Issue 62 â€˘ Spring 2016
The creative use of self in research Explorations of reflexivity and research relationships in psychotherapy
The maga zine of the UK Council for Psychother apy
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contents Feature articles A creative and effective use of self in research Being a therapist-researcher Researching the self and beyond Research? What research?: Role play as a therapeutic tool with sexual offenders Where am I with my research?: Emotional experience plus reflection Reflexivity and ethics in qualitative research Writing, telling, listening, reading, seeing A study of black issues in counsellor training Developing imagination-based methods The role of routine outcomes evaluation Using our own experience in research Discussion An existential exploration of ‘The theme of the three caskets’ Writing and storytelling: to survive and to thrive Writing and the art of practice UKCP news Improving access to psychotherapy training Reflections on my time as chair of UKCP The Professional Conduct Committee: an update Digital Delivery Project update Ethics Committee members sought UKCP members Welcome to our new UKCP members Step up, step out and speak Obituary: Patricia Williams
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
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Researching the self and beyond 9
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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.
The creative use of self … working with memories and images 29
How feminist ideas have influenced a research work/life 37 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
t is with great pleasure that I welcome you to the latest edition of The Psychotherapist and the last one I will be introducing as your Chair as I step down on 17 March.
the new chair will improve on that. Back to the magazine - my thanks to guest editor Dr Sofie Bager-Charleson and all the other contributors for putting together this issue of The Psychotherapist.
This issue focuses on reflective research: reflexivity in the research process and the continual examination of oneself as the researcher, using self-awareness and seeing how this may affect the research in question. As therapists self-reflection is an important part of our work because we know how we can affect the therapeutic process. This happens with research too. Therapists reflectivity in so many areas is so important - including in the role of the chair of any organisation - especially UKCP. I hope in my time as chair I have done so although probably not enough sometimes! I am sure
In this issue we also bring you an update on the Digital Delivery Project on page 50, where we have now chosen a supplier to work with, and we will aim to include an update in each issue of The Psychotherapist. There has been some important work on introducing a new Complaints and Conduct Process over the past few months, and Brian Lindfield discusses on page 49 what
this means for the Professional Conduct Committee. We held a successful event looking at sharing learning from complaints in February which will be covered in the summer issue, and we’re aiming to hold a similar event in the north of England later this year. As I approach the end of my term as chair of UKCP, on page 47 I have reflected on the last few years and the achievements that we have made as an organisation and as a profession. The Members’ Assembly on Saturday 12 March will be my last event as chair of UKCP and would like to welcome you to come along to the day to hear about UKCP’s work over the past year, say goodbye, and also to meet the incoming chair, who will be officially introduced at the event and will say something about their vision for UKCP going forward. If you are interested in coming, details on how to book are on page 48.
Janet Weisz is the Chair 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.
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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.
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A creative and effective use of self in research Dr Sofie Bager-Charleson, guest editor, introduces this special issue of The Psychotherapist.
earning how to use oneself creatively and effectively in the treatment process is an important aspect of therapy training. Hesitations, silences, surges of empathy or sudden irritation are examples of how both spoken and unspoken data inform us in our daily work. This kind of self-awareness is often neglected in research. There is a space-in-between, a relational aspect of our being which won’t lend itself to research that focuses on an objective reality, where discrete, observable elements interact in observable and regular ways.
Touching and feeling I am grateful for this opportunity to introduce some of those practitionerresearchers who develop research which approaches ‘the complexity, fragility, and uniqueness of our being’, as Corradi Fiumara (2001: 25) puts it in her book titled The Mind’s Affective Life, which has influenced my own thinking. This kind of research is by nature itself untidy, emotive and fluid. There is no ivory tower or privileged viewpoint for the researcher to assess the reality from; it brings us rather ‘to search in the dark by touching and feeling’ (Fiumara,
Sofie BagerCharleson is a UKCP registered psychotherapist. She also works as a lecturer and supervisor at the Metanoia institute and the University of Surrey. She has written extensively in the field of reflective practice, personal development and reflexivity. She is the co-ordinator of Metanoia’s Summer Academy for Research-Practitioner, commencing in June 2017.
2001: 37). The researcher is just as fragile, and her complex relationships to the research participants is both inevitable and a valuable part of the data. The contributors to this journal write about this kind of a ‘relational’ research. They hold a common interest in research reflexivity, which is about transparency, and positions the researcher in a linguistic, cultural, theoretical and personal sense in the research. Ruthellen Josselson, Linda Finlay and Wendy Hollway are inspiring voices in this field – their work has nourished practitioner-researchers in the field of therapy over the last two decades. I am immensely grateful for their contributions. They are joining some of my colleagues and former students in a pledge for the development of relational and reflexive research. We hope that this collection of articles might invite more therapists, experienced and novice researchers, to build on their valuable experience and engage in research about the complexity and the fragility of our being.
Research takes place in a relationship We have a long way to go. This kind of research is still relatively new. Josselson captures this in her article on page 22 about the importance of ‘trusting, empathic relationships’ in qualitative research. She asserts that ‘unlike in variable-based, hypothesis testing research… participants in qualitative research are studied… in a highly engaged relationship with a particular researcher’. This has ethical implications, stresses Josselson. She describes how the ethical attitude in qualitative research is ‘rooted in the recognition that such research takes place in relationship’ and that ‘it is the human connection rather than the “procedure” that produces data’. Ethics codes are, however, modelled after medical ethics, continues Josselson, who adds that ‘we don’t yet
have a written ethics code that covers research in which the researcher works with others, forming a relationship with them’. She puts ‘the resolute honesty of the researcher’s reflexivity’ to the forefront, and this involves stating ‘clearly the biases, aims and positioning of the knower, and the circumstances under which the knowledge was created’.
Empathetic attunement This attention to reflexivity is shared by Linda Finlay on page 16. She writes about how her relational-reflexive approach to research ‘aim[s] to engage a process which mirrors everyday psychotherapy practice’. ‘I seek to bring into the research arena my special awareness as a therapist’, writes Finlay, which involves drawing on ‘intuitions, listening skills, sensitive empathetic attunement and interpretive understandings’. Like Josselson, Finlay emphasises the value of reflexivity and trustworthiness in this research. Reflexivity is, suggests Finlay, about ’being thoughtfully and critically self-aware of subjective/ intersubjective elements and of how these impact on the research’. She continues: ‘As part of laying claim to the integrity and trustworthiness of qualitative research, researchers need to engage in an explicit, self-aware meta-analysis… at every stage of research, from the initial design through data collection/analysis to writing up.’
Each contributor brings their own slant on reflexivity and research relationships Researcher subjectivity In a similar vein, Wendy Hollway writes on page 19 about reflexivity as ‘an attempt to recognise and use the inevitable participation of the researcher’s subjectivity in the process of finding out… it offers a research stance open to examination of blindspots’. While Finlay adopts a humanistic approach to her research, Hollway builds on ‘psychoanalytic approaches to knowing, captured in the idea of transferencecountertransference dynamics, [which] can inform qualitative research methods and expand the practice of research reflexivity’. How the psychoanalytic understanding of countertransference dynamics can be made
relevant to research encounters is also a theme pursued by Maxine Daniels (page 13), a drama therapist who writes about using countertransference to understand conflicting emotions during her data analysis after interviewing sexual offenders in prison.
Being in the room Each contributor in this journal brings their own slant on reflexivity and research relationships. Isha Mckenzie-Mavinga brings a significant transcultural perspective to the researchers’ involvement on page 28. Isha shares how incorporating her personal experience of being a black researcher and trainer becomes valuable data in her research. Simon DuPlock brings his experiences from existential therapy and focuses on authenticity and ‘being in the room’ with the research – as opposed to positioning oneself as a neutral, objective observer (page 16). This is a theme expanded on by Marie Adams in her text on page 9 about writing as a form of data gathering, which Mona Livholts also highlights in her article about using writing as a methodology. Jeannie Wright (page 37) focuses on feminism, while keeping a focus on the usefulness of writing to position oneself in one’s research. Jeannie describes how her own research has developed over time, for instance towards an interest in autoethnography. Val Thomas reflects on links between her role as a therapist and a researcher (page 31). She shares how the use of imagery informs her research and how it has increased both her own and her research students’ self-awareness. Biljana Van Rijn (page 34) and Dora Brown (page 11) highlight some of the outside pressures associated with this kind of thinking. They explore the climate for therapy research in a wider context, where measurability is ‘gold’, and where NICE guidelines, high-impact journals and funding biases create a platform which many therapists regard as alien or at least different from their practice. Both Brown and Van Rijn suggest that practitioners engage more actively in the development of therapy research to influence the debate, and to contribute to the development of approaches, in order to decrease the gap between research and the complex reality that presents itself in our practice. We all hope that this collection of articles might invite you, the reader, to come forward in this debate – and share your valuable experience about our relational, fragile being.
Being a therapist-researcher: doing relational-reflexive research Every time we sit with a client and hear their story, we not only witness their experience and help them make sense of it, we also engage in a reflective search that seeks to tap into their lived experience. Linda Finlay explains how, in many ways, our everyday work is rooted in research. The interhuman opens out what otherwise remains unopened. BUBER, 1965:, P.86
a collaborative project exploring the lived experience of ‘traumatic abortion’.
n my relational-reflexive approach to doing research, I aim to engage a process which mirrors everyday psychotherapy practice. I seek to bring into the research arena my special awareness as a therapist, drawing on my intuitions, listening skills, sensitive empathetic attunement and interpretive understandings. Just as the research I engage in arises from practice, the findings from my research feed back into my practice and enrich it. I begin this article by outlining the relationalcentred approach to research developed by Ken Evans and myself (Finlay and Evans, 2015). I then consider two ‘reflexive spectacles’ we might put on when doing research: the first, intersubjective reflexivity, focuses on the intersubjective, interpersonal realm, while the second, ethical reflexivity, examines issues around methodology, process and power dynamics. Then, putting on my bifocals, I present an example of relationalreflexive research in practice, taken from
Linda Finlay is an integrative psychotherapist who teaches psychology and research at the Open University. Her particular research interest is in applying relational-reflexive approaches to exploring the lived experience of disability and trauma. She has published widely in the field of reflexivity and relational-centred research for psychotherapists.
For relational-centred researchers, the key route to accessing another’s subjectivity is through the relationship. Data arise from that mysterious intersubjective space between – where therapist-researcher and clientparticipant meet, impact on and influence one another. The dynamics created are such that a different researcher or relationship could potentially elicit an entirely different story. A particular value of relational-centred approaches is the attention they pay to the layered explicit and transferential processes at work. For instance, they may bring into awareness how shame in the research relationship may mirror the participant’s experience of shame. The researcher, like the therapist, commits to and trusts the ‘process’ of whatever appears figural in the embodied dialogical, experiential encounter. This encounter forms the basis for reflection on both self and other. A range of theoretical concepts, straddling different traditions, underpins relationalcentred research: phenomenological philosophy (Buber, 1923/1958); gestalt theory (Hycner and Jacobs, 1995); intersubjectivity theory (Stolorow and Atwood, 1992); and collaborative feminist methodology (Fonow and Cook, 1991). Of course, while relational-centred research parallels therapy practice, there are critical differences. Research may involve a oneoff encounter rather than an ongoing relationship. In therapy, we support clients to become more aware and to change; research is more instrumental and limited: its goal may simply be to deepen understanding of a particular experience. However, in subtle
overlap, relational-centred research can be therapeutic and potentially transformative. Through the being-with process, there is transformative potential for learning and growth. For instance, our research on traumatic abortion allowed the women involved to give voice to their experience, be witnessed and to engage a longmissing quality of relational contact, which challenged their shame and secretive silence. There is no pre-set, structured method for doing relational-centred research. Data are gathered through various means – research interviews, focus groups, participant observation, introspection, the use of art, poetry or drama – then analysed thematically, narratively or creatively. We would argue that the relational-centred approach can be used alongside different research methodologies. Its core feature involves engaging an attitude of openness and empathically attuned presence. It’s about being present as a human being first, as a therapist-researcher second. It’s about opening to the other while being willing to give of self and prepared to take some risks towards the co-creation of understanding and knowledge. There is also a readiness to be reflexive about what may be happening in the embodied intersubjective relational space between therapist-researcher and client-participant while being mindful of the sociocultural context.
Reflexivity Qualitative researchers are inescapably part of what is being researched. The Self is always in the mix with understandings of the Other. At the very least, our responses will impact on the research participant and thus the research. The key is to attempt to be ‘present’, to be-with the participant while also stepping
feature article back, so as to be able to reflect upon the research process and findings. I have previously defined reflexivity as being thoughtfully and critically self-aware of subjective/intersubjective elements and of how these impact on the research (Finlay, 2012). As part of laying claim to the integrity of qualitative research, researchers need to engage in an explicit, self-aware metaanalysis. And this needs to occur throughout every stage of research, from the initial design through data collection/analysis to writing up. Ethical reflexivity and intersubjective reflexivity offer different lenses through which to view participants’ experience and emerging relational processes. I call them ‘reflexive spectacles’, as they allow us a sharper focus, a way of seeing something more clearly. As we take them off and replace them with a different pair, we get a fresh perspective. Ethical reflexivity: Given the challenges of working at such depth, relational-centred researchers must be mindful of ethical dimensions and the duty of care to ensure the participant’s (and our own) safety and wellbeing. Rather than rely on professional ethical codes to guide us through the process, we need to grapple reflexively with ethical uncertainties and power issues that arise. Crucially, researchers need to ensure they are well supported in supervision. Intersubjective reflexivity: When we intertwine with another in an encounter – be it therapy or research – we can find ourselves surprised and touched by the connections we make. Psychoanalytically oriented researchers will explicitly engage ‘transferences’, while humanistically inclined ones might prefer to talk of ‘patterns of relating’ derived from historical experience. Meanings are layered, with any ‘here-and-now’ moment probably containing something of the ‘there-andthen’. These can be shown in the co-created research relationship, where the participant may expect, hope or dread certain responses from the researcher. One way of probing intersubjectivity is to recognise the multiple subjectivities and/ or ego states involved. When we enter any research context, we take with us many ‘selves’: our researcher and therapist ‘selves’, and those from different periods of our lives and internalised significant others. My wounded ‘Child’, for instance, might resonate with a participant’s story, enabling me to tune in to a potentially disowned part of the participant. The research context thus
becomes a ‘thickly populated’ encounter and the attempt to disentangle the various relational connections to identify who is talking to whom can be revealing.
A research example: Mia’s story Barbara Payman and I studied the lived experience of abortions that had been particularly traumatic (Finlay and Payman, 2013; Finlay and Evans, 2015). In our practice, we had come across several women who seemed to be experiencing post-traumatic stress for years after an abortion, despite not necessarily regretting having had it. Our project aimed to probe the trauma associated with some women’s experience of abortion. We used a relational-centred, existential-phenomenological approach to explore the lived world of one woman – Mia. Mia, a psychotherapist colleague, was one of several volunteers who shared their story of having a (self-defined) ‘traumatic abortion’. Mia, who was in her fifties when she shared her story, had her abortion when she was 16. Two weeks later she suffered a violent haemorrhage and miscarriage, indicating a botched procedure. Mia found herself feeling responsible for terminating a ‘baby’ rather than getting rid of unwanted ‘cells’. But it was the relational-social-cultural circumstances surrounding Mia’s abortion that aggravated the trauma. Specifically, Mia’s (alcoholic) mother had encouraged her to get drunk and have hot baths to effect a termination. Later, when Mia was haemorrhaging in the middle of the night, her mother’s solution was to offer her alcohol again before returning to bed, leaving her daughter alone. Mia’s story spoke to her ongoing sense of horror, guilt, grief, and shame. In our analysis, three existential themes emerged: ‘Feeling Torn’, ‘Cutting Shame’ and ‘Monstrous (M) othering’. In a follow-up article, a fourth
theme was added: ‘Entrapped Grief’ (Finlay, 2015). Our analysis tuned into her profound inner turbulence: how she was torn cognitively, emotionally, socially and ontologically. We were struck by how – in her shame – she accepted her (m)other’s repeated abandonment and neglect of her safety and needs, not appreciating that she was entitled to more loving care. Mia had found a way to cope long term through dissociating from her body, her grief and the trauma experience generally. Ethical reflexivity: At the time of interview, Mia was getting support through ongoing psychotherapy, where she was exploring the impact of various traumas on her life. Viewing our research as an opportunity to further work through this traumatic episode in her life, Mia was prepared for the possibility that the interview could be emotionally intense and have the potential to re-traumatise her. She trusted Barbara (the interviewer) to handle her material sensitively, ensure her anonymity, be supportive and take care not to transgress boundaries between research and therapy (which would be an abuse of power). Our data were collected through an in-depth dialogical-relational interview, reflexive notes written before and after the interview, and reflexive notes on our ongoing dialogue as co-researchers in supervision. Barbara interviewed Mia, while I acted as Barbara’s support and supervisor (Barbara is an experienced therapist but relatively new to research). It was through our triadic reflexive processing of Mia’s experience, Barbara’s response in the interview and our supervision dialogues that we gained insight into Mia’s experience. Intersubjective reflexivity: We were intrigued to find how many issues seemed to be recreated in our supervision in a kind of
feature article ‘parallel process’. Barbara became dissociated at points during the interview and supervision, perhaps mirroring Mia’s experience. She also experienced doubt about being a ‘good enough’ interviewer, causing us to wonder if this was related to Mia’s sense of shame.
something of how Mia felt to have been a monstrous mother who betrayed and damaged her baby. For our part, we saw the way she abandoned herself (psychically in her dissociation), just as her mother had betrayed and abandoned her.
Ethical reflexivity: We recognised that for us, as therapist-researchers, the potential for secondary traumatisation was great. We used supervision to support each other to stay with the harrowing and painful stories Mia and the other participants shared. We also felt a responsibility to represent Mia’s experience with integrity. More than simply witnessing her experience, we were giving Mia a ‘voice’, where previously she had been silenced by the secrecy and stigma surrounding her abortion.
When we analysed the data, we quickly became aware of many emotions and themes: guilt, shame, aloneness, horror, existential anxiety, abandonment.... But in themselves these words somehow lacked the ambivalence, darkness and depth of trauma implicit in Mia’s story. It seemed the problem was not so much intrapsychically within Mia as arising out of the relational-cultural context. Our own reflexive processing helped us work more deeply with our descriptions and analysis. The excerpts below indicate our attempt to examine the possible underlying meanings of Mia’s experience, which eventually evolved into the theme of Monstrous (M)Othering. Our languaging of this theme captured
The focus of the relational-reflexive approach discussed here is on process rather than outcomes; on intersubjective experience rather than objective observations; on compassion rather than strategy. Herein lies its strength and potential as well as its limitations. I have tried to show how the use of a relational-centred approach to research can result in a rich, resonant description of lived experience, as well as the possibility of new understandings and transformative growth. Through the use of our different reflexive spectacles, the essential subjectivity of the research is transformed from a problem to an opportunity. Committing to relational-reflexive research requires the therapist-researcher to surrender to ‘the between’, where we await, poised and attentive to whatever emerges, momentby-moment. Our challenge in this space is to remain ‘present’ yet retain both our capacity for empathic attunement and our ability to step back to grapple reflexively with ever-present layers of ethical and intersubjective process
confronting us. In the process, our two ‘lenses’ can help bring things into clarity and focus.
References Buber M (1923/1958). I and thou (trans RG Smith). New York: Charles Scribner’s Sons. Buber M (1951/1965). The knowledge of man: a philosophy of the interhuman. New York: Harper & Row. Finlay L (2012). ‘Five lenses for the reflexive interviewer’. In J Gubrium, J Holstein, et al (eds). Handbook of interview research. CA: Sage Publications. Finlay L (2015). ‘Probing between: reflexiverelational approaches to human science research’. In C Fischer, L Laubscher and R Brooke (eds). Invitation to psychology as a human science. Pittsburgh, PA: Duquesne University Press. Finlay L (2015). ‘The experience of ‘Entrapped Grief’ following traumatic abortion’. International Journal for Psychotherapy Integration, 6: 26-53. Can be dowloaded from www.integrative-journal.com/index.php/ijip Finlay L and Evans K (2016). ‘An invitation to engage relational-centred research’. In J Roubal, P Brownell, et al (eds). Towards a research tradition in gestalt therapy. Nieuw-Buinen, The Netherlands: Gestalt Research Press/EAGT. Finlay L and Payman B (2013). "This rifled and bleeding womb": a reflexive-relational phenomenological case study of traumatic abortion experience. Janus Head, 13(1): 144-175. Fonow M and Cook JA (eds) (1991). Beyond methodology: feminist scholarship as lived research. Bloomington: Indiana University Press. Hycner R and Jacobs L (1995). The healing relationship in gestalt therapy: a dialogic/self psychology approach. Highland, NY: Gestalt Journal Press. Stolorow RD and Atwood GE (1992). Contexts of being. Hillsdale, NJ: Analytic Press.
Excerpt from Barbara’s reflexive notes I felt highly protective and supportive of Mia as she told her story. She evoked my deep compassion, and I can see that I was monitoring throughout what was missing relationally for her and feeling the impact of this ‘absence’ in an underlying feeling of sadness. Whenever I referred to sadness with her during the interview, she reported she wasn’t feeling any, so it is not unlikely that I was ‘holding’ her suppressed sadness as well as my own ‘internal tears of compassion’. When [Mia] owned her anger with her mother at one point, I had a flash of very strong anger too, but it was fleeting. Perhaps… my prime ‘relational role’ was… to help enable her to tell her story, was to take care of the sadness that could potentially overwhelm her and possibly then prevent her telling her overall story in the way she wanted and that we had ‘contracted’ for. Perhaps if we do go along this line of thought of ‘containing feelings for the other’, one way we could think of it could be as a type of ‘maternal countertransference’ … I was very overtly aware of how an ‘attentive and loving mother’ would be responding to the various scenes I was hearing being described; I was feeling this strongly, and clearly, and probably with much protective ‘maternal fervour’(!)
Excerpt from Linda’s reflexive notes I am aware of feeling irritated that we are focusing so much on ‘mothers’ and ‘forgiveness’. Where is Mia and her lived experience?! And is there some resistance in Barbara to work more directly with the horror and trauma?… And how am I contributing? Am I disconnecting from the focus on ‘mothers’? Perhaps I am finding it hard to stay with Mia, too. It’s easier to analyse Barbara’s responses and my supervision dilemmas in this slightly detached, objectifying way. Is there some dissociation here mirroring Mia’s? Am I responding sufficiently to Barbara’s current supervision needs? Perhaps … I am paralleling Mia’s mother’s abandoning process? Having owned my irritation, I am now in touch with my deep compassion for Mia’s pain and much appreciation of Barbara’s care.
Researching the self and beyond: a virtuous circle Research has so much more to offer than proving facts, says Marie Adams. Used flexibly and creatively alongside a personal perspective, it enables us to embark on an exciting journey of exploration and discovery.
he word ‘research’ is a cold one, and for many people the very idea is anathema, evoking as it does images of statistics and graphs and incomprehensible tables purporting to indicate truth. However, if we open up the word, slice it not quite down the middle, we have re-search, an opportunity to hunt out or discover, a process not always beleaguered by numbers but offering the possibility of an exploration of an individual, or group’s, deeper experience. We go back in again for another look at a familiar subject. As du Plock argues, re-search for psychotherapists is a deeply personal process: We get into difficulties, it seems to me, when we … begin to see research as something different and separate from what we are already intimately involved in … We need to take more seriously the idea of research as a personal journey of discovery, or perhaps re-search, a continual transformation process rather than a discrete event. du Plock, 2010: 122
The use of self As a lecturer at several training institutes, I am often struck by how much students dread the notion of attending a two-day workshop on research. Only after they begin to realise that they can follow the trail of something they feel passionate about and make use of what they ‘feel’, as well
Research challenges our intuition, our ‘gut’ feeling that something exists in a particular way as what they witness and hear from their participants, do they begin to understand that research has validity beyond simply ‘proving’ facts. In a world that values empirical research so highly, it often feels like an uphill battle to argue that a personal perspective can actually contribute to research. Paradoxically, the use of the ‘self’ is the realm in which we work as psychotherapists on a daily basis – we often gain a sense of our client or patient in the therapy room through our personal response to them. Sometimes this can be through our empathy for their experience, or in our lack of empathy, informing us that this
Marie Adams is a writer and practising psychotherapist. She is on the professional doctorate staff at the Metanoia Institute and a visiting lecturer on a number of other training programmes, including those for the Institute for Arts in Therapy and Education. Her book, The Myth of the Untroubled Therapist, is a standard text on counselling and psychotherapy training courses throughout the country. Her recent novel, Telling Time, is published by Karnac.
person feels walled off from others, or has little sense of their own worth, devalues their own suffering or has received little empathy themselves. We use our training and our internal radar to understand our patient. We are sometimes caught up in dissociation, or physical symptoms directly related to our client. Most of us admit to transference and countertransference, to projective identification and enactments, in the therapy room. We may use other words and terms, depending on our training and whether or not we are analytically minded or humanistically oriented. Our CBT colleagues will certainly admit that their relationship with a client is fundamental to a good outcome. So why would we argue that bringing ourselves into the process of research is always a hindrance rather than a profound means of deriving understanding? The counter-argument to this, and a profoundly valid one, is that as therapists we often count on our ‘intuition’ – though, as Kahneman points out, our intuition isn’t always right: ‘when faced with a difficult question, we often answer an easier one
feature article What I hadn’t expected was the amount of shame I encountered in therapists instead, usually without noticing the substitution’ (2011: 12). That ‘substitution’, in the case of our clinical work, can sometimes be the imposition of our perspective on the client, based on our history rather than theirs. Research challenges our intuition, our ‘gut’ feeling that something exists in a particular way. It allows us to open up an area for exploration, sometimes confirming our view, but often highlighting contradictions. Suffering depression, for instance, is a deeply personal experience. There may be common symptoms, but the depth and visceral quality of the anguish is entirely individual. How many times have I offered what I believed was an empathically attuned response only to have my client shake their head and say, ‘No… no… it wasn’t like that…’ before going on to tell me what it was like for them. My responsibility is to hear them at that point, and to recalibrate my own idea of their distress without insisting that their experience replicates mine. As my client challenges my worldview, so does research.
The validity of a ‘self’-centred approach In memoir, we recount our personal history. There may be some reflective space interwoven with the story, but it is a narrative focused only on the author. In research, however, the process is expanded to include the other or others. The process may be ‘self’-centred but through the formality of an inquiry, through an exploration of the literature, through interviews and creative processes (the ways of discovery may be endless), we come back to study our data (another cold, dirty word?) and make sense of what we have learned. When Clark Moustakas, a proponent of heuristic research (1990), conducted an investigation into loneliness (1961), he began with himself, his own deeply felt despair during his child’s life-threatening illness. Reflecting on the question of ‘aloneness’, he began to look further, to notice the children in the hospital wards, to view people on the street. What began to emerge for him was the nature of loneliness, the universality of a sense of isolation. In the introduction to Loneliness he writes: ‘What I have written in this book is an experience of my own existence as a solitary individual,
as well as the existence of others, and of the meaning which loneliness has for human growth’ (1961: xii). What began as a ‘self’centred process was transformed though his research into a deeper understanding of personal suffering. My argument is not that quantitative research is less valuable than qualitative research but, rather, that when we make use of the ‘self’ in our research we are able to go beyond the numbers to convey something of the quality of what we are investigating. We are not attempting to prove a point but to explore an aspect of the human condition.
