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.     

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.     

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.     

Counsellors' perceptions of client progression when working with clients who intentionally self‐harm and the impact such work has on the therapist

Introduction: This paper describes a qualitative study focusing on counsellors' perceptions of client progression when working with clients who intentionally self‐harm and the impact this has on the therapist. Method: Semi‐structured interviews were employed and the constant comparative method utilised to analyse the data. Findings: Findings indicate that counsellors experience intense emotions in response to self‐harm including: shock; sadness; anxiety; anger; and frustration. Counsellors also struggled to manage the tension between multiple dualities, corresponding to professional opinions of a seemingly polar opposite nature. Although participants indicated a requirement to work in a client‐led way, they all had either an explicit or implicit agenda for change. These two conflicting states create a tension for a counsellor that is difficult to resolve. In addition there were various views of client progression, yet all participants agreed that progression was not simply about stopping self‐harm. Conclusion: There is a significant impact on the counsellor when working with clients who intentionally self‐harm and the complexity of the phenomenon appears to exacerbate their anxiety. Implications: Further research within the counselling field focusing on the ambiguous nature of the subject may increase understanding, which in turn may contribute to greater therapist efficacy when working with this client group.     

A qualitative study of client experiences of working with novice counsellors

Aims: This paper reports on a qualitative analysis of written accounts by clients who participated in a counselling relationship with beginning-level trainees. The purpose of the study was to explore how clients experience the process of counselling with novice practitioners. Method: Consensual qualitative research was used for data analysis. Findings: Three general thematic categories were identified – client perceptions of self in counselling; client perceptions of the counsellor; and client perception of the counselling process. Conclusions: Overall, the findings suggest that these clients saw the interpersonal qualities and skills of the counsellor as major contributors to their experience. Implications: Clinical training of novices should start by developing the interpersonal and collaborative skills of trainees.     

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.     

Burning or Building Bridges

SUMMARY

Among the population of physically abused women who present individually in therapy, there is a portion who struggle with their indecisiveness about whether or not they should work toward resolving or terminating their heterosexual relationship. This paper will examine clinical methods that are employed through individually based systemic therapy to assist women who find themselves in such confusing and perilous situations. Due to the complexity of the problem” emphasis is placed on addressing salient issues efficiently and non-judgmentally. Central to treatment is client engagement and the challenging of constraining client beliefs.     

Parallel Process

Summary

This article addresses parallel processes between the author (a therapist) and client when each are mourning the death of their mother. Similarities and differences in their experience and reaction are discussed. The effect of the client's unexpressed grief from her early childhood loss is explored. The author also examines her own, more recent loss and develops a new perspective on its consequences. Tools are presented to help the client work on her grief, especially when the issue is “motherloss.” The impact of the therapeutic process on the client and author is delineated, and the client's reactions to ending her therapy are analyzed.     

A qualitative exploration into how the use of prayer in counselling and psychotherapy might be ethically problematic

Aim: This research article contributes to the debate on the value and limitation of the use of spiritual strategies, like prayer, in counselling (Foskett & Lynch, 2001) by disseminating the insights that were gained from a qualitative study of mainstream counsellors whose work includes prayer. Method: Participants were 19 British Association for Counselling and Psychotherapy (BACP)‐accredited and Churches Ministerial Counselling Service (CMCS)‐approved counsellors who use prayer in their practice. They were interviewed, and the data were analysed using Interpretative Phenomenological Analysis. Results: The data reveal that counsellors who use prayer are aware that ethical problems may be encountered: if prayer changes the way that the counsellor is perceived; when using prayer with issues of psychopathology; if the counsellor uses prayer to impose faith on a client; when being professionally held to account; if prayer is used for avoidance or as a defence; if prayer is used to enhance the counsellor's power; if prayer is not part of the client's agenda; if prayer is used routinely; if prayer cannot be challenged; if there is a cultural pressure to pray; and if the prayer method is not matched to the client – but that their concern over potential ethical issues is not of sufficient strength to override their therapeutic use of prayer if facilitated with due care.     

