Journal posts 22 and 23 ( a week missed, off sick); march 11th 2013

It felt like I had been away from college for a very long time; it had been half term, and then I had been ill, so I was pleased to be back, despite not feeling quite one hundred per cent recovered. I was relieved to see everyone, and feel that they weren’t too let down by my not being there last week – everyone seemed incredibly understanding, none more so than J, our tutor, and so on check in my first tears of the day were spilled, as she made sure that I – and everyone else in the room- acknowledged just how awful the last few weeks had been for me. Oh, there is nothing like feeling a bit sorry for myself to get the waterworks flowing, and it seemed that today was going to be one of those days that examined my ‘life deficit’ in even more detail, prompting even more tears. Still, painful as it is, I am doing it, I am not shying away as I used to (although I do still try the odd trick, to get out of owning up to my upset – not because I don’t want to face it as such, but because I am embarrassed at how much crying I seem to do in our sessions). This last time last year, when we were studying our CBT module, I managed to avoid being the ‘client’ for the entire process! Nothing like that is going on any more, and I feel proud of myself that I am facing up to my stuff in a much more congruent way these day, even if I am, erm, ‘soggier’ for it…

We continued after check in with a quick recap on the work they did last week – the concept of working at ‘relational depth’ in person –centred counselling (meaning ‘A sense of connectedness and flow with another person that is so powerful that it can feel quite magical. At these times, the person feels alive, immersed in the encounter, and truly themselves while experiencing the other as open, genuine and valuing of who they are.) Developed by Dave Mearns and Mick Cooper, the idea is that the core conditions are not simply ‘tools’ that are used, that they become an integral part of the counsellor, the very principles by which we work from, enabling this work to take place at ‘relational depth’, where change can happen, where communication does not skim over the surface, but is used to facilitate movement from deep within. A hugely powerful concept, and to me, the essence of person centred counselling; something that couldn’t possibly be attained without congruence, unconditional positive regard and empathy being at its heart.  In my experience, the very best work that we do with clients is when it comes from the soul, and to touch someone’s soul, requires you to access your own. To me, it is reminiscent of those late night chats with your best friend, after a bottle or two of wine, where the real truth is revealed and dissected; pored over and pounded. We counsellors want the conversation to reach that level (but in a clear headed state, where the content can be remembered the next day!) Clients interviewed after  reporting back as having achieved this, have said they felt it was; Empowering and useful as a catalyst for change, that it lessened painful feelings; that there was a positive effect on the therapeutic process, a deepening and  equalisation of the relationship, greater trust in their therapist, and that they were more able to vocalise their innermost thoughts and feelings;  that from that they gained a sense of connectedness to their own selves, greater self-knowledge and understanding and acceptance and that with that they felt more able and powerful to move on and break their patterns of thinking, and enjoy better relationships with others.

Powerful stuff. This led on to this week’s subject – ‘the divided self’; the idea of sub-personalities, as written about by John Rowan (‘Discover your Sub Personalities’; 1993, Routledge, London). Immediately, this sounded very Jungian to me – akin to ‘personas’ and ‘archetypes’. Sub –personalities are pieces of the whole of the overall personality, which have a life of their own, beliefs, thoughts, feelings, intentions and agendas. There’s the rebel and the martyr, the seducer and the saboteur, the judge and the critic and a host of others, each with its own mythology, all co-existing within a person.  Counsellors must recognise these facets within both us and our clients, and understand that one of them has a story to tell. Each one views the world differently. Each one interprets the events of life differently. Which ones control behaviour, thinking, and choices? Attention needs to focus on those that constantly provoke, react and attack. They are hurt and angry, wounded and in need of healing, if there is to be any inner harmony.

This was both incredibly hard and incredibly easy for me to get my head around, simultaneously.  I am bipolar; I naturally exist in extremes – I am very well aware of the inner conflicts within me. I got the concept in a heartbeat, but when we went on to do a survey that measured our sense of self, in terms of pluralism, my results came out completely opposing everyone else’s in the room, and that made me extremely upset! For a bipolar person to be okay with themselves, they have to be comfortable with that level of multiplicity operating within – it is all right, they are all a part of me, and coexist within me; I have to accept myself as being multiple and opposing at times. It doesn’t mean I don’t know who I am – quite the opposite; I know exactly who I am, a person who exists in extremes (when not properly medicated, anyway).

