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The Mirror Crack'd

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Revised edition. This title is as a wake-up call to take seriously the climate in which mental health professionals practice in which complaints and civil actions against psychotherapists and counsellors are on the increase and to sharpen assessment skills accordingly. It is also designed to help professionals to think about the "therapeutic frame" and what can happen to both the practitioner and the client when it is broken and finally to give voice to some colleagues who have been involved in the area of complaints in the hope that you and the organisations under whose codes of ethics you practice will take more of an interest in making those codes and frameworks more relevant to the intricacies of the therapeutic relationship. The message is simple: injuries that happen in relationships need to be addressed in relationships.

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CHAPTER ONE: The mirror crack’d

ePub

CHAPTER ONE

The mirror crackd

Anne Kearns

This book is the second to result from my work as a supervisor of humanistic and integrative psychotherapists. The first, The Seven Deadly Sins?Issues in Clinical Practice and Supervision for Humanistic and Integrative Practitioners (Kearns, 2005) was based on a post-qualification course of the same name that was designed to address certain areas that I and colleagues had identified as under-discussed in the original training. Two of those areassexuality and erotic transference (Chapter Four) and money (Chapter Two)were not included in my first book as they more naturally seemed to belong in this one as these are the areas where the misattunements that can become problematic often occur.

This book is the result of seven years of research towards a doctorate in psychotherapy. Before you begin to glaze over let me explain that when I say research I really mean that I talked to a lot of people. I first became interested in the vulnerability of psychotherapists and counsellors in 1997 when I was chair of my professional organisation and a representative to the HIPS section of the UKCP. Up until that point I hadnt really thought about the area of complaints. Suddenly I seemed to be submerged in it. In my role as chair of an organisation I struggled to keep the organisation in the UKCP as we had not followed our published procedures in a complaint that had been made against one of our founding members. As a representative to the HIPS section I became concerned that the HIPS sections own published procedures were un-thought-through and would lead to the escalation of disputes rather than containment, mediation and resolution.

 

CHAPTER TWO: The therapeutic frame: “Good fences make good neighbours” (Robert Frost)

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CHAPTER TWO

The therapeutic frame: Good fences make good neighbours (Robert Frost)

Anne Kearns

As a supervisor of humanistic and integrative practitioners I have often struggled in helping them to move from what appears to be a more social relationship to a professional and therapeutic way of relating that includes a deeper understanding of the unspoken dynamics of the therapeutic relationship that can easily get played out in the transference/countertransference relationship. I have been concerned for some time that what I believe to be the myths of mutuality and horizontality and the emphasis of process-oriented therapies on congruence (Rogers, 1951) or on presence and open and clear communication (Hycner & Jacobs, 1995) has taken humanistic practitioners away from a clinical focus the very real difference between client and therapist.

In my experience true mutuality is not possible in any relationship where one party has ultimate responsibility for another. When that is so it is not possible to give the experience of each party equal weight. As much as the therapist must bring humanity and humility to the encounter we must be vigilant not to let the common ground that we share with our clients lead us to lose sight of the fact that we have responsibilities in the relationship that are different from the clients responsibilities. The therapist needs to attend to her experience in the room, moment by moment, but also needs to bracket all sorts of thoughts and feelings and impulses. The client has no obligation to do this. In fact we actively encourage our clients to bring us their deepest thoughts and feelings. We also insist on some level that they control their impulses when in the room with us. It would not, for example, be acceptable for a client to hit their therapist or to damage his property. We control the boundaries of time and payment.

 

CHAPTER THREE: Assessment and risk-management

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CHAPTER THREE

Assessment and risk-management

Anne Kearns

Since the establishment of national organisations such as the United Kingdom Council for Psychotherapy (UKCP) and the British Association for Counselling and Psychotherapy (BACP) that govern psychotherapy and counselling in the UK there has been an on-going discourse about the pros and cons of the professionalisation and regulation of the talking cures (Totton, 1997; Postle, 1998; 2000). Since the 1990s both organisations have taken an increasing interest in monitoring training standards and in defining ethical practice. Whatever your personal beliefs if you are a practitioner working in the UK in the 21st century you are working in a climate that is more and more defined by market forces and social trends. Stigler, an economist, won a Nobel Prize for demonstrating that regulation tends to produce the opposite effect from that which its proponents intended (Stigler, 1971). A friend tells me that complaints against solicitors doubled in the year after procedures became more user-friendly. In his opinion people are complaining more because they can and not because there has been a change in the behaviour of solicitors. If the HPC do become the regulator for psychotherapy and counseling it will be possible for even more members of the public to make complaints as third-party complaints will be accepted.

