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First sessions and initial assessments are different and in some ways more difficult than regular sessions within an established process. In a first session we do not yet have a shared understanding nor an agreed therapeutic frame. It is one of the main tasks of a first session to develop such a frame, but not just routinely or as an arbitrary or standard given, but in service of the specific work required and therefore appropriate and maybe adjusted to each individual client.
A first session, especially if it includes an assessment, therefore comprises some quite contradictory modalities of engagement (all of which have matter-of-fact, practical implications as well as therapeutic and relational ones): some quasi-medical interactions, a business negotiation, a meeting of two humans / strangers, as well as therapeutic considerations throughout, plus the tensions between the four, manifesting to some extent as contradictory pulls between the therapist's presence as a person and their presence within the role. Hopefully at the end of the hour all of that will culminate in a sufficiently solid and mutually understood and negotiated working alliance (another relational modality).
The special dilemmas of such initial sessions arise because, after all, these are quite contradictory relational modes, and thus reveal more clearly just what a confusing mix of relational modalities the therapeutic relationship consists of.
So that means that a workshop on this topic is of interest and has benefits for a wide range of therapists, including specifically beginners as well as experienced practitioners.
What will you get out of this workshop?
As a beginner trying to build up your practice, the topic is immediately relevant to how you approach initial meetings with clients and whether or not these lead to ongoing work. The way most of us handle this to begin with relies mainly on imitating and copying our own therapists and tutors. However, that may not suit you and your style. Being clear about the conflicts and dilemmas that are inherent in first sessions is helpful in you working out your way of conducting these.
These questions are not only relevant for beginners, obviously, but we can all continue learning and reflecting on the habits we have developed in our practice. We can all usefully spend some time investigating what happened with clients who did not choose to continue after initial meetings, and what was the dynamic that got in the way of a working alliance.
For experienced practitioners focusing on the complexities of first sessions helps us sharpen our awareness of the tensions between the various relational modalities that are inherent in the therapeutic relationship all the time. Based on an integration of contributions by Lavinia Gomez, Martha Stark and Petruska Clarkson, Michael has developed some formulations that bring out the inherent tensions more clearly than each of these models by itself.
Format of the day:
So in order to provide a foundation and framework, Michael will give some background teaching and briefly touch upon his ‘diamond model’. But apart from that more general and abstract input, we will stick closely to the topic of the day and its practical applications.
In preparation, it will be useful for you to remember difficult first sessions and bring these as examples for us to work on experientially.
You can find some background reading to the topic, which Michael has put together on the basis of running this kind of workshop before, here.
Date & Time: June 11th 2017 10.00 - 17.00
Venue: OTS-Witney Therapy Centre
Lunch: As usual we will arrange a bring and share lunch in the week before the event.
As this training is part of a series, a training package has been compiled and is available on booking. The material is in numbered order to support any limitations on study time you may have prior to June 11th, but please note that they are essential study prior to coming to another event in this series.
The training package includes:
A revised and worked through transcription of the first half of the May 7th training day.
A 2hr40m YouTube video of the 7th May 2017 training day.
To secure your place, please transfer the relevant fee to the OTS Account:
Account Name: EJ Smith
Account Number: 31434683
Sort Code: 40-47-39
OTS Members - £40
OTS Affiliates - £50
OTS Applicants - £60
Non-members - £75
If you live in the area and want to join, contact the director of OTS, Justin Smith via the website.
Michael is a TRS (The Relational School) member and has drawn from Martha Stark’s seminal 1999 book 'Modes of Therapeutic Action’, Lavinia Gomez’s work on object relations and the tension between humanistic and psychoanalytic traditions as well as Petruska Clarkson’s 5 modalities of therapeutic relating to develop a broad-spectrum integration of therapeutic traditions as part of the relational project. For this study day Michael will present and explore with us his particular journey since his own experience of a ‘relational turn’ in the mid-1990’s.
What do we mean by ‘relational’?
Over the last 15 years or so, relational perspectives have had a significant impact across the fields of psychotherapy. However, the wider its increasing influence has spread, the less clear it has become what we actually mean by ‘relational’. The default common denominator would be the recognition that in therapy it's the relationship between client and therapist that matters, and that the quality of that relationship is a significant indicator of outcome.
