The CAPA Quarterly
Issue One 2012
Therapist Transparency Philosophy Counselling Indigenous Australians
Shyness Journal of the Counsellors and Psychotherapists Association of NSW, Inc.
Preliminary conference announcement The Australian Centre for Integrative Studies
pr ofe Gai ss n 1 ion 8 h al ou de rs ve of lop me n
Allies and Enemies
The role of real and metaphoric siblings in our psychological worlds 23rd to 24th March 2012
Keynote Speaker - William Cornell Historically our theory has been influenced by the interpretations of unconscious processes. As a result our work, theories and methodologies have predominantly explored the vertic al transference (parent to child). Whilst this emphasis remains central and significant, we also recognise that, when working with external systems, we still tend to focus on the individual. This conference therefore wishes to extend our focus and address the impact of siblings and how these relationships translate into horizontal transferences (sibling to sibling). A focus on siblings, and attention to the horizontal transference, encourages us to broaden our lens from the individual to the collective. This conference will address and explore some of the following topics: • The nature of the horizontal transference within our psychological work • The psychological dynamics of siblings and how we can include this more consciously in our therapeutic work • The impact of siblings on both the personal and collective level • The metaphor of “the sibling” within a political context and how this affects our work This is an integrative conference, bringing together different modalities but while being held through the lens of relational theories, philosophies and methodologies. The international keynote speaker William (Bill) Cornell MA, TSTA studied behavioural psychology at Reed College in Portland, Oregon, and phenomenological psychology at Duquesne University in Pittsburgh. He is a teaching and supervising transactional analyst, body-centred and relational analyst.
Bill is a prolific author. He was the editor of the ITAA newsletter, The Script for 10 years and is the co editor of the Transactional Analysis Journal. He has written more than 40 journal articles and 10 book chapters. He is the editor of the Healer’s Bent: Solitude and Dialogue in the Clinical Encounter, a collection of the psychoanalytic writings of James McLaughlin for which Bill wrote the introduction. With Helena Hargaden he is co-editor and author of Transactions to Relations: The Emergence of Relational Paradigms in Transactional Analysis published by Haddon Press. Bill brings a high level of integration to his thinking, writing and clinical practice. He is passionate in the areas of diversity and inclusivity and is a man who walks the talk. Bill maintains an independent private practice in psychotherapy, consulting and training in Pittsburgh, PA. He also spends considerable time in Europe leading training groups in psychotherapy. He is also the author of Explorations in Transactional Analysis and the 2010 recipient of the Eric Berne Memorial Award. Visit our website to register your interest and receive updates as this ground-breaking conference takes shape. Website - www.acissydney.com.au Email - email@example.com Conference Convener: Jo Frasca
3 Church St, Waverley, NSW 2024 P: (02) 9386 1600 E: firstname.lastname@example.org W: www.acissydney.com.au
Editorial For the first time since its inauguration in 2006, CQ does not have a specific theme for the issue. A number of times we have had to decline or defer offered articles worthy of publication because they did not fit in with the assigned themes of the issues for the year to come. We have now instituted a policy of classifying each February issue as an Open Forum. At last those authors who’ve wanted to contribute but whose timing has not aligned with the nominated themes have this place to make their voices heard. We are pleased to offer this opportunity for greater diversity in the articles we offer to our readers. It is thus with delight that we present here articles ranging across a broad swathe of topics that find their way into the therapists’ rooms. We begin with Philosophy: Dr Steven Segal reminds us of the importance of philosophical thinking and its relationship with mood states and the way we understand experiences of everyday life (Page 8). Pedro Campiao presents a valuable review of the scholarly literature, addressing the ‘therapeutic alliance’ and the ‘therapeutic relationship’, how these terms are conceptualised in the world of psychotherapy, and how they relate to each other, exploring some relational psychotherapy perspectives and providing greater clarity in reading the literature (Page 12). Anthony Dillon and Phil Harker present a perspective on counselling indigenous Australians that diverges from the prevalent view, holding that such clients should be seen as people first, before focussing on their cultural differences from the mainstream of the larger Australian society, a key theme being the importance of selfesteem, no matter the cultural matrix (Page 18). Dr Malcolm Pearce leads us toward the ‘heaven-sent supervisor’ (How enticing is that?), delineating the factors to be weighed in choosing the supervisor that is ‘a good fit’ for the individual therapist or counsellor (Page 22). Toni Baily examines the debate leading up to DSM-V reclassification regarding whether Social Phobia (SP) and Avoidant Personality Disorder (APD) are discrete conditions or the same condition with different levels of severity, recognising ‘shyness’ as being part of the course of both conditions (Page 26). Dr John Woodcock presents an extensive response to our August 2011 issue on Virtual Therapies, presenting an interesting and insightful look at the relationship between psychotherapy and cybertechnologies and what, in his words, “our technological civilisation is doing to us, in contrast with what we think we may be doing with technology as psychotherapists” (Page 28 ). Readers take note that all feedback is welcome, and in addition to responsive articles, we do accept Letters to the Editor if only our readers would send some! Last but far from least, we have a new columnist, Jewel Jones, who presents in her inaugural column a discussion about when, February 2012
whether and how much it is appropriate for therapists to ‘reveal themselves’ to clients in the course of therapy. Jewel is also featured in our Member Profile for this issue, as a way of introducing her to our readers. We look forward to her regular contributions. I also take great pleasure in introducing two new members of our editorial staff: Deputy Editor Roberta Fonville and Copyeditor Elisabeth Thomas, both members of the Society of Editors (NSW), who are welcomed in more detail on Page 3. Their assistance is enthusiastically welcomed and deeply appreciated. We hope you are pleased with the new CQ logo on the cover, the culminating piece of the ‘new look’ for the journal that we have built gradually over the past year. Both content and visual appeal have been raised to a new standard, and we are quite proud of the upgrade. We have retained the same artist for our covers as his images always speak so well to our chosen themes. Special thanks go to cover illustrator Jim Frazier for allowing us to use his images in a larger format without raising the licence fee. Bless him. The main CAPA website, www.capa.asn.au, is also being redeveloped into a much richer and more useful tool for information and interaction. CQ contributor guidelines and advertising rates and specs will be found there; in the interim, that information can be obtained from email@example.com, firstname.lastname@example.org or email@example.com, depending on the nature of your enquiry. We apologise for any inconvenience this time off line may cause. As always, this journal is for you, our valued members, and I enthusiastically encourage your active participation in the professional dialogue and sharing that this journal provides. Please have a look at the upcoming themes announced on Page 36 of this issue and have your say on the topics that interest you. Journal articles are, by the nature of page space, limited, and early contact with me improves the chances of your contribution being included. Dialogue is welcome and encouraged. If you’d like to contribute to future issues, please contact me at firstname.lastname@example.org.
Laura Daniel Editor Laura Daniel, BA, JD, is a Sydney-based 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.
CAPA NSW Executive and Staff President Jeni Marin email@example.com Vice-President Tara Gulliver firstname.lastname@example.org Secretary Gina O’Neill email@example.com Treasurer Mary Jane Beach firstname.lastname@example.org Ethics Chair Tara Gulliver email@example.com Membership Chair Beate Zanner firstname.lastname@example.org Regional and Rural Liaison Chair Sharon Ellam email@example.com Professional Recognition Chair Barry Borham firstname.lastname@example.org PD Coordinator Juliana Triml email@example.com Office Coordinator tba firstname.lastname@example.org
1 Editiorial CAPA News 3 3 4
From the President’s Desk Welcome to New Editorial Staff CAPA News ~ Sharon Ellam
Regional and Rural Report ~ RnR Committee
Features 8 12
18 22 26
The Yearning for Philosophy Today: Its Transformational and Therapeutic Value ~ Steven Segal The Therapeutic Alliance, the Therapeutic Relationship, and the Relational Turn in Psychotherapy ~ Pedro Campiao Counselling Indigenous Australians: Human Commonalities and Self-Esteem ~ Anthony Dillon and Phil Harker In Search of the Heaven-Sent Clinical Supervisor ~ Malcolm Pearce Shyness as a Precursor to Social Phobia & Avoidant Personality Disorder ~ Toni Bailey
First Person 28 The Technological World: Has Psychotherapy Caught up? ~ John C. Woodcock In the Therapy Room
Administrative Assistant Freddy Ortega email@example.com
30 Revealing Ourselves … or not? ~ Jewel Jones
CQ: The CAPA Quarterly
32 Acceptance & Commitment Therapy: Six Core Processes ~ Review by Juliana Triml 33 Professional Development Events
Editor Laura Daniel firstname.lastname@example.org
Deputy Editor Roberta Fonville email@example.com
34 Jewel Jones
Copyeditor Elisabeth Thomas
Advertising Coordinator tba firstname.lastname@example.org
36 Calls for Contributions 36 Ad Rates 37 Classifieds Back Cover Conference Calendar = Peer reviewed CQ: The CAPA Quarterly respectfully acknowledges the Cadigal 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.
Cover art by Jim Frazier/Stock Illustration Source. Design by Sarah Marsden for Unik Printing.
© CAPA NSW 2011. Copyright is held with CAPA NSW and individual authors. Please direct permission requests to the editor. Opinions expressed in CQ: 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 CQ: 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 CQ: 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.
CQ: The Capa Quarterly
From the President’s Desk This issue of CQ heralds yet another year. Last year just whizzed by, did it not? In no time it will be Easter 2012. A New Year tends to encourage us to self-reflect and establish goals. I guess by now many of us have either fulfilled (or forgotten) our New Year Resolutions. Mine are to see more of my grandsons and to ease up on the pressure of teaching and counselling. A friend is urging me to take up Yoga, another friend is suggesting we go back to our Tai Chi practice, and I have promised myself to stick to my almost neglected meditation and mindfulness practice and not to cancel social pleasures because of ‘obligations’. I trust you all have made resolutions about looking after yourselves. We can hardly be role models in encouraging our clients to look after themselves if we don’t do likewise. My own self-reflection took me back almost twenty years, to a plaque I once saw on the outer wall of a Society of Friends (Quaker) Meeting House. I was so taken with it, I wrote it down and have referred to it many times over the years. I was a fairly new counsellor at the time and the wording really resonated with me:
I move in quiet circles where amazing and transforming events take place.
As counsellors and psychotherapists, is this not what we do? Whether we are devotees of Carl Rogers, the Existentialists, Post Modern Brief Therapies, or any one of numerous modalities, our goal is to support our clients to change their lives or their attitudes towards their lives. We don’t tell people what to do, rather we are here to guide and trust that “amazing and transforming events” will take place. This recollection got me ruminating on the long history of our profession and the precipitous changes that have taken place in Western societies since the days of Freud, Jung, and the early Behaviouralists. Once upon a time we either shared our pain in the family setting or simply swallowed it. In villages, going back to prehistory, there were wise men and women who handed out advice along with herbs and potions. Today we use a range of counselling and psychotherapy techniques to assist clients with a variety of life issues. We evaluate what feelings, expectations, perceptions, thoughts and behaviours our clients bring into their very first sessions with us. We determine what they are hoping this experience will be for them, and we find out what they expect to achieve from the process. We help them to divest themselves of the hurt and pain that they are carrying. As counsellors and psychotherapists, we help clients plan a course of
action for achieving their goals. It is a huge responsibility we have, and an even greater privilege to be allowed to walk with our clients through the corridors of their lives. While we support our clients, it is also important that we support our profession, and I am always impressed by our hard-working Executive members and the tireless CAPA committees who support us. Each committee has a complement of five Clinical Members and the potential to engage two Intern Members, and we encourage all members, Clinical or Intern, to check out the committee for which they might have an affinity, with a view to serving, currently or in the future. Without your help, we cannot continue to be the largest state-based counselling and psychotherapy association in Australia, so we urge each of you to contact any member of the Executive if you would like to know more about any committee. We are particularly keen to get people on board who may be interested in stepping up, at a later stage, to the Executive. This is true whether you practise in the city or in any of our regional and rural areas. The Executive would like to apologise to any members whose membership renewals or upgrade requests for 2011 were held up. Due to a staffing issue there was a delay in processing some applications. However, thanks largely to the dedication of Membership Chair Beate Zanner—who sacrificed weekend after weekend—most of the bottleneck was dealt with in record time. Planning is already under way for the CAPA 2012 Conference. The theme, broadly, is Diversity, and it is shaping up to be a super event. Although the conference will be marginally later than the 2012 cutoff date for PD credits, certificates will be processed and handed out in hard copy at the end of the conference and attendance will be counted for this year’s PD requirement. All the best for successful practices and happy lives throughout 2012 and beyond.
Jeni Jeni Marin President email@example.com
Welcome to New Editorial Staff
Roberta Fonville, BA, Dip. is a freelance editor and graduate of University of Sydney and Macleay College. Roberta is a keen student of art history and languages, particularly French and Spanish and travels every chance she gets. Trained also as a Cordon Bleu chef, she balances her passion for cooking with an active lifestyle—cycling, kayaking, running and the gym. She is the editor of online cycling publications—Chain Mail and Bike North News.
Elisabeth Thomas, BA(LibSci) AALIA(CP) ALLA, based in Sydney, has an extensive and varied career as a librarian and researcher, particularly in the law, finance, engineering and education fields. With a long-standing love of language and a keen eye for detail, Elisabeth writes, proofs and edits numerous in-house materials. Branching out into work on information profession and other journals, Elisabeth enjoys combining library life with freelance work in editing and indexing.
CAPA Participates in Inquiry into Mental Health Issues Arising from Mining On 7 October 2011, Sharon Ellam and Maxine Rosenfield attended the Rural Mental Health Network Meeting at the NSW Farmers’ Association office in Sydney. This is a quarterly forum where agencies and organisations meet to discuss, plan, and share strategies to combat the growing problem of mental ill-health in rural communities. CAPA was a founding member when this network was first formed, following the Drought Summit in Parkes in May 2005. Krystal Lockhart and Maxine Rosenfield were involved in this from the outset—the longterm plan for CAPA being that this is a forum for lobbying on behalf of members and the profession. At the previous meeting, while it was acknowledged that the original purpose of the network (mental health planning and lobbying with regard to the drought) has eased, other issues have come to the fore. CAPA is now involved in a review of the original Terms of Reference (called the Blueprint), a process that will take six months or more to complete. A critical issue that has immediate concern for many CAPA members is mining and coal seam gas (CSG) exploration and production. Presently, 70% of NSW is covered by mining & CSG titles. The NSW Farmers’ Association is taking 7-8 phone calls per day from distressed farmers or rural community members. Briefly, current NSW law allows an exploration licence to be granted over anyone’s property without that person knowing or being consulted in the approval process. The first time that most farmers become aware that a licence over their property has been granted is when an exploration or mining company representative knocks on their front door asking for access to the property. The legislation allows the farmer only the right of negotiation over that access, not denial of access. NSW Farmers has identified six ‘hotspots’ in NSW from a mining and CSG perspective —Hunter, Gunnedah, Moree, Southern Highlands, Lockhart and the Central West. At the last meeting, Sharon was involved in the formation of a submission to a NSW Upper House Inquiry into CSG. A number of regional hearings have already been held, but the first Sydney-based hearing for the Inquiry will be 17 November 2011. NSW Farmers will be giving evidence at this hearing. At the forefront of this review is the increasing land use conflict, particularly between mining/CSG and farming,
where large swathes of agricultural land and water resources are overlaid with exploration licences. NSW Farmers postulates that this conflict, combined with resulting uncertainty, and the often insensitive nature of negotiations when companies seek access to farmers’ property, is leading to increased stress and anxiety across mining/CSG-affected communities, with farmers reporting that they feel disempowered and overwhelmed. Loss of part or all of their land is a reality, and it could potentially be rendered unsuitable for their accustomed use of it. Environmental effects—including degradation of air and water quality—is also a real concern for communities. At a recent seminar, Sharon met Judith Leslie, a counsellor from Bulga in the Hunter Valley, who agreed to provide information on how the above issue is impacting her and her community. Bulga is a community of old families and people who have sought and enjoyed the peace and tranquillity of the Hunter Valley. Dairy farming was once the staple activity. The landscape is a vista of beauty with wildlife, birds and native vegetation. It’s part of the wine country and is home to important historic routes including part of the original Great North Road, which many associate with early convict labour. Within the last two years, the community of Bulga has been dramatically impacted by expansion of open-cut mining. Judith described being awakened at 3am by the sound of the roaring engines of the ‘mining mega-trucks’. At night, the sky is lit up by the lights of a 24-hour operation. Phone calls to the Environmental Hotline during the night are met with little response. Intolerable dust permeates the air, invading their homes, and their lungs. The Bulga community is currently fighting a submission from the mining company to extend the open-cut operations to within 2.6km of Bulga Village (known as the Warkworth Extension Project). This extension will include the loss of roads, land, the convict trail, Aboriginal sites, native land as well as a natural landform ‘Saddle Ridge’, which previously provided at least a protective buffer for the community. Judith reports that the current mining licence has been granted ‘in perpetuity’—a very long time—however, within the wording of the documents regarding this submission, there is much ambiguity and there has been as well frequent failure by the mining licensee to follow conditions clearly set out therein.
CQ: The Capa Quarterly
Conflicts with NSW Rural Communities Judith cites an example where the mining company has failed to adhere to previous provisions from a 2003 NSW Department of Planning Agreement. The community has apparently been told that the mine would ‘provide a better offset elsewhere away from Bulga [i.e., move the whole town to another place] in order not to sterilise valuable coal deposits’—in other words, the value of the coal is greater than the value of the community remaining in their own homes. Community members are arguing for the mining to go underground. The mining company argues that mining underground would produce a lesser yield and smaller profits. Breaches of the current mining conditions, including the maximum allowable levels of noise and dust, occur daily, according to Judith. She reports that, until two years ago, one could live in Bulga with the mining close by. Apart from blasting, the noise was tolerable, and people accepted that mining was an important part of the prosperity of the community. They now fear for their health (water, noise and dust pollution) and the sustainability of the place they call home. The degree of distress in this community is extremely high. Judith says that it affects both her personally and her clients. With this land use conflict potentially affecting 70% of the state, the issues it raises are certain to impact on the work of many regional counsellors. NSW Farmers is acting by assisting communities in practical terms to stand united in their fight to protect their homes and livelihoods. Any CAPA members who have a story to share about this, are encouraged to write it up and send it to Sharon. This issue isn’t going away. As the CAPA representative at the network meetings, Sharon will continue to liaise with and speak on behalf of affected members, as well as communicating to all members news of progress. As with Krystal and Maxine before her, she’ll continue to forge links with other organisations and raise the profile of the important work of counsellors and psychotherapists and their essential contribution to community mental health in NSW.
Code of Conduct for Unregistered Health Practitioners
As counsellors and psychotherapists, we are legally required to display two documents in our practice(s): • t he 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 ‘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 •C lient Confidentiality and Privacy and Relevant NSW and Commonwealth Legislation • Duty of Care
Sharon Ellam firstname.lastname@example.org
• Workplace Bullying and Violence • Mandatory Reporting
Membership Total as at 1 December 2011
Clinical Members Associate Members Intern Members Provisional Members Student Member Affiliate Members Special Leave Honorary Life Members Total Financial Members February 2012
411 0 178 0 75 28 3 2 697
• Keeping Track of Paperwork • I nformation for Counsellors who have been served with Subpoenas •C omplaints 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.
