Sussex Counselling & Psychotherapy
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Following the AGM yesterday, there have been changes in committee members. The website will be updated with these changes shortly.
Sally McLaren is a psychotherapist in private practice in Horsham. She has a particular interest in the work and ideas of Swiss psychiatrist and psychotherapist Carl Gustav Jung. She writes: ‘In 2012 I completed a two year Infant Observation Course with the Jungian Section of the British Psychotherapy Foundation. I observed a baby in his home each week from birth to two years in order to build up a picture of his developing inner world and relationships, and deepen my understanding of the human psyche. My experiences with baby Max have left me with a conviction that images and imagination play a central part in connecting us to the deeper levels of the psyche, that this connection is there from the beginning, long before words are available, and that this has implications for the consulting room and indeed for our own personal journeys.
Sally presented her report on observations of baby Max, focusing on events in his second year. Max was too young to speak, but growled and communicated through sounds and gestures, his house and books were full of images of the animals that he loved. The seminar was advertised with the Carlo Crivelli painting from 1480 of the Madonna with the Goldfinch, in which the infant Christ is pictured clasping a goldfinch as he sits on his mother's lap. The painting also shows a stylised landscape with strange three-part trees, turbaned people, and large images of a fly, an apple and a cucumber. Sally explained the significance of these objects, that they were part of a visual language understood at the time, but obscure to 21st century observers. The apples and fly are symbols of sin and evil and are opposed to the cucumber and the goldfinch, symbols of redemption.
Birds and a fly featured in anecdotes about Max, describing how he wished to touch a fallen bird, but obeyed his mother's instructions to hold back. Birds also featured in Sally's real experience and in dreams, leading her to speculate on their significance in her own life and in her training.
After two years as a regular silent presence in Max's life, Sally had to end her observations. Her account of her last visit impressed me that Max's behaviour that day included him disappearing behind bushes then reappearing, which he did four times. It seemed to me that Max sensed that he was facing a loss.
The talk was illustrated with drawings and paintings, by Sally and by Carl Jung - especially the series of paintings that Jung produced daily over a period of three years in an effort to connect with his own unconconscious, that are bound into the famous Red Book.
We spent the second part of the morning, like Jung, using drawing to reconnect with our own preverbal unconscious selves. It isn't easy to switch off my logical conscious self and let the unconscious take over, but we were each able to make a drawing and reflect on it without trying to interpret it. Some made drawings of experiences from childhood, others about what was happening with them today. I think we all appreciated the opportunity to connect with those other parts of ourselves as we gazed at our drawings.
Parts of Sally's observations included looking at stories that deal with the "wild things" within us, the Gruffalo, and Maurice Sendak's "Where the Wild Things Are" evoked visual versions of strong feelings, so Sendak's book was an apt leaving present that she gave to Max and his family.
The deadlines for submitting your advertisement to be published in the members quaterley magazine for 2017 have been finalised. They also appear on the submission forms.
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Report by the Women and Equalities Committee exposes the shocking scale of sexual harassment and sexual violence that is not being tackled effectively in English schools.
The report outlines evidence that:
- Almost a third (29%) of 16-18 year old girls say they have experienced unwanted sexual touching at school.
- Nearly three-quarters (71%) of all 16-18 year old boys and girls say they hear terms such as "slut" or "slag" used towards girls at schools
on a regular basis.
- 59% of girls and young women aged 13-21 said in 2014 that they had faced some form of sexual harassment at school or college in the past year.
Everyday Sexism Project
Young people told the Committee that sexual harassment has become a normal part of school life with "calling women bitches and stuff like that… a common thing that you see in school, on a daily basis really." This view was supported by evidence from Laura Bates of the Everyday Sexism Project who described sexual harassment and sexual violence in schools as "a widespread, regular and common problem [and] something that the majority of girls are experiencing."
The report finds an alarming inconsistency in how schools deal with sexual harassment and violence, which is mostly targeted at girls, a disregard for existing national and international equality obligations, and a lack of guidance and support for teachers.
MPs heard evidence that many schools are under-reporting incidents and often failing to take them seriously. The Committee was told by young people that their reports would be "forgotten about really easily and no action will be taken about what happened." Academics and specialists working in schools warned that sexual harassment and sexual violence was too often accepted as the norm by both staff and students.
Despite calls from parents, teachers and young people for action to address sexual harassment and sexual violence in schools, the Committee found that neither OFSTED nor the Department for Education has a coherent plan to tackle this issue and to monitor the scale of the problem.
“The wonderful thing about a hip operation is that you know when it is going to happen. And, therefore, you can plan/prepare around it...,”
In 2007 when, following an unfortunate accident, Catherine Baudino found herself facing a left hip replacement surgery. Eight years later Catherine’s right hip needed to be replaced as well. At this point Catherine took matters into her own hands. Having worked hard before her first operation, using Pilates as a pre-operation preparation, Catherine understood the importance of exercise for a healthy and speedy recovery.
