Hard-Earned Lessons from Counselling in Action

Windy Dryden

• Publisher: SAGE Publications Ltd
• Year: 1992
• Print ISBN: 9780803986695
• eBook ISBN: 9781446229378
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

`This is a very honest book and should be essential reading for anyone beginning training as a counsellor. It will also be useful for experienced therapists to stimulate reflections on their own practice... to examine their work and to learn from errors. It is refreshing to witness the honesty and openness of the writers - especially so in the present culture, where many therapists set themselves up as flawless experts... I would recommend this book... it provides an informed and open discussion on the problems encountered by therapists? - Clinical Psychology Forum

Counsellors often struggle in their work with clients, convinced that their more experienced colleagues have not encountered similar problems and worries. In this volume, some of Britain?s leading counsellors give the lie to this myth. Writing openly and frankly, they share the painful lessons they have learned over the course of their careers as practitioners.

The contributors? combined experience proves that all counsellors, no matter how expert or well-known, have made mistakes, or faced challenges, and from them have had to learn aspects about the process of counselling - the hard way. The five `lessons? from each contributor are placed in the context of the counsellor?s own particular circumstances, and a concluding section in each chapter links the connecting themes that emerged throughout their learning process.

1 Petrūska Clarkson

When I was seven years old, I decided to become a ‘brain surgeon’ so I could be a doctor of unhappy minds and ‘make them better’. Several career decisions later, I started formal training and learning to be a clinical psychologist, a counsellor, and then a psychotherapist. I had the deep and abiding hope that I could find under-standing of the sadness and distress of human pain, learn the skills of helping people to free themselves from the shackles of their conditioning, their restricted beliefs and cultural limitations, and develop the necessary personal qualities which would transform my promising potential for healing into the genuine article.

I studied Carl Rogers; I went on encounter groups; I did a Freudian analysis with a Tavistock-trained analyst; I learnt about changing organizational systems from American university teachers; I worked in suicide prevention and in mental hospitals, advertising, and universities; I had a brief and unhappy excursion with a Kleinian analyst; I experienced and trained in gestalt, transactional analysis, bioenergetics, individual psychoanalysis, group psychotherapy, family therapy, sex therapy, suicide prevention and crisis counselling. These were not light studies. I gave several of these systems many years – an unstinting fortune in very hard-earned money, time, and energy. I had a quest.

I studied and studied, racing from degree to degree. I eventually admitted to myself that my thesis was an attempt to ‘find the truth’ about human haziness and unhappiness. I continued to hope that the real truth, the genuine key, was in the next book, in the next lecture I would attend, or the next experiential understanding carved from my own personal struggles with my inner demons. I loved, I married, eventually I created a family. I found a guru, said my mantra and meditated on the Buddha nature for many years. The need of the world was so great. Somewhere, surely, people really knew how to help people efficiently, truly, and without taking years and fortunes to do it. I travelled Europe and North America in search of teachers. I studied at the Tavistock, the Institute of Group Analysis; I spent eight more years in Jungian analysis. One conference I attended included 7,000 psychotherapists. If the truth was not there, where could it possibly be?

The strength of my dedication and commitment was impeccable, but I was still not finding the truth about making people better, the right way - the guaranteed, successful theory and method of treating people. If only I was more intelligent, could read faster, and learn better! Perhaps it was only my ignorance, laziness, or personal weakness which prevented me from discovering where and how?

While this is a description of my existential condition before I learned the major lesson, of which five examples follow, the issue of the healing factor was embedded in my search. It was present and I knew about it, yet never before was it as vivid and obvious. It is difficult for a fish to study and discuss water, since it is the very medium of its life. It is also difficult for psychotherapists and counsellors to study the relationship, since that is the very ‘water’ in which we and our clients live and breathe and find our meaning. I studied and honed and experienced and interpreted and used ‘the relationship’. I thought it was the context for the rest of the work. I did not fully realize that it was the work itself. I do not believe I have ever seen it as clearly as I see it now. This does not mean I did not see it then; only that the figure and ground has shifted irrevocably, and I cannot overvalue its importance now.

