Journal Post 19; 4th feb 2013

 

Quite a different kind of day today – our tutor is away for a few weeks, so we have another lady standing in temporarily, and although she is basically sticking to the same format that our days have always run to before, her style and approach is so very dissimilar that the entire day felt completely unlike any other. Not in a bad way, though; and illustrating clearly for me how two counsellors can practise from the same theoretical background, yet so many other factors become relevant to the type of therapy that will be created; connection, personality, mood, energy levels, intuition – basically, the qualities that go into making every person an individual, every relationship an individual relationship, and thus, every therapy an individual therapy.

‘Check in’ was so much more in depth than it had ever been before – we were questioned not just about where we were, right there and then with our feelings and our mood, but D (the new tutor) wanted to get to know us quickly, so she asked us about our theoretical preferences and leanings – a sure-fire way to get to know what a counsellor is all about. She cut to the nub of me straight away and I got a strong feeling that she felt that vulnerability within me that people so often do, making me feel upset with myself. I had invoked that again – do I need to start recognizing this more clearly when I see it? Is it a warning to me that I am either dipping or flying, and not realising, myself? If I am to be an effective counsellor, employing all the BACP ethics and guidelines regarding self-care, and safety of practice, I must pay close attention to these signals. Yes, I know that I know myself, but my condition can mean that I have a tendency to sometimes ignore myself too – I must make sure that I don’t do this if I am to be safe in my work.

After a visualisation exercise, focussing on grounding ourselves, putting our roots down in this room, in the here and now, making us feel so much more present with ourselves and each other – we began discussing Egan’s ‘Skilled Helper’ theory – a very well used approach throughout the NHS in Britain, and a highly effective strategy used within brief therapy. It is broken down into three simple parts, questions – What is going on? What do I want instead? How do I get to what I want?

Stage I, Current Scenario – What is going on? This is where the counsellor uses their exploring skills to gain an understanding of the story – what has led the client to seek counselling. Skills used by the counsellor would be; open-ended questions, silence, focusing, empathy, paraphrasing & reflecting both meaning and feeling, structuring, summarising. Stage 1 can take five minutes or five years – it may be all someone needs – to get their story out and be heard.

Stage 2, Preferred Scenario– What do I want instead? In this part the counsellor will take a more directive role than in the previous stage, exploring possibilities (akin to the ‘golden question’ from SFBT) – what would the client prefer ideally? Using brainstorming techniques, imaginative thinking, prompting the client into further exploration; ‘what else?’ How might that feel? What would you be doing/thinking/feeling? What will be the benefits when you achieve this? How will it be different when you have done this? Reality check; are there any costs to you achieving this? This part of the approach can be used to regain positivity and really play with ideas – give the client an idea of how their life could be and an idea of what they could strive towards.

Stage 3, Action Strategies – How will I get there?  More brainstorming and creativity initially – ‘Let’s consider as many different ways of achieving this as we can’ leading to an exploration of what action would need to be taken, and eventually formulating a plan. The use of SMART goals is recommended here (Specific, Measurable, Achievable, Realistic and Time-phased), and the strategy is broken down into bite sized chunks of action –‘what will you do first? And then…?’

The key with using this model is that the client’s needs must be kept firmly in the centre of what is going on – the model should be used for the client, not the client for the model. Although, as we found when experimenting with using this in our practical part of the session, it is an extremely easy and effective model to use – such a simple strategy can lend itself to many different situations.

During my (brief) session as the counsellor (our group overran with the timing, so I only ended up with a five minute session – seemingly impossible, but strangely, using the highly focussed approach of Egan, it still worked) we found that stage 1 seemed to contain the bulk of the material; in exploring stage 1 fully, the client’s natural coping strategies were revealed, revealing that she had already pulled herself through to stages 2 and 3 without realising. Upon this being noticed, the client felt much more positive about the situation; a few new strategies were batted about, but her confidence was bolstered by the realisation that actually she had already acted in a positive way intuitively, and she felt encouraged to continue with the approach that she had already embarked on. Bingo!

