Some thoughts and ideas.........
It’s July 2020 and the UK is slowly starting to emerge from the lockdown caused by the Covid-19 pandemic which has changed the way we all live our lives and which has brought suffering and misery to thousands. With the virus still out there in the community, people still becoming ill and many continuing to die every day from it, the powers that be deem it all right for certain businesses and services in England to open up and resume trading albeit in a careful and restricted way.
Among those itching to restart will be Face to Face Counsellors, Psychotherapists and many other types of practitioners who have been unable to work over the last few months. Those of us who already delivered therapy through other mediums like Skype, Zoom or even the humble telephone, were able to continue with client sessions while the remainder had the choice to move across into the new electronic world or just not practice at all.
So what are the implications of returning to face to face client sessions and what thoughts and feelings are going to be thrown up?
Firstly let’s look at the practicalities of resuming sessions and the measures that we can put in place to help client and therapist stay safe. To kick off here’s a few ideas I’ve had for my own counselling room:
So the practical side of resuming face to face work is relatively straight forward to put together and maintain, but what of the psychological aspect of it?
As we all know in counselling a key skill is active listening and this means really hearing what the client is saying, not just the words but the tone, inflections, the silences, the little nuances and of course body language. It’s hard work and to keep focused during the whole of the counselling hour can sometimes be a challenge. Most of us in our training will have worked with `blocks to communication` and high on the list of these is `distraction`. This can be the man outside with the pneumatic drill, the circling helicopter, the need to go to the loo, or illness among countless others. But we have a duty of care to our clients and the BACP code of ethics requires it’s members to put the wellbeing of their clients first by:‘making clients our primary concern while we are working with them.` The code also requires that members look after themselves and ensure `that our wellbeing is sufficient to sustain the quality of the work`. So there can be a balancing act going on between the client and therapist.
But we are all in unchartered territory with this pandemic which has killed thousands in the UK alone and it would be unusual not to have concerns about it. As therapists we usually strive for transparency and genuineness in our work with clients but how will this authenticity be affected or compromised if we have worries and concerns about the health of our clients? Furthermore will our underlying anxiety collide head on with any unease that our clients have for being there with us? Honesty and self disclosure will play a big part here. If we discover our client has fears and worries about coming back to face to face therapy and we have similar thoughts then share those concerns, after all you are both on this journey together.
No one has the definitive answer to how best to go back to face to face therapy – it’s just theories and guesswork with rules and advice changing almost daily. It’s likely that this will be one of those occasions when we must go with our instincts and examine the evidence. How well do we know our client? Is it likely they are being completely honest with us over their health? Are we confident that the measures that we have put in place to reduce the risk are adequate? We then need to balance all this with the evidence: How does the South West compare to other areas of the UK regarding the number of cases of Covid-19. What is the current `R` number for the region? Is this number rising or falling? While juggling all these ideas, facts and figures we still have to consider asymptomatic transmission where an infected person, who has not yet developed symptoms, is still able to transmit the virus. So in essence we have to make a judgement based on a whole raft of variables, many of which are out of our control. However, despite the bizarre old saying `ignorance is bliss` gen up on the virus and how it’s spread by visiting a reliable website like https://www.nhs.uk/conditions/coronavirus-covid-19/ and use facts and evidence in making your decision.
David Trott © 2020 Council Member of Taunton Association for Psychotherapy (TAP)
This was one of TAP’s best attended talks - so many came along that extra chairs had to be put out.
Dr. Freeth is a psychiatrist and a counsellor, so she is able to look at the issues from both points of view. She has published a book and contributes to Therapy Today, the journal of the British Association for Counselling and Psychotherapy.
In her talk she posed some broad questions. What is the nature of mental distress? How does it arise and what is the most efficient response to it?
There are two approaches. One sees mental illness as arising from physical causes such as a chemical imbalance in the brain. The other view is as a response to life events and that medication can relieve symptoms and alter the emotional experience of the client. Neither can be conclusively proven and there is some overlap. It is not a precise science, although probably most psychiatrists are more in the first school. But things are changing.
