Coaching Psychology for Mental Health

Borderline Personality Disorder and Personal Psychological Recovery

Martin O'Connor, Hugh O'Donovan

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000431391
• Edition: 1
• Topic: Psychologie
• Subtopic: Industrie- & Organisationspsychologie

Traditionally, coaching psychologists have worked with people who aren't experiencing significant mental distress or have diagnosed mental illness. This book describes an innovative and challenging project of bringing coaching psychology to the lived experience of individuals with a diagnosed mental illness, Borderline Personality Disorder (BPD).

The authors present a case for why coaching psychology needs to be constructively challenged to broaden its base and be more inclusive and of service to people experiencing BPD in particular. The book describes a coaching interaction involving coaching psychologists and a number of individuals with BPD who had completed a behavioural skills programme (Dialectical Behaviour Therapy; DBT). It explores the epistemological and practice tensions involving the dominance of clinical recovery (elimination of symptoms) in mental health services and personal or psychological recovery (originating in the narratives of people with a diagnosis of mental illness who yearn to live a life worth living).

This book, written amidst the Covid-19 pandemic, makes a compelling case for coaching psychologists to engage with the philosophy and practice implications of personal recovery, at both professional and personal levels. It will be vital reading for those engaged in coaching psychology and for the education, training and continuous professional development of coaches and coaching psychologists.

Chapter 1

Introduction and background review

DOI: 10.4324/9781003048978-1

Guiding purpose

The overall guiding purpose of this book is to present to the reader a doable, flexible, adaptive, and integrated coaching psychology approach that has the potential to assist our understanding of how coaching psychology might be of service to the unique lived experience of individuals with a diagnosis of mental illness in our society, in particular Borderline Personality Disorder (BPD). GLOW 11 (goals for living, options for wellness) refers to a recent coaching psychology interaction in an Irish context with individuals with a diagnosis of BPD (who had previously participated in a Dialectical Behaviour Therapy (DBT) programme facilitated by a Clinical Psychology team in an Adult Mental Health service, and who had been behaviourally stable for the previous 12 months). It will no doubt be evident as the reader travels through this book that the actual coaching interactions with participants in GLOW11 as coachees did not overly if at all, focus on strategies for goal-formulation and became much more concerned with supporting individuals towards clarity about what a life worth living meant to each.

We (the authors) also want to draw attention to and explore concepts of mental health, in particular mental illness, not only in the traditional clinical context of the psychiatric service system, but in the broader and more primary context of societal and corporate assumptions expectations, pressures, and demands regarding the ‘good life.’

We also want to invite, if not challenge, the world of coaching psychology to reflect on our ethical and professional responsibilities in the context of a world where certainty and knowing is fast becoming past tense. Einzig (2017) writes that coaches would do well to follow our own advice to pause, step back, take stock and reflect on the role of coaching at this time, where we face into ‘a perfect storm of crises – ecological, economic, social, and psycho-spiritual – is affecting us all on a global level’ and that ‘coaches need to develop the depth, mindset and skills founded in strong values that will help reset the moral compass’ (p. 6).

In our challenge, we include traditional normative thinking and psychiatric ‘certainties’ about BPD and other forms of diagnosed mental illness. The stigmas about mental ill-health remain firmly ensconced within many aspects of contemporary culture. Einzig (2017) writes that ‘with an emphasis on performance, positivity and strengths, coaches may deliberately or inadvertently deter their clients from appearing down.’ Talking about states of depressed mood, loss of interest or pleasure in life, and generalised anxiety is not welcomed in the workplace, so we dissemble – ‘fine’ is the expected response to ‘how are you?’ (pp. 121/1220). In the GLOW 11 coaching psychology intervention, when participants were asked at the beginning of a session ‘how are you?’ happily but not without challenge to the coaching psychologist, the response was always honest, courageous and real! Consequently, when Einzig (2017) states that ‘we live now in a world that favours the light over the dark, upbeat optimism over scepticism, extroverts over introverts and action over reflection’ with little patience ‘with sadness, doubt, failure, ambivalence or despair’ (p. 122), we can invite you, the reader, to suspend your assumptions and beliefs if you have an interest in bringing coaching psychology to the lived subjective experience of persons with BPD.