Exploring the personal I researched the personal lives of 40 therapists to determine how they believed their private lives impacted their work. I chose this area because I had direct experience of a disruption to my clinical work as a result of personal anxiety, including a professional complaint, and, a few years earlier, my partner’s illness (Adams, 2014). ‘Intuition’ told me that I wasn’t alone in managing tensions between the personal and professional aspects of my life. On that count I was correct, as all my interviewees were able to connect their work as psychotherapists to events in their past. However, what I hadn’t expected, and was forced to consider myself, was the amount of shame I encountered in therapists when faced with current difficulties, as if somehow we are expected to be immune from them as a result of our training. We pay lip service to the idea of ‘being human’ but are loath to show evidence to our colleagues that we are vulnerable, often for fear of criticism. Having made use of the ‘self’ in my research, I then had to contend with the results, which rather inconveniently disrupted an element of complacency on my part. Since completing my training I had not considered aspects of my own shame when confronted with emotional disturbance. I was also forced to acknowledge, at a much deeper, more emotional level, not simply intellectually how I sought to derive meaning through the exploration of or ‘research’ into my clients’ lives. And the research itself? There is little doubt that
it was an effort to make meaning out of that complaint. How else to transform something so dreadful into something positive except by using it to develop insight and knowledge?
Formal versus informal For those psychotherapists who don’t wish to tackle a formal inquiry, research does not always need to exist within an academic frame. Some of the best examples I believe are outside the field of academic studies. Rosenberg’s A Brief Stop on the Road from Auschwitz (2014) retraces his parents’ journey from Poland, Nazi Germany to survival and residence in a small town in Sweden. Through his research, the author begins to make sense of his relationship with his parents, his country and himself. He could of course simply have written about what it was like to be a child of Holocaust camp survivors, of what it meant to be of Jewish/ Polish descent in a Swedish town rooted in protestant, northern sensibilities. This would have been interesting, and he is a fine writer, yet it would not have contained the depth, the sense of transgenerational trauma or the stark reality of his parents’ lives and the impact on his childhood had he taken the simpler route. In Sedgwick’s In My Blood (2007) we learn of the historical antecedents of bipolar, how it can become the determining force in a family covering centuries. Once again, the author makes sense of his own struggles through his research as he unravels his family’s relationship with the disease over six generations. Putting himself in the frame, we become so much better acquainted with the vicissitudes and manifestations of the disease for a great many people, rather than just one. Research was what it took to reveal his own truth. Recently a client told me the story of a distant relative, banished to Australia as a child after initially being farmed out to an orphanage because the family was too poor to care for her. Forced to work almost to the point of slavery, she later returned to Britain to find her family, only to have them shun her for being such an outsider. Eventually, manifesting psychiatric problems, she spent the last 20 years in hospital, finally dying there, all alone, never once having been visited by any member of the family. My client was drawn to this account through his own sense of isolation and history of physical abuse. Tracking down his great-aunt, documenting his findings and finally publishing her story enabled him to cast a light on his own experience of being the ‘outsider’, with views and sensibilities outside the expectations of his family.
feature article Novels, too, are windows to the world, often demanding research. Barbara Kingslover’s books include historical research which give her novels weight and authenticity: Poisonwood Bible (2000) and The Lacuna (2010), for instance. Sebastian Faulks could not have written his novel Human Traces (2006) without a personal interest in, and extensive exploration of, the early history of psychiatry and psychoanalysis. My own novel, Telling Time (2015), focusing on the troubled past of a high-profile psychotherapist, would not have been written without the backdrop of the research I did on the personal lives of therapists. Research can open up our worldview, and through the exploration of other people’s lives can also often lead us back to our own. It is the use of the self that is fundamental in this ‘personal’ research. Without it we are simply left with dry bones, on which nothing to hang except the facts, when all the while, as psychotherapists, we spend our working lives in the rich emotional terrain of our own and our clients’ histories. Why not put that personal experience to use, not simply to prove a point, as Eysenck says, ‘but rather in the hope of learning something (1976: 9)? Through research, or re-search, I believe, we have the opportunity to learn from one another.
References Adams M (2015). Telling time. London: Karnac Books. Adams M (2014). The myth of the untroubled therapist. London: Routledge. du Plock S (2010). ‘The vulnerable researcher: harnessing reflexivity for practice-based qualitative inquiry’. In S Bager-Charleson (ed) Reflective practice in counselling and psychotherapy. London: Learning Matters. Eysenck HJ (1976). Case studies in behaviour therapy. Faulks S (2006). Human traces. London: Vintage.
Research? What research?: Three obstacles to research in psychotherapy Dora Brown agrees that research is essential to the effective practice of psychotherapy but finds the competitive nature of universities and the bias towards scientific funding increasingly challenging. She argues for developing therapeutically appropriate ways of training, where practice and theory investigate and inform each other.
n the summer 2015 issue of The Psychotherapist, Dr Helen Barnes emphasises the importance of research in the psychotherapy profession. According to Barnes, psychotherapy needs to be based on credible evidence in order to establish public confidence in the practice of psychotherapy, to help practitioners become better therapists and to contribute to policy development. While I agree with Barnes’s emphasis on the importance of research, I wish to share some of the obstacles to undertaking this research that I have seen in my ten years as a research trainer.
Hand in hand I am a freelance psychologist with extensive experience as a supervisor and as a lecturer
Kahneman D (2011). Thinking fast and slow. London: Allen Lane. Kingslover B (2000). Poisonwood bible. London: Faber and Faber. Kingslover B (2010). The lacuna. London: Faber and Faber. Moustakas CE (1990). Heuristic research. Newbury Park: Sage Publications. Moustakas CE (1961). Loneliness. New York: Prentice Hall Press. Rosenberg G (2014). A brief stop on the road from Auschwitz. London: Granta. Sedgwick J (2007). In my blood. New York: Harper Collins.
Dr Dora Brown is a freelance psychologist with extensive experience as a research tutor in clinical programmes at the University of Surrey. She is a lecturer in research methods at the same institution.
in research methods on the University of Surrey’s clinical counselling psychology programmes. It has been my experience that the typical psychotherapy trainee arrives at a training programme with little if any experience of research. They arrive wanting to become therapists. That programmes put so much emphasis on research and research methods usually takes them by surprise. Some will develop a taste for research during their training but the majority will be glad to see the back of it when they finish. Surprisingly, this phenomenon is often supported by training institutions. Training programmes are usually populated with clinical experts, often with relatively little personal experience of research skills and research methodology. The philosophy behind the courses has traditionally been to train psychotherapists, not researchers, and raising the standards of research has sometimes put both the trainees and research supervisors in an awkward position. Although there is a greater emphasis on practitioner-research today, often there is still an inbuilt tension in the balance between practice and theory.
Performance-based research and funding biases Further, and in more general terms, there is an increased pressure on universities
feature article to meet financial targets in a competitive market, which impacts psychotherapists’ research training. Performance-based research has recently become the holy grail of academic life (Hicks, 2012; Cleary, et al, 2014). Performance-based research funding systems (PRFS) are complex, dynamic systems, which supposedly balance peer review and metrics alongside other factors. The importance of these systems is based on the distribution of universities’ research funding, with economic growth, diversity and equity in mind. Some, however, have referred to PRFS as an ‘illusion’ (Hicks, 2012). PRFS play into a powerful competition for prestige within universities, and the distribution tends to benefit a group of privileged professionals rather than promoting values like equity, social inclusion, access and diversity (Hicks, 2012). Published papers risk being limited to the type of knowledge encouraged by the funding-driven research environment, which in turn can lead to opportunities for exciting and innovative research opportunities being missed. There is an increasing emphasis on publishing in High Journals. The Impact Factor represents the number of citations received from other indexed journals. High citation count is often regarded as 'indicative of the influence or impact of the idea and its originator on our body of knowledge' (Thomson Rueters 2015). Research output influences the distribution of funding within universities and shapes research priorities in ways that threaten the ‘scope, and depth and the artistry’ of social sciences and ‘health care knowledge’, as Cleary et al put it (2014). Research following traditional
science principles is, for instance, more likely to get published in high-impact journals and will, as a result, more easily fulfil the new performance-based academic targets. Preparing grants is time-consuming, involves considerable effort and can take months, even for highly experienced and seasoned research teams. This time can intrude, I find, on the conduct of the research required for a well-rounded academic psychotherapeutic career. Competition and funding incentives sometimes risk being enforced excessively, and the environment itself can become dysfunctional with resulting negative impacts on productivity (Auranen and Nieminen, 2010). Clearly, in the context of developing a clinical practice, not all psychotherapy training programmes will have the resources to support research proposal development. I have found that the emphasis on research money and publications raises concerns among academic staff, and can impact on staff attitudes, morale and relationships, as well as on recruitment and retention. There is a risk that staff performance is judged in relation to acquisition of funds, creating a climate of rivalry, conflict and exclusion. This has arisen in some institutions, with a discourse of denigration and disdain directed at those who fail to meet incomegenerated targets.
The all-encompassing role of science The performance-based funding system, with its bias towards natural science, taps into an ongoing debate in psychological therapies. Freud sought acceptance from
There is a surprisingly narrow approach to the way we evidence progress
within the medical community, where he originally trained, and although many therapists abandoned this stance, there is a tendency to return to the medical model in terms of emphasising the validity of measures and seeking reliable evidence of effective interventions. In 1952, Eysenck expressed his concerns about the lack of research evidence for the effectiveness of psychotherapy based on controlled research, and there is still a surprisingly narrow approach to the way we evidence progress, with research based on controlled trials most likely to get funding. I am not sure if the evidence-based model will solve this dilemma. NICE guidelines for research stipulate specific criteria for studies, where those using randomised controlled trial methodology are prioritised. However, psychotherapists deal with subjectivities and these are very difficult to measure, let alone establish whether they are true or not. Approaching therapy through counselling psychology programmes has highlighted the importance of psychotherapy. I feel affiliated to the aim of helping clients with tools that are invisible to the naked eye and with effects that are felt privately. It therefore seems to make sense to question the utility of methods that challenge the value of this and sometimes reject the very essence of what therapy stands for. This is a chicken and egg question. Of course, there will be times when psychotherapeutic research will pose questions that can best be answered using the methods that form the basis of traditional science. However, it is my experience as a research trainer that most psychotherapists would like to use research methods that reflect the subjectivity of participants and practitioners.
Pluralism and subjectivity The importance of research has to be seen from various standpoints. First, as professionals, we have a duty to expand the knowledge in our field. Second, it is arguably unethical to offer therapy to clients without being anchored in any form of research. Third, if research is to be funded, we need to demonstrate that we have the skills to provide and communicate the findings. Research can certainly promote plurality in therapy and choice to clients. I would like to end this article by inviting psychotherapists to conduct research that
feature article engages the imagination, poses the necessary questions and focuses on the practice of psychotherapy. This type of research can, I believe, be informed mainly by the humanities and use science as a tool when necessary. Needless to say, I am not alone in advocating this stance. Hansen (2012) has already proposed something similar for the field of counselling psychology, with a dialogue between the humanities and science despite them being paradigmatically contradictory. I would argue for being creative, and for developing therapeutically appropriate ways of training, where practice and theory investigate and inform each other. In other words, therapists need to set and follow standards that reflect the complexity of mental health while educating a modern society already wise to the possible benefits of psychotherapy. In this way, we will all grow in professional identity and perhaps stop the arguments about the objective efficacy of therapies. Performance-based academic standards can then focus on those whose priority is to establish a money-making business churning out degrees. High-impact journals can be available to those interested in measuring phenomena, while funding bodies will eventually be attracted by a profession and discipline that focuses on the person and shows independence of thought and integrity.
References Auranen O and Nieminen M (2010). ‘University research funding and publication performance’. Research Policy, 39: 822-834. Barnes H (2015). ‘Why does psychotherapy research matter to UKCP?’ The Psychotherapist, 60: 35-36. Cleary M, Usher K and Jackson D (2015). ‘Editorial: Money, money, money: not so funny in the research world’. Journal of Clinical Nursing, 24: 611–613 Eysenck HJ (1952). ‘The effects of psychotherapy: an evaluation’. Journal of Counselling Psychology, 16: 319-324. Hansen JT (2012). ‘Extending the humanistic vision: toward a humanities foundation for the counselling profession’. Journal of Humanistic Counselling, 51: 133-144. Hicks D (2012). ‘Performance-based university research funding systems’. Research Policy, 41: 251-261. Available at: http://works.bepress. com/diana_hicks/27 Thomson Reuters. 2015. 'History Of Citation Indexing - IP & Science - Thomson Reuters'. Wokinfo.Com. http://wokinfo.com/essays/ history-of-citation-indexing/
Role play as a therapeutic tool with sexual offenders Dr Maxine Daniels writes about her experience of transference and countertransference when conducting research in prisons on sexual offenders.
n 2012, I completed a professional doctorate in psychotherapy with the Metanoia Institute titled ‘Role play as a therapeutic tool: what do sexual offenders experience when role reversing with their victims in HM Prison Service’s Sex Offender Treatment Programme’. My background placed me in a unique position to research prisoners’ experience of sex offender treatment programmes. I had worked in prisons as a psychodrama therapist for many years. I had also trained staff at a national level in role play techniques to develop victim empathy in sex offender programmes delivered in 22 prisons. I was looking forward to hearing prisoners’ voices and gaining insight into their experiences. The last thing I expected was to feel traumatised when analysing the data and developing anger towards the offenders, which left me wanting to abandon the research.
Dr Maxine Daniels is a national trainer with criminal justice agencies. She works as a consultant and supervisor in medium-secure hospitals, and has worked at Broadmoor Hospital and Grendon TC. She has presented at national and international conferences on her work with sex offenders. Maxine is a senior trainer in psychodrama, registered with the British Psychoanalytic Association.
This article highlights how I coped with the transference and countertransference while analysing the stories of 11 sex offenders who had committed offences against children, female adults and elderly victims, while ‘bracketing’ my own feelings during the process in order to give voice to their experiences and make a valid contribution to the literature.
My role as researcher The literature about research reflexivity highlights the importance of being transparent (Etherington, 2004; Hertz, 1997). The researcher is not a separate object in relation to the discovery of the phenomenon being unravelled, but rather a fundamental part of the discovery. The element of surprise for me as a researcher was the role that emotions played in my research, especially with regard to the impact of reading the transcripts. During my face-to-face interviews with the offenders to collect the data it felt familiar in terms of clinical work; also, because I have protective factors in place, I am able to cope with difficult material. However, analysing the data in isolation, post-interview left me feeling overwhelmed and unprepared.
Impact of working with sex offenders During the 20 years I have worked with sex offenders, I have been aware of the impact of this work on myself and other therapists. As a result of research by Clarke and Roger (2007), HM Prison Service established clear guidelines on supporting facilitators with regular supervision, briefings, personal counselling and training around ‘protective factors’. There is now far more literature in the field about working with sex offenders and the effects on therapists (Freeman-
feature article Analysing the data in isolation, postinterview, left me feeling overwhelmed and unprepared
Longo, 1997; Leicht, 2008; Friedrich and Leiper, 2006; VanDeusan and Way, 2006; Scheela, 2001) that gives insight into the factors that can cause vicarious trauma and burnout. Lea, Auburn and Kibblewhite (1999) conducted research with professionals and paraprofessionals in the prison service to find out the perceptions and experiences of this group. Their research showed a tension for the staff between the need to develop a professional relationship in order to conduct the treatment with sex offenders and not wanting to develop a relationship with an offender because of a personal abhorrence of his criminal activity. The dilemma for professionals working with sex offenders is treating the person and being aware of the crime. According to Leicht (2008), professionals may experience secondary post-traumatic stress disorder when working with sex offenders, including changes in the emotional, cognitive, biological, behavioural and interpersonal areas of therapists’ lives. Scheela (2001) interviewed 17 therapists; the results found both negative and positive outcomes of working with sex offenders, including coping strategies. One main area of coping was to become more ‘detached’ from the client. Coping strategies include training, supervision and separation of work from personal life, selfcare, hobbies and humour (Farrenkopf, 1992; Freeman-Longo, 1997; Jackson, et al, 1997; Scheela, 2001; Leitch, 2006). As the research evidences, the impact of working with sexual offenders can be particularly challenging given the nature of their offences. Interpretative phenomenological analysis (Smith, Flowers and Larkin, 2009) is a qualitative methodology and I had to immerse myself
in their stories and analyse the data line by line. Over a period of time, I began to develop symptoms as described above and I realised I was becoming traumatised by reading the material. In order to continue the analysis, I had to develop coping strategies within the research framework.
the offender’s truth. I feel so angry with him, firstly telling other professionals and they did nothing! They did not challenge him. My anger is about all those years his daughter lost, she lost 10 years of her life!! My overwhelming empathy is for her!
My experience of analysing the data
It became increasingly difficult to read the interview and to analyse the lines about his daughter and how she was affected. I struggled with the notion that he believed it was true love. I began to avoid the analysis and struggled to keep my time management on track. I had a picture of his daughter in my head – young, trying to find her way in the world, with a boyfriend who looked confused, and her looking so sad, not wanting to report her father to the police and yet living as a sexual object under the same roof. The intrusions kept happening. I would look at my own children, especially my 16-year-old daughter, and think about how this could happen. Why did her mother, who lived in the same house, allow it to happen? I could feel the rage, then the detachment, and finally the tears of a lost life and the pain the victim had suffered.
Out of the 11 transcripts I analysed, which were all quite traumatising to read, I want to highlight two examples of the transference and countertransference I experienced. The first transcript I analysed included details of an offender who abused his daughter when she was 12 years old, continuing through to her leaving home and going to university. It stopped when she was 22. I spent a lot of time on this interview trying to understand his view of the world and to give meaning to his experiences of victim empathy. I struggled at the parts where he said it was like having ‘a love affair’ (2:53) and described the relationship as ‘it was sexualised from early petting and fondling, right the way through to intercourse’ (3:60). He recounted in the interview that he moved out of his wife’s bedroom in the family home and into a bedroom with his daughter, so they could live as a ‘married couple’. The family home included his other children and his wife who lived alongside each other. Eventually he had a full-blown sexual relationship with his daughter. Reading his account line by line, immersing myself in his experiences, left me on an emotional roller coaster and in my reflective diary I wrote: I’ve spent all morning analysing interview 1 again, this time really trying to understand
Flexible supervision I knew I had to find specific supervision from someone who understood sex offender work, simply because I had to be able to talk through all the details of the offence and not feel inhibited by trying to protect the supervisor. I also wanted someone who was a trained therapist, as I realised this material was no doubt triggering my own issues, and I needed to understand the transference and countertransference I was experiencing while analysing the data.
feature article I contacted a therapist and supervisor who had trained in prison sex offender treatment work back in the early 1990s. During my session with her, my anger and tears about the injustice towards this poor 12-year-old girl had resonated. My supervisor helped me understand that it was about me as a young child feeling a victim, not in a sexual sense, more in that my father died when I was five years old – the feelings of loss of power, my mother struggling to cope but no one understanding or doing anything, and feeling very alone and isolated. This was very insightful, and feeling I was regaining control and separating myself from the 12-year-old victim helped me process my own understanding and then the interview. My understanding of the offender as the ‘abusive’ parent resonated with my own feelings of the rejecting, ‘abusive’ parent, and also my countertransference to the ‘hateful’ feelings I experienced towards the offender were triggered. It helped me separate these out and ‘detach’ myself from the content. During the analysis for interview 10, I became really upset and struggled to continue with the work. My diary entry reads: I’ve been very tearful today thinking about him [offender] downloading sexual images of young children and then saying he was 16 years old when he attacked an eightyear-old. His offence was very violent and I keep thinking about that poor child, scared, frightened and the fact it was such a horrific attack! He said she was crying and pleading with him not to do it, she was completely alone and she knew she was going to be raped. I just feel sick when I keep reading this material. DANIELS, 2010
This interview was very painful for me: the sheer abuse of the victim, the helplessness and powerlessness of the eight-year-old child. Again, this triggered my own issues – I had been drawn into the unexpected triggers of feeling absolutely helpless and powerless as a child, and that it was about survival. How had I survived my childhood? In the supervision session, we discussed the fact I put up a brick wall to ‘cut myself off’ from having to read disturbing material, and that I wanted to objectify the offenders so that I could separate the person from the offence. This reaction is quite normal according to Friedrich and Leiper (2006) in their research about the tension of
Coping strategies • Only work on analysing interviews for one or two hours at the most • During the break, do something different like go for a walk, cycle ride • If feeling overwhelmed by reading the content, write feelings and responses to the data in terms of the content • Do not ruminate on the victim and their distress • Consciously separate out any family members (especially children) from the victims • Try to focus on (visualise) the offenders talking in the interview rather than hearing the victims • Flexible supervision • Work on countertransference issues.
therapists seeing their clients in two ways, first as complex human beings, and second, objectifying them as offenders. It was the only way I could cope with the material I was reading. I did not consciously set out to put coping strategies in place in order to research this material, and I am surprised that I did not take this into account. I believe it was because I was in a new role of researcher rather than therapist, and for some reason it did not occur to me that it would be just as difficult reading these accounts as listening to them. Unwittingly, I did, somehow, slowly introduce coping strategies to help me. VanDeuson and Way (2006) highlight positive coping strategies used by therapists working with clinicians treating survivors of abuse, and Jackson et al (1997) cite supervision as a major factor in coping. Analysing the data for my doctorate was an unexpected painful process, and I struggled to ‘bracket’ my own understanding of victim empathy while immersing myself in their material to gain their perspective of the world. It is important, I have found, to acknowledge one’s own feelings in relation to the data in order to analyse the material effectively. My phenomenological aim to ‘hear’ the participant’s ‘voice’ involved listing inwards: whose voice and whose story am I really hearing? To relate to
such questions, supervision in relation to transference and countertransference issues became valuable to me. Flexible supervision also helped, both with the readings of the data and with self-care. Not surprisingly perhaps, being immersed in the research material means just that – we are immersed. It becomes important for researchers to find coping strategies to enable the research to be undertaken in a genuine, authentic way, which will include struggling with the material and working through our own issues.
References Clarke J, Roger D (2007). ‘The construction and validation of a scale to assess psychological risk and wellbeing in sex offender treatment providers’. Legal and Criminology Psychology, 12: 83–100. Daniels M (2010). ‘A personal journal of research doctorate’, unpublished. Etherington K (2004). ‘Reflexivity’. Counselling and Psychotherapy Research, 4(2): 46–47. Etherington K (2007). ‘Working with traumatic stories: from transcriber to witness’. International Journal of Social Research Methodology, 10(2): 85–97. Farrenkopf T (1992). ‘What happens to therapists who work with sex offenders?’ Journal of Offender Rehabilitation, 18(3-4): 217–223. Freeman-Longo RE (1997). ‘A personal and professional perspective on burnout’. In S BirdEdmunds (ed) Impact: working with sexual abusers. Brandon, VT: Safer Society Press. Friedrich M and Leiper R (2006). ‘Countertransference reactions in therapeutic work with incestuous sexual abusers’. Journal of Child Sexual Abuse, 15(1): 51–68. Hertz R (1997). ‘Introduction: reflexivity and voice’. Reflexivity and voice. Thousand Oaks, CA: Sage. Jackson KE, Holzman C, Barnard T and Paradis C (1997). ‘Working with sex offenders: the impact on practitioners’. In S Bird-Edmunds (ed) Impact of working with sexual abusers. Brandon, VT: Safer Society Press. Lea S, Auburn T and Kibblewhite K (1999). ‘Working with sex offenders: the perceptions and experiences of professionals and paraprofessionals’. International Journal of Offender Therapy and Comparative Criminology, 43(1): 103–119. Leicht SKC (2008). ‘The impact on professionals of working with sex offenders’. In J Houston and S Galloway (eds) Sexual offending and mental health multidisciplinary management in the community. London: Jessica Kingsley. Scheela RA (2001). ‘Sex offender treatment: therapists’ experiences and perceptions’. Issues in Mental Health Nursing, 22: 749–767. Smith JA, Flowers P, Larkin M (2009). Interpretative phenomenological analysis: theory, method and research. London: Sage. Van Deusen KM and Way I (2006). ‘Vicarious trauma: an exploratory study of the impact of providing sexual abuse treatment on clinicians’ trust and intimacy’. Journal of Child Sexual Abuse, 15(1): 69–85.
Where am I with my research?: Harnessing reflexivity for practice-based qualitative inquiry Professor Simon du Plock uses reflexivity to ground his research in subjective personal and professional experience. A study may be impoverished, he argues, if the self of the researcher is excluded from their research journey.
want to encourage us to think about the contribution reflexivity can make to our research activities. I will pursue my line of argument by providing an example of my own research, which demonstrates the impact of this strategy on both the prime researcher (in this instance myself) and participants/ co-researchers. The study suggests that a diagnosis of a chronic illness may precipitate a profound shift in identity, which can be exacerbated or engaged with creatively according to the differing relational styles adopted by healthcare professionals. I argue that the ways in which being (or at least striving to become) an explicitly reflexive researcher provided me with insights and rich descriptive material that would not otherwise have surfaced.
Demystifying the notion of ‘research’ I was diagnosed in 2006 as having myalgic encephalomyelitis (ME/CFS). Shortly afterwards, an opportunity to lead a research doctorate – I had previously led a professional doctorate in counselling psychology – encouraged me to think
Professor Simon du Plock is Head of the Faculty of Applied Research and Clinical Practice and leader of the DPsych programme at the Metanoia Institute
more deeply about the nature of research, or inquiry (I am using the terms interchangeably in this article).
professional practice, and which makes a distinct contribution to the scholarly community of therapists.
I have argued (2004, 2010) that we therapists are in a fortunate position with regard to research, provided we remember, when confronted with research, that we are ourselves primarily researchers in our everyday activity as we go about our business of providing therapy. I find it, for instance, helpful to ask myself, where am I with research? In prompting myself in this way, I am making use of my existential therapy training and Rollo May’s observation in Existence (1958) that where we are in terms of our relational world is often a more useful question than how we feel. I find it helpful to conceptualise this ‘whereness’ in terms of ‘research trajectory’, by which I mean the angle at which the researcher enters an explorative process. The angle at which we enter any field of inquiry determines what is illuminated, and also what is thrown into shadow. The notion of the neutral, objective researcher is as absurd as the notion of the neutral, objective therapist. In both cases, the illumination they can provide depends on who they are – or perhaps where they are – in relation to the client or the research topic.
The DPsych requires candidates to reflect on their work to identify what is needful, and at every stage of the research they are expected to engage with others in their specialist field to ensure the relevance of their work. This practitionerresearcher ethos is underlined by the requirement that their activities are not only conducted at doctoral level (i.e. can be mapped onto an agreed set of doctoral descriptors) but also generate a ‘product’ – a specific innovation in the form of a text, training programme, new research tool, etc, which ‘makes a difference’ to clinical practice. If we are to take the notion of the researcher’s role to heart, we need to know about the journey they have taken to generate their product.
