Relational Awareness Training Notes
The training relates to UKCP Postgraduate Master programme of study for Integrative Psychotherapy (2014)
Listen
To Feelings As Well As Words
Words – Emotions -- Implications
Focus on Speaker
Don’t plan, speak, or get distracted
What Is Speaker Talking About?
Topic? Speaker? Listener? Others?
Look At Speaker
Use Verbal & Non-Verbal Encouragers
Listening
Most people don’t communicate, they just take turns talking.
Most communication is competitive talking.
Hearing just happens. Listening is a conscious choice.
Barriers to Listening
Equate With Hearing Uninteresting Topics Speaker’s Delivery External Distractions Mentally Preparing Response | Listening for Facts Personal Concerns Personal Bias Language/Culture Differences Faking Attention |
Distortion barriers to listening?
Perceptions Language Semantics Personal Interests Emotions | Environment – noise Preconceived notions/expectations Wordiness Attention span Physical hearing problem Speed of thought |
How does your colleague know when you are listening?
• Eye contact
• Expression
• Posture
• Movements
• Para-verbal Behaviour: uhuh mmmm, ahh
• Minimal verbal prompts: and, because, tell me more
• Tone of Voice: genuineness
Decades of research indicate that the provision of therapy is an interpersonal process in which a main curative component is the nature of the therapeutic relationship.
(Lambert and Barley 2001 p357)
Lambert, M.J., And Barley D.E., 2001 Research Summary On The Therapeutic Relationship And Psychotherapy Outcome. Psychotherapy Volume 38/Winter 2001/Number 4, Pp 357-361
Common Factors
Common factors such as
• empathy,
• warmth,
• and the therapeutic relationship
have been shown to correlate more highly with client outcome than specialized treatment interventions.
Erskine, R. 2010 Integrating Expressive Methods in a Relational-Psychotherapy.
International Journal of Integrative Psychotherapy, Vol. 1, No. 2, pp55-80
I have found that an involved psychotherapist is consistently invested in the client’s welfare and spends considerable amounts of time building and maintaining a quality relationship with the client through phenomenological inquiry, acknowledgment, validation and sustained empathy – not as a set of techniques but as a genuine interest in knowing the client while helping the client to know and express him or herself.
(Erskine 2010 p56)
And The Person Centred Approach
• warm, attentive, interested, understanding, respectful
• credibility, skill, empathic understanding,
• affirmation of the patient, ability to engage the patient,
• to focus on the patient's problems
• to direct the patient's attention to the affective experience
(Lambert and Barley 2001 cite Orlinsky, Grave, and Parks (1994) findings, p358) Orlinsky, D. E., Grave, K., & Parks, B. K. (1994). Process And Outcome In Psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.), Handbook Of Psychotherapy And Behavior Change (Pp. 257-310). New York: Wiley.
Contact . . . Contract . . . Alliance
As soon as you and your client have made a commitment to work together, you are starting to develop a working alliance.
This alliance involves the development of an active partnership, a bond of trust in which client and therapist share a mutual understanding of your work together
(Bordin, 1994)
Bordin, E.S. (1994). Theory and research therapeutic working alliance: New Directions. In A. O. Horvath and L. S. Greenberg (Eds.), The Working Alliance. Theory, Research, and Practice (pp. 13-37). New York: Wiley.
Therapeutic Approach
In behavior modification, the patient's behavior is directly changed by the therapist's manipulation of environmental stimuli.
In psychoanalytic theory, behavior is caused by unconscious motivation which becomes manifest in the transference relationship
The psychodynamic therapist isolates his or her person in order to encourage a relationship based explicitly on transference (rather than contact).
The Rogerian reflect and clarify.
Gestalt therapists may use any techniques or methods as long as
o they are aimed toward increasing awareness,
o they emerge out of dialogue and phenomenological work, and
o they are within the parameters of ethical practice.
Contact Polarities
Consider …
Brown and Pedder (1991 ix) state
psychotherapy is: essentially a conversation which involves listening to and talking with those in trouble with the aim of helping them understand and resolve their predicament.
Brown, D. & Pedder, J. (1991) Introduction to Psychotherapy London: Routledge
Aveline (1992) state
The unique feature of psychotherapy is the structured professional relationship between therapist and one or more clients...who meet in a relationship which is genuine, equal in feeling but asymmetrical in disclosure and which is directed towards assisting the client in making changes in personal functioning.
Aveline, M. 2005 The Person of the Therapist. Psychotherapy Research, Vol 15(3), Jul, pp. 155-164.
