Call for participants – qualified therapists (UKCP) or counselling psychologists

call for participants

Paula MacMahon is undertaking a Doctorate in Counselling Psychology and Psychotherapy by Professional Studies (DCPsych) on a joint programme with Metanoia Institute and Middlesex University. She would like to invite qualified therapists (UKCP) or counselling psychologists to help with her research.  Here is her recruitment advert:

‘Therapist Blind Spots: A phenomenological enquiry into the experience of recognising personal blind spots through relational therapeutic work.’

I am doing a qualitative study exploring experiences where your clinical work has put you in touch with your own vulnerabilities or potential blind spots. The focus will be on your ‘lived experience.’

I will need to interview you twice for approximately an hour with an interval of up to one month. The time and place will be at your convenience. The study has been approved by Metanoia Institute Ethics Committee. If you are interested in learning more about the study or participating please contact Paula MacMahon at pmacmahon7@gmail.com. Mobile 07775072192. Your details will be kept in confidence and you are under no obligation to take part. Many thanks.

A viva gets you drunk on one glass of wine

Our guest writer, Emily Brookes, finally had her viva!  Do feel free to check out our website for details of our clinical supervision register and our research support services!


keep-drunk-and-vivaThe night before my viva I got drunk from one glass of wine. I don’t know if nerves have the same impact on alcohol as not eating dinner, but I was a mess. The phrase “this is the most important day of your life” kept throwing itself into my brain. I used all my techniques…

Upon noticing the ‘hot thought’ I challenged it. “Think about the wider picture, your doctorate isn’t your entire life. Think about the whole life you are going to lead”. I realised I was ‘struggling’ with the thought, feeding it by fighting back. DEFUSION, my brain screamed! “Ah hello thought! Popping up again are you? Thanks mind!” This was to no avail. Fantasies of having to tell my co-workers that I cried in the exam and then failed swam around. MINDFULNESS, I shouted to myself. “Feel the breath in your nostrils, notice the sensations, focus on how the air is warmer as is comes out than when it goes in”. I was a human jelly blancmange.

It seems that my saving grace was my situation. Living in a different city to my university I was staying overnight with a friend whose flat was closer. She is a very good friend, one of those sensible ones who deals well with a crisis.

“What do you need tonight love?” She asked.

“Do you need to sit quietly with your books or do you need some distraction?”

Half an hour later we were in the pub, me sozzled after a sniff of the cork. It was the very best thing I could have done. I spent the night catching up with a bestie, having a right laugh and then sleeping like a baby.

The day of the viva dawned. I arrived to the university early. Obviously, I felt sick. Wierdly I also felt kind of special in a new hat. It seemed like there were two of me; one Emily holding the other up and guiding her to the room. Seriously though, the nerves were the worst part.

The viva was fine! I think it helped that my examiners and my chairperson were so lovely. I was able to be myself, humble and honest. The ‘me’ discussing my research with my examiners was the same ‘me’ who chatted about it with her friends on a girly night. I found that there really was nothing to be worried about. Throughout the entire process I had been a conscientious researcher, always making what I believed to be the best decision at the time. This stood me in good stead. All I had to do was honestly answer the examiners questions.

I didn’t go blank once, and I’m one of those people who do that.

There was one point where the examiners ‘turned up the heat’. Things got a little complicated and they started using a word that I realised I didn’t fully understand the meaning of. (FYI the word was ‘ideographic’, used in the context of ‘the ideographic approach’). Honestly, I just smiled and nodded! As I listened to them speak I was able to grasp what they meant by this word, and was then able to respond in an appropriate manner.

What surprised me was that I enjoyed myself. I’d heard people say “oh, mine was a really enjoyable experience” and thought “yeah right, it’s a viva; it’s always going to be hideous”. But it wasn’t!  And at the end they said “congratulations” because they thought I had dealt well with a pretty challenging viva. I genuinely didn’t even realise it was a challenging one!

