In support of co-facilitated group therapy
It was a delight to read Pushan Bhatia’s insightful and encouraging article on group work in the April issue of therapy today. I have often seen good and deep work that occurred in individual therapy being ‘put to the test’ in groups. After all, what is the point of being the model client in the therapy room if one is not able to try out one’s new ways of being in the world?
Yet, I equally witness reluctance on the part of many of my individual clients to join a group. Partly, this could be interpreted as a narcissistic avoidance of having to share the group therapist with one’s ‘siblings’ and giving up being ‘special’ in order to mature – and this is of course where the work lies.
That being said, let me focus for a moment on the darker side of groups. As Yalom and others have pointed out, entire groups can fall into depression and turn ‘toxic’. Those of you who have sat in a group like this will know not to take this issue lightly. I remember co-facilitating groups with clients diagnosed with borderline personality traits. Generally, these groups were awe-inspiring, but there was a time when I felt nearly suicidal during the sessions and had to remind myself that, actually, my own life was going extremely well. If it was this bad for me – how terrible must it have been for the clients?
In addition, it became clear that not only the group had ‘gone toxic’, but the entire staff team was experiencing a powerful parallel process. This, then, brings me to the heightened role of specialised supervision for group therapists. If we regard the group as a pressure cooker, it is no wonder that the therapist, too, can be vulnerable to its dynamics. It is all too easy for the therapist to fall into a pattern of ‘holding court’, be it an adoring or a stormy one. Even if this is recognised in supervision, the therapist might struggle to change this dynamic, which might explain the bad experiences Bhatia refers to.
Finally, I would like to argue for more groups that are co-facilitated by two or more therapists. Why? First of all, there are a number of therapeutic advantages for the clients. It becomes easier to separate out a ‘good breast/bad breast’ Kleinian split or ‘mum and dad’ dynamic (especially relevant to clients who experienced abuse or neglect). This transference can then be worked through with the help of the group and therapists. Equally, when the group reaches a teenage dynamic, there is more freedom to play ‘us against them’, without having to fear that the vastly outnumbered therapist will, symbolically, die. If there are more than two therapists, perhaps even of different ages and backgrounds, the group can more coherently mimic a unit greater than that of the mere family of origin – almost like a tribe with elders, which then serves to frame maturation. This is especially valuable when the co-facilitators trust each other enough to disagree occasionally, modelling conflict resolution.
Last but not least, running a co-facilitated group holds major advantages for the therapists, which are not to be underestimated. In evaluating a group with one’s colleagues, it is striking how we remember different aspects of it, or might have blind spots. We can challenge and complement each other, both in the group and in supervision. For those of us who mostly work with individuals, it can be a real joy and inspiration to work as a team, observing our colleagues working, refreshing our skills and becoming more aware of some bad habits we might have picked up on the way.
Growing interest in groupwork
‘Group therapy is exciting, economical and effective – so why don’t more people do it?’ asks Pushan Bhatia (Therapy Today, April 2008). He provides a useful overview of some of the advantages of groupwork and speculates on some of the possible reasons why this way of working is underused by counsellors.
I am currently engaged in a research project as part of an MA in Counselling, which aims to explore counsellors’ experience of, and attitudes to, groupwork. The study is designed to answer a number of questions. How many counsellors use groupwork and what types of group are they involved in? Do counsellors think they need specific training in order to provide groupwork? What training, if any, have counsellors had in groupwork? Of counsellors who haven’t used groupwork, what are the reasons for this?
There is not space here to give a detailed account of the findings. But, broadly speaking, the questionnaire responses suggest that there may actually be more counsellors involved in groupwork than we might think. Fifty per cent of all those who responded had some experience of facilitating groups. Counsellors reported having been involved with a wide range of different types of groups. A high proportion were involved in ‘psycho-education groups’. Whether these groups are defined as ‘therapy groups’ or not opens up a whole new set of questions, but it is of interest that in the recent mapping exercise of primary care psychological therapy services by Durham University1, substantial numbers of stepped care services offered ‘psycho-education group therapy’ (their phrase), with stress management groups being offered by 48 per cent and groups tackling depression being provided by 41 per cent (although no details were available as to who was running these groups).
From my research, amongst the counsellors who said they haven’t used groupwork, the most commonly cited reason for not doing so was ‘organisational constraints’, e.g. lack of support/time/space/resources or appropriate supervision. Other common reasons were the amount of perceived extra time and effort involved in setting up and facilitating a group, and feeling they lacked the appropriate training or experience.