Inherent dangers
The relationship between therapist and client:
• is intimate and conducted in private
• the client is vulnerable
• the therapist is in a position of power
‘All therapists have the capacity to seduce or harm their patients’ (Sunday Mercury)
Potential damage
• Breaking confidentiality
• Criticising the client
• Being unpredictable
• Burdening the client with self disclosure
• Inappropriate ending
• Not assessing risk to the client or others
• Fostering unnecessary dependency
• Financial exploitation
The relationship and the task
Being gratified
but not existing for the purpose of giving or receiving gratification
Sustaining the relationship while under attack
but not attacking
Hating and being hated
without withdrawing or acting out
Being tested emotionally and intellectually
Without attacking
Feeling intensely at times
and not always understanding why
Feeling sexually stirred and aroused
but not acting on it
Being idealised
and then denigrated
Taking risks
and dealing with the consequences
Experiencing intimacy
and being able to let go
Having a powerful effect
without seeking power
Personal Therapy:
trainees undergo therapy as part of their experience.
Rationale for personal therapy.
• Producing more resilient therapists’ and/or weeding out weak ones
• Developing therapist self-awareness or self reflexivity
• Providing experiential learning about therapy skills and process
• Changing the trainee’s perceptions about therapy
• Learning about the client’s perspective
• Processing course experiences and integrating these with other life experience
Contact and Presence for a Working Alliance
WITH
o empathy,
o warmth,
IN the therapeutic relationship.
BY
• Phenomenological and Dialogic inquiry
• affirmation of the patient, ability to engage the patient,
• to focus on the patient's problems
• to direct the patient's attention to the affective experience
Dialogic Relationship
Hycner and Jacobs (1995) point out that
“the human heart yearns for contact – above all it yearns for genuine dialogue… Each of us secretly and desperately yearns to be met – to be recognized in our uniqueness, our fullness and our vulnerability” (p9).
The concept was developed from the ideas of Buber (1958) and can be described as an attitude of genuinely feeling /sensing /experiencing the other person as a person (not an object or part-object), and a willingness to deeply 'hear' the other person's experience without prejudgement.
It is the willingness to 'hear' what is not being spoken, and to 'see' what is not visible.
The dialogical is primarily an approach, an attitude, an orientation, an outlook.
It places the relational at the heart of our existence and of our work as therapists
The "dialogical" encompasses both I-Thou and I-it moments
What Buber called 'encounter" [Beginning], we call contact, i.e. the perception of and concentration on the other as the other (Perls, L. 1989, p 179).
"It is, the response of one's whole being to the otherness of the other, that otherness that is comprehended only when I open myself to him in the present and in the concrete situation and respond to his need even when he himself is not aware that he is addressing me"
(Friedman, 1965, p.xvii).
". . .genuine dialogue can take place in silence, whereas much conversation is really monologue"
(Friedman, 1965, p. xvii).
Elements necessary for a 'genuine dialogue':
1. Presence: means the willingness to allow oneself to touch and be touched by the patient(p. 64)
2. Genuine and unreserved communication: the willingness to be as honest as possible, which does not mean that everything needs to be said that comes to mind.
3. Inclusion: that the therapist experiences the patient's side of the relationship as physical contact, i.e. as a concrete imagining of the reality of the other in oneself, while still retaining one's own self-identity ( p 68).
4. Confirmation: Jacobs defines confirmation as entering the world of the other and accepting this world without judgment (p 71).
(Hycner and Jacobs 1995)
Inclusion
The term 'inclusion' has been used by Yontef (1993) as a first characteristic of a dialogical relationship and was defined as the valuing of the phenomenological experience of the client and the respectful entering of the client's sphere and the experience of his world.
'The therapist must feel the other side, the patient's side of the relationship, as a bodily touch to know how the patient feels' (Buber, 1967: 173).
The Gestalt Therapist Attends To:
In gestalt therapy [with this relational emphasis,] careful attention is paid to contact moments and also to overall character organization and development. The quality of the connection of therapist and patient is a subject of central concern. Interruptions are carefully observed both for what it says about what is happening between therapist and patient and also for the here-and-now contact moments as manifestations of ongoing characterological patterns that are a necessary focus in intensive psychotherapy. Each moment is seen as a hologram for the larger whole of the patient's life. This perspective gives guidance to diagnostic questions, and in turn is guided by diagnostic understanding or understanding of the particular characterological pattern of the patient.