 

CHAPTER FOUR: Love and hate in the in-between

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CHAPTER FOUR

Love and hate in the in-between

Anne Kearns and Steven B. Smith

Both of us have been trained in and are informed by both humanistic and psychoanalytic theories. Our grounding in the humanistic tradition leads us to value the human qualities of clinical relating that research has shown to be essential to a successful therapeutic outcome (Lambert, 1992); the psychoanalytic tradition, particularly where it was developed by the British object relations theorists, supports us in linking child development to adult experience and in learning to listen to communications from our clients that are outside of their awareness.

One of the assumptions that informs our work as integrative psychotherapists and as supervisors is that being able to read and process transferenceor the clients mostly non-verbal communication of archaic experienceis essential to a successful therapeutic outcome. We feel concerned when we meet humanistic therapists who say that they dont work with the transference. This is nonsense. All therapists work with transference. It is in the field of any relationship, particularly ones in which there is a power differential. Humanistic therapists work with the transference differently from more psycho-dynamically trained therapists in that they name, observe and use it rather than primarily interpret it. We want to help the reader to explore the non-verbal and somatic realms of the therapeutic encounter in order to be better supported to work with powerful emotion, particularly when it becomes sexualised.

 

CHAPTER FIVE: Working through an impasse

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CHAPTER FIVE

Working through an impasse

Patti Owens

Cathy came into therapy because she wanted to understand what she saw as a self-destructive need to act a role rather than really being herself. She had also been taking antidepressants at intervals over the last twenty years. Although on the surface happily married, she was concerned that people easily got bored with her and relationships often faltered or ended prematurely. She had been in therapy before but stopped just as she was on the threshold of doing deeper work.

We worked together for nearly a year and my four-week summer holiday was two weeks away. I had made a mental note that Cathy was likely to defend against her anxieties about such a long break by filling the session with anecdotal and distancing material and that I would need to help her to focus on her feelings about the upcoming break. In the penultimate session I neglected to do this, letting Cathy tell me stories about a difficulty she was having with someone else. I came to the last session before the break with a firm resolve to do better next time. Somehow I again failed to do this, only briefly touching on the implications of the break and struggling with feeling uncharacteristically sleepy and bored.

 

CHAPTER SIX: Where there’s smoke there’s fire

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CHAPTER SIX

Where theres smoke theres fire

Theresa Bernier and Anne Kearns

Theresa had a complaint made against her through an accrediting organisation by a former client who had ended therapy abruptly a year earlier. This is Theresas account of her experience, with some factual amendments that Ive (AK) made in order to protect Theresas anonymity and that of her former client. These amendments are drawn from people who I interviewed in the course of my doctoral research who had stories very similar to Theresas. The story is interspersed with some comments of my own which are drawn from interviews with others who have been through a variety of organistions complaints procedures; and several visits to the British Library, particularly to wade through the relevant parts of recent (200206) issues of counselling and psychotherapy journals.

Background

(TR) Tamara was referred to me by my supervisor when I was in the final year of my training in Person Centred counselling. I went on to train in a more psychodynamic psychotherapeutic approach and Tamara continued in therapy with me throughout that training. We worked together for nearly five years. She had come to therapy initially at the urging of her then partner who, Tamara said, thought she was mental and needed help. Tamara told me that she had difficulty containing her anger and was sometimes violent with her partner, which she linked to her having grown up in a household where father was often drunk and physically abusive and mother passive and compliant. Although I would not learn until a few months later that Tamaras pattern in life was to defend against others perceived failures by making both formal and informal complaints against colleagues, employers and various professionals, she did tell me in that first session that she often felt picked on and that she believed things went wrong for her in a way that they did not go wrong for others. She said her car never worked properly, household appliances broke down and she was often unwell herself, suffering from a series of ailments, including osteoarthritis. She was also on several medications, which she had been prescribed to help her combat pain. Among this list were at least two medicines widely known to be addictive and to result in mood swings and unpleasant side effects of withdrawal. Weeks later she would also admit to self harm. During that first session she said she suffered from terrible waking nightmares where she became anxious that she was dead. Five years earlier she had been referred to a psychiatrist after losing her job close after the break-up of a relationship caused her to shut down. Following an assessment the psychiatrist had suggested group therapy but Tamara had been horrified at the idea and had declined to take up the offer of a weekly place. She said the psychiatrist didnt really know what he was talking about. I liked Tamara. She was feisty and funny. Humour was an important factor in how we related to each other in the early days of therapy and, interestingly, even at the end. The supervisor who referred Tamara to me was seeing her brother for therapy. When I suggested that Tamara might be better served by working with someone more experienced than myself, my supervisor said, You need to cut your teeth somewhere, suggesting that, just because Tamara might be difficult to work with, this was not a sufficient reason to refer her on.

