Therapy Today October 2014
Download 465.67 Kb.
|
| Rappoport goes on to explain that there are three common types of responses by children to their parents: identification, compliance and rebellion. In this early supervisory relationship I achieved three out of three. My rebellion came in the form of ending the relationship by letter, without saying why or goodbye. The catalyst for my leaving was when I realised that perhaps the responsibility for my discomfort wasn’t all mine, and that maybe we didn’t even have a ‘relationship’ as such.
The unspoken relationship I have since come to recognise that this supervisor may have been using the CLEAR model5 (the R stands for ‘review’ of the supervision session) in some of our sessions. Asked ‘How was today’s session?’ I regularly said how helpful it had been and thanked my supervisor very much. Was this sufficient feedback? To my mind, no; it was a verbal expression of deference; it was certainly not fully authentic and there was much left unsaid. In an article in the December 2013 issue of Therapy Today, Mick Cooper argues in favour of relational systematic feedback from client to therapist.6 The article refers to David Rennie’s work on deference in the client–therapist relationship. I consider Rennie’s work applicable also to the supervisee–supervisor relationship and suggest that it should be part of the role of the supervisor to initiate enquiry into any ‘inner discomfort’ that the supervisee may be experiencing and that may be being co-created in and getting in the way of the supervisory relationship. (Similarly I would expect a supervisor to take the initiative to voice their own inner disquiet, if any exists.) Adapting Rennie’s work, I suggest that, for supervisees, withholding comment is often a ‘preferred deferential strategy’.7 Dave Mearns likens the supervisory relationship to an iceberg in which only a small percentage of the relationship is open to mutual awareness and the bulk is open to the awareness of only one or neither party and constitutes what he terms ‘the unspoken relationship’.8 The latter includes ‘unclarified differences of opinions… counsellor’s unvoiced reactions to the supervisor… supervisor’s unexpressed assumptions about the counsellor’. Addressing the lack of feedback So how can this absence of supervisee feedback be addressed? I suggest there are a number of ways in which systematic relational feedback can be enabled. Education and training It is important that supervisors receive supervision training and that their training and/or CPD pays attention to the importance of giving and receiving feedback in forming a sound and effective supervisory alliance. The Centre for Supervision and Team Development training in supervision teaches CORBS, a structured way of giving and receiving balanced feedback,9 as well appreciative enquiry.10 As I mentioned earlier, the CLEAR supervision model developed by Peter Hawkins includes the R for ‘review’,5 in which the supervisor encourages feedback from the supervisee about what in the supervision session may have been helpful or a hindrance and what they would like to be different in future supervision sessions. Hawkins and Shohet cite Batts’ ‘five barriers to supervision’.9 These barriers include avoidance of contact, denial of difference and denial of the significance of difference. Training on these issues would also seem relevant to reducing fear of feedback. Contracting Explicit and mutual contracting with a supervisee is important, including explicit reference to feedback. I was delighted to agree a contract with a supervisor for my EMDR practice in which one of the rights of the supervisee was to receive feedback. I would now add to this my own right as a supervisee to give feedback. Developing an internal supervisor I suggest that development of an internal supervisor11 (rather than being dependent on an external supervisor or the internalised supervisor) may assist in enabling supervisee feedback. Personal development/therapy Ideally a supervisor has undertaken a substantial amount of personal therapy and is a reflexive practitioner who is able, for example, to accept the interactional nature of any ruptures/blocks to the supervisory alliance and is ‘open and willing to explore his own contribution to the process’.1 Such a supervisor models and promotes a supervisory relationship and way of being characterised by qualities of the ‘healthy triangle’ of vulnerability, potency and responsiveness. Speaking the unspeakable Mearns speaks for many when he suggests that the supervisory alliance includes provision for regular ‘time-outs’ in which both parties can attend to the unspoken relationship.8 He also writes about the importance of creating a relationship of freedom, non-defensiveness and lack of fear so that a supervisee can feel safe enough to express the inexpressible. Hawkins and Shohet refer to Borders and Leddick’s checklist of 41 points for supervisees evaluating their supervisors.5 They suggest that evaluation and review should be a two-way process that is regularly scheduled into supervision arrangements so that mutual feedback around ‘how I am doing’ can be given and any renegotiation of the supervision contract attended to. The Leeds Alliance in Supervision Scale (LASS)12 is a useful tool in this process. As a starting point to dialogue, the supervisee places a mark on a scale to indicate how they feel about the supervision session in three areas: ‘approach’, ‘relationship’ and ‘meeting my needs’. The scale can be downloaded free from www.scottdmiller.com Advocating discrimination Because ‘relationship is at the heart of effective supervision’,2 I think that we can easily become complacent. After all, we know about being in relationship, don’t we? We’re effective psychotherapists. I suggest that supervisors and supervisees would benefit from thinking about the supervisory relationship: from a participant-observer position and third person perspective2 when assessing and choosing between one supervisory relationship and another in determining, individually and together (and informed by research), what an effective supervisory relationship looks like in the light of regular, quality feedback. Finally, I want to end by referring to Farhad Dalal and his thoughts on judgment. He