Rejecting the possibility of being a neutral investigator, I need to describe clearly my own research trajectory in relation to the experience of being diagnosed with a chronic illness.
Change of professional identity The Doctorate in Psychotherapy (DPsych), which I have led since 2007, promotes research by fully qualified therapists which emerges out of their clinical and
Change of personal identity My ME diagnosis radically challenged my sense of identity in a number of ways. Diagnosis typically entails an ‘expert’ of some kind making a judgment about another ‘non-expert’ person. When the patient is a psychologist and the condition is one generally thought to be at least partly psychosomatic in nature, the authority and power in play become complex and problematic. This is perhaps particularly so given the existentialphenomenological critiques of diagnosis with which I am familiar. I found myself thrown into a process of inquiry in which I was not merely the prime researcher but was also the primary subject, as I sought to engage with questions such as: How do I feel about ‘having’ an illness? How might ME
feature article journeyed from a descriptive self-analysis of the type with which phenomenological inquiry can open to a consideration of the co-constitution of relationship in the course of professional consultation. In the process, I moved from naïve inquiry – the acquiring of information, which we do on a daily basis – towards research/inquiry.
The emergence of an organising theme: ‘openness to relationship’ Within the first month of treatment, the theme of ‘relationship’ surfaced to link my observations. As an existentialphenomenological therapist, I am constantly aware of ways in which I can hold myself open to, or can close down, the possibilities of being-with-the-client. I know that a number of factors are involved in this, including my willingness or otherwise to hold myself open for the experience, which May (1958) describes as the experience of ‘here-is-a-new-person’.
The angle at which we enter any field of inquiry determines what is illuminated, and also what is thrown into shadow impact on my sense of identity? What does it mean to be a psychotherapist with a chronic debilitating condition? As a psychologist, I found it natural to reflect on this challenge by reading in depth about ME, and keeping a diary to structure what at least initially seemed a situation over which I could exercise little control. At the outset I did not specifically frame these responses as research. When I rose above the situation to take a helicopter view, I conceptualised them as subjective strategies adopted in response to a personal situation. In the case of diary keeping, I was informed by my knowledge of the therapeutic effects of writing structured accounts of stressful experiences (Hunt, 2002; Hunt and Sampson, 2002; Pennebaker, 1993; Philips, et al, 1999). I soon noted, though, that I found both activities therapeutically useful and I began to make connections between this insight and my existing professional knowledge.
From naïve to systematic inquiry This movement from subjective experience towards more general
experience meant that soon my idiosyncratic questions were reframed as: What does it mean to ‘have’ an illness? How might a diagnosis of ME impact upon sense of identity? What is it like for a psychotherapist to be diagnosed with a possibly psychosomatic condition? I found that relatively little had been written – or at least published – addressing these questions. This led me to further hypothesise that there is something about the identity of ‘psychotherapist’ which makes it difficult for us to engage with our own experience of illness. I noted that Bayne (1997), in The Needs of Counsellors and Psychotherapists, writes about emotional self-care, though primarily in terms of using strategies to cope with stress. Without necessarily doing so in full awareness, I found I had taken my diagnosis and actively sought to understand it as ‘a continual transformation process’ with which I developed a close relationship, rather than accepting it passively as a victim. Paradoxically, in closing with it to make it my own, my inquiry became one of more than just personal significance. I found I
Our ability to encounter the other in this open manner is a prerequisite, according to May, for the other to have an ‘I-am’ experience. Typically (and I had numerous meetings with these five professionals), I found I felt less unwell after meetings with the herbalist and psychologist. The herbalist, medically trained but without a counselling background, tended to present as interested and available for encounter. Briefly, her focus was holistic (she would ask me open questions about myself, and discuss various options and recent research in a relatively equal way, free of jargon). She did not attempt to hide herself but, equally, did not disclose inappropriately. I found that my therapist, an experienced male clinical psychologist in his midforties, was open to a relationship based on mutual understanding. I think our mutual agreement that we would need to start from scratch to think about what work we might undertake together was, in the event, helpful and supportive. Perhaps the most helpful aspect of our meetings was that he resonated with my frustration with the shortcomings of the GPs and supported my referral to a specialist
feature article clinic. I noticed that I looked forward to our meetings and did not need to use my diary to debrief to the extent I did after visiting the GP surgery. In contrast, the female nurse at the surgery made little eye contact and was concerned to take blood samples as quickly and efficiently as possible. She disclosed nothing of herself or her training, and her mode of relationship was of the ‘doing-to’ type. At our first meeting, I admitted a fear of needles and she responded, ‘You’re my second needlephobic so far this morning – it’s not my day!’ I felt ‘unseen’ in these encounters, except insofar as I fitted the category of ‘difficult patient’. The senior of the two GPs, a middle-aged man, stayed behind his desk most of the time and kept his eyes on a computer screen. His mode of relationship was to use the computer as intermediary. Having typed information into it, he would share the ‘factual’ information it generated. One of his most puzzling announcements was: ‘How would it strike you if I told you that you have a 20 per cent chance of a heart attack in the next ten years?’ I found this style of relating to me, as if I were an audience for medical technology, alienating; not only did I not feel seen, I felt I had somehow failed to appreciate appropriately the technology with which he was clearly enamoured. His colleague, a man in his late thirties, took pains to demonstrate his willingness to treat me as an equal by maintaining constant eye contact. So relentless was this that I began to fantasise that he had taken a short course in advanced empathy techniques.
‘Relationship’ reframed in the context of the inquiry Up to this point, my observations were focused on the extent to which each healthcare professional was able to be in relationship with me, according to my sense as an existential-phenomenological therapist of what the phenomenon of relationship might mean. I had noted how I felt more or less ill according to the extent to which each was able to encounter me. My thinking was increasingly that there might be a link between the experience of being ‘seen’ and feeling ill. As Charon asserts: Without the narrative acts of telling and being heard… the patient cannot himself or
herself grasp what the events of the illness mean. Charon, 2006: 65,66 As the inquiry widened, a further cycle of research evolved – I began to think about these communication difficulties more systemically. It seemed to me that the various healthcare professionals were not able to hear each other. My impression was reinforced by the wording of the King’s College Chronic Fatigue Research and Treatment Unit website, where I found the cautionary note for prospective patients: The perpetual battle for validation that most sufferers of CFS are caught in is literally, physiologically exhausting, depressing and dispiriting. It affects the course of the illness… As therapists, our first and last concern is to take the suffering of clients seriously. All this involves is listening. 2007: 3 While the message seems to be directed towards patients, it is obvious that such a ‘battle for validation’ is primarily one between the healthcare professionals themselves. As the website expresses it: Some GPs are sceptical about the existence or treatment of CFS/ME. If you are having problems getting a referral for these reasons, you could perhaps try another GP in your practice. The casual wording of the phrase in bold belies a serious problem: such a request will probably be interpreted as a challenge to the power structures of many GP practices. A healthy person might find making such a request daunting, and it is likely to exacerbate the symptoms experienced by an ME sufferer.
Concluding comments I have – however briefly – suggested that reflexivity enables therapists to ground their research in subjective experience and naïve inquiry with confidence. My own personal and professional experiences have led me to an enhanced awareness of the ‘self’ of the researcher at the core of a reflexive process. A thick description of a phenomenon surfaces when we attend to the researcher’s individual journey into the field. Obtained at an early stage of the research, this provides a resource for reflection on later stages of inquiry. My own experience of a diagnostic process was the catalyst
for personal identity questions and therapeutic activities which led to more general inquiry and the emergence of an organising theme – in this instance that of health professionals’ openness to being in relationship with the patient. This, in turn, led me to hypothesise about their openness to be in relation with each other, and the implications of systemic communication patterns for the patient’s sense of self. While it is not always the case that the researcher is prompted by direct personal experience to embark on their inquiry, the resulting study is impoverished and, I would argue, less valid and trustworthy if the self of the researcher is excluded from their research journey.
References Bain R (1997). Survival. In I Horton and V Varma (eds) The needs of counsellors and psychotherapists. London: Sage. Bury M (1991). ‘The sociology of chronic illness: a review of research and prospects’. Sociology of Health and Illness, 13(4): 451–468. Charmaz K (1983). ‘Loss of self: A fundamental form of suffering in the chronically ill’. Sociology of Health and Illness, 5(2): 168–195. Charon R (2006). Narrative medicine: honouring the stories of illness. New York: Oxford University Press. Clark JN and James S (2003). ‘The radicalized self: the impact on the self of the contested nature of the diagnosis of chronic fatigue syndrome’. Social Science and Medicine, 57(8): 1387–1395. Corbin J and Strauss A (1987). ‘Accompaniments of chronic illness: changes in body, self, biography, and biological time’. Research in the Sociology of Health Care, 6: 249–281. du Plock (2004). ‘What do we mean when we use the word ‘research’?’ Existential Analysis, 15(1): 29–37. Hunt C (2000). Therapeutic dimensions of autobiography in creative writing. London: Jessica Kingsley. Hunt C and Sampson F (eds) (2002). The self on the page. Theory and practice of creative writing in personal development. London: Jessica Kingsley. King’s College Chronic Fatigue (CFS) Research and Treatment Unit: www.kcl.ac.uk/projects/cfs/referrals.html. Accessed 3 September 2007. May R, Angel E and Ellenberger HF (eds). Existence: a new dimension in psychiatry and psychology. New York: Basic Books. McLeod J (1994). Doing counselling research. London: Sage. Pennebaker JW (1993). ‘Putting stress into words: health, linguistic and therapeutic implications’. Behaviour Research and Therapy, 31: 539–548. Philips D, Penman D and Linnington L (1999). Writing well. Creative writing and mental health. London: Jessica Kingsley.
Emotional experience plus reflection: countertransference and reflexivity in research Wendy Hollway offers a brief introduction to psychoanalytically informed research, where the researcher’s reflexivity is a rich resource and the knowledge gained provides an appropriately complex picture of human life.
sychoanalysis is informed by a radically alternative theorisation of knowing from the cognitive theory that underpins dominant research methodology. Here I show how psychoanalytic approaches to knowing, captured in the idea of transference-countertransference dynamics, can inform qualitative research methods and expand the practice of research reflexivity. The approach is summed up as emotional experience plus reflection, based on
Wendy Hollway is Emeritus Professor in Psychology at the Open University. She is interested in applying psychoanalytic principles to theorising subjectivity, to methodology and to empirical research on identity. Her ESRC-funded research on the transition to a maternal identity uses both free association narrative interview and psychoanalytic observation methods. Her most recent book is Knowing Mothers: Researching Maternal Identity Change, published by Palgrave in 2015.
Wilfred Bion’s theory of thinking. I trace parallels in the history of the concepts of reflexivity and countert ransference and then provide brief examples taken from research using psychoanalytically informed interviewing and observation. Psychotherapy professionals and trainees have been quick to express their interest in my psychoanalytically informed approach to qualitative research methodology because they are trained in the use of self in knowing their clients (technically the countertransference) and this provides access to a research paradigm consistent with their professional training. The research I describe here1 developed a psychoanalytically informed research paradigm and transformed my practice of reflexivity.
Reflexivity Reflexivity entered the vocabulary of research methodology as part of a critique of the 20th century’s dominant positivist methods based on scientific principles. In the scientific approach to psychology, ‘objectivity became one of the central defining principles… its purpose to achieve value neutrality and knowledge untainted by the preferences of those who produce
knowledge’.2 Its creation of a binary between objectivity and subjectivity, which labelled subjectivity a dangerous intrusion of unreliable, emotional perceptions, has cast a long shadow, including in qualitative research. Reflexivity is an attempt to recognise and use the inevitable participation of the researcher’s subjectivity in the process of finding out. In qualitative research, it offers a research stance open to the examination of blindspots and investments that risk rendering conclusions invalid. My work has used psychoanalysis to unpack what this use of subjectivity as an instrument of knowing involves, in theory and practice, not by importing a clinical view of countertransference wholesale but through a dialogue between research and psychoanalysis. I have come to recognise the value of the claim that ‘psychoanalysis is first and foremost an epistemology and methodology’. 3 It developed an account of an uncognised way of knowing that was not just about unruly emotions getting in the way of rationality but the relational communication of body-based emotional experience, past and present: in Ferenczi’s words, ‘a dialogue of unconsciouses’.
Transference and counter transference inside and beyond the clinic The terms transference and counter transference can create a mystique around some fairly basic ideas about the flow (‘transfer’) of unconscious dynamics between people and in groups, and this is partly because of how it slips between the clinical frame and the understanding of everyday dynamics. According to Hinshelwood,4 in the 1950s, the idea of countertransference changed from Freud’s wish to excise such feelings by means of thorough training to being recognised as an important instrument of knowing about aspects of the patient when they could not bring these into thought or communicate them through language.5
2 Hollway W (2013). ‘Objectivity’. Encyclopaedia of critical psychology (Thomas Teo ed). Dordrecht: Springer. 3 Devereux G (1967). From anxiety to method in the behavioural sciences. The Hague: Mouton.
1 ESRC-funded research: ‘Identity processes in becoming a mother’, with Ann Phoenix, Heather Elliott, Cathy Urwin and Yasmin Gunaratnam.
4 Hinshelwood RD (1991). Dictionary of Kleinian thought. London: Free Association Books, 255 5 Heimann P (1950). ‘On counter-transference’. International Journal of Psychoanalysis, 31: 81.
feature article The analyst’s own transferences were also acknowledged: ‘The analyst has his or her own feelings, just as the patient does.’6 In other words, dynamics between analyst and patient include the analyst’s transferences as well as their patient’s projections onto them. Like recent debates about research reflexivity, questions were raised about the status of the analyst’s feelings: an invaluable guide to the patient’s state of mind or an interference of the analyst’s own personal difficulties, not worked through in his or her own analysis? As in research, there was concern ‘that analysts might misunderstand or misuse the feelings aroused in them, to the detriment of their work’.7 Recognition that a researcher’s transferences threaten clear-sighted knowing goes beyond the idea of subjectivity as a necessary alternative to objectivity by also recognising the danger of bringing with it prejudices and blinkered thinking. The distinction, hard won in psychoanalysis, helps researchers not to throw out the countertransference baby with the (analyst’s) transference bathwater. In the clinical setting, with its therapeutic aims, there may be an emphasis on the most archaic transferences, where current emotional responses are seen to originate in relations with primary figures on whom the patient depended in early life, prior to symbol formation. Outside the clinic, it can be recognised that everybody has feelings, more or less available to conscious awareness, when confronted with emotionally redolent situations triggering previous experiences. If not reflected on, these are likely to be projected onto others as an ongoing part of everyday unconscious intersubjective dynamics. Since there is, broadly, ‘no transference without counter transference’,8 we are talking about an ongoing co-produced relational dialogue of unconsciouses. Psychotherapists will probably recognise the ubiquity and importance of such dynamics. Although the investigation of these origins for therapeutic purposes is not the aim of psychosocial research (limited by its methods to feelings
6 Hinshelwood, op cit, 256 7 Jervis S (2009). ‘The use of self as a research tool’. In S Clarke and P Hoggett (eds) Researching beneath the surface. London: Karnac, 146-7. 8 Clarke S and Hoggett P (eds) (2009). Researching beneath the surface. London: Karnac, 13.
more accessible to thought), researchers can use psychoanalytic principles.
daughters are concerned) that were central to the purposes of their project.
An example of transferencecountertransference dynamics in psychosocial research.
The research team in this example arrived at the point where inaccessible information became available by using the group to provide containment and space for thinking. This is theorised in Wilfred Bion’s concept of containment: another mind – or several – enables a person to bring into thought the emotional experience that could not previously be processed. This is how I theorise and practise the use of self as an instrument of research knowing: emotional experience plus reflection.
Helen Lucey, June Melody and Valerie Walkerdine’s9 example of how they approached ‘the messy and intractable issues of objectivity and reflexivity’ demonstrates the importance of using transference-countertransference dynamics in psychosocial research. They outline ‘three overlapping levels’ in their analysis. The first is the ‘face value’ of the story; the second pays attention to inconsistencies, contradictions, etc in the narration and reads these alongside the researcher’s recorded emotional responses to the interview (original emphasis) available in field notes. Here, the feelings they note can indicate ‘what transferences have taken place’. They then illustrate the third level of analysis through an example of a point in the dialogue when ‘Helen’s own unconscious anxieties got the better of her and forcibly made their presence known’. This point illustrates an observation by Roger Money Kyrle (who introduced the idea of normal countertransference), that the analyst’s ‘understanding fails whenever the patient corresponds too closely with some aspect of himself which he has not yet learned to understand’.10 Here, there is initially ‘too close a correspondence’ between Helen Lucey and the family whom she is interviewing (the workingclass parents who cannot envisage their daughter moving away; Helen as the working-class daughter who would have felt trapped if she had stayed). The point the researchers emphasise is that ‘Helen was not consciously aware of her own anxieties at the time and recorded nothing of this in her field notes’. These feelings were unconscious in the sense that they ‘were unwanted, denied and/or felt to belong to others’. They then go on to show how this moment in the interview encounter revealed issues about working-class intergenerational mobility (especially where
Complementary psychoanalytically informed methods Our research project about the identity changes experienced by women as they become mothers for the first time11 used, in parallel, two complementary psychoanalytically informed methods, the free association narrative interview (FANI) method12 and the infant observation method. Although the FANI method helps to elicit free associations, in experiencenear accounts that afford psychological depth in particularised social settings, the method necessarily relies on language and elicits a mode of communication that is to a significant extent under conscious control. As with all interview-based methods, there is a tendency to generate an image of a rational, unitary, language-based subject. To address this weakness, we adapted the psychoanalytic infant observation method, originally designed by Esther Bick at the Tavistock Clinic as part of professional training for those working with children and families.13 This enabled us to see aspects of identity that were less the product of conscious, intentional production through narrative and more inclusive of embodied aspects of identity: affect, practices and unconscious intersubjectivity. The observer’s stance in infant observation is based on Bion’s theory, notably the idea of making mental space for processing the emotional impact of the experience: 11 See Hollway W (2015). Knowing mothers: researching maternal identity change. Palgrave.
9 Lucey H, Melody J and Walkerdine V (2003). ‘Project 4:21. Transitions to womanhood: developing a psychosocial perspective’. International Journal of Social Research Methodology 6(3): 279-84. 10 Money Kyrle R (1956), 332; cited in Hinshelwood, op cit, 258.
12 Hollway W and Jefferson T (2013). Doing qualitative research differently: free association, narrative and the interview method. London: Sage. 13 See Urwin C (ed) (2007). ‘Becoming a mother: changing identities. Infant observation in a research project’. International Journal of Infant Observation and its Applications, 10(3).
feature article Reflection in the psychoanalytic sense is not just another word for cognitive activity; it is a supremely emotional process
‘knowledge, theory, etc are set aside during the acts of observing and recording in favour of allowing the experience to make its impact… a new concept of the observer is being employed… here the truths which interest us are emotional truths. The observer cannot register them without being stirred… correctly grasped, the emotional factor is an indispensable tool to be used in the service of greater understanding.’14 Researchers’ ability to notice the emotional impact of participation in a research encounter is only the start: in order to ‘correctly grasp’ the emotional factor, it must be thought about. Raw emotional experience must be reflected on (digested, symbolised, processed; in Bion’s15 terminology, transformed into alpha function) if it is to be used. This principle governs group work in the infant observation seminar, which we adopted in the research project. Reflection in the psychoanalytic sense is not just another word for cognitive activity; it requires keeping an open mind, and that, as Bion’s theory of thinking explains, is a supremely emotional process. Without reflection, responding to emotional impact can result in the indulgent exercise of one’s preferred view of the world and imposition of one’s own belief system in the service of
14 Miller L (1989). ‘Introduction’. In L Miller, M Rustin, M Rustin and J Shuttleworth (eds) Closely observed infants. London: Duckworth, 2. 15 Bion W (1962). Learning from experience. London: Karnac.
a wished-for certainty that does not reflect the complexities of what is observed.
help me recognise the challenges Nila faced…17
The combined use of emotional impact and reflection, supported and recursive where possible, became a fundamental principle of data production, data analysis and writing. Where possible, we analysed data in groups; we used reflexive interview field notes and provided an unusual kind of supervisory support (neither academic nor therapeutic) for our main interviewer.16
Psychoanalytically informed ethical principles are evident in this extract: a feeling of com-passion (literally ‘feeling with’) on Heather’s part, enabling her to know something in an affective, not objectifying, way and also showing a reflective capacity that would help her to be clear about whose feelings belonged to whom and thus avoid confusing transferences.
A reflexive field note The following rich example is from Heather Elliott’s reflections on part of one of her field notes. After her second interview with Nila, she notes that it ‘felt like an interview which had not worked’ and continues: However, I do note a moment when I am able to identify with her. Nila has left her baby at home and he is unhappy: her phone started buzzing almost as soon as we started. She checked her phone and ignored it; then took two or possibly three calls. For a while she looked like the essence of torn and juggling. Telling her story with an eye on the phone. I said she must take the calls and do whatever she needed to do. Writing up my notes I think of dropping off my younger son with his childminder this morning, the need to go and the need to stay. Never being entirely in one place. The feelings around getting calls from home on the mobile. These moments of connection
16 Elliott H, Ryan J and Hollway W (2012). ‘Research encounters, reflexivity and supervision’. International Journal of Social Research Methodology, 15(5): 433–444.
We can start with Alfred Lorenzer’s18 advice to notice the provocations when encountering the data. This principle is illustrated using one case from the ‘becoming a mother’ research to reach into the terrain of cultural difference while guarding against othering.19
Coda Through this brief introduction to psychoanalytically informed research, I hope to have opened a door to the research in Knowing Mothers, where full details provide an account based on principles that enable the researcher’s reflexivity to be a rich and ethical resource and where the resultant knowledge can provide an appropriately complex picture of human subjectivity and everyday action.
17 Elliott H, Ryan J and Hollway W (2012), op cit, 5. 18 For Lorenzer’s work in English, see two special issues: Psychoanalysis, Culture and Society, 15(3) and Forum: Qualitative Social Research, 13(3). 19 Urwin C, Hauge M-I, Hollway W, Haavind H (2013). ‘Becoming a mother through culture’. Qualitative Inquiry, 19(6): 470-479.
Reflexivity and ethics in qualitative research Researchers and participants in qualitative research have very different aims, says Dr Ruthellen Josselson. Ethics in research relies on reflexivity – a researcher’s awareness of the dynamics between researcher and researched and the ways in which, consciously or unconsciously, they might influence material and its interpretation.
any of the dilemmas of qualitative research derive from the reality that qualitative researchers have split allegiances – to their participants and to their scholarly communities. In studies where the data derive from interviews, researchers need to form trusting, empathic relationships with their participants to understand the experiential phenomena that are at the heart of the study. Once they have collected these reports, researchers synthesise and interpret them in some way; often, they want to go beyond the stories their participants tell. Participants and researchers, with some exceptions, have different aims. Researchers, while occupied in
Ruthellen Josselson is Professor of Clinical Psychology at the Fielding Graduate University. She is a co-founder of the Society for Qualitative Inquiry in Psychology and Editor of the APA journal, Qualitative Psychology. With Amia Lieblich, she co-edited 11 volumes of The Narrative Study of Lives, a series dedicated to publishing qualitative research. Based on interviews she has conducted over 35 years, she has published extensively, including Interviewing for Qualitative Inquiry: A Relational Approach.
great detail with their participants’ experience, are interested in making larger statements that will contribute to scholarly understanding. Participants are concerned with their own experience of the lives they are living and are seldom interested in the conceptual matters at the heart of scholarship. Only in recognition of this split can we think clearly about matters of reflexivity and ethics in qualitative research.
Influencing data Unlike variable-based, hypothesis-testing research, where participants’ data are aggregated anonymously with many others, participants in qualitative research are studied as individuals and data are collected in a highly engaged relationship with a particular researcher. We do not presume some kind of objectivity. Who the researcher is will in every way influence the data that are obtained – and we acknowledge this. This is fundamental to the idea of reflexivity, a self-awareness practice achieved by directing an analytical gaze into the researcher’s self in an attempt to understand the dynamics between the researcher and the researched. Often, reflexivity is thought to involve awareness of the social locations of the researcher in relation to the topic and/or the participants – whether and how the researcher is connected experientially to the group under study – but it goes beyond this as well. Reflexivity marks the ways in which the researcher might have influence, consciously or unconsciously,
on the material obtained and how it is analysed. While often offered as a means to suggest ‘objectivity’, in a positivist sense, as though one could somehow remove oneself from the research equation by noting one’s inescapable involvement, reflexivity can enrich the study by placing the knower squarely in the context of the known (Goldstein, in press). Rather than bracketing the researcher out of the study, reflexivity involves intersubjective reflection (Finlay, 2002, 2015) that explores the intersecting subjectivities of researcher and researched. Much has been written about the complex issues of the power dynamics of qualitative research. To many scholars, it seems that the researcher wields power, in that researchers hold the privilege of writing the public report. Yet participants have a great deal of power because they decide what they will or will not disclose. So-called member-checking does not solve this dilemma because the participant can only verify that they said what the researcher says they said (a useless waste of time, in my view); the researcher still has to take interpretive authority for interpretation of the material and that is done from a conceptual position that participants cannot occupy. As readers, we get the researcher’s account of what transpired in the research relationship and how the researcher made conceptual sense of it. The more we know about the researcher and how he or she intersected with the material, the better we can evaluate the researcher’s conclusions.
Research as part of a relationship The ethical attitude in qualitative research is rooted in the recognition that such research takes place in relationship, often intimate in its revealing, between two people. It is the human connection rather than the ‘procedure’ that produces data that will be meaningful. Ethics codes, however, are modelled after medical ethics, in which one person consents to having another person do something to them and tries to protect from harm the one who is being done to. We don’t yet have a written ethics code that covers research in which the researcher works with others, forming a relationship with them, the purpose of which is participant self-disclosure that serves the larger aim of the researcher inductively developing a theory about some human phenomena.
feature article Unlike the therapy situation, where the aim is to effect change in the participant, the research situation treats the interviewee as the expert The ethics of a research relationship are not covered by informed consent forms (which, in my view, often distort and undermine research relationships.) People can give informed consent to participate in the research project, but they cannot give prior consent to participate in an open-ended relationship that is yet to be established. Ethics relies on reflexivity, which informs every aspect of the research, from the first contact with the participant. What does the research tell the participant when the invitation for participation is made? What expectations are created in the participant?
