The CAPA Quarterly
Issue Three 2012
Journal of the Counsellors and Psychotherapists Association of NSW, Inc.
Editorial Your beliefs become your thoughts. Your thoughts become your words. Your words become your actions. Your actions become your habits. Your habits become your values. Your values become your destiny. ~ Mahatma Gandhi
Beliefs, the theme of this issue, refers not just to consciously held beliefs but, more importantly, to those embedded so deeply, mostly since childhood, that they are invisible and unrecognised by the one holding them and living them. I would add to the beginning of Gandhi’s statement quoted above that our perceptions create our beliefs. How we perceive and interpret what we see in the world is what our experience is all about. Not all of us perceive reality in the same way, nor do we all respond in the same way, even to similar perceptions. 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 as he perceives it. 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 beliefs when the need arises? In this issue of CQ, counsellors Sharon Ellam and Pedro Campiao, in separate articles, address these issues head-on with powerful case studies that illustrate such challenges, how they met them, and how the inherent conflict of beliefs ultimately produced positive growth for both client and therapist. It is probable that most of us hold some beliefs that do not serve us well, even some that are contradictory. How does the therapist reach these beliefs, and how can they be modified to release the client from those that are limiting rather than empowering? Do our techniques effect changes in the brain and body? Neuroscientist Jeffery Fannin and psychologist Rob Williams discuss their joint research and methods demonstrating the physiology of one such approach as well as its effectiveness for many who have used its processes. While many adults still hold and are guided by beliefs formed in childhood, the perspectives of children who are still children are brought to us by Nerida Oberg, who speaks of how her therapeutic work with them helps to dispel their negative beliefs and to enable her child-clients to form more positive beliefs to guide their futures. Gestalt therapist Kerry Shipman describes his approach to client beliefs then relates his personal journey through shifting beliefs and perceptions of belonging to a place between rigidity and fluidity where ‘not knowing’ can be embraced. August 2012
This quarter, CQ columnist Jewel Jones shares her insights gleaned from the use of videotapes as a tool in long-term psychotherapy. We are also pleased to announce a new feature: The Executive have decided to run in each issue a Modality Profile featuring of one of the hundreds of psychotherapeutic modalities currently in use. Members are encouraged to send feedback about their preferred approaches to email@example.com. This quarter, short descriptions of Narrative Therapy and Solution-Focused Brief Therapy are featured. The new feature replaces our previous quarterly Member Profile. The main CAPA website, www.capa.asn.au, is still being redeveloped into a much richer and more useful tool for information and interaction. Once it goes live, CQ contributor guidelines and advertising rates and specs will be found there; in the interim, that information can be obtained from office@ capa.asn.au, 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 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.
Contents CAPA NSW Executive and Staff
President Jeni Marin email@example.com
Vice-President Tara Gulliver firstname.lastname@example.org
3 4 5
Secretary Gina O’Neill email@example.com Treasurer Mary Jane Beach firstname.lastname@example.org Ethics Chair Tara Gulliver email@example.com Membership Chair vacant firstname.lastname@example.org Regional and Rural Liaison Chair Sharon Ellam email@example.com
Editorial ~ Laura Daniel
CAPA News From the President’s Desk ~ Jeni Marin CAPA News ~ Jeni Marin Regional and Rural Report ~ Sharon Ellam
First Person 6
Learning to Respect ~ Sharon Ellam
Features 10 Changing Beliefs in the Face of Shame ~ Pedro Campiao 14 Leading-Edge Neuroscience Reveals Significant Correlations Between Beliefs, the Whole-Brain State and Psychotherapy ~ Jeffrey L. Fannin & Robert M. Williams 18 Working with Children’s Core Beliefs in a Constantly Changing World ~ Nerida Oberg First Person
Professional Recognition Chair firstname.lastname@example.org Barry Borham
22 Climbing Through the Scaffolding of Beliefs ~ A Reflection ~ Kerry Ivan Shipman
PD Coordinator Juliana Triml email@example.com
In the Therapy Room
Office Coordinator Paul Dudley firstname.lastname@example.org Administrative Assistant Freddy Ortega email@example.com CQ: The CAPA Quarterly Editor Laura Daniel firstname.lastname@example.org Deputy Editor Roberta Parrott email@example.com Advertising Coordinator firstname.lastname@example.org
24 Videotapes as a Tool in Long-Term Psychotherapy ~ Jewel Jones Professional Development 26 Pathological Gambling: Is It an Addiction and What Is the Best Approach to its Management? ~ Review by Juliana Triml 27 Professional Development Events Modality Profile 34 Post-Modern Therapies Noticeboard 35 Classifieds 36 Calls for Contributions & Ad Rates Back Cover Conference Calendar = Peer Reviewed Peer-reviewed articles in this journal have undergone rigorous peer review, based on initial editor screening and double-blind review refereeing by at least two anonymous scholars. 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 Design by Sarah Marsden Printed by Unik Printing ISSN 1835-937X
© 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 Once again, the year seems to be flying past. Here we are, three quarters of the year already gone, and the Christmas signs will be in the shops before we know it. It puts me in mind of that comment by the Red Queen in Lewis Carroll’s Through the Looking Glass – and What Alice Found There: Now, here you see, it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that. I sure feel that way. What about you? August of course means CAPA’s AGM. It is on Saturday 11 August in the Pat Brunton Room at the Crows Nest Centre. The current Executive looks forward to seeing as many of you as possible at the venue so if you have not already done so, please make sure you register with the office. Our PD Co-ordinator has again arranged for a Professional Development component to the day which will provide three points towards your 2013/2014 renewal. (See page 27 for a full description). It is empowering to me as a professional counsellor to observe our positive growth during the past several years. Ties are being strengthened with colleges and universities, and our profile is being raised with the government and the general public. The Executive has been streamlining its processes, as have the various committees (all of which incidentally will be featured in CQ over the next year). The Executive have all expressed a willingness to take up the mantle of looking after CAPA’s interests once again for 2012/2013 but have been behind the eight ball virtually from the start with one member down from the outset, our Treasurer unable to get on board immediately (although she certainly caught up with the speed of light) and the loss of a committee chair part way through the year. It would be heartening to have a full component on the Executive from the outset this term. Members of our profession—counsellors and psychotherapists— work to help others see the potential within themselves: potential for success, for change, for growth and for leadership. We serve as visionaries, often seeing things our clients can’t yet see. We guide, we coach, we question and we encourage with the fundamental belief that each life is worth living and living well. We do this for our clients all the time, and these same skills can be harnessed to help our association grow and change, to provide a beacon for positive change. The current Executive really wants to provide the best possible service to members of this, the largest association of counsellors and psychotherapists in NSW, to continue to raise the profile of our profession and our members. We can do so only if members are willing to be a part of the decision-making and action. Please nominate for a position on the Executive or one of the four committees. One of our achievements this term was the successful Conference at the Novotel on 2 and 3 June. Although disappointing in the number of members, and particularly clinical members, who failed to attend, the Conference was nevertheless a success. We covered our costs and got some really August 2012
positive feedback and helpful suggestions from delegates. Many of the workshops were scaled at a 5 out of 5. One comment was “I have learned a lot and have added to my skills and confidence to practice.” Our first speaker Dr Anthony Dillon was described as BRILLIANT, and that was written in upper case. Many delegates made helpful suggestions for themes, keynote speakers and workshop presenters, and we will certainly be recording all the workshop presenter ‘5s’ for invitations to future conferences where their particular expertise fits. Many comments were about how well organised it was, and any helpful comments on the registration process and the food will either be retained for the future or suggested adjustments made. Our Entertainer/World Café MC was enthusiastically received and her lyric changes to some James Bond themes, by way of introduction to the panel, was innovative and fun. Most of the attendees were highly complimentary about the skills of our Aussie (or adopted Aussie) keynote speakers, but the Executive would hate to think that the lower-than-planned attendance was because we showcased home-grown speakers rather than pulling in someone from across the seas. The new-at-the-time Executive began organising this conference as one of our first tasks after forming and pulled it off in a pretty tight time frame. The planning of the next conference is on the final Agenda for 2012, giving well over a year and a half to plan. A Survey Monkey will be one of the planning tools used, and when we get those responses, we will be able to add comments of those who did not attend to the comments we have already received. This will help to plan in terms of time frame, content, venue, etc. Staff changes were made during this Executive’s term, and we are receiving positive comments about the courtesy and genuine willingness to help of our new staff. Indeed, a further ‘success’ has been the efficient processing of renewals for this year. Unfortunately, not everyone was spot on with their paper work, and these did slow the process down here and there, but overall members filled out the forms correctly and most submitted well on schedule. We had hoped to have the revised electronic renewal and registration system up in time for this year. Unfortunately, for a variety of reasons, that was not the case, but the process is back on track and will be live and operational by the 2013/2014 period. We are looking forward to health and well being of our association and its members for 2012/2013.
Jeni Jeni Marin President email@example.com 3
New CQ Column Features Various Modalities Following the Dimensions of Diversity theme of the 2012 CAPA Conference, CQ: The CAPA Quarterly, will be providing information each quarter about various modalities currently being followed by counsellors and psychotherapists. At present there are more than four hundred different models with differing therapeutic techniques and theoretical perspectives.
Membership Total as at 1 July 2012
Clinical Member 418 Intern Members 183 Provisional Member 9 Student Member 88 Affiliate Member 33 Special Leave 5 Life Honorary Member 3 Total Financial Members 739
In this issue we take a brief look at two popular PostModernist therapies. (See Page 34.) In subsequent issues, we will be presenting more recent therapeutic models that may be of value or at least of interest to CAPA members. CAPA would like to hear from counsellors and psychotherapists working successfully with other models. Contact firstname.lastname@example.org
CAPA 2012 Annual General Meeting Saturday 11 August 2012 Crows Nest Centre, 2 Ernest Place, Crows Nest Pat Brunton Room 10.30–12.00 AGM 12.30–1.00 Lunch 1.00–3.00 Professional Development Event (3 credits) Dr Stephen Malloch on Communicative Musicality (See Page 27 for full details.) Please book attendance with the CAPA Office email@example.com or 02 9325 1500.
Code of Conduct for Unregistered Health Practitioners As counsellors and psychotherapists, we are legally required to display two documents in our practice(s): • the NSW Code of Conduct for Unregistered Health Practitioners • information on how clients can make formal complaints to the Health Care Complaints Commission. Both are available online in the members area of the CAPA NSW website: www.capa.asn.au The Code of Conduct is also available in several community languages on the Health Care Complaints Commission website: www.hccc.nsw.gov.au These legal requirements are set out in ‘Public Health (General) Amendment Regulation 2008’ under the NSW Public Health Act (1991), and came into effect on 01/08/2008.
Ethics Checkout the CAPA NSW website for information on: • Ethics and Counselling • Problem Solving Steps • Client Confidentiality and Privacy and Relevant NSW and Commonwealth Legislation • Duty of Care • Workplace Bullying and Violence • Mandatory Reporting • Keeping Track of Paperwork • Information for Counsellors who have been served with Subpoenas • Complaints Form for Submission of Complaints and Grievances by a CAPA Member Just login to the members area of www.capa.asn.au and click on the “Ethics” button on the left.
CQ: The CAPA Quarterly
Regional and Rural Report
Realities, Challenges and the Road Ahead As you are reading this, it’s AGM time again. What a hard year it has been! This year the RnR Committee started with five members. We have dropped down to two members. Paralleling CAPA as an organisation, we have struggled to just keep the wheels moving. The ‘greatest plans of mice and men’ had to get shelved as we looked into that mirror called Reality. What can we realistically achieve with the time we have and the hands available? The PDE in Nowra had to be postponed because of lastminute hassles. Losing three committee members, a death in my family and questions over speakers made the bucket just too full. Apologies to those members who planned to attend the Nowra event. We hope to complete this task in the next year. The Shoalhaven City Arts Centre sounds like a great venue. What we’d love is some local assistance with organising catering, key pickup and local knowledge. Plans are well in hand for the PDE at Bathurst City Library 22–23 September. Please book NOW if you haven’t already. Phone or email Freddy or Paul at the CAPA office (see advertisement below). Non-members are welcome. I also remind members of the email sent by Beate Zanner on 8 December 2011 which said, “Due to policy being unclear and restrictive, professional development (PD) changes are currently being established. If a person is qualified in counselling, psychotherapy, psychology, psychiatry, mental health or social work and runs a PDE, then it will be recognised by CAPA. The biggest change we have made is that any PDE that is approved by the Australian Psychological Society (APS) will be recognised by CAPA. I would like to remind members that if you do a Senior First Aid Certificate, it does not count for PD but a Mental Health First Aid Certificate does. Anything to do with Mental Health counts for PD. WorkCover training does not count for PD as it has to do with administration requirements. Also, for our regional members, if you find something on the internet to do as PD, as I recommended to some members—for example,
www.conferenceanxiety.com—this will count for PD, as we understand the difficulty of getting to workshops from some remote areas.” Thanks to an enquiry from Heidi Tornow from the far north coast, the Executive Committee have been discussing the challenges those who are isolated face in gaining PD hours. At her suggestion, www.mentalhealthacademy.com.au was approved as a source of PD for CAPA members by the Executive Committee. If members have any queries about PD, they are welcome to email firstname.lastname@example.org. Please allow a few days for your queries to be answered. This email address receives a large number of emails each day, and it is a task sometimes to work through all the enquiries. Two other projects under way are: A n article in CQ on challenges in regional communities. We realise that regional members face these daily, and we’d like to start to explore this. Surveying our membership: Who comes from where? What does your practice look like? What do you need or want? How could you help us? Who do you know? Our aim is to create a mapping tool so that we can connect regional members and areas. It’s REALLY important that we have your input! Finally: We are DESPERATE for help with the committee! We need members or even people with local knowledge and connections who can help us set up a PDE in their areas.
Sharon Sharon Ellam, Chair Regional and Rural Committee
The Regional and Rural Committee invites you to a
Professional Development Weekend in Bathurst 22 and 23 September 2012 Topics to be addressed include: Dialectical Behavioural Therapy with Bipolar Disorder Clients Domestic Violence Suicide in Regional Rural areas When: Where: RSVP: Cost:
8 PD hours
Saturday 9.30 am – 4.00 pm Sunday 9.30 am – 1.00 pm Bathurst, Bathurst Regional Library send an email to email@example.com or call 02 9235 1500 Members – $30 weekend / $20 one day Non-members – $50 weekend / $30 one day For more about the program, payment and how to book, see the email ‘Professional Development Weekend in Bathurst’ sent to you recently.
