Erik Eriksons Stages of Human Development

Preparation for this topic suggested that we remind ourselves of other overviews of human psychological development than Erikson and with particular reference to Freud and Piaget when reengaging with our memories of Erikson.

We asked ourselves what was the value of overviews such as that of Erikson, perhaps meaning its helpfulness or otherwise for our clients ,and for our work with clients, as well as for understanding ourselves. Erikson has been criticized for developing his scheme from biological material. This is surprising given that qualitative research has an excellent pedigree! (For example in participant observation methodology, a researcher is a participant who is qualified in the same field as those s/he is observing ,is a legitimate methodology for research). So from within so to speak his material he was able to recognise characteristic psychological and behavioral developmental patterns and gift to us terminology that captures them. Thus we are given by Erikson a narrative about human development which ‘feels’ true, and provides a story in which we might be able to locate ourselves or assist our clients to do so. Peter remarked that he had found this to be helpful in client work although that had meant in practice use of the eighth state, the integrity v despair spectrum in particular, and he had not to his knowledge shared that within the context of the full eight stages. Nevertheless, the idea that if you could not integrate the experiences of life in some sort of personal story then despair going on to one’s death was more likely to be coloured by despair, a way of thinking that clients seemed to find helpful

The relevance of the poles of each stage spectrum was recognised as neither good nor bad but gained meaning mostly by the recognition that all of us find ourselves somewhere on the spectrum concerned and can sense and make sense of what it feels like and means to experience the pull towards one pole or the other. The more one is aware of one’s own narrative with respect to the integrity v despair spectrum, the  better the therapist is able to contrast and compare with what is learnt from the biographical material offered by the  client by report and by responses in therapy.

Another of the criticisms made of Erickson work is that he worked in an era apparently in which he was freer to observe that he recognised in his research biographical material that there were differences to note which were gender specific. In the ‘non-bianry’ world of today, those statements feel at risk of challenge and  perhaps feel’unsafe’. Yet it is scarcely surprising, borrowing from Freud, or using one’s own commonsense, that the requirement for the male to gain an erection and perform promotes a different way of being in the world to that of the female who must ‘receive’ the male approach. The psychological challenges are different and inform and shape the polarities of the developmental stages much as Freud observed.

Another of the criticisms which brand the responses to Erikson somewhat churlishly, is that he does not appear to have incorporated into his writings how change in our developed place on the spectrums can take place, nor how such change occurs psychologically or neurologically for example. One understanding of how change takes place is wrapped up in the complexities of what may occur when first one becomes aware of how we are functioning and the conscious and unconscious constructs in use to maintain our view of ourselves, others and the world. That awareness is necessary before change can be considered and the motivation for change is engaged, or not. Changing the story we live in brings about change. “I never realized that I could do that, and it changed my life”. Discussion brought to awareness once again that all of us are shaped by schema that shape the meaning we make of what happens, or our understanding of ourselves, others,or the world. Such schemas are both conscious and unconscious and involve affect/emotion. Indeed it is a recurrent theme in this group’s discussions that the primary emotions (see Panksepp, for example, or Solms), come first and then are given cognitive description. Using Erikson’s descriptions of our developed way of relating to ourselves, others and the world, it becomes clear that the cognitive labeling of our inner world, whilst they are routinely challenged by our own mature reasoning, nonetheless are ‘lies’. Overall then, Erikson says that our perception of our position or perception with respect to each stage can and does change and thus each stage is not finished before moving on to the next but all stages are in play throughout much of our life.

