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Issue Two 2011 ISSN 1835-937X

Death and Bereavement

Journal of the Counsellors and Psychotherapists Association of NSW Inc


Existential Therapy in Practice Workshops Emmy van Deurzen Sydney • Melbourne • Perth August 2011 Book Now!

Who?

Emmy is a psychotherapist, counsellor, chartered psychologist and philosopher. She is director of the New School of Counselling and Psychotherapy in London and is an honorary Professor at Middlesex, Sheffield and Schiller International Universities.

What?

The 2-Day Workshops in Sydney, Melbourne and Perth will explore and expand on the practice of Existential Therapy “in terms of concrete and tangible skills, tasks and interactions”. The Supervision Day in Melbourne will focus on the practice of supervision from an existential perspective. This approach is seen as complementary to other forms of supervision but adds a particular philosophical flavour allowing for a broader vision.

Where & When? Melbourne: 2-Day Workshop 17th and 18th August 2011 1-Day Supervision 19th August 2011 Sydney: 2-Day Workshop 22nd and 23rd August 2011 Perth: 2-Day Workshop 31st August and 1st September 2011

Want to know more? www.cep.net.au

+61 (0) 431 401 659

“LEARNING IS FOREVER”


Welcome

Editorial In the last analysis, it is our conception of death which decides our answers to all the questions that life puts to us. ~Dag Hammarskjold

When I set out to bring together a range of articles about various aspects and views of Death and Bereavement for this issue of The CAPA Quarterly, I sought contributions on a wide variety of perspectives that might be brought to therapy. I wanted to address the grief of those who have lost a loved one; that occurrence most often involves a parent but could be anyone loved, even an unrelated friend or an important mentor. I wanted to look at one or more therapeutic approaches taken with those who are themselves facing death—imminent death, that is, for we are all facing death. I also wanted to encompass that special grief felt when a loved one takes his or her own life. It did not occur to me that I would find an eloquent exponent of the views of one who attempted suicide and survived. But I did. I also wanted to examine the varieties of bereavement resulting from the loss of things other than physical life. Grief comes in many forms. Last but far from least, I wanted someone to talk about our social attitudes toward death itself, and our aversion to discussing it as easily as we discuss birth— that other portal of lifetimes. I found contributors to address some of these perspectives on this issue’s theme, but not all of them, and the pattern of those articles that ultimately came through surprises me. I can’t help reflecting on the notion that this accidental emphasis suggests a topic that needs more attention than it normally gets, closer scrutiny. I am left with two principal sub-themes. The first is suicide: the unspeakable, unthinkable, unexamined… It takes more lives than the road toll, more than war or disease. Maybe it really is time to bring this phenomenon out from under the rug and come to know it more clearly. I know of only one spokesperson for those who see or have seen early exit from this life as a viable choice. David Webb has been brave enough to step forward and make public his intimate acquaintance with suicidal ideation, and even action, in the hope of bringing better understanding of and respect for people such as he was. His doctoral dissertation on suicide is believed to be a world first on the topic by someone who has been there. His article in this issue is a must-read. To illuminate the other side of that coin, therapist Ceiny Maybury speaks of the plight of those left behind when a loved one completes a suicide. The Regional and Rural Report for the quarter arrived, and I was startled to see that the theme of that report is recent youth suicides that have traumatised a community—to say nothing of the pain that must’ve been felt to bring those who died to that decision. This synchronicity can’t be ignored. We need to look closely at this phenomenon and fully comprehend its scope and the social conditions that give rise to it. The second theme that has arranged itself here is the sense of spirituality that seems inexorably to find its way to the forefront of awareness in the face of or in anticipation of death. It is expressed and experienced in different ways, but it is there almost always. Therapist and meditation facilitator Maneesha James speaks in conversation with fellow therapist Chris Walker about preparing for death, just as a mother prepares May 2011

her body to give birth. James calls this ‘conscious death’, and she teaches people for whom good health is not retrievable to move past their dread of dying and embrace it as inevitable and natural, without fear or resistance, as an integral part of their lifepath. Two other therapists have brought us personal stories of their experience of the loss of a child twenty years of age. Marie Novella-McMahon lost her son suddenly in an accident, an event for the like of which no one is ever prepared. Her religious faith has buoyed her, and her own experience of loss is seen as enhancing her ability to help others similarly aggrieved. Nerida Oberg lost her daughter not so unexpectedly but still without warning as the young woman’s health, for years compromised by type 1 diabetes, had shown no sign of impending collapse. Oberg has written an remarkable book about her relationship with her daughter, both before and after her death, taking a brave leap beyond the conventional wisdom of her training into an awakened view of life and death that has illuminated her very being. She takes us as readers on an extraordinary journey into possibility. Excerpts from her book are offered here. I recommend them wholeheartedly. NSW therapist Renee McDonald addresses the shared trauma of natural disaster such as the fires, floods and cyclones that have recently ravaged much of our nation and the devastating recent earthquake in Christchurch and the earthquake/tsunami/nuclear meltdown in Japan, illuminating, through an interview with Queensland therapist Bronwyn Morris, our understanding of such events and their effects on the psyche of individuals and communities affected. A resident of Ipswich and herself a victim of the floods, Morris is also very much involved in the recovery efforts of her community and the counselling of those facing the ongoing trauma and grief of losing so much so quickly. Regular columnist Clare Mann skips the business tips in this issue, looking instead at wrenching life changes other than death that can give rise to all the symptoms typical of bereavement, and offering advice for dealing with such issues. For the benefit of those who missed the March PD event, Coordinator Juliana Triml reviews that presentation. Upcoming themes for the remainder of the year are Virtual Therapies and Addictions. The first issue of 2012 will be an Open Forum to accommodate a variety of topics, and the following issue is devoted to Sex. Please have a look at the Calls for Contributions on Page 36, and have your say on the topics that interest you.If you’d like to contribute to future issues, please contact me at editor@capa.asn.au. Laura Daniel Editor Laura Daniel, BA, JD, is a Sydney publishing professional with more than forty years’ experience in the industry, both in Australia and overseas (http://www.editorsnsw.com/esd/ae1445523.htm). In addition to editing, she also designs, writes, mentors, composes, paints, sculpts, photographs, sings, dances, walks, rides horses, does yoga and appears in minor film roles and commercials.

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CAPA NSW Executive and Staff President Maxine Rosenfield president@capa.asn.au Vice-President Linda Magson vicepresident@capa.asn.au Secretary Jennifer Heward secretary@capa.asn.au Treasurer Campbell Forsyth treasurer@capa.asn.au Ethics Chair Jeni Marin ethics@capa.asn.au PD Coordinator Juliana Triml capa.pd@hotmail.com Membership Chair Beate Zanner membership@capa.asn.au Regional and Rural Liaison Chair Phil Hough regional@capa.asn.au

Contents Welcome 1

Editorial

CAPA News 3 4 5

From the President’s Desk Rural and Regional Report ~ Sharon Ellam CAPA Update

Features 6 The Urge to Die ~ David Webb 10 Suicide: The Elephant in the Room ~ Ceiny Maybury Conversations 12 Conscious Dying ~ Maneesha James in conversation with Chris Walker 16 Counseling Communities: The Shared Impact of Natural Disaster ~ Renee McDonald in discussion with Bronwyn Morris In Review 22 Walk With Me ~ Nerida Oberg

Administrative Assistant Christine Rivers office@capa.asn.au

First Person

Advertising Coordinator Jennie Maxwell advertising@capa.asn.au

Practice Tips

The CAPA Quarterly http://thecapaquarterly.blogspot.com Editor Laura Daniel editor@capa.asn.au

26 Being Present with Grief and Loss ~ Marie Novella-McMahon

30 The Greater Scope of Bereavement ~ Clare Mann Professional Development 32 Recovering from Trauma, Healing a Life ~ Review by Juliana Triml 33 Professional Development Events Member Profile 34 Erica Pitman Noticeboard 35 Classifieds Back Cover Conference Calendar

Cover art by Jim Frazier/Stock Illustration Source Design by Unik Printing The CAPA Quarterly respectfully acknowledges the Gadigal people of the Eora Nation, the traditional owners and custodians of the land on which the CAPA NSW office is located; and the traditional owners of all the lands through which this journal may pass.

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Š CAPA NSW 2011. Copyright is held with CAPA NSW and individual authors. Please direct permission requests to the editor. Opinions expressed in The CAPA Quarterly do not necessarily represent those of the editor or of CAPA NSW. While all reasonable care has been taken in the preparation of this publication, no liability is assumed for any errors or omissions. Liability howsoever as a result of use or reliance upon advice, representation, statement or opinion expressed in The CAPA Quarterly is expressly disclaimed by CAPA NSW and all persons involved in the preparation of this publication. The appearance of an advertisement in The CAPA Quarterly does not imply endorsement of the service or approval of professional development hours from the service. Advertisers are advised that all advertising is their responsibility under the Trade Practices Act.

The Capa Quarterly


CAPA News

From the President’s Desk What a start to 2011 globally. Floods, cyclones, bushfires, earthquakes, tsunamis ... so much devastation and so much distress, grief and loss for so many people. How timely is the theme of this journal. CAPA NSW offered support to the Queensland Counselling Association to assist in any way we could— support that was warmly acknowledged—and their Vice President, Jean Tulloch wrote to me. Part of her email said: “In connection with this desperately sad situation in Queensland, thanks for the offer. I’ve sent it on to the rest of the management committee, and one response I’ve had already is, “Just their sentiment and thoughts are infinitely helpful!” Closer to home, during the early part of 2011, your Executive has continued to focus on formalising CAPA’s infrastructure, and we have been looking strategically at CAPA’s place in the counselling and psychotherapy world. The lobbying working party, chaired by Tessa Marshall, carried out excellent work over the holiday period, producing documents which members were able to use to lobby parliamentarians and prospective candidates during the campaign period of the NSW state election. The energy and enthusiasm of the members of the working party was greatly appreciated by the Executive. We are considering ways of maintaining the momentum this group has initiated. Membership Committee Chair Beate Zanner, VicePresident Linda Magson, and I attended the PACFA Council meeting in March. This is an excellent opportunity for PACFA Member Associations to network with each other, to debate and to shape the future of our profession. Melissa Neve, CAPA’s membership secretary, left the organisation in March. During her time as Membership Secretary, Melissa participated in many developments that

streamlined our membership processes and supported our membership to reach or exceed PACFA standards as these, too, developed. I am sure you will want to join the Executive in wishing Melissa well for the future. The World Congress for Psychotherapy in Sydney in August is taking shape. CAPA NSW is liaising with other Member Associations of PACFA to consider sharing exhibition space. We hope you will come and visit us at our stand! Finally, this will be my last report before the CAPA AGM in August. At the AGM, our Treasurer Campbell Forsyth, our Regional and Rural Committee Chair Phil Hough, and I will be stepping down. The remaining members of the Executive will continue, and we hope that others will join them from our committees. In order to sit on the Executive, you must be a CAPA Clinical member and have been a member of a committee in order to understand aspects of CAPA’s work and structure. I urge all Intern, Provisional and Clinical members to consider giving some time to a committee. We have good governance structures in place and the workload is manageable with teamwork. Without your help, we cannot continue to be the largest-state based counselling and psychotherapy association in Australia. Please contact me or any member of the Executive if you would like to know more about any committee. Warmest wishes

Maxine Rosenfield President president@capa.asn.au

Annual General Meeting CAPA (NSW)

Saturday 13 August 2011 Crows Nest Centre 2 Ernest Place, Crows Nest 2065 10am–12n AGM 12n–12.30pm Professor Ione Lewis, President, PACFA 1pm–4pm Professional Development Session (see page 33 for details) Book Now (02) 9235 1500 or office@capa.asn.au Early bookings are recommended as space is limited due to Occupational Health and Safety Requirements. May 2011

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CAPA News

Rural and Regional Report Tragedy struck the Mid-North Coast at the dawn of this New Year. At Wauchope, just outside of Port Macquarie, two young people took their own lives and a third attempted suicide. Patricia Herbert, CAPA RnR Committee Member, said that this had had a wide-reaching impact on the greater Port Macquarie community, with two of the young people being related to each other. While not personally or professionally involved herself, Trish said that the shock and distress were felt as a community. This is what happens in regional areas—bonds are close, and everyone feels events together. Following these events, there have been several discussions in the media about Youth Suicide and the role of the community in acknowledging and helping out when things aren’t okay. In an ABC Mid North Coast Radio segment LifeMatters Program Coordinator for MidCoast Lifeline Lee-Ann Foord said that the community is absolutely devastated and wondering what they can do. In collaboration with the Port Macquarie-Hastings Suicide Prevention Network, two Community Forums were held for all community members to attend. At the forums, a panel of experts included Professor Rick van der Zwan, from Southern Cross University; Dr Deborah Hennessey, a Clinical Psychologist with Port Macquarie Base Hospital; Catherine Vaara, CEO of Lifeline Mid Coast; and Amy Schwarze, Youth Worker in the Youth Mental Health First Aid Program. Local volunteer Lifeline Counsellors were also present to support community members at the forum. Points raised included the ‘taboo’ nature of discussions relating to suicide, and also the damaging effects of rumours. Social networking sites, such as Facebook and Twitter were also discussed including a valuable discussion of parenting, and good and bad aspects of social networking. Mort Shearer, Organising Group Member of the Port Macquarie-Hastings Suicide Prevention Network, suggested that “parents should consider protecting their children from the adverse aspects of accessing social networking sites because society is still yet to develop a proper code of conduct for these sites”. When I phoned Lee-Ann Foord, I asked her what activities had occurred locally to assist workers and Counsellors to de-brief after the extraordinary events. She said that the volunteer Lifeline Counsellors were debriefed after the Community Forums by their Lifeline Supervisor, and that she was attempting to hold as many ASIST (Applied Suicide Intervention Skills Trainings) Workshops as possible. She was unaware of any other local ‘support’ or ‘supervision’ for other Counsellors in the area. While Trish Herbert told me that she was not personally 4

involved, two of her current clients were affected by the young people’s completed suicides. In regional areas, ‘everyone knows everyone’ yet ‘help’ or ‘support’ is often difficult to access. Many regional CAPA members work in relative isolation. In the same way that we assist our clients to ‘connect’, this need is just as strong professionally in our regions. Below are some ideas for regional Counsellors to gain information, connections or support in the area of Youth Suicide: • The NSW Commission for Children & Young People http://www.kids.nsw.gov.au have a great website with information on such topics as Mandatory Reporting, Working with Children Check & the latest report on SIDS. Subscribing to their fortnightly e-newsletter is a great way to keep up to date on what’s going on. They also have a ‘Kidzone’ where young people can be involved or just find information. • Lifeline runs ASIST (Applied Suicide Intervention Skills) Trainings regionally. For those on the Mid-North Coast, contact Lee-Ann Foord, Life Matters Coordinator & LivingWorks Trainer on 02 6581 2800 or email her lifematters@lifelinemidcoast.org.au. Their website is www.lifeline.org.au/midcoast. • Connect at a Conference. A Youth Health 2011 Conference is being held in November at Darling Harbour. For more info go to http://www.youthhealth2011.com.au. • Get online with the CAPA Blog http://thecapaquarterly.blogspot.com. • Join the CAPA Regional & Rural Sub-Committee. You choose how much involvement you want. We have a roughly monthly phone teleconference for one hour and keep in contact by email. Many of our discussions are around connecting and supporting which in some ways has fulfilled an individual need. We are making PROGRESS!! If you want to make a difference with your peers contact regional@capa.asn.au. Sharon Ellam Besides being a fun piano teacher, Sharon Ellam is known around Newcastle and the Central Coast for her skills with Childhood Anxiety. Increasingly families are coming to Sharon for help with systemic issues often related to one child who is anxious. With a background in Nursing and Midwifery, Sharon also has expertise in emotional issues during and after pregnancy, and with families affected by an abnormal birth experience, sick or premature newborn. Sharon is passionate and curious about how Counsellors can build a fine film of gossamer across the CAPA space to create a ‘sharing and reaching web’.