Learning to Respect
There are times when we wonder whether we should be paying our clients instead of them contracting us for our services. We are not just speaking of the times when their stories are so intriguing, their lives so interesting, or their journeys so moving, but also those circumstances when we walk away from the encounters forever changed ourselves—often for the better. ~Kottler & Smart 2006 Unconditional positive regard. Remember that from Basic Counselling 101? Like many aspects of this profession, what we learn at counselling school gets tested and consolidated in practice. We may even make those naïve decisions in our counselling infancy about what kind of counselling work we’ll choose to do—the clients, their life experiences and worldviews. In this article I ‘fess up’ about the first time I thought my ‘unconditional positive regard’ was lost. While it sounds like a basic requirement of life and our profession that we respect others, I’d like you to take those walls of yours down. Take a moment to consider how you might counsel a client whose beliefs, behaviours or choices are worlds away from yours. Then consider how it might feel to admit to your supervisor that you may not respect your client. The Clients My counselling client was a referral from a non-government employment agency contracted by Centrelink to get employment outcomes with long-term unemployed people. The referring agency was also my client by contract. I was initially engaged by the agency for up to six sessions to provide personal counselling for Tammy. Their brief was … brief. The staff had ‘thrown their hands in the air’ in frustration. I was to simply just ‘try’ to get some movement forward with Tammy—in any aspect of her life. In fact, they’d be ecstatic if I achieved anything. If I didn’t get anywhere, the agency manager, Sue, said she wouldn’t be surprised but would ‘accept it’. I was their last option. In my favour, Sue had spent many years working in private practice as a psychotherapist. This meant that I could discuss therapeutic strategies with her and explain my rationales for directions taken. Tammy’s previous case manager at the agency was also open to discussions and more than happy to provide help and backup with ‘homework’. I believe that the web of support and backup we provided for Tammy outside her home environment was an essential requirement for safe forward movement. Aged 28, Tammy had never held a job. She was considered to be ‘gifted’—had flown through schooling with exceptional results, then apparently ‘lost the plot’. Her expertise was with computers. In fact, she had extraordinary computer skills. She was also extremely skilled at maths, language and writing. Every year, she supervised HSC exams with her mother and was chosen to assist students who required help completing their exam papers. It was recognised that she was useful with teenage students, having at one time done private maths tutoring with her mum. Tammy was reportedly the agency’s hardest client. She’d had multiple case workers, and was finally taken over by the manager, Sue, who had decided to ‘get tough’. Centrelink had recently told Tammy that if she didn’t have personal counselling, they’d cancel her benefits. Their assessment was that Tammy needed counselling for issues relating to her change of gender. The employment agency said she required 6
counselling for anxiety and gender issues. Tammy said she was just fine. She attended the agency and counselling because she was ‘playing the game’ and, in her own words, “doing just enough to make everyone leave [her] alone”. Tammy said that she shouldn’t have to work, or contribute anything to society. She also stated that she was entitled to government benefits even though she didn’t contribute to society or ‘earn’ the money. In fact, everyone should just let her be. She should be able to live her life as she wanted—at home, sitting at her computer writing or playing games in her bedroom of her parents’ house, hiding away from society. Reluctant or Resistant? Tammy was both reluctant and resistant. She was here because she was mandated to be. She appeared to be compliant, friendly but shy, though happy to talk. The problem was that she apparently had nothing to say. She was clearly anxious. In fact, for the first five sessions, Tammy presented to counselling with her mother, who sat on the chair with her. Initially, despite my misgivings, I allowed the mum to remain in the room because of Tammy’s apparent level of anxiety. When I asked questions, she looked to her mother to answer them, then sat hanging her head with her hands lying loosely beside her. When I questioned Tammy, she gave me ‘linguistic spaghetti’. We’d go around and around in circles each session. She couldn’t think of anything to say, or her mind went blank, or she’d get stuck on language or definitions. In one session, she spent an extraordinary amount of time questioning ‘what is happy?’ and ‘what is sad?’ She finally settled on the word ‘content’. She was content—neither happy nor sad. Regarding her medical gender change, she strongly stated that she’d ‘been there and done that’ with counselling. While she took me in circles, she often had a small smile on her face as if enjoying the duel. Her tactics were clearly to avoid, delay, distract and take up time. When the six sessions were over, she could tell Centrelink that she’d had counselling, and the employment agency would see that she’d ‘failed’ again. She later said that she preferred ‘failure’ because it meant that she wasn’t conforming. Tammy’s mother appeared superficially friendly and compliant. Underlying that, she was also anxious—and angry. It appeared clear from the beginning that she was present to strengthen the barriers. She came with a clipboard, pen and diary, and made notes during the sessions. She sat tensely, forward in the chair, and was eager to answer questions or fill in details when given the cue from Tammy. As a counsellor, I felt threatened and on edge. She freely answered any questions asked and used Tammy’s history as fuel to vehemently oppose the actions of Centrelink. She had long, angry explanations of all Tammy’s negative experiences with both Centrelink and their contracted employment agencies. “Why couldn’t they just leave her alone? Hadn’t they realised by now that Tammy CQ: The CAPA Quarterly
had an anxiety condition that prevented her from working or studying? Tammy wasn’t able to function in society!” When I likened Tammy’s situation to ‘living inside a bubble’, Tammy’s mum said Tammy was just like her—that in fact, if her husband hadn’t made her marry him, she’d still be at home hiding away from society. It seemed that ‘living inside a bubble’ was acceptable. Despite her best efforts to the contrary, she unwittingly showed me the environment Tammy had grown up in. This insight was helpful because it gave me enough to understand what I was to use with Tammy later. I watched how she had created in Tammy an image of herself. Sometimes I felt uneasy watching and listening to what she had to say. With some valuable supervision sessions, I developed and practised (during supervision) my strategy to exclude mum from the room. This strategy—standing inside the doorway at the beginning of the next (sixth) session and saying, “It is my professional opinion that it would be best if Tammy now attends counselling alone. You are welcome to wait outside or come back in an hour to pick her up”—was met with tense acceptance, and mum sat in the car outside for the rest of the sessions. I had also phoned Sue, who’d promised to back me up from her end at the agency. Not surprisingly, the first turning point (identified later by Tammy) occurred during the first session without mum. It was evident to me that Tammy had a very deep, long-standing depression. I postulated that this possibly began in Year 4 at school, since Tammy described escalating changes from that year. She was, however, extremely resistant to talking about how she felt inside. I took a chance and created a mental image of the black hole of depression. During that vivid description, Tammy steadily lost her composure, ending up sitting slumped in her chair and, for the first time, sobbing aloud and shaking. I did this with misgivings: Both ethically and morally, I questioned whether I was being cruel. (This was more extensively explored in later supervision, and I’d also discussed it with Sue prior to the session, and she’d told me to ‘try anything’ to reach Tammy.) When Tammy could speak, she said that the descriptive words I’d used ‘fit’ for her. She couldn’t remember when she hadn’t felt like that—this was her normality. She also said that she’d never known how to describe those feelings. She didn’t know there were words for them. This breakthrough heralded the beginning of Tammy allowing me to approach closer, and it was the reason why she, of her own volition, asked Sue to arrange six more sessions (twelve in total) with me. This was also the point from which Tammy started to become more truthful about her suicidal ideation—something she kept from her mother. When Tammy became more suicidal later and mum became aware, the situation became more volatile. Working with Sue became even more important. Gender Issues and/or Anxiety? Tammy had been an anxious, high-strung child ever since preschool, according to her mum. She required ‘special treatment’, had to have things done ‘just so’, was obsessed by rituals and ‘things’. She was bullied at school, with Year 4 being particularly bad, necessitating a change of schools. Tammy was in the ‘gifted and talented class’ and preferred to stay in the classroom all day, avoiding the playground or social interactions. August 2012
The pattern continued in high school, although she made a small group of friends who were also ‘geeks’ and avoided others. These were her only social interactions. Notes from mum allowed Tammy to avoid anything that didn’t fit with her need for seclusion and isolation. She started and finished her Higher School Certificate early, doing the maximum number of units allowed. So high school, both academically and avoidantly was, for Tammy, easy. University heralded the beginning of Tammy’s ‘breakdown’ in society. She left home to live on campus at a distant university that offered a specialised ‘pilot’ degree in computer gaming. Whilst managing to avoid most social interactions, she had to learn new rituals to survive alone. She reportedly left her dorm room only for study, washing clothes or buying food. Predictably, Tammy didn’t finish her degree. In her final year, she negotiated to study from home by distance mode, lost motivation and let the study slide. Back at home, she hid in her room, and her mum looked after her again. Later, Tammy completed a TAFE qualification. Otherwise, she stayed in her bedroom playing computer games or writing stories. Her computer was set with extraordinary security measures. Whilst she had an email account, she rarely used it, and only for friends. She didn’t ‘surf’’ the internet and refused to apply for jobs online, either on websites or by emailing her résumé. Security was an obsession. She refused to share her email address, home address or phone number. She also refused to write a cover letter for job applications because she reportedly “felt uncomfortable lying” to the prospective employer about her abilities. She believed she had none. She had many other obsessions and rituals related to food, her room, the house, the phone, going out, and contamination. She refused to job-seek at the agency with a newspaper. If she had to read a newspaper (she felt no need to know what was going on in the world) she either wore gloves or carefully turned the pages with a pen so that she didn’t touch the paper. If she was made to read a newspaper at the agency, she sat there hanging her head and quietly crying. Tammy refused to use a telephone as she was afraid to speak, not knowing what people would think of her. Actually, she had no need, as her mum made all her calls for her. In fact, she could rely on her mum for everything. According to Tammy, Centrelink thought her anxieties stemmed from her gender change when she was 20 years old. Tammy had always ‘known’ she was different, for as long as she could remember. She just didn’t know what made her different until she saw something on the internet at age 20 about being born the wrong gender. She found out from this same source that she was able to undergo a medical (hormonal) gender reassignment, so she did—apparently as easily as that. After taking the prescribed drugs from age 20, Tammy said she felt fine in her new body. However, she feared talking on the phone because she thought her voice was harsh, like a man’s voice. She also feared being out in public and being judged for her looks. She’d made no attempts to contact groups of people similarly situated, saying that she hadn’t done the change to associate with others. It was for personal reasons only. She was ‘happy’ the way she was, just not out in public. The story was complex, messy and confusing. At the very end of our sessions 7
First Person together (Session 11), after trust had been established, Tammy finally asked her questions about “how to be female”. The Counsellor Tammy was the hardest client I’d had and the first referral from that employment agency. I had a lot to think about: ‘proving myself’ to the agency and myself, wondering whether I was ‘experienced enough’ to find a way through the maze with my two clients, having a client with a worldview way beyond anything I had previously experienced. All my previous clients had been voluntary, initiated their appointments and paid me themselves. They greeted me upon arrival and thanked me when they left. Their mothers didn’t phone me at 6am if they couldn’t make an appointment that day. Nor did they have to check with their mums for their availability when making appointments. Tammy metaphorically ran away from me for the first five sessions. If she wasn’t engaging in a language duel with a smirk on her face, her mind was ‘blank’, or she didn’t have anything to say, or she didn’t know what to say, or she sat quietly hanging her head and crying. Later, without her mum around, she discussed suicide as her final act of avoidance. When she wasn’t sharing her future plans to end her life, she was making angry remarks about how she was treated by Centrelink or the employment agency. Her opinions about her ‘entitlements’ were vehemently shared. If Tammy wasn’t angry, her mother was behaving frustratedly or angrily. Between the two of them, they appeared to have a well rehearsed routine. As a counsellor, I felt confused, frustrated and threatened. As a human being and active member of this society, I was angry and offended. I really disliked Tammy and her mother. I thought that I couldn’t respect their beliefs, behaviours and choices. Their sense of ‘entitlement’ made me really angry as I thought about how hard I work. The more frustrated I felt, the harder I seemed to try to ‘out-think’ Tammy with her language duels. The more I danced, the better Tammy enjoyed the game. Supervision Supervision with regard to this case was a huge challenge for me. Once the basic questions were sorted—Who is the client? Where does confidentiality begin and end? What is the identified goal? If there isn’t an identified goal, can counselling continue? Do I feel that I can take this client on? Do I deserve to be paid if no outcome is reached—then the real issues began. What do I think about my client? Do I like or respect my client? What does unconditional positive regard look like in this counselling room? How do I sit with my client when she’s fighting or running away? Mixed with my negative thoughts and judgements was also pity. I pitied Tammy for the experiences in her life that had helped to create her. I related to some aspects of Tammy’s life, and these thoughts often ran through my head at different times. Underlying her current reality, I could easily identify her past ‘victimology’. I felt uneasy about going to supervision when I suddenly thought, “I don’t think that I respect my client!” I feared admitting this to my supervisor. “What will she think or do?” I wondered. “Does this mean that, as a counsellor, I’ve failed? If I can’t even get unconditional positive regard as a basic counselling skill, what does this mean?” Corey (2001: 178) states “Therapists communicate through their behavior that they value their clients as they are and that clients are free to have feelings and experiences without risking the loss of their therapists’ acceptance. Acceptance is the recognition of clients’ rights to have their own beliefs and feelings; it is not the approval of all behavior. All overt behavior need not be approved of or accepted.” I don’t remember hearing 8
those last words in my training—the delineation between acceptance and approval. Unconditional positive regard seemed so easy in a training room with a textbook and no live client. When my supervisor’s response was to ask how I felt about my client (“What feelings does she trigger inside?”), I felt nauseous. Nausea, I’ve found in supervision and therapy, is often a sign that I’m swallowing my emotions and thoughts—avoiding sharing them for fear that I’ll be judged. I felt pissed off! I was wasting my time with a ‘loser’, a ‘no-hoper’ who deserved nothing! And I was sad—pitying—I identified! I was frustrated and upset that this client may give me a bad reputation with a new referring agency. I was confused and frustrated that my problem-solving skills weren’t working. And I was REALLY angry with Tammy’s mum! How could a loving mother make her child so disabled? Then I thought, “How different from Tammy would I be in the same situation?” Finally, I felt disappointed with my own inadequacies. “A more experienced counsellor would know what to do,” I thought. In reviewing the research of Rogers (1977), Corey (2001: 178) discusses “caring, prizing, accepting and valuing of the client in a non-possessive way...”. In retrospect, this one question—how does your client make you feel—was the best beginning that I could have had. It let all the yucky stuff out so the real work could begin. Clearly, my head was a confused jumble. What came out in supervision paralleled my inner world in the counselling room: confused, uncertain, unhappy and inadequate. The next question from my supervisor was, “How do Tammy’s choices fit with your personal beliefs and values?” The simple answer was, most emphatically, THEY DON’T! Having my supervisor’s permission to feel that was so important. At the same time, it allowed me to own my possessiveness—accept my inner rules, framework, worldview, needs—then pack them away while I was with my client. With further questioning, I realised that I didn’t know a lot about Tammy other than her smoke-screen and my suppositions. The more my supervisor questioned me about Tammy’s worldview, the more I realised I didn’t know. I was so surprised! I’d sat through five sessions so far and assumed that I should have a good idea about my client. In reality, I had little. With my supervisor, I was embarrassed—further evidence in my mind that I was inadequate. After we’d opened the box of feelings, then discussed again, “Who is the client?”, she gave me space to just sit with Tammy. Curiosity The importance of curiosity cannot be overstated in the counselling relationship. Curiosity indicates an openness to learning—hearing from the heart. So many times I have learnt and re-learnt its value. When I’m stuck, don’t understand, or am challenged with a client, the best choice is to open my toolbox for curiosity. The counselling room is the place to be curious with the client. Curiosity with myself must go to supervision—regularly. Despite the judgements I was raised with (which pop into my head unannounced), I have a gut feeling that all people have the potential for positivity and engagement. Maybe that’s why I kept trying when Tammy was trying so hard to push me away. Rogers said that if someone is able to “get to the core of an individual” (1987c, Corey 2001:172), positivity and trust can be found. Just as Corey said, “When therapists are able to experience and communicate their realness, caring, and non-judgemental understanding, significant changes in the client are mostly likely to occur” (2001: 172), my change began Tammy’s change. When I started to communicate—“I’m really interested in finding out who you are”—the walls began to crash down. We found and described the black hole of her existence and fleshed out what Tammy really wanted. CQ: The CAPA Quarterly
Tammy’s identified second turning point was when we created on large paper a diagram showing all her inner conflicts. These were placed on a continuum where one end was ‘rebellion’ and the other end ‘conforming’. Each point in this continuum was described—feelings, beliefs, expectations, wishes. Creating this two-dimensional object had a visible effect on Tammy. She said that she’d never seen or thought of her world in that way before or with real words. She sat back with an apparent look of amazement, enlightenment, relief and pleasure. Suicide and Progress About the same time as this breakthrough in her understanding of self, she also fleshed out her plans for suicide. She shared with me her two-year timeframe, her planning steps along the way and the events which would bring her endpoint forward. Unfortunately, some of those events started to happen (increased pressure from Centrelink and the employment agency) which necessitated my need to negotiate with them so that Tammy stayed focussed on being safe. My relationship with Sue was important, as we were able to modify their requirements of Tammy in relation to what Tammy had communicated through her diagram. Identifying the small chinks where change was possible kept Tammy safe while still moving forward. The first requirement became a previously known task (when living alone at university): Tammy was to wash the dishes each day at home. Washing the dishes—a simple task—created a ripple. With excitement and surprise Tammy, Sue and I saw her world start to open up. In describing a “growth-promoting climate” Rogers’ view, as related by Corey (2001: 172), was that if the therapist can show congruence, unconditional positive regard and accurate empathic understanding, clients can be less defensive, more open to themselves and their world, and more able to behave in “prosocial and constructive ways”. Tammy liked washing up and shared that she’d rather do her own laundry. A chance comment at a family barbeque informed Tammy that her mother hated vacuuming as it hurt her back. It had never occurred to Tammy that her mum would dislike doing anything in the house. Tammy had never thought to ask or even consider helping, although she held a private fear about how she’d cope with running the house if mum died before dad. She decided it was an easy task for her to vacuum for her mum. The ripples in that pond started to grow into wishes and dreams. If she didn’t kill herself in two years, what was the alternative? Tammy had become used to the certainty of her own endpoint as she’d never had a dream for her future (another reason why she thought she was different). She didn’t know what she wanted, but she could identify where she was prepared to try, with support. There were a lot of tears at this stage, and her fear was palpable. In another breakthrough moment, though, Tammy said, “I can’t look or apply for my own job, but if they get one for me, I’m happy to do it, and I’d probably stick at it because I like routine.” Sue was so ecstatic that she employed someone to knock on doors to find something for Tammy. With the help of what we’d learnt, Sue had a list of ‘possibilities’ to work with. Ending and Beginning At our eleventh and last session (though we didn’t know it was to be the last session), Tammy asked, “How do I behave like a girl, and how do girls think?” It took this many sessions for Tammy to finally get behind those fears about being in public and engaging with the world. She bought her lipstick automatically at the same chemist as her mum (same colour as mum) but had never learnt how to apply makeup. She’d never thought to ask her sister to August 2012
join her in a ‘girls’ night’ so she could learn how to apply makeup. She wore jeans because she didn’t know how—and felt scared— to go shopping for a skirt or dress. She was embarrassed to go shopping with her sister and sister’s friends in case she didn’t understand what they took for granted when looking for girls’ clothes. It was the normally assumed ‘being a girl’ behaviours and understandings in public that had kept Tammy hiding away at home. Exploring how she could learn to be a girl turned Tammy’s face into a lovely smile. Christmas forced a break in sessions with Tammy. She was to email (she’d finally begun emailing me instead of phoning) to arrange a new time after Christmas. I never heard from her again. Conclusion We all associate unconditional positive regard with our counselling training. Carl Rogers, Gerard Egan, Gerald Corey—all those names are familiar to us. We can quote the theory anywhere and anytime. My questions are: “At what point do we consciously check to see whether it is or isn’t in the counselling room? What does it look like with different clients? How do internal conflicts change or test it?” Thankfully, with a great supervisor, I learnt to recognise that I accepted and respected my client, even though I didn’t like or approve of her choices. That small degree of separation—‘dispossessing’ the process—changed a catastrophe-in-the-making to happy engagement with life. At the same time that the client experienced positive change, the counsellor grew. We can all share stories about one client who significantly affected our practice. The work of Kottler and Smart (2006) illustrates how the challenge of coming together with a client to achieve a positive therapeutic outcome often takes us to an inner world. The mirror inside that inner world gives us a stark image of our selves. That image is always, in my experience, less than perfect. However, with Tammy’s help, and using the words of Kottler and Smart (2006: 25), I learnt that “being human is quite good enough” since “if we show up as fully human for our work, if we are open to the experiences that our clients offer to us, then we have no choice but to grow.” Postscript to the Story Sue contacted me after the holidays with great excitement! Tammy had begun a full-time job! After a three-month trial, the employer planned to offer her a skilled traineeship with a qualification at the end. Tammy apparently had never looked so happy. Her father was reportedly finally proud of her. Tammy was turning up each day happily to her new job in a quiet laboratory with no customer contact. Sue said the agency was ‘over the moon’ with joy. References Corey, G 2001, Theory and Practice of Counseling and Psychotherapy (6th Ed), Stamford, Connecticut: Wadsworth Kottler, JA and Smart, R 2006, ‘Reciprocal Influences: How Clients Change Their Therapists’, Psychotherapy in Australia 12(3): 22-28
Sharon Ellam, CMCAPA, Grad. Dip. Counselling, Cert IV Assessment & Workplace Training, Post-Grad. Cert. Neonatal Nursing, Post-Grad Cert. Midwifery, Dip. App. Sci. (Nursing) is known around Newcastle and the Central Coast for her skills with Childhood Anxiety. Increasingly families are coming to Sharon for help with systemic issues often related to one child who is anxious. With a background in Nursing and Midwifery, Sharon also has expertise in emotional issues during and after pregnancy, and with families affected by an abnormal birth experience, sick or premature newborn. The range of referrals or self-referrals for struggling families is now growing broader than merely an issue of anxiety. Complicated referrals from a local non-government Job Network Provider have gradually increased since this first client. Sharon is also a member of the CAPA Executive Committee, holding the position of Regional and Rural Committee Chair.
