The Counsellor’s Workbook
Second Edition
Second Edition
The Counsellor’s Workbook Developing a Personal Approach
John McLeod
Open University Press McGraw-Hill Education McGraw-Hill House Shoppenhangers Road Maidenhead Berkshire England SL6 2QL email:
[email protected] world wide web: www.openup.co.uk and Two Penn Plaza, New York, NY 10121-2289, USA
First published 2010 Copyright © John McLeod 2010 All rights reserved. Except for the quotation of short passages for the purpose of criticism and review, no part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher or a licence from the Copyright Licensing Agency Limited. Details of such licences (for reprographic reproduction) may be obtained from the Copyright Licensing Agency Ltd of Saffron House, 6–10 Kirby Street, London EC1N 8TS. A catalogue record of this book is available from the British Library ISBN-13: 978-0-33-522871-3 ISBN-10: 0335228712 Library of Congress Cataloging-in-Publication Data CIP data applied for Typeset by RefineCatch Limited, Bungay, Suffolk Printed in the UK by Bell and Bain Ltd, Glasgow Fictitious names of companies, products, people, characters and/or data that may be used herein (in case studies or in examples) are not intended to represent any real individual, company, product or event.
Dedication For Julia
Contents
Acknowledgements
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How to use this Workbook
1
Introduction Learning to offer a therapeutic relationship Using the Workbook Some practical suggestions Working alone and with others Taking responsibility and taking care of yourself Building a portfolio of experiences and reflections The basic assumptions informing the design of this Workbook Notes for tutors
3 3 5 5 6 7 7 9 10
Section 1 Building on life experience: the foundations of a personal approach
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Introduction Writing your autobiography: getting started Keeping a personal journal The story of a helping relationship The origins and development of your interest in therapy Your favourite story The self puzzle Thickening your autobiography: early memories An inquiry into sexuality Your personal experience of therapy What you bring to counselling Exploring cultural identity Feeling really understood Mapping your relationship patterns Engaging with difference How do you cope with crisis in your own life? The experience of changing your own behaviour The role of therapy in your life story Knowing how your emotions are organized What is your psychopathology? How relevant is spirituality? How do you cope under pressure? Do you have a preferred learning style? What motivates you? Reflecting on the experience of writing about yourself
15 17 18 19 20 21 23 24 25 26 27 29 31 33 34 36 37 38 40 42 43 44 45 47 48
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Section 2 Being a member of a learning group: working together to develop self-awareness
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Introduction Exploring your feelings, fantasies and expectations about the group Using the group to experiment with new ways of relating to others Making connections and being responsive to others First impressions of group members Talking about yourself in the group Reflecting on significant events in the group Endings: reflecting on the life of the group A brief introduction to concepts of group dynamics
53 55 56 57 59 61 62 64 66
Section 3
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Making sense: constructing a framework for understanding
Introduction What are the key theoretical ideas that you use? What is your relationship with theory? Identifying different levels of theorizing Meta-theories: how do they shape the way you think about counselling? Applying theory: making sense of personal experience Empathy: a key concept in counselling Making sense of self How theory is applied in practice: key cases Applying cognitive–behavioural concepts Irrational beliefs and dysfunctional self-talk Developing a cognitive–behavioural case formulation Congruence: the use of self in counselling Experiencing authenticity The balance between problems and solutions Specific techniques or common factors Positioning your practice in relation to social and political factors The idea of the unconscious What brings about change? The relative importance of cognition and emotion Behind the theory: the life of the theorist The cultural context of understanding What kind of therapeutic relationship? Dialogue between theorists Are you postmodern? Letter to a theorist The concept of transference
73 75 76 77 79 81 83 85 87 88 90 91 92 94 96 98 100 101 103 105 107 108 110 112 114 115
Section 4
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Putting theory to use: thinking about cases
Introduction Student counselling: the case of Ms B A client’s opening statement Cynthia: making life choices The case of Glenys – first session The case of Glenys – later sessions ‘I hear these voices telling me what to do’ A case of work stress
119 120 122 124 126 128 130 132
Contents
Thelma: a victim of therapist boundary violation Geoffrey: deconstructing demons The case of Mrs Y Charles: therapy as a ‘last resort’ The case of Ida Anna: moving on in life Case scenarios for working with emotions David: tackling self-blame
133 135 137 139 141 143 145 146
Section 5 Reflecting on practice: challenges and possibilities within the therapeutic relationship
149
Introduction Exploring moral values The implications of your moral values for your approach as a counsellor What is your personal philosophy? Moral dilemmas presented by clients Ethical decision-making Deconstructing the meaning of confidentiality Creating and maintaining a therapeutic relationship with a client Expanding your relational responsiveness Touching and being touched Making sense of stories Working therapeutically with metaphors Responding to client interest in dreams The meaning of boundary What does ‘counselling’ mean to people in your community? Writing letters The therapeutic use of reading Using Internet resources to support therapy Counselling in the media Online counselling Indoors or outdoors? Using nature in therapy How to be really ineffective Working with clients who are difficult or challenging
151 152 154 155 157 159 161 162 163 165 167 169 171 172 173 174 176 178 179 180 181 183 185
Section 6
187
Developing a professional identity: putting it all together
Introduction Reviewing your skills and qualities as therapist Images of therapy What are you aiming to achieve as a therapist?: selecting criteria for evaluating your effectiveness What’s in your toolbox? Marketing yourself as a counsellor: your one-minute intro Are you a counsellor or psychotherapist? Your therapy room Building an effective support network Your position in relation to research and inquiry What does it mean to be ‘personal’?: some questions from Carl Rogers Ten years from now Critical issues for counselling and psychotherapy
189 190 191 192 194 196 197 199 200 202 203 204 205
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Internet resources and further reading
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Appendix A: A narrative approach to personal and professional development in counselling/psychotherapy training
209
References
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Index
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Acknowledgements
This Workbook is the product of many years of teaching on counselling courses. Inevitably, it contains ideas that I have come across in books and articles, training courses I have attended, and colleagues’ handouts and worksheets. If I have neglected to give proper recognition to anyone whose ideas have been used, please let me know, so I can properly acknowledge your contribution in future editions. I have particularly appreciated the inspiring examples of teaching and training that I have observed in the work of these valued colleagues: Joe Armstrong, Art Bohart, Anne Chien, Mick Cooper, Edith Cormack, Elaine Craig, Robert Elliott, Kate Lanka, Noreen Lillie, Mhairi Macmillan, Dave Mearns, Peter Rober, Brian Rodgers, Alison Rouse, Karen Tallmann, Mhairi Thurston, Dot Weaks, Sue Wheeler and Mark Widdowson. I would also like to acknowledge how much I have learned from my students. The love, support and encouragement of my wife Julia, and my daughters Kate, Emma and Hannah has been, as ever, essential for the completion of this book. John McLeod
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Section contents Introduction
3
Learning to offer a therapeutic relationship
3
Using the Workbook
5
Some practical suggestions
5
Working alone and with others
6
Taking responsibility and taking care of yourself
7
Building a portfolio of experiences and reflections
7
The basic assumptions informing the design of this Workbook
9
Notes for tutors
10
“Contemporary psychotherapy proposes a framework of theory within which the practitioner may, to a certain degree, reveal ordinary human qualities. By contrast I would suggest that psychotherapy is the manifestation of creative human qualities in a facilitating setting, in which the task of healing is eased by a critical knowledge of the theories and techniques of twentieth-century practitioners”. (Lomas, 1981: 3)
“. . . the actual techniques employed by the therapists are of lesser importance than the unique character and personality of the therapists themselves. Therapists select techniques and theories because of who they are as persons: therapy strategies are manifestations of the therapist’s personality. The therapist as a person is the instrument of primary influence in the therapy enterprise. A corollary of this principle is that the more a therapist accepts and values himself, or herself, the more effective he or she will be in helping clients come to know and appreciate themselves”. (McConnaughy, 1987: 304)
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“. . . in the end, each therapist develops his or her own style, and the ‘theoretical orientation’ falls into the background. What remains salient is a unique personality combining artistry and skill. In this respect, a fine therapist closely resembles a painter, novelist or composer. As is true in all the arts and sciences, few reach the summit”. (Strupp, 1978: 31)
“More and more, as time has gone by, I have thought that the usual way of training is not satisfactory in that it does not give enough weight to the general way a person behaves and thinks and feels toward someone who is distressed, to the experience of being with people and of getting as much help as possible from colleagues and supervisors. There is too much stress placed on working with particular techniques. . . . I think therapy is very much a personal affair. It is not wise to try to make clones of people by making them Freudians or whatever. Student therapists have to find their own way of being with people that will help them. One can expose them to all sorts of marvellous [theorists], and it will do them a lot of good, but that is not the business. The business is to do with finding their own way, using their own intuition, learning to be themselves in the presence of someone who is asking for help, who is probably putting all kinds of pressures on them”. (Lomas, 1999: 25)
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Introduction
For anyone to become a counsellor or psychotherapist, there is typically a period of three or four years of intensive learning and training. Even if this training is ‘part time’, with the person continuing to fulfil other ongoing work and caring roles, it is usual for the person to become fully immersed in the whole process of becoming a counsellor or psychotherapist: reading widely, reflecting on relationships with trainers/tutors and fellow learners, making sense of what emerges from personal therapy or groupwork, and seeing clients under supervision for the first time. The Counsellor’s Workbook has been created as a tool for further personal exploration of the key issues that emerge for people during this crucial phase of development as a therapist. The Counsellor’s Workbook has been designed as a companion text to accompany the use of An Introduction to Counselling, 4th edition (McLeod, 2009). However, the range of issues that it covers makes it an appropriate companion piece to any mainstream counselling or psychotherapy text. To be an effective therapist, it is necessary to develop a way of being with people that is genuinely grounded in one’s own personal experience, values and cultural context. Over and over again, research studies have found that what makes a difference to clients are the personal qualities of the counsellor, and his or her capacity to form an accepting and facilitative relationship. The Workbook has therefore been organized around a series of reflective learning tasks, which invite you to explore aspects of your own life that are relevant to your capacity to offer an effective counselling relationship to others. The aim is to help you to get inside the various ideas and approaches that exist within the domain of counselling. It is recommended that you read through this introduction before attempting any of the learning activities in later sections of the Workbook.
Learning to offer a therapeutic relationship There are three core aspects of learning about counselling or psychotherapy. These are: G
self-awareness;
G
understanding the therapeutic process;
G
practical experience.
Accurate and sensitive self-awareness underpins any type of counselling work. No matter what approach to counselling or psychotherapy is being used, the main instrument for delivering help or therapy is the person or the counsellor him or herself. To be a therapist involves interacting with the person seeking help in a flexible and responsive way. There is no fixed script that a therapist can follow: almost everything is improvised in the moment. It is essential, therefore, for a therapist to be able to use him or herself as a resource: to be sensitive to the possible significance of shifts in internal feeling states,
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to have a sense of how his or her actions might be perceived by another person and to have strategies for staying fresh and alert. Effective therapy builds on the quality of the relationship between helper and person being helped, and being a therapist frequently stretches and challenges a helper’s capacity to relate: to cope with endings, confrontation, the experience of deep caring and the intricacy of unravelling impasses. In recognition of these factors, all counselling or psychotherapy incorporates an element of work on self; for example, participating in experiential groupwork, gaining the experience of being a client, or keeping a personal reflective journal. Throughout the Workbook you will find that you are invited to write about yourself, to reflect on your own experience and hopefully to gain new insights into yourself. It is important to experience this process (not only through the medium of a workbook but also through being a client yourself at some point in your life), because this is the process that anyone receiving therapy goes through. In addition to self-awareness, it is necessary for counsellors or psychotherapists to develop a framework for understanding what they are doing. There has been much debate about whether it is better for counsellors to stick to one theoretical model (e.g. the person-centred approach of Carl Rogers, or a Freudian psychodynamic approach), or whether it is more effective to piece together an integrated personal model from the various theories that are around. Each of these strategies can be effective, but what is crucial for therapists is to use concepts and ideas that are coherent and make sense to the person who is using them, and that they can communicate to the people they are trying to help. The importance of developing a robust framework for understanding really stems from the fact that, quite often, people who come for therapy are confused and confusing. They have exhausted their immediate problem-solving resources such as friends and family. They may be in crisis and feel that everything is chaotic and out of control. They may well be afraid of what they feel is happening to them. And they may, one way or another, push all this stuff on to the therapist: ‘here, you deal with all this chaos, fear and confusion’. It is at this point that a therapist needs to feel secure in his or her grasp of reality. The Workbook, as a consequence, includes many tasks that are intended to give opportunities for those who are becoming therapists to piece together and test out their evolving framework for understanding. The third key element of counselling and psychotherapy training, which goes hand in hand with self-awareness and developing a framework for understanding, is that of practical experience. There are three types of practical experience that are particularly relevant. The first involves simply sharing personal experience with others, and hearing about their experiences. The second type of practical experience concerns practising counselling and helping skills on and with fellow learners. The third form of practical experience involves being in a real counselling role with someone who has come for help with their problems. This Workbook cannot directly facilitate the development of practical experience. However, it does provide opportunities to reflect on personal experience. When learning the practice of counselling or psychotherapy, it is absolutely essential to be a member of some kind of small peer learning group that meets often enough for a climate of trust and honesty to be created, where members can be supported as well as challenged, and can learn to give and receive feedback. Being able to draw on the knowledge and expertise of a tutor or trainer is important too; to provide guidelines and standards and to model good practice. Many of the learning tasks in the
How to use this Workbook
Workbook lend themselves to exploration in a small group setting; the depth and sustainability of the learning that you can achieve through using the Workbook will be multiplied many times by exploration of learning tasks in the context of an ongoing group.
Using the Workbook There are a large number of learning tasks and activities in this Workbook. It is unlikely that anyone will want to try them all. Some of the tasks may introduce areas of selfreflection, contemplation and dialogue with others that may expand to fill many hours of time. Other tasks may seem uninteresting, trivial, or evoke a response of ‘not yet’. Yet other tasks may stimulate reading and thinking around the topic, in advance of tackling the learning activities. It is important, when using the Workbook, to trust your own gut feeling regarding the best direction for your own learning at any one time. This is also, possibly, one of the primary rules of therapy: the client’s readiness to explore any particular issue is a factor that is taken into account by all the main approaches to counselling (although in different ways). The Workbook has been written as a resource that can be relevant for counsellors and psychotherapists with different interests and needs, so it is inevitable that there will be some activities that are more relevant for you, while others are less relevant. The structure of the Workbook has a beginning and an end. The activities in Section 1 are intended to allow you to explore and honour your own experience and knowledge as a person who can engage constructively and helpfully with others who need to talk about their problems. It is essential that you complete at least four or five of the activities in this section before you attempt to begin working in any of the other sections, or before you even look at the exercises in these later sections. There are several activities in later sections, for example, that invite you to reflect theoretically on aspects of your personal story that you have written in response to the tasks in Section 1. It is best to have already completed as many of your ‘personal stories’ as possible in an intuitive, expressive, open and spontaneous manner, rather than writing them with half a mind to how they might be interpreted. Section 2 is specifically focused on the possibilities arising from using the Workbook in the context of a learning or personal development group. The activities in the final section, on integration, achieving a sense of professional identity, and reflecting on the experience of working in a group, are intended to be completed during the later stages of using the Workbook. These are activities that invite you to bring together and review themes and ideas from earlier sections. The activities in the middle sections – theory, practice and cases – can be taken in any order.
Some practical suggestions The Workbook is designed as a series of learning tasks, each of which will generate written material that can be included in a portfolio or journal; this could be in the form of a paper notebook, ringbinder or files in a folder on a personal computer.
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Many counselling and psychotherapy courses require students or trainees to keep personal learning diaries or journals, because it has been found that this is an excellent way of helping people to explore personal experience, reflect on experience, and integrate theory and practice. A learning journal also makes it possible to keep track of personal change and development, and to keep hold of new insights (by writing them down) rather than losing them through forgetting. There is also a lot of evidence that writing can in itself be therapeutic (at some point in the future you may want to suggest to some of your counselling clients that they might want to keep journals). Section 1 of the Workbook offers some guidelines for writing a personal journal. The Workbook deliberately does not specify how long each task might take, or how much written material it might generate. There are no right or wrong answers – what is important is what you learn. Most of the learning tasks in the Workbook include suggestions for further reading, either in the form of chapters or sections in An Introduction to Counselling or specific books and articles. It is important to complete the learning task activity before consulting the recommended reading. In order to develop a personal understanding, it is essential to take one’s own experience as a starting point, and then to use the ideas of others to place this experience in a wider context.
Working alone and with others All the tasks included in the Workbook are primarily designed to promote individual learning, through personal reflection and writing. This emphasis on person or individual learning is a requirement in any counselling or psychotherapy learning programme, and reflects the centrality of self-awareness in therapy. The majority of the activities in the Workbook involve periods of sustained reflection on personally significant topics. There is a great deal that can be learned from this. However, working with other people on these tasks introduces important additional opportunities for learning: G
The experience of what it is like to share your feelings and thoughts, and your ‘story’, with others; for example, how risky does this seem to be, are there things you could say but hold back on?
G
The response of other people to what you have said – do they appear to be interested, involved, shocked, surprised . . .? When others ask questions about what you have offered them, do these trigger new ways of looking at the issue?
G
Observing and listening to your colleagues sharing their responses to the learning activities – in what ways might this broaden your appreciation of the range of possible perspectives that there might be on an issue?
It can be very helpful, therefore, to have a learning partner or partners, or to be a part of a group, with whom the issues raised by this Workbook can be shared and explored. Such learning alliances may be facilitated or led by a trainer or tutor (e.g. as part of a training course) or may be organized on a peer group basis. In either case, there are ground rules that should be discussed, understood and adhered to. The existence of confidentiality is a necessary element: it can be destructive and damaging if personal information that is shared in the context of this type of learning is passed on to others
How to use this Workbook
without permission (even if for the best of intentions). The existence of respect is also necessary – people learn best at their own pace, and when the conditions are right for them. Section 2 of the Workbook includes a series of learning activities designed to explore some of the unique opportunities for learning that arise when working in an intensive learning group with a set of colleagues. Appendix A (p. 209) provides some suggestions for how such a learning group might be organized and facilitated.
Taking responsibility and taking care of yourself Some of the learning tasks in the Workbook invite you to explore intimate and sensitive parts of your own life. Some of the tasks ask you to write about things that maybe you have never told anyone else, or are emotionally painful. When using the Workbook, remember that: G
you are responsible for your own learning. If a task does not appeal to you, or seems threatening, then do not do it. It is your choice;
G
you do not have to show anyone else what you have written unless you decide to. No one has the right to see what you have written. It’s up to you to share what you are comfortable sharing;
G
keep what you write in a safe place;
G
if there is anything in the Workbook that disturbs you, then it may be helpful to talk it over in confidence with a friend or colleague, a tutor (if you are enrolled on a course), or with a therapist or spiritual adviser. If you find yourself coming back to a Workbook topic, in your own mind, days after writing about it, then this may be a signal that it has raised a significant issue that may repay discussion with another person.
Your experience of using the Workbook may mirror the experience of being a client in therapy. There may be times when you avoid the Workbook or ‘forget’ about it. There may be other times when you tackle learning tasks with great energy.
Building a portfolio of experiences and reflections The Workbook is intended to help you to work towards developing and demonstrating competence as a therapist, by accumulating a portfolio of notes, stories and ideas that you can use to inform your thinking about therapy and your confidence in what you bring to the therapeutic relationship. This portfolio may supplement a learning journal or diary that you keep, or it may be quite separate. In all likelihood, many of the assumptions that you hold about therapy are implicit rather than explicit. In other words, you may have a ‘gut feeling’ that some approaches and techniques are better than others (at least for you, or in your work context), but it may be hard to put into words exactly where you stand, and why. The learning tasks in the Workbook give you opportunities to put these ideas into words. It is essential, in using the Workbook, that you actually take the time to write down
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your responses to tasks. The process of writing will help you to articulate or ‘sort out’ your ideas in a focused way. Recording your reflections in writing also makes it possible to add more later. It allows you to reflect on what you have written, and to ‘de-centre’ yourself. Writing also enables you to reflect on how you may have changed, or on the different ‘voices’ or feeling states that appear in your words. The portfolio will give you a rich supply of experiences and reflections that will help you to define many different aspects of yourself as a counsellor. By the end of your involvement with the Workbook, your portfolio could contain: G
your responses to the learning tasks provided in the Workbook;
G
material from exercises that may have been used on courses or workshops you have attended;
G
notes or excerpts you have taken from books and articles you have read, which are relevant to the task of mapping out your own personal understanding of counselling;
G
copies of web pages that have been of interest to you;
G
personal reflections.
The Workbook is envisaged as a way of supporting your learning about therapy, through providing a structured way of exploring, recording and analysing key dimensions of your therapeutic competence. When you have completed training, or moved from a period of learning into a stage in which practice has the predominant call on your time and energy, the pressure to record so much information will not be so great. Although you may well find that you have got into the habit of writing about yourself, and building your personal portfolio, you will probably also find that it has mutated into a style and format that is uniquely your own (like your counselling style!). It is not helpful to view the Workbook as a self-contained exercise – it should connect with other facets of your learning and practice. Some suggested ways of using the Workbook and your portfolio to augment other aspects of your training are: G
identifying what you are good at and what you need to work on. During training you will get lots of opportunities to practise on and with colleagues, or discuss issues. What you write in the Workbook can help you to be clear about what would be best for you to focus on. For example, perhaps you can see in your Workbook entries that over and over again you have difficulty with challenging people, or with ending relationships. These may be key areas for further work, because they are so critical to being a good therapist;
G
building up a pool of ideas and insights that you can draw on when writing articles, giving talks, or for coursework essays, case studies and other assignments;
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integrating what you have learned in personal therapy, experiential groups and supervision. During training, people often spend a lot of time and effort on their personal therapy or supervision, but find it difficult to link up this learning with their theoretical framework, or their practice;
G
helping you to be clear about the issues you might want to explore in personal therapy or supervision;
G
being clear about who you are and what you do. Developing a professional
How to use this Workbook
identity. When you are interviewed for a job, or if you work in a setting where you need to give clients a leaflet describing your approach, you need to sum up your style and qualities as a counsellor in a few words. Some of the Workbook tasks may help you to clarify your career direction; G
as a source of support. Becoming a counsellor or psychotherapist can be a stressful or even harrowing business. For example, clients or fellow trainees may give you feedback that is hard to take on board. A learning journal or portfolio is a place where you can begin to look at what they have said, and how you feel, and make some sense of it;
G
some learning tasks help you to build up information about local resources that you can use in your role as counsellor; for example, various agencies and facilities that you might suggest that your clients make use of, or details of self-help books, articles and leaflets that clients might find helpful.
These are just some of the more obvious ways of using the Workbook during your period of training. What is important is not to see the process of writing in using this Workbook as a chore or empty ritual, but to keep in mind the advantages of gradually building up a portfolio of your knowledge, practice and achievements.
The basic assumptions informing the design of this Workbook The exercises and guidelines provided in the Workbook reflect a set of assumptions about what counselling is about, and what is involved in becoming an effective counsellor or psychotherapist: G
There is no single approach to counselling or psychotherapy that is more effective or valid than any other. There is clinical and research evidence that supports (and is critical of) all the established therapeutic approaches. In a professional environment in which a plurality of approaches are applied, and where a counsellor may find him or herself working alongside colleagues representing a wide array of models, it is essential to be familiar with the principal ideas of all the mainstream approaches;
G
Effective counselling and psychotherapy is largely dependent on the personal qualities of the therapist, such as his or her capacity to form a connection with the client, the possession of a model of practice that he or she has worked out for him or herself, and a sufficient degree of consistency between his or her therapeutic approach and who he or she is as a person;
G
At the heart of therapy is the opportunity it provides for the person to tell (and retell) their story, to a listener who will be curious, sensitive and accepting. Good counsellors and psychotherapists are people who tune into the rich meaningfulness of the stories that other people tell, and are able to draw on an appreciation of the meaningfulness of their own life story;
G
Therapy is a highly moral activity, and requires a genuine commitment to truth, honesty and a valuing of relationship and conviviality;
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G
Counselling is an activity that is much wider than the work of counsellors. Most of the time, people who need to talk find themselves a suitable friend, health worker, teacher or clergy.
Learning is most effective when it builds on personal experience, and recognizes the existing knowledges, skills and personal qualities of the learner. The sequence of learning in this Workbook begins by inviting exploration and documentation of an area of personal experience, then moves into reflection on the potential meaning or significance of that experience, then makes links with theory and research, before finally giving consideration to implications for practice. Beyond this emphasis on the importance of developing a personal approach is the idea that being a person involves being in relation with others, and that, ultimately, building a personal approach can only be done with the help and collaboration of other people. In terms of becoming a counsellor or psychotherapist, there are some relationships that appear to be more or less essential: G
being a member of a peer group that offers support and challenge, over an extended period of time, from a basis of equality of status;
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having contact with mentors – more experienced members of the profession – who can provide inspiration, affirmation and immersion in the discourse of the profession;
G
being in a client–therapist relationship, in the client’s chair, and having personal experience of what this situation feels like, and what makes it work better (and worse).
What this means, of course, is that a Workbook such as this can only ever be a resource, or a tool. It can never be a substitute for the real business, which is always about working together with others. But it may, hopefully, provide a structure or a meeting place around which this kind of co-operative learning can take place, as well as facilitating personal reflection on a wide range of personal experience that is relevant to the practice of therapy.
Notes for tutors The Counsellor’s Workbook is intended as a resource to support those at the stage of basic training in counselling or psychotherapy (in the UK, this would be diploma level), rather than those participating in more introductory skills courses. As explained in the Introduction, the underlying philosophy of the Workbook is that counselling is an intensely personal activity, and that it is essential that theories and methods are assimilated and integrated into the counsellor’s sense of who he or she is, rather than being ideas or techniques that are ‘bolted on’. At the heart of any training course is the capacity for the trainer to convey his or her ‘truth’ to the trainee, in the form of lectures, workshops and handouts that reflect the trainer’s personal and professional experience. There is no way that this Workbook is intended to replace learning activities that a trainer or staff team have devised, or form the basis for a whole syllabus. The aim of the Workbook, instead, is to play a role as a supplement to an existing programme or curriculum.
How to use this Workbook
There are a number of ways in which the Workbook can be used in the context of a counselling or psychotherapy training programme: 1
Independent study/background reading: many students on therapy courses are very keen to learn, and quickly work their way through recommended texts and reading lists. There is plenty in this workbook to keep such students busy. Particularly if An Introduction to Counselling is the core text for the course, or one of a set of core texts, students are likely to find the Workbook valuable as a means of linking together themes and issues that are dealt with in different chapters, and making connections between concepts and personal experience.
2
Building experiential workshops or seminars around specific learning tasks: many tutors and trainers like to organize classes on a workshop basis, with students engaging in an experiential exercise, or exploring case material, then coming back together for a group discussion. Many of the learning tasks in the Workbook may be applicable in such situations, and have the advantage of being referenced both to a textbook and to other activities that the student might wish to pursue. Because the learning tasks are presented in a workbook format, they can be given to students as ‘homework’ assignments, thus giving more time for participative work when the group actually gets together in class. The learning tasks and activities included in the Workbook encompass many of the central topics covered in most counselling courses: self-awareness, theory and ethical issues. The Workbook does not include inputs on counselling skills, or on preparation for practice, because these are topics that require direct tutor involvement and guidance.
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As the basis for a peer- or facilitator-led personal development group, learning set or study group: although the Workbook is written in such a way as to make it possible for students to use it on an individual basis, the majority of the learning tasks are likely to produce deeper and more significant learning if they are shared in an ongoing small group. Appendix A: A narrative approach to personal and professional development in counselling/psychotherapy training offers some guidelines for learners who might wish to work on workbook activities in a group setting.
4
As the basis for assessment tasks: the Workbook can be valuable in relation to student assessment. On some courses, students are required to submit a personal learning journal, or report based on their personal learning journal. In this situation, it may be helpful to point students in the direction of relevant Workbook activities, for example in the opening section, as a focus for at least some of the content of their personal journal. The Workbook also includes a page on keeping a learning journal. Another assessment possibility is to base assignments on specific learning tasks. Almost all the tasks involve doing some writing. By indicating a limit to this writing (e.g. 1000–1500 words), and maybe also requiring the student to discuss their self-exploration in the context of relevant theory and research (material in An Introduction to Counselling can serve as the staring point for such discussion), almost all the learning tasks/activities could form the basis for coursework assignments. A third possibility, in relation to assessment, is to invite students to submit a portfolio of their writing, done in response to learning tasks, along with a concluding section that reflects on and integrates their
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learning. This assignment format is an excellent way to encourage student initiative and creativity, since they will all choose different combinations of learning tasks, and all their answers are, inevitably, original (there is nowhere that they could find the answer to a learning task already written in a book or article – the only answer is their personal one). One highly challenging variant on the portfolio assessment option is to ask students to edit and integrate their pieces of writing into a statement of their personal philosophy of counselling/ psychotherapy.
Building on life experience: the foundations of a personal approach
Section contents Introduction
15
Writing your autobiography: getting started
17
Keeping a personal journal
18
The story of a helping relationship
19
The origins and development of your interest in therapy
20
Your favourite story
21
The self puzzle
23
Thickening your autobiography: early memories
24
An inquiry into sexuality
25
Your personal experience of therapy
26
What you bring to counselling
27
Exploring cultural identity
29
Feeling really understood
31
Mapping your relationship patterns
33
Engaging with difference
34
How do you cope with crisis in your own life?
36
The experience of changing your own behaviour
37
The role of therapy in your life story
38
Knowing how your emotions are organized
40
What is your psychopathology?
42
How relevant is spirituality?
43
How do you cope under pressure?
44
Do you have a preferred learning style?
45
What motivates you?
47
Reflecting on the experience of writing about yourself
48
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15
Introduction
This section of the Workbook contains a series of tasks that invite you to write about various aspects of your own life. To be a counsellor or psychotherapist involves being able to draw on your own experience, as a means of relating to the people you are trying to help. Your own life story therefore becomes a resource, within which you can find meaning in response to the issues presented by those who visit you for help. The writing tasks in this chapter serve two purposes, in relation to developing therapeutic competence. First, they require you to explore both difficult and hidden, and also joyful, moments in your own life. They are intended to encourage you to look at yourself in terms of certain key questions: G
What are my strengths and gifts in connection with the task of being a therapist?
G
What are my areas of vulnerability or uncertainty in relation to the activity of counselling/psychotherapy?
G
What is my own personal understanding, arising from my life experience, of core therapeutic processes such as initiating and maintaining change, sustaining satisfying relationships with others, and taking account of the ways in which my childhood and cultural environment have shaped my behaviour and identity?
By writing openly, honestly and in detail about your life, you can begin to build what narrative therapists call a ‘thick description’ of your identity as a counsellor: ‘thin description allows little space for the complexities and contradictions of life. . . . It allows little space for people to articulate their own particular meanings of their actions and the context within which they occurred’ (Morgan, 2000: 12). By contrast, a thick story is one that is ‘richly described’, in which the intricacy of one’s story, and the way it interlocks with the stories of other people, is expressed. A thick story encompasses multiple possibilities, in terms of what it says about the person’s capacity to act and feel. Second, several exercises in later sections of the Workbook make reference to the writing tasks in this chapter. You will be invited to reflect on what you have written here from a range of theoretical and practical perspectives. It is a good idea, therefore, to begin your use of the Workbook by spending some time writing in response to at least four or five of the activities in this section, before moving on to tackle any of the activities in other sections. All these writing tasks present substantial challenges. It would not be realistic, or possible, to attempt all of them at one sitting. Some of these pieces of writing may be best tackled in short sections, adding new material on different occasions. It is possible that some of the writing tasks open up areas of memory and experience that are painful or unresolved. It may be right for you to wait until the right moment before embarking on these pieces of writing.
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In any personal writing of this type, it can be helpful to create your own rituals and space within which you feel free to express yourself. Before you begin, you might wish to think about where and when would be the best time and place for you to do this kind of work.
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Writing your autobiography: getting started The purpose of this activity is to give you an opportunity to sketch the story of your life – your autobiography – in outline form. Being able to develop an understanding of your own development over time, and the ways in which you have responded to different external situations and demands, can represent an invaluable resource for a therapist. Biographical self-awareness can help to provide you with a means of understanding your own reactions to clients, and of empathizing with the experiences and dilemmas that clients describe in relation to their own lives.
Instructions Spend some time thinking about your life – its past, present and future. Imagine your life is like a book, with each of the major parts or stages comprising a chapter. Provide titles for each of the chapters, and describe the content of each in a little more detail. What is the underlying theme of the book? Can you find a title for the story as a whole? Feel free to add anything else that seems relevant to constructing a framework for your autobiography. For example, there may be photographs, objects or pieces of music that represent significant memories. Remember – the purpose of this task is to facilitate your learning – go with what feels right for you. As you are writing your autobiography, reflect on how it feels to write about yourself in this way. Are there some memories that are painful, which you would rather avoid? Are there other memories that are joyful and self-affirming? You may find that, once you have started to write your autobiography, further episodes, scenes and themes come to mind. It may be valuable to add these to what you have written, so that you gradually build a more complete story of your life. It can often be useful to return to what you have written months or years later, and reflect on the ways in which you have ‘rewritten’ your personal history.
Further reading This activity draws on the work of the narrative psychologist Dan McAdams: McAdams, D.P. (1993) The Stories We Live By: Personal Myths and the Making of the Self. New York: William Murrow. McAdams, D.P. (2000) The Person: An Integrated Introduction, 3rd edn. New York: Wiley.
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Keeping a personal learning journal Many counselling and psychotherapy courses require students to keep personal learning diaries or journals, as a means of reflecting on experience, and integrating theory and practice. A learning journal also makes it possible to keep track of personal change and development, and to keep hold of new insights (by writing them down) rather than losing them through forgetting. There is evidence that writing can in itself be therapeutic (at some point in the future you may want to suggest to some of your counselling clients that they might want to keep a personal journal). Learning how to use a learning journal can be viewed as an opportunity to gain first-hand experience of a powerful therapeutic tool. Some suggestions for how to keep a learning journal: 1
Choose a medium that is right for you. This could be a notebook, a ring binder that you can add pages to, or a wordprocessor folder.
2
Keep it safe. You will not want other people to see what you have written unless you ask them to. Find a way of maintaining your privacy.
3
Date each entry in the journal and give it a title. This will help you to make sense of what you have written when you read it later.
4
Write quickly, as if you are allowing your ‘stream of consciousness’ to flow on to the page. Try not to censor what you write. Do not worry about spelling, punctuation or grammar – what you are writing is just for you.
5
Experiment with different ways of writing. Sometimes it is useful to write a list of ideas or images rather than attempting to produce continuous prose. Sometimes it may be helpful to draw pictures, use coloured pens, or construct diagrams.
6
Some people find it helpful to get into a routine or ritual where they write their journal at a particular time and place each day.
7
Other people find it helpful to keep notebooks or scraps of paper with them so that they can note down ‘flashes’ or sudden ideas and insights.
8
A learning journal is not a personal diary. It is focused on your involvement with the roles, tasks and challenges of being or becoming a therapist.
Further reading Adams, K. (1990) Journal to the Self. New York: Warner Books. Rainer, T. (1978) The New Diary. London: Angus and Robertson. Rainer, T. (1997) Your Life as Story: Writing the New Autobiography. New York: G.P. Putnam. Thompson, K. (2004) Journal writing as a therapeutic tool, in G. Bolton, S. Howlett, C. Lago and J. Wright (eds) Writing Cures: An introductory Handbook of Writing in Counselling and Psychotherapy. London: Brunner-Routledge.
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The story of a helping relationship If you are to build on your own experience, then it is important to be aware of your own strengths and ‘gifts’ in counselling situations. The aim of this exercise is to give you an opportunity to begin to reflect on what you already know, in relation to counselling – what are the skills and areas of awareness that you already possess? This task requires writing about an occasion in which you were involved in a helping relationship with someone. The person you were helping could have been a counselling client, or equally well may have been a friend or family member. The helping relationship may be a formal one, in the context of your work, or an informal one, in the context of family or friends. Your task is to write an account of what happened when you helped this person. You should cover such points as: G
What led up to the helping incident, what was the background to you being involved with the person in this way?
G
What were your aims, what did you want to accomplish?
G
What did you say and do?
G
What was going on in your mind at every stage of the process?
G
What did you feel about what you were doing?
G
What was the outcome – how did it all end?
Your account of this incident should have a beginning, a middle and an end. Keep it descriptive of what actually happened and what you actually did and felt – there is no need to interpret or explain your actions for the purpose of the exercise. It is best if you choose an incident to write about where you felt you were reasonably successful in what you were trying to achieve. Do not include any identifying characteristics of the person being helped. Change their name and any other possible identifying features, just in case anyone else reads what you have written. The event you select should be a reasonably complex incident, something that lets you express and explore your capacity to help. You can write as much or as little as seems right to you, but aim to reach at least 500 words. Give your story a title. Later exercises in the Workbook invite you to look at what you have written from a variety of different theoretical perspectives.
Further reading Combs, A.W. (1986) What makes a good helper? Person-Centered Review, 1: 51–61. Combs, A.W. (1989) A Theory of Therapy: Guidelines for Counselling Practice. London: Sage.
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The origins and development of your interest in therapy This learning task gives you an opportunity to explore the roots in your life experience of what it means to you to be a counsellor or psychotherapist.
