Issue 64 â€¢ Autumn 2016 ISSN 2049-4912
Psychodrama and action methods in group and individual psychotherapy
The maga zine of the UK Council for Psychother apy
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contents Feature articles Psychodrama and action methods in group and individual psychotherapy 4 The five elements of psychodrama 6 Safety in action 8 Psychotherapy with traumatised refugees: healing trauma 10 When the safe container has no sides 12 Reducing the risk of offending through the use of psychodrama 14 Strength to change: psychodrama-informed work with domestic abuse 16 Roles in triangles: the interpreter, the client and the therapist 18 Liberating the heart in action 20 Rescuing the body in psychotherapy 21 Stepping back to go forward 24 Taking the tools of the trade beyond the clinic 25 Psychodrama à deux: the rewards and challenges of individual psychodrama psychotherapy 28 New technology, social media and therapy 30 Discussion Understanding and recognising sex addiction 32 Past life regression: should it be taken seriously by psychotherapists? 35 Prevention is better than a complaint: dual relationships 37 UKCP news Get involved in shaping our informal grievances procedure 39 Digital Delivery Project update 40 Generate your own media coverage 41 New and forthcoming in the UKCP books series 42 UKCP members The Hampstead Psychotherapy Club 43 Welcome to our new UKCP members 44 Book reviews 45
Diversity and equalities statement The UK Council for Psychotherapy (UKCP) promotes an active engagement with difference and therefore seeks to provide a framework for the professions of psychotherapy and psychotherapeutic counselling which allows competing and diverse ideas and perspectives on what it means to be human to be considered, respected and valued. UKCP is committed to addressing issues of prejudice and discrimination in relation to the mental wellbeing, political belief, gender and gender identity, sexual preference or
orientation, disability, marital or partnership status, race, nationality, ethnic origin, heritage identity, religious or spiritual identity, age or socioeconomic class of individuals and groups. UKCP keeps its policies and procedures under review in order to ensure that the realities of discrimination, exclusion, oppression and alienation that may form part of the experience of its members as well as of their clients are addressed appropriately. UKCP seeks to ensure that the practice of psychotherapy is utilised in the service of the celebration of human difference and diversity, and that at no time is psychotherapy used as a means of coercion or oppression of any group or individual.
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Editorial policy The Psychotherapist is published for UKCP members, to keep them informed of developments likely to impact on their practice and to provide an opportunity to share information and views on professional practice and topical issues. The contents of The Psychotherapist are provided for general information purposes and do not constitute professional advice of any nature. While every effort is made to ensure the content in The Psychotherapist is accurate and true, on occasion there may be mistakes and readers are advised not to rely on its content. The Editor and UKCP accept no responsibility or liability for any loss which may arise from
Welcome It is with great pleasure that I welcome you to the latest edition of The Psychotherapist and my first as Chief Executive of UKCP Clark Baim and Mike Chase have co-guest edited this issue of The Psychotherapist to look at psychodrama and action methods in group and individual psychotherapy.
traumatised individuals within different cultures and with people starting on the road of rebuilding their lives all add to this fascinating read.
As a UKCP therapist and having trained primarily in one modality, reading about different modalities is always fascinating learning to understand the different modalities in greater detail. The articles in this edition bring psychodrama to life - from understanding the elements of psychodrama more to the practice of it both with groups and individuals. The moving accounts of working with severely
As usual, in every issue we include an update on the progress on the Digital Delivery Project (DDP) (p.40) where you can find out the latest developments on our new website. Our new website is still to ‘go live’ but we have already started using the new CRM which forms a major part of the DDP and has been used in the recent membership renewals.
Janet Weisz is the Chief Executive of UKCP and a psychotherapist and psychodynamic counsellor who has worked in the voluntary sector, public sector and private practice for over 20 years. As well as maintaining a private practice, she works in the NHS as part of multidisciplinary teams and has first-hand experience of the demanding pressures for change and evolution in the provision of psychological services – both in the public and private sector. Janet was elected Chair of UKCP in March 2012. She was formerly the Chair of UKCP’s Colleges and Faculties Committee (CFC), where she guided the committee to enhance the collaboration between the colleges and faculties by maintaining cross-modality standards, considering approaches to diversity between the colleges, and approving college procedures for assessing organisational members’ re-accreditation processes, among many other activities. Janet was also chair of Council for Psychotherapists and Jungian Analysis (CPJA) for three years.
reliance on the information contained in The Psychotherapist.
Managing editor: Sandra Scott
From time to time The Psychotherapist may publish articles of a controversial nature. The views expressed are those of the author and not of the Editor or of UKCP.
Consulting Editors: Mary MacCallum Sullivan, Rachel Pollard, Karen Demsey
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Editorial board: Sandra Scott, Janet Weisz, Mary MacCallum Sullivan, Richard Casebow, Rachel Pollard, Richard Hunt
We also look at ways that you can generate your own media coverage, and we have developed a helpful PR toolkit for members with handy tips and advice to raise the profile of your work (p.41). We also take a look at the rapid success of the Hampstead Psychotherapy Club, led by Josefine Speyer and Claudia Nielson (p.43). Tickets for the first UKCP conference taking place on 11 March 2017 are selling fast. Early-bird booking has now ended but there are still tickets available if you are interested in coming along, more information on booking is on the back cover. We have some great speakers lined up including Iain McGilchrist, former clinical director of the Maudsley Hospital, Richard Erskine, director of the institute for integrative psychotherapy in Vancouver and Jenny Edwards, Chief Executive of the Mental Health Foundation, plus six workshops for you to choose from. It’s shaping up to be a great day and I look forward to seeing you there. Our Chair Martin will be kicking off his roadshow this October. Starting in Manchester on the Friday evening prior to the Learning from Complaints workshop on Saturday 15 October, which many of you have signed up to attend. We have also confirmed two further roadshow locations; Bristol and Cambridge. More information and dates for these roadshows will be available shortly. And finally, as we are now well into renewals period, I would urge any members who haven’t yet renewed to get in touch with us. More information can be found on p. 29.
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Psychodrama and action methods in group and individual psychotherapy Guest editors Clark Baim and Michael Chase introduce this special issue of The Psychotherapist which focusses on psychodrama psychotherapy and action methods. The aim is to increase understanding and promote dialogue about the use of such approaches in clinical practice, training and supervision. A brief introduction to psychodrama psychotherapy For readers who are completely new to psychodrama psychotherapy, there are a few important things to be aware of. Psychodrama psychotherapy is notably different from talk-based therapy, because all aspects of life are not only discussed but re-created, worked through in action and integrated in the ‘here and now’ of the therapy session through active means. This active involvement can deepen learning, recovery and growth. The scenes enacted in a psychodrama may be based on defining events in a person’s life, their current or past relationships, unfinished situations, desired roles, inner feelings and intentions, self-doubts, deep-rooted beliefs or inner conflicts. In psychodrama, people are helped, in the enactments, to enhance
Clark Baim is a senior trainer in psychodrama psychotherapy and co-director of the Birmingham Institute for Psychodrama, a training organisation within the British Psychodrama Association (BPA), which is an organisational member of HIPC/UKCP. Clark has a long track record working in criminal justice settings and he also works as an international trainer. Among his many publications he has co-edited and co-written seven books, including books on psychodrama psychotherapy, co-working, applied theatre, offender treatment and attachment-based practice, with several more in production.
their own capacity for psychological healing by expressing their own feelings, thoughts and behaviours, and re-discovering their spontaneity, creativity and imagination. A psychodrama often begins with a scene examining a current problem or difficulty, and may trace it back to earlier life situations. Here the participant may have the chance to experience what was missing but needed at that time. The enactment then returns to the present, where new learning can be integrated and put into practice. Psychodrama is holistic in the sense that it takes into account the whole personthoughts, feelings, behaviour, physical being and sensations, relationships, social context and history (including ancestry), and also the emotional/spiritual dimensions of well-being.
Michael Chase is a psychodrama psychotherapist with more than 14 years’ experience in delivering therapeutic education and psychodrama in a therapeutic community to young adults with complex needs. Among his professional roles, he is a psychodrama psychotherapist and group psychotherapist at HM Prison Grendon, a therapeutic prison in Buckinghamshire. He has published articles and chapters on psychodrama psychotherapy and applied theatre and will be publishing a book on applied masks later this year.
Unacknowledged contribution Psychodrama psychotherapy was devised in the 1920s and 1930s by the psychiatrist and singular genius Dr Jacob Levy Moreno (18891974), whose ideas have helped to shape the world and approaches to psychology in myriad and often unacknowledged ways. Moreno’s ideas and methods were further developed in collaboration with his wife Zerka Toeman Moreno (1917 - 2016), who continued to inspire new generations of psychodrama psychotherapists. Moreno also developed widely influential methods and concepts such as sociometry, sociodrama, sociatry, the theatre of spontaneity, role play, group psychotherapy, and the principle of the ‘encounter’. As a young doctor, Moreno was among the first to recognise the healing power of groups, including the importance of selfhelp groups. Many later developments in interactive, improvisational theatre, applied drama and forms of therapy such as self-help groups have their origins in the ideas and work of Moreno. His broad influence is a reminder that Moreno’s concept of human beings is that we are all – in his terms – cocreators of the world around us, with vast reserves of untapped creative power and an ‘autonomous healing centre.’ His far-reaching therapeutic vision was that all people should be helped to increase their spontaneity and creativity in order to heal and help themselves and to become co-creators of their society. Psychodrama was established in the UK in the 1970s by key trainers including Marcia Karp and Dean and Doreen Elefthery, who had all trained with Moreno. Today, psychodrama psychotherapy is practised by many thousands of practitioners in more than 75 countries. There is a vast and developing
literature on the method, supported by more than 7,300 publications listed on the worldwide bibliography of psychodrama (www.pdbib.org). Many of these publications focus on research and offer support for the developing evidence base of the method. Psychodrama and the related panoply of action methods have been applied and researched in every type of therapeutic and mental health setting, and are also used in personal development, relationship and marital counselling, community-building, professional training, coaching, and business and industry. Some of psychodrama’s central techniques such as role reversal, the ‘empty chair’, role play and doubling have been widely influential and adapted by many other modalities. Some of the articles in this special issue address this cross-fertilisation of modalities; as you read, you may find ideas and techniques described here that have influenced a wide range of modalities, and vice versa.
Action methods ‘Action methods’ is the term used to describe a wide array of active, experiential and rolebased approaches to individual and group work that are derived from psychodrama and other Morenean ideas. Common examples include role play, group-building exercises, sculpting, experiential learning activities, whole-group role plays, and the use of drama games to enhance group processes. Action methods have been applied to many contexts including industry, mental health, prisons, schools, social work, therapeutic communities, community organisations, within speech and language therapy and in group therapy. Action methods are commonly used for personal and professional work, for example job and relationship choices, couples therapy, family therapy, conflict management, strategic planning, team building, review meetings, training and development events and community consultation.
The articles in this special issue The articles in this issue of The Psychotherapist reflect some of the wide-ranging applications of psychodrama psychotherapy and action methods around the world. In the first article, Marcia Karp explains the five key elements of psychodrama, including illustrative case examples. In his article, ‘Safety in action,’ Richard Oliver describes how the process of psychodrama
The original stage that Moreno built in New York
Psychodrama’s central techniques, such as role reversal, the ‘empty chair’, role play and doubling, have been adapted by many other modalities psychotherapy can be used to build a sense of safety in the therapeutic space. Richard looks at two different settings – a closed weekly group and a one-day workshop – to illustrate how the method is used and adapted to the different contexts using a range of actionbased approaches, tools and techniques. Christina Hagelthorn then describes how psychodrama psychotherapy is used in the healing of traumatised refugees – a current and pressing topic. Sandy Jay then describes her work in Ghana training treatment staff working with children who have been trafficked and severely traumatised. Sandy explains how her approach to training is influenced by the understanding that many of the staff have also been traumatised themselves. Jinnie Jefferies offers an account of her many years of practice using psychodrama psychotherapy with adult male offenders to help them reduce their risk of re-offending. Her article is based on her work at HMP Grendon, a prison in Buckinghamshire that is run as a therapeutic community. This is followed by Dr Mark Farrall’s article describing the strengths-based programme he has developed for working with people who have committed acts of violence or abuse within intimate relationships, and which, uniquely for the field, combines a cognitive-behavioural base with psychodrama and action methods. As with
Jinnie’s work, this application of psychodrama psychotherapy is aimed at helping clients to reduce their risk of re-offending and to lead happier lives. Next, Beverley Costa describes the work of the Mothertongue multi-ethnic counselling service in Reading, focusing on the experience of training therapists and interpreters to work together. In her article entitled ‘Liberating the heart in Action,’ Biggi Hofmann offers reflections on the spiritual theme of forgiveness as explored by participants in a psychodrama psychotherapy group in Northern Ireland, where participants had previously made suicide attempts or had lost someone to suicide. She describes how both groups of people learned from the others’ perspective and suffering. Psychodrama psychotherapy involves the whole of the person, including working with the body. Doris Prügel-Bennett’s article describes how psychodramatic enactment and creative methods include the body and access deep psychological levels. Various approaches show how non-verbal levels of communication and understanding are included in psychodrama psychotherapy theory and practice. We dedicate this special feature to the memory of Zerka Toeman Moreno, co-developer of psychodrama, who sadly passed away just before this issue went to press.
feature article Annei Soanes then offers an intriguing look at the findings of her MSc research project on psychodrama psychotherapists working with trauma survivors manifesting trauma-related dissociation. Annei’s findings revealed consistent phenomena concerning the physical movement of the psychodrama psychotherapist, and she offers some interesting ideas about the function and meaning of such movement.
The five elements of psychodrama Marcia Karp sets out the five elements key to every psychodrama session
Carl Dutton’s article describes how psychodrama psychotherapy and related techniques are used in different settings including community groups, open events and school enrichment weeks. Carl describes how such techniques are used to enhance the learning, cohesiveness and overall functioning of groups, events and communities in a variety of contexts. While psychodrama is most typically thought of as a group approach, there are many contexts in which the method can be adapted for individual practice where this is more appropriate for the client. In her article, Sarah Morley reflects on the challenges and rewards of using psychodrama psychotherapy in one-toone work. We finish with a fascinating piece by Ron Wiener, Honorary President of the British Psychodrama Association, whose article explores how mobile phones, social media and other recent advances in information technology can impact on and have implications for the therapeutic process in psychodrama psychotherapy and all counselling and psychotherapeutic modalities. The article considers the implications for such important themes as confidentiality, the recording of sessions and maintaining boundaries. We hope that this issue and the array of fascinating articles will help stimulate awareness, discussion, cross-fertilisation of ideas and future research, and the development of psychotherapeutic theory and methods. Enjoy.
Psychodrama psychotherapy is one of the modalities represented in UKCP’s Humanistic and Integrative Psychotherapy College. This special issue is produced with the cooperation of the British Psychodrama Association.
The director is the psychodrama psychotherapist who guides the session. She is a co-producer of the drama, taking verbal and non-verbal clues from the client in focus (the protagonist). The director is responsible for building trust and cohesion in the group. Working with the protagonist and the group, the director guides each phase of the session.
The protagonist is the subject of the session and is a representative voice of the other people in the group. She states an aspect of life she wants to work on, for example, ‘my fear of death’, ‘my relationship with my daughter’, ‘my authority problem at work’, and sets an exemplary scene. Each scene takes place in the here and now, even though the actual event may be in the past, present or future. The protagonist has a chance to review their life script, to look at behaviour patterns that may now be inadequate, and to try out new responses.
Marcia Karp, MA, UKCP-accredited, TEP, is a founder member and first Honorary President of the British Psychodrama Association. She is a recipient of the BPA’s lifetime achievement award. After training with JL and Zerka Moreno in New York, she ran the Holwell International Psychodrama Centre from 1974 to 2001 in Devon. Marcia is a founder of the Federation of European Psychodrama Training Organizations, and a Distinguished Fellow and former board member of the International Association of Group Psychotherapy. She co-edited The Handbook of Psychodrama, Psychodrama Since Moreno, and Psychodrama: Inspiration and Technique. Marcia has a private practice in London, including a Monday evening psychodrama psychotherapy group in west London. She can be contacted at: firstname.lastname@example.org; www.marciakarp.org
sychodrama is an action-based method of group psychotherapy where people have the opportunity to explore situations in everyday life without being punished for making mistakes. It has been called a rehearsal for living: the work is about what life hasn’t given you the opportunity to do. While every psychodrama is unique and unscripted, there are techniques and guidelines to be mastered during training. Fundamental is a working knowledge of the five key elements in a psychodrama session.
The auxiliary ego
Group members are participant observers and may be asked to take the role of a significant figure. A unique aspect of psychodrama is the multiplicity of roles each person in the group may play. This continuously changes the group dynamics. Based on ideas from ancient Greek theatre, those watching may be purged (ie given the opportunity for their own emotional catharsis) while observing.
The auxiliary ego is a group member who plays the role of a significant ‘other’ in the internal or external life of the protagonist. Auxiliary roles can have a powerful effect on both the protagonist and the group. For example, in a psychodrama exploring a scene of bereavement, the auxiliary playing mum may reach out her arms to say goodbye. The protagonist may be emotionally paralysed in her own role, but then, in the role-reversed position as mum, may express the love that has never been shown. Research shows that we are more spontaneous in the role of the other because we are without a preconceived notion of ‘script’. Such scenes bring insight and the ability to express ‘bottled-up’ feelings.
In psychodrama, the time and space a person lives in is represented on the stage, which is a designated space in the room. For example, if the conversation takes place in the kitchen, we set out the table and chairs and give imaginative space to a window, sink, door, fridge, etc. Constructing the reality of an individual’s time and space helps the person to really be there and to express the feelings that do or do not exist in that space.
References and recommended reading Karp M and Holmes P (1992). Psychodrama: inspiration and technique. London: Routledge. Karp M, Holmes P and Watson M (1994). Psychodrama since Moreno. London: Routledge. Kellermann PF (1992). Focus on psychodrama. London: Jessica Kingsley. Moreno JL (1953). Who shall survive? New York: Beacon House. Moreno JL (1955). Preludes to my autobiography. New York: Beacon House. Moreno JL (1977). Psychodrama, Vol 1 (4th edn). New York: Beacon House.
‘If God ever comes back, he’ll come back as a group.’ The Psychotherapist
Moreno, 1955: 12
We can often learn more by looking at a person’s living space than we can in months of interview. I was once invited into the space of a young man’s apartment, which he created on the psychodrama stage. He walked into his apartment by carefully tiptoeing. I asked why. He said, ‘I throw my old milk cartons on the floor. They are everywhere.’ That spoke of isolation and a lack of self-care. His living space was an important clue to his alienation. His words until then belied his reality, but showing the ‘stage’ on which he lived gave us a vivid picture. The work then moved into his reclusive life style, his rejection and his early dysfunctional attachment. An added scene of ‘surplus reality’ showed us how he’d like to live in the future and gave hope for change.
Safety in action Richard Oliver describes how psychodrama psychotherapy can be used to build a sense of safety in the therapeutic space. He looks at two clinical settings – a closed weekly group and a one-day workshop – to illustrate how psychodrama can be adapted to both situations.
Richard Oliver is an accredited psychodrama practitioner based in north London. He practises at Mind in Camden and sees private clients both individually and for one-day workshops. He also helps London colleagues present psychodrama taster sessions open to the public under the title ‘London Psychodrama Network’.
A safe atmosphere Good practice demands a safe atmosphere for the client to stay with the process. In the practice of psychodrama psychotherapy, we look at how the elements of this mode of therapy can create a safe atmosphere in a group setting. At the start of a group, we typically begin with a warm-up. The warm-up lets people feel at home in the group, important after arriving from busy streets, buses and trains. For the warm-up, I may employ an actionbased game or a verbal check-in according to the mood of the group. As Karp writes:
The warm-up serves to produce an atmosphere of creative possibility. This first phase weaves a basket of safety from which the individual can begin to trust the director, the group and the method of psychodrama. When the room has its arms around you it is possible to be that which you thought you could not be. (Karp, 1998: 3)
Making a choice Once the group feels settled, I might invite group members to make a choice about who may explore an issue. It is a collective decision and we often stand in a
feature article For the warm-up, an action-based game or verbal check-in may be employed according to the mood of the group
circle or a line to make a choice. Campbell explains the benefits of this: By asking clients to choose in the moment, they are ‘forced’ to make a decision and to make it known by their choice. It can be healing for a client to make his own decision about where he wants to stand and not have anyone tell him he’s made the wrong choice. (Campbell, 2012: 92)
Scene-setting To investigate an issue, I encourage the person to show us a relevant scene using whatever props are available. Chairs and cushions may become key objects. As Kellermann describes: In scene-setting, the person is helped to regain the sense of ‘there-and-then’. This helps to revive memory and increase involvement and makes the enactment more authentic. (Kellermann, 1992: 146) The activity of scene-setting anchors the person’s thoughts in a time and place, which may be helpful when they need somewhere to be grounded.