Changing Core Beliefs in the Feelings of shame are extremely painful, frequently avoided and difficult to access in therapy. This, in turn, makes these feelings notoriously difficult to change. Working with shame therefore presents unique challenges for the clinician. (Paivo & Pascual-Leone 2010: 203).
Shame “operates everywhere in therapy because clients are constantly concerned about what part of their inner experience can be revealed and what parts must be hidden” (Greenberg & Paivo 1997: 235). Recent research (Lee & Wheeler 1996) has argued that shame and therapeutic interventions in shame work look very different when seen from an individualist-oriented therapeutic perspective compared to a relational perspective— what Wheeler (1996) calls an individualist paradigm compared to a relational paradigm. From the individualist approach, most strikingly seen in the cognitive behavioural tradition, therapy understands the shame experience as being due to self-critical beliefs (Hawton, Salkovkis, Kirk & Clark 1989). In contrast, a relational approach to therapy, especially as articulated in contemporary Gestalt therapy writings (Lee & Wheeler 1996), is interested in the relational and contextual processes of shame and argues for an understanding of shame as a “regulator of social interactions and a ... rupture in the interpersonal bridge” (Lee 1996: 7). Therapists bring their various beliefs, underpinned by differing paradigms or worldviews, to their work, and in this article, I will explore how therapy with shame differs when practiced from these two differing approaches. Paradigms and Therapeutic Approaches A paradigm underlies a worldview and involves “a set of basic assumptions, most of them outside awareness and just taken for granted in the culture and language, about human nature and the human self ” (italics original) (Wheeler 2000: 10). A paradigm operates on broad cultural levels while informing and underpinning all the elements of a therapist’s theory and practice. To Wheeler (1996, 2000) the paradigm of individualism has informed dominant therapeutic discourses throughout the history of psychotherapy. This paradigm, and the therapeutic approaches it supports, involves various beliefs about selfhood—including the important notions of self-reliance and autonomy—that are often not useful when working with shame and can lead to re-shaming experiences (Jacobs 1996, Simon & Geib 1996). Wheeler (1996) contrasts the individualist paradigm with the relational paradigm in psychotherapy, which supports therapeutic approaches where the opposite of self-reliance is affirmed—ie, intersubjectivity and interdependence. Working with this relational approach, contemporary Gestalt therapy literature has shown how a relational paradigm has important implications when working with shame. 10
Individualism and Its Consequences The origin of individualism is a contested point, some authors locating it with the Greeks (Wheeler 2000), whereas others see it as stemming from the Enlightenment (Gergen 2009). According to anthropologist Clifford Geertz, individualism is a “rather peculiar idea within the context of the world’s cultures” (cited in Gergen 2010: xv). This worldview, at times called Cartesianism, after 17th century philosopher René Descartes, informs many of our institutions. It is a worldview underpinned by several inherent pre-suppositions about the nature of reality and what it means to be human, such as: Separation between self and other/self and world is fundamental. Self is a private intra-psychic phenomenon. Individuals exist prior to relationship. The rational/cognitive is prized over the emotional. Cause and effect is linear: I am impacted by something and I respond. Objectivity (and its possibility) is prized over and against mere subjectivity. We who live in Western cultures are so embedded in this worldview that it is difficult to perceive an alternative to these assumptions. According to Fairfield and O’Shea, “the most insidious underlying assumption of the paradigm of individualism relates to the notion of self sufficiency” (2008: 26). Individualism, embodied in the rugged, self-reliant male found in our many Hollywood heroes, is valued highly in our culture. The individual is just that—alone and sufficient unto (usually) himself. The growth trajectory of the individual, as outlined in much developmental theory and enshrined in early psychoanalysis, is from infantile dependency to mature autonomy—an autonomy marked by a strong grounding in rationality (Mitchell & Black 1995). This sense of autonomy is certainly the view of the healthy individual who is the success of CBT therapeutic practice. The shadow and opposite of this self-reliance and autonomy is ‘neediness’, the reliance on others, intimacy and emotionality, all of which, in our individualist culture, especially for males, can be problematic. Although what I may be imaging here is a cultural stereotype, this stereotype is embodied by many of us, male and female, in various ways and to various degrees. This stereotype is also at the heart of how male selfhood and masculinity are CQ: The CAPA Quarterly
Face of Shame Pedro Campiao
constructed in our culture and is a theme commonly found in therapeutic work with males (Wexler 2009). The male who feels needy, in want of support, or dependent on others often struggles with a sense of shame related to failing to achieve cultural ideals of self-reliance. A Relational Worldview In contrast to individualism, a post-Cartesian relational worldview embodies the following pre-suppositions: Self and other are fundamentally interdependent. Self is a relational phenomenon that comes into being through contact between self and other. Relationship pre-exists our sense of individuality, which arises out of relationship. The rational and the emotional are fundamentally connected. Events are co-created/constructed and come into being relationally. Subjectivity is prized and objectivity not possible: the necessity of dialogue thus ensues. Mitchell (2000: xiii) has coined the phrase the ‘relational turn’ for the epistemological shift undertaken within various psychotherapeutic approaches from a one-person psychology to a two-person psychology—ie, from a focus on the individual to a focus on co-created “complex relational or intersubjective fields” (Stopford 2007: 46). This shift involves an orientation in therapy to a client’s lived contexts, inter-personal dynamics and to the dynamics of the therapeutic relationship rather than solely to the individual’s intra-psychic processes and belief systems. A relational perspective understands that a client’s experience and sense of self are a field phenomenon, arising out of a cocreation of various contextual factors (Wheeler 2000, Gergen 2009). To focus simply on a client’s beliefs, divorced from the various contexts in which the client finds herself, involves losing a relational perspective. The interrelated notions of interdependence, support, and needs are important to understand facets of the relational turn and how it supports work with shame, a topic to which we will soon turn. Within a relational worldview, our experience and sense of self are dependent upon various “relational supports that maintain, restore and transform positive self-experience” (Stawman 2009: 21). This interdependence and support mean we are dependent on each other as a basic fact of life. August 2012
In contrast to an individualist worldview where self-reliance is at the heart of health, health from a relational perspective involves an embodiment of our interdependence with others, the living of a life that affirms our essential neediness and our need for others “whose presence supports and enhances both personal well being and intimate relatedness” (Stawman 2009: 22). In the words of De Young (2003: 34), “[I]ndividual autonomy is a bogus therapeutic goal ... [W]e all depend on others our whole lives for our psychological and emotional wellbeing.” Self-Reliance and Interdependence: A Dichotomy? So far, I have dichotomised individual versus relational approaches in therapy. In the therapy room, however, the difference may be more one of emphasis of approach than of dichotomy, depending on client need or character style. Some clients need to learn to become more self-reliant; they may be deemed to be or feel too dependent on others and not differentiated enough. Other clients may be deemed to be or feel too differentiated and self-reliant, so that in our work we may support their growth toward learning to lean on and depend more on others. According to Goldman and Greenberg (2010), some clients need to learn strategies of ‘selfsoothing’ and other clients strategies of ‘other-soothing’. Although approaches stemming from individualist and relational premises may both be used to support client growth, relational psychotherapy approaches are grounded in a wider critique of the individualist paradigm while offering an alternative, intersubjective, perspective to heal the failings of the latter. Mark I first saw Mark at a health service where I worked, then we later began counselling at my private practice. Mark, in his mid-50s, had struggled with a chronic illness, chronic pain, anxiety, depression and insomnia for much of his adult life. According to Kleinman (1988) shame is often at the heart of narratives of illness, through the stigma of brokenness. Mark had recently moved interstate to live with his 80-year-old father—who had disowned him at the age of 15—due to his wife having suddenly left him for a family friend, the crisis and trauma of which led to his health failing and his needing hospitalisation. Mark was haunted by the shame engendered by his belief that this breakdown marked him as weak in the eyes of his teenage children. Now, far from home and isolated, Mark found his condition deteriorating: his pain, his chronic illness, his mental health. He 11
was told he was terminal, although a prognosis was not given. Mark felt his body was too weak for the medication offered to him, and he felt shame and the stigma of being seen as an addict for taking a little Benzodiazapine relief each day. Apart from his father, and very occasional visits to his family, his principle human contact was with health practitioners. A letter from his psychiatrist stated that he could see no improvement in Mark’s situation and that supportive therapy was all that could be provided. I saw him for 56 sessions over two or so years. The Experience of Shame The actual experience of shame involves a “cluster of observations, speculations and predictions” (Resnick 1997: 258). Some of these feelings of shame are on a continuum with shyness and embarrassment; some are about feeling exposed, found lacking any dignity or worth. Whereas guilt is about a particular behaviour, shame is about the total person or sense of self—ie, one is ‘bad’ and inferior to others. It is closely related to fear—fear of others’ negative evaluations. It involves the somatic process of contraction, lowering of eyes and slumping or turning inwards of the body and the action tendency of wanting to withdraw, hide and disappear. Feeling shame is in itself shameful—so painful that much behaviour is organised around avoiding shame. Shame arises relationally through experiences of perceived contempt and disgust by significant others, which experiences are then internalised and directed at the self through self-loathing. Shame is a social emotion that allows social norms to be regulated. Shame is adaptive in that it protects social standing and connectedness by allowing us to hide from what we believe will be judged negatively (Greenberg & Paivo 1997, Resnick 1997). The shame experience thus involves a range of affective, motivational, cognitive and behavioural elements within a relational context. As will be seen, shame work from an individualist approach differs from shame work with a relational therapeutic emphasis. Gestalt Therapy and Shame Psychoanalysis, a tradition whose history has been strongly oriented to the individual, has focused primarily on guilt—the conflict between individual drives and societal values (Mitchell & Black 1995). Since the 1960s, as an interest in relational approaches to psychotherapy has increased, so has an interest in shame (Yontef 1996). Where guilt was seen as a regulator of moral transgressions, shame began to be seen as a regulator of social connection, as a social emotion (Lee & Wheeler 1996). Contemporary practitioners of Gestalt therapy, a tradition strongly embedded in the relational turn, have written much on shame as a social emotion (Lee & Wheeler 1996, Lee 2007). Within this model, shame and support are “interrelated polar opposites within the relational field” (Mackewn 1997: 247). We are always moving towards the other in order to have our needs met. Shame is a social emotion that functions to regulate our desires, needs and yearnings. When these needs are not met by the other we pull back to protect what we care about. Shame is our experience of not being received or supported by the other.
The more support we have to move into contact, the more we feel whole, worthy and accepted. The less support, the greater the possibility for shame, the feeling that we don’t belong, that we are flawed. When the lack of support is severe enough (as in trauma or abuse), shame can be internalised into core beliefs about the self. One then becomes highly sensitised to the possibility of not being received. The risk of shame then becomes ever present (Lee & Wheeler 1996). Mark Interwoven with all Mark’s many and complex co-morbidities was the experience of shame, a topic that was at the heart of our work and that coloured much of Mark’s experience. How do I know the issue was shame? According to Yontef (1996: 367) a therapist needs to “jointly create a shame language with the client”. A focus of the work for Mark and me became how he could have some sense of dignity and worth in the face of his health challenges and circumstances. At the heart of this intention was working with shame, which meant supporting Mark to feel okay with himself, while raising his awareness both of his self-critical beliefs and how shame is a co-created process. At times, Mark could gain some distance from his shame and could name it, relate it to certain unproductive beliefs of his and to situations where he lacked support or where others acted in a certain way. More often than not, he would be profoundly convinced of his lack of worth, challenging me to find ways to support an increase in his self-esteem. CBT, Individualism and Shame
A common target of therapeutic work is beliefs. This is especially pronounced in cognitive-oriented therapy models. A diagram stemming from the founder of cognitive therapy (Beck 1976), “one of the cornerstones of the classical cognitive therapy” (Greenberg 2002: 28) is the following:
In this model of psychopathology, distressing emotional symptoms arise when dysfunctional schemas, at the heart of which are our beliefs, are activated by stressful events. Through the teaching of this model, “patients are socialized into the CBT therapeutic mind-set” (Magdulski 2010: 55). CBT is often used as a self-help tool whereby the client is taught self-reliance— often through homework strategies for monitoring their thought processes to evaluate them for appraisal operations of cognitive schemas and to assess whether these schemas are realistic (Hawton, et al 1989). Moorey (cited in O’Brien & Houston 2007) describes the following three techniques as the most commonly used in cognitive therapy: Identifying automatic negative thoughts: Here the client is taught to observe, record and challenge negative automatic thoughts and to find more helpful alternatives. Changing underlying assumptions: Here the rules guiding maladaptive behaviour and the core beliefs that underlie them are challenged through reasoning or behavioural experiments. Reality testing: Here evidence is sought that confirms or refutes automatic thoughts or core beliefs.