The Capa Quarterly


Membership Total

e t a d p U A P A C

as at 1 April 2011

Clinical Members

446

Intern Members

180

Student Members

117

Affiliate Members

15

Special Leave

14

Life honorary

2

TOTAL

774

Code of Conduct for Unregistered Health Practitioners

As counsellors and psychotherapists, we are legally required to display two documents in our practice(s): • the NSW Code of Conduct for Unregistered Health Practitioners • information on how clients can make formal complaints to the Health Care Complaints Commission. Both are available online in the members area of the CAPA NSW website: www.capa.asn.au The Code of Conduct is also available in several community languages on the Health Care Complaints Commission website: www.hccc.nsw.gov.au These legal requirements are set out in the ‘Public Health (General) Amendment Regulation 2008’ under the NSW Public Health Act (1991), and came into effect on 01/08/2008. Ethics Checkout the CAPA NSW website for information on: • Ethics and Counselling • Problem Solving Steps • Client Confidentiality and Privacy and Relevant NSW and Commonwealth Legislation • Duty of Care • Workplace Bullying and Violence • Mandatory Reporting • Keeping Track of Paperwork • Information for Counsellors who have been served with Subpoenas • Complaints Form for Submission of Complaints and Grievances by a CAPA Member

Just login to the members area of www.capa.asn.au and click on the “Ethics” button on the left.

May 2011

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Features

The Urge to Die

David Webb

The word ‘suicide’ seems to trigger an almost reflex response in many people, an emotional gut reaction that may include feelings of horror, bewilderment, fear, shame, guilt or anger. Many people seem stunned that anyone would choose to die. I find this odd because the urge to die is very familiar to me. It surprises me that so many people, including most suicide prevention experts, seem to find choosing to die so utterly mysterious. I’m surprised even further when I look at the suicide numbers. The World Health Organisation estimates that globally about a million people will die by suicide this year. To help put these big, global numbers into perspective, the WHO have estimated that suicide accounts for about half of all violent deaths—i.e. equal to the combined total for homicide (31%) and war-related deaths (19%). Despite these numbers, if you counted the column inches or broadcast hours in the mainstream media, you would think that suicide is rare in comparison to homicide or war-related death. Closer to home, about 2,000 people suicide in Australia each year, which is considerably more than the road toll. On top of this, it is estimated that for each completed suicide, another 20-30 other people will make a serious suicide attempt. Then for each of these suicide attempts, about another 10 people are estimated to give serious consideration to suicide. This all adds up to about half a million people or more each year. I’ve not been one of these statistics for more than a decade now. A conservative calculation that would include old-timers like me is that there must be at least half a million suicide attempt survivors alive in Australia today. And a staggering 2-5 million people, maybe more, who have thought deeply about suicide for themselves— or 10-20% of the population. Why, then, does suicide remain such a mystery? One reason is that the academic study of suicide, known as suicidology, gives remarkably little attention to the lived experience of suicide attempt survivors. There are several reasons for this, none of them good. First, some suicidologists believe that suicide attempt survivors can tell us little about those who succeed in killing themselves. Sometimes this is said rather more bluntly as the only genuine suicide attempt is a successful one. This view is contradicted by the data, which show that most completed suicides are preceded by an unsuccessful suicide attempt. It is also a view that people like me find offensive Another reason why suicidology ignores the lived experience of suicide attempt survivors is its prejudice against subjective knowledge as unscientific. The importance of first-person knowledge is now generally 6

recognised throughout the human sciences and although the ‘consumer voice’ is beginning to be heard in mental health more generally these days, it still remains largely absent from suicidology. A further reason why suicidology denies the validity of the first-person voice is rarely stated explicitly but is often implied. For instance, there is a long-running debate within suicidology on whether suicide is ever rational, a debate I’ve always found rather pointless and irrelevant— indeed quite silly. This debate also reveals that most suicidologists still regard suicide as crazy and therefore, almost by definition, crazy people cannot contribute anything useful to the study of suicide. There’s an even more alarming reason, however, why the millions of suicide survivors remain largely invisible and ‘in the closet’, not only within suicidology but also more generally in the wider community. The usual word for this is ‘stigma’, though it should be called by its correct name, which is discrimination. Stigma means a stain and suggests some flaw in the suicidal person, whereas recognising it as discrimination requires us to look at the prejudices of those who stigmatise the suicidal person. When I first started speaking publicly about my suicidal history, nearly ten years ago, I underestimated the animosity in the community towards suicidal people. I was aware of the many myths around suicide, which were often an attempt to deny or hide from the reality of suicidality. I saw that many of these myths—such as that suicidal behaviour is attention-seeking behaviour or ‘just’ a cry for help—represented a kind of fearful grasping for any explanation other than the reality of suicidality. We are so fearful of suicide—fearful that the person may do something dangerous but also fearful of potential consequences for ourselves—that we make every effort to convince ourselves that suicidality is anything other than what it actually is. But I was not prepared for the anger I saw towards the suicidal person. I think I first noticed this at suicide conferences where those who have lost a loved one to suicide usually have quite a strong presence. Along with their grief and sorrow, there was also quite often some anger and resentment towards the person who had died. This may be mixed with feelings of guilt and shame, usually unwarranted but nevertheless still there, for having somehow failed to help their suicidal loved one. And sometimes you’d hear angry and bitter remarks that come from a deep sense of betrayal such as, “How could they do this to me?” I do not wish to criticise those bereaved by suicide, even when they sometimes say things that are hurtful and unfair about suicidal people. Their unique and agonising The Capa Quarterly


grief is an important voice in the public debate on suicide, including their very real feelings of anger, shame, guilt and betrayal. My criticism is that there is another firstperson voice that is essential to this debate but which is largely absent, the voice of those who know suicidal feelings ‘from the inside’, the actual suicidal person. Have you ever found yourself in a conversation where people are talking rudely about a particular group of people—e.g. gay people, immigrants, drug users— and you are one of these people but no one else in the conversation knows this? I have felt like this at suicide conferences where people often speak as though there are no suicidal people actually in the room. This is most noticeable when offensive remarks are made—such as “the only genuine suicide attempt is a successful one”—and no one seems at all bothered about this. This would not occur, or would be promptly corrected, if suicide attempt survivors had as strong a voice at suicide conferences as those bereaved by suicide. It is the gatekeepers of the public debate on suicide who are most responsible for the exclusion of and discrimination against the suicidal person—this conversation ‘about us without us’. I mentioned some of their prejudices against the first-person voice of suicidality earlier—it’s anecdotal, subjective, unscientific, not genuinely suicidal and, most of all, we’re crazy. But more than just this, I have also painfully come to realise over the years that these gatekeepers, not just here in Australia but around the world, share the animosity towards the suicidal person that we find elsewhere. Indeed, I have seen that the suicidal person is often despised by those who claim leadership roles in suicide prevention. This has been very difficult for me. I have had regrets that I have gone public with my story and would now hesitate before encouraging others to do so. I’ve had times when I’ve wanted to drop out and withdraw from the work I’ve been doing for the last ten years. I was prepared and willing to face the resistance I knew would come from those with a vested interest in the status quo of the suicide prevention industry. But the nastiness of this resistance caught me by surprise. I have been sustained, however, by moments of hope and by the support of numerous people who have encouraged and inspired me to go on. In recent years I have worked in the disability sector where you’ll meet people who understand discrimination very well and who have fought against this discrimination for many years. At the heart of the disability movement is a shift away from the traditional medical model of disability, based on an individual’s impairments, towards a social model based on social inclusion and human rights. May 2011

A similar shift is urgently needed in mental health in general and in particular in society’s attitudes towards suicide. Discrimination—society’s prejudiced attitudes towards suicide—is the single most urgent issue for suicide prevention. It is this discrimination, fuelled by fear and ignorance and prejudice, that lies behind the toxic taboo that surrounds suicide and poisons the public debate about it. The only way that discrimination has ever been dismantled has been to hear from those who are discriminated against. The disability community has known this for a long time and has conducted their campaign under the slogan: ‘Nothing About Us Without Us’. We will not begin to make progress with suicide prevention unless and until society’s current discrimination against suicidal people is challenged and dismantled. The first step in this direction has to be reversing the growing trend of the last few decades of medicalising suicide. Despite quite massive public relations in recent years telling us otherwise, suicide is not primarily a medical issue. A suicide attempt may have medical consequences, including death, but it rarely—if ever— has a medical cause. It therefore rarely—if ever—has a medical solution. The suicide debate worldwide is currently dominated by the medical model, which represents the major obstacle to a better understanding of why some people choose to die. The medical model is also one of the primary sources of the prejudices that feed the discrimination against suicidal people. Suicide prevention will not advance while it remains governed by the medical profession. This may sound all very grim, and indeed I find it hard not to be pessimistic, but there are some glimmers of change on the horizon. Within mainstream suicidology there is a group of about eight eminent suicidologists who call themselves the Aeschi Group (after the name of the Swiss village where they meet every two years). Their focus is on psychotherapy with suicidal people and they challenge the current status quo of suicidology by positioning the suicidal person as the expert—rather than as some sick misfit—at the centre of the therapeutic encounter. They also emphasise a narrative approach to therapy with the suicidal person’s story in their own words as the ‘gold standard’ for understanding their suicidal crisis. I must say that what they propose all seems rather obvious to me, but in the context of modern suicidology they represent a refreshing and radical alternative. I rate their work as ‘essential reading’ for anyone interested in psychotherapy with suicidal people, and some resource references can be found at the end of this article. 7


Features

The Aeschi Group in some ways also represent the continuing legacy of one of the great pioneers of suicidology, the US psychologist Professor Edwin S Shneidman, who sadly died a couple of years ago at the age of 91. One of Professor Shneidman’s core concepts was that suicide is caused by psychache, which he defined as psychological pain—not illness—due to thwarted or frustrated psychological needs. He then worked with a taxonomy of psychological needs to identify those that a person might need help with in order to alleviate (not cure) their psychache. Like the Aeschi Group, Shneidman also showed great respect for the suicidal person’s own understanding of their psychache, saying, “It is the words that suicidal people say—about their psychological pain and their frustrated psychological needs—that make up the essential vocabulary of suicide”. He died lamenting the medicalisation of suicide and fearful that his important concept of psychache would die with him. Fortunately, the Aeschi Group and a few others have picked up his bright torch and are carrying it forward. I was therefore delighted recently, much closer to home, to receive the latest brochure from LiFE (Living is For Everyone) Communications here in Australia entitled ‘Suicide: worried about someone?’ I was delighted because they mentioned psychache in their discussion footprint books on understanding suicide. I should also acknowledge that their revised LiFE Framework documents of 2007 marked a distinct and welcome shift towards a more socio-cultural approach to suicide, though it still contained much of the medical nonsense. Another Skills in Existential Counselling glimmer of hopeful change and Psychotherapy van Deurzen and Martin here is that Suicide Prevention Emmy Adams Australia (SPA) has also recently This book is the rst practical on to a skills-based acknowledged the importance introducti Existential approach. Explaining of hearing from suicide attempt the ideas of Existential philosophy concisely yet without survivors in its Position oversimplication, the authors this approach accessible Statement on Supporting Suicide make to all those who wish to nd out Attempt Survivors—though what it has to offer. Pbk | 176pp | 2010 in other ways SPA remains a discount price: bastion of the medical model Special A$44.95 /NOW $35.95 and the status quo thinking of NZ$65/NOW $52.00 the suicide prevention industry. Despite these glimmers of Footprint Books hope, I’m not at all confident 1/6a Prosperity Parade, NSW, 2102 that the real changes we need Warriewood, P: 02 9997 3973 F: 02 9997 3185 are occurring. The dominant 8

influence is still very much the Patrick McGorry bandwagon and organisations like beyondblue telling us that suicide is caused by mental illnesses requiring medical treatment, typically psychiatric drugs. Real progress will not commence until the debate moves beyond this shallow and unhelpful response. Before finishing, I should say a little about my own work. Although I endorse Shneidman’s concept of psychache, I prefer to conceptualise suicidality as a crisis of the self, for several reasons. First, it correlates more closely with the lived experience of suicidal feelings which, as I’ve indicated, is an essential but largely missing piece in the current suicide debate. It also raises important questions that suicidology currently ignores, such as who or what is this ‘self ’ that is in a suicidal crisis? This then leads to another issue that was central to my own suicidal crisis— the role of spiritual needs and values in our sense of self— which suicidology also ignores. Quite early during my PhD research, I wrote to Professor Shneidman politely requesting that he expand his definition of psychache to include spiritual needs along with psychological needs. To my amazement, I got a charming letter in reply, and a copy of his latest book,

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books

The Capa Quarterly


but no, he did not agree to my request though he did give it respectful consideration. I raised this question with him again when I had the great good fortune to meet him during my visit to the US in 2007. Once again he respectfully declined, but he did say that what suicidology needed was a proper phenomenology of suicidality, which my work also calls for, so I figured I’ll settle for this from this great man. Whenever I mention spirituality and suicide, I feel it’s necessary to be clear that I do not claim that every suicidal crisis of the self is necessarily a spiritual crisis. Nor do I claim that spirituality is some universal panacea for a suicidal crisis. Even for those who do understand their suicidal crisis as a spiritual crisis, I do not claim that my understanding of spirituality is any better than the many other ways that people understand their spirituality. I find spiritual zealots as annoying as most of us do. But I do say that suicide is best understood as a crisis of the self and that if we truly explore our sense of self, we will probably find ourselves, in one way or another, in some sort of spiritual territory. I also say that spirituality can be a healing path out of a suicidal crisis for some people, which is confirmed not just by my own experience but by that of many others. Spirituality also reminds as that thinking about suicide as a crisis of the self also demands a truly holistic approach. The medical ‘blame it on the brain’ approach is woefully inadequate in this regard, which Shneidman’s psychache goes a long way towards correcting. Along with the psychological and the spiritual, though, we must also include the social, cultural and historical contexts of any particular suicidal crisis of the self. The current suicide prevention debate in Australia is moribund. The only hope I see for turning this around is for the community to reclaim ownership of this debate. A broad, ongoing community conversation is required that first of all must challenge and dismantle the discrimination against those of us who struggle with the urge to die. Progress with suicide prevention will not be possible unless and until the community faces up to society’s prejudices against suicidal people. This will be a difficult conversation to get going, and not just because of the resistance it will face from those with a vested interest in the current suicide prevention industry. We must admit that we are all clumsy novices as we tentatively begin this conversation and must be gentle on ourselves as we stumble forward. We must recognise our own fears about suicide, fears for ourselves as well as for others. Two of our greatest fears come together in suicide, our fear of death and our fear of madness. Death and madness are also topics that we as a society do not discuss very skilfully, so the suicide conversation we need May 2011

will have to bring these two scary issues out of the closet also. This is beginning to occur with the euthanasia debate, but euthanasia is very different from the suicide we’re talking about here. We have a long, long way to go, but the conversation must begin. This conversation must also consider that communities and societies can be suicidal too, not just individuals. There is plenty of evidence of this occurring, not the least the way we are destroying the environment that we all depend on for our survival. Furthermore, we must also look at the dehumanising, soul-destroying aspects of our culture that not only damage our sense of self but also our sense of community. We need to discuss and re-think the important role of suffering that is part of every human story and move away from the current ‘diagnose-andtreat’ response to psychological pain. We need to talk about our collective psychache, not just the psychache of individuals. Ed Shneidman famously said that “suicide prevention can be everyone’s business”. I’ll say that suicide prevention must be everyone’s business—and this begins with a community conversation. I’ll finish with some words inspired by Al Alvarez and his book The Savage God that always remind me of the huge and humbling task before us as we embark on this conversation:  e must at all times remember, W that the decision to take your own life is as vast and complex and mysterious as life itself. And I’ll finally sign off with the words of Ed Shneidman again—this time the beautiful salutation and blessing that he used to sign off one of his letters to me: May your psychache be minimal... References The Aeschi group is http://www.aeschiconference.unibe.ch/ They’ve recently published their first major book: Building a Therapeutic Alliance With the Suicidal Patient Konrad Michel and David A. Jobes (Eds) American Psychological Association, 2010 http://www.apa.org/pubs/books/4317248.aspx Webb, D 2010, Thinking About Suicide: Contemplating and comprehending the urge to die, PCCS Books, Ross-on-Wye, UK David Webb’s PhD at Victoria University (2006) is believed to be the world’s first on suicide by someone who has attempted suicide. David has been a board member of the World Network of Users and Survivors of Psychiatry (WNUSP) and is the International Representative for the Australian Federation of Disability Organisations (AFDO). He has represented both WNUSP and AFDO at numerous UN forums on the UN Convention on the Rights of Persons with Disabilities (CRPD). His book, Thinking About Suicide, based on his doctoral dissertation, was published by PCCS Books, UK in 2010.

