Integration – INTEGRA CPD

How can we Distinguish between Psychotherapy and Counselling? (2014)

Michael - Handouts — Thu, 11 Sep 2014 23:00:00 +0000

This handout in response to an interview by Psychotherapy Excellence is an attempt to clarify the question 'What is psychotherapy?' by distinguishing it from other, similar disciplines, like counselling, coaching and psycho-education. In practice, this is impossible, as these disciplines are hopelessly mixed up, after borrowing from each other, cross-fertilising as well as appropriating and belatedly jumping on prior bandwagons for decades. Most practitioners across these disciplines have little idea about the origins of their work, the traditions which the various approaches draw from, the giants on the shoulders of whom we have the benefit of standing. So no clear definition is possible: there are coaches doing therapeutic work, therapists doing counselling, counsellors doing coaching, much of it in an undifferentiated eclectic mix of approaches, which makes it fairly unpredictable for the average client to know what they are actually signing up for. In addition, the former British Association for Counselling - in a clever socio-political coup and with hardly any external consultation - re-branded itself in 2000 to unilaterally incorporate psychotherapy, changing its name and its claim to the British Association for Counselling & Psychotherapy, and calling its flagship journal 'Therapy Today'. If the ordinary public was thoroughly confused before that coup about the possible distinctions between counselling and psychotherapy, they are now positively bewildered (which suits some branches of the field which are seen as more 'accessible' according to polls). So this hand-out is not relating to any of this 'market' reality. Rather, it is trying to propose some possible distinctions if one were to validate all the 'therapeutic' disciplines in a non-partisan way for each providing something valid and essential that serves some people well some of the time. A layperson might well say about each and every one of them that they found it 'helpful' and 'therapeutic'. So together all the disciplines could be considered complementary aspects of a whole package which would require an embracing and comprehensive attitude towards the diverse needs for psychological help which are possible. What are some useful criteria and categories for thinking about these different needs? I am suggesting a possible clarifying definition of the various disciplines based on whether they work within the client's established personality structure, against as well as within that personality structure, or within, against and beyond that structure. We can use the metaphor of a house, and whether we are attempting a re-decoration job or a re-construction (which always needs to involve re-decoration as well). According to that definition, psychotherapy would need to both transcend (i.e. go beyond) counselling as well as include it, as well as coaching and psycho-education. So the tricky thing here is that I am not defining them as peers, next to each other, but more like Russian dolls, one containing and incorporating the other. The downside of that is that people inevitably turn that into a hierarchy of 'better' and 'worse' and 'superior' and 'inferior', which is not at all an implied or necessary consequence: why go and pay a builder for a re-construction job when all you need is a lick of paint in the living room? Yes, the builder would have to know how to paint as well as build walls and knock out windows, but that does not mean the builder is 'better' at painting. Conversely, you would not go and pay a painter for knocking through a wall which may endanger the stability of the whole house. This leads to a comprehensive vision of different stages, phases and modes of change in the bigger, evolutionary scheme of things: years ago Wilber had proposed a distinction between 'translation' and 'transformation', based on the same criterion as (change within the established structure versus change of the established structure) - I am adding a third: 'contradiction: change against the established structure. Wilber's terms are meant to apply to all kinds of systems, not just people, and certainly not just people's psychology. But the closer we follow psychological process, the more we realise that a lot of therapeutic effort is expended fighting against established habitual patterns (which is not a bad thing, unless it is a blind effort denying the need for transformation as well as contradiction). These three modes of change are like different universes where different laws and principles apply: what ‘works’ in translation, stops ‘working’ in contradiction, and is opposite to what ‘works’ in transformation. The same is true for transformation and translation: what ‘works’ in one is profoundly unhelpful, counterproductive or dangerous in the other.

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The Future of Counselling Training (CPCAB 2008)

Michael - Presentations — Sat, 17 May 2008 23:00:00 +0000

Counselling as a profession has come a long way in a few decades, but it is also facing serious threats and limitations, both from within and without. Over the next few years, cognitive-behavioural therapy (CBT) as the government's treatment of choice will be funded and supported to the detriment of established services and provision, including counselling. To survive into the 21st century, counselling and counselling training needs to evolve and build on its competitive advantages. An essential part of this evolution is to confront and deal with its shadow aspects and 19th century legacies. Here I suggest some integrative principles which might give counselling a paradigm foundation which will bring out its inherent strengths.

