Dual realities – The search for meaning: Psychodynamic therapy with physically ill people

Abstract

We summarize Kohut's (1971) bi-polar self which enables counsellors to understand and treat narcissistic behaviours and narcissistic personality disorders in a psychoanalytic framework. After Patton and Meara (1992), we describe Kohut's formulations regarding self-development and disorders of self and how such formulations inform critical components of psychoanalytic counselling with particular emphasis on the explicit and implicit strategies and characteristics the counsellor brings to the process. Finally, we suggest that a promising arena for future theorizing and applications of Kohut's ideas is consultation with parents, teachers and other community leaders to help prevent or remedy psychological self-injuries with systemic interventions outside short-term counselling or long-term therapy.

We have suggested that Kohut's self psychology is a good vehicle for understanding what brings a client to counselling: namely, disorders of the self or self-injury. We review strategies and ‘ways of being’ a counsellor must bring to and offer in the counselling encounter if the work is to succeed. We also examine implicit qualities (beyond the achievement of a mature bipolar self) we believe a counsellor or any facilitator must have if counselling or other helping relationships are to be effective. We purpose further conversations and empirical analyses which specifically and conceptually link critical components of psychoanalytic counselling to self psychology and to essential counsellor traits or virtues that seem intrinsic to good counselling practice.     

The emperor's new clothes: A study of narcissism and delusional greatness,denial, splitting and projection in a centre for people facing the challenge of HIV and AIDS

Abstract

Last January I began work as an untrained volunteer counsellor at a drop-in centre for young adults in London. It was the first time I had done any counselling with adults, though I had worked with children, and I found myself to be extremely anxious. I was acutely aware of my untrained and inexperienced status, not to mention any other flaws in character and health I might possess, and acutely concerned about whether I could possibly discharge my responsibilities to any client who might come to me for help. I was in therapy myself, but it was not clear to me how this could help me on the spot, so to speak.     

Cultural safety: towards postcolonial counselling practice?

ABSTRACT

This article examines the discursive production of counsellor identity and practice through the operations of colonising and postcolonial discourse in Aotearoa New Zealand. It argues that constructs of cultural safety, tino rangatiratanga and Māori sovereignty, which arose as part of the postcolonial politics of life in Aotearoa, have achieved discursive status and both enable and restrain counsellor practice. This argument is informed by research that explored the discursive production of Pākehā counsellors' practice with non-Pākehā clients.     

The enemy within An exploration of the concept of boundaries in a GP's surgery

Abstract

This paper looks at two GPs' surgeries and the way that they deal with the anxieties aroused when trying to meet patients' needs in primary health care. The practice counsellor is both an observer and a participant in this. The physical surroundings seem to influence the way these anxieties are acted out. Each surgery has to create an enemy in order to live with their anxiety.     

Loss of feeling in the university counsellor: Some clinical illustrations of personal illness in a university context

Abstract

This paper is concerned with anaesthesia, loss of feeling or state of lifelessness, including numbness, helplessness and paralysis in the university counsellor, and explores briefly contributions to such states in a university counsellor.     

Student essay competition prize winner a study of the breaking and remaking of affectional bonds

Abstract

This essay was originally presented as the author's final clinical essay for the Advanced Diploma in Psychodynamic Counselling run by the WPF (North) in conjunction with the Tuke Centre, York. It is a reflection on a year's counselling undertaken with a young man struggling with angry and violent impulses which threatened to wreck his relationship with his partner and their children. The work draws on psychoanalytic and attachment theories and examines the process involving client and counsellor as two men working together on issues of loss, relationship and intimacy.     

Young people’s perceptions of fat counsellors: “How can THAT help me?”