9


Features

Suicide: The Elephant in the Room Ceiny Maybury

Coming to terms with the death of a loved one can be difficult; however, coming to terms with the suicide of a loved one can be even more so. When one works in the area of suicide bereavement, it becomes apparent that there are significant difficulties arising for the bereaved that are inherent to the survivors of suicide. The term ‘survivors’, is used for those who have lost someone to suicide. There is evidence that suicide survivors experience more intense and longer-term grief than those who experience other types of loss (Worden 2009, p.180). None of us is immune to the possibility of a suicide of a loved one, and perhaps this is why suicide has become ‘the elephant in the room’. The word suicide is steeped in fear. Those of us who work in the area of suicide bereavement notice that certain questions come up repeatedly. Consistent themes develop out of a need to understand the death and make some sense of it. According to Jordan, there are three main themes found in suicide bereavement, which encompass: “Why did they do it?” “Why didn’t I prevent it?” and “How could he/ she do this to me?” (Jordan 2001). Questions such as these arise repeatedly and haunt the bereaved, but of course they will never be answered, as the one person who holds the answer can no longer provide it. Initial Shock The initial shock of losing a loved one can be devastating at any time, but loss to suicide can be even more so. This shock comes from the fact that the deceased has chosen to end his/her life and this can have a numbing effect that may in some strange way, act as a temporary barrier to the pain of the loss. Some may seek an alternate story and search for any signs that this could have been an accident or that somehow the deceased was not responsible. Disbelief that this could have occurred is a common response. Suicide scenes are often violent and disturbing. Those who have discovered the body may well experience flashbacks and nightmares. Acute Stress Disorder and in the longer term, Post Traumatic Stress Disorder complicate and can prolong the grieving process. It is therefore imperative that we acknowledge the impact on not only friends and family, but also the police and emergency personel who attend the scene. We need to pay special tribute both to those who are part of these services and those who have also been bereaved by suicide. These people may be at high risk for the development of vicarious trauma. Sense of Abandonment The word bereavement comes from the Latin root word “to have been robbed…” (Rando 1993, p20), which is a fairly apt description for those bereaved by suicide. It can be devastating for many survivors to feel that their loved ones have chosen to abandon them. Many who have been bereaved by suicide experience an acute sense of abandonment. This can be seen particularly with those whose parents have suicided. They may feel that the parent has failed to protect them or alternatively, that they have caused the 10

parent undue trouble thus triggering the suicide. It is very difficult for a child to comprehend how a parent could choose to desert them in such a manner, without completing their parental role. Guilt Guilt is a common phenomenon of suicide bereavement and may come from a place of wishing that something could have been done differently. How often we see the bereaved chastise themselves for not picking up on the clues, or interpreting the threats of suicide as merely attention seeking. Many are plagued by ‘if only’ statements that are recognised as futile, yet survivors often feel powerless to stop them from coming. The ‘I should have done something more’ statements can drive survivors to distraction. The suicide may follow an argument or angry words or there may be a nasty message left behind by the deceased. Indeed, I can think of an example of one young man who left a malicious message on his computer for his parents. Another told his wife: ‘This is going to be your fault, bitch. I hope you rot in hell!’ Such statements can preoccupy the survivors’ every waking hour. It is also common to hear that guilt arises when the bereaved begin to experience happiness or feel more content with life. This can be perceived as a betrayal of their loved one who lived with so much pain (SAS Newsletter 2010). Blame The need to blame is usually closely related to guilt (Worden 2009, p188). Blame can be attributed to mental health issues, which is often the case, it can also be attributed to circumstances, organisations such as hospitals, or individuals who have had issues with the deceased. Somehow if there is someone to blame, it seems to make sense of a difficult set of circumstances. As practitioners, we can often find that the views put forward in relation to blame do not necessarily make sense, or may be illogical and it can take some time for the survivor to view the situation from a logical stance. We also need to bear in mind that when a person writes a blaming suicide note they are feeling desperately disturbed and may be unable to think rationally. Once again, it can take time before the bereaved can accept this fact. Both guilt and blame can have a destabilising effect on families. It is not uncommon for family members to grieve under different clouds, each holding his or her own anxieties, passing the blame around, whilst trying to come to some resolution. Sometimes suicide can break relationships and destroy the family unit. Anger In many cases, anger seems to be connected to blame. Anger is a normal yet sometimes confusing part of the grief process, and it would seem that anger is almost always a feature of suicide bereavement. Perhaps this may be anger directed at the deceased for having chosen to leave them, but more often than not it is directed at someone or something else. Indeed, I have seen much The Capa Quarterly


anger directed at hospitals where people have completed suicide whilst in care. Anger may be felt by the survivor for having failed to stop the suicide, or alternatively, anger may be directed at God for having failed to protect the deceased. Why? The questions may become circular: Why did this happen? Why didn’t I suspect something? Why didn’t he tell me how he was feeling? Why didn’t I see the signs? Why didn’t her friends tell me? Why couldn’t she see how deeply this would affect us? Why couldn’t he feel our love? As previously mentioned, the question of why haunts most of those bereaved by suicide. This is of course the question that can never be answered. This is a hard lesson for the survivor to accept, and many become consumed by the why questions. Part of the healing process therefore, is to let go of the taunting why questions and accept that you will never fully understand. Indeed letting go of why became the greatest learning curve for one of my group members. Stigma Corrigan (2005) and Thornicroft et al. (2007) map stigma as a problem of ignorance prejudice and discrimination encountered by those with lived experience. This includes the individual, carers, friends, family and service providers (SPA 2007). The very words ‘commit suicide’ reflect that the deceased has somehow committed a crime. and it was only in 1961 that the Suicide Act in England decriminalised the act of suicide. Despite our best efforts, this kind of punitive attitude still lingers on, and in the aftermath of such views, suicide loss is often deemed to be socially unspeakable. Perhaps the families are reluctant to speak about the death, but more often than not those around the bereaved do not know how to respond appropriately. In such circumstances, it becomes very difficult for the survivor to reach out for help. Many people bereaved by suicide also avoid disclosing their loved one’s cause of death due to the anticipated or actual reactions that they have experienced from others. I recall a woman who had moved from interstate who sat in our session with arms folded. She had not spoken to anyone in her new life about her late husbands’ fairly recent and violent death, nor would she raise the topic with her teenage children. She had moved a long way from her support system to bury the past, yet the past haunted her every waking moment. It is difficult to comprehend that in our society, suicidal ideation, attempts or completed suicides can be seen as a mark of weakness, cowardliness or selfishness. “Worldwide, the prevention of suicide has not been adequately addressed due to a lack of awareness of suicide as a major problem and the taboo in many societies to openly discuss it” (WHO 2011). Those who have been bereaved by suicide find that stigma has a significant impact that may taint the grieving process. In fact, the mere anticipation of stigma in some circumstances can also May 2011

become problematic. Research by Maple et al. (SPA 2010) found that following the suicide of a child, parents felt ‘silenced’ by the reactions of others, which was detrimental to their grieving process. One woman related to me that she had been told by a close relative that she was a ‘bad mother’ and that she deserved to lose her son to suicide. Survivors feel the pain of the loss, yet may not know how, or where, to express their grief. However, the only way to heal is to express grief and have it out in the open. Like other bereaved persons mourning the loss of a loved one, suicide survivors need to talk, to cry and perhaps scream in order to be healed. Survivors Are at Risk As clinicians, we need to be aware that survivors of suicide are at high risk of completing suicide themselves. Having been closely related to suicide, their experience of suicide is very real and it is not uncommon for survivors to have thoughts of suicide themselves. This points to the very real need to support those who are bereaved by suicide. In conclusion, “The person who commits suicide puts his psychological skeleton in the survivor’s closet” (Schneidman, cited in Worden, 2009 p.179). The scars of suicide related grief run deep, and perhaps survivors do not get over it, rather they learn to assimilate their grief, thus creating a new sense of self. People often assume that working in the area of suicide bereavement is depressing and arduous. Indeed at times it can be confronting but also uplifting. On a personal level I have learned hugely from our group members, by observing the manner in which they gently nurture each other with patience, empathy and unconditional regard. As a society, we need to act in a similar way, by putting aside our fears and working towards de-stigmatising suicide related issues. This requires determination and a greater understanding of suicide bereavement issues. References Corrigan, P 2005, On the Stigma of Mental Illness, American Psychological Association Joiner, T 2005, Why People Die By Suicide, Harvard University Press _______ 2010, Myths About Suicide, Harvard University Press Jordan, JR 2001, ‘Is Suicide Bereavement Different? A Reassessment of the Literature’, Suicide and Life-Threatening Behavior, 31(1):91-103. Thornicroft, G, Rose, D, Kassam, A & Sartorius, N 2007, ‘Stigma: Ignorance, Prejudice or Discrimination?’ British Journal of Psychiatry 190:192-193 Support After Suicide Newsletter No.66 Nov/Dec 2010, Suicide Prevention Australia, Position Statement, retrieved 14 January 2011, www.suicidepreventionaust.org World Health Organisation, 2000 ‘Preventing Suicide’ A Resource for media and professionals. retrieved 12 January 2011, http://www.who.int/mental_health / prevention/suicide/suicideprevent/en/ Worden, W 2009 Grief Counselling and Grief Therapy, 4th edn, Springer New York Ceiny Maybury holds a Bachelor of Counselling and Master of Counselling. Currently she is the Suicide Bereavement Co-ordinator and Telephone Counselling Supervisor at Lifeline Harbour to Hawkesbury. Ceiny is also an Applied Suicide Intervention Skills trainer.

11


Conversations

Conscious Dying

Maneesha James in conversation with Chris Walker

A therapist and a meditation facilitator, Maneesha James’ special interest is in supporting clients in a health crisis. For many years, from her base in Europe, her group and individual work has been focused on bringing more awareness to both how we live and how we die. Now resident again in Australia, she would like to introduce her approach to the mainstream public. She talks here to fellow therapist, Chris Walker, about ‘conscious dying’ and her work as a meditative therapist. CW: Can you tell me a little about your background? MJ: Many moons ago, I trained in general nursing, midwifery and psychiatric nursing. In 1974, aged 27, I became a ‘sannyasin’—a meditator with the mystic, Osho—and had the great good fortune to live in Osho’s meditation commune in India for the last 15 years of his life. In my 40s I became intrigued with the subject of death and dying, perhaps because there are so many similarities with the experience of meditation. For example, in meditation, as in dying, we move away from the outer world into our inner reality; in both meditation and death, we are alone. Also, in both states, we ‘die’ to ourselves as a bodymind, as a personality. That initial interest became a passion after I supported Anna Freud, the child psychoanalyst and youngest daughter of Sigmund Freud, as she was dying. Shortly after she died I experienced a profound silence and stillness. It was not the usual silence and stillness I know of when I meditate; it seemed to descend on me, and to surround me like an exquisite, feather-light blanket. Afterwards, I thought that if a non-meditator could leave such peacefulness in her wake, how much more potential could a conscious death, a meditative death be? Some time after that, I started travelling extensively—to the US, Europe, Scandinavia, Turkey, Israel, India, Japan and New Zealand—facilitating meditation workshops and conducting individual sessions, all on the subject of meditation for both living and dying consciously. CW: Interesting … And a ‘conscious death’: What is that exactly? MJ: Just as a mother consciously prepares to give birth— 12

through ante-natal classes, learning what changes her body will go through, how she can do what is best both for herself and her baby—we can prepare for a conscious death. After all, we may not all give birth to another’s life but we all give birth to our own death! Death is, as the existential philosophers emphasize, “the inescapable, immovable boundary at the end of our lives” (Cooper, 2003, p 17). Given that, plus the fact that most of us fear dying, it makes sense to me to look at any issues we might have about dying while we are still able. The focus of my private practice is in providing support for clients through a health crisis—that is, supporting them back to health and, if/when that’s not on the cards, helping them prepare for dying. In my experience, when we are seriously ill, the spectre of death may well be hovering about in the background. So, my suggestion is: rather than trying to pretend it’s not there, why not use the opportunity to face the fear of dying? Ignoring or repressing fear—any emotion, for that matter—takes energy … energy that could be better channelled into healing. If you look your fears in the eye and work through them, and then it happens that you recover, great! You’ve used your sickness wisely in doing some preliminary preparation for when it is your time to die. And, as Yalom (2008) writes in Staring at the Sun, “Death awareness may serve as an awakening experience, a profoundly useful catalyst for major life changes” (p.30). And that’s what I see, too, that the process of dying provides potential for inner growth. CW: It has certainly been my experience that many individuals confronted with terminal illness experience their disease as an opportunity to do something different: to change their mindset, their habitual behaviours, to develop a spiritual practice, to tap into their creativity and so on. MJ: That’s right. And if it becomes clear that return to health is not going to happen and that you are moving towards death, you’ve made a start in getting ready for that, and from there we can continue our work together. CW: With all your meditative expertise, what made you become a counsellor? The Capa Quarterly


MJ: I’d gathered some counselling skills along the way but realized that, especially if I wanted to work with the mainstream public, I needed more. I’m really glad I did that because I have learnt so much. I think being a meditative therapist is a great mix. For example, training in psychotherapy has taught me the value of the therapeutic alliance, and how important it is that the therapist constantly works on herself. Meditation provides me the tools to do that work on the most profound level. CW: I’m wondering: Where does your work as a meditative counsellor and psychotherapist differ from that of a regular therapist? MJ: Though I’m drawn to the Existential Therapy modality, I do find it intellectually based, and as such it has limitations. The intellect is of the mind, and the mind has limitations. Yalom (2008) writes of how ideas can “help us quell roiling thoughts about death” (p.77), and “reflect usefully on our own death anxiety” ( p.92). As an editor and author, I love and respect words; as a therapist I respect the value of reflection. Yet as a meditator, I know there’s a whole dimension beyond thinking that can address far more profoundly the big issues in life—such as love and dying. For example, rather than trying to ‘quell’ those very natural thoughts about death, why not explore what those thoughts are really about? Let’s say your particular fear is of ‘not being,’ of dissolving. Rather than having you just talk about that, through various techniques, you can voluntarily enter the space of meditation in which you let go your identity as a bodymind, as a personality. You understand that they are not an essential part of your being but that they are arbitrary, limited constructs. Allowing your identification with them to dissolve opens you up to real, authentic being: that is, to consciousness. If that approach—of entering your fear—is too confrontational, I might suggest an energetic approach, i.e., in this instance, working with fear indirectly. Energetically, fear and love are diametrically opposite: fear is a contraction of energy, love is an expansion of May 2011

energy. The more expanded we are, the more loving, the less fearful. So, as a client becomes more loving, as she experiences more often that expanded state, she will become less fearful. It’s simply not possible to be fearful and loving simultaneously. So, in response to your question, those are a couple of ways in which my approach differs: in helping clients to voluntarily enter their fears; and in working energetically. CW: There’s a book about cancer counselling from the Existential modality standpoint called, When Death Enters the Therapeutic Space (2009), (ed: Laura Barnet). In one essay, the author (Lockett) writes of the counsellor “helping the client to reconstruct a new sense of self, to help her regain a sense of control, of being useful” (p.50). Is that an approach you’d take too? MJ: This is a good example of another way in which a meditative approach differs from that of any therapy modality I know of. Being sick can throw one into a gap. That gap can provide a valuable opportunity to be in, and to explore, this state where the old sense of self, the old labels and old identities have dissolved and the new has not yet come. I would support the client who is ready and willing in asking herself: Who is looking for ‘a new sense of self ’? Who am I when I let go of my need to feel useful? Or: What if I were to hang in there, in this space of notknowing, and see what happens … see what or who emerges from it? That exploration is bound to take one to the experiential understanding of oneself as just pure awareness, as the conscious observer. That position of the watcher is constant and, as such, provides an internal secure base. To have that is far more helpful than stressing out trying to stay in control. In finding that secure base or ‘centre’, one no longer needs to ‘get a grip’. In one’s dropping the effort to control and, instead, relaxing into the stance of a watchful consciousness, all the tension involved in trying to manage things drops too. That freed-up energy becomes available for healing. 13


