Category: Different types of therapy

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Couples Therapy on TV

I recently watched (with my partner) a programme on the BBC called Couples Therapy* and feel moved to share some thoughts on it.

  • it was a good advert for therapy
  • the couples were incredibly brave
  • it was well made with helpful insights
Orna Guralnik at work with a couple in therapy
https://www.bbc.co.uk/iplayer/episodes/p0b8kmch/couples-therapy

Format – Real couples agreed to be filmed in session with New York psychoanalytic psychotherapist Orna Guralnik, who also revealed something of her process through segments with her clinical supervisor**. Couples were also shown briefly at home. Each episode interwove the journeys of three or four couples over several sessions so the viewer is invited to learn about them and witness their engagement and processing within the actual therapy sessions. The second series found itself in New York lockdown and on zoom. Multiple remote cameras were used to bring us in close and smart editing, music and cutaway segments helped us follow the various stories and added some context.

The couples’ difficult experiences were handled sensitively and appropriately, allowing us insight into how couple dynamics interplay and of course, how they can become enormously frustrating, painful and seemingly intractable.

It felt like great advertising for the often misunderstood process of therapy. My hope is that viewers can see change actually happening.

The couples have become convinced of certain outcomes or responses, they look desperate or defeated when they start, but gradually, through their own motivation, trust, courage and application, they begin to find other, better ways to relate. The therapist’s kindness and skill help form a place of calm where the couples break with habits of old, where they learn to hear what each other really wants and often they hear themselves differently too. This in turn opens up possibilities for real change.

This show demonstrates how many common assumptions can be challenged and even turned on their head. I have heard people say:

  • they wouldn’t want to dredge up the past
  • they wouldn’t want a therapist telling them how to be
  • I can’t change, this is the way I am
  • My partner can’t change
  • I’ve tried and tried but they (partner, family, boss etc) wont change

When client’s history was discussed we saw how early life experiences can embed beliefs in us that feel normal, natural or unchangeable. We witnessed how lives can not only be shaped but how they can be changed. How we can change ourselves.

Bravery. I don’t quite know how to express the feeling I have for the clients’ bravery. The show includes some wonderful moments where a person who seemed stuck finds a new perspective Or someone who habitually responds by dismissing, dissociating or even attacking takes a risk and steps into new territory. This requires trust and the courage to be really honest with their partner, with the therapist and with themselves. I see this in my work quite often, but to see it from the outside and in this narrative form was for me, profound and emotional. (Not every client manages this and the show includes one who quite strikingly doesn’t do it.)

As a therapist who works with couples it was fascinating for me to see another therapist at work. We know that the client has to do the most significant part of the work, but we know also that good listening, a solid theoretical foundation and our own integrity will be really important for the therapy to succeed.

image of water to mark the end of this post

*BBC iPlayer – Couples Therapy

**a clinical supervisor in an experienced and specially trained assistant to the therapy process. A therapist meets them regularly to discuss/review the client work that we are doing to help us work safely, efficiently and to assist our continuous learning. Having an outside eye can also help us to manage our own biases and to help us notice when our own experience is unhelpfully influencing our approach.

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Podcast with Steven Porges on social distancing

I really enjoy Steven Porges’ wonderful contributions from the field of neuro-science. His studies of our nervous system have helped to deepen the scientific and therapeutic understanding of what actually happens between people. What he describes is a process common to all mammals, co-regulation, where being together allows us to calm down and assess danger/safety by perceiving (or Neuroception) another’s nervous state. In this time of physical distancing and isolation, we have increased need for contact. By contrast, texting, emailing and “social”media remove the vital elements of vocal tone and facial expression which have evolved over time to help us sense what each other feels, wants, needs, fears etc.

Thanks once again to Serge Prengel’s Relational Implicit podcast for a clear and timely conversation.

https://relationalimplicit.com/porges-social/

Personally I prefer the term physical distancing  because we need to work hard retain the social contact, as Porges says. We need to keep a safe distance to prevent possible viral transmission, but we need to maintain contact to reduce unnecessary anxiety and counter the feeling of isolation. So we talk, we make jokes, send love,… I heard of people dressing as animals and dancing outside their neighbours window on a child’s birthday…we do what we can to make contact and keep connected.

To this end I am seeing clients online using the various video/phone calling methods to meet and work with people. In some cases I am meeting clients outdoors, in the beautiful surroundings of the Calder Valley. This may not always be appropriate, but I am happy to discuss this with new clients.