Ethically, one must ask the participant at the conclusion of the interview how they felt about the interview and how they feel about having their disclosure included in the study. Reflexivity requires that researchers consider their social position with regard to the participants (Fine, et al, 2000). Ethically, researchers must also become sufficiently acquainted with the social and cultural world of their participants to be able to
interact appropriately with them. This means knowing enough about their mores and expectations so as not to appear rude, insensitive or intrusive – but knowing little enough to be able to enquire deeply about those aspects of the world of the participant one wishes to learn about. We cannot foresee all the eventualities in the relationship that will unfold. Therefore, I think, we have an ethical obligation to be aware of the implicit aspects of participants’
All interviews are interventions. The encounter itself inevitably has an impact on the interviewee’s life in the sense that it will lead to some rethinking or added meaningmaking, as the interviewee, after the interview, reflects on her or his own words. Unlike the therapy situation, where the aim is to effect change in the participant, the research situation treats the interviewee as the expert, with the task being to effect change in the researcher’s understanding of the phenomena of interest. In other words, the therapeutic situation is constructed for the participant to learn something; the research interview is oriented to the researcher learning something. Nevertheless, the participant often views the researcher as expert in something and monitors the researcher for his or her reactions to what the participant discloses. How does the researcher reflexively monitor his or her reactions to understand the effect on the participant? Good interviewers are adept at encouraging people to reveal some of the most sensitive areas of their lives. Interviewers must be sufficiently in control of their own inner processes, which they can manage to deal with complex and painful emotions. Harm can come from a defensive response by the interviewer, and this is too often overlooked. On the other hand, an accepting and sympathetic response to participants’ disclosures may lead participants to find their experiences less disconcerting or worrisome (Hollway and Jefferson, 2000).
Consent to what? People cannot know at the outset, when they give consent to participate, just what they are agreeing to participate in.
feature article The research report is not ‘about’ the participants but ‘about’ the researcher’s meaning-making consent – all those unstated expectations they may have of us – and to manage these in the dynamics of the relationship we form with each participant, both during the personal contact and in our handling of the material thus obtained.
Role as interpreter After the interview, after the analysis, the qualitative researcher then faces the conundrum of turning away from the relationship with the participants to report their findings in relationship to their scholarly peers. What had been an engaged, empathic relationship, an ‘I-Thou’ relationship in Martin Buber’s terms, at this point involves talking about people literally, behind their backs, ‘I-it’ objectified, and in terms largely unfamiliar to them. Qualitative researchers are well aware of the necessity for anonymity and disguise so that participants cannot be identified. But participants who read the published study may be able to identify themselves. An ethical awareness of ourselves in the relationship requires that we write about people respectfully but also be prepared to assert our role as interpreters of a phenomenon, of a text, rather than of a person’s life. Elsewhere I have suggested that it may be an aspect of ethics to explain to our participants that what we write will be only about aspects of them and may not correspond to their understanding of themselves – that we are trying to understand phenomena rather than the person they feel themselves to be (Josselson, 2007). The authority of experience belongs to the participant; the authority of expertise belongs to the interpreter’s disciplinary approach. As an ethical position at this point, we must be prepared to stay in relationship with the participant, to explain our purposes as fully as we can, to make transparent our choices in as kind a way as possible, and to be prepared to contain whatever responses the participant may have (Josselson, 2007). Although we are unlikely to permanently or seriously damage anyone through our research practices, we do run a risk of hurting their feelings, surprising them or influencing them (for better or worse).
We weigh the moral dilemmas of what discomfort we may cause against what potential benefits outweigh the risks of harm.
Giving voice and decoding Some qualitative researchers regard their research goals as ‘giving voice’ to their participants, making use of a hermeneutics of restoration; others frame their projects as ‘decoding’ the texts of their interviews at some other level of understanding in a hermeneutics of demystification (Josselson, 2004). Those whose research is designed to ‘give voice’ conceive their role as being a collaborator and a conduit, and struggle with the problems of faithful representation of the experiences of their participants. Others, in order to advance knowledge, make interpretive efforts at a conceptual level, excavating the intention and meaning behind appearances (Hollway and Jefferson, 2000; Hoskins, 2000; Moustakas, 1994). These researchers, whose designs involve analysing unconscious or socially constructed processes latent in the text, struggle with the ethical problems of interpretive authority (Chase, 1996; Holloway and Jefferson, 2000; Hoskins, 2000; Moustakas, 1994). Both groups of researchers can only report what the text says to them (Gadamer, 1975), embracing the unfinalisable nature of meanings. The meanings we derive from a text are not already there in the participant. But I think that we sometimes get confused about this. It is hard to escape our embeddedness in a modernist, realist worldview – a worldview we can cognitively disown but still often emotionally rely on to ground ourselves. It may seem to qualitative researchers that they are ‘finding’ meanings rather than producing them (see Gergen, 2009). Truth is primarily a matter of perspective, as the philosophers of hermeneutic science have argued. It is our interpretive framework that structures understanding and this requires our reflexivity. The ethical attitude in the report resides in the researcher’s clarity that the report is the researcher’s understanding or
interpretation of the text (Josselson, 2011). The inherent ethics of qualitative research lies in the resolute honesty of the researcher’s reflexivity, which states clearly the biases, aims and positioning of the knower, and the circumstances under which the knowledge was created, with the researcher taking full responsibility for what is written. From this point of view, the report is not ‘about’ the participants but ‘about’ the researcher’s meaning-making. Reflexivity requires a clear-eyed view of the dialectic between connection and otherness, between the relationality of the interview and the disconnection of the interpretive process, between the illusion of objectivity and the equally pernicious illusion that we can fully represent others’ subjectivity. What we can do is to recognise the relational dynamics at each stage of the research process and, ethically and reflexively, try to understand and report on our work transparently and fully.
References Chase SE (1996). Personal vulnerability and interpretive authority in narrative research. Thousand Oaks, CA: Sage, 45–59 Fine M, Weis L, Weseen S and Wong L (2000). ‘For whom? Qualitative research, representations, and social responsibilities’. In N Denzin and Y Lincoln (eds) Handbook of qualitative research. Thousand Oaks, CA: Sage, 107–132. Finlay L (2015). ‘Probing between: reflexiverelational approaches to human science research’. In C Fischer, L Laubscher and R Brooke (eds). Invitation to psychology as a human science. Pittsburgh, PA: Duquesne University Press. Finlay L (2002). ‘Negotiating the swamp: the opportunity and challenge of reflexivity in research practice’. Qualitative Research: 209-230. Gadamer H (1975). Truth and method. New York: Seabury Press. Gergen KJ (2009). Relational being: beyond self and community. New York, NY: Oxford University Press. Goldstein S (in press). ‘Reflexivity in narrative research: accessing meaning through the participant-researcher relationship’. Qualitative Psychology. Hollway W and Jefferson T (2000). Doing qualitative research differently. London: Sage. Josselson R (2004). ‘The hermeneutics of faith and the hermeneutics of suspicion’. Narrative Inquiry: 14(1): 1. Josselson R (2007). The ethical attitude in narrative research: principles and practicalities. Thousand Oaks, CA: Sage, 537–566. Josselson R (2011). ‘“Bet you think this song is about you”: Whose narrative is it in narrative research?’ Narrative Works, 1, 1: http://journals.hil. unb.ca/index.php/NW/article/view/18472 Moustakas C (1994). Phenomenological research methods. Thousand Oaks, CA: Sage.
Writing, telling, listening, reading, seeing: the creative use of self in research by working with memories and images Memories can help researchers access and develop new knowledge about where they are in research and in life, says Mona Livholts, who provides practical guidelines on memory work for practice.
emories are often actualised in the research process, but seldom acknowledged as ‘material’ or ‘clues’ to trace how we are part of the discursive story worlds that we study (Livholts, 2015: 163). In this article, I turn to the method of memory work to outline a textual and visual practice of remembering as a means of making creative and reflexive use of self in research. I will propose that working with memories and images can help researchers develop new knowledge from the perspective of their situated location in research and life. This article is inspired by my own use of memory work in the study of welfare, media
Mona Livholts is Associate Professor of Social Work in the Department of Social and Welfare Studies at Linköping University, Sweden, and Coordinator of R.A.W. The Network for Reflexive Academic Writing Methodologies. The main focus of her work is emergent writing methodologies, discourse and narrative methods, and artistic research processes.
studies and the gendering of space (Livholts, 2001/2011, 2007, 2008, 2012) and as a leader of writing groups across disciplines. It will emphasise the process of working with memories and images through using the technologies of writing, talking, reading, listening and seeing in order to create ‘mo(ve) ments’, as Davies and Gannon (2006: 7) put it.
The memory work method Memory work emerged in the 1970s in Germany when Haug et al (1987) developed a collective strategy in women’s groups to work with questions of knowledge, sexuality and the body. The method involves several steps, including writing, reading, common discussion and analysis. Writing is a central tool in memory work. Writing about specific situations allows for the recollection of what is rarely noticed in the flow of events in everyday life. It also allows us to cross the traditional science–literary divide. The growing field of memory work is interdisciplinary and diverse (Onyx and Small, 2001; Hyle, et al, 2008). It includes emotion (Crawford, Kippax, Onyx, Gault and Benton, 1992), education (Ingleton, 1999), family, fatherhood and motherhood (Widerberg, 2010; Pease, 2008), health studies (Koutroulis, 2001), social work (Fahlgren, 2009) and tourism studies (Small, 1999). Collective and poststructuralist forms of memory work occur in the edited collection Doing Collective Biography (Davies and Gannon, 2006), where the conceptualisation
‘collective biography’ marks new attempts to work with memories as mo(ve)ments in the creation of discursive meanings and selves. The becoming of selves is emphasised in different projects by Davies and Gannon (2006). During weekly group sessions, questions such as ‘becoming schoolgirls’ and ‘feminine characters in fiction’ were asked. Another example of collaborative writing is ‘nomadic inquiry’ (Wyatt, et al, 2010, 2011), which reflects a style created in the intersection of collective biography, writing as a method of inquiry and poetic writing. There is an exciting question of viewer and viewed in the process of working with memory.
Photos The work of Kuhn (1995) explores the potential of photography in memory work. In her book titled Family Secrets. Acts of Memory and Imagination, Kuhn looks into images, such as photographs or film scenes, as ‘pre-texts’ for memories. She describes photographs as ‘triggers’ that promote the practice of remembering through their role in a complex pattern of social relations, cultural contexts and historical moments. By bringing in the spectator’s agency and interpretative act in relation to an image, Kuhn suggests that ‘memories evoked by a photo do not simply spring out of the image itself, but are generated in a network, an intertext of discourses that shift between past and present, spectator and image, and between all these and cultural context, historical moments’ (1995: 14). For Kuhn, the family album opens up conflicting interpretations and she argues that ‘there can be no last word about my photograph, about any photograph’, emphasising the open-ended narrative character of photography. Photographs are like Sontag (2007: 87) describes: pieces in an
feature article The recommended technique is to write a memory in the third person to increase your attention to seeing concrete situations ongoing history, where ‘one photograph, unlike a painting, implies there will be others’.
fieldwork. Memories will be multifaceted and set in a variety of contexts and spaces.
Memory work offers in this sense creative and reflexive forms of working with written memories and images to explore tensions and contradictions relating to knowledge, power and the self. It undercuts assumptions; instead of treating an image as ‘evidence’, it can be interrogated for non-overt meanings, producing ‘counter-memories’. The longer we work with and on ourselves, the more adept we become at retrieving forgotten history. Stepping back into the past, we embark on a form of archeology. We discover fragments of an architecture which we then begin to reconstruct. (Haug, et al, 1987: 47–48). In the next section I provide guidelines for working with memories and images for your own practice (also see Livholts, 2015: 171–174).
My professional practice: choose a memory from your professional practice – any situation filled with challenges, difficulties or positive encounters and outcomes. It might involve a meeting, conversation or dialogue with a client, service user, staff or colleagues. My experience is that scholars benefit greatly from this exercise, which helps to create awareness of emotions, communication, contexts, and institutional and professional cultures and codes.
Working with memories and images – your practice 1. Departures – the working constellation and the ‘burning’ question The first aspect to consider is your working constellation. Will you be working individually, in pairs or in a group? Working in a group can help you to gain insights into a broader spectrum of memories, but it is also a good practice to work individually. You can, as a compromise, work at a distance with colleagues, through email, Skype or any other medium. The next step is to choose a question/theme. Memory work literature advises us to choose ’a burning issue’. My assumption is that you already have a ‘burning issue’ represented by your research. If so, I suggest you work with ‘my research (project)’. If you don’t have a particular project, choose any question of interest – ideas for future research, for instance. If you combine research with clinical practice, you could choose a memory guided by ‘my professional practice’. 2. Write your memory and choose or create an image My research (project): choose a memory from your research studies which represents a moment with particular meaning for you. This could be a memory from discussing your project with others, from reading texts or from
Photographic memory from my research and/ or professional practice: choose or create a photograph (or several photographs) from your research and/or professional practice which illustrates a moment of particular importance. You can choose already existing photos or you may want to create new photos. My experience from seminars and workshops is that scholars bring all sorts of photos – with or without people, of diverse geographical sites, views, buildings, schools and institutions, memorials, personal items and from the internet.
Technologies of writing, telling, listening, reading, seeing Writing and rewriting memories is an essential part of memory work. The recommended technique is to write a memory – an episode, event, moment, scene, action – in the third person to increase your attention to seeing concrete situations. Write with as much detail as possible but limit your text to half a page, maximum one page. Avoid biographical information, analysis and interpretation. I recommend you ‘enter’ the memory and write with the voice, emotional and sensory perceptions the memory evokes and to write in any style you find brings out this voice the best. Begin with a simple description of the human subject/s of the photographs and/or describe the scene, then write an account from the position of a third person. Not all participants feel comfortable with this distancing technique. However, I would encourage you to try it and evaluate the difference. After working with the other technologies, you can
rewrite your memory or write new memories to create a ‘collection’. The oral practice of talking about memories and images extends analytical reflexivity and ‘movements’. The act of speaking about and telling memories to others in the present actualises and constructs the way they create meaning today. The voice has a particular subjective and transformative function, bringing out the ‘sound’ of a memory and emotions to create context and movement between time and location – institutional, societal or local and global context. Reading memories is a technology intimately related to writing and talking, and involves both ‘silent’ reading and reading ‘aloud’. It is a performative act, where past memory encounters the present practice of interpretation through seeing and rereading. If you work individually, read your written memory aloud and record the reading and/or ask a colleague or friend to listen. For photos, begin your reading with a short, detailed description of the image. Reading aloud sometimes evokes (strong) emotions. The act of reading situates the author in relation to research and academic or professional life and may challenge university spaces dominated by mainstream research and practice as neutral and non-emotional work. Listening is an important skill in education, research and professional practice. Listening carefully to your own memory when writing it (preferably in the third person) and later reading it aloud allows you to hear intonations and nuances and contradictions. The technology of listening is used to improve ‘hearing skills’ to analyse what is said, but also to recognise silences: what is left out, what stories are not told. Seeing implies careful observation of detail and interpretation and, particularly in relation to photographs, creatively engages in a variety of ways of seeing, and seeing again. This practice of working with memories involves ‘viewing’ the aesthetics of written memories and images. Reflect on your first impression of the details in the image. Think about the relationship between viewers and viewed, why this photograph was taken and its place related with other photographs.
Summary I have addressed the memory work method as a creative use of self in research. I have suggested that memories and images can help the researcher develop new knowledge about her or his situated location in research and life. It is not
feature article so much about ‘having a good memory’ as about practising it. The longer we work with and on ourselves, the more adept we become at retrieving forgotten history. We discover, as Haug et al (1987: 4748) suggest, fragments of an architecture which we then begin to reconstruct.
Kuhn A (1995). Family secrets. Acts of memory and imagination. London and New York: Verso Classics. Kuhn A (2010). ‘Memory texts and memory work: performances of memory in and with visual media’. Memory Studies, 3(4): 298–313.
Livholts M and Tamboukou M (2015). Discourse and narrative methods. Theoretical departures, analytical strategies and situated writing. London: Sage. Onyx J and Small J (2001). ‘Memory work: the method’. Qualitative Inquiry, 7(6): 773–786.
Livholts M (2001/2011). Women, welfare, textual politics and critique. An invitation to a thinkingwriting methodology in the study of welfare. Germany: Lambert Academic Publishing. Doctoral dissertation originally published at the Department of Social Work, Umeå University, Sweden.
Small J (1999). ‘Memory work: a method for researching women’s tourist experiences’. Tourism Management, 20: 25-35.
Haug F, et al (1987). Female sexualization. A collective work of memory. Verso.
Livholts M (2007). ’Vanlig som vatten’ Manlighet och normalitet i mediernas berättelser om våldtäkt. [‘As normal as water’. Masculinity and normality in media representations of rape]. Malmö: Gleerups förlag.
Widerberg K (1995). Kunskapens Kön: Minnen, reflektioner och teori [The knowledge of gender: memories, reflections and theory]. Stockholm, Sweden: Norstedts Förlag.
Haug F (2008). ‘Memory-work as a method of social science research: a detailed rendering of memorywork method’. In AE Hyle, et al (2008). Dissecting the mundane. International perspectives on memorywork. Lanham: University Press of America.
Livholts M (2008). ‘The loathsome, the rough type and the monster: the violence and wounding of media texts on rape’. In V Burr and J Hearn Sex, violence and the body. The erotics of wounding. New York: Palgrave MacMillan, 194–211.
Hyle AE, et al (2008). Dissecting the mundane. International perspectives on memory-work. Lanham: University Press of America.
Livholts M (2015). ‘Working with memories and images’. In M Livholts and M Tamboukou Discourse and narrative methods. Theoretical departures, analytical strategies and situated writing. London: Sage, 162-176.
References Davies B and Gannon S (2006) (eds). Doing collective biography. Investigating the production of subjectivity. New York: Open University Press. Fahlgren S (2009). ‘Discourse analysis of a childcare drama: or the interfaces between paradoxical discourses of time in the context of social work’. Time and Society, 18(2/3): 208–230.
Koutroulis G (2001). ‘Soiled identity: memory-work narratives of menstruation’. Health, 5: 187–205.
Sontag S (2007). ‘The image world’. In J Evans and S Hall (eds) Visual culture. The reader. London: Sage, 80–94.
Widerberg K (2010). ‘In the homes of others: exploring new sites and methods when investigating the doings of gender, class and ethnicity’. Sociology, 44(6): 1181–1196. Wyatt J, Gale K, Gannon S and Davies B (2010). ‘Deleuzian thought and collaborative writing: a play in four acts’. Qualitative Inquiry, 16(9): 730–741. Wyatt J, Gale K, Gannon S and Davies B (2011). Deleuze and collaborative writing. An immanent plane of composition. New York: Peter Lang.
New and forthcoming in the UKCP books series For the best new thinking in psychotherapy and psychotherapeutic counselling Books about psychotherapy: Write a review?
Changing Destinies: the re-start infant family programme for early autistic behaviours Stella Acquarone 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”.
Fostering good relationships
Love and therapy in relationship
Miriam Richardson and Fiona Peacock This book is about different kinds of holding: holding the child in a safe cradle of hope and support, holding stories that contribute to a positive sense of identity; holding in mind the early trauma, holding the worry; holding a listening space for the child’s voice to be heard and holding the people together in a parachute of partnership so they can come together around the common and specific purpose of looking after the child.
Divine Charura and Stephen Paul 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.
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A study of black issues in counsellor training Dr Isha Mckenzie-Mavinga’s study highlights the marginalisation of black and multicultural issues in counsellor training and practice. Ultimately, she aims to open up theory and translate it to fully aware, inclusive practice.
ver the past couple of decades the interest in multicultural dimensions of therapeutic practice has increased, reflecting political and social change. However, as a tutor, I have often noticed that black counsellors and clients do not feel that transcultural theory has been sufficiently transferred into practice. The context of race and racism, for instance, is mentioned in the literature and addressed on some training courses without being integrated into the general programme. This suggested gap in counsellor training became the subject of my research, ‘How do trainee counsellors in Britain understand concerns about black issues raised by themselves during their training or about clients during the therapeutic process’ (McKenzieMavinga, 2015).
Dr Isha MckenzieMavinga is a psychotherapist and writer who has taught transcultural workshops at Goldsmiths, University of London for 26 years. She has also worked as a student counsellor and senior lecturer at London Metropolitan University. She is the author of Black Issues in the Therapeutic Process, published by Palgrave Macmillan in 2009, and is currently working on her next book, The Challenge of Racism in Therapeutic Practice.
Expanding methodology One of the most difficult challenges in setting up a multicultural study is finding a suitable methodology to discover new paths while not perpetuating oppression. I experienced difficulties applying the theories at hand because the approach and focus had not been attempted before. Qualitative and multicultural theory did not apply strategies to work on black issues and I found their use could confine the method and, if applied dogmatically, promote Eurocentric inferences. This supported awareness of the ethical implications of ‘epistemological power’ and ‘epistemological racism’. My trouble with finding definitions brought my own experiences to the forefront. Take the concept of black issues, for example. What is it? Where did it come from? Whose definition? My use of the concept was derived from my personal and professional experience as a trainer and black woman. I used my creative skills as a self-reflective process and to express the voice that others sometimes find difficult to listen to.
Creative use of self in research Without fully realising it, I embarked on a heuristic multicultural journey that invoked an emotional response and the development of new concepts to support understanding. Taking an active approach, I designed a study that brought together research and practice, integrating the study into my work as a counselling trainer. My role as black facilitator, tutor, researcher and ‘insider outsider’ played an important part in the challenging nature of this study and as a model for developing safety and compassion to facilitate the process.
Drawing on a pluralistic approach, the heuristic process (Mckenzie-Mavinga, 2005, 2006, 2015, 2016) of understanding trainee counsellors’ relationship with black issues was explored during training workshops. The study gave voice to trainee counsellors’ concerns. It encouraged dialogue about relationships as black people, or with black peoples, linking to the therapeutic process. The participants’ narratives demonstrated the usefulness of shared concerns and the process of finding a voice, confirming the emancipatory process of multicultural research. Through using my creativity to share my own vulnerability, I learned how to work with and overcome my own silence and use my voice. This helped me become more aware of the tone and context of my voice when exploring black issues. I also became attentive to the context and hew of my emotions when discussing racism and the rough edges I encounter within myself when I am experiencing oppression. There were times when I felt like quitting because the job felt too difficult or scary. I honestly thought that developing a new discourse that challenged institutional racism would mean I would die, or that someone would kill me. It was really just a fear of unknown territory and how volatile the theme of racism appears to be. The poem Invisible (opposite) came out of my experiences with colleagues in an open plan office.
Storytelling Storytelling and oral traditions lie deep within the heritage of African and Asian peoples and this proved to be a useful way of untangling the transformative process of the study. In Beloved (Morrison, 1988), the community is silenced when struggling to support Beloved’s mother who abandons and also attempts to destroy her children. The community later pulls together because of their new understanding; healing takes place through a shared history of slavery, oppression, mistrust, guilt and racism. Beloved returns in her broken state and creates a bridge between fear and transformation. On the one hand, she resurrects memories of her traumatic beginning and the history of white patriarchal domination and, on the other, achieves reconciliation with her mother and the community. Beloved’s mother, in her desperation to save her children from the
feature article enslavers, is driven to insanity as she recalls the terror. I cannot begin to empathise with anyone born into slavery, but somewhere in Beloved’s story there is something with which I resonate. Having no history of my father’s side of the family, who were freed slaves, I made my journey to search for his heritage. This has given me great insight into the missing parts of my education and counsellor training. In addition, I have allowed myself to transgress the pain of discovering these missing parts. These elements of human nature were emerging themes in the process of the study.
once recognised, can be worked through and used for personal development. I liken this process to Jung’s (1980) transformative concept of ‘alchemy’. When old attitudes, defences and shadow archetypes become exposed and new insights are gained, there is progress and a new discourse arises. To support these insights, I introduced the concept of ‘black western archetypes’ that inhabit racist bits of the collective shadow and can be made conscious through exploring individual shadow elements of internalised racism. Self-challenge, equalities issues and the needs of both black and white students
Black counsellors and clients do not feel that transcultural theory has been sufficiently transferred into practice Opening a can of worms The challenging nature of placing black issues in the training curriculum opened a can of worms. Those worms consisted of questions and concerns about racism as a feature of students’ lives and therefore the training of black and Asian counsellors. This assisted me in devising my research question: How do trainee counsellors in Britain (from any background) understand their concerns about black issues raised by or about themselves during training or about clients during the therapeutic process? Being both inside and outside the research raised ethical concerns about students’ feelings about the theme, and if those would influence the way I marked their assignments. I was challenged to find ways to engage with a process that supported emancipation through dialogue, as opposed to silence. Students were able to express their fears about the impingement of racism on the subject of black issues. This created a bridge from fear to transformation.
Expanding frameworks for understanding On recognising the powerful feelings evoked during the transformative phase, I developed the concept of recognition trauma. A process of powerful feelings is started when the survivor or perpetrator of oppression becomes aware of their position in this phenomenon. This process,
and clients played a key role in the study. A reconciliation of social history and transferring knowledge into deliverable techniques was considered. The study played a role in creating new social forms and opening up theory. Eurocentricism has been challenged in the process and application of the method, particularly in not leaving the responsibility to black students, or expecting students to find out about black issues in counselling outside the training. The question of how black issues are addressed has been explored through the process of understanding students’ relationship with the phenomenon. The narratives of established practitioners were also explored to affirm the research phenomenon of black issues in training. From this I gained a broader understanding of their concerns and a framework for grounding the theory and creating further data.
Can our narratives transform knowledge? I have summarised emerging themes from this period of immersion, illumination and reflection on the impact of black issues in training. Responses to the phenomenon demonstrated that racism needed to be explored as part of the process of understanding black issues. The information presented above reflects the intensity of becoming engaged in the process of a study that symbolically represents ‘a can of
Invisible They talk over my head They lean across my desk They stand beside me They ask someone else
They ignore my request They take it off the agenda They try to convince me They say it’s my problem
They arrive after me They stand in front They cue behind me They get served first
They turn their backs They want to shake hands They gave children guns They stole my lands
They wounded my heart They tortured my body They blinded my heritage They made the trail bloody
They show their tears They want compassion They carve their smiles They follow fashion
They misinterpret my words They don’t want my opinion They wear their guilt They can’t see I am broken
They fail to hear me They want me silenced They shrink away They call my power violence
They invite challenge They leave me on the frontline They include me when They want a token
They say show me how They have their problems They want it written They don’t want it spoken
They come for my soul They have already taken They want me the same They make me different
They want to be conscious They want to do it right They want me visible They want me out of sight ISHA MCKENZIE-MAVINGA (2002)
feature article worms’. Examples of issues that emerged from students’ concerns are listed below: • • • •
My tutor researcher role The role of the black expert Issues of fear, safety and finding a voice Participants knowing and ‘not knowing’ about racism • Differing levels of awareness and understanding of the meaning of ‘black issues’. There was acknowledgement that tutors felt it was difficult to do this work with students when it had not been part of their own training. My experience was no different to theirs and at times I felt unsupported. There seemed to be a lot of intellectualising and guilt expressed: for example, much attention given to reasons why they felt that they had not responded to my numerous requests for feedback, and why I was the only one keeping it on the agenda. I reminded them that they had previously asked whether they would be able to address black issues without my presence. Their responses seemed to support their fears about this topic. I challenged them to explore whether they were diluting the issue of racism. I spoke of operating from their defences and guilt about the theme. I also encouraged them by sharing the data I had already collected, which showed progress. We discussed the issues of it being my project and how sometimes individuals get apathetic and
uninterested in what seems to belong to another. I reminded them that they had all said they were willing at the beginning. I felt disappointed and impatient, yet I needed to stay with the process. I sometimes felt like just leaving it and not challenging or demanding any more response, but that would be giving up. I became concerned about destructive responses and that my own work might get picked to pieces. I guess this was a parallel to the students’ concerns about my response to their work. Another poem, Transcription (below), evolved.