Conversations

CW: I’m struck by your term, an ‘internal secure base’. MJ: That’s the term that psychotherapist and author, David Wallin uses in his book Attachment in Psychotherapy. CW: And this is especially important for a dying client? MJ: Well, think about it: You are dying, and with that is the relinquishment—albeit perhaps never articulated, perhaps not even consciously—of all your memories, of life as you have known it till now, of all roles you have played till now, of relationships, of your identity as you have understood it till now. All is in flux, and that can be really scary. To know that there is an unchanging aspect to you—that is, the observer—that is not part of your bodymind, which is clearly disappearing, is enormously significant. This is another difference, then, in my way of working: supporting my client in connecting with the secure base, and in seeking to know herself as consciousness, as the observer—of her thoughts, feelings, and all the various physical sensations and changes. CW: In her book, Everyday Mysteries, van Deurzen (1997) says that in the Existential therapy approach “the object is never simply to … dilute the tensions implied in living, but rather to maximize one’s ability to stand them” (p.230). Is that something you would agree with? MJ: Meditation certainly provides us with terrific resources. For me, personally, the most valuable is this capacity to calmly observe or unhook myself from all my experiences. It’s like inwardly stepping back, as it were, from all my thoughts and feelings and bodily sensations. From that stance, I notice that what I watch is transient, and so it is peripheral to who I am. It’s important to get that witnessing is not about avoiding or repressing any experience; on the contrary. As Wallin (2007) expresses it: exercising voluntary, sustained, and nonjudgmental attention to our here-and-now experience changes any experience—at once deepening and lightening it: Deepening because we can be more fully present, accepting and aware; lightening because present-centered awareness is 20 14

less burdened by the weight of the past and future, less encumbered by shame and fear (p.61). He adds: Such awareness can be beneficial in many ways. It contributes to the regulation of difficult emotions. It also tends to ‘de-automatise’ habitual patterns of response, enabling us to wake up and experience the world afresh—as if with a beginner’s mind (Wallin 2007, p.68). So many benefits… I often say that if meditation were a pill we’d be downing such pills by the mouthful! CW: Can you offer some examples of your work with individuals who are/were also meditators? MJ: A woman whom I met in a palliative care unit here in Sydney always used our time together to meditate. One day, she talked about her fear of dying. At some point I suggested a method in which to simply watch, from inside, the rise and fall of the chest or belly as the breath came in and went out. As she closed her eyes and began this, I commented that with each inhalation, life was entering her, and with each exhalation, she was letting go of that life, that perhaps she could notice how these two seemingly contradictory stages work so harmoniously together, and how this movement—receiving, releasing—continues every moment of our existence, and so on. In this way, she could experience, not just understand intellectually, the complimentary nature of seeming opposites, to have an experiential understanding that living and dying are not inimical but just parts of— partners in—the same dance. Observing this inner dance, she was able to relax. She became deeply still and was in quite a different space when she opened her eyes. Where before there had been anxiety—I had sensed her beseeching me for some kind of help—now I saw calmness in her eyes: she had returned to herself. That focus on a felt, experiential understanding, is another way in which my meditative approach differs I recall a client, a young woman, dying of ovarian cancer, who was generally accepting that her time had come. However, sometimes she did feel really angry, too. Then she’d take herself off to the nearby forest (we The Capa Quarterly


were in the Danish countryside), and shout and rant and rave, till she’d vented all her rage. Because she was doing that consciously—as opposed to being blindly taken over by her anger—that release was a form of meditation, too. By unburdening herself of her anger, she could contact a new spaciousness inside. I recall her coming back home and, within minutes, we would be laughing about something, or she’d want to put on some music and dance, or she’d noticed a new flower in the garden and was delighted: she had moved on. Another client used a certain meditation technique I suggested as a kind of rehearsal for dying. Osho (2007 p. 12) points out:

The experience of entering death voluntarily is meditation. The inevitable and automatic phenomenon of dropping the body that will take place at the time of death; [in meditation] we can willingly experience that through creating a distance, inside, between the self and the body. And through leaving the body from inside, we can experience the event of death; we can experience death occurring . My client did this regularly for the last months of her life. I was fortunate enough to be with her when she died, and as far as I could see, she entered that experience meditating. I cannot imagine a more graceful exit than the one she made. CW: Maneesha, thank you for your time. It has been a pleasure. MJ: For me, too! Thank you.

References Barnett, L (ed). (2009) When Death Enters the Therapeutic Space, Routledge: USA Cooper, M (2003) Existential Therapies Sage Publications: Los Angeles Osho (2007) And Now, And Here: Beyond the Duality of Life and Death Rebel Publishing: India Van Deurzen, E (1997) Everyday Mysteries: Existential Dimensions of Psychotherapy, Routledge: London & NY Wallin, DJ (2007) Attachment in Psychotherapy, The Guilford Press: NY Yalom, I (2008) Staring at the Sun: Overcoming the Dread of Death, Piatkus Books: Great Britain Maneesha James From a background in general, psychiatric nursing and midwifery, Maneesha has also trained in hypnotherapy, psychotherapy and counselling. She has worked as an editor and writer (with five books on meditation published), and has created six guided meditation CDs. For many years Maneesha has been travelling internationally as a meditation facilitator. Her individual sessions, workshops, interviews and articles, along with public seminars, focus on meditation as a unique resource for both living and dying consciously, with grace and gratitude. Contact Maneesha: Tel: 0450 125 637 e-mail: maneeshajames@gmail.com web: www.activemeditation.com and www.maneeshajames.com Christine Walker Christine achieved a Bachelor of Counselling and Human Change (Psychotherapy) at the Jansen Newman Institute (JNI). She also received the JNI Academic Achievement Award and the David Jansen Differentiation of Self Award. She is in private practice at Crows Nest, is a support worker at the National Centre for Childhood Grief and a volunteer community counsellor. Christine has an enormous regard for human dignity and is especially passionate about working with clients surrounding issues of living with terminal illness, death and dying, grief and loss, social isolation and homelessness. Contact Christine: Tel: 0416 098 627 e-mail: chris@christinewalkercounselling.com.au web: www.christinewalkercounselling.com.au Maneesha and Christine While Maneesha and Christine work independently, they nevertheless recognise the importance of creating a support network for dying individuals and their families. As such, they often work collaboratively to help families before and after death.

Journal ads and PD hours Please note that advertisements in the journal do not necessarily comply with CAPA’s professional development (PD) requirements. As with all workshops/ courses/conferences, please check their eligibility using CAPA’s ‘Professional Development Policy 2009/2010’ in the members area of the website www.capa.asn.au. If you have any queries, please contact CAPA’s Membership Chair on membership@capa.asn.au February May 20112011

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Counselling Communities: The Large swathes of Queensland and Victoria and many parts of New South Wales have been devastated by the worst deluge in living memory (Australian Government, Disaster Assist website 2011a). It would have been hard to miss the news coverage, especially of the Queensland floods. More recently, Cyclone Yasi, a category 5 storm with winds in excess of 300 kmh has torn across Far North Queensland (ABC News website, 2011b) and countless people have lost homes and livelihoods. Some have lost love ones. Some have lost everything. Hard on the heels of the soaking of the eastern states, way beyond capacity, massive bushfires have raged on the edge of Perth, destroying more than seventy homes, and damaging dozens more, Other wildfires have burned out of control in more rural parts of Western Australia; and additional floods have swept across northern and western Victoria. Not to mention Victoria’s Black Saturday bushfires of only two years ago. Mother Nature is certainly giving our country a pounding lately, and some say this is the start of more to come (ABC News website 2011c). All of these events are afflicting people with grief, bereavement and loss. As it is Queensland residents who have been most severely affected, what follows is a discussion and an interview of a counsellor from Queensland in one of the areas affected by floods. We must not, however, forget the many people in Victoria and NSW who have also been affected. The areas most severely affected by the floods were the Lockyer Valley and the Toowoomba region (Queensland Counsellors Association website 2011). Massive flooding was also experienced by residents of Ipswich and Brisbane and some parts of Northern NSW. Up to three quarters of Queensland has been inundated by these floods (Queensland Counsellors Association website 2011). At this stage, though, the focus for this article is on Queensland, as there have been thirty-five flood-related deaths since 30 November 2010 and twenty-two more confirmed deaths in Southeastern Queensland with the more recent floods (ABC News website 2011a). This news of those who have perished is current as of this writing, but there are still people missing and it seems at this stage likely they may never be found. Acute stress in times of trauma Most of us have seen the footage of people, cars, houses, equipment, and infrastructure being swept away by the raging floodwaters. It is so real and raw for the people of Queensland, especially the Lockyer Valley region, as it was there where the greatest number of people perished in the floods. The Royal Australian College of General Practitioners (RACGP 2011) discusses the need, in the event of such tragedy, to be aware of acute traumatic stress that arises from being exposed to such trauma as the threat of death, loss of loved ones, loss of possessions, or loss of income or livelihood. Those people caught up in the floods may have lost all these at once. The RACGP (2011) argues that if somebody already has a pre-existing mental illness, traumatic circumstances like these floods can exacerbate such symptoms. Grief and loss related to the floods or natural disasters In times of trauma and crisis, the shock, reality, grief and gravity of loss of the situation for many has barely set in, and the effects 16

can be long-tem and lasting. Additionally, those in crisis or traumatic circumstances react to traumatic events differently (Relationships Australia 2011). Bronwyn Morris, a Queensland counsellor, describes below the idea that we have not yet seen the full ramifications of how the Queensland floods have affected and will affect people’s lives, nor have flood victims really started to grieve their lost loved ones, homes, possessions and livelihoods. Most of these events are unparalleled in the lives of many who have experienced them, and will continue to shape their lives forever. We only have to look to the Black Saturday bushfires two years ago in Victoria, where 173 lives were lost and whole communities destroyed (ABC News website, 2011d) to see how people can be affected. We therefore must not forget any client who has been through such heartache and tragedy. The interview Renee McDonald, a psychotherapist in practice in the Illawara region of New South Wales spoke with Bronwyn Morris, who lives in Ipswich, Queensland and runs a psychiatric facility there, about the effects of the recent Queensland floods on her community. RM: How long will it take for the community to work through the initial shock of this tragedy? BM: The initial shock is really still there and some people are just going back to their houses now. The shock as a cumulative effect may take up to three to six months to be fully realised. For certain members of the community, it may take twelve months or more before the events can be processed such that the deeper grieving can emerge. When the actual event first occurred, many people did not know whether their homes were flooded or not; they had been asked by the relevant authorities. to evacuate as a safety precaution For many people, there is compounding shock, and this has multiple levels—not only loss of home [or not knowing], but not knowing whether family or friends are safe. Maybe they discover that they have lost someone close , maybe lost a job [physical losses] or business. The emotional experience of helplessness, fear and isolation arises. They could be walking back to a home that is gutted, or gone. There may be changes to what they would expect, like the absence of essential services. In our house, we couldn’t drink the water [due to concerns about whether it was contaminated]; we brought in bottled water. The electricity was turned off for many. People in our contemporary society are simply not cognisant of experiences of lack such as no good drinking water, nor access to groceries such as milk and bread nor having had a home wiped away. The enormity of the damage has only just started to be worked through. RM: How can the counselling community can support each other in such times of tragedy and grief? BM: We work as a team. It has to be a shared thing. For example, one counsellor knew of an Evacuation Centre—one outside the parameters of town—and she was called in to deal with a significant crisis in the area. A caravan park had been declared a health risk [condemned due to the mud and destruction], and the tenants were told that it was being bulldozed. The only way The Capa Quarterly


Shared Impact of Natural Disaster

Renee McDonald in discussion with Bronwyn Morris

this counsellor could deal with that was by contacting colleagues for assistance. In this instance, having the capacity to call on us other counsellors not only reduced the stress associated with telling the residents, but it also highlights the importance of networking. Importantly, counsellors need to have and use their networks of colleagues as an established practice [to be effective in these crises]. At the time, I hadn’t understood how involved I had become. We were all involved. A colleague of mine picked me up on a feeling I expressed that we, as local counsellors, were being sidelined from giving assistance when, within the week, other social service volunteers, such as social workers etc, had been flown in from interstate to help. My colleague reminded me of how tired we were and of how the impact of the events was wearing us down, [remembering that we still have our own practices, families and personal losses]. This has reminded me, on reflection, of the importance of feedback and collegial support. It is the important process of supervision—even in a crisis situation—so all important counselling practices should apply, though they will be experienced in a concertinaed form, if you like. If we had kept going, we would have burnt out very quickly, and I am now very thankful for all the interstate support. When refreshed, we will have many years ahead to continue assisting our community’s recovery. RM: Ipswich is a very small, regional town, just outside of Brisbane. How do tragedies like this affect small town residents? BM: On this occasion, I think being small was a very bonding situation so that even as counsellors, we quickly knew each other, or we’d had contact through other people. That kind of interdisciplinary/collegial respect and relationships made it easy to work with each other. We didn’t have any special clothes on, so Lifeline provided us with jackets as identification. These were a few among the team-focused practices that occurred. We could then respond immediately, more quickly walk into that immediate team structure and work as a team. Alternatively, we would have needed to introduce each other, establish ourselves, our roles and responsibilities—if we didn’t know each other. It cuts through red tape to live in a small community. It highlights the need for supportive collegial structures. That was very helpful, as were mobile phones; but at times we couldn’t communicate with these either. RM: On a personal note, it appears the flood came close and you helped others. Can you tell me a little more about this? BM: On a personal note, it was very scary. It was the Monday night. We knew the floods were imminent. We saw the inland tsunami through Toowoomba on the Tuesday morning news. In a million years we would not have expected that to happen. It was a massive shock, and I was really quite scared, as were my children [older children]. We were warned that “a wall of water” was coming towards Ipswich. You have all sorts of thoughts. Your training helps you go into emergency response mode. As for my own house and family, they are all okay. My husband was helping. There was definitely a crossover between home and family and professional roles. Directing a psychiatric facility created a greater responsibility at the time. When May 2011

disaster is imminent, it’s best to have a means of taking action, systematic action. This takes away the feeling of helplessness. We were really able to understand that we may not have clean water, sewerage, and milk. Fortunately, I have staff who were able to get things for us [before supplies ran out]. I sent our staff out to get things, though the roads were getting drenched and there was the possibility of being cut off. We then knew we had water and long-life milk. Not long afterwards, the power then went out. We were one of the very fortunate who did not lose power. Many people lost power ,food and water. All your family and friends have been affected. I know people in Toowoomba and the Lockyer Valley. There were some people you don’t get to contact for what seems like a long time—and some people I haven’t heard from yet. Toowoomba is about a two-hour drive from Ipswich, so not far. RM: What are your thoughts about counselling in your community after such untold grief? BM: First of all, having an understanding that this is not something that is going to be finished in the short term is essential. We are still going to be having people requiring help for a long time yet. State-wide, it has been estimated that there will be 20% additional mental health issues because of the floods, especially with farmers (Patrick McGorry on ABC Rural 2011). The expectation that this is going to be a long-term issue needs to be there. I have put my name forward where I can volunteer. They are suggesting some money and funding for flood crisis interventions. Counsellors are accessing avenues to assist through their respective associations ACA (the Australian Counselling Association) is opening up a crisis line. As counsellors, we need to be flexible. Volunteers are also needed in support roles, as well as counselling roles. Being prepared to exercise those micro-skills with people—often that is enough to meet immediate needs. My thought is that there is a great need to have support groups, rather than too much one-on-one counselling. I have heard that Lifeline disaster responses for the bushfires [in Victoria] found that the shared experience in a group setting is a very useful mechanism for recovery. This might be a good reference point in our own community. Remember that memories of the tragedies, dates, times and places stay with people and are re-experienced in multiple ways on anniversaries etc, so ongoing supportive groups can assist. I think Vietnam vets, RSL and other support groups will attest to the positive influence of shared experiences and show that working in a group context can assist recovery. I also think that a group context (and I saw numerous examples during the immediate crisis), inspires each of us to find our resilience; it helps to be helping. This has a flow-on affect. PTSD is mediated by the capacity for the victim to be assisting others, by feeling empowered in the context of helplessness. RM: How does one retain a professional hat in your own community, especially given that it is a small town? BM: There’s not a really succinct answer to that one. It is tremendously hard. You are trained, so that in some respects it is easier to move into a mode of professionalism; it gives you protection. You develop an inbuilt mechanism; it’s almost like an 17


Conversations

automatic response as counsellor. Things break through, though. It is very hard not to become emotionally involved; realistically, it is impossible to stay completely composed. It is very hard to get your head around it. There often aren’t words. You go back to very basic micro-skills, because it’s just too right in your face. The best and safest things are to rely on your micro-skills—on listening and empathic skills. You, too, are absorbing the events at the same time. You truly are walking beside somebody else in a profound way. There is a danger of going into over helping mode. Your defences are down somewhat .It is personal. I found that there’s no ‘off button’ in this situation. Until somebody else pushed my ‘off button’ in terms of wanting to help, I did not recognise it. This again highlights the need for other professionals to be working alongside you. It’s important to recognise that you have a family and people at work who also need you. It’s a danger to get so involved that you neglect your own life. It was important to say “Hey, let’s take a step back”—for yourself and for others. I realised how drained I was. I was beginning to neglect my regular life duties. We talk about it in counselling supervision, but we especially can’t neglect it in a traumatic situation. You need supervision on the ground in the midst of the disaster—as part of a team. In retrospect, I recognise that we need the ability and the capacity to develop our own disaster management plan. I now know one can never say ‘it won’t happen to us’! The government’s disaster management plan was brilliant. The Red Cross and Lifeline and the government were great at the evacuation centre. Thankfully, there was no playing politics. The Ipswich mayor