I was also surprised by the fact that I learned a lot in the exam. I came out knowing significantly more about my methodology than when I went in. And I passed, subject to minor amendments 🙂

The Forgotten Bridge in process reports

http://gaudibuendia.deviantart.com/art/Broken-Bridge-351293617
Copyright gaudibuendia http://gaudibuendia.deviantart.com/art/Broken-Bridge-351293617

Ah, the process report.  No one escapes counselling psychology training without turning out at least a couple, and quite right too, for the process report demonstrates oodles of developing competencies.  Make sure your knickers are clean, because this kind of assessment shows everything: whether you understand theory, whether you can apply it in practice, whether you truly understand what process is, what you’re like in the consulting room, what your blind spots are, how reflexive you can or are willing to be, and whether you can manage to convey everything you need to convey within a few thousand words.  To quote Victor Hugo, a process report requires you to showcase “Concision in style, precision in thought, [and] decision in life.”

Exact requirements for the process report vary by training context, but the structure is fairly consistent.  The heart of the report is an annotated transcript of a psychotherapy session, and your course handbook probably says that this should show “links between theory and practice”.   The report is topped by material that contextualises the session excerpt (e.g., working context, client history, formulation, theoretical orientation used) and tailed by a summary reflection of some kind.  Sounds pretty straightforward, doesn’t it?

Well, in 10 years of teaching on counselling psychology programmes, I’ve assessed my fair share of process reports.  Along the way, I’ve compiled a Buzzfeed-esque list of the Top 5 Process Report Pitfalls.  While number one (“The Process-less Process Report”) will never be unseated from the top of that list, it does have a close second.  From my vantage point it feels blindingly obvious, but most trainees don’t even know it’s there; I call it “The Forgotten Bridge”.

In a recent blog post, Russel Ayling offered his thoughts on counselling psychology “branding”, and this was closely followed by another post on what CoPs do.  Within the latter post were references to pluralism, the relationship, context, and research-informed practice.  I would add something else, an activity that incorporates all of those things: formulation.  In my opinion, formulation is the central art and the very heart of counselling psychology.  The skilled counselling psychologist takes the individual client – their past, their now, their inner life, their external situation, their relating – and melds all that with theory, with research, and with established templates of understanding.  In seeking to understand what has landed someone in your consulting room, you and your client identify and follow lots of little threads.  Together, you must weave those threads into a fabric that holds together, that makes some kind of sense, that has a useful function.  This is formulation.  An unreconstructed tangle of wool, after all, never managed to do much that was useful.

But why am I talking about formulation here?  Isn’t this a post about process reports?  Yes, you’re supposed to put a formulation in the introductory section of a process report, but isn’t a case study more the place to talk about formulation?  If you’re asking these questions, you’ve already forgotten the Forgotten Bridge.  Remember this mantra: Formulation is the bridge between theory and practice.  As counselling psychologists, we are meant to always consider the individual client in their unique context.  We are not meant to be therapybots, applying theory in a mechanical and consistent way to every person who sits before us.  All too often, however, trainees dutifully stick the client’s formulation into the introductory sections of a process report and then move swiftly onwards, never referring to formulation again.  Their annotated transcripts (a) describe something happening in session, (b) describe the response/intervention, and then (c) link or justify their response/intervention by referencing theory.  Let’s take two examples:

  1. “I notice that Mary is holding quite rigidly to this belief, and I decide to try some cognitive restructuring.  Cognitive restructuring (Beck, 1995) is intended to dispute and modify irrational beliefs.”
  2.  “Julian’s comment indicates that he is concerned about my judging him negatively; I am aware of the need to maintain and show unconditional positive regard (Rogers, 1961).  I lean forward and try to be as open and warm as possible in my tone when I reflect back his comment that he is afraid of what I will think.”

 

In the examples above, the therapists are doing some “good” things, things that don’t seem out of place in process reports.  They notice things happening.  They catch hold of them.  They demonstrate that they know theory.  They choose responses that may make absolute sense.  Yet their reflections seem somewhat hollow, as though something is missing.  Notice that each of these therapists has jumped straight from a particular moment in practice to the broad, generic expanse of theory, neatly skipping over something quite important: the client.

