Confidentiality & Safeguarding

This blog is about what breaches of confidentiality or what safeguards in confidentiality, would a counsellor and therapist put in, in terms of what agreements would you have with the client about breaks in confidentiality.  So I just want to share with you some of my ideas from a transactional analysis point of view and probably from a integrated relationship point of view, as well in what breaks I would have in confidentiality.  

So I’m working with a client and you know, I see him for the first time and of course, confidentiality is the bite word for them to feel secure and safe and building up a trusting relationship with me.  They need to know that confidentiality is in place.  So they need to know what confidentiality means so I tend to spell that out with them and talk that  through.  So confidentiality means whatever stays here, stays here.  It doesn’t go anywhere else, but I did have some breaks in confidentiality which I want to share with you which I think is important for any beginning counsellor or psychotherapist to think about so that they don’t trap themselves in a confidentiality mire or trap themselves in some ethical problems which is going to be very challenging for them to break free from in some ways.  So, the first break in confidentiality would be that if the client disclosed something that was of a criminal nature or against the laws of the land, I would have the permission to break that.  Of course, I’d talk with my client first about this to say that as this is a criminal act and you’ve given me something which is of criminal nature and it is in my duty to report this, and I’d give them the option first to be the person who actually went to the police or whatever this nature is about rather than me having to do it or perhaps even I’d go to the authorities with them, but certainly I would definitely flag that up.  Now of course there are degrees of criminality so that’s something else I’ll probably be talking about at the beginning of the counselling session but I’d certainly have that break in the confidentiality system and that is if they share something that is criminal then I would have the space to take that further if need be but I certainly would talk to them.  

Secondly would be if I deemed they were to harm themselves or in fact they were going to harm other people.  So, you know, if I thought that they were going to go away and kill themselves or if they were going to really harm other people then I would have the confidentiality space to do something about that and take that further.  Now of course, all these three actions would be talked through with the client.  I wouldn’t just go ahead without talking it through.  

This is a really important process and is talked about a lot with the client before I start therapy with them so they know exactly what my thinking is in terms of confidentiality breaks and what confidentiality actually is.  It’s a really important area I think for beginning counsellors and therapists, and even experienced counsellors and therapists to actually consider what confidentiality is and when they would break that and have they discussed that with their client, so there’s a sense of security in holding a containment in the therapeutic process.

What is integrative psychotherapy

This is an interesting blog that I’ve been thinking of writing for a while; what is integrative psychotherapy.

So, traditionally integrative psychotherapy is seen firstly by this, that the therapist will borrow from many of the different tools of the different psychotherapy models like Gestalt, transactional analysis, self-psychology, existential psychotherapy, even CBT, and they’ll use the different tools from the different psychotherapy schools and have that as an integrative package. According to what the client presents, they’ll sort of draw from their tool bag of many different concepts, techniques and tips to be able to give an integrated treatment to that person.  

However a recent integrative relational model that I particularly like comes from Richard Erskine’s ideas in integrative psychotherapy and they have two distinct paths on their views on integrative psychotherapy.  

One which is very similar to the one I’ve just described, that they borrow from different approaches, specifically psychoanalytical approaches, self-psychology approaches, the early object relation approaches, Gestalt psychotherapy and of course the infamous transactional analysis.  

But another way they look at integrative psychotherapy is that they are focusing on helping the person grasp a sense of agency and ownership of the self.  They’re looking at how the client has split off, has cut off part of the self off or disowned part of the self.  They’re looking at the fragmentations of the self and helping the client being aware of the different cut-off parts or fragmented parts of the self, so that if the client can become aware of the paths they repress or cut off, or disown or disassociate from, they then can start the process of taking ownership of the different parts of themselves they’ve cut off in the service of integration.  Then of course, as the client becomes more integrated and takes back part of the sense of self that they’ve split off in times or trauma and stress, then they will have more energy to utilise in the service of spontaneity and being more in the here and now instead of just being operating from different parts of the self.  So integration, being in contact, in the moment, spontaneity are all major goals of an integrative psychotherapy, especially the integrative psychotherapy that I’ve just talked about which comes from the Richard Erskine school.  