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was so involved and was even singing to people. That sort of personal touch helps people feel that they are not isolated or abandoned. They came together as a community. They felt that they weren’t alone. They could share the experience, all the information was there. They preferred that over being isolated in a private dwelling. In our residential facility, we took in a number of elderly residents from the local evacuation centre on the first night, as it was chaotic at the centre. The following day I went back to undertake counselling and invited others to more private accommodation. By the next day, no one seemed to want to leave the evac centre. I also noticed that over the next few days the elderly guests were agitated and unsettled at the residential setting, until someone visited them from the evac context. I note that isolation or a sense of abandonment was experienced as a very negative impact. Some communities were cut off for a few days, no communication, power or food, These people experienced an increased level of distress, I believe. RM: Can you a little more about those elderly residents? BM: That was a tricky one. They had an initial need for some comfort that night; the first night. It seemed like the best thing to do at the time. They had walkers, they had toileting needs; and there were at that stage no beds or showers close by—but as the time went on, in the more comfortable residential setting they became agitated or restless, ass they weren’t with the rest of the community in the evacuation centre. What I didn’t initially realise was that they were experiencing some sense of isolation. That’s what their agitation was about—feeling isolated. You

The Capa Quarterly


need to reconnect people really quickly, even by going up to the evacuation centre with them during the daytime. For them it may have seemed that all choices had been taken away from them. Being told you had to leave your home is not comfortable for anyone, least of all for the elderly and infirm. People’s attitudes were good, but it was incredibly hard. The elderly people already experienced considerable loss of dignity. To re-connect them more quickly might have given them a greater opportunity to gain a sense of dignity by being involved with the rest of the evacuee community. I think I will remember that—next time— though I hope there isn’t one. RM: How can counsellors stop themselves from becoming overly involved? BM: I still need to reflect on that. I still have to explore it. It was totally unexpected. There was no sense of preparedness. So if someone was a counsellor and they didn’t expect to be in that situation, they wouldn’t have even thought about how to respond. We have so much professional development and supervision. You can never ever say you’re not going to be in this kind of situation. It would be part of our responsibility as counsellors to access professional development and reading around disaster response. Trauma specialists can speak to how we deal with it. We need a plan. It creates an awareness. As a counsellor, I will explore this and reflect on it, and I will have my own understanding of disaster and trauma response management. We really need to operate as a team and have that network so that each of us at least has another colleague that has our backs, as we will theirs. Working at being active in our local

May 2011

communities, building relationships, both professionally and personally, is incredibly important and will continue to be so for the community in recovery. RM: How has this affected the people of your community? BM: It is still evolving. I think it will shape us. The sense of community will be stronger. The politicians have really helped with that. It is an equaliser. No one is untouched by it. It creates a common, shared experience. It brings out a real feeling of community—of a shared bond. It brings out the best in people. If that wasn’t there before, it certainly is now. I can’t know the ongoing repercussions. It is still possible for some further fragmentation to happen. Still some people will lose their houses, or simply move away. What does this mean for the ongoing commerce and business in the area? I don’t think I can really comment on that. Road access and where we build might change. There are discussions: Do we make another access point, such as bridges or new roads, that will change neighbourhoods [geographically speaking] again? We are going to see changes down the track. I don’t know what this will mean. It’s hard to define. In the short term, it has drawn the community closer. Everybody is watching everybody’s back. Not one person wasn’t affected. Even for our psychiatric residents. Being part of something bigger than themselves empowered them. It helped enhance their sense of belonging. Their feelings of stigma [related to their psychological diagnosis], meant this crisis helped the psychiatric residents [who live in the facility] to feel they are an integral part of things. It is probably a rare experience for them.

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Conversations

Shared catastrophe has that affect on people. This experience inadvertently created the possibility that something therapeutic might result from the event! RM: What has the support been like, from the people from outside your area? BM: A number of us—myself and other counsellors—were helping at an evacuation centre just beyond Ipswich. After a week or so, a group of people who came in through the Red Cross then put their hands on the situation and took it over. My thinking about it was that as the social services became more organised, they were able to supply fully trained disaster response teams. That response was incredible. This invaluable support assisted local support services such as volunteer counsellors to avoid very quickly burning out, becoming fatigued and losing the capacity to attend to their own grief and losses. You do shift work, somebody has to come and replace you. You can’t be on duty twenty-four hours, seven days a week. The support, the relief, also helped me to recover a little. The support from outside Queensland has been amazing. You simply cannot carry a disaster response by yourself. You need a team. RM: Is there anything other counsellors, like those from interstate, could be doing? BM: I would probably do what I have done, say, in the Victorian bushfires, and place my name on volunteer registers to counsel. If you are able and willing, from my point of view, counsellors will be needed—even more so. The government will assess the difficulties and assess the backup support required to each area [as there are so many]. There will be a longer-term need here. Our resources will get pushed. Counsellors outside this area could provide counselling by email, blogs and Skype support. It is good to know that other people are thinking about you. We could do that between our respective counselling associations. Supporting the counselling community would be a helpful thing. ACA is setting up a support help line. Not sure of any of those details. Then clients can be directed to it.

RM: How is this grief affecting your clients and/or client groups? BM In one of the places, for the group of people losing their homes, the grief is pretty multiple. It’s the initial recognition and shock that they’re losing everything they own. Their responses are initially linked to comprehending that they have absolutely nothing except their clothes—maybe. It just dislocates them. Their whole sense of who they’ve been, historically, dislocates. Houses, personal effects and other possessions are linked to family, memories, special events—significant events in their lives, and their achievements. These things are symbolic of who the person has been. A client had lost his son a few years back [prior to the floods], and in the floods he had lost all of his son’s things. The trauma becomes about a whole lot of different moments and events. It is not just one experience of shock and grief but must rather be understood as recurring shock and grief, along with the reigniting of past grief experiences. As a process, what was notable to me was the ebb and flow between the recognition of the great losses in one moment and then in the next moment having a joke—and ‘at least I’ve got my life’—was profound. That happened as a direct result of the shared context. That was the great balancer of the experience [seeing someone else affected, or worse off]. It could otherwise be a very black hole for some. People can be quite desperate in their grief. We expected people to be very angry, especially those who’d had their homes bulldozed. If they were angry, it wasn’t the anger you would expect. It is very early days, though. I think it was because of the shared context, the mitigating factor that brought some kind of anchor to all that was going on chaotically around—a sense of ‘but I’m okay’—then they could settle again. Some moved to thinking ‘I just can’t start again; I just don’t want to do this again’, but then to ‘isn’t this great that people are there for us’. That’s what was happening as the process was unfolding. It’s a very interesting, this way of being able to process enormous things in a group. It is the shared context every time that helped, in terms of resilience. That sense of resilience is a very important thing. It entails focusing on every positive asset of how they have coped and how they are going to cope. That is

the e k a M Apply for CAPA PD endorsement most d a ur of yo Advertising a course, workshop or conference? Increase your potential audience by submitting your event outline for CAPA Professional Development (PD) assessment. If your event meets the criteria, your ad will be highlighted with the CAPA seal of approval, and the number of CAPA PD hours it attracts. And it will appeal to more CAPA members. To take advantage of this service, email CAPA’s Membership Chair at membership@capa.asn.au. Assessment fee: $150.00 Submission date: event outlines are due at least two months before the relevant advertising deadline (Please note that submitting your event to this service does not guarantee endorsement) 20

The Capa Quarterly


essential to how a counsellor engages people. There was a depth of grief and possible despair, though the high level of support buoyed people from giving in to that terrible grief. RM: Have you ever seen events like this before? BM: I have never experienced this. Never. It is a unique situation. RM: What is the human spirit that you have seen in the aftermath of such a tragedy? It is just amazing—a really profound experience—to be amongst it. You can talk to someone who’s in the worst possible situation but who is concerned about or even helping someone else. The generosity of people is absolutely overwhelming. What it says to me is there’s a remarkable imprint in the human psyche. I’m feeling it’s the human spirit or ‘God in us’ because it has an unfathomable capacity. It is something that’s already there. It has to be a spiritual dimension to the person. In the right relational setting, I believe it’s not really difficult to elicit from a person their inner resilience. Once it’s fired up it’s like lighting the fire. I think it catches and it’s the whole community. You wouldn’t doubt the spirit of humanity in these crises. In some ways, that has been even more overwhelming, [heartening], and it’s like a healing balm. We can never underestimate the power of facilitating someone to a sense of his or her own resilience, and it can only happen in a shared context, in fact often one of crisis. What Renee found from this interview and the flood experiences as seen through Bronwyn’s eyes is that above all else, even when tragedy strikes, the human condition means that those affected by such trauma can rise above it to become part of a collective resolution and build on their own resilience whilst they share the load, though those who are isolated in their trauma struggle with the enormity of it (ABC Rural 2011). References ABC News Online website 2011(a), Death toll from south-east Qld floods rises to 22,

written: 24.1.2011 http://www.abc.net.au/news/stories/2011/01/24/3120613.htm (accessed 30.1.11)

ABC News Online North Queensland 2011(b), Phone call from inside the eye of TC Yasi, written 3.2.2011 http://www.abc.net.au/local/audio/2011/02/03/3129135. htm?site=northqld (accessed 7.2.11) ABC News Online 2011 (c), More natural disasters on Australia’s radar, written 23.1.2011 http://www.abc.net.au/news/stories/2011/01/23/3119109.htm?section=justin (accessed 7.2.11) ABC News Online 2011 (d), Survivors to mark Black Saturday anniversary, written 7.2.2011 http://www.abc.net.au/news/stories/2011/02/07/3131412. htm?section=justin (accessed 7.2.11) ABC Rural News Online 2011, Farmers will need continual mental support, written 21.1.2011 http://www.abc.net.au/rural/news/content/201101/s3118100.htm (accessed 7.2.11) Australian Government Initiative; Disaster Assist website 2011, http://www.disasterassist. gov.au/www/disasterassist/disasterassist.nsf/Page/LatestNews_LatestNewsoffloodsinAu stralia%28November2010-January2011%29 (accessed 30.1.11) Queensland Counsellors Association [QCA] 2011, QCA website, http://www.qca.asn.au/ (accessed 30.1.11) Queensland Government, Department of Communities 2011, Community Recovery News, http://www.communityservices.qld.gov.au/community/community-recovery/ publications/documents/cr-news-brisbane.rtf (accessed 31.1.11) Relationships Australia 2011, Trauma and Crisis Information Sheet, http://www. relationships.com.au/resources/pdfs/services/trauma_counselling.pdf (accessed 30.1.11) Royal Australian College of General Practitioners, 2011, Flooding and its impact on mental health; written 18.1.2011, http://www.racgp.org.au/disasterresources/40915 (accessed 30.1.11) Renee McDonald is a regional Clinical Member of CAPA from the Wollongong region. She holds a Grad Dip in Counselling, a Masters of Applied Social Science and a Cert IV in Training and Assessment. Renee runs a private psychotherapy practice in the Northern Suburbs of the Illawarra and has done so over the past five years.

Bronwyn Morris is a Clinical Member of the Queensland Counsellors Association (QCA). Bronwyn is from Ipswich in Queensland and works for Questcare, a psychiatric facility. Bronwyn is also currently undertaking a Masters in Social Work. Bronwyn holds a Certificate in Community and Human Service; a Bachelor of Social Science, a Grad. Cert. in Emotional Release Counselling for children and a Grad Dip. in Theology

Peer Reviewed Articles Submitting your articles for peer review has many benefits, including: elevating the quality and authority of your work expanding your Higher Education Research Data Collection (HERDC) publication count enhancing the academic rigour of The CAPA Quarterly Articles submitted for peer review will be sent to 2-3 independent reviewers. The CAPA Quarterly uses a double-blind review process, where the identities of both author(s) and reviewers remain anonymous. Guidelines for your submissions with a request for peer review are available at http://thecapaquarterly.blogspot.com/p/contribute.html or you may contact editor@capa.asn.au May 2011

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In Review

Walk With Walk With Me, by Nerida Oberg, 2011 Mistymoon Mountain, Sydney In this extraordinary book, psychotherapist and expert in the field of bereavement counselling Nerida Oberg opens her heart to share with the world the intensely personal and deeply spiritual story of her relationship with her daughter Eliza and the profound experience of losing her to death when she was only twenty. While her years of training and practice in counselling others made her better prepared than most for dealing with such an overwhelming loss, the experience as it unfolded took her far beyond anything she had ever learned about death and life and what it means to be human. Her story touches us deeply. Her insights into the transition we call death and the realm of spirit takes us beyond conventional wisdom in a way that is both stirring and encouraging. Her willingness to share this experience for the benefit of others is an act of exceptional bravery in the face of inevitable criticism by some of her professional colleagues. These excerpts from the book give a glimpse of the journey the book reveals. I strongly encourage you to read the entire book. ~Laura Daniel, Editor Introduction The year before my beautiful daughter Eliza developed Type 1 diabetes, I completed my specialisation at university on bereavement care, grief and loss, as part of my qualifications in becoming a psychotherapist. This interest and study was the beginning of my own journey of discovery into the theories of grief and the world of dying and death. Acute grief and mourning was a place I could easily be with others who were suffering immeasurable pain and loss, which then led me to teach hundreds of students who were training on the topic as part of their counselling qualification. Bereavement care felt more like a natural inclination than a learned response, one that I embodied in my being long before I entered university. I remember in 22

second grade at school being told by the teacher that we had new students joining our class the following day, children who had lost both parents in a car accident and who now lived with their grandparents. We were told that under no circumstances were we to mention the death of their parents. Needless to say, I got caught discreetly asking the girl about the loss of her parents. I was inquisitive, wanting to know more about this mysterious world called death that everyone seemed so afraid of. We were seven years old at the time and became good friends despite my ‘indiscretion’. I have never been afraid to hold a space for others to grieve. It always feels like a privilege to be with another who is so in touch with feelings. In my first years of private practice, I was neither personally removed nor affected, always fascinated at the diversity of human response, and always lovingly compassionate in my care for the broken hearts that came to see me. Human life experience involves constant losses, a natural rhythm of giving and taking I considered neither good nor bad, nor right or wrong; it just is what it is. My personal life and professional work have now been dramatically changed by the very personal experience of loss with the death of my own daughter in 2009. She was twenty years old. A new awareness about death and the nature of grief now overlays years of learned knowledge and professional experience that has, in many ways, become irrelevant and obsolete. I now see the limitations of psychotherapy when devoid of spirituality, especially with regard to grief and loss. There is no death, as we fear it to be, only the body dies, the spirit lives on. This is something I used to like to think I believed, but now this belief is replaced by a certainty with a realisation that goes beyond theory. What I have come to know through this personal experience of such a precious loss is that there is no separation. True familiar love connects us all to the source of all life, and especially to those we cherish and love. We are eternal beings of light and love. The Capa Quarterly


