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EDITORS Margaret Agee and Philip Culbertson C/o School of Counselling, Human Services & Social Work Faculty of Education University of Auckland Private Bag 92601, Symonds St Auckland 1150 Email: m.agee@auckland.ac.nz Email: p.culbertson@auckland.ac.nz A DV I S O RY G RO U P Tina Besley, California State University, San Bernadino, California Richard Cook, Bethlehem Institute, Tauranga Kathie Crocket, University of Waikato, Hamilton Hans Everts, University of Auckland Frances Griffiths, Education Review Office, Wanganui Lyn James, private practitioner, Palmerston North Catherine Love, Victoria University, Wellington Judi Miller, University of Canterbury, Christchurch Irene Paton, private practitioner, Christchurch John Tetley, private practitioner, Auckland Dick Wivell, Tamatea High School, Napier SUBSCRIPTIONS Copies of the Journal are provided free of charge to all members of the NZAC. For separate subscriptions or single-issue purchase, please contact NZAC, PO Box 165, Hamilton 3240. Single-issue costs: Within New Zealand $25 (GST and post included) Overseas $NZ35 (post included) N ZAC N EWS L E T T E R The Association also publishes a newsletter, Counselling Today, which provides more frequent and informal information about NZAC activities and New Zealand counselling in general. CORRESPONDENCE All correspondence regarding manuscript submissions should be sent to the Editors, preferably by email (see addresses above). N ZAC M E M B E R S H I P Enquiries about NZAC membership and all other correspondence should be directed to: NZAC, PO Box 165, Hamilton PRODUCTION Make-up: Afineline, Wellington Printing: Adprint Ltd, Cambridge Tce, Wellington

G E N E R A L I N F O R M AT I O N The New Zealand Journal of Counselling is the official publication of the New Zealand Association of Counsellors.

The Journal’s aim is to promote counselling practice and research that reflect the unique cultural context of Aotearoa New Zealand, respecting and encouraging the partnership principles of Te Tiriti o Waitangi/The Treaty of Waitangi. The Journal is a forum for the sharing of ideas, information, and perspectives on matters of common concern among practitioners and those undertaking research in the field. In the content of the Journal, the Editors wish to be inclusive of a wide range of topics and perspectives, representing the diversity of interests within the profession. The Editors welcome the submission of papers, including commentaries on topical issues, literature reviews, research reports, practice-based articles, case studies and brief reports from the Association’s members and applicants, as well as from others outside the Association with interests relevant to the field of counselling. We welcome papers that represent a wide range of research methodologies, and that contribute to the development of knowledge in the theory and/or practice of counselling. The overriding criteria for selection are that the material is professionally relevant, that the presentation is of high quality, and that the writer has communicated effectively, in an interesting and engaging way, with readers. Manuscripts are welcome from practitioners, counsellor educators, academics, researchers and administrators involved in counselling or in related fields. Guidelines for contributors are available in PDF form from the editors. All articles are reviewed by two referees in a double-blind process. The opinion and comment contained in articles are those of particular author(s) and do not necessarily reflect the opinion of the Journal’s Editors, the Association, or any other person. The copyright of articles contained in the Journal is vested in the New Zealand Association of Counsellors and articles may not be reprinted without the express permission of the Association. © New Zealand Association of Counsellors

ISSN: 1171-0365


New Zealand Journal of Counselling 2009: Volume 29/1

Contents

Editorial

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“Are You a Christian Counsellor?” What Christian Counselling Could and Shouldn’t Be About Philip Culbertson

A Response to Philip Culbertson’s Presentation

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John McAlpine

A Response to Philip Culbertson’s Presentation

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Ruth Penny

2 Gay-affirmative Therapy and Emerging Integrative Solutions Working with Ego-dissonant Gay Male Clients

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Andrew Kirby

4 Childhood Exposure to Domestic Violence Reflections of Young Immigrants of Indian Origin

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Meera Chetty and Margaret Agee

3 Survey of Practitioners Providing Therapy for Survivors of Sexual Abuse/Assault in Aotearoa/New Zealand

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Ruth C. Mortimer, Gillian M. Craven, Cheryl C. Woolley, Judith Campbell, Shane T. Harvey, Joanne E. Taylor, and Jan Dickson

5 Activities Influencing the Professional Development of New Zealand Counsellors Across Their Careers

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Nikolaos Kazantzis, Sarah J. Calvert, David E. Orlinsky, Sally Rooke, Kevin Ronan, and Paul Merrick

Biographical Information

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Guidelines for Contributors

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The New Zealand Journal of Counselling Editorial

It has been said that a greater spectrum of difference frequently exists within a group that outsiders see as having a distinct cultural identity, than is often found among members of ostensibly different groups. Among members of the Christian community, there are complex shades of difference that underlie the three companion pieces that open this issue, ‘Are you a Christian counsellor? What Christian counselling could and shouldn’t be about.’ This paper by Philip Culbertson and two prepared responses by John McAlpine and Ruth Penny were originally oral presentations at a seminar held in Auckland last year. In her presentation, Ruth communicated movingly through the power of song as well as the spoken word, a part of her presentation that we are unfortunately unable to include for you here. The frequently asked question in the title can be heard as a challenge from prospective clients to practitioners within the Christian community, and calls forth reflection on one’s professional identity, the assumptions that might underpin this question, and the ethics of the way in which counsellors position themselves in responding. We offer these presentations here to open up space for further reflection and dialogue, as we did in the last issue with the companion pieces, “Eros and Liberation.” Following his discussion and critique of gay-affirmative therapy in the last issue, in a second instalment here, Andrew Kirby considers emerging integrative solutions appearing in the literature for therapists working with clients who struggle to reconcile their same-sex attraction with conflicting values and beliefs. These include a sexual identity management model, and a Kleinian perspective that offers a way of working with individuals who are unable to accept, change or integrate these competing aspects of their identity. When Meera Chetty talked with young Indian adults who had survived childhood exposure to domestic violence within their immigrant families, she encountered stories of resilience as well as pain. Her article, co-authored by Margaret Agee, provides insights into the lived experiences of children and young people exposed to domestic violence, and evidence suggests that these themes are common to many young people in this situation. The stories of these young people also challenge our thinking about the part

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counsellors in schools can play in helping young people build their resilience and achieve their educational goals to create brighter futures for themselves. Two further research-based articles complete this issue. In the first of these, Ruth Mortimer, Gillian Craven and other researchers from Massey University present the results of a survey of New Zealand practitioners who provide therapy for survivors of sexual abuse and assault. The survey sought information about the processes that counsellors use to determine mental injury due to sexual abuse, and their approaches to working with clients. Data obtained from this survey have contributed to the development of the latest best-practice guidelines, released in June 2008, for counselling survivors of sexual abuse. In the last article in this issue, Nikolaos Kazantzis and his colleagues report the results of a survey of 123 New Zealand counsellors who took part in a multinational study of therapists’ professional development across their careers. The findings for New Zealand counsellors were compared with those of the Canadian and US counsellors who participated. It is interesting to see the way in which New Zealand counsellors compare with their counterparts in rating training, supervision, and personal therapy. In both of these articles, the results of the research reflect encouragingly on New Zealand counsellors and their practice. Both also highlight the fact that we have little research-based evidence about many areas of our practice and related professional issues. As a professional association we need to do all we can to encourage and support research and foster engagement between practitioners and researchers. We hope you enjoy this issue. As always, we invite contributions to ongoing dialogue about challenging questions, as well as articles that report recent research and offer new perspectives to enrich our practice. Margaret Agee and Philip Culbertson Co-editors, New Zealand Journal of Counselling

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“Are You a Christian Counsellor?” What Christian Counselling Could and Shouldn’t Be About Philip Culbertson

Originally presented as the keynote address at one of two seminars sponsored by the NZAC Auckland branch, in association with the Counsellor Education Programme, the Faculty of Education, The University of Auckland, July 18, 2008. This was followed by two prepared responses, also printed here. The first keynote address and responses appeared in the previous issue of the Journal, vol. 28, no. 2.

Some of you here will know that in the year 2000, I published a book entitled Caring for God’s People: Counseling and Christian Wholeness. Until about 2005, it remained a bestselling book in pastoral counselling in the US, England, New Zealand, Australia, and South Africa, and it was a required text in seminaries and theological colleges in many countries of the world. Sales have tapered off now, after such a period of time, but it still sells well, and still generates invitations for me to speak at regional and national conferences. In 2000, I was also a regular book-reviewer for The New Zealand Herald, and so when I informed the Herald’s book editor of the publication of Caring for God’s People, she asked if she could arrange for it to be reviewed. As is usually the case, as the writer I was not consulted about the choice of a reviewer, so perhaps you can imagine my surprise when the book received quite a negative review in the Herald a couple of months later. The reviewer, a Presbyterian minister from here in Auckland, wrote (Watkin, 2000): Aucklander Philip Culbertson’s very American references to school grades and his American spelling indicate who the real audience [of this book] is, even if some local examples are used. Not surprisingly, Culbertson begins with a number of assumptions. For example, he has chosen family systems theory, narrative

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counselling theory and object relations theory as the three most useful approaches from the field of psychotherapy for those in ministry. Of course, most ministers do trawl from a wide range of theories, so even if you do disagree with this view and are willing to grapple with the jargon, his analysis could add to any minister’s melting pot. Another assumption Culbertson works from is his perception of ministry, which he defines as recognising God through self-knowledge and then simply being among others to point where God is already present and at work. Good ministry, according to Culbertson, is ultimately dependent upon the pastor’s people skills, people knowledge, and knowing what wholeness looks like. As significant as these issues are, ministry must be more than this. What about our understanding of who God is and the skills in ministry that enable people to discover a closer relationship with God? What is Christian ministry without a living, active God? (p. I-11) This reviewer’s criticism has lurked in the back of my mind for the past eight years. It’s the most negative review I’ve received publicly since I began publishing books nearly twenty years ago. In part I was bothered because of the contrast between what that reviewer said, and what another reviewer said (Albers, 2000): Some might critique Culbertson for beginning with the context of human situations and then moving to biblical texts and theological reflection. I don’t personally find that problematic, because as a pastoral counselor one is confronted existentially with the problems that afflict and affect individuals and families. Beginning with the “presenting problem” does not mean that a theological context or presuppositions are absent. Reflecting theologically with someone in counseling and integrating the faith tradition as it speaks to the struggles of the human condition often follows as a matter of course if a person of faith seeks out a counselor who operates from the perspective of faith. (p. 431) So it is the case, in fact, that the conflict between these two reviews of the same book sets out the landscape of what I want to address today, and what I’m quite eager to hear my respondents speak to. In sum: Is there an agreed definition of Christian counselling? Can Christian counselling begin with the client and stay with the client, or should it begin with the client and end with the Bible? I realise that I’ve just wildly oversimplified the problem by setting up two positions of potential conflict. Anyone who is a counsellor knows that nothing is ever that cut

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and dried. But at least these two conflicting positions set up, via caricature, an extremely important distinction that points to the place of God, the Bible, and the many different interpretations of Christian faith and tradition when dealing not only with Christian issues in the counselling room, but many other spiritual issues as well. “Am I a Christian counsellor?”

When a potential client phones to ask if you are a Christian counsellor, what do you answer? I was occasionally confronted with this conundrum when I had my private practice in therapy here in Auckland, because enough people in town knew enough about me to also know that I am an ordained Anglican minister. But my professional experience in the church, as well as in counselling and psychotherapy, is that ordained people can seem very frightening, or perhaps rigid, to potential clients. My policy was, when asked by potential clients, to say, “I am a psychotherapist and I am a Christian.” That was a carefully constructed answer designed to avoid, at the point of initial contact, any discussion of what either “psychotherapist” or “Christian” meant, since I believe that the meaning of those terms needs to be worked out face-to-face with clients. “Psychotherapist” is not a term well-understood by much of the New Zealand public, it seems to me. More importantly, “Christian” is a term that can mean many varied things to different people—a lesson I have learned over the course of my nearly forty years of being ordained. When I would answer, “I am a psychotherapist and I am a Christian,” what was in the back of my head was the desire to leave open for face-to-face exploration all possible areas of spiritual belief, and wait to learn what the client meant by the various vocabulary words attached to both Christianity and spirituality. My use of this professional principle springs out of my deep-seated belief that the purpose of counselling and psychotherapy is to “sit with” people while they find a way to “wake up”; tell the truth as best they can; make sense out of their life; and then move into the task of living a fuller, more aware, more satisfying life in which they are making conscious, rather than driven, choices, and are able to live out interdependent relationships with those around them. As an aside, perhaps you will notice that it is difficult for me to address this topic, on the whole, without using a vocabulary in which religious philosophies and the practice of psychotherapy overlap with each other—words like principles, beliefs, and spiritual—and some of you will have noticed that I just used the words “way, truth, and life” all in the same sentence!

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The blurred boundaries of religions and spirituality

There have been times in the course of my practice when the line between Christian belief and a more amorphous spirituality seemed blurred. When I taught in the psychotherapy department at AUT, I used to familiarise my students with the work of American therapist Carlton Cornett. In his book The Soul of Psychotherapy, Cornett outlines five questions that he asks his clients in order to encourage them to bring their spiritual beliefs into the room, and place them in dialogue with the other ways in which they were making sense—or not—of their lives. The answers, he believes, to these five questions are the foundation of what he calls “an examined life.” His five questions are: • What is a meaning of life? • What values are especially important to you? • Where will you go when you die? • Who or what is in charge of the universe? • Why do people suffer? (Cornett, 1998, pp. 21–44) Cornett argues that all people can—at least eventually—find answers to these five questions during therapy, which will feed their congruency and bolster their resiliency. You and I can look at these questions and immediately realise that the major religions of the world, including Christianity, also seek answers to these same questions—just as much as less structured spiritualities do. Most of the major religions also try to dictate that there are only certain “correct” answers to these questions, in the name of faithful orthodoxy. But Cornett’s claim is that everyone, religious or spiritual, can answer these five questions, and that seeking such answers is an integral part of counselling and psychotherapy when understood holistically. Are there standard, universal, Christian answers to these five questions? If you affirmed for the potential client that you were indeed a Christian counsellor, does that mean that you and the client would agree on the same answers to each of these questions? Without turning this into a lecture in biblical studies, I will say that the Bible itself gives various answers to Cornett’s questions, except for question four, where the clear answer is that God is in charge of the universe. For those of you who are less familiar with the Christian tradition, I will point out that question three—where will you go when you die?—has at least four answers in Christianity: immediately to heaven to be with God; or, into the ground to await the final resurrection of the dead; or, it depends on how you have lived your life, whether you will go to heaven or hell; or, this is all metaphorical language which does not indicate that one goes anywhere in particular.

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Barbara Brown Taylor (2007), a brilliant contemporary Anglican writer, has yet another answer: I suppose my greatest curiosity about the afterlife is whether I will continue to be me. I want to continue being me, of course. I want not only to see all of those creatures that I have rescued through the years; I also want to see the loved ones whom I have lost. I want to lay my head on Grandma Lucy’s lap again. I want to shell field peas with Fannie Belle and listen to Schubert with Earl. The problem with this scenario is that it turns heaven into my perfect version of earth, with a perfect me in the middle of it. As appealing as this is, it strikes me as an underutilization of God’s gifts…. In the face of all that I do not know about heaven, I am still willing to go where God wants me to go and to be what God wants me to be, even if I have to leave me behind. (p. 10) Question five—Why do people suffer?—is even more complicated. For example, in 2006, when Hurricane Katrina struck New Orleans and its environs, Pastor John Hagee, whose recent endorsement of John McCain proved to be a great embarrassment to McCain’s presidential campaign, announced that God had sent the hurricane to wipe out New Orleans because that city was preparing to have a Gay Pride parade. This, of course, is not exactly a biblical answer to why people suffer, but Hagee was able to back up his logic by citing, among other things, the destruction of the whole cities of Sodom and Gomorrah because some of the adult males there had behaved rudely. Now I’m left with yet another dilemma, as this presentation unfolds: If a potential client asks me if I am Christian, would she be expecting me to give answers consistent with Pastor John Hagee’s logic? Would I be able to stay connected to her in a Rogerian manner if she gave me that explanation? These are practice questions of significant import, and behind them lies the issue of hermeneutics. Hermeneutics and clients’ expectations

I am presuming here that if someone asks me if I am Christian, they are simultaneously asking me if I know and read the Bible, and if I interpret the biblical texts and precepts in the same way they do. Pastor John Hagee is an American ordained Christian minister, and I am an American ordained Christian minister, and we are about the same age. But we “interpret” the Bible very very differently. We each bring to the Bible our particular hermeneutic, which in turn causes us to draw very different lessons from the biblical text.

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The Oxford Companion to the Bible defines “hermeneutics” as the theory of interpretation, with biblical hermeneutics being that which inquires into the conditions under which the interpretation of biblical texts may be judged possible, faithful, accurate, responsible, or productive in relation to some specified goal. Hermeneutics…entails a study of biblical texts in order to understand not only the historical aspects of the writings but also the significance of these documents for the present as well. (Metzger & Coogan, 1993) Hermeneutics are like the lenses in your eyeglasses: they are unique to you and a small group of other people in the world, but there are more people whose eyesight is not like yours or mine than whose eyesight is. We put on our eyeglasses before we read a text, and our eyeglasses are themselves lenses crafted from the raw materials of our social location: our experiences with our families, race, class, culture, education, values, and unique life experience. Wars have been fought between people wearing different eyeglasses! Note the words from the Oxford Companion to the Bible: whether a biblical text may be judged “possible, faithful, accurate, responsible, or productive in relation to some specified goal.” Let me illustrate: for a conference presentation I was making in Auckland last week, I was doing research on the phrase from the Old Testament (Hosea 11:9), in which God says: “I will not execute the fierceness of my anger, ki El anokhi, ve’lo ish, for I am God, and not a male.” As a Christian and an academic, I do not believe that God is male. I believe that we “gender” God because we humans think in gendered ways, but God is not gendered. As theologian Miroslav Volf (1996, p. 173) points out, we get our human concepts of gender from animals, not from God. But would a potential client, inquiring whether or not I am Christian, necessarily be able to understand why I prefer to speak of God in non-gendered language? I believe that my interpretation of Hosea 11:9 is “possible, faithful, accurate, responsible, or productive in relation to some specified goal,” because to get to my interpretation, I have used a defensible hermeneutical process. But would my Christian potential client think so? The answer, I believe, is that some Christian clients would feel quite liberated by the opportunity to speak of God in non-gendered language, but that many others would find it confusing, suspiciously innovative, and perhaps not at all Christian. They would find my conversation about God to be not possible, not faithful, not responsible, and not productive for their specified goal. Or should I immediately capitulate, and speak to my Christian client only in

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masculine God-words? Frankly, I don’t know if I can do that. We therapists and counsellors do have our own values which, however hard we might try to be neutral, do in fact co-inhabit the counselling room as we work. I’ve been a follower of secondwave feminism since its inception, in the late 1960s. For forty years now I have valued the challenge to speak and write in inclusive language, and the daunting task to think subversively about patriarchy and male privilege. This is a deeply embedded value of mine, and one that I doubt I could set aside without creating extreme internal conflict, even though unconditional positive regard is also a value, not just a technique. Our religious and spiritual beliefs as counsellors are also values, including our reactions to the assumed roles of women in scripture, to the use of exclusivist language, and to the way that the power assumed by human males is underwritten by entrenched masculine metaphors for God, such as King and Lord. These are contested issues in the Church which divide us already, and which prevent me from answering too facilely any question about whether I am a “Christian counsellor.” Of course I am, in one sense, and have been for nearly four decades—but possibly not the kind of Christian counsellor a client might be expecting. In many ways, we want our clients to be good, successful, and wise, just as we desire those values in ourselves. We want them to assume responsibility, to gain insight, to have personal integrity, to move toward more observable and functional individuation. Lucy Bregman (1989) comments, “therapists want their patients or clients to develop in certain ways, to become certain kinds of persons, to grow out of certain behaviours and attitudes” (p. 261). Counselling and psychotherapy also seem to discount or downplay certain other values. “For instance, nowhere are purity, chastity, and righteous indignation therapeutic virtues, nor does reaching perfection appear as a valid therapeutic goal” (p. 263). Yet some would argue that purity, chastity, righteous indignation, and perfection —“Be ye perfect, as your Father in Heaven is perfect” (Matthew 5:48)—are biblical values that Christian counsellors ought to be actively encouraging in their clients. How do we negotiate and manage the presence of our own personal and religious values in the counselling relationship? How do we manage situations in which our Christian values or Christian hermeneutics will disappoint or even anger our Christian clients? What is the point at which a clash between our personal values as counsellors and a client’s personal values becomes an issue of professional ethics? These and similar questions seem to be hardly addressed in the counselling and psychotherapy literature.

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To double-check my hunch that there is a lack of guidance in a lot of these areas, I went to that perennial academic resource, Amazon.com. There I found a few books on the compatibility, or lack thereof, between Christianity and counselling. One of the leading texts was by someone named Gary Almy, who set the two up as diametrically opposed. His book, How Christian is Christian Counselling? The Dangerous Secular Influences that Keep Us from Caring for Souls (2000), started off selling really well, because he argued that Christians should stay as far away from counsellors and psychotherapists as possible, and only consult ordained spiritual directors. Unfortunately, the sales of his book dropped off quite sharply soon after it was published, when he was arrested for sexually abusing boys. Amazon’s best-selling book in Christian counselling is Christian Counseling that Really Works: Compass Therapy in Action, by Dan Montgomery (2007). Another popular book in Christian counselling was The Christian Therapist’s Notebook: Homework, Handouts, and Activities for Use in Christian Counseling, by Philip J. Henry, Lori Marie Figueroa, and David Miller (2007). The book advertises itself as based on three pillars: the truth of scripture; the centrality of Christ; and the guidance of the Holy Spirit. A fourth book listed was Effective Biblical Counseling, by prolific Christian writer Larry Crabb. Published in 1977, it has sold well, though recent comments from readers on the Amazon site suggest that they are dissatisfied with his “liberal” use of scripture, and found the book “too influenced by secularism, and people like Freud and Carl Rogers.” I became intrigued and did another Amazon search, this time punching in “Pastoral Counseling,” rather than “Christian Counseling.” Interestingly, a completely different set of books showed up. Most of the best-selling authors in that category are acquaintances of mine—people whose work informs my work, and who I run into at conferences. But there seems to be a gulf of some kind between Christian or biblical counselling, and pastoral counselling. To me, this again points to the complexity of the topic I am addressing here: the general level of suspicion which exists between the two polar ends of biblical hermeneutics. And if secular counselling is polarised from Christian counselling, and Christian counselling is polarised into biblical counselling vs pastoral counselling, then perhaps I’ve just stumbled into a minefield. To complicate matters further, I need to note the existence of a large, and growing, body of literature in “spirituality and counselling.” A sharp distinction is made in the non-Christian literature between spirituality and religion. Carlton Cornett makes this distinction, as does Froma Walsh, in her widely read recent book, Spiritual Resources in Family Therapy (1999). Citing Wright, Watson, and Bell (Beliefs: The Heart of

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Healing in Families and Illness, 1966), Walsh (1999) describes the difference: “… distinctions between religion, as extrinsic, organized faith systems, and spirituality, as more intrinsic personal beliefs and practices” (p. 5). The field of humanistic spiritualities, for example, has mushroomed in the past thirty years. I’d venture to guess that there are as many books now on spirituality in counselling or psychotherapy as there are books on biblical counselling and pastoral counselling. This body of research is cited regularly in the pages of the New Zealand Journal of Counselling, as we in this country are increasingly open to engaging both Western and indigenous spiritualities among our increasingly multicultural client base. In some ways, classical psychotherapy has been less adventurous in exploring issues of spirituality. Of course, Jung was deeply spiritual, as his writings show repeatedly, but as object-relations psychodynamic psychotherapy moved further away from Jung’s analytical psychology, spirituality seemed to get marginalised. However, a few Christian and Jewish writers have persevered in pastoral psychotherapy with a deeply spiritual, and often religious, base. Here I would mention the writings of Pamela Cooper-White (2004), W. W. Meissner (1995), Ana-Maria Rizzuto (1979), Edwin Friedman (1985), Carrie Doehring (2006), Harry Aponte (1994), David Augsburger (1986), Herbert Anderson (1993), and Donald Capps, whose recent book Jesus, the Village Psychiatrist (2008) is a fascinating exploration of whether most of Jesus’ “healings” were due to his deep understanding of the psychosomatic, or somatoform, origin of so many physical ailments. To liberate or to discipline?