Taking a role Quite often, the scene calls for other members of the group to take a role, which is termed an ‘auxiliary role’. In doing this, the other group members get involved in the scene and this generates an increased sense of belonging to the group (Blatner, 1988: 92). As a bonus, each person taking a role feels they are making a contribution to someone’s healing process. Let us look briefly at the different emphases needed in two different settings: a weekly therapy group and a one-day workshop, both using psychodrama.
A closed weekly group The weekly therapy group is for adults with mental health problems, often overwhelming emotions. We meet
weekly for one-and-a-half hours. The group is closed (ie the same people meet each week for a designated number of sessions) and members are familiar with each other’s life stories. A strong sense of trust has built up over months of meeting together. Building on this, group members take roles in the scene unfolding before us. We avoid having one person stuck in a prolonged scene while the others look on, as this can be quite anxiety provoking and anxiety is what many of the members have an issue with. Taking a role seems to lighten the group atmosphere and one can tangibly feel the ambiance improve when the group is engaged. In one session, a group member, ‘M’, expresses her concern and anger at herself for being angry and forceful with her children. During the psychodrama, some group members take on the roles of her children and her husband. The drama goes on to trace the origins of M’s anger and, with other group members in role as M’s parents, we explore how her parents treated her as a child. While this exploration gave M new insights, and the opportunity to express thoughts and feelings that had long been hidden, there was also a positive effect for the group members involved in her process. They spoke about their feelings during the sharing and after the drama, and also spoke of the resonance that M’s drama had with their own lives. Being a mature group and seeing familiar faces each week can mean that the group needs less active prompting by the facilitator, as the members learn how to help each other.
One-day workshop The one-day workshop is for adults who want to look at aspects of their lives. In this group, some of the group members have met before and some have not. Some of them have no previous experience of psychodrama. As director of
the group, I devote most of the first two hours to preparing the group for working together. This includes warm-up exercises, asking what people need to feel safe, and introducing psychodrama by practising it with lighter topics. For example, I may introduce psychodrama and action methods by asking group members to think about and show ‘a place of tranquillity’. After some thought, one person remembers a peaceful stroll she takes through a wood. Some other group members become trees, populating the wood. To enact the role of the trees more fully, and in keeping with the perceptions of the protagonist – the person at the centre of the drama – the group members need to know how the trees communicate a sense of tranquillity. So the protagonist switches temporarily into role as a tree and I interview her. She returns to her own role. After this, the trees are able to repeat to her some of the key messages of tranquillity, including their offer of shade, protection, and strength, as she walks among them. In this way, the entire group became both co-creators and witnesses to the beauty and importance of this wood, and the meaning it has for this member of their group. This created a feeling of connection and safety for the work that followed throughout the day.
Moving on The initial stages in a psychodrama session include helping the participants to meet each other and to feel psychologically safe. After this process, we can then move on, where appropriate, to the therapeutic exploration of core issues. Building an engaged group using action comes first, and takes time, before we move to the exploration of deeper issues. I often tell the group to expect this safetybuilding process, and I call it ‘weaving the group together’.
References Blatner A (1988). Foundations of psychodrama. Springer: New York. Campbell J (2012). ‘Psychodrama, sociometry and the transition from self-loathing to self-love’. British Journal of Psychodrama and Sociodrama, 27(1,2): 92. Karp M (1998). ‘An introduction to psychodrama’ in M Karp, P Holmes and K Bradshaw Tauvon (eds) The handbook of psychodrama. London: Routledge. Kellermann PF (1992). Focus on psychodrama. London: Jessica Kingsley.
Psychotherapy with traumatised refugees: healing trauma Using two personal case studies, Christina Hagelthorn explains how psychodrama can help the client develop and enhance the inner and interpersonal roles through which they can heal themselves
his article describes how psychodrama psychotherapy can be used in the healing of traumatised refugees. It is based on my experience as a psychodrama psychotherapist working with severely traumatised refugees at Rosengrens Brygga, an organisation I founded in Sweden in 2006, which was incorporated into the Red Cross in 2015. The article can be thought of as a companion piece to the moving and informative spring 2015 issue of The Psychotherapist, which focused on trauma.
The starting point There is an important difference between helping patients open up and speak about
Christina Hagelthorn is a Swedish psychodrama psychotherapist, social worker and trained researcher. Since the mid-1980s, she has worked in private practice and in primary care with individuals, couples and groups. In 2006, she founded Rosengrens Brygga, a centre for traumatised refugees, where she worked as a director and a psychotherapist until 2014. The centre has now been taken over by the Red Cross as one of their centres for traumatised refugees. Since 2013, Christina has served as Chair of a new Swedish association for psychological trauma.
their trauma and helping patients to heal. Telling the story of a traumatic event can have a counter-therapeutic effect, unless it is done in a creative and skilful way. Healing involves being seen, heard and understood, and then finding a way to transform suffering. A person who is exposed to assault and torture becomes mentally flooded by pain and horror. A very common way of trying to cope with such overwhelming events is, one way or another, to keep the memory of the events stored and under control. With some of the refugees I have worked with, it is as if the memory of the traumatic event is stored under lock and key. Later in life, after the terrifying events are over, the strategy of storing memories locked away can become an obstacle to future living because the strategy needs constant vigilance and steals vital energy. The energy needed and the tension created by keeping such memories in check typically contributes to nightmares, anxiety and long-term suffering.
Beginning the therapeutic journey: finding a form that fits Perhaps after weeks and months of working together, when we have built confidence and trust between ourselves and the patient, the locks may start to break up. In the context of the trusting relationship, the patient can begin to have access to their dispelled material. If and when this material emerges, we first need to help the patient find another form to hold it, a form over which they have more control. For example, with many trauma survivors, who may be highly anxious and prone to developing
phobias, it can be very useful to help them learn how to relax, a physical and mental state that counters their experience of anxiety. After that, the patient can approach an anxiety-provoking event step by step, as much as they can manage at that moment. This also gives the patient a structure for dealing with emotions that can feel overwhelming. With some patients, we introduce a bodily anchorage. This is some form of touch, mutually agreed beforehand, which will be a lifeline for the patient to the here and now in the event that they dissociate or regress into re-experiencing a traumatic event. When needed, we can help patients create an imagined space where they can locate the material that remains too difficult to bring out and work through. We can also encourage the patient literally to create a space where they can feel safe if overcome by the anxiety. This gives them additional mental control over the material. These different techniques are just some of the ways we can offer structures that contain what otherwise can feel overwhelming. They offer the safety net needed for trauma-focused work. Creative therapies like psychodrama psychotherapy or expressive arts therapies work by transforming the horrible into something that is mentally useful â€“ that is, giving the experiences a more manageable shape, not erasing them. From what is broken, something new and unexpected can grow.
Case study 1 B is a woman with school-age children. She has received a permit to stay in Sweden and is about to start a programme of integration.
feature article Healing involves being seen, heard and understood, and then finding a way to transform suffering B is eager to get started with a normal and productive life for herself and her children in her new country. She feels, however, inexplicably sad, and like she has failed. What does she grieve for the most? She explains that she grieves for her father, who passed away when she was a child. That was when all her hardship began. When he died, it was not only an emotional disaster for the family but also an economic and social one. To secure B’s future, a marriage was arranged for her into a wealthy and powerful family. Her husband turned out to be a drug addict and he was cruel to B. She also suffered violence from his brother and his mother. When B asked her own mother for help, her mother said she had to stay in the marriage, and endure. The husband was suddenly killed, and B thought he had been murdered by his brother. The case was never solved. I take out my basket with stuffed animals and use a small table as a stage. Here, B can enact all the important events and illustrate them. She participates with enthusiasm. I encourage her to express what she feels about the mother and the brother-in-law. She is visibly relieved to get permission to speak her mind. After B expresses her true feelings, the doll that represents B remains with representations of her children. What does B want to tell herself? She cannot find words, so I hold out the doll to her and she embraces it intensely. At the end of our sessions together, I ask B what she will keep from our sessions. Through the interpreter, she says that she will remember ‘love’. I explain that, in a treatment situation, there must be a certain kind of love, and B nods with satisfaction. Tears begin to flow from her eyes and she says that she is not sad but moved. To her, I have felt like another kind of mother. As she leaves, we hug, and she bursts into a deeper crying. We stand like that for a moment before B leaves, with many waves.
Commentary A particular feature of this case stands out for me. In psychodramatic theory, there is an important concept called ‘tele’, from the Greek word for distance. It is a two-way communication of feelings and experiences that works
mainly on the implicit and unspoken levels of communication. While it can be understood as a type of deep rapport between people, the concept goes further: tele can sometimes appear to be almost like a sixth sense, an emotional ‘feeling into’ and empathic sensing of the other. Mutual tele in the therapeutic relationship, when both the patient and the therapist see each other as they are, with their stories, their pain and their joy, is a kind of love. In true tele, there must be a dimension of reverence, friendship and love. And both B and I felt this love during our sessions together.
Case study 2 C is a young man who studied law and was politically very active in his home country until his group and family had to go underground. He sought asylum in Sweden. During our sessions, C is depressed and very tired. His voice is barely audible. In his soft voice, he complains about the unbearable wait for a decision in his asylum case. He says it is like being in a prison of anxiety and powerlessness. He tells me that does not sleep at night and is tormented by nightmares. In a recurrent nightmare, he is frightened by a nasty sound – a whistle. It is like a train whistle, only softer, he explains. I ask him, if he could translate the whistle sound into a colour, what colour would it be? Black, he answers. Black, cold and damp. It sounds like a cellar, I suggest. Yes, he says, and the sound gives C a heavy feeling of being small, imprisoned and powerless. A memory emerges of how C’s father beat him and locked him in the cellar of their house. His mother didn’t dare to do anything to protect him. We make a connection together: this memory resembles the imprisonment and powerlessness in the waiting for a decision in the asylum case. When I encourage him to explain how unfairly he was treated, C says that he will never be able to forgive his father for the beatings. Further, he says that his father would never admit he was wrong to be so violent. Then I ask C to imagine that he, as a grownup, can open the cellar and save the boy in there. He hugs a pillow, representing himself as a
terrified little boy. He is hesitant, but sits there with the pillow and lets me sit close for the sake of offering comfort. Some weeks later, C tells us that he has been granted asylum. At first, he finds it difficult to accept the relief; yet in further sessions, he wants to look to the future. He says he wants to focus on his intention of being a different type of father should he one day have a family of his own. He also makes the important observation that the role of the violent father is likely to go back many generations in his family, where he understands there is a long legacy of slavery and violence running through the generations.
Commentary and conclusion The aim of working through traumatic experiences is to find a way to integrate the unbearable into the life of a human being. The traumatic events are part of the patient’s history but it is important to find other stories, or parts of stories, that are also true and which can help the person change their perspective. Using psychodrama, we can also imagine and enact the story about what should have happened, what was missing and needed at that time. In C’s case, what was missing in his childhood was compassion and protection, the very qualities that featured in the scene of repair, with him holding the cushion. The work of carefully regulating, reconstructing, integrating and reorganising the memory of traumatic experiences is perhaps the most difficult challenge we face as psychotherapists, and it requires a great deal of inventiveness. In reality, the patient was a victim; now it is important to recreate one’s life oneself. In psychotherapy, we try to help the patient develop or enhance the inner or interpersonal roles through which they can heal themselves.
Further reading Hagelthorn C (2009). ‘An attempt to formulate a theory on therapeutic work with traumatised refugees’. TELE – the newsletter of the British Psychodrama Association, April and November. Available at: www.psychodrama.org.uk/ psychodrama_publications.php Kellerman PF and Hudgins MK (2000). Psychodrama with trauma survivors: acting out your pain. London: Jessica Kingsley Publishers. Marrone M (2014). Attachment and interaction: from Bowlby to current clinical theory and practice. London: Jessica Kingsley Publishers. Spermon D, Gibney P and Darlington Y (2009). ‘Complex trauma, dissociation and the use of symbolism in therapy’. Journal of Trauma & Dissociation, 10(4): 436–450.
When the safe container has no sides Sandy Jay describes her collaboration with an organisation providing support and education to traumatised children in the Ghanaian care system. She explains how psychodrama psychotherapy techniques were adapted to support the training of staff who were often extremely vulnerable and suffering from the effects of multigenerational trauma.
ollowing conversations with an international charity working with traumatised children in Ghana and other countries, I agreed to devise a programme that would enable trained volunteers from a range of countries to work alongside Ghanaian staff who only had basic skills and training in the effects of trauma. The children in its care had been severely traumatised through neglect and trafficking. My work in England for many years had involved working with the legacy of trauma with adults, while my professional background includes trainings in psychodrama psychotherapy, cognitive behavioural psychotherapy and group analysis. However, I had no previous experience of Ghanaian culture, so I was on a steep learning curve.
Sandy Jay is a UKCP-registered psychotherapist, supervisor and external training examiner. She works from her practice, Psychotherapy Services Devon (www.therapydevon.co.uk), seeing individuals, couples and facilitating groups in the UK. Her work influences and complements her work in Ghana, which includes devising an integrative training package for international professionally trained volunteers to deliver training to Ghanaian staff working with children who have been traumatised, neglected and trafficked. She previously worked for many years as a psychological therapist in the NHS.
The layers of trauma in the system prevented a ‘safe enough’ container from being provided to enable effective care to occur Living moment to moment During my first trip to Ghana, I was struck by many unexpected factors. I had not anticipated the level of trauma present in the staff group or how the deprivation in the care system would impact so dramatically on the training needed. On some days, the focus was on whether there was enough food to feed all the children. This way of living moment to moment had a huge impact on staff members’ capacity to plan ahead and to debrief. Reflection was not part of their way of life. It was almost as though future and past did not exist – only the present. It was clear that the layers of trauma in the system prevented a ‘safe enough’ container from being provided to enable effective care to occur. I realised there needed to be a broad infrastructure of training and support for any of my plans to have a lasting benefit. The new support system needed to include professionally trained volunteers working alongside the staff, offering guidance on a whole range of subjects, including the importance of play, education on how the young brain is affected in trauma, and modelling the benefits of debriefing at the end of a shift.
Initial observations As part of my early assessment, I noted that some of the staff had been through the care system themselves and had limited capacity to see the children as separate. This influenced my approach to their learning
needs. They had never learned how to play themselves, so how could I expect them to use play as a vehicle to reach the children? Kindness and compassion had not been part of their world, so inevitably this would be something they struggled to offer the children. Broughton (2014) describes how, after trauma, the child learns to manage their intolerable experience by splitting off the ‘traumatised self’ (the overwhelming emotion) into the safety of the unconscious, and being left with the ‘survival self’, with accompanying behaviour such as avoidance, control or withdrawal. A staff member who witnesses distress in a caredfor child is at risk of triggering their own overwhelming memories. Safe ways of distancing themselves from this distress may include reverting to a survival strategy such as becoming aloof, controlling or distant. This strategy effectively distances them from the emerging memories. Given that many staff members had traumatic histories, this could explain why the general ethos among the staff was to control and manage, as opposed to assess and respond. What was also very evident in the culture was the incredible hope and strength they took from their Christian faith. Every day was survived and managed, never doubting that God would provide. Their faith gave them enormous strength, yet also reduced their capacity to develop. I noticed that living in severe deprivation seemed to
feature article separate enough to distinguish self from other. Many of the staff had never experienced mirroring. I was therefore concerned that inviting the staff to ‘become’ the child would evoke unbearable memories from their own history or that they might enter a survival behaviour (eg withdraw, avoid, defend), which would be damaging to the trust that had developed in me and in the group. This was not a risk I wanted to take. I decided that it felt far more productive to use a positive role model (Grandma or God) to access their ‘compassionate’ self in the hope that this could empower and promote empathy for the children.
increase the need for external hope (God), and living in the moment was a useful way to survive. The ‘container’ was clearly very fragile and needed to be supported in order to strengthen. This would take time, compassion and very slow, watchful steps.
A training session I invited the staff group of six to imagine how a child may feel on arrival. The group found this almost impossible; it was hard for them to acknowledge any feelings. Van der Kolk (2014) describes how, when someone has been traumatised, the person often cannot describe what they are feeling. This is called ‘alexithymia’. While the staff members had split off their feelings, they were very able to identify the children’s behaviours, for example, bedwetting or bullying. We wrote these down. I then invited them to think of a ‘wise person’ in their own life, for example Grandma or God. We generated ideas about what the wise person would say about this child. From this positive role, the group was able to acknowledge that kindness and compassion were needed. In order to bridge
the divide between what the wise person knew and what the child needed, I asked the group to step into the role of their wise self. I asked them (in role) to think of a time when they had felt kindness and compassion, to re-enter that moment in time and feel how that was. Following from this, I proceeded to ask the group to think about what the child may need from this place of kindness. They were instantly able to acknowledge that the child needed to be seen, to laugh, to be held and cuddled, to feel safe. There was now the much-needed emotion in the room to begin the journey towards healing.
Positive role models One powerful technique used in psychodrama to enhance empathy is role reversal, where one can step into the role of another and imagine their perspective in the first person (Goldman, 1984). However, in order to step into the role of another and ‘become’ that person, the individual first needs to have a clear sense of self. The stage where a child can see their self as separate from other people occurs after a child has been effectively seen or mirrored by a sensitively responsive caregiver (Ilbrinkde Visser, 2013). Only then can the child
This is a small example of how knowledge of psychodrama theory can be adapted to aid working with staff members who are extremely vulnerable to accessing their own trauma responses, preventing them from reaching the children they are there to serve. It is important to note that this important work will only be sustained if the staff group itself continues to be seen and valued as having its own needs. This is the role of the volunteers.
Fifteen months later I returned to Ghana 15 months after my first visit. The group was now more able to access the healthy, wiser aspects of self and more able to engage in the wider infrastructure that was now in place. Trusting relationships had been built with the volunteers, who modelled for them how to debrief and support each other. The staff had begun to learn how to write care plans, and most importantly they had begun to ‘notice’ the children, each other and themselves. The journey of discovery demonstrated how important it is to pay attention to how solid or fragile the apparently strong container really is.
References Broughton V (2014). Becoming your true self. West Sussex: Green Balloon Publishing. Goldman EE (1984). Psychodrama: experience and process. Dubuque, Iowa: Hunt Publishing Company. Ilbrink-de Visser J (2013). ‘Using sociometry to heal relationships’. British Journal of Psychodrama & Sociodrama, 28(1,2): 82-90. Van der Kolk B (2014). The body keeps the score. Great Britain: Allen Lane.
To learn more about the Sandy’s next visit to Ghana, you can visit http://crowdfunding.justgiving.com/sandraandyghana1
Reducing the risk of offending through the use of psychodrama psychotherapy Jinnie Jefferies describes how psychodrama psychotherapy is used in a highsecurity prison. She integrates the work of Moreno and Bowlby as a theoretical base and offers a case study to illustrate the ideas. The setting HM Prison Grendon in Buckinghamshire is a category B prison, run as a therapeutic community. The prison regime encourages residents to address their offending behaviour by attending small groups, large groups and a weekly art therapy or psychodrama psychotherapy group. The men who come to Grendon typically have a background of abuse and trauma, as well as being perpetrators of abuse.
Psychodrama and attachment theory John Bowlby (1988) believed that the kinds of experiences a person has in childhood and the attachments created are crucial to the development of the personality. Research supporting Bowlby’s ideas indicates that many individuals suffering from anxiety and insecurity, or showing signs of dependency, immaturity and low self-concept, have been exposed to pathogenic parenting, resulting in partially unconscious resentment persisting in
Jinnie Jefferies is the founder of the London Centre for Psychodrama and is Head of Psychodrama at HMP Grendon. She has promoted psychodrama through European projects and television programmes. Jinnie is a senior trainer in psychodrama psychotherapy and is registered with UKCP and the British Psychodrama Association.
The there and then of the moment is played out in the here and now of the psychodrama stage later life, usually expressed away from the parents towards someone weaker (Henderson, 1974). Psychodrama psychotherapy provides a forum for the offender to consider in detail how their modes of dealing with significant others (including the victim) may be influenced by early childhood experiences. Psychodramatically, the offender is helped to understand how they have come to displace and transfer their inner world onto others (Jefferies, 1991). Williams (1989) extended JL Moreno’s work on role theory, stating that how one responds (role) to parts of self or other depends on one’s ‘context’ (the situation the individual finds themselves in) and one’s feelings and beliefs about oneself, other people and the external environment. An individual’s behaviour in a given situation (context) is influenced by beliefs and feelings evoked by the situation and memory traces of the past.
