Investigating our shared ‘implicit relational knowing’ about the working alliance by considering the question:

Do therapists tend to over-estimate the working alliance they have with their clients?

Take part in our online enquiry and join us in a shared experimental learning process.

You are welcome to join in the enquiry around this topic which I take to be central in the continuing development of therapists, both individually and collectively as a profession.

In facilitating and contributing to the enquiry, I will take a broad-spectrum integrative stance which recognises the historical gifts and shadow aspects of the diverse therapeutic approaches.
One of the foundations of this enquiry will be a recognition of the multiple relational modalities of the therapeutic relationship (or kinds of therapeutic relatedness - I will provide references and starting points for discussion from the relevant literature - Petruska Clarkson, Martha Stark, etc).
As the working alliance is relevant in all kinds of helping professions as well as counselling and psychotherapy, the group will be open to these professions as well.

Our inherited understanding and definition of the working alliance is pretty vague.

Clarkson (1994 p. 34) quotes Safran: “Precisely how, why, when and what this working alliance may encompass in a particular approach may "vary as a function of a complex, interdependent and fluctuating matrix of therapist, patient and approach specific features” (Safran 1993, p. 35).”

As a starting point for the enquiry I would like to offer the following propositions regarding the working alliance:

• Considering the central importance which the working alliance has in our work, it is arguably one of the least understood and most mis-conceptualised aspects of therapy – its theoretical formulation across the approaches is incoherent and contradictory.
• As such, it offers great opportunities for profound learning and an ideal entry point for enquiry. Because it is surrounded by misleading traditional assumptions and loaded with out-dated inherited paradigms, an investigation of its reality in everyday practice promises deep insight into what we do (both what we are doing and what we are trying to do).
• Although the working alliance is not well understood or defined, it is considered one of the – if not the – main factor in the success of therapy (apparently, there is a direct correlation between the alliance and therapy outcomes).
• If the working alliance is generally accepted as the lynch pin of whether therapy works for the client or not, then investigating it may help us understand more deeply how therapy actually works - and how it doesn’t.
• I think that such enquiry works best if it is ...
  • a) phenomenological (in simple terms: sticking close to what we experience rather than what we think about it or assume) and if it is ...
  • b) a collective effort (averaging out our individual idiosyncrasies and foibles, hopefully helping us access some general principles of the profession).
• Considering that the working alliance is an intersubjective notion, comprising two people’s experience together, on what basis can I as a therapist say anything about it? How do I perceive and apprehend the working alliance?
• In the first instance, I have a sense of the working alliance, an intuition of the atmosphere of the relationship – it’s only later that I bring theoretical reflection to bear on it and evaluate it more precisely and rationally.
• Because the working alliance is such a complex multi-layered and paradoxical two-person phenomenon, my impression of it must be rooted in pre-reflexive and subliminal perceptions (‘implicit relational knowing’ is the term used by Boston Change Study Group - Lyons-Ruth 1998, or Schore’s ‘right-brain-to-right-brain attunement). In order to think or say anything about it, I must be relying on embodiment: on right-brain overall-pattern detection, non-verbal intersubjective communication and embodied perception. In order to do it justice, I will need to rely on an integration of left-brain and right-brain perceptions and understandings.
• Having studied the working alliance from an embodied perspective for many years, I have - as many of you know – proposed that the working alliance is inherently paradoxical: in order for it to exist and deepen, it needs to be capable of breaking down and disappearing.
• Rather than clinging on to the working alliance as a mark of the therapist’s competence, a paradoxical notion suggests that the therapeutic process consists of deepening rupture-and-repair cycles of the working alliance and the phenomenology of what I have called the ‘3 kinds of contact’ as the working alliance continues to oscillate through these deepening cycles.

These are the kinds of ideas and questions which I suggest we investigate over the coming months. This is an experiment – I have no idea whether and how this cyber-process will work for us.

“An approximate answer to the right question is worth a great deal more than a precise answer to the wrong question.”
John Tukey

Format of Online Enquiry

I propose to start off the process by collating in fairly condensed form the received wisdom on the working alliance - something like a review of the existing literature as well as practice. I have collected some relevant and significant quotes which I want to share, in order to establish some joint reference points and definitions as a basis for discussion. You are obviously welcome to contribute to this.