To formulate how we should appropriately respond to a potential client who phones to ask, “Are you a Christian counsellor?” we perhaps need to explore our own fantasies in relation to the questions: What is the purpose of counselling—to liberate or to discipline? How do we know whether a client wants to be set free, or to be supported in conforming to assumed Christian expectations? Both themes—liberation and discipline—are developed strongly in the Bible. On the one hand, we have the constantly surprising nature of God, who from Moses in Egypt to the end of the book of Revelation repeatedly promises the faithful that they will be liberated into an exciting new tomorrow which will offer opportunities beyond their wildest expectations. On the other hand, we have biblical phrases such as “Conform your minds to the mind of Christ” (2 Corinthians 3:18; see also Romans 8:29), or “wives, be obedient to your husbands” (Ephesians 5:22). The first example

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illustrates liberation, leading people out of slavery into freedom and new hope, and the second examples illustrate the call to the discipline and submission of human lives and minds to the will of God as expressed in the Bible, however that will is perceived. I would claim that this same tension continues unresolved throughout the Bible, and well into the subsequent history of the church. For example, among writers in the first few centuries, Matthew 25:31–46, “For I was hungry and you gave me something to eat; I was thirsty, and you gave me drink,” was called The Great Commission—Jesus’ most important charge to his followers to continue his work. But as the Church began to grow in the 4th century, Matthew 28:19, “Go unto all nations and baptize them, making them disciples,” was called The Great Commission (see Flusser, 1988, esp. p. 175, note 1). Both themes are found in the Gospel of Matthew, and the determination of which is weightier is generally influenced by historical circumstances as well as the personal opinions of diverse Christians. Both interpretations of what it means to be Christian—to liberate, or to discipline and disciple—have a long history in Church and theology. I can’t help wondering which would be the preference of any potential client who asks, “Are you a Christian counsellor?”: liberation, or discipline? What is good practice in these situations?

While I was in active practice as a therapist, I received a call about once every three months, asking if I did Christian counselling. As I said, I always answered, “I am a psychotherapist and I am a Christian.” I did that because I believed that anything beyond my simple answer needed to be explored face to face with the inquirer, and I hoped that my answer would be encouraging enough for her to come see me, at least for long enough to sort things out. However, if in the initial conversation the inquirer would rephrase and repeat her question—“But I asked if you are a Christian counsellor”—then I would say no, and offer to refer her to people that I knew advertised themselves that way. There’s something about the question that signals me that I would disappoint the inquirer by not meeting an unexplored set of prior expectations. This is not to say that I have not discussed Christianity or belief systems with my clients. Over the ten years that I was in private practice here, I would say that I discussed faith issues with about 25% of my clients. Some, of course, never indicated that they knew I was ordained; I didn’t advertise that here because I believe it repels more people than it attracts. But a few clients did ask me if I felt a conflict between being a priest and being a psychotherapist, and a few asked me if I believed in God. Several clients brought material about their activity in local congregations into the room,

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especially if they were having trouble “being true to themselves” within their Christian communities. (As you might guess, some of these clients were struggling with how to remain in their local congregations and still claim a gay identity.) This did raise the question for me about how afraid people are of disappointing God, or of God’s disappointment in them, or the Church’s basic inability to accept them for who they really are. These were usually productive conversations, but I don’t think they qualified me as a Christian counsellor. Many other therapists could have done just as well, as long as we all adopted a position of “informed not-knowing” —about the Bible, denominationalism, or the perceived requirements for a healthy faith in God. I’ll close now with a story. In about 1996, I had an idea to teach a Masters level course within Theology, entitled “Spirituality and Counselling.” The course was to be cross-listed with the MEd (Couns.) programme at the University. I had an idea what the theology students might need me to include in the course, but less of an idea what the counselling students might need to have included. So via Hans Everts and Margaret Agee, I arranged a two-hour meeting with some of the students enrolled for an MEd (Couns.). My initial plan for the course had included a brief introduction to beliefs of the major world religions which are practised in New Zealand—Christianity, Judaism, Islam, Hinduism, and Buddhism. The gathered students thought that was a terrible idea. I asked, “So if a client says that he likes Christianity because of its strong belief in reincarnation, you don’t think a counsellor needs to know what’s wrong with that statement?” “No,” replied the students, “you just need to go with the flow of what the client believes, even if it is technically incorrect.” I protested. The students replied, “What matters in a counselling session is what the client believes, not whether it’s right or wrong!” In writing this presentation, I realised that that exchange, too, has sat in the back of my mind all these years. Perhaps that’s why I don’t want to call myself a Christian counsellor: because I would feel the need to make sure that the client got Christianity “right”—probably “my kind of right”—before we could address the client’s issues. I realised then that my tendency in the counselling room, when it came to issues of Christian faith and behaviour, would probably be to discipline and disciple—that is, to teach my educated hermeneutic based on 38 years as a priest and professor—rather than to liberate clients into a healthier, more congruent, more resilient way of living their lives, even if what they were basing it on was “wrong”—whatever that means and however they believed. So I leave you with one simple question: “Are you a Christian counsellor?”

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References

Albers, R. H. (2000). Reviews. Word & World, 20(4), 428–432. Almy, G. (2000). How Christian is Christian counseling? The dangerous secular influences that keep us from caring for souls. Wheaton, IL: Crossway Books. Anderson, H. (1993). Leaving home. Louisville: Westminster/John Knox. Aponte, H. (1994). Bread & spirit: Therapy with the new poor. New York: W. W. Norton. Augsburger, D. (1986). Pastoral counseling across cultures. Philadelphia: Westminster. Bregman, L. (1989). Psychotherapies. In S. Grof & C. Grof (Eds.), Spiritual emergency: When personal transformation becomes a crisis (pp. 428–432). New York: G. P. Putnam. Capps, D. (2008). Jesus, the village psychiatrist. Louisville: Westminster/John Knox Press. Cooper-White, P. (2004). Shared wisdom: Use of the self in pastoral care and counseling. Minneapolis: Fortress. Cornett, C. (1998). The soul of psychotherapy: Recapturing the spiritual dimension in the therapeutic encounter. New York: Free Press. Crabb, L. (1977). Effective biblical counseling. Grand Rapids, MI: Zondervan. Culbertson, P. (2000). Caring for God’s people: Counseling and Christian wholeness. Minneapolis: Fortress Press. Doehring, C. (2006). The practice of pastoral care: A postmodern approach. Louisville: Westminster/John Knox. Flusser, D. (1988). An early Jewish-Christian document in the Tiburtine Sybil. In Judaism and the origins of Christianity (pp. 359–389). Jerusalem: Magnes Press. Friedman, E. (1985). Generation to generation: Family process in church and synagogue. New York: Guilford. Hagee says Hurricane Katrina struck New Orleans because it was ‘planning a sinful, homosexual rally’. Retrieved June 9, 2008, from http://regent.gospelcom.net/regentcarey library/resources/research_help/glossary.html Henry, P. J., Figuera, L. M., & Miller, D. (2007). The Christian therapist’s notebook: Homework, handouts, and activities for use in Christian counseling. New York: Routledge. Meissner, W. W. (1995). Thy kingdom come: Psychoanalytic perspectives on the Messiah and the millennium. Kansas City: Sheed & Ward. Metzger, B. M. & Coogan, M. D. (Eds.). (1993). The Oxford companion to the Bible. New York: Oxford University Press, in Regent College Library (n.d.), Glossary: Selected types of materials and terminology. Retrieved June 10, 2008, from http://regent.gospelcom. net/regentcareylibrary/resources/research_help/glossary.html Montgomery, D. (2007). Christian counseling that really works: Compass therapy in action. Santa Fe: Compass Works. Rizzuto, A.-M. (1979). The birth of the living God: A psychoanalytic study. Chicago: University of Chicago Press.

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Taylor, B. B. (2007). Leaving myself behind. In R. Ferlo (Ed.), Heaven (pp. 7–12). New York: Seabury Press. Volf, M. (1996). Exclusion and embrace: A theological exploration of identity, otherness, and reconciliation. Nashville: Abingdon. Walsh, F. (Ed.). (1999). Spiritual resources in family therapy. New York: Guilford. Watkin, N. (2000, August 26–27). The New Zealand Herald, Auckland, New Zealand, I-11.

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A Response to Philip Culbertson’s Presentation John McAlpine

Philip, thank you for your paper. I honour both you and your contribution to the field of counselling and psychotherapy. My response to you is more personal than academic. It is a response that has evolved from forty years’ experience as a Christian priest, and more than twenty years’ practice as a counsellor/psychotherapist. I trust it will be of interest to you and our counselling colleagues. Some years ago I was invited to write a concise statement summarising my counselling and psychotherapeutic philosophy. In part it read: While deeply grounded in Person Centred counselling, I work eclectically, using the therapeutic method best suited to each of my clients. … I have a deep belief that everything within us, including the unhelpful and painful, is striving towards our wholeness and healing. Accordingly, I work with clients in helping them honour all within themselves, aiming to develop the whole person with a balance of head and heart, body and spirit. … I assist clients to integrate spirituality with wholesome human living. I respect and value the spiritual dimension in each person, and believe in the freedom of everyone to follow his or her own path of spiritual development. Is this a description of a Christian counsellor? Some Christians may say “No!” Philip, I warm to your carefully formulated response to an inquiry: “Are you a Christian counsellor?” I respond in a similar way to such inquiry, i.e., “I am a counsellor /psychotherapist; and I am a Christian; and I work with people in ways that meet them and their spirituality.” Often that response sufficiently signals that I will be sensitive to the enquirer’s Christian ethic. If, however, the response to my response is: “But do you follow the Bible as you counsel?”, I need to answer along these lines: “I understand the Bible as primarily the faith stories of my forebears-in-faith—stories that can help us grapple with our issues today; stories that invite us into an intimate relationship with God, others, and ourselves. I don’t see the Bible as a rule-book telling me what to do, or as God’s last words; I believe God continues to reveal today; I believe that Jesus saw

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sacred text in everyday life, not only in the sacred texts of his forebears-in-faith.” Philip, I resonate with your conviction that: the purpose of counselling and psychotherapy is to “sit with” people while they find ways to “wake up,” tell the truth as best they can, make sense out of their lives, and then move into the task of living a fuller, more aware, more satisfying life in which they are making conscious, rather than driven, choices and are able to carry on interdependent relationships with those around them. You’ve got me thinking about your admission that in your work as a therapist, you perhaps tend more to “discipline and disciple” than to “liberate,” a tendency arising from your passion that your client discover the “correct” version of Christianity. I suspect that you “discipline and disciple” so that your client can be “liberated” from unhelpful understandings of Christianity, but still I wince at the thought of “discipline and disciple.” Is that because I suspect that I work in the same way, or do I come to the task of counselling and psychotherapy from a different angle? Do I favour “companioning” rather than “directing” my clients? By the end of this presentation I may have answered my own question and in the process, discovered that you and I are on the same page. You may also discover that I believe in, to echo the words of poet Rainer Maria Rilke in his Letters to a Young Poet, “living into the questions and gradually growing into answers,” more than answer-providing. I personally don’t believe in “past lives” or “reincarnation,” but I have worked successfully with a small number of clients who do. I once accompanied a woman— let’s call her Mary—who, after months of intensive work with me, seemed to have made little progress. Mary often hinted that she constantly felt pursued. One day, when she was ready, I helped her face her pursuer, who she discovered to be from a past life. A robust encounter ensued between the “past” and the “present.” Mary was greatly liberated and quickly moved to the next stage of her therapy. Despite my own personal belief, I was able to join her in the “metaphor” of her reality and Mary claimed liberation for herself. Many years ago I worked with a client—let’s call him Andrew. I can’t remember how he made contact with me, or if he knew I was a priest. In summary, Andrew’s primary issue was that he deeply loved a particular woman; but he also loved sex and was continuing to have sex with many other women. He was deeply dissatisfied with himself, and he wanted to commit to this one woman, but didn’t know if he could and still thrive. In brief: what did he really want of life? Shortly after he commenced work with me, I facilitated his taking a journey deep within himself as he sought that which

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A Response to Philip Culbertson’s Presentation

he really wanted out of being sexual with another. He arrived at a place within himself, describing it, after some searching for the right word(s), as “I Am.” He allowed himself to deeply experience that I Am. As he emerged from this experience, he exclaimed: “What the hell was all that? It was bloody amazing!” I paused and asked, “Have you ever used those words to describe yourself, or have you ever heard those words being used before?” “Never,” was his response; “I don’t talk like that!” I responded, “The Jewish people, in their ancient stories, believe that ‘I AM’ is one of God’s names.” His response was one of amazement: “Bloody hell, does that mean…?” I nodded: “That the divine is within you—what do you think?” “Bloody hell!” was all he could say. Andrew was radically changed after that encounter. Did he become a Christian as a result? I don’t know, but I trust he will keep journeying with I AM. He certainly was freed to commit to his fiancée, and to enter more deeply into love. Was I a Jewish counsellor in that session? Was I a Christian counsellor? Perhaps I was simply a Christian accompanying him as he travelled the path. Need I have drawn his attention to the Hebrew Scriptures? Only in that he was already quoting them without knowing that he was doing so. The Hebrew Scriptures contain stories peculiar to, but not exclusive to, Jewish people; rather, they are stories of humanity trying to answer the big questions of life, such as the five life questions posed by Carlton Cornett and referred to in your paper—five life questions foundational to what Cornett calls “an examined life.” I have been helped by the writings of Marcus Borg, a contemporary Christian scripture scholar and theologian. In various places in his writings, particularly in his book Meeting Jesus Again for the First Time: The Historical Jesus and the Heart of Contemporary Faith, Borg outlines three macro stories found in the Hebrew Scriptures; stories that can help us as we journey with God, with each other, and with self. Borg describes how these three macro stories continue into the Christian Scriptures, helping us understand both the person and the mission of Jesus of Nazareth, of whom I am a follower. These three stories are the Exodus Story, the Exile and Return Story, and the Priestly Story. They are central to the Bible. They shape the Bible as a whole, influencing the religious imagination and understanding of ancient Israel, Jesus of Nazareth, and the early Christian movement. The Exodus Story is about a people in bondage (physical, emotional, psychological, spiritual, and political, etc.), who hunger for liberation, and who embark on a journey toward a new freedom: a very human story, the likes of which we hear day in and day out in our counselling rooms. The experience of being in bondage and longing for liberation runs deep within us all.

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The Exile and Return Story is about separation (being cut off) from all that is familiar, dear, and central to our lives; about grief, anger, powerlessness and marginality, and often about oppression and victimisation; about separation with physical, emotional, psychological, spiritual and political dimensions: a very human story, the likes of which we hear day in and day out in our counselling rooms. The experience of being separated from home and longing for home runs deep within us all. The Priestly Story is about guilt and shame; about being out of right relationship with God, with others, and with self: a very human story, the likes of which we hear day in and day out in our counselling rooms. The experience of being out of right relationship and seeking right relationship, acceptance, and forgiveness runs deep within us all. Jesus of Nazareth was profoundly influenced by these three macro stories. The Christian story sees Jesus as a visible sign of God in our midst, liberating, welcoming home, accepting, and forgiving. As I accompany clients in my role as counsellor/psychotherapist/priest, I do so as one also profoundly influenced by these three macro stories lived by my faith-forebears, including Jesus of Nazareth. I can’t do otherwise. The Christian way is in my blood. The challenge that I face is to be a credible, visible sign of God, liberating, welcoming home, accepting, and forgiving. Do I need to use my faith stories in the doing? Can I meet my client with real integrity, be that client Christian, Jewish, Muslim, Buddhist, Hindu, or of another persuasion, or of the “I’m not persuaded” persuasion? Can I meet them in their stories, in their search for liberation, homecoming, acceptance, and forgiveness? Can I begin with the client and stay with the client? I profoundly hope that I can and do. Where is God in the mix? Throughout! Do I need to announce God’s presence? Not necessarily; I trust God can do that unaided! Can I remain true to my calling as a Christian and counsel in an authentic, person-centred way? Yes, but only in as much as I accompany my clients, companioning them as they discover the good news of liberation, homecoming, acceptance, and forgiveness. And when I do, then I believe I am being authentically Christian and authentically a counsellor or psychotherapist.

References

Borg, M. J. (1994). Meeting Jesus again for the first time: The historical Jesus and the heart of contemporary faith. San Francisco: Harper. Cornett, C. (1998). The soul of psychotherapy: Recapturing the spiritual dimension in the therapeutic encounter. New York: Free Press.

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A Response to Philip Culbertson’s Presentation Ruth Penny

In his paper, “‘Are you a Christian counsellor?’ What Christian counselling could and shouldn’t be about,” Philip asks, “What is the purpose of counselling—to liberate or to discipline?” My attention was caught by this question, as it was a similar question that led to my own decision to leave my role as church pastor in order to become a counsellor within the wider community. As a pastoral counsellor in a church strongly influenced by the “discipleship movement” of the 1960s and 1970s (O’Malley, 1997), I was confronted with a stark conflict between my personal desire to offer people the freedom that could lead to genuine transformation, and the expectation that as a Christian leader, I should maintain a standard of behaviour in my parish. Employed by a church that held a specific moral code, I was expected to uphold the rules of the club. In that situation, the words “Christian” and “counsellor” created a conflict that I was unable to reconcile. Many years on, I am still a counsellor and still a Christian. However, those two descriptors of myself no longer sit in such an uneasy alliance. Like Philip, I choose not to run those two descriptors together, though within myself, they are inseparable. I cannot extricate being a Christian from my everyday experiences, any more than I can extricate my Judaism, or the fact that I am a Kiwi or a woman. These factors, and many more, shape my values, my behaviours, the discourses I live by, and the expectations I have of myself and of others. Because my faith has played an integral part in learning to love and value myself, it remains part of the foundation that allows me to love and value others. If we are committed to the level of genuineness that Rogers (1961; 1980) so strongly advocates within the therapeutic relationship, how can we separate the factors that have shaped us from the people who we are? Philip asks, “Are you a Christian counsellor?” My answer is, “Yes. I am a Christian counsellor—and a Jewish counsellor, and a Kiwi counsellor, and a white middleaged female counsellor.” All these factors influence who I am and how I am perceived. Therefore, just as it may be necessary to ask a client how it is for them to be working

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with a woman, so it may be important, if they know of my history, to ask how it is to be working with a Christian and an ex-minister. The moment I am identified as a Christian, I become an image-bearer. For good or ill, my actions and personhood can become a measuring stick for Christianity and for God. Until I am known for myself, I am also likely to wear the faces of image-bearers who have gone before. For me, therefore, the question is not so much, am I a Christian counsellor, as it is, “What sort of Christian counsellor am I?” What does it mean for me to take my whole self, including my faith, into the counselling room? How does that faith influence the way that I treat my clients, my way of being with others, and the way others perceive me? Within the New Zealand Christian Counsellors’ Association, the debate about what it means to be a Christian counsellor has been a familiar and ongoing one. Members join the association because they see their faith and their counselling practice as being linked in some way, but the ways that different members would describe that link may be very, very different. As an organisation, NZCCA is constantly holding the tension between differing, and at times conflicting, expressions of faith, all of which come under the broad heading of “Christian.” Our challenge is to remain inclusive of these differences in a way that models grace, while at the same time creating opportunities for members to critique the impact their faith has on themselves, their clients, and their counselling practice. Under the NZCCA umbrella would also nestle some strongly opposing ideas of what it means to bring Christian faith into the counselling room. Some would say we bring it in through an attitude of grace and acceptance. Others would say we bring it in by conscious reference to scripture and theology. Rather than ask which is right, perhaps we would do better to ask which is most appropriate for the client that we seek to walk alongside. Philip has invited our response to two positions of potential conflict: “Can Christian counselling begin with the client and stay with the client, or should it begin with the client and end with the Bible?” I would respond with my own question: “Which ‘Bible’ are we talking about? The Bible that’s written down as scripture, or what Michael Quoist (1963, p. 2) calls ‘that new gospel, to which we ourselves add a page each day’?” It seems to me that most people of faith carry two different theologies—the espoused theology that they have been taught, and the embodied theology that they live out of. These two may carry a degree of harmony, or bear little resemblance to each other. As counsellors and Christians, which of these do we most value? Which do we invite into the counselling room, and is it the counsellor or the client who decides whether either is relevant?

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Perhaps because of my Jewish ancestry, I find it very difficult to separate sacred from secular in the way that much Christian doctrine does. Even the question of whether we can “start with the client and end with the Bible” suggests that humanity and spirituality are somehow separate from each other and that we need to leave something of our personhood behind to advance into spirituality. David Benner (1998) writes: Efforts to separate the spiritual, psychological, and physical aspects of persons, inevitably result in a trivialization of each. When spirituality is equated with “that part of us that relates to God,” suddenly we are in a position of relating to God with only a part of our being. It is then only a small step to God being seen as more interested in certain parts of us than others. The dividing line between sacred and secular then cuts through the fabric of personality…when spirituality is separated from the physical, the result is a spirituality that lacks groundedness—an ethereal experience that has no connection to the rest of one’s life. (pp. 62–63) If we see ourselves needing to add specific Christian practices into our counselling work for it to be “spiritual,” are we in fact adding to the split between humanity and spirituality? In my own experience and my work with clients who have been spiritually abused, espoused theology and the Bible have been a source of great injury rather than a source of life and healing. For clients who have experienced dominating and legalistic churches, the Bible has often been the weapon that has brutalised them. With such clients, the Bible is inevitably present in the counselling room, just as the shadow of the perpetrator is present with clients who have been sexually abused, and that presence is far from benevolent or benign. The very tool that some streams of Christian counselling (Adams, 1973; Collins, 2001; Crabb, 1977; McMinn, 1996) would see as pivotal to healing may in fact be the enemy to be faced and conquered. With some of my clients, it has been necessary to negotiate a “Bible-free” space within the counselling room, where they can go to explore their own thoughts away from the tyranny of “God-sanctioned Truth.” For others, the Bible has represented a trusted resource for their healing and move toward wholeness. Benner (2003) points out the need for care and sensitivity when using any religious resources, stressing the importance of understanding how “they are experienced by the person seeking help” (pp. 37–39). As counsellors, how do we manage the power dynamic that comes into the room when clients themselves bring in beliefs that carry a quality of divine authority? How do we create a safe place for challenging these beliefs and how do we know if

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challenging these beliefs is in a client’s best interest? Similarly, how do we manage power dynamics when asked to pray for a client? What does prayer mean for them? Is prayer a cultural practice, or a step of holistic processing, or an act of avoiding responsibility, or a request that comes out of a belief that God is more likely to listen to our prayers than to theirs? The greatest challenge for me as a Christian and a counsellor is to respectfully hold, and genuinely value, a client’s beliefs in a punitive, judgemental God. Everything in me wants to rise up and shout, “But God isn’t like that! What about love and grace?” If I say this, am I still being a counsellor, or have I moved into the role of evangelist? How can I enter my client’s world in genuine empathy and respect if I am looking for a chance to correct their theology? When I review the way that my own theology has radically changed over the years, and will likely change again, how can I assume that my version of “truth” is right, anyway? It seems to me that if I am to work holistically with my clients, I am better to look for what is already present and life-giving in their spirituality, than to look for what is lacking. If I have the audacity to believe that I model something of the face of God, am I equally expectant and willing to see God modelled in my clients, whatever their beliefs? Perhaps, for me, being a Christian counsellor is less about what I promote and more about what I am willing to hear and see—a willingness to hear and value spiritual longings and to see the sacred in those whose lives I am privileged to share. References

Adams, J. (1973). The Christian counselor’s manual. Grand Rapids: Zondervan. Benner, D. (1998). Care of souls. Grand Rapids: Baker Books. Benner, D. (2003). Strategic pastoral counseling (2nd ed.). Grand Rapids: Baker Academic. Collins, G. (2001). The biblical basis of Christian counseling for people helpers: Relating the basic teachings of scripture to people’s problems. Colorado Springs: NavPress. Crabb, L. (1977). Effective biblical counseling: A model for helping caring Christians become capable counselors. Grand Rapids: Zondervan. McMinn, M. (1996). Psychology, theology, and spirituality in Christian counseling. Forest, VA: American Association of Christian Counselors. O’Malley, J. (1997). Shepherding movement: Discipleship movement. Retrieved July 10, 2008, from http://mbsoft.com/believe/txc/shepherd.htm Quoist, M. (1963). Prayers of life. Dublin: Gill and McMillan. Rogers, C. (1961). On becoming a person. New York: Houghton Mifflin. Rogers, C. (1980). A way of being. New York: Houghton Mifflin.

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2

Gay-affirmative Therapy and Emerging Integrative Solutions Working with Ego-dissonant Gay Male Clients Andrew Kirby

Part Two Abstract A dichotomy exists in the literature in relation to treating ego-dissonant gay clients who struggle to reconcile their same-sex attraction with opposing values and beliefs. Historically, conversion therapy was the treatment of choice, which aimed to treat the “condition” (homosexuality) by changing an individual’s homosexual orientation to heterosexual. In recent years, as public opinion has shifted toward increased tolerance and acceptance of homosexuality, gayaffirmative therapy has gained popularity and advanced as the modality most likely to benefit the majority of ego-dissonant gay clients. However, each position has tended to respond with a limited, exclusionary choice: to either reject or accept one’s sexual orientation. This dichotomised treatment option may not serve all clients who seek help in dealing with conflicts regarding sexual orientation. The first instalment of this two-part discussion appeared in the New Zealand Journal of Counselling, vol. 28(2), and reviewed gay-affirmative therapy: its history, the developing relationship between the mental health profession and homosexuality, and key concepts of practice from different theoretical perspectives. In this second instalment, emerging integrative solutions appearing in the literature are examined, including a sexual identity management model, and a Kleinian perspective is offered as a way of working with individuals who are unable to accept, change or integrate competing aspects of their identity. This study recognises that each approach caters, to some degree, to the uniquely different needs of individuals.