Some clients/patients feel that having both medication and therapy is the best of both worlds, whereas others may wish to avoid any drugs. Some will accept a prescription and stop taking them. A few will prefer just the medication so it is important for psychiatrists and doctors to talk to the client/patient about the medication: what it is hoped to achieve and possible side effects.
Dr. Freeth presented two cases studies which explored the issues.
Coming off a medication is as important as the original prescription and she emphasised that just stopping can, sometimes, lead to crisis and needs to managed. It emphasises the importance of having a relationship in which the patient can discuss their situation with the psychiatrist and GP. She also went through the main categories of medication and left some hand outs with links to further research. Her handouts are available to download HERE, HERE and HERE
TAP attracts both students and experienced practitioners (as well as those who have an interest in the subject) and there was a good discussion followed by tea/coffee and biscuits.
The vote of thanks also gave notice of the forthcoming conference on body psychotherapy given by Nick Totton who has a national reputation for his work in this area. Some of the committee have seen him in conference and decided he had to speak to us. Details on the website ( www.taplimited.org.uk )
A capacity audience gathered together at the Friends Meeting House on 17th November to welcome back Paul Sunderland, a very popular speaker for TAP members and guests.
Paul treated us to some thought provoking insights into ‘Boarding School Syndrome and Recovery – When Privilege is Trauma for the Early Boarder.'
Paul originally trained as an addictions counsellor, moving to senior positions in residential treatment settings and then into private practice.
As the evening’s talk progressed it became apparent that there was a theme running that also ran through a Saturday workshop that Paul put on for TAP in October. The theme was one of ‘self-soothing’ behaviours which may bring survivors into therapy.
For the young child the moment of leaving home for boarding school is the beginning of an episode of adaption. There may be tension between the idea of privilege – ‘aren’t you lucky’ and the reality of life in ‘captivity’ with no care giver present and little privacy. Being unhappy and not feeling fortunate are a good mix to promote feelings of shame in the child. Guilt and shame make up some of the foundation for self-soothing (addictive?) behaviours to take hold as the child finds an often arid environment in which to share feelings.
Boarders and adoptees are over-represented in treatment and recovery services. Do we recognise PTSD in early boarders?
Neuroscience tells us that early experiences shape the brain. Experience is the architect of the brain. If the 7 year old learns to keep themselves to themselves, the pattern will stick.
Boarding schools began around 500 years ago preparation for empire. Graduates would be less likely to miss home.
There exists an ambiguity; socially we may consider it a tragedy when a child is taken into care, but not into boarding school.
A grateful vote of thanks and applause brought the talk to a close, but not the evening. The discussion continued over fresh coffee, various teas and some very lovely biscuits.
The next talk will be on 8th December, alongside a Christmas social event to which everyone is invited! £5 on the door, free to TAP members. Hear Suzie Grogan (a sell-out at the recent Taunton Literary Festival) give a 30 minute talk about Death Disease & Dissection – a Horrible History of medicine for grown-ups.
A full audience of TAP members and guests attended to Paul Sunderland’s most engaging presentation ‘Introduction to modern addictions’; held in the contemplative setting of the Friends Meeting House in Taunton.
With 30 years’ experience of working, researching and managing in the field of addictions, Paul provided many thought provoking insights into addiction; possible origins, treatment process and the place of the therapist.
He provided an introduction to conditions of substance misuse, finance, couple relationships, romance, love and sex addiction. It was fascinating to learn of the basic criteria that define and describe addiction as a disease and how these symptoms are shared with a wide range of compulsion processes.
There is a preoccupation, a loss of control; abstinence, tolerance, withdrawal and impact of functioning, possibly leading to symptoms of depression and anxiety, relational and legal issues – all amounting to a ‘full time job’.
Addition can be described as a ‘migrating disease’, often showing up as a dis-ease in other areas of life.
Treatment approaches begin with addictions of ingestion, abstinence, the disease process and the underlying trauma, or dis-ease. Group therapy as well as individual has been found to be effective in treatment and we heard how ‘people get well in counter-transference’.
Therapists may remind themselves that in order to be effective and compassionate require three basic elements: learning. Supervision and work on themselves.
Paul referred to addictive experience as ‘a thing’. Individuals are not bad, or weak, but primarily unwell. Behind it all tend to lay negative cognitions and un-thought knowns. The limbic brain stores trauma. There is a suggestion that we have many brains and that in the case of addictive conditions, the limbic brain acts before the frontal cortex has a chance.