Ok, that’s also how I see integrative psychotherapy.  I like those twin approaches.  Borrowing from different schools, different TA approaches but also the psychoanalytical approaches and of course helping the client take ownership of the different parts of the self in service of integration. 

I would be interested in your views on integrated psychotherapy, what it is and how you use it if you are a practitioner?

Contracts & Goal setting

This is a five stage plan for setting contracts for psychotherapists and counsellors.  The first stage is asking the client, what do you want from the psychotherapy or counselling?  What’s your goal?  What do you want to have achieved after the psychotherapy has ended?  How would you like to be different?  So you get a contract or a goal or a focus of awareness in how the person is going to be different. 

The second stage is about how they would sabotage their goal or their contract.  Now of course they might say to you, I don’t know how I would sabotage, so you need to explore that because this is their resistance or they may actually not know.  It might be out of their awareness.  So you need to explore how they might sabotage or stop themselves getting what they want because if they actually were able to get what they want, they wouldn’t be seeing you in the first place.  In transactional analysis terms that would be a question aimed at the child ego state or their unconscious, or part of themselves they have disowned or are unaware of, so this is helping them bring to awareness how they might actually be stopping themselves change.  Usually it is a decision made from history which they are projecting onto the present which actually is the problem.  Anyway, once they have identified that area which might take quite a long time, then you can move onto the next question in the contracting stage and that would be, what needs to happen in the therapy for you to make these changes?  So, you’ve found out what they want.  Secondly, you’ve looked at what the sabotage is and thirdly now you’re on to what do they need to do with you in the therapy or counselling which will achieve their goals?  Ok?  And you might actually want to say verbally but you might actually want to write that down so the person takes ownership of what they are going to do and what the changes are.  

The next stage would be checking out what support have they got while they are making these changes.  Who is going to help then or support them, even if it is only on a making contact level, talking, etc, etc.  This will be very good also for checking out how isolated they are.  How lacking they are in internal and external support frames?  And the final part of this five stage plan if you like would be to ask them how they are going to celebrate when they have made the changes they have come to counselling or psychotherapy for?  How will they celebrate, and also who they would celebrate with would be a good way.  

So we’ve got a five stage plan in the contracting in these early stages of psychotherapy and counselling.  First of all to check out what they want from therapy, and of course if they kind of say, well I’m not sure what I want, then a magic question to ask would be of course, well if you can guess what you wanted, what would that be, and that will free up the child ego stage or the  unconscious to spontaneously start looking at what they want.  The second stage of course is looking at sabotage mechanisms or the resistance to change.  Third stage is looking at what they need to do in therapy with you to make those changes.  Fourth stage is around support and the fifth stage is how they are going to celebrate the changes made.  

I have always found this a really useful plan to make at the beginning of psychotherapy or counselling so you’ve got a sort of, I wouldn’t call it a treatment plan, but at least a way forward and you’ve looked at the sabotage mechanisms, and they have taken some ownership in this process as well.

Effective Habits for Effective Psychotherapy

With the growth of psychology, psychotherapy and counselling in the 21st century, we have witnessed a growth in the area of professional psychotherapy and counselling.  Indeed, at the time of writing there are over 700 types of psychotherapy themselves in the United Kingdom.  So when I was looking at what perhaps is the essential habits that need to be addressed or the essential qualities that needs to be addressed for an effective psychotherapist in today's world, what sort of habits does the effective psychotherapist need to establish?  

Ok, so I've come up with some effective habits that I think need to be observed in the workings of a professional psychotherapist’s life. These are as follows;

Firstly confidentiality. In the world of psychotherapy the effective psychotherapist needs to have confidentiality of course, essential for their practice. They need to cultivate and I think explicitly state the notion of confidentiality and what it means.  Confidentiality means for me to be the most important feature in their professional work.  In fact clients will not only expect this but will, in most cases, demand it.   When a confidentiality is broken by the therapist the client will usually feel letdown, betrayed and fundamentally insecure or unsafe.  They will usually leave therapy perhaps and may indeed take out a complaint in extreme cases against the psychotherapist. So it’s a very important habit for any successful psychotherapist practicing in the 21st century. 

