Counselling and More
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Counselling and More
A digest of Counselling related articles, video presentations and research findings
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Are Humanistic Psychotherapies Efficacious?

Are Humanistic Psychotherapies Efficacious? | Counselling and More | Scoop.it
[Excerpt]

"...Are Humanistic Psychotherapies Efficacious?

Quantitative Humanistic Psychotherapy Research

Quantitative outcome research is the most positivistic of the different threads of HP research, and has generally been undertaken as political necessity. Since the founding of Psychotherapy Research, research on the outcome of humanistic psychotherapies has increased many times over, from 37 studies, reviewed by Greenberg, Elliott & Lietaer (1994) in the first meta-analysis of this literature, to many more than the 191 studies included in the most recent meta-analysis (Elliott et al., 2013). These meta-analyses consistently and with increasing strength and differentiation support the following conclusions: 

 1. Humanistic psychotherapies are associated with large pre-post client change. Using a 2008 sample, Elliott et al. (2013) looked at 199 samples of clients, from 191 studies, involving 14,235 clients, and reported a large weighted pre-post effect size of .93 (95% CI: .85 to 1.01). Furthermore, this is particularly true for general symptom measures, as indicated by two large UK-based studies (Stiles, Barkham, Twigg, Mellor-Clark & Cooper, 2006; Stiles, Barkham, Mellor-Clark & Connell, 2008). 

 2. Clients’ large post therapy gains are maintained over early & late follow-ups. Following therapy, Elliott et al. (2013) found that clients in humanistic psychotherapies maintained and slightly improved their gains -- pre-to-follow-up change at less than 12 months was 1.05; while at a year or more it was 1.11. The maintenance of gains post-therapy is consistent with humanistic ideas about clients’ self-determination and empowerment, suggesting that clients continue to develop on their own after they have left therapy. 

 3. Clients in humanistic psychotherapies show large gains relative to clients who receive no therapy. Elliott et al. (2013) analyzed data from 62 controlled studies, 31 of these RCTs (ns = 2,144 in humanistic psychotherapies vs. 1,958 in wait-list or no-therapy conditions). They found a controlled weighted effect size of .76 (CI: .64 to .88); with randomization making no 5 Humanistic Psychotherapy Research 1990-2015 difference, except that the confidence interval was slightly wider. These findings provide strong support that humanistic psychotherapies are useful and effective treatments for clients. 

 4. Humanistic psychotherapies in general are clinically and statistically equivalent to other therapies. In 100 studies (91 of them RCTs; n = 6,097 clients), there was virtually no difference between humanistic and other therapies in amount of pre-post change (weighted comparative effect size = .01; CI: -.05 to .07); again, results were virtually identical regardless of whether studies were randomized or not. 

 5. So-called nondirective-supportive therapies (NDSTs) have worse outcomes than CBT. Elliott et al. (2013) found that treatments labelled by researchers as “supportive” or “nondirective” have somewhat smaller amounts of pre-post change than CBT (37 studies; weighted effect size = -.27; CI : -.41 to -.13). In general, these treatments turned out to be watered-down, non bona fide versions of humanistic therapies, used by CBT researchers. 

 6. Person-centred therapy is as effective, and emotion-focused therapy (EFT) might be more effective than CBT. Person-centred therapy was equivalent to CBT (22 studies; weighted effect size: -.06; CI: -.11 to -.01). In a small number of studies, emotion-focused therapies for individuals or couples appeared to be more effective when compared to CBT (6 studies; weighted comparative effect size = .53; CI: .13 to .93). 

 7. Humanistic therapies are most effective for interpersonal/relational problems trauma. For a range of interpersonal or relational problems, Elliott et al. (2013) found very large pre-post and controlled effects, as well as significantly better comparative effects for humanistic therapies. EFT for couples has long been recognized as an evidence-based treatment (EBT) for couples (Chambless et al., 1998); however, a range of individual humanistic therapies appear to meet criteria as EBTs for interpersonal difficulties including the treatment of trauma from childhood abuse (but not necessarily PTSD, where there is still almost no research). 

 8. Humanistic therapies meet criteria as evidence-based treatments for depression. For depression in general, humanistic therapies have been extensively researched, to the point where the claim of empirical support as efficacious and specific (i.e., superior to a placebo or active treatment) can be supported in general, based on meta-analytic data, with EFT for moderate depression and person-centered therapy for perinatal depression having the most solid evidence (Elliott et al., 2013). 

 9. For psychotic conditions, humanistic therapies appear to meet criteria as evidencebased treatments. Although based on a relatively small number of studies, the evidence analyzed by Elliott et al. (2013) showed large pre-post effects and superior comparative treatment effects (6 studies; +.39; CI: .10 to .68), suggesting that humanistic therapies may be effective with clients experiencing psychotic processes (e.g., schizophrenia). 

 10. Humanistic therapies have promise for helping people cope with chronic medical conditions and for reducing habitual self-damaging activities. Coping with difficult medical or physical conditions (e.g., cancer) and habitual self-damaging activities (e.g., substance misuse) present challenges for most forms of therapy. However, Elliott et al (2013) found that for both of these client populations, humanistic therapies were in general associated with moderate prepost improvement, were superior to no treatment controls, and were equivalent to other approaches (most commonly CBT). 

 11. For anxiety difficulties, the humanistic therapies studied so far appear to be less effective than CBT. For anxiety problems (especially panic and generalized anxiety), Elliott et al. (2013) reported large pre-post effects, moderate controlled effects, but consistently poorer results when compared to CBT. Although researcher allegiance effects are a factor, Elliott et al. 6 Humanistic Psychotherapy Research 1990-2015 (2013) argued that more work is required to develop more effective process-guiding approaches, as indicated by evidence now emerging from ongoing research (Timulak & McElvaney, 2012). At this point, however, based on the available evidence, the use of traditional humanistic therapies can only be justified as second line treatments for clients who have also tried or refused CBT..."