Beginnings

The genesis of this book emerged in the course of reflective conversations over time between the authors. These conversations, several of them recorded, occurred in the context of developing ideas that eventually translated into GLOW11 and later into this book.

As each author began to experience a sense of trust, psychological safety, and emotional containment with the other, our conversations ‘strayed’ into a mutual sharing about our own struggles with mental health at various points in life. Implicit in this was sharing and reflecting on the narratives, assumptions, expectations, and beliefs about self that each of us carried forward from childhood families and communities of origin in Ireland. This sharing helped to open up a reflective interpersonal space where we helped one another to linger and go deeper into subjective lived experience, memories, impact and ‘muddling through’ the fog and sometimes darkness arising from mental health challenges along the way. Stelter (2019) writes ‘To be able to linger in dialogue, one has to move away from a narrow goal focus by exploring meaning and values and thus seek a deeper understanding of oneself and one’s world’ (p. 44). As we lingered in our dialogue about our own lived experiences, we also discovered an energising curiosity about the importance of understanding the lived experience of the individuals with BPD participating in GLOW11. The idea of writing this book thus emerged as something like the right thing to do. The reader can decide for her- or himself whether writing the book was indeed the right thing to do, at this time!

In the context of this book and our coaching psychology work with individuals with BPD, the authors identify with a definition of coaching psychology as being by its nature ‘relational and dialogic, where two or more people discover new meaning and co-create new thinking and ways of being and doing in the world between them’ (Hawkins & Turner, 2020, p. 1). This definition in being neither limiting nor prescriptive, helps to open a space for considering and reflecting on some of the ways in which the subjective experience of mental illness and our current society are in our view interdependent. In the context of the lived experience of individuals with a diagnosis of BPD, the authors have a particular interest in and concerns about the impacts of the fast-evolving nature of change in current society, the anxiety-provoking threats implicit in climate change and the insidious nature of structural economic and social inequality which pushes increasing numbers of individuals towards marginalisation and alienation. People experiencing mental distress and BPD are likely to be especially vulnerable in this context. In building coaching relationships with individuals with BPD, we frequently had direct experience of and felt challenged by their ‘dance’ between hope and despair (Wright, 2016) and admiration for their courage and resilience.

The book describes and explores some of the current constructive and energising tensions in thinking, research and approach with regard to our understanding of the lived experience of mental illness and BPD, in particular the paradigm shift from the concept of clinical recovery towards a personal or psychological recovery.

Every new development in the application of coaching psychology asks important questions about the current assumptions underpinning practice. GLOW11 is a new development in the field of coaching/coaching psychology and therefore challenges coaching practitioners, academics, and trainers to develop a critical reflective stance to question the norms and assumptions of coaching (Western, 2012). We believe that this is particularly important as regards assumptions about coaching and people experiencing significant mental distress.

A coaching psychology approach to mental illness and BPD

Cavicchia and Gilbert (2019) write that while existing definitions of coaching tend to be quite general and conceptual, this offers opportunities for coaches ‘to develop a unique approach to coaching based on their own personalities, training, histories and life experience, all interacting with these corresponding aspects and unique requirements in their different clients and their contexts’ (p. 6). Having participated in the planning and implementation of GLOW11 and engaged in ongoing critical reflection and learning subsequently, this book is an attempt to describe a unique experience of bringing coaching psychology to people with a diagnosis of BPD. In the book, we offer reflection and learning from GLOW11 in the hope of contributing to constructive conversation about the possibilities and challenges of coaching psychology interacting with the lived experience of people with BPD in particular. Here we are also cognisant of the impact of words and language that can be distinctive of different disciplines and professions. Rhodes (2020), writing about the language that tends to be the norm in clinical psychology, states ‘these forms of language seek to differentiate the clinician from the client, amplifying polarities. The clinician is objective, the client is the object. The clinician is mentally healthy, the client mentally ill. We both become objects’ (p. 2). When considering mental illness/mental distress, coaching psychology is not immune to what might be called the pitfalls of normative thinking and uses of normative language, namely an ‘us’ and ‘them’ silo approach of ‘non-clinical’ and ‘clinical’ groupings. As coaching psychology diversifies, drawing from rich multiple sources to create new genres, our conviction arising from GLOW11 is that it is timely to critically reflect on our assumptions and beliefs about mental illness/mental distress. Einzig (2017) asks ‘but suppose we allowed ourselves to entertain a different view of depression, sadness and anxiety from the polarised and pathologized view held by the Western medical model?’ (p. 123). Coaching psychology, if it is to be and remain culturally and socially relevant needs to offer something more to people suffering from significant mental distress, such as BPD, than taking refuge in the ever-increasing classifications of DSM that is resulting in an ever-increasing pathologizing of human experience in a volatile, uncertain, complex, and ambiguous world (VUCA).