‘You can’t change what you don’t know’.
Psychotherapy and counselling aid and support the knowing.
A vote of thanks on behalf of the TAP Council, members and guests was followed by copious applause and no doubt, plenty to think about.
Feedback showed that over 90% of attendees thought both the workshop and Paul Sunderland as speaker were 'Excellent'.
On 15 September the greatly anticipated presentation by Cathy Towers entitled `Filthy Lucre – Therapists Relationship with Money` took place at the Friends Meeting House, Taunton and as expected attracted a large audience. Cathy is a Workshop Leader and Speaker and Mind and Body Therapist with over 30 years experience and is based in the Exmouth area.
Cathy began her talk with a classic pop song extolling the virtues of money and with the distribution of chocolate coins. This quickly moved into Freud’s obsession with his poorhouse neurosis and his strict viewpoint on charging for his services. The audience heard how in modern times, the therapist’s relationship with money is often fraught and so requires the therapist to make decisions on charging based on a clear, coherent and consistent rational.
Cathy explained how she used to rent out rooms to therapists, only to find that they would put in their leaflets and just wait for something to happen. Because they had not addressed the issue of marketing or constructed a viable business plan, many of these enterprises were doomed to failure. With quite a brave change of policy, Cathy began to turn down many of the applications for rooms and instead started to have people that she felt had thoroughly researched their venture. However this initially resulted in a drastic plummeting of her income.
The question of a free counselling service was addressed and the audience heard how at one point Cathy worked for such an agency. Even though there was no charge, attendance was poor with only 70% of clients actually keeping their appointments. This changed significantly however, when a fee was introduced and attendance increased to 90%. This shift appears to indicate the lack of accountability attached to pro bona work.
Interacting with the audience, Cathy explored attitudes to money and found it can represent success, freedom and can enhance self esteem. The downside was seen as shame, either at having too much or too little. The talk concluded with the audience dividing themselves into three groups – those who regard themselves as charging averagely, higher than average and those below the average. This exercise, although light-hearted, focused many on their own charging structure.
Tea and coffee was served following a vote of thanks by TAP Council member David Trott and a warm round of applause acknowledged an enjoyable and educational presentation by Cathy.
The next TAP Talk takes place on Friday 20 October when Lisa Foote speaks on the subject of `Looking Beyond labels – Understanding Borderline Personality Disorder. However, before then TAP has a Saturday workshop on 7 October when Paul Sunderland presents `An Introduction to Modern Addictions: The Financial, Work, Sex and Love Addictions. How do they work and how can we treat them? To book a place at this rare event, please phone 01823 661601
TAP Talk 16/8/17 - A new approach to healing the past. An introduction to Pesso Boyden psychotherapy by Matthew Harwood
TAP members and guests gathered at the Friends Meeting House in Taunton on Friday 16th June 2017 to hear a thoroughly engaging presentation: ‘A new approach to healing the past. An introduction to Pesso Boyden psychotherapy.’
The presenter was Matthew Harwood, a Jungian psychotherapist in private practice in Bath and Bristol. He enviably trained at the CG Jung Institute in Zurich. More recently he has undertaken training on Pesso Boyden Psychotherapy and Internal Family Systems (IFS).
Matthew described having a healing experience during a CPD Pesso Boyden workshop and was inspired to develop his knowledge and application.
Pesso Boyden therapy began life thanks to Albert Pesso and Diane Boyden, a married couple from the USA, now sadly deceased. Interestingly they were originally both dancers and then dance teachers. It became apparent to them that some dancers appeared blocked from performing a full range of movements, hampered by past trauma.
The approach is not well known in the UK, but the couple developed and evolved the approach over 50 years, together and then just Albert after his wife died.
So, what is the aim of Pesso Boyden Psychotherapy? In keeping with other approaches; ‘to help us become who we really are.’
Mainly a group work approach differing significantly from other therapy group processes, it concentrates on an individual in the group, with other members role playing and bearing witness to the evolution of healing the individual’s past.
The approach can be used in a one to one setting too, although slightly less common, with the facilitator assuming the witness roles.
