Compassion Focussed Therapy

Our discussion at our November meeting was centred around Compassion Focussed Therapy. We looked at a handout produced by positive psychology (available on their website, positivepsychology.com) entitled  “16 Compassion Focussed Therapy Training Exercises and Worksheets”. Compassion Therapy was developed by Dr Paul Gilbert, a psychologist who believed that compassion, both self and other-focussed, could be the key to relieving intrusive negative feelings of shame and self-criticism. He is also the author of “The Compassionate Mind”, Constable, 2009 where he outlines his theories at length.

We all found the exercises on the hand-out interesting and relevant and agreed that one particular exercise stood out. This was the idea of creating “your ideal caring, compassionate image” and then fleshing out in detail how this image would feel and look and how it would operate in the world- we saw this as of value to ourselves as therapists and potentially to use with clients, especially those with low self-worth.

We had varying views on the usefulness of other exercises such as having a “safe” colour to use as well as an imaginary safe space to retreat to in our minds  when anxious or threatened.

Some quotations to reflect on and states of mind to aspire to

‘’Ships don’t sink because of the water around them; ships sink because of the water that gets in them. Don’t let what’s happening around you get inside you and weigh you down”

“The things that have happened to you in your life are not your fault, but it is your responsibility to alleviate your suffering”

“Compassion is about choosing to be the best version of you that you can be”

 

(from suicide awareness/prevention)

Compassion Focussed Therapy

Imperfection

The Fells & Dales network of accredited counsellors met this morning to discuss the subject of ‘Imperfection’, prompted by extracts from Brené Brown’s book ‘The Gifts of Imperfection  –  let go of who you think you’re supposed to be and embrace who you are’ (Hazelden Pubishing, 2010).

 

Carl Rogers’ concept of the ‘fully functioning person’ was seen to be aspirational, compared with the ‘wounded healer’ or the flawed therapist, which seem much closer to home!  We acknowledged what a relief it is for us, and our clients, when we stop striving or pretending to be perfect, and embrace the whole of us as we are, warts and all.  And how unhelpful it might well be for our clients if they perceive us as being perfect, ‘sorted’, the expert, the one with all the answers.  Far better to model imperfection but also courage, tenacity, faithfulness and compassion.  We liked Brené Brown’s self-description as ‘a recovering perfectionist and an aspiring good-enoughist’!

 

We discussed the inevitability, and maybe necessity, of clients being disappointed in us, and letting them down, as they discover that we don’t have the power to ‘make it all better’, and yet that doesn’t mean we have nothing to offer.  We were reminded of the hope that we hold, and our faith in the process and in the power of relationship, within which clients can feel safe and held whilst we accompany them through what might feel like turbulent waters.  Such a committed, reparative relationship might be experienced like no other.

 

We readily called to mind some of the mistakes we have made in the past, and how hard it is to forgive ourselves, especially where there have been serious consequences.  When harm has inadvertently been caused, a most helpful and compassionate response was suggested, namely “That wasn’t my intention”.

 

I close with the words from Leonard Cohen’s ‘Anthem’: There’s a crack in everything, that’s how the light gets in.

 

and this image of the ‘Kintsugi’  –  the Japanese art of repairing broken pottery with gold.

kintsugi

Imperfection

Longing, Seeking, Yearning

Peter spoke to the material he had provided for the meeting. This was chapter two and three from Longing: Psychoanalytic Musings on Desire. Jean Petrucelli ed., published by Karnac in 2006.

 

Chapter 3: Secrets of analytic love and the transformation of desire; PollyYoung -Eisendrath

Chapter 2: “It never entered my mind”; some reflections on desire, dissociation and dislosure. Philip M. Blomberg

The focus was the former chapter 2.

 

The group found a way into the essence of what the author might have meant by ‘analytic love’. That essence emerged firstly out of our sharing our work with clients and our personal experience of disappointment because of our desire for them and for ourselves. We explored therefore the ways in which we seek to ‘move’ from our own inner disturbances to be with the client in theirs.

 

We ‘knew’ the author was on to something exquisitively real when we were able to name that disappointment and both parties then found themselves experiencing a deeply felt release, physically and emotionally and psychologically.

 

We understand, of course, that our ways of defending ourselves from shame, or anger, or disappointment or being a disappointment, were formed in our beings during early life attachment experience. We eventually found the image of parent and infant seeking and finding each other’s gaze put us in touch with what we need (desire) and the pain of loss when that ‘gaze’ and its correlates were not there. Hopefully that allows us to attune to the clients inner world a little better – to be ‘good enough parents’ for ameliorated psychotherapy to be effective. What we were in touch with here collectively was that we experienced ourselves the physical disturbance in our bodies that told us we were speaking of something true about human experience. No wonder then that we acknowledge the poverty of our capacity to do this in life outside of the consulting room.