My supervisor moved me to tears when she said to me, ‘You are free now Isha, you can include your poems.’ Being told I was free was like mirroring freedom that I was about to give up. Many individuals don’t really accept that they are free; that is why this work is necessary. We think we are living in a free country, we believe we are free, but we are not fully using our freedom. This is why I introduced the concept of a black empathic approach – to encourage a shared sense of celebrating identity and connecting with the impact of racism.
Writing up the research – having a voice
Informing practice on different levels
When it came to writing up my thesis, an old pattern of not feeling good enough crept into my writing and I eliminated my poems, thinking that they would not be accepted, even though they illustrated my process. This is one of the poems that I had written.
The study transformed my own practice as a psychotherapist and trainer, first by maintaining an inclusive approach to minority issues and gathering knowledge and theory to support that approach. Second, I explicitly addressed my availability to explore the deeper meaning of oppression, racism and black issues in training and the therapeutic relationship. Third, I used ongoing support to remain aware of my countertransference responses and of the compassion I had developed to model the support process. Fourth, I developed less fear of starting at the beginning, learning from my mistakes and asking for and expecting relevant help.
I sit here in tears In fear of abandonment Patiently waiting Tuning this scenario For the voice that fears To come to me For this healing complete That we may be free But for this life This world, this family, This, the voice I wait patiently
Transcription I face the blank page/yawn, feel hysterical Laughter and tears beneath the surface With a prod my chest may exude this mass Afraid, my pen will cease to flow I stop to itch my nose/aware of stopping Stopping may distract attention My thinking once curbed, Can this narrative transform knowledge? Holding this pause/this moment in history A space to unravel, to mind and observe A cathartic matrix of writhing worms Each ventricular journey a precious growth Illumination of new born concepts/routes Past to future unfolding wisdom and notion A tapestry of experiences embrace tentatively Ignite the passion of learning new other ways ISHA MCKENZIE-MAVINGA (2002/2005)
References Jung CG (1980). ‘Psychology and alchemy’. Collected works of CG Jung. London: Routledge. McKenzie-Mavinga I (2002). ‘Creative writing as healing in black women’s group’. In A DuponJoshua (ed) Working interculturally in counselling settings. London: Routledge, 10–28. Mckenzie-Mavinga I (2003). ‘Creative writing as healing in black women’s groups’. In A DupontJoshua (ed) Counselling in intercultural settings. Routledge. Mckenzie-Mavinga I (2003). ‘Linking social history and the therapeutic process, research and practice on black issues’. Counselling & Psychotherapy Research 3(2): 103–106. Mckenzie-Mavinga I (2004). Finding a voice – understanding black issues in the therapeutic process. Association for University and College Counselling. McKenzie-Mavinga I (2005). ‘A study of black issues in counsellor training’. Doctorate in psychotherapy by professional studies, Middlesex University and Metanoia Institute, London. Mckenzie-Mavinga (2006). ‘Is counselling colour blind?’ Healthcare Counselling and Psychotherapy Journal, 6(3). Mckenzie-Mavinga I (2015). ‘Black issues in the therapeutic process: a multicultural heuristic study’. In S Goss and C Stevens (eds) Making research matter. London: Routledge. Mckenzie-Mavinga I (2016). The challenge of racism in therapeutic practice: engaging with oppression in practice and supervision. Palgrave MacMillan. Morrison T (1988). Beloved. London: Pan books.
Developing imagination-based methods to enhance researcher reflexivity Psychotherapy is a rich resource of methods and approaches that can be applied to enhance researcher reflexivity, says Val Thomas. One valuable seam is the tradition of using imagination-based methods to disclose aspects of the self that are hidden from conscious awareness. Val illustrates the article with Jo Harding’s use of innovative mental imagery to shed light on her research process.
sychotherapy, with its wealth of knowledge and theories of intrasubjective and intersubjective processes, has helped to inform methods, theories and approaches in other social science disciplines. Qualitative research has proved to be no exception and different psychotherapy modalities have made particular contributions to its repertoire. One such example would be psychoanalytically informed methods, which are designed to illuminate the unconscious dynamics operating in the researcher and the researcher/participant relationship that may impact on the research (Browne, 2006). As researcher reflexivity comes to the fore in qualitative research practice, the discipline of psychotherapy is particularly well positioned to contribute further methodological innovations to the wider field. This advantage is due to its expertise in understanding how the therapist’s self is implicated in relational therapeutic processes.
Before I consider how to develop new methods to illuminate how the researcher shapes the research, it is important to understand what is meant by the term ‘reflexivity.’
Researcher reflexivity A review of the literature would indicate that researcher reflexivity is a complex, multifaceted phenomenon that is difficult to capture. Furthermore, there is no single agreed position on this practice. Researchers from different traditions and with different theoretical perspectives construct reflexivity differently. It would be fair to say that these different positions add another level of complexity to an already complex topic. Finlay (2002a) provides a general definition of reflexivity as thoughtful, conscious self-awareness, stating ‘reflexive analysis in research encompasses continual evaluation of subjective responses, inter-subjective dynamics, and the research process itself’ (p532). Finlay (2002b) also suggests a helpful typology and identifies five different variants of reflexivity: i) introspection, ii) intersubjective reflection, iii) mutual collaboration, iv) social critique and v)
Val Thomas is a practising counsellor, psychotherapist, trainer and supervisor. She was, until recently, course leader for professional counselling training at Anglia Ruskin University and is now working at The Minster Centre as course developer and as a member of the Research Training team. Her main research interests are the research process and the therapeutic use of mental imagery.
discursive deconstruction. It is beyond the scope of this article to consider all aspects of reflexivity – the reflexive practice discussed here is informed by the introspective variant, ie the use of personal revelation, to shed light on different aspects of the research process.
Reflexivity in practice Reflexivity in practice requires a deep enquiry into the inner processes of the self. This task will very often include accessing the parts of the self that are hidden from conscious awareness. These inner unconscious dynamics shape how we construct and process our experience, and this will inevitably include how we carry out research. Clinical experience in psychotherapy generally confirms that relying purely on verbal reflections and techniques for this task can be somewhat limited, particularly with regard to the dynamics and patterns laid down during preverbal developmental stages and also during traumatic adult experience. Consequently, psychotherapists will often draw on a range of nonverbal modes, according to their particular modality, to help shed light on these unconscious processes, one contemporary example being the therapist’s embodied countertransferential responses to their client. One particularly important nonverbal mode, of course, is mental imagery, and there is a well-established tradition of using clients’ mental images to provide insights into the factors that are shaping their perspective and influencing their experience. It would follow then that the
feature article visualised a plate on the door with the words My Research Project on it. I imagined opening the door and walking into an empty room. Slowly, over the course of a few visits, an image unfolded of what appeared to me to be alchemical apparatus. Tracking developments in this image and interacting with it over the course of the project proved very helpful in terms of understanding how I was implicated in the research process (Thomas, 2014).
Incorporating the learning in our training When the research team at The Minster Centre began to advocate for more creative methods (Cotter, 2015), I took the opportunity to begin to teach this procedure to the master’s dissertation students. One of the students, Jo Harding, gives an account below of her experience of using imagery that both informed and transformed her research process.
mental imagery techniques originally developed for therapeutic purposes could be usefully applied in extra-therapeutic contexts such as qualitative research.
Positioning myself My own interest in developing methods to shed light on researcher reflexivity began when I was engaged in my own doctoral research project. I had had a creative
reflective practice for many years, based on using mental imagery to enquire into my own subjective processes. While doing research, it felt like a natural development to apply a similar approach to my project as a means of deepening my own reflexivity. I began with a standard visualisation exercise of imagining myself standing in front of a door leading to a room. I
A student's account of using imagery
y dissertation research (Harding, 2015) explored the client’s lived experience after their therapist self-disclosed a personal bereavement. I used heuristic methodology, wherein I was the research subject: the experience was one I had had as a client. For those unfamiliar with heuristic research, it involves searching internally to find the essence of an experience by accessing both explicit and vitally tacit or unconscious dimensions. It requires reflexivity and freedom of exploration (Moustakas, 1990). Throughout my research, I checked in with my image for guidance
about my process, and also sketched and wrote about it in my reflexive research journal. I first ‘met’ my image in October 2014, through a guided visualisation led by Val Thomas during a workshop at The Minster Centre. Val invited us to identify an image representing our research project. I was surprised by my image: a black climbing frame, with many interconnecting bars. It was enormous in comparison to me, reflecting how daunted I felt by my dissertation. Aspects of the image seemed immediately relevant to my research methodology. Its stark blackness symbolised clarity, and it invited me to explore and play. However, I felt confused
This example clearly demonstrates the potential for mental imagery methods to shed light on the research process. It begs the question why it has taken so long for psychotherapy research-practitioners to explore and develop innovative applications of this kind – particularly as the discipline has such a long and rich tradition of imagination-based clinical applications. Other therapy modalities have forged ahead in this regard – one in particular, art therapy, is currently at the forefront of
by seemingly contradictory elements. Initially, the solid frame seemed to represent structure, which reassured me, as habitually I organise to feel in control. However, the bars were extremely slippery, and when I imagined climbing on it, I was unable to hold on, which frustrated me. It transpired that my inability to grip the frame was an important pointer: to let go of my need for control. In heuristic research, it is essential to let the phases unfold naturally and without structure (Sela-Smith, 2002). Initially, I struggled to trust that this could happen, and drafted a timeline for the research stages. Whilst doing so, I became distracted by the incessant repetition in my mind of a familiar line from Leonard Cohen’s song, ‘Anthem’. When I looked up the lyrics, I discovered another line: ‘forget your
feature article Why has it taken so long for psychotherapy research-practitioners to explore and develop innovative applications of this kind? embracing new modes of enquiry. McNiff (1998) provides an instructive account of the development of research in this modality. In the beginning, art therapy research (in common with other therapy modalities) was primarily informed by psychology, with an attendant emphasis on enquiring into its therapeutic efficacy. However, more recently, this research paradigm has been questioned and new types of research are proposed that resonate with the artistic process. In other words, artmaking itself is being used as the vehicle for the enquiry. It is worth noting that these developments have been driven by practitioner-researchers. It has not been easy to establish these new research methods. As McNiff (p51) states in relation to art, ‘It has not been appreciated as a way of knowing and systematically studying human experience and other natural phenomena.’ This unreflected resistance to the use of imagination-based methods of enquiry is predicated on a long-held distrust of imagination as a source of valid information (Thomas, 2016). Despite this cultural resistance, innovative approaches to research are emerging from this modality that have the potential to integrate clinical and research practices as well as influence
perfect offering’ (Cohen, 1992). This felt like a sign to trust the process instead of planning it. My climbing frame then transformed from a fixed to a mobile object, swaying gently, which felt like affirmation that I was on the right path. From then, my frame often changed form. My image was helpful in overcoming the greatest challenge I faced during my research: trusting my instinct to remain the sole subject and not conduct interviews. Moustakas (1990), who developed heuristic research, advocates interviewing to gather data. Even though some contemporary writers question the necessity of using coresearchers (Sela-Smith, 2002), I was very anxious about deviating from the classic method. My image consistently indicated that I should trust my intuition. Once, it
the wider qualitative research field. Art therapy demonstrates what is possible when clinical knowledge and expertise is creatively applied to research practice.
Concluding remarks I believe that talking therapies, in particular psychotherapy, have the potential to generate similar levels of innovation in research practice, particularly in relation to shedding light on the research process. Imagination-based procedures are particularly suited to expanding the repertoire of reflexive methods in qualitative research – as I hope has been illustrated through the detailed account of applying a psychotherapy-informed imagery-based procedure to research. Art therapy has shown how practitionerresearchers have pioneered new modes of enquiry when they have applied their clinical knowledge and expertise to research. Psychotherapy also has a great deal more to offer to the wider field of qualitative research, and one way of accomplishing this is to actively foster an imaginative engagement with research. As with art therapy, practitioner-researchers can lead the way through applying clinical expertise
appeared as a round metal receptacle containing a single sunflower, as only one could flourish. Later, the frame became a mini-trampoline, on which I bounced alone, exhilarated. When I imagined another joining me via an interview, we bounced out of synch and I fell, at risk of being crushed by the other. My instinct was right, as had I conducted interviews, I would not have explored my process so deeply, which was vital for my findings. In heuristic research, going deeper involves surrendering to discovery and potential pain. In my case, this involved exploring death, which I strongly resisted initially. In querying my resistance, I saw my frame as an object resembling a heating duct, with a tube that disappeared underground. The invitation was to go deeper into
and methods to their own process of enquiry. Creative experiments such as these can lead to new ways of illuminating researcher reflexivity. It is time to embrace a more imaginative engagement with research practice in psychotherapy.
References Cohen L (1992). Anthem [lyric]. New York: Sony Music Entertainment. Cotter A (2015). ‘Humanising psychotherapy research and training in research: intersubjectivity and beyond’. The Psychotherapist, autumn 2015, issue 61. Finlay L (2002a). ‘“Outing” the researcher: the provenance, process and practice of reflexivity’. Qualitative Health Research, 12(4): 531–545. Finlay L (2002b). ‘Negotiating the swamp: the opportunity and challenge of using reflexivity in research’. Qualitative Research, 2(2): 209–230. Harding J (2015). The shock and aftershocks: a heuristic exploration of the client’s lived experience following their therapist’s self-disclosure of a personal bereavement. MA dissertation. The Minster Centre. McNiff S (1998). Art-based research. London: Jessica Kingsley. Moustakas C (1990). Heuristic research: design, methodology and applications. London: Sage Publications. Sela-Smith S (2002). ‘Heuristic research: a review and critique of Moustakas’s method’. Journal of Humanistic Psychology, 42(3): 53–88. Thomas V (2014). ‘Drawing on creative reflective practices in counselling research: an example of using mental imagery to enhance researcher reflexivity’. British Journal of Counselling and Guidance, 42(1): 43–51. Thomas V (2016). Using mental imagery in counselling and psychotherapy: a guide to more inclusive theory and practice. London: Routledge.
my unconscious domain, wherein I encountered and explored what was the heart of my findings: fearing my own death. Although at times I encountered resistance, I later struggled to let go of my exploration, afraid I would lose my way. When I checked in with my frame, it was curled over, at rest, indicating that it was time to incubate and allow my unconscious processes to work, another stage in heuristic research (Moustakas, 1990). To signal the completion of my research, my climbing frame transformed, shedding all traces of the ‘frame’. It became a large black glass vessel, in which I could rest. In retrospect, I have no doubt that my experience was far richer and truer as a consequence of using imagery.
The role of routine outcomes evaluation in developing reflexivity in clinical practice Dr Biljana van Rijn asks whether psychotherapists should embrace practice-based research in the quantitative format of ROE. Can we develop it and make it our own?
ithin the therapeutic community, we are noticing an increased emphasis on routine outcome evaluation (ROE). ROE involves using standardised questionnaires in the ordinary course of therapy, usually after each session, to evaluate therapeutic progress. In the UK, largescale ROE is used in IAPT to evaluate the effectiveness of psychotherapy for moderate anxiety and depression. Outcomes are published and used to create benchmarks for psychological therapies in the NHS (Glover, et al, 2010; Gyani, et al, 2013; Clark, et al, 2009).
Dr Biljana van Rijn is Faculty Head of Applied Research and Clinical Practice at the Metanoia Institute in London where she runs a research centre. Biljana is a TA psychotherapist and a counselling psychologist. She is also a clinical supervisor and tutor at the Metanoia Institute. Biljana has a particular interest in integrating the fields of psychotherapy practice and research and supporting the involvement of psychotherapists in research.
Bridging the gap Some voluntary and statutory sector organisations have adopted this methodology, primarily to demonstrate their effectiveness and to gain funding. ROE is, however, an area where the gap between the therapeutic community, researchers and policymakers is at its widest. The majority of psychotherapists only use it if required by their employer and don’t see it as relevant or clinically useful. This may put the therapeutic community at a disadvantage in that it places them outside the decisionmaking process about the provision of psychotherapy and counselling services. Reflection from both psychotherapists and researchers is needed to bridge this gap. As a psychotherapist and researcher, I have insight into the issues on both sides. On the one hand, a body of research indicates that the reflection we already use in practice has limits, particularly in evaluating our own effectiveness. On the other, ROE, when used mechanistically, doesn’t have the capacity to develop practice. The aim of this paper is to present some of my thinking about gaps in practice and research in this area, raise questions and make suggestions for a way forward.
Developing methods of feedback and evaluation in psychotherapy Importance of feedback in psychotherapy, as in any professional activity, seems to be self-evident. We need to recognise the impact of our interventions and adapt our work to help clients achieve their aims.
Therapists have long been alert to this, and various methods for reflecting on psychotherapy processes and outcomes have become embedded in psychotherapy training and practice. Students are observed in their practice sessions during training. Many of them audiorecord their sessions, and all have supervision and personal psychotherapy. This suggests that we already have multiple methods and skills to assess the effectiveness of our practice and our abilities. Unfortunately, research suggests that this is not as effective as we might think. Psychotherapists seem to suffer from a self-assessment bias similar to that found in other professions. Research by Walfish et al (2012) found that most of their psychotherapist participants rated their skills as above average in comparison to their peers. They thought that only 3.66 per cent of their clients deteriorated during therapy, and 47.7 per cent of the sample said that none of their clients deteriorated. Similar results have been found in other studies (Lambert and Shimokawa, 2011; Lambert, et al, 2002).
Inaccurate evaluations These evaluations seem to be very inaccurate when compared to actual psychotherapy outcomes. Psychotherapy outcomes research shows that, on average, across the different therapeutic settings, only about 40 per cent of clients achieve clinically significant change and up to 20 per cent deteriorate. In addition, a review of literature on alliance ruptures shows that they are far more frequent than therapists identify or clients disclose (Muran, et al, 2010; Safran, et al, 2011). The literature on premature endings in therapy also shows that they are common in both public services (Pekarik and FinneyOwen, 1987) and private practice (Mueller and Pekarik, 2000). Therapists’ skills in building and repairing the relationship have an impact on the dropout rates (Roos and Werbart, 2013). The question that arises is, how can we realistically assess alliance ruptures and outcomes in our own practice? Research like this suggests that we need to find a way of reviewing or supplementing ways of reflecting on our practice, even when dealing with things as familiar as identifying alliance ruptures, our own skills assessment or our clients’ need for different ways of working. As a profession, we might
feature article have moved too far away from formal evaluation methods that could have a role in this process.
What are the difficulties in using ROE? Holmqvist et al (2013) address some of the tensions when using ROE in psychotherapy. I have frequently heard from students and colleagues that some of the outcome measures are not well suited to the practice of psychotherapy. Instead of aiding therapy, they are based on the medical model and seem to suit a political purpose rather than support therapy. For example, the focus on anxiety and depression does not reflect a clinical reality where clients present with several coexisting issues. Psychotherapy formulation is far more helpful in developing treatment plans and therapeutic theory is of more help in working with clients than routine outcome measures (ROMs). ROE usually takes place in time-limited settings. However, long-term and openended therapy, which usually take place in private practice, do not have ROE protocols or measures suited to this type of work. For example, most of the commonly used measures rely on calculations of clinical cut-off scores and are not particularly useful once clients have moved below the clinical range of symptoms. In my experience, in long-term psychotherapy, this usually happens within the first six months to year of therapy, when the more in-depth work usually starts. Over my years of teaching students to use ROMs in the research clinic, I am aware of unease about using questionnaires and ‘forms’, as if this format somehow does not suit the culture of psychotherapy practice. This unease is amplified by fears of being assessed and ‘measured’.
Developing reflexivity in ROE An approach to developing ROE needs to start from a reflection on what we might gain from it in terms of the benefit of developing work with individual clients and using creativity to integrate it into the therapeutic process. The following are just some suggestions from work at the Metanoia Institute. Developing clients’ engagement and openness In some psychotherapy settings, ROMs are only used for evaluating the service.
PATIENT HEALTH QUE STIONNAIRE-9 (PHQ-9) Over the last 2 weeks, how often have you been bothered by any of the following problems? (Use “✔” to indicate your answer)
Not at all
More than half the days
Nearly every day
6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
7. Trouble concentrating on things , such as reading the newspaper or watching television
1. Little interest or pleasure in doing
2. Feeling down, depressed, or hopel
3. Trouble falling or staying aslee p, or sleeping too much 4. Feeling tired or having little energ y 5. Poor appetite or overeating
8. Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving aroun d a lot more than usual 9. Thoughts that you would be better off dead or of hurting yourself in some way
FOR OFFICE CODING
+ ______ + ______ + ______ =Total Score: ______
If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home , or get along with other people? Not difficult Somewhat Very at all Extremely difficult difficult difficult
A commonly used questionaire; PHQ-9 Developed by Drs. Robert L. Spitze r, Janet B.W. Williams, Kurt Kroen ke and colleagues, with an educa Pfizer Inc. No permission require tional grant from d to reproduce, translate, display or distribute.
Therapists do not see the clients’ responses and are unable to use them in any way. There is an argument that this gives clients more freedom to provide feedback but it is not particularly helpful to the therapeutic process. Instead, ROMs could support engagement in self-reflection between sessions. Completing a questionnaire once a week between sessions creates a structure that could assist reflection. Questionnaires also give an opportunity for feedback to the therapist without seeming too personal or rude, which is a concern for many clients. In this way, ROMs could help identify ruptures and attend to the working alliance. Finally, being able to have a conversation with a client about therapy, what works and what doesn’t, has a role in building the therapeutic relationship and engaging clients in their own therapy. Openness about negotiating the aims of therapy
and ways of working has been an integral part of humanistic therapies, such as transactional analysis (Sills, 1997), and has been more recently highlighted as a ‘metatherapeutic’ dialogue in a pluralistic approach by Cooper and McLeod (2011). Integration of measures into the therapeutic process Questionnaires are frequently seen as alien to the therapeutic process. This is particularly the case for psychotherapists, in contrast to clients. The formal wording and structure of questionnaires seem to mark them out as something different from other personal material clients bring into sessions. However, some of that formality and consistency might support the therapeutic process. For example, it would not be particularly useful to spend time each session reviewing all aspects of clients’ wellbeing, from their sleeping patterns to how often they feel despairing. Instead,
feature article Research indicates that the reflection we use in practice has limits, particularly in evaluating our own effectiveness both clients and therapists tend to choose whatever is a figural theme for them on the day. The information given by clients in ROMs could be significant for the therapeutic process and provide feedback to therapists. It could indicate that the client is at risk, becoming more distressed or deteriorating. Clients could communicate this regularly and quickly, without the need to to engage in prolonged and detailed enquiries each session. Of course, not all distress indicates deterioration and integrating the information into the therapeutic dialogue needs to be flexible and individual to each client. For example, therapists at Metanoia usually start by taking time to scan through the questionnaires the clients bring to the session, ask them if they want to focus on anything in particular, and reflect on what they have noticed, such as areas of risk, feedback on the therapeutic relationship, etc. Used in this way, questionnaires become an additional reflective tool and could be adapted to suit different clients and therapeutic styles. Choosing measures that suit psychotherapy practice Most commonly used measures in the UK focus on recognisable clinical disorders such as depression, PHQ-9 (Kroenke, et al, 2001) and anxiety, GAD-7 (Spitzer, 2006). Measures of global distress such as CORE-OM (Barkham, et al, 2001), helpful aspects of therapy (Elliott, 1993) and the therapeutic relationship (Bordin, 1979; Tracey and Kokotovic, 1989) could be more suitable outside health settings. Many other measures that focus on interpersonal styles, attachment, compassion, etc are available. They are easily accessible and many are free of charge. Training of therapists and supervisors For ROE to become common and integrated into therapeutic practice, it needs to be integrated into psychotherapy training and supervision alongside other reflective methods. Integration into training could support a change in the culture of psychotherapy, which could involve moving beyond the false dichotomy between
subjectivity and objectivity to embrace a wider range of complexity of human expression. This might also mean that, as individuals, we might also need to embrace our fallibility more fully and realise the limits to our ability to know what is going on for our clients – or even within the process of psychotherapy.
Development of research ROE in long-term psychotherapy Current methods of ROE are poorly suited to long-term psychotherapy. Giving sessional measures to clients after the first year of psychotherapy, in my experience, makes it repetitive and needlessly mechanistic. It would be helpful to consider ways in which ROE could support the long-term therapeutic process. Using measures at regular intervals might provide a history of the process that therapists and clients could use. For example, for clients who experience periods of emotional instability, ROM could develop their ability for mentalisation, helping them remember times when they felt very distressed and times when they did not. Developing new questionnaires There is a need to develop and test measures and methods led by therapeutic need that are truly useful to psychotherapists. This suggests a need to conduct more research and engage therapists who work in private practice, as they are fast becoming the only providers of long-term psychotherapy.
Conclusion Practice-based research in its quantitative, formal format of ROE presents a challenge to the therapeutic community. Is this something we could embrace and make our own? What can we learn from it? My view, as a relational psychotherapist, is that I would like to open up a wide range of discourse with my clients, including the sources that do not traditionally stem from psychotherapy. ROE could give us an opportunity to develop our reflexivity and responsiveness, as well as contribute to the body of practice-based research.
References Barkham M, Margison F, Leach C, Lucock M, MellorClark J and Evans C (2001). ‘Service profiling and outcomes benchmarking. Using the CORE-OM: toward practice-based evidence in the psychological therapiest’. Journal of Consulting and Clinical Psychology, 69: 184–196. Bordin ES (1979). ‘The generalizability of the psychoanalytic concept of the working alliance’. Psychotherapy: Theory, Research, Practice, 16(3): 252–260. Clark DM, Layard R, Smithies R, Richards DA, Suckling R and Wright B (2009). ‘Improving access to psychological therapy: initial evaluation of two demonstration sites’. Behaviour Research and Therapy, 47: 910–920. Cooper M and McLeod J (2011). Pluralistic counselling and psychotherapy. Sage. Elliott R (1993). Helpful aspects of therapy form. Accessed 30/08/12 at www.experiential-researchers. org/instruments/elliott/hat.pdf Holmqvist R, Philips B and Barkham M (2013). ‘Developing practice-based evidence: benefits, challenges, and tensions’. Psychotherapy Research, 25(1): 20–31. Kroenke K, Spitzer RL and Williams JB (2001). ‘The PHQ-9: validity of a brief depression severity measure’. Journal of General and Internal Medicine, 16: 606–613. Lambert MJ and Shimokawa K (2011). ‘Collecting client feedback’. In J Norcross and MJ Lambert (eds) Psychotherapy relationships that work, 2nd ed. Oxford University Press, 203–223. Lambert MJ, Whipple JL, Vermeersch DAD, Smart W, Hawkins EJ, Nielsen SL and Goates M (2002). ‘Enhancing psychotherapy outcomes via providing feedback on client progress: a replication’. Clinical Psychology & Psychotherapy, 9(2): 91–103. Mueller M and Pekarik G (2000). ‘Treatment duration prediction: client accuracy and its relationship to dropout, outcome, and satisfaction’. Psychotherapy: Theory, Research, Practice, Training, 37(2): 117–123. Muran JC, Safran JD snf Eubanks-Carter C (2010). ‘Developing therapist abilities to negotiate alliance ruptures’. In JC Muran and JP Barber (eds) The therapeutic alliance: an evidence-based guide to practice. US: Guilford Press, 320–340. Pekarik G and Finney-Owen K (1987). ‘Outpatient clinic therapist attitudes and beliefs relevant to client dropout’. Community Mental Health Journal, 23(2): 120–130. Roos J and Werbart A (2013). ‘Therapist and relationship factors influencing dropout from individual psychotherapy: a literature review’. Psychotherapy Research, 23(4): 394–418. Safran JD, Muran JC and Eubanks-Carter C (2011). ‘Repairing alliance ruptures’. In J Norcross and M Lambert (eds) Psychotherapy relationships that work, 2nd edn. Oxford University Press, 224–238. Sills C (1997). ‘Contracts and contract making’. In C Sills (ed) Contracts in counselling. Sage, 11–33. Spitzer RL, Kroenke R, Williams JB and Lowe B (2006). ‘A brief measure for assessing generalized anxiety disorder: the GAD-7’. Archives of Internal Medicine, 166: 1092–1097. Tracey TJ and Kokotovic AM (1989). ‘Factor structure of the Working Alliance Inventory’. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 1(3): 207–210. Walfish S, McAlister B, O’Donnell P and Lambert MJ (2012). ‘An investigation of self-assessment bias in mental health providers’. Psychological Reports, 110(2): 639–644.