I felt positive after this session, and the feedback given to me by the tutor on the counselling skills I used was lovely; very, very, encouraging. We spent a little bit of time after that watching a video from ‘Ted Talks’, which was great; very informative, and we had a good old group chat with Donna (our course facilitator) after that, which felt productive, but meant we didn’t get any time for a process group (every cloud has a silver lining! I secretly hate process group, I find it so boring and awkward…)

I was excited to get to the supervision part of the day – having recently started my placement; this was the first college supervision session that I would be able to get involved with properly, and I wanted to tell the group about a particularly troubled client I was seeing, who I felt I needed help with.  When I did though, I felt quite upset though at the reaction I got from the tutor. She seemed to leap at me, barely giving me a chance to explain. An awareness of ‘Safety in my work’ seemed to be her primary feeling that she wanted to communicate to me – she felt that I was possibly taking on too much for a student at my point in my training. But the fact of the matter is that in this placement, all of the clients are in extreme crisis, and it does involve taking on heavy issues. I have had real problems finding a suitable placement, and as long as I don’t feel that this is too much for me, I am very reluctant to let this one go. Yes, I have had an extremely positive response, initially, to this new service that has been set up, but I am well aware that this is probably because it is a new thing for the kids at the hostel, and that once they are used to me being around things will probably settle down and I will be less busy. I think that as long as I am aware of how much I am taking on, and make sure that I don’t bite off more than I can chew, so to speak, I will probably be okay. The overwhelming feeling that I have from this placement is one of positivity, and I do not want to let that get squashed. I have an appointment booked with a new supervisor next week, to discuss my work there fully, and I am excited about that, so I hate to sound so terribly rude, but *blows raspberry* – I will be carrying on with this for the time being, at least! Although, in linking back to the first paragraph of this entry, I am well aware of my own issues, and am keeping a self- critical eye on things, don’t worry…

 

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Journal no 12; 6th December 2012

Check in today was very emotional. Only a few of us had made it in again, and it triggered feelings of anger and resentment that I have already mentioned were present a few weeks ago. Whether it was because there were so few of us and the room felt more intimate or the fact that it was just the time for it to come out, there was a lot of upset and frustration erupting first thing. Again; not mine.

Whereas the other group members were feeling anxious and worried about the general workload, and this was fuelling their feelings of rage toward the others who once again had not made it in, I was not sharing this feeling; This year, I have made it my priority to be up to date on my written work, as last year I fell behind and this caused me huge anxiety. Not that I am in any way smug – I am behind on my placement hours, as the counselling placement that I had originally planned fell through, and I know that I am going to have to probably take on 2 placements (more if I can) in order to make up the required hours. This is a huge worry to me. But it did mean that, although empathic to their situation, I did not share it. Instead I was in my own little world, getting nervous about a placement interview, that I was going to that afternoon.

In fact, because of the interview, I had to leave the workshop early, and only managed to take part in one exercise before my departure; a self-study on how we all cope with crisis in our own life. We were asked to think about how our capacity for coping was affected – our capabilities in  decision making, taking care of ourselves, controlling our emotions and thinking straight – how we got through the crisis; what helped? Our own personal resources that we drew on, and finally what the crisis has taught us about ourselves. How have we changed as a result?

I had to leave before we had a chance to talk through it all together, but I spent most of the car journey to London thinking about it (mainly to keep my mind off being nervous, to be honest). In light of the tearful check in, the theme for the day had become one of ‘self care’; understanding our own limits, how important it is for us as counsellors to know when or if we are approaching a crisis moment. Burn out is a very common issue for many in this industry, and the BACP make it clear in their ethical guidelines that a counsellor has a duty of care to the self as much as to the client. After all, if the crisis point were to be reached, clients would end up being let down as well as the self, and that would result in double the fallout.