As the research is a small-scale project (based on responses from 66 counsellors in a range of work settings), it is not possible to assess how far the results can be generalised to counsellors as a whole. In addition, there is likely to have been a self-selecting bias; it would be reasonable to assume that counsellors who have an interest in groupwork are more likely to respond to a questionnaire on the subject. Nevertheless, the findings may throw a little light on this rather neglected subject.
As Bhatia says, groups are not for everyone, but, with the expansion in the range of therapeutic interventions being offered within the stepped care model of service delivery as part of the IAPT initiative, it is possible that we will see growing interest in various alternatives to traditional one-to-one therapy, including group-based approaches. Groupwork offers an effective, evidence-based therapeutic method that can be employed by CBT, person-centred, psychodynamic and other practitioners.
Increasing awareness of the benefits of groupwork and identifying some of the barriers to the use of groupwork may open up a discussion of how we could more fully exploit the potential of this way of working.
Sheila King, Lecturer in Counselling, Salford University and NHS primary care counsellor
1. Barnes D, Evans R, Hall J. The shape of psychological therapy in primary care. Healthcare Counselling and Psychotherapy Journal. 2008;19(3):19-23.
Dont be discouraged
I can understand Gillian Powton’s frustration (Letters, Therapy Today, March 2008), as I’m sure many more newly qualified counsellors will as well. I’m sure that it feels like a long haul and particularly difficult when you have filled in voluntarily but cannot apply for a paid position doing the same job. However, what she sees as an ‘obsession’ with required counselling hours and subsequent accreditation is, as I see it, a long awaited necessity. If we are to give counselling the professional status it deserves, and even more importantly clients the service they deserve, then these benchmarks are essential to the process of becoming a competent counsellor. I would like to say to Gillian, and all other newly qualified counsellors, don’t be discouraged with all the hard work that you have put in up to now. There is a long road ahead, but the experience that is gathered along the journey all helps to contribute to what as counsellors we all aspire to – to be competent professionals. From my own personal experience, the rewards gained from this sometimes-difficult process know no bounds and make whatever struggles encountered on the way worthwhile.
Linda Barnsley, MBACP (Accred) Counsellor Supervisor
Being forced into non-ethical practice
I do so agree with Paul McGahey’s view (Therapy Today, March 2008) on David Veale’s article ‘Psychotherapy in dissent’ in the February issue. I am wholeheartedly with Paul’s view that ‘many within the BACP membership and beyond... are feeling excluded, disheartened, disenfranchised, angry and upset’. And, having read the interview with Lord Layard and the Doncaster IAPT article in the March issue, I am even more disheartened.
Sarah Browne writes that she left the meeting with Lord Layard ‘with a spring in my step’, but as a cynical ex-journalist, I felt that Layard’s knowledge and understanding of psychological therapies was breathtaking in its paucity. As Paul points out, we are caught up in this Government’s obsession with a ‘medical model’ that is now attempting to turn psychotherapy into a science.
It is no surprise to me that an economist (Lord Layard) was asked to devise a ‘workable model’ for the NHS psychological therapies, but it does not follow that this is a given and should not be questioned by those of us outside the NHS, particularly as practice-based commissioning will involve the voluntary and private sectors.
A number of CBT workshops are now being advertised in the CPD section of therapy today, and I suspect many counsellors will attend in order to have the right ‘qualifications’ on their CVs. But how will they ethically practise if CBT runs counter to their belief in ‘relationship counselling’?
We are being forced into non-ethical practice in order to get a job. That’s plain crazy. I sometimes feel I moan too much (for those of you who have read my various articles and letters on the subject), but, as Paul points out, ‘we badly need more dissent’ not less.
Carol Jones, MBACP
Writing for all not just academics
I was so pleased to read the letter from Paul McGahey in the March 2008 issue of Therapy Today. It is so refreshing to find an individual who is prepared to take a risk and talk about subjects that do not follow the ‘norm’.
My particular thoughts are not about his ideas, but about the fact that increasingly as I read the magazine, I wonder when it will be compulsory to have a degree in English to write in the publication. It sometimes feels like contributors try to outdo each other with their knowledge of the English language, using words that are not in everyday use. The most interesting articles are the ones where ordinary words are used, and one of the reasons I love Yalom’s writings so much is that he is down to earth, honest and just says it as it is.
