When Does a Therapy/Helping relationship End?

Organisations such as Cruse proved a quality assured service provided by volunteers which is maintained by what happens in supervision.

The need of the client maybe for befriending, advice, guidance, counselling or psychotherapy. What is important is for supervision to work with the need of the client and the understanding of the role the helper takes on for that client. This understanding will also include espoused theory about how the role and the work ends.

The discussion noted that this understanding of the role is necessary if an ending is to be made. Working in supervision is necessary to help understand the process when either that role is no longer appropriate or the relationship moves onto a different dynamic. This was understood to be what is required of the professional helper.

Here the idea of espoused beliefs and theories-in-use (Chris Argyris) is helpful. The supervision process needs to pay attention to what is said to be the role and its justification, and what the helper is observed to actually be doing and justifying. It is likely that the helping service is enhanced by both supervisor and supervisee consciously seeking to bring this consideration into the supervisory relationship.

One of the sub-conscious theories-in-use in voluntary organisations is likely to be that of voluntarism itself. There is a commonly held and unquestioned assumption that volunteers are not professionals and even that this might mean that as volunteers, we are somehow excused the rigours we expect of ourselves as professional therapists. This has to be challenged in supervision but depends upon supervisors challenging their own theory-in-use of being a volunteer. The notion of professional volunteers is not widely held.

Regarding when the helping process ends, it was remarked that we were all familiar with awareness of ‘who is doing the work’ in the helping/therapeutic relationship. Again, awareness that perhaps the counsellor finds him or herself ‘trying to hard’ or ruminating over when s/he is doing enough, needs to be brought out in supervision. The espoused theory may be that the client does the work, but theory-in-use that I must be helpful and give wisdom to the client can easily lead to taking over the work of change.

Sometime was given to wondering about espoused theory of person centred therapy and that of cognitive behavioural therapy and how you know when the helping process ends. It is expected, in our discussion, that  in CBT we might work according to espoused theory so that the client becomes their own therapist (and with positive cognitions identified to manage a more healthy way of managing change). In PC the continual review of the process with the client so the client articulates for themselves their readiness to be autonomous is an expected outcome. In this process incongruence (spoken of in this context as intuition) informs the therapist that that change is taking place or not as the case maybe. It is helpful in supervision to bring the ‘shoulds’ we carry about our processes and those of the client to the surface for reflection.

Hopefully, helpers can and do keep a reflective journal to capture the thoughts and feelings before leaving a client and going on to the next encounter. In this way the knowing when the helping process ends is a collaborative process in supervision.

When Does a Therapy/Helping relationship End?

When does a helping/therapeutic process end?

Organisations such as Cruse proved a quality assured service provided by volunteers which is maintained by what happens in supervision.

 

The need of the client maybe for befriending, advice, guidance, counselling or psychotherapy. What is important is for supervision to work with the need of the client and the understanding of the role the helper takes on for that client. This understanding will also include espoused theory about how the role and the work ends.

 

The discussion noted that this understanding of the role is necessary if an ending is to be made. Working in supervision is necessary to help understand the process when either that role is no longer appropriate or the relationship moves onto a different dynamic. This was understood to be what is required of the professional helper.

 

Here the idea of espoused beliefs and theories-in-use (Chris Argyris) is helpful. The supervision process needs to pay attention to what is said to be the role and its justification, and what the helper is observed to actually be doing and justifying. It is likely that the helping service is enhanced by both supervisor and supervisee consciously seeking to bring this consideration into the supervisory relationship.

 

One of the sub-conscious theories-in-use in voluntary organisations is likely to be that of voluntarism itself. There is a commonly held and unquestioned assumption that volunteers are not professionals and even that this might mean that as volunteers, we are somehow excused the rigours we expect of ourselves as professional therapists. This has to be challenged in supervision but depends upon supervisors challenging their own theory-in-use of being a volunteer. The notion of professional volunteers is not widely held.

 

Regarding when the helping process ends, it was remarked that we were all familiar with awareness of ‘who is doing the work’ in the helping/therapeutic relationship. Again, awareness that perhaps the counsellor finds him or herself ‘trying to hard’ or ruminating over when s/he is doing enough, needs to be brought out in supervision. The espoused theory may be that the client does the work, but theory-in-use that I must be helpful and give wisdom to the client can easily lead to taking over the work of change.

 

Sometime was given to wondering about espoused theory of person centred therapy and that of cognitive behavioural therapy and how you know when the helping process ends. It is expected, in our discussion, that  in CBT we might work according to espoused theory so that the client becomes their own therapist (and with positive cognitions identified to manage a more healthy way of managing change). In PC the continual review of the process with the client so the client articulates for themselves their readiness to be autonomous is an expected outcome. In this process incongruence (spoken of in this context as intuition) informs the therapist that that change is taking place or not as the case maybe. It is helpful in supervision to bring the ‘shoulds’ we carry about our processes and those of the client to the surface for reflection.

 

Hopefully, helpers can and do keep a reflective journal to capture the thoughts and feelings before leaving a client and going on to the next encounter. In this way the knowing when the helping process ends is a collaborative process in supervision.

 

Notes from Fells and Dales Counsellors cpd event on March 15th 2019

When does a helping/therapeutic process end?

Behavioural Activation Treatment

Fells and Dales CPD group. 15/2/19

Today we reviewed Behavioural Activation Treatment for Depression: Returning to Contextual Roots by Neil S Jacobson , Christopher Martell and Sona Dimidjian 2001. Along with this we looked at the NHS guidelines on the stepped process of mental health care and how Behavioural Activation fits within step 3 of the model.

Behavioural Activation is a stand alone treatment for depression which attempts to help depressed people  to re-engage in their lives through focussed activation strategies.  Rumination and worry is seen as an avoidance strategy and the contents of the worries are not considered relevant to this approach.

Deficiencies are seen as residing in the life of the sufferer rather than within that individual where avoidance patterns narrow the repertoire of behaviour for the individual eg they may stay in bed.

The significance of a persons behaviour is largely driven by the reinforcers maintaining them  and stopping the avoidance behaviours is seen as key to the recovery of the depressed client. The acronyms TRAP and TRAC are used to conceptualise the old and new behaviours as Trigger, Response leading to avoidance pattern leading to response leading to avoidance behaviour (TRAP) and graded activities are created to promote the alternative Trigger, Response leading to alternative coping (TRAC) which in turn leads to breaking the feedback loop and modifying the contextual trigger .

Behavioural activation is seen as necessary and sufficient in and of itself in the treatment of depression and challenging core schema and automatic negative thoughts as in classic CBT are unnecessary.

We considered the effectiveness of such an approach if only parts of it are integrated into therapeutic counselling such as psychoeducation, exercising more, recognising and exploring avoidance patterns  and how that can be rationalised along with the need to believe the whole of the paradigm in order for any of it to be effective.

We then considered the underlying principles of therapeutic change for each of us and the importance of being genuine and congruent  and not necessarily instrumental  in our approach. We looked at how elements can be ethically integrated without totally believing in the paradigm.

A limit of the approach is the presupposition that a person is able to engage in activities and  will be compliant with home work assignments such as keeping a diary or exercising regularly.  Its overt directivity is also noted setting the therapist as expert who may even contact the client in-between sessions to check on compliance with activities.

It was noted that as it is straight forward to conceptualise Behavioural Activation can be and is included in the NHS stepped care process and psychological wellbeing practitioners (PWP’s)  who deliver first step are trained in the approach and the ethic of using  this approach for all when it might not be suitable considered.

Behavioural Activation Treatment