Journal post 29; 29th april 2013

 

I began today feeling okay about things. For me; I feel that recently my placement work has really compounded a lot of the theory work we have been doing, and my confidence as a counsellor has increased. Of course, as my out of college workload has increased I have found less time to spend on my written work, not to mention any relaxation pastimes (I can’t remember the last time I picked up  a piece of knitting and sat down for an evening’s TV watching) – but I am okay with that. I am comforted by the knowledge that is the last few weeks of the course now, the final push, so this is what I expected to happen really. Of course, technical issues (like losing an entire weekend’s worth of work due to a computer crash late on sunday night) don’t help matters, but hey – what can you do?

We began by recapping on person centred theory and practise in relation to an existential perspective, and how this should be conveyed in the exam. An exercise on enhanced empathy  was enjoyable, even if I did unconsciously put myself in the ‘rebel’ role again in class discussion, and lay myself open to criticism. I always seem to do that, throw a slightly controversial perspective on things – it’s like I just feel the need to mix things up a little bit all the time. The issue debated was; how much of one’s own personality should be brought into the counselling room in a session? Of course a counsellor should always be congruent, I feel this wholeheartedly, and cannot imagine working in any other way now – but I told the group about my placement experience last week, where a moment of silence and reflection in the session had been rudely interrupted by an engine being revved outside (there is a mechanic working directly behind the building). Upon being interrupted, as we were, I felt the client’s  annoyance at the noise, and had voiced it, saying (not over aggressively, but with a snark in my voice nonetheless) ‘Oh, will you please be quiet?’ towards the window, where the noise was coming from. This felt appropriate to me to say, as it was what I was picking up from the client, and the client certainly didn’t seem to mind my reaction – he was too cross with the noise to be cross with me. Our moment of reflection had already been broken, and voicing our shared annoyance at that seemed to strengthen our togetherness, to me,  and I very much believe, to him as well. The other members of the group were concerned that my voicing of the annoyance might have taken away from his feelings in the moment; that my personality being shown might overshadow his. I listened, and understood what they were saying, but ultimately found that I could not agree – I still feel that therapeutically, it is our relationship that carries the weight of our work, and part of that relationship rests on my personality being involved. Certainly, the session is not about me in any way, shape or form, but to inject a little of me into a reaction doesn’t feel wrong to me. Well, it didn’t, anyway.

After that, we took a long time digesting the concept of Martin Buber’s ‘I-Thou’ construct. This is concerned with the way the individual relates to the rest of the world, bridging the gap between phenomenology and existentialism. Phenomenology involves  working within the client’s frame of reference, in the here and now – by linking it with existentialism we take that internal process and link it with their view of the world, their existence and their place in the world. The relationships between objects (meaning literally, objects, or people)  can be described as I -It ( a relationship which has no empathy with the object, no real connection) or I-Thou ( a relationship where the object holds a place for the individual, the individual has feelings for it, is connected to it) Once a therapist has ascertained whether there is an I-Thou relationship with an object they can begin to work on the feelings towards it. For example, in the case of an addiction – what is the role of the object the individual is addicted to? Is it a transference relationship? How will the therapist work with that? It gives us, as therapists, tools into empathising on a deeper level and direction for our work. This was brilliant for me, as one of my placements involves counselling addicts in recovery. I felt very excited that this had given me new perspectives to take into supervision with me later this week.

After lunch, we were watching skills videos again; this time it was my turn to be the client in the video – quite a traumatic experience, actually. This particular video had been shot 6 months ago – a lifetime in terms of my learning in my way of being. I couldn’t bear it, and spend the whole duration watching between my fingers, as my hands covered my face in horror. Aside from all of my usual annoyances that I have about watching myself (my weight, my voice etc) I felt a huge sadness at the incongruence conveyed by my past self; I laughed almost all the way through, despite talking about really sad experiences. I presented my information factually, as if I were disconnected from it, yet appearing to be open and okay with my dirty laundry being aired – plainly I wasn’t! I know that this video was made before my medication levels had been really looked at in detail, maybe that played a part, but the overall feeling I had was of someone who lacked self awareness in her whole demeanour, as far away from being an effective counsellor as it is possible to be. Funny, yes – quirky, yes, probably quite nice to be with at a party or something, but not a confidante, not a fellow journeyman.  I hope I have moved on as much as I think/want to have, I really do.