Me

Nerida Oberg

Heart-felt pain involves suffering, yet creative suffering can clear and cleanse the soul, awakening us to a truth that transcends human understanding. This has been my profound experience. The passing of my daughter awakened an inner truth that enabled a spiritual connection with her which surpassed her physical death. Losing a child is without doubt one of the most heartrending emotional challenges that the human being can encounter, but I did not need to become a bereavement therapist to learn this truth, for every parent can feel this one tear at their own heart strings. And while it is the most heart-rending experience of pain and loss, it has, for me, been the most heart-opening experience that has transformed my life. Looking back at our lives often brings forth the awareness of where we are actually heading in the future. I now recognise that my training as an existential psychotherapist had the purpose of strengthening my personal resolve to conquer the feelings of fear and anxiety that lie at the heart of attachment. At the time of Eliza’s passing, I was working at the facilitation of existential group psychotherapy, supporting students in their personal and professional growth by evoking the feelings of anxiety and fear held deep within the psyche. I had gone through this process myself fifteen years earlier and still regard this ‘peeling process’ as necessary for deep personal awareness. Effective therapists are those who are clear within themselves and who have learned to be comfortable in the uncomfortable, secure in the insecurity of life, and accepting of whatever is, is meant to be, because it is so. I loved this work as it was at the heart of my own truth, and I was able to witness the unravelling of the old and the emergence of new awareness in each student. Fear of death and dying is a core existential theme, leading students into uncommon places of discovery about their world of unconscious and conscious feelings. Genuine acceptance of the unknown factor of life and death, together with the ability to exist within this acceptance, was considered to be a good place to arrive, May 2011

therapeutically speaking, and one that most students strove to achieve. It took courage and a lot of hard work to peel back the personality layers that often led to an existential crisis of some sort when concepts such as meaninglessness and helplessness were unearthed. The irony for me, after striving for years to arrive in this place for my own self and supporting others to do the same, is that my personal experience of profound loss broke through all this learning forty-eight hours after my Louie left her body. For the past eighteen months since she left, I have had the pleasure of personal discovery of the very real and true essence of self as soul, where uncertainty and the unknown no longer exist for me. Before this personal experience, I did regard myself as a spiritual person, never religious but open to the unknown, humbled by the life force around and within me. Now I know that I am a spiritual being, not a spiritual person, I am a spiritual being having an earthbound experience, not the other way around. The spirit of my much loved and beautiful daughter personally guided, loved and carried me to where I am now. I am transformed by her ongoing love, not destroyed by her physical loss. Clarity of mind and a deep inner peace now define my constant state of being. Trauma and denial have played no part, nor have most of the theories around loss, but most importantly, there is absolutely no delusion or wishful thinking. I share with you throughout this book her messages that I began to receive shortly after her passing, letters, diary entries and the intimate conversations before she so unexpectedly died which, in hindsight, were all souldirected communications in preparation for her leaving. You will glimpse through this story the beautiful, highly spirited being of my Louie and how everyone who knew her was touched by her spirit. Louie was not just my only daughter, she was also my best friend and constant companion. Allow me to share with you the intimacies of this very personal experience of love, loss, 23


In Review

and spiritual awakening. Please note that throughout the story I refer to my daughter by her given name, Eliza, and her pet names, Louie and Beautiful Louie. Chapter 21 The Purpose and the Meaning I believe the experiences of witnessing both my children suffer falls and rehabilitation, feeling helpless but with the awareness that this incident, accident, tragedy, challenge, call it what you will, was something about them, their lives, their purpose, their learning and discovery, with my role as parent and guardian. This role is possibly the most challenging role of all. How can you love and release your children without fear? How can you keep them safe and gift them freedom at the same time? As a single parent I strove to give my children what I perceived they were lacking, the constant love and care of two parents. In doing this, I self-sacrificed in the name of ensuring they had the right to their own paths. I feel very strongly that this is our role as parents, guardians of our children’s right to their own passage in life. Our children are not ours to own. They are beautiful free spirit beings that choose to journey with us. My own parents continue to give this unconditional love and support to all their children. It is a beautiful gift from the heart and one that bestows many blessings for the soul. In many ways, I recognise that the tragedies were tests to strengthen and prepare me—for the big one. It really does not get any bigger. The loss of a child is right up there as a huge experience of the feelings of attachment, loss, separation and connection, when we open to it. Our family like most, particularly with twelve adult grandchildren, have experienced other trials and tribulations during the last twenty years, in addition to Eliza’s diabetes. Her death, however, is the first within ‘the clan,’ as I call us. I remember spouting the words to my sister that our role was to strengthen our known and identified weakness that came with the feeling of anxiety, or fear, and quietly prepare for what life delivered, with courage, love and dignity. Becoming bitter, embattled, resolved, resentful, disappointed, fearful and neurotic was not a path that would assist anyone, let alone self. I had in my work witnessed many clients, mothers and fathers, knocked by life challenges where recovery or growth seemed impossible, where lives are seemingly destroyed and given up on with a resignation that it is just too hard, too big to transcend and therefore ending in a general acceptance of failure and loss. 24

Whatever we don’t transcend keeps coming back until we do, until we see, and until we realise what we need to do in order to accept and love. How many times do we hear these days that we must learn to love that which is the most painful? This is true of the pain of grief, if healing is what you truly desire. Some people choose not to heal. Some choose to stay stuck in victimhood, a prison of the mind with a seal on the heart. Life is not what you expect, or demand it to be. Refrain from judgement for self and others. Replace discord with unconditional love. It is truly this simple. I felt Eliza’s spirit stand before her own soul as she passed and left her body. I witnessed her life review. I felt her emotional recognition of events and issues she had transcended. We are, at the end of the day, up against our own selves with regard to how we fare in this, our lives. Equally, though, we measure this against the realisation that we are eternal spirits, living and having an earthly experience. How incredible this realisation must be to so many when they pass over. Only now do I understand why and what I felt when my close friend committed suicide thirty years ago. He realised through self-discovery that there is no death, no end, we keep going, and going, transforming, spiritually ascending, choosing to re-enter another earthly life in order to have another go, repeat the lessons we did not learn or transcend, all the while traversing with our own soul families. Within the first week of Louie’s passing, I could feel her leave, and I knew immediately that she was in consultation. How bizarre this knowing was, in consultation with whom? Each time I heard my own question, the answer appeared in the same moment as the thought. I felt humbled, knowing my daughter was both tending to her own life script and supporting her mother at the same time. With this, I learnt to stand on my own two feet sooner rather than later, not wanting to pull her away from what she needed to attend. The word ‘conference’ kept coming into my awareness, then later I realised she was in fact attending her own ‘conference’ on her life journey. My personal awareness in these times triggered a deep motherly love within me, just like it did when she was suffering such pain after breaking her back and needing to go within. At that time, I strengthened my own resolve, so that when she returned from managing her pain, we were both strong in spirit. This exact same process was now recurring. This earlier experience was a practice of detachment, letting go, while gifting us with the pleasure of true togetherness. Every time I followed with my deeper instinct, listened to the guidance The Capa Quarterly


within, I was released from the pain of grief, and I knew instinctively that I was supporting and releasing Eliza from any ties that could, or would bind her to this earthly realm. I would do what I felt urged to do to help her attain freedom in her spiritual ascension. There was no doubt we were and are energetically connected, and if this connection was determined or influenced by my own process and challenge in transcending the pain, as reflected in her message to all at her funeral, then this is what I did and will continue to do. My Louie knew she could rely on me just as I knew I could rely on me, as above and so below. The human suffering experienced in intense grief is indeed created by the mind—our ego that is the source of all attachment. True unconditional love knows no attachment, for it exists in the space of freedom. When the body dies, we are still connected with and by love. Spiritual enlightenment lives on the other side of the mind, neither governed nor controlled by thoughts or feelings. It is found through the freedom of thought, so, in many ways, the more ‘out of your mind’ you are, the better chance you have of finding peace, joy and love. I am not including mental illness here, but it may well be a true ‘godsend’ when a mentally challenged person is oblivious to the illusions of the world and connected only to the feelings of joy and love!

May 2011

For the therapist reading these words, ‘out of your mind’ simply means learning to quieten your thinking to make still the voice of the ego that predictably responds, reacts, and creates feelings of fear and anxiety. Start to listen to the voice of your heart and the universal source of intelligence that surrounds you and lives within. Being at one with nature, animals and small children will help you find your lost innocence and quieten the mind. Meditation, contemplation, and prayer can sit you in the silence of your essence, allowing the peace from within to enter and fill your being. Nerida Oberg (B Couns.Dip Psych/Couns Dip Prof Couns, CMCAPA, PACFA Reg) has over two decades of experience working with families and children. She first began her journey into Psychotherapy training when she owned and directed her own preschool kindergarten when her second child was born. Nerida trained as a Family and Couples Therapist with a specialisation in Bereavement Care. She taught at the Australian College of Applied Psychology in Sydney for over a decade, which included the Master’s Degree in Family Therapy, at the same time operating a private practice located in the CBD. Nerida evolved to become an Existential Psychotherapist and facilitated group psychotherapy for students in training at Jansen Newman Institute for twelve years. In 2009 she moved permanently to the south coast where she now operates the Berry Healing Centre www. berryhealingcentre.com.au. Her next book, entitled Healing in the Light of Love, is a new roadmap for grief due for release by the end of 2011.

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First Person

Being Present Throughout one’s lifetime, each individual will be faced with many and varied losses. Some will touch us deeply, and others will challenge and question the reason for our existence (Dunsmore 2000). Many experts suggest that when these life transitions occur, then we experience a sense of loss and respond with grief. However, each one of those losses will be unique to each person. Expressions of death, bereavement and loss—by way of songs, poetry, definitions, studies, discussions, research, books, theories—are myriad; but how does one truly prepare for that unimaginable loss, no matter the circumstances, age or relationship? My own personal experience is that nothing prepared me for the loss of my adored twenty-year-old son Nathan some 6 years and 9 months ago, who died tragically and without warning. Every ounce of my being was challenged—mental, physical, emotional and spiritual. I remember driving Nathan to work as the dawn was breaking on that fateful day in July 2004, and have recounted over and over again every detail of our

with

Leaving You never said I’m leaving You never said goodbye You were gone before I knew it And only God knew why A million times I needed you A million times I cried If love alone could have saved you You never would have died In life I loved you dearly In death I love you still In my heart you hold a place That no one could ever fill It broke my soul to lose you But you didn’t go alone For part of me went with you The day God took you home. ~Anonymous 2001 conversation. Our parting words to one another were: “I love you”, Most mothers I have counselled acknowledge that a part of them dies— ‘you didn’t go alone for part of me went with you’. Those famous words ‘I never thought this would happen to me!’ are often reflected in counselling sessions, no matter the loss.

I do not remember the 1000+ people who attended Nathan’s funeral. I do not remember the impressive service that people still speak about. It is a time when the world stops, with each breath you take you are hoping that your next breath will also cease. Many clients will comment, “I wake up each morning I am hoping that this has been a bad dream, and that someone has got it all wrong. This isn’t the way it is meant to be!”

Undo it. Undo it, take it back, make every day The previous one until I am returned to the day before The one that made you gone. Or set me on an airplane traveling west, crossing the date line again and again, losing this day, then that, until the day of loss still lies ahead and you are here instead of sorrow. ~Nessa Rapoport 1994

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Grief and Loss Current thinking/challenges Whether one identifies with Kübler Ross’s (1969) 5 stages of dying, Worden’s (2000) four tasks of mourning, Bowlby’s (1980) attachment and loss, Rando’s (1986) anticipatory grief, Raphael’s (1986) grieving over the loss of a baby, McKissock and McKissock’s (1998) ‘infinity’—and the many other eminent theorists and writers—the challenge for each and everyone of us is to be able to be fully present within that place of great sadness. My own tragedy was able to provide a broader understanding of the theories I had learnt. To be able to reassure clients that they weren’t going mad, to be fully present with the client in their anguish, tears, loss and grief. My knowledge, my concerns Who can say how another person will experience a loss, or when the mourning will be over? Worden (2000) so aptly describes this as ‘how high is up?’ Worden also comments that perhaps it is complete when ‘the person is able to think of the deceased without pain’; however, there can still remain a sense of sadness but not that ‘wrenching quality it previously had’. Freud wrote: May 2011

Marie Novella-McMahon

We find a place for what we lose. Although we know that after such a loss, the acute stage of mourning will subside, we also know that we shall remain inconsolable and will never find a substitute. No matter what may fill the gap, even if it be filled completely, it nevertheless remains something else (1961, p. 386). The Weaver My life is just a weaving Between my Lord and me. I cannot change the color For He works most steadily. Oft times He weaves the sorrow And I in foolish pride Forget He sees the upper And I the underside. Until the loom is silent And the shuttle cease to fly, Will God roll back the canvas And explain the reason why. The dark threads are as needful In the skillful Weaver’s Hand As the golden threads of silver He has patterned in His Plan.

~B.M. Franklin, 1950

Working with grief and loss Along with the need for focus comes the need for balance. The bereaved must achieve some balance that allows them to experience their pain, sense of loss, loneliness, fear, anger, guilt, and sadness; to let in their anguish and let out their expressions of such anguish; to know and feel in the very core of their souls what has happened to them; and yet to do all this in doses, so they will not be overwhelmed by such feelings (Schwartz-Borden, 1986, p.299). Grief is unique for each individual, and this is to be respected. There is no time frame. There are times in the bereavement process when the pattern doesn’t make sense. Clients search for an understanding to the meaning of life, let alone make some sense of their new world. 27


First Person

My personal experience of grief and loss has reinforced my learning and understanding within my counselling profession, together with the following suggestions: Dos for the therapist Be patient Mention the loved one’s name Remember birthdays, anniversaries Listen—truly listen Express thoughts Allow the client her or his space Accept the oscillation of the client’s emotions and feelings Identify and acknowledge the client’s feelings Allow silences and be comfortable with them Keep awareness of the whole person— emotional, mental, physical, spiritual Be aware of the client’s vulnerability Be sensitive to multiple losses Be aware of collective compounding losses

Don’ts for the therapist Don’t shy away from the client ‘having a bad day’ Don’t shy away from the client’s tears

Don’t avoid the person Be careful of clichés and throw away comments such as: ♦ You are a strong person and your faith will see you through ♦ Your training will help you through this ♦ Why are you so sad? He/she is in a better place ♦ You’ll adjust in time ♦ You should be grateful for what you had ♦ God needed him/her more than you ♦ It is karma ♦ There is pay back from a previous life ♦ You have another child(ren) ♦  Your grandchildren will replace your loss ♦ You have lessons to learn ♦ Your loved one had learnt all of their lessons

Helpful Suggestions – When speaking with children/adolescents about death ♦  First find out what the child already knows. ♦ Build on what the child already knows, check what has been understood, ♦  Is the child really asking for information, or for emotional reassurance? ♦  Speak simply, factually, and concretely—avoid euphemisms. ♦  Reassure the child he or she is not responsible for the death. If guilt remains, listen empathically. Discuss the guilt thoughts. ♦  Have open-ended discussions about life and death. ♦  Recommend journaling, poetry, music. ♦ Suggest writing, drawing, painting, sand play, art.

Upcoming themes in

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The Capa Quarterly


The following poem reflects a place that many clients will eventually embrace. I don’t know why. I’ll never know why. I don’t have to know why. I don’t like it. I don’t have to like it. What I do have to do is to make a choice about my living. The choice is mine. I can go on living, valuing every moment in a way I never did before or I can be destroyed by it and, in turn, destroy others. I thought I was immortal, that my family and children were also, That tragedy only happened to others. But I know now that life is tenuous and valuable, so I am choosing to go on living, making the most of the time I have, valuing my family and friends in a way never possible before. Iris Bolton 1977 References

Bolton, I 1977 My son… My son…. Bolton Press Atlanta, Roswell, Georgia

Rando, TA (Ed.) 1986, Loss and Anticipatory Grief. Lexington, Toronto

Bowlby, J 1980, Attachment and Loss: Loss, sadness, and depression (Vol III), Basic Books, New York

Raphael. B 1986, Grieving over the loss of a baby, Medical Journal of Australia, 17:281-282

Dunsmore, J 2000 The Compassionate Friends Focus Newsletter, Aug-Sep 2000 printed in the SANDS (NSW) Newsletter Summer 2000/01

Rapoport, N 1994, Woman’s Book of Grieving, Harper Collins, Sydney

Franklin, BJ 1950, The Memphis Commercial Appeal, Memphis

CARE Centre, Terrigal New South Wales

Schwartz-Borden, G 1986, ‘Grief work: prevention and intervention’, Social Casework, 499-505

Freud, EL (Ed.) 1961, Letters of Sigmund Freud. Basic Books, New York

Schwartz-Borden, G 1986, ‘Grief work: Prevention and intervention’, Social Casework: The Journal of Contemporary Social Work, 67, 499-505

Kübler-Ross, E 1969, On Death and Dying, Macmillan, New York

Worden, JE 2000, Grief Counselling and Grief Therapy, Tavistock Publications Ltd., New York

McKissock, D & McKissock, M 1998, Bereavement Counselling Guidelines for Practitioners, Bereavement

Worden JW & Kubler-Ross, E 1977-78). ‘Attitudes and experiences of death workshop attendees’, Omega,8:91-106.