Meanwhile, back at the ranch, the formulation lolls about in a bored fashion, eating grapes.  It has a function and has not just been included for the fun of it, but it has been sadly overlooked.  Mary’s formulation may have a lot to say about why she holds this particular belief and why she might be particularly resistant to its being threatened.  Julian’s formulation may illuminate how unconditional positive regard is not merely a Generally Good Therapeutic Thing in his case, but something that may be key to the work.  Let’s see what could have happened had the Forgotten Bridge been remembered (I include the original examples for contrast purposes):

1. Mary:

  • Formulation forgotten:  “I notice that Mary is holding quite rigidly to this belief, and I decide to try some cognitive restructuring.  Cognitive restructuring (Beck, 1995) is used to dispute and modify irrational beliefs.”
  • Formulation incorporated:  “In Mary’s repeated insistence that she will never find someone to love her, I can see that she is holding quite rigidly to her belief about being unloveable.  I remember that our past attempts at cognitive restructuring (Beck, 1995) around this belief have been unsuccessful, and recently we have been talking about this belief as being part of an early maladaptive schema (Young, 2003) that was partly shaped by her mother’s depression and neglect of Mary.   I realise that this belief is familiar and comfortable to Mary, as painful as it is, and that “the schema fights for survival.”  Reluctant to try cognitive restructuring again when it has not been helpful in the past, I propose an experiential exercise that Young suggests for tackling maladaptive beliefs of early origin.”

2. Julian:

  • Formulation forgotten:  “Julian’s comment indicates that he is concerned about my judging him negatively; I am aware of the need to maintain and show unconditional positive regard (Rogers, 1961).  I lean forward and try to be as open and warm as possible in my tone when I reflect back his comment that he is afraid of what I will think.”
  • Formulation incorporated:  “When Julian says that he is terrified of what I will think, I am once again keenly aware of how critical his parents were, and how he feels that he never received the acceptance that he so craved.  I am also aware that in all of his subsequent relationships, Julian has found it impossible to believe that he could be cared for unconditionally.  This has kept him constantly chasing approval, disconnected from his own organismic valuing process (Rogers, 1964). Consequently, I am aware that unconditional positive regard (UPR) is extremely important in my work with Julian, in service of providing him with a corrective experience.  In this moment, responding to his fear of my judgement, I do everything I can in my voice, body, and face to embody that UPR.”

I have tried to illustrate a few things with these (fictional) examples.  First, in the “formulation incorporated” examples, we see how the individual client has reappeared and is being honoured.  By linking the moments in session to the formulations, the therapists are able to speak about their interventions with Mary and Julian in a specific way.

Second, we observe how an ongoing awareness of the formulation within the therapeutic work itself (i.e., not just in the post hoc reflection) has steadied and guided these therapists in their responses to their clients.  These two examples show therapists using the formulation to guide them in the moment.  Had these therapists made interventions that went awry, then they could have reflected on whether this was partly because those interventions were less mindful of this – “off formulation,” as it were.

Finally, we see how the process reflections have become interesting.  They no longer have that bland, colour-by numbers feel.  Drawing upon the formulation has resulted in richer, more meaningful reflections.

If you have found this post useful, you might be keen to know more about the other items on the “Top 5 Process Report Pitfalls” list.  Perhaps I’ll be invited back another time to talk about those!  In the meantime, however, try to keep the Forgotten Bridge firmly in mind.  It will be of inestimable help in navigating the shift from therapybot to counselling psychologist!


Dr Elaine Kasket is Senior Lecturer and Research Coordinator on the Doctorate in Counselling Psychology at Regent’s University London.  If you would like to contact her to check her availability for private supervision, please check out her entry in our supervisors directory.

Call for participants – men and women aged 40-65

call for participants

Ariana Jordan is undertaking a Doctorate in Counselling Psychology at the University of East London and would like your help with her research. Here is her recruitment advert:

Being at midlife has been associated in the literature with increased reflection and awareness of our psychological and physical states, but what happens when we also need to negotiate parallel developmental changes in our children? 

This study investigates the interaction between parental and child lifestages, focusing on the effect on the parent. It takes the form of an anonymous online questionnaire, which should take no longer than 15 minutes to complete. I am looking for men and women aged 40-65, parents and non-parents, who live in the UK. Here is the link: https://www.Surveymonkey.com/s/ajordan   Thank you.

 

Call for participants – trainee and qualified therapists

call for participants

Candice Lemonius is undertaking a Masters in Psychotherapy at Roehampton and would like your help with her research. Here is her recruitment advert:

“What happens when two subjective worlds meet?”

