 Over the years there has been considerable research into why people leave or stay in therapy. A recent study, where clients were interviewed about what influenced their decision to stay or leave therapy showed that they regularly reviewed their decision to stay. The three main influencing factors were the urgency of their need to change, how they felt about their therapist and if the process was moving them towards their goals for therapy. For many clients in the study, they were strongly influenced by the extent to which their therapist had been able to present them with a credible plan to resolve their problems.
When there is an unplanned or premature ending to therapy, it leaves a lot of questions for the therapist. I believe transparency is crucial, as is engaging with the client in where you are in reaching their goals and how they are feeling about the process and their progress. When the core conditions are in place for unconditional regard, empathy and congruence, there is the possibility to explore whether their feelings and needs are being meet or not, while challenging your own work to give each individual client the best of yourself.
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Children as young as five will be able to get help for mild depression through apps on their smartphones after the NHS’s treatment advisers recommended the use of such devices in their care. See the full story on the Guardian website.... https://www.theguardian.com/society/2019/jan/23/nhs-prescribe-app-therapy-children-depression?CMP=share_btn_tw  When we lose a loved one, the emotions in the aftermath are often so raw they dominate everyday living. Many also fear that sooner or later, others and they themselves, will forget their loved one. For some grief looks like depression, with feelings of anger, bitterness, impatience and are irritated by friends. Others experience friends and community members avoiding them, not knowing what to say, which can lead to social anxiety.
In grief, we can discover that the people we love, and attach to, where there were mutually rewarding relationships, have affected us in ways that were not in our awareness previously. They have a fundamental impact on our sense of self, the loss creates confusion about ourselves, who we are and who have we become., as well as our sense of purpose - how to be without that relationship. Grief is a gradual, long-term process, about mourning a death and working with the rupture towards a sense of accepting a new reality, the finality of their absence, exploring ways of having a meaningful life without them, while loving and caring for them without their presence, through holding on to memories, making them part of the story to your life. Loss is intrinsic to the human experience and at the far end of the spectrum is grief which is one of the greatest manifestations of psychological pain that we can go through. When finding a profound sense of gratitude for having loved the way we did, in honouring the memory of the loved one, their legacy lives on.  Psychotherapy students are often taught theory developed back in the 50s and 60s with no reference to recent findings, and as therapists we can a get stuck in fixed theoretical positions that do not evolve and that are stagnating. Research, both quantitative and qualitative, can be a means of supporting us in getting unstuck, the problem is there is little funding available for mental health research.
Miranda Wolpert, professor of evidence-based practice and research at University College London says ”therapy research is too much focused on competing modalities and what goes on in the counselling room, instead of looking at external factors in clients’ lives and the resources that contribute towards client behaviour change, then therapy can build in the counselling relationship”. We also need to explore clients ability to manage their mental health issues when not in therapy, what works for them in and out of therapy and how to tailor those findings to specific needs of others .In Person-Centered therapy listening to the client tracking what is going on, looking at what is being communicated is research in itself. Counselling is exploring human distress and its meaning while supporting the clients to find their own answers.. With the need to have scientific evidence based evidence, we can lose the art form of therapy and being creative in the process, due to the pressure of winning contracts within the NHS. Evidence from numerous studies shows that across all populations and all types of presenting issues, different therapies achieve roughly the same outcome. Mick Cooper, Professor of Counselling and Psychotherapy at Roehampton University says randomised controlled trials (RCT) give us an indication of the average effect and cost effectiveness of a particular intervention and allow comparison of when you do something and when you don’t and that is what commissioners want to generally know. We need studies showing what we do is effective so we do evolve moving forward.  A study at Kings College London on genetic links to anxiety and depression is breaking new grounds by exploring not just the genetic links with depression but also the social and environmental risk factors, therefore improving an individual’s treatment.
