When integrative therapists debase some of the therapeutic approaches

For therapy to be successful I believe that it is essential that clients feel comfortable and safe with their therapist so that they can start an open and frank dialogue. Various research findings have indicated that the working alliance is as important as any other factor in successful therapeutic outcomes. John C. Norcross’s approach to integrative psychotherapy involves selecting models and methods from across orientations so that the client’s experience is best met and in context. He shows how meta-analyses demonstrates that tailoring therapy to the individual client enhances treatment effectiveness.

I sometimes wonder, however, whether integrative therapists debase some of the therapeutic approaches. When you look at various profiles on therapist directories, for instance, it is not uncommon to see practitioners describing themselves as analysts, gestaltists and CBT therapists. On closer inspection such profiles state that their psychotherapeutic training took place at generalist training institutes, usually integrative. Some profiles refer to offering ‘Jungian therapy’ as part of their counselling and psychotherapy private practice. In actual fact, what this means is that they had a few lectures on Jungian symbolism, at best. Their training was not in the Jungian approach, at depth, and they did not have analysis a few times weekly as part of their personal therapy (nor did they benefit from specific clinical supervision in the Jungian approach). The same is true of the Gestalt approach when integrative practitioners may have benefitted from a weekend of experiential work using some of the Gestalt tools and techniques in a very general way. However, they won’t have had any real thorough training in the Gestalt approach.As for CBT, it has been my experience that integrative training institutions are biased against the CBT approach and offer such a slimmed down version of it, as part of their core syllabus, that I wonder why they bother in the first place.

Of course, it is fine to say that as an integrative practitioner one can offer components of certain approaches as part of an overall psychotherapeutic offering, as a kind of generalist toolbox.  Indeed, one can use continuing professional development (cpd) to expand one’s knowledge base in particular areas throughout one’s career. However, I find it disingenuous to talk about being an analyst in the absence of specific training in that approach.

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Consultation or all vision, not supervision

Therapy Today Noel BellThis is my letter to Therapy Today, (you will need to scroll down to page 42), which was printed in the November issue, in response to an article on training in psychotherapy, (scroll to page 26), which appeared in the October issue (just click on the highlighted links). As an integrative therapist I try not to fit the client into one approach but endeavour to use whatever theoretical approach that suits and I believe that a good therapist is entirely flexible. Similarly, I believe it is also better that supervisors remain open to flexibility in their theoretical orientation rather than sticking to a fixed way of working.
The word supervision has apparently been debated for many years in our world as to the appropriateness of the term. Themes of control,management,superiority and power can often be associated with the description. I have often wondered whether the term itself sets up the potential for an unconscious creation of a narcissist–co-narcissist relationship. Some have argued that ‘independent consultation’ might be a more accurate term, as is often used in the USA.  I like the term ‘all vision’.

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My interview with Windy Dryden about CBT and integrative psychotherapy

Windy Dryden chats about CBT and integrative psychotherapy.

Windy Dryden chats about CBT and integrative psychotherapy.

I recently chatted with Windy Dryden about CBT and integrative psychotherapy. Windy was the first appointed professor of counselling studies at Goldsmiths College, University of London, in 1992.  In the interview we discuss the challenges of editing the Handbook on Individual Therapy, often viewed as essential reading for anyone wanting to know more about counselling and psychotherapy. We also discussed RECBT, IAPT in the NHS, the Albert Ellis Institute and what is uniting about the different approaches in counselling and psychotherapy.

To listen to the interview click here.

For more information on the UK CBT meetup group with live CBT demonstrations visit their website.

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Noel Bell chats to Asher Quinn about integrative psychotherapy

Noel Bell chats to Asher QuinnI had the pleasure of chatting to Asher Quinn the other day about integrative psychotherapy and his passion for music.

Asher is a transpersonal psychotherapist, shamanic healer and independent music professional, based in Putney, London SW15.   In the interview we chatted about his early involvement with the Counselling Centre for Psychotherapy Education (CCPE), which this year celebrates 30 years in existence, as well as his transpersonal psychotherapy practice.

Click here for the link to the interview.

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Reflections on two years of my psychotherapy training

Holiday time finds me reading books which I had failed to read throughout the year, such as I’m OK you’re OK as well as books which I want to read out of pure interest.  I also find myself reflecting on the last two years as I pass the mid point in my training. I recall what tutors said on the opening evening of the course. They said that we as students would develop as counsellors in our own unique way throughout our time at the Centre.  There was not a CCPE way to developing as a therapist but that we would grow in our own individual way and find our own truth.  I am reminded of this as I write.

As a result I find that I ask myself what is my way?  Have I read enough? What is my approach to counselling and psychotherapy?  What does it mean for me to be an integrative psychotherapist? These are questions that will be perhaps a constant line of questioning throughout my journey as a therapist.

My second year at CCPE has been a time when I have revisited early life issues and experiences. Indeed, Rosemary Cowan [1] points out that the developmental model that CCPE suggested was very helpful to her.  She notes that trainees in the first year were likened to wide-eyed, enthusiastic primary school children; in the second year, like pre-teens, they gain confidence and independence but may also be ‘know-alls’ who overstretch themselves; in the third year they reach the rebellious, argumentative, difficult teenager stage; in the fourth year, with increased maturity and stability, they become more rounded, finished characters.  I am not sure where I fit in with this model but it is an interesting theory.

