Me the psychotherapist

This may form part of the introduction of my book on counseling drug and alcohol users.

Professionally, the other major influences were Bob and Mary Goulding who taught me how to understand people. Not just how to observe people but how to listen with my eyes. How to stop listening to them talking and start observing them, then one can truly see who they are and what they want.

Another significant influence was the quintessential Gestaltist Jim Simkin who always left me marvelling at how he did what he did. Where he could take clients and how he took them there was craftsman like. The other person who did influence me was Michael Conant and his training in bioenergetics. How to understand the psyche of a person by looking at their body. How the bits fit together, the body holding patterns, where it bends and where it does not and how it moves. I have never been interested in practising body therapies but ‘body reading’ as they call it is a major part of bioenergetics which again taught me how to observe people.

Then of course there is the theory of transactional analysis of which cognitive behaviour therapy forms a significant part. This provides me with the nuts and bolts and practicalities of the counseling process. The behavioural things you do with the client.


Service

I was asked recently by a supervisee what approach do I use and I could not answer the question. I used to be able to answer that question and was a bit surprised that I felt I no longer could. I could no longer identify a approach that I would say defines me as a counselor or psychotherapist. Initially this concerned me as it seemed to be a retrograde step. I had gone from knowing who I was to not knowing who I was. Needless to say I subsequently pondered the question for some time.

I can state the practicalities of what I do with a client and I can cite the influences on myself as a counselor, as I have done above. Perhaps that means I am now eclectic in my approach. I have never liked the idea of being an eclectic counselor as it seems one is a collection of a lot of things but not really any of them. It seems to lack a substance.


Fainting woman and the dead mouse


As I thought about the question in the subsequent days, I wondered what had changed such that a question I once could answer, I no longer could. In my musing I calculated that I would have done between forty to fifty thousand hours of counseling in my thirty two years of working. It seems logical that if one does a task for that long then it stops being something that you do and becomes part of who you are. You have done the task so many times it becomes second nature, ‘in your bones’ and part of your character.

This idea then allowed me to answer the question. I am a person, Tony White and there are many parts or aspects of me, one being a counselor. When I go to work I am simply being me. This is what the client gets, me the person, with the counselor being part of me. I think I have shifted from being a counselor who happens to be named Tony, to being Tony who also happens to be a counselor. As you can imagine this answer left me feeling much more secure in who I am in my work.


Is this me or am I just doing it?

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Therapeutic relationship with the teenager

When counseling a teenager this is the therapeutic situation that I am wanting to set up with the various parties. This is the best case scenario and actually occurs in varying degrees.



1. In counselling the teenager one is wanting the parents or those people who are responsible for the teenager involved. Most often they are willing to be part of it but at times they refuse to do so or they may simply not be around all that much.

The age of the teenager is directly inverse to the importance of the parents in this process. If the teenager is fourteen years old the parents are central in the therapy process as shown by the diagram. If the teenager is nineteen then they are usually much less involved. However if there is an emeshed family structure then the parents remain pivotal to the process until the child can gain some kind of psychological separation.

2. The diagram is to scale in terms of the relationships of the three parties involved. I am wanting to establish myself off to the side of the relationship between parents and teenager but a bit closer to the teenager side.



3. In the teenagers mind I am wanting to establish myself as a benign confidant and advisor. I am not with the parents and at the same time I am not against the parents. This is at times a hard position to maintain. I try to sit off to the side of the teenager parent relationship in this way.

4. The more emotionally important I become for the teenager the better. I am wanting to be benign in the sense of not seen as an adversary by the teenager but if they can emotionally depend on the me this is a desirable situation.

5. I will actively interfere in the relationship between the parents and the teenager. Indeed I can use this to keep my position off to the side. For instance at times parents need to put limits and controls on the teenager. I will discuss with them how they do this and encourage it. This in one way is not fair to the parents as they take all the heat and it allows me to avoid conflict with the teenager and remain in the position I am in the diagram.



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The “Are you still there?” session.