Using our own experience in research in counselling and psychotherapy: how feminist ideas have influenced a research work/life Jeannie Wright reflects on her move towards an autoethnographic, arts-based approach to counselling and psychotherapy at a time when the prevailing climate in the UK tends towards positivism and outcome studies.
ecently leaving a job where I had used my office as a transitional holding space between jobs, countries and homes, I found all sorts of old reflective journals and research diaries that I had completely forgotten about. The move away from respect-able, ‘scientific’ methodological approaches such as interpretive phenomenological analysis (IPA) towards a more ‘alternative’ narrative, arts-based autoethnographic is very clearly mapped out in those pages.
The use of writing for therapeutic and reflective practice purposes Using my own experience is at the heart of this epistemological shift and in this brief snapshot of over 20 years’ researching
Dr Jeannie Wright has been involved in therapeutic practice and research nationally and internationally for many years. She has worked as a director of counselling and psychotherapy programmes at the University of Warwick, and was Associate Professor in Counselling at Massey University in New Zealand. Her doctoral study was on the therapeutic potential of expressive and reflective writing. She is author of Reflective Writing in Counselling and Psychotherapy.
and publishing in counselling and psychotherapy I aim to trace some of the influences that have been most important. The theoretical framework for most of my practice-based research has been feminist, in all its fragmentation. There are political principles underlying who is researching whom, why and how in the questions and critical voices of feminist research. In counselling and psychotherapy, we still seem to lag behind compared to other social sciences, arts and humanities disciplines, which is perhaps not surprising in a new and applied area (Speedy, 2008). The research topic I have returned to consistently is the use of writing for therapeutic and reflective practice purposes. Evangelical about communicating
my findings with clients and supervisees, I started out with a very ‘respect-able’ IPA study of five women who had used writing in brief, work-based therapy (Wright, 2003a). IPA values an understanding of the world from the perspective of the research participants and recognises interpretative work by the researcher (Smith, et al, 2009). The IPA thematic analysis, however, did not do justice to the thick descriptions of therapeutic experiences I was hearing, nor to my experience of working with these women. Too much was missed. I brooded about case studies, following feminist relational ethics where power sensitivity is key. Eventually, I managed to overcome ethical queasiness and worked with a former client to produce a ‘co-researched’
feature article case study, a crucial distinction maybe. The famous and very useful Josselson (1996) piece about doing this work in anguish made sense and yet I wondered about that balance between the risks involved and the benefits. In hindsight, the client decided not to use her name or even ‘co-author’ the article – the vulnerability was all hers, not mine. It was possible, however, to foreground her own words in a way that IPA would not have enabled and she managed with ongoing consent to approve the finished piece.
The (not always welcome) use of self in research Especially in counselling and psychotherapy, where the ethics of case study research have been well analysed (McLeod, 2010), I wondered about using myself as a case study instead, and so found my way towards autoethnography. I disagree with McLeod’s lukewarm appraisal of using ourselves in counselling and psychotherapy research. Some of the ethical contradictions about telling others’ stories even sent me spinning back into more ‘objective’ ways of working, such as thematic analysis – but not for long. Early on, I also realised that funding for the kind of qualitative research I wanted to do would be hard to find, if not downright impossible. In the yellowing ring binders cleared out of the office, I find paper copies of proposals for funding for research on the client’s experience of therapeutic writing online, on the role of writing therapy in time-limited workplace counselling, and so on. As far as I know there is still a gap in the counselling at work literature, where contracts are time-limited and writing, a reflective, supported kind of writing, works well for people, whether online or as an adjunct to face-to-face therapeutic relationships. I notice that in one proposal I’m using IPA in order to come across as a proper ‘scientific’ researcher, although I cannot pretend to be a psychologist. The electronic version of this funding application is long lost in a trail of laptops and university networks; in the paper copy, I’m using language like ‘superordinate themes’ and ‘verification step.’ It makes me smile. I was still passionate about the need to publish accounts of using writing with clients, but I was stuck. Here’s one extract from my research diary after I’d completed the PhD dated 2006: ‘it seems I have to go into the doldrums to come out with something – what? A bit of drive? Confidence? I re-read
The move from respect-able, ‘scientific’ methodological approaches towards a more ‘alternative’ narrative, arts-based autoethnographic is clearly mapped out parts of Kim Etherington’s (2004) Becoming a Reflexive Researcher and felt like singing – even mopped the hall floor! Energising or what.’
Perseverance and authenticity It goes to show how important it is to carry on writing and to submit for publication, even when it feels like we’re publishing into a total vacuum. In spite of Kim Etherington’s (2000) shining examples, I had felt increasingly uncomfortable with telling other people’s stories derived from the world of counselling and psychotherapy. In 2006, I was preparing to leave the UK for a new job in Aotearoa New Zealand. I write habitually and started catching down on paper some of my observations about what was going on for me at the airport, literally in transition between jobs and countries. Three years later and the subsequent article was published in an American journal where, taking extracts from my personal journals in an autoethnographic study of migration and writing, I claimed the therapeutic as well as the research value of that writing (Wright, 2009). I now see how careful I was in that article, at least on the surface, to observe Martin Tollich’s injunctions about the ethics of autoethnography (Tollich, 2010). Using a metaphor of imagined inked tattoo, Tollich suggests treating any autoethnography with great caution, anticipating the author’s future vulnerability. He also suggests that autoethnographers should always assume that all the people mentioned in the text will read it at some point. Naïvely, in retrospect, it felt safer to me to write about my own experience. When my father died in 1996, I wrote some poetry not meant to be read by anyone other than me. In an article deliberately sent again to an American journal of poetry therapy (who would read that?), I allowed that poetry out into the light where others could read it (Wright, 2003b). Now I wonder about the ethical responsibility of some of those decisions. There is no way to gain informed consent from the dead. What I did gain was another publication, though not, of course, in a recognised five-star journal. (Those who
work in academic contexts will know the tension between high scores on somebody else’s scales and using our own experience in research.) And, occasionally, an email arrives thanking me and letting me know that something I’ve written about my own experience has been read and has been useful to somebody else. Using a kind of private, confessional writing was how I always survived when the going got tough. I strongly identified with bell hooks asking for and being given a diary: Confessional writing in diaries was acceptable in our family because it was writing that was never meant to be read by anyone. Keeping a daily diary did not mean that I was seriously called to write, that I would ever write for a reading public. This was ‘safe’ writing… I could be angry – there with no threat of punishment. I could ‘talkback’. Nothing had to be concealed. I could hold on to myself there. HOOKS, 1999: 4–5
Ann Cvetkovich, more recently, using feminist and queer theories, has rehabilitated the personal confessional journal as a way out of depression as well as a form of scholarly activity (Cvetkovich, 2012). Depression is analysed as a form of public feeling, and while individual therapy is given short shrift, more collective activities are recommended.
Collaborative reflexivity Of course the isolation of this solitary personal writing position, which has been described as schizoid by one email correspondent, is reduced by reading/ connecting with other people’s writing – and that was my next move towards collective biography. The vulnerability and potential exposure of using our own experience in research are lessened in collective biography, which has different ethical and political principles, together with a clear feminist foundation (Wright, et al, 2011). Theoretically, feminist thinking and scholarship have shown up again and again for me in practice and research. In counselling and psychotherapy, we are not yet clear about a feminist infrastructure or framework for practitioners or
discussion researchers. Research in counselling and psychotherapy is still dominated by the medical model, and calls for a more pluralistic perspective on what is acceptable and publishable are urgently needed.
Concluding reflections Gradually moving towards autoethnography and collective biography, becoming more and more ‘up close and personal’, was inevitable for me (Josselson, et al, 2002). Based on practicebased research, modelling reflexivity on the way through, the aim of this short article has been to reflect on that trajectory at a time when the prevailing climate in counselling and psychotherapy in the UK tends more towards positivism and outcome studies. This particular special issue may raise some questions about that epistemological dominance and who controls what in our field.
References Cvetkovich A (2012). Depression: a public feeling. Durham and London: Duke University Press. Etherington K (2004). Becoming a reflexive researcher: using ourselves in research. London: Jessica Kingsley. Hooks B (1999). Remembered rapture: the writer at work. London: Women’s Press. Josselson R (1996). Ethics and process in the study of lives. London: Sage. Josselson R, Lieblich A and McAdams DP (eds) (2002). Up close and personal: the teaching and learning of narrative research. Washington, DC: American Psychological Association. McLeod J (2010). Case study research in counselling and psychotherapy. London: Sage. Smith JA, Flowers P and Larkin M (2009). Interpretative phenomenological analysis: theory, method and research. London: Sage. Speedy J (2008). Narrative inquiry and psychotherapy. Basingstoke: Palgrave Macmillan. Tollich M (2010). ‘A critique of current practice: ten foundational guidelines for autoethnographers’. Qualitative Health Research, 20(12): 1599–1610. Wright JK (2003a). ‘Five women talk about work-related brief therapy and therapeutic writing’. Counselling and Psychotherapy Research, 3(3): 204–209. Wright JK (2003b). ‘Writing for protection: reflective practice as a counsellor’. Journal of Poetry Therapy, 16(4): 191–198. Wright JK (2009). ‘Autoethnography and therapy: writing on the move’. Qualitative Inquiry, 15(4): 623–640. Wright JK, Lang SKW and Cornforth S (2011). ‘Fractured connections: migration and holistic models of counselling’. British Journal of Guidance and Counselling, 39(5): 471–486.
An existential exploration of ‘The theme of the three caskets’ from The Merchant of Venice Carol Ann Peters considers how the ‘three caskets’ scene in Shakespeare’s play illuminates different ways of thinking about the nature of ‘choice’. In sooth I know not why I am so sad: Antonio (I.i.1) By my troth, my little body is weary of this great world: Portia (I:ii.1-2)
s a Shakespeare enthusiast, I am often struck by how his plays express the whole spectrum of emotions in the briefest of time that is the play. In just two or three hours, the bridging and compression of time, place and character are accepted without hesitation and the dilemmas and contradictions that we all may experience are played out. During a recent performance of The Merchant of Venice, I was taken by how Shakespeare’s portrayals communicate many different psychological states, both public and private. As therapists, I feel that we could use this substantial body of work to enrich our understanding of human nature. We can learn a lot from Shakespeare – perhaps even more
Carol Ann Peters is a professionally qualified counsellor and psychotherapist based in Surbiton. Carol has worked as an honorary Staff Counsellor for the Psychological Well Being Service in Kingston NHS Hospital Trust.
about the human struggle than from the scores of psychological theories that we encounter in our work. It occurred to me that Shakespeare helps us to think in a bigger and brighter way. Involvement in the language creates fresh emergent consciousness that takes shape in a phenomenological way, in that it is felt in the guts rather than the head. These thoughts and feelings emerge as we respond to Shakespeare’s language; we become more attuned to ourselves and therefore more attuned to our clients.
The three caskets In The Merchant of Venice, one aspect of the play captivated me: the scene depicting a choice between three caskets (or chests) of gold, silver and lead. The three casket scenes take place in Belmont, a romantic setting outside the trading city of Venice. Portia, a wealthy Christian heiress from Belmont, is bound by the will of her dead father to set a challenge for a potential husband. The challenge involves a test of choosing between the caskets, each inscribed on the outside and each having a message within, but only one (the lead casket) containing her portrait. The suitor who chooses the lead casket with Portia’s portrait chooses correctly and wins her hand in marriage. The suitors are the Prince of Morocco, the Prince
discussion of Arragon and Portia’s beloved, Bassanio, who has asked his good friend Antonio to lend him the money to finance his attempt. Antonio has himself borrowed the money from a Jewish money-lender, Shylock. The three caskets scene also caught the attention of Freud, who offered a psychoanalytic interpretation in his essay ‘The theme of the three caskets’ (Freud, 1913). Freud was curious about the ‘theme of three’, which is prevalent throughout the play. He wondered why he himself preferred his third and last daughter, Anna, and he was also reminded of King Lear, where Lear’s favourite is the third daughter, Cordelia. Freud surmised that the theme of three is an archetypal motif found in many forms of literature, including fairytales like Cinderella, where the third woman, the more desirable choice, is hidden away and unobtrusive in her silent love.
The mute woman Freud’s essay approaches the ‘choice among three’ in various ways. He first looks at the concept in the context of an ancient astral myth, where gold, silver and lead relate to the sun, the moon and the north star. Freud conjectured that the Prince of Morocco aligns to the sun by choosing the gold casket, the Prince of Arragon is associated with the moon by choosing the silver casket, and Bassanio, the north star, chooses the lead casket and wins Portia’s hand. The astral myth is relevant here because it reflects on the particular nature of the chooser towards the chosen object. Freud surmised that what is really going on is a choice between three women. Caskets are symbolic of women and the correct choice of lead casket is actually the choice of a ‘mute’ woman. Portia’s right to choose a husband for herself is ‘curbed by the will of a dead father’ and as an obedient daughter to her dead father she becomes a material object and not a desiring subject (I.ii.20). Commenting on the scene as a masculine choice between three women, Freud suggests that the actual prize (the right choice) becomes a choice for death. First, the leaden woman is more desirable in that she is silent and submissive. Second – and here Freud’s pushes his theories further – the three caskets are the guises of three mothers. So the initial perceived ‘choice of love’ is inverted to reveal a choice between the mother who gives birth, the mother of one’s children and,
ultimately, the Mother Earth who takes us to death.
The nature of choice Freud’s psychoanalytic interpretation is certainly thought-provoking. But for now, I would like to consider how the three caskets scene illuminates different ways of thinking about the nature of ‘choice’ from an existential perspective. In therapy, we may ask our clients about their struggle when making choices. Why you are choosing this and not that, what appeals to you when you make a choice and whether there are implications in choosing are just a few of the angles we may explore. In the three caskets scene, each casket reveals and conceals; something is inscribed on the outside and something is hidden within. Could the ‘outside’ be a kind of calling card to each suitor and the ‘inside’ emblematic of unknowability? The questions to be explored here are: how does each casket ‘call’ to each suitor, what value do they place on the caskets when making their choice, and when they open their casket of choice what do they learn about themselves? Gold casket inscription: who chooseth me shall gain what many men desire. Silver casket inscription: who chooseth me shall get as much as he deserves. Lead casket inscription: who chooseth me must give and hazard all he hath.
The pole of ‘Otherness’ The caskets in gold, silver and lead each elicit a response. The inscription on the gold casket reads ‘who chooseth me shall gain what many men desire’ (II.vii.37). Now, when we think of the first competitor, the Prince of Morocco, he is a warrior who has proven himself in battle, but Portia’s acknowledgement of him as an outsider – ‘Let all of his complexion choose me so’ – is clearly reflective of racial difference. He is portrayed as having excessive pride when rejecting the lead casket out of hand: ‘a golden mind stoops not to show of dross’ (II. vii.65). Here we see that Morocco equates his own value to that of gold. In his ‘golden’ mind, the gold casket is a reflection of him and the inscription is all about ‘gain’. It is as though the gold casket calls to him because he sees himself in terms of high value. But rather like Shylock, who is regarded as an outsider, he is portrayed as ‘different’ and he cannot be trusted as he is clearly
motivated by profit and false appearances. Rather like today, society during this period was based on the exclusion of the foreigner and the inclusion of the familiar ‘akin’ or kind. Venetians are portrayed as acting with benevolence towards those who are similar. His choice therefore illuminates for us ideas to do with who is ‘in’ and who is ‘out’. The Prince of Morocco is clearly seen as the absolute pole of ‘Otherness’: not knowing Christian doctrines and codes of behaviour based on ‘charity and mercy’, he is revealed as being far from wise in his judgment. When he opens the gold casket, the scroll reads ‘All that glisters is not gold’, exposing Morocco’s greed and self-delusion (II.vii.65). Conforming to established stereotypes, the outsider here is portrayed as unsuccessful, so that the ‘rightful kind’, the third suitor, Bassanio, may in contrast be seen to be successful.
The blinking idiot The second competitor, the Prince of Arragon, is depicted as having a grotesquely inflated sense of his own self-worth. He rejects the lead casket outright based on its meagre appearance and not being worthy of risk. Similarly, the inscription on the gold casket, ‘who chooseth me shall gain what many men desire’, is rejected, exposing a kind of elitism (II.ix.24). Arragon’s response, ‘I will not choose what many men desire’, reveals a certain distrust of what is common (II.ix.31). His remonstration, ‘And rank me with the barbarous multitude’, is based on snobbery and exclusion of ‘Otherness’ (II. ix.33). But this ‘barbarous multitude’ that he cannot tolerate perhaps reflects an inability to see his own ‘barbarity’; the Other has to be the barbarian. As he looks at the silver casket, it reads ‘who chooseth me shall get as much as he deserves’ (II.ix.36). Based on Arragon’s misguided self-perception of high status, he thinks himself deserving. But inside he finds ‘the portrait of a blinking idiot’ and a message ‘who chooseth me shall have as much as he deserves’ (II.xi.546). The outer inscription and inside message are very similar except for ‘get/have’. So, when he chooses the silver casket, he looks to ‘get’, but when he looks inside all he ‘has’ is himself.
Insider clues When it comes to Bassanio, Portia’s beloved, he is portrayed as living beyond his means and a bit of a risk-taker. He has already borrowed money from his friend Antonio to fund the attempt. However,
discussion we find that Bassanio is seen in a better light than his competitors. He wants to secure a rich heiress for his own gain but this kind of greed is overlooked to expose hypocrisy; he is seen as a typical ‘prodigal Christian’ – inclined to waste, yes, but with a generosity of spirit. So what we get is greed but cloaked in Venetian attitudes and values, as though Bassanio’s ‘shallow foppery’ is acceptable – already he is ‘in’, so to speak. Indeed, when he is about to choose a casket, a song is offered that appears to provide him with crucial clues: ‘Tell me where is fancy bred/Or in the heart or in the head’, the end rhyming with ‘lead’ (III.ii.64-5). Here we find Portia’s independent spirit. Although she appears ‘dumb’ in matters to do with choice, she exercises it in a subtle way, in that the song provides ‘insider’ clues in favour of her kind. Bassanio too rejects the gold casket, this time based on gaudiness – ‘Hard food for Midas, I will none of thee’ – recognising that appearances can be deceptive (III.ii.101). On seeing the inscription on the lead casket, ‘who chooseth me must give and hazard all he hath’, he sees that it is is ambiguous and that he needs to decode it. ‘Hazard’ involves risk, so the least attractive is the more risky and more desired: ‘Thy paleness moves me more than eloquence’, so ‘paleness’ here moves him to choose the western aesthetic based on kinship (III.ii.106). He wins Portia’s hand owing to a succession of interactions or clues that are dependent on ‘insider’ signifiers paving the way for him.
Pulling the strings It is interesting too that the competition is devised by Portia’s dead father. Like Hamlet’s dead father, he exercises his will from beyond the grave. Why is it, for example, that he seems to be pulling the strings and influencing the outcome? Could it be that the dead father is the lead casket: choose me, or someone like me? Certainly lead caskets evoke ideas of burial and perhaps there is something about the influence of the dead on the living when we reflect on how Portia’s father is the author of the three inscriptions and messages within the caskets. Rather like a ‘presence’ within the texts, the father remains a decisive force in this scenario. The idea of authorship therefore springs to mind – a kind of ‘authority figure’ continuing to exert influence from beyond the grave. Perhaps we are oblivious to ‘authority figures’ manifesting as historical, social, political and
Shakespeare shifts us away from rigid, conventional ways of thinking towards creative pathways and an open mind
economic forces and, like the inside of the caskets, we don’t quite know or never will understand our choices.
Inclusion and exclusion The three caskets scene confronts us with our apprehension when making a choice. Each casket calls out to each suitor, but unless you know the codes of behaviour you are seen to make the wrong choice. Shakespeare thus reveals how, in our choices, we can’t help but maintain paradigms between ‘them and us’. Shakespeare enables us to see ourselves in each suitor, as the winner and the loser, and we notice how the loser is ‘different’. Choice is about inclusion and exclusion, what is taken and what is rejected. Is it that our choice in ‘taking’ is endowed with acceptance, social norms and status? And if we choose ‘wrongly’ do we inadvertently contribute to casting ourselves ‘outside’?
Interestingly, Antonio, who opens the play with ‘In sooth I know not why I am so sad’, is motivated by generosity towards his dear friend Bassanio (I.i.1). Various productions enhance a homoerotic element here, suggesting that Antonio cannot fully express his passion for Bassanio. So, like Portia and the two unsuccessful suitors, his choices are limited. Perhaps Antonio is ‘outside’ in many respects, in that he is not truly liberated and therefore his choice in helping Bassanio is an expression of passion. In borrowing money from Shylock to fund his friend’s attempt and subsequently not being able to pay it back, Antonio’s forfeit is a pound of flesh. He is willing to suffer for love and thus his passion is expressed, but he is saved by Portia (disguised as a legal expert) in a court scene where she warns Shylock he must take exactly one pound of flesh. Portia is astute enough to see the ambiguity of language. The play finishes with Antonio being saved and taken back into the fold, but Shylock remains an outsider and is finally forced to denounce his faith. ‘Difference’ is therefore underscored and Shakespeare illuminates for us our predisposition towards ‘sameness’ when making choices.
A web of tensions and paradoxes Like all Shakespeare’s plays, nothing is straightforward. Life is depicted as a web of tensions and paradoxes that highlight the quandaries we face when we make choices. Like the inscribed caskets, signs and modes of signification that are all around influence us when we make a choice. And Shakespeare’s words are no different, except Shakespeare doesn’t say this is me or this is you, but rather this is all of us. When seeing or reading Shakespeare’s plays we are presented with ourselves in various guises; we recognise ourselves and our inner lives. It strikes me that therapists can gain a lot from Shakespeare because his work shifts us away from rigid, conventional ways of thinking towards creative pathways and an open mind. Certainly from my experience of seeing many of Shakespeare’s plays performed I can say that Shakespeare has flooded my consciousness in a way that theory often fails to do.
References Freud S. ‘The theme of the three caskets’. In P Gay (1995) The Freud Reader. London: Vintage. Shakespeare W (1594-97). The Merchant of Venice. Proudfoot R, Thompson A and Scott Kastan D (eds). Arden 3rd series, 2001.
Writing and storytelling: to survive and to thrive Integrative arts-based psychotherapist Bridget Holding is a creative writing tutor with a background in screenwriting. Her passion is exploring how theories and techniques from these two disciplines might inform each other to enable growth and healing in the therapy room and beyond.
torytelling plays a central role in all of our lives. As human beings, we tell stories all the time. We default into daydreaming whenever we are not involved in an immediate, absorbing task. As Gottschall (2013: xiv) describes, ‘We are, as a species, addicted to story… Even when the body goes to sleep, the mind stays up all night, telling itself stories.’
Telling stories saves lives Writing, telling, reading or listening to stories causes the firing of neurons and the strengthening of neural pathways in the brain in the same way that performing the actions ‘for real’ would do. Stories allow us to encounter various life obstacles in symbolic guise and to practise ways of solving them, without endangering ourselves. Recent studies have found that the great majority of dreams are about ‘a problem that needs to be solved’ (Gottschall, 2013: 52). So it may be that stories are, as psychologist and novelist Keith Oatley (2011,
Bridget Holding is a writer, UKCP registered psycho therapist, and tutor of creative writing for the University of Exeter. She runs ‘Wild Words’ online and real-world courses ‘for people who write and tell stories: to survive and to thrive’. Her work fuses evolutionary psychology, body psychotherapy, and creative writing theory. www.bridgetholding.com www.wildwords.org
quoted in Gottschall, 2013: 58) puts it, ‘the flight simulators of human social life’.
form the basis of the 6-part story method (Lahad, 1992: 150–163).
Telling stories is not a luxury for human beings; it is vital for our survival and flourishing.
When telling or writing a story, the storyteller lives their lead character’s journey on a physical, emotional and psychological level. This is equally true whether the character is themselves remembered or fictional. I’ve found it helpful in my work to relate the storyteller’s journey to psychotherapist Peter Levine’s somatic experiencing model. He describes the activation that occurs in the body of a human animal when faced by a threat or opportunity in the environment. If successfully negotiated, this is followed by a discharge of energy from the nervous system and the organism returns to equilibrium.
In my psychotherapy practice, I’ve seen how storytelling can play a crucial role in rescuing us when ‘real’ life is unbearable. The state of dissociation, of feeling detached from a situation, often involves elements of storytelling. Below is the account of one of my clients. She describes herself as a survivor of sexual abuse. I could see the window from where I lay. I would look out of the window at the birds flying. I would imagine I too was flying, and that I could go anywhere, do anything. I would visit beautiful places and talk to kind people who reassured me that I would get through it. I believe this is what stopped me from going crazy, or from killing myself. Storytelling saves lives – literally.
Organismic self-regulation The majority of stories, both fiction and non-fiction, can be broken down into a three-act structure that goes something like this. In act one the lead character’s life situation is set up. In act two they encounter obstacles on the path to what they want to achieve. In act three, the situation is resolved. This is the emotional trajectory of the lead character, and the narrative arc. It is marked by the rising of tension to the climax of the story, followed by the falling of tension to the denouement, and closure. I refer to the work of screenwriter Lew Hunter (1994) when utilising this structural analysis for my own writing, as well as in my teaching work. Similar dramatic elements are also cited in dramatherapy, where they
The storyteller can be seen to exhibit signs of activation in the body when they write about, or describe, their character encountering an obstacle. I have often seen colour drain from their face, and their eyes widen at this point. When the character overcomes the obstacle, colour floods back into the storyteller’s face and they release a sigh. They’ve described to me the profound sense of relief that comes with this discharge of energy. Cycles of activation through to discharge can also be identified throughout the creative process, as the storyteller encounters and negotiates the various obstacles to completing any story. Examples of the threats might include family members coming into their writing room, having doubts about the strength of the story idea, or fearing the reaction of a therapist when information is revealed. The human being maintains health, the ‘organismic self-regulation’ of Hefferline and
discussion Goodwin (2011: 247), through the process of telling and writing stories, as well as via the journey that occurs inside the story. In the language of gestalt psychotherapy, the completing of the story enables the completion of the ‘cycle of awareness and contact’.