I feel that I have only very recently brought myself back from the brink of a precipice as far as anxiety fuelled meltdowns go. In fact, just a couple of journals back, I probably sounded quite manic and perhaps even a bit unhinged with it. All it takes, when one is carefully balancing all of their balls in the air (as we all do in life), is for one or two to suddenly get a bit out of synch with the others and before we know it, things are unmanageable all of a sudden. This is a very useful lesson for the counsellor to remember; if necessary, juggle with fewer balls until you are fully confident that ones in the air are bouncing in a good, strong rhythm – do what it takes to keep the rhythm steady, for the fallout when they have all been dropped is greater than losing one or two; As counsellors we are in a position of great responsibility and pressure at times; we have to take that seriously and safeguard ourselves and our clients.

Ironically, my major crisis point in my life (the big one, that I had been thinking about when doing the exercise, not my mini meltdown last week) was the turning point for me that put me back on the road to becoming a counsellor; it took a dramatic turn of events to make me stop and re-evaluate what my existential values really were. What was important to me? What did I need? What could I not survive without, and what sort of life did I want to live, bearing these factors in mind. The upshot was that I closed down a previous chapter of my life, and gave myself a period of enforced rest, before embarking on the next chapter; This one(this links well to the next exercise that I know the others did that afternoon – a ‘road map’ of their lives so far, tracking the decisions they have made so far, and where they could have gone instead, had they chosen a different pathway)

On reflection, even though I probably hadn’t fully processed and dealt with my crisis when I jumped back on to the ‘counselling train’, I can wholeheartedly say that it has been the focus of the course, the therapy that runs alongside it, the self- awareness and reflection that it has brought with it that has got me through and helped me to deal with my traumas. Of course, I know I am not fully there yet, but I know that I am a different person because of these events and this course of action that I have chosen to take,  to deal with them.

I just hope that the interviewers I met with on that afternoon saw all of the learning that has gone on within me, and judge me to me capable of helping others, as I have been helped by this process.  I feel that I have come such a long way on the journey, I don’t want to stop, or lose my pace! Fingers crossed…

 

Journal no 10; 26th November 2012

Today we revisited the hugely important subject of ethics and values in counselling, and in particular, how they relate to us in our placements, and in practise.

The BACP encourages its members to aspire to the following personal moral qualities

Empathy: the ability to communicate understanding of another person’s experience from that person’s perspective.

Sincerity: a personal commitment to consistency between what is professed and what is done.

Integrity: commitment to being moral in dealings with others, personal straightforwardness, honesty and coherence.

Resilience: the capacity to work with the client’s concerns without being personally diminished.

Respect: showing appropriate esteem to others and their understanding of themselves.

Humility: the ability to assess accurately and acknowledge one’s own strengths and weaknesses.

Competence: the effective deployment of the skills and knowledge needed to do what is required.

Fairness: the consistent application of appropriate criteria to inform decisions and actions.

Wisdom: possession of sound judgement that informs practice.

Courage: the capacity to act in spite of known fears, risks and uncertainty.

Through much discussion within the group, we all questioned these qualities within ourselves – whether they had been tested in any situations so far, whether we could imagine hypothetical situations in which they would be tested and so on. We all hope to aspire to these qualities, but there are times when we all question whether or not we may fall slightly short. I know that in a recent counselling session, my own counsellor helped me to identify a need to strengthen my own resilience. The last term of extreme introspection has made me feel weaker and more vulnerable than I ever have before, at times. Of course, at others, it has given me extreme strength and wisdom, and I know that self-awareness is the key to becoming a sound counsellor, so I will learn how to strengthen my own reserves at the same time from now on; Developing our own ways of coping, and improving our practise is easier when we have this structure to work towards.