Dimitris Tsantaris's insight:

 Angus, Lynne and Watson, Jeanne Cherry and Elliott, Robert and Schneider, Kirk and Timulak, Ladislav (2015) Humanistic psychotherapy research 1990-2015 : from methodological innovation to evidence-supported treatment outcomes and beyond. Psychotherapy Research, 25 (3). pp. 330-347. ISSN 1050-3307

http://strathprints.strath.ac.uk/53753/


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The Problem with Narcissistic Parents

The Problem with Narcissistic Parents | Counselling and More | Scoop.it

"...The biggest problem with narcissistic parents is that, in trying to build their children up, they are actually neglecting to recognize and support their child’s independent sense of self. Instead, the child feels a heavy amount of pressure from their parents. They may carry fears of falling short and the sense that they will never be good enough. Their insecurities may lead them to become narcissistic themselves, seeking out attention and approval just to prove they are okay. Parents who give up their own lives enter the child’s world instead of inviting the child into theirs. Because, children learn by example, not having a parent who is fulfilled within themselves leaves the child with a sense of having to take care of that parent. They have to make them happy and offer support. This is a huge burden to put on a child, and it hurts them throughout their lives. They may recreate this dynamic in their relationships, looking for someone who inflates their ego or who tears them down in ways that support deepseated attitudes they have toward themselves. They may also seek out people, who, like their parents, use them to feel better about themselves. These dynamics can be harmful to an adult, but they are almost immoral to impose on a child. When we refuse to see our children as separate individuals, we project all of the negative and critical attitudes we have toward ourselves onto them. We may try to overcompensate for our parents’ mistakes, or we may reenact destructive patterns from our own childhoods. In either case, we are missing the mark with our kids. We are misattuned to their unique needs and insensitive to their true wants. By differentiating from our own past, we are better able to see our kids as separate from ourselves. Only then can we offer them real love as opposed to a fantasy of connection. Only then, can we appreciate our children for who they are and support them in reaching their full, unique potential..."

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Study: Language and Labels May Affect Mental Health Stigma

Study: Language and Labels May Affect Mental Health Stigma | Counselling and More | Scoop.it

"...Person-centered language highlights the person rather than the diagnosis. For example, instead of calling people depressive or saying they are mentally ill, person-centered language advocates for the use of phrases such as “person with depression” or “child experiencing a mental health condition.” This language highlights a person’s humanity rather than a diagnosis.

 [...]

 To test how language affects perceptions of people with mental health conditions, researchers Darcy Haag Granello, an Ohio State University professor of educational studies, and coauthor Todd Gibbs, a graduate student in educational studies, enrolled three separate groups of participants in their study. Participants included 211 adults from the community, 221 undergraduate students, and 269 counselors and counselors-in-training. Each participant completed the Community Attitudes Toward the Mentally Ill (CAMI) questionnaire, which presented participants with questions designed to measure attitudes toward people with mental health diagnoses across four areas: authoritarianism, community mental health ideology, social restrictiveness, and benevolence. 


Although each participant reviewed virtually identical subjects as part of the questionnaire, half viewed statements that used stigmatizing language such as “the mentally ill.” The other half encountered statements using person-centered language, such as “person with a mental illness.” 


 The participants showed less tolerance for people with mental health diagnoses when the statements did not use person-centered language. The students, counselors, and counselors-in-training showed higher degrees of authoritarian and socially restricted attitudes when presented with non-person-centered language. The non-student adults who read non-person-centered statements were less benevolent toward people with mental health diagnoses. They also showed a lower community mental health ideology. This ideology is associated with less restrictive treatment, more integration, and community treatment instead of institutionalization. 


How to Talk About Mental Health 


 Mental Health America offers the following tips for adopting language sensitive to mental health issues: 


* Avoid words such as “crazy,” “psycho,” and “lunatic.” 


* Do not label people as their diagnoses. People are not bipolar, depressive, or autistic. They are experiencing these conditions. “Person with autism” can be less stigmatizing than calling someone autistic. 


* Use the language with which the person identifies or feels most comfortable. People in mental health advocacy rarely use terms such as “patient” or “mentally ill.” They are more likely to identify as a person in recovery, therapy client, or mental health peer."

[click on the title for the full article]


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Turning Against the Self: How it Causes Depressive Cycles

Turning Against the Self: How it Causes Depressive Cycles | Counselling and More | Scoop.it

"...So,how do you reverse the cycle of turning against the self? Well there are lots of possible ways. One intervention I like to do is called the “Restaurant Intervention” that a group of us developed when I was back at UPENN working at the center for cognitive therapy. It goes something like this (continuing the conversation above):

Me: So, it seems to me that you have these feelings inside of you, these dark, negative feelings that bubble up from your heart or your body and into your consciousness sending you signals that a part of you is not happy or is suffering.

Client: Yes.

Me: And then there is this self-conscious part of you that has an idea of how you want to feel and you think you should feel. That part of you is very critical of these negative feelings. It does not want them on the stage of consciousness at all.

Client: Yes.

Me: So that judging part gets annoyed and critical and angry, trying to get those feelings to go away.

Client: Yes, I get super frustrated and pissed at myself for having these feelings.

Me: And as you get pissed and criticize yourself for your feelings, what happens?

Client: I usually feel worse. It is hopeless because I know deep down that blackness is really all I am.

Me: I know you feel that way now, but I don’t believe that blackness is all that you are. Granted, it is a part of you. But there is also the part of you that hates those feelings and tries to block them (along with many other parts of you).

Client: Yes. It is like those two parts of me are at war.

Me: Exactly. Some psychologists like to divide our psychology up into three parts. One part is the emotional part, it can be kind of like a child, in the sense that it can be vulnerable and very much in the here-and-now. Then there is a part that is like a critical parent, one that is frustrated with the needs and vulnerability of the child and just wants it to stop whining and grow up and just be happy. Finally, there is the middle part that is trying to navigate the demands of life, as these two parts go at it.