Gestalt Philosophical Fundamentals
The three fundamental and indispensable philosophic principles of gestalt therapy are:
1. existential phenomenology
2. field theory
3. and dialogic existentialism
Yontef (1993): Page 15
Gestalt therapy is systematically relational in its underlying theory and methodology.
A relational perspective is so central to the theory of gestalt therapy that without it there is no coherent core of gestalt therapy theory or practice
Yontef (1993) Page 16
Gestalt therapy is based on the philosophy and method of phenomenology
One special feature of gestalt therapy is phenomenology
… [and] phenomenological study includes phenomenological experimentation
Phenomenological theories are relational theories
Yontef (1993) Page 17
Thus all perception and statements of reality are interpreted (Spinelli, 1989)
This basic phenomenological attitude rejects the Cartesian subject-object split. There is no subjective experience that is not related to some object (intentionality); there is no experienced object except through some particular interpretive vantage point.
In gestalt therapy phenomenology, the study is of the experience of the subjects and is never finished, objective, or absolute.
In gestalt therapy it is not believed that one reaches objective truth by bracketing
In phenomenological theory there are multiple valid “realities” … no perception can be validly dismissed as not real.
The therapist's reality is not more valid or objective or true than the patient's.
… psychotherapy is centered on the patient, it is the patient's existence that is the reason for the therapy …
… it is the patient that has the primary data.
Yontef (1993) Page 18
The philosophy of gestalt therapy explicitly promotes respect and appreciation of differences. Practicing this philosophy requires humility.
Bracketing and personal therapy for the therapist and trainer support this practice
An attitude by the therapist that his or her view of self, the patient, and any interaction between them is correct and the patient's different perception is wrong … indicates insufficient bracketing and personal therapy (Yontef (1993), 1999).
Yontef (1993) Page 19
Field Theory:
Field theory looks at all events as a function of the relationship of multiple interacting forces.
Interacting forces form a field in which every part of the field effects the whole and the whole effects all parts of the field.
No event occurs in isolation. The whole field determines all events in the field, with some forces being in figural awareness and some operating in the background.
It is inherent in field viewpoint that people are interdependent and not self-sufficient
In gestalt therapy the field is a phenomenological field (Lewin, 1951; Yontef (1993), 1993).
All events in the human field are a function of all of the participants and the interactions between them. The rugged individualism ideal, the ideal of self-sufficiency, is not consistent with a field way of thinking.
Yontef (1993) Page 20
The view of need and dependency as a weakness, and the creating of an icon of the self-sufficient hero, so prevalent in American rugged individualism, is fertile grounds for creating shame (Wheeler, 1996)
Properly used, the concept of self-support refers to self-regulation as part of the field, referring to defining the needs of self and others, and does not refer to self-sufficiency.
We are all "dependent", or, more accurately "interdependent".
Yontef (1993) Page 21 i
Interdependence and the need to take in from others is as true at a system level as it is at an individual level.
One of the issues is that some talk as if gestalt therapy is a self-sufficient system and that knowledge of other systems is unnecessary.
Perls would sometimes claim that gestalt therapy is unique in that it is self-sufficient, unlike other existential therapies.
Relational gestalt therapy has advocated exchanging perspective and experience with practitioners from other systems, for example modern systems of psychoanalysis.
Many gestalt therapists have expressed strong appreciation for relational gestalt therapy for legitimizing the assimilation and also have appreciated the enrichment of gestalt therapy by the integration.
critics of exchanges with other systems forget the difference between introjecting information or ideas from other systems and deconstructing, assimilating, and integrating that which is useful in gestalt therapy. (p. 22)
Yontef (1993) Page 23
The kind of contact most consistent with gestalt therapy principles is marked by the principles of dialogue.
Yontef (1993) Page24
Dialogue means being present as a person meeting the person of the other.
Dialogue in therapy means that the therapist works on the therapeutic task by contacting the patient as the patient is, the whole person that the patient is, with the whole person of the therapist him or herself.
A whole person includes being flawed and allowing that flaw to be a recognized part of one's existence, even in the therapeutic setting with patients
Dialogue, both in and out of therapy, requires not only practicing inclusion, but also a certain kind of presence.
The required presence is a presence with authenticity, transparency, and humility.
Inclusion
Inclusion is putting oneself into the experience of the patient as much as possible, feeling it as if in one's own body – without losing a separate sense of self.
by meeting the patient and not aiming to make the patient different, the patient is supported in growing by identification with his or her own experience.
The patient is the final authority on the accuracy of these reflections.