Is the profession developing a class system, because I am sure that most counsellors would not speak to their clients with long-winded words and sentences? We are not a superior class of being, and while I admire all the wonderful study that people do, and know from personal experience how hard it is, let’s try and be equal and attempt to write for all, not just the academics.
I would like to see more debate, alongside agreement, and disagreement in our magazine. We could not possibly all agree with each other, it is not being human. McGahey stated, ‘I’m prepared to bet that there are many within the BACP membership and beyond who are feeling excluded, disheartened, disenfranchised, angry and upset but unable publicly to articulate these and many more feelings.’ I thank him very much for his comments, as it gave me the courage to voice something I have been thinking for a while now, and while we may not be discussing the same subject, we are in agreement about people’s feelings. I sense in the magazine sometimes that we all must agree or something will go wrong.
Rita Matthews, MBACP
Time for a name change?
As people continue to write in questioning the probity of the decision to remove personal therapy as an absolute from BACP accredited trainings, and as the same line continues to be trotted out about other forms of self-development, might I propose one or two ideas to members?
Perhaps BACP should seriously consider changing its name so that the words ‘counsellor’ and ‘psychotherapist’ are no longer part of its title. After all, the name of this magazine has already changed from CPJ (Counselling and Psychotherapy Journal) to Therapy Today. Perhaps you were (unconsciously) ahead of yourselves.
I do not feel that BACP has much to do with maintaining the standards that were originally set with regards to levels of training. How can the Association suggest that it promotes counselling and psychotherapy when it no longer requires those training on its accredited courses to be in counselling or psychotherapy?
These professions are unique in the sense that they require the practitioner to be open inside themselves to understanding the client from a place of ‘not knowing’. By this I mean not assuming we know all the answers, because we don't. Ask anyone who has practised in this profession for a while and I suspect they will all tell you the same thing: it’s when we think we know that we are in trouble.
The things we do know – the things we want to rely on in the consulting room – are things like theory and technique. But theory and technique have nothing to do with being open. Being open to the client’s experience puts us in the extraordinarily privileged position of being able to understand their experience of themselves in the world. If someone feels understood there is the possibility of growth. Being open as a counsellor or psychotherapist comes from being in counselling or psychotherapy, and having spent a period of time allowing ourselves to be understood by another. We allow ourselves to be held in another’s mind where we are open to experiencing ourselves differently because we are being understood differently. Doesn’t BACP see what an extraordinary process it is supposed to be the custodian of?
Regulation the big freeze?
I am a person-centred/integrative counsellor in training and I agree with the views expressed by Dennis Postle in his letter in the February issue of Therapy Today regarding the dangers of statutory regulation. Entering professional training relatively late in life, and having just joined BACP, the debate is new to me. However, humanistic values and respect for diversity and the autonomy of the individual have underpinned a lifelong involvement in the arts, the human potential movement and many years of personal therapy.
From my perspective, it seems deeply incongruent to pursue a bureaucratic, statistically measured and mapped regulatory process such as the one that appears to be on the agenda. Is it not the case that the effects of such hierarchical social systems of dominance and coercion often cause or aggravate the very problems that clients are experiencing? If, as practitioners, we collude with systems that undermine our own autonomy and the trust in self this implies, what chance will we have to genuinely foster such qualities in a client?
We are constantly told that regulation is about protecting clients. Yet no research appears to have been done as to the current incidence of client harm or whether regulation is likely to prevent such abuse happening. My own experience as a client in various settings, including the US where therapists are state-licenced, suggests that professionalisation and regulation are just as likely to obscure or even justify malpractice as prevent it. It was, after all, Harold Shipman’s professional status that enabled him to get away with murder for so long.
As trainees we are told that statutory regulation is ‘inevitable’. The debate apparently is over. I do hope not. Training groups seem to me an excellent forum for discussion of these issues. Carl Rogers wrote many years ago: ‘Certification is not equivalent to competence.’ He also said ‘the first and greatest effect [of certification] is to freeze the profession in a past image1.’
Will the profession of counselling freeze itself? I don’t know, but as a student just setting out on my journey as a practitioner, I do pray that those with far greater experience and influence than myself are not about to let that happen.