Example from a psychodrama psychotherapy group session A psychodrama psychotherapy group session at HMP Grendon uses a format common to all psychodrama groups: it begins with a warm-up, moves into the enactment stage and ends with group
sharing. A contract is agreed at the beginning of the session as to the focus of the work. The protagonist (the individual who undertakes the work) is then helped to present a recent scene in which the problem (identified at the contract stage) occurred. As an example of a session, we will focus on the case of ‘John’. John raped a woman rather than deal with his feelings about his relationships with his abusive mother, his impoverished childhood and his feelings of inadequacy. John’s victim rejected his approaches of intimacy, as did his mother many years earlier, and their rejection of him confirmed his belief that he was unlovable. In talking about his crime, he said, ‘The only person I wanted to hurt was my mother.’ John’s contract in this psychodrama psychotherapy session was to understand his offence.
Reconstructing the scene In the first scene, the therapist helps John reconstruct the scene in which he is unable to understand his crime. Members of the group are used to hold significant roles (auxiliaries) and as doubles (expressing thoughts and feelings not stated by the protagonist). The ‘there and then’ of the moment is played out in the ‘here and now’ of the psychodrama stage. In the scene, John grabs the arm of his victim after the rape and states, ‘I don’t know what is going on. I don’t know what’s happened. I am sorry. I am going mental.’ His victim lies on the floor sobbing and John begins to tell us that he must have mentally hurt his victim, and that he must have degraded her. ‘We stood crying together for ten minutes.’ Because psychodrama psychotherapy is an action method, John is directed to show
feature article what happened rather than tell us, and he re-enters the here and now of the there and then and makes the statement that the only person he wanted to hurt was his mother. ‘I just want to be able to trust someone and love and hold people, because it must be lovely to have someone say that you are alright and I like you.’ During this early stage of the drama, the therapist identifies the dysfunctional behaviour driven by dysfunctional belief system. A role analysis is made, identifying context, behaviour, feelings, beliefs and consequences of the role response: Context: John facing a situation in which another person (in this case, a woman) rejects his attempts to form a friendship. Belief: He believes that the other person does not care for him. He believes that he cannot trust women, and that he is unlovable Feelings: Anger, confusion and remorse. Behaviour: He projects his anger towards himself and his mother onto his victim and rapes her. Consequences: His behaviour confirms his belief that he is unlovable.
Revisiting with caution The therapeutic work focuses on the locus – or origin – of the belief system that motivates the dysfunctional response. This normally takes the offender back to
childhood, the root of beliefs about self, other and the world that he inhabits. This is an area in which trauma or abuse has taken place. It is a place to be revisited with caution, as memory traces of abuse can evoke suppressed anger or overwhelming feelings of shame, helplessness and sadness. It is, however, an opportunity to challenge the offender’s dysfunctional internalised beliefs, as well as provide an opportunity for the offender to express suppressed feelings of anger towards his own abusers, hitherto displaced onto innocent victims. John had already made the connection between his present actions and past feelings, so the scene is set to explore his relationship with his mother and the source of his dysfunctional belief system, ie that he is unlovable and that women cannot be trusted. We revisit a scene from his early life: Mother is in the bathroom, bleeding from a selfinflicted wound. In real life, he said nothing, shut the door and went downstairs to dial for an ambulance. In the psychodrama scene, he is helped to confront her. In this encounter, he tells his mother of his hate for her, his wish that he had let her die and that had he done so he might have been a better man. He also asks why she beat him and rejected his attempts to be close. Using the technique of role reversal (ie he now speaks from the perspective and role of his mother), he considers that his very presence
reminds her of his father, a husband who abandoned her, and her resentment is that he always stood up for his father. Comparing him with his father, she considers John as selfish, mean and cruel, and she therefore hates him.
Surplus reality Using the technique of ‘surplus reality’ – in which what did not happen, but was longed for, is enacted – John is offered the experience of being held, of being told he is loved, and of receiving tenderness rather than cruelty. John’s mother died while he was in prison, but he is offered the opportunity to explore what he hoped his mother might have said before her death. With a group member holding her role, and with the use of the role-reversal technique, he hears what he had always hoped for, as she reminds him of the good things and tells him that he is loved. Whether or not his mother would have said these things, the internalised role of the persecutory mother is challenged, and John concludes his interaction by telling her through his tears that he loves and forgives her. The work returns to his first scene with his victim. He expresses his remorse and offers an explanation to his victim and to himself about his behaviour. John has made his journey, interweaving past and present. By doing so, he has come to understand the process by which he came to transfer his angry feelings
Psychodrama psychotherapy provides a forum for the offender to consider in detail how their modes of dealing with significant others (including the victim) may be influenced by early childhood experiences
feature article towards his mother and himself onto his innocent victim. As the group gather round to resonate with his psychodrama work (this is the sharing stage of the psychodrama session), John experiences the support, understanding and caring that he did not receive as a child.
Informing psychotherapeutic practice While classical psychodrama treatment should only be facilitated by trained psychodrama psychotherapists, there are many psychodrama techniques that can be safely used to inform wider psychotherapeutic practice. For example, the use of role theory, as described above, can be a useful approach when working with an individual in one-to-one and in group practice. Encountering a significant other using the empty chair technique provides an opportunity to express directly thoughts and feelings that have hitherto been suppressed. Concretising parts of self and role reversal with parts of self and other offers another creative approach. For interested readers, the Psychodrama and Creative Education In Prison: Good Practice Guide (Togoie et al, 2015) provides explanations of techniques that can be safely used to aid group introductions and group cohesion, improve communication, inspire change, promote conflict management and problem-solving, and assist group closure and endings. The guide is full of useful examples of techniques that can be used by the non-psychodramatist.
References and further reading Bowlby J (1988). A secure base: clinical applications of attachment theory. London: Routledge. Henderson A (1974). ‘Care eliciting behaviour in man’. Journal of Nervous & Mental Diseases, 159: 172-181. Jefferies J (1991). ‘What we are doing here is defusing bombs’. In P Holmes, M Karp (eds) Psychodrama inspiration and technique. London: Routledge. Togoie M, Popa P, Hurezan L, Burca C (2015). Psychodrama and creative education in prison: good practice guide. Romania. Project website: www.psychodramainprison.ro Williams A (1989). The passionate technique. London: Routledge.
Strength to change: psychodrama-informed work with domestic abuse Psychodrama has much to offer psychotherapists working with partner violence and abuse, explains Mark Farall.
istorically, the field of intimate partner violence and abuse has been dominated by a gendered analysis. This sees abusive and/ or violent behaviour in intimate relationships as being male to female, intentional, and originating in male power and control, supported by our patriarchal society. In practice, this paradigm has led to abusive men, in particular, being viewed as uniquely pathological and as a ‘separate’ population.
There has been a suspicion and often a rejection of therapeutic concepts by many people in the field. Taking account of attachment, personality disorder, the influence of trauma or the need for a therapeutic relationship has somehow been seen as colluding with abusers.
Dr Mark Farrall (UKCPregistered) is a psychodrama psychotherapist, chartered forensic psychologist and Associate Fellow of the British Psychological Society. He is Director of Ignition Creative Learning (www.ignition-learn.co.uk) and has developed several innovative treatment programmes aimed at reducing violence and abuse.
‘Treatment’ has been overwhelmingly psycho-educational in orientation.
Doing it differently Any therapist should attempt to understand the presenting difficulty and what underlies it (including gender issues), and offer an intervention that is targeted to the particular treatment needs of the individual. Strength to Change is an independently evaluated (Phillips, 2013) programme in use in local authority settings where a child protection order has been triggered by concerns of domestic violence. It is strengths based, brief (five to 16 sessions) and one-to-one, rather than an orthodox, six-month group programme. It integrates motivational interviewing, psychodrama methods and gender inclusive research (PASK, 2016). The programme is therapeutically informed and trauma aware but delivered by non-therapists (Farrall and Young, 2015).
Engagement Through motivational interviewing (Miller and Rollnick, 2012), phase 1 concentrates on building the relationship and understanding any defensiveness as a natural response to guilt and shame, rather than as a uniquely pathological reaction of ‘perpetrators’. The personcentred, non-judgmental relationship and skilled reflective listening develop ‘intrinsic motivation’ and open the door to extremely challenging conversations and materials that explore both abusive behaviours and the values of the client.
Using role reversal, the client is not just speaking in the first person from the role, but is facilitated to experience being on both ends of the conversation If a decision to go forward to treatment is reached, provisional goals are identified in a timeline which is physicalised threedimensionally. This might involve the client taking the role of a loved one with whom they wish to improve a relationship or an abstract such as ‘fear of change’. They speak in the first person, as if they were actually that person or concept, to develop insight and empathy, and to confirm motivation.
Treatment Treatment proper begins with a walkthrough, a physical reconstruction of an abusive incident. The process of ‘context reinstatement’ elicits far richer data on thinking, feeling and behaviour than that provided by a verbal discussion. The walk-through opens up the idea of process (things don’t just happen) and identifies typical negative ‘self-talk’, powering abusive behaviour. We then use the metamodel of situational analysis to further emphasise process and identify possible choice points before the ‘too late’ of abuse. Next comes identifying and physically practising the ‘behaviour of thinking’, literally speaking a positive monologue in an increasingly challenging way. For example, the client will speak the positive self-talk aloud and then take the role of their own negative self-talk in order to argue against it. The facilitator then assembles a semitailored menu of six to eight sessions
from plans addressing research-based treatment needs. These areas are universal but made relevant by the elaborated case formulation of the client’s individual situation, gained through phase 1.
Doing differently and doing new Didactic teaching and skills practice of active listening skills, assertiveness, ‘I statements’ or negotiation is enriched through role-taking, embedded in fluid coached scenes of ‘doing differently’ or ‘doing new’. This is real play, not role play, and provides a necessary degree of the embodied physiological arousal experienced in real-world situations rather than being abstract, ‘cold’ learning that is hard to apply when aroused. Using role reversal, the client is not just speaking in the first person from the role, but is facilitated to experience being on ‘both ends of the conversation’ through dialogue between the roles. The client practises responses in their own role, increasing behavioural competency, but also experiences what that response feels like ‘on the receiving end’, in the other role, potentially developing empathy and insight – knowing from the heart, not just the head. Existential issues can be addressed through ‘empty chair’ work on ‘unfinished business’, for example, enabling a client safely to express their rage or pain towards an abusive figure. Equally, this technique enables clients to express remorse or guilt, to apologise to those they have harmed, or
to express love to people where they cannot do so in person. Final sessions focus on consolidation of change. ‘Future projection’ allows the client to experience the positive emotion of a future success or achievement, in the here and now, thus supporting their motivation, change and development, and aiding lapse prevention.
Conclusion Just as psychodrama can enhance nonaction therapies (Holmes, Farrall and Kirk, 2014), it has much to offer work with intimate partner violence and abuse. Rather than a cognitively-based, ‘educational’ stance, it enables holistic working with all aspects of the person, especially the emotional dimension with which so many individuals struggle, and addresses embodied experience that lends reality and relevance to the work.
References Farrall M and Young N (2014). ‘The strength to change’. Therapy Today, May: 22-25. Holmes P, Farrall M and Kirk K (2014). Empowering therapeutic practice. Integrating psychodrama into other therapies. London: Jessica Kingsley. Miller W and Rollnick S (2012). Motivational interviewing: helping people change (3rd edn). London: Guilford Press. PASK (2016). Partner Abuse State of Knowledge project: www.domesticviolenceresearch.org Phillips L (2013). Evaluation of the Bracknell Forest Council Domestic Abuse Perpetrator Service (DAPS). Dartington.
Roles in triangles: the interpreter, the client and the therapist Beverley Costa explains how action methods can help therapists working with clients who speak a different language, offering a safe environment where mistakes can be made and learnt from.
magine three people in a therapy room, each with their anxieties about how the session will go, wondering whether they will understand each other, if they can trust each other, and who will take responsibility for what happens. This is the situation regularly experienced by therapists, interpreters and clients when they meet for the first time.
Mothertongue The Mothertongue multi-ethnic counselling service has been delivering action methods training to therapists and interpreters working together since 2009. The culturally and linguistically sensitive service provides professional counselling and psychotherapy to people from black and minority ethnic backgrounds in their preferred language. It also runs a dedicated mental health interpreting service and offers training and regular clinical supervision for interpreters and clinicians.
Dr Beverley Costa is a UKCP-registered psychodrama psychotherapist and Chief Executive Officer and Clinical Director of Mothertongue, a multi-ethnic counselling service, established in 2000 and based in Reading (www.mothertongue.org.uk). Mothertongue’s Bilingual Therapist and Mental Health Interpreter Forum meets twice a year in London. Beverley is currently executive producing the development of an Arts Council England-funded play about interpreters called ‘Triangles’.
In the past three years, the need for services to work across languages has hugely increased. On 21 December 2015, the International Organisation for Migration (IOM) stated that the total number of migrants – including asylum seekers and refugees crossing into Europe by land and sea – had reached more than 1,006,000 that year. This situation continues to intensify.
Communication across languages and cultures For therapy to be possible and effective in these multilingual contexts, therapists need to be able to work in more than one language and to make adaptations to therapeutic practices when an interpreter is present. When communication needs to be conducted across languages and cultures, it is put under strain. Professionals may feel deskilled, wandering through a hazardous course, anxious not to cause offence. Therapists, usually very mindful of the dynamics of power when working with clients, may feel wrong-footed by having an interpreter in the room. Trust, which is so important yet so fragile in this context, can be shattered easily. Understanding the dynamics of the multiple relationships is crucial, and training to do this lends itself to the use of action methods and role-taking exercises (Costa and Briggs, 2014).
Triangular relationships The training for therapists and interpreters focuses on the roles in a triangular relationship, the dynamics of power and the implications for therapeutic safety. Karpman’s (1968) drama triangle provides a useful model for human behaviour in relationships and is helpful when thinking about the interpreter, client and therapist triangle. In the drama triangle, each person in a triad occupies and moves between the position of persecutor, victim or rescuer. A potential dynamic is that both the therapist
and the interpreter may see themselves in the ‘rescuer’ role and may struggle to hold on to that role by attempting to push the other into the role of ‘persecutor’. If the therapist and the interpreter do not pay attention to the way in which they move into and occupy these different positions, the dynamics may have a negative impact on the therapy, and repetitive cycles of relationships will be played out. The following two cases demonstrate training interventions for therapists and interpreters that explore these repetitive cycles using action methods inspired by psychodramatic techniques (Moreno, 1946). These techniques include: role reversal (taking each other’s role and then reversing back); surplus reality (for example, replaying an experience as it should ideally happen); doubling (speaking for the person to reflect their inner thoughts and to provide support) and applying spontaneity (finding an appropriate response in a new situation.) Action methods can help to create a safe environment in which to make mistakes and to learn from them.
Case example 1 (using role play, doubling and surplus reality) The scenario: An interpreter is worried because the therapist seems to be annoyed with her. The client keeps looking at the interpreter and not at the therapist. The therapist wants the interpreter to stop looking at the client as it is disrupting his ability to achieve a rapport with the client. The interpreter is worried about the impact it might have on the client if she avoids her gaze. In training, this situation is played out various times, with trainees occupying different chairs in the triangle that represent the roles of client, therapist and interpreter. During the role play, the trainer/
feature article clarify roles, feel safe to practise and learn from mistakes. One comment exemplifies participants’ views on the effectiveness of using action methods in this context: the training helped her ‘anticipate and explore the potential advantages and disadvantages of working with interpreters, and come up with ideas or potential solutions to barriers through case discussion, role play and the ‘hot seat’ approach’. The effectiveness of action methods to promote empathy was also noted. This participant felt she had a new understanding of the effect of the work on the interpreter: ‘It gave us an understanding of what it’s actually like.’ For another participant, the use of action methods gave her an opportunity to experience and review the power balance in the room:
Action methods can help to create a safe environment to make mistakes – and learn from them director feeds the lines to the different participants in order to lead the scenario to a specific crisis point. The trainer/director then stops the action and the group can comment on, double or make suggestions on how to rerun the scenario in order to achieve a more productive outcome. They experience the impact of their suggestions from different role positions. This technique draws its inspiration from the psychodramatic concept of surplus reality.
Case example 2 (using roletaking and role reversal) The scenario: The therapist asks the client how her parents died. The client begins to cry and the interpreter tries to reassure the client and tells her not to cry. The therapist starts to feel that the interpreter is taking charge of the session. The therapist fears she is losing her therapeutic footing. At the same time, the therapist does not want to undermine the interpreter by stopping her from taking this action, which the interpreter clearly believes is the ‘right’ action. The trainees, in groups of three, take the roles of client, therapist and interpreter. They are instructed to play out this scenario,
that the ‘therapist’ responds in role to the ‘interpreter’s’ intervention in the scenario. On completion, the triads move one place to the left to replay the scenario in another role, role-reversing until each member of the triad has had the experience of being in each role. The group then comes back together to process and to think about issues of power, control, anxiety and safety, having had live experiences of their reactions to feelings of exclusion, alliance and collusion in a triangular relationship. If the therapist, for example, is determined to keep the role as the good doctor (or rescuer), this will place the interpreter in the perpetrator role. Consequently, the therapist may experience themselves as the victim. The client is then left to work out how to deal with this unhelpful dynamic and may perhaps take the role of rescuer or leave the session.
Evaluation This method of training therapists to work with interpreters has recently been evaluated (Bager-Charleson, et al, in press). Participants in the evaluation reported that the use of action methods in the training helped them take a perspective,
They [the interpreters] have that same power as I do, as well as the knowledge of the language, which is also a power factor in the relationship. I think the most significant impact of the training was recognising that we work as an equal threesome, that the interpreter isn’t just there as a tool to be used, but that we need to open the work as a triangle. Action methods appear to help to increase therapists’ confidence in working with interpreters. They can help therapists find a way to hold their clinical authority and containing function in the face of not understanding the client’s language, while working collaboratively with the interpreter. Using action methods allows the repetitive cycle of acting out familiar dynamics and roles in triangles to be exposed, examined and reflected upon. By creating scenarios in the training environment, we are better able to explore and practise a range of appropriate responses to what can otherwise be a complex and unhelpful process.
References Bager-Charleson S, Costa B, Dewaele J-M and Kasap Z (in press). ‘Can awareness-raising about multilingualism affect therapists’ practice? A mixed-method evaluation’. International Journal for Counselling Development. Costa B and Briggs S (2014). ‘Service-users’ experiences of interpreters in psychological therapy: a pilot study’. International Journal of Migration, Health and Social Care, 10(4): 231–244. Karpman S (1968). ‘Fairy tales and script drama analysis’. Transactional Analysis Bulletin, 7(26): 39–43. Moreno JL (1946). Psychodrama: vol 1. New York: Beacon House.
Liberating the heart in action Biggi Hofmann explains how psychodrama techniques can work with the spiritual dimensions of existence to promote healing, forgiveness and hope.
became interested in the theme of forgiveness while preparing for a presentation on forgiveness in therapy and decided to introduce the concept to my weekly psychodrama psychotherapy group. In the group were six women, some who had experienced the loss of a loved one from suicide, and some who had either attempted suicide or had suicidal thoughts.
I have come to understand that spirituality is often important to people in such circumstances. It can provide comfort or a feeling of connection to the person who has died. One notable feature of psychodrama psychotherapy is that it is grounded in spirituality. JL Moreno, the creator of psychodrama, saw humans as cosmic beings with a divine spark at their core, which he called the ‘godhead’. Some of the central psychodrama techniques – roles of restoration, surplus reality, role reversal and mirroring – can be seen as ways of working with the spiritual dimensions of existence. I illustrate these techniques through two case studies.
JL Moreno saw humans as cosmic beings with a divine spark at their core ‘discipline’, she experienced being awake, alive and able to face pain.
Here we see how roles of restoration can be used to ‘energise the trauma-based self’ (Hudgins, 2002: 76) and promote healing:
Carole survived an overdose, which she had taken in response to feeling ashamed after having an extra-marital affair. During her psychodrama, she chose her late granny as an interpersonal strength to offer her support in facing what she experienced as a shameful part of herself. In role as her granny, she experienced love, clarity and compassion towards herself.
Betty had lost her 16-year-old son to suicide four years previously. During her psychodrama, she chose ‘discipline’ as a type of strength (a transpersonal strength) that she could draw upon. In role as
The strategic use of these roles of restoration helped Betty and Carole experience clarity, empowerment and compassion while facing painful and difficult emotions.
