Group process revisited

 

In the trainee facebook group I manage (but will be handing over soon as a ‘no longer trainee’), a conversation has arisen recently about process groups and acceptance. Coming out of that, and not directly relating to any one question I’ve been thinking through process groups.

 

All too often it seems to me, people in process groups are so keen to present themselves as ‘accepting’ that they do not question things. And when your tutor is in the room, of course – you don’t want to be perceived as judgmental or stereotyping etc. So when someone presents something challenging to us, there is a big temptation to say ‘yes – that makes sense’, even when it.. doesn’t. Even when we don’t get it; when we have questions.

 

I think about my own experience, part of what caused me to leave, where something about my life is on the surface accepted and no questions have ever been asked, but when I talked about the possibility of doing some training for the year below (as part of my make-up for missing two days when my dad collapsed and later died), a majority of the group seemed very interested in attending that.

 

It is a liberalist discourse, that says ‘everyone is equal’. And yes they are, individually. I am as equal as anyone else, but I identify with a lot of the ‘protected characteristics’ (disability, gender identity, sexuality) that mean that structurally, I’m actually NOT equal (by which I mean that there are more things stacked against me than the person who is straight and cisgender and has no disabilities – for a very quick one: people in civil partnerships are not AUTOMATICALLY entitled to the same pension rights as people in marriages). And the problem with a liberalist discourse is that because everyone wants to be perceived as being liberal, ‘acceptance’ is the name of the day. No questions are asked, thus, unless I (for example) keep putting myself out in to a void where no-one asks questions, and continually explain things for everyone, it is possible to make a lot of assumptions.

 

Of course, there will be some people in the group who get it and who are not asking questions because they will get it, but Dominic Davies’ (1998) paper echoes my sentiment:

 

“However, this avoidance of difference and denial of cultural variables can be very damaging for the therapeutic relationship. Clients may spend a lot of time trying to work out the therapist’s real frame of reference, and look for subtler signals of genuineness or incongruence. This detracts from the pre-condition of psychological contact (Singh and Tudor, 1997)”.

 

This I think, is similar for group process. It certainly rings true for me in my experience of the group.

 

Dominic (I did start by saying ‘Davies’, but I know Dominic, so this felt weird!) goes on to quote Tudor and Worrall:

 

“It is likely that if as therapists we consistently ignore or deny some of our feelings and experiences we will, out of awareness, communicate such unassimilated, or partially accommodated material to our clients”

 

And Rogers himself: “Rogers makes it clear that maintaining congruence isn’t always easy or comfortable and “includes being himself even in ways which are not regarded as ideal for psychotherapy.””

 

This suggests that it is healthier for all (especially when we will go our and see clients with similar histories), if a step can be taken by individuals in group process to say ‘actually – I don’t get it. I’d like to. Can you tell me about X’.

 

As one of my group once said to me (I paraphrase): ‘assume kindness’. It’s a mantra that has worked. I know that in group, I am working from a place of kindness and trying to understand, and assuming that others are (until otherwise told) helped a lot. Here – if you don’t get something or need more understanding, you can commit to doing some research (and nothing made me happier than when people said to me ‘I was reading this thing on gender’) and at the same time, you can express that you don’t get it. You will probably be much better accepted than if you supress that and the person at the side of you can see it, despite utterances to the contrary.

 

In short – it’s DIFFICULT to say in group that you don’t get something. It’s hard to stand out and be that person. But you will make a much better experience for the person who was brave enough to speak, to KNOW that they have been heard and that you want to engage with them, than if they speak and are met with a wall of what can feel like placation with no attempt at understanding. And – if you DO get it, say so. Say why. Let the person know you’re with them, don’t let them sit alone.

 

Reference:

Davies, D. (1998) ‘The Six Necessary and Sufficient Conditions Applied to Working with Lesbian Gay and Bisexual Clients.’ The person-centered journal [online] 5 (2), 111–120

where am i?

So it’s a Tuesday. Blog night. And I’m sitting in my placement between clients, wondering what to write. There is a sense of finality around all of me right now, and it’s difficult to muster up ideas to write about. But it occurs to me that the best thing to write about is what’s on my mind, and what’s mostly been on my mind this week is setting my counselling service up properly.