Regional and Rural Report
Counselling–A Regional Snapshot CAPA is reaching out to regional and rural Counsellors and Psychotherapists through the evolving efforts of its RnR Committee. The committee was formed two years ago to give regional issues more focus, drive and acknowledgment. CAPA’s intention is to increase connectedness amongst members who may normally work alone, who work at a distance from peers and the association’s urban administrative centre. We talked with three members about their experience of being Counsellors in regional NSW, about CAPA’s organisation of regional Professional Development Events (PDEs) and the role that CAPA plays in supporting them professionally. We spoke with: Heidi Tornow from Wollongbar, on the Far North Coast, who has been a Counsellor for eight years Brian Edwards from Forresters Beach, on the Central Coast who, in his own words, has been working “a very long time”—twenty years in private practice Sharon Ellam, an original member of the RnR Committee, who has been working as a Counsellor in the Lake Macquarie area for about six years. These three members attended the May 2011 PDE held in Port Macquarie: Heidi and Brian participating, and Sharon as an organiser and attendee. From their conversations, a snapshot emerged of some of the issues and challenges that may be unique to regional members, together with their experiences of being CAPA members. Challenges for Regional Therapists One of the significant themes emerging from the interviews was the isolation experienced in working regionally. Geographic isolation brings unique problems: few peers close by, insufficient client numbers to accumulate the required number of counselling hours for Clinical status, difficulties finding a supervisor within an acceptable distance, finding enough work to pay the bills, and meeting the financial burden of professional development. If working only in private practice, without other income streams, these problems are even more critical. Heidi summed this up well when she said, “It’s huge —it’s huge! If I had to rely on private practice to get my hours, I’d still have years to go! I can’t see any way of getting your hours other than working at least part time for an organisation ... and, again, it’s the financial thing too—supervision doesn’t come cheap either! If I had to pay that and annual membership, I simply couldn’t afford it. On top of that, you can’t charge what you can in the city.” Heidi said that working for an NGO covers all of her living and professional costs. She said, “I wouldn’t be able to be in private practice otherwise.” She also said that working for an NGO also allowed her “to be part of a team”, which she feels is important. Private practice has been made especially challenging by the supply of services provided through Medicare eligible practitioners. This highlights the economic and professional identity issues associated with the mainstream 6
extension of mental health services being accessed through the public health system. Of this, Brian said, “Most counsellors in country areas survive by being connected to some agency or some workplace or some church group that does counselling. You’re very, very limited in the number of people who come to you in private practice, and with the advent of the Medicare scheme where doctors refer to psychologists. I know one guy who lost 90% of his clients when the Medicare Rebate (for psychologists) came in.” Further challenges, which were linked to the central theme of isolation, included limited access to referral networks, either to refer to or to receive referrals from other health professionals. This seemed to be one of the factors that make it hard to build up a private practice. These members also cited the added costs incurred for travel to attend professional events or supervision meetings. This expense is proportional to distance from an urban centre, together with a higher time cost to attend professional events (including days off work to get there). Heidi described briefly some of the costs associated with attending a small PDE in Brisbane. She estimated that the cost of a workshop ($150) was increased by a night’s accommodation with food ($300), travel costs ($100) of a five-hour trip each way, and the cost of a day’s pay if it’s during the week. She said, “When I see that people can go to Crow’s Nest for $30 for 2 hours, I am green with envy! If I came, I would have to take a day off work PLUS the costs of travel!” Another challenge cited was a small population from which to draw clients, as well as the hesitation of clients to travel outside their local township for services. There is also a need to subsidise income earned from psychotherapy practice with other forms of work. Brian was the exception to this, having worked for a long time and having thus built up a good referral network, including organisations for which he had worked in the past. Brian commented: “If you go into private practice, I think it takes from three to seven years to get going. A lot of people give up after about three years; but after three years, and as networks build and connect with each other—to be in associations and to be a part of something [like CAPA]—that feeds me, that nurtures me, and it enables me to check on myself.” Access to supervision was also an issue, with scant or absent local availability of experienced supervisors, plus technical and utility service limitations when attempting to access supervisors through Skype or phone. Technology promises a new level of connectivity and choice when it comes to peer support and supervision, allowing people living regionally to have a much wider choice of supervisors; however the technological side has not caught up and is patchy in regional areas. As an example of this, when trying to do the interviews via Skype, Jane Ewins had constant problems with lost connections. Skype appears to be the preferred choice, if it works, as it could allow for face-toface meeting via video, plus allowing supervisees to keep costs to a minimum. CQ: The Capa Quarterly
Commenting on online professional development, Heidi said she would access professional development via internet alone if she could no longer afford to attend face-to-face. She prefers the ‘connection’ of being physically present with others. For this reason she often travels to Brisbane to attend courses, which is a ten-hour round trip in travel alone. “Practically all the training I go to, I have to go to Brisbane. There’s nothing closeby—or not much.” The Positives Of course there were perceived benefits to being a psychotherapist or counsellor in regional NSW. The environment was a key factor cited by all three members: clean air, space, access to nature and no traffic issues, and a reported sense of “less stress”. A connection to community was also cited as a positive in working regionally; however, this was also seen to be a challenge. Within a small community, potential dual relationships and social engagements bring client and therapist together. There is often a high possibility of “shopping at the supermarket [and] bumping into people you have counselled!” CAPA and the Benefits of Membership CAPA membership has helped these three members address the issues of working alone, offering input and connection. Being state-based, it was more ‘local’ and ‘responsive’ than national organisations, which both Heidi and Brian had belonged to earlier in their careers and had chosen to move across to CAPA. Brian—who was a minister of religion before becoming a counsellor and is now a supervisor for counsellors and the clergy—joined CAPA “because it had a lot more going for it and [encompassed] a wider area of counselling and a lot of intervention at that time. The thing that appealed to me was the education side of CAPA—they’ve always had a wide range of therapies.” Heidi, similarly, had switched from a national association to CAPA, as it was more encompassing of different therapeutic modalities. CAPA is viewed as a professionally run organization, which has strict expectations regarding membership criteria and qualifications standards. This was thought of as important and positive, in the shared view that counselling is in the throes of becoming more professional. They also saw CAPA as an effective gateway to becoming members of PACFA, as expectations are aligned and the two associations are working hand-in-hand with that alignment for their members’ professional recognition within Australia. Brian noted: “The counselling world is changing. When I went in, you didn’t need a lot of qualifications. You needed qualifications, but not like today, with the demands of government and to get more recognition from government. It’s becoming more and more regulated, and I think that’s a good thing because it stops people going off on their own with no checks being put on them.” Heidi said, “The costs of maintaining membership are high, but I love what I do—and I see the value [of both membership and the annual criteria].”
Sharon joined CAPA because she sees that “professional counselling within this nation is going forward, and you need to be a part of an organisation that recognises a high standard of qualifications”. She had felt isolated, even after joining CAPA, until she made a decision to become actively involved by attending CAPA functions, and it snowballed from there to the point where she is now, a member of the governing Executive Committee. “When my training stopped, I lost a sense of belonging to a community and so getting involved with CAPA meant that need for community was met.” In addition, attending PDEs “opened up a whole new world”! CAPA membership was also seen to provide support and answers through members being able to ring or email the office to get issues addressed, or to read up on the web, though limitations to both were also mentioned. Heidi said, “If I ever have any issues—in any way—I feel really supported” by being able to contact someone at CAPA. All three members were looking forward to easier access and more information when the new website goes live soon. CAPA membership was also seen by these three regional members as providing great assistance regarding professional development (PD). Brian commented, “I can get down to Crows Nest—it’s over 100km for me, but I can get down there.” Heidi loved being able to attend the PDE at Port Macquarie, but said that Sydney and the South Coast were out of the question because of distance and associated costs of travel. As it was, it took her as long to travel south to Port Macquarie as it does to Brisbane for other PDEs. Our professional journal, CQ: The CAPA Quarterly, is seen as an important benefit of membership, an infusion of ‘life-blood’, being able to read up on things, access new information, ideas and practice approaches from colleagues. Heidi said that she loves it and hopes it will always remain a physical magazine: “I like reading it on a Sunday morning in bed with a cuppa, rather than on a screen!” she said. Port Macquarie and ‘Live’ PD In May 2011, the third CAPA regional PDE was held for members over a weekend. Organised as a series of small workshops on different subjects, and with different presenters, it allowed for participants to suit their travelling needs, yet have a ‘whole’ experience. Sharon, organiser and attendee of the event, said that many who attended the Port Macquarie PDE “reported feeling isolated in their practice and getting a lot out of the event, because they returned for the next one. That sense of isolation is quite common. It was a hot topic at our first PDE.” Initially Sharon noted that for some participants CAPA had felt a bit irrelevant up until that point, that they “didn’t feel helped [by CAPA] until then.” In regard to the scheduling of regional CAPA events, the overwhelming message was “we want more of this!” In summing up, Sharon said, “Sometimes counsellors don’t see a light at the end of the tunnel [getting started and (continued on Page 35)
The Yearning for Philosophy We have forgotten how to philosophise, yet more than ever there is a yearning for philosophy and being philosophical. This is a central theme of philosopher Martin Heidegger. The yearning for philosophy comes out of the way in which, on so many levels, we cannot take the conventions of our lives for granted. The first eleven years of this century give testimony to the fact we are living in times of surprise and disruption in which we can no longer expect the future to be the same as the past. Events like these give rise to experiences of existential anxiety, the sort of anxiety that is experienced when our way of life is no longer experienced as supporting us and we have no new conventions to replace the outdated ones. We are living between the breakdown of the old conventions and the notyet of the new. The intensity of the experience of being caught between the loss of the old gods and the not-yet of the new gods—to use a phrase of Heidegger’s—is well expressed by the authors of The Clue Train Manifesto, who state: This is an existential moment. It’s characterized by uncertainty, the dissolving of the normal ways of settling uncertainties, the evaporation of the memory of what certainty was once like. In times like this, we all have an impulse to find something stable and cling to it, but then we’ d miss the moment entirely. There isn’t a list of things you can do to work the whirlwind. The desire to have such a list betrays the moment. There may not be twelve or five or twenty things you can do, but there are ten thousand. The trick is, you have to figure out what they are. They have to come from you. They have to be your words, your moves, your authentic voice. ~The Clue Train Manifesto (2001) This experience of existential anxiety permeates all the areas of our lives. It affects our sense of self. It influences our way of being with each other. It is manifested in the lack of leadership and the perplexity experienced by many leaders in a global context. It expresses itself in the area of globalisation where people of different cultures are brought into close proximity with each other, yet do not know how to live with each other and often withdraw into the insularity of their own way of life. It is not by chance that connections and commitments between people are so difficult. Such difficulty manifests itself in terms not only of issues of work-life balance but also of ecological balance. We are a generation that is threatening to destroy the very planet on which we live. Do we know what we are doing? And is this question of knowing what we are doing centrally a philosophical question, a question that reaches right back to Socrates, who continually challenged people not to take 8
the question of the ‘good life’ for granted but to question what they mean by the ‘good life’ so that they could put life into perspective and take care for living? In many ways, we manufacture our own existential uncertainty today. Often the very means by which we strive for security produce a greater sense of insecurity. This occurs on both a personal level and a national level. In our world, we see states going to war with each other to protect themselves but creating for themselves a greater insecurity. The Israeli/Palestinian conflict is an example. So is the state response known as the ‘war on terror’. Rather than alleviating insecurity, it has generated a greater insecurity. The ‘war on terror’ is exemplary of acting before reflecting and of the need for reflection in the context of uncertainty and insecurity. As authors like Ulrich Beck (1992) have noted, we are manufacturing our own insecurity today. For example, the nuclear disaster in Japan has created a widespread feeling of insecurity, but it is an insecurity that we have created. Do we know how to care for the world we are creating through science and technology? After the dropping of the atom bombs in Japan, Albert Einstein said he would rather be a watchmaker than a scientist, for the ethical issues arising from the emergence of the power of science were too big for him to contemplate. As he himself said, and as others following him have reiterated, our way of living—our philosophies of life—have not yet caught up with the power of science and technology to save or destroy us. We can say the same thing for the free market. The patterns of creative destruction that have generated cycles of boom and bust have intensified our sense of uncertainty. Moods of Philosophical Questioning From a Heideggerian perspective, these forms of insecurity offer the possibility of re-enchanting the way of being, of philosophical attunement. Existential anxiety and insecurity are the bases of the yearning for philosophical thinking. It is at our own peril that we refuse to philosophise today, that we refuse to ask the questions that allow us to put life and beingin-the-world into perspective. So how do we do this? For Heidegger, it is by being ‘in question’ (1985) that we are called to ask questions, and the way we are ‘in question’ is in mood states such as anxiety. Homesickness is, for Heidegger, another mood state that provides a framework for philosophical thinking. Indeed, Aristotle said that both Socrates and Plato were depressed and that it was the mood of depression that allowed them to withdraw from everyday life in such a way that they came to reflect on the taken-for-granted conventions CQ: The Capa Quarterly
Today: Its Transformational and Therapeutic Value
that held everyday life together. Heidegger explicitly sees states of withdrawing as a simultaneous drawing towards the mystery of Being—that is, the mystery of philosophical questioning. In Plato’s work, Phaedrus, he writes quite unequivocally about the relation between states of madness and philosophising. It can also be argued that the perplexity Socrates saw as so central to his philosophical being is more than an intellectual perplexity. He asked fundamental questions because his being was ‘in question’. It was a state of being, and it was this state of being that opened up the possibility of philosophy to him. In the same vein, Montaigne’s melancholia is the basis, as Screech notes, for his philosophising. In fact, in his work on Montaigne, Screech (1991) reported that states of mania and melancholia are central to becoming philosophical. It is not hard to see the connection between mood states of anxiety and depression in the work of Kierkegaard (1958) and Nietzsche (Jasers 1965). Both make quite explicit the connection between these mood states and being philosophical. It is also quite evident in the way in which Wittgenstein (Finch 1995) thought about the activity of philosophising, namely, that there was an intimate connection between his philosophising and the angst of his being. Of course we could go on and on with this list. Perhaps the point is that the connection between philosophical questioning and mood states has not always been made explicit. What Heidegger (1985) is emphasising is that it is in highly charged and intense states of mood that we see our very being brought into question in such a way that we begin to philosophise. Indeed, once we recognise that anxiety and insecurity are the basis of being ‘in question’, and thus being philosophical, they become part of the impulse to question. They become what some authors have called the “erotic” basis of questioning (Rajchman 1991). Of course, in a short article it is easy to say that embracing anxiety is the basis of the enjoyment of questioning. In practice, it is much more painful than this; but it is this mixture of pain and enjoyment that underpins the aesthetic and philosophical sensibility. Be warned that we can get very lost in the uncertainty of anxiety. Kierkegaard warns us of this on an individual level; and even a cursory look at the life of Heidegger himself shows how he got lost in his turn towards National Socialism—how the sense of estrangement did not lead him to philosophical questioning, in this case, but to an insular nationalism that put the “self-assertion” of the German people above all else (1986). Yet it is precisely because of the paradox or contradiction in Heidegger’s way of being that he is so illuminative of both February 2012
open and defensive responses to the anxiety of being. Those of us who do find value in the work of Heidegger are constantly called to ask: How can someone be simultaneously so insightful and so blind and nasty? How could he create a language that has opened up the world for many us in new ways and yet be so closed off to possibilities in the world? Philosophical Experiences of Philosophers In Heidegger, we see both an open and a defensive response to the anxiety of being. To embrace the journey of being philosophical is to understand the relationship between these two kinds of response to the anxiety of being. In many ways we, today, are threatened in some of the ways Heidegger was: the narrow mindedness of nationalism or fundamentalism in contrast to staying with the uncertainty of philosophical questioning. The contradiction of Heidegger allows us to raise the question: What allows one to embrace and stay with the anxiety of being? In this regard, it is interesting to look at the autobiographies of philosophers like John Stuart Mill, who wrote most of his works from a rational and analytical perspective but, after undergoing a deeply shattering experience of existential anxiety, and being able to stay with the uncertainty of this anxiety, he began to philosophise in a very different way, coming to realise that there is more to philosophy than rational analysis, that there is a sense of wonder and curiosity that underpins philosophy. Indeed, what we see in the case of Mill is that the way in which he responded to his existential crisis allowed him to open up new possibilities for himself. He became interested in areas of thought that he would have rejected as nonsense in his rational and analytical phase. He developed a curiosity about the romantic and mystical dimensions of being philosophical. Many of his friends would have nothing to do with him, but he demonstrated the firm resolve of an inquirer and explorer who had discovered something new and was fascinated with following the path of what he had discovered. He was, as Kierkegaard would say, intoxicated by the discovery of possibility and, again as Kierkegaard would say, there is nothing more intoxicating than the world of possibility (1992). In many ways, it is this world of possibility that many of us are looking for today. Experiencing ourselves as stuck in the ‘same old, same old’, we want to open the world of possibility. The various crises and forms of uncertainty in which we live challenge us to open up to new possibilities. Globalisation, science, technology, and the limits of the free market—all of these are calling for us to do this. 9
“LEARNING IS FOREVER” “LEARNING IS FOREVER”
Deconstructing Philosophy as a Tradition This is not the usual or habitual understanding of philosophy. In the 19th and 20th centuries, philosophy removed itself from life. It has become the study of the texts of the history of philosophy rather than a way of pondering and making sense
SYDNEY WORKSHOPS 2012 SYDNEY WORKSHOPS 2012
Borrowed Time Borrowed Time
Time-Limited Existential Practice Time-Limited Existential Practice Friday 16 March Friday 16 March
Sudden Death Sudden Death
An An Existential Understanding Existential Understanding Saturday 28 April Saturday 28 April
An An Existential View Existential View Saturday 19 May Saturday 19 May
Introduction to to Introduction
Existential Theory & Practice Existential Theory & Practice Monday to Friday 21- 15 Monday to Friday 21-May 15 May
For more information For more information TheThe Centre for Existential Practice Centre for Existential Practice email@example.com www.cep.net.au firstname.lastname@example.org www.cep.net.au Telephone: 0431 401401 659659 Telephone: 0431
of the experience of living and living well. Primarily, what has been forgotten is that philosophy is connected with healing and living well and does not just analyse the logic of abstract texts or concepts of truth. It has become too scholastic—aimed at unpacking a theory of being rather than at being well. In this latter sense, philosophy is a form of therapy and counselling, and that is also why, historically, it was practiced by Socrates and others in the form of dialogues. These dialogues were not aimed simply at abstract truth but, for Socrates, were aimed at living the good life, not in the hedonistic sense of the word but in the form of a balanced life that allowed for sustainable living and a life of strength of character. Indeed, for Plato, as outlined in his work The Republic, philosophy is about the pursuit of justice, and justice is not about legal order or punishment but about harmony and a healthy life—not just for the individual but for the city-state as well—that is, for the community, social and environmental context in which one lives. One cannot look after only the self, for the self belongs to a context, and this needs to be taken care of as well. In this sense, philosophy that does not take care of the being of a person is no more effective than medicine that cannot cure the body. Here, healing of the soul is not only of our individual souls but also of our relationship to the world, of our way of being-in-the-world. That is why Heidegger connects philosophy with our way of being-in-the-world (1985). A Model for Philosophising? A very quick glance at the history of philosophy allows us to see that philosophers developed and lived out the competencies or skills of being therapeutic and opening up new narratives by
“LEARNING IS FOREVER” “LEARNING IS FOREVER”
Philosophy as a Therapeutic Activity How? We need to become philosophical. Right back to Plato and Socrates, philosophy facilitates the art of questioning fundamental assumptions, and it is only by questioning our fundamental assumptions that we can begin to open up to allow new possibilities to emerge for ourselves. We can then move beyond the assumptions that have habitually framed our world. Being able to question, deconstruct, and reflect on ingrained assumptions is the basis for re-imagining our world. It is also the basis for understanding the importance of philosophy for therapy and counselling. As Epicurus said: “Empty are the words of that philosopher who offers therapy for no human suffering. For just as there is no use in medical expertise if it does not give therapy for bodily diseases, so too there is no use in philosophy if it does not expel the suffering of the soul” (Grafton, et al 2010). In a more modern form, Thomas Kuhn has said “I wasn’t saying that I want to know what is true. I want to know what it is to be true.” (2002) Existential therapy is a philosophy that offers the opportunity for personal transformation, for establishing connection, for restoring our sense of place in the world, for promoting the need for perspective and, in more broad and general terms, for living in a world where the foundational conventions cannot be taken for granted.
YEARNING FOR PHILOSOPHY YEARNING FOR PHILOSOPHY
Philosophical Conversations Philosophical Conversations With With Dr Steven Segal Dr Steven Segal
FROM PLATO TOTO SARTRE FROM PLATO SARTRE A SERIES OF OF 8 EVENING LECTURES A SERIES 8 EVENING LECTURES WEDNESDAY NIGHTS WEDNESDAY NIGHTS
15 February - 4 April 2012 15 February - 4 April 2012
For more information For more information TheThe Centre for Existential Practice Centre for Existential Practice email@example.com www.cep.net.au firstname.lastname@example.org www.cep.net.au Telephone: 0431 401401 659659 Telephone: 0431
CQ: The Capa Quarterly
questioning the taken-for-granted conventions of the times in which they lived. This was certainly the case for Socrates. It was also the case for Descartes, David Hume, Fredrick Nietzsche and a whole range of other philosophers. Furthermore, each of the different philosophers expressed the existential basis for questioning in different ways. Socrates, for example, spoke of perplexity. Plato wrote about philosophy beginning in a state of wonder. Karl Marx wrote of estrangement as the basis of questioning. For Descartes, methodological doubt is the basis of philosophical thinking; whereas David Hume found scepticism to be its basis. In the writing of Nietzsche, we find nihilism as the basis for philosophical questioning. Most of the existential philosophers see anxiety as the basis for such questioning. Although this may be a contradiction, I would like to propose that there is almost a model for philosophical questioning. I would like to call it the convention-disruption-narrative model of philosophy. It can be argued that every great philosopher develops a narrative or language that allows us to see and be in the world in new ways, based on the practice of disrupting the conventions of the day. It is interesting to learn not only the narrative that discloses the world in new ways but also the philosophers’ practices of disrupting the conventions. Through learning to appreciate their practices for disrupting their own conventions, we will gain the strength and resilience to turn the way in which our being is ‘in question’ today into an opportunity for philosophical enquiry and thus into an opportunity to see the world through fresh eyes.