Jennifer Maidman, Musician, songwriter, trainee counsellor and student member BACP
1. Rogers C. Some new challenges to the helping professions. The Carl Rogers reader. London: Constable; 1990.
Missing the point of therapy
I am writing in response to Simon Proudlock’s article in Therapy Today (‘Presenting a united front’, April 2008). As a counsellor who has chosen to remain in personal therapy beyond the requirement of external guidelines, I take it as an affront that my relationship with my counsellor could be seen as ‘two professionals checking in with one another – both counsellor and client becoming comfortable in what seems to be a mutually beneficial relationship’.
Exploration of one’s shadow is sometimes, but rarely, about comfort and to imply this indicates some kind of collusion in the therapeutic relationship – why would I pay for that? Mr Proudlock seems to miss the whole point of therapy, that is to be able to use the ‘self’ for the benefit/help/ growth/awareness of another and as such this needs to be processed for maximum ‘availability’ in the consulting room. Personal development is a separate commitment entirely and a ‘trip to a local AA’ cannot in my view be compared with personal therapy’s commitment. This goes way beyond what Mr Proudlock calls a ‘need’ and is more about a ‘responsibility’ to ourselves and therefore subsequently our clients.
As counsellors we are all, I hope, working towards increased awareness regarding difference but I find it hard to include Mr Proudlock’s comments in this context, and perhaps this is the problem in terms of his ‘united front’? I, for one, consider myself to be arguing constructively and in awareness.
Back to the future
I read with interest Keith Tudor’s article ‘Therapy is a verb’ (Therapy Today, February 2008), in which he stresses the importance of changing the ‘grammar of our understanding of the… human being’. While I agree with his basic argument that human being and human relationships, including the therapeutic relationship, are in a constant state of change, his description of the therapeutic relationship in terms of present-centred and past-centred clients and therapists at first left me perplexed: what had happened to the future? Was there then no such thing as a future-centred client or therapist?
Further reflection revealed their existence and extended the time-centred possibilities for the therapeutic relationship, within Tudor’s basic framework, from the four combinations which he lists to nine. So, for instance, clients who tend to focus on future plans and dreams (whether grounded in the reality of their present and past, or as flights of fancy), can be in a relationship with a solution-focused therapist (who also tends to be future-centred) or a therapist that is present or past-centred; and their respective ways of relating may vary at different moments in the therapy. One could similarly highlight other ways of relating based on combinations of past-, present-, and future-centred clients and therapists.
As an existential therapist, I see past, future and present as inextricably linked: at all moments we carry our past with us, and the way we see our future affects both our present and the way we understand our past. I would therefore never see myself as being a mainly present-, past- or future-centred therapist. Yet Tudor’s way of seeing time as an intrinsic dimension of our way of relating within the therapeutic relationship is enlightening and has given me food for thought.
Existential therapy emphasises the difference between time as measured by a clock or calendar and time as we experience it: thus, for instance, a client who is depressed may be present-centred in the sense of being stuck in a present that feels endless, stretching out, unchangingly bleak. As therapists, on the other hand, whatever our theoretical orientation and our approach at that moment (whether past-, present- or future-centred), we will be holding trust and hope for that client until he can (we hope) own them himself – whether we call it trust in the client’s potentialities and possibilities (however limited these may be), trust in the client’s self-actualising tendency, trust in the process of therapy, etc. And trust and hope are future-oriented.
Although, as an existential therapist, I would see time as having an essential place in the therapeutic endeavour, Tudor’s article opens up for me another aspect of time at the very heart of the therapeutic relationship.
Laura Barnett, Psychotherapist UKCP Reg, MBACP (Accred) Supervisor
Michael White 1948 – 2008
The Australian therapist Michael White died from a heart attack on 5 April 2008. He was co-originator (with David Epston) of Narrative Therapy, which established him as an internationally influential figure. Michael trained in social work and then became a family therapist.
He developed an approach emphasising the cultural and political factors impinging on people’s lives. The therapist’s task, he proposed, is to help people reactivate memories, and explore this ‘lived experience’ through responding to sensitively
posed questions, thus creating a richer narrative than the account initially brought to therapy. This widened, enriched narrative encourages redefinition of identity, and movement towards change. He developed a range of original and
creative practices including ‘externalisation of the problem’ and the telling and re-telling of people’s developing stories to an audience of ‘witnesses’ in order to strengthen and embed them.
He was a man of great energy who loved life and whose work was suffused both with immense seriousness of purpose and a mischievous sense of humour. Survived by his own close-knit family in Adelaide and a worldwide ‘family’ of therapy
and community work practitioners, including both of us, he will be terribly missed.
Martin Payne and Jane Speedy