Client: I can see that.

Me: Great. I would like to engage in some imagery, may be to help you get an understanding of how all this is impacting you.

Client: Ok.

Me: I would like you to imagine yourself at a restaurant. This is the observing, middle part of you. Now I want you to imagine the other two parts of you in the form of a child and a parent at the next table. Can you see that?

Client: Yeah, I think so.

Me: Okay, now imagine the child begins to tell the parent they are not feeling well. The child starts to express sadness and tear up. Just as you feel inside.

Client: Okay, I can see that.

Me: Now, take some of the things you say to yourself when you feel this way and now imagine the adult saying those things to the child. Imagine that parent saying things like, “What is wrong with you?”; “Why do you have to be so negative?”; “You are a blackhole of misery”; “Why can’t you be like other kids?”; “You are defective”. Can you see that?

Client (a bit taken aback): Yes…

Me: Can you feel that?

Client: Yes. (emotion welling up). I feel bad for the child.

Me: Sort of makes you want to protect her, huh?

Client: Yes.

Me: Now, how do you think the child will respond to the criticism? Do you think they will all of a sudden become happy-go-lucky, just like the parent wants?

Client: Of course not. They will shrink. They might force a smile, but obviously the parent can’t force the kid to feel differently.

Me: Exactly. Does it now make sense why turning against yourself the way you have is only breaking you down?

Client: Yes. I never thought about it like that before.

Me: It is crucial to realize that, just as most critical parents do in fact want what is good for their kids, most inner critics desire adaptive things for the individual. It is just that the process by which they operate has the opposite effect of what is desired. Instead of decreasing the negative feelings, they instead jack them up and create a vicious psychological cycle..."

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How to Avoid Empathy Burnout, by Jamil Zaki

How to Avoid Empathy Burnout, by Jamil Zaki | Counselling and More | Scoop.it

"...Caregivers need to be empathetic, but empathy is not one thing. Both neuroscience and psychology have uncovered an important distinction between two aspects of empathy: Emotion contagion, which is vicariously sharing another person’s feeling, and empathic concern, which entails forming a goal to alleviate that person’s suffering. Whereas contagion involves blurring the boundary between self and other, concern requires retaining or even strengthening such boundaries. Learning to practice one but not the other could be the best example of how caregivers can simultaneously look out for patients and for themselves.

[...]

 Psychologists tend to think of empathy as looking outward, toward connections with friends and strangers. Verging on science fiction, the best empathizers appear to read other people’s thoughts and feelings like a stock-ticker. This view of empathy, though, covers only half of it. Empathy just as often represents a decision not about others, but about ourselves.

 If we empathized with every person’s suffering, it would be impossible to traverse a Manhattan block without collapsing into an anguished heap. Attention serves as a gate through which we sometimes let in other people’s emotions and at other times keep them out. Our needs, in turn, govern the ways we use this gate. Lonely people focus intensely on others’ minds in the hopes of connecting with others. In some cases, isolation drives us to empathize even with inanimate objects (think Tom Hanks in Castaway). At the other extreme, prison guards and executioners ignore prisoners’ emotions, especially when the time comes for prisoners to suffer at the guards’ hands. Like pupils dilating and constricting in response to darkness and light, our empathic channels open when social connection is scarce and close when connecting could hurt.

 [...]

 Many helpers have rededicated themselves, through organizations such as the Secondary Trauma Resource Center, to help their colleagues maintain a healthy lifestyle. Their efforts connect with research suggesting that helpers’ success hinges on their ability to experience concern while avoiding contagion. When other people’s emotions flood into us, it can make it harder for us to help them. Patients, after all, are often too distressed to realize what might aid them; that is not a condition the helper should emulate. As one clinician put it, “Once you are in the shoes of your patient, you cannot possibly be of any help.”

 McCreary describes the state she strives for in her interactions with patients: “I try not to metabolize their trauma, which allows me to hear what they have to share and not become what they have to share ... I need to be as irrelevant as possible, and keep the experience about them.” Basinger takes a different approach to detachment, trying to model for patients how much better they might feel after treatment: “I try to be the face of resilience, to show them how things could be for them.”

 Research suggests that these strategies can offer an antidote to burnout. In the 1980s, the psychologist Katherine Miller and her colleagues suggested that a key feature of successful therapy is therapists’ communication of warmth and understanding toward their patients. She found that concern facilitates such communication, whereas contagion interferes with it. Therapists’ ability to separate themselves from their patients’ suffering also staved off secondary trauma.

 For many helping professionals, the distinction between contagion and concern does not come naturally. It takes conscious training. Thankfully, research suggests, more and more, that empathy is not a fixed trait; it is under our control, growing and shrinking throughout our lives depending on the choices we make. Even if vulnerability to contagion is what calls people into helping professions, helpers can then train themselves to use empathy in different, healthier ways. In one remarkable demonstration of such empathic tuning, the neuroscientist Tania Singer engaged a group of subjects in Buddhist-inspired compassion meditation training. This practice, known as loving kindness, begins with concern for one’s self. Practitioners consider their own pain and extend warmth and care toward themselves. They then systematically “dilate” their caring: First toward close friends and family, then toward strangers, and finally toward all of humanity. In essence, compassion meditation provides practitioners with an exercise in sharpening and then expanding their concern.

 Singer and her colleagues scanned participants’ brain responses to others’ distress before and after the meditation training. Before, people demonstrated physiological signs of contagion—for instance, engaging parts of their brain associated with feeling pain when watching others experience it. After the training, however, they shed this pattern and instead exhibited a pattern of brain activity more commonly associated with motivation and even positive emotion. Singer believes this type of training might allow helpers to “tune” empathy toward concern, working with it but not allowing it to take them over..."