We were asked to identify five inner sub personalities, and share them with the class – I couldn’t possibly get it down to less than eight (I could have named hundreds) they were; dreamer, healer, vulnerable child, perfectionist, muse, clown, explorer and rebel. I would say that these are the main ego states I flit between. I could go on to describe how, but it would take all day, and may well be enough for a book, not a journal entry!

The morning ended with a creative realisation, where were asked to firstly focus on a part of our body, then to associate a symbol with that part of the body, then to full imagine that symbol as being alive and real, and to have a conversation with it. Here is what I managed to remember and jot down of mine;

(I had focussed on my stomach and imagined a warm, soft, red heart.)

Me; Love, how do I feel about you? You have deserted me.

Heart; No, I haven’t – you have love all around you, Ungrateful Girl – your family, your friends…

Me; But I want more than that. I want romance, to feel safe, protected and warm, again

Heart; Maybe you could have these things if you made yourself open to them, and ready.

Me; I can’t do that, I got too damaged before. When I lost you before, and lost my family along with you, I broke beyond repair.

Heart; you’ll never be like you were before again, but you can still be ready for me.

Me; How? What do I need to do?

Heart; Take risks again…

 

Wow! Yet more powerful stuff, and more tears. It was lunch time straight after that, and I needed the break. I felt exhausted and a bit ill again – probably from the strain of it. I can’t remember a morning where I had been more present and focussed, for ages…

We watched another skills video after lunch, filling me with more dread about showing mine next week, and then it was the process group; lovely process group. Actually, this week wasn’t so bad. I was really trying hard to be attentive and alert, but as often does happen, the conversation at points drifted into boring drivel. When it was alive though, it was really honest, brutal and raw – and it was  for these moments that I tried to stay with it ( the trouble is with my brain, particularly after a bout of illness, and some  new mind meds that are still settling, it goes off, and it takes all my energy to bring it back, to re-engage with myself, let alone those around me, at times), and so I tried my best to participate with the others, experience them fully. I found myself pulling them back to the here and now at various times – there was much anxiety about the future being talked about; about the exam, about next year, about completing this year and where it will take us, how we will manage. I couldn’t handle it; I was going there too if I wasn’t careful, so I kept  on bringing it back with, “but we’re here, now..,” and “what would you say to a client who told you that?” and it felt pretty good to do that. It was exactly what I would do when working with a client (and probably in my outside relationships too).  I chose not to share in the anxiety though, I didn’t want to, not just to show empathy – I mean of course, I do have fears about these things, but to actually try to empathise, more than I already do, could definitely push me over the edge into anxiety, and mania, somewhere I can easily end up anyway, without taking silly risks that I know could take me to that place!

The final part of the day, the supervision section, another part I often struggle to make it through –often being quite emotionally exhausted by that time of day – was another very conscious effort from me to stay alert and participate fully. A fellow student was sharing his experience of counselling in a drop in centre; his frustration when a client didn’t turn up, and his struggle to keep boundaries in place with a centre that is new to having counsellors working there. I have first-hand experiences of these issues, and through being thrown in at the deep end somewhat, have learnt some valuable lessons and strategies that could be useful to him, so I tried to share them with him. I think he took them on board; I was very aware that he was feeling quite defensive about it – again, just as I had during my first group supervision session, and so I tried to be sensitive, yet constructive with him by offering him suggestions of techniques that have worked for me and sympathy to his situation. (Normative and restorative, perhaps?) I hope he was okay with it; I think he was.