“Exploring therapists experience when a clients’ story touches their own”

If you have something to say about your experience of working with a client whose story has come close to your own, I would love to hear from you.  I ask that you be a practicing psychological therapist at any level of experience.  Research will be conducted through interviews lasting approx 1 hour.  Both male and female participants are welcome.  For more information please contact me on:  lemoniuc@roehampton.ac.uk

 

Call for participants – trainee and qualified therapists

call for participants

Teresa Lawless is undertaking a Masters in Psychotherapy in Dublin Business School, Ireland, and would like your help with her research. Here is her recruitment advert:

I am doing a quantitative research thesis looking at changes in Emotional Intelligence which may occur during and post Psychotherapy and Counselling training . I am working under the supervision of Mary Bartley and I am using Survey Monkey for this research.
This research is seeking participants from all disciplines within the psychotherapy and counselling profession both during (from Year 1 to completion) and post training. It will take 5-10 minutes to complete. The nature of this research is anonymous and no identification is required.

The link for this is (if you click into this it will take you straight there): https://www.surveymonkey.com/s/YTP9Z52

Many thanks

Chemical imbalance myth takes a big public fall (no, antidepressants do NOT correct an imbalance of serotonin, nor do other psychiatric drugs correct anything at all)

A very comprehensive look at psychotropic medication, from a critical psychiatry perspective

Everything Matters

Updated with some new links and quotations on Dec, 2014

Beyond Meds and anyone who’s actually paid attention to the science for the last many years has known that the serotonin myth about depression and how antidepressants work has no evidence to back it up whatsoever. So when it all came out in an NPR interview I pretty much just yawned. Yes, I’m tired and I’ve been steeped in some of this stuff for far too long.

Embracing this critique doesn’t mean there is no biological factor to such that which gets labeled mental illness…we are holistic beings, so of course there is biology involved in everything about us. What it means is the answer does not lie in the biological reductionism that psychiatry most often espouses and makes up stories about.  Everything matters. Until we start attending to the individual as part of the whole of life…

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What can we learn from the history of sexology?

An informative and easy-reading summary of a British history of sexology

Rewriting The Rules

This morning I was very excited to be included on Radio 4’s Today Programme talking about the new Wellcome Collection exhibition: The Institute of Sexology. You can listen to the piece on their website (it aired around 12 minutes to 9).

sexology-book

The radio piece also meant that I got the chance to have a sneak preview of the exhibition before it opens tomorrow. I would definitely encourage people to go. It is fascinating to view all of the sexological objects and texts that Henry Wellcome collected over the years, and to check out the contemporary artwork which they have displayed next to the various sections. However, for me, the most interesting thing was to get such a strong sense of how sexology has shaped the ways in which we understand sex today.

The exhibition gives us a clear sense that the way we currently view sex came from somewhere:…

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Bending the rules: the secrets I rarely confess

rulebreak

or Ruling the bends: authorising ourselves to practice

In this post, guest writer Emily Brookes, and Dr Russel Ayling discuss Emily’s experience of ‘bending the rules’, and Russel’s re-thinking of this idea: understanding our bentness, perhaps, or rather, ‘ruling our bends’.


 The more I have talked to my psychology friends the more I have come to understand that we all do things professionally that we wouldn’t mention in a job interview. I think it’s fair to say that we all mess up at some point. Perhaps we forget a vital piece of information or maybe we mix up a client’s story with someone else’s. I’m sure that every therapist reading this could, with enough time, recall their own blooper. The intention of this post however, is to go past discussing the common yet forgivable mistake. Rather, my aim is to take what I believe to be a brave step. I wish to discuss some of those things which I would never disclose in a job interview, yet which I do or don’t do on purpose.

I’ll join you in this, Emily, by writing in red. Think of it like a confessional, and me like your psychoanalytic priest-cum-supervisor that you never had. Not that I’m into reparenting …

There are times when it feels like I’m the odd one out. It’s like there are a set of rules or practices that everyone else agrees with and understands that I just don’t get. I feel fuzzy-headed with them. Sometimes it seems like everyone else has read some sort of seminal handbook and I missed the memo. I spoke to a trusted friend and colleague, B, about it. “Maybe” she said, “since you take a pluralistic approach you’re less bound to model-specific protocols. It could be that they just feel less useful”. Perhaps she has a point. I know these are things I feel deep down in my bones, from years of testing out the options.