[click on the title for the full article]


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Eugene Gendlin on clients finding their own way

Gene Gendlin on the dangers of therapists being too attached to their schools of thought; this is a clip from the Relationality in Focusing workshop from February 2005.

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The Loving Art of Letting Go

The Loving Art of Letting Go | Counselling and More | Scoop.it
Why do patterns hold on?

The first reason is this: the patterns that limit us weren’t always limiting. They were adaptive.

If we grew up in a threatening environment, learning how to fly under the radar was adaptive. Playing small and keeping quiet protected us.

The patterns that persist used to protect us. Whatever the pattern is—eating, yelling, hiding, the list is endless—it protected us, and it worked.

But our lives have changed.

We’ve matured. The world we live in is not that of our childhood. But the pattern persists.

So, really, why do patterns persist?

Because it doesn’t have any other choice; it can only do what it does.

The pattern is not self-aware. It cannot turn around in consciousness and witness itself. It needs us to do that.

And as long as we are unconsciously identified with the pattern, we can’t witness it.

Un-observed patterns continue to generate thoughts, speech, actions and results that conform with the needs of the pattern. Not the needs of our life-as-a-whole.

The pattern cannot conceive of our life-as-a-whole. Its horizon of awareness is limited, focused on its own emotional needs and its job of protection.

So, as long as we don’t witness the patterns, its limited horizon of awareness will continue to run our lives—at least in certain areas.
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Loving oneself with open eyes - Jorge Bucay

Loving oneself with open eyes - Jorge Bucay | Counselling and More | Scoop.it


"...Difficulties are integral part of the way of love. The solution could be to give up on the fantasy of being always in love and without conflicts. Reality becomes better when we decide to enjoy what we can, instead of suffering because of an illusion that can’t come true.

Relationship helps our personal development, to become better persons, to know ourself better. Therefore it worths the effort. It worths the torment and the pain we have to deal. And all of these are worthing, because when we have to get over them, we will not be the same anymore. We will be more conscious, we will feel more integrated.

The relationship doesn’t save us from anything: it shouldn’t save us from anything. Many people are looking for a partner as a mean to solve their problems. They believe that a close relationship will cure their anxieties, boredom, lack of meaning of life. They hope that the relationship will fill their gaps. What a mistake. When I choose a partner having these expectations, I inevitably end up to hate this person who doesn’t give me what I was expected. And then? Then I’ll try to find another one, another one……or decide to spend my life grumbling for my luck.So, the point is to make my life without waiting someone else to do that for me.

The thought that being in love will save us, will solve all our problems and will offer us a constant state of happiness or security, can only keep us trapped in fantasies and illusions, as it also weakens the original power of love, which knows how to transform us. And nothing is more enlightening from then on. There is nothing more special than experiencing your own transformation beside the one you love.

Instead of looking for shelter in a relationship, we could accept the stimulating force that awakens us of dormancy and make us come into direct contact with life. This is the meaning of relationship: not the salvation but the contact. The contacts. Me with you. You with me. Me with me. You with you. We with the world..."

[click on the title for the full article]


Dimitris Tsantaris's insight:
Jorge Bucay (born October 30, 1949) is a gestalt psychotherapist, psychodramatist, and writer from Argentina.
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The Two Carls: Brian Thorne in Conversation with Andrew Samuels (video)

The Two Carls: Brian Thorne in Conversation with Andrew Samuels (video) | Counselling and More | Scoop.it
Professor Emeritus Brian Thorne (UEA) and Professor Andrew Samuels (UoS) talk about Carl Rogers and Carl Jung and the similarities between person-centred and Jungian theory. 

[Click on the title or the picture to access the video]
Dimitris Tsantaris's insight:
Thorne, B. (2012) The Two Carls – Reflections on Jung and Rogers (1983), in Counselling and Spiritual Accompaniment: Bridging Faith and Person-Centred Therapy, John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9781118329214.ch8




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Clearing A Space Protocol

Clearing A Space Protocol | Counselling and More | Scoop.it
Clearing A Space Protocol
The First Step of Focusing

as developed by Eugene T. Gendlin, Ph.D., author of Focusing-Oriented Psychotherapy

1. Put your attention in the torso area of your body. Ask yourself, "HOW AM I RIGHT NOW?" or "WHAT'S IN THE WAY OF FEELING FINE?" Don't answer, but let what comes in your body do the answering. Wait for a FELT SENSE of a concern to form.

2. Find a HANDLE for the FELT SENSE - a word, phrase, or image that captures the quality of how the concern feels in your body.

3. RESONATE - say the HANDLE to yourself and check to see if it fits the felt sense exactly.

4. Give this concern your accepting attention for a few moments, but then put it aside for awhile by imaging placing the FELT SENSE outside your body in a safe place.

5. REPEAT steps 1, 2, 3 and 4 again until each concern that your body is carrying in this moment has been placed outside your body.

6. Now bring your attention back inside your body and experience a FELT SENSE of feeling all fine, a CLEARED space that opens up to you.

7. WELCOME this place, find a HANDLE for this space, RESONATE, WAIT, and see what comes.



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How miscommunication happens (and how to avoid it) - Katherine Hampsten

"...Human communication involves spoken and written language, nonverbal signs, and sounds or utterances. Even our use of time, silence, and artifacts communicate messages to others. In fact, some communication researchers argue that we cannot not communicate. [...] Under this perspective, communication is both intentional and unintentional. We create meaning from a variety of sources, mixing these cues into a total package of understanding. 

At the heart of human communication is the question of how we create meaning. A basic consideration of this process asks what message is being communicated to whom. The transactional model helps us to visualize the many moving parts that comprise human interaction. This model demonstrates that communication is an ongoing process. We co-construct meaning together as we use feedback to exchange ideas."