There is also circumstantial validation, and evidence from the world of psychotherapy is amplifying the lesson. It is one of the most important factors in the rise of integrative psychotherapy (Norcross, 1986). For decades there have been attempts to find which psychotherapy, which counselling method was the more effective; which theory better, which approach more efficient in terms of money, time, and benefits (whether physical or spiritual). Now the bulk of research points to the fact that the most important factor is the relationship between the client and the counsellor.

When I look back on all the varieties of transformative or healing experiences in which I took part, it is the relationship between me and my psychotherapist that was the most important, vastly the most important. The theory they espoused, the interventions or interpretations they used, all these seem as nothing compared with the vitality of a rich network of relational possibilities, well orchestrated by a healing and committed significant ‘other’. The most significant psychotherapist of my life said to me some three years ago, when she broke (again) one of the many technical prohibitions of the system of which she is a doyenne, ‘We don’t do rules around here - we’re experienced enough to know they don’t work! The rules, the guidelines - they are good for the beginners.’ Rules can prevent harm, but taken as true in themselves, they can prevent healing. Ever since the Fiedler (1950) studies, it has been one of the best-kept secrets in psychotherapy that the more experienced people resemble each other more than novices resemble their seniors in that theoretical (ideological?) system. This fits my experience. The task is not solely that of the counsellor or psychotherapist. The work lies in between, in the relationship. Much else is error.

I now understand that this is the field to study. The particular theory seems secondary to the understanding and the skilful use of self in relationship. I have identified five different kinds of psychotherapeutic relationship which are potentially available for constructive use in psychotherapy (Clarkson, 1991). These are: the working alliance; the transferential/counter-transferential relationship; the reparative/developmentally needed relationship; the person-to-person relationship; and the transpersonal relationship.

The working alliance is the part of the client-psychotherapist relationship that enables the client and therapist to work together even when the client experiences strong desires to the contrary. The transferential/counter-transferential relationship is the experience of unconscious wishes and fears transferred into the therapeutic partnership. The reparative/developmentally needed relationship is the intentional provision by the psychotherapist of a corrective, reparative, or replenishing relationship or action where the original parenting was deficient, abusive, or over-protective. The person-to-person relationship is the real relationship or core relationship – the opposite of object relationship. The transpersonal relationship is the timeless facet of the psychotherapeutic relationship, which is impossible to describe, but refers to the spiritual dimension of the healing relationship. It is important to remember these are not stages but states in psychotherapy, often subtly ‘overlapping’, in and between which a client construes his or her unique experiences.

These five relationship modalities can act as an integrative framework for different traditions or approaches to psychotherapy, notwithstanding apparently irreconcilable schisms. I do not offer it as a new truth, only as a useful way in which to keep questing. I believe I have made most of my errors in counselling when I have confused the types of relationship which would be appropriate in the counselling with a particular person, or at a particular stage in their counselling or psychotherapy. I hope others will use these, not as rules, but as lessons for themselves. I have made some mistakes and learnt from them. Even so, there is still much to learn.

You are never off duty until the client has left the office

The first hard-earned lesson I can think of is when I unwittingly used the transpersonal to undermine therapeutic work. The client was intending going to a job interview the next day, and was assuming a rather fatalistic attitude about it. He believed it was all ‘in the stars’, or at least in God’s hands. He was not used to making decisions in an active way, having had a childhood in which decisions were made for him; for example, his family had moved frequently due to his father’s alcoholism, with the result that he had gone to fifteen schools. Each time the family moved, it came as a surprise to him. The children were never consulted, or given adequate preparation time to adjust to a new situation that was not of their own choosing. As with many children of alcoholics, he had lost the causal connection between his deeds and behaviours and their effects on others in the environment.

We spent substantial time in psychotherapy exploring his pervasive sense of being a victim of circumstance, who might receive either gifts or blows without any apparent causal connection. On previous occasions he had relived and emotionally expressed some confusion, rage, and pain associated with his original powerless position in the world. Gradually, he learned to take responsibility for himself, but still fell back into magical thinking and superstition when under stress, as, for example, with this job interview.