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Article: Telling young survivors of suicide…

This essay summarises the ideas and research in a well written and researched book Suicidal: why we kill ourselves by Jesse Bering. It speaks of the effect a suicide can have on children, and in particular, how the information about the death is handled. It resists oversimplification and instead details subtleties, evolving narratives and different possibilities, using many examples and case histories. I found it a very good read.

Clicking this link should take you to the article on the AEON website which has many interesting essays on Psychology and more.

This link for info on a men’s discussion group

If you have been affected by someone’s suicide or threats to end their life you can contact me through this website and arrange a free phone call.

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Transactional Analysis concepts

Transactional Analysis or TA is a great way of understanding yourself and how you relate to the rest of the world. It uses simple concepts to help you understand your personality. People use it in many ways, to understand themselves or their relationship dynamics. Some people use it in schools, or even to change an entire organisation. It can go deep into childhood or stay in the here and now to explain your behaviour, thoughts and feelings.

TA was devised by Dr. Eric Berne, a psychiatrist. Initially it was a way to work with people suffering severe disturbance, he then went on to make it into an accessible system for exploring and understanding personality and how people relate to each other. TA is commonly used in individual or group therapy, working with children or whole schools, in couples counselling and a variety of settings. A key feature for many TA therapists is that they are able to share their method with their clients because it is easily explained. People find they can use it to de-escalate unpleasant emotional responses or defuse arguments.

It is a humanistic and compassionate theory that I have also used to explore childhood issues, loss, obsessions, compulsions irrational responses, unwanted feelings,… and sex.

My training was based in this model of understanding personality with other psychological approaches included to form what is known as an integrative style. Other models and approaches are explained briefly on this website to help you understand how I might work or how you might choose to work with me. I still enjoy the simplicity and thoroughness of TA.

Here are 3 youtube videos by Theramin Trees which animate some basic TA concepts. Books on TA cover a huge range of topics, too numerous to mention.

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Conversation with Pat Ogden on body posture

A conversation between Pat Ogden of the Sensorimotor Psychotherapy Institute and Serge Prengel.   I like the way Pat speaks about the body and I feel like my way of working has some crossover with hers (although I have not trained at her Institute). I also run workshops on Body Language and non-verbal expression (see The Human Cry)

https://mindfulpause.com/ogden/

This is one of a series of interviews or conversations as Serge prefers to call them. I think he is an excellent interviewer who skilfully summarises what he is hearing and often helps the subject to open up and share what needs to be shared. See also https://somaticperspectives.com/

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Different types of therapy

Relational therapy

We all live continuously in relation; to others, to ourselves and to our environment – we are created and shaped by our experiences of relating and thus our complex and layered personality structure is formed. Therapy allows us to learn more about the workings of our unique structure and to work through problems – in relation. Relational therapy pays attention to our relationship, using you and I, in the moment, as a way to observe in real time how we are reacting to another person. We can also then observe what is happening internally; our relationship(s) to ourself(selves).

We may look into the past or think about the future, but there are many clues in the here and now, in what happens between us. How you are in the world and what you want from life can be explored in the safe space we create each week, through openness, compassion and non-judgemental exploration.

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Katherin Stauffer talks about sex and power

I want to share this article because I enjoyed it and also because I think the current debate about sexual harassment is an important one. Serge Prengle is an excellent moderator of discussions and his conversations series is a useful resource for those wishing to learn about body/somatic psychotherapies.

She says; “In cases of abuse the shame that should be with the perpetrator gets transferred to the person who has been abused.” It’s a simple but important thing, a helpful reminder that part of the abuse is this co-creating of shame. This involves or invests the vulnerable party in the creation of a protector for the abuser. It maintains and reinforces the power imbalance.

Then she goes on to say sometimes there is an attempt to return this shame – for the abused person to try to shame the abuser. Which, whilst understandable and perhaps important, rarely helps either party. My question as a therapist is often – what will be helpful?

Kathrin Stauffer reflects on sex & power

 

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Creativity

Creative acts can be transformative and creativity can be key to problem solving.

Aside from the obviously “artistic” activities, many of our  moment-by-moment behaviours, choices and responses require creativity, including our defences. As we decide what to do, or how to respond, our subconscious works to keep us safe and avoid things it has learned to fear.  As children we learned through trial, experiences and through play. Those lessons were embedded deep in the psyche and are held in the body. Some of those lessons may now be holding us back, so creative thinking and creative play can help us contact those deeply held beliefs and feelings in a way that rational discussion can sometimes simply cannot access.