Telling stories is not a luxury for human beings; it is vital for our survival and flourishing
Re-finding the natural storyteller I work with two distinct groups with respect to storytelling: creative writing students and psychotherapy clients. I do not perceive the underlying aim of the creative writer and the therapy client to be different. I believe that unconsciously they are both primarily seeking a return to organismic equilibrium through storytelling. However, when they first talk to me, the two groups may describe their goals quite differently. While the therapy client will often speak of wanting to ‘feel better’, the creative writing student will want to ‘finish that novel’ or ‘get published’. Whether the teller labels their story fiction or non-fiction does not affect my approach, as I believe that the story we want to tell is always a symbolic representation of issues in our lives that seeks resolution, just variously disguised. Underneath everything, there is emotion, energy, which needs integrating into the system as a whole. Often when I work I ‘stick with the image’ (McNiff 1992: 55). I stay within the story, without reference to the context of the telling, aiming to enable it to become more fully formed and expressible. When the client or student has completed the story in a way that satisfies them, they are then free, of course, to fulfil any other aims. They can choose to guard the experience of the telling as private or to take their story into the public realm. If, in the therapy room, the client has told a fictional story, useful links between symbolic representations and the ‘real’ world, and new awareness around issues, can arise spontaneously after the telling is complete. Very often, only minimal intervention is needed to achieve this. To some extent, when the hero learns how to overcome obstacles in the fictional world, the storyteller is simultaneously empowered to work with obstacles in real life. Of course, with some groups I have worked with in hospital settings, it has been necessary to help clients differentiate between what is fiction and what is fact. Where clients experience delusions or
hallucinations, helping them to make distinctions between the real and imagined is a fundamental part of helping them function well in the world. My job as both a psychotherapist and creative writing tutor is to help the individual to re-find their ‘natural storyteller’. First, I support them to learn to trust their innate ability to tell their story. Second, I help them negotiate the interruptions to the completion of that communication.
Writer’s block Writers use the terms ‘writer’s block’ and ‘creative block’. Therapy clients also refer to ‘feeling blocked’. These terms refer to an inability to express, or to complete, a creative process. Block is usually frustrating, and sometimes agonising. It can finish careers and sabotage relationships. Peter Levine (2010) describes how the freezing of body and mind is a lifesaving strategy used throughout the animal
kingdom if the flight and fight responses are not possible. However, he notes that in human beings, in certain situations, it can become ‘inextricably and simultaneously coupled with intense fear and other strong negative emotions’ (p56). Energy becomes trapped in the nervous system, and the cycle of activation through to discharge is unable to complete. When clients or creative writing course participants are inhibited in their ability to tell a story, I often observe a freezing of the body and mind, characterised by stilted sentences and tense muscles. They frequently report feeling a sense of helplessness. As the therapist or course facilitator, my first awareness of their block usually arrives via the transference. I find myself inexplicably feeling stuck in various ways. I note that I am holding my breath or tensing my muscles. Sometimes my thoughts are fragmented and I struggle to form words.
discussion Interruptions to contact To be blocked is to experience the flow of thoughts or words as interrupted. Interruptions to the ability to tell stories often originate from the needs and desires of the individual having become fused over time with the needs of others. Not infrequently, the ‘other’ was a caregiver in childhood. Both in the therapy room and in creative writing group work, participants may initially repeat the stories that they feel they should tell, as well as defining themselves in self-limiting ways through their stories. The internalising of others’ viewpoints may manifest as negative or critical internal voices. This happens on at least two levels, as there is always a story to be told about the telling of a story! I help those I work with to separate out the voices of others from the expression of their own needs and desires. My work with ‘Jed’ illustrates this. Jed approached me two years ago. He was a stooped 27-year-old man presenting with writer’s block as well as physical health complaints. He told me that his father was a well-known poet. ‘I’m scared that I will never write poetry as great as my father’s,’ he said, ‘and it’s ceasing me up.’ I guided him through body awareness exercises. He became aware of where the block was located in his body, as well as where he could touch into flow. Moving between the two, he found ways of ‘chipping away’ at the block until it dissolved into flow. I also employed narrative-making techniques. Through these he explored his sense of self. After the fifth session he phoned me, very excited: ‘I’m writing. The words won’t stop coming! But now I have another problem, I’m writing a comedy screenplay, not poetry. I’ve realised that poetry isn’t my thing. It never was.’ I facilitate the bringing into awareness those aspects of self that have been disowned. What emotions has the storyteller forgotten how to feel because they were unacceptable to family, friends or society at large? What emotions are they afraid to contact because they don’t know how to contain them and therefore fear being consumed by them? The storyteller must ‘safely learn to contain’ his or her powerful sensations, emotions and impulses without becoming overwhelmed (Levine, 2011: 68). The aim is for the individual to be able to tell their story while staying in steady contact with the emotions involved, at an
appropriate level of detail and without diverging from or drowning in them.
The page as vessel It is usually possible to spot in stories where the teller has found it challenging to engage with certain aspects of their experience. They will diverge from, summarise or skim over parts of the story. As the listener or reader, I disengage from the story, thus mirroring the teller’s experience. Here I’d like to cite the example of a psychotherapy client I’ll call ‘Sue’. She was dispirited by her lack of success as a writer. We looked together at her unpublished novel. What I noticed was that every time a plot line called for anger, just before she reached the climax of the conflictual event, she cut away from the action and began a new scene. For historical reasons, she was unable to tolerate the feeling of anger in herself, and therefore unable to write to the heart of the action. I supported Sue to learn to use the page as a vessel to contain the strong feelings in her body. When she could do that, she was able to channel anger on to the page, powerfully and vividly. When an individual can tell their story, unashamedly, they are able to stand proudly in the fullness of who they are. That also enables them to delight in the potential of who they might become. They can then relate authentically to others, and to their world. They discover a quality of connection that they could previously not even dreamed of. Ironically, it’s in finding what we have in common with all other animals that we find our unique voice as storytellers.
References Gottschall J (2013). The storytelling animal: how stories make us human. New York: Mariner. Hunter L (1994). Lew Hunter’s screenwriting 434. New York: Penguin. Levine PA (2010). In an unspoken voice: how the body releases trauma and restores goodness. Berkeley: North Atlantic Books. McNiff S (1992). Art as medicine: creating a therapy of the imagination. Boston: Shambhala. Lahad M (1992). ‘Storymaking in assessment method for coping with stress’. In S Jennings (ed) Dramatherapy theory and practice II. London: Routledge. Perls F, Hefferline R and Goodwin P (2011). Gestalt psychotherapy: excitement and growth in the human personality. Maine: Gestalt Journal Press.
Writing and the art of practice Marie Adams encourages psychotherapists to put pen to paper. Like anything else worth doing, it involves hard work, she says. But what a sense of achievement when the essay, article, thesis or book is completed!
iving workshops on creativity in academic writing to senior practitioners, I am often struck by the anxiety evoked in therapists at the prospect of putting something down on paper. There are many reasons, including self-consciousness, the fear of not ‘getting it right’ and sometimes dyslexia, but the overriding belief seems to be that, unless the words come easily, you are not a ‘writer’. Yet we listen to stories every day, we tell our own stories in personal therapy, we write them in case studies in our effort to qualify, and we tell our stories and those of our clients’ in supervision. Storytelling is as old as humankind and words are the way we communicate. Writing is often the means by which we can let the world know what we have to tell. In my experience, many therapists are inhibited by
Marie Adams For author's details see page 9.
Propp VI (1968). Morphology of the folktale (LA Wagner, trans, 2nd revised edn) Austin: University of Texas Press.
discussion Many therapists are inhibited by the prospect of writing, expecting perfection from themselves early on in the process the prospect of writing, expecting perfection from themselves early on in the process. Perfection is actually impossible and writing something well takes practice, and more than a few drafts. Like anything else worth doing, it involves hard work, but also carries with it the attendant sense of achievement when the essay, article, thesis or book is completed.
Personal story ‘Is this your first novel?’ I’m repeatedly asked. ‘Well… no… just my first one published.’ The ambitions of a young girl have taken many years, and many diversions, to come to fruition. A recent article in one of the national newspapers concerned a group of writers who had formed an alliance, their common thread the fact they had all published their first book over the age of 40. Ah, I thought, what about those of us over 60? It’s taken so many years, I’d like to plant my flag somewhere! My first book, The Myth of the Untroubled Therapist (2014), was published when I was 62. This was the result of several years of doctoral research into the impact of therapists’ personal lives on their work. Halfway through the doctoral programme, in the middle of analysing the data, I went on a writing seminar for ten days intending to hammer out some of the results into a cohesive narrative. Instead, I found myself developing a fictional tale of a therapist on the run from her past. I had no idea where the story came from, and I certainly didn’t know where it was headed. During those ten days I pounded away at my computer, and by the end of it I had the draft of a first chapter for a novel, Telling Time (2015), but not a single word written on my thesis. I came home and settled back down to ‘work’, seeing clients and writing up my research. I loved every minute of that process, or most of it anyway, and realised that my novel, still rumbling at the back of my head, was actually a marriage between some internal landscape within me and the moving stories I’d heard from 40 therapists when researching The Myth of the Untroubled Therapist.
The art of practice As a child, teachers and family members often commented on how well I could write. This resulted in the erroneous belief that writing was simply the product of inspiration, that the urge to write would drive me forward and that whatever came ‘naturally’ was an end in itself. The idea of a first draft, to say nothing of 15 or 20 of them, never crossed my mind. Ann Lamott (1994), tells the story of her brother tackling an essay on birdlife the night before he was to hand it in. Overwhelmed by the subject matter, her father put his arm around him and said, ‘Bird by bird, buddy. Just take it bird by bird’ (p19). If we wrote one page a day, as the playwright Donald Freed has suggested, we would have a 365-page tome by the end of the year (Freed, 2013). There’s no getting around it – writing is hard graft, including those for whom it seems ‘natural’. Stobart, in his book The Expert Learner, points out that even the most apparently gifted child needs the opportunity to develop. For most writers and artists ‘their most creative works come on the back of extensive practice’ (Stobart, 2014: 53). The Bronte sisters, he points out, in one 15-month period as children wrote 22 little books, averaging 80 pages each, and wrote in such miniscule form ‘in tiny two-inch high books – so that it avoided adults’ comments and censure since they could not read it’ (p53). Their writing was also ‘slapdash’, their spelling terrible and their punctuation ‘nonexistent’ (Barker, 2010, p. 201). What a relief! Though its true, of course, that most of us are not the Bronte sisters. ‘Write a little every day, without hope, without despair,’ Isak Dinesen is reported to have said, suggesting that too high an expectation may set us back, sometimes to the point where we might not write at all. Haruki Murakami, in his book What I Talk About When I Talk About Running, claims that some talent may be necessary in order to write, but focus and endurance are fundamental: Fortunately, these two disciplines – focus and endurance – are different from talent, since they can be acquired and sharpened through
training … Writing itself is mental labor, but finishing an entire book is closer to manual labor. MURAKAMI, 2008: 78-79
Writing about elite musicians, Smith (2012) argues that a break between intense periods of concentration can be far more productive than practising for hours on end. I’m a lousy writer in the afternoons, usually having to scratch out whatever I’ve done. I now work on other things after lunch. The truth is, I need time to let things gestate, to let the internal machinery of my brain whirr a little in the background while I do other tasks: the laundry, grocery shopping and cooking to the music of Emmylou. When my knees aren’t causing me grief, I head out for a walk. Most of us need to take a breath in that transition period between one thought and another.
Learning the hard way I’ve had to learn the hard way, and over too many years, that writing takes effort, a narcissistic position if there ever was one. Why should it come more easily to me than anyone else? Stephen King (yes, Stephen King!) who, in my view, has written one of the best books on the subject, entitled simply On Writing, says: You can approach the act of writing with nervousness, excitement, hopefulness, or even despair – the sense that you can never completely put on the page what’s in your mind and heart. You can come to the act with your fists clenched and your eyes narrowed, ready to kick ass and take down names … But it’s writing, damn it, not washing the car or putting
discussion on eyeliner. If you can take it seriously, we can do business. If you can’t or won’t it’s time for you to close the book and do something else. KING, 2000: 80
I never really wanted to do anything else, and through the serious business of writing I have experienced an enormous amount of frustration, but also the deepest and most profound satisfaction. Anything so public as a novel I also know will reveal something of me, something to be chewed over perhaps by others; like becoming a therapist, my interests and the subject matter I’ve chosen are inevitably personal. I am now working on another novel, another therapist hopefully coming to life on the page, a therapist very different from Lisa, the main protagonist in Telling Time, a gentler soul this time, eager to do a job well. I’m not sure I could live with Lisa another five years, a character for whom I feel great compassion but haven’t always liked. From which part of me has she sprung? I’d like to deny that she has anything to do with me at all, except the city in which she was raised, but there is always some truth in fiction and I have to hold that there is a bit of me in her too, though the terrible event in her past, from which she has tried so hard to escape, is not mine. Nor is it a story I heard from any of the 40 therapists I interviewed, but perhaps there is a bit of truth in Lisa’s history in all of us. None of us is without a past, and none of us has lived a life completely devoid of pain. All of us have likely tried to move away from our pain at some point, and on the basis of what I heard from so many psychotherapists, our history invariably impacts our work. I certainly know it has done in mine.
References Adams M (2014). The myth of the untroubled therapist. London, Routledge. Adams M (2015). Telling time. London: Karnac Books. Barker J (2010). The Brontes, London: Abacus. Freed D (2013). French Writers Project, St Paul de Vence. King S (2000). On writing, London: Hodder and Stoughton.
Improving access to psychotherapy training A personal response by Mary MacCallum Sullivan to the views expressed by Andrew Samuels in the last issue on training standards.
write this in a personal capacity. I was delighted to see the interview in Val Thomas’s issue of The Psychotherapist with Andrew Samuels, in which he provocatively speaks of ‘lowering standards’ and sets forth some radical ideas about psychotherapy training. Andrew’s remarks may set a few cats among a range of pigeons, and, since I identify strongly as a teacher in the field, I welcome the debate.
I am entirely in agreement with Andrew in respect of a number of the points he makes, not least that access to training is a political matter. Andrew highlights our propensity, as a professional field, to pull up the drawbridge, and, indeed, to seek to limit access for our own benefit whilst using our advanced/senior status as a way to make money out of trainees, but I protest that I know no psychotherapy millionaires. Some kind of affirmative action or positive discrimination, such as a bursary/loan fund for BME and other disadvantaged candidates that could be managed by UKCP, would be highly welcome and arguably overdue, but this would have to be based on firm research evidence of where the problem of underrepresentation lies, which must come first. UKCP should not be accrediting any training that fails adequately to address
the realities of human complexity, or ‘difference’ and discrimination of all kinds, alongside the subjective and intersubjective biases of the therapist. Equally, a recognition of the capacity of the client for selfdevelopment and healing, given a relatively ‘safe space’ and a facilitating human environment, has to be an early and essential learning outcome in training. Where I strongly disagree with Andrew is regarding the shape and content of training. I consider his prescription a recipe for ‘dumbing down’ training – indeed a lowering of standards. Psychotherapists must learn and ‘live’ their modality, must have a strongly coherent theoretical rationale for their own formulation of an ‘integrative’ perspective on what it means to be human, on what it means to practise psychotherapy. If we insist on maintaining a focus on the differences between modalities, we remain stuck in this arid plain of professional narcissism, which prevents us from addressing the farther horizon of how to establish and maintain a therapeutic relationship under all sorts and conditions of fire. The acceptance of and emphasis on pluralism comes when, as professionals working with a diversity of colleagues and modalities, we focus on working together for the good of our clients/patients and on developing a unified voice in the world for the benefit of the field of psychotherapy.
Lamott A (1994). Bird By bird, New York, Anchor Books. Murakami H (2008). What I talk about when I talk about running. London: Harvill Secker. Smith E (2012). ‘What some people call idleness is often the best investment’. New Statesman. www. newstatesman.com/business/business/2012/07/ what-some-people-call-idleness-often-bestinvestment. Stobart G (2014). The expert learner. Maidenhead: Open University Press.
Mary MacCallum Sullivan is a former teacher, and until recently was Organising Tutor of the Human Development Scotland (HDS) Postgraduate Diploma in Psychodynamic Counselling and Therapeutic, validated by COSCA, which has been running since September 2009. Mary is a UKCP registered psychotherapist, and registered with COSCA in Scotland as a Practitioner Member and Accredited Trainer (Diploma level).
Reflections on my time as chair of UKCP
Psychotherapist Collaboration with other organisations in our field is vital in order to increase awareness of mental health issues and to increase access to psychotherapy and psychotherapeutic counselling.
While we look at raising awareness externally, it’s vital to have the internal structures to support the work we want to do. One of the key pieces of work during my time as chair was the Shape Review that I promised in my manifesto four years ago. This complex project looking at improving the way UKCP works began in 2013 and concluded in 2015 with some key changes to the governance of our organisation. More detail on the Shape Review was covered in issue 60 of The Psychotherapist. During the course of the review I travelled to meet members in regions outside London and was always made very welcome even though members came rightly so with the complaints and
his is the last copy of The Psychotherapist that I will contribute to as UKCP chair. In March this year we will welcome in a new chair who will bring with them enthusiasm and new ideas on how to take UKCP forward. With this in mind, I find myself reflecting on our achievements as an organisation during my time as chair.
Raising the profile of UKCP and of psychotherapy
A new era of working Last year I was delighted to announce collaboration between UKCP, BACP and BPC following a gradual increase in shared activity over the last few years. Our intention is to retain our unique identities while recognising that we have a stronger voice when we are united. The collaboration makes a public statement that we share a commitment to improving the nation’s health and wellbeing. The launch of this work was reported in issue 61 of The
Shaping the organisation
An important part of ensuring the success of UKCP is raising the profile of our organisation and of psychotherapy as a profession. There are many ways we do this, whether that’s engaging on social media; publishing survey results of psychotherapy provision in the UK on BBC radio 4’s You and Yours programme, being on ITV Daybreak or seeking to collaborate with other psychotherapy bodies to promote the importance of key issues surrounding psychotherapy. Increasing our work with government has been a large part of the public policy work of the last few years we have regular meetings with MPs and published our valuing mental health report in the House of Commons and have had some meetings with NICE to start a dialogue about expanding the therapies available on the NHS. Of course there is always more to be done. As we see the spotlight turn increasingly towards mental health and the provision of treatments on the NHS, I hope that we can continue increase our work in this area.
Janet Weisz UKCP Chair
ukcp news concerns too. I also attended meetings in Wales and Scotland and Scotland now has an active public policy group focusing on issue for their nation. This is work in progress for Wales and Northern relend.
Introducing the new Complaints and Conduct Process In autumn 2013 we introduced a Complaints and Conduct Process (CCP) for all UKCP members. We wanted to develop a fair and transparent process that would promote public confidence in our profession. Introducing the CCP as a requirement for UKCP registrants to come under the UKCP CCP rather than their Om’s was a vital part of maturing of our organisation and professions and became a requirement when we applied to have the register accredited by the Professional Standards Authority. You can read more about this in issue 55 of The Psychotherapist. During 2014 we consulted with members about the new CCP. We then established an independent advisory group to review and discuss the feedback received and to offer
recommendations to the UKCP Board of Trustees about what might be improved. All except one of the recommendations was approved by the Board last September. I am reminded me that when I was elected we were heading to statutory regulation by HPC. This changed with the introduction of the assured voluntary registers PSA and we spend the best part of a year getting UKCP ready to apply to the PSA.
Governance Along with reviewing our shape and applying for PSA we reviewed the workings of the Board and put the Board meetings in line with annual UKCP work. We have developed robust activity and budget setting processes for UKCP work
Project Boards One of the innovations I introduced is the use of project boards to oversee our major projects. One such board is our Digital Delivery Project Board, a group comprising psychotherapists and staff. It will oversee the work we’re doing to totally redevelop
our website and introduce a new Customer Relationship Management system (CRM – or database). See page 50 for an update on the project). I am aware of members’ frustrations regarding our website and find a therapist, we have been very slow on this, but would prefer to take time to get it right.
Memorandum of Understanding In January 2015 we launched the Memorandum of Understanding on gay conversion therapy. With support from the Department of Health, we were able to bring together 14 signatory organisations including NHS England, NHS Scotland and the Scottish government. The Memorandum details how professional therapy bodies will work to ensure both new and current therapists are better equipped to handle appropriately requests for change from those unhappy about their feelings of sexual attraction. It was a positive and significant step forward to see a large number of psychological and medical profession organisations uniting on this key issue.
Come to the Members’ Assembly in March This is just a snapshot of some of the work that has happened over the last four years which I have been involved in. There have been some promising changes within the organisation and I am grateful to have had the privilege of leading UKCP as chair throughout. As I write this article, our two candidates for chair, Pat Hunt and Martin Pollecoff, are in full-swing campaigning mode.
I wish them both every success in their campaigns to become the next chair of UKCP. We’ll be introducing the new chair at the Members’ Assembly on Saturday 12 March 2016, if you would like come along and meet the successful candidate you can book your place now at: bit.ly/1PhIwd1
The Professional Conduct Committee: an update By the time this article goes to print, we hope the Professional Conduct Committee (PCC) will have recruited two new members. It will also have held its first Learning from Complaints workshop for UKCP members. At the time of writing, 60 people have booked, which I must say is very encouraging and a clear indication that members want to engage with and learn from the complaints process. Why is the complaints system so legalistic? Speaking to members at various events and meetings, one question I’m commonly asked is: ‘Why is the complaints system so legalistic?’ I’m afraid the answer is very simple. Once a member is informed that a complaint has been made against them, their first call is usually to their insurer. The insurer, in order to mitigate any liability to themselves, then instructs legal representation for the member. Invariably, the first action of that legal representative is to try to have the complaint dismissed. If that fails, they challenge UKCP’s complaints procedure in order to try and prevent the complaint from being heard. It is important here to note that they are (usually) acting in their client’s best interests. UKCP then has no option but to instruct counsel to deal with these legal challenges, and so the legal arguments begin. No one is happy with this situation and I have had, and voiced, my concerns on this issue for several years. In my view, the only winners here are the lawyers who result in significant costs to both sides. That said, the most serious cases do need legal representation as they must always go before an adjudication panel and that
may result in a restriction to someone’s livelihood.
A fairer system So how, having just gone through a consultation on the Central Complaints Procedure (CCP), can we move to a less adversarial system that is fair to all, both members and the public? We can in my opinion do so within our current rules. I personally have always believed in local resolution and believe that if a complaint can be resolved at the point of delivery – by the UKCP member in this case – they should be given every opportunity to do so with the help of local mediation. These situations could easily be identified by the case managers and referred back to attempt local resolution. As stated above, there are the exceptionally serious cases that must come straight to UKCP, these being the most serious cases of professional misconduct. It would be good to hear your views on local resolution and how it might work (or not) – please share your thoughts with us. We will have discussed the issue at the workshop in February and aim to move it forward over the next 12 months, thereby making the complaints system less legalistic and more user-friendly for all.
Brian Linfield MBE is Lay Chair of the Professional Conduct Committee and comes from a 15-year background of statutory regulation within water industry and as a regional lay chairman for complaints within the NHS. He sits as a magistrate in both family and criminal jurisdictions and also sits as a disabilityqualified panel member of the First-tier Tribunal Service of the Social Entitlement Chamber. He works as a civil servant for the Office for National Statistics.
The latest figures The last 12 months’ figures for complaints are now in. In brief, there has been an increase in complaints made, but this is only to be expected given that all complaints are now centralised and the public can easily access the complaints procedure through the UKCP website. That said, the increase must also be put into perspective: UKCP has approximately 7,500 members and of the 42 formal complaints made only nine were accepted. Of these nine cases, six have been to adjudication panels, resulting in one ‘no case to answer’ and four members having sanctions imposed. All were dealt with by the Complaints team within specified timescales; unfortunately, there is one case currently part-heard by an adjudication panel that is just over 12 months old. There were two interim suspension order hearings that resulted in applications for interim suspension being granted. The Complaints team currently has another six complaints under investigation. The team at UKCP dealt with 280 general/complaint enquiries. I look forward to feeding back information from the workshop in my next article.
Digital Delivery Project update Richard Williams, Digital Delivery Project Manager
s reported in the last issue of the magazine, we are currently working on a project to totally redevelop our website.
I am delighted to say that, following a tendering process, the Digital Delivery Project Board has chosen a supplier for the new website. The Project Board was particularly impressed with the emphasis that the chosen company placed on researching what it is that our website visitors need, and on user experience. The company will conduct further research with members, potential members and the public in order
to ensure that the new website meets the needs of all UKCP’s stakeholders and users. A key part of the website will be the database, or Customer Relationship Management system (CRM), that sits behind it. Many of the services provided by modern websites are actually created by a database. For UKCP, it will be functions such as Find a Therapist, the UKCP register and member renewals. For this reason, much of the work at the end of last year focused on which CRM system would work effectively for us. After undertaking an extensive CRM platform and supplier selection process earlier this year, we have chosen what we
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. Richard read a Master’s degree in Management, following which he has led and implemented business change programmes in the arts and culture sectors, most recently at the Royal Opera House.
believe to be the best to suit UKCP’s needs. It’s an application built specifically for membership organisations, using one of the world’s most recognised CRM platforms – ‘Salesforce’ – as its foundation. We have completed the CRM ‘discovery’ phase where we outlined our requirements. We held a number of workshops in which members, committee chairs, trustees and staff described our processes and what we wanted from the new system. The suppliers have now costed our requirements and, not surprisingly for a project of this kind, the initial quote has come in higher than the bid. This is not unusual following ‘discovery’, so we are taking the time to see how we can reduce these costs while maintaining our commitment to quality.
Richard Williams has taken over as Digital Delivery Project Manager from Teresa Keohane. We wish Teresa every success for her future.
Ethics Committee members sought London We’re looking for TWO UKCP registrants to join our Ethics Committee, which oversees, reviews and maintains UKCP’s Ethical Principles, Code of Professional Conduct and associated policy, guidance and standards. The work of the Committee is significant in our field, as it consults and comments on ethical developments in the relevant professional areas and works to promote ethical practice through national conferences, seminars and workshops. The Committee has to consider, debate and address issues from a range of perspectives. You may have other experience which is of value to the Committee in line with our broader requirements, but whatever your background and expertise, you’ll be wellinformed, interested and engaged in the issues. UKCP and its committees work in a complex, sometimes sensitive area. You’ll bring wisdom and perspective to the group and will demonstrate high analytical capacity, with the ability to explore
and discuss complicated ethical and moral issues to arrive at a sound judgement. With outstanding interpersonal skills, you will be someone who performs at their best as part of a diverse and dynamic team. In return, these appointments offer an excellent opportunity to be part of a formidable team working together to get to the heart of the matter. To find out more about this role, and how to apply, please visit bit.ly/1Tab1vF Closing date for applications is noon on Friday 14 March 2016. UKCP aims to be an equal opportunities employer. We welcome all applications, regardless of 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 socio-economic class of individuals and groups.