Roles of restoration
Biggi Hofmann is a psychotherapist and supervisor with a passion for creative expression and action-based group therapy. Originally from Germany, she has lived in Northern Ireland since 1980 and has worked in the community and voluntary sector since 1999. She has a private practice, providing short- and long-term individual, couple and group psychotherapy, individual and group supervision, workshops and weekend residentials. She integrates a transpersonal framework and draws on symbolism, art, action methods and role for exploration, change and healing. www.creativeencounter.co.uk
Surplus reality and role reversal The use of surplus reality in psychodrama psychotherapy allows the protagonist (the client) to create and enact an imagined encounter and express themselves in new ways. This imagined encounter is typically a scene where the person needs to hear or express something that is crucial to healing and moving on in their life, but which has not been possible or available to them in ‘real life’. It is one of the most significant and restorative psychodrama techniques, a cathartic process that allows participants to create a corrective experience and regain feelings of inner peace and hope. In a surplus reality scene, Betty had a conversation with her deceased son. He told her, ‘It is not your fault that I died. I don’t blame you. I tried to come home but couldn’t.’ Carole faced the part of herself that felt shameful and tried to overdose. From that role, Carole spoke her truth: that she felt unloved by her husband. He had turned nasty and controlling after she lost weight.
feature article In these examples, Betty reversed roles with her son in order to experience a different perspective. Carole did the same in her conversation with her shameful part. The use of role reversal enabled Betty and Carole to increase empathy, shift their perspective, experience catharsis and gain greater understanding of the situation.
Mirroring In the technique of mirroring, the protagonist stands apart from the scene and observes him/herself interacting with other people or internal roles. Mirroring helps us see ourselves and other people with greater objectivity and clarity. Watching the replay of the conversation between herself and her son enabled Betty to realise that she was not to blame, that her son’s suicide was out of her control. As observer, she also became aware that she could use the strength of discipline in deciding how much time she devoted to her late son and how much time she devoted to herself, particularly in self-caring and life-enhancing ways. Carole gained insight when she observed and listened to her shameful partblaming and condemning of herself, and also saw how Granny offered comfort, support and wisdom. She spoke about what was behind the affair, and how people responded afterwards, and she was able to distribute responsibility more realistically, noting that ‘everyone makes mistakes’. Forgiving herself enabled her also to forgive others’ limitations.
Collective and individual insight The group gained insight collectively and individually by witnessing and sharing their significant moments through experiencing different roles and experiencing their drama mirrored back to them. The use of techniques such as roles of restoration, surplus reality, role reversal and mirroring assisted the process of exploration, catharsis, insight and, ultimately, liberating the heart.
References and further reading Hudgins MK (2002). Experiential treatment for PTSD: the therapeutic spiral model. New York: Springer Publishing Company. Moreno ZT, Blomkvist LD and Ruetzel T (2000). Psychodrama, surplus reality and the art of healing. London: Routledge.
Rescuing the body in psychotherapy Doris Prügel-Bennett celebrates Moreno’s creative approach to integrating the body in psychotherapy and his significant contribution to training, practice and research.
t is an exciting time to consider Dr JL Moreno’s theoretical and practical approaches to integrating the body in psychotherapy. Moreno’s writing – spanning the 1920s to the 1970s – offers profound theoretical considerations that are worth giving a new airing. His writing embraces a cross-disciplinary approach, combining his work as a medical doctor with his experiences of the diagnostic and healing powers of dramatic engagement and expression. Many advances in interrelated fields such as neuroscience, attachment theory, body psychotherapy and movement therapy support his integrative approach, which was far ahead of its time. In this article, I hope I can interest you in some strands of his thinking at a time when integration feels important.
Interaction and co-creation It seems never to have occurred to Moreno to consider a person without her or his unique physicality, nor did he consider humans being as monads – separate entities living in isolation. He recognised the body as the means by
which we fulfil our need and ability to creatively engage with the world. With this thinking, Moreno prevented the re-enactment of the body-mind split of the Enlightenment. He defied the reductionist and mechanistic tendencies of society, also reflected in the field of psychology. He defied the ‘channeltheory’ of communication (Storch and Tschacher, 2014), which today is stronger than ever.
Moreno’s integrative approach was far ahead of its time In the channel theory of communication, technically assisted communication assumes that a sender purposefully sends out messages directed to specific recipients who are required to decode the specific meanings of the messages. Instead, Moreno developed a theory of interaction and co-creation. Humans constantly interact with the self, the other and the world, and deliberate and directed communication plays only a small part in the overall communication
Doris Prügel-Bennett MSc is a member of the British Psychodrama Association and a registered psychodrama psychotherapist with UKCP. She works in private practice as a creative supervisor, and as movement therapist/ practitioner of the Alexander technique (STAT) and doula. She is an Associate Lecturer on the Performing Arts degree course at Southampton Solent University and coordinates the Hampshire Association for Counselling and Psychotherapy.
feature article network. For Moreno, a person’s self is embodied and interacts continuously on multiple levels: consciously/unconsciously, knowingly/unknowingly, verbally/nonverbally, intentionally/non-intentionally, directed/non-directed. Fellow human beings receive the ‘vibes’ and respond from a distance, and this may be equally unintentional and non-directed. Hence, interaction is a co-created and embodied activity that never stops. It creates an embodied sense of either attraction or repulsion, which Moreno called ‘tele’ – Greek for ‘operating at a distance’.
Role theory, spontaneity and creativity Moreno developed a comprehensive role theory, which includes psychological, physiological, anthropological and social roles, and provides categories with observational, diagnostic, educational and therapeutic value. Humans develop roles from conception: first and foremost, somatic roles, then psychosomatic roles, psychodramatic roles (the ability to step into somebody else’s skin, understand the other and develop the essential capacity of empathy), and finally various social roles. These roles can be over- and/or underdeveloped. Moreno wrote about the essential qualities of spontaneity and how these are essential for human development and survival. Suffering, dysfunction, disease, a dysfunctional relationship with self or other – all these processes indicate stifled spontaneity and creativity, and can lead to compromised authenticity and integrity. Psychological roles can become under- or overdeveloped (Moreno, 1985), resulting in dysfunctional psychophysical habits (Alexander, 1998), and in ‘body armour’ according to Reich (2013). By contrast, our innate gifts of spontaneity and creativity – when enabled – can promote survival; we can develop underdeveloped roles and retire dysfunctional or obsolete roles.
Case study 1: psychodrama with ‘Sonia’ In one of the psychodrama psychotherapy groups I facilitate, our protagonist (the person who engages in her/his personal work) is Sonia. She shows us, sitting on her imaginary tree, her psychosomatic resilience and her carefree, inventive qualities. On the psychodramatic stage, she creates her favourite tree and climbs
There is always a real encounter and a co-creation in the psychotherapeutic space
there are people whose muscles produce words in different ways from ours, people in female or male bodies, or bodies that choose not to be categorisable. Attraction and repulsion always take place between people, and, in the case of psychotherapy, contribute to the co-creation of unique therapeutic sessions.
on it. She reminisces: ‘It’s a good place to be. I say what I want, and make up stories when I want to.’ She also senses a fear of the chameleon that might visit her on her tree.
Case study 2: supervision with ‘Finn’
While Sonia is watching the same scene, played back by a group member she has chosen, she says: ‘Because of the treatment I experienced, I have lost my spontaneity and feel stuck in situations in the present.’ After the drama, the other group members speak about their shared sense that Sonia enjoyed revisiting her younger self. Sonia reflects that, during the drama, when she was in the carefree climber role, she was fully in her body, which made it easy to connect with her carefree climber role. She reflects that at other times, when she is in her normal adult roles, her behaviour, physicality, affect and verbal expressions do not match. The consequence is that this makes it difficult for other people to connect with her and for her to connect with other people. Sonia decides that she feels the need to go climbing as a means for her to move on.
Discussion Thinking in terms of roles and their expressions can be a useful way to integrate work with the body. ‘Roles cannot be viewed independently… The role is... nothing fixed, extra-personal or an objective entity’ (Krotz, 2009: 32). In considering roles and their expression through the body, we can identify five levels of activity in the person: 1 behaviour; 2 emotions/affect; 3 convictions; 4 context; and 5 consequences. These five levels can be considered both in terms of individual and as interpersonal functioning, and they offer a coherent platform for observation. They offer diagnostic value and underpin clinical choices. All psychotherapeutic modalities engage with embodied clients. It will perhaps sound obvious that there is always a real encounter and a co-creation in the psychotherapeutic space. We all come with specific bodies, a particular age, able bodied or with overt or hidden impairments, a particular skin colour and/or cultural behaviour and affects. And
In one of my supervision sessions, supervisee, Finn, explains a situation with a client. Finn’s words and thoughts seem to take him further into a sense of being stuck. I invite Finn to step into the role of his client. The chair is going to be the symbolic placeholder for his client. As soon as Finn gets up from his own chair, an internal process seems to be triggered in him. Suddenly, Finn becomes very still and begins to speak from a different place of deeper feeling and understanding of the contact that exists between him and his client. The physical movement, with the intention of stepping ‘into the skin’ of the client, facilitated Finn becoming unstuck in feelings and thinking. Minute movements and change of proximity can bring significant changes on behavioural, cognitive, physical and psychological levels.
Discussion Various psychotherapeutic approaches acknowledge the physicality of clients and practitioners alike and work specifically with the body. The degree of involvement of the client’s physicality depends on each psychotherapeutic modality and practitioner. In Moreno’s body of theoretical writing, he did not formulate a theory for working specifically with the body. Instead, he let the work arise from the encounter between people. He clearly trusted that, in bodily moving encounters, people remember and the unconscious begins to reveal itself. Moreno’s reflections on working with touch are absent, albeit in his therapeutic interventions he used physical contact. More research is required in this area for psychodrama psychotherapy. Modalities such as body psychotherapy and movement therapy have integrated touch into psychotherapy. They provide us with robust theoretical and ethical underpinning (Busch, 2007). As an additional example, psychoanalytic psychotherapist Graham Bass (2014) uses physical touch in his work.
Our innate gifts of spontaneity and creativity, when enabled, can promote survival With his listening and accompanying but otherwise agenda-free touch, Bass and his client co-create an ‘intersubjective field of therapist and patient’ (Bass, 2014: 162). In my research, some psychodramatists expressed their concern that withholding touch in psychotherapeutic work can have the potential for re-traumatising people (Prügel-Bennett, 2011). The reality of the therapist’s personal touch history, touch development, the ability to self-reflect and their scope and limits bring challenges and threats. This approach requires robust theoretical underpinning and embodied training. It is an enormously rich field for interaction with the self, other and the world.
Embodied practice continues to provoke lively discussions, and not only about ethical considerations. Physicality and creativity are by nature idiosyncratic; they add dynamics and can at times create mess. Moreno’s creative thinking and his practice still look unorthodox to many practitioners in the field of psychotherapy, yet his creative approach adds a valuable dimension to training, practice and research. I would therefore like to propose celebrating his contribution to the preservation of the body in the psychotherapeutic field.
Busch T (2007). ‘Therapeutisches Berühren als reifungsfördernde Intervention’. In G Marlock and H Weiss (eds) Handbuch der Körperpsychotherapie, 1 Korrigierter Nachdruck. Stuttgart: Schattauer: 517-529.
Reich W (2013). Character analysis (3rd edn). In M Higgins and CM Raphael (eds). New York: Farrar, Straus, Giroux.
Alexander FM (1998). The use of the self (10th edn). London: Gollancz. Bass G (2014). ‘Sweet are the uses of adversity’. In FS Anderson (ed) Bodies in treatment. The unspoken dimension. Hove, UK: The Analytical Press.
Krotz F (2009). ‘Interaktion als Perspektivverschränkung. Ein Beitrag zum Verständnis von Rolle und Identität. In der Theorie des Psychodrama’. In S Gunkel (ed) Zeitschrift für Psychodrama und Soziometrie, Sonderheft 1. Wiesbaden: Springer: 27-51. Moreno JL (1985). Psychodrama (1st vol, 4th edn). Ambler, PA: Beacon House Inc. Prügel-Bennett D (2011). Towards a cotemporary touch culture in psychodrama (unpublished diploma dissertation at Oxford School of Psychodrama and Integrative Psychotherapy).
Storch M and Tschacher W (2014). Embodied communication. Kommunikation beginnt im Körper nicht im Kopf. Bern: Hans Huber, Hofgrefe AG.
Stepping back to go forward Annei Soanes describes her research, which aims to investigate the experience of the person as practitioner to inform training, practice and supervision.
his article focuses on some of the subtler and more transitory processes that occur moment to moment in the process of psychotherapy. Drawing on my MSc research with psychodrama psychotherapists, I describe a phenomenon involving the embodied experience of the therapist, specifically the movement of their body when a client is perceived to manifest symptoms of trauma. While the findings emerge from research with psychodrama psychotherapists, the experience described may resonate with psychotherapists across modalities. Physical movement may manifest in a wide variety of ways, including subtly shifting body posture when seated.
A five-stage process While an abundance of literature examines the complexities of working with traumatised clients (Van der Kolk, et al, 1996), practitioner experience frequently concentrates on burnout, compassion fatigue, secondary and vicarious traumatisation (Sodeke-Gregson, et al, 2013), or ‘compassion satisfaction’ (Pack, 2014). In this qualitative study, experienced psychodrama practitioners shared their ‘in the moment’ experience of spontaneous
Annei Soanes, MSc, is a UKCP-registered psychodrama psychotherapist and supervisor in private practice. Her clinical experience includes working at HMP Grendon Therapeutic Community and the Priory Hospital, Woking.
client dissociation, which, although it happened in a rapid timeframe of seconds (or less), could nevertheless be considered in five stages: Perception: Visual and energetic changes in the client were noticed, eg the client ‘immediately… looked different… sounded different… like this really frightened child’, or ‘he was standing and he became rather rigid… and his eyes became sort of glazed’. Response: Although felt, this change was not fully made sense of. Practitioner responses included awareness of arousal and heightened alertness with a sense of shock and confusion. Experience included momentarily feeling deskilled, manifesting
as ‘a loss of creativity… and no spontaneity’, and feeling ‘rather inadequate’. Recognition: The ‘penny drops’. Sensemaking starts. Experience was intense, described by one practitioner as ‘a surge of electricity’. There was an understanding that something vital was being communicated, urgently requiring intervention, simultaneously prompting the practitioner’s own affect regulation. One practitioner described ‘taking that deep breath’. Physical movement: Physically moving away from the client and creating distance. This generated psychological and emotional space to expand perspective and achieve affect regulation. In this space, practitioners
feature article Stepping back or shifting position – physically and mentally – gives the therapist a powerful way to distance themselves from the client’s affective space
‘grounded’ themselves, enabling cognitive clarity around the choice of appropriate intervention. Pertinent to psychodrama, practitioners have freedom to move their own bodies. Responses included: It might feel right to move right away if I’m feeling overwhelmed...to see it from some distance… Those spatial things are really important in terms of having to manage whatever might be going on in me. … by being up and being able to move around… I’m aware of my whole body. It’s very important to be able to move in and to move away… and reposition myself. Movements included slightly turning the body away from the client or taking one or several steps away. Action: Participants employed grounding techniques (Ogden, et al, 2006), stimulating thinking capacity and body awareness of the client to re-establish the client in the ‘here and now’: for example ‘through the physical… feet on the ground (bangs feet on ground) other people’ or ‘do you know where you are… can you see the people around here?’
Conclusion My research found that what appeared at first to be an intuitive, unconscious action – physically stepping back in the moment – is a key component of affect regulation in practitioners, with subtle yet important stages. Interestingly, this process of stepping back reflects one of Rothschild’s self-care recommendations for breaking ‘body-to-body resonance’. According to Rothschild (2006: 200), ‘stepping back or shifting position both physically and mentally will give the therapist a powerful way to distance herself from the client’s affective space’.
The intention of this research was to investigate the experience of the person as practitioner to inform training, practice and supervision. The findings, while not conclusive, represent a platform for further research and discussion.
Taking the tools of the trade beyond the clinic
Ogden P, Minton K and Pain P (2006). Trauma and the body: a sensory motor approach to psychotherapy. New York: WW Norton & Co.
Carl Dutton describes situations from his recent practice where he has facilitated psychodrama and sociodrama sessions ‘beyond the clinic’ in school and community settings.
Pack M (2014). ‘Vicarious resilience: a multilayered model of stress and trauma’. Affilia: Journal of Women and Social Work, 29(1): 18-29. Available from SAGE Premier 2014 (accessed 7 May 2014). DOI: 10.1177/0886109913510088.
References Boon S, Steele K, Van der Hart O (2011). Coping with trauma-related dissociation: skills training for patients and therapists. New York: WW Norton & Co.
Rothschild B (2006). Help for the helper. Selfcare strategies for managing burnout and stress. New York: WW Norton & Co. Sodeke-Gregson EA, Holttum S and Billings J (2013). ‘Compassion satisfaction, burnout, and secondary traumatic stress in UK therapists who work with adult trauma clients’. European Journal of Psychotraumatology, 4: http://dx.doi. org/10.3402/ejpt.v4i0.21869 (accessed 22 March 2014). Van der Kolk BA, McFarlane AC and Weisaeth L (eds) (1996). Traumatic stress. The effects of overwhelming experience on mind, body and society, New York: Guildford Press.
uring my past 13 years of practice, I have used Dr JL Moreno’s methods of psychodrama and sociodrama in many different settings outside the clinic. In doing such work, I take inspiration from Dr Moreno’s seminal principle that ‘a truly therapeutic procedure cannot have less an objective than the whole of mankind’ (Moreno, 1953: 3). This is an encouragement to us all to use our skills not just in the clinic but beyond those parameters to help make changes in the whole of society.
Definitions First, some brief definitions. Psychodrama can be described as a ‘method of group psychotherapy that uses a dramatic format and theatrical terms’ and also as ‘a method of living not limited to the realm of therapy’ (Holmes, 1991: 7). Please see the Editorial introducing this special issue of The Psychotherapist for a fuller definition of the method. Sociodrama, by contrast, is a group action method that explores the roles we share with others. It taps into a truth about humanity, which is that we are more alike
feature article With the right facilitation, each group member can be helped to meet others, to participate, to have a voice, to be respected, to contribute, to learn, to grow, and to feel a sense of belonging than we are different (Sternberg and Garcia, 1994).
Example 1 – at school The first setting was with a group of adolescents who attended a session I was invited to run in a high school during what was termed ‘enrichment’ week. During this week, the standard school programme was changed in order to focus on personal and social development. In the early part of the session, I invited the group of young people to look through newspaper headlines and to agree on a subject area they wanted to explore in action. After much discussion, they agreed on a news story about a policeman who left his police dog in his car on one of the hottest days of the year and was consequently sacked from his job. I offered them guidance on how to explore the story in action, suggesting that they could place chairs in different places around the room to represent the key roles in this story. They identified the roles of officer, dog, general public and boss. They began to explore the story, and the perspectives of the key roles, by coming up to the chairs and making statements from the different roles. I told them that they didn’t have to stay there in a fixed role – they could
Carl Dutton coordinates and runs therapy groups in the NHS for children and young people, using psychodrama, sociodrama and other art forms. He trained at Holwell International Centre for Psychodrama and Sociodrama and also at the Northern School of Psychodrama. Carl is an Honorary Research Fellow at the University of Liverpool, with special interests in using horticulture as therapy and working with asylum/refugee children in schools. He is registered with UKCP as a psychodrama psychotherapist. email@example.com
swap around and try different roles. If they thought there was another role, they could name the role and we could add this to the scene.
the dynamics within relationships and the differing perspectives among the generations, spread across nations and cultures.
What developed from this was an exploration around work pressure, bullying bosses, trial by media, and making mistakes, as well as the voice of a loyal friend (the dog).
During this exploration in action, there were scenes of shared joy – for example the shared joy of farming animals and using traditional skills. The scenes also featured contrasting themes of loss of identity, loss of traditional skills, and struggling with new customs and social norms.
Reflecting on this exploration afterwards, the group members shared some of their connections to the themes of the drama. For example, some of them connected the story to the themes of exam pressures, expectations of parents and teachers, pressure from friends on social media, the feeling of needing to look perfect and perform well to the point where mistakes are not allowed, and the importance of having a good friend. In this way, through the use of sociodrama, a news story from the wider social world became a shared personal experience for each member of the group.
Example 2 – fathers and sons The second example was from a programme called ‘Fathers and Sons’, a community project developed in order to help participants to re-establish fractured relationships between fathers and sons in a Somali community in a UK city. I was working with a group of Somali fathers who wanted to improve their relationships with their sons, who they tended to see as not doing or being what they wanted or expected. In my work with the fathers, I first used warm-up techniques to develop group cohesiveness and trust. After establishing a psychologically safe space in which to explore important issues, we decided to use the idea of setting up scenes of past relationships in Somalia, current relationships and future relationships. Each scene was set up and key roles were created, including the roles of grandfathers, fathers, sons and grandsons. I encouraged a process where group members interviewed each other in the various roles. They also took the opportunity to reverse roles, where they gained a deeper understanding of
Towards the end of the session, the fathers spoke about their recognition that they needed to let go of some of the past, including some of their unrealistic expectations and demands of their sons, who are now living in a different culture. Equally, they rediscovered some of the important stories, skills and games traditionally shared between fathers and sons, which had been unnecessarily lost along the way.