CQ: The CAPA Quarterly
It is important to understand that cognitive behaviour therapy, as practised using the above principles and as applied as a self-help tool, is strongly based on an individualist worldview. Here the focus is on cognition, rationality and objectivity and on creating self-reliance in clients. In a literature search on a university journal database, I found no articles directly addressing CBT and shame. Shame does not appear to engender much interest within cognitive therapy, as it is understood to be a self-critical belief—just another automatic negative thought underpinned by various rules and assumptions related to core beliefs about the self. Therapeutic interventions that focus on shame are the same as those that focus on any other problematic beliefs. According to Paivo & Pascual-Leone (2011: 205) “there is increasing recognition that shame … rooted in early attachment experiences can be difficult to treat with standard cognitive-behavioural therapy methods and can interfere with the therapeutic relationship”. Furthermore, the possibility of shaming within the therapeutic relationship arises strongly from work that is based on individualistic premises (Jacobs 1996). When therapists attempt too readily to instil self-reliance in clients, when shame is seen as a problematic belief to be changed, and when validation of shame is not undertaken, thus leaving clients feeling they don’t have permission to be themselves, more shame can be the result of a therapist’s well intentioned work. What is missing from this cognitive and individualist view of shame is an understanding of relational dynamics in the experience of shame. Mark Deep down, Mark believed he was flawed, that he had failed as a father, a partner, a member of society, a man. Mark felt he did not belong, an experience that is at the heart of shame (Lee 2007). Shame was so firmly entrenched at the heart of his experience that exposing himself was shaming. Wheeler (1996) talks about the shame about shame that is at the heart of the individualist paradigm and of the construction of masculinity in Western culture. I saw this in Mark’s struggle to express his experience. To show his shame was in itself shameful for him, yet, from a relational paradigm, this shame itself needed to be exposed for healing to happen. A crucial process for Mark and me was creating space for him to be seen and validated, for this process not to be shaming and for this process to increase his sense of worth. It was slow work. At one point, Mark had to attend Centrelink counselling appointments with a person whom Mark characterised as a motivational speaker with much advice on the importance of healthy habits and positive thinking. I am sure this well meaning practitioner worked hard to support change in Mark’s situation; yet what Mark was primarily left with was not a bundle of useful strategies but feelings of being unacknowledged, wrong, and thus further confirmed in his failure, his inability to ‘get it together’, his brokenness. According to Wheeler (2000: 23), “much of the therapeutic work with people in this area [shame] ... is reduced to not much more than exhortations, affirmations and a misguided
attempt to ‘talk people out of’ their shame experiences—which can itself be shaming (first I’m overwhelmed by feelings of shame, and then I feel more shame about feeling something I’m supposed to have gotten over). Although the latter could be seen as a simple failure to achieve rapport, what it may also highlight is how delicate an act it is to create rapport with a shame-sensitive client such as Mark and how the parameters of short-term, solution-oriented counselling focused on changing unproductive or negative beliefs may fail to build ground for the healing that needs to occur. Shame Work: Between an Individual and a Relational Emphasis Emotion-Focused Therapy provides a model that gives room for both individualist and relational perspectives to be used effectively in working with shame. In their work, Greenberg and Paivo (1997) outline four different types of shame, the correct diagnosis of which is vital for differential intervention: 1. Primary maladaptive shame, internalised as a core sense of self, which is very different from shame related to a specific situation. This often occurs through negative attachment experiences, relational trauma, shame-oriented childrearing practices. 2. Generalised primary shame about violating values and standards. This arises from experiences of self contempt and disgust where the individuals cannot forgive themselves for certain behaviours, and this lack of forgiveness generalizes to problematizing the entire self. 3. Secondary shame generated by self-critical cognitions and self-contempt and disgust. This shame experience arises through pervasive self-criticism and can be based on cultural introjects such as wanting to be self-reliant and failing to accomplish such. 4. Secondary shame about internal experience. Related to number 3 above but more specific, where one feels shameful and critical of particular emotional processes, such as feeling needy or weak, rather than self-critical of a more general sense of self. (Greenberg & Paivo 1997) Although self-critical beliefs are at the core of the shame experience, according to Greenberg and Paivo, “transformation of shame about internal experiences is dependent on the empathic affirmation of another person to disconfirm pathogenic beliefs about self” (1997: 235). In this model, changing beliefs is not about proving them to be unrealistic, as in much CBT work, but is, rather, about a corrective emotional experience wherein the “client can be exposed to disconfirming experiences with the therapist” (1997: 235), thereby feeling worthy and valuable. Where the action tendency of shame is to hide, here the therapist creates the space for the client to show himself and to have his experience explored—whereby the experience of shame becomes okay, not in itself shameful. Here, the therapist is oriented toward refocusing the client on his internal experience, staying present-centred, and analysing (continued on Page 28)
Leading-Edge Neuroscience Reveals Significant Between Beliefs, The latest understandings in neuroscience are revealing important information for psychotherapists. This article is designed to inform you about some of the key elements of those new understandings, including the importance of subconscious beliefs, the Whole-Brain State, and the basic mechanisms of the mind/brain interface—all of which can assist you in being more effective with your clients. Let’s begin by defining two key terms in this article. The first is belief. The dictionary defines belief as something one accepts as true or real; a firmly held opinion or conviction. From our perspective, the origin of beliefs can be traced back to conclusions drawn from past experience, i.e. fire can hurt me because I have had an experience with fire that demonstrated that truth. Beliefs can be conscious and/or subconscious. The second term is Whole-Brain State. This is a state of coherency in the brain marked by a bilateral, symmetrical brain wave pattern, allowing for maximum communication/ data flow between the left and right hemispheres of the brain. So, what do these terms have to do with psychotherapy? The surprising answer is … everything! If we accept that the overall goal of psychotherapy is to produce fully functional human beings, then being able to optimise belief systems and brain function is a major factor in accomplishing that goal. The Role of Beliefs Consider the role of beliefs in our lives. Beliefs are like filters on a camera. What the camera ‘sees’ is a function of the filters through which it is viewing its subject. In other words, how we ‘see’ the world is a function of our beliefs and profoundly influences personality. As a result of our beliefs, we define ourselves as worthy or worthless, powerful or powerless, competent or incompetent, trusting or suspicious, belonging or outcast, self-reliant or dependent, flexible or judgmental, fairly treated or victimised, loved or hated. Your beliefs have farreaching consequences, both positive and negative, in your life. Beliefs affect your moods, relationships, job performance, selfesteem, physical health, even your religious or spiritual outlook. Most psychotherapists deal with one or more of these issues on a regular basis with their clients. Clients are often plagued by beliefs that are self-limiting. Consequently, the ability to help individuals change self-limiting beliefs into self-empowering beliefs is of great value in a psychotherapeutic environment. Conscious or Subconscious Beliefs can be conscious and/or subconscious. We are using the word conscious in its ordinary sense, as awareness of the environment. We are using the word subconscious, as awareness below the conscious level. Like a hard drive in a computer, this is where most of the belief-system ‘software’ is stored and, like a computer memory, the data are stored not in the central processing chip itself but, rather, in 14
the energy field that surrounds and interpenetrates the chip. There is an analogous relationship with the brain and mind, respectively. This ‘software’ is largely responsible for our habitual thoughts and behaviours. Advances in neuroscience have provided important information about the subconscious mind. For example, in a study cited in Harvard Professor Emeritus Gerald Zaltman’s book How Customers Think, neuroscience reveals that at least 95% of our thoughts and decisions originate at the subconscious level of the mind (Zaltman 2003). That leaves a very small percentage of our decision-making capacity for the conscious mind to exercise. These subconscious beliefs create the perceptual filters through which we respond to life’s challenges. So, while we may be mostly unaware of their influence on us, our subconscious beliefs largely ‘direct’ our observable actions and behaviours. They form the basis for our actions and reactions to each new situation in our lives. Another important quality of the subconscious mind is its processing capacity. In his book The User Illusion, Cutting Consciousness Down to Size, Tor Nørretranders, provides important information about the processing capacity of the conscious and subconscious minds (Nørrentranders 1991). As remarkable as it may seem, the conscious mind processes information at an approximate rate of 40 bits of information per second. While the subconscious mind processes approximately 40 million bits of information per second. Ironically, most standard approaches to psychotherapy address only the 40-bit processor (i.e. the conscious mind). While the enormous power of the 40 millionbit processor, (i.e. the subconscious mind), is largely unused. What about the Whole-Brain State? A great deal of research has been conducted for decades on what has come to be called ‘brain dominance theory’ (also known as split-brain research). The findings of this research indicate that in general, each hemisphere of the cerebral cortex tends to specialise in and preside over different functions, process different kinds of information, and deal with different kinds of problems. RIGHT Hemisphere LEFT Hemisphere • uses logic/reason • use emotions/intuition • thinks in words • thinks in pictures • deals in parts/specifics • deals in wholes/relationship • will analyse/break apart • will synthesise/put together • thinks sequentially • think simultaneously • identifies with the individual • identifies with the group • is ordered/controlled • is spontaneous/free It should be obvious from the qualities and characteristics described above that ideal brain functioning would be the ability to use both sides of the cerebral cortex simultaneously. However, life experiences often trigger a dominance of one side over the other when responding to specific situations. The more emotionally charged the experience (usually traumatic), CQ: The CAPA Quarterly
Correlations the Whole-Brain State, and Psychotherapy the more likely it will be stored for future reference, and the more likely we will automatically over-identify with only one hemisphere when faced with similar life experiences in future. As a psychotherapist, the ability to help clients achieve a balanced identification with both hemispheres of the brain (i.e. the whole-brain state) with respect to past traumatic experiences is paramount in helping them to achieve a new perspective of their past. This new perspective can free them from the habitual perspective, held in the subconscious, which can make a past trauma into a current nightmare. By re-perceiving a past traumatic experience with new Whole-Brain ‘filters’, clients can be freed from the automaticity of past perceptions that limit their happiness and wellbeing. In addition to its usefulness as a tool for dealing more effectively with life’s challenges—past, present, and future— the Whole-Brain State has another major benefit. It can be used as a foundation for quickly and effectively changing selflimiting subconscious beliefs. The research that follows, used PSYCH-K ®, a popular system for subconscious change. This system has been used by psychiatrists, psychologists, social workers, professional performance coaches and others for over 23 years. This is a testament to its versatility. In the hands of a professionally trained psychotherapist, it is an effective therapeutic tool. In the hands of a sports performance coach, it is a way to dramatically enhance athletic ability. Used as a tool by educators and parents, it can significantly help students raise their level of academic achievement. Healer, Heal Thyself … and Your Clients Too! The powerful influence of the whole-brain state was demonstrated in a study reported in 1988 in the International Journal of Neuroscience, by researchers at the Universidad Nacional Autonoma de Mexico (Grinberg-Zylberbaum & Ramos 1987, cited in Ferguson 1988). It suggests that synchronised brain states significantly influence nonverbal communication. The study was done with thirteen paired subjects. The subjects were tested in a darkened and soundproof Faraday cage (a lead-lined, screened chamber, that filters out all outside electromagnetic activity). Each pair of subjects was instructed to close their eyes and try to ‘communicate’ by becoming aware of the other’s presence and to signal the experimenter when they felt it had occurred. The brainwave states of the subjects were monitored during this process. Experimenters reported that during the sessions, an increase in similarity of EEG (electroencephalogram) patterns between the pairs developed. Furthermore, the experimenters noticed, “The subject with the highest concordance [hemispheric integration] was the one who most influenced the session.” In other words, when you are in a whole-brain state, your brain wave pattern can automatically affect your client in a very positive way, even before you communicate verbally. August 2012
Jeffrey L. Fannin Robert M. Williams
These conclusions support the allegation that our thoughts, even when nonverbally expressed, can influence others. In fact, the more whole-brained we become, the more we influence others toward that state of being as well. The therapeutic benefit of this kind of influence on therapists, as well as on their clients, is self-evident. QEEG and the Whole-Brain State
This research used standard electroencephalography (EEG) equipment and techniques; along with another computer program to convert raw EEG to Quantitative EEG (QEEG) tomography for processing the research findings. Our research gathering documented one hundred twenty-five (125) cases, with data gathered over 12 months in three different locations, using different EEG technicians, using two different types of EEG equipment; the result of this investigation produced a p-value of <=0.010. A baseline of EEG (electroencephalogram) data was established for each case. Three (3) baseline readings of five (5) minutes each were recorded; five minutes eyes open, five minutes eyes closed, and five minutes with the brain on task (silently reading a magazine). A Certified PSYCH-K ® Facilitator used standard PSYCH-K ® practices. (The corporate version is identified as PER-K ®.) This is a process for subconscious belief change to achieve the wholebrain state. Following the intervention of the PSYCH-K ® change process (called a ‘balance’), a post-intervention EEG was recorded in the same manner as the EEG baseline stated above. The balance took approximately 10 minutes to complete. Raw EEG data were artifacted to eliminate eye movement, tongue movement, swallowing, or other unwanted disturbances in the EEG. NeuroStat, a function of the NeuroGuide program from Applied Neuroscience, performedw statistical analysis. NeuroStat allows for individual independent t-tests to be performed. The following is an example from the base of 125 cases examined for the whole-brain state. The independent t-test compares condition A to condition B and shows whether there are differences in the dominant brain function. When we consider Shannon’s method of statistical analysis,* we understand that when we measure two groups, A and B, (such as pre-balance and post-balance) each of them having a well defined probability distribution, respectively, as well as a joint probability distribution, then the mutual information between A and B is defined. The concept of mutual information can easily be extended to quantum systems of entanglement. This leads us to understand that having quantum mutual information, which, for a general state of either A and/or B is now defined, provides the basis by which the relationship can be understood. A sample depiction of the whole-brain state is seen in Figure 1. 15
Figure 1: Following a PSYCH-K ® balance, this person demonstrated a statistically significant shift in hemispheric coherence patterns, which were reflected behaviourally in increased access to emotional resources and integrated, ‘whole-brain’ behaviours and relationships.
Figure 1 is labelled as FFT Coherence Independent T-Test (P-Value). To better understand the scientific significance of this report, understanding the significance of p-value will help to put this research into perspective. In statistical significance testing, the p-value is the probability of obtaining a test statistic at least as extreme as the one that was actually observed. When the result falls at 0.05 or 0.01, it is said to be statistically significant. In the case of the Fannin-Williams research, a very high degree of statistical significance occurred: <=0.010. This indicates that the relationship between the two phenomena is highly significant and not a function of chance. The colours on the independent t-test show phenomenon A (dominant brainwave pattern) BEFORE the PSYCH-K ® balance is depicted in light blue, left side and phenomenon B (dominant brainwave pattern) AFTER the PSYCH-K ® balance was facilitated is depicted in , right side. The wholebrain state is considered to be the combination of light blue, left side, condition A, dominance prior to the balance process; and condition B, right side, dominance after the balance process was facilitated. Due to the space restriction of this article, it is not possible to provide a comprehensive treatment of this subject, or the numerous changes that a majority of subjects in this research experienced. However, the volume of data collected, and the unique properties it represents, afford us the opportunity to evaluate and continue to understand what the data mean, as well as providing intriguing hints about the nature of its potential. Singularly, the most significant information to come from this research, in 98% of the cases measured, presented very high statistically significant correlations, demonstrating the difference between baseline measures and the presence of the whole-brain state after the intervention occurred. As mentioned above, just 16
because the whole-brain state is present does not mean it is being continually activated so that the person can take full advantage of it in a given situation. Sometimes secondary gain issues come into play, as may other subconscious belief patterns that might need to be addressed in order to effectively activate and/or allow the person to use fully the whole-brain state. The whole-brain state is better understood with some education regarding a few of its more unfamiliar components. Figure 1 uses the term coherence. This is an energy signature. In physics, coherence is a property of waves that enables stationary interference, a temporally and spatially constant to brainwave function. More generally, coherence describes all properties of the correlation between physical quantities of a wave. This is important in order to understand the physics of resonating wave patterns in the brain, its connection to the whole-brain state, and how it impacts our behaviour. An additional component of the whole-brain state is identified as constructive and destructive interference patterns. If two waves are interacting with one another in such a way that they
Figure 2: Constructive Interference
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combine to create a wave of greater amplitude than either one by itself, the result is called constructive interference. Constructive interference is said to occur when waves are ‘in phase’ with one another. However, if the waves interfere with each other in such a way as to diminish (or eliminate) their combined amplitude, a destructive interference pattern is created. In this case, the waves are said to be ‘out of phase’ with each other. Phase is important in brainwave patterns, just as it is in other principles of physics. That is to say, two waves are said to be coherent if they have a constant relative phase (see Figure 2, the peak of each wave is moving in the same direction at the same time). The degree of coherence is measured by the interference visibility, a measure of how perfectly the waves can cancel due to destructive interference (see Figure 3). Cancellation is virtual or local since a wave cannot have negative energy. Constructive Interference as seen in Figure 2, for example, would be like two sets of ripples moving across the surface of water toward each other, as seen in depiction A. Both wave A and B are moving toward each other with their ripples in-phase, in this case both waves are leading with their negative amplitude. Their cycle patterns are aligned. The waves merge together at the interface where two ripples meet. The consequences of this merger, the waves are drawn with one above the other as seen in middle depiction B. The common expression of, being in rapport, or in sync, or on the same wavelength with someone, is an example of how this concept is relevant to therapist/ client relationships. Destructive Interference, as seen in Figure 3, for example, the ripples might be best understood when thought of as waves created when a pebble is dropped into water. Wave A in depiction B, is moving from left to right. Wave B in depiction B, moving right to left, represents the ripples from a second pebble dropped shortly after the first. Since the pebbles did not enter the water at the same time, the waves will not be aligned when they merge; they will be ‘out of phase’. The physics of a destructive interference pattern has wave A leading with negative amplitude and wave B leading with positive amplitude. Where they meet, the waves mirror-image each other. As shown in depiction C, the amplitude values of each wave cancel the other out (Lipton 2005: 116). The significance of this principle of physics is fundamental to the coherence of the whole-brain state. Allowing brainwave energy to be more focused and effective at resolving problems and accessing information confers the ability to not only resonate properly to influence brain function but also to interact with subconscious beliefs.
Figure 3: Destructive Interference
Emotional Engagement and Subconscious Beliefs From a neuroscience perspective, the basis for understanding why we experience particular emotions is centred in the relationship between the anterior cingulate cortex (ACC) and the amygdala. The amygdala, usually thought of as the fear detector, also detects all other emotions. It responds to fear because it processes emotions in order of their significance, so when fear is the most significant emotion in the brain, the amygdala will respond (Whalen et al. 2001). When fear is the most dominant emotion in your thinking, it taxes the subconscious mind, which does most of the fast processing of information.
Figure 4: Anterior Cingulate Cortex (ACC). Front part of the Cingulate Gyrus
Figure 5: Amygdala – Thought of as the fear detector
For example, if a person who left a secure job to pursue her dreams, started to read statistics about the unlikelihood of success as an entrepreneur, the amygdala would likely have been stimulated, making her more anxious. As a result, her subconscious fears would be active even when she was thinking about other things. Scientific experiments found that when fearful facial expressions were shown so that people did not know they had seen them, the amygdala was still activated (Morris et al. 1999, Williams & Mattingley 2004, Whalen et al. 1998).
