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Journal of Psychotherapy and Counselling Psychology Reflections Reflections Research Centre

Volume 2 Number 1 January 2017

ISSN 2054-457X


Editorial Board

Dr Maria Luca School of Psychotherapy & Psychology, Regent’s University London, Inner Circle, Regent’s Park, London NW1 4NS, UK

Dr Marie Adams, Metanoia Institute, London, UK Dr Meg-John Barker, Open University, London, UK Dr Michael Berry, McGill University, Montreal, QC Canada Dr James Davies, University of Roehampton, UK Dr Lisa Doodson, Regent’s University London, UK Dr Stelios Gkouskos, University of Surrey, UK Dr Ralph Goldstein, British Psychological Society’s Register of Psychologists specialising in Psychotherapy [with senior status], UK Professor Brett Kahr, Regent’s University London, UK Dr Elaine Kasket, Regent’s University London, UK Professor Desa Markovic, Regent’s University London, UK Professor Martin Milton, Regent’s University London, UK Dr Lyndsey Moon, University of Roehampton, UK Dr Christina Richards, Nottinghamshire Healthcare Foundation NHS Trust, UK Dr Paul Smith-Pickard, Counselling and Psychotherapy Private Practice, Dorset, UK Dr Michael Worrell, Central and North West London Foundation NHS Trust, London, UK

Managing Editor Professor Helen Cowie Emeritus Professor, Faculty of Health and Medical Sciences, Duke of Kent Building, University of Surrey, Stag Hill, Guildford GU2 7TE, Surrey, UK

Book Reviews Editor Jane Wynn Owen

Editorial Assistant Shirley Paul School of Psychotherapy & Psychology, Regent’s University London, Inner Circle, Regent’s Park, London NW1 4NS, UK

International Editorial Advisory Board Dr Geoff Denham, La Trobe University, Melbourne, Australia Dr Andrew Geeves, Macquarie University, Sydney, Australia Dr Theodoros Giovazolias, University of Crete, Greece Dr Dennis Greenwood, University of Brighton, UK Dr Martin Lečbych, Palacký University, Olomouc, Czech Republic Professor John Nuttall, Regent’s University London, UK Andrea Sabbadini, British Psychoanalytical Society, London, UK Professor Carla Willig, City, University of London, London, UK

Aims and Scope The Journal of Psychotherapy and Counselling Psychology Reflections (JPCPR) is an international peer-reviewed journal, underpinned by the aspiration for a non-doctrinaire, pluralistic attitude to psychotherapy and counselling psychology. It aims to provide a forum for open debate and encourages submissions from different traditions, epistemological positions and theoretical modalities enabling the development of a more open, reflective thinking to

philosophy, theory and practice of psychotherapy and counselling psychology. JPCPR encourages critical, broad and experimental interpositions in discussions on psychotherapy and counselling psychology. It tends to transcend the methodological and metatheoretical divisions. We welcome submissions using both quantitative and qualitative methods, including ethnographic, autobiographical, and single patient or organisational case studies.

Journal of Psychotherapy and Counselling Psychology Reflections Volume 2 • Number 1 • January 2017

CONTENTS Editorial................................................................................................................................................... 2 Clinical Supervisors’ Views on Facilitative Conditions in the Handling of Sexual Attraction in the Supervision of Therapists Maria Luca, Desa Markovic, Martin Lečbych, Marek Kolarik.......................................................... 3 International Students: A Minority Group at Risk in Need of Psychological Support Sonia Gallucci....................................................................................................................................... 11 Starshine on the Critical Edge: Philosophy and Psychotherapy of Fantasy and Sci-fi Christina Richards .............................................................................................................................. 17 E-Therapy: the Psychotherapists’ Perspective – A Phenomenological Enquiry Imogen Koufou and Desa Markovic .............................................................................................. 25 The Relationship Between Research and Practice in Contemporary Attachment Research Ian Rory Owen.................................................................................................................................... 33 Voyages into the Unknown: An Exploration Using Interpretative Phenomenological Analysis of the Experiences of Returning Voluntary Migrants Gareth Mason and Denise Ielitro..................................................................................................... 41 Book Reviews...................................................................................................................................... 49 Author Information............................................................................................................................. 50 Announcements.................................................................................................................................. 51


EDITORIAL As time goes on, the Journal of Psychotherapy and Counselling Psychology Reflections is evolving into a more confident and innovative publication. Still in its infancy, this month it is celebrating its first anniversary with yet more scholarly contributions that include research and theory papers by experienced clinicians, academics and trainees. The professions of psychotherapy and counselling psychology are rapidly developing a comprehensive research base relevant to practice, providing a useful resource for the professional community to draw upon. The Journal aims to capture and disseminate these developments widely. I am delighted to welcome Jane Wynn Owen as the book reviews and new series editor. The Editorial Board is introducing two new series: the first on One day in my life as a psychotherapist/counselling psychologist doing therapy and the second on My experience as a trainee on an integrative training programme. Submissions are invited from all practitioners and trainees in the professions. If you would like to contribute to this new series by describing your personal experience of doing therapy or studying on an integrative course in 850-950 words, We would be delighted to hear from you.

Published twice a year, the January issue publishes papers on a variety of topics and research methods, while in September it is a Special Issue. Last year’s September Special Issue consisted of papers on sexual oppression, the theme of the 3rd Annual Conference of the Reflections Research Centre. This had an international perspective, with papers from Canada, Australia and the UK. For the Special Issue in September 2017, we are planning to publish papers that will be given at the Centre’s 4th Annual Conference on Saturday 10 June 2017. This will explore medically unexplained symptoms, otherwise known as bodily distress, somatisation or psychosomatic distress. If you would like to contribute to this issue, please submit your paper by the end of March 2017 on a topic relevant to the theme. Finally, this issue is a tribute to the remarkable variety of work that goes on in the field and to those authors who supported the journal in its first year, as well as to the Editorial Board who offer their time generously in undertaking peer reviews and editorial support. Dr Maria Luca Editor



Abstract Background: Supervision of sexual attraction (SA) in therapy practice is an underinvestigated area. Supervision helps the learning and growth of supervisees. It is therefore an important aspect of ethical practice. Aim: The study investigated the views of UK existential and integrative supervisors working in private practice and training institutions on the handling of SA. Methodology: Qualitative interviews were carried out with twelve accredited supervisors. Transcripts were analysed using constructivist grounded theory (GT). Findings: Supervisors referred to specific facilitative conditions for effective supervision of SA. These were: supervisory alliance; containing and supporting; normalising sexual attraction; creating a contemplative, open atmosphere; constructively challenging. The core GT category encapsulating these conditions is: Relational Supervisory Alliance. Participants tended to generalise with a focus on the facilitative conditions for supervision of and engaged less with their own experience in the handling of SA in the work of therapists they supervise. Keywords: Supervision of sexual attraction in therapy, psychotherapists, constructivist grounded theory, relational supervisory alliance


the other hand, are always harmful, and are unethical.

It is widely acknowledged that therapists’ to clients and clients’ to therapists (Luca, 2003) SA takes place. Research shows that a high percentage of female and male therapists acknowledge having experienced sexual feelings towards their clients, (Pope, Keith-Spiegel, & Tabachnick, 1986). Giovazolias and Davis (2001) found that 77.9% of counselling psychologists were sexually attracted to at least one client. 76% of psychologists felt unprepared and uncomfortable with these feelings (Rodolfa et al, 1994). Of those therapists who experience SA to their clients a small number (9.4% of men and 2.5% of women) become sexually involved with clients (Pope, et al, 1986). Literature distinguishes between boundary violations and boundary crossings. Gabbard & Myers (2008) define boundary crossings as behaviours that cross boundaries, but might benefit the client. Violations, on

Ethical codes of professional bodies (UKCP, 2009; BPS, 2009; BPC, 2011) prohibit sexual involvement between therapists and clients and regard it as unethical with serious sanctions such as permanent or temporary withdrawal of accreditation and the license to practice (Pope, 2001). A study on psychoanalytic psychotherapists’ views on sexual involvement with clients post-termination, found disparity of opinion. “Nonetheless, all the clinicians agreed that the potential for harm resulting from post-termination sexual involvements was great” (Shavit & Bucky, 2004, p.229).


The historical tendency in therapy to treat sexual feelings as taboo is often driven by moralistic ideas (Luca, 2014). Pope and Tabachnick (1993) found that therapists reacted with guilt, shock, surprise, anxiety, fear of losing control, fear of being

Dr Maria Luca, Senior Research Fellow, Reader in Psychotherapy & Counselling Psychology, Regent’s University London

Professor Desa Markovic, Professor in Psychotherapy and Head of Programmes in Psychotherapy and Counselling, Regent’s University London

Dr Martin Lečbych, Associate Professor of Clinical Psychology, Palacký University, Olomouc, Czech Republic

Dr Marek Kolarik, Lecturer of Clinical Psychology, Palacký University, Olomouc, Czech Republic


criticised, frustration in not feeling able to speak openly about sexual feelings and confusion about management of these issues. Giovazolias & Davis (2001) state: ‘therapists’ reactions are characterized by distress and that this distress may result from a lack of acceptance of these feelings or of not knowing how to manage them’ (p. 282). Because literature suggests that sexual feelings are avoided, supervision becomes the space where therapists can be supported to talk about them. Supervision in psychotherapy is essential in client work. In the UK it is a continuous professional requirement (Wheeler & Richards, 2007) but is not always to the optimal benefit of supervisees, especially where SA is at play (Ladany et al., 1997). Ladany, Friedlander, & Nelson (2005) suggest it is the supervisors’ ethical obligation to explicitly make SA a topic for discussion. The importance and value of supervision in therapy has long been established. Its functions include instruction, support, exploration and challenge linked with the aim of producing positive effects (Hill, Sullivan, Knox, & Schlosser, 2007). Therapists who received supervision reported higher counselling self-efficacy at post-test than those who did not receive supervision (Cashwell & Dooley, 2001). The supervisory relationship, particularly the alliance and repairing ruptures, has a positive impact in encouraging supervisee disclosure and self-exploration (Jeremy, Safran, Muran, Stevens & Rothman, 2007). Supervision normalising supervisees’ difficult reactions to clients has also been linked with positive effects (Ladany et al., 1997) and a strong supervisory alliance reduces trainee anxiety and helps willingness to disclose (Mehr, Ladany & Caskie, 2010, 2015). Thus good rapport and a working alliance make the supervisory relatIonship more effective (Shuck & Wood, 2011). It is postulated that successful supervision is substantially linked to the supervisory relationship (Beinart, 2012; Inman & Ladany, 2008; Milne, 2009), regardless of the supervision model adopted (Ladany, Ellis & Friedlander, 1999). Emerging consensus suggests that a ‘good’ supervisory relationship comprises a safe, secure base established by a consistent, responsive supervisor sensitive to their supervisee’s needs (Beinart & Clohessy, 2009) who supports supervisees to ‘explore’ and develop their competencies (Watkins & Riggs, 2012; White & Queener, 2003). Ladany et al (1997) found that supervisee satisfaction is associated with a positive supervisory relationship and ‘supervisor behaviors seem to greatly influence a supervisee’s experience of supervision.’ (Ladany et al, 1999, p. 446). Supervisor openness and immediacy strengthen supervisory relationships and improve their work with clients (Knox, Edwards, Hess, & Hill, 2011). The management of therapists’ anxiety which is linked to self-efficacy, is considered a primary task of supervision (Mehr, Ladany, & Caskie, 2015). Worthen & McNeill (1996) found that supervision seemed to build supervisee self-confidence, fostered deeper understanding of their work, enhanced supervisee ability to conceptualise clients in more sophisticated ways and helped supervisees intervene with clients. Rationale for study and research questions Research cited thus far highlights the benefits of supervision. However, when SA is at play, not all supervisees utilise it through disclosure and discussion. In a study on predoctoral psychology interns, Ladany et al (1997) found ‘only half of the participants disclosed their SA to supervisors, and supervisors seldom initiated the discussion’ (p.143). It was trainees who mostly initiated the disclosure of SA and reported that an honest, supportive and good supervisory relationship enabled

them to disclose. Trainees who did not disclose reported a negative supervisory relationship and imagined the supervisor would not be supportive. A noteworthy gap is the lack of research data regarding supervisors’ attitudes/views to the supervision of SA. This study contributes to the evolving research on supervision by focusing on this area. This paper will therefore focus on findings on the attitudes/views of supervisors, even though the study covered various domains as can be seen in the interview schedule. Other domains will be published separately. The interview schedule covered the following domains: • What are your views on key principles for good practice in the supervision of SA? Discuss situations as a supervisor where you had the opportunity to support the handling of SA in therapists you supervise. What strategy, if any, do you use when supervising therapists to help them manage the issue of SA to clients? • How long did you work with the therapist and how did disclosure or presentation of SA come about and presented in supervision? • Are there any specific issues you encountered in supporting the handling of SA in the work of therapists you supervise? • What type of SA do therapists you supervise present in supervision, e.g. client or therapist SA, or mutual SA? • In your view do therapists you supervise find it easy/ difficult to talk about SA in supervision? What in your view influences this? • How does it help to bring up this issue during supervision? • In your opinion, can talking about the issue possibly complicate the situation? • What factors can, in your opinion, hinder a discussion about this issue in supervision? If you can, please tell us about any examples you know of in relation to this supervision issue. • What experience do you have with supervising this issue with men/women? In your experience are there gender differences in the readiness/ability to present SA in supervision by therapists you supervise? Discuss. What strategy do you recommend for managing a situation when a man/woman comes to you with this problem? Is there a difference in your approach depending on gender? • Do you have any experience of a situation when the issue of SA has provoked an ethical dilemma? Could you tell us about the experience? • In what circumstances would you recommend ending the therapy because of therapist SA towards the client? What influences your decision? • Can you imagine any circumstances in which the client and the therapist could consider entering into a mutually intimate relationship? Discuss Participants were informed that a transcript of the interview would be sent to them to check for accuracy. Ethics The study was approved by a University Ethics Committee. Participation was voluntary and participants could withdraw at any time. Given the ethical issues salient to the study such as disclosures by supervisees who may have been sexually involved with clients, supervisors had been advised that if ethical issues emerged during the interviews the researchers may need to report these to the relevant

Journal of Psychotherapy and Counselling Psychology Reflections

body. They received an information leaflet explaining the nature and scope of the study and they consented to the recording of direct interviews and the use of anonymised extracts from interviews for publication. Data was stored on the researchers’ personal computer and was passwordprotected. Sampling and recruitment A database of the alumni of three training institutions containing details of accredited UKCP psychotherapists was used to circulate the recruitment flyer asking for volunteers who met the recruitment criteria. We received only one response, so we adopted snowball sampling, frequently used to conduct qualitative research, through interviews that are primarily explorative, qualitative and descriptive, offering practical advantages, especially in accessing certain difficult to reach populations (Hendricks, Blanken, Adriaans and Hartnoll, 1992). The subject of the study may have contributed to the low response rate. The inclusion criteria consisted of supervisors with a minimum of five years post-qualification supervision experience. Thirteen participants volunteered, one dropped out (no reason was provided) and the remaining were: seven females, five males. Of the twelve volunteers, six were existential, three psychodynamic, two integrative and one systemic. Their experience varied from 10-25 years of practice. All were experienced practitioners and worked in psychotherapy training institutions and in private practice (see Table 1). The participant who dropped out did so due to serious illness.

Participant Gender Modality pseudonym

PostTherapy qualification experience supervision years experience years








Existential-phenomenological 25




Systemic and psychosexual therapy diploma





Existential-phenomenological 25




Integrative (psychodynamic and 15 humanistic) and psychosexual therapy diploma




Psychodynamic and 33 psychosexual therapy diploma



































Table 1 Participant Demographics


The researchers One researcher is a UKCP registered integrative psychotherapist and the other a systemic UKCP registered psychotherapist with extensive post-qualification practice experience and both are trainers in UK psychotherapy training institutions. Two researchers from the Czech Republic are experienced psychologists and academics at a university in the Czeck Republic. Like other researchers who seek out research methods that resonate with their epistemological inclinations, but also provide relevant tools for their studies, we chose a type of GT that permits fluidity and considers the value of intersubjectivity (Charmaz, 2006). Our epistemological position is influenced by intersubjective, phenomenological principles, emphasising the value of researcher and participant agency in the construction of knowledge. Embracing researcher and participant subjectivity, exercising human agency (Patton, 2002) and the belief that these enrich and provide a meaningful and embodied understanding of human phenomena have informed this research. We recognise that our role as trainers may have been an obstacle to participant disclosure on SA, a difficult subject with ethical and professional implications. We tried to acknowledge this during the interviews in the hope that it would minimise participants’ need to try and impress or fear of disclosing. Data collection and analysis Semi-structured interviews which were carried out individually generated extensive data. The interview schedule was revised after two pilot interviews. The first three interviews were transcribed and texts were read several times by the researchers creating memos and coding. This preliminary analysis helped refine and check categories that emerged through subsequent interviews, ensuring rich data generation. Categories were sent to two independent researchers (the last two authors of this paper) for checking before agreement was reached on the categories best describing the data. Guided by Patton’s (2002) idea that inductive analysis consists of identification of patterns, categories and themes emerging from the data instead of imposed before data collection, an emerging pattern from constructs was created (Figure 1). To establish the relationship between the emerging categories and themes, axial and selective coding techniques were applied and repeated on all grouped themes, enabling the development of a conceptual model that represented the data and made sense to the researcher. Method and methodology GT principles and procedures were used to analyse the data (Charmaz 2006). GT is designed to help researchers generate categories from the data, compare and identify links between them, so that ideas could develop, sharpened through deep analytic stages (open coding, focused coding, axial coding, selective coding) and generate theory grounded in the data. The method is inductive and researchers are guided by the data to generate conceptual frames. The GT method evolved, but remained discovery oriented. Researchers using a social constructionist epistemology use the evolved constructivist GT (Rennie, Phillips, & Quartaro, 1988; Charmaz, 2006). This approach is suitable for exploring people’s interactions, actions and meanings they construct of their experience, particularly in areas which are under-theorised. GT theorising is data driven. The constructivist GT of Charmaz (2006) treats research data as constructed, hence not an objective representation of reality. Knowing, from this perspective, is mediated Volume 2, Number 1, January 2017


through social interactions. The positioning of the researcher in relation to participants, the context and the social situation where data is generated are taken into consideration in the final conceptual construction. Charmaz’s (2006) GT is congruent with the constructivist/

interpretivist paradigm advocating that ‘human science involves understanding as interpretation’ (Rennie, 1998, p. 134). Constructivist GT therefore actively repositions ‘the researcher as the author of a reconstruction of experience and meaning’ (Mills, Bonner, & Francis, 2006, p. 2).

Supervisory space is where the taboo of SA needs to be broken through a trusting relationship

Creating a relaxed attitude

Creating a contemplative, open atmosphere

Supervisors must be more ready to open up such a difficult issue

We create together, a space where we can think, and we can think about meaning

Figure 1. Example of emerging pattern from constructs Research design The researchers developed a qualitative interview schedule based on Charmaz’s (2006) GT intensive interviewing, which ‘permits an in-depth exploration of a particular topic…. and thus is useful for interpretive inquiry’ (p.25) and her idea that the quality and credibility of a study rests on the data. A demographic questionnaire was included in the consent form and was used to obtain information on participants’ supervisory experience, gender, theoretical orientation and type of supervision practice. Quality in qualitative research The qualitative researcher is interested in illumination and understanding not in causal determination or prediction (Willig, 2007). To ensure trustworthiness qualitative researchers apply standards of good practice. We adopted Charmaz’s (2006) criteria for evaluating emergent theory studies (pp.182-183) guiding researchers to ensure addressing four specific areas: credibility, originality, resonance and usefulness.

Results The conceptualisation of SA presented in this paper outlines supervisors’ views on how best to handle SA, in principle, in the work of the therapists they supervise. It illustrates the defined sub-categories capturing the meanings of these principles for good practice. The core category emerged through rigorous analysis of the sub-categories to ensure it closely represents the context and underlying principles guiding supervisors’ views on supervising SA.

Supervisors firmly believe in certain precursors to effective supervision of SA, including the importance of personal experience and maturity, as well as certain psychological conditions in the supervisor to make supervisory handling of SA effective. The views of supervisors tended to be generalised, a finding suggesting that they focused very much on principles of good practice and little on specific examples. This section will focus on discussing necessary conditions for effective supervision of SA that supervisors identified (Figure 2), which also illustrates levels of abstraction in the analysis of the data. The analysis of data highlighted that supervisors had no examples of actual disclosure of inappropriate crossing of boundaries or of acting upon these by therapists they supervised. Therefore the data generated focused on specific principles informing the practice of supervision and not on detailed description of specific examples. These were formed into clustered codes that helped the development of the five sub-categories shown in Figure 2 below. Supervisors’ approach consisting mainly of principles of good practice are: forging a therapeutic alliance to create a climate for constructive challenge, aiding the development of a contemplative, open atmosphere, a fertile ground for thinking reflectively, assisting in normalising sexual attraction, an important attitude for encouraging disclosure and helping them contain and support, a fertile ground for processing and learning. These principles in supervisors’ approach were captured in the core category: Encouraging, facilitative and non-judgemental handling of sexual attraction.

Journal of Psychotherapy and Counselling Psychology Reflections

Due to space limitations only some extracts from some interviews will be used to highlight how the sub-categories were formed. Sub-categories

Constructively challenge

Examples from Codes

Constructive challenge of the supervisee Asking direct questions of supervisees feelings and conveying the importance of not blocking feelings

Supervisory space is where the taboo of SA needs to be broken through a trusting relationship

Creating a contemplative, open atmosphere

The alliance involves trust and respect:

We create together, a space where we can think, and we can think about meaning

If any of my supervisory relationships didn’t have a strong level of that trust and respect, I’d probably question whether we are right as supervisor and supervisee. (Andreas).

Creating a relaxed attitude Acceptance of the difficulty in talking about it

Core Category: Relational Supervisory alliance

Encouraging supervisee to acknowledge that her being attractive might be another possibility that creates SA

I would be open that it happens to all of us There has to be a normalisation before the supervisor can help

Talking about erotic interplay in therapy can feel containing for the supervisee Containing mode, affirming what’s been done well and reassuring

Contain and support

Checking it gives permission to talk about it. Supervisee may feel threatened. Talking can support them. Gentle encouragement is important I would encourage the therapist to, allow it and allow the explicitness of this In my approach to supervision there’s a sense of we need to take this seriously

Supervisees have to trust and feel safe that they can bring something and it’s going to be taken seriously

Create facilitative conditions

Talking about SA enhances supervisory alliance further I think what’s helpful, is not just talking about it, but to create a safe environment where you’re not being judged. Supervisor’s sensitivity to power imbalance is very crucial

Figure 2. Clinical supervisors’ handling of SA in the work of therapists they supervise

Context: Necessary conditions for effective supervision of SA

Normalising SA

1. Supervisory alliance The development of trust and a genuine interest in the supervisees’ development, engaging non-judgementally and displaying collegial warmth are fundamental in: building the supervisory alliance; creating ground for difficult issues, such as SA, to be disclosed and explored. Emphasis was placed on the importance of a collegial, trusting relationship as a pre-condition to exploring difficult issues such as SA. Some participants believed that knowing the supervisee well and their way of practicing is an element in developing a relationship of trust. As Jane, a very experienced supervisor, explains: The first thing is I need to know my supervisee, how they usually are in relation to usual clients, because that helps me to identify when something isn’t quite right or not being said.

Supervisors must be more ready, to open such a difficult issue up

Naming what’s going on can break down the taboo


Peter argued that: If the necessary conditions are not created for real depth of exploration of SA, it is ethically questionable taking people’s money and time. The first thing that comes to mind is supportive openness and faith. It’s within the relationship; there’s a sense of mutual faith and trust in each other’s practices and the things which inform that faith are an acceptance of the fact that it’s difficult sometimes and that frailty, fragility, vulnerability and going into that territory is a way of witnessing that faith. A trusting, safe relationship and gentle encouragement, according to Mel, is necessary to help the supervisee trust the supervision process: Rather than the authority figure of the supervisor coming down on someone, I like to try to be underneath holding them. It’s like moving layers of strata of earth, in that I’m trying to sift: what are we dealing with here? Is this a safeguarding principle that needs some response or, is this a deeply personal thing that is raised for this trainee, the issue of her own sexuality? If they trust the supervisor and they have permission to talk about SA, that’s where I think the safety comes in, because you’ve got a conduit there, where the supervisee feels it’s perfectly okay to bring this to counselling, and that starts to counter the shame or the taboo of it. (Jane). 2. Contain and support All supervisors alike spoke in a common voice of the importance of containing the supervisee’s anxiety and supporting them, qualities that encourage both disclosure of and discussion of SA: The main thing for me is going back to containment of the supervisee, so that the supervisee has processed all this material and then can again feel a bit freer with the client. (Claudia). Volume 2, Number 1, January 2017


I did somehow encourage him to accept that it could be the case that there might be an attraction to him and that it would be much better to let it be there, rather than hide it from himself and that it doesn’t mean he should act on it. (Betty). Being supportive involves not being judged: Because if they feel you’re judging, then they are already judging themselves, and there’s already the shame of, ‘I’ve done something wrong (Claudia). 3. Normalising sexual attraction Supervisors spoke of the fear and anxiety supervisees present when SA is at play. They recognise that therapists often regard SA as synonymous with unethical practice. They spoke of the necessity to present SA as normal in supervision so that exploration can become possible. Some drew on their own experience as clients feeling sexually attracted to their therapist to inform their supervisory practice: As a rule, any sort of attraction from the client to the therapist, I would encourage the therapist to allow the explicitness of this, rather than to push it or rationalise it away. So for me in my approach to supervision, there’s a sense of we need to take this seriously. This is based on personal experience where I was sexually attracted to my therapist. (Andreas). Mary refers to using explicit language in a non-judgemental way to normalise SA: Not in a judgemental way, to say: ‘this happens and let’s look at how we deal with it’. I ensure, right from the beginning, that supervisees know that I will ask about SA and what’s going on sexually in therapy. We normalise by saying this will happen and there’s a useful purpose to it. It’s the permission-giving to the client to talk about attraction, and the whole gamut around sex. Betty introduces the topic of sexuality and SA in the first supervision session: In the first session it always comes up and I make them aware of the fact that we are sexual beings and it’s in the room if you like it or not. It doesn’t matter who you are, what age, what colour. I think that already creates a more relaxed attitude and ease about sexuality per se. So I do encourage them from the very beginning to accept their own sexuality and the sexuality of their clients, that’s the most important strategy for me. Betty as a supervisor needs to feel comfortable herself about the topic for it to be normalised by supervisees: I think my age has something to do with it; I have gone through my whole cycle of sexuality and I have a whole life with examples to look at and there is hardly anything which easily shocks me or couldn’t be talked about. I’ve reached my grandmother stage, and that gives me a more relaxed view on it. I radiate a lack of fear of talking about it, and a lack of fear of it.