Instructions Imagine yourself some time in the future, when you are established in your career as a counsellor or psychotherapist. Imagine that you are in your therapy room. It is your ideal counselling room, furnished and decorated to create an optimal working environment for you. Look around it – what do you see? What is this room like? Now, imagine that three or four of your closest professional colleagues or friends are coming to visit you in this room. These are people who really know you, who understand and accept you. Who are they? Welcome them. They have come for a special reason, to hear you tell your story of how you became a therapist. Think about becoming a therapist as a journey. Start right at the beginning of that journey. Tell them about your earliest experiences in family and school that somehow seem connected to your choice of becoming a therapist. Describe the people, places, relationships and events that have influenced you in the direction of counselling. Identify the choice points, where you made decisions to commit yourself more fully to this type of work. Bring the story up to date. Tell them where you have arrived on your ‘counselling journey’. You may find it useful to close your eyes for a few minutes and imagine telling this story. Then write it down. Try to write in as much detail as you can. Write quickly – do not censor what you put down. You may find that there are other bits of your story that occur to you over the next few days – add these in later. Remember, this is your personal story. There are no right or wrong answers, and no one will see what you have written, unless you invite them to.
Further reading You may find it helpful to think about the story you have written in terms of the section on ‘the counsellor’s journey’ in: McLeod, J. (2009) An Introduction to Counselling, 4th edn. Maidenhead: Open University Press (pp. 614–17). To what extent do you think that this model can help you to make sense of your experience of becoming a counsellor or psychotherapist?
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Your favourite story
Most of us have a story that, somehow, has a special appeal to us. This learning activity invites you to identify, then write down, your favourite story, and then reflect on what you have written in terms of a series of prompt questions.
Identifying your favourite story G
What is your favourite story? This could be a fairy tale, novel, short story, play, film, TV show, and so on. It may be a story that you always treasured, and returned to at different points in your life, or it could be the first story that came to mind when you started to read these instructions.
G
Write the story in your own words. It does not matter whether your version is different from the original – what matters is the story as you recall it. Write the story in as much vivid detail as you can, from beginning to end.
G
If you have more than one favourite story, complete this exercise at another time, in relation to one or more further stories.
Exploring the personal meaning of your favourite story Slowly read through the story you have written, and make notes in response to the following questions: G
Who is your favourite character in the story?
G
Why do you like this character so much?
G
What happens to this character?
G
Who are the other characters? What kind of relationship does your favourite character have with these other characters?
G
What is the setting for the story? Where does it take place?
G
What is the main feeling tone of the story?
G
How does the story end? How do you feel about the ending? If you could change the ending, what would your preferred ending be like?
G
When did you first come across this story? How often, and in what ways, do you refresh your acquaintance with this story?
G
Why do you like this particular story? Why do you think that you chose it?
Your responses to these questions may suggest further details of the story – add these in to your written version as you go along.
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Finally – give yourself some time to reflect on what you have learned about yourself from this process. Some suggestions for exploring the meaning of stories, such as a favourite story, are provided in the learning activity ‘Making sense of stories’, in Section 5 of the Workbook.
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The self puzzle
Most approaches to therapy emphasize the importance, in one way or another, of the person’s sense of self. The notion of an individual self, as the core of who a person feels him or herself to be, lies at the heart of counselling and psychotherapy. There are many different ways of understanding or picturing the self. Sigmund Freud, for example, portrayed the self as similar to an iceberg, with the largest part beneath the surface. In order to engage with a client’s sense of self, it is usual to have an appreciation of your own sense of self. This activity introduces a simple method for beginning to explore the way that the self is structured and organized. The exercise requires access to coloured pens or crayons, and a piece of blank paper (a large piece of paper is best). The task is to draw a map or puzzle to represent the way you view your self following these guidelines: In some ways everyone is a puzzle, consisting of many different parts. You are a puzzle with parts that are unique to you. Draw a puzzle with parts that are labelled that best describe you, as you see yourself now. The number of parts, the shape of the parts, and the positioning of the parts are all up to you. They should, however, be used to represent yourself as descriptively as possible. There are no right and wrong answers. This self puzzle is your own creation – take as long as you wish to complete it. An alternative way of thinking about this creation is to look at it as a map. Similarly, the map of how you see yourself now will include areas that are labelled.
Be aware of the thoughts and feelings that accompany this task as you construct your puzzle or map. After you have made your drawing, it may be helpful to write some notes about these thoughts and feelings, and also of what you have learned about yourself through engaging in this activity. Once you have completed this exercise, you may find it useful to turn to the ‘Making sense of self ’ learning task in Section 3 of the Workbook, which includes some guidelines for interpreting your self puzzle picture. It can be valuable to repeat the self puzzle on different occasions, to explore how your sense of self is affected by different contexts and life experiences.
Further reading The idea of the self puzzle has been adapted from: Loo, C.M. (1974) The self-puzzle: a diagnostic and therapeutic tool, Journal of Personality, 42: 236–42.
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Thickening your autobiography: early memories This exercise provides an opportunity to carry out some further exploration around the complexity and richness of your understanding of who you are – your autobiography. Many clients who seek therapy can be viewed as engaged in a struggle to achieve a coherent appreciation of many different, and often difficult, strands of their life experience. To be able to facilitate this kind of meaning-making, it is invaluable to have undergone such a process yourself. Early memories can often represent a highly significant source of meaning in a person’s life. Take some time to identify, then write down, your earliest memories. Describe the memories in as much detail as possible. Begin by going back to your childhood and try to recall your earliest childhood memory. Try to recall a specific incident or event, not just a fragmentary impression. What are your impressions of yourself, and of each of the other people in the memory? Describe, also, the mood or feeling tone that goes with this memory. Once you have written about your earliest memory, you may find it useful to explore other early memories; for example, your first memory of your mother, father, siblings or other family members, or memories of moments that were high points, or formative turning points, in your life. When reflecting on what you have written about your early memories, it is helpful to ask yourself whether the patterns of needs, relationships and emotions that are represented in these stories have persisted as themes in your life.
Further reading The importance of early memories was first recognized by Alfred Adler, one of Freud’s inner circle. The specific early memory instructions used in this exercise are derived from research carried out by Martin Mayman and his colleagues. Further information on these studies can be found in: Fowler, J.C., Hilsenroth, M.J. and Handler, L. (2000) Martin Mayman’s early memories technique: bridging the gap between personality assessment and psychotherapy, Journal of Personality Assessment, 75: 18–32. Many other researchers and therapists have explored the notion that early memories convey, in summary form, the key existential themes that influence the directions of a person’s life. Clark, A. (2002) Early Recollections: Theory and Practice in Counseling and Psychotherapy. New York: Brunner-Routledge. Csikzentmihalyi, M. and Beattie, O. (1979) Life themes: a theoretical and empirical exploration of their origins and effects, Journal of Humanistic Psychology, 19: 45–63. McAdams, D.P., Hoffman, B.J., Day, R. and Mansfield, E.D. (1996) Themes of agency and communion in significant autobiographical scenes, Journal of Personality, 64: 339–77.
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An inquiry into sexuality
The meaning and importance of sexuality is a topic that therapists need to be able to explore with clients. The aim of this activity is to provide a structure within which your experience of sexuality can be explored, and the implications for your approach to counselling/psychotherapy can be identified. Over the next two or three days, give yourself some time to engage in an inquiry into your sexuality. The following suggestions may help to get you started: 1
How has your sexuality developed? Draw a ‘timeline’, stretching from birth to the present, and enter the key events and stages/phases in the growth of your sexual awareness and behaviour. 2 Where does sexuality fit into your life? What part does it play? How do you use your sexual awareness and energy? 3 What are your attitudes and feelings in relation to people whose sexual orientation and behaviour differs from your own? 4 Describe how you have dealt with (or anticipate that you would deal with) a counselling relationship where: a You felt sexually attracted to the person you were helping. b The person you were helping expressed sexual attraction toward you. c How did you (or might you) respond in each case? 5
How would you react to a client who asked you to help him or her make sense of, and resolve, a sexual problem? Which sexual problems would you feel more/less confident in working with? What would you do if you did not feel confident or competent to work with the client in the way that he or she had requested?
6
How did you feel about reflecting on these questions, writing about them, and perhaps discussing them in a group? What does this response tell you about your position in relation to sex and sexuality?
Once you have written and reflected around these questions (and possibly around other questions or themes that may have struck you as interesting in this area), shift to consideration of the implications of what you have discovered for your sense of who you are as a therapist. For example, in what areas do you feel that you need to acquire more knowledge about sex and sexuality?
Further reading Denman, C. (2003) Sexuality: A Biopsychosocial Approach. London: Palgrave Macmillan. Hudson-Allez, G. (2005) Sex and Sexuality: Questions and Answers for Counsellors and Therapists. Oxford: Wiley-Blackwell. McLeod, J. (2009) An Introduction to Counselling, 4th edn. Maidenhead: Open University Press (pp. 474–81).
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Your personal experience of therapy One of the consistent themes in all approaches to counsellor and psychotherapist training is that it is important for helpers to know what it is like to be the recipient of help. The aim of this activity is to encourage you to focus on your experience of being helped, and to reflect on the implications of that experience for your understanding of the helping process.
Instructions What is your own personal experience of receiving counselling, either on a formal, contracted basis or informally from a friend, teacher or priest (or anyone else who is not a member of your immediate family)? Write a brief account of one useful or successful ‘counselling’ encounter that you have experienced. Make sure you write your story in a place that is private and confidential, so you can be as open and honest as possible. You may find the following questions useful in terms of structuring your account: G
What was troubling you?
G
At what stage of your life did this trouble emerge?
G
What made you seek help, or be open to receiving help, at this particular point?
G
How did you make contact with this ‘helper’?
G
What happened during the ‘counselling’ or ‘helping’ session or sessions?
G
What were the most useful things your ‘counsellor’ did?
G
Was there anything unhelpful that he or she did?
G
How did this ‘counselling’ help you; what was the longer-term impact on you?
Next, if possible, write a parallel account of a counselling/helping episode (again, where you were the recipient of help) that was not helpful. After you have written an account of your experience, take some further time to write about what you have learned.
Further reading Geller, J.D., Norcross, J.C. and Orlinsky, D.E. (eds) (2005) The Psychotherapist’s own Psychotherapy: Patient and Clinician Perspectives. New York: Oxford University Press.
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What you bring to counselling For many people, the decision to become a counsellor or psychotherapist may follow a period of time studying, and working in, another profession or discipline, such as nursing, social work, teaching, the ministry or psychology. These early career activities may shape the way that people are viewed, and ‘helping’ or ‘therapy’ are understood. Some trainees or students on counselling courses find that, at the beginning of their training, they have a tendency to look at issues through the lens or perspective of their primary profession. Others may be so highly motivated to leave their primary profession behind that they deny its relevance to their work as a counsellor. This learning task invites you to reflect on what you bring to counselling, in terms of previous knowledge, skills and experience. The following questions are intended to focus your exploration of this issue: 1
2
3 4
5
Divide a page into two columns. In the left column, list all the potential areas of your life experience that may be sources of knowledge, skills and experience that are relevant to counselling. These could be jobs you have done (e.g. worked as an emergency room nurse for two years) or they could be linked to your family or personal life (e.g. my mother and father divorced when I was 10 years old). In the right column, list the knowledge, skills and experience that you acquired as a result of the life experiences that you have identified. For example, ‘working as an emergency room nurse’ may have helped you to ‘understand how people behave in crisis’ and to ‘talk openly about death’. The divorce of your parents may have enabled you to ‘be sensitive to the effect that loss of attachments in childhood can have on the rest of a person’s life’. What have you brought with you from your previous experience that might be a strength or asset in relation to your work as a counsellor? What have you brought with you that might be a hindrance or distraction? Examples: ‘the “nurse” part of me wants to solve people’s problems for them’, ‘studying academic psychology encouraged me to be objective and detached, rather than empathic’. Some people find that counselling training seems to cut them off from what they already knew, in a practical sense, about helping others. Michael White (1997: 13) has described this process in these terms: “. . . entry into the culture of psychotherapy is associated with an induction in which the more local or folk knowledges that have been generated in a person’s history are marginalised, often disqualified, and displaced by the formal and expert knowledges of the professional disciplines, and by a shift in what counts in regard to the significant memberships of a person’s life. In this process the monoculture of psychotherapy is substituted for the diverse, historical and local associations of persons’ lives”.
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To what extent have you been aware of this process taking place with respect to your own involvement in counselling training and practice? In what ways has therapy training moved you away from people and modes of helping within your family and community? In order to make sense of the reflections and memories that have emerged during these activities, it may be valuable to consider that becoming a counsellor or psychotherapist can be viewed as a journey, which takes several years and on which many challenges must be faced. The questions above can help you to answer the question: What are the tools and skills that you take with you on this journey, and how best can you use them?
Further reading The experiences of counsellors and psychotherapists who have found ways to use their earlier work and study (in a wide range of professions and disciplines) to inform their therapy practice are described in: Thorne, B. and Dryden, W. (eds) (1993) Counselling: Interdisciplinary Perspectives. Buckingham: Open University Press. The narrative therapist, Michael White, has argued forcefully that it is essential for therapists to remain in touch with the everyday life roots of their capacity to care for others: White, M. (1997) Narratives of Therapists’ Lives. Adelaide: Dulwich Centre Publications.
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Exploring cultural identity
A sense of personal identity and belonging, of values and image of the ‘good life’, is rooted in the culture in which we live. When we meet someone else, we immediately begin to decode all the cues relating to their cultural position – social class, gender, ethnicity, race, religion, sexual orientation, political affiliation, and so on. At the same time, the other person is doing the same with us. In counselling, it is necessary to be aware of the various strands of your cultural identity. This helps you to: G
be aware of the kind of impact you might be having on the other person;
G
appreciate the cultural roots of the theory/model you are using;
G
be sensitive to and curious about the other person’s cultural identity;
G
talk about cultural difference when this becomes relevant within the counselling relationship;
G
appreciate the impact of social class, religion and other cultural factors in the life of the client;
G
defuse your fear of the other.
The aim of this learning task is to help you to become aware of your cultural identity.
Instructions 1
Very quickly, without thinking too much about it, write down a list of your first 20 answers to the question ‘Who am I?’. What does this list tell you about your cultural identity?
2
What are the different sources and strands of your cultural identity? Write out a genogram, or ‘family tree’, indicating beside each person (parents, grandparents, great grandparents) the information you have about their cultural and social position. What does this genogram tell you about your cultural identity: to what extent are these cultural themes influential in your life now?
3
What kind of cultural exploration have you carried out within your life? What new cultural influences have you been exposed to, or sought out? Draw a ‘lifeline’ from birth until now, and indicate on it the significant cultural shifts that you can recall. For example, have you moved away from, or towards, any of the cultural traditions represented by people depicted in your genogram? What new people or institutions have come into your life, bringing different cultural influences?
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4
What is the meaning of ‘home’ for you? Where is the place you belong? (Home can be imaginary or real.)
Finally – reflect on, and write about, what you have learned about your cultural identity. How might you describe and sum up your cultural identity if you were invited to work with a group of colleagues from another culture?
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Feeling really understood
At the heart of counselling is the hope that someone else can accept and understood us for who we are, without judgement or analysis. The aim of this exercise is to encourage you to explore the significance, in your own life, of this type of moment.
Instructions Part 1 Sit quietly for a few seconds. . . . Think about the last time you felt really accepted and understood by another person. Once you have identified such an occasion, you should briefly describe (on a piece of paper): G
what the circumstances were;
G
how you felt;
G
what the consequences or effects of being accepted and being understood were.
Following this piece of writing, take some time to reflect on the implications of the experience of being understood for your understanding of your relationships with other people.
Part 2 Take another few moments to reflect on the people who have understood you at various points in your life. Who were these people? How did they express their understanding? What impact did their understanding and acceptance have on your development as a person?
Part 3 Allow yourself some further reflection on your experience of being with people who did not understand and accept you at different points in your life. What impact did their ‘conditional’ stance in relation to you have on the way that you felt about yourself? Finally – write in your personal learning journal about these experiences, and their implications for your approach as a counsellor. How important is it to you to offer your clients an experience of being understood?
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Further reading A research study that has analysed the experience of being understood is: Bachelor, A. (1988) How clients perceive therapist empathy: a content analysis of ‘received’ empathy, Psychotherapy, 25: 227–40. You may find it interesting to look at how your own experience compares with what was reported by participants in this investigation.
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Mapping your relationship patterns The aim of this activity is to give you an opportunity to explore the different types of relationship you have had with other people at various times in your life. Take some pens and blank pieces of paper and make some simple diagrams that map out your relationships with the people who have been important to you at different stages in your life. It is best to draw each diagram on a separate piece of paper. In the middle of the page, you should draw a circle to represent yourself. Write ‘me’ or your name inside this circle. Around yourself, you should arrange the people who were important for you at that point in your life. The distance from you on the page should be used to represent their emotional, psychological or inner presence for you, rather than who was physically there, how far away they lived, or similar factors. What you will end up with is like a map of the planets, with a set of circles around a central ‘star’. Label each circle with the name of the person who belongs there. There are two additional kinds of circle that you might find yourself wanting to draw. One is a ‘dotted circle’ to indicate someone who mattered a lot to you at that time of your life but who was not there at all as a physical presence. This might be someone who you talked to in your head or thought about a lot even though you had no real connection with him or her at that time. Another kind of circle you might like to draw is a group circle. This you might draw to indicate people who were important as a group but did not really matter as individuals. This might be important, for instance, if you wanted to indicate the importance of a sports team or church group or something like that. Draw these diagrams starting at age five, then at 10-year intervals up to the present. Imagine yourself at age five; try to fix yourself in time, and then pretend to interview yourself, asking about who is in your mind at that time. Then imagine yourself at age 15, 25, and so on up to your present age. Once you have completed your diagrams, reflect on the following questions: G
Were there any moments during this activity when you had an emotional response? What do you think these feelings might mean?
G
Were there any recurring themes or patterns that emerged, around the types of relationship you have had over your life? What were these themes or patterns?
G
What might be some of the implications of your relationship style for your work as a counsellor? How might the ways of relating that run through your life have an impact on your counselling? What kinds of relationship are you more likely to have with clients, colleagues, tutors/trainers and supervisors?
This activity is adapted from Josselson (1996), a book that also provides a very useful framework for making sense of relationship patterns.
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Engaging with difference
As a counsellor, you may have little choice in relation to the characteristics of the people who use your service. Many people who seek your help will undoubtedly be easy to like, understandable, admirable. These are people with whom you may feel comfortable, and enjoy an easy rapport. But there will be some service users who, for you, are difficult. These are people who make you feel far from comfortable, in whose presence you feel threatened, on edge, lost. The purpose of this exercise is to explore the theme of difference in your life. Give yourself some time to reflect on, and write about, your responses to the following questions: G
Which groups of people do you regard as being most different from you? Make a list.
G
Beside each group, write a set of adjectives that you might use to describe what they are like.
G
Generate another set of adjectives to capture how you would imagine you might feel in the presence of a member of this group.
G
What are the sources of your information about each of these groups of people? How much of your information is first hand, arising from personal contact, and how much from other sources? How much curiosity do you have about each of these groups?
Looking at what you have written, can you identify any themes in your responses? What lies at the heart of difference for you? Is difference a matter of values, gender, social class, race, physical appearance . . .? What is it that makes someone different? Can you make connections between these meanings of difference for you and other aspects of your biography? In relation to your work as a counsellor, imagine for a few moments who your least preferred client might be. How would you react, and what would you do if this client walked into your counselling room? Finally: what is your personal experience of being different? What are the situations in your own life in which you have felt as though you did not ‘fit in’, were not accepted by others, or did not ‘know the rules’? What are your strategies for coping with such situations? How can you use your own experience of being different to inform your work as a counsellor?
Building on life experience
Further reading The essential role of curiosity in dissolving difference is discussed in: Dyche, L. and Zayas, L.H. (1995) The value of curiosity and naiveté for the cross-cultural psychotherapist, Family Process, 34: 389–99. A valuable collection of papers on the theme of identity and difference in therapy is: McGoldrick, M. (ed.) (1998a) Re-visioning Family Therapy: Race, Culture and Gender in Clinical Practice. New York: Guilford Press.
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How do you cope with crisis in your own life? The majority of people who use counselling do so in response to an immediate crisis. Even if a person has lived with difficulties for a considerable time, there is typically a particular event that triggers the decision to seek outside help. In order to appreciate what a person might be experiencing when they contact a counselling agency with a problem, it is useful to reflect on your own personal experience of crisis.
Instructions Write about your experience of a crisis in your own life within the framework provided by the following questions: G
Briefly describe an episode in your life when you felt that you had reached a real crisis point as a result of a problem such as: work pressure; the demands on you as a carer; feeling depressed or hopeless; feeling really worried; feeling panic in particular situations; feeling traumatized after an accident or assault, and so on.
G
How was your capacity to cope affected during the worst points in this episode? Briefly describe the impact of the situation on your capacity to make decisions, take care of yourself, control your emotions, and ‘think straight’?
G
What helped you to get through this? Describe how you used both your own personal resources (e.g. humour, courage, spirituality) and other people to help you to cope?
G
How long did it take you to work through this crisis?
G
What was the most difficult aspect of the crisis?
G
What helped you most?
G
What have you learned about yourself, and other people, as a result of this event?
G
How have you changed?
G
What have you learned, from your responses to these questions, that is relevant for your counselling practice?
Further reading James, R. and Gilliland, B. (2001) Crisis Intervention Strategies, 4th edn. Belmont, CA: Wadsworth. Kanel, K. (1999) A Guide to Crisis Intervention. Belmont, CA: Wadsworth.
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The experience of changing your own behaviour Think of an occasion when you were able to change your own behaviour in what you considered to be a positive direction. This should be an occasion when you intentionally planned to make a change in your behaviour, and carried it through to completion. If it is not possible for you to identify a time when you were successful in changing your behaviour, then write about an episode in which you made an attempt to do so.
Instructions Take a few moments to identify an unwanted habit or behaviour pattern that you have managed to eliminate or minimize in your life, or to establish a new pattern. The unwanted behaviour could be something like smoking, eating chocolate, arguing, being late . . . anything that you have wanted to change in yourself. A desired new behaviour could be something like taking more exercise, spending quality time with your family, or tidying up your room. Describe what happened: G
What was the behaviour you decided to change?
G
Why was this pattern of behaviour a problem for you?
G
Had you tried – unsuccessfully – to change this habit before? Why had you been unsuccessful?
G
What did you do to enable the change to take place this time?
G
What helped you in making these changes?
G
What hindered you?
G
Did you experience any setbacks or relapses? How did you overcome them?
G
What did you learn about yourself, and about how you would set about changing things in your life if you need to again in the future?
G
Have there been other change events in your life that have followed a different pattern, or is the event that you have described typical of how change happens in your life?
Finally, reflect on what you have written in relation to the following questions: G
What are the implications of the episode you have described here for the way in which you understand change to take place in counselling/psychotherapy?
G
To what extent does your experience of changing your behaviour generalize to a counselling/psychotherapy situation?
G
Which theories of therapy help you to make sense of the change process that you experienced?
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The role of therapy in your life story People who seek counselling or psychotherapy are often stuck at a point of choice in their lives, faced with a dilemma over choices to make. To appreciate what this is like, it is helpful to be able to draw on an understanding of your own experience of making important life choices.
Instructions Take a blank sheet of paper and a pen. Starting with the year of your birth, draw a line to the first choice juncture that you can think of. Show how the path forks, giving you a number of alternatives. Which path did you take? Make sure you indicate the paths not taken, as well as the one that you did take. The choices should be ones that had an important effect on your life. When you have finished with one choice point, go on to the next one. Note your age at each choice point, and give each of the paths (taken and untaken) a brief label. Continue until you reach your present age. Figure 1.1 provides an illustration of the kind of choice map that you might generate:
FIGURE 1.1 ‘My life choices’, Andy Simpson, August 2003
Building on life experience
Reflecting on your choice map Looking at your map as a whole, what patterns and themes do you see? Is there any consistency to the paths you have not chosen? What has your involvement with therapy been around these choice points in your life? To what extent, and in what ways, has therapy facilitated your life decisions?
Further reading The choices in life exercise have been adapted from the following article: Lewchanin, S. and Zubrod, L.A. (2001) Choices in life: a clinical tool for facilitating midlife review, Journal of Adult Development, 8: 193–6.
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Knowing how your emotions are organized The fundamental issue that drives most people to seek therapy is that they feel bad – there is some aspect of their emotional life that feels out of control, unmanageably painful, or shameful. Often, when a person commences therapy, he or she may spend a lot of time rationalizing about what is the matter. Behind this talking and thinking, there remains the same emotional struggle. All approaches to therapy, in their different styles, enjoin therapists to pay attention to the client’s pattern of feeling and emotion, and to take these emotions seriously. In order to be able to do this with any degree of confidence and success, it is necessary for anyone who practises counselling or psychotherapy to be aware, at a personal level, of how their own feelings and emotions are organized, and what they mean. This exercise is intended to facilitate self-exploration of personal emotional patterns. Slowly read the following story to yourself: Imagine that you are on your way to an important family occasion, a wedding that is being held in another country. In the run up to your trip to the wedding, you have been extremely busy. As a result, the other members of your family who are closest to you (e.g. your partner and/or children) have travelled in advance. You are booked on to the very last flight that will convey you to the city where the wedding is taking place on time. It is a holiday weekend, and many people have decided to take flights to foreign destinations. You know that the road to the airport will be busy, so you leave yourself plenty of time. However, there is an accident ahead of you on the road, and you are completely stuck in a traffic jam for over an hour. By the time you have arrived at the airport, parked your car, and run to the departure hall, it is too late to check in. Even though you have arrived at the check-in at least 30 minutes before the flight is due to board, the staff absolutely will not let you go through. They insist that all passengers must check in 45 minutes before the boarding time. All the other flights to your destination, or to cities that are near to your destination, are full. There is no way that you will be able to attend this important event that means so much to you. As you realize what has happened, how do you feel? Give a name to that emotion. Reflect on the following questions: G
Is this feeling or emotion one that you typically experience in stressful situations?
G
To what extent did this emotion or feeling make a contribution towards resolving your problem (at the check-in desk or in other situations in your life)? How functional is it?
G
Is it a pattern of feeling or emotion that was particularly encouraged or rewarded in your family while you were growing up?
This exercise is adapted from Stewart and Joines (1987: Chapter 21), and is linked to the
Building on life experience
TA model of emotional ‘rackets’. However, it can also be used to explore other models of emotional functioning (see, for example, Greenberg, 2002a). What have you learned about yourself from this exercise? What are the implications of this learning in relation to how you respond to your clients around emotional issues?
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What is your psychopathology? Everyone has a core issue that they struggle with throughout their life. The psychoanalyst, Michael Balint, called this the ‘basic fault’. For one person, the struggle may be around fighting off hopelessness, despair and depression. For another person, their life may be organized around controlling their fear of other people intruding on their boundaries. For a third person, the struggle may be around feeling loved and having a sense of being important to others. The aim of this learning task is to give you an opportunity to reflect on your own enduring personal struggle. Take some time to reflect on, and write about, your responses to the following questions: 1
What is your own core issue or area of psychopathology? What is the pattern of thinking, feeling and action that gets you into trouble, or consistently undermines your life goals?
2
In terms of well-known models of psychopathology, would you describe yourself as schizoid, obsessional or personality disordered (or as having a tendency in any of these directions)?
3
Where does this pattern come from? How did this area of difficulty arise in your life?
4
What do you do to cope with this issue, or to manage it? Have you used different strategies at different points in your life? What strategies have been most and least effective?
5
Who knows about your ‘basic fault’? How open or secretive are you around this issue? What might it be like for you (or has it been like for you) to talk about this topic in your personal development group, or in other contexts?
6
How do you make sense of this key life dilemma or challenge? What models or theories have you found helpful (or unhelpful) in enabling you to understand, accept and resolve this issue?
7
What are the implications of your psychopathology, and your way of understanding it, for your work as a therapist?
Further reading An accessible introduction to the meaning of concepts such as ‘schizoid’ and ‘obsessional’ can be found in: Joines, V. and Stewart, I. (2002) Personality Adaptations. Nottingham: Lifespace. Essential reading on patterns of personality disorder is: Benjamin, L.S. (2003) Interpersonal Diagnosis and Treatment of Personality Disorders, 2nd edn. New York: Guilford Press.
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How relevant is spirituality? The emergence of counselling and psychotherapy in the mid-twentieth century, as widely available forms of psychological care, was associated with an emphasis on a rational, scientific worldview that allowed little place for spirituality and religious experience. However, more recently, influential figures in the therapy profession have called for a reintegration of spiritual experience into counselling theory and practice: “Our experiences in therapy, and in groups, it is clear, involve the transcendent, the indescribable, the spiritual. I am compelled to believe that I, like many others, have under-estimated the importance of this mystical, spiritual realm”. Rogers (1980)
“My own belief . . . is that anyone who wants to be a good psychotherapist has to have their own spiritual discipline which they follow”. Rowan (1993)
What place does spirituality have within your approach as a counsellor? Consider the following questions: 1
What is your relationship with spirituality? What does spirituality mean for you?
2
In what ways do you (or might you wish to) draw on spiritual practices (e.g. prayer, meditation, yoga, reading, use of sacred objects) in preparing yourself for, or coping with the demands of, counselling work?
3
What types of spiritual experience have you encountered in your life? Have any of these experiences taken place during counselling, or similar work? What do you understand these experiences to signify?
4
How do you respond when a counselling client, or a person during an everyday conversation, starts to talk about the importance of spirituality in their life?
5
Where do spiritual and religious factors fit into your theoretical approach as a therapist?
Further reading West, W. (2000) Psychotherapy and Spirituality. London: Sage. (particularly Chapter 1).
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How do you cope under pressure? Being a counsellor requires a capacity to be a companion to other people at their times of greatest anguish, despair or rage. In arguing for the importance of each counsellor developing an approach that is firmly based in their own personal way of being, Peter Lomas has argued that: “. . . the business [of therapy] is to do with finding their own way, using their own intuition, learning to be themselves in the presence of someone who is asking for help, who is probably putting all kinds of pressures on them”. (Lomas, 1999: 25)
How have you responded in the past when someone with whom you have a relationship of care puts emotional pressure on you? Describe and explore the ways in which you have responded to the following life events: G
someone who is close to you is terminally ill;
G
you are on your own looking after a baby or young child, who will not stop crying;
G
you are with a child or teenager who has a tantrum because he or she cannot get what they want;
G
someone you care about has received news of a loss;
G
someone you care about is hurt;
G
a person in your family has a ‘breakdown’, talks in ways that do not make sense, and declares that he or she is going away to end it all.
These are all very difficult situations that can evoke a wide spectrum of feelings in a helper or companion. What has your emotional response been in these situations? What have you done – have you moved closer, retreated, withdrawn, displaced your concern into other behaviour . . .? How has the quality of your connection with the other person changed or shifted at these moments? Once you have mapped out your way of reacting to these demanding situations in everyday life, take some time to reflect on the potential implications of what you have learned for your work as a counsellor.
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Do you have a preferred learning style? Different people learn in different ways. For example, some people gain more from reading and individual reflection, while others learn better when actively doing things with others. The model of experiential learning developed by David Kolb suggests that the process of learning consists of four phases. For instance, if a person is interested in learning how to perform a task more effectively, the following processes can be observed: G
Concrete experience occurs when the person is involved in carrying out a task.
G
Reflection on that experience, on a personal basis – a process of individual sensemaking.
G
Abstract conceptualization is a phase that involves identifying general rules describing the experience, or the application of known theories to it, which leads to ideas about ways of modifying the next occurrence of the experience.
G
Active experimentation represents the application of these new skills or ideas in practice, which in turn leads to a new set of concrete experiences, which are then in turn reflected on. . . .
This sequence of learning steps may take place within a few minutes, or may extend over months, depending on the topic. Kolb, and other researchers, have noted that although any competent learner will have a capacity to function in each of these ways, individuals tend to grow up specializing in one or two ‘preferred’ learning processes. The theory of personal learning styles devised by Peter Honey is based on four primary learning styles, which correspond to the four phases of Kolb’s cyclical model: G
Activists involve themselves fully in doing things, enjoy teamwork, and eagerly embrace opportunities for practical, experiential activities. They are open to new learning experiences.
G
Reflectors prefer to stand back and look at experiences from many different perspectives. They collect data and prefer to think about it thoroughly before coming to any conclusions.
G
Theorists adapt and integrate observations into complex but logically sound theories. They are interested in concepts, and think problems through in a step-bystep, logical way.
G
Pragmatists are keen to try out ideas, theories and techniques to see if they work in practice. They positively search out new ideas and take the first opportunity to experiment with applications.
A preference for any one of these learning styles is likely to mean that a person will be frustrated with learning experiences that are based in a different model. For example, activists may become impatient with theory and precise instructions, while theorists may be uncomfortable with the messiness and ambiguity of many practical situations.
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The counsellor’s workbook
What are the implications of your learning style for your personal approach as a counsellor? Consider the following questions: G
How do you define your learning style?
G
In what way does your preferred style of learning explain your level of interest and enthusiasm in different types of learning within your counsellor training (e.g. reading about theory, participating in a personal development group, being an observer in skills practice sessions)?
G
What are the links between your preferred learning style and the theoretical approach(es) with which you most identify?
G
Could your way of working with clients, within an actual counselling session, be viewed as an expression of your learning style? Do you create certain kinds of learning opportunity for clients, and not others?
G
How sensitive are you to the learning styles of other people? How well do you respond to the learning process of clients who have learning styles different from your own?
G
What are the implications of models of learning styles for your capacity to engage empathically with the experiences of other people?
Further reading Honey, P. and Mumford, A. (1982) Manual of Learning Styles. London: P. Honey. Kolb, D.A. (1984) Experiential Learning: Experience as the Source of Learning and Development. Englewood Cliffs, NJ: Prentice-Hall. A number of self-test learning styles inventories are available on the Internet.
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What motivates you?
The list below includes some of the reasons that people give for wanting to be a counsellor or psychotherapist. How important are each of these sources of motivation for you in your counselling work? Place a ‘1’ beside the most important, ‘2’ for the second most important, and so on. Add any additional sources of motivation that come to mind. G G G G G G G G G G G G
Contact with other people (clients) in a controlled situation —— Discovery – learning about human beings —— Social status and respect —— Payment, making a living —— Helping or healing others —— Being powerful and having an impact on clients —— Self-therapy, learning about myself through the work —— Vicarious experience, the interest of learning about other people’s lives —— Feeling wanted and needed —— Because I received therapy myself and want to ‘give something back’ —— Doing a job that is intellectually challenging —— Other sources of motivation not included in the above list ——
Once you have rank ordered these sources of motivation, consider the following questions: G
How open are you with other people, such as colleagues, about your motivation to do this work? There may be sources of motivation that you conceal for others – what difference would it make to own up to these factors?
G
How do these sources of motivation/satisfaction influence and shape the way you work; for example, the decisions you make about the kind of work that you do?
G
How have you acquired these motives – where do they come from in your life? For example, are there experiences in childhood, or significant people you have met, that you can recognize as representing the origins of these motives?
G
In what ways have the sources of motivation and satisfaction associated with your work as a therapist changed over the course of your training or career? What has triggered these shifts?
G
How sustainable are these factors? Can you anticipate any of them becoming less motivating for you in the future? What would you do if this happened?
Further reading The issue of therapist motivation is discussed on page 615 of McLeod, J. (2009) An Introduction to Counselling, 4th edn. Maidenhead: Open University Press.
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Reflecting on the experience of writing about yourself The activities in this section of The Counsellor’s Workbook have invited you to write about many different aspects of your personal life. The technique of personal writing has been used by many therapists as a way of helping clients; for example, in the work of the US psychologist, James Pennebaker. In reflecting on your experience of writing about yourself, consider the following questions: G
What impact has this experience had on you? Has it been helpful to write about yourself, or unhelpful?
G
What are the ways in which writing has been useful or otherwise for you?
G
What have you learned about what is the best time and place for you, in terms of productive personal writing?
G
What have been the differences that you have noticed, between talking about an issue or experience, and writing about it?
G
In what circumstances might you use writing activities with clients? How might you integrate writing tasks into your face-to-face conversations with clients?
In relation to the autobiographical dimension of these writing activities, it may be useful to reflect on questions such as: G
What effects have you noticed, in terms of your feelings about your life and your attitude towards yourself, that have arisen from your autobiographical writing?
G
Has your autobiographical writing helped you to identify episodes or events in your life that were previously out of your awareness? How useful (or otherwise) has it been for you to remember these instances?
G
What are the distinctive personal strengths and accomplishments that you have uncovered through exploration of your autobiography?
G
How might a full and rich understanding of your own biography or life history help you in your work with clients?
G
To what extent, and in what ways, do you encourage your clients to articulate and reflect on their life stories?
Building on life experience
Further reading Bolton, G., Howlett, S., Lago, C. and Wright, J.K. (eds) (2004) Writing Cures: An Introductory Handbook of Writing in Counselling and Psychotherapy. London: Brunner-Routledge. McAdams, D.P. (1993) The Stories We Live By: Personal Myths and the Making of the Self. New York: William Murrow. Pennebaker, J. (1997) Opening Up: The Healing Power of Expressing Emotions. New York: Guilford Press. Pennebaker, J.W. (2004) Writing to Heal: A Guided Journal for Recovering from Trauma and Emotional Upheaval. Oakland, CA: New Harbinger Press.
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Being a member of a learning group: working together to develop self-awareness Section contents Introduction
53
Exploring your feelings, fantasies and expectations about the group
55
Using the group to experiment with new ways of relating to others
56
Making connections and being responsive to others
57
First impressions of group members
59
Talking about yourself in the group
61
Reflecting on significant events in the group
62
Endings: reflecting on the life of the group
64
A brief introduction to concepts of group dynamics
66
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Introduction
There are several reasons why participating in a learning group can make an important contribution to the personal and professional development of counsellors and psychotherapists in training: G
The way that a person responds to being in a group typically recapitulates earlier experiences in family and friendship groups; the learning group provides a setting for learning about these areas of personal development.
G
The group is a setting for giving and receiving support and challenge.
G
Responding to other members of the group provides ongoing practice in offering the qualities of empathy, congruence and acceptance in relationships.