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This article, the second in a two-part series, continues to explore the issue of working with ego-dissonant gay male clients. In the first part of this series, the author examined gay-affirmative therapy, recognising that this relatively new approach, which values and endorses individuals’ sexual orientation, has advanced to become the modality of choice for most clinicians working with individuals who struggle to accept their sexuality. Whereas historically, conversion therapy attempted to change one’s sexual orientation, many contemporary gay-affirmative therapists assert that the target of change is not the individual, but rather, culture. Current research suggests that gay-affirmative therapy helps most of those who experience their homosexuality as ego-dissonant to achieve an increased sense of identity, integration and wellbeing. Yet there are others who value all aspects of their identity equally, and do not wish or are not ready to choose a conventional gay-affirmative approach for fear that their sexuality might be validated at the expense of competing values or beliefs, such as holding on to traditional values regarding marriage and family, or religious doctrines that view homosexuality as unnatural and immoral. The ongoing debate about whether one should accept or reject one’s sexuality has rendered dichotomous explanations insufficient for such clients, for whom neither conversion therapy nor gay-affirmative therapy seems appropriate. In this article, emerging integrative solutions which cater to the needs of this minority of ego-dissonant gay clients are examined. Following this review, a Kleinian model is proposed as a way to think about and work with clients who are unable to resolve perceived irreconcilable differences between sexual feelings and opposing personal values and beliefs. Is change of sexual orientation really possible?

Complicating this area of research is disagreement about what sexual orientation actually is. While essentialism and social constructionism fuel the nature versus nurture debate over the aetiology of homosexuality, research does not yet clearly support one particular perspective. Some researchers (Gonsiorek, Sell, & Weinrich, 1995; Spitzer, 2003) have attempted to examine sexual orientation change; however, no consensus about accurate assessment and measurement of sexual orientation has been reached. If theorists are uncertain as to what sexual orientation is, then it is understandable that there is disagreement as to whether or not it can be changed (Yarhouse & Burkett, 2002). Worthington (2004) cautions against the tendency to fall into simplistic or dualistic

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thinking about sexuality, and argues that dichotomous notions of sexual orientation must be challenged. Distinguishing between sexual orientation, sexual identity, and sexual orientation identity creates clearer understandings of how patterns of sexual behaviour, affiliation and identification might change, even significantly, over time. Current research does not support the idea that persons can convert their core sexual orientation, and data indicate that individuals have been unable to change their core sexual arousal patterns, regardless of how hard they tried (Gonsiorek et al., 1995). Thus, perceived sexual identity and sexual orientation identities have been the focal points of most individuals’ reports in research (Phillips, 2004). Increasingly, contemporary conversion therapists acknowledge that their target of change is sexual identity and that sexual orientations are essentially immutable (Yarhouse, 1998). They defend the practice without trying to establish the pathology of homosexuality, appealing instead to the individual preferences of those who are dissatisfied with their sexual dispositions (Murphy, 1992). Thoughts about depolarising the debate

The American Psychological Association (1992) calls on clinicians to respect individuals’ diverse aspects of identity; however, the Association does not address situations where competing aspects of identity collide. So what is meant by this request for “respect”? Respect in this sense does not mean therapists have to agree with every belief, value, or expression of the client, but rather to respect why clients choose to accept and engage in the various expressions that reflect their identity (Yarhouse & Burkett, 2002)—for example, understanding why a conservatively religious gay person chooses not to engage in same-sex behaviour. Haldeman (2004) notes that the depth with which religious identity can be embedded in the psyche cannot be underestimated, and can serve as a central organising aspect of identity that some individuals cannot relinquish. Psychology is in no position to negate clients’ religious or other affiliations. Respecting a conservative religious person’s view of homosexuality is not tantamount to supporting inappropriate heterosexism: “There is a difference between moral evaluation of same-sex behaviour as volitional conduct and prejudice against another for his or her race or sex. Some gayaffirmative theorists (e.g., Stein) acknowledge this distinction” (Yarhouse & Burkett, 2002, p. 238). These writers postulate that the middle ground is perhaps to recognise that in a diverse and pluralistic society, gay-affirmative therapy, reorientation therapy, and alternative approaches may all be viable options.

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While these options might suit persons who feel they have a choice—such as bisexuals, and individuals who identify as heterosexual but engage in homosexual behaviour—there are serious problems with this position for gay people, not least of which is that the situation is fraught with ethical malpractice risks (Gonsiorek, 2004). Gonsiorek challenges the assumptions underlying the idea of “unlimited client choice.” Clients struggling with issues around sexual orientation could make treatment requests based on naïveté, immaturity, interpersonal coercion and social pressure, social desirability, misinformation, personal psychopathology, misunderstanding, curiosity, or any number of other factors. It is a therapist’s professional responsibility to ensure that clients are provided with enough information about recommended treatment options and appropriate ethical practice to be able to give informed consent. “It is nonsense to assert that, in requests for conversion therapy, respect for diversity requires that psychology abdicate these complex duties and considerations” (Gonsiorek, 2004, p. 755). Furthermore, Beckstead and Morrow (2004) argue that the benefits gained by participants in sexual reorientation could have been experienced in therapies other than conversion therapies, and the potential risks of harm are significant. In honouring the ethical principle, “First, do no harm,” and harm seems likely, “we have an ethical obligation to investigate the actual risk to patients before offering them an intervention” (Herek, 2003, p. 439). A key issue that explains why the present debate resists resolution is that conservative religious ideologies are typically based on values from a separate philosophical paradigm (faith-based), which can be incompatible with principles of scientific inquiry and professional psychological practice. Conversion therapies seek to legitimise the use of psychological techniques and behavioural science to enforce compliance with theology and religious orthodoxy. In other words, conversion therapists are asking psychology to endorse and sanction the theologically based creation of psychological distress in gay individuals. Avoiding polarisation is a worthy goal, but not at any price. “The stakes in the ‘conversion therapy’ controversy are high: psychology’s soul is in peril” (Gonsiorek, 2004, p. 758). Miville and Ferguson (2004) raise the issue of “choice” when an individual is “caught between conflicting social worlds” (p. 767). To ensure optimal psychological functioning, psychotherapists need to continue working on alternative ways to help clients as they navigate conflicts to achieve the highest level of identity synthesis possible. Thus, some authors (Beckstead & Morrow, 2001; Haldeman, 2004; Throckmorton

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& Yarhouse, 2006) have proposed integrative models to tackle the complexities of often-conflicting aspects of sexual identity and competing values or beliefs, such as religiosity. These do not presume a direction for the religiously conflicted gay person but instead enable the individual to explore and, if need be, change fundamental core aspects of identity without subscribing to either conversion therapy or gay-affirmative therapy. Integrative models also provide guidelines to practitioners “who wish to facilitate clients setting their own therapeutic agenda, often in the face of social pressure in one direction or another” (Haldeman, 2002, p. 268). An integrative model

Emerging integrative solutions share the view that all aspects of an individual’s identity are worthy of respect and that the therapeutic goal is “to assist the client in finding a solution in which different components will find some place at the table” (Gonsiorek, 2004, p. 752). For clients who are both gay and conservatively religious, therapy cannot focus solely on one of those aspects, but must work to integrate both if it is to be beneficial and effective. Conflict resolution, for example between homosexuality and religiosity, is an endeavour of psychotherapeutic practice and consistent with gayaffirmative perspectives. However, this approach differs in that, instead of a client and therapist agreeing that the goal is to help the client integrate a gay identity, this model advocates a discernment process. It should be noted that some contemporary gayaffirmative therapists do operate from such a perspective. Haldeman (2004) proposes three general stages to an integrative approach: assessment, intervention, and integration. Assessment involves evaluating the client’s current sexual behaviour and fantasy life, including a thorough investigation of the existential implications of the person’s sexual orientation, and psychosocial forces that might affect the way his sexual identity and expression are viewed. Advanced informed consent1 provides the framework for eventual goal development whereby the client may come to his own direction. Worthington (2004) raises concerns of potential ethical malfeasance where highly polarised proponents on either side of the debate might adopt only those aspects of their approach that are consistent with and confirm previously held biases. Following assessment comes a choice point for the client. This might lead to the goal of “prioritising” one identity element over another, and strategies employed in the intervention phase are dependent on the identified direction of treatment. Often a psycho-educational/experimental phase ensues, in which the individual is involved

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in social or affiliative exploration, or “trying on” the chosen lifestyle. Alternatively, the task of the therapist may be to facilitate an “integration” of the competing elements of identity. Rawls (1971) describes a similar process—“reflective equilibrium” — beginning with considered judgements (intuitions) arising from a “sense of justice” that is a source of both moral judgement and moral motivation. If our judgements are in some way conflicted, we proceed by adjusting our various beliefs until they are in equilibrium, meaning they are stable, not in conflict, and provide consistent practical guidance. For example, a gay man in therapy moves towards integrating a gay identity and so relinquishes his conservative home community of faith for a more inclusive, gay-friendly religious environment, or the other way around. Often conflicts contain a “should” side saying, “Do this,” and a “want” side saying, “I don’t want to.” Although never addressing this particular issue, Yontef ’s (1995) concept of the Gestalt two-chair approach is useful for gay clients faced with this type of conflict. The client role-plays both sides, speaking from the “should” side and then the “want” side, switching back and forth until some integration has been reached. Integration occurs because both sides begin to see some sense in the other side. “Changes in the ‘should’ side particularly facilitate integration because the should side moves from talking in ‘shouldistic’ language to expressing hopes and fears” (Bohart, 1995, p. 125). Instead of, “You shouldn’t be gay,” it says, “I’m worried [that] if you’re gay, you’ll never be happy.” However long this intervention phase lasts, the therapist needs to provide support and resources when requested, but acts as neither cheerleader nor sceptic. Haldeman’s integration phase presents a resolution of the conflict. Information gathered during intervention leads the individual to determine a course that will most likely embrace the previously conflicting elements of identity. This is an informed and fully conscious choice, and the client, supported by the therapist, can access the necessary resources to make this a realistic integration. This final phase also provides an opportunity to review and evaluate the entire process. The therapist’s task with such individuals is not to provide advice or direction but a safe holding environment, in which the client is free to explore the many challenging questions associated with identity conflicts. Freud (1918) emphasised the importance of such a client-centred approach: We refused most emphatically to turn a patient who puts himself into our hands in search of help into our private property, to decide his fate for him, to force our own ideals upon him, and with the pride of a Creator to form him in our own

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image and see that it is good…we cannot accept [the] proposal either—namely that psycho-analysis should place itself in the service of a particular philosophical outlook on the world and should urge this upon the patient for the purpose of ennobling his mind. In my opinion, this is after all only to use violence, even though it is overlaid with the most honourable motives. (p. 164) The sexual identity management model

But what of an individual who, after careful examination, still feels committed to exploring sexual reorientation? Even with data indicating that conversion therapy is not a legitimate solution to this complex problem, therapists would be hard-pressed to deny individuals the treatment or spiritual interventions they seek. Throckmorton and Yarhouse (2006) have proposed strategies of sexual identity management under specific conditions, in which a client maintains adherence to his personal values and/or faith and, while recognising same-sex attractions, develops ways to control or avoid unvalued sexual behaviour. Goals may include attempting to change sexual orientation, aspiring to celibacy, or managing homoerotic impulses and feelings in the context of a heterosexual identity. This might be achieved by expanding social networks and specific settings to those supportive of the desired sexual identity, or avoiding sexual behaviour until there is significant level of comfort with and desire for this activity. With this approach, it is essential that therapists continually monitor the impact that sexual identity interventions have on their clients’ mental and emotional status. Sexuality and religion are two issues most capable of eliciting emotional responses for both client and therapist. Given these complexities, it is vital that therapists examine and re-examine their own feelings, beliefs, experiences, values, and assumptions, and be especially vigilant that their feelings about either or both of these areas do not lead to countertransferential reactions that could exacerbate clients’ confusion. Therapists’ behaviours that could be an extension of countertransference are usually expressed as prejudice against clients who are considering a possible course of action. In the case of therapists who find themselves disappointed by a client’s choices, or feel challenged about maintaining facilitative neutrality in the face of a client choice, referral should be made. The negative therapeutic reaction

Friedman and Downey (1995) speculate on a clinical subgroup of conflicted gay clients in the context of what Freud (1923) termed the “negative therapeutic reaction.”2

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Certain types of transference reaction—frequently a manifestation of unconscious guilt, sometimes reinforced by unconscious envy—make some clients unable to accept supportive gay-affirmative interventions. They envy the therapist for being free of the tormenting conflicts from which they suffer and may experience any primary love object as destructive. These clients seem “wrecked by success” and have difficulty allowing others to be helpful to them, with histories of being success-avoidant and undermining relationships with others. Psychodynamic assessment reveals early childhood feelings of self-hate, “which [were] condensed into internalised homophobic narratives conducted during later childhood” (Friedman & Downey, 1995, p. 107). Treatment strategies generally need to then move from supportive psychotherapy to a more uncovering approach. A supportive approach with ego-dissonant gay clients who express self-hatred for being gay, for no logical reason, might encourage individuals to express, rather than attempt to suppress, their sexuality. In contrast, an uncovering approach seeks to explore with clients their negative feelings about the representation of themselves as homosexual. Instead of confrontation, clarification, and psycho-education, an exploratory approach would more likely present a relatively unstructured, although empathic and accepting, therapeutic stance to facilitate regression and transference distortion. Often, symptoms represent relationships with lost objects from childhood, and, over time, the therapist would attempt to alter the balance between the client’s unconscious wishes and fears through interpretation and other techniques. If symptoms are embedded in a self-destructive character pathology, treatment is likely to be lengthy and arduous, and the treatment outcome uncertain. A Kleinian model

There are a handful of clients for whom none of the above models will work; their wish to maintain both sides—sexuality and opposing values/beliefs—means that neither a comfortable resolution of the conflict nor a choice of a side seems possible (Haldeman, 2004). With this in mind, it may be helpful to elaborate on Klein’s (1946) concept of the paranoid-schizoid and depressive positions3 as a possible way to think about and work with individuals who are unable to integrate or choose between these competing aspects of their identity. These clients often split off conflicting aspects of themselves in a defensive manoeuvre aimed at protecting idealised fantasies of how life “should” be. In the early stages of the therapeutic process, these clients are in the paranoid-schizoid position, characterised by persecutory anxiety. Splitting allows the individual to keep contradictory feelings and impressions separate, so that they can hate

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and love safely, without their good parts being destroyed by their perceived bad parts. This, however, inhibits the individual’s ability to be congruent. If, in time, assessment reveals that all other treatment options are unsuitable, the therapist explores with the client how it might be for them to tolerate the paradox created by their conflict, or, as the person moves into the depressive position, they themselves find that matters appear differently. A shift occurs as the conflicted individual becomes able to tolerate ambivalence and, thus, to integrate both the loved and hated aspects of themselves. This painful but more realistic move to the depressive position is characterised by sadness, longing, and grieving. As the ego’s tolerance for its aggressive impulses increases, its need for splitting and projection decreases, persecutory anxiety diminishes, and the ideal and persecutory aspects are allowed to come closer. In this instance, the paradox must be accepted, not resolved. For some ego-dissonant gay clients, helping them learn to increase their capacity to “hold” ambivalence might be a realistic goal. For others, this might be an essential step in reaching a place of self-acceptance, facilitating a more favourable response to a gayaffirmative approach in time. The following vignette attempts to illustrate part of this process. After detailed assessment and examination of his experiences and motives, Matt had still been unable to fully integrate a gay identity. C1: Everything points to me accepting it, and yet, there’s something that stops me. I just can’t take that final step. It just blows everything right out the water, again! T1: You are unable to feel truly settled. C2: Yup. It just seems so futile—like why keep trying? [Client becomes teary] T2: It feels like an impossible position to be in. C3: Yup, there aren’t answers are there?… At least not for me. T3: How would it feel if there weren’t any answers? C4: It would just feel really…disappointing. [Silence] Other people seem to manage somehow. Why can’t I just accept it and be happy?… But I can’t. T4: Maybe all you can do right now is accept that there are no answers, and that your faith and being gay is who you are. C5: [Client sighs] It’s not what I was hoping for. T5: A resolution to the problem? C6: Yeah, part of me really finds that hard to accept—not having an answer… [Silence] But, in a way, it somehow feels better than constantly fighting what seems an uphill battle that just isn’t going anywhere.

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In following sessions, Matt came to grieve the loss of what seemed to be an impossible dream: that of finding a definitive answer to his conflict, which he had spent most of his adult life searching for. Feelings of disillusionment and vulnerability evoked an outpouring of sadness. Yet recognition of and connection with his overwhelming disappointment created a shift beyond his “need” to resolve this paradox. Winnicott (1968) believed that, in this instance, success in analysis must include the “delusion” of failure. This paradox needs to be accepted. From a psychoanalytic perspective, an analyst must be able to accept the role of failure as he accepts all other roles that arise from a client’s neuroses and psychoses. Many analysts have failed in the end because they could not allow a delusional failure, due to their personal need to prove their own skill through “curing” the client. Conclusion

The initial motivation and somewhat naïve intention of this research was to find a single treatment option for conflicted gay clients that neither endorses homophobic treatments nor negates opposing values and beliefs. What is evident is that people are uniquely individual, and a “one size fits all” approach to these kinds of conflicts is not advocated because the variety and complexity of issues brought by ego-dissonant gay clients defy generalisations. Investigation of the literature reveals that any ready-made, content-bound form of intervention will ultimately disenfranchise the client. Therefore, rather than attempt to synthesise the results from completely different paradigms, the two parts of this study have, consecutively, looked at gay-affirmative therapy and emerging integrative solutions, each of which caters to different needs of individuals. Current research suggests that the majority of gay clients who struggle to integrate their sexual feelings and personal values or beliefs benefit from gay-affirmative therapy. Using gay-affirmative therapy, clients have come to recognise that their conflicts, stemming from societal prejudices that they have internalised, are symptomatic manifestations of homophobia, heterosexism, insufficient social support and lack of gay role models, social stigma, and the association of a gay identity with negative stereotypes. For gay clients who enter therapy considering sexual reorientation, the goal of gayaffirmative therapy is to help these individuals realistically assess their “impossible dream.” Literature suggests that the ensuing insight and clarity that follow gayaffirmative therapy allow the majority of clients to experience a decrease in their levels of distress and an increase in self-acceptance, identity cohesion, and emotional congruency. Individuals with more advanced gay identities have a lower propensity

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to seek sexual reorientation. Furthermore, self-disclosure arising from increased selfacceptance has been shown to decrease ego-dystonicity. The reciprocal nature of behaviour, psychology, and health has long been recognised, and recent research investigating this relationship has demonstrated the salience of religiosity as a mediator of the therapeutic alliance, client psychological health and wellbeing, and treatment outcomes. Many clients perceive spirituality to be appropriate within therapeutic settings. Fear of their religious beliefs and values not being respected stops some religiously conflicted gay individuals from seeking professional help. Filling this gap, emerging integrative solutions that give equal credence to an individual’s spirituality and sexuality offer alternative treatment options to those who do not wish or are not yet ready to choose between traditional conversion and gayaffirmative psychotherapies. Available literature on integrative models, however, is limited, and largely from a gay-affirmative perspective. More research and discussion are required regarding religious integrative identity models for same-sex attracted individuals and how they reconcile conservative religious doctrines with same-sex attraction. There are a few remaining individuals for whom none of the three aforementioned modalities work; the conflict—and the wish to maintain both sides of the conflict— mean that neither a comfortable resolution of the sides nor the choice of a side is feasible. A model using Klein’s concepts of the paranoid-schizoid and depressive positions has been suggested as a way to think about and work with ego-dissonant gay clients who are unable to accept, change, or integrate competing aspects of their identity. Increasing these individuals’ capacity to hold ambivalence can decrease anxiety, eventuating in a shift that can better equip them to tolerate their conflicts. For some, this may be a transitional phase until they are ready, in time, to respond more favourably to a more affirmative approach. As counsellors and therapists working with this client group, it is important that we ourselves grapple with who we are authentically, with all our competing parts, and come to accept our own identities as rich and complex. By understanding ourselves more fully, we offer hope of providing a relationship to clients that supports them in understanding themselves. Acceptance of our own contradictions enables us to offer clients an environment that allows them to explore and ultimately accept theirs. By remaining open, we can explore with clients how they make sense of, and give meaning to, their individual experiences. We can also appreciate the delicate balance required

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in providing a safe, neutral, and holding environment in which clients can fully explore and ultimately make autonomous choices regarding treatment options, while being kept informed of appropriate ethical practice. As effective clinicians, we must be aware of our own contributions—assumptions, reactions, and agendas—and how these can affect therapeutic outcomes. Equally important is the need to be patient in a way that allows us to reflect on how our countertransference—anger, disappointment, feeling challenged, and the narcissistic need to “cure”—might enhance our capacity to understand and meet each client. In this way we can advocate for a society where individuals can be who they are, and be valued for it.

Notes

1. Advanced informed consent helps the individual understand the effects of their social environment and know what appropriate treatment options are available while therapy remains a value-neutral enterprise (Haldeman, 2004). 2. Freud (1923) describes this phenomenon sometimes occurring during the work of analysis—when the analyst speaks hopefully to the analysand or expresses satisfaction with the progress of treatment, the patient shows signs of discontent and their condition invariably becomes worse. 3. According to Klein’s (1946) theory, during the first year of life the infant develops two “positions”: the “paranoid-schizoid” position, assumed during the first three or four months of life due to the inability of the immature ego to integrate the death and life instincts, and the “depressive” position, which develops when the infant ego is somewhat more mature and better capable of integration.

References

American Psychological Association (1992). Ethical principles of psychologists and code of conduct. Washington, DC: Author. Beckstead, A., & Morrow, S. (2001). Clients’ experience of sexual reorientation: The process of seeking congruence. Paper presented at the 109th Annual Convention of the American Psychological Association, San Francisco, CA. Beckstead, A., & Morrow, S. (2004). Mormon clients’ experiences of conversion therapy: The need for a new treatment approach. The Counseling Psychologist, 32(5), 651–690. Bohart, A. (1995). Person-centered psychotherapy and related experiential approaches. In S. Gurman & S. Messer (Eds.), Essential psychotherapies: Theory and practice (2nd ed., pp. 107–148). New York: Guilford.

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Freud, S. (1918). Lines of advance in psycho-analytic therapy. In Standard Edition (Vol. 17, pp. 157–174). London: Hogarth Press, 1955. Freud, S. (1923). The ego and the id. In Standard Edition (Vol. 19, pp. 1–66). London: Hogarth Press, 1961. Friedman, R., & Downey, J. (1995). Internalized homophobia and the negative therapeutic reaction. The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 23, 99–113. Gonsiorek, J. (2004). Reflections from the conversion therapy battlefield. The Counseling Psychologist, 32(5), 750–759. Gonsiorek, J., Sell, R., & Weinrich, J. (1995). Definition and measurement of sexual orientation. Suicide and Life Threatening Behavior, 25, 40–51. Haldeman, D. (2002). Gay rights, patient rights: The implications of sexual orientation conversion therapy. Professional Psychology: Research and Practice, 33(3), 260–264. Haldeman, D. (2004). When sexual and religious orientation collide: Considerations in working with conflicted same-sex attracted male clients. The Counseling Psychologist, 32(5), 691–715. Herek, G. (2003). Evaluating interventions to alter sexual orientation: Methodological and ethical considerations. Archives of Sexual Behavior, 32, 438–439. Klein, M. (1946). Notes on some schizoid mechanisms. International Journal of Psychoanalysis, 27, 99–110. Miville, M., & Ferguson, A. (2004). Impossible “choices”: Identity and values at a crossroads. The Counseling Psychologist, 32(5), 760–770. Murphy, T. (1992). Freud and sexual orientation therapy. Journal of Homosexuality, 23(3), 21–38. Phillips, J. (2004). A welcome addition to the literature: Nonpolarized approaches to sexual orientation and religiosity. The Counseling Psychologist, 32(5), 771–777. Rawls, J. (1971). A theory of justice. Cambridge: Harvard University Press. Spitzer, R. (2003). Can some gay men and lesbians change their sexual orientation? 200 participants reporting a change from homosexual to heterosexual orientation. Archives of Sexual Behavior, 32(5), 403–417. Throckmorton, W., & Yarhouse, M. (2006). Sexual identity therapy: Practice framework for managing sexual identity conflicts. Retrieved May 17, 2007, from http://www.wthrock morton.com/wpcontent/uploads/2007/04/sexualidentitytherapyframeworkfinal.pdf. Winnicott, D. (1968). Thinking and symbol-formation. In C. Winnicott, R. Shepherd, & M. Davis (Eds.), Psycho-analytic explorations (pp. 213–216). Cambridge: Harvard University Press. Worthington, R. (2004). Sexual identity, sexual orientation, religious identity, and change: Is it possible to depolarize the debate? The Counseling Psychologist, 32(5), 741–749.