Understanding that for many a hip operation indicated the sign of ageing, Catherine was determined to prove that, no matter what your age, recovery was an option for those who were prepared to work for it. “Whatever your age, or circumstance, there is no need for trepidation, nor do you need to be a fitness fanatic to have a speedy recovery”, says Catherine.
Fitness is not the only contribution required in preparation for a speedy and successful recovery. Catherine says "determination and self-discipline appears to be equally as important when dealing with obstacles of physical and mental pain". She admits, “I was ruthless with myself and absolutely determined to be as prepared as possible for my recover, regardless of pain and discomfort”.
However, her real obstacle was not her body but rather her mind-set. Catherine, who is studying to become a Reality Therapist and is beginning to apply the ideas of Choice Theory in her life, soon realised she had choices when it came to her mental behaviour, and opted for a positive attitude, coupled with as much exercise as her body would allow.
With a surname like ‘Tregenza’ you might’ve gathered I spent part of my life in the wilds of Cornwall. I think it was here as a struggling teenager that my interest in online counselling began, though I didn’t realise it at the time. Quite simply if you didn’t have transport and couldn’t reach the distant town to see a counsellor, you did not receive support.
Fast forward to 2013, when the opportunity to set up E-motion a new online counselling service for young people age 13-25 years, arose in Brighton and Hove. I now look back on that experience of living in a poorly resourced rural community, as the driving force which has helped me overcome my doubts about working online and embrace the challenges and benefits it offers, clients and counsellors.
If you are thinking of becoming an online counsellor the BACP’s publication ‘Guidelines for online counselling and psychotherapy’ makes for a good starting point. All the potential dilemmas counsellors may face are highlighted.
The guidance recommends practitioners get some specific online counselling training, in addition to their counselling qualifications. An invaluable resource to find some good training is the ACTO (Association for Counsellors and Therapists Online) website
In training, you will learn about how to manage your anxieties about online work. Mine included:
· How can I build a relationship with someone I can’t see
· How will they know I am ‘present’ and the meaning behind what I say?
· What if I can’t work the technology or, it fails
· How will I manage ‘the black hole’ effect if a client suddenly ‘disappears’
· How do I keep a record of the sessions
· Am I contributing to end of face to face counselling?
You will also appreciate more about the benefits of working in this way:
· You have more ‘reach’ – those who are too fearful to come to face to face counselling, people with access issues (working shifts/with caring responsibilities/disability/no transport) those more comfortable working online
· There seems to be more take up of online resources if you invite clients to try them from within an online world
· Clients often feel more in control and anonymous and will disclose issues not previously discussed
For me the benefits on offer won over my fears and kept me focussed.
As with most things the safety and success of the delivery rests on having thought these things through as much as possible, listening to advice and reviewing your practice by responding to the feedback from your clients. Central to running the service has been the development of a good online assessment system. There have been many highs and lows at E-motion but we are winning; we get great client feedback.
Of course you may not want to be an online counsellor. But as an expanding area of practice, even if you don’t want to offer this service to clients directly, having some knowledge of what is out there and how it works, may benefit your clients. Consider the Tasha Foundation’s offer of a one off support session from a qualified counsellor 24/7. Few counsellors are willing to work face to face 24/7; whereas an online service can be available in a different way to a face to face service. Clients can write from the privacy of their home, at any time. The ‘Have I got a problem’ service does not offer what a face to face service can, but for some clients it will be a valued out of hours service.
As well as being a complete intervention in itself, online counselling can also provide a useful link towards face to face work or it can be something that people use after face to face to gain more independence. Considering all this, surely its wise, to know what services you can refer people on to use or, to understand what their knowledge and experience of online counselling has been.
As a counsellor working with young people who conduct a lot of their emotional life and relationships online, you may be thinking this subject is just relevant to that age group? Yet this is a growing area of practice with adults too, as evidenced by the current expansion of the NHS’s hugely successful Big White Wall adult online counselling service https://www.bigwhitewall.com. So I leave you to consider – in what way might online therapy impact on your practice now or in the future?
Jay Tregenza is joint project leader at E-motion www.e-motionbh.org.uk the free online counselling service for young people in Brighton and Hove. It’s a joint partnership project between YMCA and the YPC. To get the service clients just email firstname.lastname@example.org . All counsellors working on the project are fully qualified, experienced and all have received additional online counselling training.
Play and Laughter
Tony Buckley (Chair of the Sensorimotor Association, and former Clinical Director for London Transport’s staff counselling service) was in Brighton in September to offer his workshop on The Art and Science of Play: Using Play, Humour and Laughter in Therapy. If you missed the event, here are a few helpful nuggets from the day!