 

The author used language of Einsteinian quantum theory to try to say something that was true and real about being human. Quantum theory we think, says that the object (subatomic particle) changes by being observed. Indeed it might also be exists only when it is observed. Could it be than that the human organism needs to be observed in order to grow, develop, be more fully human? If this is the case, then person centredness providing it was love not desire, is in itself healing for the other. Perhaps this is what the author was meaning when speaking of ‘analytic love’?

 

The members shared the disappointment felt when we know we are able to focus on the other when in a group or social situation, yet we share the experience and the pain that very selfdom does anyone seem to be able to do that for us. And that can be painful.

 

So, the book’s subject of ‘longing’ directed us to wonder about the hope that appears to be within us that as homo sapiens, our best development would come from paying attention to the other and attempting that empathic connection (even though it might not be reciprocated) and yet we ‘know’that such relationships would save our society and our world.(The academic questions here are about the choice between a belief that it is our neurobiological inheritance which, in order to survive, moved towards empathic connection. One wonders if the universal need in human beings to have a language for that which we call spiritual experience, might direct us to concept of creation and an creator for which homo sapiens uses the metaphor of ‘soul’ to describe)

 

Perhaps we can console ourselves with the realisation that we can express love, as analytic love, where we have the opportunity. With that awareness there is a hope of a changing world which must suffice as motivation for living, coupled with the belief that the loving gaze and attention of another is the way in which we grow and keep our emotional balance in the world.

 

In this we hope. And could continue to survive?

 

Longing, Seeking, Yearning

Brief Therapy With Couples

 

Brief Therapy with Couples – An integrative approach. Maria Gilbert and Diana Shmukler 2001

Today our group reviewed the chapters on Working through issues of compatibility  of value systems and Frames of reference (Ch6) and working through the issues relating to caring for the other (Ch 9) of Gilbert and Shmuklers book on couples therapy. We had an early observation that many of the issues of diversity we were to look at today could equally apply to the individual therapeutic relationship.

We opened with the quote “Frames of reference are influenced and contributed to by each persons personal and historical background which shapes an individual’s values”  and beliefs are usually implicit rather than explicitly stated. This is seen as to be viewed holistically as therapy continues and not necessarily a focus early on and the therapeutic dynamic is established.

We touched on how frames of reference can be learned by interpreting early exercises such as each client listing what is wrong in the relationship and what would they want the relationship to look like and these thoughts being shared only in session so that responses can be appropriately held.

We looked then at how to work with the early “life story” of the first partner and if the other partner  is invited to respond or present their “life story” and then negotiate what is within their frame of reference to work on.

We looked at the notion of clients often feeling “sent” to therapy by their partner and one usually being more enthusiastic for therapy than the other ensuring that the process is an inclusive autonomous process.

In reviewing the chapter on frames of reference we looked at individual examples of understanding and working with diversity in the relationship including , Gender, culture, class, religion, race, education, socio economic status of each and familial expectations of being involved in decision making for the couple. We also looked at gender role scripting and managing the differing expectations of some  same sex relationships.

We reviewed various skills exercises that sometimes arise within couples therapy such as using emotionally mature language like using I instead of U in exchanges and the importance of the therapist modelling the same.  Also encouraging the other to express the effects on them of their partners non verbal communication such as finger pointing and other body language.

We looked at the issue of intimacy and differing approaches of being directive contracting to avoid intimacy or negotiation about if abstinence would help or not and acknowledging difference in the room of approaches here.

A strong consensus was of the therapeutic space being an intuitive one with responding in the moment to what comes up and not worrying too much about having an instrumental approach. We also looked at managing the time, endings and top up sessions being requested by some clients.

In looking at the chapter on caring we considered the contribution of transactional analysis to conceptualising the parenting and nurturing concepts within relationships and finding balance of each partner adopting the role along with the risks on stagnation and stuckness within that dynamic.

We looked at how reviewing the subject of working with client differing frame of reference yet again encourages us to look at our own relationships in  renewed light.

Brief Therapy With Couples

When Therapists Cry

 

At today’s meeting we used several chapters of Amy Blume-Marcovici’s  book ‘When Therapists Cry’ as a stimulus for this complex topic.

We noted that crying is a spectrum of visible emotion from glistening eyes to sobbing. Most therapists have experienced occasional tears in their work, yet it is surprisingly difficult to know exactly what they signify. The book had three helpful categories – empathic tears, care givers tears and proud parent tears. The suggestion is that each type arouses the therapist’s attachment system. Tears resulting from feeling touched by the client’s humanity and therefore deeply connected sat more easily with us than tears coming from a therapists own losses or feeling of being overwhelmed.

