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Hello and welcome

Welcome to my blog. In these posts you will find my own thoughts and opinions about counselling and psychotherapy and also those of some of the many theorists who have informed the study of psychotherapy over the last hundred years and more. I hope that these posts will be informative and help you to understand more about how therapy can work for you. I believe that the synthesis of theory and practice and a knowledge of emerging research helps in the understanding of what lies behind people’s presenting problems so I make no apology for citing a bit of academic literature!

How does counselling/psychotherapy work?

This is an enormous and constantly discussed question and one that is particularly difficult to research due to the individual and confidential nature of counselling work, and the different theoretical approaches from which therapists choose to work.

From my own perspective, effective therapy is all about providing a safe and supportive space in which you can explore distress, bringing thoughts, feelings and behaviours into awareness, leading to acceptance and healing. Crucial to this is the quality of the therapeutic relationship. As Irving Yalom famously states (1989, p.91), ‘it’s the relationship that heals, the relationship that heals, the relationship that heals’ and I will write more on this in a future blog post.

I do not judge or offer advice, but help you to re-learn to think for yourself and work towards autonomy. I believe it can be beneficial to share theory to aid this and to help to work towards continued personal growth after therapy ends.

By examining what might be at the root of behaviours, ‘blind spots’ can be revealed, leading to greater self-awareness. Often I will reflect back verbal and non-verbal language to encourage deeper exploration and it can be as much to do with sensory and bodily experiences as with verbal and cognitive processes (Stedmon and Dallos, 2009).

It is important to acknowledge that sometimes therapy can temporarily make you feel worse, before you feel better. By digging deeply into emotions, painful feelings can re-emerge, but as Van Deurzen-Smith states (1988, p.x), ‘brave acts are seldom committed without anxiety’. A good therapist will endeavour to make you feel as safe and supported as possible through this process, allowing you to take things at your own pace.

Therapy can be particularly effective when someone really invests in it and research has shown that that motivation plays a big part in successful outcomes (Norcross, 2011: Wampold, 2001, cited in Sills et al., 2012). My own experience of clients who have arrived saying ‘I’m really ready for this’ backs this up. There is truth in the rather old therapist’s joke:

Q: How many therapists does it take to change a light bulb?
A: Just one, as long as the light bulb really wants to change.

References

Sills, C., Lapworth, P., Desmond, B. (2012) An introduction to gestalt. London: Sage.

Stedmon, and Dallos, (2009) Reflective practice in psychotherapy and counselling. Berkshire: Open University Press.

Van Deurzen-Smith, E. (1988) Existential counselling in practice. London: Sage.

Yalom, I. (1989) Love’s Executioner and other tales of psychotherapy. London: Penguin.

How do I choose a counsellor/psychotherapist?

There are hundreds of different types of therapy, so it can be daunting to know where to start.

You might consider if you want to work short or longer term. As few as six sessions can prove very beneficial for some clients, whereas others may be looking for something ongoing, for many months or even years. Shorter term work often uses Cognitive Behavioural Therapy (CBT) which helps to change our ways of thinking and behaving, while longer term work may be more psychodynamic or humanistic, looking more deeply into the root causes of our feelings and behaviours and our early lived experiences. There are, however, absolutely no rules, and the key to successful psychotherapy is very often based on the quality of the relationship you have with the therapist.

Some counsellors specialise in particular issues, while others work more generally. Quite often the reason we seek therapy is not the underlying cause of our problems. However, if you are looking for help with something very specific, examples might be extreme eating disorders, or some types of addiction, it can be helpful to look for an individual therapist or organisation that specialises in treating those issues.

If you are seeking help for a child or adolescent, look for a counsellor or organisation that is specially trained to work with that age group. Couples therapy and family therapy also requires specialist training.

Talking of training, this is a very important point. Despite much debate over recent years, counselling and psychotherapy is still an unregulated profession. As such, anyone can set up and start practicing. This is not just unethical, but also potentially dangerous. It is therefore vital to check that the therapist you plan to see has suitable counselling qualifications.

An easy way to be sure of this is to check that they are members of a reputable professional body, with the BACP (British Association for Counselling and Psychotherapy) and UKCP (United Kingdom Council for Psychotherapy) being the largest and most well known, although there are others. Both of these organisations have strict ethical guidelines and will only admit and approve members who have acquired a specific level of training, have regular supervision and keep their knowledge and skills up to date with regular Continuing Professional Development (CPD).

While it is best not to choose your therapist just by location, it is sensible to find someone who you can travel to easily. By looking online, at The Counselling Directory, the BACP’s Find a Therapist, or more locally, The Suffolk Association for Counselling websites, you can find therapists by locality, specialist area of expertise, and any particular client base they might work with. These websites clearly list therapists’ membership of professional bodies as well as their qualifications.

Lastly, but very importantly, personal recommendation can be a particularly helpful place to start, as knowing a friend or family member who has really benefitted from working with a counsellor/psychotherapist can be very reassuring. Care needs to be taken, as counsellors cannot work with close friends or family members of existing clients as this may produce a conflict of interests in terms of confidentiality. However, a known and trusted therapist will no doubt be very happy to recommend or refer you to someone else who they trust would be suitable for your needs.