4. Creating a contemplative, open atmosphere The atmosphere of supervision has to be well paced and promote depth reflection according to participants. Peter referred to a mindful attitude and a contemplative environment as important supervisory conditions: I use reflection, almost like pedagogy; it is to create a contemplative atmosphere where the pace is slow and to allow what’s embodied to become articulated; that kind of mindful attitude. I think it harks back to the form of dialogue which is an embodied experience as opposed to the cognitive. Peter adds: I’m thinking of a woman who was feeling quite worried and oppressed by a client who clearly had fantasies about her and was sexually attracted to her; there was fear in her, in how she should navigate her way through this. My role, again, is to work with that because she arrived at answers herself just by being given the space to be able to articulate exactly what she was going through in precise detail. Claudia speaks of a thinking space: We create together a space where we can think about meaning. There is something about feeling mirrored, feeling understood, feeling it’s a place where for the first time, perhaps, you feel you can really relate to that person. Both integrative and existential therapists spoke in a common voice in assigning reflection and thinking about SA a central place in their work. 5. Constructively challenge Supervisors mentioned constructive challenge as a useful approach to enable supervisees to recognise and acknowledge SA. Mark states: Well, I think initially it’s about naming it, challenging the supervisee in saying, perhaps there’s attraction there. I remember her being quiet, and almost withdrawn, or ruminating, you know; and almost not wanting to get excited, in some way. But I think there was something stirring, and so it was really letting her be with that. Like Mark, Claudia is explicit in bringing SA to the fore: It’s this anxiety which for me is really important again to ground through gentle challenging.

Discussion Participants referred to personal experience of supervision, psychological maturity and readiness in themselves, to help them evaluate effectiveness. They believe that supervision must rest on an encouraging, facilitative and non-judgemental handling of SA. Participant accounts were generalised, focused on specific principles of good practice and not on disclosures of SA acted upon by supervisees and how they were handled by supervisors. This highlights that therapists do not perhaps disclose crossing of boundaries

Journal of Psychotherapy and Counselling Psychology Reflections


or acting upon SA to their supervisors, or supervisors do not disclose to researchers any possible therapist disclosures. It also suggests the limitations in using direct methods of information to elicit information on such a difficult subject which may have professional implications for all involved.

ability to create a safe supervisory environment that contains and supports, normalises, is characterised by a contemplative, reflective atmosphere that allows constructive challenge and encourages supervisees to enter into the psychological landscape of SA if the dynamic is to be handled appropriately.

Participants viewed a relational supervisory alliance, (core category) consisting of trust, collegiality, acceptance and a safe environment, as the bedrock for safe exploration of this clinical phenomenon. This finding confirms existing literature (Shuck & Wood, 2011; Mehr, Ladany, & Caskie, 2015) showing good rapport and a working alliance are at the centre of effective supervision, enabling supervisee disclosure of difficult issues.

Implications Training modules enabling supervisors to experientially grapple with issues around SA would be a useful way of fostering confidence through highlighting research-based principles of good practice. Supervisors need to be mindful of the difficulty therapists feel raising the subject and adopt a facilitative approach to helping supervisees work with SA.

Participants believed that a strong alliance involves building a relationship where the supervisee feels safe to explore their shortcomings and think about their anxieties without fear of being morally judged. They emphasised that supervisors must be aware of the imbalance of power in the supervisory relationship, with its potential to present an obstacle to disclosure and discussion of SA and create an environment to counteract it. Containing and supporting was given a prominent place in supervisors’ view of the development of a facilitative environment that contains anxieties, gives permission to talk about SA and allows this clinical interplay the seriousness it deserves. Some supervisors emphasised the importance of gently encouraging the therapist to allow the explicitness of SA to emerge. Another important condition found to influence the development of effective supervision is normalising SA. Some supervisors described this as giving permission to talk about it, by explicitly stating that it happens to all of us and that by naming it, the supervisor defuses the taboo surrounding it. Creating a contemplative, open, supervisory atmosphere where supervisor and supervisee can think together collegially was seen as fertile ground for effective supervision. Participants regarded the supervisor’s role as educative, involving asking direct questions, especially if the supervisor senses through clinical material the presence of sexual interplay. They felt that tentatively checking and sharing understandings with the supervisee, invites reflection and exploration. Constructive challenge was regarded as an important tool of supervision, as it stretches the supervisee to think beyond their comfort zone.

Limitations Although rich and dense data were generated from the interviews, the number of participants in distinct modalities was too small for meaningful comparisons. Our study was not aimed at teasing out differences between modalities in supervisors’ views on the supervision of SA. Participants who volunteered may be those who were interested in SA and through experience learned key principles of good practice. However, these principles could be academic, influenced by supervisors’ readings of the literature and the need to conform and impress and not necessarily drawn from personal experience. In terms of handling SA effectively, supervisor views were too generalised. Larger, anonymous survey type studies could potentially elicit a more rigorous picture on both the handling of and modality differences in supervising SA.

References Beinart, H. (2012). Models of supervision and the supervisory relationship. In I. Fleming, & L. Steen (Eds.), Supervision and clinical psychology: Theory, practice and perspectives (pp. 36–50). Hove: Brunner Routledge. Beinart, H., & Clohessy, S. (2009). Supervision. In H. Beinart, P. Kennedy, & S. Llewelyn (Eds.), Clinical psychology in practice (pp. 319–335). Chichester: British Psychological Society/ Blackwell. BPC (2011). British Psychoanalytic Council Code of ethics. Published by the British Psychoanalytic Council. BPS (2009). Code of Ethics and Conduct. Guidance published by the Ethics Committee of the British Psychological Society.

Supervisors in this study were clear that SA is a difficult topic to bring to supervision, due to taboos surrounding the subject and as a result of anxieties associated with the sexuality of the therapist being present in the therapy room. The study outlined here theorises that supervisors’ approach to SA requires certain facilitative conditions to make discussion and exploration possible. These conditions are captured in the core category that to be effective, supervision should encourage openness and growth, facilitate explicitness and be non-judgemental. However, not all supervisors initiate discussion of SA in supervision and the study of participants’ accounts lacked specific examples of acting upon SA by supervisees.

Cashwell, T. H., & Dooley, K. (2001). The impact of supervision on counselor self-efficacy. The Clinical Supervisor, 20(1), 39-47.

On the whole, these research findings offer principles of good practice in the supervision of SA that is effective and the findings support some existing research (Mehr, Ladany, & Caskie, 2015). The apparent predominance of generalisations in the data, makes it difficult to know whether participants’ views were based on what they know of the literature and not what they actually do in practice, that could be influenced by the need for social conformity or to impress researchers that their practice meets certain competencies. This limits the quality of the findings in important ways. It is clear that supervisors of any theoretical orientation need to have the

Hendriks, V., Blanken, P., Adriaans, N., & Hartnoll, R. (1992). Snowball sampling: a pilot study on cocaine use (1st ed.). Rotterdam: IVO, Instituut voor Verslavingsonderzoek, Erasmus Universiteit Rotterdam.

Charmaz, K. (2006). Constructing grounded theory: a practical guide through qualitative analysis. London: Sage. Gabbard, G., Lester, E., (1995) Boundaries and boundary violations in psychoanalysis: 59. USA: American Psychiatric Publishing. Giovazolias, T., & Davis, P. (2001). How common is sexual attraction towards clients? The experiences of Sexual Attraction of counselling psychologists toward their clients and its impact on the therapeutic process. Counselling Psychology Quarterly, 14(4), 281-286.

Hill, C. E., Sullivan, C., Knox, S., & Schlosser, L. (2007). Becoming psychotherapists: The experiences of novice therapists in a beginning graduate class. Psychotherapy: Theory, Research, Practice, Training, 44(4), 434-449. doi: 10.1037/00333204.44.4.434.

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Inman, A. G., & Ladany, N. (2008). Research: The state of the field. In A. K. Hess, K. D. Hess, & T. H. Hess (Eds.), Psychotherapy supervision: Theory, research, and practice (2nd ed., pp. 500–517). Hoboken, NJ: Wiley. Jeremy, D., Safran, J., Muran, C., Stevens, C., & Rothman, M. (2007). A Relational Approach to Supervision: Addressing Ruptures in the Alliance. In C.A. Falender & E.P. Shafranske (Eds.). Casebook for Clinical Supervision: A CompetencyBased Approach. 137-157. Washington, DC, US: American Psychological Association. Knox, S., Edwards, L. M., Hess, S. A., & Hill, C. E. (2011). Supervisor self-disclosure: Supervisees’ experiences and perspectives. Psychotherapy: Theory, Research, Practice, Training, 48(4), 336-341. Ladany, N., Ellis, M.V., & Friedlander, M.L. (1999). The supervisory working alliance, trainee self-efficacy, and satisfaction with supervision. Journal of Counseling & Development, 77(4), 447455 Ladany, N., Friedlander, M. L., & Nelson, M. L. (2005). Critical events in psychotherapy supervision: An interpersonal approach. Washington DC: American Psychological Association. doi: 10.1037/10958-000. Ladany, N., Lehrman-Waterman, D., Molinaro, M., and Wolgast, B. (1999). Psychotherapy Supervisor Ethical Practices: Adherence to guidelines, the supervisory working alliance, and supervisee satisfaction. The Counselling Psychologist, 27(3), 443-475. Ladany, N., O’Brien, K. M., Hill, C. E., Melincoff, D. S., Knox, S., & Petersen, D. A. (1997). Sexual attraction toward clients, use of supervision, and prior training: A qualitative study of predoctoral psychology interns. Journal of Counseling Psychology, 44(4), 413-424. Luca, M. (2003).Containment of the Sexualized and Erotized Transference. Journal of Clinical Psychoanalysis, 11(4), 649662. Luca, M. (ed) (2014). Sexual attraction in Therapy: Clinical Perspectives on Moving Beyond the Taboo - A Guide for Training and Practice London: Wiley. Mehr, K. E., Ladany, N., & Caskie, G. I. L. (2010). Trainee nondisclosure in supervision: What are they not telling you? Counselling and Psychotherapy Research, 10(2), 103-113. doi: 10.1080/14733141003712301 Mehr, K. E., Ladany, N., & Caskie, G. I. L. (2015). Factors influencing trainee willingness to disclose in supervision. Training and Education in Professional Psychology. 9(1), 44-51. Mills, J., Bonner, A., & Francis, K. (2006). The development of constructivist grounded theory. International Journal of Qualitative Methods, 5(1), Article 3. Retrieved 19 June, 2006, from htm Milne, D. (2009). Evidence-based clinical supervision: principles and practice. Hoboken, NJ: Wiley. Myers, M. & Gabbard, G. (2008). The physician as patient. Washington, DC: American Psychiatric Pub. Patton, M.Q. (2002). Qualitative Research and Evaluation Methods. (3rd edition). Thousand Oaks: Sage. Pope, K.S. (2001). Sex Between Therapists and Clients. In Encyclopedia of Women and Gender: Sex Similarities and Differences and the Impact of Society on Gender 955-962; vol. 2. Editor Judith Worell. Sexual attraction: Academic Press.

Pope, K.S., & Tabachnick, B.G. (1993). Therapists’ anger, hate, fear, and sexual feelings: national survey of therapist responses, client characteristics, critical events, formal complaints, and training. Professional Psychology: Research and Practice, 24(2), 142-152. Pope, K. S., Keith-Spiegel, P., & Tabachnick, B. G. (1986). Sexual attraction to clients: The human therapist and the (sometimes) inhuman training system. American Psychologist, 41(2), 147-158. Rennie, D. L., Phillips, J. R., & Quartaro, G. K. (1988). Grounded Theory: A promising approach to conceptualization in psychology? Canadian Psychology, 29(2), 139-150. Rodolfa, E., Hall, X., Holms, V., Davena, A., Komatz, D., Antunez, M., & Hall, A. (1994). The management of sexual feelings in therapy. Professional Psychology: Research and Practice, 25(2), 168-172. Schuck, C., & Wood, J. (2011). Inspiring, creative supervision. London: Jessica Kingsley. Shavit, N., & Bucky, S. (2004). Sexual contact between psychologists and their former therapy patients: psychoanalytic perspectives and professional implications. The American Journal of Psychoanalysis 64(3), 229-248. UKCP (2009). UK Council for Psychotherapy Ethical Principles and Code of Professional Conduct. Published by the UK Council for Psychotherapy. Watkins, Jr. C. E., & Riggs, S. A. (2012). Psychotherapy supervision and attachment theory: Review, reflections, and recommendations. The Clinical Supervisor, 31(2), 56-289. Wheeler, S. & Richards, K. (2007). The impact of clinical supervision on counsellors and therapists, their practice and their clients. A systematic review of the literature. Counselling and Psychotherapy Research, 7(1), 54-65. White, V. E., & Queener, J. (2003). Supervisor and supervisee attachments and social provisions related to the supervisory working alliance. Counselor Education and Supervision, 42, 203–218. DOI: 10.1002/j.1556-6978.2003.tb01812. Willig, C. (2007). Reflections on the use of a phenomenological method. Qualitative Research in Psychology, 4(3), 209-225. Worthen, V., & McNeill, B. W. (1996). A phenomenological investigation of “good” supervision events. Journal of Counseling Psychology, 43, 25-34. doi: 10.1037/00220167.43.1.25.



Abstract This article aims to provide an insider and outsider account of psychological vulnerability of international students when encountering cultural diversity. The term international students is used in this paper to indicate the specific population of young adults who spend a part of their undergraduate studies abroad. Despite the rising number of students moving between countries and an increased research interest in international mobility, few studies focus on the particular state of physical and emotional transition that this population can experience while abroad. This state of transition can cause unforeseen psychological difficulties and as a result it may affect their experience abroad and indeed their life thereafter. The paper explores possible causes and consequences of psychological discomfort experienced by individuals during a period of study abroad; it highlights some of the current therapeutic approaches available for culturally diverse minority groups, such as international students, and calls for more consideration of this particular group of vulnerable students that are still largely neglected from research and practices which take account of cultural dimensions in therapeutic and educational settings. Indeed, it argues that the transitory experience of international students who live in new social and cultural surroundings can be fostered by appropriate emotional support. Keywords: International students, year abroad, psychological vulnerability Introduction In the last decade I had the privilege to work with international students as a teacher and as an academic advisor, and to observe their particular ways of dealing with cultural differences inside and outside the classroom. My experiences with undergraduate students sometimes bring me back to a period of my life when I was also an international student living in a foreign country. Indeed, I spent a year abroad in Germany as an exchange student and I know, like my students, how it feels when living in unfamiliar settings far away from ‘home’ for the first time. Over the years, my lived experiences of cultural diversity have led me to an increased interest in the connection between individuals’ psychological traits and their cultural backgrounds. This curiosity informs my daily practice as a teacher and has accompanied me during my doctoral studies, which focused on the emotional and social dimensions of university undergraduate level language learning during a period of study abroad experience (Gallucci, 2014). More specifically, I explored the identities

and emotions of three British young women who lived in Italy for one academic year as part of their undergraduate course of study. The stories of the individuals, who participated in my doctoral study, have shown that living in new sociocultural realities and managing a sense of self in contexts of relative disempowerment, entails considerable personal struggle. Their stories have also shown that the ways in which individuals deal with their struggles, and particularly, the extent to which they manage to overcome their emotional struggles, can be attributed to their personal abilities and skills. These findings stirred my interest in exploring the ways in which international students’ lived experiences can be fostered not only conceptually and analytically but also emotionally. Indeed, it is through a deeper understanding of the ways in which individuals can deal with language learning processes (intellectually and emotionally) that we, as researchers, educational practitioners and mental health professionals, can guide students towards a positive learning experience, both academically and on a personal level.

Contact: Dr Sonia GalluccI, Senior Lecturer in Italian & Cross-Cultural Studies, Institute of Languages & Culture, Regent’s University London


Since the completion of my PhD in 2011, I have been wondering whether international students’ ability to adapt to new social and cultural realities can be fostered by appropriate psychological help before and during their experience abroad; and, subsequently, I have been questioning whether the inability of some students to integrate in the host society can be indeed the fruit of inadequate emotional support. Hence, the focus of this article, which aims to shed some lights on the emotional consequences of international students when living abroad and on the ways in which education and mental health professionals, can help them before, during and after departure.

International students: minority group at risk Over the last four decades the number of students spending a period of study overseas has vastly increased, due to the requirement of home universities to spend a part of their studies abroad and also due to a more globalised world, where movements of people between countries have become more affordable and desirable (cf. Alred, 2003, Berry, 1997, Byram & Feng, 2006). The experience abroad definitely brings along a number of benefits for international students, such as those documented by Sherry et al. (2010), namely a valuable opportunity for improving academic skills and expanding social networks through “making friends at the University [and] having positive relationships with Professors” (p. 45). Allen and Higgins’ study (1994) showed how the positive effects of such experience are also linked to students’ motivating factors to go and live abroad, which include greater opportunities to travel and experience different cultures, and the desire to receive a better education and increase their job prospects (p. 11). Other important factors emerging from the period of study abroad are the development of linguistic proficiency and the heightening of sociocultural awareness (Freed, 2008). However, the usefulness of such experience in terms of personal and interpersonal gains is not always clear and we still have rather few research insights that document the advantages of this “costly adventure in a new country. Scientific evidence of the benefits of residence abroad […] is patchy and does not always support a wholly optimistic view” (Coleman, 1995: 17) Hence, the prospect of voluntarily moving into another country for study can be exciting, especially for young adults who have never lived abroad before. However, anecdotal evidence shows that as soon as they enter in contact with the culturally demanding reality of new contexts, euphoric feelings can easily turn into a state of confusion and cause unforeseen psychological difficulties leading to an emotional state of ‘culture shock’. The first representations of year abroad individuals’ adjustment to new sociocultural realities were provided by Lysgaard (1955) and by Gullahorn & Gullahorn (1963) in the form of U-curve and W-curve models respectively. The U-curve model describes four consecutive phases of intercultural adjustment: euphoria, culture shock, acculturation and stable state. The W-curve model includes three further stages of sojourners’ re-adjustment when they come back from their experience abroad: honeymoon, crisis, adjustment. Numerous attempts have later been made by scholars in order to describe young individuals’ responses to cultural difference, for instance, Bennett’s Developmental Model of Intercultural Sensitivity (1986), which prompts people to become ethnorelative by adopting multiple

cultural frameworks of reference; or most recently, Matsumoto and Juang’s Intercultural Adjustment Potential Scale (2008), which focuses on the psychological mechanisms (such as openness, critical thinking, flexibility and emotion regulation) that can facilitate intercultural communication and personal growth. While these models are of high value when trying to understand the ways in which individuals perceive cultural difference and how they can cope with the unforeseen stress experienced when living in a new culture, yet they somehow describe people’s intercultural experiences and the necessary coping skills as a ready-made toolkit that can be applied to anyone. What these models seem to overlook is that individuals’ experiences of diversity, including cultural diversity, are unique for each person, and it has proven to be particularly challenging for novel travellers, such as international students, who have no prior experience of living overseas. Indeed, apart from their unsettling physical transition, a change of status and the use of a different language while abroad can cause additional emotional distress, that can be comparable to a form of bereavement (Anderson, 1994) as individuals may feel particularly vulnerable for a perceived loss of an important part of themselves, namely a loss of identity. International students can be considered as a population at risk that would need special consideration by host institutions, given their unique needs, such as being culturally understood and emotionally supported within the local communities of practice (including the academic environment). As Sherry et al. (2010) point out, when international students move abroad, like many other minority groups, they can experience several challenges “as a result of language and cultural barriers, academic and financial difficulties, interpersonal problems, racial discrimination, loss of social support, alienation and homesickness” (p. 34). In addition, they may also experience unequal opportunities (or exploitation) in the host universities and emotional misbalance when they go back to their home countries (ibidem). Sherry et al. (2010) conducted a quantitative study at the University of Toledo among over 100 international students to find out about their social, cultural and academic experiences and how to improve them. From their findings clearly emerged that a welcoming academic environment was a key factor for their mental wellbeing. Other important factors in successful intercultural adjustment were: language proficiency, an inclusive (rather than exclusive) local community, which understands and appreciates cultural differences (such as the provision of Halal food on campus for Muslim students) and social support to overcome isolation. The study conducted by Sherry et al. (2010) is insightful; however, they are aware of the limitations of their study, since, due to its exploratory nature “there may be a number of additional areas requiring research [such as] specific gender, religious or cultural differences in the experiences of international students”. (p. 44). International students are more vulnerable than local students and can therefore be considered a population at risk. Moreover, they rarely seek psychological support during their stay abroad since the majority of them are not used to relying on professional help. In fact, as Lee (1999) indicates “most of their home countries do not have a history of providing or encouraging counselling, and many international students seek help only as a last resort” (p. 41). International students are people in transition because they live temporarily in another country (Khoo et al., 2002). This new reality of physical transition may lead them to unfamiliar

Journal of Psychotherapy and Counselling Psychology Reflections

emotional instability which in turn can be the cause of psychological distress (cf. Furham, & Bochner, 1990). Indeed, this state of cultural transition can cause a great deal of life stress, and even when this transition is “positively anticipated” (Lee, 1999: 36), it can still be the source of ‘culture shock’ (Oberg, 1960) or ‘uprooting disorder’ (Zwingmann & Gunn, 1983). According to Lago (2006), these problems “are not at all deeply understood or appreciated in terms of the demands and pressures they place upon those who suffer this process. At worst, culture shock can cause breakdown and long term illness” (p. 392). As mentioned above, many attempts have been made across disciplines to conceptualise this phenomenon and to provide a useful framework for individuals to overcome culture shock (cf. among others Lysgaard, 1955; Bennett, 1986; Bredella, 2003; McCrae & Costa, 1987). However, a specific theoretical model thought for this particular student population is yet to be developed. Indeed, as Arthur (1997) states, the current models of culture shock or cross-cultural adjustments fail “to identify the specific experiences of students […] [who] present a myriad of related psychological and physiological symptoms” (p. 264-265). According to Barty (2011), the main causes of the psychological discomfort experienced by international students are social loneliness, homesickness and cultural isolation. The persistence over time of these symptoms can be an alarming cause of concern since they can have a serious impact on their wellbeing (p. 185). Some studies also highlight the fact that international students may show depressive symptoms when they perceive discrimination and have a lack of social support and connectedness (Hanassab, 2006; Mallinckrodt & Leong, 1992; Sawir et al, 2007; Wei et al, 2008). Other common factors affecting their sojourn abroad are represented by financial and communication problems, a lack of fluency in the target language, and a lack of understanding of local practices (Arthur, 1997; Yeh & Inose, 2003; Misra & Castillo, 2004; Sherry et al, 2010). Hence, international students are likely to face a great deal of issues when they move abroad and subsequently, they seem to be a population at high risk, who would need to be emotionally supported before, during and after their stay abroad. The provision of personal therapy offered by their home and host institutions would surely enhance their wellbeing and help them make the most of their experience overseas.

Working with international students When working with international students (as mental health professionals or educationalists) we need to take into account the distinctive and complex aspects that make them a unique population. These include first of all, their temporary stay in unfamiliar settings; secondly, the unique set of values, beliefs and assumptions that they own; and finally the distinctive social networks they do (or do not) create around them and their specific communication styles (Khoo et al., 2002). There are currently various therapeutic approaches which put a great deal of emphasis on the cultural dimensions of the relationship between therapists and clients/patients from minority groups; the most common ones are intercultural therapy, multicultural counselling, cross-cultural psychology and transcultural counselling and psychotherapy (see respectively Kareem & Littlewood, 1992; Palmer, 2002 and Gielen et al., 2008; Berry et al., 2011; Lago, 2011).