While in this book we lean away from adherence to universal or all-embracing definitions of coaching psychology, there are particular ‘definitions’ that resonate with us in the context of our experience of GLOW11 and which we view as helpful to discussion. For example, Hawkins and Turner (2020) in the context of systemic coaching describe coaching as a collaborative and dialogical inquiry between two people, ‘exploring how the coachee can learn and develop in relation to the worlds they are embedded within, in a way that creates positive benefit for them and all the nested systems of which they are part’ (p. 28). Einzig (2017) refers to coaches taking a view of people, elements, and actions ‘as not only interconnected but interdependent and are willing to engage with the extreme complexity of our age’ (p. 46). Western (2012) refers to four critical frames to analyse coaching – emancipation (ethics, liberation, autonomy, and justice: coaching to help create the ‘good society’; depth analysis (revealing hidden dynamics in individuals, organisations and the social field); looking awry (bringing desire and disruption to observation and understanding); and network analysis (network coaching, connectivity, interdependence, emergence) (pp. 34/35). Stelter (2019) refers to an increasing realisation in his work how important it is for the coach ‘to be a fellow human being and a co-creative partner in the dialogue’ and that ‘coaching should not be limited to a performance-oriented and goal-driven agenda’ (p. 3). In particular, Cavicchia and Gilbert’s (2019) reference to an integrative-relational orientation speaks in important ways to the necessity of taking a moment-by-moment perspective in the GLOW11 one-to-one coaching sessions. They highlight also that coaching boundaries are expanding to allow for greater appreciation of the importance of meaning making, wellbeing, complexity, and systemic perspectives. At the same time, just as every new or novel perspective appears in coaching psychology and enters the discourse to become normative, there is the need to continue to playfully experiment. Marsha Linehan (2020) the developer of Dialectical Behaviour Therapy (DBT) as a behavioural skills programme for people with BPD refers to a Zen phrase – beginner’s mind – meaning ‘that every single moment is the very first experience you have had of that moment. Every new moment is a beginning … Beginner’s mind is the recognition of this’ (pp. 275/276). Linehan (2020) adds that initially in her deliberations on BPD she analysed everything, seeking the meaning of everything, rather than a radical acceptance that ‘everything just is’ (p. 276). Certainly, for us GLOW11 required an attitude and approach of beginner’s mind! There were no coaching models to guide us on the way. In this book we do not present a coaching model. We present a jigsaw of reflections, insights, discoveries about the self in coaching psychology, and appreciation and gratitude for the people we were privileged to meet, from whom we learned the necessary coexistence of suffering and hope. We are also struck that the vast majority of attempts to define coaching/coaching psychology, including those referenced above, are specific to organisational, executive and leadership contexts. To date, there appears to be very little discussion of coaching psychology in non-organisational contexts. GLOW11 operated in a transitional space of individuals with BPD seeking to emerge from mental health services and build connections with community life.

Given the very particular life experiences of each participant in GLOW11, with a preponderance of emotional pain and trauma experiences implicit in their respective ‘recovery’ journeys, the importance of creating and sustaining a ‘holding environment’ in coaching sessions was of critical importance. Lee (2018), citing Winnicott, 1965), refers to the ‘holding environment’ as a physical and in particular a psychological space ‘in which coachees feel safe enough to be open with their thoughts and feelings; to be able to share their anxieties, frustrations, aspirations and deepest hopes’ (p. 4/5). The importance of coaching psychologists having both the inclination and capacity to provide a ‘holding environment’ in coaching sessions is perhaps self-evident generally, however its importance in the work of GLOW11 was critical. Western (2012) draws upon psychoanalytic theory and practice in applying the concepts of ‘paternal’ and ‘maternal’ ...