The value of keeping a journal

I cannot stress enough how valuable keeping a journal can be. Writing down our thoughts, feelings and behaviours is free to do, can be done at any time of day or night, with no reliance on or impact on others. It is entirely ‘our thing’, where we can enjoy the luxury of complete uncensored expression. It can provide insight and catharsis.

Something happens during the process in which we write words onto the page, changing them from abstract to concrete, acknowledging and giving weight to their importance and creating ‘a more intense relationship with ourselves …’ (Hazel, 1996).

It is important that our journals are private and for our eyes only. When uninhibited, we can release our creativity, and write exactly what we want, with no inner censor. If we find ourselves censoring, it is important to ask why. Written in this spirit, our journals can become ‘Spontaneous rather than rehearsed, reflective rather than merely descriptive, and alive rather than dead’ (Hazel, 1996).

Being able to write, ponder or rant, can help us to work through thoughts and feelings that we are ruminating on, to ‘alter self-defeating habits…and come to know and accept that self which is you…’ (Rainer, 1980, cited in Hazel, 1996). It can be helpful to become better acquainted with our thought patterns, relationships, what makes us happy and unhappy in the world and to identifying feelings, plan actions and find self-insight.

Writing in a journal can be helpful to explore our dreams, particularly for those of us who find their detail so fleeting. A journal by our beds can help us to capture these dreams before they disappear back into our subconscious.

One of the aims of counselling and psychotherapy is to enable clients to find their own inner resources, to be able to continue their own lives with their own internal counsellor. With a journal, we can work both reflectively and reflexively with that internal counsellor.

References

Hazel, J. (1996) Personal Development in Counsellor Training, London: Cassell.

How early life experiences can impact our current lived experiences

‘No one can understand the grown up without first understanding the child’ (Adler, 1992, p.64).

As a Humanistic counsellor, I believe that we all have the potential to change and develop, no matter what stage of life we are at. While I would dispute the deterministic theories of some psychotherapeutic approaches, I do agree with many psychodynamic theorists that what happens to us and how we are treated in early life can impact our current lived experience.

Post-Freudian psychodynamic thinking continues Freud’s theory that what happens in the early years of life can produce later problems. Klein’s Object Relations Theory (1963) emphasises ‘a crucial psychical contact with the first good object’ (Likierman, 2001, p.193) and suggests that even before birth, the infant has some innate unconscious knowledge of the mother, echoing Jung’s concept of the Collective Unconscious (Cashdan, 1988, cited in Hough, 2015).

Together with the work of Ainsworth, Bowlby’s Attachment theory empathises the ‘powerful influence on a child’s development of the ways he is treated by his parent’ (Bowlby, 1988, p.135). This can affect a person’s ability to have healthy relationships throughout life, as their Internal Working Model (Bowlby, 1988) becomes a template of early learned experiences.

Neuroscientific research reinforces Bowlby’s theories (Gerhard, 2015, Schore, 2003), showing how early stressful relationships can damage the formation of neural pathways, cause unregulated cortisol levels and lead to emotional dysfunctions.

The good news is that early attachment disruption can be repaired within the therapeutic relationship and working through past losses can be a vital part of attachment informed therapy (Holmes, 2001). As a Humanistic counsellor and psychotherapist, rather than emphasising the instinctual drive theories of the psychodynamic theorists, I believe that attachment is reciprocal and relational – it is about knowing what is in us and what is between us.

So next time a therapist asks you ‘tell me about your childhood’, you will know why.

References:

Adler, A. (1992) What life could mean to you. Oxford: One World.

Bowlby, J. (1997) Attachment and loss, volume 1. Attachment. Pimlico edition. London: Pimlico.

Gerhard, S. (2015) Why love matters: how affection shapes a baby’s brain. 2nd edition. London: Routledge. .

Holmes, (2001) The search for the secure base: attachment theory and psychotherapy. Hove: Routledge.

Hough, M. (2014) Counselling skills and theory. 4th edition. Abingdon: Hodder Education.

Klein, M. (1963) Our adult world and other essays. London: Heinemann.

Likierman, M. (2001) Melanie Klein: her work in context. London: Continuum.
Martinez

Schore, A. (2003) Affect dysregulation and disorders of the self. New York: W.W. Norton and Company.

What you keep in and what you keep out; the importance of boundaries and containment in counselling

Boundaries are useful things: to define physical or personal space, as lines that are not to be crossed, as guides to self and others about how to behave. In counselling and psychotherapy, boundaries are particularly important to keep both clients and counsellors safe, but also to highlight the value of the therapeutic relationship. Boundaries create a safe container in which our therapeutic work can take place. When difficult or painful feelings arise it is important that the therapist can hold a client safely in this container, as they explore these feelings.