References Beck, U 1992, Risk Society: Towards a New Modernity, New Delhi: Sage Finch, HL 1995, Wittgenstein, New York: Element Grafton, A, et al. 2010, The Classical Tradition, Cambridge, Massachusetts: Harvard University Press Heidegger, M 1985, Being and Time, Oxford: Basil Blackwell Heidegger, M 1986, ‘The Self-Assertion of the German University’, in Review of Metaphysics 38 Jaspers, K 1965, Nietzsche: An Introduction to his Philosophical Activity (trans. C. F. Wallraff and F. J. Schmitz), Tucson: University of Arizona Press Kierkegaard, S 1992, Either/Or: A Fragment of Life, (trans. Alastair Hannay), Hawthorn, Victoria: Penguin Classics Kierkegaard, S 1958, The Journals of Kierkegaard http://www.archive.org/details/ journalsofkierke002379mbp Kuhn, T 2002, The Road Since Structure, Chicago: University of Chicago Press Rajchman, J 1991, Truth and Eros: Foucault, Lacan and the Question of Ethics, New York: Routledge Screech, M 1991, Montaigne and Melancholy: The Wisdom of the Essays, London: Penguin Books Weinberger, D, et al. 2001, The Clue Train Manifesto, New York: Perseus Book
Steven Segal, PhD, is recognised internationally as a pioneer in the development of philosophical counselling and practice. The first Anthology on Philosophical Counseling in 1996 included one of his articles, and he has since then written and presented at a number of conferences on philosophical counselling. He is the author of the book Business Feel: From the Science of Management to the Philosophy of Leadership, which explores the shift from science to philosophy in the shift from management to leadership. Dr Segal is a Senior Lecturer at the Macquarie Graduate School of Management where he lectures in a range of subjects including units on philosophy, psychology, coaching, and managing with a global mindset. He is a psychologist with a PhD in Philosophy. Very heavily involved in research, he has recently been publically recognised by the Graduate School of Management for his contribution to PhD supervision where he initiated the development of a ‘hermeneutic circle’ as a process for PhD research supervision. He has a lifelong commitment to realising philosophy as a practice. email@example.com
Executive Executive Director: Director: Leon W.Leon Cowen W. DCH, Cowen Dip Hyp DCH, Mast Dip (USA), Hyp Mast Grad(USA), Dip App Grad Hyp, Dip Mast AppCH, Hyp, FAHA, Mast CH, MATMS FAHA, MATMS CAPA CAPA Professional Professional Development Development 1st Flr 3021stPacific Flr 302 Hwy Pacific Lindfield Hwy Lindfield NSW 2070 NSW Tel:2070 (02) 9415 Tel: (02) 65009415 Fax:6500 (02) Fax: 9415(02) 65889415 Web: 6588 www.aah.edu.au Web: www.aah.edu.au CAPA Professional Development VETAB VETAB Accredited Accredited - Introductory - Introductory & Website: & www.aah.edu.au Email: Email: firstname.lastname@example.org email@example.com Website: www.aah.edu.au VETAB Accredited Introductory & Advanced Hypnotherapy Training Advanced Hypnotherapy Training For Information: For Information: Ring Ring (02) 9415 (02) 9415 6500 6500 or or Advanced Hypnotherapy Training Distance Distance Learning Learning plus In-House plus In-House Workshops Workshops Enrolling Enrolling Now Now “The True Specialists “The TrueinSpecialists Clinical Hypnotherapy in Clinical Hypnotherapy Training” Training” Distance Learning plus In-House Workshops “The True Specialists in Clinical Hypnotherapy Training” Advanced Advanced Diploma Diploma of & Clinical of & Clinical Hypnotherapy Hypnotherapy (Reg: 91526NSW) (Reg: 91526NSW) Enhance Enhance your your Counselling Counselling Psychotherapy Psychotherapy – Learn – Learn Hypnosis Hypnosis Enhance your Counselling & Psychotherapy – Learn Hypnosis Diploma Diploma ofyour Clinical ofclients Clinical Hypnotherapy Hypnotherapy (Reg: 91525NSW) (Reg: 91525NSW) Increase Increase your clients with with your your additional additional skillsskills Increase your clients with your additional Certificate Certificate IV in IV Clinical in Clinical Hypnotherapy (Reg: 91524NSW) (Reg: skills 91524NSW) Advanced Advanced Practitioner Practitioner Certificate Certificate in Hypnotherapy Clinical in Clinical Hypnotherapy Hypnotherapy (CAPA and (CAPA RACGP and Endorsed Endorsed for for Development Points) Points) Advanced Certificate inDevelopment Clinical Hypnotherapy (CAPA Practitioner and (CAPA RACGP and RACGP RACGP Endorsed Endorsed for Professional Professional for Professional Professional Development Development Points) Points) (CAPAPractitioner and RACGP Endorsed for Professional Development Points) Advanced Advanced Practitioner Certificate Certificate in Clinical in Clinical Hypnotherapy Hypnotherapy Certificate Certificate IV in IV Clinical in Clinical Hypnotherapy Hypnotherapy (Reg: 91524NSW) (Reg: 91524NSW) Certificate IV inclients Clinical Hypnotherapy (Reg: 91524NSW) Increase Increase your your clients with with your your additional additional skills skills Diploma Diploma of Clinical of Clinical Hypnotherapy Hypnotherapy (Reg: 91525NSW) (Reg: 91525NSW) Diploma of Clinical Hypnotherapy 91525NSW) Enhance Enhance your your Counselling Counselling Psychotherapy Psychotherapy –(Reg: Learn – Learn Hypnosis Hypnosis Advanced Advanced Diploma Diploma of & Clinical of & Clinical Hypnotherapy Hypnotherapy (Reg: 91526NSW) (Reg: 91526NSW) Advanced Diploma of Clinical Hypnotherapy (Reg: 91526NSW) “The True Specialists “The TrueinSpecialists Clinical Hypnotherapy in Clinical Hypnotherapy Training” Training” Enrolling Enrolling Now Now Distance Distance Learning Learning plus In-House plus In-House Workshops Workshops Enrolling Now For Information: For Information: Ring Ring (02) 9415 (02) 9415 6500 6500 or or Advanced Hypnotherapy Training Advanced Hypnotherapy Training For Information: Ring (02) 9415 6500 or Email: Email: firstname.lastname@example.org email@example.com Website: www.aah.edu.au VETAB VETAB Accredited Accredited - Introductory - Introductory & Website: & www.aah.edu.au Website: www.aah.edu.au Email: firstname.lastname@example.org 1st Flr 3021stPacific Flr 302 Hwy Pacific Lindfield Hwy Lindfield NSW 2070 NSW Tel:2070 (02) 9415 Tel: (02) 65009415 Fax:6500 (02) Fax: 9415(02) 65889415 Web: 6588 www.aah.edu.au Web: www.aah.edu.au CAPA CAPA Professional Professional Development Development Executive Director: Leon W.Leon Cowen W. Cowen Hyp DCH, Mast Dip (USA), Hyp Mast Grad (USA), Dip App Grad Hyp, Dip Mast AppCH, Hyp, FAHA, Mast CH, MATMS FAHA, MATMS 1st Flr Executive 302Director: Pacific Hwy Lindfield NSW 2070DCH, Tel:Dip(02) 9415 6500 Fax: (02) 9415 6588 Web: www.aah.edu.au Executive Director: Leon W. Cowen DCH, Dip Hyp Mast (USA), Grad Dip App Hyp, Mast CH, FAHA, MATMS
The Alliance, the Relational Turn, and Rupture and Alliance issues confront therapists in their practices every day. ~LR Hatcher (2010: 7) The term ‘therapeutic alliance’ has risen in status in the psychotherapy world in the last 30 years, especially through research into the factors common to various modalities of psychotherapy (Cooper 2008). In many ways it has strongly helped to increase the importance of the therapeutic relationship, especially as a counterpoint to a research focus solely on the techniques of therapy (Safran & Muran 2006, Wampold 2010). Yet, there is a lack of consensus in the usage and meaning of the term ‘therapeutic alliance’ and its relationship to the
‘therapeutic relationship’. This article presents a wide survey of how the therapeutic alliance concept is used in the literature. It specifically focuses on various criticisms leveled against it from the relational psychotherapy tradition and explores how the therapeutic alliance concept looks from within the ‘relational turn’ (Mitchell 2000: xiii). In exploring the therapeutic alliance from a relational psychotherapy perspective I will focus on how negotiating the therapeutic alliance through processes of alliance rupture and repair can be significantly therapeutic.
Section 1: The Therapeutic A lliance and the Therapeutic R elationship Locating the Therapeutic Alliance After more than 100 years of psychotherapy, since the beginning of Freud’s project, it is estimated that “there are more than 500 distinct psychotherapy theories and that the number is growing” (Wampold 2010: 25). Two of the major impacts of this proliferation of psychotherapy theories are the divergence into ‘schoolism’ and the search for common factors. Schoolism denotes the allegiance of therapists to specific theories or schools of thought and to research programs focused primarily on the technical factors of therapy divorced from relationship factors of therapy. These research programs attempt to show the model’s efficacy and superiority compared with other therapeutic models (Wampold 2010, Norcross 2002). Attempts by other researchers aim to encourage integration between the various schools or theories of psychotherapy by identifying the common factors across and among these various models (Duncan, Hubble & Miller 2010). What is known as ‘the great psychotherapy debate’ (Wampold 2001) involves a dispute between research which claims that certain therapies are more efficacious than others and metaanalytic studies which claim the ‘Dodo Bird verdict’ (Wampold 2010). The Dodo Bird verdict in psychotherapy, named after the Dodo bird in Alice in Wonderland (1992) who claimed that “everyone has won and all must win prizes”, is based on: one of the best-established findings in the … research field: that if one looks at the data on the comparative [italics original] efficacy of different therapies (either across studies or within the same study), rather than the data on which specific therapies have been shown to be efficacious with specific psychological problems, there is an overwhelming body of evidence to suggest that there is little difference in how efficacious different psychological therapies are … (even though it is evident that the therapists are doing quite different things) (Cooper 2008: 50). Although the great psychotherapy debate continues, “with major implications for the practice, funding and development of 12
therapeutic services” (Cooper, 2008: 58), the above comparative research findings have provided a strong impetus to uncover the common factors across the different therapeutic models. Common Factors, the Therapeutic Relationship and ‘Lambert’s Pie’ A well known synthesis of the common factors research is graphically portrayed as a pie chart, known as ‘Lambert’s Pie’ after leading figure in the psychotherapy research field Michael Lambert. Lambert’s Pie Models / Techniques 15%
Hope / Placebo 15%
Client factors 40%
Relationship factors 30%
This chart expresses four fundamental factors common to therapy. In this chart, the therapeutic relationship accounts for 30% of variance in therapeutic outcomes, a figure which has inspired much research into the relational factors of therapy (Safran & Muran 2006). The research that has focused on the therapeutic relationship has primarily oriented itself around the concept of the therapeutic alliance where, as a research area, it “reigns supreme” (Cooper 2008: 102). In the last thirty years, over 4000 papers/ dissertations have been written on it and 24 different scales have been developed to measure it (Cooper 2008). Yet the definition of the ‘alliance’ and how the ‘alliance’ is connected to the ‘therapeutic relationship’ is not at all clear or universally accepted. CQ: The Capa Quarterly
Repair Processes in the Therapeutic Relationship Pedro Campiao Defining the Therapeutic Alliance Difficulty defining the therapeutic alliance, also known as the working alliance, or simply the alliance, has led to a large amount of empirical research that is inconsistent and difficult to interpret (Messer & Wolitsky 2010). The reasons for this situation are: different conceptualisations of the alliance and what make up its components (eg, therapist empathy, bonds, tasks, goals); the use of different assessment tools … and who does the rating (patient, therapist or researcher); different results, depending on the phase of therapy studied (early, middle, late); the variety of therapy outcome measures to which the alliance is correlated ( eg, symptom reduction, interpersonal changes, target complaints); the varied length of therapy; and variations reflecting the clinical group studied (Messer & Wolitsky 2010: 107). Although many difficulties exist with regard to researching and defining the therapeutic alliance, by far the most popular understanding of the alliance is “the quality and strength of the collaborative relationship between client and therapist” (Norcross 2010: 120). The most widely used measure and conceptualisation of this collaborative relationship is Bordin’s (1979) widely accepted pan-theoretical notion of the working alliance (Wampold 2010), consisting of: (a) the therapist’s and client’s agreement on the goals of therapy—ie, outcomes of their work; (b) therapist and client consensus on the tasks of therapy—ie, the various behaviours which comprise the in- and out-of-session therapeutic work; and (c) the existence of a positive affective bond between therapist and client— namely, “the patient’s ability to trust, hope, and have faith in the therapist’s ability to help” (Safran & Muran 2001: 166). Throughout this article I will use the terms alliance and therapeutic alliance synonymously. The notion of the therapeutic alliance as a collaborative relationship—a conceptualisation that can be used to apply to all “interpersonal change processes” (Hatcher 2010: 10)—has helped to increase the status of the therapeutic relationship as an important common therapeutic factor across schools and models in the last 30 years (Safran & Muran 2006). The Alliance and the Therapeutic Relationship According to Safran and Muran (2006), “the alliance construct played an important role among psychotherapy researchers in bringing the therapeutic relationship back into focus at a time when the person-centered tradition with its emphasis on the core conditions had become marginalised by the mainstream, and the cognitive–behavioral tradition was in the ascendant” (2006: 289). Due to how the therapeutic alliance research has increased the status of the therapeutic relationship, it is important to understand how the therapeutic alliance concept February 2012
is related to that of the therapeutic relationship. The literature provides us with three primary ways in which this relationship is conceptualised. In each of the following, the therapeutic alliance is understood as the collaborative relationship between client and therapist. The alliance as a component of the therapeutic relationship. The understanding of the therapeutic alliance as a component of the therapeutic relationship is common. Using the latter understanding, the American Psychological Association conducted “the largest ever review of empirical evidence” (Cooper 2008: 101) in the area of the therapeutic relationship in an attempt to identify the relationship components of effective therapy (Norcross 2002). The following elements were found to be demonstrably effective: empathy, alliance, goal consensus and collaboration, positive regard and affirmation, congruence/ genuineness, collecting client feedback, repair of alliance ruptures, management of counter-transference, and adapting the relationship to the individual client (Norcross 2010). In this study, the therapeutic alliance is defined as “the quality and strength of the collaborative relationship between client and therapist” (Norcross 2010: 120), and it is understood as one of the components of the therapeutic relationship. Equivalence between the alliance and the therapeutic relationship. The idea that the therapeutic alliance and the therapeutic relationship are equivalent is expressed in the literature as a simple equation of the therapeutic alliance to the therapeutic relationship, as if these are two terms for the same thing/process. Here one finds such article titles as ‘The Therapeutic Alliance: Cultivating and Negotiating the Therapeutic Relationship” (Safran, Muran & Rothman 2005) or phrases such as “the therapeutic relationship or alliance is a universal change factor” (Paivo & Pascual-Leone 2010: 103). In the above examples, the therapeutic relationship is equated to the therapeutic alliance, the latter being defined according to Bordin’s (1979) working alliance concept, oriented to a positive bond between client and therapist and their agreement on the tasks and goals of therapy. Alliance as one relationship among various relationships. In what has become an important research project, the alliance is understood within a tripartite model, originally stemming from the psychodynamic tradition (Greenson 1967), where the therapeutic relationship made is up of three different relationships, namely, (a) the working alliance, (b) the transference/counter-transference relationship and, (c) the real relationship (Gelso 2011, Gelso & Hayes 1998). Here, the working alliance is defined according to Bordin’s (1979) working alliance model, as a positive bond between client and therapist and agreement on the tasks and goals of therapy. 13
Features History of a Concept The therapeutic alliance concept has been found problematic throughout its history, and to understand some of these criticisms, some of its history needs to be understood. Freud “encountered alliance issues as soon as he began to use psychological methods to treat his patients” (Hatcher & Barber 2010: 8). Although he did not use the term alliance, Freud discussed a “pact” (cited in Gilbert & Orlans 2011: 132) between the client and therapist involving a positive bond, the “unobjectionable positive transference” (Freud cited in Messer & Wolitssky 2010: 97), between client and therapist. This transference was not to be analysed as it provides the client with the motivation to continue with the work of therapy. Freud’s interest in the productive pact between client and therapist came into focus with the advent of ego-psychology, in the 1930s (Hatcher 2010). An interest in rational processes led therapy to be articulated as supporting a split in the ego of the client between an observing, rational capacity and the irrational forces within the patient’s transference (Sterba cited in Hatcher 2010). The term the therapeutic alliance was coined in the 1950s. It related to the conscious, rational and collaborative agreement between therapist and client about the nature of the therapeutic work and how to proceed with it (Zetzel cited in Gilbert & Orlans 2011). In the 1960s collaboration on the therapeutic work was elaborated in an important tripartite model which split the therapeutic relationship into three components: the working alliance, the transference-countertransference relationship, and the real relationship (Gelso & Hayes 1998, Gelso 2011, Greenson 1967). Within these psychoanalytic conceptualisations, the alliance provides the facilitative conditions for the curative work of therapy and is not in any way curative itself, that being the domain of the therapeutic techniques/interventions (Gelso 2011, Safran & Muran 2000). At the heart of much therapeutic alliance debate within psychodynamic circles is the relationship between the alliance and the transferential relationship. Is the alliance to be analysed? How? If so to what extent? From the above brief exploration, it can be seen that the therapeutic alliance concept is articulated within three important dichotomies or conflicts, namely: (a) a conflict between the rational/reasonable relationship and the irrational/transferential relationship where the therapeutic alliance involves “an alignment” (MacKewn 1997: 87) between the therapist’s and the client’s rational and reasonable side. This alliance creates an anchor to the work when it becomes difficult for the client, such as when analysing the transference or when difficult emotions arise; (b) a conflict between relationship factors and technical factors, where work on the relationship is not understood as an intervention and, related to this; (c) a conflict between facilitative and curative factors of therapy where establishing the alliance between client and therapist facilitates therapy, this being the application of techniques and interventions, but is not therapeutic in itself. (See Gelso 2011, Mitchell 1988, Safran & Muran 2000.) Criticism of the Therapeutic Alliance Concept Criticisms of these conflicts from the relational psychotherapy tradition have led some researchers to question whether the therapeutic alliance concept “has outlived its usefulness” (Safran & Muran 2006: 206). Within the relational psychotherapy 14
discourses “the alliance receives less theoretical attention” (Safran & Muran 2000: 10-11), and the reasons for this relate to a clash of paradigms underpinning the dichotomies above. The “relational turn” (Mitchell, 2000: xiii) in psychotherapy is part of a wider post-modernist, social-constructivist and participatory paradigm shift across many disciplines (Gergen 2009). I understand the relational psychotherapy tradition not as one school but as a field within which many relational voices can dialogue (Wachtel 2007). Although relational psychotherapy arose out of the psychodynamic tradition (Mitchell 1988, Stolorow, Brandschaft & Atwood 1987), because much within its theory involves a critique of the modernist paradigm—with its reliance on various presuppositions underlying a Cartesian worldview, such as the possibility of objectivity, individualism and its related subject-object/mind-body/rational-irrational split (Mitchell 1988, Safran & Muran 2000, Wheeler 2000)— I include within the relational psychotherapy tradition various other schools that are oriented towards constructivism and hermeneutics. These include contemporary gestalt therapy (Jacobs & Hycner 2008, Wheeler 2000), relational-cultural therapy (Jordan 2010), some other feminist therapies, and some post-modernist therapies such as narrative therapy (Angus & Mcleod 2004). The relational psychotherapy tradition is grounded in a constructivist and dialogical epistemology, a shift from a one-person psychology to a two person-psychology, where the “therapist’s reality is not more valid or objective or true than the patient’s” (Yontef 2002: 17). At its heart is the concept of intersubjectivity, which “recognizes the constitutive role of relatedness in the making of all experience” (Stolorow 2002: 329) and involves a grappling with the “importance of the interactive in the creation of the intrapsychic” (Boston Change Process Study Group, 2010: 143). What follows are criticisms of the three dichotomies inherent within the therapeutic alliance concept. Although some of the following criticisms arise from particular relational psychotherapy traditions, I believe they apply, in one way or another, to all constructivist therapies. The real relationship versus the transferential relationship. Within a constructivist and hermeneutic orientation to therapy, the dichotomy between the therapeutic alliance and the transferential relationship is problematised through the concept of intersubjectivity (Mitchell 2000, Safran & Muran 2000, Boston Change Process Study Group 2010). Intersubjectivity, a concept “central to the entire evolution of the relational movement” (Wachtel 2000: 151), “opposes the rigid demarcation between subject and object” (Safran & Muran 2000: 10) and thus the possibility of ascertaining what is the real relationship and what is the transferential relationship in psychotherapy. Within the relational psychotherapy tradition, “what is real or unreal, true or untrue, is replaced by the recognition that there are multiple truths and that these truths are socially constructed. The distinction between transference and real aspects of the relationship thus becomes meaningless” (Safran & Muran, 2000: 10. See also Jacobs 2011 working in the gestalt therapy tradition.) Relational factors versus technical factors. A social constructivist epistemology involves the affirmation that there is no objective reality, where the “therapist’s reality is not more valid or objective or true than the patient’s” (Yontef 2002: 17). CQ: The Capa Quarterly
Without an objective reality and the unsullied authority of the therapist to fall back on, relational therapy perspectives articulate a two-person psychology grounded in hermeneutics. Here epistemic processes are dialogical, and meaning, truth and narrative are co-constructed by client and therapist. As the “meaning of any technical [task] factor can only be understood in the relational context in which it is applied” (Safran & Muran 2001: 166), technical interventions thus become “relational acts” (Boston Change Process Study Group 2010: 196). Here the dichotomy and conflict between relational and technical factors, at the heart of the therapeutic alliance conceptualisation, is seen as problematic. Facilitative versus therapeutic factors. One of the important dichotomies within which the therapeutic alliance is articulated is whether it is “a precondition of change … [or] … the central mechanism of change” (Norcross 2010: 114);—that is, whether it facilitates therapy or is therapeutic in itself. Within relational perspectives, negotiating the therapeutic alliance is seen both to “establish the necessary conditions for change to take place and [a]s an intrinsic part of the change process” (Safran & Muran 2000: 15, Jacobs &
Hycner 2011, Jordan 2011 ). This intrinsic part of the change process often comes under the rubric of the corrective emotional experience or “new relational experience” (Wachtel 2007: 237). This idea affirms therapeutic change as the client having a new relational experience with the therapist (DeYoung 2003). The notion that the therapeutic alliance is both facilitative of therapy and therapeutic in itself deconstructs the dichotomy between facilitative and curative factors at the heart of the alliance discourse (Boston Change Process Study Group 2010, Mitchell 1988, Safran & Muran 2000). Section 1 located the therapeutic alliance in current research discourses, defined it and articulated various complexities and differences within its definition and use, especially in how it is related to the therapeutic relationship, expressed some of its history while also provided various criticisms of how the therapeutic alliance is articulated. Section 2 outlines one way to understand the therapeutic alliance from a relational perspective. The criticisms of the above three dichotomies, inherent in the therapeutic alliance concept, will allow an understanding of the maintenance of the therapeutic alliance as a highly therapeutic intervention that can be seen to lie at the heart of therapy.