I spent most of the therapy exploring with him the futility and denial of personal autonomy and responsibility involved in magical thinking and superstition. It sounds less delicate in abbreviation, but it would be fair to say that we used the session to discuss taking responsibility for one’s own actions; the satisfactions of an autonomous life; the naivety of believing that one can make something happen or prevent it happening by thinking about it; the origins of his powerless feelings from childhood. This was contrasted with my client’s childhood belief that if he wished somebody dead, the hated person might actually drop dead.

In counselling and psychotherapy it is important to clarify to the client that there is often a difference between fantasy and reality. Furthermore, it is empowering for people to begin to assume responsibility for much of what they thought was outside their power to influence. This sense of increasing personal focusing is a highly important value in my approach to counselling.

After a session rich in these explorations, I accompanied my client to the door. As he left I gaily waved to him, ‘Good luck!’ I could see his face reassuming the fatalistic stare with which he had entered my consulting room. I believe there is a transpersonal element in human life, but for this particular client at this particular moment it was unhelpful to invoke it. I painfully realized I had effectively demolished much of the work we had done in the session.

There is growing evidence to the effect that ‘extra-analytic occurrences’ affect psychotherapy and counselling far more than has been allowed for. It is very clear to me that this was an example of ‘going off duty’ before the session was completed; that is, moving to a social type of interaction which can effectively destroy or undermine – or at the very least not reinforce or substantiate – the most important aspects of the counselling. A similar situation may arise with a counsellor who responds to the client who says his mother has died: ‘I’m sorry to hear that; you must be very sad.’ By using the stereotypical social response, the psychotherapist deprives the person of a permissive atmosphere in which to express, for example, not sadness but perhaps joy and relief, about which the person may feel very guilty but which is nonetheless a more authentic expression of his real feelings, which he may not easily express to anyone except a counsellor. In this case, although my response was due to a premature ‘going off duty’, an apparent social level response, I had evoked supernatural powers, thus crediting them, not my client, with the primary capacity to influence the outcome of the job interview.

Being the ‘good parent’ can backfire

Another hard-earned lesson was when I discovered that providing a developmentally needed relationship when the relationship was still in the transference/counter-transference vector can be counter-productive.

I had already worked with this particular client for some time, so I believed we had a good working alliance and that I could provide her with a beneficial reparative experience. She originally came complaining of low self-esteem, self-destructive behaviours such as wrist-cutting, and compulsive promiscuity. She came from a family background of severe physical and sexual abuse. She had grown up with virtually no encouragement or support for her developing personhood. She was used to constant criticism of herself, her behaviour, her dislikes, and her interests. Indeed, the poverty of her early experiences was palpable in her victim-like demeanour and in the defeated way in which she held her body.

She had become so used to negative attention that she could hardly recognize or respond to friendliness from co-workers, kindness from potential friends, or the psychotherapist’s nonjudgemental acceptance. During her quite long period in psychotherapy, she projected on to me the critical, judgemental, even hostile, motivations of her parents. It was only gradually, as she learned to express her angry feelings and release some of the pain which she had stored in her body and her heart, that it became possible for her to be in the world without the certain anticipation of rejection and injury. Containing her rage, mirroring her distress, and empathically entering into this painful inner world seemed to form the major part of our psychotherapeutic work. After some time it began to seem that she had worked through her transferee tial need to experience me as a hostile or rejecting parent. She developed a desire to be recognized for her progress, and said she wanted some appreciation from me.

At this point, she said to me one day that she had for the first time since entering treatment invited a friend out for a meal. This was a breakthrough because until then she had lacked the self-confidence or the motivation to attempt what was for her such a brave venture. Believing that by now she deserved and could use some positive support, I made a comment to the effect that she had done very well. The next week she phoned to say she was too scared to come for a session. I wrote offering her her usual time the following week, encouraging her to contact me so that we could deal with whatever the problem was. When we eventually met, she hesitantly explained she had lost her trust in me when I showed my appreciation of her progress, because it seemed to her that I couldn’t possibly mean it in a sincere way; I was just setting her up in order to reject her later, as she had experienced in the past.

