?
Margaret: That’s a good question. I’ll try not to get too much into history because it goes back a long time, but, essentially, I was a social worker in Berlin and I worked with young people from very dysfunctional families. The project I worked on offered these young teenagers the opportunity to live together in communities with some individually tailored support from a social worker. It was a very alive, creative, positive project and I realised that while there were a lot of good resources offered to these young people often their emotional wounds were so deep that they really didn’t know how to allow that goodness in. That moved me to try to understand more deeply what was going on internally and this then brought me into a body psychotherapy training. I came to England and joined the first training cohort at the Chiron Centre for Body Psychotherapy, which was just opening – this would have been the mid-eighties.
Silvia: So the focus on the body was there from the very beginning of your training.
Margaret: Yes. But the problem then was that when I finished [training] I worked in mental health and found that what I had learned as a body psychotherapist really didn’t match well with people who were very fragile in so many ways.
Silvia: Can you give me some examples of things you would have learned theoretically that didn’t quite match your experience in practice?
Margaret: My training had been strongly influenced by the work of Wilhelm Reich and also Alexander Lowen, which included the view of the body as carrying an armour, embodying defensive patterns. It was seen as beneficial to try and break down this armour so that the energy or vitality trapped beneath it could be released. So the techniques that were used were meant to be quite… forceful attacks on the ego, on the armour…
Silvia: Potentially quite intrusive interventions
Margaret: There was a great trust in cathartic processes in those days as a way of breaking down the armour to some degree with the hope that this would make pent up life energy more available to the client.
Silvia: A real belief in that one-off potent intervention…
Margaret: Not necessarily one-off but certainly a belief in the idea that attacking the ego was beneficial – and here I am mindful that in a sense what I am saying is black-and-white - but certainly from my point of view there was a lot of fragility in the clients I was seeing within the mental health services and I felt that a lot of the interventions I had learned in my body psychotherapy training weren’t really appropriate. I believe this got validated later on through expansive research in areas such as affective neuroscience, trauma and also attachment.
Silvia: So the research had to catch up with your direct experience through practice
Margaret: You could say that the theory and experience of trauma only became deeply researched and properly investigated from the 1980s onwards. There was a real lack of understanding in the field up until that point. We now know that complex trauma can be a real contributor to people developing mental health issues later on.
Silvia: I remember a comment that one of the panellists made earlier on about you being involved in work focusing on the body and trauma at a time when it really wasn’t ‘fashionable’ – that’s what I took from it.
Margaret: Yes, there was a sense of being on the edge of something new and important.
Silvia: So what is your sense of the widespread focus on the body at this moment? How come that so many clinicians’ interest has been captured by it in recent years?
Margaret: Actually, I think that a lot of it is to do with the fact that trauma and the whole scale of complex PTSD has become an organising paradigm in psychotherapy, for many good and some not-so-good reasons. But two good things have arisen out of this: first is that trauma research has really cemented the notion that embodied processes influence our behaviour and thinking. Second is the understanding that often what is held in the body are very early memories that have formed our sense of self, and that we are driven by these implicit processes in the way that we regulate our emotions and in the way that we handle stress. The body is involved in all of this – and that is now really understood.
Silvia: And what are the ‘not-so-good’ reasons for using complex PTSD as a framing paradigm?
Margaret: I will look first at the positive and then the negative. The PTSD paradigm offers a lot to clinicians and clients as a way to understand embodied experience and unconscious somatic processes. How do we manage stress? How do we deal with pressure? How do we manage our sense of self in relationships? If we can understand that emotional problems cause stress at the body level then suddenly we can bring the body in. We can understand that the body underpins our lived experience in every way, which also helps clarify old forms of objectification or sexualisation of the body.
Silvia: Something resonates in me with the example you gave earlier today when you described your client choking and asked us for our first association. A lot of people had thought of oral penetration because we tend to rush to psychoanalytic explanations that focus on sex and libido.
Margaret: And that’s how the brain works. We jump to conclusions – ‘it must mean that’. It will continue to happen but we can find ways to double-check or indeed investigate it.
Silvia: And to wait for the story to emerge.
Margaret: Yes. To wait for the story to emerge rather than to jump in with our assumptions, interpretations or theories.
Silvia: At times it must be unsettling to stay in that place of not knowing.
Silvia: How do you support yourself in that?
Margaret: Can I just come back to that by answering the other part of your question as I feel they are related. I think that the negative side of trauma becoming an organising paradigm is that it supports the idea that we can apply specific techniques to process trauma – and they are coming online fast. And whilst many of these techniques are very effective indeed, what can get lost is the art of attuned relating and the phenomenological exploration of an individual’s unique experience. The danger is that trauma becomes a stereotype and that’s where, as one of the panellists was saying earlier, trauma could become an empty word. That is a challenge to our clinical practice.
Silvia: Any concept loses its power through over-use.
