The ‘Fells & Dales’ group of counsellors in Cumbria/North Lancs met for our monthly meeting today, 9th December, and a new member was welcomed to the group. We discussed two chapters in Sheldon Kopp’s book ‘If you meet the Buddha on the road, kill him!’
Sheldon Kopp wrote, ‘A grown-up can be no man’s disciple’, and ‘The most important things that each man must learn no one can teach him.’ Our discussions began with considering the extent to which we, as counsellors, have an ‘expertise’ to offer our clients. We may claim to be non-directive, to have no agenda, to seek to empower the client rather than exerting any power of our own, and yet what is it that clients come to us for? Are they not needing help and expecting a service, which we have been trained, qualified and experienced in providing? How to we steer a middle course between counsellor over- and under-involvement?
We agreed that there is a valid place for psycho-education, and that we are more than merely observers or witnesses of the client’s process, but in fact play an instrumental part in that process ourselves. On the other hand, we want to disabuse clients of the myth that there’s an answer/solution ‘out there’ somewhere, waiting to be grasped – a fixed end-point, and that all will be well if only we can reach it. Perhaps the best that we can offer is to accompany the client as closely as possible on their journey, tolerating the ‘stuckness’ and the not-knowing, despite being made to feel useless and inadequate in the process, rather than trying to (mis)lead them to a non-existent destination.
We met in October to listen to and discuss two pieces of recorded client work.
The first piece prompted discussion about the effects of apparent knowingness or certainty in the therapist. While therapist confidence might reassure some clients, we saw how it could also block the client’s process. We were particularly interested in the extent to which mis-communications between client and therapist were exacerbated when the therapist is insufficiently tentative . This style in the therapist seems to intrude in the development of a mutually understandable language and increases the risk that each person attributes his own meanings. In the extreme , the client is lost and confused.
The second recording provoked a lively discussion about possible ways of responding to the erotic transference, in particular when a client falls in love with the therapist. The main question to emerge was ‘at what point should it be made known that there can be no romantic future.’ One opinion is that this information should be held back to allow the client to express as much about the loving feelings as he would wish. This approach risks inflating the client’s unrealistic fantasy but allows full expression of the client’s experience. An alternative view was that it is kinder and clearer to make an early intervention to explain that there can be no romantic attachment but the therapist is respectfully interested in hearing more. This might stiffle the clients ability to say fully what he wanted to say, but has the merit of clarity. It seemed to hinge on the extent to which the therapist can convey a quiet steady openness to the subject and the extent to which client is able to continue to explore his feelings in the face of a felt rejection. We were acutely aware of the effort required by the therapist to manage her own powerful feelings in response to a declaration like this from the client.
How do we use dreams?
In our September meeting, we explored the transference that occurs between therapist and client which, put simply, involves the client projecting onto the therapist feelings about significant figures in their own past. The therapist’s counter-transference is their response to those feelings and can be a useful tool in the therapy.
The article we read was entitled: “Mapping the landscape: Levels of transference Interpretation” by Priscilla Roth from the international journal of psychoanalysis, 82:533-543, 2001
The article looked at transference in a deeper and more complex way and defined four different levels of transference which may be used in the psycho-analytic process and which are considered key to that way of working. These levels were summarized at the beginning of the article as ranging from:
“ interpretations that point to links between current events in the analysis and events from the patient’s history, through interpretations that link events in the patient’s external life to the patient’s often unconscious phantasies about the analyst and the analysis, to interpretations that focus on the use of the analyst and the analytic situation to enact unconscious phantasy configurations, sometimes pulling the analyst into the enactment”.
We grappled to understand these concepts and how they would operate, in particular the phantasy “configurations”. a It was helpful that four consecutive sessions of the analysis of a client were presented and demonstrated how the level of interpretation could shift as the level of understanding on the part of both analyst and patient deepened also.
We did, however, have some reservations. We questioned whether the analyst was always such a central figure for the client but could at times be more tangential without this being a form of defensiveness on the part of the client/patient!
We also prefer the more person-centred notion that it is preferable for the client to make sense of their experience
before the therapist offers an interpretation. We had some distrust of the certainty shown by the analyst in the way interpretations are stated and given to the client almost as fact while respecting that this method is based on extensive training and clearly can be effective with long-term clients
who are being seen three, four or five times a week.
The article also contained a fascinating analysis of a dream which was seen as an integral part of the therapeutic process and did yield some rich material.
That led to a brief discussion of how we all work with client’s dreams in different ways, two of us liking the gestalt notion of each part of a dream representing something about the client.
As always, we had a useful sharing of views and support for each other.
Rosemary Pitt, Fells and Dales Counsellors
This month the group came having read a chapter from Isabel Clarke’s Psychosis and Spirituality, published by Wiley-Blackwell in 2010.
The chapter was entitled ‘Transformative Crisis ‘ written by Caroline Brett.
This theme came about from the recognition that clients who present with a diagnosis given by a psychiatrist, for example, can bring also the fear that they are ill, and a reluctance to engage in ameliorative therapy for fear of the return of former symptoms.
We recognised that therapists are more familiar than some other mental health practitioners with comparisons of spiritual crisis or transforming experiences with those attributed to mental illnesses, and we wondered about the similarities with those who do not make a meaning of their experience in this way. The latter however, can be helped to think of their previous distress in different paradigms. We shared evidence from our own practices.