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Yarhouse, M. (1998). When clients seek treatment for same-sex attraction: Ethical issues in the right to choose debate. Journal of Psychotherapy, 35(2), 234–259. Yarhouse, M., & Burkett, L. (2002). An inclusive response to LGB and conservative religious persons: The case of same-sex attraction and behaviour. Professional Psychology: Research and Practice, 33(3), 235–241. Yontef, G. (1995). Gestalt therapy. In S. Gurman & S. Messer (Eds.), Essential psychotherapies: Theory and practice (pp. 261–303). New York: Guilford.

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4

Childhood Exposure to Domestic Violence Reflections of Young Immigrants of Indian Origin Meera Chetty and Margaret Agee

Abstract In this qualitative investigation, four young adults of Indian ethnicity reflected on their childhood experiences of exposure to domestic violence within their immigrant families, including the nature of their exposure, the effects it had on them, and their responses to their situations. Among the themes that emerged were their powerlessness as children, their lack of mothering, and the loneliness of their role as “the responsible one� in the family. An unexpected finding was the significant part played by school counsellors in enabling these resilient young people to develop their strengths and move forward in their lives with hope.

Motivation to undertake this research arose for Meera from working as a volunteer at a women’s refuge with a group of children aged three to ten who had been exposed to domestic violence and who were immigrants of Indian origin. Immigrants often grieve the loss of community, friends and personal networks, and replacing these is a lengthy and difficult process (Hernandez & McGoldrick, 2005). For immigrant children and adolescents who are exposed to domestic violence, these losses of support structures, including extended family, could potentially leave them quite isolated in the new country. Defining domestic violence

Domestic violence, sometimes referred to in the literature as intimate partner violence, family violence, or violence to women by known men, is defined as: any violent or abusive behaviour (whether sexual, physical, psychological, emotional, verbal, financial, etc.) which is used by one person to control and dominate another with whom they have or have had a relationship. (Hester, Pearson, & Harwin, 2000, p. 14)

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Culture, gender and family socialisation are among many factors that influence an individual’s judgement about what particular actions characterise domestic violence (Levendosky, Bogat, & von Eye, 2007). Literature review

Children as victims

When referring to children’s experiences, Holden (2003) recommends using the term “exposed” rather than “witnessed” or “observed” because it is inclusive of the different ways in which children may experience domestic violence (Edleson, 1999), without assuming that a child has actually observed the violence. Exposure includes prenatal events, being victimised, participating, intervening, being an eyewitness, overhearing, observing the initial effects, experiencing the aftermath, hearing about the violence, or being ostensibly unaware (Holden, 2003). Domestic violence disrupts the one place children would normally associate with safety: their home (Card, 2004; Eggert, 2005). Like refugees, these children frequently experience family disruption and personal uprooting, being forced to flee for safety from an intolerable and dangerous environment (Berman, 1996). The perpetrator of the violence is usually a parent who would normally be the child’s protector, while the other parent is a terrified victim, often unable to support the child (Edleson, 1999; Eggert, 2005; Flores, 2001; Kilpatrick & Williams, 1997, as cited in Card, 2004). The secretive nature of domestic violence also inhibits the recognition of children as victims; parents try to hide the violence from the outside world, from their families, from their children, and sometimes from themselves (Peled, 1996). “Fights” the children witness may not be defined as violence or discussed with them by their parents. Children may be silenced by fear for their mothers, fear of getting hurt themselves, and/or fear of undesired changes in their lives as a result of the violence or their mothers’ responses to it. They are, therefore, only likely to disclose when they are somehow given permission to do so (Hester & Pearson, 1998, as cited in Hester, Pearson, & Harwin, 2000). Professionals’ efforts have concentrated on the “direct” victims of domestic violence, i.e., usually the women, but less consideration has been given to the needs of their children (Berman, 1996), who have been seen as secondary victims by the battered women’s movement (Peled, 1996). Furthermore, the extent of children’s exposure is not fully known (Osofsky, 2003), hence the references to them as “invisible,” “silent,” “forgotten,” or “unintended” victims.

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The impact of domestic violence on children

Children’s exposure to domestic violence may be traumatic, and may increase their long-term risk for a multitude of psychological, behavioural, social and educational problems (Geffner, Igelman, & Zellner, 2003). One investigation found that 84% of children studied could probably be diagnosed with DSM-IV disorders (DiamondHaas, 2005). In school-age children, low self-esteem and depressive symptoms seem common, and these children have been described as more anxious, sad, worried, fearful, and withdrawn than their peers (Onyskiw, 2003). While some studies have revealed no effects attributable to exposure to domestic violence, others have indicated that exposed children may tend to handle frustration poorly, have more difficulty regulating their emotions in interpersonal interactions, and lack effective problemsolving skills and conflict-resolution strategies, misinterpreting ambiguous interpersonal situations as potentially threatening, and attributing hostile intent to another person (Onyskiw, 2003). Exposure could therefore have significant adverse effects on children’s development (Zuckerman & Augustyn, 1995). Women exposed as children may experience long-term symptoms of depression, trauma and low self-esteem, men may experience trauma-related symptoms, and both may experience greater distress and low social adjustment. They may also carry violent and violence-tolerant roles into their adult intimate relationships (Edleson, 1999). Not all children will react to, or be affected by, exposure to domestic violence in the same way (Geffner et al., 2003). Contextual, family and environmental factors moderate the impact, and a number of factors interact with each other to create unique outcomes for different children (Allen, Wolf, Bybee, & Sullivan, 2003; Fosco, DeBoard, & Grych, 2007; Hester et al., 2000). The nature, intensity, and frequency of the conflict influence their levels of distress and the effects of their exposure (DiamondHaas, 2005; Grych & Fincham, 1990). Important factors also include perception of threat, and children’s belief in their ability to cope with the situation (Kilpatrick & Williams, 1997, as cited in Card, 2004); personal characteristics also influence children’s perceptions and interpretations of interactions (Grych & Fincham, 1990). Concurrent factors, including direct experience of aggression, poverty, community violence, parental mental illness, and parental substance abuse, could compound the effects of the exposure (Eggert, 2005; Onyskiw, 2003). It is essential to establish each child’s circumstances, to gain understanding of his or her experience. Ethnic minority group membership may be a protective or a complicating factor for children exposed to domestic violence (Lewis-O’Connor, Sharp, Humphreys,

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Gary, & Campbell, 2006). Racial factors have been influential for black children whose family homes, often their refuge from racism, have become unsafe (Iman, 1994, as cited in Hester et al., 2000). Many Indian young people are exposed to racism here in New Zealand, as are other immigrants (Wali, 2001). Violence that invades their homes can only intensify children’s insecurity and vulnerability. Maternal well-being and adjustment, parenting style, and the quality of the childparent relationship could also mediate trauma effects on child witnesses (Eggert, 2005; Hughes & Huth-Bocks, 2007; Kalil, Tolman, Rosen, & Gruber, 2003). Healthy attachment between parent and child can be disrupted in families exposed to domestic violence (Eggert, 2005), and Lieberman (1997, as cited in Eggert, 2005) found an association between the psychological and emotional unavailability of battered mothers and anxiety in young children. Children are at higher risk of developing negative internal working models when domestic violence creates such chaos that parents become unavailable, unresponsive, or punitive towards them (Flores, 2001). Mothers who are emotionally drained may take out their frustrations on their children, from whom they become emotionally distant (Abrahams, 1994, cited in Hester et al., 2000). One of the few studies that elicited responses directly from young people found that, despite all that they had experienced, many were able to rebuild their lives with hope and optimism for the future (Berman, 1996). Protective factors included the children’s interpretation of their experiences; their ability to cope with stress; the availability of a protective, non-offending parent or other support people to act as surrogate parents; psychological “hardiness” to resist negative factors in the home; development of positive self-esteem and strong social skills; a sense of hope for the future; respect and empathy for others; and the development of some sense of control over one’s life (Geffner et al., 2003). In addition, individual protective factors include a positive temperament, a child’s intellectual capacity, and social competence (Gewirtz & Edleson, 2007). Limitations of the research

As studies vary widely in the use of definitions, samples, and methodology (Geffner et al., 2003; Golob, 1997; Levendosky et al., 2007; Wolfe, Crooks, Lee, McIntyre-Smith, & Jaffe, 2003), it is difficult to make comparisons and draw conclusions. Researchers have not distinguished between children who witnessed domestic violence and those who were directly abused themselves (Edleson, 1999; Geffner et al., 2003; Golob, 1997).

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Most research has involved children who were in shelters, where there was an overrepresentation of low-income families (Edleson, 1999; Hester et al., 2000). Mothers have been the source of most data about children, and differences between adult and child perceptions have been ignored (Edleson, 1999; Hester et al., 2000). Mothers’ perceptions of their children may have been distorted when they were themselves in crisis (Onyskiw, 2003). Clearer understanding is needed about children’s resilience and factors in their environment that lessen or increase the effects of the violence, including seeking their perspectives. No studies could be found on the impact of domestic violence on children of Indian ethnicity, and specifically on those who are also recent immigrants. Meera’s own experience of immigrating, the experiences of her children, and the stories of fellow immigrants have heightened her awareness of the challenges that immigration presents. Without the support of extended family and friends, close family members are forced to depend on each other in negotiating this new experience. The destruction of this family unit by domestic violence presents further challenges for these children. Method

To give voice to the perspectives of Indian immigrant young people on their exposure to domestic violence as children and its consequences for them, a qualitative approach was indicated (McLeod, 1999). It was hoped that the insights of these young people would provide further understanding of the nature of such experiences, potentially contributing to improving support for those in similar situations. As Koverola and Heger (2003) have observed, it is ultimately the children who will inform us if we have responded effectively. Participants

The study was open to immigrant young people aged 17 and older, of Indian ethnicity, who had been exposed to domestic violence as children. As they develop a stronger sense of self, young people in this developmental stage are able to reflect on, and make meaning of, their childhood family experiences in ways that would be beyond younger children (Dacey & Kenny, 1997). The four participants recruited included three females and one male, aged between 17 and 23. Two participants were brother and sister, but were interviewed individually. None of the participants had extended family or support networks in New Zealand when they arrived, and some had themselves been the direct victims of abuse.

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Anika, aged 23, immigrated with her family at age 13, was a victim of her father’s anger and physical assaults, and witnessed her father’s physical and emotional abuse of her mother and younger brother. Mala, aged 20, the eldest of six children, arrived aged 16 with three siblings and her father, who left her mother behind in their country of origin. Prior to immigration, she witnessed her father physically and emotionally abusing her mother, physical assaults between other members of the family, and her siblings being maltreated. She was also sexually abused by other members of the family prior to arrival. After immigrating, she and her siblings were direct victims of their father’s anger, and emotional and physical abuse. Kay, aged 19, the third eldest in her family, immigrated with them when she was about four years old. She witnessed physical, emotional and financial abuse of her mother by her father, assaults on her mother by her older brother, and physical abuse of younger siblings by her father. She was also sexually abused by an older sibling. Kay’s brother Kiron, aged 17, was about two years old when they arrived in New Zealand. He was physically assaulted by his father and witnessed similar events to Kay. Procedure

An interview guide was developed, informed by literature and by Meera’s experience of working with young people exposed to domestic violence. Permission to undertake this study was obtained from the University of Auckland Human Participants Ethics Committee. Participants were recruited through school counsellors who were likely to know of former clients who would fit the criteria and could be interested in taking part in this project. In semi-structured, individual interviews, participants discussed their exposure to domestic violence and its effects on their lives. Each interview was audiotaped and transcribed, then participants were given the opportunity to check and verify the transcripts at a second interview. Throughout the interviews there were opportunities for them to confirm or clarify interpretations and understandings of their experiences (Lincoln & Guba, 1985). In addition, they were subsequently invited to add any further insights they may have had. Data analysis

Thematic analysis was used to identify patterns in the transcripts (Braun & Clarke, 2006), and verification was provided by a colleague who acted as an independent

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analyst (Miles & Huberman, 1984). Reflection on the research process and on the substance of the interviews evoked “moments of illumination and insight” (McLeod, 1999, p. 129), as well as questions that were discussed with colleagues and in supervision. Results

Key themes that emerged from the data are grouped into three major sections: themes related to the young people’s reflections on their childhood and their exposure to domestic violence; the psychological consequences; and the ways in which they have responded and built their futures. Pseudonyms have been used when referring to individual participants. Through the eyes of the child

All participants vividly recollected their exposure to domestic violence, including both the events and the feelings they experienced. Their reflections revealed themes of powerlessness, a lack of mothering, and having to be “the responsible one.” Powerlessness The young people recalled experiencing an overwhelming sense of powerlessness. Although fully aware of the violence that was occurring, sometimes witnessing it or being victims themselves, they knew there was nothing they could do about it. Their powerlessness intensified the trauma of the experience, as reflected in their stories.

I remember standing at the bottom of the stairs. I could hear Mum pleading with Dad to stop. I could hear crashing, banging—Dad was just yelling at her—that was so hard. (Anika) Dad was arguing with my brothers—he wanted to hit my brother with a chair and Mum went in front and took the full blow—I was just there—that was it. I just stayed there. (Kay) Kiron’s sense of powerlessness was not just about his inability as a young child to stop the violent attacks, but also about feeling that neither parent cared about how it affected their children. Anika also reported: “There were never any explanations. There were no apologies.” Powerlessness was accompanied by fear: I was very afraid. All the children were crying. I believed he would hurt us all. I was just scared—we cried and cried. We just were listening and can’t do anything

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… We never questioned his decisions. His force was strong. He didn’t need to hit us. It was just his voice that made us afraid. (Mala) Despite their distress, these young people accepted this environment of violence and abuse as “just part of life” (Anika), and did not talk about it. This just was normal life. There was no discussion about what happened. I didn’t really talk with siblings about things. We just knew we were all unhappy so there was no need to talk. (Kiron) They managed as best they could: I just tried to work around it. I tried to make it all as normal as I could. There was not much else! (Kay) As a result of the trauma, Kiron recalled “when I was young, when anything bad happened to me I didn’t remember it.” The lack of mothering Participants recalled being conscious of their lack of parenting, with fathers locked into their role of abuser and mothers into their role as powerless victim. All emphasised the lack of mothering or their mother’s inability to provide a safe, loving, and caring environment. Kay sadly recalled an incident that symbolised this. Having accidentally burnt her feet in the bath, she was treated for burns at the hospital. Her mother showed no concern or sympathy for her, expecting Kay to walk around, seeing to her mother’s needs, despite being told by the nurse that she had to stay off her feet. She described her unsupportive mother as having “shut out everything.” Kiron remembered, “Mum would not do stuff that we needed, e.g., for school.” He recalled being upset because his parents fought and argued in front of the younger siblings, the home had not been maintained, and the children were neglected. Their mother’s lack of care and concern for the impact the situation had on her children was confusing. The cry, “Why did we have to see all of this?” reflected Anika’s sense that her parents had not provided a safe environment for their children. While she expressed anger towards her father for resorting to violence against his wife and children, she showed even more resentment towards her mother: “I think she was so stupid for getting into a relationship like that.” The circumstances for Mala and her siblings were different, for their mother was

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prevented by their father from being in their lives. This was “a huge loss,” resulting in extreme loneliness for her: Dad didn’t understand. For years we lived closely with her. We didn’t have a big house and we all slept on the floor in one room with her. Snatched from that close relationship, she had to cope with her father’s cruelty and lack of care or support. The consequences

The consequences for these young people included shouldering responsibilities and experiencing psychological pain. The responsible one Lacking parental support, these young people became responsible for the well-being of their younger siblings.

As I was growing up, I used to take the younger siblings and sit in another room until it was all over—go to another room to get away from it all. (Kay) Willing to sacrifice herself for her siblings, Kay spoke of taking the blame to protect them. This role then passed on to her younger brother when she left home. Mala also became the key caregiver of her siblings, a major challenge: No one understood that I was in the role of mother at the time. I had to look after my siblings but it was hard for me too. As immigrants, their mothers were socially isolated and some had difficulty communicating in English, so they had to rely on their children for various forms of support. Kiron reported having to miss school to act as an interpreter for his mother. Kay expressed sympathy when describing their mother’s reality at the time: She didn’t know good English and it was scary for her too. It was only a few years after we came to New Zealand and she did not know what was going on. She had no one to really support her. Kay became their mother’s spokesperson and support person, privy to all the details of her situation: She put all the responsibility onto me. When I was growing up, it was up to me to support my mother after Dad left. Life was pretty difficult and we were just trying

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to get by. I had to help my mother talk to social workers, set up life, and take care of the younger children. The young people’s responsibilities included intervening during, or picking up the pieces after, incidents of domestic violence. Mum came into the lounge and was crying. I was only 12. Why does she come to me for comfort? (Anika) I saw all these bruises on her the next morning. It was horrible so I called the police … I now stood up to Dad. I told him I didn’t trust him and that it would be much better if he left. (Kay) Their mothers would not necessarily follow their advice, however. In a situation where an older brother had also become abusive to their mother, Kiron felt frustrated: I called the police. Mum said that the police should not arrest him. It happened a second time as well. Mum said she wanted him to come back home. Psychological pain Participants recalled having no one within their families to look after their well-being. They variously described overwhelming pressure, depression, and isolation.

I felt pressured. My sisters looked up to me, mother depended on me. It was too much … No one understood my experience as an individual—what I was going through. (Mala) Three of the participants attempted suicide prior to leaving home at age 16. Kay reported being depressed since the age of 12, and when she overdosed, she hoped that it would “change what my family was thinking about.” Kiron’s recurring thoughts were about not wanting to live. Anika was the only participant who remained within the family home, despite the distress she continued to experience. The young people were also ambivalent about their fathers, poignantly expressed by Anika: It was confusing. He was like a Jekyll and Hyde dad. We had shared so many lovely times with him too. He read with us, shared my love for animals. Yet not knowing what will happen next. We were walking on egg shells around him. It was confusing that a parent could be so abusive to his own wife and children: “I hate him but because he is my dad there is that love.”

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Kiron described learning “what Dad was really like.” He recalled wishing that his father would come back home because he remembered the “good side of Dad,” when he would take the children shopping or to the park. However, when his father returned he was deeply disappointed when things got worse. As one participant observed sadly, “The last person you expect to be mean to you is the person who created you.” Looking to the future

Remarkably, despite their experiences, all participants managed to bounce back to varying extents, taking steps toward gaining a sense of control over their lives. Three participants had left home at 16, but continued their education at school. Two obtained scholarships for tertiary study. When interviewed, two were at university, one had graduated and was working, while the fourth was still at school. The value they placed on education, their determination, their connectedness to school, and the support of pastoral care staff all appear to have contributed to their resilience. Education as opportunity These young people saw education as the way to ensure that their lives did not follow the same pattern as their families’. Generally, within the Indian community there is a strong emphasis on education (Wali, 2001), but they had added determination and focus in persevering to achieve a good education. As one said:

I cared about my future. The experience I had did it. I knew what I didn’t want it to be like. I know what I wanted my life to be. I will do that by going to university. (Kiron) Interactions with others also revealed alternative ways of being. One participant recalled being aware and taking note of how others lived. Early on, she realised that what went on at home was neither good nor normal. She actively grasped at any rules about how to be that she could learn outside of the family. Her primary school teacher’s rule, “Treat others as you would like to be treated,” was still very important to her: “I just knew that I had to be educated and successful.” Thoughts of her mother, wanting to bring her to New Zealand to take care of her, as well as wanting to “ensure my life was different,” prompted Mala to work towards academic success. As she said: The more this was going on, the more I was driven towards study. It motivated me. Now I feel confident I can do anything I want. It gave me the strength.

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School as a safe and empowering place Three participants identified school as a safe and empowering place, where they found the community, care, and opportunities that they lacked elsewhere in their lives. They were deeply grateful for the normality and nurturing it provided:

School was a safe place to be. I had friends there and it was a nice place to be. (Kay) School was best place to be. I had support/friends so did well at school. Just being here was way better than being at home. I was being treated like a normal person. (Kiron) School was fantastic. The only place I felt safe. School was enormous support and I couldn’t have done it without their support. (Mala) As well as the new lenses that education provided, these young people acknowledged in particular the vital support provided by school staff. They recalled their counsellor, principal, and various staff members helping them to leave home, and connecting them with various other support structures in the community. We were new to New Zealand and not aware of our rights … it was just our school teachers who maintained contact with us. Our real supports were there in the school with the guidance counsellor and staff and friends. (Mala) Hearing a teacher talk about sexual abuse helped one participant recognise her own past experience as abuse. She confided in the school nurse and the counsellor, who provided support at a time when her mother did not. School staff assisted her to leave home with her siblings, enabling them to set up their own home and continue their education at school. The staff members’ “enormous support” enabled her to manage: I felt strong because the counsellor and staff believed our story and knew our goals were good. (Mala) In one case, the young people were given practical support in setting up their new home and were even invited to a staff member’s home for a Christmas meal. Only one participant maintained the “family secret,” had not sought support at school nor left home like the others at 16, and was still exposed to domestic violence at the age of 23, when she sought counselling. She felt the least empowered to influence her future. The financial support offered by her father enabled him to maintain his control over her life, and her mother maintained her influence through the belief that she was

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owed her daughter’s love and support because she had stayed in the abusive relationship “for the sake of the children.” When interviewed, this young woman was quite depressed, and experienced difficulty with personal relationships. Discussion

The stories of these young people provide vivid insights into their experiences of the world of domestic violence, as well as into their ways of coping. It must be noted that this was a small, qualitative study, and participants were obtained as a result of having accessed counselling support. These results therefore cannot be seen as representing the experiences of all young people exposed to domestic violence. The participants’ exposure to domestic violence also varied, and some participants experienced other forms of abuse as well. Rather than findings that can be generalised across a wider population, the value of the results from this study lies in the depth of awareness they offer into the nature of some young people’s lived experiences. They also have particular implications for school pastoral care systems and the role of school counsellors. The manner in which the participants were recruited for this study, the fact that all of them had eventually accessed counselling, their specific ethnicity, and their immigrant status characterise them as a unique group of young people exposed to domestic violence. Nevertheless, their accounts of their experiences reflect themes found in previous studies. Domestic violence rarely occurs in isolation (Eggert, 2005; Onyskiw, 2003). These young people’s reports of being sexually abused or physically assaulted, and witnessing assaults on siblings, support the possible concurrence of domestic violence and child physical or sexual abuse (Card, 2004; Holden, 2003). Consistent with Berman’s (1996) findings, all participants in the current study described feeling powerless as young children, and their sense of abandonment and hopelessness corresponded with the terror and helplessness that were associated with powerlessness in Card’s (2004) study. As they talked, it became obvious how traumatic this powerlessness could be, and how intensely children in this situation can feel distress. Coping mechanisms such as “working around” it, and blocking out memories of bad things happening, suggest resourcefulness as well as disassociation in response to the trauma. The responsibilities they took on for caregiving, support and protection of others within their families, including role reversal with their mothers, raise questions about the effects on their developmental process (Zuckerman & Augustyn, 1995) and their frustrated personal needs for active parental support.

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To some extent the participants’ silence about the violence as children reflected a sense of hopelessness, that there was no point in talking about it when there was nothing they could do to change it. Research suggests that other reasons for this silence include the secrecy that tends to surround domestic violence due to fear of consequences (Peled & Edleson, 1999), and the difficulty believing that other adults might be more insightful and understanding than their parents (Kashersky, 2004). Findings from this study reflect those of previous research which established that a mother’s exposure to domestic violence could impair her parenting capacity, including her ability to perceive the psychological trauma being caused to her children (Card, 2004; Hester et al., 2000; Zuckerman & Augustyn, 1995), as well as her ability to protect them and to facilitate their development (Osofsky, 2004). This study also highlights the added vulnerability of immigrants who do not have their extended families to turn to. The ambivalence and confusion these young people experienced with regard to their fathers was a significant, ongoing challenge, given the affection they expressed for them, while also experiencing resentment, pain and disappointment over their violent behaviour (Peled, 1998, as cited in Edleson, 1999). Edleson (1999) has suggested that this is an area that requires further research. Participants’ reports of depression, suicidal ideation and attempted suicides reflected the potentially devastating effects of exposure to domestic violence (Diamond-Haas, 2005; Edleson, 1999; Onyskiw, 2003). It is interesting to note, though, that these occurred primarily prior to the age of 16, when three of the four participants left home. From that stage on, these young people began to turn their lives around. Like the children in Berman’s (1996) research, participants in this study were able to rebuild their lives with hope and optimism for the future. They could certainly be described as survivors who, despite still experiencing some struggles, have gained new insights and understandings that have enabled them to move forward. Among the factors considered by the American Psychological Association Presidential Task Force on Violence in the Family (as cited in Geffner et al., 2003) to promote resiliency in children are their interpretation of the experience, the availability of a protective non-offending parent or other support people to act as surrogate parents, development of positive self-esteem and strong social skills, a sense of hope for the future, and respect and empathy for others. Various factors appear to have worked together to moderate the experience of this group of young people, build their resilience and create hopeful outcomes.