View full lesson: http://ed.ted.com/lessons/how-to-avoid-miscommunication-katherine-hampsten ;

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Scientism in Psychotherapy

Scientism in Psychotherapy | Counselling and More | Scoop.it

"...Techne or technical rationality is the kind of method and knowledge required for the uniform production of things. It is exemplified in the traditional, standardized rules of psychoanalytic technique, especially as these are claimed to apply for all patients, all analysts, all analytic couples, and all relational situations. We argue “that the whole conception of psychoanalysis as technique is wrongheaded … and needs to be rethought” (p. 21). We further suggest that what is needed to ground psychoanalytic practice is nottechne but phronesis or practical wisdom. Unlike techne, phronesis is a form of practicalunderstanding that is always oriented to the particular, to the uniqueness of the individual and his or her relational situation.

Traditional psychotherapy research tends to reduce human beings and human relationships to “variables” that can be measured, calculated, and correlated.  Such procedures partake of what Heidegger calls the technological way of being or technological form of intelligibility. According to Heidegger, entities as a whole, including human beings, are intelligible in our technological era as meaningless resources to be calculated, stored, and optimized in the quest to conquer the earth. In my view, the technological way of being is also associated with the philosophical stance of scientism—the presupposition, exemplified in the scientific positivism characteristic of much research on change in psychotherapy, that the chief form of valid knowledge is that attained through experimental and quantitative methodology.

Such considerations point to the potential importance of qualitative, rather than quantitative, research. They also bring me back to a tradition in academic personality psychology—the tradition in which I was trained as a clinical psychology doctoral student at Harvard during the mid- and late 1960s—known as personology. This tradition, founded by Henry Murray at the Harvard Psychological Clinic in the 1930s, held as its basic premise the claim that knowledge of human personality can be advanced only by the systematic, in-depth study of the individual person. This emphasis on “idiographic,” rather than “nomothetic,” research was a radical departure from the philosophy of science that then dominated, and has continued to dominate, academic psychology in the United States.

I suggest that grasping the practice of psychotherapy as a form of phronesis rather than techne justifies a return to idiographic methods in studies of the psychotherapeutic relationship—methods that can investigate the unique emotional worlds of patient and psychotherapist and the specific intersubjective systems constituted by the interplay between them. It is only such idiographic research, I contend, that can illuminate the rich, complex, living relational nexus in which the psychotherapeutic process takes form...."

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Examining Our Identities and Biases in the Consulting Room

Examining Our Identities and Biases in the Consulting Room | Counselling and More | Scoop.it

"...My work isn't about educating the unenlightened: it's about helping people see the insidious impact of the "otherness process"---turning a person or a group into "the other." This may be a universal human experience: the manufacturing of "the other" promotes rigid polarization, based on the idea that one group is right and the other is wrong. Once this positioning has occurred, constructive engagement is virtually impossible.

The creation of "the other" is the dynamic at the heart of divorce and personal antagonisms, and it has always been central to racism, sexism, homophobia, and ethnic persecution. The mindset is always the same: "I/we are right, you/they are wrong, and if anything is to change, you/they must change."

My original identity as a self-righteous crusader for social justice had tripped me up. To become a true agent of change, I couldn't afford to see the world---literally and figuratively---as either black or white, us and them. I had to recognize how easily I myself could become "the other." I began to let in something that white women and gay white men had repeatedly reminded me of: that they weren't just white and privileged---they were also female and gay. To them, I was, as a heterosexual male, "the other," interacting with them from my own position of privilege. I needed to come to the uncomfortable realization that there may be a tiny piece of an oppressor in many victims---and a tiny bit of a victim in many oppressors.

When I'm severely tested in my work of helping individuals and groups bridge their differences, I've learned that the "otherness process" is usually at the root of the problem. Whether it's a white client in therapy who disparages "niggers" as he discusses his daughter's attraction to black males, or a member of the clergy accusing me of the being the Antichrist, who'll burn in hell unless I change my tolerance of homosexuals, my position is the same. I make every effort to adhere to the three core principles that guide my work: (1) the attack, insult, or accusation may be about me, but my reaction and how I respond must not be about me; (2) to find the healing and transformative potential in dialogue, my job is to respond in ways that promote, rather than suppress, heartfelt conversation; (3) validation is the bridge to constructive engagement across differences.

Anyone who wishes to move outside the consulting room to address racial, ethnic, or sexual differences must rely on the bedrock belief that everyone has redeemable parts, and you can find them if you have the will and the patience to look. The biggest lesson I’ve taken from my work is recognizing my assumption that there was nothing in any of the participants that could be redeemed: they were all 100-percent "other"---belligerent, resistant, recalcitrant, closed-minded bigots. That they'd shown up for the training, were engaging in the process, were expressing their views in ways that were (God knows) honest and transparent, and had long since committed themselves to the helping professions hadn't registered with me.

To do this kind of work, we must learn to see through the myth of otherness: we must recognize that all people, no matter how flawed, have redeemable capacities in their being. It's our responsibility to find their virtues and connect with them. Admittedly, when facing hostility and rejection, our task poses formidable challenges, but failing to look for the redeemable qualities in "the other" amounts to a retreat from the possibility of relationship..."

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The Myth of Being Unlovable

The Myth of Being Unlovable | Counselling and More | Scoop.it

"...We are not that different from the little child who was not adequately loved by his parent. If he was abused or neglected, he could not afford to see that it was his parent that was deficient. It is much too frightening for a child to see the person (who is in charge of their well-being) is not up to the job. The terror of facing that truth would be too destabilizing for the child. So he explains the unloving behavior by making himself bad and wrong. “I’m dumb; I misbehave; I’m not good looking, etc.” This form of thinking can become a mind habit that we take into adulthood.

