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’.

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

Group Supervision

I have now had my first group supervision session for my drop in centre.  It was an amazing experience to be amongst about 18 trainees bringing all sorts of issues to group discussion.  Confidentiality of client issues at drop in centres is usually within the context of the organisational framework and thus at group supervision you will hear  all sorts of presenting issues from drop in clients (counsellors maintain their own notes for their contracted clients who they might see at the centre).  I was struck by the dynamic in the room and of the incredible morale in the group.  Sir Alex Ferguson would have been proud.  Some trainees (in the 4th year) were having their last session that day and it was encouraging to hear their tribute to the group and the feedback they received from others.  They provided a very telling testimonial of their time at the centre and the benefit of having a robust group supervision framework in place.