“I Take My Waking Slow”

Entry for 19 Sept 2010:

I am not bored; there is plenty to do, and just the right level of visitors. My main frustration is with the catheter. This has gotten pretty old, especially over the past few days when, as I've gotten more active and find that it holds me back. I don't like this at all! However, it turns out that the catheter is my friend also, for one very important reason: It reminds me, forcefully at times, to go slow, to not try to rush things. This is critical for me at this point, because going slow is exactly what I need to be doing.

This going slow is such a contrast to my normal life, where I often have to rush around from meeting to meeting and sometimes end up being double-scheduled. Deadlines loom, and I feel forced to stay up late to meet them, cheating on my sleep, which isn't healthy. Email piles up, because ordinarily I don't have time to read it during the day. There were over 1000 messages in my inbox when I went into the hospital; it's less than that now, in spite of the time I've spent in hospital and resting at home. So ordinarily, I live under quite a bit of time pressure and feel like I have to do things quickly and not “waste time”.

But it does make me wonder: Was living at such a pressured, fast pace EVER a good idea? It now seems to me that this was one of the most unhealthy aspects of my old lifestyle, creating conditions for the cancer to develop -- or now for it to reoccur. Maybe the slow life I'm living now is actually closer to the way I should be living my life in general. Is there a way to go back to work in a healthy, less pressurised way? I don't have any answers about this, but it seems important to think about.

In the meantime, as Theodore Roethke writes, "I wake to sleep, and take my waking slow. I know by going where I have to go." I first encountered this line 40 years ago and now I try to take this as my motto to live by. I live in my old gray cotton bathrobe, reminding myself of some kind of celibate Hugh Heffner, but the love that surrounds me is not eros (or more accurately porneia, whence pornography), but rather philia and agape. This is calming; this is what I need; not striving (trishna, in Sanscrit), but letting go of striving, as the Buddha preached. It is a bit of heaven, as I've said before, a gift, a blessing.

2010 Emotion-Focused Therapy: Level 2 Workshop Series

Facilitated by Robert Elliott

Professor of Counselling, University of Strathclyde

Saturdays, 9.30-16.30, 20 November, 2010 – 14 May, 2011

Sir Henry Wood Building

Jordanhill Campus

(Sponsored by HASS Research & Knowledge Exchange,

University of Strathclyde)

The Counselling Unit at the University of Strathclyde is offering further training in Emotion-Focused Therapy (EFT) for counsellors and psychotherapists (Diploma level or above) who have completed Level One training in EFT or the equivalent. This series has been restructured from its previous evening format and will now meet on seven Saturdays throughout the 2010-11 academic year, beginning in November. The format will be a mixture of brief lectures, videos or demonstrations, experiential practice exercises in small groups, supervision of cases seen by course members, and discussion.

The specific topics to be covered will feature material not covered in the Level 1 course, including

· Therapist experiential response modes

· Client modes of engagement

· Narrative Retelling of difficult/traumatic experiences

· Relational Dialogue for Alliance difficulties

· Creation of Meaning for meaning protests

In addition, the Focusing and different forms of Chairwork will be particularly emphasized:

· Focusing with difficult or painful experiences

· Clearing a Space for overwhelming or chaotic experiences

· Two chair enactment for Self-interruption splits

· Two chair conflict split work for depression, anxiety and self-harm behaviour

· Compassionate Self-soothing for painful self states

· Empty chair work for unfinished business

This series is scheduled for the following dates:

Autumn 2010:

20 November

11 December

Winter-Spring 2011:

15 January

19 February

19 March

16 April

14 May

• Enrolment is set for a minimum of 10 and a maximum of 20.
• Course fee: Until 15 Oct: £395; after 15 Oct: £445
• The course could be taken for continuing professional education credit.

Please direct enquiries and requests for applications to HASS Research & Knowledge Exchange, Jan Bissett (jan.bissett@strath.ac.uk, 0141 950 3135), or alternatively Counselling Unit office (muriel.walker@strath.ac.uk or 0141 950 3165) or, after 1 October, Robert Elliott (Robert.Elliott@strath.ac.uk or fac0029@gmail.com).

Recovering from surgery

Entry for 14 September 2010:

Last January, I was diagnosed with prostate cancer, apparently early stage. I did not record here my experiences during this process; I chose not to circulate them in this forum. Why? There were many reasons, but the principal were the uncertainty; my own discomfort and embarrassment (it somehow felt like a personal failing); and because I didn't want this to turn into a cancer blog. Thus, I chose not to reveal this information here. However, because this has been the major process going on in my life throughout this time, it has had the unwanted effect of pushing this blog to the side. In this entry I attempt to remedy this situation by offering a summary of my process over this time.