G
Group members can give each other feedback on their reactions to what a person has said or done in the group, thereby helping that person to become more aware of how he or she is viewed by others.
G
Group members can encourage each other to explore difficult topics in more depth.
G
Working in a group provides opportunities to learn how to engage constructively with people who may be experienced as threatening, hard to understand or ‘different’.
G
Within a group, it is possible to become more aware of the universality of human experience, and the interconnectedness of persons.
G
Counsellors are sometimes called on to facilitate therapy groups – the experience of being a member of a learning group provides an appreciation of group dynamics, and an introduction to what is involved in the role of group facilitator.
It is recommended that the learning tasks in this Workbook should be explored not only individually; for example, through the medium of a personal learning journal, but also collectively, in the context of a learning group. The group may be facilitated by a tutor or external consultant, or may be a peer group comprising only course members or co-learners. The group may be a formal element in a training course, or organized by course members within their own time. The learning tasks in this section are designed to enable users of the Workbook to make the most out of the experience of taking part in a learning group. The first two learning tasks outlined below should be completed in advance of the first meeting of the group. It is useful to try the ‘Making connections and being responsive to others’ exercise near the beginning of the group – it is intended to function as a model or template for how the group might work together. Other exercises are intended to be completed as soon as possible after each meeting of the group. There are also some activities that can be used towards the end of the life of the group to enable members of the group to reflect together on how the group has functioned, and what it has meant to them.
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The counsellor’s workbook
Appendix A (p. 209) provides a set of guidelines for tutors and trainers on how to run a personal development group based on the activities in this Workbook using a narrative approach. These guidelines can readily be adapted for groups of learners who might wish to meet on a peer group basis in the absence of a designated leader or facilitator.
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Exploring your feelings, fantasies and expectations about the group Before the first meeting of your learning group, take some time to write freely about your feelings and fantasies about this group: G
What do you hope will happen in the group?
G
What are your fears in terms of awful things that might happen in the group, or that you might be called on to do?
G
Where do these reactions come from in terms of your own life history?
Having explored your expectations for the group, what have you learned about how a counselling client might feel in making a first appointment, and anticipating his or her first meeting with a therapist? What are the group norms or rules that are particularly important to you? In relation to establishing ‘ground rules’ for the group, take a few minutes to note what you want to see happen, in relation to such factors as: G
starting and finishing on time;
G
what happens if people do not turn up;
G
talking outside the group about what has happened inside it;
G
touching each other;
G
what happens if someone walks out during a session;
G
pressure to talk/freedom to remain silent;
G
honesty;
G
the role and responsibilities of the facilitator;
G
the role and responsibilities of group members;
G
how decisions are to be made, about how the group uses its time.
Having explored some of your ideas about desirable and undesirable group norms, take some further time to reflect on the implications of what you have written for your role as a counsellor, and your experience of being a client in therapy. To what extent, and in what ways, have you participated in discussing norms or ground rules for counselling and psychotherapy with your therapist or with your clients? How useful might it be to do more of this? Finally, reflect on your reading of therapy theory so far, particularly the theory or theories of therapy around which your training course is built (or the theories that have most personal meaning and utility for you). What do these theories have to say about processes of therapeutic learning and change? What do you think should happen in the group if it is to become an environment within which these processes will occur to maximum effect? What does optimal (or non-optimal) group functioning look like from the perspective of your preferred theories?
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Using the group to experiment with new ways of relating to others As we grow up, we tend to develop a specialized role in our family. For example, some people find themselves playing the role of ‘peacemaker’, while others will consistently be in the role of ‘troublemaker’, ‘quiet one’, ‘joker’, ‘source of good ideas’, ‘dreamer’, and so on. Usually, people carry these roles into other groups in which they are involved. For example, someone who was a ‘troublemaker’ in their family might also ask awkward questions in staff meetings at work, or always be trying to bend the rules. The existence of these roles is inevitable, but also carries negative implications for the practice of counselling. Our clients require us to be able to respond to them in a wide range of ways, and not always to revert to our preferred role position. The learning group provides an opportunity to experiment with your own role flexibility.
Instructions G
Identify the group role or roles that you have typically fulfilled in your family of origin or other groups.
G
Identify a new and different role that you have seldom or never played in a group, and which represents an aspect of yourself that you would like to make more available. For example, if you have tended to be the ‘quiet one’ in groups, you might choose to develop your capacity to be someone who is a ‘constant source of ideas’.
G
Plan and rehearse your strategies for acting this new role. For example, who are the models (people you know or people you have observed in movies or on TV) that you might base yourself on?
G
Take every possible opportunity to play this new role in the group.
G
Use your personal learning journal to reflect on the experience of this new role – what it felt like, how other people responded to you in a different way, what happened to the role that you previously fulfilled.
This exercise can include (optionally) disclosing to other group members what your ‘experimental’ role will be, and inviting them to give you feedback when they notice you performing both the new role and your older more familiar roles. Towards the later stages of the life of the group, reflect on the personal and professional implications of what you have learned through this activity. What are the implications for your own sense of self – the way that you understand yourself and describe yourself to others? What are the implications for your understanding of how people change in therapy, through carrying out behaviour change ‘experiments’?
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Making connections and being responsive to others The aim of this exercise is to explore the experience of being open to the experience of another person, and letting that person know how their story has had meaning for you. These are processes that are essential aspects of the learning group, and are intrinsic to a narrative approach to working together in groups. It is important to take responsibility for yourself – what you share is under your control. It is important to be respectful of others by being supportive and honest, and holding confidentiality. This learning task involves taking it in turns to carry out the activity described below. 1 Telling the story of a development in your life Take a few moments to think about developments in your work or life that you are pleased with. Choose one such development to describe to the group. Tell a bit of the story of what happened. Say something about the beliefs, intentions and commitments that this development contributes to in your life. Take time to get a rich description of the meaning of this development for you. Once you have described this pleasing development in your life, reflect on these further questions: G
Who is someone in your life who would be least surprised to hear you talking about these intentions or commitments – someone you know or once knew who would recognize and value the commitment you were talking about? It may be someone you actually know or knew, or it could be a character in a book or story. What is this person’s name? What do they look like? When did you know them? Are there any special things about them?
G
What might this person have noticed you doing in the past that might have helped them to notice the commitment that you spoke of just now? What might it have meant to this person to have seen how this commitment was important to you, and the actions that you have taken to fit with it? What contribution do you imagine that this might have made to their life?
G
If you were to see yourself now through that person’s eyes, what would you most appreciate about yourself?
G
What difference would it make to you, in your work and life, if you were to hold the presence of that person with you in what you do?
You will have about 10 minutes to tell this story in the group. 2 The responses of those who witnessed the story The intention is not to praise/applaud or criticize the person who told the story, or to interpret their story in theoretical terms, or to offer a therapeutic response. The aim,
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when making a response to a story you have heard, is to use the experience to thicken your own story, and that of the teller, by making connections. The following questions can be used to help you to shape your response: G
What caught your interest? What touched or moved you in what you heard? As you listened, which expressions caught your attention or captured your imagination?
G
What images of this person’s life, their identity and the world more generally, did these expressions evoke? What did these expressions suggest to you about the person’s purposes, hopes, beliefs, values, dreams and commitments?
G
What did this have you thinking about in relation to your own work and life? Which aspects of your own experiences of life resonated with the images and expressions of the teller? What is it about your own life that meant you were touched in this way?
G
Where does hearing this take you? How will it contribute to possibilities in your own life? Where have you moved to in your thinking or experience of life? How is your life different for having moved to this new place?
3 The process of going round the group Each member of the group, in turn, shares his or her response to the ‘story of a development . . .’ that they have heard until everyone has offered a response. Once this ‘round’ is complete, another member of the group tells his or her story of a ‘pleasing development’, followed by a further set of responses. Leave 10 minutes at the end, after everyone has told their story and been responded to, to reflect together on the experience of doing the exercise. What did you learn about yourself and your relationships with others?
Further reading Morgan, A. (2000) What is Narrative Therapy? Adelaide: Dulwich Centre Publications (Chapter 14). White, M. (1997) Narratives of Therapists’ Lives. Adelaide: Dulwich Centre Publications (Chapter 10).
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First impressions of group members The first meetings of a learning group represent a situation in which it is possible to reflect on the significance of first impressions. The first encounter between people is one in which a great deal of information is processed very quickly. The process that takes place can be regarded as an example of intuition, where conclusions about a person are reached without being able to explain any logical grounds for them. This kind of intuitive competence is important for therapists, who need to be able to respond to clients on the basis of a holistic, immediate, ‘felt’ sense of what may be happening in the therapeutic relationship. As a relationship develops, a person is able to engage in ‘impression management’, to create a preferred image of who they are, in the minds of those with whom they interact. Being sensitive to first impressions opens up the possibility of being able to reflect on what it might mean that one’s image of another person changes over time: ‘when I first met him/her, I thought that he/she was . . ., but as I got to know them, I realised that they were. . . .’ Make notes in relation to the following questions: G
What were your first impressions of other group members, and the group facilitator?
G
For each person, who did they remind you of?
G
Describe the physical presence of each person.
G
Describe the voice quality of each person.
G
Who did you feel close to from the start?
G
Who did you want to move away from?
G
Think of each group member as an animal – which animal would they be?
G
What was it like for you the first time you directly engaged in conversation with each member of the group?
Having recorded these first impressions, take some time to reflect on what they might mean: G
How do you make sense of these first impressions in terms of the connections in your own mind between this group and other groups to which you have belonged? Are there the same set of ‘characters’ in this group as in other groups in which you have been a member? If so, what are the implications for your sense of the drama of your own life?
G
How do you make theoretical sense of these first impressions? For example, if the members of your learning group trigger memories of people from your childhood, would this would be a confirmation of the psychoanalytic theory of transference? In what other ways could you explain these first impressions?
G
What are the implications of first impressions for the establishment of a collaborative relationship between a therapist and a client?
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Further reading The topic of first impressions and intuitive decision-making is discussed in: Gladwell, M. (2006) Blink: The Power of Thinking without Thinking. London: Penguin.
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Talking about yourself in the group At some point near the start of the learning group, you will be expected to share aspects of your life story with other members of the group. As the group moves on to other topics, you may be called on to disclose early memories, your feelings about your sexuality, and other sensitive and personal topics. Use your personal learning journal to reflect on your experience of talking about yourself: G
What was this like for you to talk about yourself?
G
How did you feel when it was your turn? At what point did you volunteer – early or late?
G
What did your way of dealing with disclosing sensitive personal stories tell you about yourself?
G
What information about yourself did you hold back? To what extent was this a conscious choice, or did you just ‘forget’ to talk about certain areas?
G
What held you back from telling your story (e.g. lack of trust, a belief that other people would not be interested in you, etc.)?
G
What made it easier for you to talk about yourself?
G
What did you observe in other people in terms of the ways in which they coped with these tasks?
G
What was it like to listen to other stories? Did these personal stories help you feel closer to other group members, or otherwise? If it did help you to feel closer, then how and why is it that personal storytelling can have this kind of effect?
What are the implications for your practice of therapy, of what you have learned about the challenges involved in sharing personal stories, and the ways in which self-disclosure can be inhibited or facilitated? How do you make sense of your own, and other people’s performances, in terms of theories of personality and psychopathology? For example, to what extent does it make sense to interpret the ways in which people tell their stories in the group, as examples of narcissism (listen to my story and you will realize how wonderful I am), early attachment difficulties (my story isn’t really very interesting – I don’t expect anyone will want to hear it) or other patterns?
Further reading Farber, B.A. (2006) Self Disclosure in Psychotherapy. New York: Guilford Press.
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Reflecting on significant events in the group After each session, take a few minutes to write a description of the most significant event that happened in the group that week. A significant event or moment can be anything that happened that is memorable and meaningful for you. Your account of the event should include: G
what led up to the event;
G
what took place;
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what the consequences were (i.e. whether and how the climate of the group shifted afterwards, and in what direction).
Describe your own involvement in the event (whether as an active participant, or passive observer), including your thoughts, feelings and fantasies, and what you did and said (or wanted to do and say). Creating a series of event descriptions of this kind can be invaluable in tracing the development of the group, and the changes taking place in your own role in the group. Yalom (2005) suggests that there are different types of helpful factors in groups: G
group cohesiveness;
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instillation of hope;
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universality;
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catharsis;
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altruism;
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guidance;
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self-disclosure;
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feedback;
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self-understanding;
G
identification;
G
family re-enactment;
G
existential awareness.
You can deepen your appreciation of group processes by looking at how the events you have described can be understood in terms of these categories, and reading Yalom’s (2005) discussion of the broader significance of these types of process. It may also be of interest to reflect on the difference between significant events in which you were directly involved as a key actor, and those where you were an observer. Finally, it can be illuminating to compare your ideas about significant events with the events identified by other members of the same group, and try to make sense of any differences in perception that emerge. Not everyone in the group will identify the same events as being significant. If you have collected significant event descriptions over the life of the group, look at
Being a member of a learning group
whether different types of event were observed in the later stages of the life of the group compared to the early stages. If there are differences, what might this mean in terms of an understanding of group processes? Finally – reflect on what you have learned from this exercise about the process of individual counselling and psychotherapy. Do different types of change event occur in individual therapy compared to group therapy? Or do the same kinds of thing happen, but in a different form?
Further reading Bloch, S., Crouch, E. and Reibstein, J. (1981) Therapeutic factors in group psychotherapy, Archives of General Psychiatry, 38: 519–26. Yalom, I.D. (2005) Theory and Practice of Group Psychotherapy, 5th edn. New York: Basic Books.
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Endings: reflecting on the life of the group In preparation for the ending of the learning group, it can be useful for group members to reflect together on how they have worked together.
Exercise: being on a journey together Take some time to draw a picture of the group, and all its members, as if it was a boat of some kind on a journey. What kind of a boat is it? What kind of a journey is it on? What roles have different members (and the facilitator) played – captain, crew, passengers, cargo, saboteurs, rescuers, and so on? What was the journey like – what were the most memorable episodes? Use your imagination, and imagery and colour, to create a picture that represents your own personal experience of the group over the last few months. Each person brings their picture into the group, shows it to your fellow group members, and talks them through what it means. This exercise is intended to open up the process of reflecting on the group experience. The group journey metaphor allows members to sum up their feelings about the group as a whole.
Exercise: reflecting on key aspects of the group experience There are many different processes that can take place in learning groups. In any particular group, some of these processes may be more salient than others. Read through the list of questions below, and create a space to reflect and write on the ones that seem to you to be most significant in relation to your own learning group experience. If you have kept notes of what happened in the group, week by week, it will be easier to explore these issues in depth. 1
The emotional climate of the group: what were the main feelings and emotions that you experienced in the group? Did you have different feelings and emotions at different times? How did you express or act on these emotions? How did you observe other people acting on their emotions?
2
Leadership style: what was facilitative for you and other people in the group? What kinds of process made learning and change possible? What has been the facilitative style of the leader? What have been the advantages and disadvantages, or consequences, of that style for the group as a whole and for you as an individual?
3
The development of group norms and culture: were there any phases or stages in the life of the group? How would you describe the different characteristics and ‘feel’ of each of these stages? What word or image would you use to describe each stage? Were there specific transition points or events that marked the shift from one stage to the next? What were they? How would you describe your own
Being a member of a learning group
behaviour and activity at each stage or phase of the group? How did you behave or feel differently at each stage? At which stage did you feel most comfortable or ‘at home’? 4
Group roles: in what ways did you act consistently in the group; for example, by saying the same kinds of thing in different sessions, or responding to particular kinds of event in a certain manner? How would you describe your consistent way of being in the group? Did you have a specific role within the group? Did this role change over time? What roles did you observe other people playing? Did their roles change over time?
5
Relationships between group members: how was the issue of intimacy handled by the group? Getting close to others in a professional arena can be threatening and confusing. How did you cope with this? What did you feel? What did you do? Did you allow yourself to get close? When you observed intimacy between other group members, how did you feel about this? What values, moral and ethical issues does the level of intimacy in the group raise for you?
6
The group as an arena for family re-enactment: what has being a member of this learning group evoked for you in terms of your experience of being a member of a family? Did you enact roles and patterns of interaction that you learned in your family of origin?
7
The group as a context for exhibiting therapist qualities and competences: having spent all these hours in a learning group with a set of colleagues, who would you go to (or recommend a friend or family member to consult) as a therapist? Have you shared these views with colleagues in the group? Who do you intend to stay in contact with after the ending of the group?
Use these questions to reflect on: G
what you have learned about yourself as a person: the self-discoveries and insights that have been triggered by interacting with other members of the group on a shared learning task;
G
what you have learned about the process of counselling and psychotherapy: what did you experience and observe in the group that can be useful for your work as a therapist?
G
what you have learned about how groups operate; for example, group norms, stages in the life of a group, roles within groups, and so on.
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A brief introduction to concepts of group dynamics When reflecting on the experience of being a member of a learning group, it can be helpful to be able to make sense of these experiences in the context of an appreciation of how groups operate, and the distinctive issues and learning opportunities that are highlighted by the process of the group. The area of group dynamics has been a central focus for social psychology and sociology for more than a century, and there exists a wealth of theory and research on this topic. An introduction to some of the main concepts that are used in theories of group dynamics is provided below.
The needs of individual members In any group there is a task to be fulfilled. The nature of the task will be different for different groups. For example, management groups must make decisions, ward-based nursing teams must organize and deliver patient care, and learning groups must create an environment for the acquisition of new skills and knowledge. But in all these groups the achievement of the group’s goals, the fulfilment of its primary task, will be strongly influenced by the quality of the relationships that exist between group members. This is because people are not robots or machines, but have needs that they try to satisfy through contact with colleagues and clients. There appear to be three broad areas of interpersonal needs that are relevant to the way that people act in groups: 1
needs for inclusion/belonging/acceptance;
2
needs to feel in control of the situation, for power, influence, to experience a sense of order;
3
needs for liking/affection/intimacy/expressing feelings.
Various theorists and researchers have observed that in many groups, the salience of these needs changes over time. At the beginning of the life of a group, people are particularly concerned about whether they will be included and accepted by others. This phase may raise personal issues around the person’s sense of belonging. The group may then shift to a concern with the question of how it is going to get things done. Needs for order and control, or individual freedom from external constraint, may come to the fore. Also, this stage in the life of the group can raise issues around the perceived need for a strong leader (dependency needs). Finally, the group may reach a stage where there is the possibility for authentic connection and intimacy between group members. At this point, some of the fears and inhibitions associated with interpersonal closeness may be exhibited.
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The group as a system Any human group can be seen as a complex system of relationships, task and roles. Often groups of people fail to work effectively together because there is something wrong with the system, rather than because of any inadequacies of individual members of the group. It is important to remember this fact, because it can be easy to attribute blame to individuals when something goes wrong, rather than recognize that the real problem is rooted in the way the group functions as a system. Three of the most fundamental aspects of group ‘systems’ are their norms, their composition and their boundaries. The norms of a group represent the shared (and usually unconscious or taken-forgranted) assumptions that group members have about what is OK in the group and what is not OK. Some of the questions that are useful to ask about the norms of a learning group include: G
Is it alright to disagree?
G
Is it alright to express feelings? Which feelings?
G
Is there a norm for excellence/quality?
G
Is it OK to help or support other group members?
The composition of a group can critically affect the way it functions. Some of the important questions here include: G
Are there too many/too few members to permit efficient decision-making, communication, and so on.
G
Is there an appropriate mix of ‘role specialists’ (e.g. individuals who are taskoriented, supportive, creative, critical, humorous, and so on)?
The boundary of a group is like an invisible, but psychologically very real, barrier or fence around a group. When you are ‘in’ the group you know you have crossed that boundary. It is very difficult for a group of people to see themselves as a unit, or a group, in the absence of a secure boundary. Significant boundary questions include: G
How does someone cross the boundary to enter the group? What are the membership rituals?
G
Can new ideas or information appropriately cross the boundary?
G
Is the boundary strong enough to withstand pressure from external sources?
G
Are there any internal boundaries (e.g. sub-groups, cliques)?
G
Who looks after the boundaries?
Group roles and leadership Effective leadership is essential for any group to perform well. However, it is necessary to recognize that the most effective ‘leadership’ is not something that is only provided by the one individual who is designated as ‘the boss’ or ‘the facilitator’, but is a quality of a group to which all its members contribute. For example, there cannot be a ‘leader’ with ‘followers’. Also, each person in a work group will have some ideas or qualities
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that they can offer – there are a wide range of roles that need to be fulfilled in a group, each of which makes its own unique contribution to a ‘leadership’ or directional function. Key questions about leadership in groups include: G
Who supplies the group with an overall sense of direction or ‘vision’? How is this achieved?
G
Who coaches group members who might not be doing well at their individual tasks?
G
How is good work recognized and rewarded?
G
Who monitors the operation of the group and initiates action to change things that are not going well?
G
Who makes sure that adequate resources are made available so that each member of the group or team can do their job properly?
Change One of the most fundamental aspects of any social group is that it changes over time. Personnel, priorities, norms, tasks and level of effectiveness all change over the lifetime of a group for a multitude of reasons. This is why many writers about small groups talk in terms of group dynamics or group processes. It is important to be aware of change processes in order to be able to understand and cope with situations where the group is either stuck or seemingly engaged in a process of chaotic, rapid change. Some useful questions to consider here are: G
How does the group deal with the arrival or departure of members?
G
How is time structured? For example, when an important decision is to be made, does the group decide to go through phases of information-gathering, evaluation and action, or when there is a meeting, is there an agenda?
G
How does the group take care of endings? Is unfinished business always dealt with? Does the group celebrate its successes?
G
Is the group capable of adapting to changed circumstances?
In some ways, these changes can be seen to unfold as discrete stages or phases in the life of a group. In other ways, however, change in a group can occur over short periods of time, and may take on a cyclical quality, with the group passing fairly rapidly through a sequence of distinct states of functioning. These themes – personal needs in relation to others, responding to change, adapting to the social norms – are central to the experience of being a person. As a result, being a member of an intensive small group can represent a situation in which a person can learn a great deal about how they are, and how they relate to others. A small learning group can be viewed as a microcosm of other social groups that a person has experienced during their life. In such a group, people reproduce patterns of being-in-relationship that reflect the ways that they felt and acted in earlier groups in their life, such as their family of origin, or friendship groups at school.
Being a member of a learning group
Further reading A useful overview of theory and research on group dynamics can be found in: Forsyth, D.R. (1990) Group Dynamics, 2nd edn. Pacific Grove, CA: Brooks/Cole. Some of the most interesting perspectives on group dynamics are derived from psychoanalytic theory, particularly the ideas of the British psychoanalyst, Wilfred Bion: Bion, W. (1961) Experiences in Groups. London: Tavistock. Rioch, M. (1970) The work of Wilfred Bion on groups, Psychiatry, 33: 56–66. Whitman, R. and Stock, D. (1958) The group focal conflict, Psychiatry, 21: 269–76. A classic paper, which presents a model of the interconnectedness of group, roles and group stages, is: Bennis, W. and Shepard, H. (1956) A theory of group development, Human Relations, 9: 415–57. Issues associated with the use of small groups to facilitate individual learning and self-awareness are discussed in: Benson, J. (2000) Working More Creatively with Groups, 2nd edn. London: Routledge. Blumberg, A. and Golombiewski, R. (1976) Learning and Change in Groups. London: Penguin. Lago, C. and Macmillan, M. (eds) (2000) Experiences in Relatedness: Groupwork and the Person-centred Approach. Hay-on-Wye: PCCS Books. Whitaker, D. (1985) Using Groups to Help People. London: Tavistock. Yalom, I. (2005) Theory and Practice of Group Psychotherapy, 5th edn. New York: Basic Books.
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Making sense: constructing a framework for understanding
Section contents Introduction
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What are the key theoretical ideas that you use?
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What is your relationship with theory?
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Identifying different levels of theorizing
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Meta-theories: how do they shape the way you think about counselling?
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Applying theory: making sense of personal experience
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Empathy: a key concept in counselling
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Making sense of self
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How theory is applied in practice: key cases
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Applying cognitive–behavioural concepts
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Irrational beliefs and dysfunctional self-talk
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Developing a cognitive–behavioural case formulation
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Congruence: the use of self in counselling
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Experiencing authenticity
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The balance between problems and solutions
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Specific techniques or common factors
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Positioning your practice in relation to social and political factors
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The idea of the unconscious
101
What brings about change? The relative importance of cognition and emotion
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Behind the theory: the life of the theorist
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The cultural context of understanding
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What kind of therapeutic relationship?
108
Dialogue between theorists
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Are you postmodern?
112
Letter to a theorist
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The concept of transference
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Introduction
The work of a counsellor or psychotherapist inevitably involves listening to people talk in detail about complex situations in their lives. Often, the person’s way of telling his or her life story may be halting, incoherent, or punctuated by strong emotion. Almost always, there will be gaps in the story – things not said, things that may be too embarrassing or shameful to share with another person. Listening to such stories, in a context in which you are expected to do something to help, can be a confusing and overwhelming experience. Where to start? What does all this information mean? What can I say or do to make things better? Theory provides a framework for understanding, a preliminary map of the territory that might be explored, and a set of suggestions for possible directions of travel. It is one of the core functions of training to enable the trainee to find a theoretical ‘home’. Some therapists prefer to develop membership of a coherent theoretical community, centred around one of the main approaches to therapy, such as psychodynamic, person-centred cognitive–behavioural therapy. Other practitioners choose to follow a more integrative or eclectic path. In either case, it is essential to become thoroughly familiar with the theoretical constructs and language that one decides to use. All the big, important concepts within therapy theory – the unconscious, the self, cognitive schema – can be understood or interpreted in different ways, and have multiple meanings and implications according to the circumstances in which they are used. Possessing a superficial understanding of such ideas can lead a counsellor into difficulties; for example, if a client realizes that their therapist is only pretending to understand, is hiding behind technical jargon, or is contradicting him or herself. The activities in this section of the Workbook are designed to approach the goal of making sense and constructing a framework for understanding in a variety of ways. These activities invite you to: G
reflect on the role of theory in counselling practice;
G
explore your own ‘personal theories’ and how these fit with the counselling models you have encountered;
G
look back at the implicit theoretical assumptions expressed in the writing you did in Section 1 of the Workbook;
G
examine key concepts in depth.
Throughout these learning activities, you are encouraged to build up a sense of your own personal framework for understanding. Many of the tasks ask you to identify your own position in relation to the theoretical ideas that you are exploring. The rationale for this is that your own personal framework for understanding is always more than any single theory of therapy can provide. Responding to people in crisis always involves drawing on your life experience and common sense, as well as your knowledge of
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therapy models. It is important, therefore, to know where you stand in relation to the theoretical traditions that inform your work. Later sections in the Workbook build on your exploration of theory; for example, in applying theory in understanding individual cases, or in resolving practice issues. The exercises in Section 6, ‘Developing a professional identity: putting it all together’, give you opportunities to integrate or sum up your theoretical position.
Further reading The role of theory in counselling and psychotherapy practice is discussed in: McLeod, J. (2009) An Introduction to Counselling, 4th edn. Maidenhead: Open University Press (Chapter 3).
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What are the key theoretical ideas that you use? If you read between the lines of most counselling, psychotherapy and personality textbooks, you will find that there is a set of core questions, related to the basic processes of counselling, which any theoretical model needs to be able to answer. These questions include: G
What are the causes of people’s problems?
G
What are the main mechanisms and processes of change? What changes? How?
G
What is the role of the therapist? What is the optimal type of counsellor–client relationship? Why is the relationship important? Why is it necessary to have a strong ‘therapeutic alliance’?
G
What are the criteria for success and failure in counselling or psychotherapy? What are the goals of therapy?
G
What is the relative importance, in terms of making sense of clients’ problems and the process of therapy, of: – – – –
cultural factors (including social class, ethnicity and gender); cognitive factors (the way the person thinks about things; the person’s beliefs); emotion (how the person feels about things); biological/genetic factors?
Make brief notes in response to all these questions. Just write down whatever answers come into your mind. Which theoretical ideas and concepts appear in your answers to these questions? Do these concepts all derive from a single theoretical model, or do your answers contain a mix of ideas? You may find it helpful to use a large sheet or roll of paper to map out your thinking in relation to these key theoretical questions. What you produce will almost inevitably be complex and incomplete, and indicate potential areas for further reading and study.
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What is your relationship with theory? The social psychologist, Kurt Lewin, once said, ‘There is nothing as practical as a good theory’. Do you agree? How important is theory for you? As fully as possible, explore your responses to these questions: G
What are the theoretical ideas or concepts that you refer to most often, in terms of your own personal thinking about counselling issues, and your discussions with other people around these matters? How deeply have you studied these concepts? Have you mainly learned about these ideas or concepts from general reading, or listening to other people, or is your knowledge based on extensive reading?
G
What are the theoretical tensions or dilemmas that you are aware of in your work as a counsellor (or in your reading as a trainee/student)? Are there times when you are caught between different ways of making sense of a client (or any person you are helping), or of your role in relation to a client? What do you do when you have this kind of experience?
G
What is the direction of your theoretical development? Are there earlier theoretical ideas that you have ‘grown out of’? Where do you feel that your theoretical interests are heading? What do you feel you want to (or need to) read next?
G
For you, what is the ideal balance between making sense of the process of counselling in terms of an explicit theoretical formulation, and arriving at an intuitive, gut response to what is happening?
G
On the whole, how satisfied are you with your current relationship with counselling/psychotherapy theory? Do you feel that you may sometimes over-theorize, and thus perhaps lose touch with what is taking place in the moment? Or do you struggle to detach yourself from the moment-by-moment complexity of counselling and perhaps lack an ability to develop a conceptual overview?
What are the implications of your responses to these questions for: 1
your practice as a counsellor or psychotherapist?
2
your ongoing professional development, for example, in respect of further reading and study?
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Identifying different levels of theorizing The previous exercises in this section invited you to explore and write down the different theoretical ideas that you use in thinking about therapy. In trying to make sense of how these concepts fit together, and how they might influence your work with clients, it can be helpful to consider them in terms of different levels of abstraction. There are three levels of abstraction within any theoretical model used in counselling and therapy: 1
statements about observational data;
2
theoretical propositions, which make connections between different observations;
3
underlying philosophical assumptions.
For example, within psychoanalysis, statements about, for example, defence mechanisms such as projection or denial are fundamentally simple observations of behavioural events. However, psychoanalytic concepts such as ‘anal personality’ go beyond mere observation, and made inferences about the connectedness of events separated by time and space. For example, the idea of anal personality implies a link between childhood events (potty training) and adult behaviour (obsessionality), and this association is inferred rather than directly observed. Finally, concepts such as the ‘unconscious’ and ‘libido’ refer to philosophical abstractions that cannot be directly observed but are used as general explanatory ideas. The use of lower-level, observational constructs can be seen to carry relatively little in the way of theoretical ‘baggage’. For example, describing a client as ‘using the defence mechanism of projection’ might be an effective shorthand means of giving information to a supervisor or colleagues in a case conference. Higher-level philosophical constructs and concepts, by contrast, cannot be as easily taken out of the context of the theoretical model within which they fit. A term such as ‘libido’ (Freudian theory) or ‘self-actualization’ (Rogerian/person-centred theory) cannot be used without making a substantial number of philosophical assumptions about what it means to be a person. As a result, any attempt to combine ‘libido’ and ‘selfactualization’ in the same conversation, case study or research project is likely to lead to confusion. Thinking about people as basically driven by libidinous desires (Freud) or as basically driven by a drive to wholeness and fulfilment (Rogers) are very different philosophical positions. The ‘middle’ level of theory, which involves theoretical propositions such as Freud’s explanation of the ‘anal personality’, or Rogers’ model of the ‘core conditions’ for therapeutic change, is potentially the most useful level of theory for practitioners, because it deals in supposedly tangible cause-and-effect sequences that give the counsellor a ‘handle’ on how to facilitate change. The difficulty here is whether the particular explanation offered by a theoretical model can be believed to be true, or be viewed as just one among many competing interpretations.
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Exercise Examine the list of theoretical ideas that you use in your practice, and label them as observational concepts, theoretical propositions or underlying philosophical assumptions. In what ways does this exercise allow you to discern the coherence within your theoretical thinking, and also to identify areas of possible contradiction?
Further reading McLeod, J. (2009) An Introduction to Counselling, 4th edn. Maidenhead: Open University Press (Chapter 3).
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Meta-theories: how do they shape the way you think about counselling? Mainstream approaches to counselling and psychotherapy – psychodynamic, personcentred and cognitive–behavioural – are based in competing psychological theories of personality. Making a choice between these alternative psychological models is no easy task. For the most part, the evidence from research does not make it possible to state with any confidence that one psychological model is correct or valid, and that another one is wrong. In practice, espousing a theoretical approach, or combination of approaches, tends to be influenced by other broader sets of beliefs, values and ideas with which the counsellor identifies him or herself. These ideas and beliefs can be described as meta-theories, because they can be viewed as overarching systems of thought within which psychological theories are embedded. The aim of this exercise is to identify the meta-theories that are significant for you, and to explore the ways in which these ideas shape your approach to counselling.
Instructions On a piece of paper, create a display of the ideas or systems of thought that are most significant in your life. Place the ideas that are most central for you in the middle of the page, and the ones that are less important nearer to the edge. These ideas can be drawn from a variety of domains: 1
Religious and spiritual beliefs that are important for you: for example, Christianity, Buddhism, Islam, atheism.
2
Philosophical ideas that are meaningful for you: for example, existentialism, phenomenology, empiricism, rationalism, postmodernism, constructivism.
3
Political ideologies that you support or oppose: for example, socialism, capitalism, individualism, feminism, environmentalism, consumerism, trade unionism, gay rights.
4
Academic or scientific disciplines that have had a formative impact on the way you view the world: for example, mathematics, sociology, anthropology, economics, history.
5
Forms of artistic expression and creativity through which you find meaning: for example, poetry, drama, cinema, music.
Once you have drawn your personal ‘meta-theory map’, take some time to reflect on the implications of these ideas, beliefs and practices for your personal approach as a counsellor: G
Which sets of ideas are most relevant to your counselling/psychothyerapy theory and practice? Which ones are less relevant, or not at all relevant?
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G
In what ways might these ideas shape the way you are, and the choices you make, as a therapist?
G
Which therapy theories and concepts are most (and least) compatible with your ‘meta-theories’?
Further reading Howard, A. (2000) Philosophy for Counselling and Psychotherapy: Pythagoras to Postmodernism. London: Macmillan.
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Applying theory: making sense of personal experience
Earlier in the Workbook, in Section 1, ‘Building on life experience: the foundations of a personal approach,’ you were invited to write about a number of aspects of your own life that represented everyday therapeutic processes that you may have encountered either in the role of helper, or as someone seeking help from another person. A valuable means of developing an awareness of your preferred position in relation to theories of counselling and psychotherapy is to reflect on what you have written about yourself in theoretical terms. 1
Read through some of the autobiographical pieces that you have written; for example, your ‘The story of a helping relationship’, ‘Thickening your autobiography: early memories’ or ‘The experience of changing your own behaviour’. Identify any theoretical concepts that are implicit in what you have written. For example, you may have described your experience in terms of being reinforced by certain outcomes (a behavioural concept), or as involving the achievement of insight (a psychodynamic concept). Is there consistency in the constructs and terminology that you have used? If there is, what does this suggest to you about your preferred theoretical position?
2
Choose one specific theoretical orientation (e.g. psychodynamic or personcentred). From this perspective, read and interpret a sample of the stories that you wrote in Section 1, ‘Building on life experience: the foundations of a personal approach’. Be rigorous in only applying ideas from that specific approach, and do your best to make use of a full range of concepts from the approach you have selected. Once you have done this, consider the following questions: G How satisfactory has this theoretical perspective been in accounting for all aspects of your experience? In what ways did using this perspective lead you to focus on some areas of experience at the expense of others? G In what ways, and to what extent, did the use of a specific framework enable you to develop a new or fresh understanding of the events and experiences you had written about? G What were the practical implications that were generated by the theoretical framework you applied? Did the theory you were applying stimulate further thinking and planning about how you might address issues in your life that were problematic to you? G Reflecting on the ‘experiment’ of imaging yourself into a theoretical stance – in general terms, how credible and convincing for you was the theoretical interpretation that you developed?
3
Apply different, alternative theoretical perspectives to your autobiographical writings, following the guidelines in the previous paragraph. Which of the perspectives seemed most useful to you? In what ways? Are there aspects of
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different theoretical models that you might wish to combine, to arrive at an ideal overall framework for understanding? If so, what are the principles or values that inform your choice?
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Empathy: a key concept in counselling Carl Rogers suggested that when the counsellor/helper is able to understand the client, and accurately convey that understanding, the person will become more able to accept previously denied or warded off aspects of their own experience. In person-centred counselling, it is important to stay within the ‘frame of reference’ of the client, to ‘walk in their shoes’, to ‘see the world the way they see it’, and not to respond on the basis of your own projections, experiences or to offer advice. Read what Rogers said about empathy: “The state of empathy, or being empathic, is to perceive the internal frame of reference of another with accuracy and with the emotional components and meanings which pertain thereto as if one were the person, but without ever losing the ‘as if’ condition. Thus it means to sense the hurt or the pleasure of another as he senses it and to perceive the causes thereof as he perceives them, but without ever losing the recognition that it is ‘as if’ I were hurt or pleased and so forth. If this ‘as if’ quality is lost, then the state is one of identification”. Rogers (1959: 325)
The way of being with another person, which is termed ‘empathic’, has several facets. It means entering the private perceptual world of the other and becoming thoroughly at home in it. It involves being sensitive, moment to moment, to the changing felt meanings that flow in this other person, to the fear or rage or tenderness or confusion or whatever that he or she is experiencing. It means temporarily living in his or her life, moving about in it delicately without making judgements, sensing meanings of which he or she is scarcely aware, but not trying to uncover feelings of which the person is totally unaware, since this would be too threatening. It includes communicating your sensings of his or her world as you look with fresh and unfrightened eyes at elements of which the individual is fearful. It means frequently checking with him or her as to the accuracy of your sensings, and being guided by the responses you receive. You are a confident companion to the person in his or her inner world. By pointing to the possible meanings in the flow of his or her experiencing, you help the person to focus on this useful type of referent, to experience the feelings more fully, and to move forward in the experiencing. “To be with another person in this way means that for the time being you lay aside the views and values you hold for yourself in order to enter another’s world without prejudice. In some sense it means that you lay aside your own self and this can only be done by a person who is secure enough in himself that he knows he will not get lost in what may turn out to be the strange or bizarre world of the other, and can comfortably return to his own world when he wishes”. Rogers (1975: 7)
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Consider the following questions: G
What are the key ideas in these statements? What are the changes in emphasis between the two?