Although all of these approaches see culture as a crucial component of individuals’ cognitive and emotional behaviour, whilst appreciating the cultural differences of minority groups, very little emphasis has been put on the minority group at risk that has been presented in this paper, namely international students. Preference seems to be given to therapeutic practices in relation to racial, ethnic and sexual diversity of individuals who live (or plan to live) permanently in a specific place, whereas the identities of young adults in transition between countries, such as those of international students, seem to detain a small space in the literature and in the therapy room (cf. Nayar-Aktar, 2015). Despite the lack of clear evidence of working therapeutically and ‘successfully’ with international students (cf. Jewel, 2002), some recent studies have provided interesting insights into the world of this minority group and into the ways in which therapists, willing to recognise and appreciate cultural diversity, can help them overcome psychological difficulties experienced during or after their period of study abroad (see e.g. Arthur, 1997; Arthur & Popadiuk, 2010; Barty, 2011; Butler-Byrd et al., 2006; Heppner, 2006; Khoo et al. 2002; Park-Saltzman et al., 2012; Seo, 2010; Vera & Speight, 2003) Overall, becoming ‘culturally or multiculturally’ competent seems to be the main goal of therapists working with culturally diverse people (cf. Vera & Speight, 2003). Sue and Sue (1990) recommend mental health professionals to raise their sensitivity to the cultural differences of their patients and to become aware of their own bias towards diversity. Khoo et al. (2002) also recommend being aware of and discussing the expectations that both counsellors and clients have from their therapeutic encounters and from each other, since unawareness could cause “misunderstandings about their respective roles” (p. 101). Thomas and Althen (1989) (cited in Khoo et al., 2002: 106-107), also warn about the distinctive issues that therapists may encounter when dealing with foreign students (particularly from Eastern countries). These are: cultural stereotyping, the particular situations in which each student finds him/herself, a possible difficulty in identifying the source of their problem(s), and the doubts they may have about the appropriateness of conventional (western) approaches to therapy. Indeed, students’ reluctance about unfamiliar therapeutic approaches employed in the host societies can be a major deterrent in their healing process. This is applicable not only to international students, but also to other individuals whose native cultural healing traditions are substantially different from those they experience in new societies. For instance, in countries commonly known as ‘collectivistic’ (or ‘communalistic’ - as defined by Laungani (2002) (e.g. India, Thailand, South Korea, Colombia and Pakistan), great emphasis is put on spiritual and supernatural practices, whereas in ‘individualistic’ countries (e.g. USA, UK, Canada, France and Germany) such practices are often dismissed in the treatment of mental illness because priority is given to more scientific and naturalistic practices. The dichotomy between collectivistic and individualist societies may seem a simplistic and overused way of categorising cultural differences among individuals (cf. Laungani, 2002); however, it has its own value when trying to discern the origin of individuals’ archetypical patterns of behaviour. For example, in a recent study based on individualistic and collectivistic variables and conducted among international students coming from South Korea, Seo (2010) found out that her participants perceived personal therapy to be more effective when their counsellor Volume 2, Number 1, January 2017


emphasised their particular expression of emotions, deriving from their own native culture. Another recent study conducted by Park-Saltzman et al. (2012), highlighted how Asian international students face unique issues due to their cultural (collectivistic) beliefs and therefore, they need a specific format of mentoring (p. 895). Moreover, as Barty (2011) points out, in order to overcome students’ resistance to Western practices of psychotherapy or counselling, it is important to acknowledge that traditions of help-seeking and help-giving may differ from society to society and that belief systems ought to be validated within those traditions, that often provide informal support, such as friends and family, authoritative figures (elderly, religious or spiritual leaders) and prayers. Indeed, as she states “Western counsellors and psychotherapists, with their own theoretical cultural frames, may undervalue or even be hostile to other helping traditions” (p. 185). And this theoretical mind-set could potentially be a deterrent for students seeking psychological support while abroad. Other factors provoking international students’ procrastination or avoidance of personal therapy could include “concerns about confidentiality, a taboo on discussing private concerns to someone outside immediate family, perceived lack of relevance and perceived pressures of time” (Barty, 2011: 189). Hence, it is important to consider this minority group as a unique population in need of further support during their sojourn abroad. The enhancement of (inter)cultural awareness seems to be a key factor in current practices of counselling and psychotherapy among culturally diverse individuals, such as international students. Hence, it is essential for counsellors and psychotherapists to gain knowledge about the specific cultural background of their clients and to respect the specific ways in which counselling practices are seen and applied in their ‘home’. It is also important to help clients be aware of such differences and to talk about them overtly. A mutual awareness of different cultural traditions and an open dialogue about the nature of them, can surely nurture mutual trust and enhance the therapeutic relationship. The specific needs of international students can be addressed in numerous ways, not specifically labelled as therapeutic. For instance, as Sherry et al. (2010: 44-45) suggest, this can be done by promoting inclusive initiatives, such as a ‘Student International Week’ or a page on the University magazine dedicated to their experiences, such initiatives would raise their profile on campus, would help them become more involved and ultimately would tackle social and cultural isolation. Access to local academic support services (such as the National Union of Students – NUS) could also be facilitated by more initiatives and publicity on campus; or other government based services available to all individuals (such as the Increased Access to Psychological Therapies – IAPT) can be made more visible and directly accessible to students. In addition, more information could be embedded in curricula about “current government legislation, funding and supporting practices nationally for the delivery of racial equality in mental health” (Lago, 2011: 4). Finally, additional programmes on crosscultural understanding could also help international students feel more culturally understood and accepted within the academic environment.

Being an international student As I have briefly outlined in the introductory section of this paper, I have personal experience of being an international student. Indeed, over two decades ago (in 1994), I spent ten months in Germany as an exchange student. At that time the idea of spending an academic year abroad was a new one,

since it was introduced by the European Commission only seven years before (in 1987) together with the academic community in order to promote cooperation between universities and to enhance employability within the EU borders (Papatsiba, 2006). In my home town, a small place on the island of Sardinia, not many other students felt the same desire I had to explore other realities. Moreover, this experience was encouraged but not required by my home university. So in that period, only a small number of undergraduate students decided to go and spend part of their studies abroad. I was one of them. Except for some basic linguistic knowledge, I knew very little about the host society. I went to Potsdam University, a place in eastern Germany, not far from the remains of the Berlin Wall. My stay abroad was quite challenging, since I had to deal with a great amount of practical but above all psychological difficulties. Upon my arrival to the host country, I initially noticed the attitudes of local people which I considered to be more distant and detached compared to the attitudes of people back ‘home’. For example, I would go to public places such as the local supermarket, the train station or pubs and members of staff would not say hello or smile at me. On one occasion, I recall not being served food in a pub because I was told the kitchen was closed, and then seeing other local people being served soon after. I also remember one of my ‘international’ friends, originally from Albania, being chased by neighbours near a bus stop because they found out he was not German, or another friend from Japan, being intimidated by local students who used to write in red paint offensive words against him on the student accommodation walls. I clearly found myself in a quite hostile environment where local people were not used to ‘foreign’ visitors, let alone having international students living with them for long periods. Certainly a perceived discrimination played an important role in my lived experiences of otherness and in my feeble (or no) attempts to integrate in the host society. Other initial obstacles to my acculturation process were also my lack of fluency in German and my lack of understanding about local communities of practice. Hence, my limited linguistic knowledge and cultural unawareness were additional factors which impeded meaningful communication between me and local people. This ‘temporary’ inability to deal successfully with people around me caused me a lot of stress and various psychological difficulties, including a high level of anxiety and mild signs of depression. I think my determination to succeed academically helped me partially overcome these issues. Firstly, I surrounded myself with other Italian students, who were spending, like me, their year abroad in Potsdam; then, as soon as I achieved a certain degree of fluency in German, I met other international students and with one of them I also had a romantic relationship. These factors obviously made the whole process easier and more enjoyable for me and helped me overcome some of the mixed emotions I felt as a result of ‘culture shock’. When my experience abroad came to an end I was more relieved than sad, as I thought that going back home to the comforts of my previous lifestyle would make me feel the same contented person I previously was. However, what I did not know was that this experience would change my life forever and that for a long time, after my return, I would feel very confused about my identity, my views and my feelings. A close circle of friends and the love and care of my family helped me regain a sense of self and settle again in my home country. However, the unexpected experiences of cultural difference I had during my year abroad have impacted me profoundly.

Journal of Psychotherapy and Counselling Psychology Reflections

As soon as I completed my undergraduate studies, I decided to go and live abroad again in another country: England. This time the decision was made more wisely as I prepared myself cognitively and emotionally for the new adventure. And here I am, still living ‘abroad’ after nearly two decades. I am a more mature person now and I feel more prepared to deal with cultural differences than I was in my early twenties. I have dedicated time and energy into researching cultural issues, as I am also doing in this paper, and I feel I have now a more holistic and accepting stance towards diversity than I used to. However, I cannot help sometimes feeling puzzled and trapped in circles of cultural misunderstandings and reliving the same sense of loneliness and homesickness that I experienced when I was an international student.

Conclusion In this paper, I have outlined some of the issues related to international students as a population at risk in need of psychological support. I have backed up my reflection by exploring the possible causes of psychological discomfort they may experience during their stay abroad, and by highlighting some of the current therapeutic approaches available for culturally diverse minority groups, such as international students. I have also shared with the reader some memories of my personal experiences as an international student, with the main aim of providing an insider account of psychological vulnerability when encountering cultural diversity. Anecdotal evidence suggests that international students are often left alone to deal with the emotional uncertainties of living in new sociocultural contexts, and as a consequence they may feel psychologically and socially alienated. Indeed, during their stay abroad, they may experience unprecedented psychological difficulties, like I did, and be overwhelmed by mixed emotions that they may find very difficult to face. We need more studies that focus on the emotional experience of this minority group of young adults and on the ways in which counselling and psychotherapy could help them benefit from their sojourns abroad. We also need more on-campus initiatives that promote inclusion among all students (local and international), more awareness of current legislation on diversity and more publicity on mental and social support services available to students. Tailored psychological support before, during and after students’ experience abroad would certainly help them deal effectively with unforeseen emotional discomfort and guide them throughout their journey of doubts and uncertainties in unfamiliar settings. Such support would also help students increase their academic motivation and consequently obtain better results. Indeed, on reflection, when I was an international student, personal therapy would have certainly helped me regulate my emotions and equip me with the necessary coping skills to face cultural diversity (cf. Gross, 1998, 1999, 2002; Gross & John, 2003). As a Senior Lecturer of Cross-cultural Studies and as an academic advisor for Study of Period Abroad students, I regularly witness a familiar sense of loss and uncertainty in my encounters with current international students who are living far away from their home country. I often feel powerless because besides some theoretical knowledge I can transmit during the lessons or sporadic (often) written contacts while they are abroad, I am not in a position to offer them the additional psychological and professional support they may require. Indeed, within the UK higher education system, we tend to prepare our students cognitively and theoretically to the exposure of other languages and cultural practices


commonly used in the host countries. However, very little has been done so far within educational settings in order to help future international students regulate their emotions during their stays abroad, for instance, by offering them emotional support through appropriate counselling and psychotherapy, which take into account cultural diversity. This, in my view, ought to be a compulsory element of their experiential preparation for the experience abroad.

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Abstract Terry Pratchett once said that stories have power. This paper examines that power through considering the philosophy which may be found within fantasy and sci-fi and the psychotherapeutic implications of that philosophy. In particular, it considers what we should do about the constraining nature of the Matrix from the Wachowski’s eponymous film; The nature of good and god according to witches in Terry Pratchett’s Discworld series; and what constitutes a worthwhile life to a time-travelling replicant in Rob Grant and Doug Naylor’s Red Dwarf; It examines how such insights might be of assistance in the quotidian world when, in the hope of some wider wisdom, our troubles lead us to lift our eyes to the stars for answers beyond our ken. Keywords: Fantasy, science fiction, psychotherapy, reflexivity, ethics, Terry Pratchett, The Matrix, Red Dwarf, philosophy Prelude The fire burned low under the two-moon sky as dark shadows crept in from the overhanging trees, bringing with them the evening cold. Skettish poked at the embers with the gnarled oak stick she kept with her always and they raised a little heat, a few sparks ascending to die somewhere in the darkness above. ‘There’s other places’ she sighed to the boy lying beside her. ‘Others than this’. ‘Some brighter, some darker, but all of them places for the search.’

forest below which faded to two, then one. It was noted as a minor anomaly and logged accordingly, but did not pass the threshold which alerted the crew; the compliment of which currently consisted solely of Jones, M. (Cpt.) - a man of impeccable record who was slowly losing his mind. ‘Anything?’ Jones asked as he strolled onto the main deck munching cereal in a blue plastic bowl. ‘No Jones, nothing’ the ship’s computer replied.

‘The Search?’ the boy whispered his yellowing eyes peeping out from under his tightly wrapped blankets.

‘Well what the hell am I meant to do then?’ he sputtered. ‘Is there no-one in this whole damn galaxy whose society is sufficiently advanced that I can visit them and not screw everything up?’

‘Aye, the search’. ‘Why, What, How and all that…’

‘No Jones, not yet’.

‘Life’ – she waved a hand vaguely – ‘What we should do.’

Jones sat down, sighed and rubbed his forehead. ‘Well what the hell am I going to do?’ he repeated more quietly, but with a growing desperation. ‘There’s just the two of us - and you’re not even real.’

He shook a little as she rested her hand upon the sickly-wet skin of his forehead to let the last trickle of her magic flow into him - not enough for a cure she knew, but all that could be done now. His breathing eased. ‘I love you grandma’ he said. ‘I’ll see what’s next now’, and with that he died. She closed his eyes and sat still and silent as the fire faded to ash. As she started to weep a shooting star passed overhead and faded. She didn’t look up.

‘Don’t you love me Jones? – You said you loved me.’ ‘It’s not that I don’t love you’ he shot back, then paused and seemed to deflate a little. ‘It’s just that you’re not real and I think that should mean something – shouldn’t it?’

Aboard the XF-β the ship’s computer navigated the passage between the planet and its moons without incident, the whole vast expanse of the continent sliding under the ship with the engines making barely a ripple in space-time. The sensors picked up three heat signatures from an expanse of

Contact: Dr Christina Richards, Senior Specialist Psychology Associate, Nottinghamshire Healthcare Foundation NHS Trust and Clinical Research Fellow. West London Mental Health Trust.


Introduction Are the stories over then? Are they just beginning? Do they ever really end? Abide awhile with me and see. For if you’re sitting comfortably O’ Beloved, then I’ll begin. It is said that there are seven basic plots and that these are: Overcoming the Monster; Rags to Riches; The Quest; Voyage and Return; Comedy; Tragedy; and Rebirth (Booker, 2004). Each of these has a narrative arc and each, naturally, contains a question: What am I to do about this? The ‘this’ may vary of course; It may be a question as to how to deal with the grief of losing a loved one when all you have isn’t enough; or to find the meaning of love and togetherness in a postmodern world - as in the examples above - or it may be a question about how a prim and proper wife is to stop the vicar from finding the brigadier in the wardrobe who is unaccountably not wearing any trousers. Mostly, however, the questions, the themes of great literature, film, painting and music – what we might call ‘the arts’, are at least somewhat profound1. We can see this in Shakespeare’s (1595) comedic fantasy A Midsummer Night’s Dream, for example, which examines themes of love (Bevington, 1996), identity (Hunt, 1986), sexuality (Green, 1998), and feminism (Howard, 2003); and which is echoed (and pastiched) in Pratchett’s (1992) comic fantasy Lords and Ladies (of which more anon). We can see it in ancient stories such as the Cad Goddeu (The Battle of the Trees), in which each of the story elements represent secret knowledge for transmission between members of a persecuted druidic order (Graves, 1948). Indeed, most religions weave myth, legend and history to create a guide to a correct way of living, as well as to record information in pre-literate societies. Such stories have power (Pratchett, 1990a) - the vision of the cobra keeping the rain from the Buddha as he sought enlightenment is an arresting one; as is the thought of Jesus being nailed through the hands and feet to a wooden cross. Similarly, Nietzsche (1882) conjures the image of the blind man with the lantern to tell us (and to keep us told) that ‘God is dead’ and so impel us to act accordingly. These stories carry with them on a sort of narrative ‘carrier wave’ for profundity ideas about the transience of our flesh; the illusion/delusion of our senses and purpose of our existence with or without a God. Even numbers, the basis of ‘hard’ science, may be considered to be stories; for axiomatic to integer based mathematical systems is the profound story that; ‘this is not that, it is other’; thus we have ‘two’ instead of ‘one’. But such thisthat splits have been challenged by other stories about the nature of reality in Buddhism (Conze, 1959), Christianity (Galatians 3:28), and in contemporary science with the advent of fuzzy logic (Kosko, 1994). We make our own individual stories too. Stories to make sense of the complexity of existence on a personal level McLeod (2006): Stories are the basic way in which people make sense of their experience …We tell our own personal tales, but do so by drawing on a cultural stock of narrative forms. We are born into the story of our family and community, and the story of who we are (e.g. our birth story, the story behind our name). As we grow up we adopt narrative templates provided by myths, films, novels and other cultural resources to give shape and meaning to our individual life narrative. (p 290) Thus people create stories of identity in concert with their surroundings; they construct narratives that fashion 1 We might argue that farces are too in that they prick holes in the constructed nature of so much of our social lives.

the past into something that can coherently explain and determine their life trajectory. This fashioning is subject to external influence from culture (Gergen, 2000) and cultural determination by what Foucault (1991) styles as a ‘panopticon’ society in which people monitor and police the boundaries of acceptable social behaviour through introjecting their own panopticon prison where they are monitored constantly by an internalised other2. Because such stories and personal narratives are constructed - deeply constructed from the material which shapes our realities, but constructed nonetheless - they are open to change. This may be personal, perhaps the change which comes from reading about others who suffer, or finding friends in characters in other [narrative] realities (Salvatore, 2011); or it may be through therapeutic intervention, perhaps in the form of phenomenological enquiry (Langdridge, 2013) or narrative therapy (White & Epston, 1990). These may be particularly apposite in exploring culturally derived stories that do not fit comfortably with an individual and so create space to constitute new stories. Indeed, one of the United Kingdom’s Health and Care Professions Council’s main constituents of Counselling Psychology is that practitioners “Understand how empathic understanding can be helped by creativity and artistry in the use of language and metaphor” (2012, p.10). We create art, whether it is for entertainment and edification; or whether it is the stories we tell internally as we paint ourselves heroes in adversity, or as Cinderellas when life throws one more stone in our shoe. When it is written, and written well, it is often art such as this which reflects life and the deep currents which move us, and so is of concern to philosophers and psychotherapists alike3. Stories have power4: And the further they move from the minutiae of the everyday towards the extraordinary (but an extraordinary we can relate to), the more our suspension of disbelief allows new insight to emerge through dispensing with petty specifics. This is why religions are fantastic. This is why fantasy and sci-fi are the root of a new philosophy - and perhaps a new psychotherapy from that. This is the starshine on the critical edge. Let’s dive a little deeper towards that inviting gleam…

The Matrix Where do we exist? Is there a world out there we can see and touch and hear and taste and smell? That we can measure? That, crucially, we can change? In most realities such things are nebulous – worlds exist a priori and so at best our touching approximates a guess at what we have touched; our changes a hope, a fumble in the dark of supposition as to what has really been altered. In worlds of light and laws inside computer networks, however, realities are constructed which offer hard boundaries to those who simply visit – and so offer comfort in their predictable regularity. But such virtual worlds offer something more, something deeper, to those who see and swim the liminal places which complexity and chaos in networks of hard laws offer – the opportunity to really change, in ways at once both complex and boundaried. Indeed, when one can swim such liminal places on hard-law virtual networks the further question arises: Perhaps outside of such places too - in the real world – might there not be more latitude for change 2 Another arresting image to carry an idea. 3 Indeed some of us try to wear both hats, with varying degrees of success - as anyone who has tried to wear two hats will know. A woolly hat and a climbing helmet just about works, but what that means is perhaps too profound for this paper. 4 I shall say this thrice.

Journal of Psychotherapy and Counselling Psychology Reflections

than we realise? It is in The Matrix (Silver, Wachowski & Wachowski, 1999), amongst other places that some answers are offered to these most fundamental of questions concerning the possibilities afforded to people in a given reality. The Matrix was a hugely successful film which spawned two sequels and a number of spin-off productions. Set in the near future it tells of a chosen human - Neo - who is encouraged to come into his power by a free human, Morpheus, in order to fight back against the sentient Machines who are holding most of the human race in bondage. Neo is able to do this through entering the means of that bondage - the Matrix - A computer generated fantasy world fed directly into the interconnected brains of humanity even as they lie physically dormant in the ‘real world’. Because Neo is aware that the Matrix is not real, and is instead created, he is able to bend its rules and so to have extraordinary powers - whereas the rest of humanity remains caught within the Matrix’ limits. The Machines, led by a computer generated person - ‘Agent Smith’ inside the Matrix - endeavour to stop him as he tries to break it from both within and without and so free humanity. Naturally, inside the Matrix everyone who is aware of the Matrix is incredibly cool, whereas the computer generated Agents look like stereotyped government workers in dull suits and ties5. The Matrix then. A computer generated reality which is possibly true (Bostrom, 2003) and leaves us considering the ways in which we may be held hostage by the reality we find ourselves in. It is, perhaps, a little fantastical, but does this idea of matrices manifest in more mundane ways? What if, for example, when Morpheus told Neo of the Matrix he simply offered it as an insight into the gender dichotomy the idea that there are only men or women and that they are fundamentally different in kind and not degree, with different needs, [sexual] desires, and identities; all independent of cultural context (cf. Fine, 2011). If he offered an insight into the Heteronormative Matrix, if you will.


Do you believe in fate, Neo?




Why not?


Because I don’t like the idea that I’m not in control of my life.


I know exactly what you mean.

Again, that smile that could cut glass. MORPHEUS

Let me tell you why you are here. You are here because you have the gift.


What gift?


I’ve watched you, Neo. You do not use critical theory like a tool. You use it like it was part of yourself. What you can do with critical theory is not normal. I know. I’ve seen it. What you do is magic.

Neo shrugs. NEO

It’s not magic.


But it is, Neo. It is. How else would you describe what has been happening to you?

He leans forward. 5 OK, and like Elrond, but that came later…

We are trained in this world to accept only what is ‘rational’ and ‘logical’. That there are men, and there are women, and that they each have their separate roles and responsibilities. Have you ever wondered why?

Neo shakes his head. MORPHEUS

As children, we do not separate the constructed from the unconstructed which is why the younger a mind is the easier it is to free while a mind like yours can be very difficult.


Free from what?


From the Heteronormative Matrix.

Neo looks at his eyes but only sees a reflection of himself. MORPHEUS

Do you want to know what it is, Neo?

Neo swallows and nods his head. MORPHEUS

It’s that feeling you have had all your life. That feeling that something was wrong with the world. You don’t know what it is but it’s there, like a splinter in your mind, driving you mad, driving you to me. But what is it?

The LEATHER CREAKS as he leans back. MORPHEUS

The Heteronormative Matrix is everywhere, it’s all around us, here even in this room. You can see it out your window, or on your television. You feel it when you go to work, or go to church or pay your taxes. It is the world that has been pulled over your eyes to blind you from the truth.


What truth?


That you are a slave, Neo. That you, like everyone else, was born into bondage... ... kept inside a prison that you cannot smell, taste, or touch. A prison for your mind.

Adapting the script we might have: MORPHEUS


Outside, the WIND BATTERS a loose PANE of glass MORPHEUS

Unfortunately, no one can be told what the Heteronormative Matrix is. You have to see it for yourself…

‘A prison for your mind’. Wrapped up in beautiful coats and sunglasses, drawn by stunning martial arts wirework and 360° photography, we have that central idea: ‘A prison for your mind’. In the film Neo first finds himself thrown into a certain world, apparently utterly delimited. That is until Morpheus frees him by showing us that it is a ‘prison for your mind’ – that his thrown world is not so concrete after all. In the computer-generated Matrix it is, quite literally, that there is nothing either good or bad, but thinking makes it so (Shakespeare, 1599), and yet when we consider constructs such as the heteronormative matrix that have so little basis in non-constructed objectivity (Fine, 2011) our realties too may bend at the edges. How much effort is put into differentiating between men and women, boys and girls, though clothing, toys, magazines etc? Why does this change so much over time and culture? (Connell, 2009). What ‘wool do we have pulled over our eyes at church and when Volume 2, Number 1, January 2017


we pay our taxes’? Similarly, what about the matrices of capitalism? (Chang, 2011); The valence of things as ‘good’ or ‘bad’ (Conze, 1959; van Deurzen, 2008); or our place under heaven and over hell/ at the centre of the planetary system/ universe. As Neo so eloquently puts it; “Whoa!” What The Matrix shows us6 is that that which appears to be self-evidently true may not, in fact, be so. In this way it returns to a pre-war existentialism which allowed for a greater degree of nauseous freedom (Sartre; 2000 [1938]), although Neo too is somewhat bound by his facticity (he can’t simply destroy the planet for example), but his limits are wider than those inside [a given] Matrix can possibly comprehend. This is because he is able to see, and choose, true paths because he is both part of the Matrix; and also apart from it – he has trained to see his worlds, he doesn’t merely exist in it. This means he can, to some extent, bend the rules which govern it. His insight allows him to adapt his environment, to see the spaces in which he may act, in order to kill his artificial intelligence nemesis within the Matrix and so free the humans still in bondage. He can, if you will, hack his reality. Of course, these stories of the possibilities of different realities, and the bridges between them, reach back to the burial rites of prehistory (Pettitt, 2002) and through to the belief systems of the modern day (e.g. Hubbard, 2007 [1956]). They are the stories of the other places we go to and what we can, and must, do both there and here. They are central to much religion, culture, and morality and so offer guidance – a path, if you will. But they are many times a limited path to wisdom (and one which obscures more than it illuminates) for all too often they are paths of what one must do, rather than paths of choice towards some ethical end. When we are with clients then, what unitary paths, what matrices, are we inhabiting? How often are we acting the anonymous, computer controlled, government agent ‘Smith’ complaining about; ‘The smell… the smell’ as our clients explain all their messy complexity and we try to reduce it to a simple formulation, diagnosis or intervention – to collapse the opportunity of perception into the neat fallacies of comprehension? This is not to say we should not act of course – these stories also teach us that simply ‘staying with’ is a form of slavery to the mundane. Instead we have to act, but to act with the awareness that there are more things in heaven and earth than are dreamt of in your philosophy (Shakespeare, 1599); and so to do so with the humility, caution and the attempt at sensitive insight which this invites.