In the USA, men are routinely screened for elevated PSA from age 50 onwards, and I'd been tracked for slightly elevated PSA scores for the 6 years before we moved here. PSA screening isn't done routinely here, because of its high false positive rate and the resulting risk of over-diagnosis and unnecessary treatment. Now my elevated PSA (7.8) had been followed by two biopsies, the second of which identified early stage prostate cancer in a small part of my prostate. What was I to do?

There is currently a controversy -- on both sides of the Atlantic -- about what if anything to do about early stage prostate cancer. Here in the UK, NICE guidelines advocate Active Surveillance, essentially continued testing until it progresses to a more advanced stage, while some in the US are beginning to question indiscriminate prostatectomies for this stage of prostate cancer, because a large majority of men diagnosed with it die of something else first ("die with it, not of it").

What I did was to read a lot studies. It turns out the prostate cancer outcome literature is far messier than the psychotherapy outcome literature, because the cancer generally grows so slowly that 15-20 year follow-up studies are needed. Also, it turns out that most early stage prostate cancer is diagnosed in men 75+ or older, only 5% of whom will die of it. Eventually, I found a study of a European study tracking men of my age with my stage of prostate cancer for 8 years: I could see that death from prostate cancer leveled off a year or two after surgery, but with Active Surveillance the death rate kept trending upward in a shallow but straight line. Extrapolating from these data and given my life expectancy (I was 59, otherwise healthy, and could expect to live at least another 20 years), there was a better than even chance that this would kill me before something else did. Furthermore, I was more likely to be able to make a full recovery, with less chance of recurrence, if I had the surgery now rather later. I decided to go for it, in defiance of the NICE guidelines.

The issue of what kind of treatment was also problematic, and has odd parallels to the psychotherapy outcome literature: There are several competing treatments, with no compelling arguments or evidence to support any particular one, but a lot of strong opinions. Paralleling psychotherapy research, however, the crucial variable appears to be skill of the surgeon, indexed in this case by their having carried out whatever procedure it was hundreds of times previously. The person of the surgeon is more important than the procedure itself. On this basis, I decided to stay in Scotland and to receive an older form of the surgery at the hands of a highly skilled surgeon, rather than attempt to fly back to the North America for a more modern laproscopic-robotic surgery.

More importantly, as I delved into all this, I learned (a) that prostate cancer is now considered by key researchers like Neil Fleshner and his team at the University of Toronto to be primarily a nutritional/lifestyle illness, and (b) that there is a pretty good chance that the cancer had already spread to other parts of my body micro-metastically. This meant that surgery, of whatever kind, wasn't going to be enough; I would have to change my lifestyle: I switched to a mostly vegetarian diet (the exceptions being fish like salmon and free range, organically grown chicken); began making sure I got at least 7 hours of sleep each night; went on about 10 micro-nutrients with research evidence supporting their anti-cancer properties; and substantially increased my level of exercise. I also starting drinking alkalinizing water (at the encouragement of my friend Leigh McCullough), and tried in general to reduce the level of stress in my life.

I'd like to say that these measures reversed my prostate cancer and removed the need for surgery, but unfortunately that turned out not to be the case, although further PSA testing clearly indicated that its steady progression was halted and remained steady for the past year after years of steady increase. They did, however, ensure that I was in peak physical condition going into the surgery.

Finally, on the 3rd of September, I had a radical prostatectomy, that is the complete removal of my prostate gland. This is a delicate, painful, major operation: I was under anaesthetic for about 5 hours and hospitalised for 4 days; the catheter will have to be in for 3 weeks, and I won't know for some time after that how much incontinence and impotence I will be left with long term. In addition, although I've been assured that the surgery was successful and appears to have removed all of the cancer, I don't have the pathology results yet. Ultimately, I'm not likely to know for years whether the combination of surgery and life style changes will have prevented a recurrence of this cancer. But in any event, I will have done my best.

So that's the story. I will be off work for at least 4 weeks through the end of September and possibly for much of October. It's my hope to be able to continue regularly to write this blog during this time, but at this point, in the meantime, really my only job is to heal as best I can: Drink a LOT of fluids, to prevent blood clots and to keep my catheter open; to take daily walks around my neighbourhood (for the same reasons); to sleep a lot (8 - 9 hrs / night); and to be at peace. Mostly, I take my days slowly, and listen a lot to my body. This makes it a special, almost holy time, like being on extended spiritual retreat, communing and listening to what my body and spirit are saying. In fact, it is a marvelous gift to be given this time for healing and reflection.