 

CHAPTER SEVEN: The courage to be human: A humanistic approach to conflict resolution

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CHAPTER SEVEN

The courage to be human:
A humanistic approach to conflict resolution

Bee Springwood

These are my personal reflections on my experience of being both a practitioner and an ethics officer of a small accrediting organisation with humanistic principles at its core.

Throughout my 25 years of practice, I have been lucky not to be subject to a complaint myself. I have done nave things, careless things, and probably failed to do or to notice other things that were important to my clients. I am also aware of the things I have doneand agonised about afterwardsthat led to learning for me and a deepening of the therapeutic relationship. It is not special wisdom or particular caution that has saved me, though I have learned lots over my ten years at the ethical coalface. It is more likely that I have learned a proper humility, which I am grateful to have had modelled for me by some of my supervisors and trainers. To me, the word humanistic before psychotherapy means accepting that we are never perfect; that in sharing our humanity with clients we must also acknowledge our mistakes and show a willingness to work through any disagreements. In my experience, not only is this the best course of action for protecting myself and my clients from the kinds of complaints that result from a bad or unplanned ending, but it is usually the most therapeutically fruitful.

 

CHAPTER EIGHT: “Everything’s fine here”—or is it? A mirror on our training institutions

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CHAPTER EIGHT

Everythings fine hereor is it? A mirror on our training institutions

Sue Jones

In psychotherapy training we often talk about mirroring and reflecting. The person centred approach mirrors back the experience of the client through empathic understanding of her frame of reference, the psychoanalytic approach holds up a mirror to the revealing world of projections. Just before his death Ian Gordon Brown held up a mirror, not to us as clients or practitioners, but as trainers and training institutions. He challenged us to see a shadow in the carefully polished glass, suggesting that in caring institutions it is the issue of power struggle that is denied. Speaking about the pressures associated with power in organisations he wrote:

On the one hand, in groups based on the ethos and attitude of love, those concerned with caring, the power struggle is terrific, and its always unconscious. On the other hand, in industrial organisations, where the power struggles are overt, everybody knows who is on a power trip, people joke about it, pull the other persons leg, its all open and above board and its something else that is unconscious. Jung talked about the polarity not of love and hate so much as love and power. Where there is power, love cant exist and vice-versa. People in the first kind of organisation where the love aspect is conscious, would flatly deny that there is any power struggle at all .

 

CHAPTER NINE: Intimacy, risk, and reciprocity in psychotherapy: Intricate ethical challenges

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CHAPTER NINE

Intimacy, risk, and reciprocity
in psychotherapy: intricate ethical challenges1

Tim Bond

This chapter is the outcome of a public dialogue at the 2005 World Transactional Analysis Conference in Edinburgh, between Bill Cornell and myself. Our conversation was facilitated by Sue Eusden, chairperson of the ethics committee of the Institute of Transactional Analysis (ITA) in the United Kingdom (UK) and Carol Shadbolt, a UK psychotherapist, with contributions from a distinguished audience. Writing this has provided me with the opportunity to digest the contributions of the participants and to integrate them within a longer-term project started five years ago in search of an ethic that will enrich and support our ethical mindfulness as we grapple with the intricate ethical challenges of routine psychotherapeutic practice.

One of the distinctive challenges for all approaches to psychotherapy is the psychologically intimate nature of the work. Our professional ethics to date have been primarily concerned with protecting the boundaries of the relationship so as to create a therapeutic space that is safe from unwelcome intrusion and strong enough to contain the interpersonal dynamics of the therapeutic process as well as to prevent the exploitation of clients in moments of vulnerability.

 

APPENDIX: Initial therapy agreement

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APPENDIX

Initial therapy agreement

This agreement expresses the commitment each of us makes at the outset. Please read it through when you have time, as we will discuss things further next week. Once we have discussed and agreed the details, we will both sign and keep one copy to register our shared understanding.

1. We have agreed to meet at (time)__ each _(day)_. This is your time each week that I have set aside for you. Each session lasts one hour. It is important for effective therapy that we try to maintain a regular and continuous commitment. If a change of circumstance makes this difficult for you, we can discuss the possibility of a different date and time and I will do my best to rearrange things if I can.

2. The fee we have agreed is __ per one hour session. Fees are due each session/on the last session of each month. (or other arrangements by agreement).

3. I will be ready for you at the appointed time. Please try to arrive on time, as I do not have a waiting room. If you arrive late for any reason the session will still finish at the appointed time.

 

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