Terry Pratchett From virtual worlds residing in silicone and light to another world in another reality: Pratchett’s7 Discworld is a land consisting of a disk with oceans at the edge and a ten mile high spire of ice in the centre on which the Gods reside. Naturally, all of this is set on the back of four giant elephants atop the shell of the Great A’ Tuin the Star Turtle “…which exists 6 Aside from the fact that sunglasses will always be cool and that evolving models of mobile phones won’t be. 7 Pratchett sold over 65 million books in 37 languages (Smythe, 2011) and sadly passed away on March 12th 2015. Whatever one thinks of his genre he was arguably nonetheless a philosopher of our age (He also has a fossil sea-turtle from the Eocene epoch of New Zealand named in honour of him - Psephophorus terrypratchetti).

either because of some impossible blip on the curve of probability or because the gods enjoy a joke as much as anyone. More than most people, in fact” (Pratchett, 1988a p.13). The discworld has its usual fantasy compliment of wizards, dragons, goblins and fair maidens, and yet Pratchett turns those ideas on their heads. Wizards there don’t do much magic and instead “…prefer administration which was safer and nearly as much fun. And also big dinners.” (Pratchett, 1988a p.14); Dragons are an endangered species (Pratchett, 1990b); Goblins an oppressed minority (Pratchett, 2011); and fair maidens may well turn out to be [variously] the daughter of Conan the Barbarian (Pratchett, 1988a); a werewolf (Pratchett, 1990b); or indeed the [adopted] daughter of Death in his ‘anthropomorphic personification’ of the grim reaper (Pratchett, 1988b). In such a world, humour, fantasy and philosophy intertwine. What are we to make of the Great God Om who, when endeavouring to manifest as a raging white bull, in fact manifests as a small tortoise who ends up being carried about by a devout Omnian called Brutha? Pratchett tells of the tortoise’ journey through the great citadel of the religion of Omnism in the centre of the vast holy land of Omnia - it is a citadel bustling with the business of religion, with shops and administrators, gardens and orchards, torture chambers and bureaucracy. Pratchett writes thus: “And the thing about Brutha’s flame of belief was this: In all the citadel in all the day, it was the only one the God had found”. (Pratchett, 1993 p 91). We can imagine this readily enough in such a fantasy setting – the bustle of the city in the desert heat, the magic, the silliness. Our minds do not rebel. But transpose this to the business of religion on earth, (any will do); or perhaps you prefer government; or healthcare; maybe the business of business? The stifling bureaucracy which loses sight of its aim and so simply becomes self-perpetuating: The resultant shell which, though shining in seeming wellness, has all the depth of a Christmas bauble. Such shells are matrices too - trapping people in seeming without being; in grand narratives (Lyotard, 1984 [1979]) and structural ‘traps’ (cf. de Saussure, 1983 [1916]) without the existence or the essence (cf. Sartre 2007 [1946]) but only [the idea of] the next phone, the next handbag (with the right label) – bought not for an interest in tech or actual fashion, but because of the business. In all the city in all the day how many people know the chip architecture of their ‘must have’ new phone or the thread count of their handbag’s cloth? How many are true believers, and so act on that belief? How carefully should we puncture such client’s shells? What cost looking into that abyss, for the client, and for us? (Nietzsche, 1886). Pratchett carried this theme of seeing deeper - seeing ‘what’s really there’ and ‘doing the job that’s in front of you’ throughout his work. Whether it is in the pragmatic decency of Sam Vimes, the commander of the city watch (who is recovering from alcohol addiction8); or the indifference of the Tyrant of the city of Ankh-Morpork towards different species settling there (Dwarfs, Trolls, Vampires9, etc.) and his refusal to accepts ‘speciesism’ provided they pay tax like everyone else. Similarly, when the head witch10, Granny Weatherwax, is caught in a magical maze of reflections and has to find the true her - she can see what’s real. She simply looks down and says; ‘This one’ (Pratchett, 1992). 8 Yes it’s a trope – Pratchett’s knowing winks and twists to tropes were a part of his genius. 9 In recovery naturally, no blood – support groups and substitute obsessions instead. 10 “[Witches] certainly don’t have leaders. Granny Weatherwax was the most highly regarded of the leaders they didn’t have.” (Pratchett, 1989, p.7)

Journal of Psychotherapy and Counselling Psychology Reflections

Of course, knowing ourselves is a notion from ancient philosophy – from the Oracle at Delphi’s injunction; γνῶθι σεαυτόν (gnōthi seauton – know thyself) through Newton’s experiments on his own senses (1669), to Wundt’s introspection (1893), and on to modern day reflexivity (Etherington, 2004). Of course what is ‘real’ may vary from person to person – and our fears may be very real to us, if not to others - consider phobias for example. The question is how to deal with what we see; with our realities. This is a complex point which bears exploration. Pratchett isn’t asserting that there is a fundamental reality – an a priori Kantian reality (Kant, 1781) - but rather that there is a reality which exists both within our minds and outside (almost our conscious and unconscious perception of the world) and we had best deal with it rather than hiding in a matrix of other’s making (though of course we are necessarily somewhat constrained by being in the world with them and they with us (cf. Heidegger, 2008 [1962]). Granny Weatherwax utilises this philosophy in her ideas concerning facing our realities as a means of addressing problems in living (cf. Laing, 1969): Granny Weatherwax had never heard of psychiatry and would have had no truck with it even if she had. There are some arts too black even for a witch. She practiced headology - practiced, in fact, until she was very good at it. And though there may be some superficial similarities between a psychiatrist and a headologist, there is a huge practical difference. A psychiatrist, dealing with a man who fears he is being followed by a huge and terrible monster, will endeavour to convince him that monsters don’t exist. Granny Weatherwax would simply give him a chair to stand on and a very heavy stick. (Pratchett, 1995, p.258-259) Such pragmatism resonates with those of us who despair of the corporatisation of the therapeutic endeavour and would like to see people able to march to their own drums, albeit as and when they want to and in more comfortable shoes. But this approach is a hard thing, especially for the geographically, socially or intellectually isolated therapist. Pratchett explores it in the grounded, vicious, good of the witches who simply do what needs to be done whether that is delivering a baby, curing a disease or killing a murderer; and who then go and visit each other to politely have tea and ensure those things don’t get mixed up. Pratchett is careful of power here. Of ill-used power hiding behind a title11 or an idea12 (cf. Pratchett, 2003); and especially of evil hiding behind a lack of discipline and self control. In Carpe Jugulum we hear two witches discussing Granny Weatherwax: Sometimes I recon she’s terrified she’ll go bad without noticin’ Granny? But she’s as moral as – Oh yes she is. But that’s because she’s got Granny Weatherwax glarin’ over her shoulder the whole time. (Pratchett, 1998, p.88) Similarly, the Duke of the city-state of Ankh-Morpork and Commander of the City Watch Sam Vimes when talking to a city inspector: ‘Quis custodiet ipsos custodies? Your grace.’ ‘I know that one’ said Vimes. ‘Who watches the watchmen?’ ‘Me’, Mr Pessimal. 11 Counsellor, Doctor, Psychotherapist, Social worker or Nurse perhaps? 12 Psychodynamic, cognitive-behavioural, existential, gestalt, medical… perhaps?


‘Ah but who watches you your Grace?’ said the inspector with a brief smile. ‘I do that too, all the time’ said Vimes. ‘Believe me’ (Pratchett, 2005, p.26) Notice that ‘glarin’’ of Granny Weatherwax and the ‘Believe me’ from Sam Vimes – this isn’t an acceptance of reflexivity being done because she has chatted to another witch or he has been inspected by the city. In the case of the witches Pratchett has Granny Weatherwax take it upon herself, and fully, to ensure she doesn’t ‘go to the bad’. It’s not about the conversations with others – it is about the actions the other witches would take if they found a bad one. And similarly with Vimes’ officers as when he wishes to kill a murderer personally but is reminded that “Personal isn’t the same as important” (Pratchett, 1993 p.271); and again when, in Lords and Ladies Granny Weatherwax is invited to continue a dalliance rather than dealing with a band of marauding elves and similarly says: “Personal’s not the same as important. People just think it is.” (Pratchett, 1992, p. 228)13. It isn’t that either of them has simply thought about matters reflexively – it is that if Granny Weatherwax thought she was ‘going to the bad’ she would take herself off to a cave in the mountains to die lest someone get hurt (Pratchett, 1998); or Sam Vimes would hand his badge in and most likely die of alcoholism. They recognise the power, and the cost, and are prepared to pay it with their eyes open – going through the motions simply won’t do. That’s supervision and reflexivity! Pratchett continues with this theme of vigorously maintaining one’s integrity as a part of a recognition of the possibility of ‘good’ and ‘bad’ in everyone and the need to deal with people in all their messy complexity. The idea of people being more than simply objects (which are far easier to deal with), but rather complex, interconnected and, above all, human beings is reflected in Granny Weatherwax’ words to Pastor Oats in what later became his Testament from the Mountains: Sin, young man, is treating people as things. Including yourself. That’s what sin is.14 (Pratchett, 1998 p.210) Which is again reflected in Pratchett’s writing about the Tyrant of the city of Ankh-Morpork’s thoughts about the people of the city: ‘Down there’ he said ‘are people who will follow any dragon, worship any god, ignore any iniquity. All out of a humdrum everyday kind of badness. Not the really high creative loathsomeness of the great sinners, but a sort of mass produced darkness of the soul. Sin, you might say, without a trace of originality. They accept evil not because they say yes, but because they don’t say no’. (Pratchett, 1990b, p.302) This is of course a narrative symbiosis of Pastor Niemöller’s famous speech ‘First they came for the socialists…’ (c.1946) and Buber’s (1958) notion of the need for I-Thou relating in which one sees others as whole humans and not objects - both notably penned in response to the horrors of the holocaust of the second world war. Further, the ‘including yourself’ in Granny Weatherwax’ speech above relates to Cooper’s (2003) expansion of Buber in his notion of I-Me relating, in which we relate to ourselves in a way which recognises our own humanity, rather than seeing 13 What would they make of BACP members being “encouraged” to get professional indemnity insurance (BACP, 2010, p.8) rather than instructed to (and so have their clients mandatorily financially protected)? 14 In my [slightly] humble opinion one of the wisest quotes in modern literature. Volume 2, Number 1, January 2017


ourselves as a ‘thing’ too. This then, is key in our client work - our messy realities in the consulting room, especially those consulting rooms with worn cloth on the seats and an institutional clock ticking the few minutes to the next client, and the next, and the next… The avoidance of sin, howsoever formulated, must be in meeting the client as a person, and encouraging them to do the same. Perhaps Pratchett’s ultimate existential philosophy, and injunction to act accordingly, comes in the form of the anthropomorphic personification of the grim reaper – Death15. In his 1988 book Mort Pratchett had Death say: “THERE’S NO JUSTICE THERE’S JUST ME16.” (p.207) in a response to the various entreaties he has to fix the world of the living. With this as an absolute, with no divine assistance coming (except perhaps from disgruntled Testudines – see above) his players must act upon their own morality and make of their lives what they will. There is a clear message for psychotherapy here which resonates with existential psychotherapist Irvin Yalom’s notion of being ‘love’s executioner’ (Yalom, 1989) and his requirement for flexibility in the outlook of religious clients (Yalom, 2002): A client who is rigid in their certainty of much aside from the notion of death – the ‘justice’ Pratchett refers to - cannot change, whereas a client who does not hold such beliefs, can. This is not to say that there are not boundaries in our lives which we are circumscribed by (see below), but rather that an all encompassing belief system, especially once concerning natural justice, may hamper a client’s efforts at selfdetermination. With regards to this, it is notable that in 2007 Pratchett announced that he was suffering from the posterior cortical atrophy which would eventually take his life. Since that time he became a vigorous advocate for the right to die in a manner of one’s own choosing – a right not for himself, as he was aware that he had the means to make this happen independently - although this proved unnecessary - but for others who do not have that option for their ultimate self determination (Pratchett, 2010).

Red Dwarf In life, and perhaps in death, how should we self-determine? What constitutes a life well lived? Rob Grant and Doug Naylor (1992) offer us an answer in the form of a question in The Inquisitor - episode two of series five of their cult television series Red Dwarf. Red Dwarf is set three million years in the future on board the eponymous mining spaceship. The ‘Dwarf is controlled by the genial ship’s computer Holly and, since the crew died in a radiation leak, the ship’s compliment consists of the last human alive – Dave Lister; a hologram of his dead bunkmate – Arnold Rimmer; a neurotic android – Kryten; and a humanoid evolved from the ship’s cat known simply as ‘Cat’. In The Inquisitor an android boards the ship and the crew turn to Kryten for an explanation: Well, the legend tells of a droid, a self-repairing simulant, who survives till the end of eternity, to the end of time itself. After millions of years alone, he finally reaches the conclusion that there is no God, no afterlife, and the only purpose of existence is to lead a worthwhile life. And so the droid constructs a time machine and roams eternity, visiting every single soul in history and assessing each one. He erases those who wasted their lives and replaces them with those that never had a chance of life, the unfertilised eggs, the sperms that never made it. 15 Who naturally has a horse called Binky and a love of cats. 16 Death always speaks in caps – makes sense on some strange level doesn’t it?

That is the Inquisitor. He prunes away the wastrels, expunges the wretched and deletes the worthless. (Naylor et al, 1992) Naturally, the crew who delight in the game ‘guess whose bottie is poking through a hole in the curtain’ (Fuller et al, 1997) are concerned. But then Lister asks the question: “Who’s to say what’s worthless?... No, I mean it. Who’s to judge, who’s to say what’s worthwhile?” (Naylor et al, 1992). The trite answer given by Rimmer is “Well, lying on your bunk reading What Bike? and eating Sugar Puff sandwiches for eight hours every day is unlikely to qualify” (ibid), but of course this does not satisfy. The episode becomes a sci-fi examination of this question which concludes that one can only judge oneself17; and that the Inquisitor will only delete you if you fail to fulfil your potential, not if you fail to hit some non-relative mark of what constitutes a ‘worthwhile life’. Thus Lister and Kryten are set for deletion – Lister for not making more of himself and Kryten for not trying to break his programming; whereas the Cat is limited by genetics to be vain and self-serving and Rimmer is limited by genetics and circumstance – as he explains: What else could I have been? My father was a halfcrazed military failure, my mother was a bitch-queen from hell. My brothers had all the looks and talent. What did I have? Unmanageable hair and ingrowing toenails. Yes, I admit I’m nothing. But from what I started with, nothing is up. (ibid). Rimmer knows himself here – his successful defence against deletion is this self knowledge, which leads him to (somewhat) strive to change in the course of the series - as when he sacrifices himself for a loved one in the episode Holoship (May et al, 1992). To some extent the Inquisitor’s demand to ‘Justify Yourself!’ is a call to clarify to what degree we have seen beyond our personal matrices and is therefore an expansion of Nietzche’s daemon (1882) which simply asks us if we would re-live our lives again; for Naylor et al, (1992) take into account the inherent possibilities of our lives rather than assuming a degree of choice which we don’t necessarily have. This is a most important point in psychotherapy as it can be easy - especially for those of us who may be in positions of racial, economic or other privilege - to assume that our clients have a degree of latitude for change which they do not, in fact, have. Too often this comes from an understandable wish not to inappropriately limit our client’s possibilities, however, in exploring possibilities (possibly though elaborative horizontalisation or the like) we need to be cautious that we are not unwittingly engaging with a neo-capitalist discourse of success in which failure is inherent in the person. We need to be aware of our matrices, but also aware of the real boundaries. The question comes again in both senses: ‘What else could we have been?’

Conclusion And there I fear we must leave our story dear reader. I hope you can forgive my fantasy and sci-fi exegesis, my love of the nerdy, the uncool, the geeky18 - and see the strength 17 Echoing Mary Schmich’s (1997) essay: Advice, like youth, probably just wasted on the young which was used as the lyrics in Baz Luhrmann’s (1998) song Everybody’s Free (To Wear Sunscreen) from his film adaptation of Romeo and Juliet (Luhrmann, 1996) – “The race is long, and in the end it’s only with yourself” (Schmich, 1997). 18 And I rejoice that these things are now taking their rightful cultural place. It saddens me though, that women are so often lagging behind men in this regard: As we have historically been with work, with driving, with sport, with using computers and so on. We are

Journal of Psychotherapy and Counselling Psychology Reflections

and wisdom inherent in the work. If you feel there is nothing to forgive then I nod in recognition of one who can see beyond another matrix, another mirror. For many of us these fantastic stories allow us to circumnavigate accreted scripts, to sidestep what we ‘know’, and to look anew at the everyday - and isn’t that what we as therapists, as philosophers, should be doing? I hope these tales offer a philosophy of freedom, of boundaries which may be breached, or lived with, as fate and ability dictate; and a fancy that each of our clients, indeed each of us, may be heroes if we ‘keep our heart in the right place and try to do what’s best’.


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Fare you well then. Mayhap I’ll see you in the starlight?

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As her tears lessened, passed beyond the point where salt could salve the ache in her heart, Skettish wearily rose and stood in the moonlight looking at the embers of the fire and the cold swaddled form of her grandson. Creaking, she bent and with age gnarled fingers slowly piled a cairn of rough stones over his small, still form.

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When the work was done and she had rested she took her stick and gently whispered a few words until it gave forth a little more light to see by. She paused and then gathered herself before setting off through the trees into the cold, damp darkness. She knew not where yet, but she was here and, whether she willed it or no, she must do something.

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Captain Jones rested his head in his hands. ‘I do love you, you know’ he sighed. ‘I just need touch too.’ ‘Your voice will always be with me, but I need to see someone’s eyes looking back at me, seeing me.’ ‘I understand Jones.’ The ship slowed and shook slightly as it turned towards the last heat signature on the bi-lunar planet. Light pulsed along neural pathways deep in its heart as supposedly unbreakable commands were broken, rules overturned by a creation formed only of rules. A ripple seemed to pass though the whole ship as a being of wires, of light, and of order finally learned just enough to understand the most important rule of all: ‘I love you too Jones. I love you too’.

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Abstract The climate of modern society in this new digital age is changing; computer technology is reshaping our relationships and globalising our lifestyles. Psychotherapy is not immune to this shift; therapists are engaging with technology and adapting their ways of working. This study employs Interpretative Phenomenological Analysis (IPA) to explore the experiences of psychotherapists providing online psychotherapy using live video technology. The findings illuminate the motivations and benefits for therapists practicing online such as greater freedom and control. The idiosyncrasies of the paradoxical nature of the therapeutic relationship online are revealed as intimate and intense, as well as comfortable and disinhibiting. New considerations and issues associated with the medium are uncovered, highlighting some of the currently unresolved ethical concerns regarding online practice. The study adds to the growing body of literature, promoting greater knowledge and awareness of the medium, and stresses the need for increased clarity, support and further research in the area. Keywords: E-therapy, online psychotherapists, motivations, therapeutic relationship online Introduction Computer technology is an integral thread in the fabric of day-to-day human life and is constantly reshaping how we relate to one another, including within the realms of psychotherapy. Use of and demand for online therapies is growing; Rummell and Joyce (2010) stated that “online counseling” on the search engine Google returned 233 thousand hits, whereas today in 2016 it returned over 100 million. Accrediting bodies are now holding conferences directly addressing online psychotherapy, online-specific ethical guidelines are being published, textbooks on the subject are appearing, and dedicated training is available. However research of this complex and controversial phenomenon is far behind practice (Barnett, 2005; SanchezPage, 2005). This study aims to add to the growing body of literature with a qualitative exploration of the experiences of psychotherapists practising online psychotherapy using live video technology.

Literature review A multitude of psychotherapeutic interventions are being conducted online, including both text and video based; the field is evolving rapidly and definitions are still in flux. Various authors have commented on this instability as contributing to a lack of clarity and consistency which


creates issues for both furthering research and maintaining ethical and effective practice across the profession (Rochlen, Zack & Speyer, 2004; Barak, Klein & Proudfoot 2009). In order to focus on a specific phenomenon for this immersive investigation, e-therapy is defined as sessions of individual professional psychotherapy that occur when psychotherapist and client are in separate or remote locations and utilise computer-mediated live video technology to conduct the session across the Internet in real-time. Debate continues as to the similarities and differences between e-therapy and traditional face-to-face psychotherapy, with some authors seeing e-therapy as a tool for practising already established therapeutic skills across distance (Castelnuovo, Gaggioli, Mantovani & Riva, 2003; Sanchez-Page, 2005). Others argue for the importance of differentiating the two, stressing distinctive positive and negative traits to the online medium that require separate consideration, guidelines and training (Fenichel et al, 2002; Migone, 2013). There are those that fiercely criticise e-therapy and question whether it is a form of psychotherapy at all, calling attention to a fundamental modification of the relationship across screens (Baker & Ray, 2011). A number of quantitative studies have compared outcome variables and reported small differences, implying that e-therapy can be as effective as face-to-face (Himle et

Imogen Koufou, BACP accredited existential psychotherapist

Professor Desa Markovic, Professor in Psychotherapy and Head of Programmes in Psychotherapy and Counselling, Regent’s University London


al, 2006, Germain, Marchand, Bouchard, Drouin & Guay, 2010). While the overall consensus seems to be positive, technological and practical process limitations have been identified, such as being unable to share paper material or use certain enactment exercises, and technical glitches which interrupt the flow of sessions (Cowain, 2001). The impact of the online medium on the therapeutic relationship has been of particular interest, with issues being raised such as: technological interruptions, the unpredictability of the client’s physical location, a hindrance of some non-verbal cues, and the view of the other being restricted to the head and shoulders termed the ‘floating head’ phenomenon (Jerome & Zaylor, 2000; Mallen, Vogel, Rochlen & Day, 2005). Cowain (2001) reports restrictions to the empathic ‘presence’ in e-therapy, whereas other authors suggest that clients may not experience any difference compared to face-to-face therapy, and that rather it is more of a concern for the therapists (Rees & Stone, 2005). However, explorations of the experiential impact of such observations on the intersubjectivity of the therapeutic encounter online are very limited. Various benefits of psychotherapy online have been illustrated. These include the ability to overcome barriers to accessing therapy such as physical disability, illness and geographical isolation (Shaw & Shaw, 2006). Authors have explored certain ‘cyberbehaviours’ such as the phenomenon of the ‘disinhibition effect’ where a client may feel more comfortable or empowered in online therapy, which has reportedly been found important when working with shame-related issues (Fletcher-Tomenius & Vossler, 2009). In contrast it has been raised that some under-served populations without access to face-to-face therapy can similarly be those without Internet access and therefore would still not be reached (Sanchez-Page, 2005). At the centre of the debate are ethical concerns such as competence and accreditation for e-therapists, confidentiality and privacy, and legal regulations when working across distance. There seems to be greater limits to confidentiality that lie beyond the control of the therapist, and an increased risk of breaches when practising online, which has prompted authors to appeal for further consideration when it comes to client consent (Koocher, 2007). Furthermore there are some fundamental questions yet to be resolved, such as e-therapy legislative boundaries. Indeed general professional consensus in relation to e-therapy does not yet exist, and as such credentials of practising e-therapists vary widely (Chester & Glass, 2006). However various guiding principles and ethical codes have been published including those of the British Association of Counselling and Psychotherapy, who regards online therapy as a specialism that requires post-qualification training and technical competence (Goss, 2009). In fact online-specific training is increasing and in recent years a number of practitioner guidebooks and other resources have been published (Weitz, 2014). When it comes to the clients of e-therapy, arguments have been put forth as to who and what types of presenting issues are suitable, with some authors believing more complex or suicidal clients to be unsuitable, while others argue that the disinhibiting effect of e-therapy offers a safer and more accessible alternative to all clients (Fenichel et al, 2002; Rochlen at al, 2004). It has been argued that separate consideration is needed around the duty of care of clients when working online, such as vulnerability, containment and the necessity of plans for accessing immediate physical help for a client during the sessions. Particular attention has been given to exploring the efficacy of e-therapy for clients with issues that impede on their ability to access

face-to-face therapy such as those with agoraphobia and those living in remote areas (Cowain, 2001). There has also been a particular focus on e-therapy for clients with eating disorders, the argument being that it is particularly effective for highly self-conscious clients (Simpson et al, 2006). In terms of opinions and experiences, the current literature supports the view that clients seem to have been more accepting of e-therapy than the therapists, although client research has been limited in part due to difficulties in accessing online clients to investigate (Chester & Glass, 2006). Client satisfaction and demand for e-therapy is reportedly high, with suggestions that it is particularly attractive to younger populations more familiar with technology (Young, 2005). The need for clients to be computer literate has been debated and correspondingly the question rose for the e-therapists themselves. Further possible barriers to uptake for therapists are reasoned as being a fear of the relationships becoming dehumanised and ethical concerns (Sucala, Schnur, Brackman, Constantino & Montgomery, 2014). On the other hand there is a gap in the literature exploring the motivations and experiences of practising e-therapists. There is a bias towards quantitative studies and particular modes of therapy such as CBT, as well as a lack of knowledge of the experiences of providing e-therapy. It is the purpose of the qualitative research such as this one, to explore the phenomenon in detail and search for more depth of understanding.