Piaget however, is clear that each of his stages has to be complete before moving on is possible. What this means probably requires discussion and does seem difficult to argue at first. However, each of his four overarching stages, although they are initiated by the reflexes or ‘senses’, have as a focus, the cognitive capacities that develop from engagement in each stage. This ‘tight’ claim finds an echo in cognitive behavioral psychology where the insistence that it is the cognitions that must be addressed and corrected. Such claims are redeemed however by another of Piaget’s formulations, that of the schema which is the way in which the human being develops to hold together the learned understanding of each experience. It is widely recognised that such schemas include much more than the cognitive component. The psychological world may be said to be divided between those who believe therapy works top down or bottom up in this respect. The group were then gifted the experience of one member who had personal reason to know how Piaget’s understanding is in use today. It is a reality that for some individuals, that the senses that are at the heart of the reflex mechanisms, are not fully engaged with as the environment is explored and the ‘stage’ is not completed leaving that individual at a significant disadvantage as their development continues. We were able to see that exercises exist that enable that underdeveloped work on the early stage development responding to the reflexes or senses, to be recovered such that other aspects of an individual’s overall capacity and capability are not compromised permanently.

It was on this note that the morning finished, enriched as always by the open and trustful sharing that happens and in this instance, was an encouragement as we journey on to Christmas and gave reason to focus not on the Omicron virus but on human hope.

Erik Eriksons Stages of Human Development

Forgiveness

We explored ideas relating to forgiveness using a chapter of Desmond  Tutu’s book ‘ No Future Without Forgiveness’ and  ‘The Enright Model of Psychological Forgiveness’ as described by Philip Sutton.

The conversation ranged widely as always. We noticed how often a relationship gets stuck while the wronged person is waiting for an apology, feeling angry and often resentful. The power in the hands of the wronged person comes from the feeling of having been offended and can be strong enough to stymie the chances of a reconciliation as there are  potential  secondary gains from the victim role, for example the attention one receives for having been wronged.  It can be hard to start the process of forgiveness if the perpetrator cannot  access sufficient humility to face hearing the impact of his or her behaviour. The acts of asking for and giving forgiveness are painful and the process may take a long time. After mentally forgiving, we can be left with residual hurt and anger and persisting resentment. Even after being whole heartedly forgiven as a perpetrator , we are likely to be left with at least some guilt and it is likely to take much longer to forgive oneself. We wondered why self -forgiveness can be especially hard, and talked about the shame we feel when we have fallen short of who we want to be. There might even be a sense of being condemned to be forever not  good enough. Conversely there might be times when self- forgiveness may be a little easier, for example when compassion for ourselves comes from knowing our own brokenness and the vulnerabilities that might have lead us to hurt someone in the first place. A useful phrase to explore this in a therapy session might be ‘What was your intention?’ or ‘What would you do differently?’

Recognising how hard it is to initiate forgiveness and to hear the distress that has been caused, we could see the value of a mediator or third person to help move it forward, perhaps in the manner of a couples counsellor. This might be most needed when the people are in very close relationships for example in a family. We raised several examples of the difficulty of managing the process between parents and children when hurts and misunderstandings can become entrenched. A mediator can ask the unbiased non critical questions ( e.g. those suggested by Enrights Model)  that are unlikely to be acceptable coming from the other family member. The drama triangle was suggested as one way of exploring stuck relationships in therapy.

We touched on the idea that acceptance may sometimes be a more realistic goal than reconciliation. The victim needs to have his whole story witnessed in full and only then can he be open to the possibility of acceptance. How? Desmond Tutu would say that acceptance is possible because of ‘ubuntu’ meaning wanting good for oneself and for the other equally. ‘What diminishes you, diminishes me’. Others call it grace or beneficence. It is a quality that might be found in the work of the best therapists. Through this grace, our humanness is defined by our willingness to struggle on with the relationship after the rift

Forgiveness

Counselling Older Clients

We discussed an article published in the BACP publication, Therapy today ,May 2017, entitled “Waiting for the Southsea bus” which had as its main topic Counselling older people. The author, Helen Kewell, has since published a whole book on her work with older adults: “living well and dying well: tales of counselling older people” (PCCS Books).