Section 2: The Therapeutic A lliance and the R elational Turn In the following inquiry, I argue that it is useful to understand the therapeutic alliance as being synonymous with the therapeutic relationship (Dryden 1989, Safran & Muran 2000, Paivo & Pascual-Leone 2010). I thus use these two terms interchangeably. The Therapeutic Alliance as Bond and the Tasks and Goals of Therapy The definition of the therapeutic alliance as an affective and positive bond between client and therapist and collaboration and agreement on the tasks and goals of therapy (Bordin 1979) has been accepted and employed by many major therapeutic approaches. It is used in integrative therapy models (Dryden 1989, O’Brien & Houston 2007), cognitive-behavioural therapy (Nelson-Jones 2005, Arnkoff 2000), Gestalt therapy (Joyce & Sills 2010, Mackewn 1997), process-experiential/ emotion-focused therapy (Elliott, et al. 2004, Watson & Greenberg 2000), psycho-dynamic models (Messer & Wolitsky 2010), and relational models (Safran & Muran 2000). The agreement on the tasks and goals of therapy articulates the therapy as a collaborative and purposeful enterprise—namely, the ‘working alliance’. The tasks of therapy are the various activities deemed therapeutic by the many therapeutic approaches, for example, free association (psychoanalysis), behavioural homework assignments (cognitivebehavioural therapy), empty chair work (gestalt therapy), and attunement to somatic process (Gendlin’s focusing). The goals of therapy are the objectives, “outcomes and priorities” (Bambling & King 2001: 38) which client and therapist agree on and work towards, for example: anxiety symptoms reduced, selfesteem increased, needs and life-direction clarified. The bond aspect of the therapeutic alliance consists of the affective quality of the therapeutic relationship between client and therapist such as “the extent to which the patient feels understood, respected, valued” (Safran & Muran 2000: 12). In this model there is an interdependence between bond, task and goals. Collaborating on the tasks and goals may strengthen the bond, whereas failure to establish the bond may February 2012
stress the alliance through inability to agree on tasks and goals (Bambling & King 2001). This integrative model provides a flexible way to negotiate the construction of different alliances, depending on different client needs or presenting issues. Some clients may need more structuring at the start of therapy, more focus on explaining tasks or clarifying goals; other clients may need a lot of work on establishing a safe and trusting bond, and much less work on clarifying goals or tasks. Agreement on the tasks and goals of therapy is often articulated in therapy manuals as the importance of creating a counselling contract at the start of therapy that is mutually agreed upon by client and therapist (eg, Feltham & Dryden 2005, O’Brien & Houston 2007). Initial Contracting Versus Ongoing Negotiation Although collaboration on tasks and goals is widely stressed in the literature, this notion is often applied at the start of therapy as a “superficial negotiation towards consensus of goals and tasks” (Safran & Muran 2000: 15). Such an understanding of the process of alliance-building conceives it as facilitating the therapeutic work and not therapeutic in itself. This conception overlooks important elements of alliancebuilding and -maintenance that persist, and require attending to, throughout the therapeutic work and that are, at critical junctures, therapeutic (Safran & Muran 2000). Although initial contracting and establishment of agreements around tasks and goals are vital processes for clients and therapists to undertake, the notion of alliance-building that is oriented to establishing initial contracts needs to be expanded by focusing on the ongoing negotiation of the bond, tasks and goals throughout therapy. The notion of negotiation, rather than collaboration, of the therapeutic alliance as an ongoing facet of therapy arises from the work of Safran & Muran (2000). To these authors the term collaboration is too loaded with idea of conscious/ rational agreement in the creation and contracting of a working alliance. Here “traditional conceptualizations of the 15
Alliance Ruptures Alliance ruptures are inevitable facets of therapeutic work. Alliance ruptures are breaches in relatedness and negative fluctuations in the quality of the relationship between the therapist and client. They vary in intensity, duration, and frequency, depending on the particular therapist–client dyad. In more extreme cases, the client may overtly indicate negative sentiments to the therapist or even terminate therapy prematurely. At the other end of the continuum are minor fluctuations in the quality of therapeutic alliance that may be extremely difficult for the outside observer, or even the skilled therapist, to detect (Safran & Muran 2000a: 159–160). Alliance ruptures arise due to the relationship factors and thus cannot simply be attributed to what the client brings, which can often happen when therapists struggle with clients. As was shown, the therapeutic alliance is negotiated both consciously and unconsciously by client and therapist. A relational perspective affirms that alliance ruptures are co-created and therapists need to inquire into their part in the rupture.
Development of the Alliance Through Time The concept of negotiation of the therapeutic alliance implies a process that extends through time. Much therapeutic alliance research has focused on the development of the alliance throughout therapy (Stiles, Glick, Hardy, Shapiro, AgnewDavies, Rees & Barkham 2004; Stevens, Muran, Safran, Gorman & Winston 2007), while looking for patterns in this development. Four patterns have been researched, and found, although research data are not conclusive: 1. a stable alliance pattern (little change in alliance strength across sessions) 2. a linear growth pattern (increasing alliance strength across sessions) 3. a U-shaped alliance pattern, involving a high-low-high development (alliance strength is relatively strong at the start of the therapy, weakens in the middle and increases in strength at the end) 4. a V-shaped pattern, (where therapy is characterised, especially in the middle sessions, by a series of brief ruptures and repairs in which the alliance is strained and then repaired) (Stiles et al 2004, Stevens et al 2007). Some of the thinking that motivates this research is based on the idea that “although the alliance is initially in the forefront of the relationship, it subsequently fades into the background, returning to the foreground only when needed” (Gelso & Carter 1994 in Stiles et al 2004). It often arises into the foreground due to strains in the alliance (Safran & Muran 2000). The field of research into V-shaped alliance patterns, where therapy is characterised by processes of rupture and repair, through negotiation of the tasks, goals and bonds of therapy, is “one of
the most innovative and exciting areas of development” (Cooper 2008: 119). It is to V-shaped alliance patterns and the important concept of alliance ruptures that I now turn.
1. Task & Goal
alliance may overemphasize the role of conscious or rational collaboration between therapist and patient and underestimate the pervasive role of unconscious factors in both patients’ and therapists’ participation in the relationship” (Safran & Muran 2006: 287-288). From an intersubjective and relational perspective the unconscious participation of the therapist in alliance negotiation is unavoidable. The term negotiation affirms that the therapeutic alliance is negotiated both consciously and unconsciously, involving emotional and ‘transferential’ aspects, thus problematising the notion of the alliance as rational agreement. Ongoing negotiation also “puts an emphasis on the process by which the tasks and goals of therapy develop and transform in the course of the therapeutic endeavour” (Rozmarin, et al. 2008). From a relational, constructivist and hermeneutic perspective, what is being negotiated is the meaning of the work, specifically the meaning of the various tasks in which client and therapist are engaging (Safran & Muran 2000). Although the greater majority of psychotherapy research, including research into the therapeutic alliance, involves splitting relational and technical factors (Cooper 2008), within a social constructivist worldview, the “meaning of any technical [task] factor can only be understood in the relational context in which it is applied” (Safran & Muran 2001: 166). The “usefulness of an intervention is always mediated by its relational meaning and ... any attempt to disentangle technical and relational dimensions [is] conceptually problematic, even if it is possible to do so statistically (Safran & Muran 2006: 288). Here, a particular hermeneutic trajectory needs to be embodied, ie, the ongoing exploration of the meaning the client is making of the various interventions made by the therapist.
1. Task & Goal
a. P roviding rationale for micro-processing tasks
a. Changing task or goal
b. E xploring core interpersonal themes
b. Reframing meaning of task or goal
A1a. Therapeutic rationale and micro-processing tasks. When a rupture arises through lack of clarity of the goals and tasks of therapy, the therapist may offer the treatment rationale, ie, explaining the reason for unpacking irrational thoughts. Rather than explaining the treatment rationale, the provision of microprocessing tasks such as a mindfulness task or a focus on somatic process can provide the client with an experiential sense of the reason for the task and how it relates to the goals. A1b. Understanding tasks and goal disagreements in terms of core-interpersonal schemes. Often, alliance ruptures due to disagreements or mis-attunements on the tasks and goals of therapy will lead to the exploration of client core-interpersonal schemes. For example, a client may struggle with opening herself up to the therapist, leading to a rupture. When this is explored, themes of not trusting authority may be apparent. The brief relational treatment of Safran & Muran (2000) understands alliance ruptures as a royal road into how clients structure their relationships and sees this exploration as central to the healing work of therapy. A2a. Clarifying misunderstandings. Rather than focusing on relational patterns that may be arising, the therapist directly explores what is transpiring in the dynamics of the here-and-now bond between client and therapist in an attempt to clarify any misunderstandings. This would focus on both attunement to the client’s process and on disclosing the therapist’s process.
CQ: The Capa Quarterly
Synthesising ideas about resolving alliance ruptures from a variety of therapeutic schools, including cognitive-behavioural, psycho-dynamic, relational and process-experiential, Safran & Muran (2000a) provide a useful schematic. This schematic allows us to understand different sorts of alliance ruptures and how to intervene in them in order to repair them through strengthening the alliance. Alliance ruptures can occur in the tasks, the goals and the therapeutic bond. A therapist can intervene in a direct or indirect way.). Repairing Alliance Rupture Guidelines When involved in alliance ruptures, it may be helpful for therapists to keep these guidelines in mind: 1. Clients often have negative feelings about therapy that they are reluctant to express. The more the therapist is attuned to subtle indications of ruptures and takes the initiative to explore with the client what is happening in the therapeutic relationship, the more the client is free to bring him- or herself into relationship with the therapist. 2. Research shows that it is important for clients to express negative feelings about therapy and perspectives which differs from the therapist’s. Supporting the client to express these negative feelings can be deeply therapeutic for the client, especially the
a. Clarifying misunderstandings
b. Exploring core interpersonal themes
a. Empathy attunement
b. Corrective emotional experience After Safran & Muran (2000a).
A2b. Exploring core-interpersonal themes. Here the therapist focuses directly on exploring the core-interpersonal themes and relational patterns that arise through ruptures in the bond between client and therapist. This could be due to mis-attunements or empathic failures on the part of the therapist or to interpersonal patterns the client brings. Either way the rupture will open a door to an exploration of the client’s interpersonal patterns. B1a. Changing the task or goal. Here, rather than directly focusing on disagreements underlying tasks and goals, the therapist works with tasks and goals that are meaningful to the client. Doing so may strengthen the bond, thus motivating the client to engage in tasks about which they may reticent . B1b. Reframing the meaning of the tasks or goal. Reframing the meaning of the tasks and goals in terms acceptable to the client is an indirect way to strengthen the alliance and to motivate the client. B2a. Empathic attunement. An indirect way to heal a rupture in the alliance bond is through empathic attunement to the client’s rupture experience. Here the client feels understood and the bond is repaired. Core-interpersonal themes that may arise are not explored. B2b. Corrective emotional experience. The provision of a corrective emotional experience may heal a rupture in the bond component. An indirect way of addressing such ruptures involves taking a certain interpersonal stance that the therapist assesses the client needing, rather than addressing the rupture directly.
more therapists are able to respond in a non-defensive manner while accepting responsibility for their contribution to the rupture. Therapeutic Value of Repairing Rupture Alliances In the literature, the therapeutic alliance has most commonly been articulated as a framework that facilitates the work of therapy but is not therapeutic in itself (Gelso 2011, Safran & Muran 2000). Research into alliance ruptures shows that they are an inevitable facet of therapy and that repairing them leads to positive therapeutic outcomes through the strengthening of the alliance. It was argued that the progress of the therapy involves a development of the therapeutic alliance that is marked by a series of rupture and repair sequences which, if engaged in, will strengthen the therapeutic alliance. It is theorised that this rupture-repair sequence is therapeutic for two reasons. Firstly, the therapist is bound to empathically fail and mis-attune to the client, just as she was failed in a similar way by her caregivers. Repairing these ruptures in attunement provides the client with a “gradually increasing ability to regulate negative affect states” while becoming more aware of the other (Dales & Jerry 2008: 283). Secondly, alliance ruptures allow the client to “reconcile their needs for agency versus relatedness” (Safran & Muran 2000a: 238), which are often in conflict. The process of negotiating alliance ruptures “involves helping clients to learn that they can express their needs in an individuated fashion and assert themselves without destroying the therapeutic relationship” (Safran & Muran 2000a: 238), supporting them to feel, paradoxically, more individuated and more relational. In short, negotiating the therapeutic alliance is not simply facilitative of therapy but therapeutic in and of itself through the provision of a corrective emotional or corrective relational experience for the client. References
Angus, L and Mcleod, J (Eds) 2004, The Handbook of Narrative and Psychotherapy, London: Sage Arnkoff, DB 2000, ‘Two examples of strains in the therapeutic alliance in an integrative cognitive therapy’, JCLP/In Session: Psychotherapy in Practice 56(2): 187-200 Asay, T and Lambert M 1999, ‘The Empirical Case for the Common Factors in Therapy: Quantitative Findings, in Hubble, M, Duncan, B & Miller, S (Eds), The Heart & Soul of Change: What Works in Therapy Washington: American Psychological Association Bachelor, A & Horvath, A 1999, ‘The Therapeutic Relationship’ in Hubble, M, Duncan, B & Miller, S (Eds) The Heart and Soul of Change: What Works in Therapy, Washington: American Psychological Association Bambling, M and King, R 2001, ‘Therapeutic alliance and clinical practice’, Psychotherapy in Australia 8(1): 38-43 November Bordin, ES 1979, ‘The generalizability of the psychoanalytic concept of the working alliance’, Psychotherapy: Theory, Research and Practice, 16(3): 252-260 Boston Change Process Study Group 2010, Change in Psychotherapy: A Unifying Paradigm, New York: W.W. Norton & Company Caroll, L. 1992, Alice in Wonderland, London: W.W. Norton & Company Cooper , M 2008, Essential research findings: The facts are friendly. London: Sage Dale, S & Jerry, P 2008, ‘Attachment, affect regulation and mutual synchrony in adult psychotherapy’, American Journal of Psychotherapy, 62(3); 283-312 DeYoung, P 2003, Relational Psychotherapy: a primer, New York: Routledge Dryden, W 1989, ‘The Therapeutic Alliance as an Integrating Framework, in Dryden, W (Ed), Key Issues for Counselling in Action, London: Sage Publications Duncan, B, Miller, S, Wampold, B, Hubble, M (Eds) 2009, The Heart and Soul of Change: Delivering What Works in Therapy (2nd Ed), Washington: American Psychological Association Elliott, R, Watson, JC, Goldman, RN & Greenberg, LS 2004, Learning EmotionFocused Therapy: The Process-Experiential Approach to Change, Washington: American Psychological Association Feltham, C & Dryden, W 2006, Brief Counselling: A Practical Integrative Approach, (2nd Ed), London: Open University Press Gelso CJ & Hayes, JA 1998, The Psychotherapy Relationship: Theory, Research and Practice, New York: John Wiley & Sons Gelso, CJ 2010, The Real Relationship in Psychotherapy: The Hidden Foundation of Change, Washington: American Psychological Association Gergen, K 2009, Relational Being: Beyond Self and Community. Oxford: Oxford University Press Gilbert, M & Orlans, V 2011, Integrative Therapy: 100 Key Points and Techniques. London: Routledge
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Counselling Indigenous Australians: Human Australia’s indigenous population is significantly disadvantaged with respect to both physical and mental health when compared with the general population. This is despite enormous and well intentioned efforts by those responsible for the planning and delivery of services to Australia’s indigenous people. In this article, two authors, both with many shared years in working with indigenous people in a range of settings, suggest that current strategies are not as effective as they could be due to their emphasis on recognising and addressing cultural differences ahead of human commonalities. In response, sound advice is offered which counsellors could use when counselling indigenous people. The advice focuses on the notion that it is important to address those needs of indigenous people that they share in common with all Australians before addressing any cultural differences, where the most important need is the need for robust self-esteem. The identification of the shortcomings of the current way of addressing the problems faced by indigenous people—and the offering of an alternative approach—has important implications for those engaged in helping indigenous people. One of the two authors is indigenous, the other nonindigenous. Though coming from different ethnic backgrounds, they share a common understanding regarding key aspects of subjective wellbeing in cross-cultural settings. Throughout this article, where relevant, experiential examples will be connected to each author, as an aid to understanding the cultural context of related observations and comments. We provide here some ideas that counsellors could use when counselling indigenous people of Australia; the term indigenous people will be used to refer to Australian Aboriginal people and Torres Strait Islander people. Though the focus is on Australia’s indigenous people, the material presented is not necessarily ‘culturally specific’—for important reasons that will be discussed shortly—but relates more to general principles that could also be used when counselling people of any cultural background. While many ideas about counselling indigenous people could be discussed, this article will primarily focus on one point: recognising human commonalities before responding to cultural differences. This article does not attempt to provide a new counselling program specific to Australia’s indigenous people but, rather, provides some ideas that can be incorporated into existing techniques which the counsellor may already be using. The ideas offered are not new. The reader will notice that the basic principles are consistent with those espoused by other counselling traditions such as the cognitive behavioural therapies (e.g., Edlestein & Steele 1997) and reality therapy (Glasser 2000). What could be considered unique, and perhaps controversial and radical, in the advice being offered is that greater emphasis needs to be placed on human commonalities, as opposed to cultural differences, when addressing the mental health problems of indigenous people. Our view is consistent with that of indigenous leader Helen McLaughlin, who has noted that the general failure of the majority of indigenous programs is due to their emphasis on differences between 18
indigenous and non-indigenous people and failure to recognise and acknowledge the similarities (McLaughlin 2001). The Magnitude of the Problem That indigenous people living in Australia experience greater disadvantage than other populations is so well known that it is not contested. What is contested is what to do about it. Craven and Bodkin-Andrews (2006) have provided a thorough overview of the alarming disadvantage and the extent of the inequalities, the details of which will not be repeated here. The focus of their article was on indigenous children, and we concur with their concerns and sentiments. For example, these authors have stated: “[I]ndigenous children and communities can ill afford psychologists, practitioners, and policy makers to continue to fail another generation of indigenous students. Our indigenous children are hurting—they are hurting physically, emotionally, socially, and economically” (2006: 51). In this article, we extend the concern to indigenous adults. In a country as resource rich as Australia, there is no need for our indigenous people to suffer. This article is our attempt to illuminate a solution that can help reduce the suffering experienced by indigenous people. The Relevance of Culture I (Anthony Dillon) stress the importance of seeing beyond culture, because as an indigenous Australian who has worked with indigenous people for several years in the health and education sectors, I have observed many failed programs that have been offered to indigenous people with little more justification for their anticipated success than that they were ‘culturally appropriate’ and presented by indigenous people, with the assertion that they are the only ones who can really understand the problems faced by indigenous people. Indeed, after having spoken to many indigenous people, some of whom work as counsellors or mental health workers for indigenous people, several have approached me and confirmed that the current approach is failing indigenous people. The exclusivist view (also referred to as a ‘separatist view’) is underpinned by the questionable assumption that indigenous people possess unique needs that are significantly different from the needs of non-indigenous people. We challenge that assumption. An important premise for the discussion that follows is that the core, principles of effective counselling are the same for all people, regardless of their cultural background. This is consistent with the notion that indigenous people are people first and indigenous second. While critics may argue that the premise of focusing on human commonalities, rather than on cultural or ethnic differences needs to be proven, a formal proof will not be given. After all, the current reigning paradigm emphasising that a different psychology is needed for indigenous people is assumed and not supported by any good evidence. Indeed, most social statistics on the health and wellbeing of indigenous people, both physical and non-physical (see Craven & Bodkin-Andrews 2006, clearly demonstrate that the current approach with its emphasis on culture and cultural differences is not working, thereby suggesting, indirectly, that the approach espoused in this article is a worthy alternative. CQ: The Capa Quarterly