Once we’ve laid out the existing diversity of ideas and inherited notions, I suggest we spend some time on a critique of these established perspectives.
Hopefully, this will allow us to generate some exploratory questions for focussed enquiry together which we can then take into actual practice, as orienting pointers for qualitative research.

After that, I suggest we use LinkedIn as a forum for discussion - they have the internet facilities for such a professional discussion already in place, so we might as well use it (if you are not already a member, it’s free to join on the basic membership). If you are already a member (or once you have signed up), you can join the discussion group for the enquiry.

Some of you may be more savvy than the rest of us at conducting these kinds of internet discussions, so please feel free to bring your expertise to bear on the format and procedure.

The post Online Enquiry: Overestimating the Working Alliance? appeared first on INTEGRA CPD.

The embodied phenomenology of enactment

It is in the area of subliminal, non-verbal and pre-verbal communications between client and therapist that enactments incubate, long before they become noticeable, articulated and problematic. Implicit relational knowing can help us gather perceptions, impressions and intuitions that help us understand the complexity of enactment when it finally becomes disturbingly explicit. How successfully we can survive, resolve and transform enactments depends upon how aware we can be of the many bodymind levels on which the enactment manifests, and how fully both client and therapist can be embodied in negotiating the enactment (otherwise the supposed resolution tends to remain a reflective verbal or mental narrative, that does not fully translate into everyday life).
In summary, the therapist’s awareness of the bodymind phenomenology of the enactment is important in the perception, understanding and resolution of enactments. In this session we will begin to survey the holistic-systemic phenomenology of enactment.

Learning Objectives

• re-integrate psychoanalytic and body-oriented traditions
• begin to think of the therapeutic relationship as a complex, holistic bodymind system
• attend to charged bodymind processes which reflect implicit and unconscious relational dynamics
• recognise how psychological conflicts manifest and are communicated as bodymind messages
• apprehend countertransference as continually embodied, rather than manifesting only in exceptional unusual or disturbing sensations
• recognise how the client’s conflict becomes the therapist’s conflict
• gather the bodymind fragments of the enactment appearing in the therapist’s stream of consciousness
• recognise how relational paradoxes are experienced and communicated on subliminal levels

Some quotes from the interview

MICHAEL: I think part of the difficulty in even talking about ‘embodiment’ is that in people’s minds the term cannot but acquire a compensating function against an overly verbal ‘talking therapy’ orientation and thus it acquires a

The post Relational Psychotherapy – Praises and Pitfalls appeared first on INTEGRA CPD.

The bullet points are not yet answering the question, they are just laying the ground work, attempting to remove some of the confusion and dogmatism around the question, and opening out the complexity of what we might mean by "it works".

Follow @INTEGRA_CPD

Look out for my upcoming series of 100 daily tweets on this long-standing conundrum in psychotherapy: HOW DOES IT WORK?