Welcome to our new UKCP members Psychotherapists Katherine Feisal Christine Lorraine Georgina Jan Rose Sasha Rachel Noel Nancy Douglas Leah Teresa Cristina Renée Anne Dianne Lucinda Alice Taru Stuart Joanne Brigid Melissa Heena Lucy Susan Sebastian Christina Julia Clive Vanessa Marietta Mary Jeremy Dave Stephen Rebecca Camille Jaqueline Lee Melissa Jonathon Cristina Denis Virginia Lauren
Rebecca Danny Felton CCPE Michael Robert Janine Fuller CCPE Ahl MC Shirley Sam Gallo SPTI Ali CCPE Barnaby Steve Gardner UPCA Andrade BPA Rebecca Helen Germaine SCPTI Bagshaw SPTI Catherine Elizabeth Gray CAP Bainbridge MI Marian Margaret Rachel Grayson MI Baker MI Julie Fergus Greer FPC Baring AA Cristina Sue Griffin UPCA Bates MC Anna Kam Gupta FPC Beaumont SPTI Shan Dawn Gwilt WPP Bell CCPE Todor Erene Hadjiioannou MI Bell MC Angela Sarah Hall IATE Bennett TER Flandina Rebecca Hall MI Bijelic RSPP Charmaine Deirdre Hartley AFT Bonilla CCPE Louise Gopalkrishna Hegde AOMP Boserman IGAP Andrea Linda Helm-Manley RV Botham MI Maggie Sophia Hilsley FPC Boyd IGA Rehana Lal Hitchcock BCPC Bradshaw AFT Jacqueline Rachel Hopping MI Bubear CCPE Diana Sandra Hughes CCPE Buckee BCPC Alexandra Lis Hughes Jones WPP Burstall AFT Elena Sarah-Jane Hull SPTI Cale NCHP Mahsheed Sam Jahara MI Calvert WPP Helen Berjanet Jazani CFAR Carley MI Shane Alison Jenkins MI Chauhan TER Barry Graham Johnston BC Christopher MI Zachary Cari Bishop Jones BI Collier SPTI Anastasios Sophie Jubb CF Colonna FPC Helga Kadia Kante AFT Condron MI Norma Helen Kerridge SEA Cooke MC Gillian Jean-Christophe Larkin IGA Cooper FPC Annette Barbara Leon FPC Correa CABP Gary Anne Lion AFT Cunningham AFT Chloe Andrea Loaiza-Palacio TER Curtis-Weight AFT Joanna Christopher Loh AFT Cutler PA Matthew David Rachel Lohan MI Davidson CCPE Lindsay Rachel Lucas SPTI Davies AFT Catrin Jasenka Lukac-Greenwood MI Davies FPC Lisa Miranda Mackay-James GP De Stempel FPC Saira Robert Manners SPTI Dias UPCA Tom Clare Manuel MI Du Plessis WMIP Louise Miranda Marsh IATE Dunlop BCPC Helen Julia Martin WPP Dunn AFT Susan Jonathan Mason SPTI Durigon MC Claudia John McDonald SPTI Echard GP Gillian Sarah Mead IFT Ellis NGPC Caroline Maria Melas IFT Errington AFT Martin Jenny Merriott BC
Marina Wilkins MI Mitchell MC Samantha Williams MI Montgomery IPSS Jackie Wilson RSPP Moore MI Virginia Winter FPC Morrison-Lyons MC Katharine Wray FPC Murkin AFT Juliet Wright CCOPPP Musto FPC Susanna Wright MC O'Connor COSRT Megan Yakeley NGPC Oates AFT Norma Yam FPC Odigie-Bulnes TER Christopher Zach AIP Patel TER Premachandra MI Psychotherapeutic Counsellors Proykov AFT Jacqueline Anslow MCCP Renders AFT Sarah Ayre SCPTI Rigamonti FPC Erica Briscoe IP Robertson-Jones AFT Audrey Bronstein UPCA Robinson UKATA Andrew Brown NGPC Rosen AFT Sally-Anne Bubbers CPPC Russell WPP Anne Bulmer TACT Saeed CCPE Susan Carter MCCP Samuel BC John Henry Carter UPCA Samuels TER Louise Elizabeth Clark MCCP Schlotterbeck GCL Charmaine Dunmow MCCP Shaftan CCPE Laura Kate Evers UPCA Sharifi CCPE Jane Ford MCCP Skelton MI Michael Grant CPPC Sneyd WMIP Gill Harvey MCCP Solomons FPC Suzi Howey NGPC Solomons SCPTI Emma Hughes TACT Spiliadis AFT Stella Hutchison CPPC St Blaize BC Cathy Ingram CPPC Stewart AFT Susan Irving NGPC Stone CF Antony Johnston UPCA Strzedulla IFT Saeed Khalilirad CPPC Symons MI Lorraine Knibbs CPPC Tahta BCPC Catherine Knibbs NGPC Thomas AFT Janette Liddement CPPC Thomas AFT Pauline Long CPPC Thomas AGIP Kinda Orfi CPPC Thorp WMIP Alicia Pinkston CPPC Tilling SPTI Jane Porterfield CPPC Todd IATE Mark Sainsbury CPPC Tomaszewski CCOPPP Collin Siemer UPCA Tunbridge MI Rebecca Southall CPPC Tunnicliffe SPTI Deborah Spratling MCCP Tyler FPC Jean Staff MCCP Venosa NLPCA Kathy Stewart NGPC Verdugo FPC Sharon Lesley Summers NGPC Walker TER Diana Wells CPPC Weegmann IGA
ACOMP Accrediting Organisation for Medical Psychotherapy · ARBS Arbours Association · ACAT Association for Cognitive Analytic Therapy · AFT Association for Family Therapy and Systemic Practice · AWAKEN Awaken School of Outcome Oriented Psychotherapies · BCPC Bath Centre for Psychotherapy and Counselling · BPA British Psychodrama Association · CFET Caspari Foundation · CCOPPP Canterbury Consortium of Psychoanalytic and Psychodynamic Psychotherapists · CCPE Centre for Counselling and Psychotherapy Education · CAP Confederation for Analytical Psychology · 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 · 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 · IPS Institute of Psychosynthesis · IPSS Institute of Psychotherapy and Social Studies · KI Karuna Institute · MCCP Matrix College of Counselling and Psychotherapy · MET Metanoia Institute · MC Minster Centre · NCHP National College of Hypnosis and Psychotherapy · NGP Northern Guild for Psychotherapy and Counselling · NRHP National Register of Hypnotherapists and Psychotherapists · PCP PCP Education and Training · PA Philadelphia Association · SCPTI Scarborough Counselling and Psychotherapy Training Institute · SPTI Sherwood Psychotherapy Training Institute · SITE Site for Contemporary Psychoanalysis · SEA Society for Existential Analysis · TACT Therapy And Counselling Teesside · TER Terapia · BC The Bowlby Centre · GAPS The Guild of Analytical Psychologists · SPCRC The Regent’s School of Psychotherapy and Psychology · UKAHPP UK Association of Humanistic Psychology Practitioners · ITA United Kingdom Association for Transactional Analysis · UPCA Universities Psychotherapy and Counselling Association · WMIP West Midlands Institute of Psychotherapy
Step up, step out and speak ‘How about putting a TEDx talk on your wish list this year?’ Lou Lebentz asks. Why? Because it’s an ideal platform for therapists and helps you develop professionally too.
was absolutely delighted and extremely grateful to be offered a talk this year at the TEDx Covent Garden. I was also, to be honest, utterly terrified at the prospect, as this was only my third time ever standing on a stage speaking, so even more fear-inducing to boot.
Inspirational speaking I was fortunate in one respect, though. I had spent the previous 18 months overcoming my horrendous glossophobia (intense fear of public speaking). So, although I was still scared, I wasn’t quite as horrified as I would have been had I been asked a couple of years beforehand. Furthermore, I’d also decided to change career direction, hence my training in public speaking the previous summer. I’d chosen to depart my oneto-one therapy practice and venture into online training and, wait for it, inspirational speaking. Haha! So I guess overcoming the fear, practising coming out from behind the therapy screen and putting my own story out there unequivocally had to be part of the changing direction and identity process.
The appropriate decision But I faced a dilemma: the TEDx curator who’d invited me to speak witnessed my first talk and wanted me to tell the same ‘mental health, psychosis and addiction’ story she had heard. However, I hadn’t quite completed the career switch to online trainer/speaker yet. I had a handful of regulars remaining in my private practice and I believed that my existing clientele should not have to hear my story online. I was concerned – perhaps overly in hindsight – that if they did it might affect them negatively or even undo our therapeutic work. It was really hard to make the appropriate decision, especially with all the ethics entailed in our work. I was also (somewhat selfishly) worried about how it might impact on my change of direction if I declined the opportunity. Eventually, after multiple supervision sessions, testing
the water with clients and a lot of soul searching, I decided it was too great an opportunity to dismiss.
couldn’t recommend the whole experience highly enough.
I was given a maximum of 18 minutes, which isn’t that long to get your message across, but plenty long enough for my beginner’s stress levels to cope with for sure! I soon realised that the biggest challenge was editing the talk down to the time length; if you go over, TED often won’t upload it online.
This article is about how strongly I would recommend the TED platform to therapists in particular. As therapists, we have some great messages and stories to tell. We are so lucky to be able to spend time daily honing a skillset that is totally transferable to other transformational positions and roles. Speaking has to fall into this category, and
Putting my own story out there … had to be part of the changing direction and identity process One diamond thread You are advised strongly to go for one message, one diamond thread that is the main argument of the talk. For me, this was the trickiest task, but eventually I chose the message ‘believe in yourself’. Self-belief is such a fundamental foundation of good mental health and has been the area I, like a lot of people, have personally struggled with. I had to learn the whole 18-minute talk by heart as I was advised not to use slides or any visuals. This turned out to be rather challenging on the day, especially when the nerves kicked in. I would recommend when doing your TEDx or TED talk that you use the slide option if you can – that way you get a prompt on stage of what’s coming up next, which in hindsight would have been really useful. The day of the event itself was amazing – the team at TEDx, the other speakers and the crowd who turned up were fantastic and the energy was electric. It’s such a wonderful experience and yet totally terrifying at the same time. However, the support from everyone is superb and it feels incredible once you’ve done it. I
it’s so fulfilling and almost joyful once you get out there and over the fear. TEDx are always looking for speakers who can share their experiences and thoughts with the world, and the feedback I’ve received from clients and colleagues alike has been really positive and supportive. None of my clients, thank goodness, seemed upset by my disclosure, nor traumatised! If anything, seeing me like them, as a human being, with a history, not perfect, vulnerable, but vitally as a work in progress, has helped our relationship.
Many benefits The talk has not gone viral, nor is it getting high viewing figures, but having dusted
Lou Lebentz is founder and CEO of Sweet Dreams, an online quit sugar programme with live motivational seminars launching later this year. For more information about Lou and Sweet Dreams visit www.loulebentz.com
ukcp members down my ego and coming back to my newly found good-enough self, that really doesn’t matter. The benefits have been the people contacting me since the talk about book publishing, speaking gigs or offering themselves as agents – so, on that score, it’s been worth doing a TEDx purely for professional development reasons. Of course, that’s not and should never be the reason for doing a TED in the first place; if that is the case, the curator will probably sniff it a mile off and you most
likely won’t get asked. But in our profession we are never self-serving first, which is why doing a TEDx should be on your ‘to do’ list. In essence, it’s the same as we do daily – changing, informing and inspiring people with our words, our hearts and our voices. There will be a few listeners with whom your message and your story will truly resonate and that’s the real diamond of participating in the whole TEDx event – to know that through using your therapeutic
grounding you can reach and help a wider audience who would otherwise not have crossed paths with you. To end, I’d encourage you to put a TEDx on your list for next year. It’s in alignment with our whole ethos and what our training and years of development are genuinely geared up to be all about. Lou’s talk, ‘The sweet sanity of madness’, can be viewed at bit.ly/1Nkj7xR
Obituary: Patricia Williams Tricia Williams, Principal of Iron Mill College, died peacefully and gently in the early evening of 28 November 2015, her family by her side.
ricia had lived a full and active life until she was diagnosed with pancreatic cancer only a matter of weeks before she died. Having visited her in the hospice only a week before she died, it came as no surprise to us that her room looked like Kew Gardens in the springtime, with beautiful flowers spilling over their vases in every possible space; the walls were covered in the many cards and letters she had received from all whose lives have been touched by her and who loved her so dearly. Taking a look back over her career, it would be no exaggeration to say that there have been many hundreds of people whose lives have been better for having known her. She initially trained as a general nurse, later becoming a paediatric nurse and a health visitor. Her interest in counselling began here at the Iron Mill in 1990, when she took part in a Certificate in Counselling, and this passion continued to grow over the years as she completed further training, first in TA and then in Psychodrama Psychotherapy. She became a Macmillan Counsellor in 1995, responsible for setting up the counselling service within the Oncology Directorate in the Poole Hospital
skill and care enabled the college to go from strength to strength. She maintained her private practice throughout, working mainly with looked after children and their carers. Finally, but most importantly, it would be impossible to describe Tricia’s life without mentioning what was at the beating heart of it - her children and grandchildren, of whom she was always immensely proud.
NHS Trust, where part of her role included setting up a grief support programme for children and families. Her office for the nine years she held this role was just down the hall from the flower-filled hospice room in which she spent her last few weeks. Tricia went on to take a number of senior and lead roles as a therapist, and became the co-founder of Mosaic, a childhood bereavement support charity. From January 2011 she became Principal of Iron Mill College, where she remained an inspiration and a leading light, and she led it as she lived: with strength, warmth, passion, feeling, kindness and love. She was instrumental in developing the potential of the college in the same way she developed the potential of the many people she trained and worked with; her
Her room came to be filled with so many flowers and cards because so many people were trying to find the right words to say how much she meant to them. Her warmth, skill and care touched and changed many hundreds of lives over the years, and the world is left a far better place because she was in it. Tricia collected many gifts given to her by people whose lives she had touched over the years. One such gift is still on display on her mantelpiece in her office: a poem, by Dawna Markova. It says: “I will not die an unlived life”. We can safely say that Tricia didn’t ‘die an unlived life’ - quite the opposite - and we are glad she shared it with us. Rose Bedford, Academic Development Lead, Iron Mill College.
continuing professional development
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ISTDP-UK PRESENTS A ONE DAY CONFERENCE TREATING SURVIVORS OF TRAUMA An Intensive Short-Term Dynamic Psychotherapy (ISTDP) Perspective
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Browns Covent Garden, 82-84 St. Martins Lane, London WC2N 4AG
Dr Steve Allder, Neurologist Alexandra Knowles (Pokorny), Psychoanalytic Psychotherapist Dr Nat Kuhn, Psychiatrist Full fee: £150 Earlybird: £135 ISTDP-UK member: £135 Student rate (limited places): £100
Friday 1st July, 2016
Followed by a MASTERCLASS on the 2nd July To find out more and book visit our website www.istdp.org.uk
continuing professional development To accompany our new Routledge manual, we present:
‘The Un-Making of Them’ A Diploma Training and CPD in
Specialist Psychotherapy with Ex-Boarders
L RT O F SI
A two-day conference exploring the place of Silence in Psychotherapy, Society and our World 16th/17th April 2016 Regent’s University, London S PEAKER S Brian Keenan – Writer and Poet Maura Sills – Founder, Karuna Institute Rebecca Crane PhD – Director, Centre for Mindfulness Research and Practice, Bangor University Matthew Adams PhD and David Harley – Lecturers, University of Brighton Catherine McGee – International Meditation Teacher and Advisor to One Earth Sangha Mac Macartney – Public Speaker, Author and Embercombe Founder
For all further information visit the conference website: www.theheartofsilence.co.uk
Cutting-edge 8-day programme and referral network for this rapidly growing client group, experienced staff team: main trainer Nick Duffell and senior supervisor Prof Joy Schaverien. Starts April 16th in London. Download full details of post-graduate training curriculum and CPD options at: www.boardingschoolsurvivors.co.uk/for-therapists
Harley Therapy – Psychotherapy & Counselling We are looking for experienced UKCP accredited psychotherapists who are competent in at least two psychological models one being CBT or third wave psychotherapy model. You will work at least 10 hours a week (evenings and/or weekends) on a long-term sessional basis from our rooms in Canary Wharf, City of London or Harley Street. Hourly rates of pay apply. We welcome applications from therapists who are compassionate, hard working, committed to professional development and to promoting clients’ mental health. For more details and to apply please visit:
EMDR Therapy Accredited Training
3 Part Psychotherapy training delivered by
Matthew Wesson - EMDR Trainer, Psychotherapist, Military Veteran
NICE & WHO recommended for PTSD. Also used for many other conditions
The Association of Core Process Psychotherapists
ACPP is the membership organisation for practitioners of Core Process Psychotherapy. THIS CONFERENCE COUNTS FOR 14 HOURS CPD
Small, friendly trainings inc’ lots of video & demo’s
Dates throughout 2016 in Chester, Sheffield, Newcastle, Exeter & Milton Keynes In-house training available for groups of 8 or more www.emdracademy.com email@example.com
+44 (0)1829 732721
continuing professional development INSPIRE CONNECTION
Certificate in Coaching Are you a counsellor or therapist wanting to expand your practice by providing coaching in a variety of contexts, including private practice, organisational settings or as part of everyday life and work?
â€˘ TAKES PLACE SOON: MARCH 7-11 2016. â€˘ LEARN A RELATIONAL APPROACH TO COACHING. â€˘ BUILD ON YOUR EXISTING STRENGTHS AND EXPERIENCE AS A COUNSELLOR/THERAPIST. â€˘ ONE-WEEK INTENSIVE COURSE. â€˘ NO EXISTING EXPERIENCE OF COACHING REQUIRED. â€˘ LOW-COST FOLLOW-UP ACCREDITATION OPTION WITH THE NHS-RECOGNISED ILM.
Led by Simon Cavicchia and Mark Gawlinski, with guest trainer Tina Dickens. Simon Cavicchia is an international organisational coach and consultant and a psychotherapist. He is joint co-ordinator of the MA/MSc in Coaching Psychology, Metanoia Institute, London. Mark Gawlinski is a psychotherapist and coach and former senior lecturer in leadership. Tina Dickens is a qualified and accredited business coach, trainer and mentor - and specialist in sales mentoring.
The Chiron Association for Body Psychotherapists offers a new
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Body psychotherapy is at the forefront of integrating the main contemporary psychotherapeutic modalities and teaches the most versatile and most state-of-the-art approaches to truly integrated work. The main sub-modalities of body psychotherapy (Biodynamic psychotherapy, Biosynthesis, Bioenergetics, and BodynamicÂŽ psychotherapy) and some body-based trauma therapy methods, as well as relational psychoanalysis, attachment theory and Gestalt therapy will be included in our cutting-edge body psychotherapy training. The course is over 2 to 3 years and intended to be completed by therapists who have an ongoing therapeutic practice. It is oriented towards UKCP accreditation as a Body and Integrative Psychotherapist. It is most suitable for those who want to become more rounded, work at a deeper level, and be more clinically effective. # .,$($("1$&&$($.$&&2 !),.#)- 1#), +/&$3 *-2#).# ,*$-.-& 0 &), +/$0& (. $,-..,$($("$(.% $( *. ' , -. ,2- *,$& (/(
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INVEST IN YOUR PRACTICE Sex and Sexuality in Couples Work 11-12 April 2016. Want to gain confidence and skills in working with sex issues? Led by Dr Lynda Osborne and Carole Ashton.
Attachment, Separation & Loss in Couples Work 19-20 May 2016. Want to support couples and yourself during difficult transitions? Led by Dr Lynda Osborne and Dr Marie-Anne Chidiac.
Certificate in Couples Work Starts October 2016. Want to start or develop couples work? Four two-day modules. Led by Glenn Nicholls.
Certificate in Supervision Starts October 2016. Expand your practice. Five two-day modules. Led by Dave Mann.
Certificate in Counselling and Therapy for Adolescents Starts November 2016. Build connection with adolescents. Two four-day modules. Led by Bronagh Starrs. MORE INFO: Web: www.TheRelationalAcademy.org E-mail: admin@TheRelationalAcademy.org Phone: +44 (0) 1223 967 971 Location: Cambridge, UK (50 min London)
continuing professional development Relational Organisational Gestalt (ROG)
The ROG training programme we offer provides skill enhancing training for coaches, consultants, OD & HR professionals and enables managers/team leaders of larger systems to work more effectively. This training is also ideal for therapists and counsellors aiming to move into coaching or organisational work. Facilitated by Nicky Burton, Marie-Anne Chidiac and Sally Denham-Vaughan. Date: Starts 2-3 March 2016, Surrey
Couple Work Certificate
This programme of four workshops (ten days in total) 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. Facilitated by Lynda Osborne & Marie-Anne Chidiac. Date: Starts 5-7 May 2016, Reading, Berkshire
International Dialogue Masterclass We help individuals, couples, families, teams, organisations and communities find improved outcomes through better relationships. For more information and to JOIN US visit
This workshop will introduce relational theory and leadership practices and show how they draw upon and put to work dialogical understandings. It is aimed at all practitioners with an interest in the theory and practice of dialogue. We shall draw upon the work of scholars and researchers including Buber, Bakhtin, Bohm, Foucault and Hosking. Facilitated by Maggie Shelton & Dian Marie Hosking. Date: 14-17 June 2016, Worcestershire
Residential â€“ The Well-Grounded Therapist
This weekend retreat is held in the stunning setting of Poulstone Court in the Wye valley near Hereford. In this quiet place, we will explore inner and outer landscapes to restore connections with ourselves, with others and the wider environment. Use of story, ritual and creative materials will help create structure for the workshop. Facilitated by Miriam Taylor & Vienna Duff. Date: 10-12 June 2016, Hereford
BA Therapeutic Care ASSOCIATION OF JUNGIAN ANALYSTS
MAKE A DIFFERENCE Care for those who need it most
12th March 2016, 2pm - 4pm For psychotherapists wishing to become Jungian Analysts The Association of Jungian Analysts (AJA) is a London-based Jungian organisation, offering experienced therapists the opportunity to train as Jungian analysts.
Why do some people have emotional or psychological difficulties? How can you help?
This specialised training course enables practitioners to make the transition from psychotherapist to Jungian Analyst. Candidates may come from many different backgrounds and trainings; psychodynamic, arts therapy, humanistic and integrative, individual and group, and would normally be members of BPC or UKCP. AJA is among the more pluralistic trainings in Analytical Psychology in London and includes a wide range of seminar leaders with international reputations on the training faculty. The training leads to membership of AJA and registration with: IAAP (the international umbrella organisation for Jungian Analysts) BPC (British Psychotherapy Council) UKCP (UK Council for Psychotherapy). To book a place or make enquiries email our training administrator:
firstname.lastname@example.org or call 07901 590015
For further information on AJA and future events visit www.jungiananalysts.org.uk
BA Psychoanalytic Studies
WHATâ€™S REALLY GOING ON UNDER THE SURFACE? How well do you understand our inner motivations, fantasies, and defence mechanisms? www.essex.ac.uk/cps/ug
continuing professional development Trauma — Attachment — Complex Dissociation Conferences, Workshops & Training Courses
Affordable Practical Training for People in Practice from the UK Network of
European Society for Trauma & Dissociation
Understanding and Working with Dissociation A Foundation Course in four one-day modules at BOURNEMOUTH UNIVERSITY
Module 1 : Introduction to trauma-related complex dissociation………………………………12 May 2016 Module 2 : Developmental origins of dissociation in childhood………………………………….13 May 2016 Module 3 : Introduction to assessment & treatment of complex dissociation………………9 June 2016 Module 4 : Resources & resourcing, body-centred work with dissociation………………...10 June 2016
Details & booking at http://estdukfoundation2016.eventbrite.co.uk
Working Therapeutically with Complex Dissociation A Post-Foundation Course in four one-day modules at NORWICH WELL-BEING CENTRE
Module 1 : Evidence based diagnosis and informed treatment for dissociative disorders & PTSD …………. 13 Oct 2016
Module 2 : More resources & resourcing, body-centred work with dissociation…………..14 Oct 2016 Module 3 : Evolving therapeutic relationship from the perspectives of D.I.D. clients……10 Nov 2016
Module 4 : Struggling for relationship—exploring complex practice issues…………………11 Nov 2016
Details & booking at http://estdukpostfoundation2016.eventbrite.co.uk
Train with the IGA ABERDEEN • BRIGHTON • EDINBURGH • LONDON • MANCHESTER MIDLANDS • NORTH EAST • OXFORD • TURVEY (BEDS) • YORK 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.
The IGA provides:
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.
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
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. 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. Book online at www.groupanalysis.org or ring the National Office on 020 7431 2693.
INSTITUTE OF GROUP ANALYSIS
1 DALEHAM GARDENS • LONDON NW3 5BY • TEL: 020 7431 2693 • WWW.GROUPANALYSIS.ORG
Book online: www.groupanalysis.org
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Enquires: 020 7431 2693
continuing professional development
Psychotherapy, professional training and continued professional development in London 7 Endymion Road London N4 1EE 020 8341 2277 email@example.com www.spectrumtherapy.co.uk
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
The Guild of Analytical Psychologists The Guild offers courses in Analytical Psychology, including a one-year FOUNDATION COURSE and a DIPLOMA training leading to UKCP & IAAP registration
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Listen to my story conference: the wrong side of the line Saturday 16 April 2016
Holborn Bars · 138-142 Holborn · London EC1N 2NQ “In my dreams and visions, I seemed to see a line, and on the other side of that line were green fields and lovely flowers … but I couldn’t reach them nohow.” Harriet Tubman Our conference will present stories from the wrong side of the line and some examples of how young people have been empowered to create a different story. This forum offers a space for all those working with children and young people to share their experiences. Confirmed speakers and conference sessions Breaking down barriers to give every baby the best start in life Alison Baum, award winning campaigner, Chief Executive and founder of the charity Best Beginnings, will be sharing the platform with a young mother who will share how she has been empowered through working with Best Beginnings and their early intervention programmes.
The emancipatory power of storytelling amongst marginal groups Dexter Dias QC, award winning Human Rights Barrister, Crown Court judge, visiting researcher at Cambridge University and past advisor to Parliament in strengthening the law against FGM. Dexter will be speaking about his commitment to representing those disadvantaged by poverty and discrimination, including how his research enables those in the youth offending system to tell their story.
Inspired Youth Kev Curran, award winning filmmaker, founder and director of Inspired Youth, will be sharing his dedication making a difference in the world using storytelling as a powerful vehicle to engage with audiences through a range of media and film outputs.
To find out more about any of our events please visit our website www.psychotherapy.org.uk or contact Sophia Dick at email@example.com
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Restorative storytelling: sharing perpetrator narratives as part of a restorative dynamic Marina Cantacuzino an award-winning journalist, founded The Forgiveness Project collecting stories of people who had lived through violence, tragedy or injustice and sought forgiveness rather than revenge.