Scientific proof is not the whole story in psychotherapy

Therapy Today May 2015My letter to Therapy Today on the validity of psychotherapeutic interventions, (scroll to page 41), which was published in the May 2015 edition, outside the prism of ‘evidence base’ and randomised control trials (RCTs) in public sector commissioning. This followed an article by the chair of BACP in the March edition of the journal (page 46) in which Andrew Reeves made a passionate plea for qualities of life and non-RCTs when assessing the effectiveness of psychotherapeutic interventions. The issue of how to prove effectiveness may become even more pertinent given the recent change of government when the squeeze on public sector spending might take on a new momentum in the next few years.

 

Do counsellors in training really ‘do the work’

Therapists are human tooI read Dr Marie Adam’s article on ‘Therapists are human too’ with interest (Therapy Today, November, 2014). The article starts by asking whether counsellors in training pitch up for their therapy sessions without really ‘doing the work’. I’ve had the same thought: how many counsellors in training ‘do the work’ even on their courses? Do they turn up at their training institutes to merely tick the attendance sheet for the lecture, supervision group or experiential workshop, without really engaging? I remain sceptical how such individuals can demonstrate the reflective capacity necessary to work in the field of helping psychologically distressed clients, when they themselves, have not ‘done the work’. This raises another important question about the ethical and academic rigour of the respective training institutes allowing such individuals to progress through the prescribed training programmes.

The article goes on to state ‘so many of us are resistant to returning to therapy during hard times’. This may well be true, although I was unsure what data the author was basing this statement on. Was it the people she interviewed or was this her own experience of people known to her? Personally, I know of many therapists who are still in therapy post training or who have returned to personal therapy, be it in hard times or not, without the kind of resistance that the article refers to.

I learned a lot from the article such as the author’s explanation of the Johari Window, which was new to me, as well as the reasons why Carl Rogers became a therapist. However, I do wonder if the underlying assumption within the article was that the therapist is the expert in the relationship and that all therapeutic movement occurs through his or her direction. For instance, the article’s final paragraph alludes to the dangers of the therapist hiding behind a mask of mythical perfection.  I, for one, do not believe that I, as therapist, am the sole orchestrating agent in the relationship nor do I subscribe to the fiction of the untroubled therapist. I believe that would be adopting a self-important position.  I may be a skilled facilitator, as outlined by Egan,[1] indeed, I would hope so after four years of specialist professional training, but as Langs [2] articulates very well: the unconscious of the patient can often be very accurate about the unconscious of the therapist. Therefore, perhaps it is not surprising after all if our clients notice things in us and perhaps we need to acknowledge that we don’t have to be rigid poker faced therapists at all, but maybe just be ourselves and acknowledge our humanness.

[1]  Egan, G. The Skilled Helper: A Problem-Management and Opportunity-Development Approach to Helping. Wadsworth Publishing Co Inc; 7th Revised edition edition ( 2001).

[2] Langs, R. The Psychotherapeutic Conspiracy. New York: Jason Aronson; 1982.

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’.

Do we have ‘wounded-healer syndrome’ when starting our training?

The current edition of Therapy Today arrived on the doormat today and as well as the themed and topical article on exercise and wellbeing there was also an interesting article on the effect of psychotherapy training on one’s relationship.  

Rosemary Cowan interviewed trainees as well as their partners to try to understand the pressures involved in  training and the pressures placed on their relationships. The article is based on research she conducted for an MA in Transpersonal Psychotherapy and Counselling.

The study found that the majority of problems that occurred between couples involved in training took place early in the training. Respondents said that this was a period of major adjustment for both parties.  Trainees were engaged with multi-faceted, new demands and began to question old ways of being. It was noted that partners often felt a range of mixed emotions, and this ranged from exclusion to irritation. Partners reported that they objected quite strongly to the new way the trainee was behaving.

 do colleges support couples during training?

What are psychotherapy training colleges doing to support couples undergoing training? Well, you might ask.  Given that colleges find it difficult addressing the needs of their student population (and particularly those with any kind of learning and development issues) you might not be surprised to learn that colleges do not even consider the support needs of couples. Rosemary Cowan points out that the developmental model that her college 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.

‘wounded-healer syndrome’ 

I have often wondered is there a particular type of person that trains in counselling and psychotherapy. Some say that the motivation for embarking on training in psychotherapy was very often what might be termed ‘wounded-healer syndrome’. Problems such as mid-life crises, physical and mental ill health and relationship and family issues are common with trainees and these drivers had sparked an interest in becoming a therapist. Of course, this raised the spectre that there were pre-existing stresses, and possibly fragility, right at the beginning of the training.  Anyone attending open evenings at colleges will get a glimpse of this, often from the line of questioning that takes place between prospective students and the college management. This all suggests that trainees may be in need of more support than most other students in other disciplines and explains why trainees have to be in therapy themselves. However, while undertaking personal therapy will ultimately be helpful to them, it may also stir more difficulties.  It was often problematic for partners, digging up suspicion, jealousy and resentment that the trainee was talking about them to someone else.

the course should come with a health warning

I recall from the very early days of my course what my tutor said that the course should come with a health warning. He meant that people going through the training undertake great change and personal growth and this can cause tensions and cracks in existing relationships.  However, if your relationship is strong then there is nothing to worry about.  Indeed partners of trainees are as useful in the therapeutic community as the trainees themselves.  They will offer support and strength to the trainees which ultimately benefits the clients.

Do we have ‘wounded-healer syndrome’ when starting our training? You decide.

 

The benefit of 12 step treatments

12 step treatments are not to be confused with the self help followships such as AA and NA

The new edition of Therapy Today dropped through the letterbox today and it is always interesting to see what is inside.  Rachel Young from the Banbury Therapy Centre writes an interesting article on group therapy for addiction.   

12 step group therapy aims to create a safe space where clients with addictions can learn to reconnect with others and create the foundations for recovery. It is important to note that 12 step treatments are not to be confused with the self help fellowships such as AA and NA. These fellowships aim to provide peer support indefinitely but 12 step treatment is typically 3 to 6 months of intensive rehabilitation therapy at the start of the recovery process. AA and NA can often be the perfect after care support system for clients seeking to stay on the straight and narrow.

Trust, peer support and honesty are put forward by Rachel Young as the most important criteria for the success of the treatment. Also, a thorough awareness of group dynamics is essential in order to facilitate a 12 step group therapy treatment model as conflict resolution needs to be tackled very early on. Well worth a read!