A child does not have the life experience and sophistication to say, “It’s too bad that my parent is so limited that they can’t appreciate how wonderful and lovable I am.” But an adult’s life is not as vulnerable as the dependent child’s. An adult has more life experience and more varied resources and support available. The ability to think issues through is more developed. Options are available to the adult to question their assumptions about being unlovable. Other vantage points for viewing the situation exist:

- Perhaps they do love me and are just preoccupied by other concerns right now.

- Perhaps they love me and just don’t know how to show the love they feel in their heart.

- Perhaps I haven’t been clear about how I delight in having love shown to me.

- Perhaps others have previously hurt this person when he opened up leaving him feeling inhibited in showing the love he feels.

- Perhaps I have issues about my own worthiness and his ignoring me activates those issues.

- Perhaps I do need to develop myself in this particular area to more fully trust that I am indeed lovable. I can accomplish this.

- Perhaps she actually doesn’t love me. We could be a mismatched pair, with only love on one side. But that doesn’t mean I’m unlovable; there are others who can love me.

- Perhaps he is inexperienced in showing the love he feels and we can learn together to be artful lovers.

The shift in perspective from believing that we are unlovable to knowing that we are lovable means a great deal. Inserting the perhaps into our thinking frees us from the grip of thinking the unpleasant, sometimes downright tormenting thoughts that we are unlovable. When we question our own belief and look more deeply to see what’s really true, we open our mind, which can assist us in the process of placing responsibility where it actually belongs and not take on more than is rightfully ours..."

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How Insecure Attachment Creates Fertile Ground for Addictions

How Insecure Attachment Creates Fertile Ground for Addictions | Counselling and More | Scoop.it

"...We are wired to need secure attachment, not just for our survival but also for optimal brain development.

 Here is what it looks like when secure attachment doesn’t happen: Baby is upset, turns to caregiver for comfort and connection; instead, baby gets ignored, is left alone, or worse, is abused for having needs. These types of reactions from caregiver will have an enormous dysregulating effect on baby. Most likely baby will protest (i.e., cry) or give some kind of distress signal. If this is ineffective, eventually baby will stop seeking care and comfort from their caregiver; instead, baby withdraws and starts finding other ways to self-regulate and self-soothe.

 This is where I believe fertile grounds for addiction start to develop. This baby is wired to not turn to humans for care and comfort; instead, they will seek alternatives to help them self-regulate. Addictions to drugs, food, rituals around food, over- or under-eating, can all become compensatory mechanisms for replacing the regulating effect a secure attachment would have provided. I have yet to meet someone who struggles with addiction who doesn’t also have some kind of attachment trauma.

 Viewing clinical issues through the lens of attachment theory has helped me enormously in my work with clients. Problems and dysfunction make perfect sense when viewed through this lens. Take my client Becky, for instance. (I’ve changed her name for confidentiality purposes.) Becky had a problem with drinking. She turned to drink whenever she felt anxious, stressed or overwhelmed. In her words: “It helps me numb out, and suddenly those things that seemed so big and overwhelming are gone.” Becky turns to alcohol to help herself regulate. She didn’t have caregivers who were really there for her or very responsive to her needs growing up. In fact, her father was an alcoholic and her mother suffered from obsessive compulsive disorder. This background provided fertile grounds for an addiction to develop. I believe that because Becky had not experienced the regulatory effect that secure attachment would have provided, she had to get creative. She had to find a substitute to help her regulate; alcohol became that substitute..."

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Signs of Counter-Dependency

Signs of Counter-Dependency | Counselling and More | Scoop.it
Whereas maladaptive dependency is fundamentally about a failure to trust one’s self to manage life separately from others, counter-dependency is fundamentally about a failure to trust others. While there are many things that contribute to counter-dependency, it often has its earliest developmental roots in an insecure attachment pattern resulting in the emergence of an “avoidant attachment” style. This style emerges from a misattunement between infant and caregiver(s) or possibly even abuse, and it is characterized in the young child as exaggerated autonomy and a suppressed emotional reliance on care-givers.

The key in understanding counter-dependency is differentiating it from healthy autonomy. Healthy autonomy is a state of confident self-reliance in which an individual a) recognizes their interdependency with others; b) has an agentic sense of self (i.e., a sense that one can effectively control one’s destiny) and c) is not unduly controlled or influenced by others. The primary defining feature of a healthy autonomy is first that the autonomy motive is an “approach mindset,” meaning that the individual desires to be (relatively) self-reliant because they want to recognize their full potential as an individual, but one who is simultaneously and securely interconnected with others. Second, healthy autonomous individuals can regularly form effective, meaningful, intimate long term relations with others. That is, they can share, be vulnerable, and are comfortable relying on others when it is reasonable to do so.

On the surface, counter-dependency may look similar to a healthy autonomy. For example, both involve the capacity to separate from others. But what drives counter-dependency is an “avoidance mindset,” namely the avoidance of relying on others because of a fundamental mistrust of the consequence of doing so. In addition, although these individuals might have superficially positive relationships, but because they fundamentally fear intimacy and do not trust others, they do not form lasting deep relationships. Indeed, even in marriage, a counter dependent will hide core aspects of their experience, resist showing dependency needs, and be reluctant to open up. Instead, they will often offer a superficial confidence and/or simply separate and avoid whenever a need or opportunity for deep emotional connection surfaces. It can be a very frustrating experience for the partner.
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Overcoming Bad Inner Voices

All of us have deeply unhelpful inner voices inside us, dragging us down with criticisms and unfair accusations. Wisdom involves learning how to replace them with more benevolent guides.
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Eugene Gendlin - Beyond Words

Lynn Preston interviews Gene Gendlin in New York City in relation to the APSP Beyond Words conference.

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We cannot fix people’s grief, only sit with them, in their darkness

We cannot fix people’s grief, only sit with them, in their darkness | Counselling and More | Scoop.it
There is commonly a double loneliness to grief – the loss of the loved one who has died and the loss of those who withdraw. Many people are not prepared to, or are simply not capable of, sharing in the darkness, staying with it. Indeed, often it’s the bereaved person themselves who ends up feeling pressure to comfort and reassure those who are supposed to be their comforters. And not wanting others to run away, it’s common for the bereaved to feel obligated to disavow the extent of their own darkness, to say that it’s not so bad, that things are getting better etc.