The audience was fascinated by a series of chronological video clips charting the process in action.
It is generally accepted that the roots of trauma lie in early life and we are born with a genetic expectation that our basic needs will be met by loving care givers. The Peso Boyden approach works towards supplementing memory experiences, not cancellations. It is the protagonist that does the work.
The speaker emphasised to the audience that the best way to understand Pesso Boyden, is to have the experience.
An engaged and enthusiastic audience was represented by a vote of thanks on behalf of the TAP Committee.
The next TAP Talk takes place after our summer break, on 15th September 2017, when psychotherapist Cathy Towers will speak on the subject 'Filthy Lucre - Therapists' Relationship with Money'.
TAP Council member
An eager audience of TAP members and colleagues welcomed Mark Conway this month to his talk entitled ‘Fostering resilience: An opportunity for improving outcomes’ Mark is a specialist Child and Adolescent Mental Health Service (CAMHS) team manager, who is highly qualified and equipped with many years’ experience working with young people.
The audience heard of the importance of building resilience in children and young people to provide the foundation for good mental health. In terms of academic resilience we heard that young people can achieve good educational outcomes, despite adversity and will often perform better than expected.
The CAMHS and schools link project pilot commissioned by the Somerset Clinical Commissioning Group (CCG) yielded some very positive outcomes and a basis for action. The project promoted good mental health and early intervention within schools and including teaching emotional intelligence for teachers.
It was acknowledged that during the school years children really have very little control over their situations, both in compulsory education and domestic home life. Focussing on resilience examines how children learn to cope well and manage within these constraints.
The audience was introduced to a ‘resilience framework’ which provides a guide to the elements to consider in building healthy resilience, likened in some ways to Maslow’s hierarchy of needs. Conditions need to meet basic and progressive criteria in order for the child to have the opportunity become the best that they can be.
Mark pointed out clearly that adults who experience difficulties with their mental health have the origins rooted in childhood, increasing the necessity for early intervention.
You can download Mark's presentation HERE.
An enthusiastic vote of thanks from the TAP council preceded a sociable time over tea and coffee.
The next TAP Talk takes place on June 16th entitled ‘A new approach to healing the past. An introduction to Pesso Boyden Psychotherapy’. Matthew Harwood will be the guest speaker. He is a Jungian Analyst, trained in Pesso Boyden psychotherapy and internal family systems.
by Ian Stevenson
This year's TAP Conference, which takes place on 18th March, is headlined Cutting Edge Connections between Spirituality and Psychotherapy and features top speakers Melody Cranborne Rosser and Larry Culliford. (Find out more and book HERE) But what do we mean by 'cutting edge'? Here long-time TAP Council member Ian Stevenson puts forward his thoughts....
What is 'cutting edge spirituality'? It’s a good question. Just before the last OFSTED inspection I had to endure, the Head shared a worry. “In the last inspection, the lay assessor said he saw little spirituality in the school. What did he mean and how can we improve on it?’
There were various answers: ‘a sense of awe’ said the Head of Science, who was a churchgoer; a sense of community; having prayers in Assembly (we didn’t do that very often) and encouraging moral behaviour. Personally, I think we have other words for these things. To me, spirituality implies something meta-physical, something beyond the material world. (As it turned out, it was not commented on in the inspection.)
Is Spirituality just a nice idea or do we have reasons for thinking it is more than that?
In my youth, 1960s, spirituality more or less equaled religion. When, as a new teacher, we took information on pupils for registers there was a box marked religion. Many children said, ‘I’ll have to ask.’ I was told, if uncertain, ‘Church of England’ would do!
Religion was something you believed in or not. There were a few who looked for a more empirical approach. The Society for Psychic Research, which goes back to 1882, investigated supernatural, or in more modern terms, para-normal phenomena. Despite a vast amount of data, few educated people gave it much credence. The end of the sixties did see what was dubbed “the New Age’, which was a bottom up exploration of new ideas in psychology and science blended with old teachings from around the world such as Buddhism. It ranged from the ridiculous to high philosophy. Carl Jung, who died in 1961, was the most quoted psychologist but there were others such as Maslow or Grof. However, the ‘New Age’ thinking was largely ignored by the educational and religious establishments even though ‘New Age’ books sold well. It was also ignored by the scientific world although meditation and yoga became popular albeit usually justified by its therapeutic properties.