 

I started this placement almost two years ago. And by started (for any newish people) I approached a charity and said ‘do you want to offer counselling to the LGBT community?’ they said ‘yes please’ and a placement was born. Fast forward a year and the charity started to run in to financial difficulty, although the counselling service is blooming. What started as me on my own very quickly involved me taking on another counsellor and us running the service together. We felt that it was a bit TOO insecure – at one point we were four weeks away from a potential disaster, so we started looking for new premises. Having found those, it felt good to move on, so we are now becoming our own charity.

 

Moving from being a service under a charity to being our own charity has been hard work. Far harder than I thought it would be. The room was the easiest part, and chairs and a rug have been procured (and we get to take our lights and screen with us). But there has been the indemnity insurance (now almost sorted – thanks Howdens), and actually CREATING the charity. That has taken hours of form-filling. And, you can’t have only two trustees and at the time there were only two of us, so we approached a lesbian counsellor we know to ask if she wanted to join us. Luckily for us, she did. Also luckily my primary partner is an accountant and can be our treasurer. We also have a student from a local university who is doing some internship work for us and has created a website and will manage social media profiles etc.

But it feels like a weight of responsibility all of a sudden. I’ve been managing the waiting list forever (the main contact is my ‘work’ phone), but this feels much bigger. We’ve since also taken on a trainee/student (who will qualify to diploma level in sept and then continue on to a further qualification) and my colleague will do the management of trainees. It seems fair – I do the waiting list admin and she does the placement admin. When I qualify I’ll be able to do assessments for trainees as well (I do my own at the moment and my colleague does hers, and trainees’).

It’s been a lot of stuff to think through. Aims, objectives, potential fundings, how often we will meet, and so on It’s good, but very tiring! Right now, I’m waiting for our third trustee to send me back a sheet of paper so that I can get everyone ELSE to sign it and then I can upload it to the charities commission website. Hopefully we will be registered by the start of August when we move. Hopefully then I will be able to complete the bank account details also!

 

I’m worried I’ve forgotten something, but we will see, I’m sure. So that’s where I am. Moving on!

 

Holiday

im very sorry but I forgot to write a proper blog post and I am away Tuesday evening so there is no blog post! I haven’t disappeared 🙂

Endings. More endings


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So it’s that end of year time again. My (academic) year has ended. One academic year, anyway. PhD students don’t get ‘years’, they just get to work (if only we could be paid our stipend and still get six months a year off….). Anyway. My end of term on my MSc came around. And it’s all been a sea-change here. When I started this course three years ago, I was heading for a four-year MSc. But various things have happened, and when I discovered that I could exit this year with a PG.Dip, that felt like the best option for me.

 

In short, I’ve withdrawn from my course, I get to graduate with a Pg.Dip in Psychotherapy and Counselling, and QUALIFY this year. I’m very happy about this. I have to complete some counselling hours and then I’ll be done. It will be a tight squeeze, but I have an excellent therapist who has made me a lot of accommodations (double sessions, hello…)

 

I wasn’t going to write about it yet, because it hasn’t happened yet. But I figure I have to have some faith somewhere. As long as something (else) terrible doesn’t happen to me in the next three months, everything will be fine and I will be qualified by the end of September. Then I get to graduate in November in a very cold cathedral, probably much to the bemusement of the year above me, who will ALSO be graduating in a very cold cathedral and won’t have a clue who I am.

 

When I set out in training, I created my own placement. Since then my hours have mushroomed, and now there are three of us. We are about to become our own counselling charity, specialising in working with LGBTQ people, and being qualified will really help with that – I can register with people like Pink Therapy, so that I can be PT-accredited etc. My long-term colleague and I have big plans for our future (somewhere in there is ‘get paid’ although that isn’t a priority to be fair). But as they way (in the UK): The future’s orange…

 

I’m not sure what to do with this blog in the long-term. I will be blogging until I graduate, that is certain. What I do after? I don’t know. I could turn it into ‘newlyqualifiedtherapist.wordpress’, but somehow, that just doesn’t seem quite as catchy. Thoughts?

bracket bracket bracket. and self-disclosure

 


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I have new clients a lot – it feels like. I am in one placement where I might see a new client every six weeks (it’s up to the client if they want to stay after six weeks, and often they feel like they are ‘done’ by then).