She presents a positive picture of working with the elderly by valuing their stories or narratives, entering their world and finding meaning and being attentive to themes of love and loss as well as facing the challenges of change and acceptance of this- of further relevance here is a quote by Jung who wrote , when reviewing his life: “ there is no linear evolution; there is only circumambulation of the self”. Thus transitions in later life can be viewed as the self re-visited in the light of new experience.

This notion also links with the description by Erikson (1977) of the final life stage in his developmental theory as integrity versus despair. Here integrity refers more to integration and as Helen kewell  puts it: “integrating past, present and future to find acceptance of the life that has been lived” . A critique of her article was that the notion of despair was absent which rather skews the lived reality for many elderly people.

We touched on the topic of dementia and how ,as Peter eloquently described it, the scaffolding falls away that holds experience together.

We also touched on feelings of regret for the life not lived as in Robert Frost’s poem , the road not taken, and speculated briefly on the many-layered question of what would we do differently if we had our life over again.

Reference was made here to the power of metaphor and the excellent book by Murray Cox: “Mutative metaphors in psychotherapy: the aeolian mode” (1997) which explores the therapeutic possibilities inherent in metaphor and image whereby clients are enabled to tell their story and unconscious and conscious material can become integrated.

Another book was mentioned on the topic of dying and facing the challenge of being left on your own if your partner dies first – recently published by the renowned therapist Irvin Yalom: “ a matter of death and life: love, loss and what matters in the end” (2021) which follows on from his earlier work on what he terms death anxiety and the struggle involved in being at peace with your own mortality- “Staring at the sun”(2020).

As always, we had a lively and fruitful discussion of these knotty and emotional issues that face us all.

Counselling Older Clients

Masculinity

The ‘Fells & Dales’ network of accredited counsellors met on 10th Sept. to reflect on the subject of gender and particularly male-ness and masculinity.  A catalyst for our discussions was Catherine Jackson’s article entitled ‘Sometimes it’s hard to be a man’ in Therapy Today (July/August 2021, Vol. 32, Issue 6), and Chapter 8 ‘Discovering our emotional needs’ in John Gray’s classic text ‘Men are from Mars, Women are from Venus’ (Harper Collins 1992).

We shared something of our own upbringings and experiences of being expected to comply with the stereotypical societal roles assigned to men/boys and women/girls, and noted how perceptions have changed within the past generation  –  how much more accepting people generally are today, of feminine qualities in men and vice versa, and of diversity of sexuality.

We spoke of the difficulties some male clients have in accessing and naming feelings, and of the need for therapists to work with ‘what is’ but maybe to find another language that is meaningful to men, but which still enables them to contact emotion and to feel safe enough to be vulnerable.  As quoted in the TT article, ‘emotions… exist so we can connect with what we need.’  It was noted that there can be an ambivalence around men seeking counselling, in that they are often looking for solutions, or tools to ‘fix’ their problem, and yet they might need to believe that they achieved what they came for but without any help from us!  We also noted the predominance of male compared with female suicides, and the association with shame, e.g. the belief that “I’m not man enough to survive.”

We spent some time debating the sensitivities associated with pronouns, and the risks of quite unknowingly causing offence in the current ‘non-binary’ world.

For further reading: James O’Brien’s ‘How not to be wrong – The art of changing your mind’ (Penguin, 2020)

In chapter 1 O’Brien describes how he grew up with, and fully believed, ‘‘It never did me any harm” (corporal punishment etc.), until he allowed himself to ask “Or did it?!”

Masculinity

Reflection on Spirituality

The Therapeutic Process and Relationship and reflection on Spirituality (with reference to Mind and Consciousness) was a discussion led by Peter Bowes.

The paper given for reference was Exploring the God Question – a presentation made by Peter Bowes to a Grasping the Nettle audience and now available from that website.