Figure 6: Prefrontal Cortex (PFC)
Figure 7: Amygdala
The amygdala is connected to multiple brain regions. One of those regions is the frontal lobe, where many important decisions are processed. If the amygdala is activated, the activation affects various regions in the frontal lobe, particularly the prefrontal cortex (PFC), and thereafter affects decision-making, as well as emotional centres. We can recognise that we are vulnerable to fear and anxiety in such a way that it compromises our own abilities to attend to relevant content. The impact of this is that it consumes our thinking resources. We should also understand that the amygdala is the emotional relevance detector rather than just a fear detector. The amygdala-PFC connection is important because a part of it acts as short-term memory and another part as the ‘accountant’ in the brain, calculating risks and benefits of our thinking. Subconscious threats over-activate the amygdala (continued on Page 32)
W orking with Children’s Core Beliefs in a Dr Benjamin Spock’s message to mothers in his best seller Baby and Child Care, first published in 1946, that “you know more than you think you do” has literally caught up with itself and run itself over in the process of parental confusion. Despite being more informed and supported by a host of professional experts, many parents today experience a lack of real knowing with regard to keeping abreast of their child’s emotional and psychological development. Overworked parents with excessively busy lifestyles equates to a high level of daily stress where ‘getting things done’ is number one on the priority list. ‘Doing’ has become so prevalent in our society that ‘being’ is very often relegated to sleep or zoning out in front of a television and being bombarded with things to do or buy when we are not zoned out. We have only to lift our eyes above the horizon of our scripted daily lives and glimpse the perceptions that sustain it to see the ‘busy fix’ core belief perpetuated by all in our Western culture. As a child-focussed play therapist and family therapist for the past 24 years, I have witnessed many a trial and struggle of parents versus the ever invading influence of globalisation on values and beliefs that inevitably flow with the rhythm of change. Multimedia marketing in support of consumerism and materialism lies at the heart of Western society, unconsciously influencing and affecting all of us. Many children are no longer necessarily guided by their parents or the teaching influence of schools, and most children are aware of what is on offer from the world. Even children in the remote highlands of Papua New Guinea are challenging parental and cultural beliefs in the pursuit of Western values and the belief that ‘having something’ makes you complete. We all know that our true human needs are few, yet consumerism continues to influence thinking so that wants are considered to be needs without awareness of the difference. Children’s and teenagers’ desires are constantly fed by the multimedia corporations creating an insatiable appetite that, in the truest sense of the word, can never be filled. The more we seek external gratification, the less connected to real self we become, with the gap ever widening as children grow into adults. ‘Doing’ and ‘having’ are powerful forces in family life today which often override very basic needs of children. I have heard so many parents report that their child has everything she or he wants, everything they themselves did not have in their childhood, and that all the parents want is a little appreciation and respect. Most fail to realise that the child is seeking the parent. The question is: just how available are parents today to spend quality time with their children? Children whom I see in therapy have no problem with spending 60 to 90 minutes engaged in interpersonal and intrapersonal connection. In fact, my experience is that most are thirsty for this level of human connection with someone who sees them without the trappings of the external world. I often resist the temptation to fill the therapy time with ‘doing’, despite the eager intention of the child to play or paint. 18
Settling in with and truly noticing a child takes time, time to talk, time to listen and a moment to connect with the energy of the being before you. I even preface sessions with “We don’t have to do anything if you like” as a first step in challenging the learned belief that we do. It is understandable to me in my work that children are indeed challenged when given the choice of entering a space of ‘being’ in therapy, but this is how I glimpse the true essence of the child. Let’s face it, children have an innate ability to just be; they learn to be ‘doers’. How sad it is that this wonderful human capacity has often faded by the time we reach adulthood, for it is where creativity springs from, where peace of mind is developed and where connection to real self can anchor a life full of delightful encounters without the risk of losing self in the process. Marty, aged 10, told me in one of our sessions that he really enjoyed coming to counselling because he got to choose what he did and that it did not matter if he got paint on the table. He went on to say that counselling was a bit weird because it gave him different feelings, not bad feelings, just different. Marty was a high achiever in everything and, consequently, his life was very full in sustaining this level of functioning. Both parents were proud of him, and he thought this was a good thing but said it was also bad because it meant he could not “muck up”. Everything this child did was monitored, measured and praised by parents and teachers. Marty was brought to counselling for emotional development. Society’s core belief of ‘doing, trying hard and harder, pushing beyond limits and achieving results’ was already heavily etched in this child’s belief structure. Therapy time for Marty was learning to ‘let go and play’, without reason or purpose. He asked me one day whether this was my real job—playing with kids, etc—and whether I got paid to do it. When I confirmed that I did, he became animated and excited at the notion of doing what I wanted and being paid into the bargain! This was a moment in Marty’s therapy where a rigid core belief was challenged and expanded through a lived experience. I am a big adherent of the notion that core beliefs can be changed through new, positive experiences which naturally challenge the learned assumption, especially when the experience is reinforced by a positive, uplifting feeling. We all have a limited experiential realm that is dependent on our external influences and contacts. A positive teacher can make a huge difference to a child’s life and the choices he or she makes; the same is true for a negative teacher. Therapists need to be mindful of supporting the expansion of the child’s experiential realm to help develop positive, affirming beliefs about self, despite and regardless of external influence. A child’s life is like a piece of paper where every passerby leaves a mark. ~Old Chinese Proverb On the opposite end of the spectrum is the child who resists doing ‘anything’ that parents or teachers request or demand. The causes of defiant and rebellious child and adolescent CQ: The CAPA Quarterly
Constantly Changing W orld behaviour are indeed complex, yet I find the same approach to work in therapy as in other contexts. ‘Freedom thinkers’, as I call them, are often intuitive beings who resist co-operating with the created flow for their own good reasons, and one of the common reasons is ‘not being heard or listened to’. Many of them are extremely creative in play therapy, more so than others, revealing original ways of seeing and perceiving things, events, life, family relationships and the world around them. When I ask from where did they derive such ideas, they say they have just always known. Sociologist, Paul H. Ray and psychologist Sherry Ruth Anderson explore their research in a co-authored book entitled The Cultural Creatives: How 50 Million People Are Changing the World (2000). They introduce the term ‘cultural creative’ to describe a large segment in Western society that has recently developed beyond the standard paradigm of Modernists or Progressives versus Traditionalist or Conservatives. One mother of an 11-year-old girl said to me that she “want[s] me to change the school system”. These ‘cultural creatives’ are said to come with a new order of thinking, uncluttered by the old and with different core beliefs about life, purpose and way of being. The challenge for many children of this ilk is that they tend to take most external influences with a grain of salt, are less likely to be coerced and less inclined towards suggestibility, which often leads them to being labelled non-conformists, difficult or wayward. They are definitely not mainstream yet clearly differentiate themselves from damaged and traumatised children. Many have a keen interest in caring for the environment and the animals, righting obvious wrongs from the past and changing laws to support freedom. Kristy was barely 6 years old when she came to see me. She had never been to counselling before but asked her separated parents for the opportunity to talk to someone. She had lived the 50/50 arrangement with her parents since she was 3 months old. It was her father who brought her to counselling, and he was unsure what his role was in the counselling process, so Kristy told him to go have a cup of coffee but not a “sneaky cigarette”. I saw the surprised look on her father’s face as I followed this new child-client into my healing centre. Kristy launched straight into why she had come to counselling, saying she heard a man talk on the radio who said that parents should never ever yell at their children. Needless to say, this child had a report of all the incidences when her father had yelled directly in her face—so much so that, she told me, she got so scared she could not move. Kristy also informed me that she had indeed ‘told’ her father that she did not like him yelling at her, but still he kept up with the behaviour. Kristy agreed to bring her father into the end of one of our sessions, but not the first one as she “wasn’t finished with telling me things” and, to be honest I was glad, for I thoroughly enjoyed ‘hearing’ this child’s take on her life. She had only just turned 6. The first session ended with her writing a list of behaviours that she needed addressed with August 2012
her father, which included his smoking, which she knew about but he tried to hide. This child struggled to understand why he continued to smoke when he knew it was bad for his health and why he denied he smoked when she could easily smell it on him. I was taken aback when she said that his guilt might kill him first and by her innate wisdom about the nature of guilt when I asked her to elaborate. In a later session, she made a list of preferred changes for her mother, which included Kristy not being told how she should feel. This differentiated child was well aware of her real self and of the clash with her parents’ ways of being. I often hear myself saying to parents that children often bring us into new awareness of ourselves and ‘call us’ into our true potentials—but it is a delicate road of awakening when core belief dictates that it is the adult who knows best. We have come a long way in our growing awareness of the importance of self-esteem, how to build it in our children and how to differentiate between inappropriate behaviour and the person without shaming and blaming. Nonetheless, therapists know that damage to children’s self-esteem continues in families and at schools, regardless. Conservative, well functioning families as well as highly dysfunctional families today produce drug-using, abusive teenagers with attitude. Likewise with non-smoking, non-drinking/non-drug-misusing parents: they too produce smoking, binge-drinking and drugtaking teenagers. Family systems rules no longer truly apply; it can happen to any family system, and for family therapists to grasp the real picture, they need to expand the therapeutic lens to encapsulate the whole picture—that being the larger family at hand, the family living within an ever changing transient culture, and the multitude of external influences at play. Television—paid and otherwise—internet access, movies, and the influence of technological games is the norm for today’s families, with many parents opting for the easy road and allowing children to indulge and, in some cases, become dependent on such devices. Children often have TV in their bedrooms or playrooms to handle the dispute of different viewing needs, and many cannot go to sleep without it; many parents often engage in the same behaviour. Parents’ work demands often result in children being left unsupervised before or after school, or supervised by older siblings—dabbling or indulging in internet and social media influence. Whichever way you turn, the influence is flowing constantly, relentlessly and effortlessly—all with the press of simple buttons. So how do parents combat such major influence in their children’s lives? Other values, ideals and beliefs pushed forward with glamour often at their forefront? Moderation and balance is the only way to manage these family life situations if healthy development is desired. This of course requires the setting and upholding of boundaries balanced with interpersonal connections, sustained by ongoing verbal communication. In some ways we have gone backwards to parenting where children were seen and not heard, where children are merely managed and monitored. The only difference now is that children are immersed in multi-dimensional technologies. 19
It is inevitable that children’s beliefs will be and are constantly influenced by the external factors in their lives, whatever phase or stage of development they are progressing through. Society’s cultural climate at any given point in time will dictate to children what and how to think, not just what to wear and how to act. The script of life in many ways is cast by the collective more so than being driven by the individual, and it does not take long to identify the external influences that affect a child’s developing belief system and/or effect a change in behaviour. Most children are bombarded daily by TV and the media at large, and entry into secondary school continues to provide a mélange of personality possibilities as influence for identity development. I am not saying parenting children is an easy task today. I recognise the challenges for overworked, tired and despairing parents up against the machine that governs lifestyle, but in saying that, it is important to note that parents rise to the challenge at hand and, in doing so, attempt to keep up with the changes influencing their children’s ways of thinking. In the case of the ‘freedom thinkers’, listen to what they are saying. I love the complexity and diversity of working with children today and discovering the layers of influence, how they imprint and, in some cases, how they do not—more than often challenging most theories on child development as inept or behind the times. It is a fast-paced world of change but, as with everything else, we have choice about how we engage. This, I contend, is a valuable core belief that can be learned by children through a therapeutic process wherein true self is not just unearthed, healed or transformed but harnessed as a reliable compass for finding ones way in life. Your children are not your children They are the sons and daughters of life’s longing for itself. They come through you, but not from you, And though they are with you, yet they belong not to you. You may house their bodies, but not their souls, For their souls dwell in the house of tomorrow Which you cannot visit, Not even in your dreams. You may strive to be like them, But seek not to make them like you. ~Khalil Gibran,The Prophet
I particularly enjoyed reading the article ‘Counselling Indigenous Australians: Human Commonalities and Self Esteem’ by Anthony Dillon and Phil Harker in CQ Issue 1 2012—their point being to acknowledge the person first and indigenous status second. I was fortunate to train during 2011 under Rosemary Wanganeen, South Australian Elder and Founder and CEO of the Australian Institute for Loss and Grief. Wanganeen has developed a 7-step healing model for holistic healing and the well being of Aboriginal people, and whilst it recognises the need to acknowledge the ill effects of the colonial history on Aboriginal people, the emphasis IS on the individual as a person with significant unmet human needs. As a non-Aboriginal Australian, I sought to become filled with the experience of ‘being’ Aboriginal in order to enhance the development of my work with children and their families and, with a specialisation in grief and loss, I carried the intention for healing transgenerational suppressed and unresolved grief in individuals, families and communities. A proud indigenous man wrote the following words to me not long after I began working in his community. Would be good to take all the 20-odd million ‘Australians’ with me for 40,000 years and let the Aborigines recreate their world as our temporary temples of consumerism decay back into dust. We indigenous men have been united by our suffering and oppression, but we have the spirit of resilience that has carried us through history and many a cataclysmic episode, and it is that spirit that holds us. Despite the systemic and systemised oppression and dehumanising social processes we are subjected to, we will not die, we will get stronger every day. I took this perspective with me when I first started working with Aboriginal children as young as 3 years old, although my therapeutic radar scanned for grief, fear and core values that were consistent with low self-esteem carried over from the history of oppression. What I found with all these children, however, was a deep-seated sense of self that was strong, vibrant, alive and well. The true self that I help non-Aboriginal children find in therapy was very present in the Aboriginal children of this community. In fact, they continue to teach me about the essence of real self. Like this elder says, it is the social process of dehumanisation that continues to disable Aboriginal people today, not their Aboriginality. The Influence on the Inner World All healing and empowerment starts with the individual—in this case, early intervention with the children to help build core beliefs about self that can and will lead to healthy actualisation, despite and regardless of anything. The fact that children can, will and do adopt many core beliefs about self during the developmental years has its upside. If something can be taken on board then it can also be challenged, transformed or released. The following words from Moustakas (1974) Psychotherapy with Children: The Living Relationship are a basis for psychotherapy with distressed children—a quotation that can easily apply to the collective plight of the indigenous people of Australia, especially when the word ‘parent’ is replaced with ‘paternalism’. Read if you will from both stances.
CQ: The CAPA Quarterly
At the root of a child’s difficulty, is the submission and denial of self. Somewhere along the line of growth and development, they have given up the essence of being and the unique patterns that distinguish them from every other person. The growth of self has been impaired because of rejection in important personal relationships. Having been rejected by others, they come to be rejecting of self. Parents gradually, often subtly and indirectly, convey to the child that they consider them a person of limited value and potentiality. The child will not at first show feelings of strong anger or fear, but as demands are made upon them and pressures increase, feelings become generalized and defused. Eventually they lose touch with the situations which arouse deep feelings of self-inadequacy and consequently lose touch with their own real feelings and themselves. More than often, a child’s internalised image of self stems from the feeling he or she gets from parental responses. Being egocentric, children naturally create negative core beliefs about themselves in order to make sense of the unpleasant feelings associated with the experiences. An emotional disturbance can be dealt with by giving it visible shape. ~CG Jung Melissa was 10 years old when she was first brought to counselling by her maternal grandmother. Her parents had separated 18 months earlier, and she lived with her father and his parents. She was fortunate to share a loving, close bond with her grandmother, especially since her mother had left to pursue a new relationship. Melissa had not seen her mother for over 12 months and had closed her heart to the pain of abandonment she experienced when her mother failed to return to collect her after a weekend access visit with her father. This rejection pain unearthed itself when her mother phoned to recommence access. Melissa was angry and said she did not want to see her mother ever again. While her grandmother understood this as a normal response given the circumstances, she knew in her heart that reconnection was a good thing for her granddaughter. Melissa’s father was still in anger and grief about the separation and said nothing, which she interpreted as his support in her not wanting to reconnect with the mother. I saw Melissa for quite some time before she was ready to disarm her anger and reveal the depth of her sadness. She struggled mostly with the grief and loss of her parents having separated in the first place. Melissa had not been aware of any fighting, so she was perplexed by the separation, angry that her mother had abandoned her and disappointed that her father showed no obvious emotion about the separation. “He should have told Mum to come back home.” Sometimes when parents attempt to hide their distress, children interpret this as ‘not caring’ and at other times when parents do reveal their distress, children worry that somehow they are to blame. It can be complicated for a child to talk directly to a parent, especially when the child intuitively senses that a parent is suffering. The clay sculpture created by Melissa was her representation of her internal feeling world. Three long ropes of clay were twisted and tangled together; she used black paint to reflect her anger and yellow to reflect hope and happiness at her mother’s return. Even though August 2012
Melissa could not show her hope or happiness, she was glad her mother wanted to see her as it challenged her belief that her mother no longer loved her. “How could she love me if she left me?” It was months, however, before she agreed to meet with her mother in the safety of the therapy room. She called her sculpture ‘Confused’ because she found the whole experience confusing. Somewhere deep inside, she knew her mother had loved her, remembered the feeling of connection and intimacy, but she was equally confused about how and why her mother had stayed away so long, confused about her father’s feelings, and confused about where she belonged. After she made the sculpture, Melissa agreed to participate in separate sessions with each parent in which she had the opportunity to express her feelings to the people who matter the most. Her voice trembled with emotion when she spoke. She was so filled with fear, so scared to speak her truth, so terrified of being vulnerable and rejected; but as she spoke, I saw this fear transmute into strength through the courage she revealed. The greatest fear a child will carry is that she is not loved, or not loved enough to matter. Melissa’s parents were both visibly touched and opened by the pain and courage of their daughter. Neither had any idea how hurt she was, given that she appeared to cope so well and to enjoy her close relationship with her grandmother. Her adapted self had played an important role in her coping, but it was her real self that she needed to be connected with in order to heal and move forward. In the therapeutic relationship, the therapist conveys to the child a deep belief in him as a person and in his potentialities for growth. He respects the child’s values, ways, peculiarities, and symbolisms and lets the child know these are worthy because they are part of him. The relationship enables the child to explore the full intensity, impact, and meaning of his generalised negative feelings. These attitudes were originally learned in his early experiences with parents and other significant adults. They may now be modified in a very different type of relationship where the child finds personal strength, experiences self significance, and becomes able to express his capacities (Moustakas 1974). Ambiguity and confusion often lurk in the belief system of a child. They may well ‘feel’ loved one minute and ‘unloved (continued on Page 33)
Climbing Through the Scaffolding of Beliefs ~ At the most basic level of human experience, we all need beliefs to give us direction and meaning in our day-to-day, momentto-moment experience of being alive. Beliefs are our reference points—our scaffolding; they assist us to navigate through complex and unpredictable events encountered in life. Some beliefs are born out of nurturing and supportive families and some are born out of traumas and disappointments. Psychotherapy as a profession is blessed (some may say plagued) by a multitude of beliefs, and the way we do therapy is based on the beliefs born out of our lived experience of what it is to be human. Beliefs and Shame Shame is the experience of being over-exposed and unsupported. “It is the affect of indignity, of defeat, of transgression, of inferiority, and of alienation” (Wheeler & Lee 2003:45), and our responses to these experiences are referred to as creative adjustments. The point of the creative adjustment is to ensure our survival by learning to navigate through what appeared to be an overwhelming and hostile environment. A creative adjustment for a male client who has been sexually abused as a child could be to find ways of not drawing attention to himself, to become more background than foreground, to become intensely selfsupportive because seeking support from the environment holds the real potential for further abuse and injury. From this experience, a belief system emerges: beliefs such as: I must learn to stand on my own two feet, don’t show vulnerability in the presence of others, and learn to solve my own problems alone. Here we have a definition, a belief in fact, of what it means to be masculine—in the Australian context at least. “[M]en are shamed for displaying too little autonomy, [and] too much connection” (Wheeler & Lee 2003:73). Some beliefs are supported by the cultural and social field. If we take masculinity in the Australian context, pragmatism wins out over idealism, individualism over community, competition over collaboration, self-containment over vulnerability. The thing is, we don’t get many self-contained, pragmatic, competition, individualistic men making appointments for psychotherapy, mainly because the culture they swim in is full of affirmation of their masculine qualities and they don’t need our support. Men anywhere else on the spectrum do tend to seek us out; and psychotherapy, in a very real sense, is subversive in the face of the dominant discourse in our culture and society. In Gestalt, we take time to honour the creative adjustment because it got him here—he survived and did his best to protect himself—and now the original creative adjustment is getting in the way of his need to become more fully alive. Their time with us involves a process from a belief system based on ‘either/or’ to ‘both/and’. It is a journey into relationship and connection. We can be both self-contained and vulnerable at the same time. Whose Belief Is It Anyway? From a Gestalt perspective, beliefs emerge through every layer or dimension of a person’s experienced field phenomena. Our exposure to external field dimensions such as family, 22