Commonalities and Self-Esteem While the central idea presented here—the need to address human commonalities ahead of cultural differences—may seem radical, especially as it runs counter to the plethora of indigenous-specific programs and interventions for indigenous people, it is actually an idea that is very consistent with the traditional people’s understanding of life: namely the interconnectedness of life where all of life—human, animal, and nature—is seen as one. Hence, what is being offered in this article is not new, but rather a return to an old concept. In essence, we recognise that while people of different cultures may express the symptoms of their underlying problems differently, the underlying problems generating those symptoms are the same. It is with this belief that we have written this article. Focussing on issues common to all people regardless of ethnic background does not mean that important cultural differences should not be considered. They should be considered, but only once the ‘human commonalities’ have been recognised and embraced. After all, as previously mentioned, indigenous people are people first, and indigenous second. In fact, whilst reading this article, the reader may notice that most of the ideas presented are not indigenous-specific (this is intentional), yet they are effective for counselling indigenous people nonetheless. It may be difficult for those adopting the popular separatist approach to objectively evaluate the alternative paradigm being offered here, as “our interpretation of events tends to confirm the perspective from which they are observed” (Mackay 1994: 64). That is, if one believes that in a counselling setting the indigenous client needs to be primarily understood in terms of his or her cultural identity, then the counsellor’s perceptions of events will tend to confirm that belief. Further, as de Mello (1997) has pointed out, people do not fear embracing new ideas so much as they do of letting go of old ideas; hence we expect that the ideas presented in this article may not be easily grasped by some, due to a reluctance to let go of the separatist paradigm, despite its obvious failure. Resistance to letting go of the separatist approach is costing indigenous people dearly. An Orienting Perspective The process of counselling typically involves the counsellor working with the client to identify an underlying problem and then assisting the client towards a solution. The importance of counsellor guidance in the process of identifying the underlying problem beneath the presenting symptoms cannot be overstated, as clients generally are not able to identify the true underlying problem themselves. They may be very aware of the symptoms of their problem, but not of the underlying problem itself, for if they were aware, such realisation would almost always lead to a solution becoming obvious to them. Though on the surface, the situational issues that clients present to counsellors may be many and varied, the psychological and emotional reactions they are manifesting in response to those situational factors very often stem from a deeply engrained and early learned belief that their outer world experience (circumstances, personal histories, etc.) causes their inner world experience (subjective wellbeing). While there is no shortage of examples that would seem to support the claim that circumstances February 2012
Anthony Dillon and Phil Harker
determine one’s emotional wellbeing, it must be remembered that correlation does not equal causation. Further, there is no shortage of counter examples that would tend to falsify this popular belief. Indeed, many fine indigenous role models have proven that despite undesirable circumstances and personal histories (ranging from the effects of colonisation to current poverty, unemployment, etc.) they can rise above these and go on to lead very rewarding lives. A person’s response to circumstances is not directly caused by those circumstances. For any given circumstance, people can make choices in how they respond to that circumstance. In short, it is a person’s inner world experience that gives meaning to his or her outer world experience. Personal Responses Imagine two people of similar ages, from the same family, with similar upbringing, who have been involved in an event many would consider tragic. While each might experience an initial shock or feel grieved (which is quite normal, given the flight or fight reflex), it is easy to imagine that each person could go on to deal with the event in very different ways. One may come out ‘bitter’ while the other might come out ‘better.’ Clearly, if both people experience the same circumstances, yet their responses are very different, then the most influential factor in determining a person’s response has to be the person, not the circumstances. The good news is, although we cannot always choose our circumstances, we can choose our response to our circumstances; and this includes not only our present and ongoing circumstances, but also our past circumstances. Certainly, one’s past and present circumstances may influence the meaning one gives to those circumstances, but the meaning or interpretation primarily lies with the observer, not with the events themselves. Situations and circumstances do not automatically determine whether we are going to be psychological victims or not. There is no direct, one-to-one relationship between our circumstances and the way we view our circumstances—past and present. Further, we are not suggesting that no attempt should ever be made to change current circumstances. This should, however, be done only after those circumstances are evaluated through a more appropriate set of interpretive filters. In this discussion, the term interpretive filters relates to the view people have of themselves and the world in which they live. Self-Esteem The most important view people have is the view they have of themselves: that is, their self-concepts. The view people have of themselves typically has an evaluative component (Shavelson et al. 1976), commonly referred to as self-esteem. The term selfesteem, though widely used, has come to have different meanings over the years. Typically, the term is used to refer to how individuals feel about themselves relative to their estimation of social standing in relation to others. These feelings or appraisals are often based on how well individuals believe they measure up on some desirable criteria set by the dominant culture within which they live. Hence, if an individual ranks him- or herself favourably on such criteria (e.g., looks, monetary wealth, social status, academic performance, peer acceptance, job, etc.), then 19
Features that individual is commonly said to possess high self-esteem (Edelstein & Steele 1997). Conversely, if an individual ranks him- or herself lowly on those criteria, then the individual is said to have low self-esteem. Clearly, any such sense of personal worth would only be as stable as the criteria on which it is based. When one’s personal evaluation is dependent on meeting certain criteria, which typically involve comparisons of oneself with others, three things can change: the criteria themselves, an individual’s ranking on the criteria, or the degree of satisfaction derived from meeting the criteria (similar to the tolerance experienced with ongoing drug use where higher doses are needed to achieve the same level of satisfaction). Worth mentioning are two other characteristics of self-esteem that are contingent on meeting certain criteria. Firstly, if people feel good about themselves because of their performance or possession of a desirable attribute, it is likely that they will experience a degree of anxiety arising from the fear that they may lose their skill, talent or attribute (de Mello 1995). Secondly, perhaps not consciously, individuals have a sense that they are more than just their performance, body, or personality traits and, hence, they are looking for greater value that goes beyond these things. A clue to this realisation is given when examining the language a person uses to describe him- or herself. For example, to speak of ‘my car’, ‘my body’, ‘my performance’, or ‘my personality’, implies that the individual (the ‘me’) is separate from those things described as being owned by the individual. Just as a person is not her car, neither is he his achievements, body, and so forth. Popular use of the term self-esteem as described in the preceding paragraph is referred to by Deci and Ryan (1995) as contingent self-esteem, as opposed to true self-esteem, which they assert is more securely based and results in a more robust sense of self. Other researchers, such as Kernis (2003) use the terms fragile and secure in relation to high self-esteem. That is, while a person may possess high self-esteem, it may be either secure or fragile. Still other researchers, such as Jordan, Spencer, Zanna, HoshinoBrowne, and Correll (2003) use the terms defensive and secure when discussing high self-esteem. What this means is that when discussing high self-esteem, it is important to determine whether it is secure, as opposed to fragile. That is, whether it is non-contingent or contingent. It is often difficult to distinguish between the two. It is often only when individuals begin to perceive that they may lose those things which have been the basis for their sense of selfworth in the past (as in the depression felt by ‘has-been’ athletes in what has become known as ‘post-champion syndrome’) that they have the opportunity to realise that their contingent self-esteem was not robust or true self-esteem. It is through fostering this more robust type of high self-esteem that the psychological foundation of more effective counselling can be established. Locating the Source of Emotional Pain/Discomfort Underlying most emotional pain, frustration, and discomfort is low self-esteem or contingent high self-esteem disguised as true high-esteem. According to Scott and Harker (1998), people whose self-esteem is dependent upon external conditions such as feedback from others (i.e., contingent self-esteem) are likely to be easily hurt and defensive. Those with unhealthy self-concepts spend considerable time trying to enhance or protect their selfconcepts—time which could be better used for other more productive purposes. So, an important step when counselling indigenous people is to help them gain a more robust opinion of themselves—that is, to help raise levels of true self-esteem. 20
This is simple, but not easy! One of the reasons it is not easy is that people often become so accustomed to their psychological and emotional discomfort that they do not even realise it is there; it just seems the normal state to be in. This is consistent with Thoreau’s (1854) observation that “[t]he mass of men [and women] lead lives of quiet desperation”. Confirmation of this ‘normal state’ is achieved by individuals when they look around to see how many people genuinely have a sense of high non-contingent self-esteem, and how many others experience the same uneasiness as themselves— again, either because they possess low self-esteem, or more commonly, contingent high self-esteem. A second reason it is difficult to address the effects associated with contingent self-esteem, is that even if the emotional pain is realised, people are more likely to have learned to attribute emotional discomfort to their circumstances, and hence will seek to change those circumstances, rather than look to causes and solutions within themselves. According to Dyer (2001), “if you believe that something outside yourself made you down, you will reach for something outside yourself to get back up” (2001: 125). Questioning and attempting to change this faulty reasoning is the thrust of cognitive therapy. According to Beck (1989), cognitive therapy suggests “that the individual’s problems are derived largely from certain distortions of reality, based on erroneous premises and assumptions” (1989: 3). The most common premise for people seeking counselling is the belief that their emotional wellbeing is caused by their circumstances, where their circumstances may include their past, and other people’s opinions of them. Actually, it is usually not a person’s circumstances that cause their problems but, rather, their view of their circumstances; and when their view of themselves changes (i.e., their self-concept and self-esteem), so too does their view of their circumstances. In sum, we assert that the psychological problems that indigenous people face do not come about because primarily of their personal or cultural histories or their current circumstances. Rather, like anyone else, their most pressing psychological problem is that they lack high self-esteem that is robust in nature. When a person has a poor opinion of him- or herself (i.e., low selfesteem), that person experiences emotional pain. It is much easier for such individuals to locate the source of this pain outside of themselves, than to face that they do not value themselves. When a person really wants a solution (as opposed to short-term relief), one can be attained by correcting this belief that the emotional discomfort/pain experienced is dues to external factors. On this matter, Beck (1989) suggests that the therapist helps their clients to deal with their distorted beliefs by helping them to learn more realistic ways to formulate their experiences. Low Self-Esteem’s Link to Maladaptive Behaviour There is a very important (though largely unrecognised) principle of psychology that can assist our understanding of how people relate to their circumstances. When seeking to understand a person’s behaviour (particularly behaviour we would label as strange, neurotic, maladaptive, etc.), the single most important question that needs to be asked is “What is the purpose of the behaviour?” (Narciso & Burkett, 1975). Or, asked another way, “What is the desired outcome of such behaviour?” When considering those maladaptive behaviours—e.g., defensiveness, nervousness, helplessness, debilitation, or those behaviours referred to as ‘mental illnesses’— a quick answer to the question, “What is the purpose of the behaviour?” reveals CQ: The Capa Quarterly
that the underlying motive driving the manifest psychological and behavioural responses is the need to protect or enhance self-esteem. So widely accepted is this tendency to enhance or preserve self-esteem, that Leary and Downs (1995) state: “In a discipline with few universally accepted principles, the proposition that people are motivated to maintain and enhance their self-esteem has achieved the rare status of an axiom” (1995: 123). Echoing the words of Leary and Downs are those of Psyszczynski, Greenberg, Solomon, and Schimel (2004), who state, “the notion that people are motivated to sustain high levels of self-esteem is so pervasive … that most theorists use it as a postulate or paradigmatic assumption without providing justification or explanation” (2004: 435). On this matter, Colbert (2001) states, “Furthermore, experience has shown me that all behaviors or symptoms associated with the different categories of mental illness are created by the mind to protect the selfhood from overwhelming, unhealed emotional pain” (2001: 16). There can be no greater emotional pain than not liking oneself. Further, Combs and Gonzalez (1994) have stated, “People with highly positive feelings about self are less likely to feel threatened by any given event than those with inadequate self-concepts. People with low self-esteem are likely to be highly sensitive to threat” (1994: 80). What Can the Counsellor Do? It was stated earlier that the ideas contained in this article can be incorporated into existing counselling techniques, and that a new counselling paradigm specific for indigenous people is not required. However, to assist in incorporating these ideas into current counselling practices, the follow points may prove useful: 1. Acknowledge the person first, and their indigenous status second. Such a practice is actually more consistent with the holistic view of life that is embraced by those indigenous people who have been able to retain the best qualities of traditional thinking. 2. Help clients understand the importance and role of selfesteem and that their sense of self-worth should not be contingent on external criteria. 3. If a client seems ‘stuck’ in a victim mentality, it can help to gently encourage her or him to explore different ways of interpreting the situation—being careful not to infer any personal fault or blame for the currently held interpretation—and not just different ways of changing the situation to fit into the current interpretive filter. Counselling can entail education as well as guidance. 4. Encourage the client to seek out indigenous role models who have proven that there is no long-term positive place for maintaining a victim mentality (e.g., Cathy Freeman, or some other person closer to them who may have adopted more positive approaches to dealing with life in all its ups and downs). To help a client see his or her problem differently, it is sometimes helpful to ask the client how he or she would advise someone else facing a similar situation. The reversal of roles can allow the client to more easily move away from the dependent victim view of a situation. 5. Ask clients how they would wish to view themselves once the problem or situation they were facing had changed for the better. This can open up the discussion to viewing things from a different perspective and then working back to the more ingrained mindset. February 2012
6. All in all, the change process is more about ‘seeing differently’ than ‘doing differently’, as long-term change depends upon the former and the latter will then happen largely as a natural process of change. Perhaps, in order to help people see more clearly, there is a great need for frank and open discussion regarding current perceptive filters and mindsets that have become part of popular indigenous ‘folk-law’—such a discussion is particularly pressing amongst those who have taken on the professional helper role. Conclusion The problems faced by indigenous Australians are similar to those faced by other Australians. Assisting indigenous Australians in the counselling setting, therefore, requires that the counsellor recognise the commonalities between indigenous and non-indigenous Australians before addressing differences of a cultural or ethnic nature. References
Beck, AT 1989, Cognitive Therapy and the Emotional Disorders, London: Penguin Books Colbert, TC 2001, Rape of the Soul: How the Chemical Imbalance Model of Modern Psychiatry Has Failed Its Patients, Tustin, CA: Kevco Combs, AW, & Gonzalez, DM 1994, Helping Relationships: Basic Concepts for the Helping Professions, Boston: Allyn and Bacon Craven, RG & Bodkin-Andrews, G 2006, ‘New Solutions for Addressing Indigenous Mental Health: A Call to Counsellors to Introduce the New Positive Psychology of Success, Australian Journal of Guidance & Counselling, 16(1): 41-54 Deci, EL & Ryan, RM 1995, ‘Human Autonomy: The Basis for True Self-Esteem’, In MH Kernis (Ed.), Efficacy, Agency, and Self-Esteem (31-49), New York: Plenum Press de Mello, A 1995, The Way to Love, New York: Image Books Dyer, WW 2001, What Do You Really Want for Your Children? New York: Quill Edelstein, MR & Steele, DR 1997, Three Minute Therapy: Change Your Thinking Change Your Life, Aura, CO: Glenbridge Glasser, W 2000, Reality Therapy in Action, New York: HarperCollins Jordan, CH, Spencer, SJ, Zanna, MP, Hoshino-Browne, E, & Correll, J 2003, ‘Secure and Defensive High Self-Esteem. Journal of Personality and Social Psychology, 85(5): 969-978 Kernis, MH 2003, ‘Toward a Conceptualization of Optimal Self-Esteem’, Psychological Inquiry, 14(1): 1-26 Leary, MR & Downs, DL 1995, ‘Interpersonal Functions of the Self-Esteem Motive: The Self-Esteem System as a Sociometer’, In MH Kernis (Ed.), Efficacy, Agency, and Self-Esteem (123-144), New York: Plenum Press. McLaughlin, H 2001, ‘Are we headed in the right direction?’ In G Johns (Ed.), Waking Up to Dreamtime: The Illusion of Aboriginal Self-Determination, Singapore: Media Masters Narciso, J & Burkett, D 1975, Declare Yourself: Discovering the Me in Relationships, Englewood Cliffs, New Jersey: Prentice Hall. Pyszczynski, T, Greenberg, J, Solomon, S, Arndt, J & Schimel, J 2004, ‘Why Do People Need Self-Esteem? A Theoretical and Empirical Review’, Psychological Bulletin, 130(3): 435-468 Scott, T & Harker, P 1998, Humanity at Work, Luscombe, Australia: Phil Harker and Associates Shavelson, RJ, Hubner, HJ, & Stanton, GC 1976, ‘Self-concept: Validation of Construct Interpretations’, Review of Educational Research, 46(3):407- 441 Thoreau, HD 1854, Walden, Boston: Ticknor and Fields
Anthony Dillon holds a Bachelor’s degree in mathematics, a Master’s degree in adult education, and an Honours degree in psychology. Originally from Queensland, he is the recipient of the prestigious Yaramundi scholarship at The University of Western Sydney, which enabled him to complete his PhD. His research interests are in the area of statistics, psychometrics, applied psychology, indigenous health and well-being, and most passionately, the conceptualisation, understanding, and treatment of behaviours labelled as ‘mental illnesses’ (e.g., depression, attention deficit hyperactivity disorder). He is now undertaking post-doctoral research at The University of Western Sydney and is a lecturer in Health Sciences and Indigenous Health at The University of Sydney. Phil Harker, BA MA, PhD, has spent the last thirty-five years lecturing and practicing in the fields of organisational, clinical, and educational psychology, both as an academic at the University of Queensland, Queensland University of Technology, and Griffith University and as a Organisational Consultant and Clinical Practitioner. Phil has been a consultant to a wide range of Government Departments and nongovernment organisations in Australia and New Zealand. He has also conducted, throughout this same period, a pro bono practice in clinical psychology and a personal counselling service, with over two thousand clients from private, business, educational, and family settings and has presented over one hundred parenting and family relationship programs in Australia in New Zealand.