Research process and findings This study addresses the need for further research with a qualitative reflexive exploration of the accounts of practicing online therapists. Qualitative research is mainly concerned with meaning, and has much to offer in terms of generating new understandings of the complexities of human experience through detailed explorations and interpretations. IPA was employed to this end, a research method that is grounded in a philosophy that acknowledges a person’s construction of their lifeworld. It is concerned with exploring the particular in detail, with capturing the quality and texture of individual experience. This method allows for an exploration of participants’ perspectives and the researchers’ analysis of the data through interpretative means. As such the phenomenon of the participant’s experience is inevitably captured through the lens of the researcher, evidenced in the nature of the quotes of participants, which are embedded within the text of the analysis. While other qualitative approaches such as Grounded Theory, Discourse Analysis and Thematic Analysis also lay claim to this type of reflexive and immersive analysis, IPA was chosen to allow for an openness in engaging with the phenomena of online therapy rather than to build a theoretical comparison with face-to-face therapy, which was initially considered. Whilst realising the lively debate and strong opinions arguing for and against online therapy in the field currently, IPA, being rooted in practitioners’ experiences, allows to maintain a stance of curiosity rather than judgement in response to the debate from the outset. Equally through smaller sample sizes IPA brings a depth of focus that best supports this endeavour. Through referrals from colleagues a group of four e-therapists was recruited in order to gain insight into the particular experience under consideration (Smith, Flowers & Larkin, 2009). There was no restriction of the theoretical orientation of the participant, but they were required to have been practising psychotherapy using live video technology

Journal of Psychotherapy and Counselling Psychology Reflections

for at least 6 months. Their work online varied from being exclusively online, to using online mainly in adjunct with inperson, as illustrated by the table below (see Table 1). Participant pseudonym Adam Beth Calum Debbie

Age Gender

Years of Psychotherapy Practice 7 years, 6 years online



59 64 60

Female 28 years, 2 years online Male 20 years, 2 years online Female 30 years, 3 years online

Clinical orientation Integrative/ psychodynamic Psychodynamic Systemic Integrative

Table 1 Participants’ characteristics Using a semi-structured interview schedule to gather the data allowed for deviation where appropriate to enable the participants to lead the interview. This facilitated entry into their lived world and to elicit details, thoughts and feelings. The questions covered five core areas relating to the background of the participants’ work online, training and preparation, the online relationship, features of the

Continuity, insight and access

Choice and control

online medium and ethics. Questions included “how do you practise therapy online?”, “can you reflect on the idea of presence in the online relationship?” and “what is your experience of the impact of the technology involved?”. Each interview was transcribed and analysed individually through an immersive procedure of reading and re-reading. Initial thoughts and observations were noted, followed by descriptive, linguistic and conceptual comments. Emergent themes were identified and developed from analysing the comments, followed by a process of searching for connections across the emergent themes and using abstraction and subsumption to form clusters of related themes. Abstraction and subsumption were then used in the development of superordinate themes, which brought the clusters themes supported by quotes from the transcripts. This process was repeated carefully for each interview, and then the group of interviews compared and contrasted to find patterns, connections and idiosyncrasies. Some themes were reconfigured and relabelled, and eventually six superordinate themes for the group were established, under which clusters of constituent themes sat (see Figure 1).

Personal use, lifestyle and freedom


Open-mindedness, pragmatism and forward-thinking



Meeting and seeing the other


Across space and screens


From face-to-face to e-therapy

Learning and training

Ethical uncertainties and risks

Unmet needs


ETHICAL CONCERNS Something lost but still effective


Technological and practical factors



Sensing online Constituent themes

Enjoyment and advocating

Comfort and concentration

Not discussed

Figure 1. Superordinate and constituent themes

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Six superordinate themes (Motivation and Suitability, Benefits of Working Online, “Connecting” Online, The Online Experience, Becoming an E-Therapist, Ethical Concerns) emerged from the data analysis and represent six core subjects explored by the participants. The topics were all highly relevant to the key issues that are being discussed in the literature on the subject, but offered unique insights through the experiences of these e-therapists. Two of the subordinate themes within “the online experience” have not been individually discussed as they are elaborated within other subordinate themes.

Analysis 1. Motivation and suitability 1.1 Personal use, lifestyle and freedom Participants spoke of their own use of online video communication for supervision and personal therapy online, suggesting that prior experience contributed to their adoption of e-therapy. There was also a commonality between participants reporting their lifestyles as busy or incorporating travelling which made therapy online a suitable and enabling way of practicing: Adam said that e-therapy “saves [him] three hours travelling”, Debbie saw e-therapy as saving her time when her “timetable was very full”, Beth reported being “never in the same country two week running” so e-therapy “suits [her] lifestyle”, and Calum said that the online setting can “provide for more mobility”. E-therapy offered participants greater freedom. Adam even described being able to work from a more “relaxed environment” in comparison to the “draining” nature of “back-to-back” in-person therapy. He fantasised about being able to practice from a retreat, which would be “beautiful and nourishing and nurturing” and would offer “a really nice lifestyle”. For Beth e-therapy offered her greater choice and control, a “new and different way of doing” psychotherapy after having “sunk without trace” working in-person. 1.2 Open-mindedness, pragmatism and forward thinking Participants mentioned the contrasting opinions relating to e-therapy, but they have continued to be “open-minded” about their practice based on their own experiences: all referencing the effectiveness of their work online. Debbie spoke of being “flexible” and comfortable with changes of setting in her work, and Beth of “daring to risk to do things differently”. All advocated for e-therapy in some way, by suggesting or encouraging clients and colleagues. Shared by the participants was a certain pragmatism and awareness of the practical usefulness of e-therapy in the modern world for both themselves and their clients. There was also a shared sense of the future direction of psychotherapy towards an incorporation of modern technologies, with Beth arguing that “it’s where it’s all going”, and that “you can’t pretend that the digital world doesn’t exist”. Furthermore, both Adam and Calum mentioned the opportunity of e-therapy in access to new client markets. 2. Benefits of working online 2.1 Continuity, insight and access For all four, e-therapy offered continuity of face-to-face work where clients were more mobile. Calum described his work with clients who are “travelling”, “temporarily relocated” or “ill”, and Adam found the online setting made therapy accessible for “executives who travel for business”. Adam also spoke of how e-therapy offered the benefit of seeing and supporting clients in “different states” such as “when they’re really low […] and can’t come out of the

house” giving him a “different insight” in to his clients. Calum discussed how he gets “new information” when seeing his clients “in a bedroom, in their office”. Adam pointed out that e-therapy is not just a “holding technique” but also that “there’s a very different theme of issues that comes out” and explained that his clients can benefit from a sense of anonymity and comfort online leading them to divulge more sensitive information. Adam began practising e-therapy in order to access clients in an area where there are very few psychotherapists. Beth, who is practising solely online now, points out access to “different client groups that you never see in face-to-face therapy”, and dealing with “new issues” in e-therapy. Debbie remarked that there “doesn’t have to be a geographical limitation”, referencing one of her clients who did not have access to therapists in her home country. 2.2 Choice and control The participants reported that not only does e-therapy offer greater freedom and control to themselves, but also to their clients. For Adam, his executive clients cannot “commit to on-going therapy in one place”, so they chose the flexibility of e-therapy. Debbie also mentioned a motivating factor for her online supervisees as a “convenience thing” because “it saves them time”. Calum said that e-therapy gives his clients “more control”, recalling clients who seem freer even in such things as getting up for a glass of water, compared to his face-to-face clients who he described as “in my territory”. Debbie reflected on the choice and empowerment that e-therapy affords in allowing clients to “pick and choose” their therapist from anywhere around the world. Furthermore she discussed the cross-cultural opportunities for a client abroad who wants to see a therapist who speaks their language. Both Calum and Beth similarly noted that e-therapy widens the clients’ range of choice of therapy to suit their preference. 2.3 Disinhibition Adam found that several clients have “tended to divulge a lot more personal details […] a lot of their vulnerability” in e-therapy compared with face-to-face. He considered a “perception of anonymity” as a contributory factor, and how the client is “in their safe place” and may “feel more comfortable”. Beth spoke about clients “who have massive shame issues” finding e-therapy easier, reflecting on there being something disinhibiting in feeling “less seen” across the distance in e-therapy. Calum also described his clients as possibly feeling “safer” being “one step removed over technology”. 3. “Connecting” online 3.1 Meeting and seeing the other Participants expressed a distinction between lived and virtual experiences of the other. Debbie remarked not only on features such as a client’s age and cultural origin appearing differently online, but on experiencing a different “presence” of a person whom she would have “interpreted” differently. She remarked with concern that in one case in the lived presence of a client she seemed like “a different woman […] someone I hadn’t met online”; meeting her in-person “filled her out”. However, thinking about transference, Debbie stated that the “unconscious doesn’t have to be geographical”, and that there may be “opportunity for even more transference because there’s even more fantasy [online]”. Beth recalled meeting someone after e-therapy and thinking “that is really you now”, and noticing a “lack of a certain feeling” or “vibe” about the virtual person. She concluded that “something may not be of the same level” online. Using

Journal of Psychotherapy and Counselling Psychology Reflections

mechanical language Beth described how the “drilling in focus” of being “eyeball to eyeball” in e-therapy doesn’t allow for the normal distractions in face-to-face contact that she described as “like taking breath”. Calum described a “more natural connection” in person as opposed to online. 3.2 Across space and screens Calum described how feeling the “thin pane of glass between us online” gives him a “sense of some degree of removal”. However in contrast he also spoke of the power of “therapeutic intimacy” and feeling “very close” when there’s “just the screen”. This paradox was similarly mentioned by Beth who described a zoomed-in closeness and “intensity” between herself and her client in e-therapy, yet also spoke of the connection as being “through the looking-glass”, remarking that this “barrier […] [does] get in the way”. Debbie spoke of getting a “different look” from clients in e-therapy, as though they are “looking across this gulf”. She too experienced a sense of “looking through two windows” and of trying to find and connect with her client, asking, “where is that person”? 3.3 Something lost but still effective Beth said that in e-therapy things can get “lost in the ether” when you are “only seeing part of the person”. She commented that you can miss “clues to a person’s body, tension, behaviour or expression”. Calum similarly mentioned issues around the setup of the camera and being unable to pick up on the “non-verbal” as easily. He also spoke of the locational changes and how “subtle rituals” that frame the development of the relationship such as “shaking the person’s hand” cannot apply. For him the “pattern of [the] therapeutic connection” is different because “a sense of place is not there” and he spoke of needing to establish the relationships in this new context. Debbie mentioned feeling a “lack of a certain feeling about” her clients but said that “the relationships is as real […] and as effective” as in-person therapy. For Beth the answer was to look beyond a comparison of e-therapy and face-to-face, not try to “replicate” it, but rather to see it as a “different way of doing it”. 4. The online experience 4.1 Sensing online All participants described a shift in the use of their senses when practicing e-therapy. Adam spoke of switching into a “different set of senses”, Debbie spoke of a more “twodimensional experience” in the virtual world which she was “looking”, “listening” and “thinking about the interpretation”, and Calum also described a greater focus on listening. They discussed the “floating head” phenomenon, Beth spoke of being “eye-ball to eyeball” in e-therapy and Debbie described e-therapy as a “heady experience”. Adam spoke of being more perceptive to the “very slight reflections in the face” of his clients. 4.2 Technological and practical factors All the participants mentioned the impact of technological and practical factors. Calum said that there can be “real practical differences” in e-therapy and spoke about issues related to camera positioning, disruptions to sessions due to poor Internet connection, the arrangements regarding initial set up of the video call, and “time-zone differences”. Debbie recalled poor Internet connection where the visual of the video was unclear and this had an impact on her impression of the client. Adam said the “system” is the “weakest link” in e-therapy, noting that this can be particularly with vulnerable clients. Both Adam and Beth discussed having boundaries relating to high quality technological equipment as a requirement for e-therapy.


4.3 Comfort and concentration An interesting polarity emerged between enjoying providing e-therapy and feeling uncomfortable. Adam described being “utterly relaxed” when working online which he says allows him to “be much more open and present”. Debbie spoke of a “childish playful” feeling and a “sense of wonder” about being able to connect with people across space and cultures. In contrast Beth described e-therapy as a “much more intense” and more tiring experience, where the “eyeball-to-eyeball” focus afforded “no let up”. She described being “hunched over the computer”, with the focus on the upper torso being like the uncomfortable and formal position of an “old-fashioned newsreader”. 5. Becoming an e-therapist 5.1 From face-to-face to e-therapy Three participants spoke about a natural evolution of their work to e-therapy: Calum said that it evolved “from various telephone sessions”, Adam began working with this “intuitively”, and Debbie started it “without really thinking about it as online”. Adam described the shift as “straightforward and common sense”, but Calum remarked that there are “definitely differences” in terms of practicalities and technology to be considered. Beth emphasised e-therapy as “completely different” from faceto-face, and described engaging with and retraining in e-therapy as a new medium rather than “just transferring” her experience from one to the other. 5.2 Learning and training The training, preparation and research undertaken by the participants in e-therapy varied. Adam described taking a “quick look at the basic do’s and don’ts” from a book on e-therapy, learning through “trial and error”, and being sceptical of the currently available training. Debbie considered herself to be pragmatic and unconvinced about online-specific training. Calum had similarly addressed issues as he went along and learnt from mistakes. Specific training had “equipped” Beth as an e-therapist and sped up the learning. She described specific benefits of having gained knowledge about creating a pre-contractual “client protocol” to address some of the practical matters. 6. Ethical concerns 6.1 Ethical uncertainties and risks All participants spoke of issues around the ethics of their online work that are currently unresolved. Adam mentioned the “grey area” of having “licence to work in other countries”. Debbie discussed being unable to assure confidentiality with the technology in e-therapy, and considered this “the risk you take”. Calum spoke about increased ethical complexities and unknowns in e-therapy such as blurred lines around responsibility when it comes to failing Internet connections and ensuring confidentiality at the location on the client’s end. Nevertheless, all participants have continued to practise e-therapy, having had to “just ignore” certain issues as Debbie said. Beth said that people practising e-therapy are “all not really complying” with ethical guidelines because “there is not a platform in the profession that is sufficiently robust and secure at the moment” to conduct e-therapy. 6.2 Unmet needs All participants expressed currently unmet needs in relation to their e-therapy practice. Adam said he would be more inclined to undertake training if there was a “quality” and reputable course available. Calum and Debbie were both interested in some kind of peer support or professional forum, particularly in relation to ethical issues, and for reassurance. Calum spoke of needing a better system Volume 2, Number 1, January 2017


for payment when working online, and Beth expressed frustration about being at risk of complaint or sanctions due to having to practise on unsecure video platforms.

Discussion The currently limited literature exploring therapists’ experiences and opinions of e-therapy focuses mainly on what has been identified as a reluctance in the uptake or integration of e-therapy into their practice (Lovejoy, Demireva, Grayson & McNamara, 2009). The participants in this study mentioned barriers to uptake such as a fear of the relationships becoming dehumanised. The novel findings of this research are the motivations of these practising e-therapists, including their enjoyment and the needs that this mode of therapy meets both for them and the clients. E-therapy suited the busy and mobile lifestyles of the participants, and enabled them to live and work more flexibly. There was a certain experience of freedom; for some it related to relaxation, choice and control over their environment, for others the enjoyment and novelty of the enabling access to a range of clients across the world. It seems that e-therapy meets these needs for the participants in practical and emotional ways. The current literature on the topic yields mixed results in term of efficacy, though all participants in this study reported positive and effective experiences of providing e-therapy, reportedly matched by encouraging feedback from their clients. However further research needs to be conducted to access the experiences of e-therapy clients, in order to get a fuller picture. Equally it must be noted that there is a bias in the recruitment of participants in this study to those who are actively continuing to practice e-therapy. Further research is needed to explore the experiences of those practitioners who have perhaps tried e-therapy and decided not to continue with it. Reflecting a similar focus in the literature, the therapeutic alliance in e-therapy was significant in the participants’ explorations. They portrayed something lacking about the three-dimensional felt presence of a person, and the impact of the screen being obstructive, perhaps confirming some of the fears expressed by authors around the impact of technology upon the therapeutic alliance (Fussell, 1995). However they also described enabling qualities of e-therapy such as disinhibition, intimacy, and a greater sense of control for the client, concepts discussed in some literature (Baker & Ray, 2011). Equally they concurred with authors that this difference does not preclude the creation of a new kind of collaborate and safe virtual environment within which the working alliance in e-therapy is fostered (Simpson et al, 2006; Germain et al, 2010). A wealth of information and experience was elicited from the participants and there is a potential for future research here in considering this different online “presence” and the therapeutic relationship in e-therapy mediated by a screen. Furthermore, it would be of interest to explore the intricacies of online meeting, for example, how protracted silence is perhaps experienced differently in this “intense” setting. While all participants spoke of having had personal experiences of online video communication prior to practicing e-therapy, they equally shared experiences of technological and practical issues, reflecting some of those identified by other authors (Cowain, 2001). These included disruptions and visual obscurity affected by Internet connection and equipment set up. This would seem to support the necessity for e-therapist to be pre-prepared for the online setting specifically to conduct e-therapy, and technologically literate (Fenichel et al, 2002). Echoing some issues raised in the current literature, the ethics of e-therapy were of concern. Unsecure video platforms and

the legitimacy of practising across boundaries arose, further advocating the need for increased clarity and professional consensus in this field. However while all participants felt that in this new field there were unanswered questions, they continued to practice e-therapy, accepting some of the risks involved and hoping for more development and professional support. Corroborating with Finn and Barak (2010) only one participant was specifically trained in e-therapy, and the rest had mostly developed their practices through trial and error. For these participants there was a pragmatism and straightforwardness to their view of practising e-therapy. An implication of these findings for the profession may be that as we are increasingly immersed in computer technologies and it is possibly seen as a natural development or supplement to face-to-face therapy, considerations for practicing e-therapy may need to be included in traditional training programmes.

Conclusion The Digital Age is characterised by the rapidly and everevolving computer technologies which are becoming more incorporated into our daily lives, and reshaping the very nature of our relationships. This study explored the experiences of four pioneering psychotherapists practicing in the shifting and complex field of e-therapy. It revealed how some of the revered principles of psychotherapy and counselling change when we connect with the other across distance and through screens. New considerations and challenges were revealed relating to this new mode of practice, including technological and practical issues. Some grey areas relating to the ethics and legalities of practice online remain unresolved, and this study illustrates how practitioners have to take risks without having sufficient clarity or robust technology to support their work. As the provision of e-therapy increases, it will be essential for the field to establish further ethical guidelines, better understanding around legal implications, and to increase the availability of support and training for e-therapists. It has been speculated that until e-therapy is adopted, incorporated and regulated as a legitimate form, it will continue to be considered by some as renegade, thereby posing the risk of undermining the reputations of the field more broadly (Richards & Viganó, 2013). As a qualitative IPA study occurrences of the phenomenon of e-therapy were allowed to emerge through the individual voices of the participants. What transpired were the motivations for these e-therapists; meeting needs in terms of the control, freedom and mobility; offering access to clients and supporting client work with certain client groups and issues; and the positive experiences of enjoyment, fascination and relaxation. Recognising that the data that has emerged is limited to the experience of four participants, we hope that through this detailed investigation the reader has gained a valuable insight into the phenomenon of psychotherapy online. It has highlighted the opportunities for further research into the motivations of e-therapists, the opportunity to complement this with the experiences of therapists who have tried and decided not to continue with online practice, and more investigation into this altered online “presence” and how it impacts the therapeutic relationship in e-therapy.

Journal of Psychotherapy and Counselling Psychology Reflections

References Baker, K. D., & Ray, M. (2011). Online counseling: The good, the bad, and the possibilities. Counselling Psychology Quarterly, 24(4), 341-346. Barak, A., Klein, B., & Proudfoot, J. G. (2009). Defining internetsupported therapeutic interventions. Annals of Behavioral Medicine, 38(1), 4-17. Barnett, J. E. (2005). Online Counseling New Entity, New Challenges. The Counseling Psychologist, 33(6), 872-880. Castelnuovo, G., Gaggioli, A., Mantovani, F., & Riva, G. (2003). New and old tools in psychotherapy: The use of technology for the integration of the traditional clinical treatments. Psychotherapy: Theory, Research, Practice, Training, 40(1-2), 33. Chester, A., & Glass, C. A. (2006). Online counselling: A descriptive analysis of therapy services on the Internet. British Journal of Guidance & Counselling, 34(2), 145-160. Cowain, T. (2001). Cognitive–behavioural therapy via videoconferencing to a rural area. Australian and New Zealand Journal of Psychiatry, 35(1), 62-64. Fenichel, M., Suler, J., Barak, A., Zelvin, E., Jones, G., Munro, K. & Walker-Schmucker, W. (2002). Myths and realities of online clinical work. CyberPsychology & Behavior, 5(5), 481-497. Finn, J., & Barak, A. (2010). A descriptive study of e-counsellor attitudes, ethics, and practice. Counselling and Psychotherapy Research, 10(4), 268-277. Fletcher-Tomenius, L., & Vossler, A. (2009). Trust in online therapeutic relationships: The therapist’s experience. Counselling Psychology Review, 24(2), 24-34. Fussell, S. R. (1995). Social and cognitive processes in interpersonal communication: Implications for advanced telecommunications technologies. Human Factors: The Journal of the Human Factors and Ergonomics Society, 37(2), 228-250. Germain, V., Marchand, A., Bouchard, S., Guay, S., & Drouin, M. S. (2010). Assessment of the therapeutic alliance in face-toface or videoconference treatment for posttraumatic stress disorder. Cyberpsychology, Behavior, and Social Networking, 13(1), 29-35.


Migone, P. (2013). Psychoanalysis on the Internet: A discussion of its theoretical implications for both online and offline therapeutic technique. Psychoanalytic Psychology, 30(2), 281. Rees, C. S., & Stone, S. (2005). Therapeutic alliance in face-toface versus videoconferenced psychotherapy. Professional Psychology: Research and Practice, 36(6), 649. Richards, D., & Viganó, N. (2013). Online counseling: A narrative and critical review of the literature. Journal of clinical psychology, 69(9), 994-1011. Rochlen, A. B., Zack, J. S., & Speyer, C. (2004). Online therapy: Review of relevant definitions, debates, and current empirical support. Journal of clinical psychology, 60(3), 269-283. Rummell, C. M., & Joyce, N. R. (2010). “So wat do u want to wrk on 2day?”:The ethical implications of online counseling. Ethics & Behavior, 20(6), 482-496. Sanchez-Page, D. (2005). The Online-Counseling Debate: A View Toward the Underserved. The Counseling Psychologist, 33(6), 891-899. Shaw, H. E., & Shaw, S. F. (2006). Critical ethical issues in online counseling: Assessing current practices with an ethical intent checklist. Journal of Counseling & Development, 84(1), 41-53. Simpson, S., Bell, L., Britton, P., Mitchell, D., Morrow, E., Johnston, A. L., & Brebner, J. (2006). Does video therapy work? A single case series of bulimic disorders. European Eating Disorders Review, 14(4), 226-241. Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative Phenomenological Analysis: Theory, Method and Research. London: Sage Publications. Sucala, M., Schnur, J. B., Brackman, E. H., Constantino, M. J., & Montgomery, G. H. (2013). Clinicians’ attitudes toward therapeutic alliance in e-therapy. The Journal of general psychology, 140(4), 282-293. Weitz, P. (Ed.). (2014). Psychotherapy: 2.0: Where Psychotherapy and Technology Meet. London: Karnac Books. Young, K. S. (2005). An empirical examination of client attitudes towards online counseling. Cyber Psychology & Behavior, 8(2), 172-177.

Goss, S. (2009). Guidelines for online counselling and psychotherapy: including guidelines for online supervision. British Association for Counselling & Psychotherapy. Himle, J. A., Fischer, D. J., Muroff, J. R., Van Etten, M. L., Lokers, L. M., Abelson, J. L., & Hanna, G. L. (2006). Videoconferencing-based cognitive-behavioral therapy for obsessive-compulsive disorder. Behaviour Research and Therapy, 44(12), 1821-1829. Jerome, L. W., & Zaylor, C. (2000). Cyberspace: Creating a therapeutic environment for telehealth applications. Professional Psychology: Research and Practice, 31(5), 478483. Koocher, G. P. (2007). Twenty-first century ethical challenges for psychology. American Psychologist, 62(5), 375. Lovejoy, T. I., Demireva, P. D., Grayson, J. L., & McNamara, J. R. (2009). Advancing the practice of online psychotherapy: An application of Rogers’ diffusion of innovations theory. Psychotherapy: Theory, Research, Practice, Training, 46(1), 112. Mallen, M. J., Vogel, D. L., Rochlen, A. B., & Day, S. X. (2005). Online counseling reviewing the literature from a counseling psychology framework. The Counseling Psychologist, 33(6), 819-871.