However, whilst there is quite a lot of agreement that the therapeutic relationship matters, this apparent consensus breaks down at the first hurdle: there is no such level of agreement as to what actually constitutes quality of relationship. On the contrary: there is a tendency for the traditional approaches to define ‘therapeutic relating’ predominantly within their own frame of reference, taking their own paradigm of relating for granted. It is, therefore, not generally accepted that 100 years of psychotherapy have given us a diversity of distinct notions of what kind of relating is to be considered ‘therapeutic’. The common ground of ‘relationality’ is a negative distinction from classical one-person psychology and ‘medical model’ non-relationality, but beyond that it is unclear whether relating means in Gomez’s terms being ‘alongside’ as an ally or ‘opposite’ as a relational other. And then what kind of other: positive, nurturing and reparative or authentic/dialogical or transferential other? And in amongst all that, what happens with the ‘bad’ object, and who relates to it how?
A multiplicity of diverse, contradictory and complementary relational spaces.
Unless we take into account these different and contradictory notions of relatedness - or in the terms of Petruska Clarkson’s seminal contribution from the early 1990's: the different relational modalities we now find in existence across the field - what we mean by ‘relational’ will remain confused and confusing. It clearly means very different things to different therapists, without - however - these differences being sufficiently acknowledged or investigated.
Michael’s starting point will be the polarisation between object-relating and inter(subject)-relating: when we validate both and recognise the tension between them as essential to the therapeutic endeavor (a tension not to be reduced, resolved or short-circuited ideologically, but to be entered into in each unique client-therapist relationship), a multiplicity of relational spaces – contradictory and complementary, forming a complex dynamic whole – can be seen to arise from it. Michael proposes his ‘diamond model’ as a map that can help therapists process their conflicted (countertransference) experience when involved in layers of multiple enactment.
Engaging with therapeutic impasses, breakdowns and stuckness by integrating non-verbal communication, somatic processes and ‘implicit relational knowing’
“How can we use our own embodied awareness and our perception of the client's bodymind to maximise our understanding of the intersubjective dynamics in the therapeutic process?”
This workshop is based on integrating the wisdom and expertise of two diverse and in many ways contradictory traditions: the psychoanalytic tradition and the body-oriented Reichian and post-Reichian tradition. Psychoanalysis has developed incredible sensitivity to unconscious mental processes and relational vicissitudes, but remains limited to the ‘talking cure’.
Body psychotherapy has developed a profound understanding of bodymind processes, and a rich and creative toolbox of working experientially bottom-up towards an integration of physical, emotional, imaginal and mental aspects of being, but remains limited by fixed relational stances on the part of the therapist and a lack of awareness around countertransference (where it is understood as the therapist’s problem only, rather than also containing information about the client’s unconscious).
By bringing the two traditions together, we get the best of both worlds, leading to profound possibilities of deepening the therapeutic process, making therapy more effective, and dealing with otherwise unmanageable impasses and complications.
Whereas recognising and working with the transference has been an essential aspect of the Reichian tradition, working in the transference and with the countertransference has been a neglected part of the therapeutic relationship in body-oriented work. Most humanistic therapists share with Freud the classical assumption that countertransference boils down to the therapist’s own ‘stuff’ or pathology, and is therefore best dealt with by further therapeutic work on one's own process and character as a therapist, towards authenticity or congruence.
As long as we reduce countertransference - in David Boadella’s terms – to an “interference with contact”, our work can not benefit from what the psychoanalytic tradition calls the ‘countertransference revolution’: the recognition that the transference and countertransference “interlock” (in Heinrich Racker’s terms) and that some of our experience in the therapeutic position can give us deep insight into the client’s inner world, including their early relational experiences which contributed to their character formation. This interlocking depends upon ‘somatic resonance’, but goes way beyond its traditional meaning as ‘feeling the client’s feelings’. The ‘countertransference revolution’ helps us recognise how the “client’s conflict becomes the therapist’s conflict”.
The fact that body-oriented tradition has overlooked and ignored the ‘countertransference revolution’ is curious, because it is precisely embodied perception should enable the therapist to be much more acutely aware of the ways in which the client's unconscious experience is communicated nonverbally, subliminally - via empathic attunement, somatic resonance, projective identification - and thus appears in the countertransference.
“Within the Body Psychotherapy tradition … the relational vicissitudes of the therapeutic endeavour are still under-theorised. Thus, a holistic and phenomenological two-person psychology as bodymind process still awaits formulation.”