Second, safety and security is an essential habit to get into. The psychological safety and security of their clients must be paramount. So I suppose what do we mean by the term psychological safety? When I use the term psychological safety I mean how the client internally protects themselves or indeed abandons themselves. Many of the clients the therapist may work with have not internalised their protective nurturing other than that which is on their side in the terms of safety and security. These type of clients often may present in a chaotic or neglected manner. In other words they psychologically don't take care of themselves in either an emotional or practical way.  So in that example the therapist needs to have a habit of actually making sure or establishing a routine where the clients will take on the therapist's psychological protectiveness.  So the therapist needs to model psychological protectiveness and this will not only provide a sense of safety and security for clients, it will also be the mechanism of osmosis, helping with the creating of a more protective psychic skin.  This psychic skin will create a more robust sense of self for the client, especially when dealing psychologically with their more chaotic, sensitive self.  Indeed the importance of this cannot be underestimated and must become an effective habit in the army of the professional psychotherapists today.  

Next, the psychotherapist needs to have the habit of wisdom.  I think this is important in the context of this blog in the imparting of the wisdom of the therapist within the therapeutic dialogue.  Wisdom is not only essential per se, it's also important to know that wisdom for the therapist is also gained through heart, hard earned experience of many hours of working with clients within the therapeutic process.   Not only is it important for the client to often see you as a sage or mental figure within the therapeutic journey, it is also vital for the therapist to pass down some of their wise words and wise attitudes to the client in the service of emotional help and wellbeing.  The parting wisdom does not mean a complete sharing of yourself as this can be often inappropriate and counter to the therapeutic process.  Indeed in this context the best combination would be considered wisdom with clinical judgement.  Does this mean then that the inexperienced therapist will not be seen as a wise person?  No, because often wisdom is a way of being and can therefore run through the essence of the therapeutic relationship.  

Next, habit robustness.  The psychotherapist needs to be robust.  It is an important habit for a therapist to cultivate and indeed it is this robustness or strength of self that the therapist portrays that is so important of the client when working through their struggles and adversities within the therapeutic process.  Often on a psychological level the client needs to feel and almost touch the strength of the therapist so they can psychologically internalise the therapist’s vital strength in their quest of health.  For the therapist themselves it is the strengthening of their psychic self or the development of the robustness of the therapist’s self which will be crucial in providing a psychological container for the client to express their anxieties, fears and emotional insecurities.  

Finally another discipline which is really important is the use of humour.  Another positive habit for the therapist to develop which will make their psychotherapy practice more effective I believe is the use of humour within a therapeutic process.  For any psychotherapy to be effective and secure well being, the therapy journey will inimitably pass through some areas of lightness and darkness.  Indeed it is often through these dark times that real therapy happens.  Often we can see that through acute discomfort motivation will occur and if we can grab hold of this motivation, the road to cure will often follow.  However, it is with this in place, we often witness great courage and the human spirit   will prevail on the road to victory and celebration.  In a transition between the light and darkness, it is often necessary to use humour as a light relief, otherwise the darkness may become so overwhelming that the client may stay with the “psychological safety” or their default swift pattern.  Humour is more than not a spontaneous transaction or set of transactions which the therapist will often use in a clinical manner with the client.  The clinical thinking does not have to take away the authenticity and genuineness of the humorous intent.  In fact the humour will hopefully provide a time of intimacy and therapeutic closeness within the therapy setting.  Humour of course is natural to the human condition and can be a useful tool for the therapist to utilise in the service of therapy to cure and well being.  

My invitation in this blog is for psychotherapists and counsellors to allow themselves to use humour with clinical forethought within the psychotherapy journey.  Finally courage needs to be cultivated as a habit for the psychotherapist or counsellor.  These qualities need to be developed per se.  It is very, very important that the therapist can take the extra risk, go the extra mile for their clients.  Courage is modelled down so that the clients can not only feel the courage but be empowered to take courageous risks themselves.  In my professional experience it is the courage of psychotherapists that often becomes the bedrock for the client to empower themselves in the journey of their therapeutic life.