It’s not about artistic expression. It’s about engaging more than the cognitive mind and helping the vague notions and out-of-awareness feelings to emerge into consciousness. Exploration allows us to soften the rational grip and makes room for a more open perspectives, it relaxes the rigidity of thinking that may be needed for change to occur.

Sometimes we cannot understand rationally or cognitively, but we still need to find a way to express or explore our thoughts, feelings or actions.

Sometimes clients and I make drawings or diagrams to represent or catch something elusive. We may come back to these scribbles and schema to help us remember the themes and layers of previous sessions. Patterns appear, symbols speak and feelings become more meaningful.

Sometimes we can lay out objects to illustrate tangled relationships or a complex set of feelings. This enables a perspective, or multiple perspectives to be seen, to be layered…. and even to be challenged.

Sometimes we may need to stand tall, curl up, walk around the room or jump up and down. By changing ourselves physically we encourage different psychological perspectives to emerge.

 

I believe that we are all creative, through necessity. In times of distress, crisis or chaos our creativity can be illuminating, freeing, soothing and so helpful.

And of course it can add humour, fun, relief or distraction where needed.

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Body Psychotherapy

There are many different schools of Body (Somatic) Psychotherapy, from the Focussing work of Eugene Gendlin to the Sensorimotor school, bringing together the psychoanalytic experience of relational therapy and the discoveries of Neuroscience. There are also psychotherapists working with dance and movement who work with the body to bring about release, to unlock memory and to inform discussion from the unconscious. I draw inspiration from these highly effective approaches and share an interest in the body as a store of non-cognitive knowledge. By this I mean that we learn and remember through our experiences and these stay with us, sometimes out of awareness. But this “knowledge” can still be used. We often find that the body is trying to tell us something but we are resisting hearing it. We can take time to listen – I prefer the word attend as there may not be words or clear messages – and we may find out what is holding us back or causing a problem.

I have also studied how the voice changes and inflects in response to desires, defences and fears held in the body. Posture and body tensions can be observed in a detailed way to help our discussion reach carefully into the psyche. By slowing down and observing somatics I Zenegra find we can bypass some of the verbal knots and complexities that bind us to unhelpful ideas and behaviours.

We all know that worry can make us sick. It shows up in the body. Fear, trauma and loss can also have serious physical effects as can identity issues and low self-esteem. I find working with the body often helps to restore health and build up confidence.

Some body therapists use directive touching such as massage or joint manipulation, but I do not use these techniques. I would enquire and help you to notice and attend. Together we may discover or explore what is happening somatically and emotionally. This helps us to balance between thoughts, feelings and actions – the alternatives might include:

  • getting tied up in circular thoughts
  • obsessing on negative ideas
  • low moods or depressive energy making change impossible
  • fear of change
  • being a victim of a habit despite knowing it is bad
  • repeating patterns of behaviour we regret

My work in Music, Theatre, Dance and many other somatic practices have given me valuable insights and skills. It is a way of working that requires sensitivity and curiosity on the part of therapist and client alike. Compassion for ourselves and our bodies is also important.

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Psychodrama

Psychodrama is a form of therapy using action alongside or instead of talking. It uses dramatisation in a broad sense, including role play, visualisation and action, to explore issues, ideas, conflicts, relationships, history, dreams, fantasies…. and work with them.

This could include:

  • Roleplay, such as rehearsing a difficult conversation with a boss, colleague or family member.
  • In order to separate confusing inner voices we might choose an object to represent each one – then ask direct questions of the object. The client provides the answers but this technique helps them to clearly define them. In this way a client may have a constructive conversation with conflicting parts of their self.
  • Asking someone else to represent a family member so you can dialogue with them.
  • Re-imagining past events from multiple perspectives. Recreations can illuminate the past and provide fresh perspective.

Or it could be a more complex work which helps to explore an issue by dramatising aspects of it or by reimagining it as you might want it to be. This allows for reflection, contemplation, insight and an experiential view.

These techniques are very effective for working through complicated or frightening issues, for coming to terms with changes or getting a different perspective. They also have the advantage of accessing embodied memory or deep subconcious levels of knowledge. It’s not as scary as it sounds, it can be even be playful and joyous.

Psychodrama was developed by Jacob L Moreno in the early 1900’s and is considered by many to be the genesis of group therapy and many commonly used therapy techniques.

I have a 1 year certificate in action methods awarded by the Northern School of Psychodrama.

Learn more at BPA or The Northern School.