1. Play is universal to all mammals
We have always played, even when we were cave dwellers. Play prepares us for life by helping us develop the relational and survival skills necessary for a successful life. An example of this is when kittens chase and pounce on string that their humans dangle in front of them. Really they are learning to catch mice. When people have been traumatised or are depressed, their play system shuts down. They forget how to play.
2. Play is hard-wired into our brains
Play is ‘hard-wired’ into our brains according to neuroscientist Jaak Panksepp. In his book The Archaeology of Mind (Norton, 2012) Panksepp seeks to discover the origins of emotion and outlines 7 main hard-wired emotional systems in the brain. These are: Seeking, Rage, Fear, Lust, Care, Panic, and Play. Panksepp has given a TED talk on The Science of Emotions which explains the 7 emotional systems. You can watch Panksepp’s TED talk on You Tube.
3. What is Real Play?
“Real Play” is defined as an activity that is spontaneous, intrinsically pleasurable, free of anxiety or other overpowering emotion. Typically play involves ‘alternating dominance’ where one mammal is dominant over the other and then the roles are reversed. We can observe this behaviour in baby animals who play with one another by rolling around, first one on top then the other.
In humans we can observe that if one person remains always dominant in play this ceases to be pleasurable and free of anxiety for the submissive person. Play turns into bullying. Real play involves laughter and rough-and-tumble type activities as characterised by natural child-play. It doesn’t include organised activities like playing a football game as these are too structured and competitive, causing stress and anxiety.
4. Depression and play
Why is play and laughter important? Jaak Panksepp sums this up by saying that “depression and play are opposite sides of the same coin”. Laughter (the result of playfulness) can help to regulate feelings, enable both feelings of hyper arousal (anxiety, for example) or hypo arousal (depression, for example) to be safely and positively moderated. In short, play helps us develop the capacity to be happy. Panksepp can be seen discussing the play system and his discovery that rats laugh when tickled in a brief video called The Primal Power of Play (which you can find on You Tube).
5. Play and laughter as emotional regulators
The lesson for therapists is that playfulness and laughter are emotionally regulating and if encouraged and nurtured can enable clients to become more resilient. It doesn’t mean that therapists need to do a short-course in stand-up comedy, but if you understand the importance of play, laughter and humour you can use and share laughter to positive effect within the therapeutic relationship.
Polyvagel Theory Workshop Report
After the SCAP AGM on 26.7.14, local Brighton therapist Matt Ingrams spoke to us with a fascinating review of the latest research to support
“Client Safety, Stabilisation and Self Regulation”
Matt commenced by outlining a little of his background, including that as part of his training, he had studied TA at Wealden College in East Sussex, and this provided a frame for his current work with clients. He said he would also be drawing on the work of Dr Stephen Porges*, who has researched what he discovered about mammalian responses to trauma, now termed Polyvagal Theory, and on Dr Dan Siegal's# concept of 'the window of tolerance' (the idea that there is a self-regulated mode of sufficient calmness, safety and rationality which clients can learn to induce for themselves rather than swinging wildly between hyper- and hypo-arousal, which actually leaves them very vulnerable and definiately not safe. )
To quote from a NICABM interview with Dr Porges*, “For some people, specific physical characteristics of an environmental challenge will trigger a fight/flight behavior, while others may totally shut down to exactly the same physical features in their environment. I want to emphasize that we have to understand that it is the response, and not the traumatic event, that is critical.For some people, so-called traumatic events are just events. And for other people, they are really life-threatening experiences, and their body responds as if they are going to die; similar to the mouse in the jaws of the cat. ”
Matt suggested there is now a crossover between a knowledge of trauma and what might previously have been thought of as the general counselling forum, which enables competent practice, with benefit both to our clients and ourselves.
Matt reminded us that when human beings experience a perceived overwhelming threat to life, certain unconscious neurobiological mechanisms kick in, over which the individual has no conscious control; the primitive brain decides how to respond in a millisecond. The cognitively functioning and highly developed “front brain”, with its capacity for rational thought and logical risk assessment, which needs time and a sense of safety to calculate the best course of action in any given situation, does not have time to take control! To quote the Porges interview again “The polyvagal theory basically emphasizes that our nervous system has more than one defense strategy and the selection of whether we use a mobilized flight/flight or an immobilization shutdown defense strategy is not a voluntary decision. Outside the realm of our conscious awareness, our nervous system is continuously evaluating risk in the environment, making judgments, and setting up priorities for behaviors that are adaptive, but are not cognitive.”