• Whether & how therapy works seems to me to be surrounded by lots of categorical & absolutist opinions, traditional dogma & blinkered theory.
• Can we find an integrative perspective that can embrace psycho-education, coaching, counselling & psychotherapy as ALL working in some way?
• How can regular meetings of two people sitting in a room, apparently having a chat together, be expected to have deep & helpful effects?
• The various therapeutic traditions have tried to address that question with their particular ‘theory of therapeutic action’, in jargon terms.
• There are profound divergences & paradigm clashes between the traditions regarding that apparently innocuous question of therapeutic action.
• With the general public considering psychotherapy supposedly as ONE recognisable profession,how can there be such fundamental disagreements?
• How can the profession have so many versions of what makes therapy work? How can they all claim to be doing the same psychotherapeutic work?
• Apparently, ALL psychotherapy works – across ALL therapeutic approaches, this is the most robust finding of decades of outcome research
• Research has established over and over again the so-called 'Dodo-bird Verdict': "all are winners and all must have prizes" – all therapies WORK – somewhat!
• However, the research statement ‘it works’ is based on averages, without any idea ‘WHY it works’ in a particular therapeutic relationship.
• Therapy-as we know it-DOES work,but in haphazard, elusive and unpredictable ways, subject to the vagaries of the two subjectivities involved.
• It DOES work, but that ignores and denies a) how damaging it can be, b) and the huge differences in effectiveness - see: http://bit.ly/1kPMvuI
• The contested and heated debate about WHETHER therapy works or not occludes the more fundamental question: What do we MEAN by ‘it works’?
• An embracing, non-partisan view of how therapy works would need to recognise that different people find a multitude of things helpful.
• When people say ‘it works’ they mean they’re finding things helpful or therapeutic,without distinguishing levels of experience referred to.
• Usually they mean: “something has changed, and I feel better”, but that could result from a variety of profoundly different change processes
• One of the most quoted modern references for theories of therapeutic action: Boston Change Process Study Group http://www.changeprocess.org/
• What doesn’t become explicit usually is the idea that there are different KINDS of change/change processes at different depths of experience
• Wilber provides a good starting point by distinguishing change via ‘translation’ from change via ‘transformation’ – what does he mean by that?
• ‘Translation’ means ‘change WITHIN an established structure’, whereas ‘transformation’ means ‘change OF the established structure’.
• That’s a useful distinction, but I find more helpful the following three-way distinction: ‘translation’, ‘contradiction’, ‘transformation’.
• Over the longer term, as Wilber proposed, every development goes through phases of translation alternating with phases of transformation.
• Once a new structure has established itself, change proceeds via translation WITHIN that new structure; but eventually that reaches a limit.
• At its structural,developmental limit, change via translation STOPS working, and a deeper transformation of the underlying structure occurs.
• Tracking -as we do in therapy- our subjective, experiential reality, that breakdown of the existing structure involves an internal struggle.
• That struggle usually involves –before the emergence/creation of a new structure- the destruction of the old: what I call: ‘contradiction’.
• I call it ‘contradiction’ because on the level of psychological reality, the person finds themselves – or is consciously – opposing the old.
• For example: in order to escape a negative addictive pattern, the person would decide to contradict and counteract the addictive impulse.
• However, simply contradicting the old, established pattern, as necessary a stage as it is in the change process, often does not work & last.
• In order to find a sustainable new structure, beyond fighting & contradicting the old structure, a more fundamental transformation is needed
• That’s because the contradiction impulse is usually caught within the logic of the structure it is trying to escape,in a simplistic reversal
• As Einstein said: we cannot hope to solve problems with the same kind of consciousness that created them. Transformation is then needed.
• The question how therapy works has different answers in each of the 3 phases of the change process: translation,contradiction,transformation
• What ‘works’ in translation, stops ‘working’ in contradiction, & is opposite to what ‘works’ in transformation. Different principles apply.
• Same is true for transformation and translation: what ‘works’ in one is profoundly unhelpful, counterproductive or dangerous in the other.
• So unless we appreciate the complexity of these different kinds of change, ALL of which are valid and subjectively experienced as helpful…
• … we will not be able to formulate a comprehensive theory of therapeutic action that is capable of embracing the inherent paradoxes.
• These 3 different modes of change underlie the confusing complexity of why different things work at different times for different people.
• As a client,what I want my therapist to have is a comprehensive view that is not habitually biased towards one or the other of these 3 modes
• What we can’t expect as client/therapists is lasting structural change when we’re applying only principles of translation and contradiction.
• What we mustn’t demand as clients and mustn’t promise as therapists is the expected results of one mode by the principles of the other.
• The deeper the change that is longed for, the higher the stakes, the less predictable the outcome and the more dangerous the procedure.
• Psycho-education, coaching, counselling and psychotherapy all offer themselves to be helpful and they all ‘work’ to some extent some times.
• They all need to work WITH and WITHIN the client’s existing personality structure in order to (Rule No 1) ‘meet the client where they are’.
• But the various disciplines differ & struggle when what is needed is to CONTRADICT or TRANSFORM the client’s existing personality structure.
• more to follow ...

Some of your COMMENTS and my REPLIES:

• In response to: How can regular meetings of two people sitting in a room, apparently having a chat together, be expected to have deep & helpful effects? I suggest you look at "Essential Research Findings ... The Facts are Friendly" by Mick Cooper - or was that a rhetorical question?
  MS: It WAS a rhetorical question from the viewpoint of the public, as part of my series of tweets on how therapy works. Mick's research shows that therapy DOES work, confirming the famous Dodo-bird verdict, but does not answer the question HOW. There are MANY ideas of HOW therapy works, but clients rightly ask: how come these ideas are so varied and contradictory?