society, culture, education, religion, economics, sexuality, etc. constitute the ground from which all our beliefs manifest themselves in the here and now. Seeking psychotherapy presents an opportunity for clients to sort out the beliefs and values they have uncritically swallowed (introjects) from their past field of experiences, thus giving them an opportunity to decide which beliefs they need to keep, modify or reject. In Gestalt, introjects are the beliefs and values we swallowed at some stage in our lives without having the opportunity to ‘chew them over’. Part of my work as a psychotherapist involves working with sex offenders after release from prison and finishing off their parole. My job is to support them to reintegrate back into community after having paid their debt to society. If we portray belief as a polarity from rigid to fluid, what I find with these clients is that they are either one or the other, rarely somewhere in between. From the fluid end are those brought up in an atmosphere of indifference and at the rigid end are those from a more brutish upbringing. With these clients, my primary focus is on developing the relationship in the therapeutic process. It doesn’t matter at which end of the belief polarity they are, they display an entrenched belief that they do not deserve to be seen, heard or received while at the same time displaying a deep yearning for all three. They are trapped at an impasse. From a very early stage in their development, their need for love and support was as strong as their need to avoid seeking the same. This is not an experience born out of their offending behaviour; this experience was embedded in their own childhoods. Most of these men have never experienced a mutually respectful relationship, and once they have established some sense of their own ground within the therapeutic relationship, they can reconstruct and reconfigure their belief systems in ways both grounding and relational that are uniquely theirs. They can learn to be both the river and the rock. When encountering the fixed and immobilised, they can be the river and flow around both with grace. When they need to take a principled stand in the face of coercion, they need to be the rock and trust that the environment will reorganise itself around them. It is a dance, and the trick is to know when to be which. Not all shoulds/introjects are negative of course, we should clean our teeth, and we should take care of our bodies; we should at least attempt to be respectful towards ourselves and others, and we should conduct ourselves professionally and ethically. From a Gestalt perspective, all beliefs are relevant. What is is. Once we have given a client the opportunity to differentiate which beliefs are toxic and which ones are nurturing, which are theirs and which not theirs, they will have a greater capacity to formulate beliefs from their own ground rather than the ground of others. How many times have we heard clients self-reference in statements like “I shouldn’t feel this way”, “I should be able to cope better”, or when referring to others make statements such as “People shouldn’t be allowed to…”. My response to a client’s shoulds is to invite them to reflect a little and see whether any particular person from their past pops up behind their should. CQ: The CAPA Quarterly
A Reflection It doesn’t take long for someone to emerge. Once this is done, I work dialogically and invite them to be that person and have a dialogue with them in the context of here and now. Personal Reflection Sometimes it’s a good exercise to remind ourselves of our own journeys through confusion, disillusionment, and self-doubt, remembering the people who sat with us, as relational fellow beings rather than impartial observers and, in so doing, allowed us to experience what it’s really like to be seen, heard and received in our brokenness and life-giving potential at the same time. When I entered adolescence, I was emerging out of an asthmatic childhood. We had left a dairy farm, relocating to a large regional town. I ended up in a class with twice the number of students as in my entire old school. Right at this point, the doctor changed my asthma medication; it was the new wonder drug called cortisone. From being a lean little kid, I became within a few months a fat blimp of a boy and the recipient of adolescent nastiness. There was a miscommunication between my old school and my new school, and I was placed in a class higher than the one I had come from. I was literally dumbfounded and had no idea what they were teaching me. The rows in the class were arranged with smart ones in the front and then according to diminishing gradations of perceived intelligence, the dumb ones were down the back. Two intellectually disabled brothers who travelled in from a farm each day were seated in the back row; my desk was just in front of them. I liked these boys because they were authentic and non-judgemental. As I write this, I can still experience in my body my sense of overwhelm and shame—I was dumb, and everyone knew it. Not only was I dumb, I was a dumb fat blimp, and I needed to be invisible. I was pretty much at the fluid end of the belief spectrum. At the same time, my eldest sister developed a serious heart condition, so my parents were understandably distracted. In the face of such overwhelm, I creatively adjusted and learned to be very much background, because being foreground was way too dangerous. The price of course was profound loneliness. Although we were not Catholic, my parents decided to send me to a Catholic school run by the Good Samaritan nuns, who graciously made an exception and accepted an unchurched Protestant boy. The teasing continued, and I found a good hiding place to go to during lunch time. It was a giant eucalyptus tree next to the fence with a concave trunk, and I could slip into this hollow and blot out the entire school yard while observing the streetscape. What was different was that one old nun took particular interest in me and, for the first time in this phase of my life, I felt seen—not heard and received just yet, but at least seen—and it was a life-giving experience. The nuns never put any pressure on me to become religious, and they allowed me to sit in on their rituals. I remember clearly one day when they took me to sit in on Benediction, and to this day I remember that experience as my first encounter with beauty. Suddenly I didn’t feel so fluid in my beliefs anymore. August 2012
Kerry Ivan Shipman When I was eighteen, I became a Catholic, not because I had faith but because I needed to belong. Like most converts to anything, I uncritically swallowed every mad belief they threw at me. As I got older, I was encouraged to be more critical and discriminating, and when I was forty, I entered a seminary for mature age men to study for the Catholic priesthood—again, not because I felt especially called by God but more out of curiosity and the deep sense of belonging. The years in the seminary were extremely turbulent for me, not because they were trying to ram dogma and doctrines down my throat but because they challenged every belief I ever had. I got my degree, but I didn’t proceed to priesthood. In 2008, I went to an international Gestalt conference in Manchester, England, and attended a workshop on the history of Gestalt. Four walls had a strip of butcher’s paper across them. The first person on this history line was Emmanuel Kant, then Soren Kierkegaard, Edmund Husserl, Martin Heidegger, Martin Buber, Jean-Paul Sartre, and Maurice Merleau-Ponty followed by all contributors up to the present. My deep sense of belonging was evoked and, again, not because I uncritically swallowed every aspect of Gestalt theory; to the contrary, like the seminary, my four years of training yet again challenged deeply held beliefs. One of the aspects I do love about Gestalt is its deep philosophical grounding and affirmation of the human condition. We were then invited to put on the history timeline our names and the year each of us started our training as Gestalt Therapists. I put my name down under 1980—the year I entered the seminary. Conclusion The reason I’m sharing this brief personal history is to remind myself that, for most mortals, we start somewhere on the spectrum between rigid and fluid beliefs. It takes courage to journey to the between and hold that space where our beliefs can be rigid and fluid, certain and mysterious, at the same time. From here we can pass from our places of shallow certainties to a place of genuine ‘not knowing’ and paradox. We can discover that wisdom is not to be found in what we know; rather, wisdom finds its home in our awareness of what we don’t know. This is the life-space where we come home to ourselves, and from this place meet our clients. Beliefs are like scaffolding. They hold us while we explore and find our ground. They are the container that holds the ever evolving self. Scaffolding is both rigid and fragile at the same time, and we allow the container to become the content at our peril. References Wheeler, G and Lee, GR (Eds) 2003, The Voice of Shame: Silence and Connection in Psychotherapy, Cambridge, MA: Gestalt Press
Kerry Ivan Shipman, BTh, MEd, Grad. Dip. Gestalt., CMCAPA, is a Gestalt Psychotherapist, Trainer, and Supervisor, and has a private practice in Coffs Harbour and Dorrigo. He is the facilitator of the annual Association for the Advancement of Gestalt Therapy (AAGT) Gathering and Retreat conducted at Nobbys Creek during the last weekend of November, an event which is now PD accredited. He is also the AAGT Regional Contact Person for Australia North and currently is part of a discussion group established by the AAGT Board to review its ethics. He can be contacted at firstname.lastname@example.org.
In the Therapy Room
Videotapes as a Tool in Long-Term Sometimes beliefs take us out of our comfort zone; we take risks because we believe in a cause, or an approach, or a person. I’m sticking my neck out here because I have a belief that our stories of failure, of vulnerability (within reason) and of experimentation may enrich and inform each other’s work. My Experience as a Client Being Taped I had often considered asking my therapist if he or she would consider videotaping our sessions regularly. I wondered what impact it would have on our work, and whether it might be useful to someone down the track. I think, as a therapist, I was always wondering what it was that we were doing when we were counselling. Why was this working? What processes were shifting me forward? How could I learn from my experiences of feeling it challenge and change me? I knew that I knew the experience from the inside and, as a therapist myself, surely I could learn and perhaps pass my findings onto others some time in the future. The other internal driver was the need to recall what was experienced and learnt in the session. I wanted to maximise my progress, and to be able to keep moving through some of my resistance by using the tapes. I was working on so many levels because of my awareness from a number of perspectives. There was the process itself for me as the client, the observing therapist, the co-therapist, the observing self, and the student of life and therapy. I wanted to learn as much as possible, to grow and change. Finally, I felt able to ask a therapist if I could video our sessions. We clarified my purpose, our confidentiality, and agreed that either of us could ask for it to be discontinued at any time. It became part of our contract. After the first week, we both found we could increasingly ignore the camera. Themes That Emerged Some of the learning I have done through the taping has been unexpected. Therefore I thought it would be helpful to put down on paper what I have learnt.
Observing My Body Self
This was a hurdle! I am overweight, and have put on even more excess kilos as my therapy challenged me. So I have had the challenge of watching the concrete ‘in your face’ reality of becoming more and more overweight over an 18-month period. What surprised me was that the shame and embarrassment I felt about this accelerated my work with shame on many levels, and I have been able to have genuine compassion for this woman on the tapes, and thus for myself. I recalled clients who had experienced the same struggle with food, and I was able to show myself the same acceptance and tender compassion I felt for them. Somehow, watching the tapes helped me to link the two: I became a client who needed empathy rather than a self who was failing. This then fed back into my therapy, facilitating the process. In addition, many of the issues I was addressing were related to somatic problems: chronic pain and several medical conditions. Observing my body helped me to identify with my body and to understand my self as a body. 24
Re-Experiencing the Work
Integrating learning: I found that watching the tapes was a way of re-entering the feelings and experiences from the session. This enabled me to complete and further integrate various elements from counselling sessions. I would remember some themes or struggles that were lost to me afterwards because of the amount of territory we covered or because I had been focussed on one aspect of the process when there had in fact been several strands impacting on me concurrently. Challenging myself: Re-visiting the session enabled me to self-challenge. I would see where I had blocked or when the counsellor was trying to help me to access experiences, and could then allow myself to progress to a new place. Sometimes I would write out the sequence from the tape, or replay a section, allowing myself to hear myself afresh. Did I really say that? I had no idea that I knew I was stuck, or brave, or lost! Maybe I can do it differently. Denial denied: Sometimes I accessed memories of childhood trauma as part of the work. It was difficult to watch myself re-living events full of horror, and yet it was also a profound challenge to move to greater acceptance of the extent of harm done. Watching the therapist’s discomfort, compassion and tenacity further challenged me to accept the truth that something significantly bad had happened. I did not find I doubted issues around the veracity of literal memory, though the somatic re-enactment leads me to question our innate scepticism about the nature of memory. It became more and more difficult to interpret such experiences as symbolic or representative. I questioned truth and memory, but I was not lost in that battle. The tape gave me information I could not have gained from just being the client experiencing necessary pain. Relationship Stuff
Watching the Therapist
This was a surprise to me! At first we were taping the sessions so that the therapist and I were both in view. As I watched tapes between sessions, I became aware that I was watching the therapist to gauge his reactions to me in session. At first I kept this to myself, fascinated, trying to make sense of what was going on for me. Then my therapist self knew it needed to be named in session. So I took that along as a topic to be worked through. I felt like I was confessing! After talking about it, I eventually noticed that the camera view no longer included the therapist. Then I named that in session. The therapist was not conscious of having made a decision to change the set-up of the room. I suggested we leave him out for the time being, and perhaps we could come back to putting him in the picture at a later stage to see whether there was a change in my observing patterns. I noticed that I would avert my eyes in session after this when I was concerned that I might be influenced by or was trying to CQ: The CAPA Quarterly
evoke a particular response from the therapist. This awareness of myself in reaction to the therapist is a direct result of observing the tapes; it increased my awareness of the relationship and its impact on the process of change.
Deepening and Sustaining Attachment to the Therapist
The tapes would act as transition objects during the times that therapy was particularly demanding; I felt ‘held’ again as I reexperienced the connection between us. I was reassured when I observed that the counsellor was deeply connected to me, even when he was being especially spontaneous. It seemed to me that watching our sessions deepened and hastened the process of me internalising my therapist. The repetition and the two different ways of experiencing his ‘holding’ helped me to know, and then to know again, the in-the-moment reality of being esteemed, valued and heard. Those messages more readily became part of me because they were re-experienced at home.
Changes in My Experience of Power in the Relationship
Taping the sessions showed many things in a real and grounded way. The therapist’s trust of me and his implied trust in himself, his work, and the process were all demonstrated in the act of taping. Additionally, if he could subject himself to such scrutiny from me, and be so vulnerable, surely we were equals on some level? I had custody of the tapes! There has been such power in that, back then, and even now. It is a sacred trust—one I don’t take lightly. I increasingly felt like an agent of change in the sessions. I was aware that I began to see myself as co-therapist. There was not a sense of being done to, or of the therapist doing familiar stuff. We were both learning, both un-knowing in the moment. Yet I knew he was meta-processing. I was especially aware of this when my terror increased as a deeper issue emerged; then I depended on his expertise. The rest of the time, any awareness of him meta-processing would have been an impediment to my process. Yet at this time I felt a sense of safety, trusting he knew what was happening at some level, and I could just go with my confusion. I didn’t have to work so hard. Mostly, I have to say, I had no idea what was going on because I was a client doing hard emotional work; but I knew I was allowed the freedom to ‘take charge’ if it was—even in a convoluted way—contributing to the process. How did I know? Because he might say very little but, when he did, his response profoundly matched where I was. That held me. I knew he knew what I was experiencing, or would catch up. Watching the Tapes for New Learning I would often watch the tape a second time after a few days to do a different kind of learning. I would still engage with the process at certain points, but my focus was more on the content of the session. What had I learnt that could help me to change? What were the main challenges I took from the session? How could I work with this? August 2012
Over a period of many months, my ability to critique the tapes from a theoretical framework increased. I began to catch the moments of dissonance, and to notice how that might have occurred. This led, eventually, to me suggesting different ways through an impasse in the session, or to being more assertive about my needs. I became curious about the way we could move into smooth leap-frogging the process—one making a leap, and then the other, a seamless dance of souls, hearts, minds. What preceded that? Was there a pattern? Did it depend on all that had gone before? As a client, those times were sublime. I am still investigating this, even several years after the therapy finished. Then theoretical frameworks began to emerge for me. I was making connections between our work and work I had done with clients as a therapist. My professional capability was expanding. I was learning so much because I was in the hot-seat! I found myself reading in new areas of therapy to augment my learning. I would sometimes—without losing the actual emotional work—reflect in session with the therapist about what we were doing. This became more finely tuned as time went on. At my request we would capture a moment as it occurred and reflect on the experience for each of us. We would name out loud our experience, and brainstorm associations or connections, knowing that the tape would record it for us. Always it has followed my lead. Then we would re-enter the flow of the work. I could be ‘IN’ and then ‘OUT’ in a dance. The Camera as a Silent Witness There were implications in the use of the camera for my felt safety. Each time the camera was switched on, I felt a great deal of safety. We were accountable for our work; there was a ‘supervisor’ watching. I knew my therapist had regular supervision, but this was different. There was a third person in the room, and therefore I felt able to take more risks as a client. The camera acted as a sort of containment, and we were both answerable to the professional codes that were overtly implied. I am not necessarily talking about sexual boundaries, though perhaps some might say, “Yes, that too”. There was the felt sense of Another watching, which was needful at times; the experience of having a witness to deep and private pain is healing. I am beginning to wonder whether having a representative of the Great Other in the room was healing? This brings us full circle back to our starting point—to ‘Belief’. Perhaps we will leave it there?
Jewel Jones is a counsellor with over 14 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, email@example.com
Is It an Addiction and W hat is the Best Approach to Its Management? Review by Juliana Triml
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. Pathological gambling is about to be reclassified from an impulse control disorder to a behavioural addiction in DSM-5. This presentation outlined the conceptual models of gambling and discussed practical applications in assessment and cognitivebehavioural interventions. The presentation facilitated a greater understanding of the processes leading to pathological gambling, and then erroneous cognitions were addressed in order to reduce gambling-related urges and drives. Professor Blaszczynski noted that gambling goes back to the Mesopotamian era, if not earlier. In some cultures (ancient and present), gambling is uncommon. For example, Australian indigenous culture did not embrace gambling; neither did Indian religions. However, in modern times, gambling is big business. Casinos first opened in Las Vegas, and the first legal Australian casino opened in Hobart in 1973; small illegal casinos operated in most cities but, probably due to its illegal nature, gambling was not acknowledged as a problem. There are three main forms of gambling: (1) Social/ Recreational Gambling, which does not seem to create serious problems—until it develops for some people into (2) Problem Gambling that has an impact on gamblers’ family and social environment. When gambling is a form of escapism from other issues and an element of compulsivity is present alongside other symptoms, such individuals may be non-responsive to any form of treatment. That would indicate a diagnosis of (3) Pathological Gambling, which impacts on self control due to compulsory activity and preoccupation with gambling, similar to addiction criteria. Pathological gamblers suffer withdrawal symptoms during abstinence, with anxiety and even gastrointestinal symptoms present. Controlled gambling does not work and abstinence is the goal. One of the first treatment modalities in the 1960s included behavioural interventions, and then Gamblers Anonymous started operating. As gambling became legalised in most countries, many other forms of therapeutic modalities that had been formulated as approaches to addictions were extended to gambling. These therapies were based on Psychodynamic, later Evidence-Based Behavioural, CBT, Motivational Intervention, 26
Systemic Family, Minimal Brief and Biological therapies. There is little support for pharmacological treatment. However, statistics show that 70% of gamblers will stop gambling behaviour without any treatment. A proportion will do well with any form of therapy, and a proportion of clients will be resistant to any form of therapy. Professor Blaszczynski suggested that availability (variety of gambling/games), accessibility (in one’s home using the iPad) and acceptability (legalisation of gambling and advertising) are the three main factors that support gamblers in their activity (similarly to addictions). The main evidence of recovery would be when the person has access to money and can resist gambling. Further, gambling needs to be replaced by another satisfying activity that meets that person’s psychological needs. Whilst people can learn about relapse prevention strategies, there is lack of evidence that it actually works, as other factors may give false evidence. Professor Blaszczynski suggested that psychiatric/ psychological issues should be addressed prior to gambling issues. This would involve exploring personal and family history (dysfunctional family), as well as neurobiological genetic traits. Gambling can give some persons an illusion of control through biased memories, fallacy, probability and myths. This is because gambling could be seen as self-medication to some issues that make people vulnerable to substance abuse and addictions. Co‑morbidities are quite common, for example, a high number of pathological gamblers are known to have depression (75%), substance abuse (30-40%), illegal activities (60%). It is impossible to determine whether depression precedes gambling or develops as a consequence of gambling. Alex Blaszczynski gave us a realistic indication for possible therapeutic outcomes. His earlier book, Overcoming Compulsive Gambling, published in 1998 gives an overview of social/family and personal impact of gambling and it is a self-help guide using Cognitive Behavioural Techniques, including guided imagery. I have personally tested some of the exercises with clients and found that they helped some to self-regulate anxiety and compulsivity, while others may be still struggling or may have shifted to another addiction.
