A Therapist in Therapy

I think I am in a fairly unusual position (at least judging by the small sample of my own personal acquaintances) of having a relationship with my own therapist which predates the beginning of my training, so I suppose my experiences of being a therapist in therapy are likely to be atypical.

 

There was no concern, for example, about needing to ‘get my counselling hours in’, no urgency to stick with a therapist and just get the thing done. I feel very lucky to have had an established relationship and to have avoided the frustrating and sometimes futile search for a good relational match in such a limited time.

As I read through the BACP professional conduct hearings, I have often been struck by the high number of cases brought by trainees or qualified therapists. I suspect that prior knowledge of ethical considerations and what constitutes good practice may account for some of this, and it links with the Macaskill and Macaskill statistic that 27% of therapists in training report experiencing harm in therapy, which was highlighted in Philip Cox’s recent article.

Reflecting on my own therapy, I believe there has been some evolution in the way we work – as an example, my therapist recently offered me a reference for a research-related chapter he thought I might find interesting – however I am aware that I like to keep an ongoing conversation in all of my therapeutic work (as a client and a therapist) about therapeutic purpose, and clarity in boundaries which ensures my therapy can retain purpose and direction, and avoid meandering into supervision or collegial chat.

I have learnt a lot about therapeutic practice from my therapist, but much of this has been unconscious learning, and a byproduct of good therapy rather than a conscious effort on my part to take note of the way he practices. This feels organic, and not a primary purpose or outcome of the therapy.

I find myself curious about what it might feel like to counsel a therapist. My sense is that there could be a number of potential difficulties for therapist and client to navigate.

I have heard it said that counselling trainees can be frustrating when the client views the therapy as simply another hurdle in the race to qualification, rather than an opportunity to engage at depth. Impatience on both sides of this type of situation is likely to be a major barrier to psychological contact, and it seems really important to have an ongoing dialogue about therapeutic aims and how the relationship is working. I think it’s also important to avoid falling into a generalisation that any trainee that walks through the door will be motivated by the course requirements rather than a desire and willingness to engage with the process.

As with any client, I think it’s important to be aware of whatever might be lurking in our shadows when working with therapists or trainees. Unconscious competitiveness, sensitivity to one’s work being judged, desire to mentor, desire to identify, underlying resentments about specific training establishments, assumptions about trainees or desire for friendship could all interfere with the effectiveness of the therapy if left unacknowledged and unchecked.

Not only do therapists deserve effective therapy in their own right, but I would argue they need it to be effective therapists themselves. It is my feeling that any potential barriers to the work of therapy need to be brought into the daylight should they emerge in the relationship.

I would also encourage any trainee therapist who does not feel they are getting effective therapy, and has not been able to resolve the issues within the relationship, to find a new therapist. I don’t think there is a more valuable part of the training process than the opportunity to explore oneself at depth. It is not something you want to miss out on.

Awareness and The Counsellor’s Unconscious

We all know that a therapist should possess good self-awareness. But how do we know what good self-awareness looks like? After all, we do not know what we are not aware of. We do not know what lurks in our unconscious until it arises into consciousness. For this reason, I think that self-awareness can never be declared to be achieved. We become increasingly self-aware as we uncover more about ourselves and our experiences, however self-discovery is not something we stumble upon, or even work to one day achieve; it is a lifelong process.

Steve Page looks at elements of the counsellor’s unconscious which may impact on therapeutic work through the lens of the Jungian concept of shadow in his excellent book The Shadow and the Counsellor; one of my takeaways from reading the book is that our unconscious processes as individuals, and also as a profession inevitably influence our work (and indeed our lives) at all levels, and it is our responsibility to manage our own shadow material as it emerges, whilst also acknowledging our unconscious’s ubiquitous, albeit often silent presence.

Countertranference responses in particular might not always be immediately apparent to us. I think that by being non-defensively aware of their potential to emerge, we give ourselves the best opportunity for making the unconscious conscious, and for appropriate reflection.

If we acknowledge the potential of unconscious material to emerge without our awareness or conscious control, it follows that a client may spot unconscious material before the therapist. This is where our capacity for self-reflection is really important.

It may be tempting, for example, in response to a client saying something like “What you said really hurt; I think you are frustrated with me” to respond immediately with a consciously congruent response such as “No! I am not frustrated. You misunderstood my intention.”.