So, to finish the day off, a quick run through of the last essay we had to do, with a fellow group member who feels she is struggling academically at the moment. I told her “I am no expert but I can show you how I went about it,” and she seemed to be appreciative of that. It made me feel good to try to help. My inner healer, rising up again for fulfilment…

 

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Strategic therapy; techniques used by Milton Erickson

Whilst looking at my blog stats, it came to light that many people had arrived here whilst searching for information on the therapeutic techniques used by Milton Erickson. I recently had to write about them myself, and became aware that there are not that many online resources for this information; particularly ‘simple’ ones, that aren’t buried deep in the middle of other (wonderful, of course) academic works. It is with this in mind that I have decide to post a small extract from one of my essays about him, in the hope that it will prove useful to any other out there who find themselves in the situation I was in – hope it helps! 

Jay Haley, the popular proponent for this approach, wrote “Strategic therapy isn’t a particular approach or theory, but a name for the types of therapy where the therapist takes responsibility for directly influencing people” It is developed from the work of  Milton H. Erickson MD, one of the world’s leading hypnotists and psychiatrists. Erickson believed that within one’s consciousness, everyone has the power to heal himself or herself, and he used some quite revolutionary techniques to facilitate the client’s acknowledgment of these resources.

His work with hypnosis continued directly from  Freud’s early findings, where the procedure was initially used, but abandoned in favour of other unconscious delving methods such as free-association. Traditional psychoanalytic techniques, although effective, are time consuming, often taking many months for therapeutic progress to be made; psychoanalysis can take years. Erickson wanted a faster moving approach. He believed that the unconscious mind was always alert and listening to the world whether a trance state or waking state;  it was said that he could make suggestions that would lead to a hypnotic state without the client being aware of ‘being put under’ or any such process that could feel unusual or uncomfortable in any way. It must be noted that as the word hypnosis” is used here, it does not apply to a ritual but to a type of communication between people. Milton Erickson explored an almost infinite variety of ways of inducing hypnotic trance and he used this knowledge to engage in what seemed to be perfectly normal conversations with clients however these speech communications would induce a trance.

Acknowledging that both hypnosis and therapy require persuasion, a degree of cooperation and motivation from the client, Erickson recognised that even when motivated, clients would still resist the benefits offered by the practitioner. There are two main types of resistance: not being quite cooperative enough, and being too cooperative. When a subject does not respond quite as he should, the therapist accepts that response, and encourages it so that the client finds himself caught; his attempt to resist is now defined as cooperative behaviour; No matter what he does, he is following the therapist’s suggestion, obliging is unavoidable, and once that is acknowledged it makes the whole process clearer. Once the client and counsellor are truly working together the new desired behaviours can be introduced and accepted.

Reframing would be used to recast a particular conflict or situation in a less threatening light. For instance; a father who constantly pressures his son regarding his grades may be seen as a threatening figure by the son. Reframing this conflict would involve gently steering the conversation into focusing on the father’s concern for his son’s future and helping the son to “hear” his father’s concern instead of constant demands for improvement.

Another technique he used, providing a worse alternative; directing the patient in one direction in such a way that he is provoked to go in another. He might ask for a response the subject does not care for, and the subject will then choose an alternative in which he participates fully. We commonly call that ‘reverse psychology’, and although with our traditional views on therapy it may seem odd for a therapist to practise in this way, Erickson proved that using this technique can sometimes provide the jolt a client needs to stimulate their autonomy kicking into action.

Sometimes when a client is particularly resistant, Erickson tried communicating in metaphor; when A is resisted, the therapist can talk about B, and unconsciously realising that the two are connected, the client can do the processing at a more comfortable level for the client.

He also advocated encouraging relapse in clients that were ‘too receptive’. He was aware of the potential for transference within the client/counsellor relationship providing a situation where the client may want to please the therapist, often through ‘over cooperating’. By encouraging the client to revert to previously discarded behaviours, he created a situation where they have either have to resist (thus breaking that transference, and pushing the client into independence) or comply, whereby he can ascertain that the therapy hadn’t been truly effective and then work with the client to find other ways of achieving the desired result, in a more effectual way.

These techniques lend themselves particularly well to group therapy, and as such Brief Strategic Therapy is commonly used as a family therapy. The therapist can take the directive, creating the right circumstances for clients to really get a feel for the point of view and feelings of the others within the group and challenging the group into working together as a team (or not). The therapist can use his powers of guidance to deal with the issues and perspectives he deems necessary, with his objective perspective.