Margaret: Yes. Especially when we think the technique will do the work for us.
Silvia: I am thinking now about a client who laughed at me recently for talking about the impact of stress. He scoffed at me because the word has become meaningless. Although it has been proven that stress has a profound impact on the body and is linked to a host of diseases such as diabetes, cancer, as a concept it has become trivialised and has lost the power to impact us.
Margaret: Clients jump to conclusions too. You say ‘stress’ and the client assumes ‘you must mean that… and if you think my problems could be sorted by learning a few relaxation techniques, you must be joking’!
Silvia: I have recently taken a course in mindfulness and have been thinking about how to bring mindfulness into my work. And I don’t know about your experience when using technique, but to me it still feels a little clunky and it feels like I am shifting into a different gear relationally. My style is to be quite interactive and contactful– maybe we can call this a two-person/relational mode. I struggle with using mindfulness as a ‘technique’ because it seems to change the relationship – it takes us into a different space, one in which I am an ‘expert’ teaching my client a technique.
Margaret: It doesn’t have to, although I can see where you are coming from and I can see how that could be problematic. The way I look at it is that mindfulness is a lived practice for me which evolves through living mindfully as best as I can in my daily life but also having a commitment to regular meditation practice. At heart, the way that I understand mindfulness through the teachings that I’ve received, is that it really is a practice of learning to investigate and understand our own mind. For me mindfulness is not about trying to stay calm, although that sometimes arises – for me mindfulness is the practice of observing as best as I can, with acceptance, what my mind produces. That includes what arises somatically and emotionally and within my thinking mind. As I continue with this practice it helps my capacity to simply pay attention.
For example if we go to the gym three times a week our muscles tone improves and the same goes for our attention span when we practise mindfulness in that way. It’s very different from practising in order to achieve a goal such as enlightenment. My mindfulness practice isn’t that. At best it’s an attempt to live with greater awareness and empathy for what it is like as a human being. This practice translates naturally into my work. I like Germer’s definition of therapy as an opportunity to practice mindfulness. And I think this is so important because there seems to be a tendency emerging that mindfulness is being sold as the new ‘hot cake’ that offers immediate results. Now, a growing number of therapists – which really concerns me – offer mindfulness skills training to clients with all these promises – how it will help with anxiety, depression, eating disorders etc. And it can! But it requires a lot of commitment and practice from the client. And above all it requires a capacity to be motivated and self-caring, which is exactly where many of the individuals who come for therapy struggle.
Silvia: At some level it has been monetised as well – there’s an aspect of that – it’s ‘the thing’ to be offered at the moment. I was wondering: do we actually need teachers to instruct us in the ways of mindfulness?
Margaret: Yes. Yes, absolutely! Certainly in the spiritual mindfulness traditions, as you learn mindfulness you do want the support of a teacher. It’s traditionally a process of experiential and relational learning, with a teacher. That’s just so supportive and helpful. In a sense it doesn’t have to be that dissimilar from a therapeutic relationship. The idea is that the teacher would be more experienced in their practice and therefore skilled and capable to offer individually attuned support to their student – hopefully!
Silvia: I guess as with therapy, at the heart of teaching and learning is trust. You do open yourself up to someone else and there aren’t any guarantees to begin with you have found a safe or good or skilful enough partner. So it’s all about taking a plunge, a huge risk!
Margaret: It’s a big thing to go to therapy – that’s what you’re referring to! It’s a big thing to trust a therapist.
Silvia: I don’t know about you but therapy was an integral part of my training and I certainly went into it with a lot of naivety.
Margaret: Me too, for sure! [we both laugh]
Silvia: I have a sense that what you are offering is trans-modal, it can be used no matter what your theoretical background may be.
Margaret: In a way. Certainly when I go out into the world to teach I get to meet people from all modalities, from all approaches – and I really appreciate that mixed community – from the humanist, to the more psycho-dynamically orientated, to the CBT practitioner.
Silvia: It’s almost like you are trying to address people who speak different languages in a sense. What are the challenges of doing that? There must be some tension at times.
Margaret: Actually, I don’t experience that as much, but maybe it’s because what I’ve always searched for has been to understand the common denominators, to have a common language – because I don’t believe in jargon in therapy – I mean I understand that it has its place but it’s never the language I would choose to relate with. I feel that within a therapeutic relationship we develop our own, common sense language and I believe in therapy as being a normalizing process in terms of helping raise understanding, awareness and acceptance of the client’s dilemmas – and normalizing in the sense that a lot of clients come to therapy feeling bad about who they are and about what’s happening to them. To put all of this into context, it helps to use ordinary language. The same with my teaching: I try to speak to our common and shared clinical experiences first and then introduce relevant theories and clinical ideas or paradigms.
Silvia: That came across very well today. As a transactional analyst I certainly felt I could follow you and that we were speaking a common language. So thank you so much.
Margaret: And thank you. I’ve enjoyed this!