Matt spoke of the “containing” concept of the personal therapeutic encounter, and the need for therapists to understand and work with the idea that everyone who seeks a therapeutic relationship has some unfinished business they want to resolve; up till then, they've adapted, intellectualised, coped, dissociated ….. and eventually those defensive responses against experiencing what has become an ongoing sense of overwhelming threat start to crumble and no longer serve adequately to defend the individual from imminent psychological and associated physiological collapse.
Matt referred to the Gestalt “cycle of awareness”, illustrating his point with the analogy of needing to go to the toilet – avoidance of the need doesn't work long term, eventually the individual will be obliged to go! Similarly, after a while, avoiding the triggers for feeling traumatised – often experienced as symptoms of depression, anxiety, worthlessness, incapacitation, demotivation, hypervigilance – is no longer an option. He referred also to what TA calls a decisional model, where an early experience leads to a “decision” - outside of conscious awareness - about how to survive in a particular situation This then generalises to become the default response to any similar situation; the decision is incorporated into the individuals's “life script”, and “rackets” (self-manipulating behaviours, thoughts and feelings) , develop to maintain the script.
In order to work with these early decisions, and facilitate the individual to make some new decisions about how they want to be in the world, thus changing their script, clients need to develop a sense of safety and containment. Matt spoke of the importance of being 'potently present', a concept first identified by Pat Crossman, a transactional analyst contemporary with Eric Berne, as “the 3 Ps: Permission, Protection and Potency.” (Leaving aside for the moment any debate about the validity, reliability or ethical value of these concepts, for anyone not trained in TA I'm giving my own paraphrase: “Permission” to the client to dare to question their inner Parent voice which tells them they're stupid/worthless/can't change; “Protection” to the client's inner Child from the punitive Parent voice while they tentatively start to question those early beliefs; and “Potency” of the therapist to offer the required Protection and Permissions until the client develops sufficient autonomy to provide them for themselves.) Matt described 'potently present' as a 'felt presence', that is, felt as an experience rather than talked about; which is why in his view the telephone had limitations as a therapeutic tool.
Matt referred also to Peter Levine's research on the concept of internal arousal – the incomplete cycle of fear from the unfinished business of “internal family systems”, a term used by Richard Schwartz to described a client's un-metabolised experience. He spoke of the importance of the therapist's ability to be continuously 'noticing' and conscious of their own and the other's metabolism – heart rate, breathing, eye blinks etc in order to maintain constant awareness of the client's state.
Matt then went on to speak of one of the functions of the vagus nerve – a part of the Autonomic Nervous System which could be likened to a “vagabond”, travelling around the body's organs and sending millisecond messages from eg the viscera to the brain and back. For instance, it is now known that there are five nerves which send messages from the gut to the brain, and only one which goes from the brain to the gut. Modern homo sapiens may wish to believe otherwise, but the fact is that our guts have far more influence over our actions than our cognitive “front” brain! Matt spoke of the neurobiological components of the Fight/Flight/Freeze response – the archaic pre-limbic system which evolutionists believe to be five million years old, and which is unmyelinated, that is, it is slow, immobilised, and results in the organism being very still to avoid predation. As an aside, he observed that a very powerful Be Strong Driver (from TA theory) could well be an individual in a form of Freeze mode!
Antagonistic to this is the Sympathetic Nervous System which is myelinated (much more recent in evolutionary terms) and when it senses threat, instead of immobilising sends an instant signal via the amygdala to the body to Fight or Flight. To enable immediate mobilisation, the Sympathetic Nervous System will pump blood to the muscles and outer organs, and the Parasympathetic Nervous System, which includes the ability for social engagement eg smile, speak, slow down and be calm, will be inhibited. Dr Porges' research has demonstrated and he emphasises, all this is entirely outside conscious control, and is decided in a matter of milliseconds.
To quote the interview again: “the vagus is a cranial nerve that exits the brainstem and travels through much of our body. It is primarily a sensory nerve with approximately eighty percent of its fibers sending information about the viscera to the brain. However, about twenty percent of the fibers are motor and the brain’s dynamic regulation of these motor pathways can dramatically change our physiology with some of these changes occurring within seconds. For example, the motor pathways can cause our hearts to go faster or they can cause our hearts to go slower.
In its tonic state, the vagus functions like a brake on the heart’s pacemaker. When the brake is removed, the lower vagal tone enables the heart to be beat faster. Functionally, the vagus is an inhibitory nerve that slows our heart up and enables us to, for instance, calm down. Thus, the vagus has been promoted by many as an “anti-stress” mechanism. However, there is another literature contradicting these positive attributes of the vagus and linking vagal mechanisms to life threatening bradycardia and functionally to sudden death. Basically, the same nerve proposed as an anti-stress system is capable of stopping the heart and producing defecation in response to life threatening experiences. ….
we were (also) taught that the vagus is the major part of the parasympathetic nervous system, an opposing system to the sympathetic nervous system. The sympathetic component of the autonomic nervous system mobilizes the body, gets us moving. …. most of our visceral organs have neural connections from both the parasympathetic and the sympathetic nervous systems with most of these parasympathetic neural fibers traveling from the vagus. “
Dr Porges framed what he called the vagal paradox. He questioned, how could the vagus be both protective when it was expressed as reparatory sinus arrhythmia and lethal when it was expressed as bradycardias and apneas?