Example 3 – a city-wide cultural week As a third example, I recently facilitated an open session as part of a city-wide cultural week, using art and creative methods to explore what people thought about the city. This was a public event, and before the start of the session I had no idea who would turn up or even if anyone would. In the event, people did arrive for the session, and most were keen to participate. As the session started, however, one person stated that he did not want to take part in active, experiential exercises. I reassured him that this was fine, and I encouraged him to simply observe. I told him that if he had any thoughts or comments, we would be glad to hear them.
Being the watchful observer can have the paradoxical effect of encouraging people to warm up to participating
Being the watchful observer is an important role, and it can frequently have the paradoxical effect of encouraging people to warm up to participating. Soon enough, this watchful observer became an active participant; he spoke about the history of the buildings in the area, most of which were to be redeveloped. He knew a great deal about the history of the area. For example, we learned that, at one point in the 1950s, one of the buildings nearby was a small zoo. Some of the participants remembered this, and others learned this for the first time. The group welcomed this knowledge, and the contribution from the ‘outsider’ of the group – who in short order was very much a full participant in the group. Thus we see, in microcosm, the powerful potential of working in groups: with the right facilitation, each group member can be helped to meet others, to participate, to have a voice, to be respected,
It taps into a truth about humanity, which is that we are more alike than we are different to contribute, to learn, to grow, and to feel a sense of belonging. And this, in turn, is of great benefit to the whole of the group.
Beyond the clinical setting As I hope these examples have shown, therapeutic work with groups of people can happen in a wide variety of settings beyond the formal clinical setting. In each of these group sessions, I gave priority to encouraging the spontaneity and contribution of all group participants. Whether we are working in the clinic, in
schools, in institutions, in the charitable sector or in the wider community, many of the challenges of facilitation are the same. It is important to develop a psychologically safe container and structure for action to flow, so that new responses to old situations can develop, and new thoughts, attitudes and behaviours can emerge in safety. At the centre of it all is the creativity and spontaneity of the facilitator and the encouragement of creativity and spontaneity in the group.
References Holmes P (1991). ‘Classical psychodrama: an overview’. In P Holmes and M Karp (eds) Psychodrama inspiration and technique. London: Routledge. Moreno JL (1953). Who shall survive: foundations of sociometry, group psychotherapy, and sociodrama. Beacon, NY: Beacon House, Inc. Sternberg P and Garcia A (1994). Sociodrama: who’s in your shoes? London: Praeger.
Psychodrama à deux: the rewards and challenges of individual psychodrama psychotherapy
While psychodrama psychotherapy is typically thought of as a group approach, there are contexts in which the method can be adapted for individual practice, asserts Sarah Morley. Here she explores areas of debate and reflects on the challenges and rewards of using the approach in one-to-one work.
Sarah Morley (UKCP) is a psychodrama psychotherapist specialising in the person-centred approach. She works with individuals and groups in private practice and also with adult women survivors of sexual abuse at SRASACS and SWCTS in Sheffield.
The therapist in role One area where there are differing views is whether or not, in one-to-one sessions, the therapist takes a role in the client’s psychodrama. To illustrate: following his mother’s death, David, a client in his sixties, wanted to revisit the scene of her dying. In the session, he spoke to her tearfully: ‘I just wish you could hold me, Mum. You never held me.’ If this scene were being enacted in a psychodrama group, David would have another group member – termed an ‘auxiliary’ – to enact the role of his mother, and he could experience the holding he wished for, which he had never experienced in ‘real life’. In a one-to-one situation, the dilemma for me, as therapist, is do I play the role of his mother and hold him, or do I stay in my own role, facilitating the exchange from a distance? Along with the issue of whether or not I go into the role, there is the issue of whether or not I hold him. In psychodrama, touch between therapist and
feature article The skill of the psychodrama psychotherapist is in being able to accurately sense what is being called for in the moment client may become an issue which needs to be carefully considered in a way that may not arise if everyone is safely sitting in a chair.
Responding in the moment Casson (1997) and Kipper (1986) advocate the therapist taking roles. However, they suggest that this is done ‘lightly’; and if the therapist takes a role, it ‘should be kept short and brief’ (Kipper, 1986: 341). The brevity is intended to dilute the transference, which in a group can be channelled towards other group members as they enact the auxiliary roles in the drama. In individual sessions, ‘transferential feelings towards the director… may be more intense: there is nowhere else for them to go!’ (Casson, 1997: 9). Knittel (2009) takes the opposite view when he writes, ‘Most important, the director stays in the role of director throughout the sessions and resists assuming auxiliary roles’ (Knittel, 2009: 28). The argument here is that if the therapist is playing a role, the session is effectively without a therapist.
My own view is that we can get bogged down with the minutiae of theory, which is really only of interest to ourselves. I agree that some clients would feel anchorless or minus a therapist if I were to play a role in their drama, but others may not. The skill of the psychodrama psychotherapist (indeed, psychotherapists from all modalities) is in being able to accurately sense what is being called for in the moment and respond appropriately. The American psychiatrist Dr Bruce Perry, whose special focus is on helping traumatised children, writes about working with threeyear-old Sandy. He describes how he went along with Sandy’s need to re-enact the murder of her mother, which she had witnessed. Sandy put him in role as her mother. ‘For the next forty minutes, she wandered the classroom, muttering things… While she did this I had to do exactly as she wanted… She needed to have total control while she performed this re-enactment’ (Perry
and Szalavitz, 2008: 52). Perry judged that Sandy needed to go back to this trauma and re-experience it from a position of power. He stayed in the role as long as it was needed.
Challenges and rewards Psychodrama psychotherapy in the one-toone setting comes with many challenges. However, the potential for a trusting and empathic bond between therapist and client can, in my experience, often be enhanced when the therapist enacts a crucial role. As one client put it when we psychodramatically confronted a group of bullies together, ‘It feels better doing that with back-up.’
References Casson J (1997). ‘Psychodrama in individual psychotherapy’. British Journal of Psychodrama and Sociodrama, 12(1,2): 3-20. Kipper D (1986). Psychotherapy through clinical role playing. New York: Bruner Mazel. Knittel M (2009). Counselling and drama: psychodrama à deux. USA: Xlibris. Perry B and Szalavitz M (2008). The boy who was raised as a dog. USA: Basic Books.
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New technology, social media and therapy In our emerging digital universe, we need to rethink key issues such as confidentiality, power, transparency and boundaries, says Dr Ron Wiener. He encourages all psychotherapists, counsellors and group workers to reflect on the use and impact of the new technologies.
n this article, I explore the uses of social media and technology and consider the ethics and efficacy of using electronic devices to augment the therapeutic process. To carry out this exploration, I will use the format of an imagined sociodrama, where a range of stakeholders and aspects of the debate are represented in dialogue. Sociodrama is a method where groups can tell their story in order to understand it better and, where appropriate, to change it. Sociodrama aims to understand the wider system in which the group operates through creating role-play scenes in which group members take on the roles of key stakeholders.
A hypothetical sociodrama New technology involves devices such as smart phones, tablets and laptops. Social media is ‘the use of web-based technology
Dr Ron Wiener is a senior sociodrama trainer and Honorary President of the British Psychodrama Association. He was awarded the BPA’s lifetime achievement award in 2008. He is the author of Creative Training and co-editor of Sociodrama in a Changing World. He has written many book chapters and articles. He also works as a community theatre director.
that allows the exchange of user-generated content’ (Kolmes, 2010). Here we are talking about communications such as Facebook, Twitter and blogs. In a workshop looking at the impact of new technology on the therapeutic relationship, the key roles might include the psychodrama psychotherapist, the client, group members, a mobile phone, confidentiality, Facebook, email and blog. After a group warm-up, participants taking roles might well follow on with a discussion such as this: Client: ‘I would like to use my mobile phone to record key moments in the session, so that I can think about them later.’ Psychodramatist: ‘That would be helpful.’ Psychodramatist’s double (the unspoken thoughts and feelings of the psychodramatist): ‘Hold on, I’m not sure that I want my words to be recorded. Who owns that recording? Who else can he show it to?’ Psychodramatist: ‘Of course it would be confidential to just the two of us.’ Psychodramatist’s double: ‘But how can I stop him showing it to someone else or uploading it onto the internet? On YouTube there are already recordings of countless therapy sessions.’ Confidentiality: ‘You can’t. It’s life in the digital age. You must work on the assumption that anything can be recorded and, once recorded, anyone might possibly end up being able to see it.’ Client: ‘I read all about you on your Facebook page.’
Psychodramatist’s double: ‘And I searched the internet before your first appointment to see what I could find out about you.’ Facebook: ‘I hold all this information about so many millions of people – the good, the bad and the ugly.’ Blog: ‘I like the fact that you [the psychodramatist] write about your work on me almost every day.’ Client: ‘I thought I recognised a disguised version of myself in one of your musings.’ Psychodramatist: ‘I think it is okay to record parts of the sessions, provided all other group members agree.’ Confidentiality: ‘At the end of the 5th International Sociodrama Conference in Kos, Greece, in 2015, where there had been a lot of recording of workshop sessions, the organisers wanted to distribute an edited version to the conference delegates. I objected.’ Group member: ‘I was at that conference. A DVD would have been really useful for my memory of what happened in key sessions.’ Mobile phone: ‘If only we were more transparent and open, you could have used me to record those learning points.’ Confidentiality: ‘And then who has access to you?’ Email: Don’t forget me, client. Once you have found her email address, you can write as often as you like to the therapist – even if it’s 2am.’ Psychodramatist: ‘What about boundaries? Therapy should remain confined to the session.’ Client: ‘Piffle; it goes on all the time. All that’s changed is that now I have lots of ways to be in contact with you all the time.’ And so on…
Discussion If this had been an actual sociodrama session, at the end of the session, people involved in the process would have time to share their thoughts and feelings from having taken on the various roles, and they would also have the opportunity to offer their own reflections and learning. We now live in a world with ubiquitous CCTV, mobile phones that track our presence, and government agencies
scanning our emails. In myriad ways, we are now in a post-privacy era. In this digital universe, as psychotherapists, counsellors and group workers, we need to rethink key issues such as confidentiality, power, transparency and boundaries. In this short article, I have aimed to prompt the reader’s reflections on the use and impact of the new technologies, and I offer some useful resources for further reflections below.
What you will uncover with just a little searching is that there is already a large and vibrant discussion of these issues – most of it available, suitably enough, online.
References and further study Kolmes K (2010). ‘A psychotherapist’s guide to Facebook and Twitter: why clinicians should give a tweet!’ Available at: www.psychotherapy.net/ article/Psychotherapists_Guide_Social_Media (accessed 20 February 2016).
Langois M (2011). ‘What is the power of social media for therapy?’ Available at: www. gamertherapist.com/2011/04/03/what-is-thepower-of-social-media-for-therapy/ (accessed 20 February 2016). Zur Institute online course: Digital and Social Media Ethics for Therapists: clinical and ethical considerations for psychologists, counsellors, and clinicians using the internet. www.zurinstitute. com/digitalethicscourse.html
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Understanding and recognising sex addiction Paula Hall outlines a brief history of sex addiction, along with an outline of current research and thinking. In addition, she suggests diagnostic criteria and treatment objectives
ex addiction is a contentious problem, with some professionals questioning its existence and others claiming it’s the latest epidemic. And while the DSM did not include the diagnosis in its latest update, demand for therapeutic services and training continues to rise.
communities continue to debate the most accurate name for the problem, the terms ‘sex addiction’ and ‘porn addiction’ are becoming increasingly popular in the media and on the street. And whatever the problem is called, it seems that more and more people are seeking help with unwanted sexual behaviours.
The history of sex addiction
The absence of clinically proven diagnostic criteria has further confused professional dialogues, as have changing views around the term ‘addiction’ in general. Addiction has been viewed through many lenses, with some preferring a medical model focusing on dysregulation of the reward centres of the brain and others using a psychological model to highlight the role of affect regulation. Social context is also considered a key factor by many, especially given the increased accessibility to internet pornography and the lack of education about potential addiction. The most common approach is now biopsychosocial (Hall, 2011). This approach allows clinicians and therapists to expand their thinking beyond traditional models and focus on the client as an individual. It also encourages a comprehensive treatment plan, which
The term ‘sex addiction’ was first popularised by Patrick Carnes in the 1980s when he wrote his first of many books, Out of the Shadows. Carnes was working as a prison psychologist and noticed that many of his patients struggled with compulsive sexual behaviours in a similar way to those who had chemical dependencies. Over the following years, an increasing number of professionals wrote about the topic, some favouring the term sexual compulsivity (Coleman, 1991), hypersexual disorder (Reid, 2012) and dysregulated sexuality (Winters, Christof and Gorzalka, 2010). Meanwhile, there were many who believed the condition a myth and most likely a symptom of society’s repressive sexual attitudes (Ley, 2012; Moser, 2013). While social commentators and the therapeutic
Paula Hall (UKCP-registered, BACP-accredited, COSRTaccredited, ATSAC) has been working in the field of sex addiction for nearly 15 years and is author of Understanding & Treating Sex Addiction (Routledge, 2013) and Sex Addiction – The Partner’s Perspective (Routledge, 2015). She has also been published in a number of academic journals and in the professional press. Paula was a founder member of the Association for the Treatment of Sexual Addiction and Compulsivity (ATSAC), serving as Chair for three years, and was a SASH board member in the USA. In addition to working with individuals and couples, she developed the Hall Recovery Course, which is available around the UK and under licence in Denmark and Holland, and provides intensive group recovery programmes for people with addiction and their partners. She is Course Director for ISAT (Institute for Sex Addiction Training), which provides the Accredited Diploma in Sex Addiction Counselling.
address the complexities of each individual case.
Fuelling the problem The growth of internet pornography and online sexual services and opportunities has undoubtedly fuelled the problem. Search engines receive 68 million requests for pornography daily, accounting for approximately 25 per cent of all search terms, and 27,000 people google sex and porn addiction every day. All pornography may be classed as a supernormal stimulus, a term first coined in the 1930s to describe any substance or situation that triggers our instinctive impulses beyond their original evolutionary purpose. One example of this is sugar. In hunter-gatherer days our limbic system would have driven us to seek out this essential food and, without the ability to store it, we would binge whenever it was available. Regrettably, many of us continue to binge on sugar in spite of, or perhaps because of, easy availability. Pornography works in a similar way, flooding our senses with an infinite variety of fertile bodies with which to widen our gene pool. Unfortunately, appetite is not always the best judge of what is best for us. But the internet provides much more than just porn at the computer screen. The advent of smart phones and adult apps means that porn can be accessed anywhere, along with any other kind of sexual service. And while for many this may be seen as a technological advance that promotes sexual freedom, for a growing number of people it becomes compulsive.
The prevalence of sex and porn addiction There are no reliable statistics on the number of people struggling with sex
discussion Assessment of addiction is rarely a binary yes/no decision but rather an evaluation of severity
and/or porn addiction. Most estimates are between 3 and 6 per cent of the population, but others suggest that the figure is much higher. In terms of seeking help, selfhelp forums estimate they have 260,000 members of their message boards and an equal number of visitors. The website www.yourbrainonporn.com receives 25,000 hits a day and 27,000 people google sex addiction or porn addiction daily. Twelvestep groups such as SAA and SLAA are spreading around the UK and applicants for ISAT’s diploma training in sex addiction counselling doubles year on year. Judging by the scope of professionals taking our diploma, people are seeking help for sex and porn addiction through the NHS, Relate, rehabs, voluntary sexual health agencies, Christian counselling services and university counselling services, as well as through a wide range of therapists in private practice. The type of agency or service approached will depend on the client’s perception of their problem and also on the most problematic consequence of their behaviour. For example, those presenting to couple counsellors are often trying to save their relationship after their partner discovers their acting-out behaviours. Those approaching psychosexual therapy may be experiencing erectile dysfunction or orgasmic difficulties due to the increased arousal threshold that often accompanies heavy porn use. Rehabs may be the first port of call for those with a co-existing chemical addiction or cross-addiction to food or gambling, and some clients will choose an agency or service based on their social context. For the many who seek individual therapy, their primary objective may be to resolve what they perceive as the cause of their unwanted behaviour, for example anxiety, depression or low selfesteem. But many feel unable to pinpoint
any explanation for why they continue in sexual behaviours that they don’t want to practise: behaviours that are causing significant problems in their life and are rarely enjoyable and never enough.
Assessment There are many different assessment tools available for sex and porn addiction but, to date, none have been externally verified. The assessment process is often complicated by delayed disclosure of behaviours and also by a client’s perceived distress at those behaviours. For example, one client may be convinced they are addicted to pornography because it is opposed to the values of their religion but nonetheless they can’t stop. However, on investigation, their porn use may be limited to just once or twice a month. Another client reluctantly attending an appointment because of the impact on their relationship may use pornography for hours at a time on a daily basis and regularly visit escorts and hook-up sites yet not perceive it as a problem. Unlike other addictions, measuring amounts of behaviour is rarely sufficient; rather, it is the distress created. Furthermore, assessment of addiction is rarely a binary yes/no decision but rather an evaluation of severity. Some addictions may be described as mild whereas others may be severe. A common model used for assessment is Griffiths’ components model (Griffiths, 2005), which recommends exploration of the following five areas: Salience – does the client consider their behaviour ‘important’? For example, do they find that the behaviour preoccupies their time, thinking and emotions? Does the client experience craving for the behaviour if it is not available?
Mood modification – does the behaviour modify mood? For example, is it used to soothe anxiety or escape depression or reduce anger or feelings of loneliness? Tolerance – has the client noticed that they spend more and more time engaging in the behaviour? Or that their behaviours have escalated in order to achieve the same level of arousal: for example, watching more extreme genres of pornography or taking more sexual risks? Withdrawal – when the behaviour cannot be accessed, does the client experience physical symptoms such as shakiness, lethargy, difficulty sleeping or concentrating? Or psychological symptoms such as irritability, moodiness, anxiety or depression? Conflict – does the behaviour cause interpersonal conflict, such as impacting relationships with partners, family or friends? Or does the behaviour impact work or other important commitments? Or is their intrapsychic conflict against their own value system? In addition to these components, an exploration of both the actual and potential consequences of continuing the behaviour can highlight how urgent the problem may be. In research for my book, Understanding and Treating Sex Addiction (Hall, 2013), 49.8 per cent reported mental health problems as a consequence, 46.5 per cent had lost a relationship, 26.7 per cent reported sexual dysfunctions, and 19.4 per cent had contracted an STI. But, most worryingly, 19.4 per cent, nearly one in five, had experienced a serious desire to commit suicide. The bottom line in assessment is identifying whether or not there is an inability to stop and reliably stay stopped in the face of what may be significant harmful consequences.
Understanding sex addiction Like some with chemical addictions, many people with sex addiction present for therapy believing that if they could just stop their behaviour, everything would be fine. But, as with all addictions, focusing on behavioural change is only a fraction of the solution. Recognising and acknowledging the power of craving is important for building empathy, as is identifying triggers and establishing relapse prevention strategies. But most addictions mask a deeper need, one that, if not addressed, will continue to trigger compulsive behaviours.
discussion Six-phase cycle of addiction
Source: Hall, 2013
DORMANT Sex addiction, like all addictions, starts as a pursuit of pleasure. But as neurological pathways rewire in the brain and psychological dependency builds, it becomes a primary coping mechanism for the challenges of life and a way of escaping emotional pain. In my research (Hall, 2013), 38 per cent said they had never learned to healthily manage emotions. For many, the root of the addiction lies in childhood attachment issues and/or trauma. The survey showed that 48 per cent had experienced abuse, 36 per cent felt they had insufficient affection and attention in childhood and 21 per cent had experienced bereavement of someone close to them. Addressing core issues is essential for overcoming any addiction, but one of the challenges of working with addiction is that, until a period of abstinence is achieved, it may be impossible to identify and access the deeper unconscious causes. Addiction is often referred to as an emotional anaesthetic; hence, until the anaesthesia has worn off, there may be little or no awareness of emotional pain. Furthermore, the addictive behaviour often creates more of the emotion that the client is trying to avoid. For example, someone who uses their addiction to manage anger may experience increased agitation at their failed attempts to stop, or when withdrawing from their drug of choice. Someone with attachment difficulties finds themselves increasingly withdrawing into the addiction and hence experiencing greater feelings of loneliness and isolation. The cause of the addiction often becomes the consequence, so an endless cycle of emotional pain, addiction, more emotional pain, more addiction is set up, as Tom’s story illustrates.