 

And sometimes, a client comes who feels like they are telling ‘your’ story somehow. Not all of it, not all of the time, but they say the things you’ve said. Their history mirrors yours, or perhaps it almost does; perhaps there are parallels, if it’s not an exact copy. And my experience suggests that it is a lot easier to deal with these experiences when it’s a one-off. I remember a client of similar age to me who knew this, (unusual because most people think I’m about ten years younger than i am!) who referenced some tv that was on when ‘we’ were children, and i knew exactly what they meant. But I could bracket that because it’s a one-off that’s maybe not so important as the situation around that TV-watching. But sometimes, a client comes and it almost feels like they are telling your story. And they want your understanding. They want to know they aren’t alone.

 

That was an experience for me a few months ago now – a client talked about something in their life experience that hit my biggest buttons. The feelings they described about that experience could have been my words. And this was the subject of the hour. It was one of the hardest hours I’ve done, because you have to be able to bracket your experience, whilst leaving enough of yourself in the room to be fully present with the client. If you remove yourself from contact, your client is losing out. The client went from talking about that life experience to a physical effect it had in the present. They weren’t sure if I would understand, but it happened that it was my experience almost exactly (although for them the two things had stemmed from each other and for me they were separate). I considered what they were saying, and what they were asking, took a breath and said ‘yes. That is my experience also. It can be like…..’ It wasn’t a particularly big disclosure (it was around levels of physical comfort in a certain situation), but once the words were out, they felt right.

 

At the start of my journey, I would not have disclosed anything at all, attempting to be a blank slate. But the more I learn, the more I try and put ‘me’ in the room. I suspect that part of that sharing of myself there was an attempt at trying to compensate for having had to move so much of myself out of the conversation when I was bracketing. I wanted to ‘give something back’. I think that I was fairly careful in what I did and didn’t trample. But it can be very hard. For me it’s about, ‘this is my experience. from what you say, it sounds like similar may be the case for you. tell me more about that’ (I actually wouldn’t be that stereotypical about it, but it’s a quick shorthand!) In this instance, it worked. The client could see that i did have a real understanding on their comment and we moved forward to a place of understanding they had not yet seen. Sometimes, it can be really useful to ‘put yourself out there’.

Feeling the pressure of using ‘skills’


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I remember how metaphorically naked I felt. That first session. My face (which has a tendency to betray me, colour-wise) feeling somewhat scarlet in a building not overly warm. I should probably go back and look at that blog post for the first hour – see what I said. But one of my biggest thoughts was that i HAD NO TOOLS! JUST ME! and those tools were a potential armour. The stereotypical ‘tell me how you feel’ not quite seeming to cut it as a protection in the same way that a CBT worksheet might.

 

It was just me.  Alone. With nothing. REALLY SCARY! However, I should say that my tenth hour was with a client who went on to stay with me for over a year. They recently came back to help them through an unexpected situation for a couple of sessions, and somehow the topic of them first coming, came up, and in the conversation I mentioned that it was fairly soon (although I didn’t say exactly when) into my seeing clients that they came. They were surprised, not having registered that i was SO new. All my clients know that I am a trainee, but no-one has ever questioned my statements so I have never had to say more than I am comfortable with. But it was lovely to hear that I had not been seen as ‘rubbish’, even though I had nothing to ‘hide behind’, as it were.

 

But recently I spoke to a new client about the possibility of doing some focusing, because that feels appropriate for what has come to therapy. I’ve had training, I’ve USED focusing, but I don’t use it as part of my therapy, so to speak. I do it separately, and don’t use much of it in sessions. The discussion of, and desire of the client to try focusing sent me rapidly scrambling for books (noticing that one has gone AWOL and i haven’t the slightest clue where it is!), ready for the most recent session. And before the session, desperately trying to remember ‘these things are important. DO THESE THINGS!’. As it happened, we didn’t do focusing, as it didn’t feel the right time.