Subscribe today  eer reviewed papers on therapeutic p approaches articles on therapist and client issues interviews with practitioners therapeutic techniques professional development updates practice management tips book reviews

Marie Novella-McMahon has worked extensively in human services. Her past appointments include Educator with the Australian College of Applied Psychology, Clinical Supervisor of Telephone Counsellors at Lifeline, and Suicide Survivors Support Group Facilitator. Her current appointments are Personal Counsellor, Loss and Grief Counsellor, Outof-Home Care Manager, and Supervisor of Social Workers. Marie has an academic background including a graduate degree in Counselling, Social Work and Masters Degrees in Counselling, Adult Education, and Suicidology. She is an accredited Mental Health Social Worker. Marie would welcome any comments, discussion and can be contacted via stassisi@bigpond.com

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May 2011

29


Practice Tips

The Greater Scope Bereavement is often considered to be an experience that arises from the physical death of another person. Typical symptoms of bereavement include anxiety, stress, anger, disillusionment, sadness and rage. Most therapists are well versed in assisting people through the different stages of grief. Numerous models of grief exist, e.g. Kübler-Ross (1969), but all models primarily relate to five stages, namely Denial, Anger, Bargaining, Depression, and Acceptance Experiences other than physical death and loss can also cause intense pain and feelings of loss and grief. For example, in my own practice, clients experiencing divorce or the breakup of an important intimate relationship also report symptoms of bereavement. Their pain is further intensified when they have little social support or where others constantly remind them of the rightness of the breakup when they themselves are struggling to reconcile competing and complex emotions. Similarly, retrenchment or retirement can be intensely painful for people as they struggle with the death of their identities and loss of social support and belonging. Also, when people lose purpose or direction following major change in their lives, they may be more vulnerable to illness or possibly even death. 30

For example, a study at Shell Oil showed that those taking early retirement at age fifty-five had double the risk of death before reaching age sixty-five, compared with those still working at age sixty. Whilst these studies have not accounted for the health of those employees, it is possible that major change or loss might have contributed to their vulnerability. The intensity of experiences of those undergoing major change and loss is, to a large extent, dependent on the amount of choice or control sufferers perceive they have over their situations. Voluntary redundancy or early retirement, for example, often entails choice and an expectation of new possibilities or increased independence. Conversely, being ‘let go’ or fired leaves a person with no opportunity to negotiate his immediate fate. In each of these examples and more, what can the therapist do to go beyond taking a client from Disbelief to Acceptance? What does the therapist have to change in her- or himself or be open to truly enabling clients to embrace the finitude of individual existence, the uncertainty of being and the inevitable angst that accompanies living—namely the existential parameters of being alive? Consider the following example:

Mary came to see me afar the death of her dog. She was not a stranger to loss, having lost her husband to cancer fifteen years previously. She had also endured the death of her adult daughter to a car accident and, in more recent years, experienced intense loneliness resulting from losing friends to death of old age. At eighty-two, Mary (my oldest client to date) was bewildered that the death of her dog, whom she had bought the year her husband died, was so overwhelming to her. She described his loss as ‘a searing grief that consumes me’. To a new counsellor, her response might seem bizarre, since surely the death of her husband or child would engender more powerful feelings of loss. Assumptions might be made about unresolved or complicated residual grief that stopped her from moving forward. Counselling interventions might be aimed at encouraging her to revisit old grief or denial of the intensity of the loss of her family. Had I taken Mary on this journey without being open to appreciating the uniqueness of her experience, I would have missed an aspect of therapy very important for her healing. I would also not have learnt an important lesson that counsellors must master: • Never assume you know the source of your client’s pain. The Capa Quarterly


of Bereavement

Clare Mann

• Don’t assume that the death of a human being significant to the bereaved person is more painful that the loss of a pet, other living being, belief system or lifeway. • N  ever assume that you must have experienced similar life events in order to empathise with clients and assist them in reconciling their losses. Assisting Bereaved Clients Understanding and using staged grief processes in counselling is important but not sufficient to deal with the uniqueness of clients who are bereaved. Clients come to us wanting to have their stories heard, their lives validated—and there is something enormously valuable for them in them having their stories witnessed and hearing themselves tell them. A therapist who continues to work on him- or herself and to ‘go deep’ within to examine personal feelings of loss, is preparing to be the witness of the clients’ stories in an open and expansive way. By putting aside assumptions as far as possible about the nature, contributors, and anticipated grief stages essential for recovery, I believe we are offering our clients the best context in which those clients can experience life change, of which May 2011

bereavement is only one part. Loss and grief occur and are inevitable throughout our lives. Loss of opportunity, of youth, dreams, expectations, myths and ideologies force us to experience ourselves differently and to grapple with the unfixed nature of our existential selves. The more willing we therapists are—as existent humans as well as midwives of our clients’ transitions—to experience our lives as subjective co-constructions with our worlds, the more we can embrace the finitude of our existence and the angst of creating meaningful living without the backcloth of any objective rightness of how we should live. Throughout our lives, loss involves change and change involves loss. An article I wrote on this subject, entitled ‘Loss Involves Change and Change Involves Loss’ (http://lifemyths.com/ existentialarticles/loss-involves-change/), further explores how the experience of emigration, when viewed from an existential perspective, often gives rise to bereavement. Taking an existential perspective invites us, as therapists, to truly help both our clients and ourselves to live well lived lives. References Kübler-Ross, E 1969, On Death and Dying, Macmillan, New York

Tsia et al. 2005, ‘Age at Retirement and Long Term Survival of an Industrial Population’, British Medical Journal, UK Clare Mann Clare Mann is a psychologist, author, and professional speaker who helps psychologists and counsellors run successful and sustainable private practices. Through her teaching, workshops, and writing, she ensures therapists attract the clients they love to work with. Visit www.besttherapypractice.com for more details or call her on +61 2 9006 3336. Read Clare Mann’s blog at: www.thesydneypsychologist.com/blogs

You don’t want to write an academic paper?? We welcome more informal anecdotes from your practice. Topics could include: • A client who changed my practice (or my life) • The most valuable lesson I learned in the therapy room • Ideas that inform my practice • My most important therapeutic mistake • Some things I wish I knew before becoming a therapist Send your submissions (up to 600 words) to editor@capa.asn.au

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Professional Development

Recovering from Trauma, Dr Linda MacKay, PhD (Critical Psychology), has extensive experience as a clinician, trainer and clinical supervisor in working with individuals, couples and families, and a specialty in clinical work with those who have suffered severe trauma. She has particular expertise regarding what makes for healing after overwhelming life events where the common sequelae from such events include dissociation, self-harm, suicidality, depression and extreme anxiety. Dr Mackay, who is on the faculty of The Family Systems Institute, is a past executive member of the Australian and New Zealand Journal of Family Therapy and is currently an Executive Member of the Australasian Society for Traumatic Stress Studies. On 21 March 2011, Dr Linda Mackay presented a CAPA PDE about various factors that make for healing and recovery from trauma. She often referred to abuse sustained by children or young adults within their family environments. Dr Mackay has researched neurobiological and physiological factors and, in addition to other things, her research examined suicides, and other traumatic deaths that she encountered during her work in rural Tasmania. During her twohour presentation she attempted to address most of the complexities arising from trauma, which was a challenge by itself. As a Bowen’s follower, Linda used herself for her research—that is, she initially used her emotional responses, as well as her bodily sensations to explore her own family systems and her position within them. Murray Bowen’s textbooks invite all students to examine their own family and their own position in it, before attempting to deal with 32

clients. In my own training in different modalities, I was always reminded that a therapists need to “clear their own backyard before raking through anyone else’s”. What makes some people more likely to succumb under traumatic conditions whilst other will process a similar situation as a learning experience? Linda noted that earlier psychologists thought some people’s brains “held vulnerabilities”. We may remember that the diagnosis of PTSD was formulated only after Vietnam War veterans returned home and were experiencing emotional symptoms they could not control. Current research of PTSD experienced by soldiers returning from Iraq, is looking at their early attachment experiences in terms of Bowen’s theory. Linda noted that “trauma is not an event but the subjective reaction of a person to that event” (Stoic philosophy). To be considered ‘traumatised’, a person would have to have developed substantial symptoms related to that event and over the course of years (Van der Hart, Nijenhuis & Steele 2005 p. 414). Linda’s research of trauma and recovery is partially based on exploring the function of survival strategies. In humans, this process is similar to that of reptiles in that people would often ‘flight, fight or freeze’ as an automatic function of the brain stem and limbic system, where the amygdala becomes overactive and the hippocampus underactive. This leads to the person starting to ‘run before thinking’ as the overactive limbic system reduces the ability to think. This brings us to consider anxiety as either acute or chronic. Linda explained the difference between these two forms as ‘present/ real’ versus ‘projected/imagined’ threats. She also linked chronic anxiety to an in-utero experience through the hormonal changes and states that can

transfer from the mother to the foetus (Friesen 1997). Linda mentioned how Murray Bowen explained the family relationship of Togetherness and Fusion as elements of Harmony and sense of survival. She juxtaposed this to Autonomy, which allows multiplicity to coexist. However, Adaptation, a necessary element of survival and Anxiety reduction, can actually maintain the anxiety resulting in its becoming chronic. This occurs through conflict, accommodation, distance, symptom development in a spouse, over- or under-functioning and projection of anxiety onto a third person. Linda raised a question: “How can parents sacrifice their moral principles and ignore an abuse, allowing it to continue?” This happens when someone accommodates for a variety of reasons. Linda quoted J.P. Henry as stating, “People with abuse experience have the right side of the brain less active,” probably as a protective measure. On the other hand, tribal mind says, “If I have no family, I can be dead.” A form of ‘cut-off’ mental strategy comes in to alleviate the emotional experience. Linda noted that sometimes babies of anorexic mothers may become obese as a result of this unconscious processing. Linda referred briefly to neurology of Self-Harm as explained by Louis Cozolino (2002, pp. 264-5) in terms of separation and togetherness forces and the biochemical reaction of this process when endorphins provide analgesia from pain to allow us to continue to fight or flee and its impact on the modulation of emotional state. What part do we play in the maintenance of the problem and the sequence of who does what in their roles? Linda noted that Bowen Family Systems encourage people to think, to manage symptoms, using a variety of strategies such as EMDR, tapping, The Capa Quarterly


Healing a Life mindfulness, etc. as appropriate for client’s emotional state. She concluded that therapy for trauma needs to be multidimensional as is it is experienced on several levels over the time. References

Review by Juliana Triml

Systems Thinking, Routledge, New York&London

Henry, J & Wang, S 1998, ‘Effects of early stress on adult affiliative behaviour’, Psychoneuroendocrinology, 23, 863-875 Kerr, KB 2009, ‘Attachment Theory and Bowen Theory’, The Family Systems Institute Annual Conference: What differences do the differences make? June

Relational treatment of complex trauma’, Journal of Traumatic Stress, 18(5), 449-459

Porges, SW 2009, ‘The polyvagal theory. New insights into adaptive reactions of the autonomic nervous system’, Cleveland Clinic Journal of Medicine. 76, 86-90 Smith, Walter Howard Jr 2001, ‘Child Abuse in family emotional process’, Family Systems, 5(2), 101-126

 ozolino, L 2002, The Neuroscience of Psychotherapy: C Ford, JD, Courtois, CA, Steele, K, van der Hart, O, & Nijenhuis, ERS 2005, ‘Treatment of complex posttraumatic self-dysregulation’, Journal of Traumatic Stress, 18(5), 437-447

Kerr, M & Bowen, M 1988, Family Evaluation, Norton, New York

Friesen, PJ 1997, ‘Faculty case conference: Neurofeedback and the developing child’, Family Systems, 4(1), 63-83

MacKay, LM 2011 (in press), Trauma: The Making of a Viable Life, Blackfeather Publishing, Sydney

Juliana Triml is the CAPA NSW PD Coordinator.

Papero, D 1990, Bowen Family Systems Theory, Allyn & Bacon, Needham Heights, Massachusetts

If you have any suggestions regarding future professional development events, please contact her at: capa.pd@hotmail.com

Harrison, VA 2011, ‘Live Learning: Differentiation of self as the basis for learning’, In Bregman, OC & White, CM (Eds) 2011, Bringing Systems Thinking to Life: Expanding the Horizons for Bowen Family

Kuyken, W, Padesky, CA, & Dudley, R 2008, Collaborative Case Conceptualization, Guildford, New York.

Pearlman, LA, & Courtois, CA 2005, ‘Clinical application of the attachment framework:

van der Hart, O, Nijenhuis, E R S & Steele, K 2005, ‘Dissociation: an insufficiently recognised major feature of complex posttraumatic stress disorder’, Journal of Traumatic Stress, 18, 413-423

CAPA NSW Professional Development Events CAPA NSW members must complete twenty hours of approved professional development each year. To help members meet this requirement, CAPA is hosting PDEs on the following dates: Wednesday 15 June 2011 7.00 pm–9.00 pm PD hours: 2 Dr Alison Strasser Grief & Loss: A Grieving Self–The Loss and Search for Identity We, as humans, experience loss as part of our life cycle with its challenges of what it is to be human. Loss is seen as both a period of upheaval and a place for reflection, adjustment and change. It is a time to raise those fundamental human questions around purpose and meaning: our search for identity. The grieving process is a human response to loss that allows the person both to both separate and to seek personal meaning, challenging the familiar with the unexpected. As practitioners, we can facilitate this questioning and reflective process. As a philosophical approach, existentialism can lend some alternative insights into clients’ emotional and spiritual experiences as they journey through life’s numerous losses. Alison Strasser DProf (Psychotherapy & Counselling), MA, BA (Hons)
is Director of the Centre for Existential Practice. Alison has been instrumental in creating the existential curriculum for a variety of counselling and psychotherapy trainings in Australia. She is a practising psychotherapist, coach and supervisor, and former Director, Academic Programs, at the Australian College of Applied Psychology. Alison is co-author of Time-Limited May 2011

Existential Therapy and founder of the Australasian Existential Society. Saturday 13 August 2011 1.00 pm–4.00 pm PD hours: 4 Dr Gary Galambos Consulting Psychiatrist at St John of God Hospital, Dr Gary Galambos will be presenting on diagnosing/misdiagnosing Bipolar disorder type 2 and its implications. For Dr Galambos this is a topic of great interest and focus, due to the overlap of BPAD type 2 and depressive symptoms in patients with borderline personality disorders, traits and developmental trauma histories. 22 November 2011 7.00 pm 9.00 pm PD hours: 2 Bookings: (02) 9235 1500 or office@capa.asn.au Please book as soon as possible. Spaces are limited due to Occupational Health and Safety requirements. Cost: Free for CAPA members. $35 for non-members Venue: Crows Nest Centre, 2 Ernest Place, Crows Nest, Sydney (unless otherwise stated) If you have any suggestions for future PDEs, contact CAPA’s PD Coordinator, Juliana Triml, on capa.pd@hotmail.com CAPA is also exploring more convenient options for members in rural and regional areas. Please email the Regional and Rural Committee with your suggestions regional@capa.asn.au. 33


Member Profile

Erica Pitman I had thought I would like to be a doctor. However, in 1983, at the age of 16, I travelled to Malaysia as an exchange student with American Field Service (AFS) Intercultural Programs. I consequently returned to New Zealand (my country of birth) and eventually decided to train as a travel consultant (the world was far more interesting than spending my life studying). While attending technical college for travel training, I was intrigued by some students who walked around in pin-striped suits. I eventually found out they were training to be funeral directors. Somehow this sparked a fascination in me, probably related to my having experienced a number of deaths already in my short life. The death of my brother followed in 1989. I went on to spend eleven years in the travel industry, through to management level, and was awarded the prestigious title of New Zealand Travel Consultant of the Year in 1994. “What next?” was my question, which was answered very quickly: I’ll move to Sydney to study counselling, which was a path I had vaguely considered while studying travel but decided at that time that some life experience would be important before doing such work. My life experience also involved living with mental illness in my family so, naturally, I was drawn to working with families affected by mental illness. My personal and professional experience exposed me constantly to the ‘living grief’ that we experience when someone has a mental illness. 34

My work has also involved working with children of prisoners, young carers of family members with any disability, innovative service delivery using telephone group counselling, video conferencing, private practice counselling, supervising, group work and training. Still intrigued by the whole death and dying process I eventually decided that I didn’t want the hours of a funeral director, so I decided that becoming a funeral celebrant alongside my counselling work would be a great combination. In November last year, I had the honour and privilege of officiating at a dear friend’s funeral in New Zealand. Having walked through the death and dying process with her for two years (she had a brain tumour) I was reminded of the sacred space we are privileged to enter not only in our professional lives but also in our personal lives. Connecting with fellow human beings at this time of transition in their lives is an incredible experience. Seize the opportunity should it come your way. Erica is a registered counsellor (CMCAPA) (RMPACFA) and registered supervisor with an advanced diploma of applied social science from the Australian College of Applied Psychology (Sydney). She has certificate IV workplace training, certificates of management, funeral celebrant training and is a member of the Funeral Celebrants Association of Australia (MFCAA). Erica is the creator of the SMILES Program (Simplifying Mental Illness + Life Enhancement Skills) for children with a parent or sibling experiencing a mental health problem—internationally recognised as best practice by the American Journal of Orthopsychiatry 2004. Erica’s biographical profile was selected for inclusion in Who’s Who in the World 2011 featuring biographies of the most accomplished men and women from around the world and across all fields of endeavour. She is currently a Counsellor & the Manager of Interrelate Family Centre, Orange.