Tom’s story Tom, a 35-year-old financial adviser, had been in therapy for a number of years. He had initially been referred to an educational psychologist in his mid-teens, struggling with extreme anxiety and difficulties fitting into school routines. He was later diagnosed with high-functioning autism and after a number of CBT sessions seemed to be coping well. He described continuing to struggle with anxiety during his university years and of a gradual decline in his self-confidence. At the time of our first appointment he was married and had a new baby on the way; his anxiety symptoms were increasing in spite of further counselling, which had focused on childhood trauma issues. His reason for seeing me was that he was becoming increasingly concerned by his pornography use, which had escalated to online sex chats, which his wife had recently discovered. He said he had started using pornography in his teens to alleviate his anxiety and it continued to be his primary source of comfort whenever he felt stressed. He had never disclosed his pornography use to any previous therapist as he did not consider it relevant and he had never been asked. Over the next few sessions, Tom gained insight into how his secretive porn use contributed to his anxiety and how the shame he felt about his dependency on it eroded his selfconfidence. He also talked of how difficulties getting an erection had damaged his sexual relationship with his wife. Although Tom had a close group of friends whom he experienced as supportive, he felt isolated from them as he was sure they would think less of him if they knew about his porn habit and the sex chats he had with other women, rather than making love to his wife. It was easy to see that Tom’s
anxiety was the main cause of his addiction, and also that his addiction had now become the main cause of his anxiety. This complex interplay of cause and consequence can be challenging in establishing appropriate treatment. The route to recovery will be different for each individual, but will require understanding and development of relapse prevention strategies, in addition to work on underlying issues.
Therapeutic approaches The six-phase cycle of addiction is a useful tool for helping clients to recognise the therapeutic work involved in overcoming their compulsive behaviour and also why they may have failed to successfully stop in the past. For some clients, the dormant phase may last for many weeks or months, but after a period of time they are triggered again into their acting-out behaviour. The dormant phase is where the underlying issues reside, be they trauma, attachment or affect related. Triggers may be environmental, for example an opportunity such as being away on business or having easy access to unprotected internet, or they will be emotional, such as relational conflict or stress at work. Often there are a number of triggers, rather than one. In the preparation phase, both practical and cognitive strategies are taking place to enable the acting-out behaviour to occur. After acting out, many clients experience significant regret, though that will depend on the consequences of the behaviour. During the reconstitution phase, they may enlist strategies to try to limit or stop themselves acting out again, such as putting blockers on their computer, removing profiles from websites and deleting apps. But unless the dormant phase issues have been addressed, it will simply be a matter of time before they are triggered into acting out again. Or they will find themselves doing what is commonly called ‘white-knuckling’ it, an exhausting experience where life becomes dominated by ‘not’ acting out. The goal of addiction recovery is to get off the cycle of addiction completely and develop a life that no longer needs the addictive behaviour. This almost always requires a multidisciplinary treatment approach to ensure long-term change: for example, CBT for breaking negative thinking patterns, behavioural therapy
discussion for relapse prevention, psychosexual therapy for developing positive sexuality, and psychotherapy for addressing underlying causes. In addition, many require specialist trauma work and couple therapy. Group work has been the bedrock of addiction recovery for many years, primarily because of its ability to break through shame and denial, along with addressing attachment issues. In addiction recovery, it also provides long-term peer support and a place for accountability. Undoubtedly, the biggest block to getting help with compulsive sexual behaviours and/or porn use is shame. Not necessarily shame about the behaviour itself, but shame about the impact their behaviour has on others and the lengths they will go to engage in their chosen activity. Many clients are initially horrified at the idea of group work, but experience has shown that Yalom’s therapeutic factors, such as universality, altruism and instillation of hope (Yalom, 2005), can not only break through shame but also speed recovery in a way that individual therapy cannot rival.
Conclusion Sex and pornography addiction is a growing problem in the UK today, a problem that is multifaceted and requires a multidisciplinary approach. Assessment can be complex and treatment must address both underlying causes and relapse prevention, as well as helping a client develop positive sexuality.
References Coleman E (1991). ‘Compulsive sexual behaviour’. Journal of Psychology & Human Sexuality, 4(2): 37–52. Griffiths MD (2005). ‘A ‘components’ model of addiction within a biopsychosocial framework’. Journal of Substance Misuse, 10: 191–197. Hall PA (2011). ‘A biopsychosocial view of sex addiction’. Sexual & Relationship Therapy, 26(3): 217–228. Hall PA (2013). Understanding & treating sex addiction. London: Routledge. Ley DL (2012). The myth of sex addiction. Roman & Littlefield. Moser C (2013). ‘Hypersexuality disorder: searching for clarity’. Sexual Addiction & Compulsivity, 20(1-2): 48–58. Reid RC (2012). ‘Report findings in a DSM-5 field trial for hypersexual disorder’. Journal of Sexual Medicine, 8(11): 2868–2877. Winters J, Christoff K and Gorzalka B (2010). ‘Dysregulated sexuality & high sexual desire: distinct constructs’. Archives of Sexual Behaviour, 39(5): 1029–1043. Yalom I (2005). The theory and practice of group psychotherapy (5th edn). Basic Books.
Past life regression: should it be taken seriously by psychotherapists? Andy Tomlinson shares his personal thoughts about using past life stories in a transpersonal healing process. Increasing numbers of professionals are quietly using it, he says, often getting dramatic results. He also discusses taboos and resistance to the approach
remember during my hypnosis and psychotherapy training asking what to do if a client wanted to experience a past life. I was told to treat it as though it were a metaphor. Shortly after I qualified, an elderly, rather prim lady came to me and said she had recently visited Venice for the first time, yet found some of the buildings familiar, as if she had seen them before. She wondered whether it was in a past life. I used hypnosis and, in trance, prompted by my questions, a story emerged of her being the keeper of prostitutes for sailors in Venice. When out of trance, she urged me not to tell her friends what she had been! The story that emerged was quite spontaneous and a real surprise for her.
Working with past life stories prompts two questions: are they real, and is there any therapeutic value for clients?
Are past lives real? The idea of reincarnation appears to have originated in the ancient philosophies and religions of India around the second century BC, and is part of many religions including Hinduism and Buddhism. In the western world, belief in reincarnation goes all the way back to Ancient Greece. Pherecydes of Syros taught the concept of reincarnation and Pythagoras, Empedocles, Plato, Virgil and Ovid embraced it in their philosophies. One area to examine for proof of reincarnation is evidence of consciousness surviving physical death. Research over
13 years by Dr Pim van Lommel and his colleagues from Rijnstate Hospital, Arnhem, Holland investigated the experiences of 344 heart patients resuscitated after cardiac arrest. All had been clinically dead at some point during their treatment. Of these, 62 patients reported a near-death experience, overhearing conversations and looking down from above. During this period, many had no electrical activity in the brain, which meant that their memory recall of the experience could not be explained by traditional scientific explanations. Their research was published in the medical journal The Lancet (Van Lommel, et al, 2001). Other work suggesting that consciousness survives includes that by Dr Ian Stevenson, former Head of the Department of Parapsychology at the University of Virginia, and his successor, child psychiatrist Dr Jim Tucker. Both specialised in collecting the past life stories from young children around the world through interviewing them and witnesses to their past life experiences.
Andy Tomlinson has been a UKCP member and regression therapist for over 20 years. He is an international trainer and author of three books on regression therapy.
discussion When children are just beginning to talk, yet have information, including verified obscure details, explanations like cryptomnesia and imagination are not applicable. The researchers also looked for inconsistency or fraud through follow-up visits, checking for signs of personal gain that could account for deception. In all, Stevenson and his colleagues painstakingly collected over 2,000 cases from a wide range of cultures and religions around the world.
History of past life regression in healing In the west, work with past life regression started in the 1970s. Dr Hans TenDam led the way in Europe with his book Deep Healing. Three further books on past life regression were published: Reliving Past Lives by Helen Wambach; You Have Been Here Before by Edith Fiore; and Past Lives Therapy by Morris Netherton. All these books had in common was a focus on the therapeutic use of past life regression. In the 1980s, Dr Roger Woolger, from a background of being a Jungian therapist, contributed to the therapeutic aspects of past life regression by introducing the importance of working with the body. He pioneered the technique of combining body psychotherapy with psychodrama to release traumatic memories.
If something is not completed in one life, the soul returns to similar situations until it has been mastered At the turn of 2000, the therapeutic use of past life regression started to include age regression and body therapy, and was named regression therapy. The first World Congress for Regression Therapy was held in the Netherlands in 2003. In the summer of 2006, the Earth Association of Regression Therapy was founded in Frankfurt and established a standard for regression therapy that today is a single worldwide standard. Dr Peter Mack, a practising surgeon from Singapore, became dissatisfied with the limitations of traditional medical practices and was trained in regression therapy. In the
‘Pathophysiology of a past life issue’ by Dr Peter Mack from Life Changing Moments
early 2010s he wrote two books about his clients’ past life regression healing stories – Healing Deep Hurt Within and Life-changing Moments. Shortly afterwards, in April 2013, an international meeting of psychiatrists, medical doctors and clinical psychologists using regression therapy took place, and from this the Society for Medical Advance and Research in Regression Therapy was formed, with 20 medical members. The Society published its first book, Inner Healing Journey: A Medical Perspective, in which six medical doctors, including two psychiatrists, shared 11 client healing stories using past life regression.
How does past life regression help? When the memories involve the current life or early childhood, the term often used is age regression. When the timeline is allowed to continue backwards, past life stories can appear, and this is called past life regression. These stories are rich in metaphorical interpretation by the client and provide a powerful transpersonal experience for healing. Past life regression works from within the client and is based on the principle that the client’s emotional issues and illness reflect the deeper struggles of their life. Ill health does not happen randomly, but when emotional, psychological or spiritual stresses have overwhelmed and weakened the body’s defences in the past. Something in the client’s life needs to be changed, which may be their work situation, family relationships, lifestyle, rest patterns or life purpose. When they understand why they are ill and what can be done differently, it allows healing to take place and is an opportunity for spiritual growth.
The theory behind past life regression Everything in the Universe is energy and has consciousness. Part of this consciousness splits off and is given an opportunity to experience and grow in human life. This is called a soul and it survives physical death. One way the soul grows is by incarnating on Earth and experiencing difficult life situations and emotional challenges. If something is not completed in one life, the soul returns to similar situations until it has been mastered. It is like the Earth is a classroom with different life lessons, and when one is mastered it proceeds to the next. An important principle is free will, to be able to respond to life situations and through this experience grow.
Resistance to psychotherapists working with past lives Past life regression may be dismissed as a New Age fad. It is true that in an unregulated market anyone can call themselves a past life therapist, so standards are not controlled. However, psychotherapists and professionals who have undergone professional training programmes in regression therapy work to high standards. Perhaps the evidence for reincarnation is considered unconvincing. Or there is a cultural bias still existing from religions that in the past equated reincarnation with heresy. Maybe it touches on a taboo subject, namely death; consequently, there may be an unspoken resistance to talk about death or what may happen next. However, there is increasing recognition of the need to take into account the cultural environment and belief systems of clients because these values reflect basic assumptions
discussion about a person’s nature and ways of coping with psychological difficulties. Currently accepted psychotherapeutic approaches take no account of the belief in life after death held by many of the world’s population (Peres). The Pew Forum on Religion and Public Life survey (December 2009) found that 22 per cent of American Christians believe in reincarnation. The following was written by Mário Simões, Professor of Psychiatry and of Consciousness Sciences in the Faculty of Medicine, Lisbon, Portugal. He is the Director of the postgraduate course in Clinical and Experimental Hypnosis and the Laboratory for Mind-Matter Interaction with Therapeutic Intention, and is trained in using regression therapy.
Prevention is better than a complaint: dual relationships Sheila Foxgold outlines the issues surrounding dual relationships for psychotherapists
Being symbolic in nature, imagination permits representations of things that do not exist or which are approximations of reality. It is a capacity that allows elaboration of concepts or precognitions that would be impossible to realize in any other way. The idea of exploring reincarnation is close to the concept that a patient must re-experience the primeval drama to exhaust the emotions from it. It does not matter if the experience is true or not, but that it is experienced in a personalised way. (Simões, 2002) In other words, from a therapeutic perspective, it does not matter if a past life is real or not. What is important is the metaphorical interpretation of material emerging from the client that delivers a powerful transpersonal experience for healing. Respect for clients’ opinions and their subjective realities is a therapeutic need and an ethical duty, even though therapists may not share the same belief.
References Peres J (2012). ‘Should psychotherapy consider reincarnation’. Journal of Nervous and Medical Disease, 200(2): 174. Simões M (2002). ‘Altered states of consciousness and psychotherapy’. International Journal of Transpersonal Studies, 21: 150. Van Lommel, et al (2001). ‘Near-death experience in survivors of cardiac arrest. A prospective study in the Netherlands’. The Lancet, 15 December.
Promoting professionalism and trust You uphold the reputation of your profession at all times. You should display a personal commitment to the standards of practice and behaviour set out in the Code. You should be a model of integrity and leadership for others to aspire to. This should lead to trust and confidence in the profession from patients, people receiving care, other healthcare professionals and the public. Nursing and Midwifery Council Code, section 20 (2015)
‘Dual relationships’ and ‘sexual relationships’ are two issues that consistently arise in complaints. A sexual relationship with a client, supervisee or trainee is, by its very nature, a dual relationship. Sexual relationships are prohibited under clause 1.4 and wider dual relationships are discussed in clauses 1.5 and 1.6 of UKCP’s Ethical Principles and Code of Professional Conduct (2009). The proposed revised version of the UKCP code includes at part B, ‘Principles for ethical practice: avoiding harm’, the following statements: ‘avoiding
discussion dual relationships’ and ‘not having sexual or intimate contact with clients’.
Two or more role relationships One definition of a dual relationship is the existence of two or more role relationships between two parties that occur concurrently with or sequentially to the primary relationship. On one level, dual relationships blur the boundaries and create role confusion and, on the other, verge on being or are actually harmful. Transient and unintentional dual relationships can occur naturally in the course of everyday life: for example, when you have or have had a professional relationship with the person serving you at the checkout. The option of queuing again is more likely to breach the client’s confidentiality, especially if you are with someone who knows you’re a psychotherapist. Such situations can be preempted by including in your contract, or as general information, a statement outlining how you will manage encounters that occur outside the therapy space.
Discussion, negotiation and agreement Continuing professional development (CPD) inevitably has the potential for transient dual relationships when your client, supervisee or trainee and yourself wish or need to attend the same event. The key word here is event. The temporary dual relationship can be managed through prior discussion, negotiation and agreement as to how you intend to avoid or interact with each other. Ongoing training events or courses are a different matter. The old adage ‘never mix business with pleasure’ evolved out of long and often bitter experience. Time and time again,
Sheila Foxgold is a UKCP registered psychotherapist, originally training as a counsellor before qualifying as a psychotherapist in 2000. Her particular expertise and interest includes trauma work, the family dynamics of addiction and therapeutic life story work with looked-after or adopted children/young people.
people have thought they were different, that they could manage engaging in dual relationships because, after all, they were intelligent adults and it wouldn’t happen to them. That is until there is a rupture in the relationship and the hurt, disappointment and confusion lead to a potentially acrimonious split and a complaint being filed. The dual relationship acts as a roadblock in any current therapy and either inhibits or prohibits the client from returning to therapy. Whether this is weeks, months or years later, this is a point that is so often overlooked.
The dual relationship acts as a roadblock in any current therapy Recipe for disaster We are all well aware of the challenges that projection, transference, countertransference and (ph)fantasy create within the professional relationship. Add to that mix an actual dual relationship and you have the perfect recipe for disaster. Which role relationship are we in? Therapist/client, landlord/tenant or party host/guest? It is for these reasons that extreme care should be taken in relation to any images of you in social situations that are in the public domain because the therapy relationship is contextual in that it occurs within a defined space and time. Images of you lying on a beach might be innocuous in nature, yet set off a chain of events in the client’s mind that can lead to a complaint. Doverspike (2008: 1065) helps us think about dual relationships with his more everyday term, ‘conflicts of interest’. He cites the American Psychological Association (2002) guidance: ‘Psychologists refrain from taking on a professional role when personal, scientific, professional, legal, financial or other interests or relationships could reasonably be expected to (1) impair their objectivity, competence, or effectiveness in performing their functions as psychologists or (2) expose the person or organisation with whom the professional relationship exists to harm or exploitation.’
Unique position Knowledge is power and, as therapists, the knowledge we have of our clients’ internal and external worlds puts us in a unique position. Moving into a dual relationship could therefore potentially involve abuse of that power and subsequent exploitation of the client. We routinely ask, is this client at risk of serious harm to themselves or others? So, when considering dual relationships or conflicts of interest, we’d do well to undertake a risk assessment and begin with the question, what are the potential consequences of my not performing a risk assessment? Writing about the need for boundaries for social workers, Dewane (2010) helpfully reminds us that boundaries are there to protect the therapeutic process because the professional relationship is a fiduciary one and clients are vulnerable. So what should a risk assessment for dual relationships look like? Doverspike suggests asking several questions, all beginning with the phrase ‘is there a chance of...’ and focusing these on impairment of objectivity, competence or effectiveness. Another angle might be to assess whether your intended action has the potential to harm the client, supervisee or trainee? Does it have the potential to harm me, my organisation or my profession? In the event that a dual relationship ends with a complaint, a root cause analysis might well ask the following questions: ‘How did the therapist give themselves permission to proceed?’ ‘How did the therapist break down any resistance of the other?’ Prevention and avoidance of dual relationships is better than harm.
References American Psychological Association (2002). Ethical Principles of Psychologists and Code of Conduct, ethical standard 3.06 (Conflict of interest). Dewane CJ (2010). ‘Respecting boundaries – the don’ts of dual relationships’. Social Work Today, 10(1): 18. Doverspike WF (2008). ‘Dual relationships and psychotherapy’. Georgia Psychologist, 62(3): 17. UKCP (2009). Ethical Principles and Code of Professional Conduct. London: UKCP.
Get involved in shaping our informal grievances procedure UKCP is launching a public consultation to help shape the way we handle informal grievances and we need your help
a more formal setting through UKCP, we need to make sure that everyone has a chance to be heard and supported, and that the process is trustworthy, fair and easily accessible.
ediation and informal resolution have always been a high priority for UKCP, particularly now that the Complaints and Conduct Process (CCP) is in place and functioning well. Over the past few months, I’ve been speaking to our organisational members to try to understand what members are looking for in an informal resolution process.
What I’m hearing is that although organisational members don’t receive a large volume of concerns, when they do arise it’s important that they’re handled with care. Psychotherapists are part of a ‘talking profession’ and it’s important that we at UKCP take a therapeutic approach to trying to resolve these issues – this is a strength as UKCP-trained psychotherapists. Whether this is done at a local level or in
Samantha Lind works as a Case Manager in UKCP’s Complaints and Conduct team. She has almost ten years’ experience working in complaints and customer experience roles, both in corporate environments and the third sector, and has a keen interest in policy and process development.
The purpose of this consultation is to gather your views on the most helpful ways to resolve issues when they arise. Mediation is not like a complaints process – CCP is necessarily legalistic and, as a registrant, you are subject to it. Mediation, on the other hand, is a voluntary process that works best when both parties have faith in the possibility of reaching a resolution. This is your chance to have your say, to ensure that that you feel comfortable with the process and would be happy to recommend it to your clients. Participating in the consultation can be found online at www.ukcp.org.uk/news. Participation can be as full or as brief as you like – the survey has been designed so that you can quickly and easily answer each question but also gives you the option of adding as much feedback or additional information as you like. I would encourage as many of you as possible to get involved and let us know what you think. The more people giving their views, the more likely it is we’ll come up with a considered and workable policy. Remember, the consultation is also available to members of the public – please direct anyone interested in participating to our website.
Topics The consultation has been designed to cover a broad array of topics that you’ve told us are important to you. This includes (but is not limited to) what sort of tools and types of resolution you would like available, whether mediation belongs at a local or more centralised level, confidentiality of mediation sessions, independence and transparency of mediation, cost of mediation, and mediation training.
Consultation launch As I write this article, we are planning an event in Manchester for the middle of October. This is a re-run of our highly successful Learning from Complaints event held in London earlier this year and we’ll also be using it to launch the consultation. I’ll be on hand to answer any questions you may have about the process and about informal resolution in general. If you’re not able to attend this event, please feel free to contact me directly with any questions or concerns.
What happens next? When the consultation period is finished, we’ll produce a report that will be available to view on our website. This will detail the responses we’ve received and you’ll be able to see the information we’ll be using to shape the direction of the final policy. I’ll also provide an update in the next issue of The Psychotherapist to let you know how the consultation went and our planned next steps.