 

It’s a marker of how far I’ve come, that I was absolutely happy with just seeing a client, vs lots of panic! It was the application of tools that made the difference to me and has gone from being a ‘good thing’ (to hide behind) to something additive to my normal therapy. It’s also a reminder to keep myself up with the things that are important to me. I love the PCA, but focusing also speaks to me. And life – that has a habit of getting in the way. Must make/take time.

words


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I drive an unusual make of car. It’s becoming more popular, but as it’s not a western european make, it’s got a pronunciation no-one expects from the spelling. Randomly recently, a client, as part of a point she was making, asked me what car I drove and I told her the make. It took her a while to understand the car I meant because of the spelling/pronunciation issue. It was an odd moment where I wasn’t sure whether to be explicit about the car (spelling it) etc or just hope that she got it (which she did after a couple of tries). But it made me think about some other clients I’ve had in the past, and a similar issue I have as a patient at my GP. Being the lucky owner of a chronic condition, I take a medication daily. Without it, I wouldn’t be working, or doing much of anything. But again, it’s unusual in spelling (not anything out of the ordinary for mediations – they’re all pretty odd!). I always always struggle to order the repeat, because I and the receptionist do not pronounce the medication the same way. I have just discovered (through google) that actually, neither I, nor ANY of the receptionists I’ve spoken to, have ever got that pronunciation right. But in my case it’s a two minute phone call and I can go away again.

 

In the case of some clients they will talk about medication conditions, or medications, and their pronunciation of those will differ from mine significantly; sometimes it’s down to a regional accent, sometimes it’s down to a misunderstanding (theirs OR mine) about what the generally accepted pronunciation is, and sometimes there is more than one accepted pronunciation (potato/potato etc). But it’s hard. and that feels strange to say. It’s a word. But on the one hand, I feel like I am not being congruent if I pronounce it the client’s way, and on the other hand I worry about the possibly of looking like I’m passing judgement by saying it my way. Thus far I’ve mostly avoided this by not directly referring to the client’s word, but it does feel like that might have to change soon. Do I yet know what I’m going to do? no…

Messing up

 

 

We all mess up when we see clients. And to prove it, I’ve asked around a couple of trainee friends and acquaintances to share some of their experiences with you. I’m naming no names, and I’ve changed details if people are possibly identifiable, but you’ll see from the list that the mess ups go from ‘inconsequential’ to ‘something that was talked about in supervision’. Some of them are mine, some aren’t. I’m not sharing which are which. But this is for students not yet in (or just starting) training – we mess up! It’s usually not the end of all things!

 

1: when getting up to show out a client, I stood up and immediately fell over. My foot had gone to sleep and I hadn’t noticed.

 

2: I wore my top inside out for the whole evening, only noticing on my third client.

 

3: I once didn’t turn the handle to the waiting room properly and as a result, walked into the door, and then the waiting room with a very red face.

 

4: Checking my phone between clients I realised I’d not put it on silent. Lucky for me, no calls came in!

 

5: I got in to my client room to discover the clock had been taken away and I wasn’t wearing a watch. I managed to time it JUST right

 

6: On an evening placement, I became aware the cleaners were cleaning as I was seeing my client and I had forgotten to flip the ‘counselling’ sign to ‘in use’. I felt my heart pounding as I tried to decide what was best to do. It seems daft now.

 

7: I asked for some fairly low-key advice on a client thinking they had left, but they hadn’t. It wasn’t anything that broke confidentiality, but I feel mortified.

 

8: Seeing a client for their second session I went in whilst they were getting a hot drink and started to say hi but they ignored me. As they turned around I realised it was a friend of the client’s and the client was there waiting for me.

 

9: One of my clients always has squash. All the others have water (squash is an option if asked for but they are the only person to ask for it). Last week I was flustered with the client before and I forgot and put water out. I felt terrible when they asked why they had water.