The BACP website states that the fundamental values of counselling and psychotherapy include a commitment to:

  • Respecting human rights and dignity
  • Ensuring the integrity of practitioner-client relationships
  • Enhancing the quality of professional knowledge and its application
  • Alleviating personal distress and suffering
  • Fostering a sense of self that is meaningful to the person(s) concerned
  • Increasing personal effectiveness
  • Enhancing the quality of relationships between people
  • Appreciating the variety of human experience and culture
  • Striving for the fair and adequate provision of counselling and psychotherapy services

In our group discussion, we all agreed that the morals and values that we have talked about are rapidly becoming who we are.  Confidence in our abilities as therapists has led to less fear of any awkward issues arising. For instance, one of the hypothetical situations that many of the group expressed nervousness about dealing with would be in a case involving child abuse.  However, on further exploration of those feelings, that fear was dissolved by the understanding that every person that enters into the therapeutic contract is always considered as a human being first; their behaviours are secondary, and a counsellors must never be judgemental, as there is usually a story behind an abuser, leading to an understanding of why they have fallen into such behaviour patterns.

Morning’s discussion over, the afternoon’s skills practise led me into new waters. I purposely chose to work with a group member I don’t know so well, someone I hadn’t ever worked with before. Why? I don’t know, really. The reason I hadn’t worked with her already is unclear to me – I have always thought her a perfectly lovely person, but I suppose I was slightly intimidated by her quietness, thinking it may lead to awkwardness in the counselling situation (there is a judgment in itself – tsk!) Of course, I was completely wrong. It was a wonderful session – I enjoyed being with her so much, aside from the material we discussed, I just loved the feeling of building a relationship. Core conditions established; the relationship is key, and as I discovered then, can be just as powerful for the counsellor as the client. A new relationship can be just as energising within the context of a counselling relationship as they are in the outside world! The inspiration from that counselling session left my head buzzing with thoughts and ideas, and I’m afraid to say I was not a terribly active participant in the process group that took place straight afterwards. All of my learning was going on internally, and I didn’t feel the need to share it with the rest of the group – or more to the point, I didn’t think that they would be interested in any way in what was going on in my head.

On the subject of ‘what was going on in my head’, the last part of the day was spent looking at an article discussing our ‘internal supervisor’ from Therapy Today. The ‘internal supervisor’ is the source we counsellors have within ourselves, an ability to self-monitor, to step back from the situation, both whilst within the session, and afterwards too; to reflect and learn from what took place.  One quote in particular really stood out for me “an internal locus of evaluation can lead the supervisee to lessening reliance on the evaluations and opinions of others, and to developing more faith and belief in their own judgement”

Certainly valuable words for the student counsellor; unsure and nervous about ‘doing the right or wrong thing’ as I am, but equally valuable words for my everyday life too – I must learn to have more faith in my own intuitions; Definitely an ability I have been less confident in over the last few years. Call it a career move!

Journal no 7; 12th November 2012

This week, we spent our morning studying ‘Hobson’s conversational model’ ,  (Robert Hobson, an English psychotherapist  born 1920-died 1999) which has been more recently called a  ‘psychodynamic -interpersonal approach’ to therapy.

At the core of this approach is the concept of self by William James, the philosopher, who said that;

(1) All thought is owned by some personal self;

(2) All thought, as experienced by human consciousness, is constantly in flux and never static;

(3) There is an on-going continuity of thought, as it moves from one object to another, constantly comprising shifting focus and context

(4) Thought typically deals with objects different from and independent of consciousness itself, so that two minds can experience common objects

(5) Consciousness takes an interest in particular objects, choosing to focus on them rather than on others

In my opinion, these concepts naturally lend themselves as cornerstones for a therapeutic process – although it is one that Hobson was ‘unwilling to present as a fixed and definitive set of ideas. To me, it is about fluidity, flux and flexibility, about the process of change – and for that reason, I really resonate with this. (In fact I would say that in reading his ideas on the page, it seemed to articulate all my intuitive thoughts on the essence of the counselling process)

The approach was originally called ‘conversational’ because of the emphasis on the use of language. Hobson stated that the therapist and client have a ‘special friendship’ – therapy, and the therapist  can build this relationship through developing a mutual ‘feeling language’ . The therapist can be with the client ‘together in their aloneness’, thereby helping the client through the development of this relationship and the healing power of ‘being there’ with them (echoing several other attachment theories, to me – I recall Fairbairn and Bowlby talking of rebuilding insecure attachments)