[/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]

The post How does psychotherapy work? – laying the groundwork in 100 daily tweets! appeared first on INTEGRA CPD.

Last Monday I completed the second in the Psychotherapy Excellence series of interviews, with Tom Warnecke, on the topic of how psychotherapy works. This is building on the first interview on the question “What is Psychotherapy?” some months ago. The idea of this series is that a fundamental question will be addressed by representatives of different therapeutic modalities, approaching the question from within the context and background of their tradition.

As I am representing Body Psychotherapy in the mixture of modalities contributing to the series, I was in a bit of a dilemma: what in the jargon we traditionally call the ‘theory of therapeutic action’, i.e. how does therapy do the work it does (if and when it does, that is), is not easy to answer as this is something that has changed radically in my mind over the last 30 years. As I have been proposing over the last 15 years or so, I need to make a distinction between ‘traditional’ Body Psychotherapy, and what I would think of as a modern integrative and relational version of it. These two versions of Body Psychotherapy have profoundly different assumptions in terms of their underlying ‘theory of therapeutic action’.

There is a lot of tension and confusion about this distinction and the relationship between these two versions of Body Psychotherapy - as we know from many other things, ‘later’ is not necessarily ‘better’. This is not just some advertising gimmick: buy now! - the much improved version – better, longer, deeper, cleaner, higher, or whatever. We’re not talking about cars or other technological gadgets where the latest model outperforms and supersedes the earlier one.

No, this is a good example of Wilber’s “transcend and include”, where the later version is only as good as it qualitatively transcends, but comprehensively includes the earlier version - which if you get into the nitty-gritty is ultimately a paradoxical thing, and not a comparison chart with ticks and crosses indicating which version/model has which features, with built-in obsolescence guaranteeing that the later pro version gives you a lot more bang for your buck.

It would be difficult to do the delicate paradoxical integration of these two versions of Body Psychotherapy justice in 50 minutes, but the interview does include some indications.

The interview will need to be edited and transcripted before it appears as a free webcast and then as a download to be purchased within the whole series  - follow me on Twitter (@INTEGRA_CPD) to be sure you receive the information about the date and time of the webcast.

Follow @INTEGRA_CPD

The post Interview 2 for Psychotherapy Excellence webcast series appeared first on INTEGRA CPD.

It’s not surprising that mindfulness has turned into another fad & can’t possibly live up to people’s desperate expectations & idealisations.

Westerners are in grave danger of misreading the Eastern teachings on mindfulness through the legacies of our dualistic, religious heritage.

Mindfulness can plug into our established dissociation between mind & body, exacerbating the crippling dominance of the mind over the body.

In our entrancement with the supposedly superior mind we miss the fact that the Eastern aim of mindfulness is to TRANSCEND the mind.

Mindless-ness is considered deeper than mindfulness. It is this effortless state which gives the effort of mindfulness practice its purpose.

In a culture rampant with addictive mindlessness, it is difficult to get our heads around the possible benefits of mindless-ness.

The dissociative mis-uses of mindfulness techniques exacerbate delusions of mental control which fortunately/unfortunately always backfire.

A potentially deeper and more challenging, but infinitely more satisfying version of mindfulness can occur only within ‘bodymind fullness’.

What kind of psychology (un-psychology) will help to establish that ‘bodymind fullness’ without which mindfulness cannot flower?

What kind of techniques (un-techniques) are effective in walking the knife-edge between mindfulness and mindlessness?

Want to participate in a workshop that experientially explores ‘mindfulness’ versus ‘mindlessness’ versus ‘bodymind fullness’?

Read the full blog post or Get in touch to register your interest!

The post 12 tweet summary: Mindfulness – Mindlessness – Bodymind Fullness appeared first on INTEGRA CPD.