The trouble with an immediate and non-reflective response such as this, is that it runs the risk of invalidating the client’s experience of the therapist, and presumes an instant understanding of processes which might be outside of the therapist’s awareness. Perhaps the therapist really isn’t feeling frustrated at all, which is perfectly possible, but to jump directly into a rebuttal without first exploring possible unconscious feelings runs the risk of being seen to be defensive or incongruent. Much better to explore this feeling together and work out what is happening in the relationship through here-and-now discussion.

Not all unconscious material will have a negative impact on the relationship, and it is likely that many things emerge from unconscious responses which are never picked up upon by either counsellor or client. In moments where an unconscious action jars with the reality of the relationship or the role, we are more likely to become aware of its presence. I feel that any awareness we can glean of our unconscious is a positive thing, though it’s perfectly feasible that nothing will need to change as a result of bringing something into consciousness, so long as it is not negatively impacting on the work. The positive part of its movement into awareness, is that it may then be monitored and reflected upon moving forward.

Rollo May (1965) makes a distinction between “intention” (conscious motivation) and “intentionality” (unconscious motivation) which I believe is a useful frame through which to view every intervention made in the therapy room. I think it is important to look at what we are doing with clients and ask ourselves not only “What is my intention?” but also “What is my intentionality?”.

So rather than aiming for an unmeasurable level of self-awareness, I am focusing my energy on developing my capacity to self-reflect and be reflexive in my work and my life as a whole. My feeling is that this is the food and sunlight required to allow my awareness to continue to grow.

For me to achieve this, I think I need to continue to accept my unconscious, to welcome it as a part of me and continue to be curious about what it has to teach me. Working with a non-defensive openness to how others, especially clients view me, is a crucial part of that process – both for forming good working alliances with clients, and also nurturing and allowing movement in my own self-development.

Refs

May, R. (1965) Intentionality, The Heart of Human Will. Journal of Humanistic Psychology, 5 (2).

Page, S. (1999) The Shadow and the Counsellor. New York: Routledge.

The Resilient Therapist

Last week, I wrote a blog post titled The Vulnerable Therapist, exploring the inevitability and value of vulnerability in a therapist, and how this is expressed  in the therapeutic encounter.

In this post I would like to explore resilience as a counterbalance to vulnerability. If our vulnerability is to be managed in the counselling room, I believe that our resilience provides us with the strength and courage necessary for the job.

So what is resilience? The BACP describe it as: “the capacity to work with the client’s concerns without being personally diminished.” (BACP, 2016) and as I browse the internet I find it variously defined as the ability to get up after a fall, and the confidence that we have the ability to deal with challenges should they head our way.

I like the latter definition most of all. It seems to me that our vulnerability becomes something we can embrace rather than fear when we trust ourselves to deal with whatever challenges may arise. To develop this inner-confidence, we must of course have adequate support in place for ourselves – a reliable network which we know we can call upon should we need to. In my work as a counsellor, supervision is central to this. I would also count my therapist, university tutors, peers and family among those who contribute to my resilience in different ways.

I do not think resilience can truly be present without self-care. Breaks, creativity, fun, rest and attending to our own needs strengthen and enrich us. If we are approaching burnout we are becoming personally diminished, and therefore our resilience is diminished too.

So while I am celebrating vulnerability, I also want to give a little shout out to resilience. These fraternal twins of wellbeing are essential parts of who we are as therapists, and as people.

Reference:

 BACP Ethical Framework. (2016). [pdf] Leicestershire: BACP. Available at:  https://www.bacp.co.uk/docs/pdf/15595_ethical_framework.pdf. [Accessed 16 Jan. 2018].

The Vulnerable Therapist

Vulnerability is an inevitability in human relationships, and the therapeutic relationship is no exception. If relational depth is to be achieved in therapy, both parties must bring something of themselves to the relationship – to put trust in each other and the process – to become vulnerable.

As well as being a building block of relational depth, therapist vulnerability can also model an acceptance of feelings, and a sense that it is possible to meet one’s own needs. I remember an occasion when my therapist said to me “I felt vulnerable. But that’s okay. I like that I can be vulnerable, and I can take care of myself.”. Here was somebody sitting in front of me expressing vulnerability and I did not have to rescue or protect them – this was a big moment of learning for me and has changed the way I view vulnerability, in myself and others. It was a huge step on my journey towards acceptance of all feelings.