G
To what extent do Rogers’ words capture what empathy means to you? You may find it helpful to refer back to what you wrote in response to ‘Feeling really understood’ in Section 1 (p. 31), and reflect on whether the description given by Rogers matches your own experience.
G
What would you wish to add to Rogers’ ideas in order to arrive at an account of the process of empathy that fully captured your own sense of this phenomenon?
G
What are the personal challenges raised for you by these descriptions of empathy? How readily can you ‘sense the hurt or the pleasure of another’ or ‘lay aside the views and values you hold for yourself in order to enter another’s world’. What helps or hinders you in achieving this kind of contact with others.
G
How important is the concept of empathy for you in terms of your own personal thinking about counselling? Is it an essential force for therapeutic change? Or is it merely one element of relationship building?
G
In what ways do ideas and assumptions from other theoretical perspectives (e.g. narrative, feminist, psychodynamic, cognitive–behavioural therapy) challenge or extend a person-centred understanding of empathy?
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Making sense of self
Self is a concept that occurs in most theories of therapy, for example, self-concept (person-centred), self-object (object relations) and self-efficacy (cognitive–behavioural therapy). The aim of this learning task is to help you to be clear about your own personal understanding of the idea of self. 1
Reflect on the words you use when talking about counselling or psychotherapy. How often do you use the term ‘self’? How often do you use other terms that are broadly equivalent, such as ‘ego’, ‘identity’ or ‘personality’? Which of these terms sits most comfortably with your way of seeing relationships?
2
How important for you is the idea of self? Some philosophical approaches, such as Buddhism and postmodernism, take the view that ‘self’ is an illusion. Some cultures make little use of the idea of an individual self, preferring to talk in terms of ‘we’.
3
How do you define ‘self’? In Section 1 of the Workbook, you may have completed an exercise titled ‘The self puzzle’ in which you drew a picture of your ‘self’, with each of the ‘parts’ of the self labelled. Look again at that picture, and consider which of the following elements of different self theories are expressed within it: G Core and peripheral self: is there a central section of your puzzle or map that contains qualities or values that are, in some way, essential to your sense of who you are? Are there sections towards the edge of your page that describe values and qualities that are somehow less essential? G Internalized self objects: object relations theory suggests that we include, within the self, images of significant others, or parts of these others (such as their words or voice) that are important to our emotional functioning. Are there any such figures in your puzzle? G Relational self: have you portrayed a relational self (lots of links to other people) or a boundaried, autonomous self? G Multiplicity or unity: does your picture convey a sense of a single entity, or are there separate parts (sub-selves) that are separated from each other? G Self-esteem and self-acceptance: person-centred theory assumes that the extent to which a person accepts or values all aspects of self is an indicator of well-being. To what extent is acceptance a theme in your picture? G Self-efficacy: cognitive–behavioural theorists argue that the extent to which a person views him or herself as being in control, and able to bring about change, is a key dimension of self. Does efficacy, or agency, appear as a theme in your drawing? G Other dimensions of self: there are other dimensions of self that may be relevant to you: conscious–unconscious, actualization and fulfilment, spirituality.
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Once you have explored your self puzzle in the light of these ideas, it may be useful to reflect on the degree to which your own personal ‘theory of self’ is consistent with the concept of self as articulated in the theoretical model(s) that inform your practice.
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How theory is applied in practice: key cases Over the years a number of counsellors and psychotherapists (and some clients) have written case studies that express the complexity of their experiences of counselling. Some of these case histories have become highly influential within the field, because they have been regarded as defining how ‘master therapists’ carry out therapy. It is very useful to read case studies, because they provide a unique insight into the ways that therapists think about their work. A case study also allows the reader to arrive at their own sense of whether the approach to thinking about and working with clients that is being described actually fits with their own personal way of being. When you are reading or viewing a case study, keep in mind that it is a representation of therapy, which highlights some aspects of what is happening and glosses over other elements. You may find the following questions helpful in reflecting on a case: G
How did you feel about the therapist? Would you have liked him or her to be your therapist? Why, or why not?
G
How did you feel about the client? If you had been the counsellor, how might you have tried to work with him or her?
G
What is helpful and/or unhelpful in what the therapist did?
G
To what extent does the effectiveness of the therapy rely on the application of specific techniques, as opposed to the creation of a strong relationship? What is the balance between ‘specific’ and ‘non-specific’ elements?
G
How strictly did the therapist keep to his or her espoused theoretical model? If and when he or she diverged from the model, was this useful or did it seem to be a mistake?
Further reading Axline, V. (1990) Dibs: In Search of Self. London: Penguin An account of the use of a client-centred or person-centred approach in therapy with a disturbed young boy. Dryden, W. (ed.) (1986) Key Cases in Psychotherapy. London: Croom Helm. Gay, P. (ed.) (1995) The Freud Reader. New York: W.W. Norton. Includes several classic cases, along with other important papers by Freud. Wedding, D. and Corsini, R.J. (eds) (2000) Case Studies in Psychotherapy. Itasca, IL: F.E. Peacock Publishers. Yalom, I. (1989) Love’s Executioner and Other Tales of Psychotherapy. London: Piatkus. A series of fictionalized case studies by Irving Yalom, one of the leading figures in existential therapy and a highly influential contemporary writer on therapy. Pragmatic Case Studies in Psychotherapy (online journal).
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Applying cognitive– behavioural concepts Cognitive–behavioural therapy (CBT) is one of the most widely used forms of psychological therapy. Even if you are not a CBT therapist, it is important to be able to develop an appreciation of the ways in which problems can be conceptualized and worked with from this perspective. The intellectual origins of CBT are in behavioural psychology. The reflective activities described below illustrate how two of the basic principles of behavioural psychology – operant and classical conditioning – can be applied in the analysis of everyday problems.
Operant or instrumental conditioning (functional analysis) Choose an ordinary behaviour that you engage in every day. Examples might be: drinking tea, drinking coffee, drinking beer or wine, listening to the radio, dancing, reading the newspaper. . . . Analyse this behaviour in behavioural terms: 1
What are the stimuli, situations or antecedents that elicit this behaviour?
2
What is the actual behaviour? Describe it in as much concrete detail as possible. Try to describe it in terms of a sequence of behaviours.
3
What are the consequences of the behaviour? What follows it? How is the behaviour reinforced or rewarded? Are there contingencies of reinforcement that cause the behaviour to occur more frequently, or less frequently?
It can be instructive to try this analysis out on a range of different behaviours, including ‘habits’ that you might consider to be problematic in your life, such as smoking, eating chocolate, nail-biting, procrastinating, and so on.
Classical conditioning Choose one situation in which you feel moderately afraid, but which you feel OK about exploring in a brief exercise. Examples could include: speaking in a seminar group, meeting new people, being in an exam, being in a lift, looking out of a high window. The following prompts take you through an analysis of your behaviour in terms of the application of a classical conditioning model to the acquisition of a conditioned emotional response. G
When was the first time you remember feeling like this? What were the original unconditioned stimuli and responses (reflex responses) from which this fear pattern originated? It may be hard to recall such an incident if you have had this fear for some time. You may need to imagine a hypothetical situation in which you first experienced this fear.
Making sense: constructing a framework for understanding
G
What was the process of generalization that resulted in the present pattern of fearfulness?
G
In what ways has this fear led to an avoidance of certain situations or stimuli?
G
To what extent has this avoidance resulted in the perpetuation or maintenance of the fear pattern?
G
Applying a behavioural approach, what could you do to extinguish the connection between certain situations, and a fear response that you have identified in this analysis.
Again, it can be interesting to try this analysis out on different behaviours. Reflect on what you have learned from engaging with these exercises in terms of your relationship with CBT as a way of making sense of personal problems: G
How useful did you find the application of these basic CBT concepts?
G
Can these ways of thinking about problems be integrated or reconciled with other theoretical frameworks you espouse (e.g. psychodynamic, person-centred) or do they imply a completely different understanding of persons and lives?
Further reading Westbrook, D., Kennerley, H. and Kirk, J. (2007) An Introduction to Cognitive Behaviour Therapy: Skills and Applications. London: Sage.
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Irrational beliefs and dysfunctional self-talk The emphasis in CBT is on analysing and changing cognitive processes and content – the way that a person thinks about his or her problems. This learning activity invites you to explore some of the ways in which your own behaviour is influenced by such cognitive processes. Identify one situation or recurring scenario that you find difficult to cope with, such as: saying no to a request that someone has made of you, lacking confidence when working on a task, or feeling anxious, tense and afraid. Your task is to consider how you might apply the ideas of Ellis regarding irrational beliefs, and Meichenbaum concerning dysfunctional thinking/self-talk, to develop a better understanding of this problem. Follow these steps: 1
Describe the situation or scenario in as much detail as possible. What triggers the event? What do you do in terms of specific actions and behaviours? Most important, what goes through your head at these moments – what are you thinking? What do you pay attention to?
2
Can you identify irrational beliefs that may be triggered by the situation? Irrational beliefs are exaggerated ways of thinking about yourself. An example might be ‘I must be perfect and do everything faultlessly . . . otherwise I am a completely useless person’.
3
Can you identify any sequences of self-talk that accompany your behaviour? What is your ‘stream of consciousness’? Is there some kind of voice in your head that could be making statements such as ‘you’ll never get this right’ or ‘no-one will believe you could have the right answer’.
4
To what extent, and in what ways, do these irrational or self-defeating beliefs and cognitions undermine your ability to cope more positively with the situation you are exploring?
(Note: it can be hard to recall dysfunctional cognitive processes after the event. You may find it useful to carry around a notebook for a few days, and write down irrational beliefs and critical self-talk at the time they occur.) Reflect on what you have learned from this activity in relation to your theoretical approach to counselling: G
How useful did you find the application of these CBT concepts?
G
Can these ways of analysing a problem be integrated or reconciled with other theoretical frameworks you espouse (e.g. psychodynamic, person-centred) or do they imply a completely different understanding of what is involved in effective therapy?
G
What difference would it make to apply this kind of analysis with the help of another person? What impact might the quality of the therapeutic relationship have on the benefit you might gain from using this technique?
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Developing a cognitive– behavioural case formulation The aim of this learning task is to give you some experience of what it is like to apply cognitive–behavioural methods in practice. First, you need to identify a problem in your own life that is real but limited (i.e. not too upsetting to look at). This could be something like smoking, eating too much chocolate, nail-biting, feeling anxious making a presentation to a group, avoiding completing a piece of work, and so on. Do not choose an issue that is too personal, difficult, upsetting or traumatic. Choose a problem that is meaningful, yet manageable in the context of a learning exercise: it is not helpful to open up difficulties or feelings that may spill over from the exercise, and be disruptive to your life. Your task is to formulate a cognitive–behavioural programme to deal with this problem. Follow these steps: 1
Build up a full description of the thoughts and actions/behaviours that make up the problem. Describe in detail the sequence of stimuli, responses and reinforcers that maintain the ‘problem’ in place. You may find it helpful to ‘map’ your analysis of the problem behaviour on a large sheet of paper.
2
Identify your optimal scenario or goal – what is your target for change? How would you, ideally, like to behave in relation to this area of your life?
3
Develop a list of possible CBT techniques or interventions that might be employed to help you to move towards your goal. Work out which order you might try these interventions – where would you start?
4
Make a list of your strengths and resources that would assist you in achieving a change in relation to this problem, and also a list of factors that could undermine your attempts to change.
Once you have completed your case formulation along the lines described above, consider the following questions: G
How helpful do you think this approach would be in helping you to overcome the problem? What other approach to counselling might help you better? Why?
G
Have you tried any of these strategies before? Did they help? If not, then why didn’t they help?
Further reading Bruch, M. and Bond, F.W. (1998) Beyond Diagnosis: Case Formulation Approach in CBT. Chichester: Wiley. Eells, T.D. (ed.) (1997) Handbook of Psychotherapy Case Formulation. New York: Guilford Press.
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Congruence: the use of self in counselling Within the person-centred approach, the capacity of the counsellor to make constructive use of their own feelings, reactions and imaginings in relation to the client is considered as one of the key aspects of effective therapy. This way of understanding the counsellor’s ‘use of self’ is generally referred to within the person-centred approach as congruence. Many other concepts have been employed to describe this phenomenon: counter-transference, authenticity, transparency, genuineness, openness, presence, honesty, resonance and immediacy. Different facets of the person-centred idea of congruence are expressed in the following definitions: “Congruence is the state of being of the counsellor when her outward responses to the client consistently match her inner feelings and sensations she has in relation to the client”. (Mearns and Thorne, 1998: 75)
“. . . the feelings the therapist is experiencing are available to him, and to his awareness, and he is able to live these feelings, be them, and to communicate them if appropriate. No one fully achieves this condition, yet the more the therapist is able to listen acceptantly to what is going on within himself, and the more he is able to be the complexity of his feelings, without fear, the higher the degree of his congruence”. (Rogers, 1961: 61)
“At every moment there occur a great many feelings and events in the therapist. Most of these concern the client and the present moment. The therapist need not wait passively till the client expresses something intimate or therapeutically relevant. Instead, he can draw upon his own momentary experiencing and find there an ever present reservoir from which he can draw, and with which he can initiate, deepen and carry on therapeutic interaction even with an unmotivated, silent or externalised person. . . . To respond truly from within me I must, of course, pay some attention to what is going on within me. . . . I require a few steps of self-attention, a few moments in which I attend to what I feel”. (Gendlin, 1967: 120–1)
Reflect on these definitions and consider the implications they might hold for you in relation to your work with clients.
Making sense: constructing a framework for understanding
Further reading Mearns, D. and Cooper, M. (2005) Working at Relational Depth in Counselling and Psychotherapy. London: Sage. Wosket, V. (1999) The Therapeutic Use of Self: Counselling Practice, Research and Supervision. London: Routledge.
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Experiencing authenticity
For person-centred and humanistic counsellors, authenticity is central to practice. These learning tasks offer opportunities to reflect on your personal experience of offering, and receiving, authentic contact. Mearns and Thorne (1988: 75) provide a list of concrete ways in which a personal response to a client may be expressed. They formulate these ways as a set of questions that a therapist might ask about his or her willingness to be involved in the relationship with a client: Can I dare to: Feel the feelings that are within me? Hold my client when I feel he needs to be held? Show my anger when that is strongly felt? Admit my distraction when challenged about it? Voice my irritation when that grows? Put words to my affection when that is there? Shout when something is seething inside me? Be spontaneous even when I don’t know where that will lead? Be forceful as well as gentle? Be gentle as well as forceful? Use my sensuous self in relation to my client? Step out from behind my ‘professional façade’? Can I dare to be me in response to my client?
How do you respond to these questions in terms of your own experience as a counsellor or psychotherapist? In your own personal experience (either in therapy or elsewhere) how often have you felt that another person has been really congruent or genuine with you? Think of times when this has happened. Take a specific instance – what impact did the experience have on you? How did it effect your relationship with that person? When are you ‘open to your self’? What are the circumstances under which you make discoveries about yourself, or deepen your story of who you are?
Reflecting on these tasks What have you learned about yourself, and your approach to counselling, from engaging with these tasks? How do you understand the impact of authentic contact on the client, and on the therapeutic process?
Making sense: constructing a framework for understanding
Further reading Mearns, D. and Cooper, M. (2005) Working at Relational Depth in Counselling and Psychotherapy. London: Sage. Mearns, D. and Thorne, B. (1988) Person-centred Therapy Today: New Frontiers in Theory and Practice. London: Sage.
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The balance between problems and solutions Over the last decade, there has been a powerful movement within counselling and psychotherapy away from a preoccupation with helping people to analyse their problems, and towards the goal of building up the person’s strengths and skills, and helping them to find practical solutions. This trend is reflected in various approaches to counselling and psychotherapy, ranging from the emphasis on personal growth that is found in humanistic therapies, to the goal-oriented nature of behaviour therapy. However, it has found its clearest expression in solution-focused therapy and in narrative therapy. This learning task gives you an opportunity to reflect on some of the implications of a strengths-based approach to therapy. Think about some specific situations where you have been involved in a counselling relationship, trying to help another person. Think also about occasions when you have been the recipient of counselling yourself. In these situations: G
How much of the time was spent talking about ‘problems’, and how much time was devoted to ‘strengths’ and ‘solutions’?
G
In what ways was it helpful for you (or the person you were helping) to talk about the detail of their problems?
G
In what ways was it helpful to talk about solutions (strengths, ‘good news’, achievements)?
G
What is your sense of the right balance between a problem focus and a solution focus in the counselling episode(s) you have been looking at?
G
What has made the difference for you at times when you have struggled with an area of difficulty in your life: expressing and exploring your pain and distress, or expressing and exploring creative ways of resolving your difficulties?
More broadly: G
What does a person gain by becoming aware of, and taking note of, their solutions to problems?
G
What can a person learn, or gain, from becoming aware of the possible causes of their problems?
In considering these questions, what have you learned about your own position as a counsellor in relation to the adoption of a solution-focused or problem-oriented approach to working with clients?
Making sense: constructing a framework for understanding
Further reading McLeod, J. (2009) An Introduction to Counselling, 4th edn. Maidenhead: Open University Press (Chapter 8).
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Specific techniques or common factors Over the last 50 years there has been a great deal of research that has compared the effectiveness of different models of therapy. This research has arrived at an apparently paradoxical conclusion: all approaches to therapy, no matter what their methods, appear to yield equivalent results in terms of client outcomes. These findings have stimulated debate over the role of common or non-specific factors in counselling and psychotherapy. A common factor is a therapeutic process that occurs in any kind of therapy. A specific technique, by contrast, is an intervention that forms part of a particular, named approach to therapy. Consider the following lists of common and non-specific factors, and then respond to the questions that follow: Common factors
Specific techniques
Encouraging the client to have positive expectations for change
Systematic desensitization (behaviour therapy)
The therapist being warmly and genuinely interested in the client
Interpretation of dreams (psychoanalysis)
Offering a safe environment within which to talk about shameful or difficult attitudes and experiences
Empathic reflection of meaning (personcentred approach)
The counsellor having the status of a socially sanctioned, credible, ‘healer’
Counsellor congruence (person-centred) or use of counter-transference (psychodynamic)
Having permission to express emotion
Writing a ‘re-authoring’ letter to the client (narrative therapy)
Being offered a framework for understanding one’s problems Being introduced to a set of procedures or rituals that will bring about change Observing at close hand a person (the counsellor) who is skilful in dealing with relationships
Two-chair dialogues (Gestalt therapy)
Challenging irrational beliefs and destructive self-talk (CBT) Exploring the assumptions that inform one’s worldview (philosophical counselling)
Key questions for reflection: G
To what extent can the therapeutic impact of each of these specific techniques be explained or understood in terms of the list of common factors in the left-hand column?
G
Are there any therapeutic processes associated with the specific techniques in the right-hand column that cannot be reduced to common factors? How would you describe or characterize these ‘uncommon’ factors?
G
What is your position on the relationship between specific techniques and common factors? What are the implications of this position for the way that you work with clients?
Making sense: constructing a framework for understanding
Further reading The common factors perspective is discussed on pages 358–62 and 371–3 of McLeod, J. (2009) An Introduction to Counselling, 4th edn. Maidenhead: Open University Press.
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Positioning your practice in relation to social and political factors Counselling and psychotherapy have evolved as forms of help that typically operate at an individual level. One of the most powerful critiques of contemporary counselling comes from those who argue that it functions within society to promote an overindividualized approach to problems that are in fact cultural, social and political in nature. This critique has led in two directions: 1
an argument that counselling/psychotherapy should be replaced by some form of social and political activism;
2
attempts to make therapy more socially informed.
Take some time to reflect on, and write about, the following questions: G
Politics can be understood as referring to the way that different groups in society exert power, influence and control to advance their own interests, and to ensure that their own vision of the ‘good life’ will prevail. In general terms, what is the role of therapy and therapists in this process? Is therapy (or should it be) an activity that stands outside the political arena? If it does not, then what is its role?
G
What are the political factors that affect the lives of your clients, and the therapeutic process that you engage in with them?
G
What do you actually do yourself (if anything) to address political issues in your work with clients?
G
What are your personal political beliefs and values? How do these beliefs and values influence your work as a counsellor?
G
How seriously do you feel that the social critiques you have read threaten the basic mainstream approaches to counselling? Should these mainstream approaches be abandoned? If they shouldn’t be abandoned, do they need to be adapted or reconfigured to take better account of social factors? How could this happen? How might ‘mainstream’ approaches to counselling change in order to become more socially inclusive?
G
What are the implications of these critiques for your own practice; for example, in terms of your relationship with clients, the organizational setting in which you might wish to work, and your theoretical model?
Further reading McLeod, J. (2009) An Introduction to Counselling, 4th edn. Maidenhead: Open University Press (Chapter 16).
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The idea of the unconscious
It is part of everyday common-sense to admit that there are times when one is not consciously aware of what one is doing, or why a particular action has been taken. However, the notion of the unconscious, as used in psychoanalytic and psychodynamic approaches to counselling and psychotherapy, goes far beyond this common-sense view in assuming that the unconscious mind operates in a highly specific manner. Take some time to read carefully, and reflect on, the following key passage, written by Freud towards the end of his career: “. . . we call ‘unconscious’ any mental process the existence of which we are obliged to assume . . . but of which we are not directly aware. . . . We call a process ‘unconscious’ when we have to assume that it was active at a certain time, although at that time we knew nothing about it. . . . Psycho-analysis has impressed us very strongly with the new idea that large and important regions of the mind are normally removed from the knowledge of the ego, so that the processes that occur in them must be recognised as unconscious in the true dynamic sense of the term. . . . The id is the obscure inaccessible part of our personality . . . a chaos, a cauldron of seething excitement. We suppose that it is somewhere in direct contact with somatic processes, and takes over from them instinctual needs and gives them mental expression, but we cannot say in what substratum this contact is made. These instincts fill it with energy, but it has no organization and no unified will, only an impulsion to obtain satisfaction for the instinctual needs, in accordance with the pleasureprinciple. The laws of logic – above all, the law of contradiction – do not hold for processes in the id. Contradictory impulses exist side by side without neutralising each other or drawing apart. . . . There is nothing in the id which can be compared to negation, and we are astonished to find in it an exception to the philosophers’ assertion that space and time are necessary forms of our mental acts. In the id there is nothing corresponding to the idea of time, no recognition of the passage of time . . . no alteration of mental processes by the passage of time . . . impulses which have never got beyond the id, and even impressions which have been pushed down into the id by repression, are virtually immortal and are preserved for whole decades as though they had only recently occurred. They can only be recognised as belonging to the past, deprived of their significance, and robbed of their charge of energy, after they have been made conscious by the work of analysis, and no small part of the therapeutic effect of analytic treatment rests upon this fact. . . . Naturally, the id knows no values, no good and evil, no morality . . .” (Freud, 1933: 93–100)
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Is this a definition of ‘the unconscious’ with which you agree? Does it fully capture the way that you might wish to use this concept in your therapeutic work? If it does not reflect the way you view ‘the unconscious’, then what kind of alternative definition might you suggest? Is it possible to imagine conducting therapy without making any reference to unconscious processes?
Further reading These issues are explored further in: Edwards, D. and Jacobs, M. (2003) Conscious and Unconscious. Buckingham: Open University Press.
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What brings about change? The relative importance of cognition and emotion All theories of therapy acknowledge that the process of change involves an interplay of cognitive factors (changing the way that the person thinks about an issue) and emotion (e.g. expressing repressed feelings). However, theoretical approaches differ significantly in the extent to which they emphasize one or the other of these key factors. For instance, the cognitive therapies of Beck and Ellis regard cognition as primary, with emotions being determined by the way that a person perceives or construes events. By contrast, both psychoanalysis and person-centred counselling regard the inner emotional life, or ‘felt sense’, of the person as the main driver of therapeutic change, and would view changes in the way a person thinks about an issue as following from changes in the way they feel. What is your own position in relation to the relative importance of emotion and cognition? Your own personal experience and belief in relation to this issue will inevitably shape your choice of theoretical orientation. Read through the descriptions of personal learning and change that you created in response to some of the learning tasks in Section 2 of this Workbook. Are there any recurrent themes in these descriptions concerning the relative importance of emotion and cognition. Do your descriptions include mainly examples of cognitive insight and understanding, or have you mainly written about moments of emotional release and catharsis? When reflecting on what this learning activity has produced for you, it may be helpful to consider the following questions: G
What have you learned about the relative importance of cognitive and emotional processes in your own way of understanding change in therapy?
G
How well does your own ‘take’ on cognition and emotion correspond to the theoretical approaches that interest you, or with which you have identified yourself?
G
What is your own personal model of the links between cognition and emotion? In your opinion, how do they link up – what causes what?
G
How long have you held these ideas about cognition and emotion? Where and how did you learn them?
G
What are the implications of your position on emotion cognition for your practice as a counsellor?
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Further reading Greenberg, L.S. (2002a) Integrating an emotion-focused approach to treatment into psychotherapy integration, Journal of Psychotherapy Integration, 12: 154–89. Greenberg, L.S. (2002b) Emotion-focused Therapy: Coaching Clients to Work Through their Feelings. Washington, DC: American Psychological Association. Oatley, K., Keltner, D. and Jenkins, J. (2006) Understanding Emotions, 2nd edn. Oxford: Blackwell.
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Behind the theory: the life of the theorist Theories of counselling and psychotherapy have tended to be associated with the ideas of ‘key figures’, such as Sigmund Freud or Carl Rogers. These leading theorists are often revered as brilliant thinkers, who transformed the field through their genius. However, it is possible to view the importance of these individuals in a different light. Any theory of therapy can be regarded as a set of ideas and assumptions that reflect the cultural milieu within which they were generated. In important ways, the theories of Freud and Rogers became influential because they somehow reflected and articulated aspects of human experience that were challenging and significant in pre-World War I Europe (for Freud) and in post-World War II USA (for Rogers). The popularity of a theorist can be taken as indicating the extent to which his or her writings can operate as a channel for expressing the distinctive personal and interpersonal issues being faced by a particular group of people at a specific time in history. It is often pointed out that the childhood experiences of theorists such as Freud and Rogers played a large part in shaping their ideas. But, in important ways, these childhood experiences themselves may reflect broader aspects of the culture within which the person grew up. In becoming a counsellor or psychotherapist, it is essential to develop a theoretical framework with which client issues, and the process of therapy, can be understood. Inevitably, this theoretical framework will largely draw on the ideas of a small number of influential writers and theorists. In order to gain a full appreciation of these theories, it can be very useful to learn about the lives of the theoreticians themselves. To a large extent, their theories evolved to enable them to make sense of issues within their own lives, and in the lives of people they knew. A useful learning activity is to make an effort to go beyond the kind of brief biographical snapshot that is provided in introductory textbooks, and read actual biographies of theorists who have had an influence on you. Although autobiographical writing may be interesting and relevant, they are likely to be grounded in the worldview of the author – a good biographer should have the capacity to place the life and work of his or her subject in a wider cultural context.
Further reading Some biographies of therapy theorists that have been particularly well received include: Cohen, D. (1997) Carl Rogers: A Critical Biography. London: Constable. Gay, P. (1988) Freud: A Life for Our Time. London: Dent. Kirschenbaum, H. (2007) The Life and Work of Carl Rogers. Ross-on-Wye: PCCS Books. Shepard, M. (1975) Fritz. New York: Bantam Books (biography of Fritz Perls). Two books that explore the personal and cultural influences on a number of important therapy theorists are:
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Atwood, G. and Stolorow, R. (1993) Faces in a Cloud: Intersubjectivity in Personality Theory, 2nd edn. Northvale, NJ: Jason Aronson. Magai, C. and Haviland-Jones, J. (2002) The Hidden Genius of Emotion: Lifespan Transformations of Personality. Cambridge: Cambridge University Press.
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The cultural context of understanding How does your cultural identity influence your choice of counselling approach in relation to training and practice? The impact of the social, cultural and family environment on the ideas of mainstream therapy theorists has been widely documented. But what are the ways in which your own social, cultural and family environment has shaped your personal approach to counselling? In the ‘Exploring cultural identity’ activity, which was introduced in Section 1 (p. 29), you were invited to examine various aspects of your cultural origins and experiences. Looking back at what you wrote in response to that activity, consider the following questions: G
What are some of the values and beliefs that you associate with your cultural background that seem most relevant to counselling?
G
Imagine explaining your work as a counsellor, and the theories that you follow, to your grandmother. Would she be interested? Would she think that what you were doing was useful? What advice might she give you about how to be a better therapist?
G
Are there areas of tension in your cultural identity? For example, your mother and father may have grown up in quite different cultures. Or were there times in your life when you deliberately attempted to distance yourself from your culture of origin? How has your awareness of these tensions informed your understanding of counselling?
G
Are there any rituals within your ‘home’ culture that could be viewed as having a psychotherapeutic function (e.g. confessionals in church, family meetings, pilgrimages)? How might your engagement in such activities have informed your thinking about counselling?
G
Is counselling for you a means of reinforcing and supporting the core values of your culture, or has it been a way of creating a new and different identity for yourself?
The underlying issue here is linked to the view of Lomas (1999: 25) that a person learning to become a counsellor needs to explore how best they can go about ‘finding their own way, using their own intuition, learning to be themselves in the presence of someone who is asking for help’. Does you theoretical framework express who you are, including your sense of your own cultural identity?
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What kind of therapeutic relationship? Counselling is fundamentally a relationship between two persons. There is a wealth of evidence, from carefully conducted research studies and practical experience, that the quality of the therapeutic relationship has a huge impact on the amount that the client can gain from therapy. However, relationships are difficult. We can all experience problems in making, keeping and ending relationships. The challenge, in becoming a counsellor, of seeking to be some kind of ‘relationship expert’ is considerable. Clients may be seeking all sorts of different kinds of relationship with their counsellor, and may create different kinds of barrier to form a productive working ‘alliance’. In turn, the needs and relationship patterns of the client may uncover gaps in the counsellor’s capacity to relate. These activities are intended to enable exploration of the relationship issues and challenges associated with counselling practice: 1
An experienced therapist, interviewed by Skovholt and Jennings (2004: 64), described his way of seeing the relationship between counsellor and client in the following terms: “One of the metaphors I often use with my clients is the metaphor of the ‘Wilderness Guide’, and the way I put that is they can hire me as a guide, because I know a lot about survival in the wilderness – my own, and I’ve travelled through a lot of wildrenesses. I’ve got a compass, I can start a fire in the rain. I know how to make it through, but this is a new wilderness to me. I haven’t been in this particular wilderness before, and so I can’t quite predict what we’re going to encounter”. In An Introduction to Counselling (Chapter 14), other metaphors of relationship found in mainstream approaches to counselling are discussed: G G G G
therapist as container; therapist as authentic presence; therapist as teacher, coach or scientist; the ‘not-knowing’ stance: therapist as editor.
Which of these images seem closest to the way that you experience yourself as being, or would aim to be, when in the role of counsellor or psychotherapist? What are the implications of each of these metaphors, both for you and the client? 2
Petruska Clarkson (1994: 42) argues that effective counsellors should be able to relate to clients, if necessary, at a transpersonal level: “the transpersonal relationship is . . . characterised . . . by a kind of intimacy and by an ‘emptying of the ego’ at the same time. It is rather as if the ego of even the personal unconscious of the psychotherapist
Making sense: constructing a framework for understanding
is ‘emptied out’ of the therapeutic space, leaving space for something numinous to be created in the ‘between’ of the relationship. . . . It implies a letting-go of skills, of knowledge, of experience, of preconceptions, even of the desire to heal, to be present. It is essentially allowing ‘passivity’ and receptiveness for which preparation is always inadequate . . . It cannot be made to happen, it can only be encouraged in the same way that the inspirational muse of creativity cannot be forced, but needs to have the ground prepared or seized in the serendipitous moment of readiness”. To what extent is this form of therapeutic relationship meaningful for you? If it seems to you to represent an important dimension of therapy, how might you integrate this kind of possibility into your theoretical framework? 3
Return to the ‘Mapping your relationship patterns’ exercise in Section 1 (p. 33). What did you write in response to that set of tasks? Looking now at what you wrote, what are the implications for your preferred ways of relating to clients? What are the implications in terms of difficulties that you might experience in relating fully to clients?
4
A wonderful book by Deborah Lott (1999) provides a rich account of women’s experiences of their relationships with their therapists. The idea for this book arose from her involvement with a group of women friends who met regularly to ‘share their therapy war stories’: “. . . it struck me that our exchanges resembled nothing so much as accounts of love affairs. We felt the same urgent need to get every detail straight, every word right. . . . We found the very structure of the therapeutic relationship problematic. It was inherently unequal: We needed our therapists more than they needed us, they were much more important to us than we were to them. . . . To what extent was this even a real relationship, and if it wasn’t real, what exactly was it? It wasn’t friendship, and yet it was different from any other professional relationship we had ever had” (pp. 1–2). Is this an account of the therapeutic relation that you recognize? If it is, what significance does this perspective have for you in terms of your personal approach?
In reflecting on these activities, it may be helpful to address the following questions: G
What is your image, or model, of the client–counsellor relationship?
G
Which theories or concepts do you find useful in making sense of the therapeutic relationship?
G
Are there aspects of the therapeutic relationship that, for you, seem to sit outside the established theories?
G
How would you want a counsellor to be with you?
G
How do you want to be with clients?
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Dialogue between theorists
In the process of building a theoretical framework through which you can make sense of your work as a counsellor or psychotherapist, you will almost certainly discover that you are drawn toward sets of ideas that are different from competing traditions, or hard to integrate or reconcile with each other. It is valuable to regard such experiences as opportunities for learning. If you find meaning in different theories, then they are (by definition) meaningful for you. What may be lacking is a conceptual ‘bridge’ or idea that might enable you to see how the apparently conflicting ideas may be connected. This learning task provides a technique that you might like to use to make such connections.
Dialogue between therapists Choose two theorists whose work is important to you, but who seem to be saying quite different things. (It is possible to carry out this exercise with more than two theorists, but it gets more complicated.) Imagine that these theorists are in a room talking together, or are in email contact with each other. They are being stimulated and interviewed (by you) to engage in an exchange of views over some of their ideas. Write down this dialogue. Allow the dialogue to flow – the intention is not to come up with a version of each therapist’s model that is necessarily factually accurate, but to begin to explore what their ideas mean to you. For example, you may be convinced by Carl Rogers’ ideas about the therapeutic ‘core conditions’, and also interested in Erik Erikson’s model of stages of psychosocial development, but be at a loss to understand how they might fit together. Your imaginary dialogue might look something like: Interviewer: One of you has a very clearly worked out theory of development, but the other – Rogers – seems to talk only about ‘conditions of worth’. How can these perspectives be reconciled? Carl Rogers: I always knew about Erik’s ideas, but I didn’t want to go down that road. My fear was always that a too definite model of development would detract from the client’s ‘frame of reference’ and impose a set of assumptions based on the therapist’s theory, rather than the client’s reality. Erik Erikson: I share that fear. That’s why I always argued that these themes (identity, trust and so on) were in a sense always present – even if they seemed to be most prominent at certain ages. I always thought there were big connections to be made between autonomy, initiative, trust and so on, and the way you talked about empathy . . . Carl Rogers: Yes, in a sense accurate empathy involves trust, and being separate, and having a good sense of your own identity . . .
Making sense: constructing a framework for understanding
This is only a hypothetical example. Your own dialogue might take a very different direction. Your protagonists may find they have a lot in common . . . or they may end up shouting at each other! When you read through the dialogue you have created, look for the connections that have been made, and also for the new concepts that may act as ‘bridges’ between the two sets of ideas.
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Are you postmodern?
According to many philosophers and social theorists, the closing years of the twentieth century saw the beginnings of a shift in the pattern of the dominant culture within Western industrial societies. The period from the 1700s to the mid-1900s can be viewed, historically, as comprising an era characterized by the growth and consolidation of a modern world in which rationality, science, individualism, consumerism and the idea of progress were central to the way that people made sense of the world that they lived in. Psychology, and then counselling and psychotherapy, have been integral to the efforts of individuals to adapt to the demands of living in a modern society. Theories of therapy, and the research that has backed them up, have for the most part been formulated in accordance with the principles of modernity. More recently, the ideas and social structures associated with modernity have started to fragment, and to be replaced by a different form of understanding. This new perspective has been described as postmodernity. Some of the distinctive themes of postmodern thought have been described by Steiner Kvale as: “. . . a loss of belief in an objective world and an incredulity towards meta-narratives of legitimation . . . with the collapse of universal metanarratives, local narratives come into prominence. The particular, heterogeneous and changing language games replace the global horizon of meaning. With a pervasive decentralization, communal interaction and local knowledge become important in their own right . . . a postmodern world is characterized by a continual change of perspectives, with no underlying frame of reference, but rather a manifold of changing horizons . . . language and knowledge do not copy reality. Rather, language constitutes reality, each language constituting specific aspects of reality in its own way. . . . Postmodern thought focuses on the surface. . . .” (Kvale, 1992: 32–7)
A postmodern perspective is suspicious of all-encompassing ‘grand theories’, such as psychoanalysis and person-centred theory, and of any attempt to claim ‘depth’, in the sense of an underlying fundamental truth. Instead, postmodern thinking is interested in the way that realities are constructed through language. To what extent do these ideas have meaning for you? If you are personally drawn to postmodern thinking, what are the implications for your approach as a counsellor? If you are not, what are the implications for your work with any client who does embrace these ideas?