Two diverse books, A Theory of Everything by Brian Greene, (String Theory discoverer and mathematician), and The Devil You Know by Gwen Adshead and Eileen Horne et al (a reflection on working with the minds of violent criminals that reveals profound consequences for human nature and society at large), were mentioned during discussion. The reference arose because both authors have a reference to ‘soul’ in the very last paragraph in their referenced books. The observation seemed relevant as the group grappled with finding understanding of ‘spirituality’ and its meaning for therapists and therapy.

It can surely be stated that human beings in all societies in the world seem to need a word to capture experiences common to all. ‘Soul’ appears to point to a capacity of the human mind to feel that there is part of us that seeks expression and whose meaning relates to a seeking within or without us,  a relationship to that which is somehow always beyond us. Spirituality is intended perhaps to be the envelope into which many different expressions of that capacity are located. Peter offered that his current summary definition of ‘spirituality’ was related to the capacity of consciousness that needs to make meaning. Sadly religion, with which spirituality is frequently confused, is more related to human beings attempts to define and control that experience. The orthodoxy (right teaching) that emerges seems more about the power and control which is evident in history or religions.

Group members related life changing experiences involving awe and wonder that were also found occasionally in our relationships with our clients. These are of a profound awareness, somehow known by both therapist and client, of something taking place which might also be of dimensions beyond the normal, involving awe and wonder and invoking deep emotion and usually without cognitive understanding.

A reference to our dying and the return of our atoms to the pool of particles in the Universe that sustains us, permitted a reference to the current conundrum that in each of us these particles somehow produce consciousness and the legacy of many such as Jung that there may exist a collective and even archetypal consciousness ‘out there’. Peter noted that his interest lay certainly in the metaphor of ‘soul seeking’ and how it occurs and what it implies for human beings. Is evolution a chance happening or by design is a decision that each of us might be invited to consider. Our response does matter since our values and our survival as humans depend on our answer.

As therapists, it seems we are united in holding onto high valuing of our clients and in having the motivation to seek what is best for each of them. What then comes to the fore is that as therapists we ‘see’ in each person a core that we love and respect. Furthermore we catch an awareness that this that we love is beyond, and perhaps before, reason and cognitive belief. We learn to be aware of what our most primitive emotions tell us. Sometimes we catch our bodies, our guts, speaking before our cognitive processes take over. The awe and wonder that prompts our love and glimpses of the potential of the other is surely at the core of what drives us therapists. If so, that renders that experience, potentially, as one of the highest pursuits of humanity and one which, if its values and behaviours were more widely expressed, might save our planet ….and our souls?

Reflection on Spirituality

Long Covid

This session opened with a short 5 News  documentary on long covid to start with called “What is long covid COVID 19  Ruth Liptrott” Minutes :  2:30-9:50 and we continued to explore our own experiences of long covid in those that we know and also with our clients along with the impact on us. We learnt about the research into long covid being linked to an auto immune response to the infection and raised some questions about the observations we have of clients struggling to cognitively process and remember along with fatigue.

There was an observation where conditions such as ME often have a psychological link to them where as there does not seem to be any such link with COVID.

We recognised the comment from a participant on the video who said “I’m not the person I used to be” along with the comments about feeling frightened and lost as  a result and how bereavement is a recurring feature in therapy.

We recognised the link of trauma to COVID and how the effect of trauma is held in the whole of our bodies.

We reviewed the article in Therapy Today   (Jan 2021)  “Inside the long COVID Maze” by Karen Rawden.

This article opened a discussion about the authors continuing journey with covid herself and the suggestion that “witnessing my fallibility invited my clients to see and honour their own”. The risks of over disclosing issues of self were raised and the question askes “who is this disclosure for”  led to highlighting a risk of role reversal and the client taking care of the therapist. It was recognised that self awareness is generally a private process and as therapists we take the internal moment after connecting with a congruent response to consider who benefit is disclosure for before making it.

However it was recognised that the article did accept that there may come a point to withdraw from counselling as the most appropriate and ethical response to personal COVID.