Yontef (1993) Page 25
Relational gestalt therapy emphasizes the importance in therapy of compassion, kindness, wisdom, equanimity, and humility.
the therapist is not committed to any predetermined outcome and can support "cultivation of uncertainty" (Staemmler, 1997).
This also requires faith in the awareness and contact process.
Yontef (1993) Page 27
Relational gestalt therapy partially arose out of an increasing sensitivity to and sophistication about shame (Lee & Wheeler, 1996; Yontef (1993), 1993, 1997a, 1997b).
Sensitivity to shame has shaped the sensitivity to the relational aspects of psychotherapy.
Patients are vulnerable to feeling shame just by coming to therapy. … Patients come to therapy because of some sense of being inadequate … They mostly start therapy with a sense of not being OK. This is not avoidable.
But unnecessarily triggering shame in therapy and training can be avoided.
therapist activities that can trigger shame:
Sarcasm
Humour
attack
Condescension
Abandonment
one-person interpretations
an attitude that the therapist knows best (p28)
the attitude that self sufficiency is better than dependence (p28)
(Inappropriateness) to the right level of emotionality (p28)
(a) focus on one value or another without awareness that other important values are involved.
(Other) metatheoretical issues include, but are not limited to:
Attitudes about the person (patient or significant others).
Philosophy of living, values.
How growth happens and psychotherapy works.
sounds innocent in its text (yet) have a very critical, shaming, condescending, contemptuous edge
Yontef (1993) Page 28
A relational approach requires careful and consistent observation of all the data in the field
Yontef (1993) Page 31
The relational emphasis is on honesty, which is more than being nice, but in a process that is attentive to shame-triggering. We are not interested in being empathic and/or sympathetic at the cost of honesty.
Relational therapy is an approach within gestalt therapy that is strongly centered on existential phenomenology, dialogic existentialism, and cognitive grounding in field theory. It is not a whole, new system or approach. Rather it is steeped in what is central to gestalt therapy and has sometimes gotten lost or neglected.
It is a form of gestalt therapy that emphasizes respect, compassion, the fullest experience and respect by the therapist of patients’ experience in accordance with the paradoxical theory of change and manifesting maximum trust in the process of contact with awareness and without aiming.
Yontef (1993) Page 32
Relational gestalt therapy is centered around dialogue, contact that takes into account the person of the patient and the task of therapy.
Relational gestalt therapy takes into account probable impact on the patient, patient vulnerability, and the impact of the therapy on others that will be affected.
Shame
Shame is always a component of the client- therapist relationship.
Interpersonal Bridge (Kaufman)
Be alert to client states of shame.
Help clients work through shame.
Don’t
Overlook shame as an issue.
By-pass opportunities to help clients through shame.
Inadvertently add judgmental interpretations to client’s repressed shame.
Genuiness
Refers to the therapist’s ability to
• Be self-reflective;
• Be aware and identify their personal cultural assumptions from those of the client;
• Overcome prejudices, stereotypes, and biases;
• Become culturally self-aware
Implies therapist are “real” with clients.
• “without a false front,
• …their inner and outer experiences match,
• …can openly express feelings and attitudes….” (Corey, 1996)
Balance shared feelings with the impact.
Be honest in helpful, not destructive, ways.
Must not impulsively share every thought and feeling.
Self and Other
When the boundary between self and other becomes unclear, lost or impermeable, this results in a disturbance of the distinction between self and other, a disturbance of both contact and awareness
(Perls, 1973)
Transference
Experiment
Visualize a particular client.
Now imagine that you have license to say or do anything without fear of injury or repercussion.
What would you say?
What have you held back or been reluctant to admit to yourself
How much of these reactions or impulses are familiar to you in general, how many of them are particular to this client?
Transference
a demand for love
Greek and Latin: the word transference means “to carry over”
Transference was first described by Freud in the early 1900’s in which the client transfers aspects of past relationships onto the current relationship with their therapist.
Transference is a natural and necessary component of learning
With memory and learning, anticipation is synonymous with transference
So we generally anticipate similar experiences and reactions for similar situations and similar people from our past. (Clarkson 1995)
The healthy individual anticipates as such AND modifies in the face of the here and now experience
Gestalt Perspective
In Gestalt therapy, transference is viewed as a contact boundary disturbance which impairs the patient's ability to accurately perceive the present therapy situation
‘You cannot do therapy without dealing competently with the transference phenomena’ Yontef, (1993)
From a Gestalt perspective:
transference is a way in which the individual shape their perception of current reality through the lens of their history, their unfinished business, their fixed gestalts rather than the current situation.