Making sense: constructing a framework for understanding
Further reading Loewenthal, D. and Snell, R. (2003) Post-modernism for Psychotherapists: A Critical Reader. London: Brunner-Routledge. Polkinghorne, D.E. (1992) Postmodern epistemology of practice, in S. Kvale (ed.) Psychology and Postmodernism. London: Sage.
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Letter to a theorist
One of the techniques that is used in both personal journal writing, and in some forms of narrative therapy, is to compose a letter to a person with whom one would like to have a discussion, but who is not actually available to talk with. In bereavement work, for example, a person may write a letter to the person who has died. The value of an unsent letter is that it can provide an opportunity to get thoughts and feelings out into the open, and to begin, through a process of writing, to bring some order and structure to them. This exercise invites you to make use of this technique to advance your understanding of theoretical issues in counselling.
Learning activity Write a letter to a theorist who has some significance for you in terms of the way you make sense of counselling. Give yourself permission to write anything you wish to the person – what you like or do not like about his or her ideas, aspects of their thinking that make you angry or frustrated, questions that you have, counter-arguments, requests for help, compliments, invitations, and so on It may be useful to consider different occasions that might call for such a letter: G
a theorist that you have just come across;
G
a theorist who is a major influence on your thinking;
G
a ‘goodbye’ letter to a theorist whose influence on your thinking you are trying to reduce or eliminate.
Once you have written the letter, reflect on what you have learned about yourself, and your theoretical stance as a counsellor or psychotherapist. Further related activities might include: G
writing letters to other theorists;
G
writing a letter to yourself as a theorist;
G
writing a letter from one of your clients to a theorist who has influenced and informed your work with that client;
G
storing these letters, and rereading them at some time in the future, as a means of tracking the development of your theoretical interests and concerns.
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The concept of transference
The concept of transference represents one of the key ideas within contemporary counselling and psychotherapy. Most counsellors and psychotherapists will acknowledge that clients may express strong feelings – both positive and negative – towards them. The existence of powerful and persistent client reactions to therapists is not disputed. However, there are major disagreements over the meaning and significance of such emotional responses. From a psychoanalytic or psychodynamic perspective, these reactions are indicators of patterns of early experience. From a person-centred or humanistic perspective, by contrast, these responses are understandable in terms of the here-and-now relationship between client and counsellor, often arising from the efforts of the counsellor to understand the client. These opposing positions are captured in the following passages from Sigmund Freud, and from a leading person-centred theorist and researcher, John Shlien: “The patient is not satisfied with regarding the analyst in the light of reality as a helper and adviser who, moreover, is remunerated for the trouble he takes and who would himself be content with some such role as that of a guide on a difficult mountain climb. On the contrary, the patient sees in him the return, the reincarnation, of some important figure out of his childhood or past, and consequently transfers on to him feelings and reactions which undoubtedly applied to this prototype. This fact of transference soon proves to be a factor of undreamt-of importance, on the one hand an instrument of irreplaceable value and on the other hand a source of serious dangers. This transference is ambivalent: it comprises positive (affectionate) as well as negative (hostile) attitudes towards the analyst, who as a rule is put in the place of one or other of the patient’s parents, his father or mother. So long as it is positive it serves us admirably. It alters the whole analytic situation; it pushes to one side the patient’s rational aim of becoming healthy and free from his ailments. Instead of it there emerges the aim of pleasing the analyst and of winning his applause and love. It becomes the true motive force of the patient’s collaboration; his weak ego becomes strong; under its influence he achieves things that would ordinarily be beyond his power; he leaves off his symptoms and seems apparently to have recovered – merely for the sake of the analyst. The analyst may shamefacedly admit to himself that he set out on a difficult undertaking without any suspicion of the extraordinary powers that would be at his command”. (Freud 1938)
“ ‘Transference’ is a fiction, invented and maintained by the therapist to protect himself from the consequences of his own behavior. . . . Dependency is a built-in feature for the (client) at the beginning, and the
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treatment itself often promotes further dependency. The patient (or client) is typically anxious, distressed, in need of help, often lonely. The therapist, presumably, is not. Instead, he holds a professional role (especially if a physician) that ranks at or near the top in sociological surveys of romantic attractiveness to women seeking husbands (ahead of astronauts and other celebrities). The situation is set for intimacy, privacy, trust, frequent contact, revelation of precious secrets. Second, it is also the case that there is an ongoing search, on the part of most adolescents and adults, for sexual companionship. It requires only the opportunity for intimacy. One does not need to look into therapy for arcane and mysterious sources of erotic feelings. They are commonplace, everywhere, carried about from place to place. Psychotherapy will encounter sexual attraction as surely as it encounters nature. The simple combination of urge and situation is a formula for instant, if casual, romantic fantasy. . . . Third, there is a supremely important special factor in a behavior to which all therapists subscribe and try to produce. It is understanding. Freud bluntly put it, (of transference) ‘it is a kind of falling in love.’ Let me put this bluntly too: understanding is a form of love-making. It may not be so intended, but that is one of its effects. . . . In this same context, misunderstanding is a form of hate-making. It works equally well since being misunderstood in a generally understanding relation is a shock, betrayal, frustration”. (Shlien 1984)
Learning task Read through these two passages, and decide which of these statements best reflects your own understanding and experience. Do you find some validity on both positions? If so, how would you seek to integrate or reconcile these different points of view? What are the implications, in terms of how a counsellor might work with a client, of the ‘transference’ and ‘counter-theory’ perspectives?
Putting theory to use: thinking about cases
Section contents Introduction
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Student counselling: the case of Ms B
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A client’s opening statement
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Cynthia: making life choices
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The case of Glenys – first session
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The case of Glenys – later sessions
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‘I hear these voices telling me what to do’
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A case of work stress
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Thelma: a victim of therapist boundary violation
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Geoffrey: deconstructing demons
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The case of Mrs Y
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Charles: therapy as a ‘last resort’
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The case of Ida
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Anna: moving on in life
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Case scenarios for working with emotions
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David: tackling self-blame
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This section of the Workbook includes some case scenarios, describing clients who are making use of counselling or psychotherapy services. With each of the cases, you may find it useful first of all to respond on the basis of your own intuitive or personal reactions and thoughts. Try to imagine that you are the therapist to each of these clients, and do your best to enter into the imaginary situation that is depicted. After you have written down you own personal response to the case, then you may find it helpful to look at it from the vantage point of theoretical perspectives that interest you: psychodynamic, cognitive–behavioural, person-centred, feminist, systemic, narrative, transactional analysis, and so on. Once you have worked through how you might make sense of the case from alternative theoretical standpoints, you are ready to consider a number of questions that are highly relevant to the task of developing your own personal approach as a counsellor: G
Which of the alternative analyses of the case seemed most helpful? Why?
G
Which of the alternative analyses of the case seemed least helpful? Why?
G
Which theoretical model, or combination of models, seemed to fit most closely with your own personal reading of the case?
G
What do your answers to these questions say about you, and what you stand for as a therapist?
It is possible to expand your awareness of both theoretical and practice issues by working on these case studies on your own. However, it can also be illuminating to discuss the cases in the context of a peer learning group. It is probable that, in a group, you may find that your awareness of the issues presented by each of the case study clients may be significantly expanded, as different members of the group introduce their own perceptions, sensitivity and experience. This kind of group discussion can give a sense of what can happen in good supervision. What you may also find, however, is that you become more aware of the reality that each practitioner seems to make use of a somewhat limited palette of assumptions and emotions when responding to clients. Several of the cases in this section are taken from published sources, reflecting the work of a range of well-known ‘master therapists’. Once you have arrived at your own formulation of the case, you may find it interesting to track down the original publication, and find out what really happened to each of these people.
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Student counselling: the case of Ms B Ms B is 24, single, and a university student in the final year of a social science degree. Throughout the course she has felt frustrated at the grades she has received, which have averaged around 50–55 per cent. Now, having returned in October, she finds herself worrying about her grades so much that she goes to the student counselling service. At the first meeting, the counsellor asks her to talk about what the problem is, and about the important things in her life that she feels might be associated with it. The main points that emerge are: G
just feels herself to be a ‘complete failure’;
G
she was the oldest of four children, and always felt under pressure to do well at school;
G
was close to her grandmother, who died when she was 16 – she describes this as ‘the worst moment in my life’;
G
she did not feel that she got enough support or encouragement from her parents, particularly when she did her university entrance exams;
G
the thought of going home to live with her parents after the degree is ‘scary’;
G
she failed to get good grades in her university entrance exams, and worked in a shop for a year before doing an ‘Access to University’ course at a community college;
G
she is lonely, with no friends or boyfriend. Finds it difficult to talk to her flatmates;
G
has no idea what she is going to do after graduating. When asked what her ideal job would be, she pauses for several seconds and then answers that she would like to be a trainee manager with a large supermarket chain, but that she has no hope of getting a good enough degree for that, and ‘anyway they only take really confident types’;
G
sees herself as overweight and eats too much chocolate;
G
avoids writing essays. Spends a lot of time reading novels rather than doing academic work;
G
gets very anxious when she starts work on an essay, which makes it difficult to concentrate;
G
it is difficult to ask tutors what is wrong with her essays;
G
only speaks in seminars when explicitly asked a question;
G
she is critical of some tutors for being unfair in their marking and not making sure that books are in the library;
G
when asked what her aim is for counselling, and what she would like to change, she first says that she is not sure, then after a few moments adds: ‘I guess the biggest
Putting theory to use: thinking about cases
thing is being afraid of other people . . . I just feel as if everyone is going to criticize me . . . I can never relax with anyone’; G
the counsellor notices that Ms B seems distant and talks about herself in a detached manner;
G
throughout the session, Ms B uses metaphors and images associated with fighting, such as ‘It was a battle to get to University’, and ‘I retreat into my bed with a carton of ice cream’;
G
at the end of the session, the counsellor is aware of a strong feeling of sadness, and of wondering whether Ms B would come back for another session. The counsellor wondered whether he or she had somehow not been good enough for Ms B, and may have let her down in some way.
Consider the following questions: G
What are the main issues that Ms B is bringing to counselling?
G
How would you describe the way that Ms B relates to the world? What kind of a world does she inhabit?
G
Why now? What is the possible significance of choosing to visit the counselling service at this time?
G
If you were her counsellor, what else would you be interested in knowing about Ms B in future sessions?
G
How would you work with Ms B? What would you be trying to do?
G
How many sessions do you think Ms B would need? On what basis do you make this estimate?
G
What might be the significance of the counsellor’s emotional response to Ms B?
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A client’s opening statement What a person says first, at the beginning of their initial counselling session, can often encapsulate the key issues for which he or she is seeking help. It is important as a counsellor to be able to ‘tune in’ to a client from their first words. The following statement was made by a young black man at the start of his first counselling session: “I was sitting in the room and waiting beforehand and I was thinking about why I was about seven or eight years old and I remember reading a book I believe I can’t recall the name of this book by Jung, I think it was and I recall when I was reading that that at that time I used to go down the basement of my home and turn off all the lights and in a way that was kind of closing the outside world and concentrating on what I wanted to do and what I wanted to be. And at seven years old I was I was into that and today I am in the same position really, you know, trying to find out what I want to do, what I want to be and I’ve learned a lot of things. I’ve learned a lot of things since I found out that I had leukemia which is about a year ago this June and I learned an awful lot of things . . . I think that I’ve listened for so long to other people about who I was and I remember in second grade I was a potential credit to my race that was one of the . . . I would always wonder why I couldn’t be a credit to somebody else’s race also but I think I really conditioned to be something, to be some kind of a symbol or whatever and not really being a person you know I kind of missed out on my childhood to an extent you know I don’t really regret it, I don’t think I regret it anyway but I’ve really been through a lot of changes and I think that now after finding out I had the leukemia and after dealing with the leukemia in the way I did it’s just really incredible, you see it was last June when I found out and I proceeded to get everything in order because I was told that I had less than a year to live and that was a trip and that was a trip and . . . and on one hand you know I accepted the death, you know at my young age I think I have lived long and a great deal but that was the start of some things that err that really has had an affect on me today like I am much happier than I have ever been today, I am much happier, but there’s some there’s a lot of hurt to . . . there’s an awful lot of hurt and I think I am just beginning to realize that. Because, you know, in being a credit to your race in being an outstanding student, an outstanding scholar, an outstanding football player whatever leaves you little room to to be. . . .”
Consider the following questions: G
What feelings, emotions and images does this opening statement trigger in you?
Putting theory to use: thinking about cases
G
What is your sense of the key themes and issues in what this person is presenting?
G
What would you say to this person at this point?
Further reading This statement is taken from a case of Carl Rogers, filmed in 1977, and widely available on video. As with many of Rogers’ recorded cases, the process of his work with this client has been subjected to careful analysis. A book containing a series of responses to this case, from a range of different writers, can be found in: Moodley, R., Lago, C. and Talahite, C. (2004) Carl Rogers Counsels a Black Client: Race and Culture in Person-centred Counselling. Ross-on-Wye: PCCS Books. Other cases involving Rogers are examined in: Farber, B.A., Brink, D.C. and Raskin, P.M. (eds) (1996) The Psychotherapy of Carl Rogers: Cases and Commentary. New York: Guilford Press.
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Cynthia: making life choices Cynthia was 32 years of age, a successful mathematics lecturer in a community college. For several months she had felt anxiety and worry, which interfered with her ability to concentrate. In addition, she felt depressed. In her first meeting with a counsellor, she said that: G
She had grown up in a happy, conventional family environment, with her mother (a housewife), father (businessman) and two brothers. Her brothers now had successful professional careers, and were both married with children.
G
She described her current partner, Fred, as ‘solid and sensible’; he wanted her to marry him, give up her job and have children.
G
She had only one previous serious boyfriend, at college – her preference was to work and study, rather than socialize.
G
The ‘biological clock’ was ticking – soon she would be too old to have children – the recent birth of a new baby to one of her brothers had acted as a signal to her. Also, she felt that she would let down her parents if she did not have a child.
G
Cynthia did not want to give up her job; on the contrary, her goal was to go back to university to do a Ph.D.
G
She was not sure if she really wanted to have a child at all.
G
Cynthia was uncertain about her sexuality – she had recently had a six-month affair with Martha, a fellow tutor at the college. Martha had become involved with someone else; Cynthia had not moved on from this loss, and had met Fred soon afterwards.
Cynthia believed that counselling would be more helpful for her than medication or cognitive–behavioural therapy, because what she was looking for was a chance to talk through the life choices that confronted her, and in particular to find a way to handle the strong feelings of approval/disapproval that she felt from her mother and father. G
What are the main issues that Cynthia is bringing to therapy?
G
How would you describe the way that Cynthia relates to the world? What kind of a world does she inhabit?
G
Why now? What is the possible significance of choosing to visit a therapist at this time?
G
If you were her therapist, what else would you be interested in knowing about Cynthia, in future sessions?
G
How would you work with Cynthia? What would you be trying to do? What techniques or strategies might you employ?
G
What are Cynthia’s strengths?
G
How many sessions do you think Cynthia would need? On what basis do you make this estimate?
Putting theory to use: thinking about cases
G
What feelings are triggered in you by listening to Cynthia’s story? What might be the significance of this emotional response?
Further reading A detailed account of this case can be found in: Bohart, A.C. (2006) The client as active self-healer, in G. Stricker and J. Gold (eds) A Casebook of Psychotherapy Integration. Washington, DC: American Psychological Association.
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The case of Glenys – first session You are working as a counsellor in a GP practice. One of the GPs refers Glenys to you. She has been making appointments to see the GP every week for more than two years, complaining of pains in her gut, and breathing difficulties. Glenys has been sent for extensive tests and specialist consultations, but no physical causes for her symptoms have been identified. The GP suggested that it might be helpful for Glenys to see the practice counsellor. The practice offers clients 6 sessions of counselling, with an extension to 12 sessions with the permission of the GP. It has taken several weeks to find an appointment time that is suitable for Glenys. During this period she has continued to visit the GP. Glenys is 45 years of age. She is married with two children. Before her marriage, she worked as a care assistant in a home for the elderly. She took some time off when the children were small, and then returned to work. After gaining some qualifications, she now has a demanding job as the manager of a residential unit for people with learning difficulties. At the first counselling session, Glenys walks into the room slowly, and doubled over, as if appearing to be in some pain. She is slightly built, and neatly dressed. She immediately engages in conversation, and starts to tell you about the various medical tests she has undergone, and complementary therapies that she has tried out. She comes over as a very positive person, who is determined to get to the bottom of these health problems. It is difficult for you to get a word in edgeways. She talks quickly, and repeats the same information at different points in the session. When asked about the situations that seem to bring about her symptoms, Glenys replies that both the pain and breathing difficulties are around most of the time, except when she goes to Spain on holiday. When asked about the worst recent episodes, she describes a couple of occasions at work, when she has had to deal with difficult staff meetings, and ended up needing to go home because she felt so bad. You invite Glenys to talk about her relationship with her husband and children. She describes these as wonderful: ‘they are such a help to me’. She describes in some detail the accomplishments of her children, and the qualities of her husband: ‘he is a rock’. She uses very few feeling words. She does not mention ay members of her extended family during this first session. Towards the end of the first session, you talk to Glenys about what counselling will involve. She vehemently denies that she is mentally ill, or that there is any psychological side to her difficulties. She insists that what she needs is better pain management, or a surgical intervention. You explain that many people find it stressful to live with pain and other symptoms, and that counselling may help her with this. She replies stating that ‘I will try anything that might help’. Your impression of Glenys in this first meeting is of someone who is presenting a ‘nice’ face to the world, but who is concealing sides of herself that are perhaps not so ‘nice’. You have a slight feeling of irritation, which you wonder might be the result of
Putting theory to use: thinking about cases
being forced to be a passive audience to Glenys’s high-speed monologues. You also have a sense of needing to handle her carefully. Consider the following questions: G
What theoretical approaches might help you to make sense of the information you have about this client?
G
What approach might you take with Glenys?
G
What are the themes and issues that you might potentially wish to explore with her?
G
What might be the challenges involved in developing a relationship with this woman?
G
Are there any counselling methods or techniques that might be particularly relevant or effective?
Further progress of this case is described on the following page. It is recommended that you respond to the questions on this page before reading about what happened next.
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The case of Glenys – later sessions In sessions 2 and 3, Glenys talked at length about the situations in which her pain and breathing difficulties occur. Your impression is that she has thought deeply about the question you asked in the first session, and is perhaps trying to please you, or conform to your expectations, by working hard on this task. At the start of session 4, she excitedly tells you that during the previous week, she had experienced a moment of ‘really bad’ breathing difficulties. She describes a staff meeting at work, where all the care staff and domestics were together to hear about some new arrangements about overtime payments and holidays. Some of them had become very angry, and directed their anger at her, even though her boss, the divisional manager, had also been present. “At one point I had to sit down, because I thought that I was going to have a heart attack. I was breathing very quickly, like it was out of control. My arms were sort of numb and tingly at the same time. I thought I was going to choke or faint. Everyone was very good. They told me I had been under a lot of stress, and brought me some water, and then the meeting went ahead. But I felt extremely shaky all day.”
After saying this, Glenys quickly moves on to give her account of other situations during the week that had been associated with symptoms. You feel convinced that the episode at the staff meeting was a panic attack.
Task for reflection How might you work with these further developments on Glenys’s life? What could you do to explore the meaning and experience of the panic attack for Glenys? Would you want to offer information or strategies that would help her to cope with such situations in future?
Session 7 Glenys was very pleased with the work you did together over the panic attacks: ‘it has made a huge difference’. She fed this information back to the GP, who was very happy to agree to a further six sessions. At the beginning of session 7, Glenys seems very agitated, and almost tearful. She begins to describe an occasion the previous day when she and her husband disagreed over how to respond to a demand from one of their children. “It was like a knife in my gut. Very painful, I had to take three of my pills. He just wasn’t listening to me. He seemed too sure of what was right, and
Putting theory to use: thinking about cases
wouldn’t allow me to get a word in at all. I felt like my tummy was really bloated and almost exploding. It was sort of the same as the pain that is usually there, but much more intense, and focused on one place. Later on I developed a headache and had to go to bed. I tried some yoga exercises, but it didn’t do much good.”
Your immediate sense is that Glenys has told you something that is very important, for her and for your relationship. You feel closer to her. It is the first time that she has ever been even slightly critical of her husband.
Task for reflection What could you do to explore the meaning and experience of this pain episode for Glenys?
Session 11 Glenys is very aware that the counselling sessions have come to an end. You have referred her to the local NHS psychotherapy service, and she is on their waiting list (average waiting time: 15 months). Up until now Glenys has talked almost entirely about events that have taken place within the last year. Today, she comes in and tells you that she has visited her father’s grave. She had not mentioned her father before. “I don’t know why I did it. I was just driving past the cemetery and the idea came to me. It was only when I found the headstone that I realized that it was virtually the anniversary of his death. I was only 12 when he died [tears]. He had been in trouble with some financial business at his work, and died in a car crash, It must have been suicide, but no-one ever talked about it. It was good to stand there on the hillside and just remember a few things about what he was like. He was a great dad [more tears]. He used to take me to gymnastics, even to competitions in England. I was so much into sport, it was what I wanted to do with my life. He was always around. My life was never the same afterwards. My mother needed so much help.”
Task for reflection How might you work with this story? How might you respond to what Glenys has said? Finally, look back at all of your responses to the Glenys case: G
What are the therapeutic ideas and strategies that you have used in relation to your hypothetical work with this person?
G
What does your sense of how you might work with this client say to you about your theoretical position as a counsellor?
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‘I hear these voices telling me what to do’ You are a counsellor working with a voluntary sector agency, which offers open-ended weekly counselling sessions to people with a wide variety of problems. There are no assessment screening or ‘intake’ interviews – the client phones up and makes an appointment, and the counsellor is the first person in the agency that they talk to. Gary is in his mid-20s. He is neatly dressed, and seems rather nervous when he enters the counselling room. He walks to his chair slowly and deliberately, and does not engage in eye contact. When you ask him to say what has brought him to counselling, he replies: “I hear these voices telling me what to do. It’s getting so bad that my brother told me that I need to get some help.”
When invited to say more about what is happening in his life as a whole, it emerges that Gary lives at home with his parents. He mentions several times that he has a predictable routine, which he does not like to change. He has had a clerical job for many years, which involves minimal contact with the public. Recently, he has felt ‘stressed out’ by his father’s illness (he has been diagnosed with cancer). It seems as though the family dynamic has started to change – Gary has found himself being required to take a more active role in supporting his mother. He does not mention the ‘voices’ again, and you do not ask him about them. Gary has a ‘needy’ way of talking, and is highly sensitive, almost suspicious, about any suggestions or questions that you put to him. Throughout the session, you have a sense of ‘walking on eggshells’, and being very careful to go at Gary’s pace. At the end of the counselling session, you agree to see Gary again. You feel uncertain about how best to make sense of what happened in the session, and wonder about the significance of these ‘voices’.
Learning tasks G
What are the main themes or issues that this client is expressing?
G
What therapeutic ideas and strategies might you find helpful in relation to your hypothetical work with Gary?
G
How would you approach the issue of the ‘voices’?
G
How might you negotiate a therapeutic ‘contract’ with this client? What would you want to include in the contract?
G
What does your sense of how you might work with this client say to you about your theoretical position as a counsellor?
Putting theory to use: thinking about cases
Further reading Romme, M. and Escher, S. (1993) Making Sense of Voices. London: Mind.
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A case of work stress
You are working as a counsellor for an Employee Assistance Programme (EAP), which has a contract to provide brief (six-session) counselling for staff of a major national financial services company. Jeff (27) makes an appointment to see a counsellor. He tells you that he saw his GP earlier in the week about his depression. All the GP offered was pills, so Jeff decided to try the company EAP. He tells you that he has had a successful career as an IT analyst. He has a good salary and owns his own flat in town. He describes himself as ‘devastated’ because his partner of five years – Rita – has suddenly left him to move in with another man. In a flat tone, he responds to your question about how he feels: “I just keep thinking about it. I can’t go to work at all. In fact I can’t do anything but sit in the flat playing records and looking at photo albums. I don’t want to speak to anyone. My parents, my brother, my best friend, have all been round to see me but I pretend I am not in. I feel hurt and betrayed and angry and depressed all at the same time. Some of the time I think that if I can’t have her, then no-one should have her. I feel like ending it all. I feel so worthless and tired of this nightmare that I wish I could just go to sleep forever and forget about it all. It would be all over. I know that things weren’t going too well between us. She kept telling me that I was locked up in my work and always seemed tired and irritable. But I had no idea that it could have been that bad. The company has been going through a merger, and it’s like everyone has two jobs – at least – to do. It’s not the sort of place that you want to be first out of the car park at 5.”
Learning task G
How might you feel at this moment? How might you respond? What would you say?
G
What themes and issues might you want to explore further?
G
How might you structure the remaining 30 minutes of the session?
G
Which theoretical models or techniques might be helpful in your work with this client over the remaining five sessions?
Finally: G
What have you learned, in thinking about your response to this case, about yourself as a counsellor?
G
What does your sense of how you might work with this client say to you about your theoretical approach?
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Thelma: a victim of therapist boundary violation At the time of entering therapy, Thelma was 70 years of age. She had been married to Harry for more than 40 years. Although his career in the navy had taken him away from home for long periods, there was little closeness in their relationship. Since retiring from the navy, Harry had taken a senior position with the Boy Scout movement, which involved regular travel to inspect Scout groups in distant parts of the country. Thelma had enjoyed a successful career as a dancer. Since the age of 50, when her dance career had come to an end, she had become depressed, and had been continuously in psychiatric treatment, receiving therapy from a series of trainee psychologists at a community mental health clinic, as well as regular episodes of antidepressant medication. At her first appointment, Thelma looked haggard and unkempt, wearing a baggy jogging outfit and thick coat. At the start of the session, she clearly stated her goal for therapy: “Eight years ago I had a love affair with my therapist. Since then he has never left my mind. I almost killed myself once, and I believe I will succeed the next time. You are my last hope of finding a way to live with at least a little happiness.”
In the remainder of that first session, Thelma talked about what had happened. Matthew had been in the final stage of his training when he took Thelma on as a client at the community mental health centre. She described him as the first therapist who had ever made a difference to her. He was in his early 30s, caring and affirming, and also challenging. He had introduced her to spiritual ideas that had become important for her. When he completed his training internship at the centre, and went into private practice, Thelma had followed him and remained his client for another 12 months. Their therapy contract ended when he took a job in a hospital, and was no longer able to see private clients. Their relationship throughout this period of therapy had been on a purely professional basis, with no contact outside of their regular therapy sessions. One year after the end of therapy, she bumped into Matthew in the city. He was interested in what had happened for her in the year since they had last met, so they had coffee and talked. Their conversation stretched on into the evening, so they had dinner together. Following this, they went to Matthew’s apartment and made love. Their affair continued for the next month, until ended by Matthew. The ending was ‘devastating’ and ‘unbearable’ for her. She became obsessed by him, and phoned him every day. Eventually, she made a serious suicide attempt. Matthew visited her in hospital but was cold and professional, and stayed for only 15 minutes. Over the following eight years, Thelma had become increasingly depressed, spending most of her time thinking obsessively about Matthew – what had happened, why it had ended, how she could get him back. She had seen a number of therapists, but had not told any of them about the affair. She explained that she had decided to see you as a
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‘last hope’, because you were older and more experienced – if anyone could help her, it would be you. G
What are the main issues that Thelma is bringing to therapy?
G
How would you describe the way that Thelma relates to the world? What kind of a world does she inhabit?
G
Why now? What is the possible significance of choosing to visit a therapist at this time?
G
If you were her therapist, what else would you be interested in knowing about Thelma in future sessions?
G
How would you work with Thelma? What would you be trying to do? What techniques or strategies might you employ?
G
What are Thelma’s strengths?
G
How many sessions do you think Thelma would need? On what basis do you make this estimate?
G
What feelings are triggered in you by listening to Thelma’s story? What might be the significance of this emotional response?
Further reading This case is described in more detail in: Yalom, I.D. (1989) Love’s Executioner and Other Tales of Psychotherapy. London: Penguin.
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Geoffrey: deconstructing demons Geoffrey was a divorced African American man, 66 years old, unemployed (working voluntarily in a centre for older people), and living alone in a small, one-room apartment in a city in the Northeastern USA. At his assessment interview, Geoffrey told the following story: G
grew up in a small town with both parents and one brother;
G
attended university for two years, to study English, but dropped out because of examination anxiety;
G
an avid reader;
G
had served in the Vietnam War, in a non-combat administrative role;
G
had been married with three daughters (now estranged);
G
politically active in the 1980s and 1990s but had stopped because ‘people made him nervous’;
G
recent 5-year period of heavy drug use, ending 3 years previously (also previous 10-year history of misuse of alcohol, marijuana and crack cocaine);
G
held a series of administrative jobs until addiction led to loss of employment;
G
built up substantial credit card debts during period of drug misuse; currently living on benefits;
G
during drug phase, started seeing other women. One female fellow addict died of a drug overdose in bed with him;
G
this event resulted in his divorce, and rejection by his family;
G
event also triggered post-traumatic stress disorder symptoms: flashbacks, hypervigilance, mistrust of people and emotional numbing;
G
ex-wife died three years later of cancer – they had never resolved the issues between them;
G
in good physical health other than high blood pressure and type II diabetes (was not adhering consistently to the recommended diabetes self-care guidelines);
G
smoked 10 cigarettes per day, but no alcohol intake;
G
had successfully completed two 28-day inpatient detoxification programmes; had been clean for 3 years.
Geoffrey described himself as depressed, and reported low motivation, lack of energy, feelings of worthlessness and inappropriate guilt, trouble concentrating and making decisions, and thoughts of his own death. He had cut out most activities over the past year. He also ruminated obsessively about events from the past, and had a short attention span. He said that his ‘brain was dead’ and that he felt like ‘a very old man’. He spent most of his time watching television, which he believed ‘prevented loneliness’. He believed that his symptoms had become worse over the last two months, and that his
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apartment had begun to ‘make him uncomfortable’ for reasons he was not able to articulate. Geoffrey viewed himself as a worthless, insecure failure. He felt that the events of his life caused him to always ‘aim low’. Geoffrey acknowledged that he almost always felt anxious when interacting with unfamiliar people, because he felt sure that they were secretly judging him on the basis of his previous mistakes. He also reported severe claustrophobia, which had started as a young adult, and had grown worse over the years. He was unwilling to ride in elevators, and disliked small, hot rooms. During the assessment interview, he showed signs of difficulty in concentration, and was readily distracted by any external noises. He had read about cognitive–behavioural therapy, and thought that it made a lot of sense. Geoffrey stated that his goals for therapy were to overcome anxiety and depression, ‘fill his life back up’, increase his levels of social, intellectual, and occupational functioning, and ‘feel better about himself’. G
What are the main issues that Geoffrey is bringing to therapy?
G
How would you describe the way that Geoffrey relates to the world? What kind of a world does he inhabit?
G
Why now? What is the possible significance of choosing to visit a therapist at this time?
G
If you were his therapist, what else would you be interested in knowing about Geoffrey in future sessions?
G
How would you work with Geoffrey? What would you be trying to do? What techniques or strategies might you employ?
G
What are Geoffrey’s strengths?
G
How many sessions do you think Geoffrey would need? On what basis do you make this estimate?
G
What feelings are triggered in you by listening to Geoffrey’s story? What might be the significance of this emotional response?
Further reading A detailed account of this case can be found in: Mohlman, J., Cedeno, L.A., Price, R.B., Hekler, E.B., Yan, G.W. and Fishman, D.B. (2009) Deconstructing demons: the case of Geoffrey, Pragmatic Case Studies in Psychotherapy, Volume 4, Module 3, Article 1, pp. 1–39, www:pcsp.libraries.rutgers.edu.
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The case of Mrs Y
Mrs Y was an attractive woman in her early 60s, who had enjoyed a successful educational and professional career. At her first session, she described her life in these terms: G
She had been brought up in a prosperous middle-class setting: ‘emotional poverty in the midst of material luxury’ – she had almost no happy memories of childhood.
G
A middle child – an older brother who was brain-damaged at birth, and a younger sister.
G
She perceived her mother as being caught up with her own needs and troubles, and favouring her siblings.
G
Her mother seldom touched her.
G
A frequent childhood nightmare had been: ‘my mother is watching indifferently from the porch of our house while I was run down by a laundry truck in the driveway’.
G
She had adored her father, but he was usually preoccupied with business.
G
Her father would look after her when she was ill.
G
Her father was prone to attacks of sudden rage.
G
When Mrs Y was eight years old, her father became ill, and was bedridden at home for six years until his death.
G
Mrs Y was not allowed to disturb her father during his illness; after his death, all emotion was denied in the family.
G
She had never felt that she could make anyone happy.
G
A few years before, her husband had an affair and had left her.
Mrs Y had been in therapy before (with little success), and described her goals for therapy at this time as overcoming her depression, and becoming able to develop better relationships – she always had the sense that she was holding something back in relationships, leaving her with a sense of loneliness. G
What are the main issues that Mrs Y is bringing to therapy?
G
How would you describe the way that Mrs Y relates to the world? What kind of a world does she inhabit?
G
Why now? What is the possible significance of choosing to visit a therapist at this time?
G
If you were her therapist, what else would you be interested in knowing about Mrs Y in future sessions?
G
How would you work with Mrs Y? What would you be trying to do? What techniques or strategies might you employ?
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G
What are Mrs Y’s strengths?
G
How many sessions do you think Mrs Y would need? On what basis do you make this estimate?
G
What feelings are triggered in you by listening to Mrs Y’s story? What might be the significance of this emotional response?
Further reading A detailed account of this case can be found in: Kalsched, D. (1996) The Inner World of Trauma: Archetypal Defences of the Personal Spirit. London: Routledge (pp. 19–28).
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Charles: therapy as a ‘last resort’ Charles was a student on a university Masters course in business administration. He looked older than his age of 28, with prematurely grey hair and a stiff, formal manner of relating to people. Charles described himself as depressed. In the first session, he told this story: G
Following graduation with his BA degree, he had worked for a large multinational company for four years.
G
He was single, had never had a relationship with a woman, and had no friends.
G
During the Masters programme, Charles had been in a series of constant battles with tutors and the university administration about low grades and access to part-time work – he felt that the university was wanting to get rid of him.
G
He felt frustrated, fatigued and demoralized, with poor concentration and memory.
G
Slept and ate well, and had no suicidal thoughts.
G
Grew up in a ‘normal middle-class family’ – youngest of three children. Father worked as a supervisor in a manufacturing plant; mother was a housewife.
G
Beneath the surface, family life had been ‘chaotic and violent’ – parents continually fought with each other, and physically abused their children.
G
Charles was the one who fought back, and as a result became a target of his father’s rage.
G
Father ignored the children as if they were ‘pieces of furniture’ (did not say hello to them if he passed them in the street), and played sadistic games that invited no-win conflicts.
G
Charles viewed his mother as ‘weak and passive’, and too frightened to get out of a bad marriage.
G
Parents divorced when he was at college.
G
Charles did well at school – this was valued by his mother and by teachers.
G
In adolescence, perceived himself as ‘awkward, unattractive and unathletic’.
G
Had chronic eye problems, had undergone several operations, beginning at age 12.
G
Had not been encouraged to talk about or work through any emotional reactions he had to these frightening experiences.
G
From the age of 13, Charles earned all his own money, as he never felt he could ask his parents for anything, and paid his own way through college.
G
Self-image was of himself as a ‘fighter, a survivor, someone who could take care of himself by himself’ – entering therapy was seen as an admission of defeat, shameful and a ‘last resort’.
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G
Had been referred for therapy by the doctor who has been monitoring his eye condition.
During the first session, Charles was concerned about confidentiality, and guarded about revealing anything of himself, in case it might be used against him. He was tense, cold and humourless. His difficulties were all the fault of someone else. The therapist noted that she felt ‘locked out of meaningful contact yet punished for my failure to reach him, as he would always manage to let me know I was failing him in some way’. G
What are the main issues that Charles is bringing to therapy?
G
How would you describe the way that Charles relates to the world? What kind of a world does he inhabit?
G
Why now? What is the possible significance of choosing to visit a therapist at this time?
G
If you were his therapist, what else would you be interested in knowing about Charles in future sessions?
G
How would you work with Charles? What would you be trying to do? What techniques or strategies might you employ?
G
What are Charles’s strengths?
G
How many sessions do you think Charles would need? On what basis do you make this estimate?
G
What feelings are triggered in you by listening to Charles’s story? What might be the significance of this emotional response?
Further reading A detailed account of this case can be found in: Skean, K.R. (2005) The case of ‘CG’: balancing supportive and insight-oriented psychodynamic therapy with a client undergoing intense life stresses, Pragmatic Case Studies in Psychotherapy, Volume 1, Module 3, Article 1, pp. 1–18, www.pcsp.libraries.rutgers.edu
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The case of Ida
Ida is an intelligent and attractive young woman of 18 years of age. She has grown up in a prosperous middle-class family with her father (a businessman), mother and brother. Her father insists that she attend therapy, because of a range of symptoms that have developed, and are severely limiting her life. These symptoms include: difficulty breathing and speaking, sensation of choking, fainting spells, depression, avoidance of social contact and threatening to commit suicide. At the first session, with some difficulty, Ida describes her life in these terms: G
She is very close to her father, who is the dominant figure in the family.
G
She is also close to her aunt (father’s sister), who has significant psychological problems.