Counsellors becoming counsellor educators: a New Zealand example

ABSTRACT

The international literature on adjunct faculty in higher education, including professional education, does not yet cover counsellor education in particular, although many programmes rely on the teaching services of experienced practitioners in adjunct faculty positions. This article reports on a small, exploratory study conducted with adjunct faculty members appointed to one-year, full time fellowships in the counsellor education programme in which the authors are full time academics. The study identifies the mutual benefits of this practice, to the practitioners who teach as adjunct faculty and to the counsellor education programme. It also identifies areas that are problematic. In view both of the identified benefits and the difficulties experienced, the authors discuss their responsibilities as permanent academic staff to the practitioners who teach as adjunct faculty. The authors suggest that programmes benefit from the ethic of hospitality that adjunct faculty can offer and invite academic staff to bring (un)conditional hospitality to the collegial relationship in counsellor education.     

Private work in public places: Confidentiality and role tensions in a university counselling service

This paper aims to explore issues of confidentiality relating to working with undergraduate and postgraduate students in a university counselling service. The context of a counselling service within our institute of higher education has to be understood in its relationship to academic, administrative and managerial staff, to medical and psychiatric services personnel and to the wide range of other student support and welfare services in the organization whether run by university staff or the students' union. Some reflection will be given to the need for clarity in the range of roles counsellors have to play within the different functions of the university. The client-counselling relationship cannot be seen as a dyad but as a triad or an even more complex constellation of relationships when regarded in an institutional context. The central premise is based on understanding the conscious and unconscious dynamics in the institution and how these impinge on the relationship between client and counsellor in challenging or assuming the confidentiality held by the service. Such boundary issues are identified in consultation and referral, breaking confidentiality, referral of disruptive students, calls for help and holding confidentiality. The case material drawn on to illustrate these five areas is also described in terms of anxieties raised and how these are projected, introjected and contained.

Within the service client and counsellor contract to work together. It is made clear that counselling is a professional relationship with agreed boundaries and a commitment to confidentiality. This is crucial to the working relationship and is a means of providing the client with both safety and privacy. Any limitation on the degree of confidentiality offered may reduce the usefulness of counselling. Bound by his or her professional code of ethics the counsellor will reach an agreement with the client at the outset about the extent of confidentiality they are offering, take care not to disclose information given in confidence and, when possible, be able to negotiate any change in agreement with the client.

Exceptional circumstances which may occur and give rise to the counsellor's decision to break the confidentiality formerly agreed between him or herself and the client are those which give grounds for believing the client will cause serious harm to others or themselves or have harm caused to them. Reference will be made to the role of consultant supervision in such situations and how any breaking of confidentiality can best be minimized. Attention will be given to the relevant ethical codes to which counsellors adhere and the issues of confidentiality within the legal process as well as whether the requirements of providing counselling services for students in higher education impel us, logically and practically, towards certain policies in regard to boundaries.     

How do you see me? Coming out in counselling

Recent large-scale survey research has raised serious concerns in both the counselling community and the mass media about the ways in which counsellors work with lesbian, gay and bisexual (LGB) clients. The current questionnaire-based research focused on client experiences of their own, and their counsellor's, self-disclosures of sexuality. Most clients did not require counsellor disclosure. However, failure of the counsellor to disclose could result in problems and assumptions being made by the client. We conclude that LGB awareness is improving, but there is still much need for training in this area to challenge limiting assumptions by some counsellors and to avoid the need for clients to educate them.     

'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.     

Hope

Summary

The author describes her treatment of her first alcoholic client and observes how the process of providing hope to this client heightened the author's personal capacity to hope. Hope as an aspect of healing is considered and personal reflections on psychotherapeutic work with alcoholics are discussed.     

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.     

Time's wingèd chariot: Short-term psychotherapy in later life

Abstract

This paper is concerned with the appropriateness of short-term psychodynamic psychotherapy with older adults, a client group which has historically been neglected in psychotherapeutic practice. Drawing on the case study of a fourteen-session therapy with a woman in her seventies, it is argued that brief exploratory work can be of particular value to people nearing the end of their lives. The nearness of death gives a special urgency and motivation to the work and a time-limited therapeutic contract mirrors the reality of having only a short time left. Making psychotherapy available to older people also represents an important valuing and validation of their experience.     

Book Review: Contemporary Perspectives on Psychotherapy and Homosexualities

Abstract

This paper is an attempt to illustrate some of the ethical and clinical difficulties which may arise when student counselling takes place under conditions which pay insufficient attention to the ground rules of therapy. It considers the importance of the frame in psychotherapy and the implications for this of working in an institutional setting. It also looks at the changes that may be made in the way the counsellor functions in the institution in order to secure the best conditions for effective counselling work with students, based on the author's personal experience.