Recently though, I felt jarred by hearing from a tutor “I am a vulnerable practitioner; if the client doesn’t want a vulnerable practitioner, they can find another therapist.”. For me there are a few questionable things about this statement. Primarily, I do not believe there is such a thing as an invulnerable practitioner, and I think this hypothetical client would probably spend the rest of their lives searching for such a person. I believe the tutor was really referring to the means by which he expresses his vulnerability to the client. The statement in question came as part of a debate about self-disclosure, and self-disclosure is one means by which a therapist may express their vulnerability to a client. The tutor did point out that he wouldn’t self-disclose to every client and he would make a judgement in the moment, which seems to me to show a willingness to adapt to the needs of the client. I believe that if the therapist is willing to put the needs of the client first and to express their vulnerabilities in ways which do not unsettle, antagonise or trigger a vulnerable client, then the need to find the mystical invulnerable therapist should never arise.

Some therapeutic relationships may be very delicately balanced, and if copious expression of therapist vulnerability in any way threatens the safety of the relationship from the client’s perspective, I would argue such exploration is better reserved for supervision and personal therapy, at least until the client’s needs have shifted. My first question, as I consider the appropriateness of any intervention, is always: “Who does this serve?”.

But I do want to celebrate vulnerability. It is what makes us human, it is the seed from which empathy and compassion can grow. It nourishes all of our most intimate human relationships. To love vulnerability is to love ourselves – it is a part of myself I would not wish to be without.

Can Effective Supervision Prevent Harm in Therapy?

Philip Cox’s recent article on harm in therapy got me thinking about the value of the supervision I seek, and my relationship with my supervisor. I like the notion that the word supervision literally means “over-view” and I can picture my supervisor in a little helicopter, observing the wider picture as I manage the finer details on the ground.

So what is the purpose of supervision? For me, the supervisory relationship serves several functions.

Firstly, I have a trusted and confidential space to discuss my work with clients, which feels like an essential counterbalance to the isolating nature of the work which is so often talked about in the profession. It is in itself a form of self-care.

Secondly, I find the strength of the relationship provides a solid platform on which I know I can stand when I need to. I feel confident it will not break beneath me. This security gives me the courage to co-create new platforms with my clients, on which they too can stand and experience safety within the relationship. Being part of this solid base for my clients feels possible because I am anchored by my own firm footing in supervision.

Thirdly, the trust I have in my supervisor helps me in a number of ways. Through talking about client work and other areas of my process openly, I have allowed myself to become vulnerable, and at no point have I ever felt judged. This mirrors beautifully the function of the therapeutic relationship and allows me to bring whatever I need to discuss to supervision, even times when I feel I have made mistakes in my work. The transparency allows us to shine a light on areas of my work that we might otherwise miss, and to raise anything to my awareness which might impact on the work. I value my supervisor’s willingness to challenge me, and to be challenged; I find the parts of the work where we each hold different perspectives the most illuminating of all – there is always so much to learn and to take forward into my practice. Parallel process fits nicely into this area of working within the relationship; it is a fascinating phenomenon and, I find, rich with data about myself and my relationships with clients.

Do I disclose all my thoughts and feelings about the work to my supervisor? Well, I try to, but there will always be things outside of my awareness which don’t become immediately apparent. As my supervisor gets to know me better, he becomes even better placed to spot my shadow material as it emerges and bring to my attention anything I might not have seen. I try to make a point of accepting the observations he makes curiously and non-defensively, even if I do not recognise what he is saying. I find this work exciting and engaging.

A good supervisory relationship doesn’t make harm occurring in client work an impossibility. It would be arrogant and naive for any therapist to assume they do not have the potential to do harm for any reason. But I do think that supervision is an important safeguard against harm. When we have a trusted relationship, a space to explore every aspect of ourselves and our actions towards clients, we have a safety net – the opportunity to catch areas of the work which could become problematic before any harm occurs.

I think this is as true for very experienced practitioners as it is for those at the beginning of their career. Certainly the nature of supervision for a practitioner with forty years experience is likely to differ from that of a student or newly qualified therapist, but all therapists require support, and of course, we are all vulnerable to the emergence of shadow material – supervision is an important part of managing this throughout our career.