Anne Gray (1994) writes of the importance of the ‘therapeutic frame’ as a clear marker for boundaries and containment. How a client deals with these boundaries can often suggest how we were cared for in the past and also how the therapy is perceived or prioritised. If someone is regularly late, or misses sessions without prior notice, this can often echo how they behave in the rest of their life, or lessons that they learned in early years. There may be unconscious reasons why they are avoiding facing difficult issues in their sessions.

Whilst the relationship between a client and counsellor is friendly, it is not a friendship; it is a working alliance. If a counsellor suggests the relationship becomes more than this, they are heading into dangerous and unprofessional territory. If a client wants something different from the relationship, it is useful to explore which of their needs they are trying to meet, while stressing the importance of maintaining boundaries.

As a counsellor, I work hard to ensure my clients’ safety; we sign a contract at the start of our work together to make sure that we both understand exactly what we are agreeing to; the length and number of sessions, how much they cost and the cancellation policy. It is hugely important that we maintain this contract as it serves as an important reminder of the boundary that we are putting between the outside world of the client’s work, family and relationships and our time together in our therapy sessions.

Confidentiality is an integral part of this as it is vital that a client feels safe to speak honestly and without the fear of being judged. Working as a counsellor in Woodbridge, I am aware that I may (although I have not so far) bump into a client and it is therefore important that we agree what we would do in that instance. Would you rather that we acknowledged each other, or that we ignore each other? These details will be discussed in our early sessions to make sure that possibilities are covered.

References

Gray, A. (1994). An introduction to the therapeutic frame. London: Routledge.

The importance of the relationship in counselling and psychotherapy.

My previous post touched on the importance of the therapeutic relationship between a therapist and client. I believe that so much that is good in life is about making connections and achieving relational contact and this is the same in therapy. The ability to build trusting, honest and creative relationships is one of the major agents of effective change. Feeling safe within this relationship can allow you to explore and experience feelings that might be too difficult to face on your own.

Bowlby states that ‘the therapist’s role has been likened to that of a mother who provides her child with a secure base from which to explore’ (Bowlby, 1988, p.172) and sometimes the therapist will ‘model’ by giving the client a relationship that they never had, to enable them to grow and learn. Reparative enactments of early attachment experiences can be fundamental to healing and I shall write in a future post about how early life experiences can effect our current lived experiences.

Despite many different theoretical approaches, the relationship is acknowledged by many theorists to be paramount, and Erskine et al. (1999) state that the underlying and essential element of successful therapy is the relationship. For me, this is summed up best by Carl Rogers (1995, quoted in Bager-Charleson, 2010, p.81) who writes of moments in the relationship when ‘deep realness in one meets a realness in the other’.

If we can achieve those connections, those moments of deep realness, I believe we are truly experiencing life and healing at its best.

References

Bager-Charleson, S. (2010) Reflective practice in counselling and psychotherapy. London: Sage.

Bowlby, J. (1988) A secure base. Abingdon: Routledge.

Erskine, R., Moursand, J., and Trautmann, R. (1999) Beyond empathy: a therapy of contact-in-relationship. London: Routledge.

What is Integrative Counselling/Psychotherapy?

Some counsellors and psychotherapists work within one theoretical perspective, some adopt a more pluralistic approach, calling on many different theories. Others, including myself, work from an integrative approach which incorporates theories and techniques which reflect my own values and beliefs, but equally importantly, puts your needs first.

As Reid and Westergaard (2013, p.51) state ‘Integration recognises that no one theory can fully explain what it is to be human and that each theory may address some or many, but not all of the facets of human experience’.

I work from a humanistic relational approach which is based within a framework of the humanistic philosophies, within which I aim to embody Carl Rogers’ ‘core conditions’ (Rogers, 2003), emphasizing empathy, congruence and unconditional positive regard. I work with Eric Berne’s Transactional Analysis (1961) as well as Gestalt theories and techniques originated by Laura and Fritz Perls (1951), whilst also acknowledging how early life experience can impact on later life, as explored in Bowlby’s attachment theory (1997). This rests in a philosophical base of existentialism which comes closest to describing the ‘universal human experiences that transcend the boundaries that separate cultures’. (Corey, 2001, p.37). I believe that personal development is a lifelong process, and as such, my integrative approach is constantly developing.

Overall, it is the therapeutic relationship that is at the very heart of my practice and the ‘glue’ that holds its integrating elements together. Together we can work together in a supportive and confidential way to help you achieve a successful outcome.

References

Berne, E. (1961) Transactional analysis in therapy: a systematic individual and social psychiatry. New York: Grove.

Bowlby, J. (1997) Attachment and loss volume 1. Attachment. Pimlico edition. London: Pimlico.

Corey, G. (2001) The art of integrative counselling. Belmont: Wadsworth.

Perls, F., Hefferline, R. and Goodman, P, (1951) Gestalt therapy: excitement and growth in the human personality. Middlesex: Penguin.

Reid, H., and Westergaard, J. (2013) Effective supervision for counsellors: an introduction. London: Sage.

Rogers, C. (2003) Client-centred therapy: its current practice, implications and theory. London: Constable.