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The Seven Deadly Sins?

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The Seven Deadly Sins? grew out of a post-qualification training course of the same name. It aims to make more accessible some concepts from the world of psychoanalysis, self-psychology and affective neuroscience, as well as commenting on the challenge of working "in the real world". This is achieved by offering an integrative and anecdotal perspective on issues that have been generally un- or under-explored in trainings that have a humanistic emphasis, issues such as envy, shame, love and hate, trauma, addiction, money, and eating disorders. These issues are illustrated through the judicious use of clinical case studies. Various "maps" are provided to assist the supervisor and clinician in holding opposing diagnostic models and in working with psychotherapy and counselling trainees.The chapters can be read in isolation, which makes the book an ideal tool for the supervisor and clinician to use in response to specific issues.

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8 Chapters

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CHAPTER ONE: The sorcerer’s apprentice

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The main challenge for me, as a supervisor of emerging psychotherapists, is to teach the theoretical and practical aspects of a psychotherapy that is based on the intentional use of relationship to people who may have had very little experience of clinical relationship, either as therapists or as clients. The paradox is that most of the relational issues addressed in the training are the very ones that the majority of trainees are struggling with for the first time, not just as beginning clinicians but, often, as beginning clients.

It is not unusual for entry-level psychotherapy trainees to have had no previous clinical experience or personal therapy. These trainees look to the outside for learning and may also have limitations in ego development that will affect their growth as a therapist. (Stoltenberg & Delworth, 1987). Trainees at this level tend to focus on the client rather than on themselves and, when they do focus on their own experience, it tends to be as a result of ‘performance anxiety and does not usually lead to clinically useful self-awareness. I have found it particularly stretching of myself as a trainer to help trainees to see that having ‘negative’ feelings such as irritation and exasperation towards a client does not necessarily indicate a flaw in the therapist’s character but, rather, can be a form of communication from or about the client.

 

CHAPTER TWO: Fragile self-process

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In the previous chapter we looked at some of the challenges for supervisors of trainee psychotherapists, including how to support supervisees to be available to ‘use’ themselves in a clinical relationship. The focus of that chapter was on the influences in the ‘field’ – including myth and transference – that the supervisor needs to understand in order to help the trainee to be a more effective practitioner

We also looked at the relationship between being vs. doing, arriving at the place where both the person of the therapist and technique were partners in the work. In this chapter I want to highlight the existential, intrapsychic, and interpersonal dynamics of the therapeutic relationship. Over the last few years I’ve made a sort of ‘map’ for myself and my supervisees that seeks to divide people into categories in order to emphasize the commonality of human experience as well as to underscore that we feel and think and behave with some people differently than we feel and think and behave with others. When this happens in a therapeutic relationship, I believe that we need to enter fully into those thoughts and feelings in an internal dialogue and in supervision in order to see them as something the client is telling us that he has not got the words to say. Those dialogues, then, inform how we are and what we do in the clinical encounter.

 

CHAPTER THREE: Schizoid self-process

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I include this chapter here because understanding the aetiology and relational dynamics of the schizoid presentation has helped me immeasureably to work more effectively – not just with clients with a schizoid self-process, but also with addictions and eating disorders, which will be the subjects of Chapters Four and Five. I have also come to understand something about the link between schizoid and narcissistic presentation and will share what I have learnt with you.

It was only after fifteen or so years of practice and my own psychotherapy that I had any relational understanding of a schizoid self-process. I eventually realized that a good deal of confusion about the term ‘schizoid’ comes from the fact that the DSM schizoid and the object relations schizoid are not the same thing.1

My training included very little input on schizoid self-process. The term was mentioned, particularly by TA writers (Stewart & Joines, 2002; Ware, 1983), who referred to the withdrawn, ‘un-feeling’ aspects of a schizoid presentation, the goal of therapy being to help these clients to ‘get out of their heads’ and into their bodies. Just teach them to feel. It all seemed so simple in those days. Over time I have come to realize just how terrifying feeling at all levels is to the more schizoid amongst us.

 

CHAPTER FOUR: Some thoughts on addiction or ‘Everybody be doin’ somethin’’

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I love the warnings that come with certain things I buy. You can tell the entire history of consumer dissatisfaction and ensuing lawsuits from reading the advice to the purchaser. My particular favourite came with a hairdryer I once bought that bore the caveat, ‘Do not use while sleeping’. There’s a story there.

This chapter comes with a sort of consumer warning based on past experience. Participants on ‘The Seven Deadly Sins?’ training over the years have found the day on ‘Addiction’ to be unsatisfying. No matter how we have changed the content or the structure of the day the feedback is pretty much unchanged. I suspect that this feeling of being unsatisfied is as much an identification with the material as a comment on the quality of teaching and information.

