Therapy Today October 2014
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2. Connor M. Training the counsellor; an integrative model. London: Routledge; 1994. 3. Nelson ML, Barnes KL, Evans AL, Triggiano PJ. Working with conflict in clinical supervision: wise supervisors’ perspectives. Journal of Counselling Psychology 2008; 55(2): 172–184. +++
A story of falling A life-threatening accident and the resulting awareness of his own vulnerability have transformed the way Alistair Ross works with clients As counsellors and therapists, we become used to dealing with the trauma of other people’s lives. We go to the darkest places with them and accompany them back into the light. So you would think that we would be prepared for our own traumas, not imagining they could happen so unexpectedly. This is my account of surviving one such trauma earlier this year and how I now reflect on its impact on my ongoing work as a therapist and supervisor. Nobody teaches you how to fall, unless you are taking up judo or want to jump out of an aeroplane. Even then the emphasis is on how you land, rather than fall. Falling is an alien activity for the human species. This is a story of how I fell. My worst nightmare was happening before my very open eyes. As a child I had a recurring and disturbing dream in which I was falling endlessly into darkness. It would only stop when I jolted awake, sitting bolt upright, bathed in sweat, breathing deeply. This time I was falling 160 feet down a rock gulley, until I crashed to an abrupt halt on a water-filled ledge. This was no nightmare from which I could wake and escape. Each stage of my fall, as I tumbled over and over, resulted in my head, arms, back, ribs, knees, shins and ankles crashing against unrelenting rock. I can recall as if in slow motion the exact moment my forehead smacked against a sharp rock and my vision became obscured by blood dripping from my head. Once I stopped falling down the mountain, I knew immediately I was alive but badly injured. I could not move my right wrist; my legs and ankles couldn’t bear any weight, as I discovered when I tried to stand up; my back issued warnings of excruciating pain every time I moved. I had been walking on my own on Tryfan, an iconic and rather beautiful mountain in Snowdonia, which I had climbed before with friends. The snow was becoming unstable because of an unexpected rise in the temperature. After slipping several times, I decided to return the way I had come but took a wrong turn and found myself in unfamiliar terrain. I came across a gulley and was looking over to see if it offered a navigable way down; my foot slipped and I fell forward, my momentum carrying me down head first. Despite the effort and pain I dragged myself to one side of the ledge and balanced on a rock, out of the water. The shock and cold hit as I began to shiver uncontrollably. I had lost my hat and gloves and, despite my lined trousers, now torn, and my warm jacket, the cold began to creep in like some stealthy, deadly enemy. I can recall very clearly thinking, ‘I wonder if this is it?’ I knew I was in a remote part of Tryfan (somewhere above Milestone Buttress) where it was unlikely that any walkers would come across me. I knew hypothermia was setting in. I also knew my son would not be alarmed as I was not expected home for another five hours. Your life does indeed flash through your mind when faced with the possibility of death. My personal faith in God allowed me to say, ‘Well, God, if this is it, this is it.’ The words of the Old Testament book of Ecclesiastes came to mind: ‘To every thing there is a season, and a time to every purpose under the heaven: a time to be born, and a time to die.’ Yet, paradoxically, I also felt a burning desire for this not to be so; there was so much more of my life to be lived, even if how I lived might be irrevocably changed. I did not have the energy to bargain with God. Actually, that is not the kind of God I believe in. Miraculously, my mobile phone was undamaged and located a signal strong enough to get a message through to my son, who contacted the Ogwen mountain rescue team. Those who know me think it was miraculous that I had even charged it up, although I had consciously done this the day before. When I got through, apparently I told my son somewhat nonchalantly that I had had ‘a bit of a fall, hit my head and hurt my hand’. He imagined I had simply fallen over. Within an hour Ogwen mountain rescue rang and informed me they had sent a team out to find me. The team happened to be practising on Tryfan that day and so were able to get to me more quickly. I became aware of the noise of a helicopter that drowned out the chatter of my teeth but watched with a sickening feeling as they flew past several times. I never felt so abandoned or bereft in my entire life. It transpired that the air crew had seen me but were having some difficulty with turbulence