At this point Matt acknowledged that the lack of a flip chart or any other audio-visual aids might be a hindrance! To better understand Porges's Polyvagal Theory it is helpful to have diagrams and definitions. The way Matt explained it, it made sense to me, but I confess that reading my notes now, its hard to convey that sense of grasping a complex subject. Hence my use of quotes from the interview. All credit to Matt that he enabled me to believe at the time that I had a firm grasp of it!
A final quote from Dr Porges “This paradox motivated me to develop the polyvagal theory . If a life threat triggers a biobehavioral response that puts a human into this state, it may be very difficult to reorganize to become “normal” again. …. Therapists are aware that many people, who report abuse especially sexual abuse, experience being held down or physically abused. These abused clients often describe a psychological experience of not really being there. They dissociate or pass out.
For these individuals, the abusive event actually triggered an adaptive response, maybe not fully, but part of it, to enable them not to experience the traumatic event. The problem, of course, is how do you get people back out of that? “
Matt's talk helped answer that question for us. He ended by observing that as humans, we have lost the ability to shake ourselves free of the Freeze response; other mammals and birds are able to give themselves a good literal shake when the danger is passed and revert to their previous normal activities; instead, we humans stay in a state of semi-immobilisation, deeply depressed, alternately fretting and anxious, often using phobic behaviours to avoid thinking clearly, stuck in incapacity The solution is literally to get moving! Encouraging clients to move around, if necessary in the consulting room, and most importantly to engage with regular gentle exercise, is essential to recovery.
He likened these to Babette Rothschild's** concept of 'anchors' – Stretch! Breathe! Express (give voice to)! ie get the airwaves open and circulation going. Matt cited Janina Fisher, another well known name in the field of trauma recovery, who recommends two further options to suppport self-soothing – Attach (to a safe figure, even if only by listening to the therapist's answerphone message if no-one safe to be around is available) and Think – get your 'front brain' back online by doing puzzles, crosswords, suduku.
(In passing, Matt noted that clients with Borderline characteristics are believed to be scared of social contact (engagement) because they feel they need to control every situation; and are therefore likely to dissociate or avoid attaching to the therapist, and will need alternative approaches to support them in the early stages of therapy, if indeed they maintain the relationship for any length of time.)
He proposed that a sense of empowerment – perhaps at first simply by being given factual information – helps clients move out of depression/freeze mode and start to feel safer. A very important ability for the therapist is to develop attunement (one of Carl Rogers's core conditions), and empathy, though he wryly admitted that perhaps too much of that with borderline clients may be counter productive).
When working with severely dissociated clients, Matt has found the analogy of the person being like a house, with a chute between the attic (hyper arousal) and the basement (hypo arousal, or incapacitation) can be very useful. The client can understand that regularly using the chute to zoom back and forth outside the limits of their window of tolerance is unhelpful; learning how to stop at different points in the chute and access the 'living room' filing cabinet of Inner Resources which stabilise and regulate, is much better.
MSc CTA(P) CertEd
UKCP reg, BACP Register
EMDR Europe Accredited Practitioner
* Quoted from a recorded interview between Dr Ruth Buczinski, co-founder of the National Institute for the Clinical Application of Behavioural Medicine, and Dr Porges, broadcast by NICABM last year (www.nicabm.com) as part of a series of podcasts on the latest developments in neurobiology and working with traumatised clients.
# Daniel J. Siegel is a clinical professor of psychiatry at the UCLA School of Medicine and Executive Director of the Mindsight Institute.
** Babette Rothschild, author of The Body Remembers,and associated work on trauma a survivors
Anyone interested in hearing more of Dr Fisher's work may like to note that in April 2015, a seminar will be held in Brighton under the auspices of the PODS organisation (Positive Outcomes for Dissociative Survivors) – see www.pods-online.org.uk for further information. A review of the PODS workshop held in Crawley in July this year entitled Living and Working with Dissociation will be reviewed in the Spring issue of SCAP newsletter.
Trauma Without Borders in the Calais Camp
Counsellor Rose Allett travelled to France to volunteer at The Jungle. She describes the trauma suffered by those in search of a better life.
