Reference: Poppink, J. (1997). Chaos and complexity as theoretical grounding for psychotherapeutic listening: Psychotherapist's presence with patient in flooding stage of post traumatic stress disorder. Paper presented to The Society for Chaos Theory in Psychology Life Sciences, Seventh Annual International Conference, Marquette University, Milwaukee, Wisconsin, July 31 - Aug 3.

The principles, images and metaphors within chaos and complexity can provide useful strategies in a psychotherapist's clinical work.

I'm a psychotherapist in ongoing practice since 1980, and I've incorporated chaos and complexity awareness into my theoretical and experiential grounding. I'm presenting these thoughts and experiences so that we may begin a dialogue, and because you may find something in this discussion that triggers a useful idea or perspective for your own work.

When I was an intern working with young psychotics in a residential treatment center in 1977, I had a learning experience with a 25 year old male patient. I was becoming adept in the use of guided imagery and thought I would offer this black haired, open faced, intelligent, psychotic young man an imagery experience. At this stage in my training, I had been taught not to use these methods with psychotics unless we were in a protected setting, and so I thought, here was an opportunity for both of us.

The imagery process I used at the time usually took from 20 to 45 minutes. The young man and I sat under a tree on a lovely spring day in Los Angeles. He closed his eyes, and I suggested that he be in a meadow. In 90 seconds, this man whirled through a series of horrific misadventures, three dimensional, vivid, in Technicolor, full of scents, sounds, and texture, with blood, murder, torture, and mayhem in full detail. I later wondered if his process was in any way similar to what people describe as their entire life passing before their eyes in a flash.

In the moment, he took my breath away. Nothing I had been taught, nothing in my experience, equipped me to process this material with him. He looked like he was in a state of alert shock after this sudden trauma.

I said, drawing on I don't know what, "Okay. Now let's do it again, except this time we'll do it slowly." He said, "Oh, no. I could never go through that again. I said, "I'll be with you."

We did it again and took about 30 minutes to review the terrain. He was more calm as he described the details of his sudden and terrifying experience. Then we parted.

Because it was a residence, we were both still on the premises. A few hours later he came looking for me. He looked serious, thoughtful, aware and clear. He looked straight into my face and said, "Thank you."

I looked at him and smiled. Then quite seriously I asked, "What are you thanking me for?" He said, "For staying with me."

That was my lesson. The more I understood, could analyze and interpret phenomena, the more theories and options I had in my repertoire, the more capable I would be as a therapist. But the most basic key in working with someone was my ability to remain present for their experience.

Often, it's the therapist's internal emotional limits which stop a patient's exploration. It can be therapist fear which interrupts a patient's process, particularly when the process is emotionally charged and sustained. The frightened, unsure therapist may bring in interpretations too early, offer appeasing explanations, directions, attempts to soothe, critical judgements and perhaps medication. I was so new when I had this experience, I didn't know enough to even attempt these strategies. Now that I know them, I have to work harder not to use them.

When a patient is internally flooded by a cacophony of thoughts and emotions and the flood pours out, his or her internal chaos becomes more visible. It's seems formless at first to both therapist and patient, but in my mind set now, I hold a certainty that structure exists within this chaos. I'm familiar with the rushing forces on the edge of chaos which may diminish and the tumult of chaos out of which a new emergence can eventually arise. I have a certainty that a deep structure, not necessarily in the patient's conscious awareness, is working to establish itself.

When I have this certainty it helps my emotional center stay present and even calm sometimes. When a patient is in a torrent of emotion, perhaps especially then, the patient is acutely sensitive to the inner life of the therapist. Fear, including therapist fear, is catching and can make a patient's turbulence even more frightening to himself.

I believe my task is to ride out the turbulence with the patient, not trying to shape it but allowing the shape to emerge. I have no template, but I am becoming more familiar with the process. The emotional fractals, the bits and pieces of a fractured, fragmented mind and spirit, are attempting to find their own way to each other and create a form, reveal the integrity of the person, in a way no theory or therapist I know of could shape or predict.

To me, this is the stuff of healing. It's tough to sit through this chaos and be present, solid and non-interfering. I suggest that knowledge and appreciation, if not deep understanding, of chaos theory, chaos in nature, and complex systems can extend to an awareness and trust in the life forces of emotional chaos. With this can come a confidence that within emotional chaos lies structure. This structure is unpredictable regarding exactly when, and where it will take shape or what it will look like. But if the process is given a chance both the patient and therapist can be confident that it will emerge.

Remember when someone sat down with you and helped you to see a world you never knew existed? And it was right there in front of your eyes, all along?

Watching ants, exploring snowflakes, looking at the details of a flower or better yet, watching how a frightening bee transformed itself into a benign, graceful industrious creature sucking nectar from a daffodil? Remember how amazing it was to see a strand of your own hair through a magnifying glass or how you felt the first time you saw a drop of water under a microscope?

We all probably share these or similar moments from our early awakening experiences. We were discovering the fascinating wonder and surprise in a world we thought was ordinary. And what made these discoveries all the mere wonderful was the fact that they didn't come from any make believe place. This was all real.