ABSTRACT

Being fat is widely recognised as a stigmatised identity which disproportionately impacts women, both personally and professionally. Women are numerically dominant as therapy practitioners, and we use this group to explore the ways a “fat counsellor” is imagined in the context of counselling. A qualitative story completion task, about a woman starting therapy, was presented to 203 British young people ages 15–24. Participants were 75% female, 88% white, 93% heterosexual, and 98% able-bodied. The story stem did not specify the sex of the counsellor, who was identified as fat; the vast majority of stories assumed the counsellor was female. Overall, fatness was perceived as negatively affecting therapy and the counsellor’s professional credibility because fatness was equated with a lack of psychological health, which rendered fat counsellors professionally “unfit.” This finding extends the literature on “weight bias” in professional settings and has implications for counsellors of all body sizes.     

On counsellors' investment in theory

Abstract

Working as a counsellor presupposes some kind of relationship to theory. No such relationship could be acquired without considerable investment of personal resources. But sometimes the significance with which theories or theoretical outlooks are invested can interfere with actual communication, as, for instance, when the awkward issue of theoretical difference can seem to become the real agenda in discussions ostensibly about clinical material. Such occurrences are the product of strong mutual influence between individuals' investments and the current interpersonal situation.     

Genetic counselling: Predicting patient outcomes

Abstract

With the rapid development of genetic testing, the demand for genetic counselling is increasing. Yet there is little known about what makes for effective or efficient genetic counselling. The aim of the current study is to determine the main factors influencing outcomes of genetic consultations. One hundred and thirty one routine consultations conducted in a regional genetics centre were audiotaped, transcribed and coded. The main predictors of outcome tested were pre-interview patient and counsellor expectations; pre-interview patient concerns; length of consultations; counsellor directiveness; and the extent to which social and emotional issues are addressed in the consultation. The main outcomes were the patient's view of the extent to which their expectations were met, their satisfaction with information provided, and concern about the problem they were referred with.

Although there were six significant correlations between the process of consultation and outcome variables, multivariate analyses revealed no significant predictors of any of the outcomes. Using multiple regression analyses, small amounts of variance in patient outcomes were predicted by patient and counsellor variables assessed before the consultation, but none was predicted by any of the process measures made of the consultation. Various explanations are considered to explain the lack of influence of process variables upon outcomes. One possible explanation for these findings is that the consultation has a minimal effect upon patient outcomes. Alternatively, the study, in design or analysis, was not sufficiently sensitive to detect the influential aspects of the consultation.     

Power and Pleasure

SUMMARY

In exploring issues of power and pleasure in relationships the author uses Erikson's (1965) developmental 'eight ages of man' as both a conceptual framework and a way of describing aspects of the developmental growth of boys as men, and he completes Erikson's (1968) epigenesis of the life cycle in relation to identity and intimacy. Drawing on literature on male psychology, his own experience and his experience as a counsellor and a Transactional Analysis (TA) psychotherapist in clinical training, the author focuses on male identity and men's capacity for intimacy in relationships. The use and abuse of power in achieving male identity, and the implications for mutual pleasure and interdependence in intimate relationships are outlined and practice issues for counselling and psychotherapy with men in relation to identity and intimacy issues are considered.     

Public perception of the professional titles used within psychological services

Background and aim: There have been several calls for adopting an empirical approach investigating public opinion concerning the differentiation between the professional titles ‘counsellor’ and ‘psychotherapist’. The present research makes a first step to addressing this issue. Method: Sixteen interviewers, recruited across the UK, interviewed 450 members of the public in 57 UK district codes. Age, gender and education were monitored for sampling purposes. Results: The findings indicated that around two thirds of the public perceive the professional title ‘counsellor’ to be distinct from the professional titles ‘psychotherapist’ and ‘psychological therapist’ and for these latter two titles to be almost identical. About one third of the public perceive the opposite trend, and one tenth is undecided whether these professional titles are distinct or indistinct. Conclusion: These results have implications for the debate concerning the structure of the Health Professions Council (HPC) Register in the regulation of counsellors and psychotherapists.     

Tate Modern: Jung modern

Abstract

This paper describes how a counsellor in education has to take on and respond to a number of transferences in the clinical work in addition to holding onto a number of centres within the institution and personally. It takes a close look at one student presentation and speaks to the quality of the emotional and psychological impact on the counsellor. It argues for the need to be both thoughtfully containing and thoughtfully penetrating in the clinical work despite the bombardment of conscious and unconscious material. Over all, the paper states how important it is for the counsellor to stay in touch with his/her own feelings, thereby effectively maintaining the depressive position, though this is painful given the current predominance of suicide and serious suicidal intentions among adolescents and young adults.     