Process group was awful. Painful. Literally. My head started hurting towards the end of the video being shown, and built and built throughout one of the quietest, slowest, most torturous process groups ever. Hardly anyone spoke. I know why it was torturous, but I wasn’t going to say. I couldn’t be bothered to – and no one else was going to either. It is because our group has been fragmented, the splits within it have finally been acknowledged – they were out loud during our extra workshop last week. Almost all of the group members were finally present this week – way, way, way too late in the day to change things now, as far as I am concerned. I am not interested in them as participators anymore, I am sorry to say. I ran out of empathy a while ago, having given them the benefit of the doubt again and again. So, as a result there seemed little point in participating in process with them. My head was pounding by then, despite the tablets I took, and after the group had finished, I made my excuses and left the day an hour early, to go home and lie in a dark room. A somatic response to stress, pain, frustration, disappointment? Probably. Definitely. A lack of congruence in not saying anything? Just exhaustion, I think, and a feeling that it is pointless. *sigh*

 

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.

 

Journal post 20; 11th february 2013

A Good Read

A Good Read (Photo credit: Them Elks)

I didn’t go in this week. Again… I know. I feel bad about it. In my defence, it did snow. Fairly heavily, I suppose – I mean, it would have been hard to reverse the car out of the road, but truthfully – there was another reason why I didn’t go in. In my heart I really didn’t want to. I felt wounded by what I perceived as the ‘attack’ the week before, where I had arrived feeling so good about my placement, and felt that I had cold water poured on my joy by (a few of) the others in the group, tutor included.

Anyway, I have discussed it all with my (new) supervisor, and I think I feel okay about it now. She says that she has no worries about the way that I am working, in regards to safety and ethics, and suggested that I have a chat with my regular tutor (J) about it when she returns. Having previously had the ‘okay’ from her about my work there, I can’t see it as being a problem, so I feel better about things.

Oh, did I mention my new supervisor then? *acting faux surprised* I think she is WONDERFUL! I have met with her twice now, and I love going in to see her; I can talk about anything there (provided it is relevant to the work, of course). She works to the Proctor model (normative, formative, restorative ) which suits me very well.

So far it has been like this; I bring my clients in to her, give her a brief description of how I perceive them to be, we talk about the sessions, what work has gone on, how they seemed to react to the work, what has impacted on me the most, what are my feelings are about it, how I felt I was working – success as well as concerns, did I have any ideas about how things may develop, and the measure of the work to both the service provider and my college course. She gives me her feedback and shares her insight on how she feels I am doing. It feels very different in the room, to that of a regular counselling session – even though we use her regular counselling room – for one thing, she likes us to have a cup of tea or coffee together, saying that this is one way she distinguishes between clients and supervisees. I like that; little things like that do mark a difference, and make me feel more like a ‘grown up’ in the room with her. That we are two professionals, sharing case notes together – which is, actually, what we really are! It feels good, it feels that I am a ‘real live counsellor’ finally – which I can still can’t fully believe is exactly what I am these days!

Her input to my work has had many effects; for one, I feel lighter with it. I feel supported, that I don’t have to hold the mass of all that goes on in my counselling room alone. My clients give me some of their heaviest weights to hold – it is my job, and I am happy to do it, but to feel that I have someone to share my load with feels comforting, and lightens it for me immeasurably. She has increased my confidence in my work. To have someone to sound off to; run things past; check out how they think I am getting on with the work is bolstering. She reassures me about this line of work which is, after all, 99% instinctive – and as such, one can never fully know that one has always been ‘correct’ as there is no real check-list to work from. Being a student; being ‘green’, I feel nervous at times – there is a real feeling of having been tossed in to the water, and the gravity of the work, the importance of this relationship to the client and their life, their future, does sometimes pull at me. But she helps me to remember that I can float without even realising I am doing so, and that by applying thought and doing what I have been trained to do, I can actually swim rather well at times! I feel that we have an honest and open dialogue – not everything she says is ‘super positive’ – I feel sure that she gives her honest and critical opinion, but she definitely shows me unconditional positive regard too, which makes me feel safe, and in turn, more able to be congruent with her, and able to confide my doubts and fears.

Coincidentally, the book I am reading at the moment, “When Nietzche Wept” by Irvin Yalom (who I now think can be officially elevated to the position of my all time favourite psychoanalytic writer – I am sure he would be pleased to know) illustrates the three way, client, counsellor, supervisor relationship beautifully – and also, with that, the potential transience of these roles within the triad. After all, we all learn from our clients as well as our supervisors; the learning is shared three ways, and although the non -fictional counsellor should never switch  roles with the client or supervisor (clear contracts have been agreed upon), the beauty of this novel is that it is set at the birth of psychoanalysis, where these rules hadn’t yet been established, and so Freud, Breuer and Nietzche all take on each of these roles at different points through the novel, muddling through and exploring methods of working.

I have spent the last few months working my way through many different styles of writing – training as a humanistic counsellor leads me to read a lot of existential literature, and I have found this Yalom novel to be a breath of fresh air, even though it deals with essentially the same type of content. Mind you, the last few works I had read were by Kafka, Camus and Dostoevsky though, so that is probably why it feels so light in comparison! I must be careful, I suspect I may be becoming a little evangelical, preaching the power of Yalom to everyone that will listen, and we all hate being preached at, don’t we?