Therapygenetics, the study of genetic predictors of response to psychological therapy, is able to predict treatment response. Looking at the future, it is hoped therapygenetics will deliver a risk index for patients visiting a GP with anxiety or depression, to provide the treatment option that would work best for them, medication or talking therapy, rather than a trial and error approach. Several studies have provided evidence that individuals respond differently to different psychological interventions and that genetic differences are capable of predicting these different susceptibilities to psychotherapy. What has been found is that your genes put you in a certain place on the spectrum of emotional vulnerability to stress but when taught psychological techniques, it can increase a person’s resilience while reducing vulnerability. Genes cannot be changed but environmental changes can support the management of life’s stressors. Given, that for many people that drugs are the first line of treatment, genetic research offers a way of working out what will and will not work for them. We are in currently in an epidemic of distress with poverty, social isolation, social inequality, bereavement and loss creating anxiety and depression. We need to offer people the opportunity to be heard and to make sense of their life, while supporting them to find their own answers on how to move forward, developing a stronger resilience and self-esteem. Therapygenetics promises to deliver that opportunity more efficiently. Mentalizing is the ability to understand actions by both other people and oneself in terms of thoughts, feelings, wishes and desires, such as seeing ourselves from the outside and others from the inside. It supports us in making sense of ourselves and others.
An example of this, is when the US president, Barack Obama, had a commemorative photo-shot taken with two young ladies along with their serious boyfriends, which he learnt about during their introduction, and he suggested the two young ladies had another photo without their boyfriends, ‘You know just in case’ he said jokingly. He said it playfully and no one was offended. He was being very thoughtful, thinking if the relationships did not work out, they still had a commemorative photo without the boyfriends. He hinted that he remembered being younger and that relationships do not always last. If we have a good mentalization capacity like this, we tend to enjoy better interpersonal relationships and intrapersonally (self-to-self), we tend to self-regulate better and have a healthier sense of self, where the two worlds interact. Knowing who we are, helps not being exploited by others. Mentalization often happens automatically without thinking about it. It requires imagination, involving mental states which are an invisible collection of someone’s subjective experiences. It helps to gain insight into ourselves and others and how we interact. Source: Barley A. (2018). Holding Mind In Mind. Therapy Today. 29 (7), 34.  A growing number of children are being diagnosed with mental health disorders such as anxiety, separation anxiety, attention-deficit hyperactivity disorder and many more and this labelling can make a child deeply misunderstood. While the 21st century brings numerous benefits to young people in the western world, it has also brought contaminated areas such as the pressure to succeed, social media promoting unattainable images of perfect bodies, along with gender and sexual norms - many young people have viewed pornography by the age of fourteen and parents cannot always protect their children with the ubiquitous access presented by the digital age.
Countless factors contribute to difficult family life such as poverty, child abuse, violence, neglect, mental health difficulties, along with the pressure to be successful. We need to help young people by understanding the context of their difficulties and the impact it is having on their mental health. Empowering children to understand their behaviour is a natural response to their difficult experiences and may help them develop a more accurate acceptance of their strengths, while developing the vehicle for change and finding meaning. This will allow them to be all they can be and enable them to love and be loved.  Dementia is a progressive neurological impairment creating emotional trauma in social relationships with their care givers and those around them. The person has a sense of emptiness through loss of ability to do tasks effecting their verbal and cognitive abilities. This can create a loss of sensory, social contacts and memories. A person can lose the ability to recognise close family members and places, creating a frightening daily existence. Some can also hallucinate or be delusional.
With the person-centred approach concentrating on feelings, a sense of belonging, attachments and personal identity supports them as all behaviour has meaning however confusing or meaningless it may appear. The aim of therapy is to improve well-being and emotional security to create and maintain self worth for the client. Through empathic listening and adjusting ourselves to their emotional reality, viewing the world through their eyes. For many people with dementia the present moment is often the only place they can be and giving those moments a sense of well-being and belonging is what counselling should be. |
AuthorJacinta Bourke is a counsellor and psychotherapist operating in the Ealing W5 and surrounding areas. She is a member of BACP - the British Association for Counselling and Psychotherapy. Archives
January 2019
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