Tag: Counselling London Bridge

What are the core conditions?

siobhantoner

I was really bothered by a news story a few days ago and very angry at the ignorance the individual at the centre of it displayed.

I don’t want to link to it and give it more attention, but basically a young man had no idea on what it was like for women to have their periods but felt qualified to spout opinions on the tampon tax which completely denied female anatomy.

How would I work with someone like this in the therapeutic space? Could I?

As therapists we can hear opinions that we disagree with every day, our client’s views and values may be different to ours and it’s something we have to find a way to cope with.

Like any model of therapy, the Person-Centred Approach has a lot of theory behind it but Carl Rogers the founder crystallised it into three Core Conditions. If these are present, then change can occur for the client.

The first is congruence, that the counsellor is congruent with the client. In respond to the opinions above, my first thought would be “You are a bloody idiot” but that really doesn’t sit with the next two conditions so maybe I will come back to that.

The second condition is that the therapist extends unconditional positive regard to the client. Rogers described this at times as “Prizing” his clients. If I think my client is an idiot, then that doesn’t really work.

The third condition is showing empathic understanding to the client. Letting them know you really get where they are coming from. It’s when I thought more about this I felt my views shift. What does a young man really know about a female body? He might have done some biology but not have been academic or too busy sniggering to take much notice. When it comes to the topic of our periods, we as females don’t on the whole share the details with men. If we don’t talk about the details, how do they really understand? Especially someone who is young and inexperienced.

So a way of showing my empathy might go something like “I understand that this is what you believe based on your knowledge of the female body….” because from the point of view of this person, that is truly what he believes.

Showing congruence with this perspective might mean adding “I know from my experience as a woman you are wrong in your view and I have to say that to you as otherwise it will get in the way of our working together”. How I say this, with an open and friendly manner can let the client see that I can still prize him while disagreeing with his opinion on this topic.

Unconditional positive regard doesn’t mean accepting everyone does as ok, it means being able to still value the person even if we dislike some of their behaviour or opinions.

However, I have to confess it took me a few days to really be able to begin to feel empathy with these views, so I don’t know if I could have got there in a therapy session.

Frequency

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I talked a bit about how long counselling should be in a previous post but I didn’t mention frequency.

The most common is to have a weekly session. This is so that the client has time to process what may have come up for them and review where they are before the next week while still keeping things fresh in memory at the next session.

However, this a huge commitment for some people both in time and money so every two weeks has become something that a lot of people choose. I work online this way but not face to face for personal practical reasons. I only have office hours on Fridays so I would have to find two clients that would use the same slot on alternating weeks which wouldn’t necessary be easy, otherwise I would be wasting a time slot every two weeks.

However working online I do offer every two weeks as I can be a lot more flexible with my working hours that way.

I really wouldn’t recommend planning to work on a longer frequency than every two weeks. I believe it would make it very difficult to build a therapeutic relationship and then see change occur. It may be that after a period of regular therapy then the client would like some check in sessions after a longer period to see what progress has been made and if it is being sustained. This could be useful towards the end of an alliance once an relationship has been formed and worked on. However again for practical reasons I could only offer this online.

How long is long enough?

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How long is long enough?

It’s one of the hardest questions to answer from a client. How many sessions do you think I will need?

It’s just like the question how long is a piece of string?

I have worked with people who got what they wanted from one session, others needed years.

I recommend giving the start of therapy six sessions. This six session model has become a bit of a standard. It gives the client and counsellor some time to get to know each other which I believe is the most part of the therapeutic process. There is time to address a specific issue the client wants to focus on and maybe see some results.

I say maybe because it really does depend on the issue. For example, if the client wants to use the space to offload about some work related stuff that is going on, then this can happen.

Some clients have an initial group of sessions and then come back later. E.g. they may want a few techniques for improving their behaviour when they are angry. They can get these and then take some time to put these into practice. They may choose to continue therapy during this process or take and break and come back to explore the results.

There are some issues that clients bring that may have built up over years and may need longer term work. Low self esteem, anxiety, bereavement and depression can take time to work on and it’s impossible to guarantee the outcomes or how long it will take. But there are always exceptions to this and sometimes the six sessions are enough.

It may be that the six sessions are enough for right now and the client may find what they are really looking for is coping mechanisms for the present time so that in the future when they are in a better place they can address more of the underlying issues.