So these are some of my thoughts on the blog in terms of habits the psychotherapists and counsellors need to cultivate and need to build on so they become the bedrock of their psychotherapy practice.

A picture of me!!

Hi there I thought i would post a picture of myself so you can see who you are blogging with!!!!!

TA

I love Transactional Analysis, and it the first model that informed me as a Psychotherapist.
I thought i would define for my readers ,what TA is:

Transactional Analysis can be defined as many things, first and foremost it is a philosophy that begins with the belief that each of us is fundamentally OK whilst also expressing a point of view and a description of people which gives us an understanding to the structure of personality.

Woollams and Brown (1978) describe it as "An ever-expanding system of related techniques designed to help people understand and change their feelings and behaviors."

Eric Berne began to develop the theory of TA before 1958 when he had his first articles published containing the principles of TA and its concepts. His first book Transactional Analysis in Psychotherapy was published in 1961. This laid out a theory of personality and interpersonal relationships, in all his works extended over thirty - two years including seven books and fifty articles, transcripts and papers (Stewart 1992).

Berne described TA primarily as "a unified system of individual and social psychiatry", because of his extensive work within the psychiatric community both working with individuals and groups. In its strictest sense the term transactional analysis was used by Berne to denote the analysis of transactions. In his book Transactional Analysis in Psychotherapy 1961 he described TA as “Structural and transactional analysis that offers a systematic, consistent theory of personality and social dynamics derived from clinical experience, and an actionistic, rational form of therapy which is suitable for, easily understood by, and naturally adapted to the great majority of psychiatric patients".

TA Today (Stewart & Joines 1987) describe TA as defined by the ITAA (International Transactional Analysis Association) as "a theory of psychotherapy for personal growth and personal change". Stewart and Joines go on to say it is a theory of personality which uses a three part model known as the ego state model, which helps us understand how people function and express their personality in terms of behaviour.

Briefly TA also provides us with a theory of communication, it gives a method for analysing systems and organisations. It also offers a theory of child development, it offers life script explaining how are influenced by our history and the decisions we make about ourselves, others and the world because of that. It offers explanations as to how we continue to repeat patterns of behaviour that may be self-defeating. Overall TA gives us a theory of psychopathology, a system of psychotherapy, a treatment system for all types psychological problems from average neurosis to psychosis.

About Me!!

Bob who is the founder of the Manchester Institute is an experienced psychotherapist and freelance trainer and supervisor. He runs a clinical practice encompassing both individual and group psychotherapy. He also runs a four-year TA Psychotherapy course with a UKCP accreditation. The basic theoretical framework that he uses in his work is Transactional Analysis, and he offers an integrative approach to therapy, incorporating Gestalt and bodywork techniques.

Bob is the Principle Director of the Manchester Institute.

The Manchester Institute for Psychotherapy evolved from the Lifestream Centre for Psychotherapy, which was founded by Bob Cooke in September 1987. Bob Cooke was interested in the idea of creating a therapy centre in south Manchester and saw it as a place where people could come, knowing that they would be attended by skilled therapists and treated with high regard and with confidence in safety and confidentially. At that time the staff consisted of two full time therapists, Bob Cooke and June Brereton, and several other part time therapists. It was through the establishment of this centre in 1987 that the Institute has its roots and subsequently evolved to now encompass a training dimension as well as a clinical base.

We have a fundamental belief that those who are personally motivated and willing to change will do so, and in so doing inspire the growth of others. Whilst on this path of self-development those who change will enhance the development of their environment.

For those working and training at the Institute, personal therapy and supervision are a basic requirement, thus ensuring a clear and safe environment for all clients in attendance.

In practice the commitment to anti-oppressive practice and values will involve the following:

The Institute’s Psychotherapy Training is recognised by the Institute of Transactional Analysis (ITA) and the European Association For Transactional Analysis (EATA) which is a member of the United Kingdom Council for Psychotherapy (UKCP).

We provide a comprehensive training programme in psychotherapy together with a wide range of clinical specialities in areas of self-esteem, lack of confidence, anxiety, panic attacks, relationship difficulties, addiction, bereavement and loss etc