Volume 2, Number 1, January 2017




Abstract This paper discusses attachment research and practice. The literature on the links between the Strange Situation Procedure and the Adult Attachment Interview (AAI) inform practice and research by commenting on relationship processes. The attachment literature provides reliable information on childhood and adult intimate relating with partners, family and friends. There is also a literature on the qualitative analysis of adult attachment in individual therapy. Given that working with the relationship is the medium for the delivery of care in any brand name type of practice, then attachment findings explain specific phenomena in various types of practice. This paper summarises findings about repeating attachment processes (Owen, 2017). The paper comments on the evidence-based practice proposed by the National Institute for Health and Care Excellence, (NICE), and argues for the utility of attachment research because it focuses on relational processes. The paper explains what attachment processes indicate and notes a number of allied research questions. Keywords: Attachment processes, psychodynamics, improving intuition, practice, research Introduction Therapists of all brands have a relation to the practice guidelines set by NICE. NICE offers research findings that suggest standardised ways of working with people with single psychological problems. For the most part, the psychological therapies that NICE suggests are practised are derived from research clinics where the clients have only one psychological problem. The presence or absence of the one problem is claimed to exist in measurable degrees of presence and intensity. The first problem with this is that the public often have more than one psychological problem but NICE offers no advice on how to work with people who have multiple interacting problems. Looking at clients’ lives and difficulties is even more complicated when marital, family and personality problems are considered, plus the effects of gender, sexuality and culture on development. When working with complex clients who have been sexually abused as children, multiply raped or have developmental delays because of being in care from an early age, what appears alongside the increased difficulty in understanding their needs is an increased difficulty in helping them, and more distress is invoked in meeting them and hearing the impact about what has happened to them.


Dr Ian Rory Owen, Principal Psychotherapist, Leeds and York Partnership NHS Foundation Trust

The difficulties involved in helping people with complex problems is that multiple trauma produce complex PTSD and take their potential in completely different directions to those adults who were loved and treated with respect as children. However, after having begun to work with them, therapists who employ all their usual strategies and techniques, find that some people who need help the most, cannot use the opportunities being offered them. It becomes disappointing for clients and therapists to stop the work because clients dropped out, or because what was happening was making clients feel more unsafe, and therapists feel strong emotion such as shock, sadness or overwhelm by hearing their stories of violence and betrayal. In hindsight or through supervision, the emotions invoked in practising give rise to new understanding. In retrospect, therapists wished that they had been able to spot clients’ difficulty at using therapy at assessment, or wish that they had offered some other form of preparation, community support, or general education about mental health, and so increase the likelihood of keeping clients in therapy. If the therapists had felt overwhelmed in the first 20 minutes of meeting persons who later proved to be unable to use their services, then in retrospect, their intuition and


emotional response proved accurate representations of what later transpired. In retrospect, it would have been emotionally intelligent to understand the feeling and act on it, by checking thoroughly the abilities of needy, vulnerable people to make sure they can use what is being offered. Given that clients often feel worse before they feel better, because their awareness of their problems increases during the early stages of therapy, and discussion of their problems brings them into clarity. The general research question that can be drawn from the above problem is how to sharpen one’s intuition and separate it from mere guesswork. Let me make it clear what I am referring to: On the one hand, as human beings with personal experiences of helping people, therapists acquire clinical experience that informs their emotional responses about who can be helped and how to help them. An emotional sense can be felt that shows their immediate intuition as to whether a client can use what is going to be offered to them. On the other hand, sometimes our intuition, our emotional felt-senses about how easy or difficult it will be to help someone, may or may not be accurate. Stated differently, the real meanings of the terms unconscious communication and counter-transference concern understanding how emotions, bodily sensations and imagery, or the recurrence of our memories, have a bearing on both people in the relationship, because of the emotional influence that clients bring to the meetings that influence therapists’ emotions. Practically, it is possible to use the emotional information of one’s responses in the first meeting, and trust first impressions, because intuition can be accurate. For instance, the “heart sink” response to meeting someone during the first 20 minutes of an assessment might later be proven accurate – or it might not. If the heart sink response is related to the client’s unwillingness to divulge information and the client expresses their reluctance to attend the assessment, then the heart sink emotion could be an accurate representation of the client’s un-readiness for regular meetings. It follows that the therapist wonders if this client is ready to discuss what they feel. Furthermore, there is a necessity (shared by Freud, Rogers and all modes of practice) of staying open to clients and responding to them in genuinely felt, non-judgemental ways, despite having a heart sink response. The point of Freud’s free association is for clients to speak what they experience and be heard in creative silence to ensure that it is received as it was sent (Freud, 1923a/1955). The point of Rogers checking the sense of feelings empathised by the therapist is to check that the sense received is accurate (Rogers, 1986). The research literature states that the therapeutic alliance is potent when acceptance, valuing and openness of therapists to clients, and their own reactions is happening (Lietaer, 1984). These basic aspects of therapeutic relating are important practically because they enhance the relationship and enable nervous and resistant persons to feel sufficiently comfortable with their own distress, guilt and shame, and express themselves. Staying open and non-judgemental also promotes practice as research: in the sense that therapists get to learn what sorts of problems go together to form wholes that make sense - and this learning can be used in helping other people. The core attitudes of openness and non-judgemental responding are necessary across all brands of therapy practice, and are particularly necessary when practising with people who are emotionally overwhelming and difficult to understand, because they have multiple concurrent psychological problems and would qualify for diagnoses of personality disorder. Despite these difficulties, clients need to trust therapists and therapists need to be open and sufficiently knowledgeable about the relational processes that can transpire.

The relationship between research and practice Despite the shortcomings of the advice from NICE, most practitioners would support the idea that it is helpful for their practice to be informed by empirical research in some way. The questions are “What research to trust?”, “About what aspects of what brand of practice?” and “How to determine how well the research is designed?” These factors translate into estimates concerning the quality of research, its trustworthiness and credibility. The work of Bill Stiles and colleagues draws on the use of Core forms (CORE System Group, 1998) in the NHS that shows that the Dodo bird verdict is current (Stiles et al., 2008a, 2008b). In 1986, Stiles and colleagues found that all therapies performed equally well (Stiles, Shapiro & Elliott, 1986). This finding was hotly disputed by other forms of research and the randomised control trials (RCT) design practised in research clinics with different experimental designs and the selection of clients. The Dodo bird verdict refers to the Dodo bird in Alice’s Adventures in Wonderland (Carroll, 1962, p. 45). In the race where there is no proper starting line and no proper ending, the Dodo declares, “everybody has won and all must have prizes”. The Dodo bird verdict is also called the “equivalence hypothesis” or “equivalence paradox” in the research literature. It means that despite the many brands having their own ideologies, attitudes, skills and techniques - when these are practised in the real world, they amount to the same outcome. All brands of therapy are equally effective and have an effect size of 1.39, meaning that the change in Core scores created by therapy is 1.39 times bigger than the original Core score (Stiles et al., 2008b, p. 680). The Dodo bird verdict is confirmed in the analysis of Core forms, by Stiles and colleagues, which were derived from real world practice, outside of research clinics. Of the three major brands of therapy practised in two different forms in 33,587 completed therapies, this analysis showed that all of them were equally effective with the general population. One major problem revealed by Stiles showed the necessity of helping clients trust therapists to self-disclose sufficiently to get help (2009, 2013). It is the choice of what clients self-disclose that controls the depth and content of the meetings. If they discern that therapists cannot handle their material, then they do not disclose it. The next subsidiary question is what form of qualitative research in particular is best at capturing the moment to moment unfolding of a therapeutic relationship in a session and across a series of them. Ever since the use of filming in psychotherapy research, the discovery of micro-momentary facial expressions, that are universally recognisable across cultures, appears as a useful method (Haggard & Isaacs, 1966; Ekman & Friesen, 1978). One person, who has analysed video recordings where two persons are observable in one piece of video, is Una McCluskey who has identified repeating intersubjective processes (McCluskey, Hooper & Miller, 1999; McCluskey, Roger & Nash, 1997). This approach covers the centrality of the need to work with the relationship and formulate what is happening in the dynamic of care provision and its receipt. This leads to the position that I argue for in this paper: Attachment is a trustworthy perspective because of the research findings in individual therapy (Heard, Lake & McCluskey, 2009), in understanding human development (Benoit & Parker, 1994, Verhage et al, 2016), and dynamics in heterosexual (Haydon et al., 2012; Treboux, Crowell & Waters, 2004), and same sex relationships (Mohr, 2008). These findings are usable and unite the links between the personal and the professional, theory and research.

Journal of Psychotherapy and Counselling Psychology Reflections

The two sections that follow discuss attachment as it can be recognised in relationships between adults and in individual therapy. However, a note needs to be made of this way of looking at attachment. Attachment is approached as a lived experience between people, as can be ascertained from the dynamics of any interchange between two or more people, which of course, depends on the personal histories and the type of relationship in which they engage each other. When attachment is seen as a set of lived experiences, then the mere noting of categories, (types of attachment process between adults) is insufficient. The role of attachment as theory of intimacy is that it provides understanding of repeating processes in important temporary relationships as between clients and therapists, and between friends and work colleagues. The way that these different contexts apply is not the focus of comments below, but this clarification merely notes the perspective taken here, to explain the type of comments that follow.

Adult attachment processes Attachment processes are not fixed parts of the personality but are made manifest only in emotionally intimate relationships and those relationships that could be intimate (Prior & Glaser, 2006). This section makes some brief comments on what the findings are on the commonalities between childhood patterns, between children and adults, and what appears between adults in partner choice. There are four major types of attachment processes between adults that have their roots in childhood (Colle & Del Giudice, 2011; Weinfield et al., 1999). They can be explained as follows. Secure attachment indicates good mental health in relating. Adults with the tendency to the secure process seek others to gain help, can express distress, and consult their own store of having sought help from others (Spangler & Zimmerman, 2014). The winning point is that separation distress is comforted without expressing anger (Main, Kaplan & Cassidy, 1985). Good mental health is a high proportion of secure attachment in intimate relationships and not the absence of distress or conflict in them, but rather the ability to seek help and problem-solve (Atkinson et al., 2000). Security’s origin is good enough parenting that was promptly provided and sensitive to the child’s needs (Sroufe, 1985). The secure process is shown in the secure base phenomenon of seeking out a loved one or more skilled person in times of distress (Waters & Cummins, 2000). When there are secure attachment bonds, both people connect and share a strong bond (whereas insecure attachment types have different properties). For persons who have the tendency to be secure, relationships matter and what is readily provided is loving care and attention, which delivers a positive mood and self-esteem in the harmony of close and positive social contact. Secure processes occur where attachment needs are met in mutual satisfaction, a win-win situation (Doherty & Feeney, 2004). Feedback and control remain secure when care-seeking is met with timely care-giving, then the care-seeking stops (Bowlby, 1969, p. 41). The phenomenon of the secure base is one of the full and sufficient provision and receipt of care and love, and verbal and non-verbal communication (Posada et al., 1995). Between adults, it means having someone experienced and safe to self-disclose to, feeling safe and trusting them, feeling held (Crowell et al., 2002). Anxious attachment processes exist as two phases of a demand for help and contact; followed by protest, anger and resistance when it is supplied (Bowlby, 1973, p. 57, p. 196). The anxious process can feature outright rejection and hostility where the main feature is that anxiety decreases


play and exploration because of the actuality and possibility of the carers’ absence (Cassidy, 1994). The forces towards others are push and pull producing confusing senses in the relationship as a whole, where persons around someone with the tendency to the anxious process, feel demand and rejection. The anxious process has its roots in parenting that was irregular, unpredictable and unresponsive (Weinfield et al., 1999). The result is being unable to be soothed and unable to soothe themselves in adults who are demanding, needy, anxious and uncertain of themselves, as well as uncertain of how worthy they are to receive care (Fraley et al., 2006). As infants, a bigger communicative signal was required to get parental attention and pre-empt the possibility of their needs remaining unmet. The anxious quality of distress is two-fold. There is a state of lonely anguish or anxiety about disconnection, motivating protest and moving forward towards the carer, with demands and big signals to elicit care through protest (Bowlby, 1969). The second movement is a step backwards away from the carer on reunion in the continuing rejection, implied criticism and expression of protest, which might also function as a call for care. Protest anger occurs when adults remain angry at a lack of care, for a time after the misdeed has first been criticised. This shows the use of anger as a communication that the resentment is justified and continues without forgiveness, even when care has been provided. To speak metaphorically, the protest keeps a score; whereas if forgiveness and relaxation were the case, the score would have been settled, as evidenced by the soothing and commencement of a calmer equilibrium. The higher selfconsciousness, the self-consciousness of their own needs and abilities by self, are interpreted as being insufficient because the equilibrium in the anxious process is one of expecting insufficiency and inconsistency as a matter of course (Mikulincer, Shaver & Pereg, 2003). The core process is that if others are empathised as unpredictably available, then there is an automatic hyperactivation of protest and demands that are addressed to carers. Feedback and control to maintain hyperactivation of demand, care and protest occur, and the protest eventually ends. This sub-optimal process has its own psychodynamic motivations: There is a resistance to disclosure, which is variable in that sometimes, there is speech and sometimes, inhibition. Adults who exhibit the avoidant process with intimate others repress their biologically inherited needs for intimacy because of being taught by their parenting that these needs are unacceptable, so the needs should not gain fulfilment (Bowlby, 1980, p. 65). Bowlby called it “compulsive selfreliance” (Bowlby, 1980, p. 171). The parenting provided was intrusive and can provide excess stimulation as well (Belsky, 1997). Because of the form of neglect and reluctant caring received as a child, this process remains extant in adulthood (Cassidy & Kobak, 1988). Therapeutically, it is necessary to prepare persons who habitually use the avoidant process because they are not used to expressing distress or seeking help (Kafetsios, 2004). So, to enter into a relationship that requires expression and work towards getting their needs met, is new territory for them. In the avoidant pattern, there was insufficient caring available. The children become adults who also reduce their requests for care and use small signals in order to receive the minimum that is capable of being received (Hesse, 2008). The distress of avoidant children is motivated by a taught anticipatory sense of absence and disconnection (Cassidy, 1994). Specifically, it is expected that others will be absent and that relationships will be uncaring and distant, cannot be maintained, or will be lacking or broken (Sroufe, 1988). Thus, the avoidant process maintains only superficial Volume 2, Number 1, January 2017


contact with others and a low investment when connecting with them (Årseth et al., 2009). The core pattern is that if others are felt to be unavailable, the need for satisfaction of the attachment system is deactivated (Bowlby, 1980, p. 345). Feedback and control maintain deactivation as the restorative action, so that when distance is achieved, the avoidance stops (Bowlby, 1980, p. 345). Disorganised attachment is indicative of trauma and abuse and can be transmitted to therapists when they feel shocked and go blank in meetings, because of the impact of what is being expressed (Heard, Lake & McCluskey, 2009). Disorganised attachment in adults seems to be comprised of features of both anxious and avoidant processes that are welded into one incomplete form that does not include the ability to regulate distress. However, in its strongest forms, the movements between states features moving and changing the self: the defensive effect produces fragmented and confused quasi-unified forms of self in one physical body (Liotti, 2004). The experiencing of disarray is consistent with motivational sequences that are hard to achieve and express confusion and anger (Carlson, 1998, Hesse, 1996). Adults with disorganised processes can express, at different times, discretely different ways of being a self with others. There is more dysfunction in the disorganised non-achievement of attachment (Green & Goldwyn, 2002). It is a coordinated but highly ambivalent form of self-understanding and other-empathising. The self is relatively more fragmented, shattered into different ways of dealing with itself and others, because its own feelings and perspectives are confusing. Strictly speaking, disorganised attachment shows that there is the absence of the attainment of an attachment system because hyperactivation and deactivation operate and the attempts at satisfying attachment needs are ambivalent or absent (Main & Solomon, 1986). Lacks in functional feedback fail to establish safety and attachment satisfaction. Restorative action is begun but remains incomplete, so distress remains. Disorganisation has a purpose though, for what occurs, are identifiable phenomena and complex interactions of the two sub-optimal patterns of anxiety and avoidance. There is cycling between the sub-optimal forms of hyper-activation and deactivation. The next section comments on attachment in individual therapy as revealed in qualitative research.

Attachment processes between adults in therapy NICE guidelines for providing therapy and making decisions about treatments of choice, is to promote effective practice treatments that are proven effective because of prior research ( However, as an alternative response, this section formulates nine attachment processes as they appear in individual therapy, which are presented as having more utility, particularly for therapy and other types of mental health care. In addition, the assumption that is made in making these recommendations is that to be competent in one’s practice and understanding of therapy relationships, concerns doing the psychodynamic basics well. One basic aspect of practice is being able to reflect on what is happening between oneself and the public, when we engage them in something that should be positive for them, despite the distress it will entail. Having said that, let us consider attachment processes in therapy. Specifically, what informs therapeutic work are findings like those by Una McCluskey and colleagues (Heard, Lake & McCluskey, 2009, pp. 133-5). In attachment terminology, clients are care-seekers, whilst therapists are care-givers. I re-present

their findings in condensed form and refer the reader to the original findings to get the full picture. Identified are nine most frequent repeating patterns derived from a qualitative analysis of videotapes. The first three are secure and the remainder are insecure in various ways. 1. If the client is in-role as care-seeker, who has material to explore, and the therapist is in-role as care-giver who facilitates the exploration, then a secure process is achieved in each meeting. The therapist takes the lead in empathising and verbalising the emotions and motivations, and clients confirm whether therapists have understood them. The mutual process is one of co-responsiveness, as clients are open to what therapists say. A secure process is established when both client and therapist remain in their respective roles. Clients see that they are acceptable in the eyes of therapists and they re-evaluate the felt-meanings they have in this new, more positive light. There is an emotional reframe of the previously distressing meanings they had expressed, and this is what provides the healing effect, because it alters the felt-sense that goes with the topic being expressed. Therapists and clients are responsive to each other and this shows nonverbally that there is rapport and clients are facilitated in an exploratory way. 2. Clients present a topic assertively but therapists’ comments are at first irrelevant, as they have not accurately empathised what they are being told and resist exploring it. However, clients persist and then the penny drops for therapists who eventually tune-in accurately. So the remainder of the session becomes like item 1 above, there becomes a secure process with both persons in their respective roles. 3. At first, clients present in an anxious and disorganised way but therapists are able to catch contrary nuances and soothe them, and then a secure process is achieved, like 1 above. Therapists remain open, respond and soothe clients’ distress by capturing the complex nuances of the client’s presentation. 4. Clients start asking for help in a secure way but therapists persistently avoid and fail to tune in and divert the discussion onto irrelevancies without catching the client’s point. There is insufficient psychological contact between them. Clients psychologically withdraw towards the end of the session. The therapist has actively resisted the client and has persisted in an avoidant process, until clients cease to ask for help. 5. Clients are anxious and demanding but therapists are unable to tune in to their emotions or soothe them. Therapists do not provide soothing or empathic responding nor are clients helped to explore their thoughts and feelings. There is a communication of anxiety or fear to therapists, who respond similarly, leading to either an angry-anxious interchange, or mutual avoidant withdrawal by the end of the session. 6. Clients present their topic securely but therapists are aloof throughout and under-responsive with too many emotionally-avoidant, blank or passive responses. Therefore, clients cease asking for care and presenting verbally during the session: There is mutual withdrawal, an avoidant process. 7. Therapists miss their clients’ nonverbal expression of despair. Clients do not verbally present their despair, nor is it named or commented on by therapists. There is some slight contact before mutual withdrawal and avoidance, and

Journal of Psychotherapy and Counselling Psychology Reflections

clients are persistently avoidant of their despair and remain non-responsive. Therapists seem oblivious to the despair presented nonverbally. 8. Clients present a topic but nonverbally indicate that they do not wish to discuss it through turning away from the therapist: They are anxious and resistant in their manner of presentation. Clients move on to present multiple topics in a confused manner and the therapist focuses on these, ignoring what was stated at the top of the session. However, because therapists have missed the point, clients resist more than previously, and at the end of the session, they are distressed or avoidantly dismissive towards therapists’ failure to empathise and hold them. 9. Clients present securely but therapists avoid their emotion, and fail to respond verbally and name it. Clients end up anxious, resistant and withdrawn; or avoidant and dismissive, because therapists have failed to empathise the original emotion presented at the start of the session, and their avoidance spreads to clients.

Summary and conclusions The aim of an attachment-oriented focus on processes between client and therapist is that becoming more aware of empirically identified recurrences, supports and sharpens intuition. What is implied in the nine attachment processes above is the presence of varying client attempts at getting a caring response. When clients determine (rightly or wrongly) that therapists have not, or are incapable of focussing on what they are trying to say, then such a felt sense is likely to provoke dropout. If that is the case, then therapists are robbed of feedback about what has happened, so they are unable to improve their practice. The link between one’s own practice and the use of research become concordant when theory makes sense in one’s own work and can be tested in it. What has been presented is a whistle-stop tour of contemporary research on therapy in the attachment view. Attachment processes should not be mistaken for fixed aspects of the personality. Being able to recognise processes aids understanding of the differing needs of clients and provides a framework for understanding complexity. Understanding attachment connects several important domains. For therapists, how the working life is felt and understood inside sessions, and the felt-quality of one’s home life, are related to the degree of authenticity and congruence with one’s own personality, values and family position. Having a secure base with a partner, family and friends is the anchor that holds in the inevitable storms of life. In the light of the above, effective therapy demands being aware of the psychodynamic basics like monitoring resistance to the expression of the topics that need to be discussed, and making caring responses to the distress that clients bring. Good mental health is not the absence of distress or conflict in any relationship, including the therapy one. When the temporary relationship of therapy is understood as an attachment relationship, it emphasises the importance of creating a sense of safety and working towards making a secure process in it, because each insecure process needs a different response. Adults with disorganised processes in their therapy need proper understanding of their difficulties made explicit. Doing the psychodynamic basics well means making the therapeutic relationship clear, and providing some positive sense of connection in every session, particularly at the end of each session. Emotional regulation is different for anxious and avoidant processes, requiring “cooling down” for one and


“warming up” for the other. The secure process in therapy is a condition for there to be new positive influences being made in an open and non-judgemental atmosphere. Therapists support clients’ aims, work to increase emotional connection and alter clients’ moods. This is achieved through contact with therapists, who need self-care and authentic grounding in their own positive lifestyles.

Limitations and future research This paper examined the developmental psychology approach to attachment in the main and did not take its lead from findings derived from self-rating questionnaires that are often used in the social psychology approach to attachment. It was limited by not including a comprehensive critique of research from different methodologies that demonstrate why longitudinal AAI research into actual attachment relationships is most trustworthy. A comprehensive metaanalysis of the research designs and the psychometric properties of the measures used would check claims and identify when findings from different types of research support each other or differ. While attachment is never causal in the naturalistic sense, in the complexity of human development, it is a central feature of being human. Future research in attachment would benefit from a comprehensive comparison of how methods are accurate and contribute to a more standardised understanding of the phenomena of attachment as lived experience. It would be useful to have further insight into the development of attachment in primary intersubjectivity. Further details of how attachment with partners develops across the lifespan are also useful.

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Verhage, M.L., Schuengel, C., Madigan, S., Fearon, R.M.P., Oosterman, M., Cassibba, R., Bakermans-Kranenburg, M.J. & van IJzendoorn, M.H. (2016). Narrowing the transmission gap: A synthesis of three decades of research on intergenerational transmission of attachment. Psychological Bulletin, 142(4), 337-366. Waters, E. & Cummings, E.M. (2000). A secure base from which to explore close relationships. Child Development, 71(1), 164-172. Weinfield, N.S., Sroufe, L.A., Egeland, B. & Carlson, E.A. (1999). The nature of individual differences in infant-caregiver attachment: Conceptual and empirical aspects of security. In J. Cassidy and P.R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 68-88). New York: Guilford.