‘Thank you, my sister,’ said the man from Sudan, and he touched my cheek as I handed him a blanket from the back of our truck. Like the 500 or so men who’d stood before him, as he got to the front of the line I’d greeted him with a smile and a handshake, and thanked him for waiting patiently. It was raining and we stood in a muddy clearing surrounded by tents and tarpaulins on all sides. He took his blanket and moved away.
Welcome to The Jungle, the camp in Calais currently housing over 5,000 refugees, our neighbours just a few miles over the water. Over a hundred people arrive each day, many without a tent, blanket or shoes. Several people wear flip flops, and the temperature is dropping fast. There is no sign of any established organisation. All aid is provided by volunteers who have given up their jobs, or in my case just their weekend, to sort through donations, co-ordinate mass distributions, build shelters, or provide medical, dental or therapy care. There can be little doubt that PTSD and trauma, caused by their journey alone, let alone memories of the life they left behind, are rife.
Volunteers have created a theatre space and a library, and the refugees are setting up cafés, shops, mosques, a church, even a nightclub. They don't want to get too comfortable (this is a stopover, not a home) but the human spirit endures and community is everything here. People have travelled from Sudan, Eritrea, Afghanistan, Iraq, Syria. I’d heard the camp had segregated into separate areas and asked if there was any tension between the different nationalities. The answer was unanimous: ‘We are all brothers and sisters here'.
Our blankets were running low, and there were still over 100 men in the line, and a few women. A few minutes later I had to call out: “That’s it for today, I’m sorry, they’re finished.” Blankets this time, hoodies earlier and over the weekend, we distributed food parcels, sleeping bags and water, and there was never enough. Every time, I found their responses extraordinary: a proud shrug of the shoulders, a grateful smile, a look to the heavens, “maybe tomorrow, Insha’Allah”.
And yet these people are desperate. I spoke with many about their journeys: lorries, buses, on foot, the boat to Europe (two friends told me that 26 people had died on their crossing) – all this they said was ‘the easy bit’. The hard bit was the remaining few miles into the UK. Hundreds attempt to cross each night: (How? ‘jump, jump’), and failed attempts were evident all around: fresh barbed wire cuts, twisted ankles, broken limbs.
Ali, just 17-years-old, knew a man that had made it through a few days before. He also knew people who’d died on the tracks. “I die in Africa, I die in France, what’s the difference? I have to try,” he said. “In England, the people are kind, the people are like you. Here, the police gas us. The people in England care. Yes? What do they say about us, in England?” And what could I say?
Rose Allett is a counsellor at the Young People’s Centre and RISE, both in Brighton, as well as coordinating the Safe Space project for YMCA DownsLink Group.
Visit www.calaidipedia.co.uk or join the Facebook group Calais – People to People Solidarity.
Brighton-based Hummingbird Project (www.facebook.com/Hummingbirduk)recently opened a centre in the camp to provide medical care and legal advice, and in November 2015 they plan to add a space offering specialist trauma support and creative projects.
Contact them directly if you want to help, or donate at www.chuffed.org/project/thehummingbirdprojectbrighton.
Psychotherapy and Hypnosis
Paul gave a fascinating talk on the subject of Medical Hypnosis: when it might sensibly be chosen as a referral option by a therapist not specifically trained in its use, and contrasted the benefits and limitations of hypnosis with other potential options. We learned that hypnosis is not a standalone model; it is best used as an adjunct to a practitioner's core approach.
Why would a therapist want to know about hypnosis, if they didn't use it? In Paul's opinion hypnotic phenomena are often encountered by therapists (eg dissociation) and it is helpful to understand that hypnosis could in turn potentially enhance the efficacy of other approaches and modalities.
There is still a view in the NHS that the efficacy of hypnosis is unproven but this is not so (Wampold 2008). Lang & Rosen 2002 found that the use of hypnosis to enhance eg relaxation, greatly reduces the costs of surgical procedures and aftercare. Research also shows that antidepressant drugs produce only a very small percentage improvement (2 points) compared with Placebo when assessed using the Hamilton Depression scale - pharmaceutical and psychotherapeutic interventions are “equally effective at turning misery into money”! Kirsch et al (2008) found “the effects for SSRIs are greatly inflated” and the NHS bill for them is similarly large!
I found a real bonus of Paul's approach was his meticulous referencing from academic clinical research – he included no less than 7 pages of references in the set of slides he kindly circulated to participants in advance. ( This review will only include a few but for further information, please contact Paul direct.) Despite his academic credentials and in depth knowledge of the subject however, his style of presenting was relaxed and conversational, liberally interspersed with laconic humour. He was able to de-mystify the jargon and often impenetrable terminology of research with clarity and good humour.