Revenge of the fathers Incest and the male therapist

Abstract

This paper argues that the socio-psychological foundation of incestuous relations between father and daughter resides in the primordial rivalry between father and son and is a manifestation of the property relations existing between them throughout the period of patriarchy. After an attempt to trace this rivalry along a path through Western civilization by summarizing evidence from both religious and mythological sources, I introduce it into our own times by using two case illustrations from my own clinical work. Here I claim that when a male counsellor/therapist engages a sexually abused female patient he, at the same time, encounters the incestuous father in a potentially rivalrous struggle over the patient. For genuine healing to take place in the patient, the counsellor/therapist must form an alliance with the father and utilize his hidden value in enhancing his own therapeutic capability.

I began by stating that particular clinical complexities exist when male therapists engage with female clients who have been the victims of paternal incest. I then postulated the idea that the socio-psychological foundation of such relationships is the primordial rivalry between father and son and is in fact a particular manifestation of the property relations existing between them. I then traced this father/son rivalry along its path down through Western civilization via Jerusalem and the Judaic/Christian religions, and Athens with its early creation myth, and the somewhat later myth of Oedipus. I then pursued the course of its influence to our own times, to the incestuous father/daughter relationship, and, using examples from my own clinical work, I attempted to show how this father/son rivalry survives as a powerfully pervasive influence in the clinical relationship between the female patient who has experienced paternal incest and her male therapist.     

'What did we talk about last week?' a study of forgetting in one schizophrenic and two borderline clients in counselling

Abstract

This paper describes ‘forgetting between sessions’ by two borderline and one schizophrenic client in counselling. What was forgotten included: progress made, awareness of dependence, an experience of having a helpful and sympathetic counsellor, and the ability to think. Understanding of this phenomenon is explored in terms of schizoid mechanisms (Klein 1946), omnipotent narcissistic object relations (Rosenfeld 1987) and attacks on linking and thinking (Bion 1959, 1962). The need to avoid or evacuate painful experiences which are intolerable to the individual, or to recreate and remember existentially infantile traumata, are proposed to be some of the reasons behind this forgetting. The counsellor's capacity to remember, forget, contain, and think about the client's experiences is considered.     

The international student sojourn,identity conflict and threats to well-being

ABSTRACT

This article reports findings from a qualitative (interview) study of the identity conflict experienced by five international students at a university in the south of England for whom real and perceived challenges to national self-image were shown to be unsettling. The article suggests that our cultures of origin are centrally important to our private and personal sense of self and it argues that counsellor educators and counsellors need to understand their students' and clients' emotional and behavioural problems in the context of their cultural identities. In this research, there was a strong emotional response to threats to collective identity, which appeared to be influenced by both the degree of students' cultural identification and their country's global standing. The following themes were generated from a thematic analysis and capture the essence of student responses to perceived derogation of their national identity: re-identifying with the culture of origin; allying with the West; resisting the discourse of western supremacy; and acquiescence with stigma. Of importance to all participants' perceptions of derogation was their location in the western world.     

Counsellor response to clients' metaphors: An evaluation and refinement of Strong's model

Experienced counsellors recorded clients' metaphors, their responses to the metaphors and their views on the effects of the interchange. Two of the three responses in Strong's model of counsellor response to clients' metaphors were used frequently. They were: explicating what is implicit in a metaphor and therapeutically extending or modifying it. The third response proposed by Strong'the counsellor creating and delivering a 'therapeutic metaphor''was used only once. A further kind of response was found: the counsellor recognizing and remembering a client's metaphor for possible future use. Overall, Strong's model was supported. The effect of counsellor orientation on counsellor response to clients' metaphors and the value and use of metaphors in counselling are briefly discussed, and some guidelines suggested.