An article in the current Therapy today “Generation Covid” (May 2021)

https://www.bacp.co.uk/bacp-journals/therapy-today/2021/may-2021/the-big-issue/ on the effects of COVID 19 on children and how counselling can help looked at the question of if we are storing up distress in our children to come out another day. Children are seen as generally resiliant and if they have a supportive home environment then then are likely to do well but it was recognised that not all children benefit from this.  We looked at the recommendation in the article that counsellors should be placed in all schools with enhanced training in counselling for depression and the opposing view of this may not be necessary if enough funding and training were  to be put into teachers so that they have the time to listen would probably be more effective.

Long Covid

Anorexia – a hospital and school combined

We welcomed Ellie Curtis who works as a teacher at a hospital and school for young people with eating disorders, primarily anorexia. It was a very stimulating and lively talk from someone clearly  very thoughtful about her work. She outlined the children’s experience of being hospitalised (and usually sectioned under the mental health act), with particular emphasis on the unwelcome but crucial restraints that have to be imposed to prevent them dying  without food. We heard the disturbing lengths that these patients go to in order to avoid food and the medical interventions that have to be imposed.  The children see their anorexia as the solution to their problems and are therefore not motivated to recover. ‘No one with anorexia wants to get better’. There is a dilemma that the child is necessarily  the centre of attention of an impressive group of professionals. This makes them feel important and might be an incentive to hold on to the illness. Children are hospitalised here for at least several months and often for many years. Happily there have been no deaths at this hospital and there is a high success rate – most children eventually becoming well enough to function outside again. Leaving  is a milestone which is deliberately celebrated .

We discussed the theory that feelings are so deeply buried that the anorexia serves as a way of keeping feelings repressed. The control the patients exert over their eating ironically means that the anorexia ends up controlling them. Anorexia was described as a mental illness which manifests itself as a drawn out suicide attempt and this lead to a discussion about the ethics of preventing death in adults with anorexia .

There is no incentive to get better, anorexia to the sufferer is the answer not the problem. Although there is frequently a history of trauma, exploration of feelings  in therapy is generally unwelcome and we noted how rarely adult clients present with anorexia. Ellie’s experience is that most of the children do not engage with therapists. Touchingly she talked of the joys of breakthroughs when children begin to relate to her as a teacher.

Relationships between the children are sometimes intense and sometimes there is harsh competition to be the thinnest, the most successful at being anorexic. There is a danger that the children teach each other ingenious ways of avoiding food or burning calories, many exercise compulsively.  In terms of family dynamics, Ellie reluctantly admitted that the children in her care very often have problematic relationships with their parents, mothers in particular. Mothers have often had their own experience with anorexia. Fathers are typically left feeling helpless. She also mentioned in passing that they care for a disproportionate number of twins, hypothesising that anorexia could be an unconscious response to competition or comparison between them.

Relationships with the helping adults in the hospital are not always straightforward either. We talked about deceit which is a necessary part of being a successful anorexic. Ellie mentioned the discomfort of feeling suspicious that every positive gesture from a student is likely to be disingenuous. She was so honest about her natural feeling of wanting to be liked by her students whilst knowing that she is probably being manipulated much of the time.

Finally we heard a case study of a student with the very rare condition Pervasive Arousal Withdrawal  Syndrome (PAWS) where the child had withdrawn from all physical activity including eating, speaking, moving. In this case, the person was detached for several years before slowly reengaging.

Anorexia – a hospital and school combined

The Therapy Square

We met as the Fells and Dales group of therapists on Friday, April 9th, 2021 and the focus of our discussion was an article from “Therapy Today”, July 2020, entitled “The Therapy Square” by Anthony Prendergast. This article offers an interesting model and hence a  tool to potentially use with clients – a laminated sheet which has 4 quadrants. It  invites a client to identify and write down inhibiting emotions such as shame, guilt, fear or anxiety and the inhibiting messages conveyed by these feelings. It also includes “Human potential” which Prendergast believes we are born with but then , due to social conditioning (including internalised messages from parents), we “end up in blocked potential”. The goal of therapy is then to help us “get back to our full human potential”.