and finding a safe location to drop down a paramedic. I sobbed tears of relief when the paramedic appeared over the side of the gulley. Sadly, I can’t recall his name but his friendly, matter of fact approach was an immense comfort. He wrapped me in an emergency foil blanket and placed heating pads on whatever part of my body he could reach and stabilised my head in a neck collar. The mountain rescue team then arrived with an ingenious two-piece stretcher and loaded me onto it while the helicopter hovered low enough to be able to winch me on board. The line reached my stretcher, just. I had never felt so helpless, my broken body needing the firm but gentle care of others, just like a baby. As I was winched hundreds of feet through the air I could see very little and registered with regret that I had missed the view of a lifetime. Once cocooned in the helicopter I expressed my faith through a prayer, thanking God for my continuing life, however it would unfold. As my stretcher was wheeled into the emergency department at Bangor Hospital a team of doctors and nurses were standing in a semi-circle poised for action. My clothes were cut off so I could be properly assessed. Various needles and drips were stuck in. In the midst of this medical care there were two acts of kindness that deeply touched me. The first was the doctor who used warm water and cotton wool balls (or equivalent) to gently clean my head wounds and remove the dried blood from my face and scalp, saying, ‘So you might look a bit better and it will be less of a shock for your wife when she arrives.’ Even more touching was the nurse who gently massaged my toes to help provide some warmth while my body temperature recovered. That skin-to-skin human contact meant so much. After the fall It transpired I had two fractures to my left fibula, three fractures to my right fibula and ankle and three fractures to my right wrist, including a spiral fracture that required an operation to insert a Y-plate and various pins to hold the wrist together. My head wound was a deep dent in my forehead as well as multiple lacerations (which they glued together). I had fallen, but not into some dark abyss, as in my childhood nightmares or as chronicled by Kierkegaard.1 I was not in despair; nor was I experiencing the ‘nameless dread’ about which Bion writes.2 I had fallen physically, but spiritually I experienced being held. This takes me to why I love being on mountains, which is captured in the title of one of my favourite books, The Solace of Fierce Landscapes.3 This is a theological and academic text that explores how we develop our spirituality in barren, inhospitable and remote places. For me it is to do with a wild freedom and the aliveness of being ‘on the edge’, but the mountains are not all about triumph and conquest: there is also present the dark side of a granite-like God. Yet my experience was not a descent into an abyss; paradoxically I felt ‘held’ by the presence of God, as if this God of mine would not let me go. When the British psychoanalyst DW Winnicott talked about dreadful childhood experience, he identified a sense of ‘falling forever’, as if falling into infinite and endless space, and the disintegration of being.4 I felt that, fearful as I was of Winnicott’s ‘falling forever’ and a return of my childhood trauma, I was instead falling into an infinite and eternal God where being remains being in connection to the Other. Nobody told me that becoming a patient is so like becoming a baby. My week in Bangor Hospital was spent in constant pain, alleviated by oxygen and morphine. With only one working limb, I needed four people to turn me, wash me and move me. I slept during the day but was woken every three hours throughout the night for ‘observations’. Most of the staff and patients spoke Welsh, which was an experience I enjoyed. I was unable to communicate (my Welsh is very limited), unable to walk or move, and needed help to go to the toilet; refuge came in sleep. Adulthood babyhood connects unconsciously with original babyhood that is beyond our conscious recall. My distress at no one answering my buzzer at night and my overwhelming anxiety that this pain would never go away have echoes of a pre-time existence as a baby. Some staff had the capacity to be ‘good enough’ mothers; others I experienced as ‘abandoning’, with little capacity for empathy. Having experienced being a helpless and vulnerable patient, it dawned on me that being treated as human and with respect in even the simplest acts was so important. All this took place on a ward with beautiful views of the very mountains on which I had so perilously fallen. Discharged from hospital, I needed to learn to become ‘at home’ in a broken but recovering body. At six weeks my legs were out of plaster; I no longer needed to rely on a walking frame or wheelchair to help me move from room to room, although I needed to re-learn how to balance