This was a powerful and humbling lesson for me, since it reminded me how easy it is to misjudge the readiness of patients for the corrective emotional experience or reparative work. Even though my client was able to use my positive encouragement later, at this stage it was mistimed. I had given the matter of starting to offer positive experience a great deal of thought and supervision before implementing it, so I was shocked and surprised to under-stand the fragility of the working alliance and the strength of the transference.

Having studied and struggled with the intricacies of the developmental^ needed relationship, this incident has served to increase my caution about providing potentially reparative experiences for clients without providing very clear mutual agreements. In situations where the transference dynamic may be actively or passively present, there is risk of undermining the adult-adult working alliance to an extent where a potentially beneficial intervention can perpetuate or reinforce negative life patterns (Balint, 1959).

We cannot live by analysis alone

Early in my career, when I was still very influenced and impressed by my orthodox psychoanalytic training, I persisted in working within the transference mode – at the expense of validating the personal humanity of the client with whom I was working. A particular client taught me about this.

The client was middle-aged, a mother of six demanding children, with a husband who vacillated between being demanding and cold. She held her body in a sunken position, as if she had symbolically been kicked. Even though her deprivation of affection and her yearning for comfort tugged at my heart, I solidly interpreted her need for touch and reassurance in line with my training and psychoanalytic supervision, that is, I consistently refused to answer personal questions or to accede to human requests, for a hand to be held or a warm word of reassurance to be spoken as such action had been construed as non-analytic. This ‘abstinent’ manner was the way I had been treated in my first psychoanalysis, and I was modelling this.

A colleague of mine has said that most people are so badly treated in their homes of origin in childhood they will tolerate a remarkable level of deprivation in psychotherapy or counselling because it is not as bad as what originally happened to them. At least I was present for this client and did not abuse her, but I was analyzing her transference towards me.

After too long a time, my confidence in my therapeutic abilities grew, and competence in understanding and utilizing my own counter-transference issues developed sufficiently for me to respond spontaneously to her. The day she held out her hand again to me in a very tentative, supplicating way, and I reached out to hold it in a simple, human, compassionate way, I truly learnt the value of person-to-person relationship and the futility of applying prescriptions or proscriptions to the human spirit. She knew what she needed to be healed, which was subsequently borne out by her therapeutic progress - a human touch. I was moved by her and by her pain, and touched by her experience to feel an empathy that could only flower in human mutuality.

Throughout the last twenty years of studying this field (and for most of this time I have been in psychoanalysis or psychotherapy of some kind), I have moved further and further away from appreciating the relevance of withholding person-to-person acknowledgement, and have become more profoundly impressed, touched, and awed by the healing capacity of a skilled clinician working within the person-to-person relationship. In addition to my personal experience, I have watched some of my colleagues in protracted psychoanalysis become more depersonalized as they attempt to model themselves on the depersonalizing analytic relationship, whereas they went into psychoanalysis seeking how to be more intimate with others. Distortion probably creates distortion, as the subtle induction for the patient to display resistance probably creates resistance. Woodmansey (1988) recently challenged the psychoanalytic establishment: ‘Perhaps we are doing our patients harm when we do not touch them?’ Certainly it is possible that ‘good’ is thus not being done.

I have taken very seriously research which shows that positive or negative expectations in educational situations can significantly affect the performance of students. There is research evidence that school children and students respond differentially ...

Table of contents

• Cover Page
• Title
• Copyright
• Contents
• Preface
• 1 Petruska Clarkson
• 2 Peggy Dalton
• 3 Emmy van Deurzen-Smith
• 4 Windy Dryden
• 5 Michael Jacobs
• 6 Dave Mearns
• 7 Pat Milner
• 8 John Rowan
• 9 Robin Shohet
• 10 Moira Walker
• Index