Further information about this project will be published in future issues of The Psychotherapist, on our website, and communicated through bulletins, but if you would like any further information, please contact Samantha Lind: firstname.lastname@example.org or 020 7014 9978.
Digital Delivery Project update In the summer issue of The Psychotherapist I wrote about the processes behind putting together the website, in particular the customer relationship management (CRM) system and the cleaning and moving of the data from the old system to the new. Since then, we have had a busy few months developing the content that will appear on the website, as well as undergoing thorough testing to make sure that everything works as it should. Adopting a collaborative approach
In choosing suppliers to develop the new website, we wanted to make sure that we found the right fit for us as a membership organisation. It was important that members were involved through ongoing consultation and that our new CRM system integrated with the website to provide the best service possible, both to our members and the public.
We have worked closely with all our suppliers to integrate your data with the registers and new â€˜Find a Therapistâ€™ tool that will appear on the public-facing website. Our web developers have been busy evolving the look and feel of the website based on member feedback. They have also ensured that the chosen design works just as well on smartphones, tablets, desktops and other devices.
The complex nature of our structure meant that the process of building a new website was made longer, but it means that we have been able to, and will continue to, seek member input at every stage to help it succeed.
The content of our existing key website pages has been reviewed and many staff members have spent time populating the new website with content that is optimised for high rankings on search engines such as Google. As I write this in September,
Richard Williams is the Digital Delivery Project Manager leading the implementation of the new UKCP website and database (CRM). He has been developing websites and databases since the late 1990s, and has a keen interest in helping companies to maximise their potential through the adoption of virtualisation and a digital culture.
we are undergoing an extensive period of testing and fixing, both internally and with members, to identify and fix any bugs and make any changes.
The database Salesforce, our new CRM system, has been successfully built and configured. This will power your member profile pages, allowing you greater ability to manage your membership and give you more opportunity to collaborate with other members. A substantial amount of work has taken place on user acceptance testing (UAT) and we continue to test the system.
The data CCR, our data migration company, have now successfully taken all of our data in the old systems and migrated them to the new CRM. This involved a series of data test loads, following each of which the data were checked and verified against the old system.
Students â€“ take advantage of our new FREE student membership of UKCP If you are a student, you are now eligible for free membership of UKCP. This gives you access to the online version of The Psychotherapist magazine and discounts on seminars and events. To find our more and to join, visit www.ukcp.org.uk/join-us 40
Generate your own media coverage Members tell us all the time that they would like greater awareness in the media about UKCP and psychotherapy, and that they would like more referrals. To help achieve this, we have developed a PR toolkit for members.
he PR toolkit contains the tools, advice and templates you need to generate your own media coverage and raise the profile of your work and of psychotherapy in general. We want members to feel confident engaging with the media. Working with journalists and knowing what to say when they contact you can feel daunting. We hope that our toolkit will show you how to get the most out of these opportunities.
Public relations (PR), when done correctly, can be a great way to raise your profile as a psychotherapist, to campaign on local mental health issues, and to increase awareness of UKCP. It can help build links in local areas and encourage others to seek therapy, or to choose a career in psychotherapy.
local media; how to organise your thoughts; points for press interviews; and a template press release and guidance on putting your press release together. The PR toolkit is available as a digital pdf. If you would like a copy of the toolkit please go to www.surveymonkey.co.uk/r/YHK5H2L
The toolkit includes a handy guide to the different ways to generate coverage and get the journalistsâ€™ attention: how to know what is newsworthy; tips for approaching
New and forthcoming in the UKCP books series For the best new thinking in psychotherapy and psychotherapeutic counselling
Surviving the Early Years: The Importance of Early Intervention with Babies at Risk
Changing Destinies: The Re-Start Infant Family Programme for Early Autistic Behaviours
Some babies born into difficulties are pretty much alone because their mothers might be too ill to look after them, and nurses are too busy to fulfil the maternal function other than changing and feeding them. This book is about the hope underlying the ability to survive the early years.
This book is about a new approach called 'Re-Start', developed by Stella Acquarone, to diagnose and treat early autism. In the Re-Start infant/family programme, a multidisciplinary team works with the parents and through the family relationships to reconfigure dysfunctional dynamics with the aim to ‘change destinies’.
Love and Therapy: In Relationship
Telling Time: A Novel
Divine Charura and Stephen Paul
Everyone has secrets. Lisa Harden has spent years polishing her image as a successful psychotherapist, highly respected and well known in her field. When a new patient appears in her office asking for therapy, Lisa is inexplicably unnerved and fights hard to keep up appearances. Only when the price of keeping her secret takes her to the brink of losing everything, including her marriage, does Lisa finally return to Canada to confront her past. But it may already be too late.
Sigmund Freud noted the importance of love in the healing of the human psyche. So many of life's distresses have their origins in lack of love, disruption of love, or trauma. People naturally seek love in their lives to feel complete. Is therapy a substitute for love? Or is it love by another name? This book offers explorations of the complexity of love from different modalities: psychoanalytic, humanistic, person-centred, psychosexual, family and systemic, transpersonal, existential and transcultural.
To order a book, or for more information on the full series, go to: http://bit.ly/book_series
Books about psychotherapy: Write a review? We regularly publish book reviews in The Psychotherapist written by members of UKCP. If you would be interested in writing your own review of a book that would be of interest to our members, we want to hear from you. You can choose any book related to psychotherapy. You can either suggest your own book that you have enjoyed, or pick from our list of suggestions online (http://bit.ly/ukcp_books). We have also joined forces with Karnac Books, a specialist in psychotherapy and mental health publishing, to develop a series of books that reflect on and contribute to emerging themes in psychotherapy practice, training and research. Members are entitled to a 10% discount on all titles in the series when ordering through Karnac’s website.
The Hampstead Psychotherapy Club: developing community-based resources for practitioners Josefine Speyer and Claudia Nielsen explain how they successfully started a club for practising psychotherapists in their local community
fter attending a couple of psychotherapy club meetings held by Martin Pollecoff in Notting Hill, I [Josefine] was inspired to start a club in my local area of Hampstead. Since its inception in February 2015, the Hampstead Psychotherapy Club has rapidly established itself as a popular resource for the many psychotherapists who live and practise in this part of London and further afield.
Networking I originally set up the club with the aim of giving local therapists the opportunity to socialise and network and to discuss topics of interest. The first meetings were held in the upstairs room at Café Rouge on Hampstead High Street. UKCP advertised the club on its website and emailed an invitation to members in the London area. In no time I had a mailing list of over 100 people. The private room had space for 30 people and, right from the start, meetings were packed. Sitting around small tables, we discussed suggested topics such as transgenerational trauma from a personal and professional point of view, ending the evening with a group discussion sitting in a large circle. We may well have continued along these lines but for a sudden forced change of venue: the new manager of Café Rouge decided that the premises were no longer available for our
It helps us to connect within a profession where there is so much solitude and isolation in our individual working lives use. Fortunately, a colleague, Claudia Nielsen, stepped in and offered to hold the meetings at her house.
Regular talks Claudia’s house, which is a beautiful converted Methodist chapel, is an ideal venue for larger gatherings, accommodating up to 60 people; therefore Claudia and I took this opportunity to develop a programme of regular talks on topics of interest to psychotherapists. We have been very heartened by the quality of the presentations delivered by experts in the field, which we have organised, and by the enthusiastic response from the members of the club. In November 2015, Dr Val Thomas gave a presentation on her
recently published book, Using Mental Imagery in Counselling and Psychotherapy: Developing More Inclusive Theory and Practice. The audience appreciated the opportunity to participate in an experiential exercise as part of the presentation. In February 2016, Professor Brett Kahr presented a paper on ‘Committing crimes without breaking the law: unconscious sadism in the “non-forensic” patient’. It was again a full house and an exciting evening on a thought-provoking paper. In May, Dr Marie Adams gave a talk based on her book, The Myth of the Untroubled Therapist, which led to stimulating discussions about the challenges of being a psychotherapist. And, at the end of July, our speaker was Dr Anne Power, who addressed the
subject of ‘Closing a practice: retirement, relocation, transition – the decision to retire and the process of closing a private practice’, based on her book, Forced Endings in Psychotherapy and Psychoanalysis Attachment and Loss in Retirement. At our next meeting on 17 October, psychiatrist and psychotherapist Dr Tim Read will consider the topic ‘Archetype and psyche in crisis and growth’.
Overwhelming response From the start when UKCP advertised the club to its membership in London, the response was overwhelming. We now have around 250 members on our mailing list. However, we can only comfortably accommodate 50 people for the meeting, so
ukcp members we have to limit the bookings to this number. We are open to include people not only from the Hampstead area but from anywhere and everywhere. Our plan is to have four meetings a year on a Monday. We start at 7pm (doors open at 6:30pm) and we divide the evening into three sections: 45 minutes for the presentation, 45 minutes for questions and comments, and the rest of the evening, up to 9:30pm, for socialising and networking. We offer CPDs of 2.5 hours at our events. The advantages of belonging to the club is eloquently summed up by one of our members: I found the Hampstead Psychotherapy Club to be wonderful and an invaluable resource. Claudia, Josefine and Val have organised it in a way that is very conducive to sharing, learning, exchanging ideas, inspiring and stimulating further thought and reflection, making friendships and links with colleagues, and overall enhancing the work we do in our practices. This is achieved through the beautiful environment and atmosphere that is created in Claudia’s home, and through the sourcing of interesting and engaging speakers, as well as the opportunity to socialise with others present. It helps us to connect within a profession where there is so much solitude and isolation in our individual working lives. I am very grateful for it, and find it of enormous benefit. A Wheeler, member The Hampstead Psychotherapy Club is an evolving project. To judge by the response, it does seem to be meeting a need for community-based resources for practitioners, and we would certainly encourage others to consider starting similar clubs in their localities. For more information or if you wish to join our circulation list, please contact us: Josefine Speyer: email@example.com Claudia Nielsen: firstname.lastname@example.org
If you're interested in setting up your own psychotherapy club, visit our website at: http://bit.ly/2dh6cRv or email email@example.com
Welcome to our new UKCP members Psychotherapists Vicky Claire Rachel Penelope Anne Andrew Ursula Sara Celine Deborah Lucy Natasha Sandy Sreety Rani Anthony Lindsay Stephen Susanne Andrea Dawn Katharyn Eric Geraldine Elizabeth Annie Joanne Maria Elizabeth Kristina Hilary Charlotte Clare Roger Eugene Katherine Peter Bronwen Sebastian Nathalie James Fran Jeanne Alexander Johanna David
Bailey AWAKEN Barnes IGA Bates UPCA Best ADMP UK Biss UPCA Blumenthal MET Browne MC Butte ADMP UK Chamberlin MET Colbert ADMP UK Cotter MET Das AFT Davids KI Denton KI Doyle AFT Forster IATE Francois-Taylor AFT Grantham CCPE Hall AFT Harper SITE Harrison ADMP UK Hedges IATE Hipplewith AFT Hofberg BPA Holford MET Holloway MC Howlett MET Hoyte AFT Hughes IATE Jhugroo FPC Kendall LSBP Koolik MET Kraemer AFT Kriving AFT Lamper ITA Lavendel ADMP UK Leonard IGA Leslie IATE Lindemann UPCA Litchfield KI
Jeannette Tara Michelle Dermot Julie Diana Christine Diane Emma Kerry Simon Kathy Dario Joanna Denise Ella Julie Duncan Michelle Angela Annette Iulia Ruhsen Claire Allison Nicola Andrew Bella Dawn Louise Jane Nicholas
MacDonald ADMP UK Macey CCOPPP Martin MET McCarthy UPCA Moffat CAP Morley AFT Nelson KI O'Shaughnessy MET Osborne KI Osborne MC Pellegrini AFT Ray IATE Reeves IATE Risi KA Robinson AFT Roebuck KI Russell RV Sams AFT Schwalbe ADMP UK Scott CCOPPP Sevketoglu CCOPPP Shaub-Moore ADMP UK Singer ADMP UK Singleton CCOPPP Smith AFT Tebbs MC Thibert AFT Wilson IATE Wolstenholme KI
Psychotherapeutic Counsellors Phillip Hermione Helen Claire Kate Jenny Marjorie Jayne Julie Maria
Beisty NGP Brown MCCP Hamond MCCP Harland TACT Hockley MCCP Shipton NGP Sturgess NGP Vafeiadi NGP
Organisational Member Manchester Institute for Psychotherapy
ACAT Association for Cognitive Analytic Therapy · ACOMP Accrediting Organisation for Medical Psychotherapy · ADMP UK Association for Dance Movement Psychotherapy UK · AFT Association for Family Therapy and Systemic Practice · ARBS Arbours Association · AWAKEN Awaken School of Outcome Oriented Psychotherapies · BCPC Bath Centre for Psychotherapy and Counselling · BC The Bowlby Centre · BEELEAF Beeleaf Institute for Contemporary Psychotherapy · BI The Berne Institute · BPA British Psychodrama Association · CAP Confederation for Analytical Psychology · CCOPPP Canterbury Consortium of Psychoanalytic and Psychodynamic Psychotherapists · CCPE Centre for Counselling and Psychotherapy Education · CFET Caspari Foundation · CHF Childhood First · CPJAC Council for Psychoanalysis and Jungian Analysis College · CPPC Counsellors and Psychotherapists in Primary Care · FIP Forum for Independent Psychotherapists · FPC Foundation for Psychotherapy and Counselling · GAPS The Guild of Analytical Psychologists · GCL Gestalt Centre London · GPTI Gestalt Psychotherapy Training Institute · GUILD Guild of Psychotherapists · HIP Hallam Institute of Psychotherapy · IATE Institute for Arts in Therapy and Education · IFT Institute of Family Therapy · IGA Institute of Group Analysis · IGAP Independent Group Analytical Psychologists · IPS Institute of Psychosynthesis · IPSS Institute of Psychotherapy and Social Studies · ITA United Kingdom Association for Transactional Analysis · KI Karuna Institute · LSBP London School of Biodynamic Psychotherapy · MCCP Matrix College of Counselling and Psychotherapy · MC Minster Centre · MET Metanoia Institute · NCHP National College of Hypnosis and Psychotherapy · NGP Northern Guild for Psychotherapy and Counselling · NLPtCA Neuro Linguistic Psychotherapy Counselling Association · NRHP National Register of Hypnotherapists and Psychotherapists · PA Philadelphia Association · PCP PCP Education and Training · PET Psychosynthesis and Education Trust · RSPP Regent’s School of Psychotherapy and Psychology · RV Re-Vision · SCPTI Scarborough Counselling and Psychotherapy Training Institute · SEA Society for Existential Analysis · SITE Site for Contemporary Psychoanalysis · SPCRC The Regent’s School of Psychotherapy and Psychology · SPTI Sherwood Psychotherapy Training Institute · ST South Trent · TACT Therapy And Counselling Teesside · TER Terapia · UKAHPP UK Association of Humanistic Psychology Practitioners · UPCA Universities Psychotherapy and Counselling Association · WMIP West Midlands Institute of Psychotherapy · WPP Welsh Psychotherapy Partnership
ukcp members Book review by Tamar Posner
Using Mental Imagery in Counselling and Psychotherapy: A Guide to More Inclusive Theory and Practice By Valerie Thomas · ISBN 978-0-415-72886-7 · £20.99 · Routeledge 2016
or a ‘visual thinker’ such as myself, the title of this book held immediate appeal. I was keen to discover how my practice might be better informed as a result of reading it – and I was not disappointed.
Tamar Posner is a UKCPregistered integrative psychotherapist and clinical supervisor.
The book, which derives from Thomas’s doctoral research on therapeutic practice with mental imagery, is presented in two parts. Part I focuses on theory, tracing the development of mental imagery as a therapeutic tool, reviewing the historic and cultural contexts in which it has evolved, summarising the various explanations that have been put forward to account for its therapeutic efficacy, and identifying the commonalities in the ways mental imagery is and has been used. This section culminates with a proposed framework – the interactive communicative model – for integrating mental imagery into talking therapies, whatever their modality.
Part II provides a step-by-step guide to the use of the model in practice. It draws on the author’s extensive clinical experience and a set of mental images she has used to good effect, which can either be adopted by practitioners or serve to stimulate new ideas. Overall, I found the book fascinating and easy to assimilate. The switch from philosophical contemplation in part I to detailed practical considerations in part II initially had me somewhat confused as to the intended readership until I reminded myself that it was, after all, intended to be a guide. It is a welcome addition to my library and a text I can readily envisage revisiting for guidance and inspiration.
Book review by Pat Hoare
Landscapes of the Heart By Juliet Grayson · ISBN 978-0-9930306-2-8 · £12.99 Jessica Kingsley Publishers
his book is unusual in its presentation and content by allowing the reader into the privileged position of witness to very specific therapeutic engagement with clients as they struggle with relationship issues.
Pat Hoare is a BACP Senior Accredited Counsellor and Supervisor.
What follows throughout the book is a reflection of Juliet’s insight into her own intuitive and creative approach to therapy, giving a clear explanation of her work with relationship and sexual difficulties by taking the reader through various therapeutic interventions. A chapter on emotional fusion offers clarity into the roles often played out in relationships giving positive suggestions for growth and change. A model of Five Star Conscious Relating created by the author and described in detail is a valuable resource for anyone seeking a deeper understanding and awareness of roles chosen by couples. By introducing Pesso Boyden System Psychomotor (PBSP) therapy to her clients Juliet makes this fascinating reading; she gives a clear explanation of its effectiveness and the profound changes
that often evolve as a result. Further chapters give more detail about the unfolding process of PBSP which is such a remarkable and as yet little known therapeutic intervention in this country. The chapter on ‘Juliet’s Story’ and her experience with horses tells how this eventually led her to train as a therapist and later to use some insights she had developed whilst riding in her work with clients. I found this book totally absorbing in its clarity and wisdom, above all the depth of compassion which Juliet possesses and brings to her therapeutic practice make it quite remarkable. This excellent book is full of insight and I am sure that it will inform and appeal to couples and therapists alike as a reliable therapeutic resource on which to draw. At the end of the book there are a number of helpful appendices to guide the reader who may be looking for a therapist or need further clarification.
ukcp members Book review by Morris Nitsun
From the Couch to the Circle: Group-Analytic Psychotherapy in Practice By John Schlapobersky · ISBN 978-0415-67220-7 · Routledge 2016
ohn Schlapobersky is a senior training group analyst who has taught and inspired generations of trainees at the Institute of Group Analysis in London and elsewhere over many years. He has made a major contribution to the field with his own publications and by facilitating the publication of many colleagues’ writing.
Morris Nitsun PhD is a consultant NHS psychologist in group psychotherapy and a training group analyst at the Institute of Group Analysis, London. He runs the Fitzrovia Group analytic practice and is author of The Anti-Group.
From the Couch to the Circle is his first book and its publication is an occasion to celebrate. He brings vast knowledge to his writing in terms of both breadth and depth and the book is filled with the wisdom and clarity of a senior practitioner. Group analysis is the major approach to group psychotherapy and allied fields in the UK and abroad. For all its strengths and creativity, it has suffered from a degree of theoretical vagueness. This is not surprising given the complexity and unpredictability of group process. It is also not entirely a disadvantage as it has maintained an openness of discourse that distinguishes group analysis from some of the more doctrinaire or rigid approaches of some schools of psychotherapy. However, the time has come for greater theoretical clarity, and in particular the allimportant theory-practice link that makes for strength and confidence in our clinical work. Schlapobersky takes a bold, convincing step in this direction, describing a wide range
of applications and offering coherence to some of the more ambiguous group analytic concepts. More than that, he illustrates his arguments with clinical material, bringing group analytic therapy alive at its best: human, compassionate, transformative. His clinical vignettes could stand alone for their narrative power and originality, and it is a double treat that they also serve to augment the theory-practice link. The book never loses the seriousness of its intent and is backed up throughout by outstanding scholarship and an evenhanded, generous and comprehensive appreciation of the contribution of other writers in the field in Europe and North America. Group analysts and students of the discipline will find this book expansive and rewarding, while readers who are not well versed in the subject will find it accessible and meaningful. They may well be tempted out of the familiar confines of individual psychotherapy into the exciting and challenging territory of group analysis.
Ethics consultation update Thank you to everyone who completed the survey as part of the ethics consultation into the new Code of Ethics. The consultation closed on 30 September 2016, and we will now begin to draft the new Code of Ethics. We will provide a further update on progress in January.