and walk again. But there was also the realisation that major injuries masked more minor ones, such as torn ligaments in my knees and a shoulder that didn’t work quite as it should. There was a long road ahead to recovery, but many people sustained me through their visits, thoughts, prayers, kindness and generosity. Wisdom drawn from Ecclesiastes 3:7 states there is ‘a time to tear and a time to mend’. I had experienced my tearing and so I was now (and still am) living for my mending. Returning to practice How has the knowledge of this event and my unplanned absence affected my clients, if at all? Is it just ‘business as usual’, as if I have been on some grand prolonged holiday? I returned to my therapeutic practice five months ago. Due to the demands of my primary role as Director of Psychodynamic Studies at Oxford University, I only maintain a small private practice from my home, consisting of two clients and three supervisees. One client I have been seeing for 10 years and he is able to contain his own childhood anxieties, identify his current issues and hold his ego identity. My second client is a 16-year-old student whom I had been seeing for nine months before we agreed to take a break. The issues we had been working on therapeutically were her depression and conviction that she will die young, following the sudden death of her very close friend a year earlier. She had not received the texts I had sent saying we could not meet on our pre-arranged date. When she turned up on my doorstep, expecting to resume our sessions, she was visibly shaken and upset to find me sitting in a chair with my ankle encased in a large plastic boot and a walking frame beside me. ‘OMG, are you OK?’ she asked. ‘You could have died!’ We have started work again and we have both changed. I bring to my work an increased vulnerability that I cannot hide behind theory or the intellectual defences in which I am practised. Hiding vulnerability is difficult to do when you are still using a crutch and wearing a large, grey, plastic boot. My client had seen me in a physically vulnerable state and her first concern now was to know if I was up to seeing her again. The fact of my vulnerability meant that she turned her anger on God for allowing this to happen to me, adding ‘even though I am not sure I even believe in God’. I suggested that she might be angry with me and also trying to protect me at the same time. She smiled in a knowing way. In the therapeutic space what has happened is that I have brought my physical vulnerability, which matches her psychological vulnerability, and both of us have had to admit that this is in the room. In our own differing ways we both find this difficult to do, so in many ways we are a good match for one another. My external wounds match her internal wounds. I am not using her to meet my emotional needs, but the quality of my being has changed and this is present consciously and unconsciously, to be used in any therapeutic work I do. There is a quality of attunement that has been enhanced through this process. A time will come when she can express her anger to me in a more direct way but that, of course, will be a step in the right direction of her wholeness and healing. My physical steps in the right direction are still happening, so it is an ongoing journey we both need to maintain, stepping out into an unknown future. I do not see myself as some kind of ‘wounded healer’, despite my wounds. For me that would be to claim too much, or it may simply be that I am not yet ready, but I do think I may become a better therapist. What I do claim is to have been swamped by an overwhelming experience of warmth, love, affection, care and prayer from the widest range of people imaginable. Long-lost people from my past have been in touch. People have cared who I didn’t know cared. And, sadly, some people who I thought would have been in touch have remained stubbornly silent. My wife started a daily blog, using her typical Scouse humour, mainly at my expense. She once posted a picture of me lying in bed looking ill, a post-it note attached to my forehead with a ‘Best before’ sell-by date on it, which went viral. So I bring a ‘me’ into the therapeutic space who has experienced the humbling yet profound gift of being loved and valued as a human being just as I am. This is a part of me I hope I can continue to make available to others, in and out of therapy. Alistair Ross is Associate Professor of Psychotherapy, Director of Psychodynamic Studies and Dean of Kellogg College, Oxford. He is Chair of BACP’s Professional Ethics and Quality Standards Committee. His latest books are Research Ethics for Counsellors, Nurses and Social Workers (with Dee Danchev; Sage, 2013) and Counselling: a practical guide (Icon, 2013). References