Mindfulness is all the rage and in fashion everywhere – in therapy, in business, in health.
It’s supposed to cure all ills, increase performance, improve your relationships, help you make money, relieve all sorts of pain from physical to mental, and establish a peaceful society.
But the promise of mindfulness is already flagging, and people are becoming disenchanted with it and disappointed in it.
Any deep and powerful practice that has the potential to transform our increasingly driven, alienated, self-destructive contorted misery, will – once there is evidence that it is ‘working’ – attract the ‘wrong’ kind of attention. Having become over-hyped, popularised and commercialised by upstarts looking for any marketable niche, jumping on the bandwagon and diluting the practice beyond recognition, it’s not surprising that mindfulness has turned into another fad which can’t possibly live up to people’s desperate expectations and idealisations.

What a shame! Because it can be a profoundly powerful and transformative practice, that is: unless an alienated and disembodied ego gets hold of it and uses it for its own purposes.

As Westerners, we are in grave danger of misreading the Eastern teachings on mindfulness through the legacies of our dualistic, religious heritage. Instead of ‘attending to the body in the body’, as the Buddha taught, the idea of mindfulness can easily plug into our established dissociation between mind and body, and exacerbate the crippling established dominance of the mind over the body which culturally we find ourselves always already ‘thrown into’.

In our entrancement with the supposedly superior mind we miss the fact that arguably, in many Eastern traditions, the aim of mindfulness is to transcend the mind, i.e. to get beyond the mind and arrive at a state of mindless-ness which is considered as even deeper/higher than mindfulness. It is this effortless state which gives the effort of mindfulness practice its ultimate purpose.
In a culture which is rampant with addictive mindlessness designed to numb out dissociated trauma and unaddressed pain, it is difficult to get our heads around the possible benefits of mindless-ness.
But when we recognise the dissociative mis-uses of mindfulness techniques, exacerbating the delusions of mental control (which always backfire), we are intuitively being attracted towards a potentially deeper and more challenging, but infinitely more satisfying version of mindfulness. We then realise that ‘true’ mindfulness can occur only within what we might call ‘bodymind fullness’.

If confronting addictive mindlessness is difficult, and mindfulness constitutes a challenge, ‘bodymind fullness’ is off the scale – no wonder it’s not usually on the menu. But without ‘bodymind fullness’, we can work our mindful socks off, running past the point of exhaustion just to stand still, and still not get anywhere worth while. Without ‘bodymind fullness’, you ain’t going nowhere.

Therefore, for most Westerners, our experiential starting point and most useful and realistic focus is the initial question:

• what kind of psychology (and ‘un-psychology') will help ourselves and others to establish that ‘bodymind fullness’ without which mindfulness cannot flower?
• what kind of techniques (and ‘un-techniques') are effective in walking the knife-edge between mindfulness and mindlessness, towards that place we long for, but do not want to arrive at?

If you are interested in participating in a workshop that experientially explores these questions (some time next spring or summer), let me know … and I’ll put you on the long, long waiting list

The post Mindfulness – Mindlessness – Bodymind Fullness appeared first on INTEGRA CPD.

To subscribe to future newsletters, join our mailing list.

The post The latest INTEGRA newsletter (Sep. 2014) appeared first on INTEGRA CPD.

The working alliance is the part of client- psychotherapist relationship that enables the client and therapist to work together even when the patient client experiences some desires to the contrary. (Clarkson 1994 p. 31)

The working alliance or psychotherapeutic alliance is probably first encountered as a concept in psychoanalytic theory (Greenson 1967; Sterba 1934; Zetzel 1956). It is conceptualised as an explicit or implicit contract or agreement between the psychotherapist and the client. (Clarkson 1994 p. 32)

The post Defining the working alliance – 1 appeared first on INTEGRA CPD.

Greenson defined the working alliance as: “the relatively non-and neurotic, rational, and realistic attitudes of the patient towards the analyst … It is this part of the patient-analyst relationship that enables the patient to identify with the analyst’s point of view and to work with the analyst despite the neurotic transference reactions” (Greenson 1967 p.29)

The post Defining the working alliance – 2 appeared first on INTEGRA CPD.

This 2008 paper "Supershrinks - What's the secret of their success?" by Scott Miller, Mark Hubble, and Barry Duncan is one of the inspiration for this enquiry. They claim that therapists DO over-estimate their effectiveness and the working alliance. It's a great read (that does not mean I agree with everything they say, but they do say it clearly, evocatively and entertainingly) - what do YOU think about it?

The post Supershrinks – What’s the secret of their success? appeared first on INTEGRA CPD.