I’ve been taking funerals for over 20 years. I still remember my first – a bit like a nervous lover, how anxious I was not to say or do anything wrong. But what I now know is that no well-chosen phrase is ever going to make things better. Words are unable to fix it, so don’t try and force them to do things they can’t. And nor will an artificially sympathetic face. Bereaved people don’t want you acting all weird around them. Compassion literally means to suffer with, to suffer alongside. You stand with people in their darkness so it’s not so lonely there. Yes, it’s OK to laugh and smile. But the most important thing is simply to be there and listen and not be frightened by not being able to make things right.

In the Bible, Job’s so-called comforters were a useless lot, always trying to make some religious sense of the tragedy that had befallen him. In fact, the Book of Job’s line on talking to the bereaved is probably: don’t try and rationalise things, theologically or in any other way. That’s often more about the comforter’s need to explain away the darkness than the need of the bereaved, who is living it and knows its reality.
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Shame and the Pendulum of Blame

Shame and the Pendulum of Blame | Counselling and More | Scoop.it

"...Consciously or unconsciously, if you struggle with chronic shame you tend to experience misfortune as a negative verdict on your very sense of self. Often your default thinking may be couched in the language of accusation and blame. But in my therapy work, I have learned that it is more useful to focus on the nature of the impulses that give rise to blaming rather than the specifics of who or what is blamed.

 Research in neuroscience and moral psychology suggests that emotional, morally judging brain systems operate swiftly and out of conscious awareness. The specific story or narrative that we tell ourselves or others about our moral judgments is the product of “interpreter” modules in the left hemisphere of our brains (Gazzaniga, 2011). Plausible sounding blame narratives are produced after our emotional brain systems have already lodged the judgment. In a similar vein, Dr. Jonathon Haidt (2012) has likened discourse about moral “reasoning” to a rider on the back of an elephant. The conscious, verbally facile rider has only limited control of the moral elephant, but generates convincing, elaborate rationalizations to defend powerful, instantaneous, deep-seated moral intuitions. In short, the impulse to assign blame originates as an emotional and moral intuition; the particular expressed locus of blame is often the result of a downstream imposition of narrative by our interpreter modules. Whether lashing out at tormentors or flagellating the self, blame often dislocates a warded off sense of shame. When we blame, a sense of wrongness is being elaborated, attributed and projected in a plausible account. But my interest as a psychologist is in providing the patient a safe space to discuss the sense of wrongness itself.

 Blaming can be internalized or externalized. People who tend to self-blame may attribute virtually any negative outcome to a lurking sense of badness or deficiency. Cognitive psychologists (Abramson, et. al, 1999) have coined the term “depressogenic attributional style” to refer to the tendency to interpret all negative events as evidence of personal failure or toxicity. On the other hand, we are all aware of people (narcissists, for example) who externalize blame. Victims, other actors or forces beyond control may be targets for blame. In the process, externalizing personalities regulate and project shameful feelings that would otherwise attach to a sense of responsibility for the shameful quality. This also preempts the feeling of guilt for harmful actions.

 Guilt, in contrast to shame, is seen by social psychologists as a separate emotion in which there is regret at an action that has caused suffering to another person. Guilt involves an empathic response to the one harmed. When guilty, people express regret for having caused injury. An ability to identify with the sufferer is essential to guilt. Research has associated guilt-proneness (as opposed to shame-proneness) with psychological benefits, leading the guilty individual to reach out in expressing regret or making amends. These have been referred to as “affiliative social scripts.”

 Obviously, shame and guilt are frequently experienced together. For example, it is not uncommon for a guilty individual to blame herself for having hurt someone’s feelings. But the primary focus in the guilty emotion is on the real or imagined suffering of the person harmed, shame being secondary. For example, the statement, “I blame myself for hurting Fred’s feelings with callous words” is evidence of guilty consideration of actions that harmed Fred. The shameful issue for the guilty person is an awareness of responsibility for having acted harmfully.

 On the other hand, people who are extremely preoccupied with shame and its management actually exhibit less guilt than “normal” people lacking this shame sensitivity. It appears that the preoccupation with shame hijacks the ability for the individual to own actions of the self, to empathize with others hurt by those actions, and experience the impulse to make amends. In short, people who are shame-prone tend to be relatively immune to mature, prosocial guilt. They blame themselves not for their behavior but for who they are; blame pivots not on injury to others but who is fundamentally good or bad. For such people, casting blame dislocates undesirable attributes to others, obscuring any focus on the suffering caused by harmful acts they have committed..."

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Struggling with Internal Hijackers?

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Dimitris Tsantaris's insight:
A classic Acceptance and Commitment Therapy (ACT) metaphor that resonates with many therapeutic approaches.

Call it The Adult Ego State, call it The Observer, call it Self-In-Presence, call it Self-As-Context, call it Self-As-Process. What is rather certain is that we need that pilot to be able to stay detached and defused.
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Sandra - Onlinevents's curator insight, March 15, 12:23 PM
A classic Acceptance and Commitment Therapy (ACT) metaphor that resonates with many therapeutic approaches.

Call it The Adult Ego State, call it The Observer, call it Self-In-Presence, call it Self-As-Context, call it Self-As-Process. What is rather certain is that we need that pilot to be able to stay detached and defused.
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Patient experience of negative effects of psychological treatment: results of a national survey

Patient experience of negative effects of psychological treatment: results of a national survey | Counselling and More | Scoop.it


Results

Of 14 587 respondents, 763 (5.2%) reported experiencing lasting bad effects. People aged over 65 were less likely to report such effects and sexual and ethnic minorities were more likely to report them. People who were unsure what type of therapy they received were more likely to report negative effects (odds ratio (OR) = 1.51, 95% CI 1.22–1.87), and those that stated that they were given enough information about therapy before it started were less likely to report them (OR = 0.65, 95% CI 0.54–0.79).