 

 

 

Searching for a Therapist – Some Considerations

Whether it is your first time seeking therapy or you are changing or restarting, looking for a new therapist is a daunting task. You are likely to have pressing difficulties in your life and the last thing you want to do is to spend time figuring out which therapist and approach is right for you. In this post I intend to focus on some considerations which may be important to you when looking for a therapist.

  • Therapeutic approach This may or may not be something you consider when searching through the wide variety of counsellors and psychotherapists registered with the popular internet directories. Thinking back to my own initial search for a therapist, I did not know one approach from another, and the modality of the therapist barely crossed my mind. What I have learned from my own journey, is that the quality of the therapeutic relationship is key to positive outcomes in therapy, and research has shown this is a more influential factor than the therapist’s theoretical approach. Broadly speaking, some modalities may be more beneficial for certain people or difficulties, and more information about therapeutic modalities can be found here.
  • The right therapist There is no easy way to tell from a directory listing or website whether you will work well with a particular therapist. You may have preferences around age, gender, location or price. You may prefer a therapist with a particular area of interest, such as working with LGBTQ clients or religious issues. Those preferences may provide a helpful foundation for your search. It is often useful to read carefully through what the therapist has written about the way they work and their philosophies. Does anything resonate? Is there anything you don’t agree with? When you meet with a therapist for the first time, it is important to remember that you are both exploring whether you will work well together. You are not committing to working with this therapist; you are essentially interviewing them – deciding if you want to hire them. If at all possible, I recommend meeting with more than one therapist to get a feel for different styles and personalities before you make your choice. Many therapists offer a free initial consultation or phone call – take advantage of that.
  • Professional Body Membership There is no statutory regulation of counselling and psychotherapy in the UK. This means that therapists and organisations do not have to be a member of a regulatory body to practice, however, in my opinion most reputable therapists are members of a professional body (either personally or organisationally). Membership requires the therapist to keep up-to-date with their training, seek appropriate professional supervision and work to an ethical framework. These things protect clients and promote quality therapy. I recommend that before meeting with a therapist, it is a good idea to make yourself aware of which professional body the therapist is a member of, and check the professional body’s online register to ensure this information is up-to-date. The BACP register can be found here. If you are seeking therapy through an organisation, it is worth checking the organisation’s professional body membership too.
  • Is this okay? No matter whom you work with, therapy is likely to be uncomfortable. You are working with difficult and sometimes distressing material and talking with your therapist about how you are experiencing therapy is often an important part of the work. Your therapist should listen to any concerns you raise and seek to address them with you. This is a collaborative process. If you feel that your relationship with your therapist is problematic, and this is not resolved or addressed by discussing the issue with the therapist, you may decide that you would be better served seeking therapy elsewhere. This is okay and your therapist should not pressure you to stay. If you are unsure about any aspect of therapy with a BACP registered therapist, you can contact BACP’s Ask Kathleen service for confidential guidance and advice. Ultimately, I would say trust yourself  – you are the expert on you and best placed to decide whether the relationship is right for you.

Peering into Dreams

Last night I dreamt that a large snake was swallowing a smaller snake. Aghast, I pulled and pulled on the smaller snake to prise it from the larger snake’s jaws. When I finally pulled the snakes apart, they both were dead. 

I ruminated about the meaning of the dream and what the two snakes might represent. I decided that they might represent parts of myself – the larger snake symbolising my present self and the smaller snake a representation of past experiences or former versions of me. In trying to keep those parts of myself away from one another I lost them both. I see this as a powerful reminder that my past experiences serve to nourish the person that I am today. The message I take from this dream is that rather than try to hold areas of my experience in isolation, it is important for my growth to seek to integrate aspects of myself into the self-structure, as Carl Rogers theorised. It feels like a wholly positive and wholesome reminder.

Is this what my unconscious had intended me to take away from this dream? The answer to that is, well, unconscious. But this meaning resonated with me, and it helped me to refocus and reflect. For me, this is the value of dreamwork. Those hidden messages; whether spontaneously existent or emergent in the interpretation, they nourish and inform us. The unconscious is a wondrous place.