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Most important were their interpretations of their experiences and their determination to construct new futures. They seemed to know, even when quite young, that what they had experienced was unacceptable. For one participant, consciously studying the way that others lived and looking for ways of living to emulate seemed important, as well as absorbing the values of role models such as teachers. They actively worked to escape the powerlessness of their past by constructing their own values, caring about their futures, protecting and trying to ensure a better life for themselves and their siblings, and focusing strongly on education as the way to a more positive future. A notable and unexpected outcome that was apparent in this research was the crucial role played by school pastoral care systems in the life directions taken by three of these young people. Osofsky (2004) suggested that schools, community centres and others provide support to children when their parents are victims of domestic violence and are unavailable to them. As immigrants, these young people had no alternative support available, so school played a very important role in providing safety, care, information, and educational opportunities. This finding has clear implications for the provision of pastoral care within schools, which are in the unique position of being able to offer both educational and therapeutic support to young people, and afford an “arena of comfort” (Gossens & Marcoen, 1999) that these young people clearly valued. Factors that build young people’s resilience and protect their well-being include strong, supportive connections with important adults such as teachers and school counsellors, as well as feeling connected to school through a sense of belonging, being valued, and feeling safe and secure (Resnick, Bearman, Bauman, Harris, & Jones, 1997). School provided these young people with the caring, normal, trusting relationships they lacked at home, nurturing them in a safe environment that enabled them to achieve their goals. The extent to which counsellors and others were involved in assisting the participants was admirable, and undoubtedly played a significant part in ensuring they maintained their education and achieved academically. The needs of young people exposed to domestic violence, and the responses that played such a significant part in enabling these young people to create positive futures for themselves, could stretch our beliefs about the limits of our practice. The provision of support is also predicated on teachers’ and school counsellors’ awareness of the prevalence and consequences of domestic violence, particularly for children and adolescents, and sensitivity to the ways in which the effects may manifest.

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Conclusion

The findings of this study present a case for further, longitudinal research into the experiences of children who are exposed to domestic violence, as well as research into the particular experiences of children and young people who are immigrants to this country. Although the resilience of this small group of young people is noteworthy, the results highlight the fact that not all children are affected by, or cope in the same way with, exposure to domestic violence. Questions arise as to the influence of their ethnicity on the choices they made with regard to focusing on education and pursuing ongoing contact with their families, and about what could possibly have helped one of the participants to seek assistance earlier. Their shift from the powerlessness of childhood to empowerment for the future was very significant. Their positive relationships within the school environment, and in particular the role of the school counsellor, served as a significant protective factor. This may or may not be the case for other immigrant young people, or for young people in general who have been exposed to domestic violence. Staff in pastoral care roles in schools need to be aware of the likelihood that some students will be affected by domestic violence in their families, and that the school may well be their only source of hope and support. This has implications for staff development, as well as for school policies and procedures, in order to ensure effective pastoral care for children and young people of all ethnicities who are affected by domestic violence. The participants who accessed help in this study, and those who assisted them, serve as an example of what can be achieved when we support young people in navigating their own pathways through trauma to a brighter future.

References

Allen, N. E., Wolf, A. M., Bybee, D. I., & Sullivan, C. M. (2003). Diversity of children’s immediate coping responses to witnessing domestic violence. In R. Geffner, R. S. Igelman, & J. Zellner (Eds.), The effects of intimate partner violence on children (pp. 123–147). Binghamton, NY: Haworth Maltreatment & Trauma Press. Berman, H. A. (1996). Growing up amid violence: A critical narrative analysis of children of war and children of battered women. Unpublished doctoral dissertation, Wayne State University, Detroit, Michigan. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. Card, J. R. (2004). Posttraumatic stress disorder in children exposed to domestic violence: Parental

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versus self-report. Unpublished doctoral dissertation, Alliant International University, Fresno, California. Dacey, J., & Kenny, M. (1997). Adolescent development (2nd ed.). Madison, WI: Brown & Benchmark. Diamond-Haas, A. (2005). Predictors of DSM-IV diagnoses in children who witness domestic violence. Unpublished doctoral dissertation, Yeshiva University, New York. Edleson, J. L. (1999). Children’s witnessing of adult domestic violence. Journal of Interpersonal Violence, 14(8), 839–870. Eggert, J. (2005). A qualitative analysis of mother-preschooler dyads exposed to trauma participating in child-parent psychotherapy. Unpublished doctoral dissertation, Alliant International University, San Francisco, California. Flores, S. S. (2001). A study of mothers’ perceptions of the effects of domestic violence on their children. Unpublished Masters thesis, California State University, Long Beach, California. Fosco, G. M., DeBoard, R. L., & Grych, J. H. (2007). Making sense of family violence: Implications of children’s appraisals of interparental aggression for their short- and longterm functioning. European Psychologist, 12(1), 6–16. Geffner, R., Igelman, R. S., & Zellner, J. (2003). Introduction. Children exposed to interparental violence: A need for additional research and validated treatment programmes. In R. Geffner, R. S. Igelman, & J. Zellner (Eds.), The effects of intimate partner violence on children (pp. 1–10). Binghamton, NY: Haworth Maltreatment & Trauma Press. Gewirtz, A., & Edleson, J. (2007). Young children’s exposure to intimate partner violence: Towards a developmental risk and resilience framework for research and intervention. Journal of Family Violence, 22(3), 151–163. Golob, J. S. (1997). The forgotten victim: The child witness to domestic violence. An intervention program for the preschool-aged child. Unpublished doctoral dissertation, Widener University, Chester, Pennsylvania. Gossens, L., & Marcoen, A. (1999). Relationships during adolescence: Constructive vs negative themes and relational dissatisfaction. Journal of Adolescence, 22, 65–79. Grych, J. H., & Fincham, F. D. (1990). Marital conflict and children’s adjustment: A cognitivecontextual framework. Psychological Bulletin, 108(2), 267–290. Hernandez, M., & McGoldrick, M. (2005). Migration and the life cycle. In B. Carter & M. McGoldrick (Eds.), The expanded family life cycle: Individual, family, and social perspectives (3rd ed., pp. 169–184). New York: Pearson. Hester, M., Pearson, C., & Harwin, N. (2000). Making an impact: Children and domestic violence. London: Jessica Kingsley. Holden, G. W. (2003). Children exposed to domestic violence and child abuse: Terminology and taxonomy. Clinical Child & Family Psychology Review, 6(3), 151–160. Hughes, H. M., & Huth-Bocks, A. C. (2007). Variations in parenting stress in AfricanAmerican battered women: Implications for children’s adjustment and family intervention. European Psychologist, 12(1), 62–71.

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Kalil, A., Tolman, R., Rosen, D., & Gruber, G. (2003). Domestic violence and children’s behaviour in low-income families. In R. Geffner, R. S. Igelman, & J. Zellner (Eds.), The effects of intimate partner violence on children (pp. 75–101). Binghamton, NY: Haworth Maltreatment & Trauma Press. Kashersky, L. S. (2004). Posttraumatic stress symptomatology in children: Differentiating effects of witness domestic violence and experiencing physical abuse. Unpublished doctoral dissertation, Alliant International University, California. Koverola, C., & Heger, A. (2003). Responding to children exposed to domestic violence: Research informing practice and policy. Journal of Interpersonal Violence, 18(4), 331–337. Levendosky, A. A., Bogat, G. A., & von Eye, A. (2007). New directions for research on intimate partner violence and children. European Psychologist, 12(1), 1–5. Lewis-O’Connor, A., Sharp, P. W., Humphreys, J., Gary, F. A., & Campbell, J. (2006). Children exposed to intimate partner violence. In M. M. Feerick & G. B. Silverman (Eds.), Children exposed to violence (pp. 2–38). Baltimore: Paul H. Brookes. Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage. McLeod, J. (1999). Practitioner research in counselling. London: Sage. Miles, M. B., & Huberman, A. M. (1984). Qualitative data analysis: A sourcebook of new methods. Beverly Hills, CA: Sage. Onyskiw, J. E. (2003). Adjustment in children exposed to intimate partner violence: Clinical research. In R. Geffner, R. S. Igelman & J. Zellner (Eds.), The effects of intimate partner violence on children (pp. 11–45). Binghamton, NY: Haworth Maltreatment & Trauma Press. Osofsky, J. D. (2003). Prevalence of children’s exposure to domestic violence and child maltreatment: Implications for prevention and intervention. Clinical Child & Family Psychology Review, 6(3), 161–170. Osofsky, J. D. (2004). Community outreach for children exposed to violence. Infant Mental Health Journal, 25(5), 478–487. Peled, E. (1996). “Secondary” victims no more: Refocusing intervention with children. In J. L. Edelson & Z. C. Eisikovits (Eds.), Future interventions with battered women and their families (pp. 125–153). New Delhi: Sage. Peled, E., & Edleson, J. L. (1999). Barriers to children’s domestic violence counseling: A qualitative study. Families in Society, 80(6), 578–586. Resnick, M. D., Bearman, P. S., Bauman, R. W., Harris, K. E., & Jones, K. M. (1997). Protecting adolescents from harm: Findings from the national longitudinal study on adolescent health. Journal of the American Academy of Child and Adolescent Psychiatry, 278, 823–832. Wali, R. (2001). Working therapeutically with Indian families within a New Zealand context. Australia and New Zealand Journal of Family Therapy, 22(1), 10–17. Wolfe, D. A., Crooks, C. V., Lee, V., McIntyre-Smith, A., & Jaffe, P. G. (2003). The effects of children’s exposure to domestic violence: A meta-analysis and critique. Clinical Child and Family Psychology Review, 6(3), 171–187. Zuckerman, B., & Augustyn, M. (1995). Silent victims revisited: The special case of domestic violence. Pediatrics, 96(3), 511–513.

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3

Survey of Practitioners Providing Therapy for Survivors of Sexual Abuse/Assault in Aotearoa/New Zealand Ruth C. Mortimer, Gillian M. Craven, Cheryl C. Woolley, Judith Campbell, Shane T. Harvey, Joanne E. Taylor, and Jan Dickson

Abstract Providing therapy for survivors of sexual abuse is a complex area of therapeutic practice. In order to identify the processes that mental health practitioners in Aotearoa/New Zealand use to identify mental injury due to sexual abuse, and their approaches to treatment, a nationwide survey was undertaken. Six hundred and ninety-five surveys were mailed to practitioners. One hundred and sixty-six questionnaires were returned, a response rate of 24%. Both qualitative and quantitative questions were included, seeking information on practitioner demographic characteristics, as well as their practice modalities as sexual abuse/assault counsellors. Emerging themes are presented and discussed briefly. Information generated via the survey has provided a strong local contribution to the development of best-practice guidelines for counselling survivors of sexual abuse in Aotearoa/New Zealand. These were released in June 2008.

Childhood sexual abuse (CSA) and the short- and long-term sequelae experienced by survivors of sexual abuse are significant societal problems. It is difficult to ascertain accurately how many people are affected by CSA due to variations in the definition of sexual abuse, low reporting rates, and the diffuseness of psychological symptoms that are characteristic of such abuse (Briere & Scott, 2006; Ferguson, 2003; Heflin & Deblinger, 2007; Johnson, 2008). However, recent prevalence estimates in New Zealand range from around 24% to 30% for females and 6% for males (Fanslow, Robinson, Crengle, & Perese, 2007; Ferguson, 2003).

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Ruth C. Mortimer, Gillian M. Craven, Cheryl C. Woolley, Judith Campbell et al.

Research indicates that CSA can lead to both short- and long-term impaired psychological functioning. Adverse effects can include depression, anxiety and fear, self-destructive and suicidal behaviour, social isolation, sexual dysfunction, low selfesteem, substance abuse, eating disorders, and other symptoms of personality and psychiatric disorders (Callahan, Price, & Hilsenroth, 2003; Draper et al., 2007; Duncan et al., 2008; Fergusson, Boden, & Horwood, 2008; Haller & Miles, 2004; Holzer, Uppala, Wonderlich, Crosby, & Simonich, 2008; Kaplow & Widom, 2007; Lemieux & Byers, 2008; McCrae, Chapman, & Christ, 2006). The experience of CSA is also associated with a greater likelihood of being sexually abused or assaulted later in adolescence or adulthood (Briere & Scott, 2006). Survivors may experience a variety of traumatic stressors, including the set of symptoms associated with post-traumatic stress disorder (PTSD): re-experiencing the trauma, avoidance and dissociation, and hyperarousal (Briere & Scott, 2006). While there is no evidence of a specific post-sexual-abuse syndrome, 50% of affected children show symptoms of PTSD, and 32% to 48% meet the full criteria for a diagnosis of PTSD (Heflin & Deblinger, 2007). Feelings of helplessness and cognitive misattributions, along with abuse-specific internal attributions due to CSA, are associated with increased levels of long-term distress (Heflin & Deblinger, 2007). However, the above symptoms are not specific to sexual abuse. They also occur due to other forms of trauma (Briere & Scott, 2006), abuse (Draper et al., 2007; Fergusson et al., 2008; Gibb, Chelminski, & Zimmerman, 2007; Hunter, 2006; McCrae et al., 2006), and life contextual stressors (Hunter, 2006; McCrae et al., 2006; Noll, 2008). Moreover, Heflin and Deblinger (2007) argue that these symptoms are not necessarily experienced by all survivors. It also needs to be noted that the most essential evidence for determining the presence of sexual abuse is disclosure by the survivor. Factors explaining the differential effects of CSA have been identified as the level of emotional connection between an abuser and a survivor, the numbers of perpetrators, the duration and frequency of the abuse, the level of force or invasiveness involved in the abuse, the cognitive attribution style of a survivor, the quality of support provided by a child’s non-offending parent, and the level of family functioning. The developmental stage of a child at the time abuse occurs can also impact on later psychosocial functioning and symptomatology (Noll, 2008). The literature has reported on impaired development of secure attachment (Cook et al., 2005) and lifelong difficulties in negotiating stable interpersonal relationships (van der Kolk, 2007). Survivors with a history of complex trauma in childhood are also likely to fail to develop the capacity to regulate internal experiences and self-soothe, resulting in

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behavioural and emotional pathology (Cook et al., 2005). Some survivors display “sleeper effects” of trauma, and negative effects may not manifest themselves until they are triggered by salient developmental issues such as sexual identity, romantic relationships, sexual activity, and becoming a parent (Briere, 1992). Heflin and Deblinger (2007) have noted that little formal training is available for professionals working with survivors of sexual abuse, and clinicians can find themselves poorly prepared to conduct therapy focused on abuse and its sequelae. They also suggest that clinicians may experience personal discomfort, which can compromise their response to disclosures, and decrease the likelihood of identifying a history of sexual abuse. Factors involved in practitioners’ reluctance to ask about abuse include the presence of more pressing issues, fear of disturbing clients, client diagnosis of schizophrenia, biological etiological perspectives, and fear of inducing “false memories” (Young, Read, Barker-Collo, & Harrison, 2001). However, most of the literature strongly suggests that direct inquiry is essential to the identification of CSA survivors, the formulation of appropriate diagnosis and treatment plans, and possible prevention of further victimisation (Heflin & Deblinger, 2007). Personal biases and common misconceptions may also influence professional attitudes regarding the therapeutic management of sexual abuse. Along with the affect heuristic, which can result in clinical decisions being made on the basis of rapid and automatic affective responses (Garb, 2005), social and gender biases have been identified in the literature. Misconceptions also occur regarding the prevalence of CSA, the perceived credibility of memories associated with CSA, and the non-offending mothers of survivors (Gore-Felton et al., 2000; Heflin & Deblinger, 2007). Practitioners from a variety of disciplines and with differing levels of experience provide counselling for children and adults who have experienced sexual abuse/sexual assault in Aotearoa/New Zealand. Northey (2004), however, has noted that more research has focused on psychiatrists and psychologists than on marriage and family therapists, social workers, and counsellors. In order to address this imbalance, a survey was generated to gain an understanding of the experiences and challenges faced by practitioners from a variety of disciplines working in the complex area of sexual abuse/sexual assault in Aotearoa/New Zealand. The survey was designed to ascertain practitioners’ understandings of the effects of sexual abuse, the processes they use to identify mental injury due to sexual abuse, their approaches to treatment, and factors that either facilitate or act as barriers to effective therapy. This article describes the results of this survey, and is based on the report by Taylor, Harvey, Mortimer, Campbell, and Woolley (2006).

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The ultimate aim of the survey was to provide New Zealand-based information to be incorporated into evidence-based recommendations for practitioners to (a) improve the identification of different aspects of mental injury that result from the experience of sexual abuse, and (b) enhance the effective delivery of therapeutic interventions for survivors of sexual abuse (Räranga Whatumanawa, 2008). Method

A questionnaire was developed to determine practitioners’ perceptions of the effects of sexual abuse, assessment techniques used to establish mental injury, and the range of treatment approaches utilised. Closed questions were used to obtain demographic data, and open questions were used to elicit written responses describing therapists’ understanding of the effects of sexual abuse, information about how they work therapeutically with clients, and difficulties they encounter in their practice. Prior to the survey being posted, a nationwide road show enabled the researchers to introduce and discuss the project with key stakeholders. Potential participants were identified through lists of Sensitive Claims practitioners registered through the Accident Compensation Corporation (ACC) to work with survivors of sexual abuse (ACC, 2005). Following these information sessions, a pre-survey letter was mailed to practitioners, and in a second mailout, an information sheet about the wider project accompanied the survey questionnaire. A thank you/reminder postcard was subsequently mailed to practitioners who had not returned their questionnaires after three weeks. Of the 695 mailed surveys, 166 questionnaires were completed and returned by practitioners, constituting a response rate of 24%. Section A provided quantitative data about demographic characteristics of practitioner respondents, as well as their practice in the field of sexual abuse/assault. This was analysed using the Statistical Package for the Social Sciences (SPSS), Version 13.0. In Section B, open-ended questions granted practitioners freedom of response, eliciting a broad range of qualitative information about their perceptions of the effects of sexual abuse, their approaches to assessment and therapy with sexual abuse survivors, and barriers experienced in their practice. With this data, a qualitative analysis was carried out using the computer software programme NVivo, as well as a paper-based thematic analysis. Each practitioner’s responses were sorted into main themes, then resorted into sub-themes. Illustrative quotes, capturing the essence of the themes indicated by most practitioners, have been presented, wherever possible, as written by the respondents in order to preserve their voices. While the survey relates

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to therapeutic practice with people who have experienced sexual abuse and/or sexual assault, the term “sexual abuse” will be used in presenting the results. Results

Demographic characteristics

Respondents represented a range of primary discipline areas, as indicated in Table 1. Most of the respondents identified themselves as European New Zealanders, with New Zealand Mäori and other ethnic groups also represented, albeit in smaller numbers. Respondents worked in various locations nationwide, incorporating a range of therapeutic practices (as seen in Table 1), and belonged to a variety of professional associations, including the New Zealand Association of Counsellors, the New Zealand Association of Psychotherapists, the New Zealand Psychological Society, the Aotearoa/ New Zealand Association of Social Workers, the New Zealand College of Clinical Psychologists, and the New Zealand Association of Child and Adolescent Psychotherapists. Practitioner experience ranged from 3 to 40 years (M = 17 yrs, SD = 7.7). Experience as sexual abuse counsellors averaged 15 years (SD = 7.6). The bulk of respondents indicated being registered with ACC for an average of 10 years (SD = 5.1, range 0–22; 1 person had missing data). Counsellors were currently seeing an average of eight Sensitive Claims clients (SD = 6.5; 9 had missing data). Most practitioners had small caseloads of sexual abuse survivors, although a few (2%) had very high caseloads (30 or more). Of note was the fact that the latter were not the practitioners who had been working in the area the longest amount of time. As can be seen in Table 2, practitioners primarily worked with a diverse range of clients in terms of gender, age, ethnicity, and the nature of the sexual abuse. Sexual abuse—meanings and effects

The meanings and effects of sexual abuse were identified through two open-ended questions: (a) Question 16: “The experience of sexual abuse means different things to different people. As a professional, what are the key thoughts that come into your mind when you think about what the experience of sexual abuse means?” and (b) Question 17: “When people have experienced sexual abuse, they are affected in different ways. What do you think are the most critical consequences affecting individuals who have been sexually abused?” Responses varied from a few lines to comprehensive lists, reflecting a range of understandings and perceptions. Thematic analysis identified three main themes: damaged lives, loss, and factors that influence the impact of sexual abuse.

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Table 1: Characteristics of respondent practitioners Practitioner characteristic Primary discipline area Counsellor Psychotherapist Psychologist/clinical psychologist Child psychotherapist Social Worker Physician

Ethnicity European New Zealander New Zealand M채ori New Zealand M채ori/European Pacific peoples Other ethnicities

Primary therapeutic practice Psychotherapy Cognitive behavioural therapya Post-modern/narrativeb Eclecticc Humanistic/person-centred Self-psychology/object relations Transactional analysis Gestalt Psychoanalytic Mindfulness-based Art therapy Bioenergetic analysis Neurolinguistic programming Existential Trauma models Play therapy Drama therapy Developmental-based therapies Miscellaneous

Percentage

53.0% 35.5% 6.6% 3.6% 0.6% 0.6% Total 100%

60.2% 1.2% 0.6% 0.6% 25.9% Total 88.5%*

24.1% 13.9% 10.2% 10.2% 9.0% 6.6% 5.4% 3.6% 2.4% 1.8% 1.8% 1.2% 1.2% 0.6% 0.6% 0.6% 0.6% 0.6% 3.0% Total 97.4%*

Notes: a Includes cognitive therapy and rational-emotive behaviour therapy. b Includes metaphor-related therapies. c Respondents reported a variety of practices. * As a result of some data being missing, percentages do not add up to 100%.

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Table 2: Caseload Composition Percentage of Practitioners working with each client group

Client characteristic

43.4% 96.4%

Gender Male Female

16.3% 36.1% 95.8%

Age group Children (up to 10 yrs) Adolescents (11–17 yrs) Adults (18 yrs and older)

98.2% 63.9% 21.1% 12.0%

Ethnicity Päkehä Mäori Pacific Island people Other

99.4% 50.6%

Occurrence of event Historical Recent

96.4% 73.5%

Type of sexual abuse Sexual abuse Sexual assault (e.g. rape)

Note: Practitioners often responded to more than one category within a single characteristic, therefore percentages within each characteristic do not add up to 100%.

Damaged lives

Practitioners reported that sexual abuse had a damaging effect on an individual’s development, health and well-being, and social functioning. Words such as “wounded,” “shattered,” “disrupted,” “ruined,” “distorted,” “broken,” and “impaired” were used to describe the impact of abuse, giving rise to the notion of damage. Subthemes of damaged development, damaged health and well-being, and damaged social functioning were also identified. Damaged development—Some respondents advised that individuals were impaired developmentally, for example, “emotionally stuck at an earlier age,” and that there was “disintegration in their development.” According to respondents, people may

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experience disruptions to any or all of the following areas of development: “relationships,” “sexuality,” “physicality,” “cognition,” “education,” “moral issues,” “emotions,” and “identity.” For example, one practitioner linked attachment issues and emotions by reporting “when sexual abuse has occurred in the absence of secure attachment, a child often has difficulty regulating feeling states, often at an earlier stage of social or emotional development.” Furthermore, damaged identity was expressed in terms of “erosion of self-esteem,” “it results in existential issues [that impact upon a person’s] sense of self and meaning of self,” “disconnection from peers—I’m no longer the same,” and “loss of connection between self and the world.” Damaged health and well-being—Practitioners focused mostly on the psychological domain rather than on physical disorders or impairments. In relation to the latter, attention was drawn to self-inflicted physical harm or potentially harmful behaviours that resulted from the trauma of abuse. Examples included “tension reduction activities such as drug and alcohol abuse, self-harming and physical violence,” “prostitution, promiscuity,” and “the physical expression of the inner angst.” Some practitioners explained that mental health problems were often adaptive behaviours that in turn became disorders. Furthermore, existing mental and physical health concerns could be exacerbated. Mental health issues reported included anxiety disorders, mood disorders, obsessive-compulsive disorder, somatic and personality disorders, psychosis, delusional thinking, post-traumatic stress disorder (PTSD), complex PTSD, suicidality, cognitive distortions, and eating disorders. Other psychological issues mentioned were fears, lack of trust, anger, co-dependency, denial, and a feeling of being different. Damaged social functioning—Within this sub-theme, respondents noted that sexual abuse survivors often developed difficulties with intimate relationships, family interactions—in fact, all types of relationships with other people. One respondent expressed the problem this way: “The inability to form close intimate relationships with a partner, friends, or even their own children.” Difficulties relating to others were believed to have arisen from issues of “power and control,” “broken trust,” “being exploited and being betrayed,” “feeling isolated,” “being alienated,” and “being stigmatised.” The understanding that disrupted attachment resulting from abuse by a parent could also lead to impaired social functioning was raised. Following sexual abuse, children were seen as particularly vulnerable to misunderstandings and confusions in developing relationships. “Distortion of perception of relationships and roles” was one comment.