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…

 

Journal post 16; Monday 14th january

Today, we began by looking at ‘strategic therapy’ – a model originally developed by Milton Erickson (who is often credited with the founding of several popular NLP techniques that are commonly used) and popularly advocated by Jay Haley, for use in brief courses of therapy. The therapist initiates what happens during therapy and designs a particular, individualistic approach for each problem. “Strategic therapy isn’t a particular approach or theory, but a name for the type of therapy where the therapist takes responsibility for directly influencing people” (Uncommon Therapy: The Psychiatric Techniques Of Milton H. Erickson MD)

We went on to discuss Milton Erickson’s techniques. He was quite a controversial figure in psychology, being largely self-taught, and favouring methods that some considered unorthodox. He regarded the unconscious mind as creative and solution-generating, and used approaches such as hypnosis (although his definition varies from the commonly held image of a client being put to sleep and being made to do things that they would not usually consider doing – his meaning of this word is more to do with achieving a deep state of relaxation and ease with the client, whereby they are more receptive to ideas that the therapist suggests, more aware of intonation, tone of voice, more perceptive of other signals that could be given), working with metaphor (a wonderful example was given of his discussing sex with a couple who he was counselling – he used the simile of a three course meal – did they prefer to slowly savour their food, enjoying a leisurely entrée with a good wine, or was it better for them to rush through to the dessert?) reframing (suggesting it would be more bother to continue presenting symptoms of unease than to give them up)and my favourite – encouraging resistance (whereby the encouragement of the client’s negativity to any suggestions by the therapist, creates a situation where the client, wanting to oppose the suggestion, finds himself unable to resist without cooperating with the very aim of the therapist anyway – often described as ‘reverse psychology’)

In reading about his work, and the lovely anecdotes about his unusual approach to it, a real sense of his quirky personality came across, and the obvious success of his uncommon methods made me warm to them, rather than reject them.  These all seemed to me to be really effective, exciting techniques; but I completely appreciate that a great deal of skill must be acquired in order to practise in this way. Definitely to be used by a confident, experienced and highly intuitive therapist – I have a long way to go yet!

The book by Jay Haley ‘Uncommon Therapy’ (a copy of which I simply had to order, as soon as I got home) describes his technique beautifully here;

One way to view the strategic therapy of Milton Erickson is as a logical extension of

hypnotic technique. Out of hypnotic training comes skill in observing people and

the complex ways they communicate, skill in motivating people to follow directives,

and skill in using one’s own words, intonations, and body movements to influence

other people. Also out of hypnosis come a conception of people as changeable, an

appreciation of the malleability of space and time, and specific ideas about how to

direct another person to become more autonomous. Just as a hypnotist can think

of transforming a severe symptom into a milder one, or one of shorter duration, he

can think of shifting an interpersonal problem into an advantage.

This ‘strategic therapy’ ; where the therapist most definitely takes charge of the treatment, and uses their powers of suggestion, intuition, and at times, plain trickery, into facilitating the client’s change of perception – is commonly used in family therapy situation these days. The therapist will focus on identifying problems, setting goals and helping the clients to examine both the outcome and the effectiveness of them. The British Strategic Therapy Centre advertises this on its website by calling it ” the art of solving complicated human problems with apparently simple solutions” and it strikes me that this quite an accurate summary  -of how I perceive it to be, anyway; assisting the client by breaking the problems down into less complex, more manageable issues, and  in turn, helping them to find solutions – in other words COMMON SENSE (!) – What any helping professional would try to do; be they a social worker, a support worker, nurse, care assistant or counsellor.

The discussion within the group was really interesting that day, but was slightly marred by the anxiety that the weather was bringing – snow was falling, thick and fast, and many of us in the group had concerns about travelling home, and about how our children were being affected by their school’s snow policies (School these days seem to just shut at the first sign of snow. In fact, England just seems to lose the plot as soon as the weather starts to get a little more extreme – you’d think we would be prepared for it by now; after all, it happens almost every winter. Grrrr…) So, after a brief chat about the paradox of failure within counselling (can counselling ever be considered a ‘failure – aren’t all experiences, regardless of the positivity or negativity of their perception at the time, simply lessons to grow from; the very aim of counselling) those of us with children who needed rescuing from their schools took the decision to cut the day short; me included. Such a shame, as the subject matter on today, of all days, was absolutely fascinating – well I thought so, anyway…

 

Journal 15; Monday January 7th 2013

The first day back at college after the Christmas break – and what a Christmas break it had been for me! Sadly, my holiday had been one of my worst Christmases ever –  I had gone down, big time, and had been put on some very strong medication to try to help me deal with it. Needless to say, it didn’t particularly help; it simply tranquilised me so that I felt disconnected from everything around me. I made a decision to stop taking the drugs that were having this effect a few days before my return to college, and am sorry to say that the effects of the withdrawal were still taking their toll on me, and as such, my concentration levels on this day were, let us say, “patchy”  Even now, a day later, I am struggling to keep my mind focussed on writing this journal – I know I must try to write down how I feel though, as it is important for me, as a counsellor, to remember the chaos of these feelings whilst in crisis, as this is how many clients will be in initial sessions, and possibly again and again, throughout treatment, as the road to psychological wellness is not always a straight line(in fact it rarely is).