G
Her mother rarely leaves the house, and is obsessed with order and cleanliness.
G
Her brother is closer to his mother, and avoids his father.
Ida explains that her symptoms started to develop on a family holiday two years previously at the lakeside villa of Mr K, a long-time friend of the family – the two families had often gone on holiday together. Ida had been a babysitter for the children of Mr and Mrs K, and was particularly fond of Mrs K. On this holiday, unknown to anyone else, Mr K made a sexual advance to Ida, which she found very frightening. She told her father about this, but he did not believe her, accusing her of making up what had happened. Ida described a dream that she had, which seems to her to refer to the sexual incident: “the house was on fire. My father was standing beside my bed and woke me up. I dressed quickly. Mother wanted to stop and save her jewel-case; but Father said: ‘I refuse to let myself and my two children be burnt for the sake of your jewel-case.’ We hurried downstairs, and as soon as I was outside I woke up.” G
What are the main issues that Ida is bringing to therapy?
G
If you were her therapist, what else would you be interested in knowing about Ida in future sessions?
G
How would you work with Ida? What would you be trying to do? What techniques or strategies might you employ?
G
What feelings are triggered in you by listening to Ida’s story? What might be the significance of this emotional response?
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Further reading The descriptive details provided above are taken from Freud’s case of Dora (real name Ida Bauer). This was one of the first cases to establish Freud’s reputation. His own analysis of the case can be found in: Freud, S. (1977) Fragment of an analysis of a case of hysteria, in S. Freud (ed.) Case Histories, Volume 1. Harmondsworth: Pelican Books. As with many of Freud’s cases, a great deal of additional material has been unearthed about Ida/Dora, which provide the basis for a rage of different interpretations of what happened. Particularly recommended are: Bernheimer, C. and Kahane, C. (eds) (1986) In Dora’s Case. London: Virago. Billig, M. (1997) Freud and Dora: repressing an oppressed identity, Theory, Culture and Society, 14: 29–55. Mahony, P.J. (1996) Freud’s Dora: A Psychoanalytic, Historical, and Textual Study. New Haven, CT: Yale University Press.
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Anna: moving on in life
Anna had moved with her young son to a new city in a new part of the country to escape from her former boyfriend, who had started to harass her after she had told him that their relationship was at an end. He had spied on her by hacking into her computer, wiretapping her phone and breaking in to her apartment. During this period she feared for her life, and felt that she was going crazy. She was now feeling depressed, desperate and alone, and decided that therapy might help her. Her story was: G
Her best memories of her childhood were winning prizes at school for writing and drama.
G
Her parents had behaved in a physically and emotionally abusive way, which had left her fearful about taking initiatives.
G
In the early years of being a single parent, she had made money by working for an escort agency at night; by day, she attended university and attained a nursing degree.
G
Her nursing licence had now lapsed, and she had no means of financial support – she relied on handouts from her parents.
G
Her parents believed that she could not manage to bring up her son on her own.
G
Her previous therapist had terminated treatment after one session, because she regarded Anna as too seriously disturbed to work with in weekly therapy.
G
Her doctor had suggested that she needed to see a psychiatrist, and receive medication.
Anna told this story in an animated, expressive style, and made powerful contact with her therapist. G
What are the main issues that Anna is bringing to therapy?
G
How would you describe the way that Anna relates to the world? What kind of a world does she inhabit?
G
Why now? What is the possible significance of choosing to visit a therapist at this time?
G
If you were her therapist, what else would you be interested in knowing about Anna in future sessions?
G
How would you work with Anna? What would you be trying to do? What techniques or strategies might you employ?
G
What are Anna’s strengths?
G
How many sessions do you think Anna would need? On what basis do you make this estimate?
G
What feelings are triggered in you by listening to Anna’s story? What might be the significance of this emotional response?
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Further reading A detailed account of this case can be found in: Duncan, B.L., Sparks, J.A. and Miller, S.D. (2006) Client, not theory, directed: integrating approaches one client at a time, in G. Striker and J. Gold (eds) A Casebook of Psychotherapy Integration. Washington, DC: American Psychological Association.
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Case scenarios for working with emotions 1
Whenever Pru felt criticized or hurt, she automatically went into a state of dissociation, described as ‘going out of my body’, in which she could not speak, and felt physically weak. It was impossible to work with either feelings or thoughts at the core of her problems.
2
Janet was referred for therapy for her claustrophobia. Even after several sessions, it was still very unclear what Janet actually experienced in relation to small spaces – she had avoided such experiences for so long that she had no recent episodes to draw on.
3
Anna came from a strict religious background in which self-sufficiency and stoicism were encouraged. She was referred with chronic fatigue syndrome. It soon became apparent that she kept constantly busy to keep difficult thoughts and feelings at bay.
4
Sarah had received a diagnosis of borderline personality disorder. She felt severely depressed and became increasingly out of control after her college tutor said about a piece of her work ‘that’s interesting, but it isn’t quite what I meant’. She was bombarded by a series of (familiar) thoughts – ‘I can’t do anything right’, ‘this is horrible’, ‘I can’t control this’ – and wished to burn herself. She said she knew the feelings would stop if she did.
How would you approach each of these cases? Which theoretical ideas might you use to gain a ‘handle’ on the client’s problems, in these scenarios? What further information would you wish to collect from the client? What interventions might be suggested to the client? These case vignettes are adapted from: Bennett-Levy, J., Butler, G., Fennell, M., Hackmann, A., Mueller, M. and Westbrook, D. (eds) (2004) Oxford Guide to Behavioural Experiments in Cognitive Therapy. New York: Oxford University Press. These authors offer an authoritative account of how these cases might be approached from a behavioural–cognitive perspective (see Chapter 17 and p. 411).
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David: tackling self-blame
David was in his mid-50s when he entered therapy. He was married with one son, and had a successful professional career. In the first session, he told his story: G
He had lost motivation and ambition in his career – he felt that he had made the wrong choice of career (influenced by his mother’s expectations).
G
Recently, he was becoming increasingly withdrawn from his wife.
G
He was depressed since the age of 10.
G
Entered therapy for the first time 10 years previously to deal with his depression.
G
During a period of separation from his wife during a previous episode of therapy, he had started to feel better; however, she begged him to return; he did so, and became depressed again.
G
Currently working from home; would prefer to have a job where he had more direct contact with people.
G
Anxious around people, particularly those in authority.
G
Emotionally cut off from his siblings.
G
Childhood family life characterized by fear, anger, loneliness and chaos.
G
Experienced his mother as ‘critical’ and ‘withdrawn’.
G
Mother died when David was 13; his father then became an alcoholic, leaving David to look after his younger siblings until he went to university at age 18.
As he told this story, David was self-critical, blaming himself for everything that had gone wrong in his life. In the session, he was able to express his feelings, as well as reflect on them, and to make a good contact with the therapist. His goal for therapy was to stop being depressed. G
What are the main issues that David is bringing to therapy?
G
How would you describe the way that David relates to the world? What kind of a world does he inhabit?
G
Why now? What is the possible significance of choosing to visit a therapist at this time?
G
If you were his therapist, what else would you be interested in knowing about David in future sessions?
G
How would you work with David? What would you be trying to do? What techniques or strategies might you employ?
G
What are David’s strengths?
G
How many sessions do you think David would need? On what basis do you make this estimate?
Putting theory to use: thinking about cases
G
What feelings are triggered in you by listening to David’s story? What might be the significance of this emotional response?
Further reading A detailed account of this case can be found in: Watson, J.C., Goldman, R.N. and Greenberg, L.S. (2007) Case Studies in Emotion-focused Treatment of Depression: A Comparison of Good and Poor Outcomes. Washington, DC: American Psychological Association (Chapter 2).
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Reflecting on practice: challenges and possibilities within the therapeutic relationship Section contents Introduction
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Exploring moral values
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The implications of your moral values for your approach as a counsellor
154
What is your personal philosophy?
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Moral dilemmas presented by clients
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Ethical decision-making
159
Deconstructing the meaning of confidentiality
161
Creating and maintaining a therapeutic relationship with a client
162
Expanding your relational responsiveness
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Touching and being touched
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Making sense of stories
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Working therapeutically with metaphors
169
Responding to client interest in dreams
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The meaning of boundary
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What does ‘counselling’ mean to people in your community?
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Writing letters
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The therapeutic use of reading
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Using Internet resources to support therapy
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Counselling in the media
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Online counselling
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Indoors or outdoors? Using nature in therapy
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How to be really ineffective
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Working with clients who are difficult or challenging
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Introduction
The task of evolving a personal approach as a counsellor or psychotherapist is not merely a matter of adopting a particular theoretical orientation, or assembling an integration of different theoretical ideas. For many counsellors, the process of discovering who they are as therapists only really hits them when they are faced with critical issues in practice. The aim of this section of the Workbook is to present a series of activities that evoke practical dilemmas that are associated with underlying questions such as ‘what kind of a counsellor do I want to be?’ and ‘what is the personal style, or way of being with others, which suits me best?’ You may find that some of the scenarios and dilemmas described in these activities are already familiar to you from your work as a therapist. In these cases, your response to the learning task may help you to reflect more fully on your response to that situation, or to begin to consider what your preferred response might be. Other scenarios and activities may introduce situations that you may never have encountered in your actual work with clients. In these cases, you may be able to use the learning task to imagine, or rehearse, the ways in which you might approach such a situation when it does cross your path. The series of tasks in this section begin with a set of activities that invite you to articulate and reflect on the moral choices and principles that you draw on in guiding your work, and your life as a whole. The reason for beginning with moral issues is that counselling is a highly morally sensitive endeavour. People who come to see a counsellor are often struggling to make choices in their life to decide what is ‘right’ for them to do. The counsellor is inevitably drawn close to the person’s life in a way that makes it possible for him or her to hurt or exploit, as well as to help, the person. If a counsellor does not have confidence in the moral stance that he or she is taking in relation to the counselling relationship, it is likely that he or she may be paralysed, unable to continue to be open to the client’s process. It is therefore important, as a counsellor, to be aware of one’s own values and moral landscape. For most people, this is a difficult thing to do; we live in a culture in which there are many competing moral stances. Other activities in the section reflect the huge diversity of counselling and psychotherapy methods that are currently in use. Becoming more aware of where you stand in relation to these methods is a good way to explore your identity as a counsellor. Inevitably, all counsellors find themselves drawn towards certain techniques, client groups and modes of delivery, while avoiding others. Some of the learning tasks invite you to look beyond your fascination or disinterest and to consider what having these views means to you in terms of who you are – or wish to be – as a counsellor.
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Exploring moral values
What are the moral values that are most important for you? Your practice as a counsellor is inevitably embedded in your sense of what it means to be a ‘good’ human being. The issues and choices that some clients make will undoubtedly challenge that sense of what is ‘good’ or ‘right’. A personal approach to counselling is, therefore, informed by an appreciation of your own moral positions, as well as a capacity to respect the moral positions taken by others. The three exercises described below are designed to enable you to begin to explore your personal moral values.
Instructions 1 Sources of moral influence in your life Take a piece of paper and draw a ‘timeline’ from your birth to present. Along this line, indicate the ‘moral communities’ that you have belonged to at various stages in your life. A moral community could be an organized religion, such as the Roman Catholic Church or the communist party, or it could be a less formal network, such as ‘the rugby club’, ‘my friends’ or ‘the feminism seminar group’. A moral community is any grouping that sets standards for its members about ‘correct’ beliefs and the ‘right’ way to do things. For each of the moral communities, add a label listing the core moral rules or values for which it stood. You may find that at particular points in your life you may have been a member of more than one community. Once you have completed the timeline, reflect on what you have learned, in relation to the consistent moral themes in your life, and the areas of moral tension or uncertainty. 2 Moral proverbs and sayings A good way to begin to map out your personal moral beliefs is to think about the moral proverbs and sayings to which you make reference in everyday life. It is also of interest to identify, if you can, the person who you heard saying these things to you in the first instance. For example, you may have heard your grandmother saying, ‘who does he think he is?’, or ‘men are only interested in one thing’. What do statements like these tell you about your moral values and beliefs? 3 Your vision of the good life What would your ideal world be like? What would ‘Utopia’ be for you? Take a few minutes to write about the characteristics of the good life from your own individual perspective.
Reflecting on practice
Once you have completed these three exercises, bring together what you have learned about your moral values by drawing a list of the values or ‘virtues’ that are of central importance in your life.
Further reading To place your reflections in a broader context, you might wish to read the following book: Tjeltveit, A. (1998) Ethics and Values in Psychotherapy. London: Routledge.
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The implications of your moral values for your approach as a counsellor The moral values and virtues that you espouse may help to shape the approach you take as a counsellor or psychotherapist in a variety of ways. For each of the dimensions of practice listed below, write some notes on the possible implications that might arise from your moral position. For example, if aesthetic/artistic values are highly significant for you, then this may imply developing a theoretical approach that makes space for creativity, working in a setting that allows art therapy methods to be employed, and so on. If socialist and egalitarian values are significant, there may be quite different implications in terms of theoretical choice and work setting. You may find that your individuality as a counsellor arises from the ways that you have found to balance or reconcile different values in your own practice. Theoretical orientation: different theoretical orientations tend to emphasize different values, such as rationality, individual autonomy, spirituality, and so on. For you, what are the links between your values and moral position, and the theories of counselling that have meaning for you? It may be that certain theories allow you a vehicle to express your values fully. Alternatively, there may be areas of tension: a theoretical model may make a lot of sense to you in most respects, but there can nevertheless be specific ways in which it is hard to align it with some of your moral beliefs. Way of working as a therapist: there are many practical issues in therapy that reflect value choices. Some of these issues include setting a limit to the number of sessions that a client can receive, charging fees, seeing a client individually or in a family context. Where do you stand on these matters? Client groups: are there client groups that you are drawn towards, which you get great satisfaction from? Are there groups of clients who are difficult for you to accept, or whose values are hard for you to appreciate and understand? Practice setting: in what ways do your values influence the types of counselling settings within which you choose to work. For example, do you practise on a volunteer, unpaid basis, or in a paid job, or both? In what ways might the values of your colleagues matter to you? The values of organizational contexts may differ too, for example, some counselling agencies are grounded in religious commitment, while others embrace rational, ‘evidence-based’ practice. How much do these factors matter to you? Once you have reflected on these practice domains, and written some notes in response to the questions outlined above, spend some time looking at the totality of your response: what have you learned about your own values, and about the relationships between these values and your counselling pracice?
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What is your personal philosophy? Arthur Combs was an American psychologist who worked with Carl Rogers in the 1950s. His research looked mainly at one of the fundamental notions of early clientcentred therapy – that effective counselling was essentially a matter of possessing an appropriate attitude or philosophy of life, and conveying this to clients. For Combs (1986: 51–61; see also Combs, 1990), the key elements of the counsellor’s attitude were: Beliefs about significant data. Good helpers are people-oriented. They seem to attend to internal personal meanings rather than external behavioural data and tune in to how things seem from the point of view of those with whom they work. Beliefs about people. Effective helpers seem to hold more positive beliefs about the people they work with than do less effective helpers. They see them as trustworthy, able, dependable and worthy. Co-operative rather than adversarial relationship attitudes: helper and client are on the same side of the fence. Perceives others as having the capacity to deal with their problems, and has faith that they can find adequate solutions, as opposed to doubting the capacity of people to handle themselves and their lives. Others are essentially dependable rather than undependable. Confidence in the stability and reliability of others, and no need to be suspicious of them. Beliefs about self. A positive view of self, confidence in one’s abilities, and a feeling of oneness with others. Identifies with people, rather than sets self apart from people – tends to see self as a part of all mankind. Enough rather than wanting – self as having what is needed to deal with problems, rather than as lacking or unable to cope with problems. Willingness to disclose or share things about self – feelings and shortcomings are important and significant rather than needing to be hidden or covered up. Beliefs about purposes or priorities. Good helpers tend to see events in terms of wider meanings and perspectives, from a broad rather than narrow perspective. Concerned with the implications of events, rather than merely with the immediate and specific. Not exclusively concerned with details but can perceive beyond the immediate to future and larger horizons.
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Learning task Reflect on the following questions: G
To what extent do your basic beliefs or personal philosophy correspond with the pattern that Combs views as associated with effective counselling?
G
Do you believe that Combs’s model is necessarily correct? Some would argue that he takes an over-optimistic and romantic view of the world, and that there are other ‘worldviews’ that can also be found in successful counsellors.
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Moral dilemmas presented by clients To a large extent, developing a personal approach to counselling or psychotherapy is a matter of learning from experience. Things happen in therapy that challenge our beliefs and assumptions, and force us to reflect deeply on what it is that we stand for. The brief client vignettes on this page include situations that are not straightforward for any counsellor or psychotherapist. How would you respond to these clients? For each vignette, make some notes around the key practical and moral issues, as you perceive them, and around the possible courses of action that you might pursue in each case. What would you do? Sam is a client referred by one of the GPs in the primary health clinic in which you are employed as a counsellor as a member of the primary care mental health team. The brief referral note that you have received states that Sam is undergoing a lot of stress and needs help to deal with his anxiety. Sam comes in to your office and begins by saying: “I need to get this off my chest. It’s no good even starting to talk about anything until I have made this clear. I need help because I am in court in six weeks because I had sex with my partner’s eight-year-old daughter. She threw me out of the house and called the police. I just feel awful. I can’t function at work at all. Everyone thinks I am just a piece of dirt. I keep thinking about it all the time.”
Eva and Dave are clients in a marriage/couple counselling agency in which you work as a volunteer counsellor. They have already attended three sessions, and have talked mainly about the arguments they have been having around whether they should stay together. Both of them feel, for different reasons, that the ‘sparkle’ has gone out of their relationship. At the start of the fourth session, Eva begins to talk about the way that Dave controls money. He sees himself as the breadwinner, and only gives Eva a fixed amount of money each week to run the household. Eva does not have a bank account in her own name, or any access to money without asking Dave. She turns to you and asks: ‘this isn’t right, is it?’ How do you reply to Eva? Gina is a university student, who has been using the counselling service off and on throughout her course. She is in the second year of a degree. She has talked a lot about how her parents have always been emotionally distant, and divorced when she was 12, each of them starting new lives with different partners and starting new families. She believes that other people do not like her, and complains that she has no ‘real friends’. Now, she seems to have reached an impasse regarding her university work. Things have not been going well, and she has fallen behind. She seems very depressed. In your most recent session, she talked a bit about how she sometimes cuts herself. On the evening following that session, she sends you an email in which she writes that she is feeling worse than ever.
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What are the moral values that are evoked for you by each of these cases? What are the moral principles that you might refer to when arriving at a solution or strategy in response to the needs of these clients? Which of these cases would be most and least difficult for you? Why?
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Ethical decision-making
Chapter 17 of An Introduction to Counselling provides an outline of the ethical principles that can be used as a guide for the practice of counselling. The websites of counselling organizations such as the British Association for Counselling and Psychotherapy also carry detailed codes of ethical practice. Use this material, and any other sources available to you, to formulate your decisions in relation to the following ethical dilemmas: 1
A client has been in counselling for a year, and has made great progress. She brings in an expensive gift for you. She knows that this is something that you would like, and she knows that you know that she would know this.
2
You have been counselling someone for six months who has a serious medical condition. You have a similar medical problem yourself. At the start of counselling you decided not to mention your similar health problem to the client. However, now you are finding it extremely difficult to carry on with the counselling, because what the client is talking about reminds you of your own pain, and you keep wanting to cry during sessions.
3
You are a counsellor in a school. The rule is that any children under 16 need to have parental permission to see you. You have just finished a group workshop for a class of 15-year-old children on relationship skills. At the end one of them comes up to you and launches into the story of her problems. When asked, she says that her parents would never give her permission to see you officially.
4
You work in a therapy agency where you have a first assessment session with a client, and then decide whether to offer him therapy or refer him elsewhere. During the first assessment meeting with this client, you realize that: (a) his problem is within the remit of the service, (b) he is motivated to use therapy, and (c) you find him physically threatening and intimidating.
5
You have been counselling a couple for some time. You all decide that it would be useful to have a couple of individual sessions, where you see the husband and wife separately. In the first individual session with the wife, she tells you that she has been having an affair but that she does not want you to tell her husband.
6
You have been counselling a couple for some time, and it is clear that they have serious relationship difficulties. At the time of the appointment only the wife turns up. The phone rings. It is the husband. He tells you that he has moved his belongings out of the house, and the marriage is over. He asks you to convey this information to his wife.
7
For some time you have been struggling to find a publisher for a book you want to write. It emerges that a client is a senior executive in a major publishing house. Her professional advice would be invaluable to you. In passing, at the and of a session, she mentions, ‘if you ever need any help getting a book published. . . .’
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8 After a long day seeing several clients, you use your partner as a ‘sounding board’ to talk through aspects of the work, but without disclosing details of the identity of any of your clients. 9 With a client, you consistently feel a pull of sexual attraction. 10 At the end of a session, a client asks you for a hug. 11 At the end of a session, a client asks you to kiss him or her on the lips. 12 It is a late evening session, which has been a difficult and harrowing for the client. She has no car, and has to walk through deserted inner-city streets. 13 A client you have worked with for a long time in private practice is terminally ill. He asks if you would continue to see him in the hospice. 14 You are a counsellor in a rural area where everyone knows everyone else. How do you deal with confidentiality? 15 You are a student counsellor in university. The counselling service is grossly under-resourced, but you try to do the best you can. You feel strongly that people in need should not be shunted on to a waiting list. You start to see clients during lunch breaks, and stay late in the evening. One week, you add up that you have seen 34 clients. 16 You work for a psychotherapy clinic that is highly sensitive to ethical issues. After several stormy staff meetings, it is decided that to ensure informed consent, anyone applying for therapy must be informed during their assessment interview of all the alternative treatments that might exist for their problem, including drug treatment, exercise regimes and meditation.
Questions for further reflection G
What have you learned about yourself, your values and your approach to therapy from this exercise?
G
What are the implications of these dilemmas, in terms of the supervision, support and consultation that you require in order to work effectively as a counsellor or psychotherapist?
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Deconstructing the meaning of confidentiality The principle of confidentiality represents an essential aspect of therapy. It is clear that counselling or psychotherapy is a conversation or meeting that takes place for the person who is the client, rather than to compile any kind of report that might be handed on to a third party. However, much of the time the significance of confidentiality is largely taken for granted. Confidentiality is interpreted as being about making sure that client records are kept safe, the fact that the client is attending a therapy clinic is not made known to others, and so on. This activity invites you to develop a fuller appreciation of the idea of confidentiality. Over the space of a few days, carry out a personal inquiry into the meaning of confidentiality. Some of the inquiry tasks that you might attempt are: 1
Look up the meanings of confidentiality contained in the Oxford English Dictionary. Pay attention to the origins of this term. What does the etymology of the word tell you about some of the hidden, or implicit, meanings associated with the ways in which the word ‘confidential’ is used in both everyday and professional conversations.
2
Imagine that you are going to see a counsellor for the first time. What are your expectations or needs around confidentiality? What are your fears? Are there any questions that you want to ask your counsellor concerning confidentiality? Do you expect him or her to bring up the issue? What do you expect him or her to say? What would happen if you came away from that first meeting with doubts about the capacity of the counsellor to respect the confidentiality of information about you?
3
Interview colleagues about their experience of confidentiality breaches. Have they ever, when in the role of client or service user, known or suspected that their confidentiality had been breached? How did they feel and what did they do? Have they ever, in the role of practitioner, intentionally or unwittingly breached the confidentiality of a client?
4
Consider the confidentiality guidelines from three professional codes of ethics, reproduced on pages 508–9 of An Introduction to Counselling. In the light of what you have found in your inquiry, how adequate are these statements?
There may be many other inquiry strategies that you might pursue – the ones listed above are merely suggestions. Once you have reached a sense of closure in relation to your inquiry, write a summary statement of your understanding of the meaning and significance of confidentiality in counselling.
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Creating and maintaining a therapeutic relationship with a client The quality of the therapist–client relationship is considered within most schools of practice to represent a key factor in therapeutic success. It is important for any therapist to be aware of what he or she can do – to promote a solid and reliable ‘alliance’ with clients. The aim of this exercise is to give you an opportunity to reflect on what you do to create a therapeutic relationship with a client. When reflecting on the questions below, try to focus on the relationship dimension of your work with clients, rather than on the therapeutic process. Take a sheet of paper or page in your personal learning journal. Spend around 20 minutes writing about: G
What do I do in practice to create and maintain a relationship with my clients (this can include verbal and non-verbal behaviours, actions, strategies, etc.)?
G
What have I observed other therapists doing (e.g. in my own personal therapy, in videos, in case studies) around relationship-building (both positive and negative)?
G
What are the main cognitive resources (ideas, theories) that I use in making sense of how I create and maintain a therapeutic relationship?
Reflection on this task Take some further time to consider the following reflective prompts: G
What have I learned from this exercise about the way I work with clients, and the theoretical basis of how I practise?
G
What are my strengths and weaknesses around forming therapeutic relationships?
A study by Bedi et al. (2005) invited a sample of therapy clients to describe moments or incidents in their therapy that they believed had been important in terms of developing a relationship with their therapist. Compare the list of relationship-building strategies that you use in your own work with the list of strategies that clients see as significant. Does this suggest any gaps in your ‘relationship repertoire’?
Further reading Bedi, R.P., Davis, M.D. and Williams, M. (2005) Critical incidents in the formation of the therapeutic alliance from the client’s perspective, Psychotherapy: Theory, Research, Practice, Training, 41: 311–23.
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Expanding your relational responsiveness The quality of the client–therapist relationship has emerged as possibly the single most significant factor in effective therapy. In the absence of a relationship of trust, and a capacity to work together, there is little hope that even the most well thought out therapeutic activities will have much impact. Different approaches to therapy are based on contrasting ideas about what might be the best kind of relationship to offer clients. For example, the psychodynamic approach advocates the establishment of a slightly distanced and highly consistent relationship, which will function as a ‘container’ for painful or shameful emotional material. By contrast, cognitive–behavioural therapy (CBT) advocates a kind of athlete– coach, teacher–pupil relationship, where the therapist seeks to help the clients to acquire new skills. Another way of looking at the therapeutic relationship is to take the view that different clients need different kinds of relationship at different times, and that the most effective therapists are those who have a broad enough ‘relationship repertoire’ to adapt to these needs. What is you relationship repertoire? Howard et al. (1987) have identified four relationship modes that can be helpful for clients at different stages in therapy: 1
High direction/low support: the therapist is in charge of what is happening. This style is appropriate when the client is unwilling or unable to move him or herself towards the goals of therapy.
2
High direction/high support: the therapist adopts a teaching/psycho-educational role in relation to a client who has indicated a willingness to learn. This is the relational style commonly found in CBT approaches.
3
Low direction/high support: the therapist using this style is essentially accompanying a client who is engaged in a process of exploration and growth. This is the relational style associated with person-centred counselling.
4
Low direction/low support: the therapist functions mainly as an observer of the client’s progress. This relational style is characteristic of classical psychoanalysis.
Questions for reflection G
Which of these relationship styles do you use most often in you work with clients?
G
Which style do you use least often?
G
Which is your preferred style, the one that you are most comfortable with? Is there a relationship style that is impossible for you to exhibit?
G
To what extent does this model help you to make sense of occasions when you have felt that you were not being helpful to a client? On these occasions was the
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client looking for a way of relating from you that you were unable or unwilling to fulfil? G
Identify one client with whom you have done good work. In what ways did your relationship with this person change over the course of therapy in response to the different learning needs of the client?
Further reading Feltham, C. (ed.) (1999) Understanding the Counselling Relationship. London: Sage. Howard, G.S., Nance, D.W. and Myers, P. (1987) Adaptive Counseling and Therapy: A Systematic Approach to Selecting Effective Treatments. San Francisco, CA: Jossey-Bass. This book includes a therapist relationship-style questionnaire. Josselson, R. (1996) The Space Between Us: Exploring the Dimensions of Human Relationships. Thousand Oaks, CA: Sage. This book offers a more comprehensive model of possible relationship dimensions on therapy. McLeod, J. (2009) An Introduction to Counselling, 4th edn. Maidenhead: Open University Press (Chapter 14).
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Touching and being touched The question of whether it is valuable, or acceptable, to touch clients (or be touched by them) has been widely debated within the counselling and psychotherapy profession. The position that a practitioner takes in relation to touch can be highly significant in defining his or her personal approach. On the one hand, some therapists within the humanistic tradition would argue that touch is a basic and fundamental form of human contact and communication, and if clients are to ‘come to their senses’, touch will need to be involved at some point. On the other hand, some psychoanalytic and psychodynamic therapists would regard touching as deeply mistaken, reflecting a violation of the boundary between client and therapist. Some classical analysts, sitting at the head of a couch, situate themselves so that the patient cannot see them, never mind touch them. The following questions are designed to allow you to begin to map out your position in relation to touch: 1
What are your own ‘personal rules’ about touching and being touched? Under what circumstances do you appreciate being physically ‘in touch’ with another person? What feelings do you associate with touch? What are the different meanings associated with touch around different parts of your body, or the other person’s body?
2
It is possible to analyse counsellor–client touching into six categories. Touch can be initiated either by the client or by the counsellor. Touch can take place at three times: G
G G
before the sessions (for instance, on the way to the counselling room – shaking hands on arrival); during the session (e.g. putting an arm round a client who is in distress); after the session (touching the client’s shoulder on the way out of the room).
Which of these categories of touch do you engage in, or could imagine yourself engaging in? To what extent does this depend on the client? Are there categories of client who are for you ‘touchable’ or ‘out of touch’? 3
What are the dilemmas that you have come across, or can imagine coming across, in respect of client–counsellor touch within your own practice?
Make some notes to record your reflections in response to these questions. Try to sum up your conclusions in terms of your personal approach to touching in counselling. To what extent, and in what ways, might your personal position be in accordance with, or in conflict with, the ‘rules for touching’ implicitly or explicitly adopted by the theoretical model, workplace or training course within which you operate?
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Further reading Hunter, M. and Struve, J. (1998) The Ethical Use of Touch in Psychotherapy. Thousand Oaks, CA: Sage.
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Making sense of stories
Sensitivity and awareness in relation to stories is a key skill in any kind of counselling or psychotherapy practice. There are two kinds of story that clients tell, or refer to, in counselling sessions: G
Stories about actual events or incidents that happened in the person’s life. These are concrete, specific accounts of what took place, who was involved and what the person felt. Typically, clients tell five or six such stories during the course of a therapy session.
G
Stories about other people that have meaning for the client. These may often be fictional stories, such as fairy tales, novels or films or religious stories. This kind of story is mentioned less often in therapy sessions, but can be highly significant.
In recent years, a substantial amount of research has been carried out into the significance of the stories that clients tell in therapy. Some key principles have emerged from these studies: 1
The story reflects the typical pattern of relationships in the person’s life: the interplay of relationships within the stories that a person tells, or in which the person is interested, can often reflect the pattern of relationships in that person’s life as a whole. For instance, does the person tell stories of being alone, being in twoperson relationships, being in three-person relationships, and so on? Lester Luborsky has suggested that stories have an underlying structure in terms of how the person expresses his or her needs in relation to others. He argues that any story can be analysed in terms of the wish of the person, the response of the other and the response of self. The types of wish, responses of other and responses of self that a person expresses appear to be fairly consistent across all, or most, of the stories that he or she tells.
2
The story conveys the person’s image of the world that he or she lives in: what kind of environment is described? Is the world that is evoked by the story a place that is safe, where people’s needs are met, or is it a hostile and dangerous world?
3
The story expresses, or triggers in the listener, the emotions that are significant for the teller: what are the feelings that are associated with different characters in the story? How do you feel as a listener when hearing or reading the story?
In the ‘Your favourite story’ exercise, in Section 1 of the Workbook, you were invited to identify and summarize a favourite story from your own life. Apply the three principles above to that story. In what ways does your favourite story encapsulate the key emotional and relationship themes in your life? What have you learned about yourself from reflecting on this story in these terms? In what ways might you envisage being able to use these ideas in order to listen more fully to the meanings embedded in the stories that your clients are telling you?
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If you chose a fairy story as your favourite story, you may be interested in considering the special significance of this kind of narrative. The psychoanalyst, Bruno Bettelheim, and the founder of transactional analysis, Eric Berne, along with many other therapists, have suggested that fairy tales embody basic human life-scripts. Moreover, because fairy stories are heard by a child early in life, they have the potential to act as a kind of ‘template’ for the development of personality throughout a child’s later development.
Further reading Ideas about different approaches to analysing clients’ narratives (including Luborsky’s model) can be found in: Angus, L.E. and McLeod, J. (eds) (2004) Handbook of Narrative and Psychotherapy: Practice, Theory and Research. Thousand Oaks, CA: Sage. McLeod, J. (1997) Narrative and Psychotherapy. London: Sage. The significance of early childhood stories, such as fairy tales, is explored in two classic books: Berne, E. (1975) What Do You Say After You Say Hello? The Psychology of Human Destiny. London: Corgi. Bettelheim, B. (1976) The Uses of Enchantment: The Meaning and Importance of Fairy Tales. Harmondsworth: Penguin.
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Working therapeutically with metaphors A great deal of what happens in counselling and psychotherapy relies on the use of language – the capacity of the client and therapist to communicate what they are thinking and feeling, and use talk to negotiate different perspectives on problems. Metaphors play a particularly crucial role within the language of therapy. Metaphors can operate as a means of putting into words experiences that may be felt, but hard to articulate. Metaphors also operate as ‘shorthand’ reference points to complex patterns of behaviour. However, working constructively with metaphors presents a major challenge for therapists: language is saturated with metaphor, and it can be difficult to stand back from the ongoing flow of talk and be aware of the metaphoric expressions that have arisen. There are probably two main ways in which an awareness of metaphors can be used by practitioners: 1
Listening for the metaphors that are generated by the client, and either exploring these images and expressions in a spirit of collaborative inquiry (Rasmussen and Angus, 1996; White, 2007) or using them as the starting point for a more structured exploration of meaning (Kopp and Craw, 1998).
2
Introducing ‘healing metaphors’ into the conversation, which offer the client a fresh and hope-inducing set of possibilities around reimagining their problem. For example, in working with people who have experienced traumatic events that have resulted in intrusive memories, Meichenbaum (1994: 381–2) suggests that there are a range of metaphors that can have healing potential, such as: ‘not addressing the traumatic memory is like building your house on top of a toxic waste deposit’, or ‘talking about the painful memories in therapy is like setting a broken bone or lancing a wound’.
Learning task Over a period of one or two weeks, use your personal learning journal to keep a record of metaphors that arise in your work with clients, and in your everyday life. As you document these observations, reflect on the following questions: G
How aware and sensitive am I to the occurrence of metaphors? What could I do to become more sensitive?
G
How effectively do I employ the opportunities afforded by metaphors to make connection with the person with whom I am in conversation, or to explore the potential meanings that are implied by metaphoric images and expressions?
G
What are the most memorable metaphors that I have come across during this period of documenting metaphors? What makes them memorable?
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G
Are there metaphors that appear to have functioned in a negative fashion (e.g. by locking the person into a destructive or self-limiting view of the world)?
Further reading Kopp, R.R. and Craw, M.J. (1998) Metaphoric language, metaphoric cognition, and cognitive therapy, Psychotherapy, 35: 306–11. McLeod, J. (2009) An Introduction to Counselling, 4th edn. Maidenhead: Open University Press. Meichenbaum, D. (1994) Treating Post-traumatic Stress Disorder: A Handbook and Practical Manual for Therapy. Chichester: Wiley. Rasmussen, B. and Angus, L. (1996) Metaphor in psychodynamic psychotherapy with borderline and non-borderline clients: a qualitative analysis, Psychotherapy, 33: 521–30. White, M. (2007) Maps of Narrative Practice. New York: W.W. Norton.
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Responding to client interest in dreams Within modern societies, there are many people who are convinced that their dreams offer them a valuable guide to finding answers to their difficulties in life. However, relatively few therapists feel confident about their ability to work with client dreams. In order to begin to be sensitive to the meaning-making potential of dreams, it is necessary to have some experience of analysing one’s own dreams. For a period of one week, keep a record of what you dream each night. An effective way to facilitate the recording of dreams is to keep a pen and notebook beside your bed, and write down your dreams as soon as you awake. Before you go to sleep, gently ask yourself to dream, and to remember what you dream. Over the period of a week, this procedure will generate a number of examples of personal dreams. You may also find it helpful to write down any memories you have of the most important dream you have ever had, or of particularly powerful dreams you have experienced in the past. When you explore your dreams, follow these steps: G
Are there any everyday events and experiences that seem to be reflected in your dreams? If so, what does it mean that you have chosen to dream about these particular events?
G
Retell the dream out loud, as if it was happening, including any additional detail that occurs to you as you are telling it. What are the thoughts and feelings that occur to you as you are retelling the dream?
G
What do you believe that the message of the dream is for you? Think of your dream as a way in which you speak to yourself? What are you saying?
G
Is there anything that the dream may be suggesting to you that you might do differently in your life? How useful is this suggestion? How might you implement it or follow it up? What might happen if you went along with what the dream wanted you to do?
If you have found that this activity is helpful or interesting for you, then the next stage may be to consider how you might incorporate these principles of dreamworking into your practice with clients. There are many models of how to work with dreams in therapy, and many training courses and workshops are available. Many therapists have found that the ideas of Clara Hill provide a down-to-earth, practical means of working with dreams, which can be integrated into most approaches to therapy.
Further reading Hill, C.E. (1996) Working with Dreams in Psychotherapy. New York: Guilford Press. Hill, C.E. (ed.) (2004) Dream Work in Therapy: Facilitation, Exploration, Insight and Action. Washington, DC: American Psychological Association.