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Others included, “client has had her trust exploited and betrayed,” “may have difficulty trusting,” “sexual abuse confuses a person’s thoughts and feelings about sexuality,” and “difficulties with enjoying sex.” The probability of disruption to a child’s schooling and not being able to have “normal childhood experiences” was understood to hinder normal social functioning. Overlap and links between the three sub-themes are apparent with respect to relationships and identity. Impairment of, or disruption to, an individual’s development and the ability to have normal childhood experiences are linked to psychological problems. These were identified as difficulty in trusting other people, experiencing confusion about sexuality, having problems with parenting, and so forth. All these difficulties, along with many other outcomes of sexual abuse, can arguably affect a person’s sense of identity. Practitioners spoke of “changed self-concept,” “low self-worth,” “low selfimage,” and “shame and guilt,” along with other concepts relating to a sense of being different and being marginalised. Respondents expressed how, in differing ways, the experience of being sexually abused can threaten a person’s sense of identity. Loss The experience of sexual abuse was conceptualised as a loss relating to factors fundamental to a person’s health and well-being. The concept of loss was understood to have long-term consequences for well-being. Sub-themes of personal losses and social losses were identified.

Personal losses—Some practitioners used phrases such as “degradation of a human being that causes loss of sense of self,” “a loss of hope and trust,” “utter confusion,” and “an undermining of human potential” to illustrate these understandings. The personal sense of loss revolved around identity, self-esteem, dignity, control, safety, potential, and the ability to lead a productive and normal life. Social losses—Social losses related to relationships with family, friends, community, and employment. In the present context, the concept of loss can also be conceptualised as an outcome of damaged lives. Factors that influence the impact of sexual abuse Respondents pointed out that the effects of sexual abuse were different for each person. Outcomes were understood as being dependent, in part, on the characteristics of the individuals, their families, and the attitudes that a person’s culture and society have

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toward sexual abuse. As such, sub-themes of individual factors, family factors, and sociocultural factors were identified. Individual factors—Individual characteristics affecting survivors’ responses to sexual abuse were noted as “resilience,” “degree of resources,” “self-esteem,” “level of safety,” and “knowledge of sexual abuse and its effects.” Family factors—Factors relating to family that were considered salient included whether the abuse was the result of incest; whether the family was dysfunctional; the degree of care, protection, and support; and whether the child was deemed credible in relation to the disclosure of sexual abuse. Sociocultural factors—From a sociocultural perspective, it was perceived that beliefs helped shape attitudes towards sexual abuse and people who have been sexually abused. For example, one respondent stated that “experiencing sexual abuse remains covertly the responsibility of the sufferer.” Other respondents believed that society often denies the reality of sexual abuse and, as one person noted, sexual abuse is “a social issue that is linked to how society excuses violence.” The terms “disconnection,” “whakamä,” and “shame” were frequently used when describing the social environment of people who had been sexually abused. One respondent advised that the behavioural responses by people around the individual could have greater traumatic effect than the actual abuse or could vastly increase devastation. Key themes emerging from respondents’ understandings about the meanings and effects of sexual abuse suggested that sexual abuse can result in damaging and often long-term consequences that have the potential to affect all areas of an individual’s life. These understandings were articulated in terms of “development,” “identity,” and “social functioning.” Other factors, particularly those related to family, were considered significant in mitigating or exacerbating the effects of the abuse. Treatment/therapy

Practitioners’ information about therapeutic practice was identified through three open-ended questions: (a) Question 18: “When people present for therapy or counselling following sexual abuse, they bring with them unique histories, stories, concerns, issues, or problems. How do you think about and strategise how to help each client? What do you need to know to decide how to help them?” (b) Question 19: “When working with clients who have been sexually abused, different people recommend different types of therapeutic interventions. What interventions have

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you found to be useful?” and (c) Question 20: “Various aspects of counselling/therapy are necessary for addressing particular issues faced by someone who has been sexually abused. What in your opinion are the essential components that need to be operating for counselling/therapy to be successful?” Thematic analysis articulated initial stages, and techniques and essential components of therapy. The terms “treatment” and “therapy” are used here interchangeably, reflecting practitioner terminology. Initial stages

Information was sought to determine how practitioners strategised their work when clients presented for therapy. A thematic analysis of written responses indicated that they considered a wide range of issues. Four sub-themes emerged: therapeutic relationship, safety, general assessment, and goal setting. Therapeutic relationship There was consensus across respondents that if a good therapeutic relationship was not developed, the therapeutic process would be undermined. Therapists expressed these ideas in terms of promoting healing, and providing a base from which clients could feel safe and free to talk about their experiences. The perceived importance of the relationship was exemplified by statements such as “the building of the therapeutic relationship is crucial,” and “feel listened to—validated—normalised—understood.” Other respondents expanded on the theme, articulating specific reasons for its importance: “within the safety of the container provided by the therapeutic relationship, the client can face their experience and be supported to let go of the shame and terror associated with the trauma,” and “time and time again I find that the factor that the client felt was the most helpful in her healing was that someone really heard her, believed her, and knew that she could make progress. It wasn’t the clever methods I thought I was pulling out of my learning—it was the relationship that mattered—it is almost a heart to heart connection and I know from experience that when this is really happening, the client’s progress is much faster.” Safety Safety issues covered the client’s current safety, safety from further sexual abuse, risk of self-harm, and suicidal ideation. General assessment This sub-theme addressed areas of general functioning; symptoms, with particular focus on trauma symptoms and degree of dissociation; personal history; attachment

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patterns; a client’s goals; contextual issues; and observation of how the client responded in the interview. Specific assessment techniques are beyond the scope of this article. Goal setting Goal setting evoked differing responses. Some practitioners were inclined to follow the client’s lead, while others developed goals with their client. A few mentioned specific goals such as “develop self-acceptance,” “set up systems to manage issues,” “empowerment,” and “work with the client to rebuild and develop mastery over their life.” Techniques and essential components of therapy

As noted above, a range of techniques and modalities were listed, with some therapists noting more than one approach. The following describes what respondents considered were essential components of therapy, accompanied by illustrative quotes. Qualitative analysis of the content of each of the practitioner’s responses indicated that these components embraced the following sub-themes: therapeutic relationship, therapeutic environment, therapist characteristics, client characteristics, tasks of therapy, and structure and process issues. Therapeutic relationship Once again, this theme emerged strongly, with its frequent occurrence suggesting that it was considered a principal element of the therapeutic process. Therapeutic environment People advised that the room in which therapy is conducted should be “comfortable,” “warm,” “friendly,” “a confidential venue,” and that clients should feel welcome and safe. Therapist characteristics Many responses were written that identified the qualities and abilities of a competent therapist, yielding embedded sub-themes of ways of being and competencies.

Ways of being—The competent therapist was considered to have personal qualities of “acceptance,” “awareness,” “clear and sound mind,” “belief in client,” “grounded,” “sensitivity,” “gentleness,” “engendering hope,” “down to earth,” “respectful,” “congruent,” “approachable,” and being “supportive.” Many abilities were noted that would derive not only from training, but also from experience with sexual abuse counselling. The following generic abilities were considered relevant to any counselling practitioner: “pacing,” “clear communication,” “ability to hold transference and work with them to create powerful healing,” “attend to the countertransference and process

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it,” “quick thinking,” “challenging,” “coaching,” “empowering,” “reflexive,” “provide structure and boundaries,” “eye contact,” “working within client’s frame of reference,” “modelling,” and “ability to be clear and directive.” However, the following quotes, while also relevant to other clients, do reflect the importance of issues specifically related to clients who have experienced sexual abuse: “belief in the client’s story however bizarre,” “ability to be with/hear the hard stuff,” “not shocked,” and “not to be afraid or avoid difficult material.” Competencies—The competencies sub-theme relates to training, education, and supervision. Respondents expected a high level of competence among their colleagues that suggests appropriate and adequate training, as well as ongoing professional development. They expected colleagues to have a good understanding of cultural values and developmental issues; possess a thorough understanding of sexual abuse and its effects; understand trauma and trauma theory; have a sound theoretical base; have the ability to recognise mental health problems and be able to refer on if necessary; be competent in their assessment, formulation, and treatment planning; and possess a wide range of intervention skills and strategies. When working with this specific client population, it was expected that therapists would allow and facilitate clients’ expressions of grief and suffering. It was considered helpful for the therapist to share a little personal history. Some respondents reported their particular expectations of therapists in this field. A practitioner should be well informed. Therefore, as well as ongoing training, there should be ongoing reading, regular supervision, networking with other professionals, and having a professional support system. Inherent in these ideas is the conviction that practitioners should not be isolated. They need to be able to share ideas and receive support from colleagues and supervisors within the stressful and potentially traumatising climate of sexual abuse work. Further, it was stated that therapists should go through their own therapy, and address any of their own sexual abuse issues. Client characteristics Several client-related characteristics were believed to be factors in effective therapy. The issue of a client’s readiness for therapy was mentioned, as well as a commitment to attending therapy, and being prepared and motivated to do therapeutic work to make changes. To some extent, this issue links to the importance of pacing. The concept of belief was raised and expressed in terms of the client believing in the therapist and believing they could heal and change. Stability in the life of the client was illustrated by the following comments: “not filled with chaos and drama,” “no longer in abusive

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relationship,” “availability of support for client outside of therapy,” “no addictions, no psychotic disorders.” Tasks of therapy Although practitioners responding to this survey were multi-disciplinary, the list of issues that emerged was considered important across practitioners working with sexual abuse clients. Tasks of therapy included teaching clients specific techniques and “building capacities and skills.” These covered “anger management,” “breathing/relaxation,” “affect work,” “self-soothing thoughts and behaviour,” “safety building,” “teaching client to ground self,” “reconnecting to life and self,” and “methods to deal with trauma-related effects.” Other tasks of therapy not specifically related to teaching clients included “identification of the effects of the abuse,” “consolidation,” “address mental health issues,” “encourage grief process,” and “review progress and needs.” As noted earlier, responses such as “safety building,” “identification of the trauma symptoms,” and “empowering clients by teaching skills” were also given in the initial tasks of therapy. Structure and process Factors relating to timing and pacing were given attention, for example: “regular appointments,” “consistent appointment days and times,” “uninterrupted sessions,” “ensuring the provision of sufficient time for the client,” and “working at the client’s pace and not trying to hurry the work.” Providing structure and boundaries was noted. Several individuals stated it was important to let the clients tell their stories, and this narrative thread was evident in some of the responses. Discussion

The survey yielded information about the therapeutic approaches of practitioners working with sexual abuse survivors in Aotearoa/New Zealand. Respondents comprised a range of people with differing backgrounds, training, and client groups. Most were counsellors or psychotherapists, reflecting the predominance of these disciplines among practitioners registered with ACC to work with sexual abuse survivors (ACC, 2009). Although practitioners used a variety of therapeutic approaches when working with sexual abuse survivors, issues that emerged were considered important across disciplines. In recognition of the diversity of therapeutic techniques, no one specific approach has been focused on in the present article. Respondents demonstrated insight into relevant issues surrounding their practice, reflecting wide-ranging experiences, compassion for their clients, and commitment to their work. Some individuals devoted much time to answering the questions, as shown by quite lengthy responses.

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Sexual abuse—meanings and effects

Practitioners considered that sexual abuse had the potential to damage all areas of a person’s life and could result in lifelong problems. Development could be impaired, leading to a variety of losses. Practitioners’ reporting was consistent with the literature outlining impaired development of secure attachment, resulting in lifelong difficulties in negotiating stable interpersonal relationships and decreasing feelings of connection with others (Cook et al., 2005; van der Kolk, 2007), impaired sexual functioning (Lemieux & Byers, 2008), and impaired ability to regulate internal experiences and to self-soothe (Cook et al., 2005). In an effort to manage negative emotional states, poor self-esteem, and poor social and sexual functioning, survivors were described by practitioners as engaging in potentially harmful behaviours, self-harm, and drug and alcohol use. High rates of risk-taking sexual practices (Lemieux & Byers, 2008), substance abuse/dependence (Duncan et al., 2008; Fergusson et al., 2008), as well as suicidal ideation and suicide attempts (Fergusson et al., 2008) are found among survivors of sexual abuse. It was noted by practitioners that the severity of the consequences could be affected by personal factors, the family’s response to the abuse, family support, and whether the perpetrator was a family member, as well as sociocultural characteristics. These differential factors have been well-documented in the literature (Heflin & Deblinger, 2007). Factors increasing resilience to the trauma include others’ beliefs about disclosure, support, and the ability to place responsibility on the perpetrator (Hunter, 2006). Coping self-efficacy can also mediate the effects of negative cognitions caused by trauma (Cieslak, Benight, & Lehman, 2008). Treatment/therapy

In the initial stages of therapy, the therapeutic relationship emerged as the key component. The importance of the therapeutic relationship has been emphasised in the literature (Antoniou & Blom, 2006; Dattilio & Freeman, 2007; Pollack & Brezina, 2007). Practitioner qualities identified by participants reflected those needed to engender a sound therapeutic relationship. Arguably, these qualities and abilities are able to be taught and then grounded in the experience of counselling practice. The importance of safety issues, general assessment, and goal setting was emphasised. Many essential components of therapy were identified which covered the therapeutic environment, the therapist, the client, and the therapy itself. While many of the issues raised would be relevant to most client populations, it was important to elucidate what practitioners considered pertinent to their work with survivors of sexual abuse.

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The complexity of working with this client group was illustrated by the degree of overlap in responses regarding tasks of therapy. In some cases practitioners considered the main tasks of therapy, such as safety building, identifying trauma symptoms, and empowering clients, as important to consider during the initial stages. Overall, many of the respondents expressed an awareness of the complex nature of the issues surrounding sexual abuse and therefore the importance of supporting well-trained, experienced practitioners to work in this field. Conclusion

The survey was the first stage of a multi-faceted research project undertaken to inform the development of best-practice guidelines for practitioners working with survivors of sexual abuse (Räranga Whatumanawa, 2008). Other methods included reviewing the national and international literature, conducting archival file and meta-analyses, and holding focus groups and key informant interviews with practitioners and consumers. Triangulating data from several sources enabled the information gathered from the survey to be validated and extended. While the survey response rate of 24% is somewhat less than reported in some health practitioner surveys, where the response rate was between 33% and 83% (Bor, Mallandain, & Vetere, 1998; Cull, O’Connor, Sharp, & Tang, 2005; Cummings, Savitz, & Konrad, 2001; Puleo et al., 2002), it is similar to the 26% reported in a study of mental health practice in the United Kingdom (Skidmore, Warne, & Stark, 2004). The present survey was time-consuming for respondents to complete, which is likely to have reduced the response rate (Dillman, 2000). However, an open-ended question format allowed respondents to provide comprehensive information, resulting in a depth and richness of data, which was analysed qualitatively. Responses were provided by a range of people experienced and knowledgeable in providing therapy for survivors of sexual abuse. The data elicited through the survey could provide a baseline for follow-up studies to determine how New Zealand-based practitioners evolve their practice methods in response to the emergence of the latest evidence-based guidelines. Furthermore, information provided by practitioners allows specific issues to be identified, which can be studied in more depth as practices evolve over time.

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Acknowledgements

Räranga Whatumanawa (The Weaving of Heart Patterns) is a research project undertaken by the Psychology Clinic at Massey University (Cheryl Woolley, Principal Investigator, and Ian Evans, Senior Research Consultant) to investigate the assessment, diagnosis, treatment, and outcomes for people experiencing mental injury arising from sexual abuse. The research was funded by the Accident Compensation Corporation of New Zealand (ACC). The project was conducted in conjunction with the Psychology Centre in Hamilton, and involved a large team of researchers as well as an Advisory Committee representing distinguished researchers, practitioners, consumers, and tangata whenua. No official endorsement of this paper by ACC should be inferred, nor does it necessarily reflect the policy and opinions of ACC. The Räranga Whatumanawa research team was impressed by the overall response to and interest in the survey, and is grateful for the input of this dedicated group of practitioners. Correspondence concerning this article should be addressed to Gillian Craven, Research Officer, Räranga Whatumanawa, School of Psychology, Massey University, Private Bag 11-222, Palmerston North, New Zealand. Email: G.Craven@massey.ac.nz References

Accident Compensation Corporation. (2005). ACC recognised sexual abuse counsellors. Retrieved January 10, 2005, from http://www.acc.co.nz/claimscare/registered-providers/accrecognised-sexual-abuse-counsellors/index Accident Compensation Corporation. (2009). Registered counsellors. Retrieved February 20, 2009, from http://www.acc.co.nz/claims/useful-information/treatment-provider-details/ registered-counsellors Antoniou, A. S., & Blom, T. G. (2006). The five therapeutic relationships. Clinical Case Studies, 5(5), 437–451. Bor, R., Mallandain, I., & Vetere, A. (1998). What we say we do: Results of the 1997 UK Association of Family Therapy members survey. Journal of Family Therapy, 20, 333–351. Briere, J. (1992). Methodological issues in the study of sexual abuse effects. Journal of Consulting & Clinical Psychology, 60, 196–203. Briere, J., & Scott, C. (2006). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment. Thousand Oaks: Sage Publications. Callahan, K. L., Price, J. L., & Hilsenroth, M. J. (2003). Psychological assessment of adult survivors of childhood sexual abuse within a naturalistic clinical sample. Journal of Personality Assessment, 80(2), 173–184.

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Cieslak, R., Benight, C. C., & Lehman, V. C. (2008). Coping self-efficacy mediates the effects of negative cognitions on posttraumatic stress. Behaviour Research and Therapy, 46, 788-798. Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., et al. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35(5), 390–398. Cull, W. L., O’Connor, K. G., Sharp, S., & Tang, S.-f. S. (2005). Response rates and response bias for 50 surveys of pediatricians. Health Services Research, 40(1), 213–226. Cummings, S. M., Savitz, L. A., & Konrad, T. R. (2001). Reported response rates to mailed physician questionnaires. Health Services Research, 35(6), 1347–1355. Dattilio, F. M., & Freeman, A. (Eds.). (2007). Cognitive-behavioral strategies in crisis intervention (3rd ed.). New York: Guilford Press. Dillman, D. A. (2000). Mail and internet surveys (2nd ed.). New York: John Wiley & Sons. Draper, B., Pfaff, J. J., Pirkis, J., Snowdon, J., Lautenschlager, N. T., Wilson, I., et al. (2007). Long-term effects of childhood abuse on the quality of life and health of older people: Results from the depression and early prevention of suicide in general practice project. JAGS: Journal of the American Geriatrics Society, 56, 262–271. Duncan, A. E., Sartor, C. E., Scherrer, Z. F., Grant, J. D., Heath, A. C., Nelson, E. C., et al. (2008). The association between cannabis abuse and dependence and childhood physical and sexual abuse: Evidence from an offspring of twins design. Addiction, 103, 990–997. Fanslow, J. L., Robinson, E. M., Crengle, S., & Perese, L. (2007). Prevalence of child sexual abuse reported by a cross-sectional sample of New Zealand women. Child Abuse & Neglect, 31, 935–945. Ferguson, H. (2003). Outline of a critical best practice perspective on social work and social care. British Journal of Social Work, 33, 105–124. Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2008). Exposure to childhood sexual and physical abuse and adjustment in early adulthood. Child Abuse & Neglect, 32, 607–619. Garb, H. N. (2005). Clinical judgement and decision making. Annual Review of Clinical Psychology, 1, 67–89. Gibb, B. E., Chelminski, I., & Zimmerman, M. (2007). Childhood emotional, physical, and sexual abuse, and diagnoses of depressive and anxiety disorders in adult psychiatric outpatients. Depression and Anxiety, 24, 256–263. Gore-Felton, C., Koopman, C., Thoresen, C., Arnow, B., Bridges, E., & Spiegel, D. (2000). Psychologists’ beliefs and clinical characteristics: Judging the veracity of childhood sexual abuse memories. Professional Psychology: Research and Practice, 31(4), 372–377. Haller, D. L., & Miles, D. R. (2004). Personality disturbances in drug-dependent women: Relationship to childhood abuse. American Journal of Drug and Alcohol Abuse, 30(2), 269–287. Heflin, A. H., & Deblinger, E. (2007). Child sexual abuse. In F. M. Dattilio & A. Freeman (Eds.), Cognitive-behavioral strategies in crisis intervention (pp. 247–276). New York: Guilford Press.

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Holzer, S. R., Uppala, S., Wonderlich, S. A., Crosby, R. D., & Simonich, H. (2008). Mediational significance of PTSD in the relationship of sexual trauma and eating disorders. Child Abuse & Neglect, 32, 561–566. Hunter, S. V. (2006). Understanding the complexity of child sexual abuse: A review of the literature with implications for family counseling. The Family Journal, 14, 349–358. Johnson, R. J. (2008). Advances in understanding and treating childhood sexual abuse: Implications for research and policy. Family Community Health, 31(15), S24–S31. Kaplow, J. B., & Widom, C. S. (2007). Age of onset of child maltreatment predicts long-term mental health outcomes. Journal of Abnormal Psychology, 116(1), 176–187. Lemieux, S. R., & Byers, E. S. (2008). The sexual well-being of women who have experienced child sexual abuse. Psychology of Women Quarterly, 32, 126–144. McCrae, J. S., Chapman, M. V., & Christ, S. L. (2006). Profile of children investigated for sexual abuse: Association with psychopathology symptoms and services. American Journal of Orthopsychiatry, 76(4), 468–481. Noll, J. G. (2008). Sexual abuse of children: Unique in its effects on development? Child Abuse & Neglect, 32, 603–605. Northey, W. F. (2004). Characteristics and clinical practices of marriage and family therapists: A national survey. Journal of Abnormal Child Psychology, 28(4), 487–494. Pollack, S., & Brezina, K. (2007). Negotiating contradictions: Sexual abuse counseling with imprisoned women. Women & Therapy, 29(3–4), 117–133. Puleo, E., Zapka, J., Jo, W. M., Mouchawar, J., Somkin, C., & Taplin, S. (2002). Caffeine, cajoling, and other strategies to maximize clinician survey response rates. Evaluation & the Health Professions, 25, 169–184. Räranga Whatumanawa. (2008). Sexual abuse and mental injury: Practice guidelines for Aotearoa New Zealand. Wellington: Accident Compensation Corporation. Skidmore, D., Warne, T., & Stark, S. (2004). Mental health practice and the rhetoric-reality gap. Journal of Psychiatric and Mental Health Nursing, 11, 348–356. Taylor, J. E., Harvey, S. T., Mortimer, R. C., Campbell, J., & Woolley, C. C. (2006). Practitioner survey: Respondent profile, and practitioner survey: Section B and section D. (Räranga Whatumanawa Technical Report 8). Palmerston North: Massey University, School of Psychology, Räranga Whatumanawa. van der Kolk, B. A. (2007). The developmental impact of childhood trauma. In L. J. Kirmayer, R. Lemelson, & M. Barad (Eds.), Understanding trauma: Integrating biological, clinical, and cultural perspectives (pp. 224–241). New York: Cambridge University Press. Young, M., Read, J., Barker-Collo, S., & Harrison, R. (2001). Evaluating and overcoming barriers to taking abuse histories. Professional Psychology: Research and Practice, 32(4), 407–414.

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Activities Influencing the Professional Development of New Zealand Counsellors Across Their Careers Nikolaos Kazantzis, Sarah J. Calvert, David E. Orlinsky, Sally Rooke, Kevin Ronan, and Paul Merrick

Abstract New Zealand counsellors (n = 123) were surveyed as an extension of a multinational study of therapist development. Comparisons were made with samples of Canadian and US counsellors. New Zealand counsellors perceived themselves to have developed in skill and knowledge across their careers, and reported high levels of ongoing development at all stages of their careers. Involvement in supervision and training were notably high, exceeding that of the Canadian and US samples, and did not diminish with increasing time in practice. Involvement in personal therapy was also high, though slightly lower than the comparison samples. New Zealand counsellors regarded supervision, training, and personal therapy as having had a strong, positive influence on their professional development. Ratings of the influence of these activities exceeded the ratings of comparison samples.