Today’s session was spent discussing ‘solution focused brief therapy’; an approach to psychotherapy based on solution-building rather than problem-solving, and pioneered by Steve DeShazer, who is quoted as stating that ‘the essence of psychotherapy was that the client is helped to make a change in their situation.’

SFBT targets the solution; what the client is striving to achieve through therapy, rather than the situation, event or obstacle that brought them to treatment. The therapist works with the client to place their attention on the present and future, not the past. The client begins by first envisioning what their desired future looks like, and then taking small steps toward achieving that outcome. It is an effective treatment model used across a whole range of presenting issues. As the name describes, it is a short course (anything up to 20 sessions) of therapy.

First, the problem is identified and described; “How often does … happen? How long has it been going on? Has it ever happened before? How did you deal with it then?”

Any goals that the client wishes to achieve are discussed, clients to are encouraged to identify these goals, even when they are finding it hard to see any way through their problem – “What do you want to get out of being here? What will it be like when the problem is solved? What will you be doing instead? When that happens, what difference will it make? What else will be different? What else?” The counsellor can use their questions to facilitate the client viewing their possibilities in a more positive light, encouraging them to imagine the ‘knock on’ effects that reaching their goals will have.

Exceptions to the problem are noted and attended to, helping the client to start to take on ideas that could lead to potential solutions. “What about times when the problem is not happening? Or when it is less? You mentioned earlier that some days/times are better. What is it like at these times? What are you doing instead at these times?”

Scales are another useful tool for the counsellor to use, “If you think of a scale from 0–10 with 10 being the best. Nought is how you felt when things were at their worst. Ten is as good as things can be in relation to this problem. Where are you now on that scale right now?  Give it a number, for example 2 or 3. How long will it take to get to 10? Maybe 10 is too big a goal? Is something lower more realistic? What number will be acceptable for you?” his helps to break the goals down into something achievable so a sense of success, and the encouragement gained from that success can be achieved.

The miracle question is designed to elicit a clearer picture of the client’s future without the presence of the current obstacles they face. “Suppose you go to bed and to sleep tonight as usual and while you are asleep a miracle happens and the problem that brought you here today is solved. But you are asleep and don’t know that it has been solved What will be the first small signs that this miracle has happened and that the problem is solved?” This gives the client the opportunity to visualise how there life could be – a powerful tool in itself, in terms of encouragement and inspiration.

DeShazer said “All that is necessary is that the person involved in a troublesome situation does something different.” It was once I read this, that I realised that SFBT is very similar to the kind of counselling that I had been receiving on an ‘every other day’ basis through the christmas holiday break. My counsellor said those very words to me “just do something different”. He asked me to scale in my mood at the beginning of every session, and he asked me the ‘miracle question’. First at the beginning of the sessions with him, and then again as we neared the end (we haven’t quite got there yet – I will still be seeing him once more). Thinking back, more clearly now, we set goals at the beginning of the treatment and he (very skillfully, without me even realising he was doing it) drew my attention to any exceptions to my own ‘bleak prognosis’ of my future.

Finding it as hard as I have to concentrate recently, this simple yet effective treatment outline was more than enough to focus on. As a client in crisis, I can see now, and understand that any deeper probing into the past may have been too much for me to cope with at that moment – even though, when the psychiatrist tried to tell me this, I argued with him, that being a student counsellor myself, I knew the difference, and I wanted ‘proper therapy’(!)

So, big BIG learning for me  – even with my ‘addled’ brain!

I cannot recall many details from the more practical part of the day. I know that I was ‘present’ for the individual skills part – I may have floated off during the process group a little, and I am quite sure that my mind had fully checked out by the time we hit ‘supervision’ at the end of the day, but in my defence I don’t think I did too badly really; considering the medication I was coming off of. In my head, the feeling was similar to as if I had attended a college session at the tail end of having had a bad cold. I know that I wouldn’t have been able to ‘counsel’ for a full hour in the ‘real world’, but I did muster everything I had in order to manage the 25 minutes skills practise we did, and it did seem to go ok. Certainly, when I reported back to my therapist this morning, he was pleased with my progress, in terms of mood, and quite surprised when I explained to him that his techniques were the ones we had been learning about!

 

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!