2. Bion WR. Attention and interpretation. London: a scientific approach to insight in psycho-analysis and groups. London: Tavistock Publications; 1970. 3. Lane B. The solace of fierce landscapes: exploring desert and mountain spirituality. New York: Oxford University Press; 1998. 4. Winnicott DW. Ego integration in child development (1962). In: Winnicott DW. The maturational process and the facilitating environment. London: Hogarth Press; 1965. +++ Feedback in supervision Why is feedback rarely sought by supervisors? Emma Redfern explores the possible blocks and fears and why systematic relational feedback is essential to a healthy supervisory relationship I have been a therapist for 11 years and a supervisor for four. During that time I have been in relationship with and given feedback (systematic or otherwise) to six different counselling supervisors and two EMDR (eye movement desensitisation and reprocessing) supervisors. Or have I? To supervisees reading this article, I ask: when was the last time you gave feedback to your supervisor (whether verbal or written as a lead in to dialogue, either ad hoc or systematic)? when was the last time your supervisor asked for feedback? is the feedback you give restricted to a particular area of the work? do you schedule regular reviews of your work and relationship? are you able to dialogue with your supervisor about your relationship? To all supervisors reading this article, I ask: when was the last time you requested feedback from your supervisee(s) about how you are doing? have you asked how well supervision is meeting your supervisees’ needs? how much do you rely on observation of your supervisees’ behaviour (they smile, pay and come back) to assess the health of your supervisory relationships? What is good supervision? According to Gilbert and Evans,1 research into supervisor effectiveness suggests that the ‘best’ supervisors both receive feedback about how they relate to their supervisees and also provide clear and direct feedback of their own to those same supervisees. The BACP information sheet S2 ‘What is supervision?’ similarly states that ‘good supervision provides a space in which reactions, comments, challenges, feelings and two-way feedback can all be shared’ (my emphasis).2 I believe there is a place for relational systematic feedback from supervisee to supervisor. Sadly, my experience has been otherwise: feedback has been rarely invited by my supervisors and, if attempted, has often not been welcomed or understood. Talking with peers, therapists and supervisors and reflecting on my own practice as a supervisor, this absence of relational systematic feedback, particularly in the direction of supervisee to supervisor, appears to be fairly widespread. Here I want to explore some of the unconscious and sometimes conscious phenomena that I think contribute to this. In my experience there is often disquiet/distaste in parts of the psychotherapy world about ‘being judgmental’. I believe one of my early supervisors may have experienced this disquiet. Their report, when I was in counsellor training, offered four words on my counselling abilities (I imagine it was a stock phrase). They were positive words, thankfully, but the giving of them, without examples, dialogue and personalising, contributed to my own disquiet about ‘being judgmental’ and provided me with an unhelpful model. Such inner fears and shame do not contribute to building a relationship in which mutual feedback is possible. The drama triangle Many of us in the helping professions would identify as ‘wounded healers’. As such, we may have been victims in childhood and later find ourselves as adults acting out Karpman’s drama triangle of victim, persecutor and rescuer in our relationships with others.3 Aspects of this include insecure attachment styles; limited authentic expression; increased feelings of fear, shame, blame and increased dissociation, and activation of the fight/flight/freeze responses. It hardly needs spelling out that any such responses run counter to the giving and receiving of appropriate and constructive feedback. I am sure we can all remember or can imagine how difficult it can be for a supervisee to give feedback to a more experienced, more powerful supervisor. This can be exacerbated when a trainee has no means of choosing their supervisor or when some sort of formal appraisal is required from the supervisor (a report for a training organisation perhaps, or an accrediting body). Also, drama triangle dynamics can affect both parties. As Gilbert and Evans point out: ‘Realistically, we cannot assume that all supervisors have a secure attachment base; the co-creation of the supervisory relationship will be influenced by the “working models” that both supervisor and supervisee bring to the relationship.’1 Supervisees have told me about past supervisors who regularly wept or behaved in a punitive and fear-driven way towards them when they refused to accept that their supervisor’s views were necessarily the ‘right way’. Oppression in relationship Other