So the answer to the question is no real help I suspect for people. All I can say is that when people commit to the process I have seen real change occur and I believe it is possible for anyone. Give yourself time to heal from the wounds of the past.

Loneliness

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I found this article on loneliness very moving and sad. there are so many lonely people yet it seems harder and harder for us to make meaningful connections with each other.

Its an issue that affects all age groups. I know how distressing it can be for younger people and children not covered by this survey as well who find it hard to learn how to develop social connections in the first place. This then follows them throughout their life.

Its important to acknowledge the difference between being alone and being lonely. An introverted person may be perfectly content with spending a lot of time alone and yet have enough connections in their life to never feel lonely.

An extravert may be surrounded by people at all times yet feel they are missing meaningful intimate connections and feel desperately lonely.

Its a complex social issue that impacts so many of us, but it also gets hidden because of the shame that comes with admitting it. So many of us are pretending that we are ok. Comparing ourselves negatively to others who seem to have it all and not noticing that actually we are not the only ones experiencing it. It takes enormous bravery to say “I am lonely”.

Do you know what makes you happy?

siobhantoner

I’ve been doing some training (as counsellors always do a lot of additional training every year) and came across something called the Easterlin Paradox. It may be something you already know about but the name was new to me.

 

The basic premise is that while some money makes you happier, lots of it doesn’t increase your long term happiness. There are lots of fancy graphs online if you are interested in those but I found it gave me something to reflect on.

What makes me happy? What makes you happy? It may be different for each of us, but how often do we really take the time to explore it?

Giving ourselves the gift of time for self-reflection is such a valuable thing, possibly one of the greatest gifts we can actually give ourselves. Thats one of the things therapy gives us, the space for this self-reflection. To explore our values, what we really want out of life, what enhances our well-being and allows us to live a fulfilled – and happy life.

Why not give yourself that gift?

Reflective practice

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Have you heard of the term reflective practice? For counsellors it is incredibly important and plays a big part of our work.

As counsellors we have duty to provide the best service possible to our clients. You trust us with your inner thoughts and feelings, we have to respect that by ensuring that we give you the best of ourselves.

We have a number of ways to do that. The first comes during our initial training. We explore our own history in detail and attempt to identify our sore spots, the parts of ourselves that are difficult to revisit and cause us pain. This includes our prejudices and why we want to be counsellors.

But as we are only human we have to keep checking into these things and watching out for new things that may come up in our lives.

If a client brings something into a session that we can identify with but haven’t worked on in ourselves that will block the client from being able to deal with it. For example if we have had a bereavement that we are still struggling with we would find it very hard to stay in the clients frame of reference.

So we spend a lot of time reflecting on our practice and the sessions we have with clients to pick up any areas we need to develop. This can start with some initial reflections after each season but we also have supervision.

We are duty bound to our professional organisations to have a minimum of 1.5 hours a month supervision. During this time we look in detail at some of the things coming up in our work to ensure the client is getting the best service we can provide. This can be one to one with a supervisor or in a group environment to get different perspectives. Our clients anonymity is still held in this space, by that I mean that although we may discuss some of the things they bring to sessions they are not identifiable. Confidentially is still covered.

We also engage in a great deal of training each year to ensure we keep are professional knowledge up to date and we are working on the areas that we feel we need to develop. We identify these from our own reflections, from the sort of themes our clients bring and feedback both from clients and those we have supervision with.

All of this effort put into reflective practice means that as counsellors, we are working safely and within our competency levels. It also means that we can identify our limits and recognise when self care is required.

Sexual assault in College and University

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The new year is starting and thousands of young people are going away to University and College for the first time. This should be a exciting, nervous and hopefully fun and rewarding time.

Sadly though there will be a lot of people who will suffer sexual assault. This article has the staggering statistic that 3 in 5 are assaulted or harassed. Revolt Sexual Assault is a UK based charity working to expose the scale and campaign for change. You will also find a list of support organisation for those who need it on their website.

Male domestic abuse

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Its so important that male victims of domestic abuse are finally getting more attention in the news. This article details some of the statistics and difficulties men have accessing support due to how limited the resources are to help them.

It also has a link to an program that will be available on iPlayer from tomorrow and I am keen to watch that as well when it is released.