Conclusions

One in 20 people responding to this survey reported lasting bad effects from psychological treatment. Clinicians should discuss the potential for both the positive and negative effects of therapy before it starts.


Crawford, M., Thana, L., Farquharson, L., Palmer, L., Hancock, E., Bassett, P., Clarke, J., & Parry, G. (2016). Patient experience of negative effects of psychological treatment: results of a national survey The British Journal of Psychiatry, 208 (3), 260-265 DOI: 10.1192/bjp.bp.114.162628 

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‘I’ Messages: How Removing ‘You’ Can Change a Conversation

‘I’ Messages: How Removing ‘You’ Can Change a Conversation | Counselling and More | Scoop.it

"...An emotion is one word. If you say, “I feel like you aren’t listening to me,” that’s not a feeling. Feelings may include: anger, frustration, confusion, guilt, encouragement, gratitude, happiness—you get the point. When you begin a conversation with “I feel” and then express an emotion, you are putting your perspective first. This reminds the person you are talking to that this is how you feel and not about what they did to you.

Once you have expressed the emotion you are feeling, describe what happened. Try to avoid saying “you” whenever possible. Again, this is about keeping the other person’s defenses down. Instead of saying, “I feel frustrated when you leave the dishes in the sink,” say, “I feel frustrated when I see dishes in the sink.” As another example, instead of, “I feel left out when you make plans without asking me,” try, “I feel left out when I’m not included in plan making.”

After you get the feeling and specific behavior down, you will want to explain why the behavior made you feel that way. This helps the person you are speaking to better understand why it’s so important. It might sound something like this: “I feel left out when I’m not included in plan making because I like to be aware of the schedule.”

Finally, provide a suggestion to take the guesswork out of what you need in the future. Using the last example, a replacement behavior might sound like, “I feel left out when I’m not included in plan making because I like to be aware of the schedule. I would prefer if you could send me an email before committing to our friends.” Sometimes there might not be an immediate solution, but even saying, “Can we talk about this further?” can be a good start.

The opposite of an “I” message is a “you” message. “You” messages often sound accusatory and tend to put people on the defensive. As soon as someone hears “you,” preparing for an attack is a common reaction. The goal of “I” messages is to diffuse that possibility, and instead enable a more meaningful discussion..."

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Negative Emotions Are Key to Well-Being

Negative Emotions Are Key to Well-Being | Counselling and More | Scoop.it

"...A crucial goal of therapy is to learn to acknowledge and express a full range of emotions, and here was a client apologizing for doing just that. In my psychotherapy practice, many of my clients struggle with highly distressing emotions, such as extreme anger, or with suicidal thoughts. In recent years I have noticed an increase in the number of people who also feel guilty or ashamed about what they perceive to be negativity. Such reactions undoubtedly stem from our culture's overriding bias toward positive thinking. Although positive emotions are worth cultivating, problems arise when people start believing they must be upbeat all the time.

 

In fact, anger and sadness are an important part of life, and new research shows that experiencing and accepting such emotions are vital to our mental health. Attempting to suppress thoughts can backfire and even diminish our sense of contentment. “Acknowledging the complexity of life may be an especially fruitful path to psychological well-being,” says psychologist Jonathan M. Adler of the Franklin W. Olin College of Engineering.

 

Positive thoughts and emotions can, of course, benefit mental health. Hedonic theories define well-being as the presence of positive emotion, the relative absence of negative emotion and a sense of life satisfaction. Taken to an extreme, however, that definition is not congruent with the messiness of real life. In addition, people's outlook can become so rosy that they ignore dangers or become complacent [see “Can Positive Thinking Be Negative?” by Scott O. Lilienfeld and Hal Arkowitz; Scientific American Mind, May/June 2011].

 

Eudaemonic approaches, on the other hand, emphasize a sense of meaning, personal growth and understanding of the self—goals that require confronting life's adversities. Unpleasant feelings are just as crucial as the enjoyable ones in helping you make sense of life's ups and downs. “Remember, one of the primary reasons we have emotions in the first place is to help us evaluate our experiences,” Adler says...."

 

  [click on the title for the full article] 

 

 


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Rune Moelbak's curator insight, February 23, 8:32 AM

Negative emotions contain valuable information about your needs and whether or not things are going your way

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Where the power lies in the therapist-client relationship

Where the power lies in the therapist-client relationship | Counselling and More | Scoop.it

"...I too am sceptical about the claims made for traditional psychoanalysis, with its power-base located in the “expert” interpretations of the analyst. I have encountered former analysis clients who have retrospectively come to regard their analytic experience as exploitative, even abusive. But I am no more enamoured by the idea that reducing our emotional challenges to a series of left-brain box-ticking exercises is of lasting value either. A number of my clients have reported similar reactions to those of “Rachel” in Burkeman’s article.

 

Between these two poles of CBT and psychoanalysis lies a rich field of integrative theory and practice, in recent years endorsed by and increasingly informed by the findings of neuroscience. Central to these findings is the notion of relationship. Every therapy client is in some way struggling in this area, whether with self or other. From this perspective, an analyst who is capable of evoking and maintaining a client’s trust through how they approach and build the therapist-client relationship is likely to have equal success with a CBT practitioner who does the same. The problem with both schools is that they tend to major on procedural method more than they do on “relationship” – a much harder concept to quantify and pin down, and one that can rather frighteningly equalise the status of therapist and client.

 

Where psychotherapy enables a right-brain to right-brain reparative relationship to be created, for use by the client whose early experience has left them starved of this, I’m in no doubt that lasting positive transformation can occur. This is contemporary psychotherapy at its best..."

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