In Search of the Heaven-Sent What do the terms supervisors and supervision actually mean in the context of therapy? In counselling and psychotherapy circles, the ideal clinical supervisor does not fit any of the descriptions typical in common parlance, where the designation ‘supervisor’ is equivalent in meaning to ‘overseer’, ‘person in charge’, ‘superintendent’ ‘controller’ or, as one business dictionary has it, ‘person in front-line management who monitors and regulates employees in their performance of assigned tasks’. In the managerial context, a supervisor also has the role of reporting on an employee’s performance to higher levels of management. There is a world of difference between the function of a linemanagement supervisor and that of a clinical supervisor. One of the major distinctions is that a worker has no choice about who will fill the supervisory role, but in the clinical context, the supervisee can usually pick and choose, within reasonable limits. It is widely accepted throughout the counselling sector that a counsellor should have a clinical supervisor who is ‘external to her or his agency and therefore independent of organisational processes and issues’ (Ask & Roche 2005). Admittedly, there are some systems in which the distinction between the role of managing supervisor and that of clinical supervisor is not recognised, and situations do exist where the two functions are conflated and undertaken by the same person. This may not always be conducive to the professional development of the counsellor nor to that person’s sense of personal wellbeing. The Supervisor’s Role Given that a clinical supervisor is normally not in any sense a counsellor’s boss, what can we reasonably expect that person to be or to do? What is clinical supervision in an optimum conception of the process? I have filled the role of accredited clinical supervisor myself for the past five years and have received supervision as a counsellor and therapist for twenty-five years prior to that. As a result, I am interested in both defining the qualities I appreciate in those who have supervised me and examining the standards I set for fulfilling that role myself. The Supervisory Relationship I begin by looking at the supervisor/supervisee relationship. Since the 1980s and the advent of post-modernist thinking, there have been changes in attitudes towards relationships of all kinds. There has been, in many relational contexts, a trend toward egalitarianism, and this has influenced the functioning of the therapy sector. As is widely the case with counsellor/ client relationships, there is now a common agreement that, at its best, the supervisor/supervisee relationship is one of partnership (RGF Guidelines 2008). Ideally, it is a cooperative working alliance between two professionals in which one of them offers the other an account of his/her work, is helped to reflect on it, and receives whatever feedback and guidance may be appropriate. The alliance has the object of enabling the counsellor to gain in confidence, creativity and ethical competency so that clients may receive the best possible 22
service (Inskipp & Proctor 2001). Clinical supervision, in its most desirable manifestation, has been described as a form of conversation that is closer to dialogue than to any other form of talk. In such a conversation, the supervisor and the supervisee work together to arrive at conclusions and solutions that did not necessarily pre-exist (Carroll and Gilbert 2006). Supervision is a place of trust where a healthy relationship gives me a safe place to acknowledge and work with my clinical concerns, stresses, fears and joys. ~Johnson (2001) Supervision is a regular, protected time for facilitated, in depth reflection on clinical practice. ~Bond and Holland (1998) Bearing in mind these descriptions, I have often thought that the term ‘supervisor’, in the clinical supervision context, is misleading. A more accurate term would be ‘clinical consultant’. Such a designation would be less encumbered with hierarchical connotations and we would have instead the clear notion of an experienced professional, working alongside a less experienced colleague in an advisory capacity, with the sole purpose of enhancing the professional functioning and wellbeing of the latter. ‘Consultant’ would be a far more accurate description of the role but, unfortunately, we have to go along with the established terminology. The Ideal Supervisor In the ideal supervisor, you would find a person who, despite having more experience and skill than you have, would treat you as an equal, with all the respect that is due to a fellow professional. The ideal supervisor’s manner would hold no hint of condescension; you would have instead a sense of travelling with the supervisor on a path of shared discovery How could such an egalitarian situation always be possible if part of a clinical supervisor’s role is to notice any apparent errors you may be making in your counselling practice and bring these to your attention? It is, of course, all a matter of the supervisor’s attitude. Respect and empathy are close companions. Through empathy and respect, your supervisor would help you attend to your mistakes so that you see them not as failings but, instead, as opportunities for further development of your knowledge and skills. The aim of supervision is that the supervisee will experience him/herself as more competent and successful. ~Durant (2004) Reasonable Expectations It is reasonable to have certain expectations of a clinical supervisor. Your supervisor would reasonably be expected to have qualifications that are appropriate to your role. Hopefully, as a counsellor in a specific area of work, you would choose to be supervised by a person who is at least as qualified and experienced in that same field as you are. However, in circumstances where this expectation was difficult to satisfy, it might be that a highly skilled generalist who was open to extending his or her knowledge could serve your needs very well. CQ: The Capa Quarterly
Clinical Supervisor There are certain virtues that it is wise to look for in a clinical supervisor. Cultural sensitivity is one of these. In the counselling sector, there is as much ethnic and cultural diversity among counsellors as there is among their clients. A clinical supervisor from one culturally and linguistically diverse (CALD) background may have a supervisee from another CALD background who is working with a client from yet another. The supervisor therefore needs to be sensitively aware of the manifold attitudes, values, mores and beliefs that are part of this diversity. Although it is impossible to change backgrounds, pluralistic counselors can avoid the problems of stereotyping and false expectations by examining their own values and norms, researching their clients’ backgrounds, and finding counseling methods to suit the clients’ needs. Counselors cannot adopt their clients’ ethnicity or cultural heritage, but they can become more sensitive to these things and to their own and their clients’ biases. ~Bolton-Brownlea (1987) I think it is accurate to say that multicultural values sit shallowly in the population at large. There is among many a tendency for their acceptance of multiculturalism to be limited to a sentimental appreciation of minority populations, who are seen as having quaint customs and eating interesting food. Residing in the minds of many is the condescending view that populations other than their own ‘have cultures’, whereas they are themselves part of a ‘mainstream society’ that is just ordinary/normal. As counsellors with a need to develop cultural sensitivity, we should be mindful that our ‘normality’ is no more than an expression of the culture in which we are unconsciously imbedded. As part of helping a supervisee to develop cultural sensitivity, a good supervisor will avoid problems of stereotyping and erroneous expectations by examining his/her own values, norms, and biases, recognising that these are as much the result of cultural conditioning as are any others. The good supervisor will thus be able to view them objectively (Bolton-Brownlea 1987). From this objective viewpoint, the culturally sensitive supervisor will be more capable of assisting the supervisee to function beyond the limitations of “personal cultural lens, blind spots and prejudices” (Korin 1994). Only those who escape the web of their own assumptions and maintain a balanced perspective will be able to communicate effectively with other cultures. ~Pedersen (1997) Finding a Good Fit How does one find the ideal supervisor? In my early years as a fledgling counsellor I explored as widely as I could among the available professionals offering supervision. I made known to each one that my visit was part of a wider tour in search of supervisory techniques and approaches that I could relate to. I discovered an interesting diversity among these professionals. I certainly found that some were more helpful than others but, even so, I gained something useful from each one. February 2012
Inevitably, some supervisors will have supervising styles more supportive of your professional needs than others. You may benefit the most from supervision that is largely strength-based and enabling of your latent abilities. On the other hand, you may respond better to a supervisor who frequently challenges you. Alternatively, one who relies on expressions of respectful curiosity may help you more. A balanced, eclectic combination of all these styles may suit you best. I suggest you should shop around, as I once did, to find the supervisor who best fits your needs. A cautionary note: You may not immediately find one who is ‘heaven sent’—whose approach will satisfy all your requirements. It is important to be aware that presently, outside of some professional associations, there is little or no regulation of supervisors in terms of qualification. Any person with some counselling experience is free to present himself or herself as a provider of supervision, despite having no specialised training for that role. Unfortunately, there are few training programs available by which an aspiring supervisor can develop the skills and acquire the knowledge necessary to function as such at optimal levels. It is commonly assumed that being a good therapist will automatically translate into being a good supervisor. This is by no means the actual case. A skilled therapist who is an untrained supervisor is not always able to establish a supervisory posture that includes support for your personal style, recognition of your existing competencies, collaborative exploration, positive critical reflection, creative problem solving, and flexible planning for action (Clare 2001). Too frequently, a supervisor without adequate training will fall back on a didactic strategy in which you are invited to describe a client’s problem and the supervisor responds by telling you how to fix it. Supervision of this kind does not enhance your own capacity to be creatively adaptive. I believe it is rare to find a supervisor who practices a learnercentred style of supervision. That is, most supervisors believe they know what therapists need and what a particular therapist must do to become competent. ~Thomas (2000) Too often we have had to put up with supervisor-based supervision where supervisors take most of the initiatives … dazzle with their ‘wisdom’ and take the spotlight off supervisees. ~Carroll and Gilbert (2006) Another difficulty you may encounter is to find yourself working with a supervisor who has a strong bias toward a particular model and a disparaging attitude toward other options. This is not uncommon, and your supervision arrangements may not be very fruitful if your preferred model is one of those not highly regarded by your supervisor. Just as problematic is a situation wherein you and a biased supervisor find yourselves in full accord with each other’s prejudiced views and collaborate to reinforce them. Boundaries Having located an ideal supervisor, one should learn not to approach that person with unreasonable requests. Counsellors 23
Features sometimes have expectations of clinical supervision that go beyond what is appropriate. Some counsellors expect their supervisors to perform extra-supervisory roles, such as providing therapy, being a trainer, or functioning as an advocate. There are some limitations on what you can reasonably expect your clinical supervisor to do for you. While you expect your clinical supervisor to be an accomplished therapist, that is not the role you should expect her/him to fill for you in giving you supervision. In a supervision session, your work with clients is always the central issue. Munson (2002) insists on an absolute dichotomy saying; “Supervision is supervision and therapy is therapy. There is limited value to a practitioner’s learning to do treatment from being in therapy.” An analyst would, of course, disagree with Munson on the second point, and many counsellors would point out that, despite what Munson says, supervision does have a restorative function. Sometimes the boundaries between supervision and therapy can become a little fuzzy. For one thing, your supervisor should be alert to identifying signs of burnout in you. Where this is in evidence, he/she should allow you to debrief and permit some therapeutic offloading. However, if the venting of emotional issues is leading to you becoming self-preoccupied rather than thinking about the client, your supervisor should find ways for both of you to step outside that process, review what is happening and make a transition from venting to talking about the client. If you have some personal difficulties that are in need of therapeutic attention but not directly related to your counselling work, you might disclose these to your supervisor and expect that you would be given an appropriate referral. Can your supervisor also be your trainer? You can expect to learn much from a person who is more experienced in your field of work than you are, but to what extent can you expect to be trained by that person? There are some boundaries, admittedly somewhat blurred, between formal training and the educational dimensions of clinical supervision. A supervisor may at times coach you in developing professional skills and knowledge. This may involve demonstration, practical exercises, and provision of resource materials, but it should not extend into providing you with a structured training program. If this is what you need, the supervisor can point you in the right direction to access a range of choices. Nor should the supervisor be an advocate on your behalf. Some years ago a skilled therapist was contracted by an agency to provide group supervision to its team of counsellors. The therapist, inexperienced as a supervisor, allowed the sessions to develop into forums for complaints about the agency’s procedures and the conduct of its management. With the agreement and encouragement of the team, the supervisor regularly took these issues to the agency’s operations manager. This line of action proved to be counter-productive. After around eighteen months, the agency terminated the supervision contract, and the provision of group supervision was discontinued. In grievances concerning an employer or your work environment, it isn’t appropriate for your supervisor to take up an advocacy role. However, if employer/workplace grievances are impacting on your work with clients, they can and should be aired in supervision. The supervisor should then refer you to suitable grievance procedures for further action. 24
The Session Agenda Who should set the supervision session agenda? The supervisee has the responsibility of choosing the subject matter for clinical supervision. Your supervisor should, of course, be alert for issues in your practice that need attention and will bring these up for discussion. Overall, though, she/he does not decide what the agenda of a supervision session should be. You, therefore, need to form clear objectives in your mind for each session. You should prepare the full agenda each time to suit your special requirements, allowing flexibility for your supervisor to suggest appropriate modifications if needed. In a group setting, group members should collaborate with each other and with the supervisor in setting the agenda. Confidentiality What degree of confidentiality can be expected in the supervisorsupervisee relationship? You can expect all clinical supervisors to exercise the same level of confidentiality with you as you do with a client. This means that in supervision you can express yourself freely, without fear that what you say will be disclosed to others. There are, though, certain limitations. Just as a counsellor is legally obliged to notify an appropriate authority if a client speaks of having committed an indictable offence or reveals an intention to harm self or others, a clinical supervisor is also constrained by safety issues and legal considerations. On the one hand there is a need to ensure the confidentiality of individual sessions in order to provide a safe and constructive learning environment. On the other, given the role of clinical supervision as a mechanism for clinical quality and safety, there is a need to ensure that any sufficiently serious issues related to clinical practice are dealt with appropriately and transparently. ~NSW Drug and Alcohol Clinical Supervision Guidelines (2006) Confidentiality conditions should be clearly set out in the contract you have with your supervisor. If the contract is made between the two of you and no one else, it will have conditions such as are described above, but there are exceptions with some contractual situations. If, for example, the contract is a threeway agreement between you, the supervisor and your employer, it may permit your employer to be privy to details of what ensues in clinical supervision. This arrangement might impact substantially on how you would choose to present in supervision. Supervision Alternatives What alternative formats exist for supervision? Suppose you have found your heaven-sent supervisor: What format would you like for your supervision experience? A private face-to-face interaction between you and the supervisor is the most common and generally the most preferred. Some circumstances, though, may make this choice impracticable, and there are other options. Group supervision, video conferencing, or telephone supervision are available from some supervisors and, while each of these alternative forms has certain limitations, there are also some advantages. Whether group supervision is helpful or not depends a great deal on the size and composition of the group and whether the supervisor has been adequately trained in group dynamics. The participants need to have equal status, and a group consisting of two counsellors and a person from line-management will be likely to develop difficulties. There has to be a way of ensuring that every participant has a fair share of attention. Dominant personalities must be skillfully managed. A high level of mutual respect and empathy among the participants must be maintained. If these CQ: The Capa Quarterly
elements can be held at an optimum level, group supervision can be a rewarding experience. In the group setting, you have the benefit of sharing diverse perspectives as you, your supervisor and your colleagues engage with several cases. Perhaps you, like many other counsellors, prefer one-to-one supervision because you and your issues have the undivided attention of the supervisor for the full session. Without the presence of peers, you may feel less need to be guarded in disclosing feelings of doubt about your adequacy in difficulties you are having with some clients. Telephone supervision and video conferencing have their merits in that they can save the inconvenience of travel for you or for your supervisor. Not everyone feels comfortable with those formats and they are as yet, not anywhere near as widely practised as are in-person supervision arrangements.
Conclusion A therapist never outgrows the need for clinical supervision. Seeking supervision is not an indication that a practitioner is lacking in competence but indicates, rather, an awareness of the value of continual professional skills development—a striving toward excellence in the supervisee’s chosen field of work). Clinical supervision has been called “the cornerstone of clinical practice” (Kirk, Eaton & Auty 2003). As such, it should be regarded as essential for the development of professional competence in therapists and for enhancing the value of the therapeutic process for their clients. In conclusion, I suggest that effective supervision should have something of a ‘feel good’ factor. Following a good supervision session you should feel encouraged—that your professional standing has been enhanced. Clinical supervision should be an experience that is anticipated with more than a degree of pleasure.
Korin, EC 1994, ‘Social Inequalities and Therapeutic Relationships: Applying Freire’s Ideas to Clinical Practice’, Journal of Feminist Family Therapy 5(1):79-98
Ask, A and Roche, AM 2005, Clinical Supervision: A Practical Guide for the Alcohol and Other Drugs Field, Adelaide: National Centre for Education and Training on Addiction, Flinders University. Bolton-Brownlea, A 1987. Issues in Multicultural Counselling. Ann Arbor, Michigan: Education Resources Information Center (ERIC) Clearing House on Counseling and Personal Services Bond, M and Holland, S 1998, Skills of Clinical Supervision for Nurses, Buckingham: Open University Press Carroll, M and Gilbert, M 2006, On Being a Supervisee: Creating Learning Partnerships, Kew, Victoria: PsychOz Publications Clare, M 2001, ‘Operationalising Professional Supervision in this Age of Accountabilities’, Australian Social Work. 54(2): 32-40 Durant, M 2004. Solution-focused and Strengths-based Approaches to Supervision. Parramatta: Brief Therapy Institute of Sydney Inskipp F and Proctor B 2001, Making the Most of Supervision (2nd Edition), London: Cascade Johnson, P 2001, Clinical supervision: An introduction, Presentation at the annual meeting of the Montana Counseling Association, Big Sky, Montana Kirk, SFL, Eaton, J and Auty, L 2000, ‘Dietitians and supervision: should we be doing more?’, Journal of Human Nutrition and Dietetics, 13:317-322
NSW Department of Health 2006, Clinical Supervision Guidelines. www.health.nsw.gov.au Pedersen, P 1997, Culture-Centered Counselling Interventions: Striving for Accuracy, Thousand Oaks, California: Sage Publications Proctor, B 2000, Group Supervision: A Guide to Creative Practice, London: Sage Publications Responsible Gambling Fund 2010, Clinical Supervision Guidelines for the Problem Gambling Counselling Sector, NSW Office of Liquor Gaming and Racing, www.olgr.nsw.gov.au/gaming_rgf_info_srvcs.asp Thomas, FN 2000, Mutual Admiration: Fortifying Your Competency-Based Supervision Experience, Ratkes, Journal of the Finnish Association for the Advancement of Solution and Resource Oriented Therapy and Methods, 2:65-72
Malcolm Pearce, a practising psychologist and supervisor with offices in Walker Street, North Sydney, has a PhD in Transpersonal Psychology and a Masters in Counselling. He is accredited as a clinical supervisor to counsellors working in the field of problem gambling. His own therapeutic work is based mainly on humanistic and post-modern modalities, and he specialises in post-trauma recovery and treatment of addictive behaviours.
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Shyness as a Precursor to Social Phobia & Social Phobia (SP) and Avoidant Personality Disorder (APD) are psychiatric diagnostic classifications of mental disorders. Classifications guide psychiatric service, research and education, they define illness in order for treatment protocols to be established, assess levels of disorder, and provide evidence for a structured approach of assessment as well as being a communication tool between clinicians (Andrews, Anderson, Slade, & Sunderland 2008). Classification issues arise for many reasons including when disorders overlap, respond to the same treatment regime, and differ in severity (Reich 2009). One example of a classification issue is the historical debate regarding the distinction between SP and APD being discrete conditions or alternative conceptualisations of the same condition on a continuum (Furmark, et al. 1999; Hummelen, Wilberg, Pedersen, & Karterud 2007; Reich 2009; Rettew 2000). This paper reviews the history of this debate, defines the characteristics of SP, APD and shyness, describes the functioning and disability associated with each disorder, and considers the reliability and validity of the current classifications ending with a review of what is proposed for the DSM-V. It will be argued that shyness is a precursor to SP and APD and that phenomenological data and evidence is leaning towards SP and APD being placed on the same social anxiety continuum rather than being distinct conditions. The American Psychiatric Association (APA) first classified SP and APD in the DSM-III (APA 1980) and stated that SP and APD could not be co-morbid. This exclusion was dropped in criterion changes within the DSM-III-R (APA 1987) where SP was subdivided into SP and Generalised SP (GSP) (APA 1980; APA 1987; Reich 2009; Reichborn-Kjennerud, et al 2007). This classification debate continues today and is part of the DSM-V revision currently taking place. Workgroups are considering replacing the current groupings of mental disorders with a more empirically based structure. This approach is based on the premise that empirically based data provides a more accurate view of mental health conditions and their comorbidities (Andrews, et al. 2008; APA 2009). The DSM-V workgroup report for Anxiety, ObsessiveCompulsive Spectrum, Posttraumatic, and Dissociative Disorders are currently discussing issues around SP such as the name, changes to the wording and organisation of the diagnostic criteria, the usefulness of the current ‘generalised’ and ‘nongeneralised’ criteria and the differential diagnosis between SP and APD (APA 2009). The workgroup for Personality and Personality Disorders under which APD currently resides are completing literature reviews and developing an alternative model of personality and personality disorder assessment classification (APA 2009). The workgroups will determine whether SP and APD remain as discrete conditions or become part of the social anxiety continuum within the DSM-V, although this decision will not necessarily end the debate. 26
With the APA changing the definition for SP and APD within the DSM-III-R (APA 1987), it now appears that APD overlaps significantly with SP, particularly with GSP (Reich 2009), more so than it would if it were a discrete condition. If SP and APD as per the DSM-IV-R are discrete conditions, then the rates of co-occurrence would be at chance levels. Research conducted by Reich shows that co-occurrence is considerably higher than would be expected by chance alone (Andrews, et al. 2008), supporting the debate that there is now sufficient evidence for an empirically based structure to replace the current grouping of disorders (APA 2009). The course, characteristics, functioning, and disability for SP, GSP and APD provide evidence for a severity continuum beginning with shyness, moving through SP and GSP and concluding with APD (Andrews, et al. 2008; Hummelen, et al. 2007; Reich 2009; Rettew 2000). Shyness is seen as a precursor in the course of both SP and APD; however, shyness does not lead to SP unless the person has “clinically significant impairment or marked distress” (APA 2000: 344). Whilst shyness is a precursor of APD for most people, shyness is transitory and APD is not diagnosed unless the person becomes “increasingly shy and avoidant during adolescence and early adulthood” (APA 2000: 720). The social anxiety continuum commences with shyness; although shyness is not synonymous with SP, shyness does appear to be an important consideration, particularly with GSP (Rettew 2000). Turner, et al (as cited in Chavira, Stein & Malcarne 2002) distinguish shyness and SP by the level of impairment in social and occupational functioning and the severity of avoidance with shy people often having transitory symptoms, less avoidant behaviours and less impairment than those individuals with SP (Rettew 2000). Carducci and Zimbardo, 1995 (as cited in Chavira, et al. 2002) showed that an extremely shy person does not necessarily develop SP with 40 to 50% of individuals reporting shyness and only 3 to 16% developing SP. This suggests that although SP and shyness symptoms overlap, the frequency rates are significantly different (Chavira, et al. 2002). Next on the proposed continuum is SP, which is sometimes linked to panic disorder (Hummelen, et al. 2007). SP refers to a clinically significant anxiety that is triggered by exposure to one or more social or performance situations in which the person is fearful of scrutiny or humiliation by others and thus tries to avoid the fearful situations. Examples of SP are fear of public speaking, signing one’s name, and eating in public (Andrews, et al. 2008; Chambless, Fydrich, & Rodebaugh 2008; Tillfors, Furmark, Ekselius, & Fredrikson 2004). A type of SP, GSP is characterised as individuals “who fear both public performance situations and social interactional situations” (APA 2000: 451) and is closely linked to GSP (Chavira, et al. 2002). The usefulness of this subdivision is currently under debate within the DSM-V workgroup (APA 2009). CQ: The Capa Quarterly
Avoidant Personality Disorder APD is at the acute end of the continuum and is classified as a personality disorder it is a chronic condition that begins in childhood and leads to impairment in global functioning with higher levels of interpersonal problems and general symptom distress, the person may feel inadequate and tend to have a heightened sensitivity to negative evaluation (DSM-IV-R 2000; Hummelen, et al. 2007; Reich 2009; Reichborn-Kjennerud, et al. 2007). The co-occurrence of SP, GSP and APD was shown in an empirical literature review conducted by Reich (2009). Reich found that GSP and APD overlap significantly, and that APD and SP are genetically identical, sharing symptoms that differ only in severity and respond to the same treatment psychotherapeutically and pharmacologically, with SP being a milder variant of APD. It was proposed by Reichborn-Kjennerud, et al. (2007) that childhood environment factors influence whether an individual will develop SP or APD. A study conducted by Ralevski, et al (2005), which analysed clinical-phenomenological data, concluded that GSP is closely linked to APD. Ralevski and colleagues (2005) where unable to find any meaningful difference between treatment groups that had APD without SP and treatment groups that had APD with SP. Chambless, et al. (2008) question the inter-rater reliability for SP for this study, suggesting that it is less than desirable and that some cases of GSP may have been missed due to the abbreviated version of the SP module being used. The distinction between GSP and SP was not addressed; again the subdivision between SP and GSP seems to be a place of dispute and debate. The other side of this debate is that SP and APD are discrete conditions. Within the DSM-IV-R (2000), they appear on two axes with SP being placed on axis I as a clinical syndrome and APD being placed on axis II as a personality disorder (Ralevski, et al. 2005). This distinction has been significantly influenced according to Reich (2009) by Millon’s work. Millon makes the point that an individual who has SP does not necessarily show difficulty in forming intimate relationships whereas a person with APD can have SP as well as other fears and difficulty in forming intimate relationships (as cited in Chambless, et al. 2008), which sounds remarkably similar to GSP. The significant overlap between APD and GSP, with difference only in the severity of dysfunction between these two disorders, supports the reclassification of APD as an anxiety disorder at the acute end of the severity continuum. In summary, the debate about whether SP and APD are discrete conditions or the same condition with different levels of severity continues. No literature was found that disputed shyness as being part of the course of both conditions. Authors of the DSM-IV acknowledged limitations regarding the categorical approach and stated that “there is no assumption that each category of mental disorder is a completely discrete entity with February 2012
absolute boundaries dividing it from other mental disorders or from no mental disorder” (APA 2000). Moreover the DSM-V workgroup is currently considering replacing the current mental disorder groupings with a more empirically based structure. The decision of the DSM-V workgroups may lead to the redefining of some discrete conditions that currently show significant overlap of symptoms which differ in severity yet respond to the same treatment regime with a model that places them on a severity continuum. Research supports the position that shyness, SP, GSP and APD are in fact conceptualisations of the same condition that fits into a severity continuum beginning with shyness and ending with APD. References Andrews, G, Anderson, TM, Slade, T, & Sunderland, M 2008, ‘Classification of anxiety and depressive disorders: Problems and solutions’, Depression and Anxiety 25: 274-281 American Psychiatric Association, 1980, Diagnostic and statistical manual of mental disorders (3rd ed.), American Psychiatric Association, Washington, DC American Psychiatric Association 1987, Diagnostic and statistical manual of mental disorders (Rev.ed.) (3rd ed.), American Psychiatric Association, Washington, DC American Psychiatric Association 2000, Diagnostic and statistical manual of mental disorders, (Rev.ed.) (4th ed.), American Psychiatric Association, Washington, DC American Psychiatric Association 2009, Report of the DSM-V anxiety, obsessive-compulsive spectrum, posttraumatic, and dissociative disorders work group, retrieved 24 September 2009 from http://www.psych.org/DSMRRevisionActivities American Psychiatric Association 2009, Report of the DSM-V personality and personality disorders work group, retrieved 24 September 2009 from http://www. psych.org/DSMRRevisionActivities Chambless D., Fydrich, T, & Rodebaugh, TL 2008, ‘Generalized social phobia and avoidant personality disorder: Meaningful distinction or useless duplication?’, Depression and Anxiety, 25: 8-19 Chavira, DA, Stein, MB, & Malcarne, VL 2002, ‘Scrutinizing the relationship between shyness and social phobia’, Anxiety Disorders, 16: 585-598 Furmark, T, Tillfors, M, Everz, PO, Marteinsdottir, I, Gefvert, O, & Fredrikson, M 1999, ‘Social Phobia in the general population: prevalence and sociodemographic profile’, Soc Psychiatry Psychiatr Epidemiol, 34: 416-424 Hummelen, B, Wilberg, T, Pedersen, G, & Karterud, S 2007, ‘The relationship between avoidant personality disorder and social phobia’, Comprehensive Psychiatry, 48:348-356 Ralevski, E, Sanislow, CA, Grilo, CM, Skodol, AE, Gunderson, JG, & Tracie Shea, M, et al. 2005, ‘Avoidant personality disorder and social phobia: distinct enough to be separate disorders?’, Acta Psychiatrica Scandinavica, 112: 208-214 Reich, J 2009, ‘Avoidant Personality Disorder and its relationship to social phobia’, Current Psychiatry Reports, 11: 89-93 Reichborn-Kjennerud, T, Czajkowski, N, Torgersen, S, Neale, MC, Orstavik, RE, & Tambs, K, et al. 2007, ‘The relationship between avoidant personality disorder and social phobia: A population-based twin study’, Am J Psychiatry, 164: 1722-1728 Rettew, DC 2000, ‘Avoidant personality disorder, generalized social phobia, and shyness: Putting the personality back into personality disorders’, Harvard Rev Psychiatry, 8:283-297 Tillfors, M, Furmark, T, Ekselius, M, & Fredrikson, M 2004, ‘Social phobia and avoidant personality disorder: One spectrum disorder?’, Nord J Psychiatry, 58: 147-152
Toni Bailey, BA (Counselling and Human Change), Dip. & Cert. IV Couns., Dip. Hypnotherapy, has been in private practice for more than a decade. She works with all areas of counselling and her particular areas of interest include working with adult survivors of sexual abuse, dissociative identity disorder, domestic violence, loss and trauma and spirituality. She strongly believes in strengths-based therapy and in the need to venerate clients. Toni continues to run her private practice— Life In Perspective Counselling Centre—supervise, and teach in the sector, and is conducting research into resilience. She is currently a clinical member of CAPA, PACFA and the AHA.