Hobson holds true the fundamental notions of psychodynamic theory; that people repeat destructive relationship patterns from the past, that we all use defence mechanisms to shield ourselves from difficult internal feelings, memories and desires, that our problems can stem from unresolved developmental tasks, that we have a need for secure emotional attachments and that the therapist in working with these issues must be aware of transference and counter transference occurring. Yet to me, it seems that his approach bridges the gap between traditional psychoanalysis, where the therapist is at a distance from the process – abstaining from any self- disclosure or impacting their own personality on the therapy – and humanistic approaches, where the therapist is almost as much a part of the process as the client; where the relationship is the key which unlocks the therapy. The concept of ‘aloneness’ is undoubtedly an existential issue, which requires warmth and compassion in discussion, and imposes personality on all who discuss it. I feel it is this concept of the therapist being integral, as an individual, to the process, that brings the psychodynamic approach up to date – shedding the image of a cigar smoking doctor, holding a notebook, sitting behind a client on a couch, saying very little, and I like that it does that.

AS a group, we spent a long time discussing our inbuilt need to feel some kind of resolution from the counselling interview – that as keen students; heads exploding with theory, we are unconsciously striving to apply that theory and to see some kind of progress being made, for our own satisfaction and the consolidation of our learning. However this is not necessarily what is always going to happen, and often it is just not necessary – the process in itself is enough, and trust and faith in the long term power of the process and respect for the client’s autonomy in their own change is vital, and must be remembered. Often, we are so engrossed in the story being presented, that we forget about the process itself. Supervision is the place where we need to take our reflections on the session, and use our supervisor to help us clarify the power of the process as much as the theory and story. Hobson’s model exemplifies this beautifully.

Luckily for me, I had only recently watched a video of myself counselling, (and bizarrely, fortuitously, one where the volume was very poor) and so I had a slightly more objective view of my own experience of the counselling process to draw from. Because of the poor volume, I had paid extra attention to the body language used, the intonation in voices, shifts in rhythm and the overall feel of the session, and in my reflection I felt my eyes being truly opened to my own abilities as a counsellor. I saw so many areas for improvement, and so many new areas for future work. The benefit of reflection like this is huge, again highlighting the importance and huge gains to be made from supervision. The supervisor is the third person in the relationship, providing that objectivity of someone from the outside looking in – vital and so valuable!

I don’t know whether I was invigorated or intoxicated by this idea, but (in retrospect, foolishly) I put myself forward to be recorded again in the afternoon, and let the whole class watch my abilities as a counsellor on the big screen – an exercise in studying ‘the process’. Why, why, why??? BACP Self care – lesson to be learnt, K, you are not a natural extrovert! Why do I feel the need to constantly push myself forward towards other people with my own personal learning? Firstly, allowing myself to be counselled in front of the whole class during the last lesson of last year, then blogging this journal, then doing this??? Is it for the adrenaline rush? Cos I feel so awful afterwards, having done it – but then I am well aware that I like making myself feel uncomfortable, as I am secretly pleased with myself for having pushed myself through the pain. Ooooh, this really is stuff for my therapy – I’m hearing echoes of the eating disorder inner voice coming back “punish, punish, take control,” as well as the overactive superego, my family telling me ”don’t be shy,” and Fairbairn’s internal saboteur; setting myself up for criticism and failure, some external punishment for my internal self- hater.

Sadly, the crash after I did this, did exactly what the saboteur wanted – set me up to fall, and I felt myself crashing after that – not that anyone around me would have known – well, I may have been slightly quieter outwardly, but I know that I do a very good acting job – I have been perfecting it for nearly forty years now!  The rest of the afternoon was a blur to me, and that evening, and the next day too. It is only now, two days later, that I feel able to write about it, and I still don’t understand it.  More exploration  needed, plainly…