For sure, there are some things as psychologists that we have to learn how to do, but we also have to interrogate our feelings about them. What does this offer to the client in helping them verbalising their own desires? And us with ours? We probably wouldn’t want our clients to blindly accept our instructions, just as we are right not to want to blindly accept those of our supervisors. Maybe, the aim of a therapeutic training is to make our own ‘rules’, to authorise ourselves to practice, rather than accepting (or resisting) someone else’s authority? I think we find out how to do the former, by doing some of the latter too. But could you be authorising your practice – from deep in your bones?

The first element I feel a disconnect with is diagrammatic formulations. I can honestly say that I have never sat with a client and presented them with a “this is your life” formulation and felt good about it. I either tend to feel frustrated because the client has engaged with the formulation and keeps telling me more information that doesn’t fit well into the diagram. Or, I feel worried because my client appears politely interested but not jumping out of their seat. They are not saying, as one client once delightfully did during a particularly effective ‘reflecting back’ comment, “you hear me my sister!” I guess one could argue that my disconnection with formulation diagrams is because I’m not skilled enough in that area. Yet, being honest, something inside tells me that’s just not it.

How about the idea that the diagrammatic formulation – perhaps like all elements of the frame – is more for the therapist than the client? They’re good as teaching aids in the classroom, but I worry about the idea that we are trying to ‘teach’ our clients. Who are we to ‘know’ what’s in their minds, and what should be in their minds? Clients have spent their lives fitting (or not fitting) boxes, as have therapists. Perhaps they need validation from their therapist (or their supervisors and trainers) that ‘fitting’ isn’t on the side of life. And even if we do teach, and do expect to fit, who says that just because a client isn’t jumping out of their seat with joy at our interpretation, that it hasn’t landed somewhere? Do they really have to let us know that? And should we believe them if they did?

The second guideline I seem to be shirking is the idea that one cannot do good work without a deep and complete formulation. Have you ever read a book and found it has changed you? Have you seen a quote on the internet that has made profound sense? Ever spoken to someone and realised it has altered the way you look at life? In my experience I haven’t needed a sound understanding of (for example) what my core beliefs and rules for living are to find a connection with things and to be moved by them. I’m not saying that formulation is redundant, far from it. What I am saying is that from where I’m sitting, a neat initial formulation doesn’t always seem essential for good therapeutic work.

What is this idealisation of completeness? As if we can know something or someone totally? Again, so many clients have this idea that their identities, their beliefs and their thoughts need to be ‘coherent’. That we need to find a partner to be ‘complete’. Perhaps instead, we need to recognise our inherent lack, that we are born dependent, and fed with and by language from the moment of (and before) our birth. Clients (and trainers) might demand that we know, but our clients really need us not to know, to tolerate uncertainty, ambiguity, and speak through this, in order that they can learn to do that themselves.

I’m well aware however that if I had presented an incomplete formulation in a case-study, one with question marks and which was representative of the “I don’t know” answers my client had given me, I would have failed. The case studies and process reports I see written up for publication always appear to have full and complete formulations. I haven’t read any CBT textbooks which have said “Your client may not be aware of all the elements which trigger their difficulty. Seeing as you have limited time together, it might be worth moving forward with the information you have got”. Is it possible that the textbooks and journal articles sometimes don’t translate into real therapeutic practice?

Books are books, people are people, and the unconscious is … unconscious! The lovely, frustrating thing about the unconscious is that it isn’t to be known. That’s what defences are for: to protect us from what we can’t or won’t know. Lacan says that the client comes to the therapist, demanding that they are the one ‘supposed to know’. Our job is not to be seduced into that demand, but to hold the position of not knowing, so that there is space, in the frustration that ensues, for the client’s desire to appear. Winnicott is great on this – he suggests that interpretations have to be imperfect, in order that the client can give up the quest for perfection in the therapist, and indeed in themselves.  