Throughout their careers, counsellors are engaged in a process of professional development that includes growth in therapeutic skills, theoretical understanding, and confidence in the therapeutic role (Blair & Peake, 1995; Friedman & Kaslow, 1986; Grater, 1985; Kottler & Jones, 2003). Although the ultimate aim of this process is to achieve optimal effectiveness in their therapeutic practice, a sense of ongoing professional development may also be a source of satisfaction and sustenance for counsellors themselves, potentially helping to counteract the emotional drain that is common in mental health careers (Farber & Heifetz, 1981; Kramen-Kahn & Hansen, 1998; Norcross & Guy, 1989; Skovholt, Grier, & Hanson, 2001). The issue of professional development is also of interest to those involved in counsellor education and supervision,

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who require an understanding of how best to promote such development with practitioners across different levels of experience (Worthington, 2006). While recognition of the importance of this topic has led to an increase in research on counsellors’ professional development at an international level, studies within the New Zealand context remain sparse. Given that New Zealand practice conditions differ in many ways from those overseas (Paton, 1999), international findings on professional development may lack applicability to New Zealand counsellors. Only two surveys that included data on the professional development of New Zealand counsellors were able to be located. The first was a national survey of members of the New Zealand Association of Counsellors (NZAC) working in private practice (Paton, 1999). Two hundred and sixty counsellors responded to the survey (response rate was not indicated), and a wide range of demographic and clinical practice variables were reported. Most of the sample reported receiving individual supervision, and 75% of respondents reported receiving supervision at least fortnightly, the minimum frequency recommended by NZAC. The second relevant study was a survey of 212 school counsellors (55% response rate) (Manthei, 1999). In this study 92% of the sample reported receiving supervision, and this proportion was higher among less experienced counsellors (r = .34). Those who received supervision at least fortnightly made up 53% of the sample. Although both of these surveys had large sample sizes, findings are unlikely to generalise to the wider population of New Zealand counsellors given the select groups sampled (school counsellors and NZAC members in private practice). Additionally, few variables relating to professional development were explored in either study; for example, neither study explored counsellors’ perceptions of the usefulness of supervision or training, nor counsellors’ use of personal therapy. In order to expand the little that is known about the professional development of New Zealand counsellors, the present study represents the New Zealand extension of a multinational investigation of therapist development. The Society for Psychotherapy Research Collaborative Research Network (CRN) has surveyed close to 5,000 mental health practitioners since the inception of its study in 1989 (Orlinsky et al., 2005a, b). The CRN adopted a cross-sectional approach to assess development, sampling therapists at every stage in their professional careers. The Development of Psychotherapists Common Core Questionnaire (DPCCQ) was designed specifically for the study, and investigates a range of personal and practice characteristics in addition to professional development issues. Using this questionnaire, the present

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study investigates the following three areas of professional development for a sample of New Zealand counsellors, comparing the New Zealand sample with available data from counsellors practising in the United States and Canada. Of course, any comparison with non-representative samples has inherent limitations, including a lack of comparability in terms of age, gender, experience, training, and requirements within different countries for a professional to identify as a counsellor. Readers are encouraged to keep these limitations in mind when reading this paper. Perceptions of development across the career span

Although many studies have considered changes in counsellors’ specific therapeutic skills and characteristics across the career span (Kivlighan, 2008; Kivlighan & Quigley, 1991; Mallinckrodt & Nelson, 1991; Martin, Slemon, Hiebert, & Hallberg, 1989; Tracey, Hays, Malone, & Herman, 1988), few have explored the wider concept of development as a multifaceted, complex process. The majority of empirical studies have also been limited by the use of therapists with little clinical experience, making it impossible to determine patterns of development across the full career span. This is a significant limitation, given that the journey from novice to expert is believed to span at least ten years (Skovholt, Rønnestad, & Jennings, 1997), with even the most senior therapists reporting continued professional development (Rønnestad & Skovholt, 2001). Although conceptual studies have adopted a broader perspective on development, they have typically focused on the supervision or training of counsellors in their pre- or early post-qualification stages (e.g., Friedman & Kaslow, 1986; Grater, 1985; Hogan, 1964; King, 2007; Stoltenberg, 1981). One exception is a study in which 100 practitioners of all experience levels were interviewed to develop a career-span stage model of professional development (Skovholt & Rønnestad, 1992a). Respondents described becoming more confident and autonomous in their professional roles, deepening their level of insight and self-awareness, and increasing their repertoire of skills and approaches (Rønnestad & Skovholt, 2003). However, it is difficult to determine the extent to which these experiences and perceptions are likely to be representative of New Zealand counsellors, given that the sample was relatively small and drawn solely from North America. Taking into account the limitations of prior research and the lack of New Zealand-relevant studies, the first aim of the current study was to explore New Zealand counsellors’ perceptions of their professional development, investigating how these perceptions compared with those of Canadian and North American samples and how they changed over practitioners’ careers.

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Use of professional development activities across the career span

Multiple activities undoubtedly contribute to counsellors’ professional development, but three have been viewed as particularly important following their introduction by Freud as a “tripartite” model of training (Botermans, 1996; Strupp, Butler, & Rosser, 1988). Freud’s three major methods of educating trainee therapists were didactic teaching, supervision, and personal analysis (Lasky, 2005; Matthews & Treacher, 2004), activities which continue to be used to support counsellors and improve their therapeutic work (Gabbay, Kiemle, & Maguire, 1999; Hill, Charles, & Reed, 1981; Lucock, Hall, & Noble, 2006; Strupp et al., 1988). Supervision remains a cornerstone of counsellor education (Grant & Schofield, 2007; Wheeler & Richards, 2007), and is viewed as essential to the development of counsellors’ clinical competence and professional identity (Guest & Beutler, 1988; Lambert & Hawkins, 2001; Rosenbaum & Ronen, 1998; Stinchfield, Hill, & Kleist, 2007). Formal training provides the theoretical foundations of counselling practice, and continuing professional development helps therapists to remain up to date with the developments that are continually occurring (Stein & Lambert, 1995; Vitulano & Copeland, 1980). Personal therapy is thought to enhance therapeutic skill, empathy, and self-awareness through a more interpersonal, experiential process (Geller, Norcross, & Orlinsky, 2005; Greenberg & Staller, 1981; Macran & Shapiro, 1998; Macran, Stiles, & Smith, 1999; Rizq & Target, 2008). Prior data on New Zealand counsellors’ use of supervision and training are very limited and represent only subsections of the counsellor population (namely, school counsellors and NZAC members in private practice). No studies examining New Zealand counsellors’ use of personal therapy could be located, and indeed, Paton (1999) specifically recommended that future studies explore this area for New Zealand counsellors. Additionally, on an international level, little research has investigated how counsellors’ use of supervision, training, and personal therapy changes over their careers. The second broad aim of the present study is thus to explore New Zealand counsellors’ use of supervision, training, and personal therapy, making comparisons with Canadian and US samples and exploring how use changes with experience level. Perceived influences on professional development

The extent to which counsellors use supervision, training, and personal therapy is not necessarily indicative of the helpfulness of these activities; this must be investigated directly. In past surveys, therapists have tended to rate experiential and interpersonal activities as contributing most strongly to their professional development, particularly their work with clients (Henry, Sims, & Spray, 1971; Morrow-Bradley & Elliott, 1986;

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Orlinsky, Botermans, & Rønnestad, 2001; Orlinsky & Rønnestad, 2005c; Rachelson & Clance, 1980; Skovholt & Rønnestad, 1992b). Work with clients is not considered a professional development activity in the current study, as it is the focus of the therapist’s job, but clearly this activity represents the key opportunity for therapists to apply and develop their skills and knowledge. Following work with clients, the two activities typically rated as most important are supervision and personal therapy, while ratings of training are more variable (e.g., Orlinsky et al., 2001; Rachelson & Clance, 1980). Many previous studies have sampled only therapists trained and practising in the United States, and few have assessed changes in therapists’ perceptions of the importance of supervision, training and personal therapy across their careers. One study that did so found changes in perceptions. For example, the perceived importance of supervision peaked early in their careers while the perceived importance of personal therapy increased throughout their careers (Orlinsky et al., 2001). Given that no study has assessed New Zealand counsellors’ perceptions of the importance of supervision, training, or personal therapy for their professional development, this forms the third broad aim of the current study. Perceptions will be compared with those of Canadian and US counsellors, and changes across the career span will also be investigated. The body of research on therapist professional development is small to date, and many previous findings may lack generalisability to New Zealand counsellors, given that samples have frequently been drawn solely from the United States (Orlinsky et al., 2005b). The CRN appears to be the first group to collect substantial data on the professional development of therapists for a large international sample. As yet, the CRN has published data on the use of supervision, training, and personal therapy only in limited forms (e.g., Bae, Joo, & Orlinsky, 2003; Botermans, 1996; Willutzki & Botermans, 1997), and generally not in relation to counsellors as a group separate from other mental health professionals. One CRN study has investigated the use of personal therapy among counsellors (Wiseman & Egozi, 2006). However, this study included school counsellors only. CRN analyses have typically grouped all professional affiliations (psychologists, psychiatrists, counsellors, social workers, etc.) together, in view of the aim of prior investigations to explore elements of professional development common across professional groups. This limits the extent to which the findings generalise to counsellors, given that professional groups differ in numerous ways such as training, practices, salient theoretical orientations, and work environments. Not surprisingly, the few analyses of CRN data that have compared professional groups have found

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notable differences in their perceptions of development (Orlinsky & Rønnestad, 2005a), and perceptions of the activities that influence development (Orlinsky et al., 2001). Likewise, prior analyses of CRN data have found differences among countries in terms of professional development variables (Orlinsky et al., 2001; Orlinsky & Rønnestad, 2005a), suggesting that unique country-related factors may indeed influence professional development. The present study aimed to address gaps in the literature relating to the professional development of New Zealand counsellors, and to make comparisons with available data from counsellors working in the United States and Canada. Only very small sections of the New Zealand CRN data have been analysed to date, and no analyses had focused on New Zealand counsellors. In line with the career-length perspective adopted by the CRN, the present study also sought to investigate the influence of New Zealand counsellors’ experience level on the professional development variables being explored. All aims were investigated in an exploratory fashion as opposed to forming and testing explicit hypotheses, given the small amount of directly relevant research and the preliminary nature of the present study. Method

Sample

The present study analysed data for the 123 respondents who identified themselves as counsellors. For the New Zealand sample, this included respondents who identified themselves as both counsellors and psychotherapists, counsellors and ministers, and counsellors and “other” (these “other” professional identifications were examined and did not appear to be significantly different from the rest of the sample). The Canadian and US samples did not include those who jointly identified as psychotherapists, because psychotherapists are likely to have undergone different training in those countries. However, the term psychotherapist was not controlled in New Zealand at the time of data collection (between 1998 and 2000) and in practice, was often used synonymously with counsellor. The New Zealand sample is compared with other CRN samples of counsellors from Canada (n = 24) and the United States (n = 33). Table 1 displays the basic demographic characteristics for the three samples. Only 13% of the New Zealand sample were male (n = 15); 87% were female (n = 99); 9 respondents did not specify gender. By contrast, current data held by the NZAC on full members (n = 2,047) shows that 66% are female (P. Marshall, NZAC, personal communication, December 19, 2008), indicating that female counsellors were over-

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Table 1: Demographic details for all samples NZ (n = 123) Characteristic Age Years in practice Gender (% female)

Canada (n = 24)

US (n = 33)

M

SD

M

SD

M

SD

49.6

8.7

50.3

12.0

45.5

12.2

5.4

10.9

7.1

11.6

10.0

9.3 87%

75%

79%

Theoretical orientationa Analytic/psychodynamic

2.7

1.6

2.5

1.9

2.4

1.5

Behavioural

2.4

1.4

2.7

1.4

2.3

1.6

Cognitive

2.7

1.4

3.1

1.4

2.9

1.7

Humanistic

3.2

1.5

2.8

1.8

3.4

1.7

Systemic

2.4

1.6

3.2

1.9

2.9

1.7

Notes: n figures in analyses vary slightly due to missing data. a Ratings on a 0–5 scale of influence on therapeutic practice; multiple ratings allowed.

represented in the present survey. The proportion of male counsellors was also low in the Canadian and US samples: the Canadian sample included 6 males (25%), and the US sample included 7 males (21%). The New Zealand sample had a mean age of 49.6 (range = 25–86), similar to that of Canada (M = 50.3) and the US (M = 45.5). The mean age of the New Zealand sample was similar to that found in a survey of 260 NZAC members working in private practice (Paton, 1999), in which the mean age bracket was 45–49 years. The mean age of current NZAC members is 49.6 (P. Marshall, NZAC, personal communication, February 14, 2006). All three samples had also spent similar years in practice on average; for New Zealand, the sample had spent an average of 9.3 years in practice (range = 1–26) compared with Canada (M = 10.9) and the US (M = 11.6). Theoretical orientation was assessed by asking “How much is your current therapeutic practice guided by each of the following theoretical frameworks?” Respondents rated analytic/psychodynamic, behavioural, cognitive, humanistic, and systems theory from 0 (not at all) to 5 (very greatly). The New Zealand sample rated the humanistic orientation as having the greatest influence on their therapeutic work, and indicated a lower emphasis on the systems theory orientation compared with the US and Canadian samples.

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The New Zealand sample reported working an average of 28.5 hours per week in various mental health settings (SD = 12.9; range = 3–70), of which an average of 16.6 hours was spent conducting therapy (SD = 8.8; range = 0–40). Independent private practice was the most common work setting, with 46% of the sample spending at least some time conducting therapy in this setting. This was followed by school settings (19%), then public outpatient settings (15%). Only four respondents (3.3%) spent any time conducting therapy in inpatient settings. The sample’s work settings were similar to those reported by NZAC members (P. Marshall, NZAC, personal communication, December, 2008), with 46% of the NZAC respondents working primarily in private practice, and 14% in school settings (the public outpatient setting was not included in the NZAC survey). The average caseload reported by the sample was 21.8 clients (SD = 14.5; range = 1–80). Questionnaire

The instrument designed by the CRN for its study of therapist development is a selfreport questionnaire named the Development of Psychotherapists Common Core Questionnaire (DPCCQ). The DPCCQ was designed as a broad composite measure encompassing personal and professional background, training, work settings, and experience in clinical practice (Botermans, 1996). This lengthy questionnaire, comprising 392 items, was selected for the present study on the basis of its wide use in prior research (Bae et al., 2003; Botermans, 1996; Orlinsky et al., 1999b, 2001; Orlinsky & Rønnestad, 2005e; Willutzki & Botermans, 1997). The first aim of the present study (exploring development perceptions) involved using two scales on the DPCCQ: Current Development, which assessed therapists’ sense of current growth in their professional work, and Overall Development, which assessed perceptions of development from the first clinical case during training to the therapist’s most recent clinical work (Orlinsky & Rønnestad, 2005b). The Overall Development Scale is further divided into three subscales: Retrospected Career Development, Felt Therapeutic Mastery, and Skill Change. Formation of these scales was supported by factor analysis, and all scales were found to have adequate internal consistency, with alpha coefficients of .77, .85 and .86 respectively (Orlinsky & Rønnestad, 2005b). Retrospected Career Development consists of three items that ask therapists to directly assess their cumulative development since they began working as a therapist (e.g., how much they have changed overall, and how much they have succeeded in overcoming past limitations). Items are rated 0 (not at all) to 5 (very much). Felt Therapeutic Mastery consists of five items (also rated 0–5) assessing therapists’ current

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therapeutic proficiency, including mastery of techniques and understanding of the therapeutic process. A therapist’s current mastery level is assumed to reflect the culmination of development across the career. The third scale, Skill Change, requires that therapists rate themselves on 11 skills, firstly estimating their current skill level and secondly estimating their skill level at the beginning of their career. Ratings of initial skill are then subtracted from ratings of present skill, yielding a measure that potentially ranges from -5 (substantial decline in skill over the career) to +5 (substantial increase in skill, with a minimal skill level at the beginning of the career). Skill Change items incorporate both relational skills (e.g., effectively communicating concern to patients) and technical skills (e.g., understanding the moment-by-moment therapy process, mastery of techniques). The second aim of the present study (exploring counsellors’ use of supervision, training, and personal therapy) used a range of items on the DPCCQ that assessed therapists’ use of these processes. Supervision: (a) “How much formal case supervision have you received for your therapeutic work (regular individual or group supervisory sessions)?” (b) “Are you currently receiving regular supervision for any of your psychotherapy cases?” Training: (a) “How much formal didactic training have you received in therapeutic theory and technique (courses, lectures, or seminars)? Include both initial and subsequent therapeutic training.” (b) “In the past, have you undergone training in any specific type of psychotherapy?” (c) “Are you currently undergoing training in a specific form of therapy?” Personal therapy: (a) “Have you previously been in personal therapy, analysis, or counselling?” (b) “Estimate the total amount of time you have devoted to personal therapy/analysis.” (c) “Are you currently in personal therapy, analysis, or counselling?” For the third aim (exploring therapists’ perceptions of the influence of supervision, training and personal therapy on their development), a scale was used in which therapists rated the influence of 14 professional activities and work-related variables on their overall professional development. Activities were rated on a scale of -3 (very negative influence) to +3 (very positive influence), and respondents could assign both a negative and a positive rating. The present study analyses only positive ratings, given the aim of determining the positive contribution of supervision, training, and personal therapy. Along with ratings of supervision, training, and personal therapy, ratings of seven other relevant activities are also presented in this study to allow comparisons with the activities of interest.

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The predictor variable included in the present study, experience level, was assessed by asking “Overall, how long is it since you first began to practise psychotherapy?� Respondents specified their practice duration in years and months. Procedure

Both the New Zealand and international data were collected as part of a collaborative study of the professional development of psychotherapists, initiated by the Collaborative Research Network (CRN). Independent surveys of mental health practitioners have been conducted as part of this ongoing project in over 20 countries within Europe, Asia, the Middle East, North America, South America, and the South Pacific (Bae et al., 2003). Representative sampling was not considered viable, firstly because therapists as a group are not clearly defined, and secondly because there are no professional bodies to which all therapists within a certain nation must belong (Orlinsky et al., 2005c). Thus, the CRN used two main strategies for collecting data. The first method involved representative sampling of a wide range of regional and national professional associations (e.g., the American Academy of Psychotherapists), and the second involved collecting data from a broad range of mental health practitioners within each country (e.g., soliciting attendees of mental health conferences and trainees of counselling schools), with the aim of gathering a diverse, heterogeneous database which could then be disaggregated into meaningful subgroups (Orlinsky et al., 2005c). Data collection methods of the CRN have been described in more detail previously, in Orlinsky et al. (1999a, 2005c). New Zealand data were collected by Dr Kazantzis, and followed the general approach employed by the CRN in sampling other countries. Thus, the data collection was aimed primarily at obtaining a large, diverse sample of mental health practitioners (Bae et al., 2003; Orlinsky et al., 1999a). Participation was solicited among the members of academic departments responsible for the training of mental health practitioners and at professional conferences, with the support of organisers. Additionally, 2,350 flyers were inserted into NZAC newsletters. Flyers were also inserted into the newsletters of other professional bodies, including the Alcoholic Liquor Advisory Council of New Zealand, the Compulsive Gambling Society, the New Zealand Association of Psychotherapists, the New Zealand Psychological Society, and the Salvation Army. Flyers were pre-addressed and postage paid, and those who responded were sent a copy of the questionnaire along with a cover letter and prepaid return envelope. Participation in the study was entirely voluntary and anonymous. Two

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hundred and thirteen counsellors returned flyers, and of these, 123 returned completed questionnaires. Although this represents a 58% response rate, comparable with the 55% response rate of a survey of New Zealand school counsellors (Manthei, 1999), the actual response rate may have been much lower, as the number of questionnaires distributed at conferences etc. is unknown. Data analysis

Given the exploratory nature of the present study, the majority of variables required only the calculation of means and standard deviations (for continuous variables), or frequencies and percentages (for discrete variables). Pearsonâ&#x20AC;&#x2122;s correlation was used to assess the relationship between experience level and professional development variables for the New Zealand sample. Correlations where p < .05 are considered statistically significant. In order to make cross-national comparisons, the standardised mean difference effect size (d) was calculated; d was calculated separately for data from the Canadian and United States samples, with the New Zealand sample as the comparison group, using the following formula (Lipsey & Wilson, 2001): d = Mean (group 1) â&#x20AC;&#x201C; Mean (group 2) Pooled Standard Deviation The New Zealand mean was entered first (as group 1), so that a positive d always indicates a higher score for New Zealand, and a negative d indicates a higher score for the comparison country (Canada or the United States). Cohenâ&#x20AC;&#x2122;s (1988) conventions are used to guide interpretation of effect sizes, whereby an effect size of 0.2 is considered small, 0.5 is considered medium, and 0.8 is considered large. Results

Perceptions of development across the career span

Table 2 presents perceptions of Current Development and Overall Development for the three samples. Mean ratings of Current Development, Overall Development, Retrospected Career Development, and Felt Therapeutic Mastery were all above the mid-point (2.5) for all samples, indicating that counsellors tended to perceive themselves both as having developed considerably since the beginning of their career, and as experiencing development currently. Mean ratings of the New Zealand sample exceeded the Canadian and US samples, with these differences representing small to medium effects (effect sizes ranged from 0.26, comparing New Zealand with Canada on Current Development, to 0.55, comparing New Zealand to the US sample on Skill

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Table 2: Current and overall development: Cross-national comparison NZ (n = 123) M Current Development (total)

3.85

Overall Development (total)

Canada (n = 24)

SD .62

US (n = 33)

M

SD

M

3.68

0.8

3.79

SD .78

3.09

.45

3.02

0.56

2.86

.77

Retrospected Career Development 4.11

.57

4.13

0.65

3.85

1.16

Felt Therapeutic Mastery

3.72

.59

3.71

0.74

3.52

.9

Skill Change

1.46

.68

1.1

0.77

1.08

.75

Notes: n figures in analyses vary slightly due to missing data. Means presented in bold are those that meet criteria for a “small” standard mean difference to the New Zealand subsample (i.e., d less than or equal to 0.2). Means presented in bold and underlined indicate medium-sized differences (d greater than 0.5). All scales except Skill Change range 0–5; Skill Change potentially ranges from -5 to +5.

Table 3: Correlations of current and overall development with experience level: New Zealand sample only Measure Current Development (total) Overall Development (total)

n

r

p

118

.12

.21

115

.41

.00

Retrospected Career Development

118

.25

.01

Felt Therapeutic Mastery

120

.51

.00

Skill Change

118

.12

.20

Change). As shown in Table 3, both Current and Overall Development show positive relationships with experience level for the New Zealand sample, although only Overall Development, Retrospected Career Development, and Felt Therapeutic Mastery showed statistically significant correlations with experience level. Changes in specific skills (Skill Change) showed a weak, non-significant correlation with experience level, as did Current Development. Use of supervision, training, and personal therapy

Table 4 presents respondents’ involvement in supervision, training, and personal therapy. Almost the entire New Zealand sample (94%) were currently involved in

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Table 4: Use of supervision, training and personal therapy: Cross-national comparison

Professional development activity

NZ (n = 115) M

Canada (n = 25)

SD

M

5.11

5.90

US (n = 32)

SD

M

SD

4.15

5.15

Supervision Years of supervision Currently in supervision

8.56

94%

72%

5.33

55%

Training Years of formal training

5.27

3.94

4.98

3.68

5.05

3.49

Previous specialised training

85%

81%

76%

Current specialised training

26%

25%

25%

Personal therapy Years in personal therapy a

3.29

2.70

4.69

3.98

3.89

3.99

Previous personal therapy

87%

92%

88%

Current personal therapy

25%

33%

31%

Notes: n figures vary slightly for different analyses due to missing data. a Computed for those who reported having had therapy.

Table 5: Correlations of use of supervision, training and personal therapy with experience level: New Zealand sample only Professional development activity

n

r

p

Years in supervision

109

.82

.00

Currently in supervision

117

.09

.31

Years of formal training

113

.41

.00

Previous specialised training

112

.12

.19

Current specialised training

114

-.11

.23

Supervision

Training

Personal therapy

a

Time in personal therapy (years) a

106

.15

.12

Previous personal therapy

119

-.07

.42

Current personal therapy

119

-.08

.39

Computed for those who reported having had therapy.