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A free service for CAPA NSW members, contact advertising@capa.asn.au Rooms for Rent Brookvale New building behind Warringah Mall, suit counsellor, coach, psychologist. Room available most days, half day or full day. Client parking available. Call Peta on (02) 9938 5860 or email jangrant@optusnet.com.au Crows Nest Modern, bright, fully furnished room and large, fully equipped group room available in an established practice on the Pacific Highway. Metered/free parking nearby. Half, full and multiple day rates available. Contact Eve on 0412 011 950 Crows Nest Well presented consulting room in brand new clinic located in the heart of Crows Nest. Excellent parking and public transport. Sessional and permanent rates. Also available: group space for up to 14 people. Fair rates. Please contact Sabina on 0419 980 923 or sabina@wellforlife.net.au Glebe Warm and inviting, well-presented consulting rooms available for reasonable rates on a permanent, weekly or part-time basis. Large, pleasant waiting room, good facilities and great location on Glebe Point Road in the midst of Glebe village. Public transport at the door and ample off-street parking. Contact Lee on 0407 063 300 Glebe Inviting and warm consulting room available for hire on Mondays and Wednesdays; other days negotiable. Spacious and welcoming waiting room. Easy access on St Johns Road, Glebe. Public transport at the door and ample on-street parking. Contact Gay on 0409 986 740 Lane Cove Rooms/room available to rent on a daily basis in a beautifully renovated health care clinic. Ideal for a Professional Health Care Provider. Flexible lease agreement. Unrestricted and ample parking. Please contact Peter on (02) 9427 1785 Lilyfield Bright, sunny, unfurnished room available at the Lilyfield Psychotherapy Centre, established practice. Very reasonable room rental. Convenient location close to public transport and cafes. Contact Jen Fox on (02) 9560 0719 or (02) 9799 3387 Mosman Beautiful practice room at the heart of Mosman, close to public transport and easy parking. Available on a daily basis with good rates. Please contact Eva on 0411 498 468 or eva@ardstrom.com.au May 2011

Parramatta Four airconditioned and well appointed counselling rooms and a group room are available at hourly casual rates (from $25) or on a permanent basis. Rooms are located in George St, Parramatta and room bookings can be made on our website www.lifexplored.com.au. Contact John Carroll on 0419703410 or john@lifexplored.com.au Sydney CBD Stylish consulting rooms in landmark Macquarie St building, in Sydney’s prestigious medical district. Polished wooden floors, air conditioning, waiting area, kitchen amenities and printer/copier/phone/fax. Bright, leafy outlook and nearby public transport. Opportunities for cross-referral and crosspromotion. Full day, half day and casual sessions. Photos available. Contact Susie on (02) 9221 1155 or beingcounselling@iprimus.com.au Woolloomooloo – CBD Two comfortable, spacious consulting rooms to choose from. One room complete with sandplay tray and figures. Large group/ workshop/training space also available. Close to transport and ample parking. Photos available on our website under Room Rentals. www.gloo.org.au Full day, half-day or weekend rental available for workshop venue. Contact Tanya on 0425240928 or email tanyadawson@iinet.net.au

Supervision – Penrith and Richmond Experienced supervisor and adult educator offers supervision for counsellors, group workers, community workers etc. Penrith and Richmond..PACFA Reg. Contact Jewel Jones on 0432 275 468 or email jeweljones@iprimus.com.au Web: www.jewel-jones.com.au Supervision – Disability and Sexuality Individual and group supervision for counsellors, group leaders and those supporting people with a disability or Asperger’s syndrome. Twenty years’ experience working in disability field; seven years in relationships and sexuality counselling and education including working with victims and perpetrators of sexual harassment and assault. CMCAPA. Burwood and Newtown. Contact Liz Dore on 0416 122 634 or lizdore@bigpond.com Web: www.relationshipsandprivatestuff.com Supervision – Newtown Available for those doing individual, couples and group work. Over twenty years of clinical experience. Accredited in Professional Supervision (Canberra Uni), Registered member PACFA. Contact Vivian Baruch on (02) 9516 4399 or email via www.vivianbaruch.com

Supervision – Brookvale and Glebe Experienced supervisor for counsellors and group leaders. Qualified trainer and supervisor, CMCAPA, Registered member PACFA. Call Jan Grant on (02) 99385860 or email jangrant@optusnet.com.au Supervision – Chatswood West Supervision for individual, couple and group work, including counselling, psychotherapy and coaching approaches. Flexibly designed to suit your needs. Over twenty years of clinical experience. Clinical Member CAPA/Reg. PACFA.Contact Gemma Summers on 0417 298 370 or email gemma@goodmind.com.au. Web: www.goodmind.com.au Counsellors/Hypnotherapists Just graduated and looking to go into private practice? Supervision and business coaching available to help you on your way. Also rooms for rent on sessional/permanent basis. Contact Lidy@northernbeachescounselling.com.au or phone (02) 9997 8518 or 0414 971 871 Supervision for working with Adolescents and Parents – Coogee and telephone Individual and group supervision for counsellors, educators, allied health workers, group leaders and parents. Fifteen years in private practice as psychotherapist/counsellor; eighteen years working with pre-teen/teen girls and their parents,addressing developmental issues and popular culture/media’s impact on girls’ body image. Registered clinical member PACFA. Contact Shushann Movsessian on (02) 96654606. Web: www.shushann.com and www.letstalkgrowingup.com.au Supervision Experienced supervisor. Registered member PACFA. Accredited supervisor with Australian Association of Relationship Counsellors (AARC). Available for psychotherapists, counsellors and group leaders. Caringbah. Contact Jan Wernej on (02) 9525 4434 or email janwernej@optusnet.com.au Counselling, Psychotherapy and Supervision For personal and professional development, self-care and mentoring. Thirteen years’ experience in private practice. PACFA Reg.20566. Location: Mosman. Contact Christine Bennett on 0418 226 961 or email christine@caring4couples.com.au Web: www.cb-counselling.com.au and www. caring4couples.com.au

Mental Health Connect Essential Training for those who are working on an ongoing basis with people with mental health issues.  23-24 June 2010. Details www.mhcc.org.au 

or 02-9555 8388 ext 106

35


online Visit The CAPA Quarterly’s blog for the latest journal updates, bonus articles and links to related resources.

Check out the PACFA website at

www.pacfa.org.au for an update on all the things that are current events

http://thecapaquarterly.blogspot.com

Call for Contributions

November 2011 – Working with Addictions

With the prevalence of drug and alcohol in the news, the word ‘addiction’ tends to conjure images of chemical dependence of one sort or another, but we as humans can become addicted to many other things, both physical and behavioural. Addiction is a phenomenon that touches us all in one way or another, and researchers are continually searching for ways to help people cope with and overcome their addictions. Counsellors and therapists are on the front lines in such battles. Join the discussion by sharing your experiences and observations of the addictions confronted by your clients and how they did or did not deal with them effectively with your contribution to The CAPA Quarterly’s November 2011 issue. Peer reviewed papers due by: 1 July

Non-peer reviewed due by: 1 August

February 2012 – Open Forum Do you have an insight to share about the practice of therapy, but haven’t been able to align it with any of the announced themes for The CAPA Quarterly? Now we have an Open Forum each February so that articles on any aspect of therapeutic practice can be welcomed. Share your knowledge with your peers and open up discussion on topics of importance to you. Peer reviewed papers due by: 1 October Non-peer reviewed due by: 1 November

May 2012 – Sex In our multicultural society and global community, many people have personal and societal challenges around sexuality —sexual attractiveness, sexual performance, sexual orientation, and sexual identity as well as sexual abuse. Such issues often find their way into the therapist’s rooms as clients search for clarity and resolution, comfort and confidence. Sex can be a tricky subject, but it is fundamental and can arise in many contexts for both children and adults. Sexual issues can also be buried —hidden behind other issues more amenable to revelation and discussion. Clients, may suffer anxiety or depression, or may even act out violently in response to unresolved sexual issues of one sort or another. Some therapists specialise in sexual issues; others prefer to avoid them. Does best practice necessarily include dealing with the subject of sex? How does a therapist identify such issues when the client doesn’t voice them? How are the varieties of sexual issues best approached and discussed in therapy? Join the discussion with a contribution to the May 2012 issue of The CAPA Quarterly. Peer reviewed papers due by: 1 January     Non-peer reviewed due by: 1 February

Deadlines are for articles that have been accepted, not for new ideas.

Please send expressions of interest as soon as possible, to maximise your chance of inclusion. Contributor Guidelines: http://thecapaquarterly.blogspot.com/p/contribute.html or contact editor@capa.asn.au

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G de ain ve pr lop of me ess nt ion po al int s

Professional Development Workshops May – November Calendar, 2011 Working with Children and Families from an Integrative Approach Child and Adolescent treatment brings certain challenges in terms of the complex systemic processes that surround and affect the two-person experience. Dates: 21st May, 2011 Cost: $275.00 (inc. GST)

Transactional Analysis 101 Weekend Workshops This two day Introductory Workshop is for individuals interested in understanding the theory and practice of Transactional Analysis (TA). This workshop is a comprehensive experiential introduction to Transactional Analysis and its application. The application of Transactional Analysis covers a broad spectrum of uses for people working with the public. Dates: 4th to 5th June, 2011 and 12th to 13th Nov, 2011 Cost: $275.00 (inc. GST)

The Critical Incident Approach in Supervision This supervision seminar is another part of the ACIS supervision program on methods of supervision. The Critical Incident Approach, sometimes referred to as the ‘open space’ approach, looks at the broader thinking of supervision, i.e. diagnosis, multilayered issues and problem solving. It is probably the most misunderstood of techniques, as contracting for outcomes is not popular; however, association and interpretation are. Curiosity in exploring and the zeal for playing with meaning and potential meaning are central in this approach. Dates: 11th and 12th June, 2011 Cost: $550.00 (inc. GST)

The Edge Workshop Where the Edge of the Psychotherapist meets the edge of the client - working in the realm of uncertainty A great deal is written and spoken about how the therapeutic relationship is the most curative factor in our work. Many of us have been well trained in counselling and psychotherapy theories and practice. However, this does not salvage us from those moments where we come face to face with our clients and are left with feelings of helplessness and hopelessness. Dates: Group 2: 23/07/11, 03/09/11, 15/10/11, 26/11/11 Cost: $275.00 (inc. GST) a day x 4 = $1,100 for the 4 days

Diagnosis and Treatment Planning The astuteness of our practice lies in how we think about who we work with and what the therapeutic plan is? The therapeutic relationship is one of the most curative factors in the work psychotherapists and counsellors do. This broad statement can be interpreted in many ways. Each therapeutic relationship and journey is based on a clinical understanding of who is sitting with us and how the practitioner is impacted. To know this is to have an indepth understanding of diagnosis and treatment

planning. In this didactic and experiential workshop we will explore: Philosophies on Diagnosis and treatment planning, Different theories and approaches to diagnosis and treatment planning and advantages and disadvantages of diagnosis Date: Sunday 21st Aug and Monday 22nd Aug, 2011 Cost: $550.00 (inc. GST)

The Organisational Role Analysis Approach This seminar is part of a program, which identifies four different approaches to supervision: the contractual approach, the relational approach, the open space approach and the role analysis approach. The organisational role analysis approach is probably the least known approach. In this approach it is not about the individual and also not about the system, but about the overlap between the two. The role is the central concept, where individual and system meet, with attention for the unconscious images. This approach is specially suitable for supervisors, psychotherapists and consultants who work with individual clients and their organisational systems Date: 3rd and 4th September, 2011 Cost: $550.00 (inc. GST)

A Practical Supervision Workshop 101 This workshop is specifically designed for practitioners who provide supervision to the professions of counselling, psychology, psychotherapy and social work. The areas covered will include philosophy, approaches, definitions, ethics, practice, models, relationship, contracting and more. The role of supervisor is often taken on as the natural progression of seniority as a practitioner developments. A belief is that as we become more experienced practitioners we are able to guide and assist other practitioners in their work. Contrary to popular belief this is frequently not the case. Supervision is a complex tool and requires training. Supervision is the gate-keeper to professional ethics, practice and guidance. Given with training and awareness, our supervisees flourish. This workshop is designed to assist practitioners in giving their supervisees the best possible outcomes while enhancing the process for the supervisor. Dates: 29th and 30th October, 2011 Cost: $550 (inc. GST) Venue: All the abovementioned workshops are held at 3 Church Street, Waverley

For further information and courses visit our website: www.acissydney.com.au

3 Church St, Waverley, NSW 2024 P: (02) 9386 1600 E: info@acissydney.com.au W: www.acissydney.com.au


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Journal of the Counsellors and Psychotherapists Association of NSW Inc http://thecapaquarterly.blogspot.com ABN 50 035 123 804 If undeliverable, please return to: CAPA NSW Suite 134 / Level 13 183 Macquarie Street Sydney NSW 2000 Phone: +61 2 9235 1500 Email: office@capa.asn.au Web: www.capa.asn.au Changed your address? Please notify CAPA NSW

Looking for a Conference? To include your free conference listing, contact editor@capa.asn.au

Some prominent psychology conferences in Australia and elsewhere this year are listed below. For a more comprehensive list of psychology conferences worldwide, visit http://www.conferencealerts.com/psychology.htm

26-27 May 2011 Johannesburg

1st International Congress of Coaching Psychology: The Southern Hemisphere Event

www.siopsa.org.za/asp/interestgroups/consulting.aspx

18-20 May 2011 Sydney

Australian Society of Rehabilitation Counsellors (ASORC) National Conference ‘Challenging Perceptions’

www.asorc.org.au

16-17 June 2011 Brisbane

4th Annual Happiness and Its Causes Conference ‘The Psychology of Happiness & Goodness’

www.happinessanditscauses.com.au

22-25 June 2011 Miami, USA

9th International Conference on Grief and Bereavement in Contemporary Society ‘Making Connections: Dying, Death and Bereavement in the Global Community’

www.adec.org/conf

27 June-1 July 2011 Thessaloniki

14th Biennial Conference of the International Society for Theoretical Psychology: Doing Psychology Under New Conditions

http://www.researchraven.com/conferences/category/ clinical-psychology.aspx

28-30 June 2011 Paris

International Conference on Psychology and Psychological Sciences

http://www.waset.org/conferences/2011/france/icpps/

4-8 July 2011 Istanbul

12th European Congress of Psychology

http://www.ecp2011.org/

11-13 July 2011 Adelaide

4th Australian Conference on Spirituality & Health ‘Forgiveness, Spirituality & Health: From Brokenness to Wholeness’

www.spiritualityhealth.org.au/page.asp?parentid=69

13-15 July 2011 Salvador, Brazil

10th International Narrative Therapy and Community Work Conference

www.dulwichcentre.com.au/conference.html

12-13 August 2011 Brisbane

Cult Information and Family Support (CIFS) National Conference ‘Assessment, Diagnosis and Treatment’

www.cifs.org.au/successful.php

24-26 August 2011 Gold Coast

12th International mental Health Conference ‘Personality Disorders: Out of the Darknesss’

www.anzmh.asn.au/conference2011

24-28 August 2011 Sydney

6th World Congress for Psychotherapy: ‘World Dreaming’

www.wcp2011.org

23-27 August 2011 Bergen, Norway

15th European Conference on Developmental Psychology

http://www.ecdp2011.com

15-17 September 2011 Adelaide

The Cutting Edge: Integrating Practices, People & Professions

http://sash.asn.au

19-21 September 2011 Oxford, UK

1st Global Conference: Gender and Love

http://www.inter-disciplinary.net/at-the-interface/genderand-sexuality/gender-and-love/

1-3 October 2011 Cambridge, CA, US

Psychology and the Other

http://www.psychologyandtheother.com

27-29 October 2011 Sydney

Canadian Grief & Bereavement Conference

http://www.griefconference.org

CQ 2011-2 Death & Bereavement  
CQ 2011-2 Death & Bereavement  

The Urge to Die ~ David Webb Suicide: The Elephant in the Room ~ Ceiny Maybury Conscious Dying ~ Maneesha James in conversation with Chris W...

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