 I became more conscious of the emotional effects of group-work

I learned a lot about my early childhood experiences and how I act in groups following 16 weeks of group process. Families are, after all, our first blueprint for how we act in groups. It became evident to me that my early experiences were constellating in my life as an adult. I like what Bion [2] said about experiential groups. When under attack it is far more beneficial to one’s own learning process to try to observe that one is being attacked, and take in what that experience really feels like, rather than reacting to the source of the attack.It was also interesting to sit with how I felt about those in the group who didn’t participate in the group’s discussions.

My placement gave me an insight into the limitations of psychotherapy.

I had been fortunate to secure a psychiatric observational placement at an NHS Mental Health Trust where medical students were also on placement. It proved to be an amazing experience from a learning point of view as there were many specialist services in the Trust.

I had been familiar with Cognitive Behavioural Therapy (CBT) before the start of my placement through my lectures and my own prior knowledge. However, I attended a team meeting in a sexual behaviour unit in a forensics unit and learned about the Dialectical behaviour therapy treatment programme.  It was welcome to see that Zen techniques have been incorporated into the treatment models, even in the NHS.

My placement gave me an insight into the limitations of psychotherapy.  Some patients are so ill they lack the capacity for insight and a pharmacological treatment plan is critical for their recovery.  I believe we need to proceed with great caution when working with clients with psychotic conditions as there is often an absence of a healthy ego.

Gestalt Psychotherapy proved to be one of the most powerful components of the course so far

I have enjoyed the second year lectures starting off with short term therapy.  I found the lecture on short term therapy to be very helpful from a practical point of view given that I see clients for an initial period of six weeks at Help Counselling.   One or two lectures (though thankfully the minority) were uninspiring and at times I wondered whether we were really on a postgraduate level course given the poor quality of discourse in the room.

We had a three day weekend on Gestalt Psychotherapy, which for me, proved to be one of the most powerful components of the course so far.  The word gestalt is used to describe a phenomenon/concept in which the ‘whole’ is considered as greater than the sum total of all its parts.  I found the empty chair technique to be a good technique for dialoguing with absent parents, friends or colleague, dealing with unfinished business.

I believe that in psychotherapy clients make theory rather than theory making therapy. I need, therefore, to remain open-minded and use early life theory as a map which might be helpful in the navigation rather than as a set of rules. Pattern recognition is essential to good therapy. The primary difference between talking to our friends or Aunt Dorris is that counsellors are trained to look for patterns.

I believe that transpersonal psychotherapy is not alone in encompassing spirituality into treatment. Indeed, other modalities allow for the spiritual in their therapeutic approach but transpersonal psychotherapy actively involves the spiritual element in the client work.

 

[1] Therapy Today July 2012
[2] What is a Group? A discussion of Bion’s Experiences in Groups Antony Froggett 2005
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Noel Bell interviews Paula Hall, UK based sexual and relationship psychotherapist

Yesterday I had the pleasure of interviewing Paula Hall, sexual and relationship psychotherapist.

Paul Hall (pictured below) is a UK based sexual and relationship psychotherapist who has been specialising in the field of sex addiction for over 10 years. Paula has trained with Thaddeus Birchard in the UK and with Dr Patrick Carnes in the US. Paula is a founder member of ATSAC (Association for the Treatment of Sex Addiction and Compulsivity). Click here for a self assessment tool if you are worried about your sexual behaviour. She is a trainer on the UK’s first Professional Certificate in Sex Addiction Treatment.

In the interview we discuss the nature of sex addiction, the treatment models for sex addiction, 12 step recovery programmes, psycho-therapeutic modalities and her plans for the publication of her book on sex addition and treatment.

Click here to listen to the Paula Hall interview.

 

See also

Sex and love addiction resources

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BACP to close accreditation route 4.3

The Board of BACP has decided that route 4.3 to accreditation will close to new applications on 31st October 2012

Have you been seeing a therapist or counsellor who had not received accreditation through a practitioner course?  Route 4.3 route has been available for over 10 years to allow therapists who were working in the field, before what is currently defined as a practitioner training course was widely available, to demonstrate equivalence of skills, knowledge and practice and to apply for accreditation. BACP* are closing this route to “ensure consistent standards in the future”.

Before I started my training I was curious what existing non accredited counsellors would do in the new regulatory framework.  The experience of being a counsellor must count for a sizable component of one’s competencies but equally students now embarking on the long training path will perhaps wonder how someone should be able to be accredited in the absence of fulfilling the same training requirements.

* The British Association for Counselling & Psychotherapy (BACP) is a membership organisation and a registered charity that sets standards for therapeutic practice and provides information for therapists, clients of therapy, and the general public.

As the largest professional body representing counselling and psychotherapy in the UK, BACP aim to increase public understanding of the benefits of counselling and psychotherapy, raise awareness of what can be expected from the process of therapy and promote education and/or training for counsellors and psychotherapists.