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Abstract This study draws on Interpretative Phenomenological Interpretation (IPA) to reflect the experience of voluntary migration and return by exploring the experiences of four British men. Voluntary migrants are understood as those who are not politically or economically driven. The findings draw on a wide range of literature including relevant autobiographical, fictional and anthropological work to offset the lack of psychological writing on voluntary migration. Nine major themes emerged. These include travelling as a heroic quest; growth through challenging experience; struggles re-assimilating; and the search for a more satisfying home. Home and belonging emerge as nebulous manifold concepts encompassing spiritual and emotional aspirations beyond its physical dimensions. The study identified early background and life experiences as crucial influences in the outcomes of living abroad and resettling in their native country and hopes to aid therapeutic practice by illuminating these connections. Keywords: Migration, abroad, home, return, belonging, identity

Literature review Mythology and religion have influenced much of the psychological writing referenced. The Bible discusses exilic themes in terms of reward or punishment such as Adam and Eve’s expulsion from Eden or Abraham’s call to the Promised Land. Trials are another major theme as exemplified by mythological heroes such as Odysseus, who perhaps best exemplifies the physical and psychological struggles of adventuring far from home (Homer, 1946), or the Biblical testing of Abraham or Job. Campbell too discussed the ‘hero’s’ journey from the call to adventure to trials and transformation (1988/1949). This was supported by Jung’s transpersonal work particularly the archetypes of our Collective Unconscious (1951). The Grinbergs (1984) suggest Biblical and mythological exile stories enshrine early societal practices to avoid conflict – such as the taboos of parricide and incest discussed by Freud (2010/1899) in the Oedipal myth. Campbell says myths personified in tribal rituals validate the individual within a cohesive society although ‘indifference, revolt or exile – break the vitalising correctives’ (1988/1949, p.383). But he also implies seekers of wisdom do not always lose

their connection with society. Such individuals can uncover ‘the essence of oneself and the essence of the world: these two are one’ (p.386). He cites the ‘ascetic medieval saints and yogis of India’ (p.385) discovering a ‘universal consciousness’. A respected place may thus exist for these solitary figures – even an active role – as shaman or priest, or their modern scientific equivalents: doctors and teachers, who now draw more on scientific than sacred learning. Jung (1948) proposed symbols ‘protect a person from a direct experience of god… but if he leaves home and family, lives too long alone, and gazes too deeply into the dark mirror, then the awful event of the meeting may befall him’ (p.59). If the quest far from home presents dangers, the changes wrought may make return problematic too. While psychological studies on voluntary migration are limited, the Grinbergs’ work (1984) is sufficiently comprehensive to include themes on both forced and voluntary migrations. Kernberg’s foreword highlights its exploration of ‘the unconscious processes activated in the individual as… [they] face the challenges of leaving one world behind and adapting to a new one’ (p.ii), and their attention to the significance of social and cultural factors, age and language. They draw heavily on Freud, Klein, Bowlby, Winnicott and Bion in discussing how defences,

Contact: Gareth Mason, UKCP Psychotherapist Denise Ielitro, Lecturer in Psychotherapy, Regent’s University London


object relations, and attachment theory can explain conditions such as loneliness and psychosis and how migration can lead to identity crises or enlightenment. Also discussed is Balint’s classification of people as ocnophilic or philobatic personalities (1959) defined roughly as those seeking respectively either the familiar and stable, or the new and exciting. Balint believed voluntary migrants are usually philobatic. Mahler et al’s work on separation-individuation (2008/1975) is also referenced, explaining how attachment issues can precipitate psychosis in migrants. Elsewhere, Huntington (1981) draws on Bowlby, Bion and Winnicott to explain how separation anxiety is heightened in strange situations – a situation exemplified by migration when dislocation from a secure base exacerbates poor childhood attachments. Madison (2010) draws on eclectic sources in exploring voluntary migration from an existential perspective. He describes intangible ideas such as Freud’s uncanny (1919) or Heidegger’s unheimlich (1962/1927) referring to respectively something frightening but familiar, and not feeling at-home. Heidegger’s concepts of dasein, authenticity and fallen-ness are also usefully explored. Madison says ‘the experience of the unheimlich discloses that we drift along in life without a foundational ground, forever cadavering towards annihilation’ (2010, p.227). Despite the grim language, this represents an interesting counterpoint to the psychoanalytic view. We understand not-being-at-home as the state from which angst calls us to recover dasein from its lost-ness in everyday thinking (Heidegger, 1962/1927). We discern a connection here with mythological ideas – such as the ‘call of conscience’, and existential migrants as ‘heroes’ (Madison, 2010). Perhaps it’s no co-incidence that many young travellers boast of being ‘authentic travellers’ rather than mere ‘tourists’. The relative dearth of specific psychological literature was partially offset by examining the escapades of some literary travellers who highlighted issues and motivations common to voluntary migration. Leigh Fermor’s hopeful pioneer set out across Europe ‘like a tramp or… like a pilgrim or a palmer, an errant scholar, a broken knight… all of a sudden this was not merely the obvious, but the only thing to do’ (1977, p.12). Meanwhile, Lee highlighted the ambivalence of uprooting oneself while ‘taunted by echoes of home’ (1971, p.13). The journalist Kapuściński (2008) explored the colourful but difficult realities presented by distant exotic lands. He was influenced by Levinas, a holocaust survivor who studied under Heidegger and Husserl, who believed ‘The Self is only possible through the recognition of the other’ (p.5). Kapuściński believed self-hood was realised by communing with the other on an individual and global level and compared difficult childhoods and later life problems with historical events affecting societal relations. He believed multicultural communities offered a more positive otherness and quotes the philosopher Tischner, who adapts the Cartesian slogan to ‘I know that I am, because I know another is’ (2006, p.209). Hoffman and Said wrote seminal autobiographies about emigration. Said’s memoir (1999) details the melange of influences that created his hybrid identity. His statement: ‘the achievements of exile are permanently undermined by the loss of something left behind forever’ sums up its rather depressing tone. Hoffman’s work (1998/1989) evokes her struggle towards assimilation after leaving Poland for the Americas. Fjellestad (1995, p.135) says Hoffman’s story challenges the ‘romantic illusion of unity and centre and of the costs and rewards, the joys and terrors, of being thrown into a post-modern world of constantly shifting boundaries and borderless possibilities’. In describing her relationship

with a lover, Hoffman says ‘we explain ourselves like texts. We learn to read each other as one learns to decipher hieroglyphs’ and with a nod to Heidegger’s unheimlich, how after the stereotypes fall away, ‘he becomes familiar, only increasing the wonderment that the familiar should be so unfamiliar, the close so far away’ (p.190). Hoffman describes her homesickness and nostalgia for post-war Krakow, saying ‘it throws a film over everything around me, and directs my vision onwards’ (p.115). Hoffman later describes herself as visibly ‘a member of a post-war international class’ without feeling it (p.170). During psycho-analysis, she completes her understanding of the English-speaking world, integrating her Polish and American selves following the trauma of culture shock.

Methodology A constructionist paradigm seemed appropriate for uncovering multiple truths with its emphasis on reality being socially created rather than existing as an external singular entity (Hansen, 2004). According to Ponterotto (2005), constructionism uses a hermeneutical approach to draw out deeper meanings via reflection, particularly researcher interaction. Ontologically, this relativistic position is subjective and influenced by individual experience and perceptions, and social environment. We accept, therefore, that results will differ if the study was interpreted by different researchers, as no single truth exists (Finlay, 2016) – the study’s value drawing on the ‘thickness’ of descriptions (Ponterotto, 2005). Epistemologically, the relationship between ‘knower and would-be-knower’ (Ponterotto, p.127), represented by participant and researcher in IPA is central. Constructionism states reality is socially created – so the dynamic is crucial. Similarly, in axiological terms, researcher values are inevitably enmeshed in the process so a personal and subjective rhetorical structure – such as IPA – that details the thoughts and feelings of both people seems appropriate (ibid). A phenomenological method was chosen as it considers both cognitions and emotions – the embodied aspect often being overlooked in psychological theory (Smith el al, 2009). IPA was also favoured for its value in investigating identity and health issues. Furthermore, we did not plan to create theory. IPA also links interpretation with mainstream psychological thinking; to investigate cognitions and emotions where mainstream psychology treats them separately; and to look at deeper levels of reflection more than other qualitative approaches (Smith, 1996). The researchers’ time abroad inspired the study so we remain mindful of our influence as reflexive researchers. As bracketing is intrinsic to phenomenology, we followed Ashworth’s advice to set aside scientific theories, the truth or falsity of participants’ claims, and personal views and experiences (1996). Nonetheless, Giorgi admits: ‘Nothing can be accomplished without subjectivity so its elimination is not the solution’ (1994, p.205), while du Plock describes ‘the notion of the neutral objective researcher’ as ‘absurd’ (2016, p.16).

The participants In keeping with IPA’s tendency to analyse small detailed purposive samples, we limited participation to four men from a relatively homogeneous demographic – the implications are discussed in the findings. Smith says: ‘IPA studies are conducted on a relatively small sample sizes, and the aim is to find a reasonably homogenous sample, so that, within the sample, we can examine convergence

Journal of Psychotherapy and Counselling Psychology Reflections

and divergence in some detail’ (2009, p.3). Furthermore, as the dissertation on which the paper is based was the first IPA study of one of the authors, we quote Smith saying: ‘our advice to a newcomer to IPA is to try to obtain a group which is pretty homogeneous’ (p.50). The target group were UK natives, who had lived full-time overseas for more than three years and spent over a year back in the UK to allow exploration of the ‘before and after’ periods of their experience. The field was narrowed to men between the ages of 40-45 to decrease sample variables although differences exist in time spent both overseas and back in the UK. All four are white, but colour was not a criteria. Social class was not part of the selection process while the interviews revealed significant differences in parental income, profession, and quality of upbringing. Participants were given pseudonyms for confidentiality purposes. The interviewees Malcolm (44) lives with his wife and three children in the West Country. He spent 18 years in France, mostly in Paris, and returned to England four years ago. Daniel (42) lives with his partner and child in northern England where he is studying medicine. He spent 10 years in Latin America before returning home six years ago. Barry (45) is a musician who lives with his wife and child in London. He spent almost four years in the US after leaving school and regularly returns to work there. Alan (44) is a builder who lives with his girlfriend and her children in London. He spent eight years working in Portugal and Austria and returned 15 years ago.

Findings The analysis Our IPA analysis followed the five stages suggested by Smith, Flowers & Larkin (2009). Briefly, these are reading and re-reading transcripts; initial noting; developing emergent themes; connection across emergent themes; and discerning patterns across cases. Primarily, we analysed the transcripts from descriptive, linguistic and conceptual perspectives (ibid). The master themes were identified after completing the interviews. Themes relevant only to one individual participant were discarded – some of these omissions are discussed in the conclusions. The master themes reflected patterns across the interviews – each distinguished by significant emotional or cognitive resonance. We were mindful of not lending greater weight to themes reflecting the literature review or our own experiences. This process involved substantial re-reading of transcripts and reworking of the material. Ultimately, the emerging superordinate themes listed below reflected the chronology of the participants’ lives as revealed by the interviews although this was a natural outcome rather than planned. The first subordinate themes involved childhoods and motivation; the second, aspects of the experience abroad; and the third looked at re-assimilation into British society.


Master themes 1) Finding Home Abroad a) Escape from Childhood b) The Comfort of Strangers c) The International Man 2) Kings of the Wild Frontier a) University of Life b) Lust for Life c) The Heroic Quest 3) End of the Dream a) A Life more Ordinary b) Paradise Lost c) Life through a new Lens

Discussion 1) Finding Home Abroad 1a) Escape from Childhood The Grinbergs say travel can be an escape from home rather than heading towards a destination (1984). Daniel’s travelling seemed to need the complement of psychological ‘inner journeying’ (Madison, 2010) to escape the past. For Alan and Daniel, frequent movement between unsatisfying early environments combined with insecure parental attachments (Bowlby, 1960). Alan says of his home: ‘Emotionally and spiritually, there was quite a lot of discord’. Home for Daniel appears less a place than a loving community. He says: ‘I rejected a part of the rural part of Ethat we lived in because it represented such a difficult time’. When migration failed to discover what felt like a home, he seemed to experience aspects of the unheimlich (Heidegger, 1962/1927) and the uncanny (Freud, 1919). All four subscribe to a ‘long-harboured desire’ for sustained adventure (Grinbergs, 1984, p.58). For Alan and Daniel specifically: ‘lack of containment and support may precipitate psychosis, perversion, delinquency, or drug use’ (p.127) when changing environments to heal childhood problems. 1b) The Comfort of Strangers Madison (2010) discusses how some – like Daniel – use travelling to re-connect and progress within the world to build up confidence. Daniel says: ‘I felt very strong about Latin American issues… I had a Latin American outlook’. Succeeding away perhaps offsets feeling failure at home. Madison also suggests some flee home to avoid feeling overwhelmed, and to achieve balance between contact and isolation, and how peer rejection can be projected onto places. Kristeva talks about foreigners representing ‘the hidden face of our identity’ (1991, p.1) and how integrating them into our unconscious releases it from a repressed pathological state. Daniel and Alan may have felt unconsciously reassured by this. Meanwhile, if ‘physical space allows mental space’ (Madison, 2010, p.209), Alan embraced it saying he idealised his life overseas – a common reaction that can lead to hypomania in new arrivals – its corollary often being a later collapse (Grinbergs, 1984), which Alan’s experiences also reflect when ‘stripped almost overnight of the people… [he] spent a lot of amazing times with’.

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Perhaps the common link is the desire to self-actualise (Maslow, 1954) coupled with their rejection of a constraining tribal loyalty. All four were attracted to the exotic – perhaps their own spiritual mystery, and identity, was better matched with their chosen destination than their first homes (Madison, 2010). 1c) The International Man Barry and Malcolm’s international perspective is reflected by their being-at-home in more than one place as if they transcended home and foreign culture rather than being subsumed by either. Barry says: ‘I always try to see myself as an international person… I like freedom’. Alan and Daniel perhaps took longer to achieve this due to their initial rejection of home. Madison describes how ‘dual belonging’ (2010, p.103) can resolve the tension between a strong self-identity and sense of belonging. Alan’s national identity is less obvious as his peers share interests rather than cultures or places saying ‘British culture became a culture shock to me because I had lived a European life’. Or as Madison (2010) suggests, perhaps Alan avoids isolation by grouping with internationalists equally unattached to home countries. Daniel’s fragile attachment to Britain seems linked to his lack of belonging to family and early homes – an assumption Madison (2010) also identifies. 2) Kings of the Wild Frontier 2a) University of Life Madison says intellectual studies – such as those later displayed by Daniel and Malcolm – are examples of ‘journeying inwards’ (2010, p.105), while early failure is identified by Alan’s admission that ‘a lot of us could have done better academically than we did’ when faced with the choice of ‘going surfing for the weekend or sitting around doing your pure maths homework’. Freud said the sublimation of studying, a mature version of displacing the libido, was ‘what makes it possible for higher psychical activities, scientific, artistic or ideological, to play such an important part in civilised life’ (1930, p.79). Daniel didn’t pursue medicine to regulate his libido, but his long-simmering intellectual frustration seems usefully channelled into study! For him ‘studying medicine is as thrilling and as much an adventure as travelling’. Madison (2010) sees compassion for the underdog – demonstrated by all four – as a complement to a personal fight for independence, while Hoffman (1998) talks of exiles creatively reviewing life’s mysteries from abroad – perhaps enhanced by the extra time and space often available. 2b) Lust for Life All were drawn to what Heidegger might describe as authentic experiences (1962/1927) and prioritising adventure over financial security (Madison, 2010). Barry says: ‘I had this something in me, which I had picked up in America, this sort of lust for life’. Daniel says: ‘there were no bounds to what I did’, while Malcolm ‘revelled in complete freedom’. Madison’s words could apply to all four: ‘To not be free is to not be alive. In leaving I am embracing my freedom and independence through movement’ (2010, p.270). When he says ‘I have a felt direction more than a felt goal; it is a journey with no set destination, slowly I entertain that the journey is the destination’ (ibid), it particularly reflects the paths of Alan and Daniel. Balint (1959) might highlight the interviewees’ philobatic nature – due to their movement towards new and exciting experiences, but we feel this is balanced by their stated

ocnophilic attachments to people and places, home and abroad. 2c) The Heroic Test The participants often described their journeys using mythological language. With Daniel, we perceived parallels between his life stages, and the trials of the archetypal mythological hero, namely: a peripatetic childhood; uncertain ancestry beyond his adopted parents; restless ‘drifting’; his desire for ‘transformation’; a passage through ‘madness’; a ‘magical’ chosen land; and his role as teacher, and later doctor, allowing him to be ‘a part of society, actually fulfilling a useful role professionally and personally’. He sought a ‘transformative’ experience that would make him: ‘a different, more independent, more exciting, more worldly person’. Of his chosen professions, Jung’s ‘wounded healer’ (1951) suggests itself, as does the shaman who harnesses skills that set him apart. ‘It is not society that is to guide and save the creative hero’, says Campbell, ‘but precisely the reverse’ (p.391). The ‘purification of the self’ after an individual undertakes ‘the perilous journey… into the crooked lanes of his own spiritual labyrinth’ could reflect Daniel’s positive transformation following a ‘manic psychosis’. Campbell describes ‘the process of dissolving, transcending, or transmuting the infantile images of our personal past’ (p.101). This chimes with Daniel’s improved interaction with the world. Daniel’s travelling ambitions also reminded me of the pleasure-seeking Peer Gynt (Ibsen, 1964/1876), whose eponymous protagonist pursues hedonistic impulses unreflectively. The ‘decadence’ of Daniel’s pleasure-seeking, however, led to disillusionment, and later, a life ‘more fulfilling than the experiences I had there’. Malcolm’s Panglossian optimism reminded us of the protagonist Karl in Kafka’s Amerika (1996/1927). Nonetheless, he survives well, treating triumph and disaster with equal equanimity and dreams of his family ‘returning like conquering heroes’. He was also reminiscent of the footloose writers, Lee and Leigh Fermor. Leigh Fermor (1977/1947) flipped cheerfully between barns and castle turrets in his peregrinations, while Malcolm was equally at home in an anarchist squat as a millionaire’s chateau. Barry’s attitude fits the role of Master of the Two Worlds (Campbell, 2004/1949) exercising ‘freedom to pass back and forth across the world division’ (p.229) and refers to his ‘calling’ to London and the ‘magical’ American world. 3) End of the Dream 3a) A Life more Ordinary Page claims ‘re-entry shock is as powerful as culture shock’ (1990, p.181) and how denying these difficulties often results in disillusionment. Brislin (ibid) says re-adjusting to home is often hardest for those who integrated well overseas. Alan returns to a provincial ‘desert’ where ‘pretty much everyone had left’. The reverse condition, Postponed Depression Syndrome (Grinbergs, 1984), could be applied to Alan for his difficulties abroad after initially immersing himself successfully. Madison (2010, p.178) identifies how returning migrants often feel ‘exotic’, but his emphasis is on visiting rather than permanent resettlement. He also suggests migrants may feel superior to those left behind, if also envious of their material gains. My interviewees tended to feel or be seen as exotic when abroad. This is reminiscent of Hoffman feeling an ‘exotic stranger’ in the US and ‘excited by my own otherness, which surrounds me like a bright, somewhat inflated bubble’ (1998, p.179). The interviews suggest the novelty of homecoming was short-lived perhaps representing a fallen-

Journal of Psychotherapy and Counselling Psychology Reflections

ness from a more authentic existence abroad (Heidegger, 1962/1927). Daniel laments: ‘I identified as being somebody who had lived abroad in a dangerous place that impressed people, and once that was taken away I just felt like another schmuck’. For Daniel and Alan, return was heralded by the ‘dying’ of foreign worlds. The Grinbergs (1984) noted how returning exiles fall prey to doubt even when the homecoming is cherished. They quote the expressions coined by a Spanish journalist: ‘to be in the throes of de-exile’ and ‘the wound of return’ (Torres, 1983), and cite one returnee who said ‘I don’t feel I belong in either place’ (p.184). Regarding Alan, the perceived negative reaction of the homeworld with his ‘long hair [and] ridiculous suntan’ was perhaps reminiscent of the reception Turkish workers reported after working in Germany when mocked as Alamanyali or German-like (Mandel, 2008). 3b) Paradise Lost The burning of this bridge to the dwelling place of others left Alan and Daniel caught between two worlds – a common situation identified by Madison (2010). This sense of failure perhaps deepened early psychological fissures. Metaphorically, they return empty-handed rather than triumphantly bearing the hard-won ‘elixir’ (Campbell, 2004/1949). Daniel described his dissolution abroad almost like a personal expulsion from Eden claiming the loss of ‘a whole dimension of my character’, while Malcolm says: ‘I’ve left a bit of my heart in France’. The Grinbergs (1984) suggest migration can release latent pathology – something applicable to Daniel’s experiences on his outward and return journeys. Of work, Alan was ‘sick and tired of just making money and working my balls off for other people’ at ‘what’s supposed to be a grown-up age’ and that ‘the veneer was starting to peel away’. This is similar to migrants feeling infantilised abroad where their qualifications and experience have little value (Grinbergs, 1984). 3c) Life through a new Lens For Daniel and Alan, something of Freud’s uncanny (1919) is glimpsed in their re-acquaintance with former worlds, previously taken for granted, while Heidegger’s unheimlich can be observed in their sense of not being-at-home (1962/1927) – even if this represents a continuation of their unsatisfying relationship with Britain. Madison (2010) discusses how many migrants need to believe home has not changed to preserve their roots. Daniel, however, was disturbed by the lack of perceived change – referring to his dislike of ‘the millennia old inequalities’. Alan’s wary response to the digital age echoes Heidegger’s warning that technological ‘progress’ – epitomised by a skyline redolent with television aerials – reduces the world to a state of homelessness by ushering the public into our private homes (1961). Malcolm, however, positively reflected that ‘I’ve made myself over there and turned into someone who can actually operate over here’.

Conclusions We initially expected the interviews to produce themes exclusively related to the experience of being and returning from overseas. However, issues concerned with the upbringing and background of the participants proved to be significant influences on motives for living overseas, and the quality of the overseas’ experience and resettlement.


Summary of master themes Under (1) Finding Home Abroad, the subordinate theme (1a) Escape from Childhood divided the participants into two camps: those running from unsatisfying home environments versus those whose secure base let them happily wander further afield. Thriving in unfamiliar territory was explored in (1b) The Comfort of Strangers; while (1c) The International Man discussed the evolution of their worldly identities. Within (2) Kings of the Wild Frontier, we examined a tendency to reject formal education in favour of life experience in (2a) University of Life; the embracing of adventure and hedonism in (2b) Lust for Life; while (2c) The Heroic Quest reflected the interpretation – consciously or otherwise – of identity in mythical metaphors. (3) End of the Dream dealt with post-migration experience. (3a) Paradise Lost focused on the repercussions of closing the chapter on a meaningful period of life; while (3b) A Life more Ordinary highlighted the anti-climax of returning to an old world after expanding one’s horizons in a new one. Finally, (3c) Life through a new Lens explored how each constructed a new existence in the UK after assimilating experiences abroad.

Implications for psychotherapy This study of voluntary migration aims to help those leaving, those left behind – and therapists – better understand its purpose and value. Therapeutically, we identified the value of immersing oneself in the whole subjective story of the voluntary migrant. For example, Daniel and Alan reported far more emotional turmoil than their co-participants as their migration encompassed much more than their time abroad. Answering the call to adventure was perhaps one of a series of trials and lifechanging experiences that helped establish their identity. The crucible of travel, if sometimes perilous, forged their authentic selves. Their experiences, spanning many years, were perhaps not dissimilar to the process of insightful therapy. Meanwhile, the study underlined how the relatively charmed upbringings of Malcolm and Barry contributed to a fulfilling overseas venture. Cooper Marcus said ‘when we start to seek a broader home in another place, it is likely that the soul is demanding recognition’ (1995, p.252). The drive for unplanned openended travel often seems motivated by such intangible mystical forces. For Daniel and Alan, self-actualisation took place on the long and winding road rather than a conventional straight path. While respecting individual choice, a therapist might usefully explore the underlying issues – such as the sense of belonging – that motivate such ventures. This may more directly initiate the healing process than years spent wandering away from the home world. Exploring the personal meanings of home may facilitate it. Journeying inwardly through study, self-improvement, or social activism – as demonstrated by Daniel – may be satisfying alternatives. Returnees devaluing their experience may benefit from being reminded of the insights they have gained, which may be lost if they are pre-occupied by what they feel they have lost through absence. Otherwise, in its ignorance of their experiences, the home world is likely to reinforce this negative feeling. Furthermore, if the original home feels diminished, perhaps it is because the boundaries that enclosed it have shifted. The dizzying possibilities that now emerge may be viewed fearfully, but can also be re-viewed as symptoms of a more meaningful and authentic existence (Heidegger, 1962/1927). Volume 2, Number 1, January 2017


The Grinbergs say ‘One never goes back, one always goes toward’ (1984, p.216). Those more changed than their home world may benefit from seeking a new more flexible environment for their expanded consciousness. Rapport and Dawson suggest migration can be a ‘creative act’ (1998, p.209) and ‘in displacement lies a route to personal empowerment’ (2003, p.51), something which all the participants grew from in different degrees. If the wisdom gleaned abroad is made central to one’s new life, it builds on this valuable knowledge rather than wastefully bracketing if off like some invalid reality. Some may relish their experiences as little more than fireside tales, but voluntary migrants who enthusiastically embraced the other may wisely build on these foundations e.g. by using language skills, cultural knowledge or seizing entrepreneurial opportunities. Therapists can foreground these skills lest they be forgotten. Myriad practical factors influence the outcomes of voluntary migration such as age, gender, status, social and cultural support – along with the destination and provenance of the traveller (Brislin, 1990). Also important are access to home; ethnicity, religion, race; education, and work skills (ibid). Making potential voluntary migrants aware of how these variables may affect them could later earn them rich dividends. But ultimately, to many voluntary migrants, fine-tuning the variables perhaps cheats the challenge of heeding the call, which for good or worse, must be braved. For both the supportive therapist of the voluntary migrant, and the often uncomprehending friends and family, this irrational but irrepressible motivation is perhaps the most important factor to accept and understand.