The third ‘no no’ I frequently engage in is swearing (sorry mum). My employee handbook states that swearing is inappropriate and must not be engaged in. I’m under the impression it could lead to a warning and with repeated use, dismissal. Yet behind closed doors with my lovely and foul-mouthed clients I have been known to drop the f-bomb. Sometimes nothing quite puts emotion into words like “that sounds absolutely f*cking sh*t”. Although I’m not quite sure he was referring to such profanity I believe that Rogers is behind me all the way on this one. For me, a good obscenity communicates empathy and a realness in the relationship that “hard time” doesn’t quite convey.

Therapists are not judges, we’re not here to moralise on client’s language use. Indeed, it’s very important that clients can see that language is all we have to represent ourselves and our desires, however imperfectly, and to explore the possibilities and impossibilities in that. How can we understand our client’s communications, if we can’t join them in their linguistic play, and be curious together about that? The very idea that a word can be ‘forbidden’, is up for a lot of analysis!

My fourth and perhaps “worst” confession is that yes, I very much want to help my clients, but that I’m also in it for me. The reason I get up and go to work in the morning, the reason I have dedicated uncountable hours to writing my final portfolio, the reason I spent an enormous amount of money on training isn’t all for my client. I like the connection I feel in the room with clients. I like it when I can inspire them towards change and I like it because it makes me feel good. I think it’s important to recognise that I’m in it for me for many reasons. One of these is that there are certain clients I can’t work with because when I do I just don’t get from my job what I want to. Actually, I get a lot of pain and frustration and an agonising sense of inadequacy. I don’t want to go to work and dread seeing my clients. The instinct part of me says that this is totally understandable and okay, who would want this? But the practical part would never dream of admitting this to my superiors. Surely as a professional with sufficient knowledge and experience in the area you ‘should’ be able to work with anybody? That is your job, after all.

Desire! Clients want to feel better, and so do we. What other rewards are there? There are plenty of jobs that psychology graduates could do to get rich quick, although a few celebrity therapists do manage that, many of us earn enough to get by very comfortably. So maybe we love it, and love to hate it too? I remember sharing my ideas with my own analyst that she must get so bored of me saying the same things, blah blah, and she said ‘maybe I enjoy it’. For me, therapy is about how to enjoy life better – and therapist and client are in that together. Sure, we need to learn about the way we get pleasure and unpleasure, and I think it’s important to work with people we don’t like, especially when we’re training. These days though, if there’s a client I really can’t find a way of enjoying, I reckon I should probably pass them to someone who can. Our inadequacy is something for our own analysis, rather than making it our client’s problem.

And whilst I’m really bearing all – ever tried poking fun at a client? Obviously as with any intervention this is only helpful in the right moment with the right client. Individuals might repeatedly say they cannot do something. It is impossible for them. They’re just not that sort of person. They’re not clever enough, not brave enough, not good looking enough. Ask them if they’d do it for a billion pounds. It changes things! I guess I could argue the intervention from an ACT values stance. Would I have written it into a process report – I think not. BUT IT WORKS!

Sarcasm is one of the most delightful interventions when the relationship can take it. I recently spent a session with a client talking very deeply and meaningfully about his fantasies about being dead. Towards the end of the session, he shared that his girlfriend talked so much about her dead father, and he felt quite jealous. I said, without thinking about it, ‘well, you definitely can’t compete with that alive then, can you?’. I would defend that interpretation – to death!

So is it just me being a bit creative with the guidelines occasionally? Are other people still following hunches which they cannot quite explain where they came from? Are others working with both the textbook and the practicalities of their service or team? My inkling is that we are.

Oh sure, but the beauty of a psychoanalytic approach for me is that we have a way of thinking about our unconscious motives, and those of our clients. Our own analysis and supervision is precisely for these times – where we find ourselves doing something that feels ‘wrong’ that we can’t quite account for, and perhaps can’t quite stop doing! As a supervisor, analyst and person, it’s so important that I can open up dialogue on these things, rather than closing it down. This gets me through a world and a job that can sometimes feel very punishing, and helps me not act out that punishment in my own work – not all the time, anyway! I’d love to hear more from our readers about their hunches, no-nos and secret rule breaking too – there’s so much life in them!


Need a supervisor who you can discuss these kinds of issues with? Check out our directory!