Michael has been working on re-integrating the Reichian and psychoanalytic traditions since the 1980’s and is an internationally recognised trainer in this field.
In this workshop, we will use participants’ own personal-professional experience and client material to learn experientially and theoretically, using role-plays to work through supervision vignettes in an embodied and experiential way. Michael will interweave the group process with the learning as well as skills practice, to demonstrate and teach, drawing on our shared experience in the group.
to deepen and enhance our ‘implicit relational knowing’
to deepen our awareness of the relational significance of non-verbal communication
to apply the insight of modern neuroscience to our practice
to integrate ‘one-person‘, ‘one-and-a-half-person’ and ‘two-person psychology’
to recognise oscillations in the working alliance in response to unconscious processes
to recognise transference and countertransference as bodymind processes
to understand the principles and application of the countertransference revolution
to recognise the therapeutic potential of impasses and enactments
Ενώ το να αναγνωρίζουμε και να εργαζόμαστε με τη μεταβίβαση έχει υπάρξει ένα βασικό στοιχείο της Ραϊχικής παράδοσης, το να εργαζόμαστε μέσα στη μεταβίβαση και στην αντιμεταβίβαση έχει υπάρξει ένα παραμελημένο κομμάτι της θεραπευτικής σχέσης στη σωματικά προσανατολισμένη θεραπεία. Οι πιο πολλοί ανθρωπιστικοί θεραπευτές μοιράζονται με τον Φρόυντ την κλασσική υπόθεση ότι η αντιμεταβίβαση συνοψίζεται στα θέματα του ίδιου του θεραπευτή ή στην παθολογία του και συνεπώς αντιμετωπίζεται καλύτερα με περαιτέρω θεραπευτική εργασία επί της προσωπικής διεργασίας και του χαρακτήρα ως θεραπευτή, με στόχο την αυθεντικότητα ή τη συνέπεια.
Όσο αναγάγουμε την αντιμεταβίβαση σε μια «παρεμβολή στην επαφή» (με τους όρους του David Boadella), η εργασία μας δεν μπορεί να επωφεληθεί από αυτό που η ψυχαναλυτική παράδοση ονομάζει «την επανάσταση της αντιμεταβίβασης»: η αναγνώριση ότι η μεταβίβαση και η αντιμεταβίβαση «αλληλοεμπλέκονται» (με τον όρο του Heinrich Racker) και ένα μέρος της εμπειρίας μας στη θεραπευτική θέση μπορεί να μας δώσει βαθιά επίγνωση για τον εσωτερικό κόσμο του θεραπευόμενου, συμπεριλαμβανομένων των πρώιμων σχεσιακών βιωμάτων που έχουν συνεισφέρει στη δημιουργία του χαρακτήρα του. Αυτή η αλληλοεμπλοκή εξαρτάται από τη σωματική αντήχηση (somatic resonance), αλλά είναι πολύ διαφορετική από την κλασσική έννοια του «νιώθω τα συναισθήματα του θεραπευόμενου». Η «επανάσταση της αντιμεταβίβασης» μάς βοηθάει να αναγνωρίσουμε πώς η «σύγκρουση του θεραπευόμενου γίνεται η σύγκρουση του θεραπευτή».
Είναι περίεργο που η σωματικά προσανατολισμένη παράδοση έχει παραβλέψει και αγνοήσει «την επανάσταση της αντιμεταβίβασης», επειδή ακριβώς η ενσώματη ακρίβεια είναι η οποία θα έπρεπε να επιτρέπει στον θεραπευτή να είναι πολύ περισσότερο ενήμερος των τρόπων με τους οποίους η ασυνείδητη εμπειρία του θεραπευόμενου επικοινωνείται μη λεκτικά, υποσυνείδητα δια μέσω ενσυναισθητικού συντονισμού, σωματικής αντήχησης, προβολικής ταύτισης και συνεπώς παρουσιάζεται στην αντιμεταβίβαση.
«Εντός της παράδοσης της Σωματικής Ψυχοθεραπείας… οι σχεσιακές δυσκολίες της θεραπευτικού εγχειρήματος είναι ακόμα ελλιπώς θεωρητικοποιημένες. Έτσι, μια ολιστική και φαινομενολογική ψυχολογία των δύο προσώπων ως διεργασία ψυχοσώματος ακόμα παραμένει να αναπτυχθεί.»