The author digresses to examine Malan’s triangle of conflict with the hypothesis of a Defence existing in reaction to Anxiety which is rooted in Hidden feelings which then need to be made conscious and worked through psychodynamically. Prendergast’s model adds 2 new concepts: the concept of Injunctions leading to inhibiting messages. He states that “Inhibiting messages are the crucial missing element driving internal conflict because without such messages there would be no inhibiting emotion to enforce it and , as a result, no blocked potential, internal conflict or transference”.

In the ensuing discussion, we gave clinical examples from clients of evidence of blocked potential and inhibiting messages and felt these were useful concepts to encapsulate some issues that clients bring.

An interesting image was discussed by one of us, who had worked with a client with autism, of a tree with many leaves- this arose when the therapist spoke to the client about the trunk of the tree as a kind of solid central core and the client said he could not relate to this since, for him, all parts of the tree had equal weight and importance and he couldn’t differentiate between them. We all felt this was a useful piece of learning in shedding light on the different ways our minds work and process information and feelings.

We all felt that it was valuable to know about different models of counselling and to ask ourselves “ Do I understand the model and how do I apply it?”. There was, however, a cautionary note about using a model with a client in the sense that it would be more likely to be effective and appropriate if the presentation of a model by the therapist arose spontaneously in the course of a session. For example, one of us recalled a colleague presenting a client who had suffered from trauma with a drawing done there and then of the window of tolerance and how this had worked well.

We also discussed how we might use transference in a session and whether it is effective to directly name it in the here-and-now with the client by looking at the relationship between you both.

Reference was made here to Malan’s 2 triangles which explore transference and counter-transference and the unconscious dynamics involved. Some of us felt that raising this question could be confusing or alienating for the client and needed to be handled sensitively if at all.

All in all, it was a stimulating and enriching meeting as is usually the case.

Rosemary Pitt

The Therapy Square

Where Do Ethics Come From?

The fells & Dales group of counsellors/psychotherapists met on 12th March, when we considered the questions, “Where do ethics come from? What give us our sense of right and wrong?”

The pre-reading was Ch 6 ‘Working ethically as a counsellor or psychotherapist’ in Peter Jenkins:  ‘Professional Practice in Counselling & Psychotherapy’ and the paper ‘What is Ethics?’- BBC Ethics Guide 2014

We  began by each of us sharing where our own sense of ‘right and wrong’ came from. Ideas included our parents, siblings, extended family, religious faith, the 10 Commandments and social mores.  We debated the extent to which ‘ethics’ are innate/hereditary or acquired, how they are learned through observation of others, and how they have evolved over time.  We noted the strong sense of (in)justice that even young children can experience.  It was pointed out that ethical values are socially construed, meaning some could develop in different ways in different cultures, while others might be universally understood and applied.  We spoke of resistance to externally imposed regulations (“rules are to be broken!”).

We considered the BACP Ethical Framework based on ethical principles, and noted the significance of it having moved away from the previous Code of Conduct with its lists of rules (especially what not to do).  A number of ethical issues arising from present-day circumstances were tackled, e.g. what to do if a client refuses to be vaccinated, or if a client discloses that they are infected but not self-isolating?

We also raised the issue of ‘mistakes’ in therapy, the duty of candour, and the differing possible interpretations of having ‘got it wrong’.  The conclusion we reached was the importance of having a rationale with which to justify and account for our decisions, and if our practice is ever scrutinised, hoping we would be judged by those with similar standards to our own!

Where Do Ethics Come From?