barriers to mutual feedback/review of the supervisory relationship include common unconscious models of mental health such as the medical model and the deficit model. In the medical model the supervisor is perceived (by one or both parties) as the mental health professional dispensing expertise, knowledge and prescribing certain courses of action to a dependent supervisee/patient. In the deficit model the supervisee may be viewed (by one or both parties) as flawed and as someone who must be prevented from harming their patient/client who is even more in need of the non-flawed/fixed supervisor’s expertise (via the supervisee). According to such power dynamics, giving feedback becomes the province of the supervisor; the supervisee may not even realise that feedback can go both ways and that he or she has needs that may not be addressed. In my experience (which includes being a traumatically-birthed incubator baby, white, educated, middle-class, professional, raised by parents who grew up in World War II, the ‘younger’ twin, now living and working in a relatively non-multicultural area), the medical and deficit models sketched out above have been influential in three of my past supervisory relationships. In all three cases I ended the relationship because I felt that my needs came last (after those of the supervisor and/or organisation, followed by those of the client) or were squeezed out completely. Only in the most recent relationship was I able to state that my needs were not being met, and I still ended the relationship (I felt that the supervisor had no desire to change to accommodate my preferences and needs). Now, as a supervisor, I can see that at times I have been seduced by a similar dynamic in some supervisory relationships. The supervisee fills the hour with talk of the clients and I/we make no room for talk about ‘us’ and whether the supervision is meeting the supervisee’s needs. Time and money are too limited. Gilbert and Evans quote Heath: ‘One of the typical symptoms of oppression is that there are no resources available to address the oppressed groups’ concerns and dilemmas. Only selected and dominant “truths” can be met. No time. No resources… means no inclination and no commitment.’1 Narcissist–co-narcissist relationships Early in my life as a counsellor I experienced what I call ‘vertical supervision’ in which it seemed that my supervisor tried to counsel my clients via me. It was as if I was meant to be a receptacle that carried away what I had been given to pass it on to my clients when next we met. I felt unseen, unvalued and silenced (none of which I could voice). In the supervisor’s presence I was compliant, hiding from both of us my inner discomfort. Afterwards I might rebel by rejecting what had taken place as inappropriate or untimely. I would also feel angry. Thankfully, as part of my professional growth, I have learned to reflect and make meaning of experience. The meaning I have made of this early relationship is that we created a narcissist–co-narcissist relationship (particularly as defined by Alan Rappoport4). My early experiences have provided me with a tendency to default into a co-narcissistic role, especially when encountering a person with narcissistic tendencies. Thus, I struggled hard to please my supervisor, deferring to their opinions. In their presence I struggled even to know my own view or hold onto my own experience. Out of their presence, I took the blame for the interpersonal problems I sensed existed between us. (At the time I was also dependent on my supervisor for a supervisor’s report.) In the circumstances Rappoport describes and I experienced, feedback from the co-narcissistic position to the narcissistic position is virtually impossible. Similarly, if the polarities are reversed, with the supervisee taking the narcissistic role and the supervisor the co-narcissistic role, then the supervisory relationship and processes will also be badly compromised. As Rappoport writes: ‘In a narcissistic encounter, there is, psychologically, only one person present. The co-narcissist disappears for both people, and only the narcissistic person’s experience is important’.4 Directory: docs -> doc doc -> Ap english Language and Composition doc -> 2 Pre Columbian-1775 Land bridge- american Revolution doc -> Achievements (2013-14) 2013-14 Another year of coveted credentials at dps vindhyanagar doc -> International Journal of Enhanced Research Publications, issn: 2319-7471 doc -> Review on Wireless Sensor Network Techniques for Security in Railways doc -> Service provider access in mobile networks doc -> Design and Implementation of Home Energy Management System Based on gsm network doc -> Annual Meeting Press Policy asa’s 105th Annual Meeting: Toward a Sociology of Citizenship doc -> Explanatory memorandum introduction Download 465.67 Kb. Share with your friends:
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