 

10: My files are anonymised. I had two new clients lined up to start in two weeks. When I went in to start, I didn’t have a record of what their names were. Luckily for me, they were recorded on an old version of the spreadsheet for the placement. It took me about half an hour to find the names. (They both DNAed).

 

So there you go. Random things trainees have done and had it work out ok.

 

What things have readers done?

 

 

Endings

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Someone asked me to write about endings, so here it is.

 

There are several types of endings I’ve been through since I started seeing clients:

 

The ones where clients stop coming without notice and don’t respond to any contact

The ones where clients call (or text) and tell you they aren’t coming

The ones where clients come and ‘out of the blue’ tell you in session that this is their last session

The ones where you and the client plan for an ending together.

 

Putting aside the ones where you don’t see a client to plan, this is how I have experienced endings in the past.

 

When a client reaches a point where either they express a desire to end (or spread out sessions), or I notice that they seem to be heading towards this, I tend to point out that something has changed, and ask them how they feel about lessening or ending sessions. I often find that clients are surprised when I suggest that they can move to fortnightly (and then monthly) sessions rather than just ‘leaving’ and so far, I haven’t had a client say they would rather just stop – there is a certain safety net in ending more slowly and seeing how it feels to extend time without seeing your counsellor. I recognise that not all placements allow this however (I believe that my formal placement – as opposed to my own service – runs in this manner, although I’ve never tested it).

 

In that last session, it can feel odd – what do you do? How do you keep it person centered?

 

For me, I let the client run the session where I can. If I am at one placement I have to go through some paperwork. I get that completed at the start of the session, and then I let it go pretty much as a normal session in all honesty. I might ask a client how they are feeling about ending and explore that with them, but it’s unlikely to be the first time it’s come up – I would probably feeling a bit remiss I’ve got to an end session with a client and HAVEN’T talked about endings.Once my clients understand what is available from me in future if needed I am happy for them to direct the session as normal. As however they want to have the session. Is there something specific? No. For me it’s about making sure the client is ok in the last 50 minutes. I’ve had clients come in their last hour who obviously didn’t feel they *needed* to come, but wanted to. I’ve had clients come and say ‘I haven’t mentioned this BIG thing before, but I just want someone to know it: (XYZ)’, and then once I’m told, I become almost the ‘holder’ of that thing, and they feel they have achieved what they need. In my own placement, I let clients know that if they want to come back, they just need to contact me and I will put them on the waiting list (or offer them a space if there is one), and in my other placement, I explain what the procedure is (there is a period of time clients must wait before they can go back on the waiting list, but in that time the associated helpline is accessible).

 

There’s no real ‘one way’ to do it, and it’s more about staying true to each of my client relationships, than any particular ‘person-centered’ process. Do what feels right 🙂

Wondering what you’d like to know

 

 

I’ve been writing blog posts on and off (mostly on) for just about 18 months now. In that time I’ve gained over 100 followers that I can see on wordpress, and others who have signed up via RSS (and I have no idea about. Hi! *waves*).

 

Often times I don’t know what I’m going to write about until I sit down at the computer on a Tuesday afternoon, desperately trying to come up with something. Often something from a client session will trigger something (even if not directly related) that will give me a topic, so I’m usually glad to wait until the evening after I’ve seen at least a client or two that week, but sometimes, like today, nothing immediately comes to mind. As I was walking back to my counselling room (having brought my laptop in case a client DNAed) after a client DNAed, it occurred to me to wonder – is there anything people reading would like to know?

 

Whether it’s been a long time since your training (or whether you’ve had no training), or whether you’re in training and you want someone else’s opinion on something around training, or being a trainee, and how that relates to anything in the journey. Or whether you’re a client, and you want to know something from (albeit a trainee’s) point of view about counselling. I’d be happy to answer things if I can – with the understanding that I’m just one person, and it’s just my fledgling opinion and experience..

 

So – I’m signing out, wondering ‘what do you want to know?’ Comments go up with whatever name you please, and I’m happy with anonymity, so please ask. It would be a lovely change to answer something, rather than just send myself out blithely!