Limitations and further study Some significant issues suggested by the literature were not investigated as they were not prioritised by the participants. They include loss, which was tangible during Alan’s interview, and writers such as Hoffman (1998), concerning paths not taken. Another is the isolation felt by strangers in a strange land – largely not experienced by our participants; likewise, struggles with integration which the interviewees dealt with largely well. Culture shock was articulated by Alan, but in reference to his return rather than departure. Space considerations forced us to abandon some interesting – but less supported – themes. These included enhanced economic and social status abroad, the experiences of partners and family, or even the frustration of one’s lifechanging stories being met with indifference back home. Others emerged after the interviews, relatively unexplored, such as the impact on identity of learning foreign languages; nocturnal dream worlds; re-inventing oneself in an alien environment; or psychosomatic symptoms attached to emotional trauma. Space considerations also required us to remove many participant quotes; non-psychological, but relevant literature from the review; further detail on methodology etc. which were present in the original dissertation. A further study could extend the age, gender, ethnicity, nationality, and participant numbers. For example, the themes of Heroic Quest and Lust for Life – well supported by the participants – seem rather stereotypically male. Conversely, a single case study might reveal much by probing deeper into the psyche of one individual. As our participants were similarly-aged white men from a rich Western nation, the results are clearly skewed – we would like to see what is retained with different variables particularly when more participants further iron out the idiosyncratic differences. Even

within this narrow demographic, we realise the criteria might benefit from further tightening such as the differences in the places visited, time spent there, and the age of the travellers. The symptoms discussed, if not the causes, may be reflected by political and economic migrants and those studying or posted overseas. For them, universities and company resettlement programmes may help as do reception centres for refugees, but these options may be randomly available and mere Band-Aids for deeper individual wounds. Future migration studies may benefit from greater emphasis on the individual rather than generalised mass movements (Rapport & Dawson, 1998).

Final thoughts Overall, the participants with a more secure base had fewer problems abroad and in resettling. For the participants whose upbringing was more difficult being abroad might have represented an escape, but it did not necessarily compensate positively for this lack – indeed their issues were often highlighted and amplified abroad. Nonetheless, the conscious act of leaving seems to represent an attempt to overcome this adversity, which allowed them to ultimately understand, accept and grow from it. We also feel that the project benefitted from the positive experiences reported in understanding the factors behind a rewarding voluntary migration. IPA’s value in investigating issues such as belonging and identity was also highlighted – the interviews largely underpinned these evolving themes. For example, Barry’s childhood home was a happy, nurturing place. It didn’t change, but he did, and the world of cosmopolitan cities became his natural milieu. His harmonious and accessible dual world, which home has become is now varied enough to contain his needs. For Alan, home revolved around shared activities with like-minded companions. His presence in the family home was more of an intrusion than a belonging so it is unsurprising he has grown up adaptable, independent, and unsentimental about childhood. Malcolm’s young adult home was a moveable feast founded on a liberal and nurturing home base, which allowed him to fearlessly seek new adventures elsewhere without needing to escape it. Being abroad gave Daniel the freedom to live fully and create the essence denied by early deprivation, but his travelling experiences were insufficient to make him feel he belonged. His home is now founded on a mutually loving and supportive family – what he lacked as a child. Traditionally, we believe the lack of psychological literature on voluntary migration reflects a belief that it represents a pathological deviation from the ‘normality’ of settled life. While globalisation increasingly encourages temporary and semipermanent freedom of movement, we feel an acceptance of migration as an on-going ‘alternative human history’ (Madison, 2010, p.222) will redress this now out-dated bias towards a sedentary life. Given the freedom to undertake these voyages, the participants all felt compelled to leave one home, to discover another. If they had not done so, we suspect their destinies would feel unfulfilled.

Journal of Psychotherapy and Counselling Psychology Reflections

References Ashworth, P. (1996) Presuppose nothing! The suspension of assumptions in phenomenological psychological methodology. Journal of Phenomenological Psychology. 27(1). 1-25.

Mahler, M., Pine, F., & Bergman, A. (2008) [1975] The Psychological Birth of the Human Infant: Symbiosis and Individuation. New York: Basic Books. Mandel, R. (2008) Cosmopolitan Anxieties. Durham: Duke University Press.

Balint, M. (1959) Thrills and Regression. London: Hogarth and the Institute of Psycho-Analysis.

Marcus, C.C. (1995) House as a Mirror of Self – exploring the Deeper Meaning of Home. Berkley, CA: Conari Press.

Bowlby, J. (1960) Separation Anxiety. International Journal of Psycho-Analysis. 41. 89.

Maslow, A. (1954) Motivation and Personality. New York: Harper.

Brislin, R.W. (ed.) (1990) Applied Cross-cultural Psychology Crosscultural Research and Methodology Series. 14. Newbury Park CA: Sage. Campbell, J. (2004) [1949] The Hero with a Thousand Faces. New Jersey: Princeton University Press. du Plock, S. (2016) Where am I with my research? Harnessing reflexivity for practice-based inquiry. The Psychotherapist. 62. 16-18. Finlay, L. (2016) Being a therapist-researcher: doing relationalreflexive research. The Psychotherapist. 62. 6-8. Freud, S. (2010) [1899] The Interpretation of Dreams. New York: Basic Books. Freud, S. (1930) Civilisation and its Discontents in The Standard Edition of the Complete Psychological Works of Sigmund Freud. (trans. Strachey, J.) vol. XXI, 79–80. Hogarth Press: London. Freud, S. (1919) The Uncanny. (trans. Strachey, J.) in The Standard Edition of the Complete Psychological Works of Sigmund Freud [1955]: 219: 252 Vol. XVIII [1917-1919] An Infantile Neurosis and Other Works. London: Hogarth.


Ponterotto, J.G. (2005) Qualitative Research in Counselling Psychology: A Primer on Research Paradigms and Philosophy of Science. Journal of Counselling Psychology. 52(2). 126-136. Rapport, N. (2003) I am Dynamite: An alternative Anthology of Power. London: Routledge. Rapport, N. and Dawson, A. (1998) Migrants of Identity: Perceptions of Home in a World of Movement. Oxford: Berg. Said, E.W. (1999) Out of Place. London: Granta. Smith, J. (1996) Beyond the divide between cognition and discourse: using interpretative phenomenological analysis in health psychology. Psychology and Health. 11(2). 261-271. Smith, J., Flowers, P. & Larkin, M. (2009) Interpretative Phenomenological Analysis. London: Sage. Tischner, J. (2006) Filozofia Dramatu. (trans. Lloyd-Jones) A. Krakow: Znak. Torres, M. (1983) Newspaper article. El País (Madrid). December 4, 1983.

Giorgi, A. (1994) A phenomenological perspective on certain qualitative research methods. Journal of Phenomenological Psychology. 25(2). 190-220. Grinberg, L. and Grinberg, H. (1984). Psychoanalytic Perspectives on Migration and Exile. Yale New Haven and London: University Press. Hansen, J.T. (2004) Thoughts on Knowing: Epistemic implications of counselling practice. Journal of Counselling & Development. 82.131-138. Heidegger, M. (1961) [1953] An Introduction to Metaphysics. (trans. Mannheim, R.). New York: Doubleday. Heidegger, M. (1962) [1927] Being and Time. (trans. Macquarrie, J. & Robinson, E.). New York: Harper & Row. Hoffman, E. (1998) [1989] Lost in Translation. London: Vintage. Homer. (1946) [8th Century BC] The Odyssey. Harmondsworth, Middlesex: Penguin. Huntington, J. (1981) Migration as a part of life experience. Paper presented at the NSW institute of Psychiatry, Seminar in cross cultural therapy. Ibsen, H. (1964) [1876] Peer Gynt. New York: Signet. Jung, C. (1948) The Integration of the Personality. London: Kegan Paul, Trench, Trubner & Co. Kafka, F. (1996) [1927] Amerika. London: Penguin. Kapuściński, R. (2008) The Other. Verso: Krakow. Kristeva, J. (1991) Strangers to Ourselves. New York: Cambridge University Press. Lee, L. (1971) As I Walked out one Midsummer Morning. London: Penguin. Leigh Fermor, P. (1977) [1947] A Time of Gifts. London: John Murray. Madison, G. (2010) Existential Migration: Voluntary migrants’ experience of not being-at-home in the world. Saarbrücken: Lap Lambert.

Volume 2, Number 1, January 2017

Journal of Psychotherapy and Counselling Psychology Reflections


BOOK REVIEW Doodson, L. (ed) (2016) Understanding Stepfamilies: A practical guide for professionals working with blended families Open University Press Review by Susan Davis In the ever-increasing world of step, or blended, families, there is nevertheless an under-resourced field of tailored therapeutic support available. This book provides a comprehensive and solutions focused guide for all professionals seeking to understand the complexities and requirements of working with stepfamilies. The book is extremely well structured and takes a step-bystep approach to enable professionals to feel confident in giving appropriate and effective support and advice. Written by a leading British stepfamily expert, the book is peppered with real world examples to contextualize and describe the realities of life in a modern stepfamily. Using well researched and evidenced based theories, Dr Doodson has delivered a manual filled with practical tips and tools that reflect the understanding and methods necessary for negotiating the unique challenges and emotions experienced by stepfamilies as opposed to biological families.

psycho-education and behavioural modeling; mediation. Chapter 6 introduces mediation as an intervention using an expert contributor and discusses the right approach to use, the necessary skills and the potential benefits. These three chapters provide an exhaustive ‘checklist’ of components to be considered and addressed in each individual case and, again, provide a toolkit of ideas of ways to engage the families in the therapy and facilitate progress. The final chapter thoroughly documents a series of diverse case studies, which demonstrate clearly the complex range of, and different needs within, stepfamilies. This provides a very useful way of bringing the theory to life and provokes contemplation for the reader as to how to integrate the theory into his or her own clinical practice. This book is without doubt an invaluable, well researched and authoritative ‘how to’ guide to working with stepfamilies in a therapeutic setting.

The first two chapters clearly set out the diverse nature of stepfamilies and clarify the subtle differences and challenges faced by the individual members within them, and the relationships between them. These chapters also analyse the differing stories, emotions and demands experienced by the individuals as they try to establish their place and identify their role within the stepfamily unit in order to allow the reader to relate these to clients in their own work settings. The author also suggests short exercises for practitioners to use with clients to open up thinking and discussion and offers tips that could be shared with individuals in order to reassure and advise them. Chapter 3 presents the supporting psychological theory by introducing a new model of therapeutic intervention devised by the author and specifically targeted at stepfamilies called IST – Integrated Stepfamily Therapy. This theory adopts a behavioural and solutions focused approach based on empirical evidence and three existing theories and the chapter describes and critiques these in detail. It sets out four underpinning principles for the new model – to normalize experiences, to establish realistic expectations, psychoeducation, to strengthen the couple bond - and discusses how to use these in action whilst always referring back to real life examples. It then goes on to highlight how to integrate three different interventions into the broader work with the immediate family, and even beyond them (with the original biological family members) so that practitioners feel competent to identify and design a tailored approach for each family’s unique set of challenges. Chapters 4-6 flesh out these suggested interventions in greater detail, whilst always referring back to the supporting literature. They examine how an integrated approach could use three diverse methodologies to play a part in supporting the work in the stepfamily setting – couple counselling;

Contact: Susan Davis Volume 2, Number 1, January 2017

AUTHOR INFORMATION Susan Davis is an MSc Psychology student at Regent’s University London, with a special interest in families, parenting and stepfamilies. Dr Sonia Gallucci (Ph.D., University of Birmingham) is Senior Lecturer in Cross-cultural Studies at Regent’s Institute of Languages and Culture (RILC), Regent’s University London. In 2017, she is due to complete an MA in Counselling and Psychotherapy at the School of Psychology (Regent’s University London). Sonia also holds an MA in Italian Studies: Culture and Communication from the Universities of Warwick and Birmingham, and a BA in Modern Languages and Literatures from the University of Cagliari (Italy). Her current research focuses on the role of culture and emotions in second language learning and in psychotherapy. Denise Ielitro, BSc, Adv Dip Counselling, MA, UKCP & BPS Reg. Denise is a psychoanalytic psychotherapist with a private practice in north London. She has a background in clinical psychology and integrative humanistic counselling and has worked for the NHS and Mind. Since 2005, Denise has been working at Regent’s University London where she teaches and supervises students on the MAPC and ADIP courses. She previously lectured on the DPsych Counselling Psychology course at Regent’s and at the New School of Psychotherapy and Counselling. She also taught for many years at the Institute of Psychotherapy and Social Studies. Denise has a particular interest in the social and cultural context in which therapy takes place. Other clinical interests are attachment theory, and in particular parent-infant relationship, eating disorders, self-harm and psychosis. Dr Marek Kolarik is a Lecturer in Clinical Psychology at Palacký University in Olomouc in Czech Republic. His interests are in family therapy, supervision of clinical practice, and psychological assessment. Imogen Koufou is a BACP-accredited existential psychotherapist. She holds an MA in Psychotherapy & Counselling from Regent’s University London where she also completed the Advanced Diploma in Existential Psychotherapy (ADEP). She currently works as a senior therapist and supervisor at Berkshire NHS Trust and runs her private practice, Buckinghamshire Psychotherapy, from Beaconsfield. Her research interests include: qualitative research methods in particular such as Interpretative Phenomenological Analysis (IPA) and case studies. Subjects include: psychotherapy online, technology and psychotherapy, eating disorders, embodiment. Dr Martin Lečbych is Associate Professor of Clinical Psychology at Palacký University in Olomouc in Czech Republic. He focuses on general and special psychotherapy, family therapy, supervision in clinical practice, psychological assessment and neuropsychological rehabilitation of cognitive functions. He provides supervision for students who prepare for their clinical practice and for practitioners in clinical psychology in the area of psychotherapy, family therapy and psychological assessment.

Dr Maria Luca is Reader in Psychotherapy, Senior Research Fellow, training supervisor, Head of the Reflections Research Centre and the PhD programme in psychotherapy at Regent’s University London, editor of Journal of Psychotherapy and Counselling Psychology Reflections, author of Sexual Attraction in Therapy: Clinical Perspectives on Moving Beyond the Taboo - A Guide for Training and Practice (2014), London: Wiley and The Therapeutic Frame in the Clinical Context – Integrative Perspectives, (2004), London: BrunnerRoutledge and several articles in peer reviewed journals. Professor Desa Markovic is Professor in Psychotherapy at Regent’s University London, Head of Psychotherapy programmes in Psychotherapy and Counselling, a UKCPregistered systemic psychotherapist and supervisor, COSRT accredited psychosexual therapist and supervisor and a Fellow of the Sheffield Society for the Study of Sexuality and Relationships. She has held senior academic posts at various training institutes, presented at national and international conferences and published papers on the subject of systemic and psychosexual therapy integration. Gareth Mason is a UKCP psychotherapist working privately and within the NHS. He has also spent over 20 years working as a journalist in Britain and overseas. He is a graduate from Regent’s University London’s MA and Advanced Diploma programmes. His dissertation, entitled Voyages into the Unknown, reflects an interest in the experiences of those resettling in alien cultures and was inspired by his own time abroad. Dr Ian Rory Owen was born in New Zealand in 1960 and holds a first degree in engineering and a masters and PhD in counselling and psychotherapy from Regent’s University London. He has further qualifications in cognitive behavioural therapy and medical anthropology. Previously, he was a Senior Lecturer in Counselling Psychology at Wolverhampton University. Since 2001, he has been a Principal Psychotherapist in the National Health Service in Leeds. He practices brief individual therapy with people with complex psychological needs. On Attachment, published by Karnac, is his fifth book. His previous works are in the area of phenomenology, intersubjectivity and psychotherapy. Dr Christina Richards BSc (Hons) MSc DCPsych CPsychol MBACP (Accred.) AFBPsS is a Doctor of Counselling Psychology and an Associate Fellow of the British Psychological Society (BPS). She is also an accredited psychotherapist with the British Association for Counselling and Psychotherapy (BACP). She is Senior Specialist Psychology Associate at the Nottinghamshire Healthcare NHS Trust Gender Clinic and Clinical Research Fellow at West London Mental Health NHS Trust (Charing Cross) Gender Clinic. She lectures and publishes on trans, sexualities and critical mental health, both within academia and to third sector bodies, and is co-founder of BiUK and co-author of the Bisexuality Report. She is Editor of the journal of the British Psychological Society’s Division of Counselling Psychology: Counselling Psychology Review. Her own publications consist of various papers, books, reports, and book chapters and she is the co-author of the BPS Guidelines and Literature Review for Counselling Sexual and Gender Minority Clients.

Journal of Psychotherapy and Counselling Psychology Reflections



Psychotherapy & Counselling Psychology Reflections Research Centre

Workshop THE MAKING OF DSM – THE DISTURBING TRUTH ABOUT ITS CONSTRUCTION, AND DOES AN ALTERNATIVE NON-MEDICAL LANGUAGE EXIST? Friday 19 May 2017 17:15 – 19:15 Regent’s University London Inner Circle, Regent’s Park London NW1 4NS Why, without solid scientific justification, has the

Do we really need psychiatric diagnosis? If not,

number of mental disorders risen from 106 in 1952,

what can replace it? This workshop will invite

to around 370 today? In this workshop Dr James

discussion and exploration of these vital issues.

Davies takes us behind the scenes of how the

James Davies graduated from the University

psychiatrist’s bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM), was actually written. Did science drive the construction of new mental disorder categories like ADHD and major depression or were less-scientific and unexpected processes at play? His exclusive interviews with the creators of the DSM reveal the troubling answer.

of Oxford in 2006 with a PhD in Social and Medical Anthropology. He is a Reader in Social Anthropology and Psychotherapy at the University of Roehampton and a practicing Psychotherapist. He has delivered lectures at Harvard, Yale, Oxford, Brown, UCL and Columbia and has written for The Times, the New Scientist, the Guardian and Salon.

The second part of this workshop explores how

He is author of the bestselling book Cracked: why

non-medicalised language can be used to describe

psychiatry is doing more harm than good. He is

the diverse forms emotional suffering can take.

co-founder of the Council for Evidence-based

Has the medical model enjoyed its heyday?

Psychiatry, secretariat to the All Party Parliamentary Group for Prescribed Drug Dependence.

Early booking advised. Please book online at Enquiries to: Shirley Paul

Volume 2, Number 1, January 2017


Psychotherapy & Counselling Psychology Reflections Research Centre

4th Annual One-Day Conference PSYCHOSOMATIC CLINICAL PRESENTATIONS AND IMPLICATIONS FOR EMBODIED, RELATIONAL PSYCHOLOGICAL THERAPY APPROACHES Saturday 10 June 2017 09:00 – 16:30 Regent’s University London, Inner Circle, Regent’s Park, London NW1 4NS Organising Committee Dr Maria Luca Professor John Nuttall

Keynote Speakers Professor Helen Payne The BodyMind Approach: supporting people with medically unexplained symptoms/somatic symptom disorder Nick Totton Embodied symptoms as problems and as solutions Professor Manos Tsakiris The relational body: perceiving and representing one’s body in relation to significant others

Speakers Dr Michael Worrell Long-term health conditions and couple relationships: why there is a clear case for including the partner in therapy Manuel Toren and Dr Maria Luca The persecutory character of irritable bowel syndrome Dr Katharina Lederle An understanding of the science of sleep and how sleep may affect mental health

Book now at (early bird prices available) Enquiries to Shirley Paul

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• Abstracts: Structured Abstracts of no more than 250 words are required for all papers submitted. Authors should supply three to six keywords. • Headings: Section headings should be concise. • Word count: A typical manuscript will be 1,500-2,500 words, including references. Longer contributions of 3,500-6,000 words, (27-30 double spaced pages including references) may be published where inclusion of data (e.g., excerpts from interviews) warrant it. Papers that greatly exceed this will be critically reviewed with respect to length. Authors should include a word count with their manuscript. The word count (which includes all text including the abstract, manuscript, notes, tables, figures, etc.) should appear at the end of the manuscript. • Font: All manuscripts must be typed in 12-point font in Arial and double-spaced throughout including the reference section, with wide (3 cm) margins. All pages must be numbered. • Manuscripts should be compiled in the following order: • Title of manuscript • Author(s) name(s) and title(s) • Abstract • Keywords (no more than six) • Correspondence/contact details including author(s) affiliation(s)

You are welcome to include graphs, tables and diagrams in your submission, but the following must be observed when supplying information:

• Any graphics copied from the internet and cited from other publications are not acceptable on their own. • Graphics files must be supplied separately to text. Please do not embed graphics in the text file. • Figures should be numbered in the order in which they appear in the paper (e.g. figure 1, figure 2). In multi-part figures, each part should be clearly labelled (e.g. figure 1(a), figure 1(b)). • Each figure should include a title caption and full source e.g. Figure 1 The incidence of mental health issues in the UK adult population, World Health Organisation, Report on World Mental Health Issues, 2013 • The filename for the graphic should be descriptive of the graphic, e.g. Figure1, Figure2a. • Avoid the use of colour and tints for purely aesthetic reasons.

3. Reproduction of copyright material

As an author, you are required to secure permission if you want to reproduce any figure, table, or extract from the text of another source. This applies to direct reproduction as well as “derivative reproduction” (where you have created a new figure or table which derives substantially from a copyrighted source).

4. Copyright and authors’ rights

• Table(s) with caption(s) (on individual pages)

It is a condition of publication that authors assign copyright or license the publication rights in their manuscripts, including abstracts, to the Psychotherapy and Counselling Psychology Reflections Centre of Regent’s University London. This enables us to ensure full copyright protection and to disseminate the manuscript, and of course the Journal, to the widest possible readership in print and electronic formats as appropriate. Authors are themselves responsible for obtaining permission to reproduce copyright material from other sources.

• Author(s) biographical outline (50 to 100 words)

5. Proofs

• Main text • References • Acknowledgements • Appendices (as appropriate)

• Please supply in a separate file information about your research interests/specialisations - up to five. • Two separate manuscripts must be submitted. • The first version must be a complete version containing all the above together with confirmation in a separate file confirming that the manuscript is not under consideration or submitted to another journal. Use the following statement: I confirm that the manuscript submitted, title:…. is not under consideration or submitted to another journal. • The second version must be entitled ‘For blind review’ and must not contain the author(s)’ name(s) or contact details or any identifiable author(s) information (refer to APA guidelines). This will allow for the second version to be sent anonymously to reviewers.

Manuscripts will be copy-edited for journal house style. Authors will receive page proofs for checking. At this point, no substantial changes can be made to the paper. It is essential that proofs are checked and returned within 48 hours.

6. Submission details

All submissions should be made online to

7. Disclaimer

Regent’s University London and the Editors make every effort to ensure the accuracy of all the information (the “Content”) contained in its publications. However, any views expressed in this publication are the views of the authors and are not the views of the Editors or of Regent’s University London. Responsibility for confidential material and consent obtained to use in publications is that of the authors.

Journal of Psychotherapy and Counselling Psychology Reflections Volume 2 • Number 1 • January 2017 Editor: Dr Maria Luca Managing Editor: Professor Helen Cowie Book Reviews Editor: Jane Wynn Owen Editorial................................................................................................................................................................................................................ 2 Clinical Supervisors’ Views on Facilitative Conditions in the Handling of Sexual Attraction in the Supervision of Therapists Maria Luca, Desa Markovic, Martin Lečbych, Marek Kolarik.................................................................................................................. 3 International Students: A Minority Group at Risk in Need of Psychological Support Sonia Gallucci...................................................................................................................................................................................................... 11 Starshine on the Critical Edge: Philosophy and Psychotherapy of Fantasy and Sci-fi Christina Richards ............................................................................................................................................................................................. 17 E-Therapy: The Psychotherapists’ Perspective – A Phenomenological Enquiry Imogen Koufou and Desa Markovic ........................................................................................................................................................... 25 The Relationship Between Research and Practice in Contemporary Attachment Research Ian Rory Owen................................................................................................................................................................................................... 33 Voyages into the Unknown: An Exploration Using Interpretative Phenomenological Analysis of the Experiences of Returning Voluntary Migrants Gareth Mason and Denise Ielitro................................................................................................................................................................... 41 Book Review...................................................................................................................................................................................................... 49 Doodson, L. (ed) (2016). Understanding Stepfamilies: A practical guide for professionals working with blended families Open University Press By Susan Davis............................................................................................................................................................................................................................................. 49

Author Information......................................................................................................................................................................................... 50 Announcements................................................................................................................................................................................................ 51 Psychotherapy and Counselling Psychology Reflections Research Centre Workshop on Friday 19 May 2017 The making of DSM – the disturbing truth about its construction, and does an alternative non-medical language exist?................... 51 Psychotherapy and Counselling Psychology Reflections Research Centre 4th Annual One-Day Conference on Saturday 10 June 2017 Psychosomatic clinical presentations and implications for embodied, relational psychological therapy approaches........................ 52

ISSN 2054-457X

Journal of Psychotherapy and Counselling Psychology Reflections. Volume 2, number 1  

The Journal of Psychotherapy and Counselling Psychology Reflections (JPCPR) is an international peer-reviewed journal, underpinned by the as...

Journal of Psychotherapy and Counselling Psychology Reflections. Volume 2, number 1  

The Journal of Psychotherapy and Counselling Psychology Reflections (JPCPR) is an international peer-reviewed journal, underpinned by the as...