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regular supervision, compared with 72% of the Canadian sample and just 55% of the US sample. Despite having had the fewest average years of clinical experience, the New Zealand sample also reported having spent the greatest amount of time in supervision. New Zealand counsellors reported receiving regular supervision for an average of 8.6 years (only slightly less than their mean practice duration of 9.3 years), compared with 5.9 years for the Canadian sample, and 5.2 years for the US sample. The New Zealand sample had also spent the greatest time in formal training, an average of 5.3 years compared with 5.0 years for the Canadian sample and 5.1 years for the US sample. Eighty-five percent of the New Zealand sample had undergone specialised training in a specific psychotherapy at some point, and 26% of the sample were currently undergoing such training. Again, these values were slightly greater than those of the other samples. The majority of all three samples had experienced personal therapy: 87% of the New Zealand sample, 92% of the Canadian sample, and 88% of the US sample. The New Zealand sample had spent the least total time in therapy (M = 3.29 years), and just 25% were currently engaged in therapy, compared with 33% of the Canadian sample and 31% of the US sample. The influence of experience level on counsellorsâ&#x20AC;&#x2122; length of time in supervision, training, and personal therapy is shown in Table 5. The significant positive relationship between years in supervision and experience level (r = .82) is clearly intuitive. Total years spent in training also showed a significant relationship with experience level (r = .41), while time spent in personal therapy did not. The relationships between experience level and current involvement in supervision, training, and personal therapy were all non-significant. Perceived influences of supervision, training, and personal therapy

Table 6 presents counsellorsâ&#x20AC;&#x2122; ratings of the influence of supervision, training, and personal therapy on their development, amidst a range of other activities and variables that have been included for comparison. While experience with clients received the highest mean rating in the Canadian and US samples, in the New Zealand sample this was ranked as the second most valuable source of professional development, following supervision. Indeed, the mean New Zealand ratings of the influence of supervision were substantially higher than the other samples (d = 0.79 for the Canadian comparison, d = 0.81 for the US comparison), for whom supervision was ranked fourth on average. The New Zealand sample also perceived didactic training (courses and seminars) to

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Table 6: Perceived influence of sources of professional development: Cross-national comparison Source of influence on professional development

NZ (n = 121)

Canada (n = 25)

US (n = 32)

2.60

2.04

2.03

[1]

[4]

[4]

2.44

1.72

2.22

[3]

[7]

[2]

2.36

2.27

2.17

[4]

[2]

[3]

Experience working with patients

2.52

2.32

2.55

[2]

[1]

[1]

Informal case discussion

2.05

2.16

1.97

[6]

[3]

[6]

2.13

1.80

1.84

[5]

[6]

[8]

1.74

1.88

[9]

[7]

1.91

1.83

2.00

[7]

[5]

[5]

Observing other therapists

1.83

1.28

1.69

[8]

[8]

[9]

Doing research

1.05

0.81

Getting supervision Taking courses or seminars Getting personal therapy

a

Reading books or journals Working with co-therapists Giving supervision

b

[10]

[10]

Note: Table shows mean ratings, which range from 0 (no influence) to 3 (very positive influence). Rankings are presented in square brackets. Means presented in bold are those that meet criteria for a “small” standard mean difference to the New Zealand subsample (i.e., d less than or equal to 0.2). Means presented in bold and underlined indicate medium-sized differences (d greater than 0.5). Ratings of two items are missing for the Canadian sample due to slight differences in the Canadian version of the DPCCQ. a Computed for those who reported having had personal therapy. b Computed for those who reported having given supervision.

have had a greater influence on their development, compared with the other samples. Didactic training received the third highest ratings among the New Zealand sample, compared with the sixth highest in the Canadian and US samples (d = 0.97 for the Canada comparison, d = 0.28 for the US comparison). The influence of personal therapy was also rated highly by the New Zealand sample, ranking fourth among the set

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Table 7: Correlation of perceived influence on development with experience level: New Zealand sample only Source of influence on development

a b

n

r

p

Getting supervision or consultation

119

.10

.30

Taking courses or seminars (training)

119

.01

.88

Getting personal therapy

.05

105

.19

Experience with patients

117

-.04

.63

Informal case discussion

117

-.00

.10

Reading books or journals

119

-.03

.72

Working with co-therapists

111

-.08

.38

Giving supervisionb

80

.21

.06

Observing therapists

118

.00

.99

Doing research

96

-.25

.01

a

Computed for those who reported having had personal therapy. Computed for those who reported having given supervision.

of ten activities. Other differences between New Zealand and the other samples included higher ratings of reading books or journals (d = 0.40 compared with Canada, 0.37 with the US) and working with other therapists (d = 0.60 compared with Canada). Experience level was not significantly related to the perceived importance of supervision or training for the New Zealand sample (see Table 7). The perceived influence of personal therapy showed a significant (but weak) positive correlation with experience level (r = .19). The only other activity significantly related to practice duration was doing research; counsellors’ rating of the influence of this activity on professional development tended to decrease with increasing time in practice (r = -.25). Discussion

The overall aim of the present study was to explore New Zealand counsellors’ professional development, a topic that had received very little previous attention. Specifically, aims were to describe counsellors’ perceptions of development and their use of, and perceptions of the influence of, supervision, training, and personal therapy. The impact of experience level on these activities and perceptions was also explored. Before discussing key findings, a number of limitations of the study must be acknowledged.

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Firstly, the generalisability of the findings is limited by the non-representative sampling method used. The methods employed do not allow for a finer level analysis of counsellors who were NZAC members and those who were members of other organisations, such as the New Zealand Psychological Society, and the New Zealand Association of Psychotherapists, each requiring different training for membership and accreditation. However, the sample’s demographic details appeared to be reasonably similar to those of a prior sample of New Zealand counsellors (Paton, 1999) and to those of current NZAC members. The small sample sizes of the Canadian and US samples greatly limits the generalisability of findings to the populations from which they were drawn, and consequently, data from these samples provide only rough comparisons with the New Zealand sample. Secondly, the reliance on therapist self-reporting introduces potential inaccuracies due to memory and judgement errors, and social-desirability bias, although the anonymity of the survey is likely to reduce the social-desirability effects. At present, the lack of agreement on what constitutes “essential factors” of therapist development (Orlinsky & Rønnestad, 2005d) limits the construction of more objective measures. Nevertheless, counsellors’ personal, subjective experiences of development are both interesting and important in their own right. Finally, the cross-sectional approach adopted in the present study makes it impossible to determine whether differences associated with experience level reflect transitions across practitioners’ careers or cohort differences. While a longitudinal approach would be ideal in the study of development across the career span, such an approach would require significant time and funding. Despite the confounding effect of cohort differences, the information discovered in the present study is still valuable in that it indicates differences between less and more experienced counsellors at the time the study was conducted. New Zealand counsellors’ perceptions of development were fairly high on average, and typically higher than the perceptions of the Canadian and US samples. This indicates a general sense of positive change, attainment of therapeutic mastery and increase in skill across their careers, as well as an ongoing sense of current development. Equally encouraging was the finding that Current Development was positively associated with experience level. While the significant positive relationship between experience level and Overall Development is intuitive, in that those who have been practising for longer have had a greater time to develop professionally, the positive (although non-significant)

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relationship with Current Development is less intuitive. Given the steep learning curve faced by new practitioners, it might be expected that counsellors’ sense of current development would begin high and then diminish across their careers. This trend was not observed among the New Zealand sample, despite the wide range of practice durations represented (1–26 years). If a sense of ongoing professional development is indeed an important source of sustenance for therapists, to help prevent burnout and stagnation (Farber & Heifetz, 1981; Norcross & Guy, 1989; Skovholt et al., 2001), then the sense of ongoing (and perhaps even increasing) development among New Zealand counsellors who have been in practice for some time is clearly a positive finding. Another positive finding was the higher mean Skill Change ratings for the New Zealand sample, compared with the Canadian and US samples, despite the shorter practice duration of the New Zealand sample. Mean ratings of Skill Change, while appearing low across all samples, were in fact very similar to those reported in other studies (Orlinsky & Rønnestad, 2005b). The low mean scores on this scale are likely to reflect the large number of items measuring change in relational skills, which therapists tend to feel they already possessed at the beginning of their careers (Orlinsky & Rønnestad, 2005b). One notable finding of the present study was the high involvement of New Zealand counsellors in the traditional professional development activities of the tripartite model, particularly supervision. Indeed, it is possible that the high perceptions of development across the career span among the New Zealand sample are partially attributable to their high involvement in professional development activities. Ninety-four percent of the sample were currently receiving regular supervision, a finding that was very similar to the rate reported in a New Zealand survey of 212 school counsellors (92%) (Manthei, 1999). The mean time the New Zealand sample had spent in supervision was higher than that of the comparison samples, despite their similarities in mean experience level. Compared to the survey of school counsellors (Manthei, 1999), in which more experienced counsellors were less likely to receive supervision, New Zealand counsellors in the present study did not show this trend. The non-significant relationship between experience level and currently receiving supervision suggests that more experienced counsellors were no less likely to receive regular supervision than new graduates. This finding may well reflect the fact that supervision is mandated for all members of NZAC and NZAP, regardless of experience level. The New Zealand sample had also spent the greatest average time in training of all three samples, and had the greatest involvement in specialised psychotherapy training.

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The percentage of New Zealand counsellors who had undergone personal therapy (87%) was also very high, although slightly lower than that of the Canadian and US samples. The non-significant correlation between experience level and current engagement in personal therapy within the New Zealand sample indicates that New Zealand counsellors are equally likely to undergo therapy at any stage during their careers. New Zealand counsellors strongly perceived the three activities of the tripartite model as having been major influences on their development. Of all the activities listed in the DPCCQ, supervision was given the highest mean influence rating by New Zealand counsellors, followed by work with clients, then didactic training and personal therapy. The most significant difference between New Zealand and the comparison countries related to their perceptions of the strong positive influence of supervision. Given respondents’ high involvement in supervision, it is not surprising that this activity was perceived to have greatly influenced their professional development. The positive perceptions indicate that counsellors are not simply engaging in supervision to fulfil responsible obligations, but genuinely view this activity as a worthwhile, high-quality source of professional development. Ratings of the importance of training and personal therapy were also higher among the New Zealand sample than the Canadian and US samples, potentially indicating satisfaction with the quality of these sources of professional development also. It thus appears that the “professional development triad” of supervision, training, and personal therapy may represent a widely accepted and useful basis for counsellor development in New Zealand, as it is internationally (Botermans, 1996). Thus, the fairly consistent findings of past research that interpersonal sources are perceived to contribute most strongly to therapists’ professional development (Henry et al., 1971; Morrow-Bradley & Elliott, 1986; Rachelson & Clance, 1980; Skovholt & Rønnestad, 1992b) were only partially confirmed in the present study. While the two sources of development that were rated most highly (work with clients and supervision) are both interpersonal in nature, didactic activities, such as reading books and journals, were also highly rated by New Zealand counsellors. In the same way as New Zealand counsellors’ use of supervision, training, and personal therapy did not diminish across their career span, their perceptions of the influence of these activities also showed no sign of decreasing. This suggests that counsellors of all career levels in New Zealand perceive supervision, training, and personal therapy as playing an important role in their professional development. Indeed, ratings of the influence of personal therapy increased across the career span, as has been noted in a previous study (Orlinsky et al., 2001).

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Despite its limitations, this study represents the first attempt to identify the effects of certain professional activities on the professional development of New Zealand counsellors. Findings of the survey depict New Zealand counsellors as a group who highly utilise supervision, training, and personal therapy, who experience these activities as exerting a strongly positive influence on their professional development, and who (perhaps due to these positive influences) perceive themselves as having developed greatly in the course of their careers and as continuing to develop in their current practice. These positive findings should be encouraging to those involved in the training and supervision of counsellors in New Zealand, as well as to counsellors themselves, for whom ongoing development across the duration of their careers is clearly very possible. Future research might usefully explore the ways in which activities such as supervision, training, and personal therapy can have maximum impact on professional development, at all career levels.

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Nikolaos Kazantzis, Sarah J. Calvert, David E. Orlinsky, Sally Rooke, Kevin Ronan et al

(2005a). The psychotherapists. In D. E. Orlinsky & M. H. Rønnestad (Eds.), How psychotherapists develop: A study of therapeutic work and professional growth (pp. 27–37). Washington, DC: American Psychological Association. Orlinsky, D. E., Rønnestad, M. H., Gerin, P., Davis, J. D., Ambühl, H., Davis, M. L., et al. (2005b). The development of psychotherapists. In D. E. Orlinsky & M. H. Rønnestad (Eds.), How psychotherapists develop: A study of therapeutic work and professional growth (pp. 3–13). Washington, DC: American Psychological Association. Orlinsky, D. E., Rønnestad, M. H., Gerin, P., Davis, J. D., Ambühl, H., Willutzki, U., et al. (2005c). Study methods. In D. E. Orlinsky & M. H. Rønnestad (Eds.), How psychotherapists develop: A study of therapeutic work and professional growth (pp. 15–25). Washington, DC: American Psychological Association. Paton, I. (1999). The nature and experience of private practice counselling in New Zealand. New Zealand Journal of Counselling, 20, 1–23. Rachelson, J., & Clance, P. R. (1980). Attitudes of psychotherapists toward the 1970 APA standards for psychotherapy training. Professional Psychology: Research & Practice, 11, 261–267. Rizq, R., & Target, M. (2008). “The power of being seen”: An interpretive phenomenological analysis of how experienced counselling psychologists describe the meaning and significance of personal therapy in clinical practice. British Journal of Guidance and Counselling, 36, 131–153. Rønnestad, M. H., & Skovholt, T. M. (2001). Learning arenas for professional development: Retrospective accounts of senior psychotherapists. Professional Psychology: Research & Practice, 32, 181–187. Rønnestad, M. H., & Skovholt, T. M. (2003). The journey of the counselor and therapist: Research findings and perspectives on professional development. Journal of Career Development, 30, 5–44. Rosenbaum, M., & Ronen, T. (1998). Clinical supervision from the standpoint of cognitivebehavior therapy. Psychotherapy: Theory, Research, Practice, Training, 35, 220–230. Skovholt, T. M., Grier, T. L., & Hanson, M. R. (2001). Career counseling for longevity: Self-care and burnout prevention strategies for counselor resilience. Journal of Career Development, 27, 167–176. Skovholt, T. M., & Rønnestad, M. H. (1992a). The evolving professional self: Stages and themes in therapist and counselor development. Oxford, England: John Wiley & Sons. Skovholt, T. M., & Rønnestad, M. H. (1992b). Themes in therapist and counselor development. Journal of Counseling & Development, 70, 505–515. Skovholt, T. M., Rønnestad, M. H., & Jennings, L. (1997). Searching for expertise in counseling, psychotherapy, and professional psychology. Educational Psychology Review, 9, 361–369. Stein, D. M., & Lambert, M. J. (1995). Graduate training in psychotherapy: Are therapy outcomes enhanced? Journal of Consulting & Clinical Psychology, 63, 182–196. Stinchfield, T. A., Hill, N. R., & Kleist, D. H. (2007). The reflective model of triadic supervision: Defining and emerging modality. Counsellor Education and Supervision, 46, 172–183.

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Stoltenberg, C. (1981). Approaching supervision from a developmental perspective: The counselor complexity model. Journal of Counseling Psychology, 28, 59–65. Strupp, H. H., Butler, S. F., & Rosser, C. L. (1988). Training in psychodynamic therapy. Journal of Consulting & Clinical Psychology, 56, 689–695. Tracey, T. J., Hays, K. A., Malone, J., & Herman, B. (1988). Changes in counselor response as a function of experience. Journal of Counseling Psychology, 35, 119–126. Vitulano, L. A., & Copeland, B. A. (1980). Trends in continuing education and competency demonstrations. Professional Psychology: Research and Practice, 11, 891–897. Wheeler, S., & Richards, K. (2007). The impact of clinical supervision on counsellors and therapists, their practice and their clients. A systematic review of the literature. Counselling and Psychotherapy Research, 7, 54–65. Willutzki, U., & Botermans, J. F. (1997). Ausbildung in psychotherapie in Deutschland und der Schweiz und ihre bedeutung für die therapeutische kompetenz. Psychotherapeut, 42, 282–289. Wiseman, H., & Egozi, S. (2006). Personal therapy for Israeli school counselors: Prevalence, parameters, and professional difficulties and burnout. Psychotherapy Research, 16, 332–347. Worthington, E. L. (2006). Changes in supervision as counsellors and supervisors gain experience: A review. Training and Education in Professional Psychology, S(2), 133–160.

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Biographical Information

Margaret Agee is a Senior Lecturer and Coordinator of the Counsellor Education Programme at the University of Auckland. She is co-editor with Philip Culbertson of the New Zealand Journal of Counselling. Email: m.agee@auckland.ac.nz Sarah J. Calvert is a doctoral student at Massey Universityâ&#x20AC;&#x2122;s School of Psychology, Albany campus, New Zealand. Email: S.J.Calvert@massey.ac.nz Judith Campbell is a doctoral candidate and graduate assistant at the School of Psychology, Massey University, Palmerston North, New Zealand. Email: J.A.Campbell1@massey.ac.nz Meera Chetty is a counsellor and supervisor working in private practice in South Auckland. She is also a trainer/facilitator for programmes offered by Skylight. Email: meerachetty@hotmail.com Gillian M. Craven is a Research Officer for R ranga Whatumanawa, School of Psychology, Massey University, Palmerston North, New Zealand. Email: G.Craven@massey.ac.nz Philip Culbertson is an Adjunct Lecturer in Theology at the University of Auckland, and an Adjunct Instructor in Philosophy at the College of the Desert in Palm Desert, California. He presently works as a freelance copy-editor and writer in California and, along with Margaret Agee, is co-editor of the New Zealand Journal of Counselling. Email: p.culbertson@auckland.ac.nz. Jan Dickson is a Senior Clinician at the Psychology Clinic, School of Psychology, Massey University, Palmerston North, New Zealand. Email: J.A.Dickson@massey.ac.nz Shane T. Harvey is Psychology Clinic Director at the School of Psychology, Massey University, Palmerston North, New Zealand. Email: S.T.Harvey@massey.ac.nz Nikolaos Kazantzis has recently taken up a position in the clinical psychology training programme at La Trobe University, Australia, where he teaches and supervises in clinical psychology and cognitive behavioural therapy. He served on the staff at Massey University, New Zealand between 2000 and 2008. Email: N.Kazantzis@latrobe.edu.au

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Andrew Kirby is a psychotherapist working with the sexual health team at the Auckland District Health Board, and runs a private practice in Ponsonby. He holds a Masters of Health Science degree in adult psychotherapy and previously worked as a therapist with the New Zealand AIDS Foundation. Email: andrew@info-ware.biz John McAlpine is a psychotherapist, counsellor, supervisor, adult educator and parish priest, with experience in assisting people integrate spirituality with wholesome human living. Email: j.mcalpine@slingshot.co.nz Paul Merrick is Associate Professor at Massey Universityâ&#x20AC;&#x2122;s School of Psychology, Albany campus, New Zealand. Email: P.L.Merrick@massey.ac.nz Ruth C. Mortimer is a researcher at the School of Psychology, Massey University, Palmerston North, New Zealand. Email: R.C.Mortimer@massey.ac.nz David E. Orlinsky is Professor at the Department of Comparative Human Development and Social Sciences Collegiate Division, University of Chicago, Illinois, USA. Email: d-orlinsky@uchicago.edu Ruth Penny was an Auckland-based counsellor, supervisor and counsellor educator. A leader in the Christian Counsellorsâ&#x20AC;&#x2122; Association, as well as a member of NZAC, she was a talented musician, composer, artist and writer. She died on September 29, 2008. Kevin Ronan is Professor and Head of School, the School of Psychology and Sociology, Central Queensland University, Australia. Email: k.ronan@cqu.edu.au Sally Rooke has recently taken up a position on the academic staff at the University of New South Wales, Australia. Email: S.Rooke@unsw.edu.au Joanne E. Taylor is a clinical psychologist and Senior Lecturer at the School of Psychology, Massey University, Palmerston North, New Zealand. Email: J.E.Taylor@massey.ac.nz Cheryl C. Woolley is Senior Consultant Clinical Psychologist, Senior Lecturer and Coordinator of the Clinical Training Programme, School of Psychology, Massey University, Palmerston North, New Zealand. Email: C.C.Woolley@massey.ac.nz

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New Zealand Journal of Counselling guidelines for contributors

The purpose of the Journal is to provide a forum for the sharing of ideas, information, and perspectives on matters of common concern among practitioners and those undertaking research in the field. The editors welcome the submission of papers including commentaries, research reports, practice-based articles and brief reports from the Associationâ&#x20AC;&#x2122;s members and applicants, as well as from others outside the Association with interests relevant to the field of counselling. The overriding criteria for selection are that the material is professionally relevant, the presentation is of high quality, and that the writer has communicated effectively with readers. There are two issues per year. The closing date for the submission of papers for the December 2008 issue is Friday, July 25; the closing date for the June 2009 issue is Friday, February 27. 1. Manuscripts should preferably be submitted to the editors as electronic documents in MS Word format, using Times New Roman 12 pt and double spaced throughout, with reasonably wide margins. If submitted in hard copy, they should be typed on one side of A4 paper, and accompanied by a disk copy. (Copies submitted in this way will not normally be returned.) Ensure pages are numbered. 2. The text should not exceed 5,000 words (excluding notes and references) unless special arrangements have been made with the editors. 3. The title and abstract (no longer than 150 words) should appear on the first page of the article, or title page. Keep the title short and descriptive of the article. The abstract should cover the intent, scope, general procedures and principal findings of the article. On a separate page list the name(s), job title, and business and email addresses of the author(s). 4. Authors should consult articles in recent issues of the Journal on general matters of style, e.g. conventions regarding headings, tables and graphs, etc. 5. Do not justify your text, but have it left-aligned (i.e. ragged right-hand margin), including headings. Make sure the heading hierarchy is clear and keep the

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number of heading levels to a minimum, preferably no more than three, e.g. Text heading A (14 point for title), Text heading B, and Text heading C. Keep the layout as simple as possible, and do not add additional formatting styles or use Track Changes. Do not have a heading ‘Introduction’—it should be self-evident that the first part of the text is an introduction. Have only one space after a full stop. 6. The location of tables, figures, graphs, drawings or photographs in the text must be clearly indicated, e.g. [TABLE 2 ABOUT HERE], and they should be attached as separate files (jpeg in the case of drawings or photographs), and/or submitted on separate pages at the end of the article. Make sure each table and figure is numbered correctly and has a heading. Position the heading above the figure or table, and place sources and notes immediately below. Do not embed the heading or caption in the figure. If a table or figure is reproduced or adapted from another publication, make sure you have permission to use it. In the text, always refer to a table by its number (rather than, e.g., “the table below”). 7. Mäori orthographic conventions need to be observed by authors, as established by the Mäori Language Commission. Briefly, this means macrons are used consistently to mark long vowels. A copy of the document on Mäori orthographic conventions can be obtained from the editors or from the source at: http://www.tetaurawhiri .govt.nz/english/pub_e/conventions.shtml. Definitions will not be provided for Mäori and Pacific words that are considered to be in common usage, nor will those words be italicised in the text. 8. Footnotes should be avoided. When endnotes may be necessary, number from one upwards and indicate the location of each in the text by a number in superscript. 9. Follow APA editorial style in general, but use New Zealand spelling. 10. Citations within the text should include in parentheses the author’s surname and year of publication, consistent with the item in the references at the end of the article. When a quotation has been used, include the page number(s), e.g. (Jones, 2006, p. 30), with a full stop and a space after the p. Use double quotation marks around the words quoted, and single for any quote within the quotation itself. 11. Quoted material of more than 40 words should be indented from the left-hand margin (set as a block quotation). The source of the quotation should be on a new line below the quotation, within parentheses, and ranged right (i.e., be on the right-hand margin). No quotation marks should be used. 12. Authors alone are responsible for securing, when necessary, permission to use

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quotations or other illustrations from copyrighted materials. Any charges connected to permissions will be paid by the article’s author(s). 13. The reference list at the end of the article should be arranged alphabetically by authors’ surnames. The following examples should be used as a guide, paying particular attention to the sequence of items in the reference and to the capitalisation and punctuation: Hulme, K. (1981). Mauri: An introduction to bicultural poetry in New Zealand. In G. Amirthanayagam & S. C. Harrex (Eds.), Only connect (pp. 290–310). Honolulu: Center for Research in the New Literatures in English. Ifekwunigwe, J. O. (Ed.). (2004). “Mixed race” studies: A reader. London: Routledge. Johnston, M. (2007, April 21). Census planners blasted for “distorted” ethnicity statistics. The New Zealand Herald. Retrieved April 27, 2007, from http://www .nzherald.co.nz/section/1/story.cfm?c_id=1&objectid=10435396. Keddell, E. (2006). Pavlova and pineapple pie: Selected identity influences on SamoanPakeha people in Aotearoa/New Zealand. Kötuitui: New Zealand Journal of Social Sciences Online, 1, 45–63. Krueger, R. A., & Casey, M. A. (2000). Focus groups: A practical guide for applied research (3rd ed.). Thousand Oaks: Sage. Kukutai, T. (2005, August 23). White mothers, brown children: Understanding the intergenerational transmission of minority ethnic identity. Paper presented at the Annual American Population Association Meeting, Philadelphia.

NB: The place of publication for a book is always a city (not a state, province or country). 14. Use abbreviations sparingly; overuse hinders rather than aids clarity. Where an abbreviation or acronym is used, spell out in full at the first reference, with the abbreviation in brackets immediately after, then use the abbreviation. With the abbreviations i.e. and e.g., use no italics but full stops and a comma when used within parentheses or in a table or figure; when used in the text, write out in full. At the beginning of a sentence, write out a number or percentage in full rather than using a numeral. 15. Use bold type sparingly, and do not use bold or underlining in the text for emphasis; instead, use italics, but do so sparingly as well. 16. It is advisable to submit a manuscript to one or two colleagues for critical comment and proofreading before submitting it for publication. 17. The editors reserve the right to make minor alterations or deletions to articles without consulting the author(s), as long as such changes do not materially affect the substance of the article. Authors will be contacted if clarification is required.

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18. All articles will be reviewed by at least two referees before a decision regarding publication is made. In the review process, the identities of both the author and the referees will remain anonymous. 19. Authors are asked to avoid the use of sexist language, and generalisations about all people from limited data. 20. Submission does not guarantee publication. Furthermore, publication does not imply that the views expressed in any article represent those of the New Zealand Association of Counsellors Te Röpü Kaiwhiriwhiri o Aotearoa. 21. The typical process to publication will be: • Submission of paper • Acknowledgement of receipt • Paper sent to referees • Feedback to author following receipt of referees’ responses re acceptance/ changes needed • Resubmission following author modifications (if required) • Copy-edit • Proofs created • Publication Manuscripts for consideration should be emailed to both editors, Margaret Agee and Philip Culbertson, at: m.agee@auckland.ac.nz and p.culbertson@auckland.ac.nz The postal address for the New Zealand Journal of Counselling is: Dr Margaret Agee and Dr Philip Culbertson Editors, New Zealand Journal of Counselling C/o School of Counselling, Human Services & Social Work Faculty of Education The University of Auckland Private Bag 92601, Symonds St Auckland 1150

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