Correction notice: In the summer 2016 issue of The Psychotherapist we printed a book review by Jana Burger who reviewed The Training Patient. The magazine incorrectly states the author as Gail May, who is in fact the main character in the book. We would like to apologise to the author, Anna Fodorova, who deserves full credit for this interesting novel.
continuing professional development
Psychotherapy, professional training and continued professional development in London
Don’t miss out If you are not a member of UKCP and would like to receive a regular copy of The Psychotherapist, send this completed form, along with your payment to: Subscriptions, UKCP, 2nd Floor Edward House, 2 Wakley Street, London EC1V 7LT. I would like to subscribe to The Psychotherapist for 12 months (three issues). Subscription type: New Renewal Subscription amount: £50 £25 (Students, educational establishments or libraries)
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Group-Analytic Psychotherapy in Practice
‘Schlapobersky and his book – the literary analogue of a group at its best – are worthy successors to his predecessor giants Foulkes and Anthony, Yalom, Skynner, Pines.’
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‘The next fine turning point in group education and practice.’
‘Destined to become a classic in group psychotherapy.
This handbook is a guide to the group-analytic model enriched by the author’s innovations. It draws from his extensive clinical and teaching practice and the experience of people in groups.
‘A remarkable synthesis of accrued clinical wisdom, cuttingedge knowledge and thoughtful clinical application. The author builds articulate, eloquent bridges between individual and group psychotherapy… and between depth theory and accessible technique.’
20% discount available from the publisher’s website Enter code FLR40 at checkout* www.routledge.com/9780415672207 *Offer cannot be used in conjunction with any other offer or discount and only applies to books purchased directly via Routledge website until 31 December 2016
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continuing professional development R
R TE IS ! W EG O
Become a Couple Therapist FREE Open Evening:
Friday, 4 November 2016 - 6 to 8pm
Certificate in Counselling and Therapy for Adolescents Do you want to expand your practice by working with adolescents? Or build rigour into your existing work with adolescents? This course will help you build meaningful connections with adolescents and understand how to intervene therapeutically.
• ADDRESS YOUR CLIENTS’ DEVELOPMENTAL DILEMMAS • PROVEN PROGRAMME, DELIVERED OVER MANY YEARS • LEARN A RELATIONAL APPROACH TO INTERVENING
For qualified counsellors or psychotherapists who want to pursue Couple Training to boost their professional offer.
• WORK WITH THE IMPACT OF SHAME • BUILD CONFIDENCE IN WORKING WITH PARENTS • TWO FOUR-DAY INTENSIVES • DATES: 22-25 November 2016 & 14-17 March 2017
Our Open Evening is the perfect place to discover more about training with us, the world leading experts in couple therapy.
She maintains a private practice in Omagh, Northern Ireland, as a psychotherapist, clinical supervisor, writer and trainer, specialising in working with children, adolescents and their families.
Learn about our qualifications and Advanced Standing options. Tavistock Relationships offers 3 Advanced Standing pathways enabling you to become fully trained professionally in couple work: Advanced Standing MA in Couple & Individual Psychodynamic Counselling & Psychotherapy (2 yrs P/T) Advanced Standing MA in Couple Psychoanalytic Psychotherapy (2 yrs P/T) Advanced Standing MSc in Psychosexual and Relationship Therapy (2 yrs P/T) Discover more: www.TavistockRelationships.ac.uk (Attendees can take 1 FREE book from our research publication library)
Led by Bronagh Starrs. Bronagh is Director of Blackfort Adolescent Gestalt Institute and principal faculty for the 2-Year Advanced Post-Qualifying Diploma in Gestalt Adolescent Psychotherapy, which has been offered in Ireland since 2012.
INVEST IN YOUR PRACTICE Certificate in Couples Work Bu i l d y o u r c o n f i d e n c e a n d s k i l l s i n p r o v i d i n g co u p l e s c o u n s e l l i n g a n d p s y c h o t h e r a p y. Wo r k i n g w i t h co u p l e s c a n b e h i g h l y c h a l l e n g i n g a n d h i g h l y r e w a r d in g - th i s c o u r s e a i m s t o r e f l e c t t h i s . L e d b y G l e n n N i ch o l l s.
• WORK WITH INTIMACY AND WITH CONFLICT. • DATES: 17-18 Oct, 5-6 Dec 2016, 9-10 Jan, 6-7 Feb 2017
Certificate in Relational Supervision
Bu i l d y o u r c o n f i d e n c e i n p r o v i d i n g s u p e r v i s i on to peers, colleagues, trainees and supervisees. P a r t i c u l a r a t t e n t i o n w i l l b e g i v e n t o u s i n g b o dy p r o c e s s , t o w o r k i n g w i t h s h a m e a n d t o m o m e n t- b ym o m e n t r e l a t i o n a l d y n a m i c s . L e d b y D a v e M an n .
• DEEPEN RELATIONAL CONNECTION • DATES: 27-28 Oct, 1-2 Dec 2016, 16-17 Jan, 23-24 Feb, 6-7 April 2017
Certificate in Relational Coaching
Expand your practice into coaching, with a programme that builds on your skills as a counsellor or therapist.
• OPTIONAL ACCREDITATION, GREAT VALUE • DATES: 8-12 May 2017
70 Warren Street, London W1T 5PB email@example.com 020 7380 8288
Web: www.TheRelationalAcademy.org E-mail: admin@TheRelationalAcademy.org Phone: +44 (0) 1223 967 971 Location: Cambridge, UK (50 min London) Bursaries available
continuing professional development Are you ready to specialise? Do you want to stand out from the counselling crowd?
Re -Vision Counselling & Psychotherapy with a Soulful Perspective
2-Year, Part-Time Diploma in Clinical Sexology January 2017 to December 2018 Enrich your practice by taking the CICS Diploma in Clinical Sexology and qualify as a sex and relationship psychotherapist with leading specialists in the field. Designed to meet the requirements of COSRT, EFS and ESSM you will learn how to work with and treat psychosexual and relationship problems with individuals, couples and multiples, addressing the biological, psychological and social aspects of sex and relationship health and wellbeing. One Friday & Saturday a month in Cambridge. For more info & an application form visit cambridgeinstitute.co.uk or email firstname.lastname@example.org
Re-Vision is a registered charity offering a spiritual perspective with down-to-earth, quality training. A member of BACP and UKCP who accredit counselling training and psychotherapy training respectively.
Couples in search of Soul
Starting January 2017 – 7 weekends over 6 months Part 1 of a two-part training programme for qualified practitioners. Central to this training in couples work is the idea that the Relationship is the Client. It is not a matter of working with two individuals but with the dynamic between them.
Our CPD 2017 programme includes: Radical Hope – Sat 14 Jan 2017 and 5 Thurs evenings Jan-March How might an extension of therapeutic work lead to more direct work with our cultural malaise? Could a radical new hope be birthed out of facing into the cultural shadow?
Pandora’s Box – 25-26 Feb 2017 Identifying and constructively using the sensitive and vulnerable feelings of shame to enable individuals to For further details of find a more satisfying and all events and training contact: meaningful Re-Vision 97 Brondesbury existence. Road, London NW6 6RY 020 8357 8881 email@example.com
ABERDEEN · BRIGHTON · EDINBURGH · LONDON · MANCHESTER · MIDLANDS · NORTH EAST OXFORD · TURVEY (BEDS) · YORK
Training and Development in Group Analysis Providing training for over 1100 individuals every year throughout the UK, the Institute of Group Analysis is the premier provider of group analytic and group work training in the UK. Relevant to anyone with an interest in the dynamic relationship between the individual and the group, the IGA Foundation Course in Group Analysis introduces students to an exploration of our essentially social nature and the wide range of applications of group analytic theory. Group analytic training will equip students to understand and to participate more fully in a range of group settings including: work, family, social, learning and therapeutic. Institute Of Group Analysis
Graduates of the IGA Qualifying Course in Group Analysis are eligible to become full members of the IGA and to gain professional registration with the UKCP. Suitably qualified and experienced therapists (including from non group trainings) can continue their learning and development with an IGA Qualifying Training in Group Supervision or our new Qualifying Training in Reflective Practice in Organisations which lead to IGA associate membership (subject to terms and conditions). If you would like to know more about group analysis and group therapy, or how to continue your learning journey, join one of our free events or courses.
1 Daleham Gardens London NW3 5BY
020 7431 2693
The IGA provides: • Foundation Courses • Introductory Week-ends • Professional training (UKCP accredited) • Short Courses • Personal development and CPD workshops • Bespoke Training and Consultancy • Group and individual therapy referrals • Supervisor and TGA referrals • Reflective Practice in Organisations
020 7431 2693 www.groupanalysis.org
The IGA is a charity registered in England and Wales (280942), and in Scotland (SC040468); and is a company registered in England and Wales 01499655
continuing professional development
CCPE Centre for Counselling and Psychotherapy Education
M.A. in Transpersonal Counselling and Psychotherapy Two-year part-time, depending on entry level and previous experience/training. Professionally (UKCP and BACP) and academically accredited.
Diploma in Supervision from a Transpersonal Perspective * This course covers individual and group supervision from an integrative and transpersonal perspective. This is a one-year p/t course, held over 30 weeks with four weekend seminars. Supervised practicum work is an integral part of the training.
Advanced Diploma in Transpersonal Psychotherapy* This two-year part-time course aims to explore the transpersonal perspective in greater depth. The course includes a study of the symbolism of alchemy, the role of the creative imagination, intuition and spiritual guidance in psychotherapy. A group retreat and an individual retreat are integral parts of the course. CCPE is seeking to create a professional doctorate qualification from the below courses.
Post-Graduate Trainings in Dreamwork* under the auspices of CCPE's Dream Research Institute One-year Dreamwork Certificate (Essentials and Advanced) and one-year Lucid Dreaming Certificate
Diploma in Transpersonal Couples Counselling & Psychotherapy This one-year p/t post-graduate course offers a holistic and integrative approach to working with couples and takes place over nine weekends. All courses are part-time and commencing January 2017 unless otherwise stated. * Note: CCPE is seeking to create a professional doctorate qualification from the above courses.
Weekend Seminars 2016 Cost: £190 per workshop (non-refundable deposit £100) Times: Sat/Sun 10am – 5pm 22/23 October 12/13 November
Facilitating Spiritual Growth in therapy Alchemy of Relationships
CCPE, Beauchamp Lodge, 2 Warwick Crescent, London, W2 6NE firstname.lastname@example.org, www.ccpe.org.uk,Tel: 020 7266 3006 50
UKCP- The Psychotherapist – October Issue 2016
continuing professional development
The London Centre for Psychodrama Group and Individual Psychotherapy is a UKCP and BPA registered psychotherapy training organisation oﬀering both professional psychotherapy training and continuous professional development.
Professional Psychotherapy Training
Creative Approaches to Superversion
Level One: Our Certiﬁcate/Foundation Year in Psychodrama is a one-year, ten-weekend course for those considering full professional training as psychodrama psychotherapists.
This post-qualiﬁying one-year cross-professional course is open to those who are at least three years qualiﬁed as practitioners.
Level 2: The Advanced Postgraduate Diploma in Psychodrama Group and Individual psychotherapy is a four year training (including the foundation year) meeting the requirements for Group and Individual Psychotherapy within the integrative (HIPC) college of the UKCP. Each year consists of ten training weekends, and trainees are required to participate in personal, weekly therapy throughout.
Experiential Weekend, 9-11 September
Level 3: A post-qualifying MA in Psychodrama runs at Anglia Ruskin University and is open to UKCPregistered graduates and honorary members of the London Centre for Psychodrama
Where we are... All our training takes place at the Cawley Centre, Maudsley Hospital, Denmark Hill, London SE5 8AZ For more information email email@example.com or telephone 020 7515 6342
Friday evening to Sunday 5pm
Open Access Weekend, 22-23 October
The True Self and the False Self: Authenticity and the Mask
Experiential Weekend, 11-13 November Friday evening to Sunday 5pm
Training Practice Weekend, 19-20 November Cinderella and Other Stories, Myth and Metaphor
Experiential Weekend, 10-12 February Friday evening to Sunday 5pm
Training Practice Weekend, 18-19 March Addictions through a Psychodrama Lens
Experiential Weekend, 12-14 May Friday evening to Sunday 5pm
Open Access Weekend, 20-21 May Sexuality and Gender
Training Practice Weekend, 24-25 June Depression: Psychodrama and CBT
Experiential Weekend, 7-9 July Friday evening to Sunday 5pm
All weekends are £195 and bookable online at http://www.londoncentreforpsychodrama.org/events
continuing professional development We help individuals, couples, families, teams, organisations and communities find improved outcomes through better relationships. Couple Work Certificate/Diploma
This programme focuses on effective, relational couple work. It includes a combination of theoretical frameworks, experiential learning and relevant skills as well as working with embodied process and experimental interventions. Date: Starts 13-14 January, 2017 – Kingston-Upon-Thames, London.
Certificate/Diploma in Contemporary Trauma Practice
Grounded in a relational perspective, this programme will offer a safe, non-pathologising and accessible approach to building your confidence and skills to work with trauma. Date: Starts 13-14 January, 2017, Oxford.
rEgISTEr TODay FOr OUr 2017 COUrSES
Exploring the Erotic in our Personal and Professional Lives
This series of workshops, with international trainer Leanne O’Shea, explores the impact of creativity, sexuality and the erotic in our lives personally and at work. Workshops can be booked together or separately. - Introductory Day – 4 February 2017, London - Supervision Day – 6 February 2017, Oxford - Masterclass – 7-10 February 2017, Oxford
For more information and to JOIN US visit
College of Psychoanalysts – UK INTERNATIONAL CONFERENCE University of Manchester, 26-27 June 2017
ISLAMIC PSYCHOANALYSIS / PSYCHOANALYTIC ISLAM This international conference organised by the College of Psychoanalysts – UK with the support of Manchester Psychoanalytic Matrix and CIDRAL University of Manchester promises to function as a site for dialogue. It will be an opportunity to speak across the many conflicting traditions of work that comprise psychoanalysis, and of different interpretations of Islam and what it is to be a Muslim today. Abstracts of between 200 and 250 words together with an indication of the conference theme to be addressed should be submitted to the organisers before 31 January 2017. For further information about the conference and the College, please email firstname.lastname@example.org or visit www.psychoanalysis-cpuk.org.
5TH ANNUAL CONFERENCE FOR THERAPISTS Days can be booked separately or together // Resource for Contemporary Issues London // 9am-5pm both days Facing Gay Men Further details and sign up: Saturday 25 March 2017 http://conta.cc/2aGhMEN Pre-conference workshop: We’re currently interviewing Treating Out of Control qualified therapists for our Sexual Behaviour: 2-year PG Diploma in Gender Rethinking Sex Addiction & Sexual Diversity Therapy with Doug Braun Harvey Details: http://tinyurl.com/ Friday 24 March 2017 PinkDiploma
Qualified Accountant available to assist fellow counsellors and psychotherapists with tax returns, accounts and other financial needs. Please contact Paul Silver-Myer FCCA, UKCP [Reg.] 020 7486 0541 or email@example.com www.ukcp.org.uk
continuing professional development
NORTHERN GUILD Newcastle & Teesside
Accredited Diploma & MSc Courses The Home of Existential Therapy Applications throughout the year • • • • • • •
MA in Existential Coaching* MSc in Psychotherapy Studies* + MSc in Typical and Atypical Development through the Lifespan* + DProf in Existential Psychotherapy and Counselling** DCPsych in Counselling Psychology and Psychotherapy** Prof. Certificate Existential Supervision and Group Leadership Foundation certificate in Psychotherapy, Counselling and Coaching * Validated by Middlesex University ** Joint courses with Middlesex University + This course is taught entirely online
FOR FURTHER INFORMATION Existential Academy 61– 63 Fortune Green Road London NW6 1DR
Child / Adolescent
Psychotherapy or Counselling Individual Learning Plans
Supervision Training & CPD www.northernguild.org Email: firstname.lastname@example.org Tel: 0191 209 8383
In partnership with
T 0845 557 7752
Child Marker Certificate Post Qualifying Diploma
0207 435 8067 E email@example.com www.nspc.org.uk
Applications are open for our TA Psychotherapy Foundation Course TA Psychotherapy Foundation Course
Starts 12th November in Exeter
This entry level, 1 year course covers the main theoretical bases of Transactional Analysis in a high level of detail. The Foundation Course can be taken alone for personal and professional development, or lead to a further 3 years’ training on the Advanced Course. The emphasis is on the application of TA in the fields of psychotherapy and counselling, but the theory is also relevant to other fields of TA (organisations and education).
For more information and to apply: 01392 219200 / firstname.lastname@example.org
www.ironmill.co.uk The Psychotherapist
continuing professional development
TAKE A NEW COURSE Whether youâ€™re taking a new direction or looking to develop your skills, the Gestalt Centre has a course for you. Join us this January, overlooking the beach in Bournemouth for our Large Group Residential. This five-day event, now in its twentieth year, is always a unique, reinvigorating experience. Alternatively, take one of our short CPD Courses in London: a chance to gain insight into working with children, adolescents, couples or groups or to pursue an interest in Organisational Development.
Explore all our courses or hire one of our central London therapy or meeting rooms at gestaltcentre.org.uk
Gestalt_press ad_Pyschotherapist_180x127mm_2_PRESS.indd 1
continuing professional development
The Minster Centre Pioneers of integrative training since 1978 Part-time training in Queens Park, London
Apply now for courses starting in January 2017 •
PG Dip / MA in Advanced Clinical Practice
Dip / PG Dip / MA in Supervision
Our courses offer a unique opportunity to qualified counsellors and psychotherapists to extend their expertise by studying advanced clinical practice or supervision in small supportive groups to Diploma, PG Diploma (1 year or less) or MA Level (2 years). nd
Our next open days are on Saturday 22 October and Friday 25th November - booking essential or contact Betti to discuss your options at email@example.com For more information see www.minstercentre.org.uk
3 Part Psychotherapy training delivered by Matthew Wesson
EMDR Trainer, Supervisor, Psychotherapist, Military Veteran
NICE / WHO recommended for PTSD Also effective in many other conditions Small, friendly trainings including lots of video & demonstrations Competitively Priced Training in London, Leeds, Chester & Exeter “This is the best psychotherapy training I’ve been on in over 10 years.” Dr Andre Geel
In-house / on-site training also available
To book visit: www.emdracademy.co.uk
The Minster Centre, 20 Lonsdale Road, Queens Park, London NW6 6RD. Registered charity no 1042052. Company registered in England and Wales number 2966937
Research: The Current Debate 10-part Seminar Series
Questioning the relevance of research to the development of effective clinical work?
01829 732721 firstname.lastname@example.org
Between Mind and Culture: Ordinary Differences One day Conference £80
Then join us for as many seminars of our 10-part series as you like, with renowned and inspiring researchers discussing the challenges, benefits and varying approaches of emerging and established research taking place in the psychoanalytic and psychodynamic psychotherapy community today. Chaired by Ann Scott & Jessica Yakeley. Speakers include: Mark Solms, Bob Hinshelwood, Jean Knox, Mary Target, Peter Fonagy and more.
Monthly from 21 Oct 2016 | 18.30 to 21.00 | London
More Info & How to book these events: www.bpc.org.uk/eventscalendar
Join keynote speaker Salman Akhtar and other leading professionals in the discussion around issues of cultural diversity in psychotherapy. Explore Identity and Culture, Security and Freedom or Changing the Game in selected breakout sessions. Share your experiences and best practice Chaired by Maxine Dennis.
Other Speakers include: Fakhry Davids, Julian Lousada, Narendra Keval, and more.
Book now to avoid disappointment!
Saturday, 19 Nov 2016 | 9.30 to 18.00 | London
UKCP Conference 2017 – book now! The future of psychotherapy:
science, politics and best practice
Keynote speakers and panellists
– former clinical director of the Maudsley Hospital and author of The master and his emissary
– director of the Institute for Integrative Psychotherapy in Vancouver
Jenny Edwards – Chief Executive of the Mental Health Foundation
Saturday, 11 March 2017 Regent’s University, London
Six workshops confirmed
Hear from researchers and therapists
Contribute to the political debate
Share your insights
Open to all counsellors and psychotherapists
Book your place
T sel ickets l i Sec ng fa pla ure y st. o ce tod ur ay.
UKCP, 2nd Floor Edward House, 2 Wakley Street, London EC1V 7LT. Registered Charity No. 1058545. Company No. 3258939. Registered in England.
Sponsorship opportunity Hungry to make hundreds of new contacts in the world of psychotherapy? • Make new contacts in the world of psychotherapy • ‘The future of psychotherapy: science, politics and best practice’ (see above) is the first UKCP conference of its kind - and is already attracting many psychotherapists from across the country. • Unique opportunity for you to promote your products and services to our members, most of who run their own practices. • 80% of our members are self-employed and working as independent private practitioners. • Many networking opportunities. • Full range of exhibitor and sponsorship packages which can be tailored to your individual needs. To book or discuss further then please contact Sophia Dick on 0207 014 9966 or email email@example.com