 

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Exercises extracted from the One in Four hand book “The Warrior Within”

It is amazing what you can stumble across on the Web often from twitter links whilst you are looking for other things. For example, today I came across the complete list of exclusive exercises extracted from the One in Four hand book “The Warrior Within“.  One in Four is a registered charity that offers a voice to and support for people who have experienced sexual abuse and sexual violence. As they point out on their website research has consistently shown that one in four children will experience sexual abuse before the age of 18 years.

The organisation provides a unique service to individuals, both directly and indirectly. Directly,through individual therapy and helpline support. Indirectly through campaigning, policy making, in-house research, training, and consultancy work with statutory and non statutory agencies. However, their telephone helpline has been hit due to government spending cuts.

Check out their exercise workbooks which were extracted from the One in Four hand book “The Warrior Within“.  I might add that you do not need to have suffered from abuse to avail of the exercise books. The workbooks are a useful guide in their own right.

See also

My extended interview with systemic psychotherapist, social worker and researcher Dr Marie Keenan, author of Child Sexual Abuse and the Catholic Church Gender, Power, and Organizational Culture. Click here to listen again to the Dr Marie Keenan interview.

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Transference when seeing clients in prison

I have previously discussed the issues surrounding transference and indeed pre transference where I wondered how the circumstances and location of the therapy session affected the minds of both the counsellor and the client. This week I attended a ward round in a health-care setting in a prison as part of psychiatric placement.

The unit serves the prison community which is comprised of adult men, with no upper age limit and accepts patients who have mental health problems. It incorporates those suffering from acute psychotic episodes and/or other mental health illnesses, patients with a personality disorder and some patients with a learning disability. Occasionally a patient with a mental health problem and a substance misuse problem may be admitted. It excludes those patients who primarily have a substance misuse problem.

I was speculating with myself about the type of patient that would present at the ward round. Some of the patients were lifers and seemed resigned to their sentence, others were on remand awaiting a court date.  Seeing patients with suicide ideation can be draining especially when some talk at length and in great detail about how they would seek to end their life.  I felt helpless and powerless, was this my counter transference?  It is also frustrating to hear the evident need for talking therapy resources in such institutions at a time of cut backs and limited resource. However, I was there in an observing capacity and actually witnessed an upbeat and cheerful psychiatrist who seemed to take the ward round very much in his stride.

Resources

RAPt delivers drug and alcohol services – in prisons and in the community – which help people move away from addiction and crime.
Mental Health Care in Prisons a guide to mental ill health in adults and adolescents in prison and young offender institutions.
CARAT (Counselling Assessment Referral Advice and Throughcare) is a drug service that is available in every prison in the UK. CARAT teams were introduced in 1999 as part of HM Prison Service’s strategy to tackle drugs in prison.
Prison Reform Trust a registered charity that works to create a just, human and effective penal system. The organisation was established in 1981 in London by a small group of prison reform campaigners who were concentrating more on community punishments than on traditional prison reform issues.
Evaluation and Treatment of Patients with Suicidal Ideation  

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The Treatment of Eating Disorders in the NHS

I have been continuing with my NHS clinical placement and have been fortunate to shadow the work of one of the largest and oldest established Eating Disorders Services in the world. The service is for anyone from the age of 11 years (with no upper age limit) who are requiring assessment, care and treatment. The course of treatment is offered on an outpatient, day-care or inpatient basis dependent upon the severity and the individual needs of the patient. The Service also accepts patients detained under the Mental Health Act and provides specialist opinions.

The patients present with very severe symptoms and can remind you that psychiatry has its own unique challenges. It has been interesting to note the wider health-care team working with eating disorders, and areas of expertise include occupational therapy (OT),  psychotherapy, social work, dietetics, psychology, family therapy, psychodrama and exercise therapy.  However, treatment has the very obvious input from nursing and medicine as this is after all a psychiatric setting.

The extent of the severity of the symptoms can be gauged from the in ward unit which offers re-feeding including naso-gastric feeding and medical monitoring of people with severe anorexia nervosa in crisis. The service also takes male patients, though I haven’t seen one yet. There is a full programme of groups and individual psychological therapies.

The outcome measures and audit include patient experience, quality of life, and change in eating behaviours. Results show that the majority of patients leave having increased their BMI, reduced use of behaviours and having learned new skills.

I have been intrigued about the approaches taken with such a vulnerable client base. In the outpatient services the multidisciplinary team offers a wide range of evidence based therapies including Cognitive Behavioural Therapy for Eating Disorders, Cognitive Analytical Therapy, Mentalisation Based Therapy, Dialectic Behavioural Therapy, OT, psychodynamic behavioural psychotherapy, psycho-education, psychotherapy groups, and non-specific supportive clinical management or person centred treatment and the nurse led intervention.

Click on the links below if you are effected by any of these issues.

More soon.

Resources:

The treatment of Bulimia in the NHS
Overcoming Eating Disorders
Eating Disorders and NICE guidelines
Information and help for Eating Disorders
Eating Disorder information leaflets

 

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