It was very encouraging to learn of so much evidence already “out there” for the efficacy of the talking therapies; also that despite each modality being passionate about the superiority and distinctiveness of its own approach, in fact this has not been proven to be so! Research concludes that psychotherapy outcomes are generally beneficial but that it is difficult to differentiate between different therapeutic systems in terms of outcomes. “Differences attributable to specific treatments are small”(Wampold 2008). Therapy works! But no particular approach works better than another. It seems that the passion with which a therapist espouses the presenting issues of the client, and how much account they take of the story, IS very significant. What makes a difference to outcome is the individual therapist; the working alliance being a significant predictor of retention and hence improvement, independent of outcome (Springhovn et al 2007).
What does hypnosis offer? As a specialist “tool” it seems to intensify, or turbo-charge, any approach. It can amplify or de-amplify specific elements of memory, strengthen ego and accelerate rapport between therapist and client. It could be viewed as on a spiritual spectrum of experience, but does not require a specific faith, or any faith at all, to be effective as a therapeutic intervention. As Kirsch comments (op cit) “hypnosis is Placebo without deception”! (Paul explained that “Placebo” became synonymous with “there's nothing there” because of Random Control Trial research, an unfortunate link, since hypnotic phenomena are definitely “there” and experienced by us all in everyday life eg “having a train of thought” is a type of hypnotic trance where the thoughtstream runs along a specific “track”,, often to the exclusion of other thoughts, while the Placebo response is a distinctively different phenomenon.) Illnesses like IBS are very susceptible to Placebo apparently, yet PTSD patients are more hypnotisable than susceptible to Placebo.
One of the benefits of hypnosis is its transparency regarding the procedures, itself an alliance building element for clients. Hypnosis isn't related to either sleep or gullibility (NB gullibility is not the same as suggestibility), its about client skills, and those skills can be learned, putting the client firmly in the driving seat at all times. It is an “altered state” over which an individual has complete control. There is also a strict adherence to procedure with hypnosis, which can build confidence for clients because again, they know what's coming and are active and essential participants. Without active participation, hypnosis cannot occur. Lastly, if the client knows the therapist has confidence in the approach, this too helps build their confidence in it. A quote from Mende 2009 (p 180) regarding the Altered State Debate – Paul recommended downloading this if possible - “hypnotic trance has special qualities as a distinctive state of awareness with the patterns of brain activities characteristic only for the hypnotic trance, setting it aside from the waking state, relaxation, sleep and even meditation.”
So what exactly is hypnosis? Paul posed another question: what is the baseline of “consciousness”? “ “Hypnotic phenomena are behavioural, cognitive, and experiential alterations that emerge with or are enhanced by an induction. This might include a series of compulsive/enhanced suggestibility, diminution of reflective awareness/absorption, unusual experiences eg alternations in body image, sense of time, dissociative experiences.” (BPS 2001). “Induction” is therefore via a series of therapist's suggestions – following a strict protocol - to achieve a trance-like state which includes inter alia enhanced suggestibility. This enables the client to accept new information, or different perspectives, much more readily. Paul pointed out that hynosis doesn't enhance recall of memories, but does enhance remembering. It is a myth that hypnosis removes control from a client: control doesn't occur other than by the client, in the same way that a pilot is in control and the “driving seat” but has a co-pilot (herapist) as back up At no point can the co-pilot (= therapist) take over without the full consent and willing participation of the pilot. Agency always remains with the client, and if there is resistance to it, it can't happen.
The idea of “brain washing” has been compared to hypnosis, but this is another myth. Paul pointed out brainwashing occurs as a result of a combination of environment (usually fear filled and coercive), repetition and duration, and is thus quite distinct from hypnotic trance induced in a therapeutic setting.
Induction is via concentrated focus on X – by definition, this will mean a lessened focus on YWZ, where YWZ are the anxieties or preoccupations currently and normally occupying much brain space for the client and causing distress. Raz et al 2006 state “it appears that trance learned suggestions bypass the control of the executive attentional system and allow the subject to interpret information independently of deeply entrenched learning”. In other words, hypnotic trance enables the client to bypass any previous negative assumptions/beliefs/fears and focus on something else which is positive. It is in this sense only that hypnosis enhances suggestibility.3
A comparison of Medical Hypnosis with EMDR (another altered state of consciousness) was summed up by Paul in his own words as “EMDR is a therapy-facilitating memory reconsolidation which dissolves and reconstitutes emotional learning, enabling change of current unwanted responses [to that memory]. This involves activation of memory networks including sensory, affective, cognitive and somatic aspects, via application of bilateral stimulation of the brain”
A comparison of meditative practice with Hypnosis: “mindfulness can be defined in part as the self regulation of attention ...” (Bishop et al 2003).
Paul believes that all these approaches encourage a healthy scepticism towards habitual experience, and aim to disrupt automaticity of responses, but they do so by quite different means, and practitioners may have different underlying accounts of the acquisition and maintenance of psychological disturbance.