I am affiliated with an organisation, MenCASA which promotes awareness and training in this area for therapists. It also is a resource for clients to use to be able to find a counsellor to work with who will take their experiences seriously.

Privilege, ACEs and Protective Factors

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I listened to a podcast recently and someone being interviewed said something along the lines of

“If you are a positive person, positive things happen to you” which leaves the inference that if you are a negative person then negative things will happen to you.

My initial response was one of fury. How dare this bleep bleep bleep person blame all the people who have had terrible experiences for bringing them on themselves due to the wrong mindset.

I work with children and adult survivors whose lives have been incredibly difficult. How on earth could this self-satisfied smug bleeping person think they just needed to be more positive and then things would be ok?

So, I admit, I stewed on this on and off for weeks. Then one day I finally worked out why I hadn’t been able to let it go.

Positive things do happen in general for some people more than others; those are people with privilege.

If you have privilege it’s easy to assume that the good things that happen to you are because of your positive outlook. The problem though is this denies the experience of those without privilege and makes them responsible for the impact that it has on their lives, rather than their lack of privilege which is a problem with society.

What do I mean by privilege? There are much better examples than I can find words for. One of the most powerful is this video https://www.youtube.com/watch?v=4K5fbQ1-zps

This cartoon strip shows how those with privilege can really assume it is because of them and their talent, or in the case of the person who set me off on this article it’s because of their positive outlook!

It’s worse though than just not getting a job, it is an enormous health crisis. A study on Adverse Childhood Experiences (ACEs) by the CDC in America over 20 years ago raised the awareness of ACEs and their long-term impact.

Difficult experiences in childhood have a significant impact on our adult health, wellbeing and life expectancy. The image below gives some statistics on the type of events that can happen and the risks to the adult when they have 4 or more. More details can be found at https://vetoviolence.cdc.gov/apps/phl/resource_center_infographic.html

6 or more ACEs means your life expectancy is 20 years shorter and your adult life is more likely to have been blighted by addiction, mental and physical health issues and incarceration.

When we talk about privilege we usually think of rich white males, but it is more than that. Class, wealth and race are some things, but it’s also a privilege to be in the 52% who have not had any ACEs or the 23% who have only had one.

If we allow to go unchallenged ideas about positivity being all a person needs to succeed it means we can turn a blind eye to the 9% of children who are currently experiencing 6 or more aces ACEs and the 9% of adults they will become.

A recent report by the NHS in Wales shows it not just a problem in America but the data applies in the UK as well https://phw.nhs.wales/topics/adverse-childhood-experiences/

We are ignoring a massive societal injustice and health issue that impacts all of society in one way or another. Even if it means paying more taxes for supporting those who can’t work, prison costs and the police. No matter how privileged you are, you have some risk of being burgled or robbed in some other way. The people committing those crimes are highly likely to have multiple ACEs. Think what would happen if they had been helped when young?

My challenge to everyone reading this is to think about what their privileges are. Did you have ACEs as well and if so did your privileges help counteract them? In that case, the privileges become a useful protective factor.

I admit for a long time I couldn’t see the protective factors I was privileged to have. I was also one of those people who ignored the impact of the lack of privilege in others. After all, I was poor, a child of Irish immigrants, growing up on estates in Southwark, with a very difficult family history and my ACEs score is quite high. I did well, got a job, built a career. I proved it could be done so why couldn’t others? Maybe they didn’t want to work hard enough.

But I do have privilege and I now am able to see how much that has helped me. In the race of life, I wasn’t at the very back of the line starting off. I had a few steps head start. Not nearly as many as some, but those steps have made a difference. There are probably loads of others I haven’t listed as well.

  • I am white
  • I am able bodied
  • I am straight
  • I am cis gendered
  • I had a Mother’s love
  • I had enough food to eat
  • I had stable and permanent accommodation
  • I was encouraged to read very young
  • I was able to learn quickly and achieve good grades

These privileges helped counteract the impact of my ACE’s, they protected me a lot but not completely, I have scars. I experienced anxiety and depression as an adult, but I know now from the studies that have been done how much worse it could have been.

Count your privilege, respect what they have given you, the advantages and/or protection.

And maybe then you will see what under privilege is as well. Because until those with privilege absorb this, nothing is going to change and millions of people will continue to suffer.