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The meaning of boundary
The idea that relationships between people can be understood in terms of boundaries has had wide application within the domain of counselling and psychotherapy. The notion of boundary implies that there is a limit beyond which a person should not go in their relationship with the other. Venturing beyond that limit is a ‘violation’ or ‘transgression’ that may express something about the motivation of the violator. There is much debate between therapists concerning the implications of the use of the idea of boundary in counselling practice. It is important to keep in mind that ‘boundary’ is a metaphor, which – like any metaphor – highlights some aspects of a phenomenon while concealing others. This learning activity invites you to examine the meaning of the term ‘boundary’ in your own life through the following questions: G
What are the boundaries that you draw in your own everyday life? What are the qualities or characteristics of these boundaries? How would anyone know that a boundary existed for you? How would they know when they had transgressed that boundary?
G
A ‘boundary’ can be defined as the edge of a territory or space – where that territory meets another territory. What other words or images do you use to refer to this kind of phenomenon? (e.g. wall, barrier, fence, interface, line, and so on). How does the use of these alternative terms change the meaning of this phenomenon?
G
When you meet another person for the first time, what do you do to establish your mutual boundaries?
G
With someone you have known for some time, how do boundaries become renegotiated or redefined?
G
What kind of boundary do you seem to need in different situations? (boundaries can be strong or weak, flexible or rigid, permeable or impermeable).
Once you have explored your personal experience of boundaries in your everyday life, look at the implications of what you have learned for how you are (or how you would wish to be) as a counsellor or psychotherapist: G
What are the different kinds of boundary that exist between you and your clients?
G
How do you (and your clients) create and maintain these boundaries?
Further reading The concept of boundary is discussed in: McLeod, J. (2009) An Introduction to Counselling, 4th edn. Maidenhead: Open University Press (pp. 411–14).
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What does ‘counselling’ mean to people in your community? In contemporary society, the theory and practice of counselling and psychotherapy are characterized by diversity and multiple perspectives. Therapy is not a single, unitary activity – there are many different approaches and types of counselling and psychotherapy. To understand what therapy is, it is necessary to appreciate the contours and implications of this diversity. This activity provides an opportunity to begin to map out the various shades of meaning of the terms ‘counselling’ and ‘psychotherapy’, both in the community or city in which you live, and in the wider culture of which that community is a part.
Tasks G
Where does ‘counselling’ (defined broadly, to include both formal and informal sources of ‘therapy’) take place in your community? Make a list of all the sources of ‘counselling’ that you can discover.
G
What do the words ‘counselling’ and ‘psychotherapy’ mean to people? Ask four or five people you know for their definitions of these terms. Talk to people in different age groups.
G
What do words like counselling, counseling, psychotherapy, coaching and selfhelp produce from an Internet search?
G
Over the course of a week, make a note of the prevalence of counselling and psychotherapy stories and coverage, and the use of ‘therapy jargon’ in the media (newspapers, magazines, films, TV).
G
Collect examples of jokes and cartoons about counselling and psychotherapy.
Once you have collected enough material on the social and cultural meanings of ‘counselling’ and ‘psychotherapy’, use it as a basis for reflecting on the following issues: G
What has your research taught you about the state of therapy today?
G
What do people know about counselling and psychotherapy? What are their fantasies?
G
What are the key themes in people’s views of counselling and psychotherapy?
G
How positive is the public perception of therapy? What are the areas of public misunderstanding of counselling and therapy that you have come across?
G
What might be the possible sources of this confusion?
G
What is your impression about what could be changed to make counselling and psychotherapy more relevant or accessible to people?
G
How do these public images of therapy have an impact on your work as a counsellor?
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Writing letters
A constant issue in counselling is the person’s relationship with ‘significant others’ in his or her life. From a narrative perspective, people can often become ‘stuck’ in their lives by repeating the same ‘old story’ over and over again to other people close to them. One useful way of helping people to review and, if necessary, change these stories is to invite them to write a letter to this other person. Typically, these letters are never sent, or maybe the final one from a series of letters is sent, with the earlier letters (angry, confused, despairing) being retained in a diary or destroyed. Clients may be invited to write a letter during a counselling session, but more usually write in their own time and bring the letter in the next time they see their therapist. Letter writing is often used by bereavement counsellors; for example, writing to someone who has died. The aim of this learning activity is to give you an opportunity to explore the experience of therapeutic letter-writing.
Instructions Think of someone in your life who is, or has been, important to you, but with whom there are currently some unresolved issues. This could be someone you have fallen out with, someone who has moved away to live in another place, or someone who has died. Give yourself at least 45 minutes to write a letter to this person. Do not censor what you write – this letter will never be sent. Keep writing down everything that you might possibly wish to say to this person – positive as well as negative. Once you have finished writing the letter, put it in a safe place. One or two days after your letter-writing episode, take some time to consider the following questions: G
How did you feel when you were writing the letter? What was the experience like for you?
G
Have your thoughts, feelings and attitude towards the letter recipient changed? In what ways?
G
Do you now wish to read the letter again? What do you want to do with it? Is there anyone you would like to ask to read the letter?
G
Has the writing of this letter been helpful or beneficial for you, or unhelpful and destructive? Or both?
G
What are the therapeutic processes that took place?
Reflecting on practice
Finally: G
What have you learned about the relevance of therapeutic letter-writing for your own approach to counselling?
G
What further training, research or supervision might you need in order to become competent in this way of working with clients?
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The therapeutic use of reading One of the techniques that has always been used by people to sort out their problems is to get insight and advice through reading. Although some counsellors and psychotherapists have always recommended books to their clients, it is only recently that this practice has received much attention in terms of theory and research. This learning activity invites you to think about the extent to which therapeutic reading (self-help books or ‘bibliotherapy’) might form part of your personal approach as a counsellor. Visit a public library and examine the section with self-help books. Most of these will be for medical conditions, but some will concentrate on psychological problems such as assertiveness, depression, and so on. Look through these books to get a sense of what they have to offer, and then choose one book to read, preferably on a topic that has some personal meaning for you. When reading the self-help book, consider these questions: G
How helpful do you think this book would be? Would you recommend it to a client?
G
Who would find it useful?
G
What makes it helpful or unhelpful?
G
What model or models of therapy is the book promoting? For example, is it essentially offering common-sense advice, psychodynamic insights, or some other approach?
G
Are there any ways in which, in your opinion, the book might be dangerous or misleading?
G
How culturally inclusive is the book?
G
What are the advantages and disadvantages of using this book when compared to face-to-face counselling?
You might also find it interesting to do an Internet search on ‘self-help’, or follow up the reviews and discussion of recently published self-help books on the Amazon bookshop website (you can even send in your thoughts on the book you have read as a contribution to Amazon).
Final questions G
What are the characteristics of good self-help books in your view? Are stories of how others had overcome similar problems most helpful, or is it better to provide structured learning routines? How important is it for self-help materials to have a spiritual dimension?
G
What are the practical implications of integrating the use of self-help reading materials into your counselling practice; for example, at what point might you
Reflecting on practice
recommend a book? How might you link the book into what happens in face-toface sessions? G
How useful might movies be as an alternative to self-help books? Which films could you imagine using? People typically become more emotionally involved in movies – is this helpful or not?
Further reading Campbell, L.F. and Smith, T.P. (2003) Integrating self-help books into psychotherapy, Journal of Clinical Psychology, 59: 177–86. Norcross, J.C. (2006) Integrating self-help into psychotherapy: 16 practical suggestions, Professional Psychology: Research and Practice, 37: 683–93.
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Using Internet resources to support therapy An increasing proportion of the public turn to the Internet for information and advice on relationship issues and mental health problems. The Internet represents a potentially invaluable resource for counselling and psychotherapy as a means of augmenting and supporting the work done within conventional face-to-face therapy. How aware are you of websites that might be of value for your clients? How often do you ask clients about their use of websites as a means of managing their problems? How do you respond when a client reports that he or she has made use of online sources? Identify a problem area that occurs on a regular basis in your client group (e.g. depression, eating disorders, social phobia/loneliness, relationship problems, low self-esteem, etc.), and spend some time searching the Internet for sites on that topic. When examining these sites, consider the following questions: G
How helpful do you think various sites would be for your clients? Which ones would you recommend to clients?
G
What are the features of the sites you have explored that makes them more or less helpful or unhelpful?
G
Are there any ways in which, in your opinion, the book might be dangerous or misleading?
G
How culturally inclusive are the sites you have visited?
G
What are the issues involved in integrating the use of Internet sites into your therapy practice?
Further reading Grohol, J.M. (2004) The Insider’s Guide to Mental Health Resources Online, revised edition. New York: Guilford Press. Zuckerman, E. (2003) Finding, evaluating, and incorporating internet self-help resources into psychotherapy practice, Journal of Clinical Psychology, 59: 217–25.
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Counselling in the media
Magazine problem pages (‘agony aunts’) and TV shows such as Oprah Winfrey probably represent the most widely used forms of ‘counselling’ in Western societies. However, are these outlets providing experiences that are genuinely therapeutic, or are they merely forms of entertainment?
Learning tasks G
Analyse what you find in the problem pages of at least two contrasting publications (e.g. one from a serious newspaper and one from a popular women’s magazine). What kind of advice do they give? What types of problem are addressed? What are the therapeutic processes that could be taking place?
G
Analyse, in a similar fashion, some TV shows in which personal problems are explored.
Once you have collected some material on media counselling, consider the following questions: G
How helpful do you think these outlets might be for those who use them? Would you recommend them, or use them yourself?
G
Who seems to make use of these forms of help? Are they the same people who make use of counselling?
G
What are the helpful and unhelpful aspects of ‘media therapy’
G
What model or models of therapy are being promoted? For example, are they essentially offering behaviourist advice, or psychodynamic insights, or some other approach?
G
What are the advantages and disadvantages when compared to face-to-face counselling?
G
Are there any ways in which they might be dangerous or misleading?
G
If asked, would you host a TV show of this kind, or edit a problem page? If not, why not?
G
How should professional counselling and psychotherapy associations respond to the growth of ‘media therapy’?
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Online counselling
One of the basic assumptions or cherished ‘truths’ held by the vast majority of counsellors and psychotherapists is that the quality of the therapeutic relationship is crucial to success in therapy. But what happens when client and counsellor never meet each other? Most therapists believe that counselling ‘at a distance’ (e.g. using telephone, letter or email) may be necessary in emergencies (e.g. crisis helplines such as the Samaritans) but can never achieve the depth and meaningfulness of conventional face-to-face therapy. However, in recent years email has increasingly been used as a medium for therapy. Reflect on your own experience with email: G
Do you ever use it for ‘therapeutic’ purposes (e.g. with friends)? How effective is this for you? For you personally, what are the advantages and disadvantages of email when compared to talking to someone face-to-face?
Spend some time searching the Internet for online counselling services: G
How helpful and trustworthy do these services appear to you?
G
How do you imagine you might feel, as a potential client, using such a service for the first time – what might your hopes and fears be?
G
What are the challenges that you might imagine as an online counsellor? What new or different skills might you require?
Finally, in terms of the online counselling that you have examined, what do you believe could be the opportunities and also the limitations of email therapy?
Further reading Goss, S. and Anthony, K. (eds) (2003) Technology in Counselling and Psychotherapy: A Practitioner’s Guide. London: Palgrave Macmillan. Lange, A., Schoutrop, M., Schrieken, B. and Ven, J.-P. (2002). Interapy: a model for therapeutic writing through the internet, in S.J. Lepore and J.M. Smyth (eds) The Writing Cure: How Expressive Writing Promotes Health and Emotional Well Being. Washington, DC: American Psychological Association.
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Indoors or outdoors? Using nature in therapy Traditionally, influenced by the example of the doctor–patient consultation, counselling and psychotherapy sessions have taken place in offices. The content of therapy sessions has generally focused on either interpersonal problems that have been troubling the client, or difficulties the person has been having in regulating their thoughts and feelings. In recent years, some practitioners have started to challenge these assumptions, in arguing that the relationship of a person with nature represents a crucial dimension of well-being, and that finding ways of bringing nature into the therapeutic process can be highly beneficial. One approach to the use of nature is to hold therapy sessions out of doors, for example, in a wilderness area. Another approach is to invite the client to consider their relationship with nature, and to examine the link between that relationship and the problems they are experiencing in their life. Burns (1998) has devised a simple technique for facilitating this process, which he has called the sensory awareness inventory. The client is given a piece of paper divided into six labelled columns: sight, sound, smell, taste, touch and activity. They are then instructed: ‘under each heading, please list 10–20 items or activities from which you get pleasure, enjoyment or comfort’. What the client has written can be used in therapy in different ways. The client can be asked simply to consider what he or she has learned about him or herself from completing the exercise. Typically, clients report that there are many sources of sensory pleasure, enjoyment and comfort that they have been neglecting in their life, and which would be valuable to restore or expand. Following further exploration, connections may often be made between personal problems and the absence of nature-based experience. How relevant is working in and with nature for your practice, and your personal approach as a counsellor? What are the advantages and disadvantages that you imagine might be associated with seeing clients out of doors? Try the sensory awareness inventory for yourself. What did you discover about yourself? Could these discoveries be of potential value in your therapy? If you find, arising from these reflections, that nature-influenced work is attractive and meaningful for you, then also consider: what are the theoretical implications of working in this way?
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Further reading Burns, G.A. (1998) Nature-guided Therapy: Brief Intervention Strategies for Health and Well-being. London: Taylor & Francis. McLeod, J. (2009) An Introduction to Counselling, 4th edn. Maidenhead: Open University Press (pp. 349–52).
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How to be really ineffective
Research studies into the outcomes of therapy have found that a substantial number of people with psychological problems get better without making use of professional help, and that there is a wide range of levels of effectiveness across therapists. Some counsellors and psychotherapists appear to get good results with almost every client they see, while other practitioners may only generate a good outcome with around 30 per cent of their clients. These issues were recognized as early as 1969 by the family therapist Jay Haley (1969, 691–5): “What has been lacking in the field of therapy is a theory of failure. Many clinicians have assumed that any psychotherapist could fail if he wished. However, recent studies of the outcome of therapy indicate that spontaneous improvement of patients is far more extensive than was previously realized. There is a consistent finding that between fifty and seventy percent of patients on waiting list control groups not only do not wish treatment after the waiting list period but have really recovered from their emotional problems . . . Assuming that these findings hold up in further studies, a therapist who is incompetent and does no more than sit in silence and scratch himself will have at least a fifty percent success rate with his patients. How then can a therapist be a failure?”
In an attempt to develop a comprehensive theory of therapeutic failure, Haley (1969, 691–5) identified 12 key factors. There is not space to summarize all the Haley model here. However, the first factor conveys the gist of his analysis: “The central pathway to failure is based upon a nucleus of ideas which, if used in combination, make success as a failure almost inevitable: Step A: Insist that the problem which brings the patient into therapy is not important. Dismiss it as merely a ‘symptom’ and shift the conversation elsewhere . . . Step B: Refuse to treat the presenting problem directly. Offer some rationale, such as the idea that symptoms have ‘roots’, to avoid treating the problem . . . Step C: Insist that if a presenting problem is relieved, something worse will develop. This myth makes it proper not to know what to do about symptoms and will even encourage patients to cooperate by developing a fear of recovery.”
How far do you agree with Haley’s analysis of the process of therapeutic failure? Do you agree with him that an understanding of failure is an essential element of any approach
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to counselling? What is your own theory of failure in terms of your own work as a counsellor? How do you explain failure?
Further reading Haley, J. (1969) The art of being a failure as a psychotherapist, American Journal of Orthopsychiatry, 39: 691–5.
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Working with clients who are difficult or challenging For any counsellor or psychotherapist, the majority of clients that he or she works with are people who are likeable, constructive and open to learning. However, there are some clients who are hard to reach, and other clients who may be experienced as threatening or intrusive. One of the key hurdles for any practitioner is to develop strategies for responding effectively and professionally to the needs of clients who may be difficult or challenging. Use the questions below to explore your perceptions of one difficult or challenging client or situation that you might come across as a counsellor or psychotherapist. This can be a client who you have already met, or someone that you fear that you may come across in the future. 1
What would the situation be (e.g. agency setting, first session or later session, etc.)?
2
What are the characteristics of the client; for example, age, gender, social class, ethnicity, physical appearance, and so on?
3
What is this client’s presenting problem?
4
What lies behind the problem?
5
What does the client do that is most hard for you to handle? (e.g. gets angry, acts seductively, challenges and questions you, hears voices, talks about being an abuser, demands that you give advice, etc.).
Take some time to write about this client, the emotions and reactions that he or she triggers in you, and your strategies for responding to him or her. Once you have described this scenario, take some further time to write about what you have learned about: G
how you either undermine or support yourself in tough situations, through your self-talk/internal dialogue;
G
how you deal with emotions that are strong and not under control;
G
your strategies for dealing with therapy crises: what skills or concepts/theories do you ‘fall back on’ when under most pressure;
G
your willingness to be honest with colleagues or your supervisor about how scary a client has been for you;
G
your resilience and resourcefulness as a therapist;
G
your career choices – what clients or counselling settings are best/worst for you to work with?
G
your future training needs in relation to how to handle difficult situations.
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Further reading You may find it helpful to place your own experience of difficult client situations in a broader context by reading about the experiences of other therapists in relation to this issue: Kottler, J. and Carlson, J. (2003) Bad Therapy: Master Therapists Share Their Worst Failures. London: Brunner-Routledge. Kottler, J. and Carlson, J. (2005) The Client who Changed Me: Stories of Therapist Personal Transformation. London: Routledge. Schroder, T. and Davis, J. (2004) Therapists’ experiences of difficulty in practice. Psychotherapy Research, 14: 328–45. Theriault, A. and Gazzola, N. (2006) What are the sources of feelings of incompetence in experienced therapists? Counselling Psychology Quarterly, 19: 313–30.
Developing a professional identity: putting it all together
Section contents Introduction
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Reviewing your skills and qualities as therapist
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Images of therapy
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What are you aiming to achieve as a therapist?: selecting criteria for evaluating your effectiveness
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What’s in your toolbox?
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Marketing yourself as a counsellor: your one-minute intro
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Are you a counsellor or psychotherapist?
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Your therapy room
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Building an effective support network
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Your position in relation to research and inquiry
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What does it mean to be ‘personal’?: some questions from Carl Rogers
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Ten years from now
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Critical issues for counselling and psychotherapy
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Introduction
The aim of this section of the Workbook is to provide some opportunities for reflecting on the questions and activities in earlier sections in order to arrive at an understanding and appreciation of your sense of identity as a counsellor or psychotherapist. There are perhaps two main dimensions to this process: summing up, and looking ahead. The exercises in the Workbook have involved exploring many different aspects of what is involved in being a therapist. Learning about therapy is an open-ended commitment: there is always more to be known, new edges of awareness, surprises. But it is also likely that you may have used the Workbook at a stage in your career when learning and development have been a primary focus, and are set to move into another stage in which application and practice are more central. It can be useful, at this point of transition, to take stock of what you have learned in the sense of being clear about your achievements and resources. Moreover, by documenting these achievements and resources (e.g. by writing and keeping your reflections on the tasks in this section) you are creating a statement about ‘where you are now’ to which you may wish to return at some point in the future. Summing up and taking stock can also contribute to a sense of closure at the end of training. Many training programmes and courses require students to assemble a self-evaluation statement at the end of the course, which is then reviewed by tutors and fellow course members. The exercises in this section of the Workbook are no substitute for such an assignment, but may still be useful in stimulating self-reflection around relevant themes. This final section also looks ahead at the future possibilities and next steps in your journey as a therapist, in relation to the type of work you might do, and the further training and personal development that might be helpful. Becoming a counsellor or psychotherapist is about more than learning theory and skills, and acquiring practical experience. It is about evolving a professional identity, a sense of who you are in your work. Hopefully, by the time you have completed this Workbook, the outline of that professional identity, and its basis in who you are as a person, should be at least beginning to be more consistently visible.
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Reviewing your skills and qualities as a therapist The aim of this exercise is to give you an opportunity to draw some conclusions from the exercises you have completed in the Workbook. Reflect on the various learning tasks with which you have engaged in the Workbook, and also on other sources of learning concerning yourself as a counsellor or psychotherapist (for instance, courses you have attended, work with clients). Taking all this as a whole, how can you sum up your qualities as a therapist? Spend some time writing in response to these instructions: 1
Make a list of your gifts, glittering qualities and strengths as a therapist.
2
Make a list of areas that might sometimes be personal limitations, gaps or ‘blind spots’ in your capacity to offer a therapeutic relationship.
3
Tell the story of at least one of the ‘gifts’ in a bit more detail: (i) what it was in your life that allowed you to develop this gift, and (ii) the effect this quality has on people you are helping.
4
Explore one of your limitations in a similar fashion: (i) what it was in your life that contributed to this limitation in your capacity to help, and (ii) the effect this limitation might have on the people you are helping.
What are the implications for you as a therapist of what you have written in response to these questions? What do your responses say about who you are, and what you stand for as a therapist? Chapter 20 of An Introduction to Counselling offers a model for understanding counsellor development in terms of seven dimensions of competence. How do the gifts and limitations you have identified fit into this model? Does the model suggest other gifts and limitations that you had not considered? Looking ahead: when you reflect on what you have learned from this exercise, what are the implications for: G
the type of work you do as a therapist (e.g. long- or short-term therapy with clients, specific client groups, etc.);
G
your future learning needs; for instance, through training, supervision or personal study;
G
your role within the profession (as a supervisor, trainer, professional activist, writer, researcher).
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Images of therapy
One of the key skills possessed by effective therapists is sensitivity to language, to the ways in which people construct their emotional and interpersonal worlds through the words, images and metaphors that they use. An awareness of your own language use can also provide you with a creative means of exploring your own personal assumptions about therapy. In this activity, you are invited to find images and metaphors that capture the overall sense of what counselling and psychotherapy means to you. This task involves taking a few moments to reflect on the images and metaphors that come to mind when you think about different aspects of the therapy process. Write whatever comes into your mind when you read the following questions: G
What kind of animal is a counsellor or psychotherapist? A client?
G
What kind of a sport is counselling or psychotherapy?
G
What kind of imagery comes to mind when you think about the process of counselling or psychotherapy: – The interaction between a therapist and client is similar to. . . .? – A good counsellor or psychotherapist is like a. . . .? – Completing a series of counselling sessions is like. . . .?
Many different types of image and metaphor may arise for you – write them all down. If possible, categorize these images and metaphors into themes. Look at each of the metaphors you have generated. What aspects of therapy are highlighted by each metaphor, and which aspects are downplayed? Once you have thought of the images and metaphors that strike a chord for you, you might wish to think about how they compare with the metaphors that underpin mainstream theories such as person-centred, psychodynamic and cognitive– behavioural. What have you learned from this task about your own deeply held attitudes and assumptions? What have you learned about your position in relation to mainstream theories? The psychotherapy researcher, Lisa Navajits, asked a number of counsellors and therapists to write down their images for the therapy process. What she found is described in McLeod (2009: 428). Do her results include metaphors that surprise you, or which you disagree with? If so, what might this mean in relation to your personal approach as a counsellor or psychotherapist?
Further reading A fascinating book on the role of metaphor in human thought, which explains the highlighting/ downplaying notion, is: Lakoff, G. and Johnson, M. (1980) Metaphors We Live By. Chicago, IL: University of Chicago Press.
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What are you aiming to achieve as a therapist?: selecting criteria for evaluating your effectiveness One way of summing up your approach to counselling or psychotherapy is to be clear about what it is you believe that therapy is trying to achieve. What are the desired outcomes of therapy? There are many competing ideas about the appropriate criteria for assessing the effectiveness of counselling and psychotherapy. Many research studies, and counselling organizations, use questionnaires that measure client change in terms of psychiatric categories such as depression and anxiety. Some practitioners view outcomes in terms of factors that are consistent with their theoretical approach. For example, person-centred counsellors look for change in self-esteem and selfacceptance, while cognitive–behavioural therapists seek change in observable behaviour and dysfunctional beliefs. The CORE system is increasingly being used as an evaluation tool that provides an integrative focus, not rooted in any particular therapeutic model or ideology. The CORE questionnaire assesses client outcomes on four dimensions: subjective well-being, psychological symptoms, social and interpersonal functioning, and risk to self and others. The CORE system is discussed in McLeod (2009: 591–2). The Just Therapy centre in New Zealand, led by Charles Waldegrave, Kiwi Tamasese, Flora Tuhaka and Warihi Campbell, has developed an approach to therapy that draws on the traditions of the three main communities in their country: Maori, Samoan and Pakeha (European). They identify their criteria for effective work in the following way: “. . . we have chosen three primary concepts that characterise our Just Therapy approach. When assessing the quality of our work, we measure it against the interrelationship of these three concepts. The first is belonging, which refers to the essence of identity, to who we are, our cultured and gendered histories, and our ancestry. The second is sacredness, which refers to the deepest respect for humanity, its qualities, and the environment. The third is liberation, which refers to freedom, wholeness and justice. We are interested in the inter-dependence of these concepts, not one without another. Not all stories of belonging are liberating, for example, and some experiences of liberation are not sacred. We are interested in the harmony between all three concepts as an expression of Just Therapy.” (Waldegrave, 2003: 75)
Take a few moments to reflect on the outcome/effectiveness criteria that you use in your work as a counsellor or psychotherapist. It may be helpful to think about clients who you might consider to be ‘good outcome’ cases, and some who you felt had ‘poor outcomes’. What are the factors that made these cases seem ‘good’ or ‘not so good’?
Developing a professional identity
Make a list of the outcome criteria that are important for you. What does this list say about who you are as a counsellor or psychotherapist, and what you stand for?
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What’s in your toolbox?
Counsellors can be divided into those who have toolboxes and those who do not. A toolbox is a personal store of ideas, exercises, stories and strategies that the counsellor can draw on to facilitate the therapeutic process, or to move things on when the therapy seems to have reached an impasse. An example of a counsellor’s toolbox can be found in a brilliant book by Susan Carrell, who describes more than 40 tools that she has acquired in over 20 years of practice. Some of these tools are tangible and take up space; for example, a sand tray for adults. Others require only paper and pens; for instance, a ‘Life-Line’ (timeline) exercise. Still others are virtual tools, stored in the counsellor’s head. For instance: “when your female client is agonizing over what to do about a difficult situation – her boyfriend is treating her poorly, a co-worker humiliated her, she suspects her husband is cheating her . . . and she looks at you pleadingly seeking advice, ask her this question: What would you say to a girlfriend who came to you with this story?. . . . This question elicits responses that come from a deep place in a woman’s psyche. It appeals to the sanctity of friendship between women and the long history of devotion that women friends have enjoyed . . . Women know that boyfriends come and go, husbands come and go, children come and go, but girlfriends are forever. She will give her girlfriend (and thus, herself) the best advice ever.” (Carrell, 2001: 184)
Some therapists might argue that such tools are inevitably superficial, and are no substitute, in the end, for the rigorous application of basic therapeutic principles derived from a solid theory. But is this necessarily true? Maybe therapists who are grounded in a specific theory (unlike Susan Carrell, who could perhaps be described as a pragmatic eclectic) merely carry a kit of tools that are selected on the basis of theoretical consistency (as well as effectiveness). Irvin Yalom is a leading figure in existential psychotherapy – perhaps one of the least ‘toolbox-oriented’ therapies that could be imagined. Yet he has published what he has described as a ‘nuts-and-bolts collection of favourite interventions’ (Yalom, 2002: xiv). These include guidelines for challenging clients (‘strike while the iron is cold’), strategies for checking into the here-and-now each hour, suggestions for making home visits and interviewing the client’s significant other, and much else.
Instructions Take a few minutes to list the items in your own therapeutic toolbox. Are there tools that you have once used, and have now discarded, or rarely employ? Are there tools that you
Developing a professional identity
would wish to include in your kitbox, or that you have acquired and are uncertain about using? What do these tools signify about your identity as a counsellor?
Further reading Glimpses into the toolkits of some well-known therapists can be found in: Carrell, S. (2001) The Therapist’s Toolbox: 26 Tools and an Assortment of Implements for the Busy Therapist. Thousand Oaks, CA: Sage. Mahoney, M.J. (2003) Constructive Psychotherapy: A Practical Guide. New York: Guilford Press. Seiser, L. and Wastell, C. (2002) Interventions and Techniques. Buckingham: Open University Press. Yalom, I. (2002) The Gift of Therapy: Reflections on Being a Therapist. London: Piatkus.
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Marketing yourself as a counsellor: your one-minute intro Developing a coherent and integrated sense of who you are as a counsellor is not merely a personal development task. There are many situations where you may be called upon to explain or describe your approach to different audiences. This exercise invites you to write your response to the following scenarios: 1
The one-minute intro: you are in a group situation where you have been given one minute to introduce yourself and your counselling approach. Perhaps you have been invited to discuss your work with some trainees on a counselling course, or you are being interviewed for a job as a counsellor, or you are joining a peer support group. What do you say about yourself?
2
A leaflet: you have been appointed as a counsellor in a health clinic, student counselling service or some other setting. In order to help potential clients to access your service, you need to design a leaflet that describes your counselling approach and explains what is involved in being a client. What do you write?
3
A website: as a means of promoting your private practice work, you decide to develop your own website. How do you describe yourself within this medium?
4
An activity: imagine that you have been asked to facilitate a two-hour workshop with a group of students of nursing or social work, with the aim of helping them to learn about what your approach to counselling is about, at an experiential level. Is there one exercise or activity that might allow these students to go beyond a purely intellectual understanding of your approach?
After you have completed these tasks, you may find it interesting to carry out a survey of leaflets and websites composed by other practitioners. Reflect on the different ways in which other colleagues have approached the task of depicting their approach. What does the approach you have adopted say about who you are as a counsellor?
Further reading Two writers who have explored their own struggle to characterize their approach for external audiences are: Morgan, A. (1999) Practice notes: introducing narrative ways of working, in D. Denborough and C. White (eds) Extending Narrative Therapy: A Collection of Narrative-based Papers. Adelaide: Dulwich Centre Publications. Sween, E. (1999) The one-minute question: what is narrative therapy?, in D. Denborough and C. White (eds) Extending Narrative Therapy: A Collection of Narrative-based Papers. Adelaide: Dulwich Centre Publications.
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Are you a counsellor or psychotherapist? How do you identify yourself in professional terms? In the table below, counselling and psychotherapy are depicted as activities that are equally valuable, with many areas of overlap, but also representing distinctive traditions of helping.
Psychotherapy
Counselling
Similarities Provides the person with a confidential space in which to explore personal difficulties
Provides the person with a confidential space in which to explore personal difficulties
Effective practice depends to a great extent on the quality of the client–psychotherapist relationship
Effective practice depends to a great extent on the quality of the client–counsellor relationship
Self-awareness and personal psychotherapy are valued elements of training and ongoing development
Self-awareness and personal therapy are valued elements of training and ongoing development
Differences A wholly professionalized occupation
An activity that includes specialist professional workers, but also encompasses paraprofessionals, volunteers, and those whose practice is embedded within other occupational roles
Public perception: inaccessible, expensive, middle class
Public perception: accessible, free, working class
Perception by government/State: given prominent role in mental health services; strongly supported by evidence-based practice policies
Perception by government/State: largely invisible
Conceptualizes the client as an individual with problems in psychological functioning
Conceptualizes the client as a person in a social context
Training and practice focuses on delivering interventions
Training and practice involves not only delivering interventions, but also working with embedded colleagues, and promoting self-help
Psychotherapy agencies are separate from the communities within which they are located
Counselling agencies are part of their communities (e.g. a student counselling service in a university)
Treatment may involve the application of interventions defined by a protocol, manual or specific therapy model
The helping process typically involves counsellor and client working collaboratively, using methods that may stretch beyond any single protocol or manual
Treatment has a theory-derived brand name (e.g. interpersonal therapy, cognitive–behavioural therapy, solution-focused therapy)
Often has a context-derived title (e.g. workplace counselling, bereavement counselling, student counselling) (Continued overleaf )
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Psychotherapy
Counselling
Many psychotherapists have a psychology degree, which functions as a key entrance qualification
Counsellors are likely to be drawn from a wide variety of backgrounds; entrance qualification is life experience and maturity rather than any particular academic specialism
Predominant focus on the pathology of the person
Predominant focus on personal strengths and resources
Where do you position yourself in relation to these therapeutic traditions? What are the implications for your future career development and training? What are the implications for what you say to your clients about how you will work together, the kind of therapy goals that you negotiate and the contract that you make?
Further reading McLeod, J. (2009) An Introduction to Counselling, 4th edn. Maidenhead: Open University Press (Preface and Chapters 1 and 2).
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Your therapy room
The physical environment in which therapy takes place is an important, but seldom acknowledged, element of the counselling process. The furnishing and layout of a counselling room both raises expectations and sets limits regarding the ways in which a client can express him or herself, how safe he or she feels, the extent to which movement is possible, and much else. The location of the room – the building, how accessible it is, what the waiting area is like – also sets the scene for the type of therapeutic work that can occur. Imagine your own ideal therapy room. In designing your therapeutic space, consider the following questions: G
What kind of building is the room in? Where is the building? What are the surroundings?
G
How is the waiting area furnished and laid out? What does the client do while waiting?
G
How is the therapy room furnished and laid out? What objects and images are in the room?
G
What use is made of texture, colour, design, fragrance, sound, etc.?
You may find it useful to make a sketch of this space. Once you have constructed your image of an ideal therapy environment, reflect on these further questions: G
What are the main differences between your ideal therapy room and counselling spaces that you have visited or worked in? What does this comparison tell you about possible goals for the future?
G
What have you learned about yourself and your personal approach as a counsellor from this exercise? To what extent could your ideal therapy room be understood as a projection of your core values as a counsellor?
G
In what ways does your design reflect the concepts and assumptions of your preferred theoretical approach(es)?
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Building an effective support network A critical aspect of developing a sense of professional identity as a counsellor or psychotherapist involves finding ways of dealing with the stress and pressure that can result from this kind of work. The construction of survival strategies depends to a large extent on the existence of a support network, comprising colleagues, therapists, supervisors and other people who can contribute to the maintenance of work–life balance. The purpose of this learning task is to invite reflection on the elements of your own personal, actual or intended support network, and to consider the ways in which this network reflects or expresses your identity as a therapist.
Reflecting on your position in relation to supervision G
Write a character sketch of your ideal supervisor.
G
Write a character sketch of what would be for you the ‘supervisor from hell’.
G
What do you need from supervision? What are you looking for?
G
What would it take (has it taken) to make you change your supervisor?
Reflecting on your position in relation to personal therapy G
Write a character sketch of your ideal therapist.
G
Write a character sketch of what would be for you the ‘therapist from hell’.
G
What do you need from your own therapy? What are you looking for?
G
What would it take (has it taken) to make you enter therapy?
Stress and coping G
What do you find most stressful in your work?
G
What activities do you find most satisfying and nurturing in your work?
G
What strategies do you employ to cope with stressful aspects of your work?
G
What would it take to make you review these strategies?
Make some notes in response to the questions listed above. Once you have done some writing, consider the following additional issues: G
How well are you supporting yourself?
G
What impact does the kind of support network you have constructed have on your work with clients?
Developing a professional identity
G
What impact does the kind of support network you have constructed have on your life outside your work?
G
What does your support network say about who you are, and what you stand for, as a counsellor?
Further reading Dryden, W. (ed.) (1994) The Stress of Counselling in Action. London: Sage. Horton, I. (ed.) (1997) The Needs of Counsellors and Psychotherapists: Emotional, Social, Physical, Professional. London: Sage. Skovholt, T.M. (2001) The Resilient Practitioner: Burnout Prevention and Self-care Strategies. Boston, MA: Allyn & Bacon. Weaks, D. (2002) Unlocking the secrets of ‘good supervision’, Counselling and Psychotherapy Research, 2: 33–9.
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Your position in relation to research and inquiry The primary focus of this Workbook has been to integrate the theory and practice of counselling within the narrative of your own personal life experience, with the goal of creating a ‘knowledge base’ that is firmly grounded in your everyday reality. However, it is important to acknowledge that there exists another knowledge base, which lies outside of personal experience – the knowledge that can be derived from systematic research. In recent years, counselling and psychotherapy research has evolved in the direction of what is known as ‘methodological pluralism’. In the past, research tended to mean statistics and experiments. Now, research and inquiry draw on personal experience, interviews, action, stories, and much else. Current research therefore represents a potentially rich source of knowledge for practitioners. What is your relationship with the knowledge base represented by systematic research and inquiry? Take some time to write your responses to the following questions: G
In principle, how important do you think research is in relation to counselling and psychotherapy? What are the reasons for being interested in research at all?
G
What are your criticisms of therapy research? What should or could researchers do in order to make research more relevant or useful?
G
In what ways do you use research to inform your practice? List some research reports that you have recently read. How have these influenced how you think about your work as a counsellor?
G
How do you access research? How often do you read about research findings?
G
If you were in a position to have some free time to do research, which questions or topics would interest you?
Once you have responded to these questions, reflect on what you have discovered about who you are as a counsellor, and also about future directions that your career or interests might take.
Further reading The main themes and methods in contemporary research in counselling are examined in: McLeod, J. (2009) An Introduction to Counselling, 4th edn. Maidenhead: Open University Press (Chapter 18). Overviews of the methods and findings of current counselling and psychotherapy research are available in: Cooper, M. (2008) Essential Research Findings in Counselling and Psychotherapy: The Facts are Friendly. London: Sage. Timulak, L. (2008) Research in Counselling and Psychotherapy. London: Sage.