What about outcomes for hypnosis? Kirsch et al (op cit ) state that “hypnosis in general enhances the effectiveness of therapy” and found that meta-analysis of outcomes indicate that “patients receiving hypnosis as an adjunct to treatment show significantly greater improvement than 70% of patients receiving the same treatment without hypnosis.” Mendoza &Capafons 2009 also found that clinical/medical hypnosis can be an effective adjunct to treatment of a wide range of medical and psychological problems; but that “hypnosis should be excluded in medical conditions when the use of hypnosis is understood to be the only intervention.”
Finally, what conditions might therapists choose to treat using hypnosis as an adjunct to their core model? (Mendoza & Capafons op cit ) list typical problems such as
- anxiety including phobias
- psychosomatic disorders
- medical settings
In Paul's opinion, in addition to the above are conditions such as IBS, excema and other skin disorders.
During a lively Q&A session at the end, Paul recommended anyone interested in finding out more to visit the official website of the British Association of Academic & Clinical Hypnosis (www.bsach.com) which has recommended training options.
Paul Atkinson is a BACP Senior Registered Practitioner, qualified Hypnotherapist and EMDR Consultant based in Brighton. He can be contacted via his website www.hypnotherapy-emdr.com
Treating Traumatised Clients
Treating Traumatised Clients – by Joanna Beazley Richards – 15th March.
In this workshop Joanna gave an overview of how to treat traumatised clients. She began by defining trauma as involving fear for life, or physical/ mental integrity, and pointed out this is unique to the individual, when their ability to deal with the event is overwhelmed. PTSD results from severe trauma and its symptoms include intrusive memories or flashbacks, avoidance of stimuli associated with the traumatic event (“triggers”), and being in a constant state of alert. Untreated childhood trauma affects survivors throughout life and there may also be effects on development, problems with social attachments, and/or sexual responses, difficulty with concentration, or dissociation.
Joanna used Berne’s analogy that a pile of pennies not stacked properly is unstable and needs to be taken down and reassembled; psychotherapy aims to “fix the past in the present to ensure the future”. There are recognised stages of treatment and therapists need specialist trauma training to undertake it.
First we need to understand something of the neurological/physiological effects of trauma. The older parts of the brain in evolutionary terms are the reptilian brain (or brainstem) and the old mammalian brain, surrounded by the neocortex - the primate/or human brain. Within the old brain are various structures forming the limbic system, which react to any perceived threat or danger, causing a state of high arousal. We need this increased energy to deal with emergency, and there will be an instant decision on how to respond to threat - fight, flight or freeze – at an instinctive rather than conscious level. This is a survival mechanism -
there is no time to think through options – “stop and think and you’re lunch!”
Joanna explained that the area called the amygdala mediates emotions and releases chemicals to stimulate adrenalin production. These stress hormones suppress neocortex functioning so thinking processes are cut off in a high arousal state, and we are emotional not rational. In this state the client is unable to think about or process traumatic memories, and may be retraumatised. The therapist needs to help the client to find a ‘window of tolerance’ within which they can work, where memories arouse a medium level of stress without causing hyperarousal.
DON’T get clients to tell their past experiences immediately, advised Joanna, try to stop them doing so until you have established a sense of safety and practised grounding techniques. If traumatic memories from the past are triggered you need to bring them back into the present and into the room, into awareness of their physical surroundings now. For example you could get them to feel their feet on the ground, to walk round the room, to count the number of blue things in the room, count their breathing, go to a safe place in the mind.
Joanna emphasised that it is important to build trust between client and therapist, and imperative in stage one of trauma counselling to spend as much time as necessary establishing safety and empowerment, until the client can talk about their experiences without falling apart or dissociating. You may negotiate how the client wishes to sit, lighting in the room, distance between you, so as to give the client a sense of empowerment. They need to be able to regulate emotional arousal and return to present awareness, staying within the ‘window of tolerance’.
Only when this has been achieved is it safe to proceed to stage 2 of reporting and retelling. The client may be asked to recount their traumatic experience, having set up a special method - called the running technique - which ensures an escape route if they start to re-experience the trauma. The client is at first listened to while they recount as much as they can recall, then asked to repeat until it loses its emotional charge.
Stage 3 involves mourning and grieving, looking at the effects of trauma and facilitating them to process the loss of their lives before the event. In the final stage (4) of resolution and integration, therapy involves helping the client to achieve a sense of resolution about what has happened to them, and integrate it into their current lives, reconnecting with the present.
Joanna’s vivid presentation used humour and practical illustrations to engage our interest, enabling us to grasp the main concepts, so all those present enjoyed her talk and felt more confident at how to approach this difficult area of therapy.
Biddy Harling is an integrative counsellor working in Haywards Heath and Plumpton Green.