A psychodynamic concern is that the therapist should avoid interactions that gratify the client’s emotional needs. One possibility is that the therapist cries as an unintentional reaction in response to the client’s transferences. The client is unconsciously triggering the therapist to feel and respond in ways that are in line with the client’s hopes or fears. This is called enactment – the therapist’s inadvertent actualization of the client’s fears or fantasies.  Enactment might be viewed positively – evidence of an authentic emotionally alive experience, or it might be viewed negatively as a sign that the therapist cannot contain him/herself and is therefore not safe. We were intrigued at the reference to a paper by Slochower  postulating that tears are ‘one of the quiet disengagements we make by temporarily and secretly withdrawing our attention away from clients’

Since tears are autonomic, the question arose – can they be controlled? And if so, should they be controlled? There may be no willful control possible.  We discussed the difference between crying gently at the same time as a client versus the therapist crying while the client is dry eyed. This lead to a discussion about how we give the client the opportunity to explore how he/she experienced the therapists tears .

The last sub topic was tears in therapy with men. We all felt that men generally find it harder to cry but that when they do cry, it is often a dramatic a release, possibly because they have been constrained from crying for so long. It seemed important to realise that a bigger volume of tears is not an indicator of more distress.

We recognised the importance of being able to explore our tears (and our clients’ reactions to them) with our supervisors. Since tears are spontaneous and unplanned, they can only be reviewed retrospectively. We don’t have a choice about when we cry, but we can think about what the tears signify and how we might use them in the therapeutic setting.

When Therapists Cry

Schema Therapy

The fells and dales group met on Friday, 17/9/19 to discuss a paper on schema therapy which was published in the BACP journal, therapy today in March this year entitled “Attachment is key” by Dan Rivers. The article states that “ we all have schemas” and, similar to the notion of “drivers” in transactional analysis, these are imprinted from an early age.They are identified by the client filling in a questionnaire. Rivers suggests that there are 18 early maladaptive schemas and that these influence us for good or ill but mostly ill until recognised and worked through in a positive therapeutic relationship. The list is well worth perusing and reflecting on- the one that linked particularly for me with recent clinical work was “abandonment or instability “ when you fear constantly that relationships will end. Most point to low self- worth as the main underlying issue. Another useful one was “Defectiveness/ Shame” when the client feels a failure and has strong self- critical beliefs possibly stemming from harshly critical parents or failing at school perhaps due in part to being dyslexic – whatever the cause, we felt that these categories were a helpful way of conceptualising and making sense of distress while also being wary of pigeonholing or over- simplifying what  the client is bringing. They could also be a useful mirror or prism for reviewing and re- evaluating our own experience.
We liked Rivers’ emphasis on an integrative approach which acknowledges the value of different ways of working including object relations and attachment -he states that schema therapy is essentially a mixture of CBT, gestalt and psychodynamic theories and originated in the mid 1980’s in the work of Jeffrey Young who was an associate of Aaron Beck, the founder of cognitive therapy.
Our meeting then mainly focussed on an exploration of the power dynamic in therapy including transference and how the counsellor accepts and views their authority and/or are uncomfortable with this to the extent of denying and being blind to their own effectiveness when they have achieved “good” work with a client who has a positive outcome- an example given was a possible tendency( which most of us owned and recognised) to say to a client at the end of the work together that they, the client, had “ done most of the hard work” so avoiding/ denying our own positive input! We then discussed why this might be, stemming from our own childhood experience and conditioning.
Schema Therapy

Is It Possible to be Authentic

The ‘Fells & Dales’ group of counsellors met on 12th April, to reflect on the subject of ‘Authenticity’.  The paper for discussion was entitled ‘Authenticity: A Goal For Therapy?’ by Miriam Donaghy (Practical Philosophy Autumn 2002).  We also listened to a recent broadcast of Radio 4’s ‘In Our Time’  –  a panel discussion chaired by Melvyn Bragg on the theme of ‘Authenticity.

We had a wide-ranging conversation about the meaning of authenticity, as generally understood but also as applied particularly to the work of therapy.  It is, perhaps, a given that as therapists we aim to model authenticity, our hope being that our clients might also discover a way of living authentically.  However, we asked ourselves what being “true to oneself” actually means, and how it relates to other concepts such as congruence, transparency, integrity, honesty, genuineness and autonomy (the latter meaning literally ‘giving oneself the law’).  We noted how helpful clients might find our occasional self-disclosures (judiciously used), and how authenticity might mean revealing our humanness and our fallibility.

A concern was raised over the possibility of authenticity leading to narcissism, self-centredness or isolation (“I’m OK, never mind anyone else”), but this was countered by the notion that self-acceptance and self-awareness tend to result in both greater acceptance of others, and an ability to receive others’ acceptance, and an enhanced capacity for empathy.

We concluded, as we often do, that it is a great privilege to draw alongside our clients for part of their journey towards authenticity.  However, we acknowledged that authenticity is an ideal, rarely achieved and only sustainable for brief spells.  For some, the cost of being fully authentic might be too great, if it puts relationships with significant others at risk.  But at least there could be something ‘authentic’ about recognising and perhaps finding a place for whatever inauthenticity is within us.

Is It Possible to be Authentic