Familiarity with the ‘window of tolerance’ could invite awareness that hyper-arousal of the autonomic nervous system can be alarming but is in truth the human mind-body protecting that individual from intolerable stress. Managing stress differently means that that arousal will not re-occur and medication may not be appropriate. Awareness of different ego-states and dissociative identity disorders, and the way in which dissociated ego states come into existence often, albeit mistakenly, to protect another part of that person, can become the insight that brings about the integration of those separate parts which have led to extravagant and diagnosable behaviours.
Some therapists in private practice, and this was true our group, can be a little nervous because they are aware of the presence in the consulting room of ‘white coated’ mental health practitioners who have given their client a DSM category and treated them according to current NICE guidelines. Having the courage to explore alternative paradigms to make meaning of the client’s experience is what we do in therapy and such an approach anticipates what therapeutic experience has shown, namely that clients do reinterpret their experience given the constructs they need in order to do so and no longer think of themselves as mentally ill.
One of our number was fortunate enough to be offered supervision from members of a mental health team in a frontline psychiatric hospital. Encouragement was gratefully received when it was noted that the team concerned was asking the same questions about the meaning of mental illnesses. That team is using EMDR therapy with those formerly labelled psychotic and schizophrenic patients and indeed looking at the role of anti-psychotic drugs. The changes in perception encouraged by emerging neuro-biological research is evident. The challenge to all therapists must be therefore to try to keep up to date with that research. A significant challenge.
A useful reference work is that by Paul William Miller, EMDR Therapy for Schizophrenia and other psychoses, published in 2016 by Springer Publishing Company.
The value of supervisory processes taking place across the divide between private and institutional practice is recognised therefore within the group and should be promoted.
Our ‘Fells & Dales’ network of local counsellors met today, 1st July, the first day that the new BACP Ethical Framework for the Counselling Professions comes into effect. We looked at what was new in the revised Ethical Framework, such as the ‘Commitment to clients’ with its clear emphasis on the client as our primary concern; accountability and candour and what they might mean in practice (what might ‘anything that has gone wrong’ mean? Are not perceived ‘mistakes’, disappointments, therapeutic ruptures all grist to the mill?); and the increased responsibilities of supervisors, for example the application of the law, where the weight of responsibility lies, and the requirement to review the Ethical Framework regularly with supervisees.
The chosen paper for discussion today was Chapter 3 ‘Building a Collaborative Therapeutic Relationship’ from ‘Pluralistic Counselling & Psychotherapy’ by Mick Cooper and John McLeod (Sage 2011). We pondered the invitation to be more explicit in our negotiation with clients around the goals, tasks and methods of counselling, as advocated by Cooper and McLeod, but expressed some doubt about how ‘experienced’ in therapy we might reasonably expect our clients to be. They may well not know what they can expect from their therapist, or what might be achievable goals, or what range of tasks/methods might be available. The frequent session-by-session use of the ‘Therapy Personalisation Form’ is also questionable, and assumes that the therapist is able/willing to accommodate the client’s requests, e.g. to set homework, to be more humorous, etc. Some clients might be deeply interested in ‘metacommunication’ about the process of therapy, whilst to others this would be of no concern. It could be the case that some clients would find it more convenient to be talking about the process than actually engaging in it! ‘Collaboration’ with the client’s expressed goals/tasks/methods could, in fact, mean ‘collusion’ with possible avoidance of painful material.
The chapter certainly got us thinking about what we offer to our clients, and how clearly we communicate that, how we might elicit honest feedback (both positive and negative), and how we can share with clients the responsibility for the therapeutic process.
The most recent meeting of Fells and Dales Counsellors explored Grandiose Narcissism as an adaptation in response to an early lack of empathy. Kohut’s Self Psychology Model was used as an initial stimulus to the debate.
It was noteworthy that people with narcissistic traits present for therapy relatively rarely. However, a good proportion of clients in therapy are the children of narcissists.
We used professional and personal experience to think and talk about the particular challenges of working with people who relate in this way. We recognised that we are best serving these clients when we can meet the vulnerable parts of the individual. These parts might have low self esteem or feel shame and inadequacy , or be interpersonally isolated. The therapeutic challenge is to access this suffering through the thicket of a complex defence mechanism. When defences include a sense of entitlement, grandiosity or bravado, and an extreme sensitivity to criticism, the work is delicate.
For our May meeting of Fells and Dales counsellors, we explored the relationship between twins, and in particular to what extent the twin bond is “special”. We read a research article by Tancredy and Fraley on ” The nature of Adult Twin relationships: an attachment-theoretical perspective” from the Journal of Personality and Social Psychology,2006, vol.90,no1,78-93.
The article defined the main characteristic of attachment relationships as comprising proximity seeking, separation distress, and the use of one another as a secure haven and safe base. Twins were then measured against non-twins to assess whether twins used each other as attachment figures rather than mother in the first instance and then siblings or other key figures.
An interesting finding was that twins do not fully acknowledge the presence of their co-twin until the end of the separation-individuation process at around 36 months so until then are more focused on the mother to meet their needs. However, for identical twins who share the womb space, there can be ” an embodied sense of the other” which creates a lasting attachment greater than that between fraternal twins or non-twins.
We then discussed the relevance of these findings for the therapeutic relationship and the extent of sibling rivalry between twins.