Transference can be seen as a way of organising the field.
The process of transference is complex and unconscious (out of the individuals awareness). It involves introjection of, and some confluence with past figures or situations as well as projection of these figures on the present with the reawakening of the associated feelings, embodied memories, thoughts and sensory experiences.
Transference – v - Projection
Projection is a psychological process that involves the attribution of unacceptable thoughts, feelings, traits or behaviours to others that are characteristic of oneself (Clarkson, 1998)
In Transference the therapist or others are experienced as having the same attributes as significant others,
in Projection it is the disowned aspects of self that are transferred onto the other.
Projection from a classical stance is considered a defence mechanism, it protects an individual from a perceived threat and reduce anxiety.
Transference and Countertransference
Transference and countertransference phenomena are carried across in a verbal content and also in non-verbal ways through body language, smells, or atmospheric and contextual cues.
Transference is the client feelings, ideas and images onto the therapist, which derive from previous figures in the client’s life
Countertransference is the therapist’s feelings, ideas and images towards the client,
EITHER from previous figures in the therapist’s life (PROACTIVE)
OR evoked/ in reaction to the Client’s life (REACTIVE)
What to Look Out For
Menninger (1958) noted a number of common ways in which countertransference makes its appearance
• The inability to understand certain kinds of material that touch on the therapists personal problems
• Depressed and uneasy feelings during or after the sessions
• Carelessness with regard to certain arrangements for the clients appointment, being late, going over time.
• Persistent drowsiness of the therapist during the session or even falling asleep.
• Trying to impress the client.
• Arguing with the client.
• Trying to help the client in matters outside the session.
• Getting involved with client in financial deals outside the therapeutic context.
• Dreaming about the client.
• Much preoccupation with the client or with his problem during one’s leisure time.
Countertransference
There are ways in which you might respond to the client i.e. ask yourself the following questions.
• Is this a realistic response to the here and now situation? You may feel positive or cautious toward the client, Is this your own transference – i.e., your own unfinished business about this sort of person?
• Clarkson (1992) calls this proactive counter transference i.e. you may have a reaction if the client reminds you of your needy mother. Is this a familiar feeling for me?
• It may be reactive counter transference i.e. you are reacting to the transference expectations of the client either by feeling the same as the client or by adopting the expected role
Erotic transference
When a client falls in love with the therapist: Create an openness about talking about attraction and sexuality. Need to be clear about your boundary and the ethical code you subscribe to.
Storr, 1979 states
‘the therapist must react to those patients who make declarations of love with tenderness and understanding. It is important to realise that the love that is shown by the patient for the therapist is just as ‘genuine’ even though it may not be as realistic as love occurring outside the therapeutic situation’ (p.78)
Methods of working with transference
Neither assume your client’s responses are, or are not, transferential and explore your client’s experiences phenomenologically – When? What? How? Where?
Accept your client’s described response and explore what in the present may have triggered this responding authentically
Co-operatively explore how you, your client, or both may be viewing present events/people though a historical lens
Enable your client to study their transferring - what? when? how? where?
Surface unfinished business, or make the transferential material overt, and explore and resolve the pattern of experiences differently e.g. by an alive and different experience in the dialogic relationship, enactment experiment etc.
Explore the transferential and countertransferential interactions within the ongoing counselling relationship, guided by your understanding of projective identification
Actively try to shake the transference (Perls (1996)
Gestalt Philosophical Fundamentals
The three fundamental and indispensable philosophic principles of gestalt therapy are:
1. existential phenomenology
2. field theory
3. and dialogic existentialism
Gestalt: four characteristics of dialogue
Emphasis is on:
Inclusion.
This is putting oneself as fully as possible into the experience of the other without judging, analysing or interpreting
Presence
The Gestalt therapist expresses herself to the patient.
Commitment to dialogue.
allowing contact to happen rather than manipulating, making contact
Dialogue is lived.
Dialogue is something done rather than talked about
Experience Cycle
Change requires the de-structuring of ‘what is’ and forming ‘something new’
Contact and Resistances to Contact
Contact
interacting with nature and with other people without losing one’s individuality
Contact (connect) and Withdrawal (separate)
Resistance to Contact
the defenses we develop to prevent us from experiencing the present fully
Five major channels of resistance:
Introjection Deflection Projection Confluence Retroflection
Cycle of Experience translated to Spectrum of Contact Styles and Balance Position
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