The Technological World: Has Psychotherapy Virtual Therapies! This was the theme for The CAPA Quarterly: Issue Three 2011. In reading the various articles devoted to this theme, it became clear to me that psychotherapists today have embraced technology, even with the inevitable glitches that come from using the hardware (losing connections, privacy and boundary issues, confidentiality and texting and so on). These are indeed serious issues for the therapist who goes on line today, and the articles presented in CQ were well rounded, balanced, and helpful. The articles also represent a prevailing attitude towards technology that I think lies largely unexamined within the field of psychotherapy. This is the almost universal attitude today that technology is a useful means by which we can advance the theories and methods of psychotherapy. I want to examine this attitude, unpack it a bit and see what we uncover by doing so. In advance of my discussion, I want to assure the reader I am not a modern Luddite arguing for a return to former times. What a waste of ink that would be! There is no stopping this juggernaut that we call our technological civilisation. What I will be arguing for is the importance of stepping up and comprehending, in terms of our profession, these incredible, irreversible changes going on today. The first thing to note is that psychotherapy came into existence well before technology took hold of our civilisation, as it has today. Any healing practice at all springs from the soil of the culture whose individuals need healing. This includes the reality in which everyone is embedded, as expressed by the culture. I’ll give an example. The Asclepian temples of ancient Greece show evidence that the sick person could be healed by a dream in which a snake (the animal form of Asclepius) bites the injured limb. This form of healing is only possible for a culture in which reality is very different from our own. The very definition of ‘body’ must have been profoundly different in order for the body to be penetrated and healed by a dream. In fact, dream reality and waking reality must have interpenetrated in some way that is no longer available to us today. So what culture and reality gave birth to psychotherapy? By the early 1800s the West had finally broken the great Chain of Being that held the cosmos together for millennia, linking the small to the great, the earthly to the heavenly. Modern subjective consciousness was now ‘emancipated’ from any connection to Being and thus felt its freedom fully. We experienced ourselves for the first time, as ‘selves’ quite separate from ‘the world’, and psychotherapy emerged when the integrity of that self was challenged in one way or another (called neuroses at the time). The concept, central to understanding how this separate self could be challenged, was of course at the time the concept of the unconscious self. 28
Psychotherapy since then has burgeoned from this root into a thousand branches, but they all share a belief in and dedication to the existence of a separate self (however defined today). When this self is challenged, healing is available through a plethora of ‘restoration’ methodologies. This notion of a separate self is enshrined in our legal and political systems as well. It underlies our notions of responsibility, freedom, consequences, relatedness, ethics, knowledge, economics (e.g., corporations have the legal status of a ‘person’) and so on. So, when we regard technology as an extension of our psychotherapy, we are saying that technology can assist us in the therapeutic work of developing healthy separate selves (however these are defined by the various schools). Meanwhile, what is technology itself doing to this notion of a separate self? Let’s take a look. 1. As I write this, millions of people are going on line in the guise of an avatar, where they can create and live a life that is completely absent of ethics, responsibility, relatedness—a kind of freedom empty of any consequences. This feature of virtual reality alone makes a mockery of the notion of a solid, single self that each of us is. We can become anyone we please! Just a game, you may think. I rather suspect it is a training ground, getting us used to the idea that the definition of a human being as a substantial separate self is gone, over, finished and replaced by… Well, we’ll see. 2. Programs that fill the media today—from ‘reality shows’ to advertisements, to soaps, to news programs—all demonstrate convincingly that the time of the self that once carried dignity and self-respect is a thing of the past. People seem to fall over themselves to get onto a show, any show, in order to be reduced to a figure of ridicule in front of millions. What could drive such enthusiasm? It must be to bring home to us all the inconsequentiality of the ‘substantial self’ and its inherent dignity. 3. Our emotions are daily excited to fever pitch by an increasingly sophisticated media ‘science’ that seeks only to rivet us to the couch or the movie seat, for the sake of the ratings, no matter the content! So these excited emotions are not coupled with meaning, as they once were. No, they are coupled with images that flow rapidly across the screen, from images of atrocity to ads, to drama to health advice to… Well, we have all seen it. The message is that none of it has any meaning while simultaneously our emotions are excited to the maximum. What is being ingrained in us from this extreme experience dished out on a daily basis to millions of people? I think we have to conclude that we are being inducted into a new experience of time—let’s call it, CQ: The Capa Quarterly
Caught Up? after Wolfgang Giegerich (1997), the empty now! Where once the now was pregnant with its own meaning that could impress itself on the receptive self, enriching and deepening that self, now we are being inducted into the emptiness of the self: the self as couch potato! These are only three examples of what our technological civilisation is doing to us, in contrast with what we think we may be doing with technology as psychotherapists. Any notion of substantiality is being dissolved before our eyes under the impact of our technological civilisation. Take money for example: Now it is sheer fluidity going around the world without ceasing. Knowledge as we once knew it (i.e. collective memory with its selection criteria) has completely broken down, as Umberto Eco (1999) shows us with reference to modern search engines: Everyone would produce his or her own criteria for selecting information … every common norm disappears because everyone will be able to concoct his or her own interpretation of historical events (and) there won’t be any common basis left on which to construct the history of the human race . . . we would end up with a society of 5,000 million inadequate memories. That’s tantamount to saying that we have a society of 5,000 million languages, every one of them pidgin. (pp. 194, 196) Knowledge, as collective memory is now replaced by “what our peers will let us get away with saying”, as Tarnas (1991), quoting Rorty, says, “reducing our culture to incoherence”. Under these circumstances, how can we seriously claim ‘to know who I am’, a requirement necessary to therapies of the substantial self? As substantiality dissolves under the impact of technology, we are instead faced with fluidity or sheer motion. Remember McLuhan’s, “The medium is the message”? The focus of our civilisation has moved off ‘things’, or substantiality, to the media, or movement itself. This is our new reality! It is a reality that psychotherapy simply has not caught up to, in theory or in practice. As I said earlier, any healing practice that has viability must arise from the culture in which we are embedded at the time and the reality that the culture reflects. Our reality has shifted— transformed, really, and a new healing practice is called for that emerges from and therefore can redefine health and pathology. For example, when understood from the old paradigm of a therapy of substantial self, spending hours on the internet watching pornography certainly can become pathology, diminishing that self’s capacity to relate in an adequate way to other real selves. But what do we see when we work from within the new paradigm? Firstly, we have to come to terms with the February 2012
John C. Woodcock
compelling fact that millions of ordinary people of all ages, gender, and sexual orientation are uploading their home videos to public domains where all manner of what was once private sexual behaviour is freely watched by millions of other people. The most intimate secrets of our being, what once constituted our innermost essence, requiring the most careful guarding through secrecy or ritual or, dare I say it, modesty, are now turned inside out and paraded shamelessly on the surface for all to see. Our innermost essence of selfhood appears no longer to have any cultural value. This teaching is what millions of people seem willing to submit themselves to today. Again, why do so many enthusiastically display this lack of dignity, modesty, or even shame—emotions that once were sure expressions of a knowledge that the innermost essence of self-hood carries the highest values known to us? From within the new paradigm, we must conclude that all these people are all being inculcated by technology with a new view of being human in which the substantial self and its innermost essential mystery holds no cultural value at all. This new status is, of course, reinforced throughout the economic world where ‘selves’ have become ‘human resources’, or ‘assets’, etc. and are very disposable, as many of us have experienced, to our astonishment or horror, when fired suddenly, without warning. Are we willing to say simply that these millions of people are pathological? I for one am wary about making such judgements. Rather, I believe that psychotherapy has not caught up with the deeper meaning embedded in this phenomenon that we call technology. To regard technology only as a tool we can use to further the interests of a profession founded on principles that belong to another time long outstripped by historical developments, is folly. I believe we must also turn to technology and ask what it is doing to us, to our definition of our humanness, and develop healing practices that can adequately address these momentous changes occurring today. References Eco, U, et al. 1999, Conversations About the End of Time, London: Penguin Giegerich, W 1997, Technology and the Soul, New Orleans: Spring Journal Books Tarnas, R 1991, The Passion of the Western Mind, Reading: Cox and Wyman Ltd.
John C. Woodcock, PhD, is a Jungian Psychotherapist (since 1983) and clinical member of CAPA, now in private practice in Sydney after returning in 2003 from the USA where he lived, worked, and trained for over twenty years. He is the self-published author of several books (through iUniverse.com) all of which represent his postdoctoral research into the question of our collective future as expressed through the hints of dreams and other phenomena, including our technological civilisation. Further information may be found at his website: www.lighthousdownunder.com and he can be reached at email@example.com.
In the Therapy Room
Revealing Ourselves … or not? As therapists, we all have ways of hiding ourselves, and much of that is useful, even necessary. So we talk about professional boundaries, careful use of implicit and explicit self-disclosure, limiting between-session availability, and preserving a level of professional distance by not being over-involved, rescuing and so forth. Such matters are part of any good training program and, as such, provide protection for both client and therapist. It’s all part of our professional identity, ethical practice and duty of care. But what about other kinds of hiding ourselves? Let me illustrate from my own experience. A client says something wise and succinct as she realises something profoundly new about her situation. And it just so happens that on that day and at that moment, my heart is deeply open to the client, and to my own pain. I am being there in a healthy, fully empathic way, so her statement speaks to my heart as much as it does to her own, and it flies in and nests inside me before I have closed the door. It is plain, pure Truth for both of us somehow. Do I ‘park’ my own experience, push it aside and plough on, or do I in some gentle, careful and appropriate way allow my response to the client to be congruent with my own deeply felt resonance? Do I hide, or allow myself to be seen at a new level, a deeper level? I may not use words, but can I risk letting the client see that in some way I am in there with her beyond the normal engagement. Might I even find a way with immediacy to risk being vulnerable as I give her some information about what is behind my eyes? Not with my content or my story, but with my healing, mutual, presence, perhaps with a statement about the feeling between us in the room. There is something about that moment of choosing to reveal or conceal ourselves that is common for many counsellors. In that moment of choice, it is often easier to play it safe (for ourselves) rather than meet the client at the level they need. Of course there are times when it is advisable, even necessary, to stay quite apart, but I am not talking about those times. Staying hidden can be as simple as avoiding the ‘and then... ?’ question, or actively blocking a client’s deep processing by shifting him back into his head so he doesn’t get too deeply into feelings, when the deeper work might be a better therapeutic choice on that day. It could be that the depth of a particular client’s grief threatens our sense of control or nudges us toward our own unexpressed grief. So we run away. A common time of choice is when clients ask us personal questions. Our immediate, professional response is usually to deflect the question, to ask why they need to know, though 30
many writers are now daring to say they might do something different. What if, after some thought, and with deep awareness, it becomes clear to you that some of these questions need real answers, at least to some degree? Here we have the moment of choice in a different guise: explicit, verbal self-disclosure. It is not an easy choice, and if we find ourselves frantically fixating on fig leaves, maybe it might have been more helpful not to hide on that occasion? For me, the challenge to reveal has come recently in a session when a client’s world finally reached a deeper place inside me. It physically tugged at my being, after three sessions of faithfully slogging through sludge with him. I felt dumb, and I questioned whether I had been shut off from him all that time. I had a choice. I could press on as if I had always been in this place ‘with’ him, or I could step out into the light (if you like!) and name that I had finally got it, that I was hearing him a new way. I could risk him thinking he has been wasting his time and money, but it could also build something new. I needed to base my response on my hunches about what was happening in the relationship, what would facilitate a shift in the client. In any case, I needed to make the choice for clinical reasons rather than because I needed to hide. Another example. A client* is in my room, still and quiet, deeply processing a feeling or experience of being accepted and heard for the first time about a very painful issue which she has kept hidden for a long time. She feels exposed, raw, and new—kind of like a newly born foal standing spread-eagled and awkward, shaky on its legs. She looks up and lets me see ‘her’ in all her raw ‘being-ness’. At this moment, I can choose my level of meeting with this woman. I can be there with all of me, and in the silence communicate to her profound acceptance and mutual vulnerability, or I can be a respectful witness, acknowledge the moment, and sensitively move to processing what she has experienced. Whichever I choose, though, impacts on the healing process, on the work we are doing together. The client will know if I take that extra step toward her because it will be potentially life-changing: If I take a step back, she may be fine, or she may be confused, but either way an opportunity will be lost. It is true that we may not always be ready or able to take that extra step to a deeper empathic place, a more mutual experience, yet I wish to heighten that we make choices. Sometimes we make choices because we are afraid or we may simply never have experienced such moments for ourselves, and that limits what we offer. CQ: The Capa Quarterly
Some of the ideas I am playing around with here are in some ways related to a thought-provoking book: The Therapist’s Use of Self (Rowan & Jacobs 2002). They talk about three “ways of being a therapist”: instrumental, authentic, and transpersonal. The instrumental way has firmer boundaries (particularly around the ‘self’), is clinically sound and skilfully empathic. This way of being might, in my terms, hide at times. (They use the term “defended” which feels a little harsh to me.) The instrumental way takes fewer risks; the therapist is making sure she is not “pulled in too deep” (Rowan & Jacobs 2002: 24). A therapist who comes from the authentic framework has a more vulnerable stance, and makes more of her self available. This is what I would call more visible or less hidden. It involves going in to the client’s world and then coming out again; there is a rhythm to it. There is a cost to this way of working. I call it ‘letting go’. It’s not exactly bungee jumping, but it does take trust—in myself, in the process, in my ability to land again and keep tracking the process in the session. When it is working well, I feel the ‘hum’ of our resonance in the room. We’re in flow. The transpersonal is perhaps hardest to describe, and is often seen as a bit ‘out there’. It involves moving from hiding to a place of spaciousness and deep mutuality: together and separate. We let go of the concealing fig leaf and, perhaps, experience union with the divine? I liked one writer’s summation: “We are not lost in the other, as in fusion, but found” (Rowan & Jacobs 2002: 73, quoting Field). As a client I have been seen by a deeply available and present therapist who was able to risk meeting me in silence as I sat trembling and transparent, eyes locked on hers, fearful and unsure. The moment I remember is tattooed in my psyche. Eventually I spoke: Me: You’re not afraid Therapist: How can essence be afraid of essence? What I experienced internally from the therapist in that interaction was something akin to the following: Yes. I am here too. I can see you in all your exposed vulnerability, and I meet you here. We are two human beings saying hello in the deepest way. I am not afraid of this meeting of two beings, and you don’t need to be afraid. I will not run away, mock you, or dismiss you. You are not too much. There is no shame here. All is light and openness, warmth and flow. Breathe. Just be. Here we are. We are one. And yet not. I had done some individual work with several other therapists, and it was after that moment that I realised none had been able to be there with me in that way; they had stayed hidden at February 2012
this deeper level, and that had left me feeling I was ‘wrong’ somehow, that what I needed and longed for was obscene, forbidden, shameful. Rowan and Jacobs (2002) would see this experience, perhaps, as fitting somewhere between the authentic and the transpersonal way of being. Whatever label we give it, it was transformative and healing. Not just for me, but for my work with clients, and for how I then built on such moments to become who I am, clinically and personally. (I think the debriefing of the moment was almost as important as the moment itself. I tend to need to externalise my process, and to understand what is happening. Some clients may not need this as much as I do.) So I come back to my focussing question: Do we reveal ourselves in the therapy room? The answer, it would seem, is more about the degree to which we choose to make ourselves available. It is not an absolute. It depends on my cultural background, that of the clients, client (and therapist?) resilience at that time, and always, always, the needs of the client. Our models for the work we do also vary the demands on our use of our selves. Some models call for a more didactic or systemic approach. Then we are using ourselves more instrumentally. Some days, it is in our clients’ best interests if we move back to a solid, rhythmic use of basic empathic responses with our clients, yet also gently holding our own life issues so they do not intrude. Clients courageously reveal themselves to us, simply by entering our rooms and telling their stories. Yet they also make choices about when and how much to reveal about themselves. It is respectful and professional to finely adjust our level of selfdisclosure—implicit or explicit—to the level at which they are operating. When we follow our clients, we will not be zealously intrusive with our eye contact, nor inadvertently alienate or shame them by hiding ourselves from them. *All clinical vignettes are disguised to protect clients. Reference Rowan J and Jacobs M 2002, The Therapist’s Use of Self, Maidenhead, UK: Open University Press
Jewel Jones is a counsellor with over fourteen years’ counselling experience in agencies and in private practice. She has a Masters in Adult Education and her private practice is increasingly concerned with having influence through training and supervision. www.jewel-jones.com.au, firstname.lastname@example.org
Acceptance &Commitment Therapy: Six Mary Sawyer, RN, BA, MApp Psych, MAPS, MCN, has a private psychology practice in Sydney. One of the foremost ACT therapists in Australia, she has trained with leading ACT researchers and clinicians in Australia, New Zealand, the UK, the Netherlands and the US and has presented ACT workshops at International Conferences. She is the first Convenor of the Australian Psychological Society (APS) ACT Interest Group and has been actively involved in promoting ACT in Australia since 2003, facilitating ACT workshops in Sydney and rural areas of New South Wales. She has provided clinical supervision for Alcohol and Other Drug workers in the NSW Department of Corrective services for 10 years and is now a clinical supervisor for St Vincent’s Hospital Sydney Alcohol and Other Drug Service and Homeless Health Outreach Workers, using ACT as the predominant therapy.