New ideas often infiltrate themselves into public acceptance as the older generation passes on and a new generation looks for different answers to perennial questions. There were more university educated people looking for meaning and now they could glean information from a wide range of available resources thanks to modern communications. New leaders began to emerge.
For the last thirty years the Dalai Lama (who has endorsed one of our speakers’ -Larry Culliford-books) has held a conference at Dharamsala or elsewhere with Western scientists and they discuss their understandings of such subjects as meditation and neuroscience; the role of emotions, and the interface between modern physics and ancient wisdom. When they started, the Dalai Lama said if they showed something that Buddhism believed to be scientifically wrong, then Buddhism wold have to change. In fact they didn’t find anything.
In 1973 Dr Edgar Mitchell, the Apollo 14 astronaut, founded the Institute of Noetic Sciences. On the way back from the Moon, he had an experience of being part of ‘Universe of Consciousness’. Noetic means using intuitive knowledge. Together with the scientific (left brain?) approach, the Institute addresses the questions raised by the experience. He felt it could bring about a deeper understanding of who we really are and would help to bring people together.
In that same year, 1973, In Britain, George Blaker and several others founded the Scientific and Medical Network. They thought that neither orthodox religion nor conventional science could give adequate answers to ‘the mysteries of he Cosmos’. The materialist explanation of the brain didn’t seem to explain a lot of things. The SMN has numbered such people as -Dr. Mary Midgeley , Sir John Polkinghorn, Sir Crispin Tickell, Sir Roger Penrose and …me (to dilute it a bit )!
In 1999 Dr.Antony Powell at the Royal College of Psychiatrists formed a special interest group on Spirituality. Other groups include working with the elderly or in criminality. Today it is the largest special interest group and one can read their newsletter on the web. Our speaker, Larry Culliford was part of this.
I would also include Dr.Gary Schwatrz’s research in the US. We have probably seen on TV , Darren Browne who describes himself as a ‘mentalist’. He says he can replicate the results achieved by mediums and clairvoyants by using techniques such as cold reading. Schwartz put the mediums and the ‘sitters’ in different rooms where they could see or hear each other, and the mediums continued to get results. I have given a talk on this in Bristol. The work is criticised by some but I thought the criticisms were generalities and did not address the points raised.
So what has emerged to engage these very distinguished people? I could suggest several things but there are two main ones: the ability to investigate the brain in greater depth e.g. with fMRI, and the implications of that such as the near death experiences ; 2) the greater understanding of quantum physics and how that relates to consciousness.
Some quantum physicists see consciousness as a fundamental property of the universe and not something produced by the brain, but rather mediated by it as a radio is not the origin of a program but the medium by which we hear it. This would imply we do indeed swim like fish in an ocean of consciousness.
These are raise exciting and fundamental questions as to who we really are but one may ask; what has this to do with counselling and psychotherapy? We do things like finding out what is of meaning to our clients and helping them to have a better relationship with themselves and live more resourcefully. But what could a study of spirituality add?
This was a question when we first had brain scanning equipment. How would knowing which parts of the brain ‘light up’ when we experience certain emotions, actually influence therapy. But I think many would answer it has been , for many, a useful contribution. We gain a better understanding of who we are.
I suggest there are several areas it could influence.
We can look at evidence for a metaphysical ( beyond or above ) dimension and not just take it on faith. Of course, there are persuasive people who argue the opposite, like Daniel Dennett, but we have evidence we can assess, rather than believe it or not.
Our sense of connection with the wider universe. This is the traditional area of religion and philosophy, where the field of universal consciousness, or whatever you wish to call it, might influence us giving meaning and purpose to our lives. The study could enable one to see the different religions as tributaries flowing into a common stream. Surely of use in the modern world?
Spirituality suggests we are not separate collections of neutrons but individuals as having a part in the universe, and relationships with others and the natural world.
To end on a personal note, when I look at the neurological information and the ethics of spirituality in their several forms, I am reminded of Paul Gilbert’s Compassion Focused Therapy which we heard so ably presented by Dr. Christopher Irons in the 2013 conference . Those concepts have enhanced my practice.