The Brain and the Inner World

Peter had made available Chapter 9 of The Brain and the Inner World by Marc Solms, Karnac Books, 2002, which focuses on ‘neuroscience and the talking cure’. The chapter summarised a little of the current knowledge of the Self, and how the Mind works; the understanding of awareness and consciousness with reference to the internal and external world. Solms reviewed current understanding (from Jaak Panksepp in particular) of basic primary instinctive emotions and the manner in which self-object relationships are encoded in the brain both for the automatic responses necessary for survival. This activity is at first unconscious. Then memory of interaction with objects experienced as ‘good’ and ‘bad’ are laid down in memory systems which in turn act unconsciously on further experience of the world of objects. This sounds like a more or less passive mechanism.
However, there is a difference between the inner and the outer perspectives of the mind which is experienced as having an active agency which is synonymous with the sense of self we all have perceived, of course, subjectively. This SELF (the capitals are used by Panksepp to denote emotional and primary instinct different from our conscious acknowledgment of an emotion) guides action on the basis of evaluation without however free will at first.
“Free will” is understood from a neuroscience perspective as the capacity of the prefontlal lobes to inhibit what is otherwise what Freud called “repetition compulsion” of triggered motor programmes. And this ‘choice’  and “agency”is regarded as being at the core of our humanity as homo sapiens. The developed potential for delay in “motor responses” is thus in the interests of “thinking”. This capacity develops early and is heavily dependent on child life experience of what parents do and what parents say.Critical to this process is the language which becomes “inner speech” whereby as Solms says, prohibitions for example become inhibitions which is one of the processes by which humans develop their pathology whereby ‘”knowing is dissociated from doing, a diminution of the ability to regulate behaviour verbally. 
The “talking cure” which Freud described as strengthening the “ego” meant extending the sphere of influence of the “ego” over the “id”. but he abandoned his early distinction between the conscious and unconscious parts of the mind and saw also the core capacity of the ego was for “inhibition”. Thus repression is an unconstrained primary process and the inhibitory constraints a secondary one. The aim of the talking therapy is to bring to bear on the repressed inhibitory constraints of this secondary process and bring them “under the flexible control of the ego/SELF/free will.
So, anything which is not under the control of the prefrontal lobes is ‘repressed. Talking therapy aims to  extend that sphere of influence. To do so it uses language which is the means by which, at a higher level abstract connections between perception and memory are ‘named,’ and allow then behaviour to be subordinated  to “programs of activity”.  But, teasingly, Solsm suggests that we ‘know’ that  such internalised and unconscious connections are ‘rekindled’ by transference in the therapeutic relationship being that which is repressed to consciousness.  But, he says, of this “we know virtually nothing! So Solms avoids adroitly false claims for the “talking cure”
Discussion properly focused on the experience of clients observed and felt by members of the group. We were able to contrast approaches along the spectrum from cognitive and analytical to person centred, directive to non-directive. The value of full body relaxation experience for noting the existence of emotions and their location in the body was appreciated. This would appear to be a process of allowing something of the unconscious connections and control to be acknowledged and, if named, then able to be within conscious reach allowing some aspect of the executive function of the prefrontal lobes to allow ‘space’ for alternate behaviour.
The value of transitional objects in childhood was recognised, but the relationship of this phenomena to an adult life encounter with a therapist required thought. The teddy bear may be torn apart but the desire to do that to the therapist is perhaps unlikely to be owned unless named by the therapist?
A number of the group ‘have to’ work short term with clients and the application of the processes of the ‘talking cure’ needed elaboration and exploration. Working intensely to establish a therapeutic alliance that acknowledged the power of relationship to effect awareness and potential change, might be one response. Attending carefully to the client’s understanding of the goal of being in therapy might be another. 
Perhaps learning from neuroscience about brain processes and what is unconscious and what is consciousness might help therapists to use deliberately the value of the human relationship for ameliorative change. The current stage of neuroscience awareness has yet to be able to define and understand “consciousness’ so therapists’ experience now is vital information for future understanding of what brings about change therapeutically. 

The Brain and the Inner World