Juliana Triml is the CAPA NSW PD Coordinator. If you have any suggestions regarding future professional development events, please contact her at: firstname.lastname@example.org
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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:
Saturday 11 August 2012
1.00 pm–3.00 pm PD hours: 3 Stephen Malloch Communicative Musicality: Gestural Narratives in the Therapeutic Relationship We all have innate skill to structure and share the passing of time meaningfully with others as we work, play and talk about our experiences. This Communicative Musicality (Malloch 1999; Malloch & Trevarthen 2009) underpins our gestures of body, thinking and feeling. In a combination of presentation and experiential learning, we will explore the implications for counselling and psychotherapy of this ‘song and dance’ between therapist and client.
Stephen Malloch, a counsellor and executive coach based in Mosman, Sydney, first trained in performance (violin) and musicology, completing an MMus at the University of London and a PhD at the University of Edinburgh. At Edinburgh, he began his collaboration with Prof Colwyn Trevarthen, researching and publishing on the psychology of mother-infant communication. Out of this work came his theory of Communicative Musicality, now used by a wide variety of authors and researchers. (For further information, see www.heartmind.com.au.)
Saturday 14 November 2012
7.00 pm–9.00 pm PD hours: 2 Elisabeth Shaw Exploring Ethical Practice: When there are theoretically so many rules to guide us, how does practice still get so complicated? Most of us would like to claim that we are ethical practitioners; certainly we don’t intend to do harm. When malpractice occurs, we tend to think that either the person was ignorant or corrupt. However research tells us that practitioners generally know the rules, it isn’t as if education on our Codes is actually required. Further, as it is generally experienced and highly trained therapists who commit the gravest errors, we have to assume that with all the good intentions and training, something is still able to go awry. In other cases, people know what is the right thing to do, but end up doing nothing. What is all this about? Drawing on research about ethics, transgressions, and all sorts of things in between, this will be a discussion to challenge your thinking about an area you probably feel is well resolved. For most practitioners, it is not about whether they are likely to commit a heinous boundary violation, but how to respond well to the ordinary, challenging moments in therapy. We will look at how to think thoroughly and well about ethical practice, how to know your own mind, and how to work when all seems unclear.
Elisabeth Shaw is an individual, couple and family therapist, supervisor and trainer in private practice in Drummoyne, NSW. Previously a Manager & Director of Relationships Australia NSW, she has presented and published papers over many years focused on the couple bond, intimacy and sexuality, violence, working with men in therapy, ethical and legal issues in therapy and supervision, and other areas of supervision best practice. She is the co-editor (with Jim Crawley) of Couple Therapy in Australia; Issues Emerging from Practice (Psychoz Publications, 2007), and with Michael Carroll of Ethical Maturity in the Helping Professions: making Difficult Work and Life Decisions (2012). Elisabeth has considerable experience as a trainer of clinical practitioners, and supervises and consults extensively with individuals and teams, from nursing and welfare to psychotherapy and the corporate sector, responding to clients with very diverse presenting problems and needs. She is Chair of the PACFA Ethics Committee, and writes a regular column for Psychotherapy in Australia on ethical issues in practice entitled ‘Sacred Cows and Sleeping Dogs’.
Bookings: (02) 9235 1500 or email@example.com 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 firstname.lastname@example.org. CAPA is also exploring more options for members in rural and regional areas. Please email the Regional and Rural Committee with your suggestions email@example.com.
Regional 2012 Professional Development Event Saturday 22 and Sunday 23 September 2012
Saturday 9.30 am–4.00 pm Sunday 9.30 am–1.00 pm PD hours: 8 Topics to be addressed include: Dialectical Behavioural Therapy with Bipolar Disorder clients, Domestic Violence, Suicide in Regional and Rural areas. For more detail about the program, payment and how to book, see the email ‘Professional Development weekend in Bathurst’ sent to you recently. Bookings: (02) 9235 1500 or firstname.lastname@example.org Cost: Members – $30 weekend / $20 one day Non-members – $50 weekend / $30 one day Venue: Bathurst, Bathurst Regional Library 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.
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the client’s expression—all the while providing a holding and validating space (Greenberg & Paivo 1997). Mark In my work with Mark, I struggled to get results. I so wanted him to have a better life, yet change was slow or non-existent, and I questioned my duty of care. Every few sessions, we discussed what he wanted from therapy, and Mark would say such things as: “to be human”, “a place to have dignity”, “a place where I don’t have to hide”. I tried to provide this space for him, to validate his experience as much as I could—which often meant sitting with his shame. At times this was difficult; his shame would trigger my own, or I would feel hopeless about his situation, my capacity as a therapist, or impatient about the lack of results. Jacobs (1996) argues that a difficulty therapists may have in acknowledging and ‘being with’ the shame of a client is often due to a lack of comfort a therapist has with his own shame. At these times, I would become solution-oriented, would end up trying to raise awareness of his problematic beliefs and attempt to motivate him into action. Sometimes this had positive results but would most often rupture our connection, and Mark would be quick to alert me that I was giving him much of the same that he’d got from his family and other health practitioners—that he was failing or getting it wrong. We would then find ourselves talking about what he needed from me—which was primarily a relationship wherein he could be deeply acknowledged and accepted. There was nowhere else he found this.
A Relational Approach to Working with Shame Contemporary Gestalt therapy has outlined some important approaches to working with shame from a relational perspective (Lee & Wheeler 1996, Lee 2007). Going farther than the Emotion-Focused Therapy approach to healing shame through a corrective experience, as outlined above, Gestalt therapy’s writings on shame work can involve a strong focus on the shame dynamics that can be found in the therapeutic relationship and how to work therapeutically with these. From a relational perspective, shame is a “rupture [or threat of rupture] in the interpersonal bridge between us and another” (Lee 1996: 7). This co-created nature of shame highlights the need for therapists to be ever present to the possibility of shaming clients. Although clients may be exceedingly sensitive to being shamed, and although we may impute to them various self-critical beliefs, they are always moving towards us with their needs. If clients have not had these needs received in the past, these needs may in fact be experienced as shameful (Lee 1996). Several important practice consequences arise here. If a client’s need feels shameful to him, our validation of it is part of the healing process. If shame is an ever present risk in contacting another, exploring how shame arises in the here-and-now therapeutic encounter can be therapeutic, as the client may come to understand the co-created nature of shame and thus cease to believe that shame is something that simply exists within as negative or unproductive belief. Lastly, if shame is ever present in our interpersonal encounters, then a trajectory of
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therapy involves supporting the client to become more at ease in living with shame (Wheeler 1996). Mark Although Mark certainly had a sensitivity to experiencing shame, it also arose in many of his encounters because of how he was being related to. From an individualist perspective, Mark’s shame experiences were due to various self-critical beliefs causing him trouble. From a relational perspective, Mark’s shame was co-created, and its amelioration required a certain sort of therapeutic relationship. Although Mark and I found ways where he could admit his need for relationship, he was profoundly ambivalent about being in psychotherapy and admitting a need for support. Mark felt much shame about needing support, and struggled to follow my referrals to other services or practitioners; asking for support would involve exposing himself, his failings and his needs. We talked often of this. In many ways, Mark had embodied the ideals of individualism and self-reliance that are at the heart of the construction of maleness in Western culture. The introjections of these cultural ideals led Mark to experience failure to live up to these standards and to criticise himself for this failure. I attempted to deconstruct these beliefs, to show him how these beliefs were problematic, and to provide him with experiences where he was okay with feeling in need of support. This was difficult for Mark, as exploring his need for support led him deeper into his shame that he wasn’t, after all, self-reliant—a belief I felt he could well let go. The only way
I thought of to do this was to provide him with nurture in the way of a strongly attuned relationship wherein he could taste the support, and come to accept his need for support from others and to recognise the value of this. I found the work difficult. The relational literature (De Young 2003) argues that this can be enough, or is the ground upon which shame is healed and transformation occurs. My supervisor and I often felt there was little else to work with in Mark’s case. Mark was isolated, struggled with motivation, and would not accept support from other services. Often, we would work very slowly, exploring his contact with me and how that felt—whether there was any pleasure or nurture there. In exploring these little micro-moments, Mark was able to find his voice more and more, telling me how I failed to acknowledge him in subtle ways, what he needed from me and what he did not want. Mark often stated that in my little room for that one hour a week, he felt the most human. In that space, he could be himself, however shameful that felt at times. We often explored what I brought to the encounter that he felt was shaming, and often this was my impatience to see him change, and my impatience with what I felt were very unproductive belief systems of his. Mark experienced such impatience from me as invalidating. I wanted these dialogues to support Mark in understanding the dynamics of how shame is a co-created process and hoped that this understanding allowed him to let go some of his attachments to his self-critical beliefs. (continued on Page 30)
“LEARNING IS FOREVER”
EXPLORE AN EXISTENTIAL APPROACH WORKSHOPS THAT WORK UPCOMING WORKSHOPS Mirror Mirror - What do I see?
The Wheel of Supervision
The relationship between body, mind and self esteem
Supervisor Training Part 1
Monday to Friday 13 - 17 August 2012
Friday 31 August 2012
Forget Your Skills Be in relationship
Wednesday 24 October 2012
SHORT & SNAPPY
Supervising in a Group Environment
Exploring the Four Worlds
Friday 30 November & Saturday 1 December 2012
Saturday mornings 1 Sept, 20 Oct, 3 Nov, 17 Nov & 8 Dec 2012
Series of 5 half-day workshops
For more information The Centre for Existential Practice email@example.com www.cep.net.au Telephone: 0431 401 659
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Our therapy was marked by a number of cancelled appointments, failures to show, and arrivals at my office on the wrong day/hour. I made some extra efforts with Mark, checking on him between sessions, reminding him of appointments, following him up after cancellations. We would discuss this process, and Mark expressed that although supportive, it was also exposing and shameful. At the end of our work, Mark became busy with medical appointments and one day told me he would call to schedule his next session. When he failed to do so, I chose not to call for fear that he would perceive my call as intrusive and more shaming. Mark struggled to voice his needs, and ending therapy this way was possibly the most empowering way he could. I will never know. I wondered whether Mark had internalised my support and validation to the point where could feel more self-supportive and self-reliant. This I will never know either. I rang Mark during the writing of this article and learned he had been losing a lot of weight and was not well. Still isolated, he talked of his struggles in getting support. I stated my availability if he wanted to contact me, which he hasn’t. I am unsure whether or not this therapy would be deemed successful. Mark chose to continue to work with me when I offered possible referrals. I believe I provided him with some dignity along his journey, witnessed his struggles, provided company, which is what we contracted. The shame literature states that healing shame requires particular relationships. It was an experience for me that certainly highlighted the 30
difficulty of changing core beliefs in the face of shame and the work of creating a shame-healing relationship. Conclusion The individualist paradigm underpins much of our psychotherapy tradition in ways that are often not questioned (Wheeler 2000). It seems obvious to undertake therapy by focusing on the individual and their belief systems, divorced from context, while supporting a movement towards greater self-reliance. This is at the heart of much CBT and the belief systems about what therapy looks like that many of us therapists bring to our work. The relational turn in psychotherapy counters this ‘one-person psychology’ with a ‘two-person psychology’, a shift in emphasis to relational processes which has implications when working with shame (Lee & Wheeler 1996). Rather than simply locating shame within a person—as a self-critical belief—a relational orientation to shame involves locating the shame experience between people, an essentially social process. Whereas working with shame from an individualist approach can be re-shaming (Jacobs 1996) and often not effective (Paivo & Pascual-Leone 2011), shame work from a relational perspective involves a greater sensitivity to relational dynamics and to the process of connection and disconnection, or rupture and repair, that occurs between client and therapist. Shame is an ever present co-created possibility that is dependent on how able we are to receive our clients and how sensitive a client is to shame. In my work with Mark, I saw how the individualist orientation CQ: The CAPA Quarterly
was embodied—by myself, other practitioners, and Mark— and how much of a struggle it was to dance between an individualist and a relational orientation in providing some amelioration to this client’s deep shame. References Beck, A 1976, Cognitive Therapies and the Emotional Disorders, New York: International Universities Press Fairfield, M and O’Shea, L 2008, Getting ‘Beyond Individualism’, British Gestalt Journal, 17(2): 24-38 Gergen, K 2009, Relational Being: Beyond Self and Community, New York: Oxford University Press Goldman, R and Greenberg, L 2010. ‘Self-Soothing and Other-Soothing in Emotion Focused Therapy for Couples’, in A Gurman (Ed), Clinical Casebook of Couple Therapy, London: Guildford Press Greenberg, L 2002, Emotion Focused Therapy: Coaching Clients to Work Through Their Feelings, Washington, DC: American Psychological Society 2011, Emotion Focused Therapy, Washington, DC: American Psychological Association Greenberg, L and Paivo, S 1997, Working with Emotions in Psychotherapy, New York: The Guildford Press Hawton, K, Salkovskis, P, Kirk, J and Clark, D 1989, Cognitive Behaviour Therapy for Psychiatric Problems: A Practical Guide, Oxford: Oxford University Press Jacobs, L 1996, ‘Shame in the Therapeutic Dialogue’, in R. Lee and G Wheeler (Eds), The Voice of Shame: Silence and Connection in Psychotherapy (297-314), Santa Cruz, CA: Gestalt Press Kleinman, A 1988, The Illness Narratives, New York: Basic Books Lee, RG 1996, ‘Shame and the Gestalt Model’, in R Lee and G Wheeler (Eds), The Voice of Shame: Silence and Connection in Psychotherapy (3-22), Santa Cruz, CA: Gestalt Press Lee, R 2007, ‘Shame and Belonging in Childhood: The Interaction Between Relationship and Neurobiological Development in the Early years of Life’, British Gestalt Journal, 16(2): 38-45 Magdulski, G 2010, ‘Is the Theoretical Rationale Upon Which CBT is Founded ‘Evidence-Based’?’, Psychotherapy in Australia, 16 (3): 52-55 Mackewn, J 1997, Developing Gestalt Counselling, London: Sage Publications Mitchell, SA 2000, Relationality: From Attachment to Intersubjectivity, New York: Routledge
Mitchell S and Black, M 1995, Freud and Beyond: A History of Modern Psychoanalytic Thought, New York: Basic Books O’Brien M and Houston, G 2007, Integrative Therapy: A Practitioner’s Guide, London: Sage Publications Paivo, S and Pascual-Leone, A 2010, Emotion-Focused Therapy for Complex Trauma: An Integrative Approach, Washington, DC: American Psychological Association Resnick, R 1997, ‘The “Recursive Loop” of Shame: An Alternate Gestalt Therapy Viewpoint’, Gestalt Review, 1(3): 256-269 Simon, S and Geib, P 1996, ‘When Therapists Cause Shame: Rupture and Repair at the Contact Boundary’, R Lee and G Wheeler (Eds), The Voice of Shame: Silence and Connection in Psychotherapy (315-326), Santa Cruz, CA: Gestalt Press Stawman, S 2009, ‘Relational Gestalt: Four Waves’, in L Jacobs and R Hycner (Eds), Relational Approaches in Gestalt Therapy ( 11-37), New York: Gestalt Press Stopford, A 2007, ‘Relational Theory: New Growth in Psychoanalysis and Psychotherapy’, Psychotherapy in Australia, 14(1): 46-51 Wachtel, PL 2007, Relational Theory and the Practice of Psychotherapy, New York: The Guildford Press Wexler, D 2009, Men in Therapy: New Approaches for Effective Treatment, New York: WW Norton Wheeler, G 1996, ‘Self and Shame: A New Paradigm for Psychotherapy’, in R Lee and G Wheeler (Eds), The Voice of Shame: Silence and Connection in Psychotherapy (2360), Santa Cruz, CA: Gestalt Press 2000, Beyond Individualism: Toward a New Understanding of Self, Relationship & Experience. Hillsdale, NJ: The Analytic Press Yontef, G 1996, ‘Shame and Guilt in Gestalt Therapy’, in R Lee and G Wheeler (Eds), The Voice of Shame: Silence and Connection in Psychotherapy (351-381), Santa Cruz, CA: Gestalt Press
Pedro Campiao BA, Grad Dip Edu, Grad Dip Couns, MGestalt, Clin CAPA, GANZ, PACFA Reg, divides his time equally between part-time work as a counsellor for NSW Health, in the area of chronic illness, and private psychotherapy practice, where he sees individuals and couples. In 2012 he is undertaking research for NSW Health in transformational learning experiences during medical treatment. He is based in the Northern Rivers area of NSW working privately in Mullumbimby and Lismore where he directs the Northern Rivers Counselling Practice with partner Alice Robertson. www.pcampiao.com
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and lead to a decline in thinking and productivity when we focus on negative statements such as: How am I ever going to keep up with everything? What if I fail? What if I can’t afford food, gas, healthcare on what I make? The government is not doing much to help me or my family, so the odds for success are stacked against me. What if I get laid off? I’m not smart enough to be successful. These kinds of negative thought patterns can create what could be identified as an amygdala hijacking. The amygdala kicks into action in preparation for ‘fight or flight’, creating unacceptable levels of anxiety and fear at a subconscious level that negatively impact our behaviour and productivity. This subconscious patterning becomes part of the default network and will keep us focussed on looking out for danger. The authors of this paper contend that entering into what we call the wholebrain state will move the brain out of the negative default mode and allow access to more resourceful thinking processes. Highspeed mindset change taught in PSYCH-K ® and/or PER-K ® is an effective method for identifying and changing the conflict between the conscious and subconscious beliefs. Worry is another component related to normal brain function. The brain’s response to fear, it is thought of as a response of the brain to block out negative emotions that reside in the subconscious (Rhudy 2000). Some neuroscientists have suggested that worry is a strategy of cognitive avoidance in which internal verbalisation acts to suppress threatening emotional imagery. It is believed that worry leads to missing important negative information such as risk that may be relevant to making optimal decisions. This information is mostly subconscious. Worry disrupts the ‘brain bridge’ (corpus callosum, see Figure 8) and slows the transfer time across from the left to the right hemisphere, taking additional time for processing without creating a solution to the problem (Mohlman et al. 2009). People who are constantly worried often see this worry as an attempt to find a solution, but they may in fact be stuck in worry. That usually keeps productivity to a minimum. The whole-brain state increases communication between the left and right hemispheres of the brain and speeds up the transfer of information across the corpus callosum, thereby diminishing the capacity to worry without excluding or ignoring important information leading to more productive behaviour.