On 22 November 2011, ACT Therapist and Trainer Mary Sawyer presented a CAPA PDE on the six core processes of Acceptance & Commitment Therapy (ACT). In the development of ACT, American psychologist Steven Hayes and his collaborators, have taken B.F. Skinner’s Behavioural Analysis a step further. Skinner’s theory concerning how speaking about private events evolves is what he called Verbal Behaviour. Hayes initially worked with B.F. Skinner. Subsequently, he and others have worked together as researchers and clinicians to evolve ACT as the third wave of Behaviour Therapy, transformed into clinically useful six core processes. The acronym ACT, pronounced as the word ‘act’, represents: Accept thoughts and feelings Choose Actions Take Action to live a valued life Mary uses ACT with a variety of psychological problems such as: depression and anxiety, grief and loss, post traumatic stress disorder, all addictions including gambling, alcohol and other drug problems, adult survivors of sexual abuse, and relationship, separation and divorce issues. The workshop began with an invitation to practice a mini mindfulness exercise, focusing on the breath and observing the mind’s busy-ness. Some people in the audience described this experience as “peaceful, expansive, letting go of earlier events of the day, another state, a sense of being detached, etc.” In the United States, ACT is now recognised as an evidencebased therapy, and hopefully Australia will follow. As Mary briefly commented, ACT somehow grew from Behavioural Analysis (BA), Relational Frame Theory (RFT), and Cognitive Behaviour Therapy (CBT) and draws on Buddhist and other philosophies that invite clients to be mindful and live more in the present and live a life congruent with their values. The past and future are often subjected to personal judgment with associated anxieties about change. This was explained as related to following: Mind can be full of thoughts and reflect subjective reality with interpretations, judgments, and self criticisms. Using ACT, the therapist gently encourages clients to feel uncomfortable feelings and stay with those thoughts, feelings, and bodily sensations—sometimes called present moment awareness As part of functional analysis, the therapist could ask the client “how is being where you are, without change, helping you live the life you yearn for?” For example, experiential avoidance may have several functions. Willingness to feel a feeling can be a defusion in itself. Clients are invited to become the ‘observer’ of their own behaviour, the ‘observing self’ noticing the ‘sticky thoughts’ that can hold the client back from moving on through the process. 32
Mary went on to clarify the ‘informed consent process’ that is essential at the beginning of therapy. The ACT therapist informs the client that the therapy is not about making the client feel better but, rather, to teach the client to feel better, that is, to acquire the perceptual skill of better experiencing feelings. Therapy may bring up some difficult moments, as it does not aim to make painful feelings go away (or to deny them). The aim is to learn to be with painful feelings (emotional or physical) and at the same time pursue valued things in life. The main aim of ACT is to help the client to achieve a greater psychological flexibility. To achieve that, ACT follows six core processes: 1. Acceptance: as an alternate to experiential avoidance 2. Cognitive defusion: alters function, not form, of undesirable thoughts 3. Being in the present moment: experiencing the world more directly 4. Self as context: opening up to your entire experience 5. Values: chosen qualities for life directions 6. Committed action: effective action linked to chosen values The ACT Theory of Change postulates that our psychological problems originate from thought and language. Verbal regulation and rigid rules prevent us from moving in valued directions. The goal is psychological flexibility to connect with the present moment in order to change or persist toward our valued ends. ACT is a behavioural therapy that aims to assist the client to get beyond thoughts that are mostly verbally constructed at an early age and that may have any useful function in the present. ACT moves clients toward different ways of responding to thoughts and feelings that may be getting in the way of how they want to be in life. Mindfulness assists in learning to observe one’s own thoughts and to acknowledge that one is ‘having a thought’ about something rather than interpreting a judgmental thought as a real experience and then act upon that thought—i.e., “I am having a thought about being depressed” rather than “I am depressed”. Values play an important therapeutic role in ACT and can move clients toward their goals. Values motivate one to continuously and endlessly strive for something of meaning for them—for example, “I value honesty in relationship”. On the other hand, definition of a goal could be the final point of a striving—for example, getting married. A brief DVD with Steve Hayes described the six ACT core processes, clarifying the importance of observing one’s own thoughts rather than just acting from one’s thoughts—or, stated another way, learning to observe one’s own thoughts and transcend them rather than over-analysing and dwelling on them. The use of metaphor with ACT assists clients to make sense of their own struggles and take a different perspective. Mary gave a metaphoric example of how people often drift away CQ: The Capa Quarterly
Core Processes from their values: On a school bus, students have thoughts of jumping off and doing something more enjoyable on the day (mind/thought tricks) but the bus driver (observing self) still follows the route to school (value), acknowledging students’ comments without allowing them to follow their thoughts and get off the bus. When I was introduced to ACT some years ago, its philosophy made sense to me immediately. It should be noted that my interpretation of Mary’s presentation as described above, represents my own understanding. I could see some elements of existentialism, which also adopts some Buddhist philosophical concepts. ACT uses many metaphors that assist clients to
Review by Juliana Triml
understand their ways of thinking and behaving. Perhaps the most difficult therapeutic goal is that of encouraging clients to learn to live with their pain without avoiding it or selfmedicating (substances or prescription/over the counter drugs), especially as we are conditioned by our society from an early age that pain must be avoided.
Juliana Triml is the CAPA NSW PD Coordinator. If you have any suggestions regarding future professional development events, please contact her at: email@example.com
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 date: Wednesday 6 March 2012, 7.00 pm–9.00 pm, PD hours: 2
Professor Alex Blaszczynski
‘Pathological Gambling: Is it an addiction and what is the best approach to its management?’ Pathological gambling is about to be reclassified from an impulse control disorder to a behavioural addiction in DSM-V. This presentation will outline the conceptual models of gambling and discuss practical applications in assessment and cognitivebehavioural interventions. The presentation outcomes are a greater understanding of the processes leading to pathological gambling and how to address erroneous cognitions and reduce gambling-related urges and drives. Alex Blaszczynski, BA, MA Dip Psych, PhD, is Professor of Clinical Psychology, University of Sydney, Co-Director of the University of Sydney’s Gambling Research Unit, and Director, Gambling Treatment Centre. He is a researcher and clinical psychologist with a long history of involvement in treatment and clinical research covering a range of impulse control disorders, in particular, pathological gambling. Professor Blaszczynski has published extensively on the topic of gambling, carried out randomised treatment outcomes studies using behavioural interventions, assessed the prevalence of depression and suicidality, the relationship between crime, gambling, and personality characteristics of impulsivity and sensation-seeking in pathological gamblers. He has developed a conceptual pathways model explaining the aetiology of pathological gamblers, evaluated the impact of changes to the design of electronic gaming machines and, in conjunction with collaborators from Harvard and Laval Universities, developed policy guidelines for the Australian Gaming Council. He has authored or co-authored books, scientific articles, reports and papers; conducted numerous training workshops. Professor Blaszczynski is undertaking collaborative research with the researchers at Laval, McGill and Rutgers Universities. In 1995, Professor Blaszczynski was a co-recipient of the American Council of Problem Gambling Directors Award, and in 2004, the National Centre for Responsible Gambling senior investigator’s research award for his work in the field of pathological gambling.
Bookings: (02) 9235 1500 or firstname.lastname@example.org Please book as soon as possible. Spaces are limited due to Occupational Health and Safety requirements. Cost: Free for CAPA members. $30 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 PD Coordinator, Juliana Triml, on email@example.com. CAPA is also exploring more options for members in rural and regional areas. Please email the Regional and Rural Committee with your suggestions firstname.lastname@example.org. Further 2012 Professional Development Events On 12 & 13 May, a PDE will be held on the South Coast (details to come). On 2 & 3 June, the bi-annual CAPA Conference will be held, with the theme being ‘Diversity’ (details to come). On 22 & 23 September, a PDE will be held in the Bathurst area (details to come). I n August, immediately following the AGM, at the Crows Nest Centre, Elisabeth Shaw, for the past three years Chair of the PACFA Ethics Committee, will give a presentation on Ethics in Counselling, further details to follow. Suggestions from members for future PDEs are welcome. We are selective with the choice of presenters and invite only those who have qualifications adequate to garner PD credit for attendees. Topics are under negotiation as most presenters do not like to commit too far in advance, and there is always a risk that they may cancel, sometimes at short notice. February 2012
Having just been appointed the new columnist for CQ: The CAPA Quarterly, I have been asked to introduce myself and to foreshadow what you can expect from me in these pages. My column explores the inner world of therapists, particularly when we are in the counselling room, or reflecting on our work. So much literature in our field talks about the therapist-client relationship as being a significant factor in outcomes for clients, yet much of the time we focus more on methods, models and mannerisms than we do on our Selves and our impact on the therapeutic relationship. I want to reflect in this column on some themes I have noticed in my personal therapy, my work with clients and supervisees, in groups and in training I have provided. I am an avid reader, so you will find me mentioning great books I have discovered. I welcome your comments and feedback, or even suggestions about topics to consider here. So, in what I hope will be one of many jottings, my first column is on Pages 30-31 of this issue. As for a little something about me personally: I love the Blues—real Mississippi delta blues for starters. Add in The Bondi Cigars, Chain, The Backsliders... I could go on! And tv talent shows, particularly ones that involve singing. Gardens, dirt under my fingernails, swimming, the beach. Food! I love food much too much, which is evident when you meet me. Bookshops are heaven for me: the smell of the book, the feel of the dust jacket, the texture of the pages… But this is supposed to be about my work? I guess that’s the point. It is difficult for me to decide when the work begins, because my work is my passion, and yet it is not my whole life. There are friends, family, the theatre, movies, and singing. All that life and passion for so many things bubbles over into my work with clients—and it supports the work. So do my own therapy, collage-making, journaling and my supervision. Like many of us, I got into this line of work through my own therapy. It changed me, opened me to another side of life, leading me to exit high school English and Drama teaching. I 34
began with group leading; then moved into counselling about 14 years ago. I’ve worked for several agencies: Interrelate, the Salvation Army Counselling Service, Relationships Australia, and also a stint as a manager with LifeCare Counselling. Now I focus on my private practice in Penrith and Richmond, working with individuals and couples, though I still sometimes run groups at a local agency for men who use violence. Increasingly, I find myself using my Masters in Adult Education: I run local training for practitioners, and am beginning to move farther afield. What excites me about this is the opportunity to enrich and influence the work of others—to help them be the best they can when with clients. I guess I love supervising for much the same reason; I have had extraordinary, positive experiences in my own supervision, and this gives me energy for this side of my work. Who would not want to supervise when it can be so productive and safe? Models? Hmm... Emotionally Focussed Therapy is my primary modality, though I draw on many of the Experiential approaches, and am strongly Rogerian at times. Systems are always at the back of my mind, and Narrative approaches seem to clamour for my attention with some clients. I am certainly open to the spiritual moments that come, and the Existentialist approaches make a great deal of sense to me … but my roots are EFT. I have a particular interest in trauma work, and its close relative, shame. In particular, I see the client-therapist relationship and all its complexities as so full of interest and significance. A growing edge in my work is working with couples or individuals with Asperger’s traits. Finding ways to work that are less focussed on emotions (or at least, the naming of them) and to find ways to meet the needs of clients whose experience of life is so very different from mine is a challenge and a good discipline for me. It is humbling and a joy to learn from these clients. Back to the Blues. And cake! CQ: The Capa Quarterly
RnR Report (continued)
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gaining the required hours]. So, it is great to be able to organise a CAPA event that helps people connect and learn from each other. I believe reaching out to the community you live in is an important step in our profession. This certainly gives me the motivation and confirmation that we [the Regional and Rural Committee] are on the right track.” General benefits reported by attendees included the content itself—information provided and keeping up to date—and the camaraderie of meeting others, which assisted in feeling less isolated and in learning from other attendees. Port Macquarie also lent itself to particular pluses with the location being so beautiful. It provided an opportunity for getting together on Saturday night, and ‘time out’—a mini break from our usual lives. Brian said of his Port Macquarie experience, “It was very well run. The venue was great. The area was great. And you felt, ‘Oh, there are people like me, probably going through the same things I’m going through.’ I think one of the things with therapists is their self-evaluation: they might be stumped by different clients they have been working with in their local area so to meet like that and share stories was a big breakthrough. Plus the speakers were excellent as well.” He went on to say, “I think that interaction with other therapists, that bonding, that coming together, that sharing… We had a meal together on the Saturday night; you got to know some people. People would ask me questions about my therapy and what I thought on certain things. I think that had a flow-on effect on people.” Heidi commented on what she liked about the Port Macquarie PDE as, “The whole way it was set up—the different topics, meeting other members, the location, the lot!” She thought the low price of $50 was “unbelievable” and said that she likes the idea of weekend PDs for the value for money in regard to time and travel, and that they offer “a bit of R&R, socialising” as well as professional development.
Greenson, R 1967, The Technique and Practice of Psychoanalysis (Vol. 1), New York: International University Press Hatcher, LR 2010, ‘Alliance theory and measurement’, in Muran, JC & Barber, JP (Eds), The Therapeutic Alliance: An Evidence-Based Guide to Practice, New York: Guildford Press Horvarth, A, 2006, ‘The alliance in context: Accomplishments, challenges and future directions’, Psychotherapy: Theory, Research, Practice, Training, 43(3): 258-263 Jacobs, L 2011, Critiquing Projection: Supporting Dialogue in a Post-Cartesian world. In Talia Bar-Yoseph Levine (Ed.) Gestalt Therapy: Advances in Theory and Practice, London: Routledge Jacobs L. & Hycner R (Eds) 2008, Relational approaches in gestalt therapy, New York: Gestalt Journal Press Joyce, P & Sills, C 2009, Skills in Gestalt Counselling and Psychotherapy (2nd Ed), London: Sage Mackewn, J 1997, Developing Gestalt Counselling, London: Sage Messer, SB & Wolitsky, DL 2010, ‘A Psychodynamic Perspective on the Therapeutic Alliance: Theory, Research, and Practice’, in Muran, JC & Barber, JP (Eds), The Therapeutic Alliance: An Evidence-Based Guide to Practice, New York: Guildford Press Mitchell, SA 2000, Relationality: From Attachment to Intersubjectivity, New York: Routledge Nelson-Jones, R 2005, practical counselling and helping skills (5th Ed), London: Sage Publications Norcross, J (Ed), 2002, Psychotherapy Relationships That Work, Oxford: Oxford University Press Norcross, J 2010, ‘The Therapeutic Relationship’, in Hubble, MA, Duncan, BL, & Miller, SD (Eds) The Heart and Soul of Change: What Works in Therapy, Washington: American Psychological Association O’Brien, M & Houston, G 2007, Integrative Therapy: A Practitioner’s Guide, London: Sage Publications Paivo, S & Pascual-Leone, A 2010, Emotion-Focused Therapy for Complex Trauma: An Integrative Approach, Washington: American Psychological Association Rosmarin, E, Muran, C, Safran, J, Gorman, B, Nagy, J & Winston, M 2008, ‘Subjective and intersubjective analyses of the therapeutic alliance in a brief relational therapy’, American Journal of Psychotherapy, 62(3): 313-328 Safran JD and Muran JC 2000, Negotiating the Therapeutic Alliance: A Relational Treatment Guide, New York: The Guildford Press Safran, JD and Muran JC 2001, ‘The Therapeutic Alliance as a Process of Intersubjective Negotiation’, in Muran JC (Ed) Self-Relations in the Psychotherapy Process, Washington DC: American Psychological Association Books Safran, JD and Muran JC 2006, ‘Has the Concept of the Therapeutic Alliance Outlived Its Usefulness?’, Psychotherapy: Theory, Research, Practice, Training. 43(3): 286–291 Safran, JD, Muran, JC and Rothman M 2006, ‘The Therapeutic Alliance: Cultivating and Negotiating the Therapeutic Relationship’, in O’Donohue, W, Cummings, N & Cummings, J (Eds) Clinical Strategies for Becoming a Master Psychotherapist, London: Elsevier Safran J, and Muran C 2000a, ‘Resolving therapeutic alliance ruptures: Diversity and integration’ JCLP/In Session: Psychotherapy in Practice, 56(2): 159–161 Stevens, C, Muran, C, Safran, J, Gorman, B and Winston, A 2007, Levels and patterns of the therapeutic alliance in brief psychotherapy, American Journal of Psychotherapy, Vol. 61, No. 2, 2007 Stiles, W, Glick, M, Osatuke, K, Hardy, G, Shapiro, D Agnew-Davies, R, Rees, A and Barkham, M 2004, ‘Patterns of alliance development and the rupture-repair hypotheses: Are productive relationships U-shaped or V-shaped?’, Journal of Counselling Psychology, 2004, 51(1): 81-92 Stolorow, R 2002, ‘Impasse, Affectivity and Intersubjective Systems’, Psychoanalytic Review 89(3): 329 337 Stolorow, RD, Brandchaft, B and Atwood, GE 1987, Psychoanalytic Treatment: An Intersubjective Approach, Hillsdale, NJ: The Analytic Press Wachtel, PL 2007, Relational Theory and the Practice of Psychotherapy, New York: The Guildford Press Wampold, BE 2001, The Great Psychotherapy Debate: Models, Methods, and Findings, New York: Routledge Wampold, BE 2010, The Basics of Psychotherapy: An Introduction to Theory and Practice, Washington: American Psychological Association Wheeler, G 2000, Beyond Individualism: Toward a New Understanding of Self, Relationship & Experience, Hillsdale, NJ: The Analytic Press Wolitsky, D 2010, ‘Psychoanalytic Theories of Psychotherapy’, in Norcross, J, Vandenboss, J & Fredheim, D (Eds) History of Psychotherapy: Continuity and Change (2nd Ed), New York: American Psychological Association Yontef, G 2002, ‘The Relational Attitude in Gestalt Theory and Practice’, International Gestalt Journal 25(1): 15-34
Words of Wisdom for New Practitioners and Interns Sharon: “Work for an organisation, at least part time, whether paid or unpaid, to get up your hours, feel connected to others, have peer support and, hopefully, be provided with professional development and supervision. Get involved with CAPA in some way such as this committee!” Brian: “They have a lot of queries and uncertainties. It’s all these questions you’re asking yourself, and that sharing with others—especially those with more experience—helps.” Heidi: “I have the advantage that I also work in an organisation. If I were on my own, I think I would feel very isolated. I would have to be so reliant on myself, and I think after some time that would be really draining.” On whether she knows counsellors just working in private practice who are making a living: “The ones I know don’t—especially now that psychologists can get Medicare payments.” Heidi also suggested: “If CAPA could somehow offer mentoring, that would be great!” Sharon Ellam, Brian Edwards, Jane Ewins, Christine Judd, Claudia Pit-Mairbock Regional and Rural Committee email@example.com February 2012
I would like to acknowledge the influence on this article of Jeremy Safran and Christopher Muran’s work, and to thank Laura Daniel for her invaluable editing support. Pedro Campiao, BA, Grad Dip Edu, Grad Dip Couns, MA Gestalt. Clin CAPA, GANZ, PACFA Reg., divides his time equally between parttime work as a counsellor for NSW Health, in the area of chronic illness, and private practice, where he sees individuals and couples and facilitates Gestalt/Yalom relationally oriented therapeutic groups. In 2012 he will be undertaking research for NSW Health in transformational learning experiences during Hepatitis C treatment. He is based in the Northern Rivers area of NSW where he directs a therapy centre in Mullumbimby, the Stuart St Practice Rooms. www.pcampiao.com.
Calls for Contributions
August 2012 – Belief Systems in Therapy
It is probable that many of us hold some beliefs that do not serve us well, even some that are contradictory. Every client walks into the therapy room with a set of beliefs that define and drive who he thinks he is and how he fits into the world. Every therapist also has a personal belief system. How does the therapist find ways through these systems or sets of beliefs, and how do those of the therapist and those of the client interact in the therapy room to build trust and a working relationship that can achieve positive results for the client? How do you as a therapist first discover and identify then work with or change those beliefs toward resolution of the issues the client has brought? How do you set aside your own when the need arises? The August 2012 issue of CQ: The CAPA Quarterly holds a space for discussion of this tangled web. Peer reviewed papers due by: 1 April
Non-peer reviewed due by: 1 May
November 2012 – Dealing with Dementia What is dementia? Where does it come from? How does one cope with growing evidence of its erosion of the person we know— either the self or a loved one? How can the therapist assist someone who has dementia? How can carers cope with the gradual disappearance of the person they have known and loved? What special skills and insights can illuminate such situations in the therapy room? As people live longer and dementia becomes a more common experience, what do therapists need to know to enhance their ability to help in this circumstance? Share your insights and experience with a contribution to the November 2012 issue of CQ: The CAPA Quarterly. Peer reviewed papers due by: 1 January Non-peer reviewed due by: 1 Februar y
February 2013 – 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 CQ: 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 2013 – undecided If you have suggestions for a theme for this or future issues, please send them to firstname.lastname@example.org. 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. For Contributor Guidelines contact email@example.com
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Rooms for Rent Brookvale New building behind Warringah Mall, suit counsellor, coach, psychologist. Room available most days, half day or full day. Clientparking available. Call Peta on (02) 9938 5860 or email firstname.lastname@example.org 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 email@example.com 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 firstname.lastname@example.org February 2012
Parramatta Four air-conditioned 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 email@example.com 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 firstname.lastname@example.org 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 email@example.com
Supervision 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 firstname.lastname@example.org 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 email@example.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 firstname.lastname@example.org 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 email@example.com. 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 firstname.lastname@example.org 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 email@example.com Web: www.cb-counselling.com.au and www.caring4couples.com.au 37
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Journal of the Counsellors and Psychotherapists Association of NSW Inc 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: firstname.lastname@example.org Web: www.capa.asn.au Changed your address? Please notify CAPA NSW
Looking for a Conference? To include your free conference listing here, contact email@example.com
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
Date & Location
13-14 February 2012, Singapore
Annual International Conference on Cognitive and Behavioral Psychology—CBP 2012
23-24 February 2012, Melbourne
3rd Annual National Dementia Congress
1-2 March 2012, Sydney
Happiness & Its Causes 2012
5-10 March 2012, New York
AGPA Annual Conference – Group as Common Ground
17 March 2012, Melbourne
RANZCP Body in Mind 2012
13-15 April 2012, Syracuse, USA
The Empathic Therapy Conference 2012
17-21 April 2012, Cape Town, South Africa
13th World Congress of the World Association for Infant Mental Health
18-20 April 2012, London
2012 British Psychological Society Annual Conference
19-23 April 2012, Jersey City, USA
70th ASGPP Annual Conference
9-12 May 2012, Izmir, Turkey
3rd World Conference on Psychology, Counseling and Guidance - WCPCG-2012
20-24 May 2012, Hobart
RANZCP Congress 2012
24-27 May 2012, Athens
Conflict and Reconciliation in Groups, Couples, Families and Society
30-31 May 2012, Sydney
CALD Patient Management Conference
15-17 June 2012, Boston
International Commission on Couple and Family Relations Conference
8-12 July 2012, Antwerp
10th PCE Conference—World Association for Person Centered & Experiential Psychotherapy & Counselling
16-21 July 2012, Cartagena de Indias, Colombia
18th IAGP Conference—Between Worlds and Cultures Social Transformation.