It’s kind of nice when you get one of these and I have had one over the last two weeks. A 30 year old woman who I had not seen for three years. Prior to that I had seen her quite intensively for about two years. The time had come for her to deal with some childhood trauma which resulted in quite dysfunctional relationships with men. I would not call it a sex addiction but she did have some quite promiscuous periods. She did very well, got her life back on track and established quite a good relationship with an OK guy.



Then she stops coming and I hear nothing for three years. A few weeks back I get a phone call and she comes and sees me twice. She comes in and we greet, I catch up on all the developments with family, boy friend, work, social life and so forth. She talks about things that are troubling her and I keep waiting for the ’thing’ to come out and it never does. Nothing serious is being presented which leaves me asking myself why is she here?

She is getting on quite well with her partner but I can tell from how she is talking it is getting to the point where she wants a marriage type thing or that may be that. They are not arguing or anything and have talked about this type of thing but it is not moving that way and she is getting to the point where something may have to happen.



She is just checking out to see if I am still there, in case things turn bad and the relationships ends. Is he still there and is he still the same? - is what I think is behind this revisit. As a therapist it feels kind of nice when that happens.

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The great road toll lie.

I can’t take the BS anymore. It’s all over the radio, TV and newspapers. The endless harping on about the danger on our roads over the festive season. The massive amount of money that is being given to the police to police our roads and apparently keep us safe.

The police commissioner announces that over this christmas and new year season 16 people will die from car accidents. That amounts to one ten thousandth of one percent of the population of this state. It is a minute threat to us. Even if you add in all the injured people it is still going to be a very tiny number. There are far more serious dangers particularly from cancer and heart disease and diabetes that will kill and injure us, than motor vehicle accidents.



This amounts to a major mismanagement of public money by the government.

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Child psychotherapy

I was asked the other day what model do I use when I work with children and I could not answer the question. I originally trained for two years in a psychoanalytic approach to child psychotherapy but that was a long time ago and I have changed my approach considerably since that time.

Eventually in answer to the question I simply made a list of the things I would look for and do at least in the early stages of working with a child.

Usually via drawing I establish the emotional status of the child. I use the catharsis approach to feelings - identify the feeling, express the feeling and drop the feeling.



Again usually via drawing I establish the family structure as the child sees it. I ask the child to draw their family and then analyse aspects of the drawing to get an understanding of the child’s perception of the what they see as their family.

Establish the life script decisions the child has made:
Don’t
Don’t exist
Don’t be you (the sex you are)
Don’t be a child
Don’t grow up
Don’t make it (succeed)
Don’t be close
Don’t be important
Don’t belong
Don’t be well (sane)
Don’t think
Don’t feel
Don’t get your needs met
Don’t be separate



Establish the inborn temperament of the child
Rhythmicity - Regular or irregular
Approach/withdrawal - Positive or negative
Adaptability - Adaptive or non-adaptive
Intensity of reaction - Mild or intense
Quality of mood - Positive or negative
Activity level - Low or high

Attachment style between mother and child - it requires a couple of sessions with mother and child together to ascertain the attachment quality

Parenting strategies - interviews with the mother and father to discuss various parenting strategies to deal with difficult circumstances



Establish overall family structure - emeshed vs distancing family structure

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Psychodynamics of the recreational drug user.

The social drinker unlike the alcoholic has the ability to do these transactions. The Child ego state has the desire for more but the Adult ego state and the Parent ego state have the strength to curb the excesses of the Child.



The alcoholic or problem drug user does not have the strength in the Adult and Parent to restrict the Child ego state desire for more.


Too much?

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Gender identity

Gender identity - Am I male or am I female
Sexual orientation - Am I sexually or romantically attracted to the same sex or opposite sex.
Sex role - how do I practically display my gender identity and how do I relate to the opposite sex.



An interesting statement about cross dressing which seems to make sense. But the male cross dressers I have worked with by and large are not homosexual which does not make logical sense really. But it does indicate that gender identity and sexual orientation are two separate things.


Who am I?

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