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 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!