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The Diamond Model of Modalities – The force field between medical model, working alliance, enactment (2004)

Michael - Handouts — Fri, 01 Oct 2004 23:00:00 +0000

This handout presents the underlying force field and fundamental tension which the therapeutic endeavour operates within. Historically, and in the public (mis-)perception, therapy is seen as equivalent with 'medical model' treatment, i.e. symptom reduction through the therapist operating as a 'doctor for the feelings' (or the mind/mental states, in some people's perception). Whether amongst ourselves we agree with this construction or not (and amongst a significant fraction of the therapeutic field there is vehement disagreement and opposition to the 'medical model'), we need to make some kind of alliance with the client who is bound to labour under that misperception. For the opposite faction (i.e. those who subscribe to the 'medical model' without hesitation or misgivings), there is no issue, because they assume the working alliance by virtue of the patient walking through the door and wanting help. For those of us who hold a paradoxical third position between these ideological extremes, we can see the fallacies of each of these positions: as long as the client is paying us, they are entitled to certain expectations, whether these are valid in our opinion or not (we get paid to make some 'better', and we do take responsibility for that fact); on the other hand, to assume cooperation and working alliance just because the patient turns up, is profoundly naive, as we see a whole host of rational and irrational, good and bad reasons why the client is coming to us, and under which preconceptions. So, for those of us who hold that paradoxical third position, the situation is complex, ambiguous and complicated. We operate within the ongoing tension between these positions and we see the inherent conflictedness and 'artificiality' of the therapeutic space somewhat like a magnetic field in which the client's own conflicted experience becomes visible like iron filings. On the basis of that crucial recognition, we do not see the force field as static, but as profoundly dynamic, with the working alliance going through cycles of rupture and repair in a way that can become profoundly transformative. But this potential of the field only becomes activated once we can inhabit and surrender to its paradoxical and non-linear nature.

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The Diamond Model of Modalities – Oscillations (2004)

Michael - Handouts — Sat, 06 Mar 2004 00:00:00 +0000

My 'Diamond Model of the Modalities', based on Clarkson's modalities of the therapeutic relationship, uses my extended version of the modalities by including 'medical model'-relating. This model is designed to transform what are usually understood as sequential treatment options into it dynamic system in which all modalities are in tension with each other all the time. This dynamic system is structured by the oscillations in the working alliance, swinging around the three kinds of contact between effortless alliance on the one hand and alliance-undermining enactment on the other. We can think of this as similar to the rupture-repair cycles which are now considered essential in early development, in some ways are the early development.

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The Diamond Model of Modalities – Overlaps & Tensions (2004)

Michael - Handouts — Thu, 04 Mar 2004 00:00:00 +0000

This handout summarises the dynamic system of the modalities of the therapeutic relationship, the hexagon representing the therapeutic frame, and all modalities having potentially therapeutic as well as countertherapeutic effects. to some extent the modalities overlap, but traditionally therapists have emphasised the tensions, and absolutised them into mutually exclusive dogmatic positions. This diagram summarises these overlaps and tensions, spelling out some of the traditional polarisations. Rather than as ingrained theoretical-philosophical positions, we can find these tensions in the dynamic between each client and therapist, reflecting both internal and external dynamics via parallel process. So rather than thinking of the modalities as therapeutic alternatives, we can think of them as parallel process enactments, by which the dynamics of the clients inner world are reflected not only in the therapist's psyche, but also in the whole field of psychotherapy. We can thus use the modalities as mirrors and vehicles of the process, rather than objective and objectifying 'truths'.

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The Diamond Model of Modalities – Tensions (2004)

Michael - Handouts — Wed, 03 Mar 2004 00:00:00 +0000

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The Diamond Model of Modalities – Overlaps (2004)

Michael - Handouts — Tue, 02 Mar 2004 00:00:00 +0000

This handout summarises the dynamic system of the modalities of the therapeutic relationship, the hexagon representing the therapeutic frame, and all modalities having potentially therapeutic as well as countertherapeutic effects. To some extent the modalities overlap, but traditionally therapists have emphasised the tensions, and absolutised them into mutually exclusive dogmatic positions. This diagram summarises these overlaps and tensions, spelling out some of the traditional polarisations. Rather than as ingrained theoretical-philosophical positions, we can find these tensions in the dynamic between each client and therapist, reflecting both internal and external dynamics via parallel process. So rather than thinking of the modalities as therapeutic alternatives, we can think of them as parallel process enactments, by which the dynamics of the clients inner world are reflected not only in the therapist's psyche, but also in the whole field of psychotherapy. We can thus use the modalities as mirrors and vehicles of the process, rather than objective and objectifying 'truths'.

To gain access to the full resource, please log-in if you are a member already (and then re-fresh this page after log-in), or to become a member of the site register here (it's free).

The post The Diamond Model of Modalities – Overlaps (2004) appeared first on INTEGRA CPD.