Figure 8: Corpus callosum, the ‘brain-bridge’
The authors of this paper point to the research herein, which suggests that the whole-brain state allows access to the inter-hemispheric activity connecting to more efficient brain function. Further, we would have you understand that from the research presented here we identify the whole-brain state as 32
a bi-lateral, symmetrical brain wave pattern allowing access to positive mood and cognitive openness. In conclusion, we suggest that this research demonstrates a significant connection between beliefs—especially at the subconscious level of the mind—the Whole-Brain State, and high-speed mindset change, as well as their relevant utility to psychotherapists. The data presented here strongly suggest a correlation between the state of mind of the psychotherapist and the state of the mind of the patient/client, highlighting the relevancy of doing psychotherapy from a Whole-Brain State, with the appropriate subconscious belief systems, in order to be optimally effective as a catalyst for change. References Grinberg-Zylberbaum, J and Ramos, J 1987, ‘Patterns of Interhemispheric Correlation During Human Communication’ International Journal of Neuroscience, 36(1-2):41-53, cited in Ferguson, M 1988, ‘Silent Communication Increases EEG Synchrony’, Brain/ Mind Bulletin, 13(10): 1,8 Lipton, BH 2005, The Biology of Belief, Santa Rosa, CA: Mountain of Love/Elite Books Mohlman, J, Price, AB, Eldreth, DA, Chazin, D, Glover, DM and Kates, WR 2009, ‘The Relation of Worry to Prefrontal Cortex Volume in Older Adults Without Generalized Anxiety Disorder’, Psychiatry Res 173(2): 121-7 Morris, JS, Ohman, A and Dolan, RJ 1999, ‘A Subcortical Pathway to the Right Amygdala Mediating “Unseen” Fear”, Proc Natl Acad Sci. 96 (4): 1680-5 Nørrentranders, T 1991, The User Illusion: Cutting Consciousness Down to Size, New York: Penguin Books Rhudy, JL and Meagher, MW 2000, ‘Fear and Anxiety: Divergent Effects on Human Pain Thresholds’, Pain, 84(1): 65-75 *Claude Elwood Shannon (1916-2001) was an American mathematician, electronic engineer, and cryptographer known as the ‘father of information theory’. Shannon is famous for having founded information theory in 1937 when, as a 21-year-old Master’s student at MIT, he wrote a thesis demonstrating that electrical application of Boolean algebra could construct and resolve logical, numerical relationship. Williams, MA and Mattingley, JB 2004, ‘Unconscious Perception of Non-threatening Facial Emotions in Parietal Extinction’, Exp Brain Res 154 (4): 403-6 Whalen, PJ, Rauch, SL, Etcoff, NL, McInerney, SC, Lee, MB and Jenike, MA 1998, ‘Masked Presentations of Emotional Facial Expressions Modulate Amygdala Activity without Explicit Knowledge’, J Neurosci 18(1): 411-8 Whalen, PJ, Shin, LM, McInerny, SC, Fischer, H, Wright, C and Rauch, SL 2001, ‘AFunctional MRI Study of Human Amygdala Responses to Facial Expressions of Fear versus Anger’, Emotion, 1(1): 70-83 Zaltman, G 2003, How Customers Think: Essential Insights into the Mind of the Market. Boston: Harvard Business School Publishing
Jeffrey L. Fannin, PhD (Psychology), Director of the US-based Center for Cognitive Enhancement, has been involved in the neuroscience of the brain for 15 years and has extensive experience training the brain for optimal performance to improve brain function, and to enhance mental and emotional dexterity. He has been involved in cutting-edge research to accurately measure balanced brainwave energy identified as the wholebrain state, using electroencephalogram (EEG) technology. This research focuses on subconscious belief patterns, translating limited personal success into balanced brain performance. He has co-authored several peerreviewed articles on the subject that have been published in the world of neuroscience as well as other disciplines. His work has been featured in The Wall Street Journal, Business Week, Financial Times (London), Weekend Edition (Singapore), on BBC radio, Fox News, and many more. He is currently completing a fun, easy to read book about how the brain works, why subconscious beliefs drive our behaviors and how to achieve higher states of consciousness. www.enhanceyourbrain.com Robert M. Williams, MA (Counseling and Personnel Services), spent a number of years in the corporate world before becoming a therapist. In 1988, as a result of his successful experience as a psychotherapist, he developed proprietary, non-invasive, interactive processes known as PSYCH-K ® and PER-K ® for changing self-limiting subconscious beliefs. He is the author of PSYCH-K : The Missing Piece/Peace in Your Life and is co¬-presenter with Dr Bruce H. Lipton, on the popular DVD, The Biology of Perception, The Psychology of Change. Rob has co-authored peer-reviewed research articles with colleague and neuroscientist Jeffery L. Fannin. Their joint research focuses on the creation and application of what is referred to as the WholeBrain State, the most common brainwave pattern resulting from the use of both PSYCH-K and PER-K . Rob has become an internationally known presenter, specialising in personal and professional development. www.psych-k.com, www.per-k.com
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and unwanted’ in the next. Feelings form the barometer that dictates belief and the development of thinking. If a child’s experience is a positive one where ambiguity and confusion are cleared or transmuted through the process of childfocussed play and art therapy, then I feel the path is laid for an uncluttered life. Children can easily learn how not to take things on board, yet this level of learning is unfortunately not taught in the education of their lives. It is still up to parents and therapists to help instil core values and beliefs that connect children to their true and real selves. References Spock, B 1946, Baby and Child Care, New York: Simon & Schuster Ray, PH and Anderson, SR 2001, The Cultural Creatives: How 50 Million People Are Changing the World, Newburgh, New York: Three Rivers Press Dillion, A and Harker, P 2012, ‘Counselling Indigenous Australians: Human Commonalities and Self-Esteem’, CQ: The CAPA Quarterly, Issue One (February) Wanganeen, R 2011, AIRRFII: 7 Principles for Healing Grief for Holistic Wellbeing, Ethelton, SA: Australian Institute for Loss and Grief Moustakas, C 1974, Psychotherapy with Children: The Living Relationship, New York: Harper & Row
Nerida Oberg, B Couns, Dip Psych/Couns Dip Prof Couns, Clin Memb CAPA, PACFA Reg, is a psychotherapist and family therapist with over 20 years experience in the field as well as teaching extensively at the Australian College of Applied Psychology and facilitating Existential Group Psychotherapy at Jansen Newman Institute for many years. In 2009 she ‘semi-retired’ from a busy CBD practice and moved to south coast Berry where she operates the Berry Healing Centre and works in outreach for local Aboriginal communities. In 2011, she released her first book Walk with Me and, earlier this year, Voices of the Children. Nerida continues to provide direct teaching and supervision through regular workshops held at the Berry Healing Centre www.berryhealingcentre.com and teaches at The Metavision Institute in Bowral.
Solution-Focused Brief Therapy and Narrative Therapy are both client-centred approaches that focus on the future and future solutions to current issues.
Narrative Therapy The person is not the problem, the problem is the problem. ~ Michael White* Narrative therapy is a respectful, non-blaming approach to counselling which places people as the experts in their own lives. It views problems as separate from people and assumes people have many skills, competencies, beliefs, values, commitments and abilities that will assist them to reduce the influence of problems in their lives. Narrative practices separate the person from their “taken-forgranted” negative qualities or attributes. Narrative approaches involve ways of understanding the story of the client’s life, and in collaboration with the client, determine how to externalise problems, re-authorise their story and help the client to engage in the construction and performance of a preferred identity.
It is a way of working that is interested in the broader context that is affecting people’s lives, always maintaining a stance of curiosity, and always asking questions to which the therapist genuinely does not know the answers (Morgan 2000). For narrative therapists, stories consist of events in a person’s life which are linked in sequence, and unfold across time. Curiosity and a willingness to ask questions to which we genuinely don’t know the answers are important principles of narrative work and there is no single correct direction any conversation can take rather there are many possible directions. The client plays a significant part in determining the directions taken.
References Epston, D and White, M 1990, ‘Story, Knowledge, Power.’ in D. Epston, D. and M. White, Narrative Means to Therapeutic Ends, Chapter 1, New York: Norton Morgan, A 2000, What is Narrative Therapy, Adelaide: Dulwich Centre Publications *Michael White, who died in April 2008, was co-founder of Narrative Therapy at the Dulwich Centre in Adelaide.
Solution-Focused Brief Therapy ...[W]e discovered that there’s no connection between a problem and its solution. No connection whatsoever. ~ Insoo Kim Berg Instrumental in the establishment of the Brief Family Therapy Center in Milwaukee in 1978 and the spread of SolutionFocused philosophy and techniques were husband and wife team Insoo Kim Berg and Steve de Shazer. Solution-Focused Therapy originated due to an interest in the inconsistencies in problem behaviour identified by its developers. Steve de Shazer used the metaphor of looking at the client’s complaints as a lock on the door. He stated, “Examining the lock will not lead to it unlocking. However, finding a key that will open the lock will more successfully lead one to a solution.” Solution-focused therapists believe that change is constant. They help their clients to construct a concrete vision of a preferred future with the aim of helping clients identify the things that they wish to be different in their lives and also to attend to those things currently happening which they want to continue to happen.
The therapist/client relationship is based on engendering trust and developing a relationship by respecting the client’s need to talk through their problems. The process limits focus on the past and its problems, encourages the client to engage in problem-free talk about him or herself and aims to elicit and expand positive change in a client’s life. Solution-Focused Therapy claims that most problems do not require a great deal of gathering of historical information to resolve them. Rather, the resolution of a problem does not require knowing what caused it and that how the ‘problem’ is constructed is of less significance than how solutions are co-constructed. Key solution-focused techniques include seeking exceptions (ie, When was the problem less or non-existent?), the Miracle Question (What does the client want to be different?), and scaling the intensity of the problem.
References Berg, IK 1994, Family Based Services: A Solution-Focused Approach, New York: WW Norton deShazer, S, Dolan, Y, Korman, H, Trepper, T. McCollum, E and Berg, IK 2007, More than Miracles: The State of the Art of Solution-Focused Brief Therapy, New York: Routledge
CQ: The CAPA Quarterly Peer-Reviewed Articles Submitting your articles for peer review has many benefits, including: elevating the quality and authority of your work enhancing the academic rigour of CQ: The CAPA Quarterly CQ uses a double-blind review process, where the identities of both author(s) and reviewers remain anonymous. Articles submitted for peer review will be sent to 2-3 independent reviewers. Articles to be peer-reviewed are due six months in advance of their publication date. Guidelines for your submissions with a request for peer review are available by contacting firstname.lastname@example.org 34
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A free service for CAPA NSW members, contact email@example.com Rooms for R ent CBD Fully furnished and appointed quiet counselling room in Sydney CBD, heritage building, near MLC Building. Whole or half days available. Call or SMS 0425 281 251. 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 firstname.lastname@example.org Edgecliff Delightfully appointed room, Edgecliff. On station. Free Parking. Available 2 days per week, $160. Days negotiable. Susan Hamilton 0424 426 110 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 Lane Cove Room available to rent on a daily basis in a well established mutli-modality Health Care Clinic. Ideal for a Professional Health Care Provider. Great working environment with unrestricted and ample parking. Flexible lease agreement. Please contact Catherine on 0416 178 517 or email to email@example.com.
Supervision Supervision – Burwood & Dulwich Hill 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 firstname.lastname@example.org Web: www.relationshipsandprivatestuff.com Supervision – Caringbah 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 0411 083 694 or email email@example.com 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.soulfulwoman.com.au Supervision – Edgecliff Warm, rigorous supervision by experienced therapist. PACFA Reg Member. In private practice for 16 years. Former President, CAPA, committee member PACFA, trainer ACAP (6 yrs). At station. Free parking. Susan Hamilton 0424 426 110 Supervision – Faulconbridge & 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 – 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 – Lilyfield 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 – Northern Beaches 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. Counselling, Psychotherapy and Supervision – Mosman 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 firstname.lastname@example.org Web: www.cb-counselling.com.au and www.caring4couples.com.au Supervision – Penrith & 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 email@example.com Web: www.jewel-jones.com.au
Calls for Contributions 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 August
Non-peer-reviewed due by: 1 November
May 2013 – Ethics
Ethics are an essential cornerstone of any therapist’s practice allowing for the respectful creation of a safe and structured environment within which a client may reveal his or her deepest fears and vulnerabilities and upon which the success and quality of transference relies, contributing to the overall outcome of any therapeutic work. How does a therapist ensure best practice at all times? What are the challenges and dilemmas facing therapists and how can they best safeguard against them? Is there adequate training in ethics for those just embarking on a career as a counsellor or psychotherapist and is there room for improvement within the field? The May 2013 issue of CQ: The CAPA Quarterly will examine the thought-provoking subject of Ethics and we welcome your valued contribution. Peer reviewed papers due by: 1 November
Non-peer-reviewed due by: 1 February
August 20123 – Dreams
The rich world of dreams and the unconscious, while often immensely healing and a great source of individual creativity, can at times and for some be both overwhelming and terrifying. Seventy-three years on from the death of Sigmund Freud and half a century after the death of Carl Jung, how has our thinking evolved around the use and importance of dreams in the therapeutic context? How does a therapist best harness the wealth of insight offered by a client’s dream world and impart skills to the client to encourage greater selfawareness, healing and understanding? Share your perspective and experience by contributing to the August 2013 issue of CQ: The CAPA Quarterly. Peer-reviewed papers due by: 1 February
Non-peer-reviewed due by: 1 May
November 2013 – The Profession
Every therapist and counsellor faces common challenges and issues in their practice that are specific to the profession. In this issue we invite you discuss the needs, challenges and issues therapists and counsellors face as normal hazards of the profession. How do we prevent burnout, find the time and discipline to ensure adequate supervision, maintain a steady client base while achieving a work-life balance, stay current and ensure that you are ‘good enough’? The November issue of CQ: The CAPA Quarterly offers a forum for exploration of these and other questions about the personal side of being a therapist or counsellor. Step forward and have your say. Peer-reviewed papers due by: 1 May
Non-peer-reviewed due by: 1 August
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 firstname.lastname@example.org
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Looking for a Conference? To include your free conference listing here, contact email@example.com 7–9 September 2012 Melbourne
Looking for a conference? 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
Gestalt Australia and New Zealand (GANZ) Melbourne Conference, 2012
15–16 September 2012 Sydney
Australian Association of Buddhist Counsellors and Psychotherapists (AABCAP) 6th Annual Conference ‘Being with Dying’
15–20 September 2012 Daydream Island, Qld
Australian Society of Hypnosis Annual Congress & Workshops
19–22 September 2012 San Antonio, Texas
Society for the Advancement of Sexual Health, 2012 National Conference ‘Creating a Culture of Healthy Sexuality: Shaping the Future’
27–29 September 2012 Krakow, Poland
1st International Krakow Conference in Cognitive Science ‘Consciousness and Volition’
27–30 September 2012 Perth
47th Australian Psychological Society Annual Conference ‘Psychology Addressing the Challenges of the Modern Age’
13–14 October 2012 Melbourne 17– 21 October 2012 Gold Coast 18–21 October 2012 Washington, DC 20–22 October 2012 Long Beach, California
Australian Society of Sex Educators, Researchers and Therapists (ASSERT) National Conference 2012 ‘Sexuality: Beyond Difficulties, Definitions and Diversity’
http://cognitivescience.eu www.apsconference.com.au http://www.assertnatconf.org.au/
Australian Association for Cognitive & Behaviour Therapy (AACBT) http://www.aacbt.org.au/conference/Index.html 35th Conference 2012. ‘Innovations in Self-Care and Resiliency: Promoting Empowerment and Well Being’ 35th Annual Int. Conference on the Psychology of the Self ‘Is Self an Illusion’ International Society for the Study of Trauma & Dissociation (ISSTD) 2012 Annual Conference ‘Integrating Science and Practice: Moving Forward Together in the Field of Trauma and Dissociation’
24–25 October 2012 Cleveland, Ohio
International NeuroEthics Confernence – Brain Matters 3: Values at the Crossroads of Neurology, Psychiatry, and Psychology
27–28 October 2012 Melbourne
PACFA 2012 Biennial Conference ‘What Works?’
10–12 November 2012 Salzburg
Interdisciplinary Conference 9th Global Conference – Making Sense of Death and Dying
10–12 November 2012 Salzburg
Interdisciplinary Conference 3rd Global Conference – Making Sense of Suicide
13–15 November 2012 Salzburg
Interdisciplinary Conference 3rd Global Conference – Making Sense of Suffering
22–25 November 2012 Launceston
Australian Psychological Society 18th College of Clinical Neuropsychology Conference Neuropsychology in Action
7–10 February 2013 Los Angles 26–28 April 2013 Syracuse, NY
The Evolution of Addiction Treatment 2012 Conference The 2013 Empathic Therapy Conference
http://ccn2012.blogspot.com http://theevolutionofaddictiontreatment.com/ http://www.empathictherapy.org/Conference.html
Published on Jul 1, 2012
Published on Jul 1, 2012
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