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What does it mean to be ‘personal’?: some questions from Carl Rogers In On Becoming a Person, Carl Rogers (1961) consistently returns to the theme that it is the person of the counsellor, and his or her capacity to enter into a non-judgemental relationship with the client, which makes a difference. Many passages in this book read like a conversation, with Rogers engaging in dialogue with aspects of his own experiencing, and attempting to open dialogue with his readers. In Chapter 3, Rogers asks a series of questions that remain meaningful to anyone seeking to develop a personal approach to counselling: Can I be in some way which will be perceived by the other person as trustworthy, as dependable or consistent in some deep sense? Can I be expressive enough as a person that what I am will be communicated unambiguously? Can I let myself experience positive attitudes towards this other person – attitudes of warmth, caring, liking, interest, respect? Can I be strong enough as a person to be separate from the other? Am I secure enough within myself to permit his or her separateness? Can I permit him or her to be what he or she is? Can I let myself enter fully into the world of his or her feelings and personal meanings and see these as he or she does? Can I accept each facet of this other person when he or she presents it to me? Can I act with sufficient sensitivity in the relationship that my behaviour will not be perceived as a threat? Can I free the other from the threat of external evaluation? Can I meet this other individual as a person who is in the process of becoming, or will I be bound by his past and by my past?
In the light of what you have written in response to other activities in this Workbook, and referring also to other relevant learning experiences, reflect on the following questions: G
Do Carl Rogers’ questions capture for you an adequate sense of what it might mean to use a personal approach in your work as a counsellor? If not, which questions would you add, delete or reword?
G
Where are the areas of personal challenge for you in relation to these aspects of a ‘personal’ approach?
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Ten years from now
Imagine that the date is 10 years in the future. You have achieved all the main goals that you set yourself at the end of your period of training as a counsellor or psychotherapist. You are in a peer support group, which has decided to devote a couple of sessions to giving each member time and space to review their career. You are being interviewed by these close colleagues, and invited to explore the following questions: G
How do you sum up your work now – who you are in terms of your professional identity, where and how you work, and the approach you take?
G
In what ways is this current situation different from your working life 10 years ago?
G
What have been the main challenges and choice points for you during the last 10 years?
G
What have been your main sources of support and assistance that have enabled you to achieve your aims?
G
What are the most important things you have learned over this period of time?
G
How have you changed, and how have you remained the same as a person?
G
What would you like to say to the ‘you’ of 10 years ago?
Once you have responded to these questions, take some time to reflect on the implications of this piece of ‘time travelling’ for your professional identity now.
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Critical issues for counselling and psychotherapy The closing chapter of McLeod (2009) discusses a number of critical issues that the counselling and psychotherapy professions will be required to address and resolve within the next two decades. These critical issues include: 1 developing ways of helping people to explore and adjust to the impact of global warming and the destruction of the natural environment; 2 being able to incorporate into practice, innovations and advances in technology (e.g. Internet, biotechnology); 3 developing forms of therapeutic practice that take account of the place of spirituality in human experience; 4 resolving the debate or standoff between the movement towards an integrated approach to theory and practice, versus the existence of separate ‘schools’ of therapy; 5 developing an identity for counselling as an activity distinct from psychotherapy; 6 constructing an appropriate knowledge base for practice and service delivery in counselling; 7 adopting the concept of learning as a ‘root metaphor’ for theory and practice (rather than the medical model metaphor of ‘intervention’); 8 moving from a pathology-oriented to a strengths-focused approach to clients; 9 maximizing client/user involvement in the design and delivery of services; 10 taking seriously the implications of the capacity for therapy to do harm. Do you agree that these are the central issues of policy and practice that will be facing the counselling and psychotherapy professions during the next phase of your career? If not, what other critical issues do you believe will be more salient? Identify two or three critical issues that seem most important to you. What position do you adopt in relation to the direction that the profession should take in respect of these issues? What might the barriers be to achieving change around these issues? What are the forces that are pressing for change? What are the implications of these particular issues for the shape and direction of your career? How do you see your own role in relation to contributing to the efforts of the profession collectively to work through these particular issues? How do you feel in yourself about your capacity to make a difference? What can you do in the immediate future to take forward your active involvement in this area?
Internet resources and further reading One of the recurring themes that weaves through this Workbook is the idea that becoming a counsellor is like being on a journey. This is a lengthy journey – to develop a sense of competence, and a secure professional identity as a counsellor can take between three and five years. The most important type of assistance that anyone can have on a journey is other people, such as guides and mentors, fellow travellers. But there are other resources that can be helpful too. In this section, some suggestions for potentially useful ‘tools for a counsellor’s journey’ are assembled.
Internet resources There is an ever-increasing range of websites that carry information about theory, research and practice in counselling and psychotherapy. An up-to-date set of links can be found through the website for this book: www.openup.co.uk/mcleod.
Therapy thrillers It is worth while asking experienced counsellors and psychotherapists about special books that have inspired them. Sometimes they will mention serious theoretical books. Very occasionally they may refer to books that are research-based. But most often, they will point you in the direction of ‘therapy thrillers’ – gripping stories that are drawn from personal experience. Some of the most popular books in this category are: Axline, V. (1971) Dibs: In Search of Self. Harmondsworth: Penguin. A case study of play therapy with a young boy captures the spirit of the client-centred approach. Galloway, J. (1999) The Trick is to Keep Breathing. New York: Vintage. A book that explores the experience of a mental breakdown. Jamison, K. (1996) An Unquiet Mind. New York: Vintage Books. A famous psychologist writes about her personal battle with manic-depressive disorder. Peck, M.S. (1978) The Road Less Traveled: A New Psychology of Love, Traditional Values and Spiritual Growth. New York: Simon & Schuster. A book that many therapists have found highly meaningful as a source of inspiration regarding the possibility of growth and change. Yalom, I. (1989) Love’s Executioner and Other Tales of Psychotherapy London: Penguin. Stories about therapy cases (Yalom has also written novels on therapy themes – google his website for more information).
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Internet resources and further reading
The experiences of people undergoing therapy training There are always stages in a long journey that are demanding, exhausting or hazardous. At these times it can be useful to know that other people have travelled the same road, and survived. There are several excellent books that have brought together trainees’ accounts of aspects of the experience of becoming a counsellor: Alred, G., Davies, G., Hunt, K. and Davies, V.H. (eds) (2004) Experiences of Counsellor Training: Challenge, Surprise and Change. London: Palgrave Macmillan. Buchanan, L. and Hughes, R. (2001) Experiences of Person-centred Training: A Compendium of Case Studies to Assist Prospective Applicants. Ross-on-Wye: PCCS Books. Dryden, W. and Spurling, L. (eds) (1989) On Becoming a Psychotherapist. London: Tavistock/ Routledge. Dryden, W. and Thorne, B. (eds) (1991) Training and Supervision for Counselling in Action. London: Sage. Johns, H. (ed.) (1998) Balancing Acts: Studies in Counselling Training. London: Routledge. Noonan, E. and Spurling, L. (eds) (1992) The Making of a Counsellor. London: Routledge. Skovholt, T.M. and Ronnestad, M.H. (1995) The Evolving Professional Self: Themes in Counselor and Therapist Development. New York: Wiley. White, C. and Hales, J. (eds) (1997) The Personal is the Professional: Therapists Reflect on their Families, Lives and Work. Adelaide: Dulwich Centre Publications.
Applied wisdom: learning from those who have been there A particularly interesting area of research, pioneered by Thomas Skovholt, Len Jennings and Helge Ronnestad, has examined the experiences and characteristics of therapists who have been successful within the profession in the sense of being recognized by their colleagues as ‘the best of the best’, or who have worked as therapists for a long time, and are able to look back on a rich and varied career. These studies have been written up in an accessible and stimulating manner, and have a lot to offer to anyone seeking to know more about the realities of a career as a therapist. Ronnestad, M.H. and Skovholt, T.M. (2001) Learning arena for professional development: retrospective accounts of senior psychotherapists, Professional Psychology: Research and Practice, 32: 181–7. This article is an analysis of interviews with some very experienced therapists. Skovholt, T.M. (2001) The Resilient Practitioner: Burnout Prevention and Self-care Strategies. Boston: Allyn & Bacon. This book considers the implications of research in terms of strategies for surviving the stress of being a counsellor. Skovholt, T.M. and Jennings, L. (eds) (2004) Master Therapists: Exploring Expertise in Therapy and Counseling. Boston, MA: Allyn & Bacon. Examines the attitudes and competences of therapists considered to be the leaders of the profession. A similar set of resources that brings together some of the wisdom of experienced therapists is the series of books by Jeffrey Kottler, for example: Kottler, J. and Carlson, J. (2003) Bad Therapy: Master Therapists Share their Worst. Hove: BrunnerRoutledge.
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Kottler, J. and Carlson, J. (2005) The Client who Changed Me: Stories of Therapist Personal Transformation. London: Routledge. Another distillation of a lifetime of therapeutic experience can be found in: Yalom, I. (2002) The Gift of Therapy: Reflections on Being a Therapist. London: Piatkus.
Personal development guidebooks There are other books that, like this Workbook, provide reading material and learning activities that are designed to encourage the development of a personally grounded approach to counselling. Particularly recommended are: Corey, M.S. and Corey, G. (2003) Becoming a Helper, 4th edn. Pacific Grove, CA: Brooks/Cole. Cross, M.C. and Papadopoulos, L. (2001) Becoming a Therapist: A Manual for Personal and Professional Development. Hove: Brunner-Routledge.
Appendix A: A narrative approach to personal and professional development in counselling/psychotherapy training Almost all counselling and psychotherapy training programmes in the UK incorporate some element of experiential work in small groups. A variety of labels are used to describe these activities: personal development, personal and professional development, group therapy, self-awareness, home groups, and so on. Depending on the overall aims, structure and theoretical orientation of the programme, such groups may serve a range of functions including: G
developing personal self-awareness and addressing personal issues;
G
developing awareness of self in the professional role of being a therapist;
G
providing a context for mutual support for students engaged in a demanding programme of study;
G
fostering a sense of community;
G
enabling participants to learn about the dynamics and functioning of small groups.
In general, this kind of group is not used as an arena for didactic inputs or for discussions of course management matters such as the quality of teaching or library provision – the learning process is primarily experiential and participative. Although the performance of a student or trainee in the experiential group and the learning that takes place are acknowledged as central to the training process, it is usual that the experience is not directly assessed. In recognition of the fact that that it is important for participants to experiment within the group, and be honest, assessment will normally take the form of a reflective report written by the student or trainee, rather than being based on direct assessment of behaviour within the group itself. There appear to be many different ways of organizing experiential groupwork on counselling and psychotherapy training courses. For example, the time devoted to this kind of activity can vary. In some programmes, groups are facilitated by core tutors/trainers. In others, independent external facilitators are used. In some settings, the group operates on a peer facilitation basis. Groups also vary in the degree to which they make use of exercises and activities, or are unstructured. Finally, there are differences in the extent to which participants are provided with formal opportunities to make theoretical sense of the group experience. There seems to be little recent research on the effectiveness of experiential learning groups on counselling and psychotherapy courses in terms of their contribution to the development of therapist competences. Discussion of the issues involved in such groupwork can be found in Johns (1998, 2002), Lago and Macmillan (2000), Mearns 209
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(1997) and Rose (2008). One of the themes that emerges from this literature is that participants are often unclear about what they are meant to be doing in the group, and how the group experience is linked to the broader goal of becoming a counsellor or psychotherapist. While students and trainees are usually clear about the value of personal therapy, as a means of developing self-awareness and learning about therapeutic process, in many instances they are less convinced about the value of the experiential group, which they view as uncomfortably straddling a boundary between therapy and training. As a result, there is a sense on the part of many students and trainees that their experiential group represented a frustrating experience, which did not deliver what they expected or needed, in the context of the amount of training time that was devoted to it. A narrative approach to personal and professional development groups in counselling and psychotherapy training has the potential to address many of these issues. A narrative approach is constructed around the central idea that effective therapists need to possess a detailed understanding of their own personal history, and the way in which their life story both impacts on clients, and is affected by the client’s story. No matter what therapeutic theory or model is being used, it is necessary for a practitioner to possess a personal understanding of what it means and how it operates; techniques and concepts are conveyed to the client through the person or the practitioner. From this perspective, the key personal and professional development questions that need to be explored during training are: G
who am I as a therapist?
G
what do I bring from my personal experience of life to the role of therapist?
G
what meaning do therapeutic concepts have for me personally in relation to their capacity to enable me to live a good life?
In order to make pragmatic use of the answers to these questions, in terms of being able to work effectively with clients, it is necessary that the personal understanding that emerges is sufficiently comprehensive, in taking account of all relevant aspects of life experience, and sufficiently coherent, in offering a life story that makes overall sense rather than being confusing and contradictory. A narrative approach to experiential learning groups is based around autobiographical exploration (thickening my story of who I am). The process incorporates reflection on practice that allows meaningful links to be made between current experience and the broader life story. This kind of learning can take place in many different settings; for example, keeping a personal journal, seeing a therapist, consultations with tutors, conversations with friends and family members. The distinctive function of the small group, in relation to this activity, is that it represents a setting in which the person hears other course members tell their stories, which is helpful in enabling connections to be made between personal experience and broader patterns of shared cultural experience. The small group is also a place in which the person can be called to account; for example, if he or she describes him or herself in ways that contradict the ways in which he or she is experienced by other members of the group. In practice, a learning or experiential group operating along narrative lines functions by taking one of the learning tasks in this Workbook each week, and using that as the focus for the session. Members of the group are expected to write about the activity in
Appendix A
their personal learning journal, and then to take turns in the group to report back what they have written, to talk spontaneously on the topic, or to reflect on the experience of exploring the topic. Depending on how much time the group wishes to allocate to each topic, and how many members there are, each report may be followed by a round of responses and reflections, using the format described in the ‘Making connections and being responsive to others’ exercise (Section 2). Alternatively, each member may simply make their report in turn, with responses and reflections being made once the whole ‘round’ has been completed. Following the group session, the student or trainee privately reflects further on the topic in his or her personal learning journal. Over time, each member accumulates a rich and detailed autobiographical account in their personal learning journal. Key aspects of this autobiography are shared with other members of the group, thus providing a potentially profound experience of being known. In addition, this structure offers plentiful experience in the process of responding to life stories, making connection, and being responded to. The responses of other group members function as a kind of ‘reflecting team’ (Andersen, 1987; White, 1995) whose offerings may help the initial speaker to develop a reflective stance in relation to his or her own story. The structure of a narrative-informed learning group or personal and professional development group will depend on the circumstances in which it meets in terms of time available, number of members and facilitator role. It may be useful to plan for the work of the group as passing through three stages: Stage 1: beginning the group: Introductions, review aims and information that has been provided to members about the aims and functioning of the group, agree on a set of ground rules for the operation of the group, plan for initial group tasks; Stage 2: working together on learning about self. Work through learning tasks, week by week – choice and sequence of tasks decided by the group; regular reviews of the functioning of the group/revisiting ground rules; Stage 3: reflecting on the experience of being in a group. The group journey exercise and other ending activities. The structure of weekly sessions might incorporate: (a) report in – anything you want to say to other members of the group; check out who is absent and why, and so on; (b) the weekly learning task; (d) planning for future sessions; and (e) closing reflection – unfinished business, feedback (resentments and appreciations). It is open to the group to decide to adapt or modify this structure to meet its needs at any particular point. For example, groups may wish to include unstructured sessions to allow a more open and spontaneous expression of feeling and interaction. If a group feels ‘stuck’, it may be helpful to devote one or more sessions to reflecting on the dynamics of the group, reviewing ground rules, and so on. A group may opt to spend more than one week on a topic, or to devise its own topics and activities. Flexibility and creativity are encouraged, as long as they contribute to the achievement of the overall goals of the group experience. The group needs to operate within the usual standards of ethical good practice around confidentiality, consent, autononomy, fairness, respect,
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and so on – it is up to each group to work out what these ethical principles should operate in their specific context. The primary role of the facilitator is to contribute to maintaining the boundaries of the group (start and finish on time, ensure that the room is appropriately equipped, deal with any intrusions, and monitor and address any possible confidentiality breaches). The facilitator also works with the group to establish a set of ground rules for the operation of the group, and to review these where necessary, and facilitates the process of learning within sessions; for example, by making sure that enough time is devoted to each member, encouraging the participation of group members, and if appropriate reflecting on the process of the group. The facilitator also has a role as a representative of the training team to monitor the well-being of group members, and if necessary to arrange individual meetings outside the group to share concerns. The process of a learning group will be influenced by the stage of training of group members. Students or trainees at an early stage of training can be viewed as learning about what is involved in using a group to enhance self-exploration. By contrast, those at a more advanced stage of training are in a position to adapt the group format to meet their self-identified learning needs and priorities (see Table A.1.1): Table A.1.1. Personal development goals at different stages of training Introductory stage of training
Advanced stage of training
Likely to be students’ only involvement in personal development work, other than writing a personal learning journal
Students are likely to be engaged in several different forms of personal development work: personal therapy, supervision, keeping a personal journal, consultation with course colleagues
Aim is to learn how to make use of self-awareness activities
Aim is to reflect on and integrate different types of awareness activity into a coherent account of ‘who I am as a counsellor’
More freedom to experiment – course assessment load is relatively light, and consequences of not doing well are minimal
More pressure to present a ‘competent self’ – assessment pressure is higher, and lack of success on course may have significant consequences in terms of professional accreditation. As a result, group participants may need to work harder to achieve a sufficient level of trust and safety
Individual self-awareness is primary goal
Learning about group process is a central goal, in addition to the development of individual self-awareness
Group members learn how to support each other
Group members learn how to both support and challenge each other
The movement from early to later stages of training leads to different emphases within a learning group. At a later stage, members are more engaged in a relational experience in which they reflect on their identity in relation to other members of the group. It may be useful to support this learning by providing students with opportunities to learn about models of group dynamics, or to explore relationally oriented models of therapy. By contrast, for students and trainees entering this kind of learning environment for the first time, there can be a great deal of immediate personal learning as the person explores certain topics for the first time, or may experience for the first time a sense of affirmation and acceptance in a group context. Participants at an introductory stage of
Appendix A
training are unlikely to have much basis on which to make decisions about which topics the group might address. For these participants, it may be helpful for the facilitator to take a clear lead in suggesting topics and ground rules. For more advanced participants, who have more experience of how groups work, and more ideas about their own learning needs, the group can become a co-constructed, negotiated, improvised and flexible experience. The Counsellor’s Workbook includes a sufficient number of learning tasks for facilitators and group members to be able to select what seems right for them at any particular time. Group members and facilitators may also generate new learning tasks that correspond to the particular interests of group members, or the cultural milieu in which the group and the training course takes place. There may be times when it can be valuable for members of a group to return to a learning task that had been explored in the past, as a means of mapping the personal journeys in which members have been engaged.
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219
Index
abstract conceptualization 45 abuse, sexual 141, 157 academic disciplines 79 acceptance 9, 31–2, 53, 66 active experimentation 45 activism 100 activist learning style 45 activities 196 Adler, Alfred 24 affection, need for 66 agony aunts 179 altruism 62 Amazon 176 anal personality 77 anger 128 anxiety 135–6, 157 approaches to counselling/psychotherapy 9, 73, 119 applying to personal experience 81–2 CBT 73, 85, 88–91, 103, 163, 192 humanistic 94, 115, 165 person-centred see person-centred approach personal approach see personal approach to counselling psychoanalysis 101, 103, 115, 163, 165 psychodynamic 73, 101, 115, 163, 165 approval, parental 124 artistic expression 79 assessment 11–12, 209 assignments 11–12 assumptions implicit 7 informing one’s worldview 98 attachment difficulties 61 attraction, sexual 25, 116, 160 authentic presence, therapist as 108 authenticity 92 experiencing 94–5 autobiographical writings 17, 210–11 early memories 24 making sense of 81–2 avoidance 89 background reading 11 Balint, Michael 42 basic fault 42 Beck, Aaron T. 103 Bedi, R.P. 162
behaviour, changing 37 beliefs 57 irrational 90, 98 personal philosophy 155–6 belonging 66, 192 bereavement counselling 114, 174 Berne, Eric 168 Bettelheim, Bruno 168 bibliotherapy 176–7 biographies of theorists 105–6 biology 75 borderline personality disorder 145 boundaries of a group 67, 212 meaning of 172 boundary violations 133–4, 172 breathing difficulties 126, 128, 141 British Association for Counselling and Psychotherapy 159 Burns, G.A. 181 Campbell, Warihi 192 Carrell, Susan 194 case formulation 91 case studies 87, 119 catharsis 62, 103 challenge 53 challenging irrational beliefs/dysfunctional self-talk 98 challenging clients 34, 53, 159, 185–6 change experience of changing behaviour 37 group dynamics 68 relative importance of cognition and emotion 103–4 child development 110, 168 childhood experiences 105 memories 24, 137 children 159 choice map 38–9 chronic fatigue syndrome 145 Clarkson, Petruska 108–9 classical conditioning 88–9 claustrophobia 136, 145 client-therapist relationship see therapeutic relationship client groups 154
221
222
Index
clients difficult 34, 53, 159, 185–6 maximizing involvement of 205 moral dilemmas presented by 157–8 opening statement 122–3 readiness 5 re-authoring letter to the client 98 transference 115–16 coach, therapist as 108, 163 codes of ethics 159, 161 cognition 75 dysfunctional 90, 98 relative importance of cognition and emotion in change 103–4 cognitive-behavioural therapy (CBT) 73, 85, 88–91, 103, 163, 192 case formulation 91 classical conditioning 88–9 irrational beliefs and dysfunctional self-talk 90 operant conditioning 88 cognitive schema 73 cohesiveness, group 62 Combs, Arthur 155 commitments 57 common factors 98–9 community meaning of counselling in 173 moral communities 152 competence 190 composition, group 67 concentration problems 135–6 concrete experience 45 conditioning 88–9 confidentiality 6–7, 57, 160 deconstruction of meaning 161 congruence 53, 92–3, 98 connections 57–8 consciousness 85 consent, informed 160 contact with others 47 container, therapist as 108, 163 contradictory impulses 101 control 66 coping 200 with crises 36 under pressure 44 core conditions model 77, 110 core issue 42 core and peripheral self 85 CORE system 192 counselling 10 comparison with psychotherapy 197–8 counsellor’s contribution to 27–8 critical issues 205 images of 191
meaning in the community 173 personal experience of 26 counsellor/therapist 3 boundary violations by 133–4, 172 congruence 92–3, 98 contribution to counselling 27–8 effectiveness 183–4, 192–3 group as a context for exhibiting qualities and competencies of 65 importance of character and personality 1–2 marketing of 196 metaphors for 108, 163 origins and development of interest in therapy 20 personal approach see personal approach to counselling personal qualities 9, 190 reviewing skills and qualities 190 toolbox 194–5 training see training way of working and moral values 154 counsellor’s journey 20, 28 counter-transference 92, 98 couple counselling 157, 159 creativity 79 crises, coping with 36 critical issues 205 cultural identity 29–30 and personal approach to counselling 107 culture 75, 105 group culture 64–5 meaning of counselling and psychotherapy 173 decision-making, ethical 159–60 dependency 115–16 dependency needs 66 depression 135–6, 139–40, 146 development child development 110, 168 personal 54, 209–13 story of a development in one’s life 57–8 dialogue 203 imaginary dialogue between theorists 110–11 difference 53 engaging with 34–5 difficult clients 34, 53, 159, 185–6 direction 163 discovery 47 dissociation 145 diversity of perspectives 173 downplaying 191 dreams 98 working with 171 dysfunctional thinking/self-talk 90, 98
Index
early memories 24 editor, therapist as 108 effectiveness 183–4 criteria for evaluating 192–3 ego, emptying of the 108–9 Ellis, Albert 90, 103 email 180 emotional climate 64 emotional pressure 44 emotions 75 case scenarios for working with emotions 145 relative importance of cognition and emotion in change 103–4 self-exploration of personal emotional patterns 40–1 stories and significant emotions 167 empathic reflection of meaning 98 empathy 53, 83–4, 110 employee assistance programme (EAP) 132 endings, group 64–5, 68 environment, natural 205 Erikson, Erik 110 ethical decision-making 159–60 ethical principles 211–12 see also morality existential awareness 62 existential psychotherapy 194 expectations of learning group 55 experience concrete 45 personal see personal experience practical 3, 4–5 portfolio of experiences and reflections 7–9 previous 27–8 responsiveness to others’ 57–8 vicarious 47 experiential learning 11, 45 experiential learning groups 8, 54, 209–13 experimentation active 45 new ways of relating to others 56 extinguishing connections 89 facilitation, group 53, 209, 212 failure feelings of 120–1, 135–6 therapeutic failure 183–4 fairy tales 167, 168 family re-enactment 62, 65 family roles 56 family tree 29 fantasies 55 favourite story 21–2, 167–8 fear 88–9 feedback 9, 53, 62
feelings about a learning group 55 feeling wanted and needed 47 need to express 66 first impressions 59–60 frame of reference, internal 83 framework for understanding 3, 4, 73–4 Freud, Sigmund 23, 105 transference 115 the unconscious 101 functional analysis 88 future, the 204 Gendlin, E.T. 92 generalization 89 genetics 75 genogram 29 genuineness 92 gifts 159 ‘giving something back’ 47 global warming 205 good life, vision of 152 ground rules 55, 212 group cohesiveness 62 group dynamics 66–9, 211 change 68 group as a system 67 group roles and leadership 67–8 needs of individual members 66 group facilitation 53, 209, 212 group norms 55, 64–5, 67 group roles 55, 56, 65, 67–8 groups helpful factors in 62 learning groups see learning groups mapping your relationship patterns 33 therapeutic factors 62 guidance 62 habits 88 Haley, Jay 183 harassment 143 harm, capacity to cause 205 healing 47 metaphors 169 hearing voices 130–1 help 47 helping relationship story 19 receiving 26 high direction/high support mode 163 high direction/low support mode 163 highlighting 191 Hill, Clara 171 home 30 honesty 9, 55, 92
223
224
Index
Honey, Peter 45 hope 62 Howard, G.S. 163 hugging 160 humanistic approach 94, 115, 165 id, the 101 ideal therapy room 199 identification 62, 83 identity cultural 29–30, 107 professional 8–9, 189 images of counselling/psychotherapy 191 of the world 167 immediacy 92 implicit assumptions 7 impression management 59 inclusion, need for 66 independent study 11 individual learning 6 influence 66 informed consent 160 insight 81, 103 instrumental conditioning 88 integration of theory and practice 8, 205 intellectual challenge 47 intentions 57 internalized self objects 85 Internet online counselling 180 resources 178, 206 interpersonal needs 66 interventions toolbox 194–5 intimacy 65, 66, 116 intimidating clients 34, 53, 159, 185–6 intuition 59 irrational beliefs 90, 98 Jennings, Len 108, 207 journal, learning 5–6, 7, 11, 18, 56, 114, 210–11 journey counsellor’s 20, 28 group 64 Just Therapy centre 192 kissing 160 knowledge, previous 27–8 knowledge base 202, 205 Kolb, David 45 Kvale, Steiner 112 language 112, 169, 191 ‘last resort’, therapy as 139–40
leadership 67–8 style 64 leaflets 196 learning 10, 205 core aspects of learning about counselling/ psychotherapy 3–5 experiential see experiential learning; experiential learning groups individual 6 style 45–6 learning alliances 6–7 learning groups 4–5, 6–7, 11, 51–69, 119 exploring feelings, fantasies and expectations about 55 first impressions of group members 59–60 narrative approach to personal development groups 54, 209–13 reflecting on the life of the group 64–5 reflecting on significant events in 62–3 talking about oneself in 61 see also group dynamics learning journals 5–6, 7, 11, 18, 56, 114, 210–11 learning tasks 5, 11 letters re-authoring letter to the client 98 to significant others 174–5 to theorists 114 levels of abstraction 77–8 Lewin, Kurt 76 liberation 192 libido 77 life choices 38–9 case study 124–5 life experiences 27 liking, need for 66 local resources 9 Lomas, Peter 1, 2, 44, 107 Lott, Deborah 109 low direction/high support mode 163 low direction/low support mode 163 Luborsky, Lester 167 magazine problem pages 179 maintenance 89 maps/mapping choice maps 38–9 relationship patterns 33, 109 marketing oneself 196 ‘master therapists’ 119, 207–8 McConnaughy, E.A. 1 Mearns, D. 92, 94 media 179 medical problems counsellor’s disclosure dilemma 159
Index
physical symptoms 126–9, 141 terminal illness 122, 160 Meichenbaum, Donald 90, 169 memories 17 early 24 mentors 10 metaphors for counselling and psychotherapy 191 for counsellor/psychotherapist 108, 163 working therapeutically with 169–70 meta-theories 79–80 methodological pluralism 202 modernity 112 moral communities 152 morality 9, 151 ethical decision-making 159–60 ethical good practice 211–12 exploring moral values 152–3 moral dilemmas presented by clients 157–8 moral values and personal approach to counselling 154 Morgan, A. 15 motivation 47 moving on in life 143–4 multiplicity of self 85 narcissism 61 narrative approach to personal development groups 54, 209–13 narrative therapy 96, 114 natural environment 205 nature-guided therapy 181–2 Navajits, Lisa 191 needs, interpersonal 66 new start 143–4 New Zealand 192 non-specific factors 98–9 norms, group 55, 64–5, 67 not-knowing stance 108 notebooks 18 object relations theory 85 observational concepts 77 one-minute intro 196 online counselling 180 opening statement 122–3 openness 92 operant conditioning 88 order, need for 66 others beliefs about 155 contact with 47 experimenting with relating to 56
responsiveness to 57–8 significant 174–5 outcome criteria 192–3 outdoor therapy 181–2 pain symptoms 126–9 panic attacks 128 parental approval 124 payment 47 peer group 10 peer learning groups 4, 6, 11, 53, 209 see also learning groups Pennebaker, James 48 people orientation 155 peripheral and core self 85 person-centred approach 73, 103, 115, 155, 163, 192 client’s frame of reference 83 congruence 92, 94 personal approach to counselling 151 cultural identity and choice of 107 explaining/describing 196 moral values and 154 Rogers’ questions 203 personal development groups 54, 209–13 personal development guidebooks 208 personal experience 10, 15 of changing one’s behaviour 37 of counselling/therapy 26 of crisis 36 theory and making sense of 81–2 personal gain dilemma 159 personal learning journal 5–6, 7, 11, 18, 56, 114, 210–11 personal learning styles 45–6 personal philosophy 155–6 statement of 12 personal qualities 9, 190 personal struggle 42 personal therapy 7, 8, 200, 210 personal writing 15–16, 48 perspectives continual change 112 diversity of 173 philosophical assumptions 78 philosophy 79 physical symptoms 126–9, 141 political ideologies 79 politics 100 portfolio 5 assessment 11–12 of experiences and reflections 7–9 postmodernism 112–13 power 47 need for 66
225
226
Index
practical experience 3, 4–5 practice integration of theory and 8, 205 reflection on 151, 210–11 setting 154 pragmatist learning style 45 preferred learning style 45–6 presence 92 pressure, coping under 44 previous knowledge/experience 27–8 priorities 155 privacy 7, 18 problem focus 96 problem pages of magazines 179 professional codes of ethics 159, 161 professional development 209–13 see also training professional identity 8–9, 189 propositions 77 proverbs, moral 152 psychoanalysis 101, 103, 115, 163, 165 psychodynamic approach 73, 101, 115, 163, 165 psychopathology 42 psychosocial development 110 psychotherapy comparison with counselling 197–8 critical issues 205 images of 191 meaning in the community 173 origins of interest in 20 purposes, beliefs about 155
relationships 10 boundaries 172 breakdown 132, 143 clients’ problems in 137–8 between group members 65 making connections and being responsive to others 57–8 mapping your relationship patterns 33, 109 stories and pattern of 167 therapeutic relationship see therapeutic relationship writing about a helping relationship 19 release, emotional 103 religion 79 research 202 resonance 92 respect 7, 47 responsibility 7, 57 responsiveness to others 57–8 ritual 18 Rogers, Carl 43, 92, 105, 110, 123 empathy 83 questions relating to personal approach 203 roles family 56 group 55, 56, 65, 67–8 Ronnestad, Helge 207 room, therapy 20, 199 routine 18 Rowan, J. 43
qualities, personal 9, 190
sacredness 192 satisfaction 47 sayings, moral 152 schema 73 scientist, therapist as 108 self 73 beliefs about 155 making sense of 85–6 sense of 23 taking care of oneself 7 use of 92–3 work on 4 self-acceptance 85 self-actualization 77, 85 self-awareness 3–4, 6 self-blame 146–7 self-concept 85 self-disclosure 61, 62 self-efficacy 85 self-esteem 85 self-evaluation statement 189 self-fulfilment 85 self-help books 9, 176–7
race 122 readiness, client’s 5 reading background 11 therapeutic use of 176–7 re-authoring letter 98 receiving help 25 reflection 45 on the experience of writing about oneself 48–9 on the life of a group 64–5 on personal experience 4 portfolio of experiences and reflections 7–9 on practice 151, 210–11 on significant events in a group 62–3 reflection of meaning, empathic 98 reflector learning style 45 reflex responses 88 reinforcement 81 relational self 85 relationship styles 163–4
Index
self-image 139 self-object 85 self-promotion 196 self puzzle 23, 85 self-talk, dysfunctional 90, 98 self-therapy 47 self-understanding 62 seminars 11 sensory awareness inventory 181 separate schools 205 service design/delivery 205 settings 154 sexual abuse 141, 157 sexual attraction 25, 116, 160 sexual problems 25 sexuality 25, 124 Shlien, John 115–16 significant events, of a group 62–3 significant others, letters to 174–5 skills 27, 190 Skovholt, Thomas 108, 207 small groups see learning groups social factors 100 social groups 68 social status 47 solution-focused therapy 96–7 specific techniques 98–9 spirituality 43, 79, 85, 205 statement of personal philosophy of counselling/ psychotherapy 12 stimuli 88 stories 9, 73 development in one’s life 57–8 favourite 21–2, 167–8 helping relationship 19 making sense of 167–8 origins and development of interest in therapy 20 see also writing strengths-based approach 96–7, 205 strengths and weaknesses, identifying 8 stress 130, 157, 200 work stress 132 Strupp, H. 1–2 student counselling 120–1, 139–40, 157, 159, 160 study groups 11 see also learning groups summing up 189 supervision 8, 119, 200 support 7, 9, 53, 163 support network 200–1 symptoms, physical 126–9, 141 system, group as a 67 systematic desensitization 98
taking stock 189 talking about oneself 61 Tamasese, Kiwi 192 teacher, therapist as 108, 163 technological advances 205 television 179 terminal illness 122, 160 themes, existential 24 theorist learning style 45 theorists biographies of 105–6 imaginary dialogue between 110–11 letter to a theorist 114 theory 73–4 applying to one’s personal experience 81–2 applying in practice 87 and group learning 55 integration with practice 8, 205 key theoretical ideas 75 levels of theorizing 77–8 relationship with 76 theoretical orientation and moral values 154 therapeutic failure 183–4 therapeutic relationship 10, 75, 162–4 creating and maintaining 162 issues and challenges 108–9 learning to offer 3–5 relationship styles 163–4 therapist see counsellor/therapist therapy room 20, 199 therapy thrillers 206 thick/thin description 15 thick story 15 Thorne, B. 92, 94 timelines 25, 29, 152 toolbox, counsellor’s 193–4 touching 55, 160, 165–6 trainer see tutor/trainer training 2, 3, 189 accounts of 207 narrative approach to personal and professional development 54, 209–13 stage of and learning group processes 212–13 transference 115–16 transgressions (boundary violations) 133–4, 172 transparency 92 transpersonal relationship 108–9 trust 110 Tuhaka, Flora 192 tutor/trainer learning group facilitation 4, 6, 11, 53, 209 notes for 10–12 two-chair dialogues 98
227
228
Index
unconscious, the 73, 77, 85, 101–2 understanding 103, 116 cultural context of 107 experience of being understood 31–2 framework for 3, 4, 73–4 unity of self 85 universality 62 values, moral 152–4 vicarious experience 47 voices, hearing 130–1 Waldegrave, Charles 192 websites counsellor’s website 196 as resources 178 White, Michael 27 ‘wilderness guide’ metaphor 108
women 109, 194 work stress 132 workshops 11 world, image of the 167 worldview, assumptions informing 98 writing 7–8, 11 autobiographical 17, 24, 81–2, 210–11 personal 15–16, 48 personal learning journal 5–6, 7, 11, 18, 56, 114, 210–11 portfolio of 11–12 reflecting on the experience of writing about oneself 48–9 therapeutic nature of 6, 18 see also stories Yalom, Irvin 62, 194
The
Second Edition This new edition of The Counsellor’s Workbook offers you a personal exploration of the key issues that may emerge during your development as a therapist. It provides you with an opportunity to document and consolidate your learning and personal development. The Counsellor’s Workbook can be used as a stand-alone resource or as a companion text with either the bestselling text, An Introduction to Counselling 4e or other key sources. This book will help you to become an effective counsellor or psychotherapist by: • Deepening and consolidating personal learning and development • Facilitating the integration of theory, practice and personal experience • Providing arenas for collaborative dialogue and exploration with fellow trainees This edition of The Counsellor’s Workbook has been comprehensively updated to reflect developments in the field and it now contains over eighty unique exercises.
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Other enhancements to the book include: • A helpful introduction to the book so that you understand how to use The Counsellor’s Workbook effectively • Learning tasks that cover new topics in An Introduction to Counselling 4e, such as transactional analysis theory • An entirely new section that focuses upon being a member of a learning group and developing self-awareness • New case studies that illustrate effective counselling in practice • Clear cross-referencing between The Counsellor’s Workbook and the relevant passages in An Introduction to Counselling 4e
• A new appendix that presents a narrative approach to personal and professional development in counselling and psychotherapy training The Counsellor’s Workbook is an invaluable resource for counselling or psychotherapy students, tutors and trainers, as well as for experienced practitioners engaging in continuing professional development. John McLeod is Professor of Counselling at the University of Abertay, Dundee, UK. He has practised in a range of counselling settings, as well as being involved in training, research and consultancy with many occupational groups, including nurses, doctors, social workers and emergency services personnel. His many publications include An Introduction to Counselling 4e and Counselling Skill.
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