The whole area of addiction is problematic. Many of my colleagues who work in private practice have made the decision that they will not work with alcohol and drug related problems. They say that they don’t have specialized training to do so, but I suspect that the real reason is that working with people who are on some level deadening – or even killing – themselves through substance abuse leads to a deadening of the therapist that is difficult to sustain in private practice without the support of a team. As a supervisee recently said, the therapist can’t bear feeling the level of defeat and frustration that is part and parcel of working with addictions.

 

CHAPTER FIVE: Eating disorders

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The chapter headings in this book pretty much correspond to the order that we teach them on ‘The Seven Deadly Sins?’ training. Because of the emphasis on the course of being able to ‘use’ what is being evoked in us in the therapeutic relationship, we tell the participants at the beginning of each year to pay particular attention to what is evoked in them by each of the topics. It has been our experience that people have felt ‘unsatisfied’ at the end of the day on addiction and, if you’ve just read that chapter, that might be how you’re feeling now. Just be prepared for how you may feel when you read this chapter. I’ve already been to the kitchen twice to look for something to eat. We usually find that people on the course buy chocolate at lunchtime on the day on eating disorders to have at teatime, even though biscuits are in no short supply. When we were working on the chapter for its inclusion in another book, we ate a lot of KitKats. I don’t even really like chocolate.

Our aim here is to introduce you to some of the influénces, developmental and cultural, that affect a client’s relationship with food and with her body and then, through examples of our work over the years, to help you to identify when a client has a food-related problem, how to work with these and when to refer on or to work alongside other professionals. We urge you to seek specialist supervision when working with, or when supervising therápists who are working with, clients with eating problems. You may find the Eating Disorders Association website (www.edauk.com) a good place to start if you are seeking further training or access to specific information and current research.

 

CHAPTER SIX: Envy

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Pride, envy, gluttony, avarice, lust, anger, sloth – we used to call them the Seven Deadly Sins – now we call them personality disorder or, more kindly, fragile self-process.

Human beings have been telling stories in order to explain the darker side of living and loving since the beginning of recorded time. Take the creation story in Genesis, for example. God tells Adam and Eve who, let’s face it, have pretty much everything they could want, not to eat of the fruit of the tree of the knowledge of good and evil. The serpent, who envies Adam and Eve, takes Eve aside and tempts her to have a go. Eve’s pride (she thought she knew better than God) and her greed (what she had wasn’t enough) led to shame and exile. Some of my clients with ‘overdoing’ problems go through this cycle, sometimes several times a day. I’ve had plenty to eat. I shouldn’t have a cream cake. I could have just one. I hate myself for being weak. I must hide my weakness from others or they will reject me. Interestingly, the ‘original sin’ that the creation myth described was induced by a power outside of Eve. Sin is usually explained as a response to an external stimulus or is ascribed to something else. The milk spilt, the ball broke the window, the devil made me do it. In other words, the stimulus is in the environment, not in the self.

 

CHAPTER SEVEN: Living with the enemy – shame in the supervisory relationship

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Introduction

When we were talking about how to approach the subject of shame in supervision we were reminded of a story a colleague once told us. Her seven-year-old daughter and a friend asked our colleague if she could take them to the park the following afternoon. ‘I can’t,’ she said, ‘I’ve got supervision.’

Unwittingly, our colleague was soon to become some-thing of a schoolyard legend. Her daughter was used to this kind of pronouncement but her beautifully literal little friend announced to her classmates the next morning that ‘Jenny’s mum has x-ray vision. You know, like superman.’

Of course Jenny’s friend was on the right track. Supervision is a process of seeing-through, albeit with different punctuation. A supervisor ‘sees’ the client through the supervisee. Supervision is also a process of seeing, through the supervisory relationship and what it evokes in the supervisor and supervisee, possible parallels in the client–therapist relationship. Finally, it is also a process of seeing-through, or beyond, a supervisee’s ‘growing edges’,2 to their unique potential for doing effective therapy. It is, perhaps, the x-ray vision aspect of the supervisory relationship that increases the possibilities for shame to occur, particularly for trainees.

 

CHAPTER EIGHT: Trauma, memory, and the brain

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In my early teens I, like most other Americans, was bombarded night after night on the six o’clock news by the atrocities taking place in Vietnam. It was hard to imagine then that anything good would come out of America’s extended ‘police action’ there. Once the Americans pulled out of Vietnam and turned their attention to the Middle East, and to the oil that replaced Communism as the new national obsession, Vietnam was rapidly forgotten. In New York, where I lived, returning war veterans were usually honoured by a hero’s welcome complete with what’s known as a ‘ticker-tape’ parade through the financial district. This did not happen for the Vietnam veterans until ten or so years after they came home, once someone made the connection that the way the young men who had fought in Vietnam were ignored on their return by a nation that was on some level ashamed to acknowledge them contributed to their posttraumatic experience. Just like the soldiers who returned from the First World War suffering from ‘shell shock spurred an interest in the clinical treatment of trauma, so id the Vietnam vets. Three out of four who had experiénced heavy combat with its associated atrocities suffered symptoms of what came to be known as post-traumatic stress disorder (PTSD).

 

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