One doesn’t need to accept all the concepts I’ve outlined here in order to derive some benefit from the study. My hope is that the conference won’t just be the delivery of information on the day but an encouragement to find out more.
We would love to know what you think - please do post comment below.
'The Phone Call From Hell` - the therapist’s reaction to when a sex offender calls - A TAP Talk by Juliet Grayson
Report by David Trott Tap Council Member.
On 14 October, TAP members and guests had another opportunity to expand their own Continuing Professional Development when Juliet Grayson presented her talk entitled `The Phone Call From Hell` - the title reflecting a Therapist’s possible reaction to when a sex offender calls.
Juliet is co-founder and chair of StopSo (Specialist Treatment Organisation for the Prevention of Sexual Offending) which is a not for profit organisation that is working to stop sexual offending through therapy. StopSo has formed a nationwide network of therapists who are trained to work with anyone who is concerned about their sexual behaviour and feels that they may be at risk of committing a sexual offence, or re-offending.
Although hugely busy with StopSo, Juliet explained that her main work as a psychotherapist lies with couples who are experiencing sexual problems in their relationship. She is also an accomplished author and one of the most experienced practitioners of Pesso Boyden System Psychotherapy in the UK.
The evening commenced with some audience participation in the form of a quiz entitled `Sex, Statistics and the Law`. This gave participants the opportunity to test themselves in current law with regard to sexual offending in the UK. The cleverly compiled twenty questions produced some head scratching and a few surprises when the correct answers were revealed. This resulted in the mild suspicion that there were possibly some gaps in the audience’s knowledge.
Later a video of Dr James Cantor, who is a Canadian clinical psychologist and sexologist was shown. In this, he discusses the work which has been done to understand the minds of paedophiles as well as some common physical characteristics, such as lower IQ, left handedness and below average height.
Juliet revealed that there are only around 86,000 places in UK prisons and so it’s not possible to incarcerate every offender. This simple fact highlighted the value of the work of StopSo and other similar organisations in this field.
The slides from Juliet's presentation are available to download HERE.
Tea and coffee were served afterwards which gave everyone the chance to discuss and reflect on yet another superb presentation. The next TAP Talk is on18 November when Dr Sue Whitcombe presents Smoke Without Fire: The challenges of identifying and working with Parental Alienation. All are very welcome.
Extra chairs were needed on 16 September to accommodate a pleasing number of TAP members and guests to a presentation entitled `Understanding and Recognising Sex Addiction` by Nick Turner. Nick is a Sexual & Relationship Psychotherapist and Sex Addiction Therapist and explained that his work encompasses clients of all social differences, ages and genders.
The audience heard how sex addiction is defined as any sexual activity that is used to modulate emotion and which `feels` out of control with an inability to stop or stay stopped, despite significant harmful consequences. It’s also seen as an unhealthy relationship with a mood-altering experience, however it was stressed that it is not the activity that defines addiction but the dependency upon it.
Nick explained how our brains become addicted by the creation of Neural Pathways that `wire` the brain from sexual activity such as porn, which then becomes an optimum source of dopamine to the dependent person. This can lead to increased shame that increases the desire to escape painful feelings with more of the chosen activity.
The impact on partners was discussed and this included the damage to intimacy and the sexual relationship, the reigniting of old wounds, the compromising of parenting and the triggering of unwanted behaviours or other addictions within the partner. Unsurprisingly common reactions include shock, betrayal, disgust, isolation, despair and hopelessness, many of which closely resemble bereavement.
Thankfully, there are many treatment options for those considered to have a sex addiction and these include individual Counselling/Psychotherapy, Group Therapy, Group Support – 12 step or similar and Couples Counselling.
In his vote of thanks, TAP council member Ian Stevenson said that this is what TAP is all about i.e. the provision of quality speakers, who in turn provide useful and long lasting information for people to take away with them and use in their work. A very sociable tea and coffee time concluded the evening.
Nick Turner's presentation is available to download HERE
The next TAP Talk takes place on October 14th 2016 when JULIET GRAYSON presents `The phone call from hell: What do we do as a therapist when a sex offender calls? ` All are welcome. David Trott TAP Council Member