argues that, as a society, our capacity for judgment has become frozen, rendering us unable to think. He suggests that ‘there is an important distinction to be made between judgement and judgementalism’ and that there is a need to ‘[hold] on to our capacity for judgement’.13 He continues: ‘We can say, adapting Descartes, I discriminate, therefore I am. If I give up discriminating (that is, thinking), then I cease to be human. In fact, I would go so far as to argue that what the world needs is not less discrimination, but more.’13 Emma Redfern works in private practice in Devon as a trauma-informed senior accredited psychotherapist and supervisor. She uses Hawkins and Shohet’s process model of supervision and an integrative relational approach. Email emmalizbeth@hotmail.com; visit www.emmaredfern.co.uk References 1. Gilbert M, Evans K. Psychotherapy supervision: an integrative relational approach to psychotherapy supervision. Milton Keynes: Open University Press; 2000 (p91). 2. Despenser S. What is supervision? Information sheet S2. Lutterworth: BACP; 2011. 3. Karpman S. Fairy tales and script drama analysis. Transactional Analysis Bulletin 1968; 7(26): 39–43. 4. Rappoport A. Co-narcissism: how we accommodate to narcissistic parents. Free to download from www.alanrappoport.com/pdf/Co-Narcissism%20Article.pdf; 2005 (accessed September 2014). 5. Hawkins P, Shohet R. Supervision in the helping professions (4th edition). Maidenhead: McGraw Hill; 2012 (pp66–68). 6. Cooper M, Wilson J. Systematic feedback: a relational perspective. Therapy Today 2013; 24(10): 30–32. 7. Rennie DL. Clients’ deference in psychotherapy. Journal of Counselling Psychology 1994; 41(4): 427–437. 8. Mearns D. On being a supervisor. In: Dryden M, Thorne B (eds). Training and supervision for counselling in action. London: Sage Publications; 1991 (pp116–128). 9. Hawkins P, Shohet R. Supervision in the helping professions (3rd edition). Maidenhead: Open University Press; 2006. 10. Shohet R. Love and fear in supervision. Masterclass. British Psychological Society, London; 1 March 2013. 11. Casement PJ. Learning from the patient. New York: Guilford Press; 1991. 12. Wainwright NA. The development of the Leeds Alliance in Supervision Scale (LASS): a brief sessional measure of the supervisory alliance. Unpublished doctoral thesis. Leeds: University of Leeds; 2010. 13. Dalal F. Thought paralysis: the virtues of discrimination. London: Karnac Books; 2012 (p9). +++
Making meaning in a third language Awareness of difference through language can lead to a deeper level of communication between client and counsellor, writes Gala Connell Practitioners in Europe have worked in a second language since the inception of psychoanalysis, although this aspect of their practice is rarely documented in the literature. Recent years, however, have seen a growing interest in the issues that may arise in therapy when the practitioner is using a second language to communicate with clients. Research shows that practitioners can successfully conduct psychotherapy in their second language, especially if they are sufficiently fluent in the language and if they manage to achieve a good therapeutic alliance.1, 2 Difficulties highlighted in the literature include the challenges presented by dialects/accents, emotional vocabulary, splitting between languages in different roles and the use of a second language to disconnect or distance oneself emotionally.3 I grew up in Russia and moved to England 16 years ago. Now I am one of the many practitioners who use their second language to communicate with clients. I was curious to know what I was bringing to therapy as a practitioner with a difference, and I wanted to explore the challenges and opportunities it offered. This article draws on my own research for my master’s dissertation into the experiences of therapists who use their second language to work with clients.4 I asked four practitioners from different European countries to share their experiences with me. I also chose to be interviewed myself: I wanted to have a similar experience to that of my participants and I was also hoping to surprise my unconscious: that I would find out something new about myself. The research was mainly focused on the existential and metaphorical meaning of the lived experience of migrant practitioners working in the UK. But the issues discussed here are, I argue, relevant beyond the migrant practitioner or client and their struggles to communicate, and beyond the challenges posed by interpretation/translation too. What I am writing about is, essentially, the fundamental psychotherapeutic process of finding a common language with clients. All participant and client details, except my own, have been anonymised. Language and self Emma, one of my interviewees, described vividly the impossibility of ever fully integrating the English language into her sense of self: ‘It’s much more than just words that come out of your mouth. You embody your language. It’s part of my fabric. English is still like a foreign body... There are still certain bits of the language that my face hasn’t grown around.’ Her words encapsulate the separation that having to use a second language can open up in a process that is essentially all about presence, congruence and communication. One of the central ideas used in Gestalt therapy is change of perception through the switch between figure and ground. Figure is something at the forefront of our mind; the ground comprises those things that are outside our immediate awareness. The foreignness of a therapist brings the difference into conscious awareness, making it figural: Emma: ‘As soon as I open my mouth people know that I am different.’ Gala: ‘I am asking myself to what extent is my speaking a foreign language different from any other difference that a counsellor may have and that would be obvious, that you wouldn’t have to disclose; it would be there in the room.’ The illusion of understanding that comes simply from sharing the same language is gone, stripped away. Two people are trying to make meaning of experience: ‘There are no expectations, just a desire to understand.’5 Interestingly, from my interviews came a strong sense that, if they trained in English or another second language, these therapists struggled to work with clients who share their mother tongue: Nefeli: ‘In Greek I would struggle to communicate, because the experience is not there, I am not really used to be a counsellor in Greek.’ They described how, if they worked in their mother tongue with a client of the same nationality, it could lead to a kind of collusion. Emma: ‘… there could be a real pull in some sort of… collusion or whatever the word is for it… You know, where you suddenly felt, “God, yes, we are the same here! We’re both whatever, Russian, Dutch,” and so you suddenly find it more difficult to keep separate… especially when you are separate from all the rest of the world.’ George: ‘… it helps in the beginning. Therapy goes, wow, great even... Good joining, good contacting and later what? You come to the point… when your identity… joins… subconsciously really.’ There is a creeping loss of role clarity and a blurring of identities; the therapist struggles to maintain objectivity. This phenomenon is what Akhtar6 calls ‘nostalgic collusion’. Third language In the face of these difficulties, I would argue that what emerges for these ‘second language therapists’ and their clients is a new ‘third language’ of therapy, in which the practitioner’s professional identity and language identity are integrated. The therapist has to start from scratch, to abandon all preconceptions and engage with the client in developing a language that works for both of them. This ‘third language’ is a dynamic, ever-changing language that emerges through dialogical interaction between practitioner and client. The concept complements the other ‘thirds’ used in psychoanalytic theory. Akhtar7 writes about ‘a third individuation’ as a process whereby immigrants form a new bilingual identity that is not just a combination of two separate identities but something new and distinct. Lacan8 introduced the idea of thirdness in relation to the intersubjective encounter: the third element acts as a mediator between two subjectivities and makes it possible to see the other’s point of view without losing one’s own perspective. Then there is ‘the analytic third’: the unconscious third subject co-created in intersubjective therapeutic encounter,9 and Jung’s ‘the third thing’ that unites the opposites.10 The difference is that the third language is real, conscious (or easier to bring into consciousness) and tangible, and can therefore act as a working metaphor for the analytic third and potentially transcend the context of therapy in a second language. It is interesting to ask how the ‘third language’ may relate to the intersubjectivity of a therapy session and whether it changes with each client. I am aware that every one of my clients has an impact on me and I change accordingly. Yet there must be a core element that helps me to maintain my identity. I would argue that the concept of thirdness, the third language, helps me to stay in touch with my core, and allows me to feel safe so I can be creative and flexible in my work with clients. Indeed, I may use many different third languages that emerge, one for each client, in each intersubjective encounter. The new language identity is not a fixed structure; it grows and changes and this process is unique for each individual. The boundary between the separate identities gradually becomes less prominent as the foreign language gets more internalised, resulting in spontaneous use of humour, dreams etc.7 One of my interviewees, Nefeli, for example, told me excitedly about her newly found ability to write poems in the English language. A lot of my dreams are now in English and I sometimes speak English in my sleep. Back to basics Another interviewee, Paula, was particularly self-conscious and worried that she might not be able to help her clients because of her lack of language proficiency. But this example from her work I think very strongly illustrates what I am arguing here. Paula was talking about a client whose speech had been affected by a brain injury. This client had been in therapy before but never stayed beyond the first couple of sessions: Paula: ‘I struggled. I don’t even know what we were talking about most of the time, and I struggled a lot, but things changed… and it was amazing… we reached the point that we speak very slow… I can send back to him the feelings, I think… the language is not that important… we were just being together and it didn’t matter much… Now he start talking about, you know… important things… he tries… he says, you know, like…. if I have to guess the words because he can’t have these basic words… so he says the other way… “It’s not a school, it’s not the university”…and I say “college?” and he says “Yeah, that’s the word!”… so it’s slow you know… Or he’s describing things with hands, he moves a lot … I think that’s the most beautiful thing that I’ve experienced.’ There are several important elements in this extract: struggle, feeling lost, lack of words and then slowing down, using hands, helping each other to find a word and language becoming ‘not important’. There’s also excitement and joy: ‘It was amazing… the most beautiful thing.’ The struggle with language brings the therapist–client interaction back to an almost preverbal state of basic connection, basic emotion. Jiménez, a Spanish speaking psychotherapist working in Germany, has written similarly about his own experience. At the time his command of the German language was limited, but the linguistic difficulties were overcome by a higher degree of attunement and by sharing the emotional state at a non-verbal level. These also allowed Jiménez to connect directly to the patient’s unconscious:11 ‘I believe that… the central and supporting kernel of the analytic relation is basically non-verbal. In this sense, a command of a foreign language that would not be sufficient to carry out tasks such as text translation may suffice to establish and maintain an analytic relation, as long as analyst and patient develop an emotional relation… Experience showed me now and again that a continuous exchange process would occur between my patients and me, a process whose most outstanding product was a progressive sharpening of verbal communication. While I played mainly the role of “translator of the unconscious”, my patients would put into a more differentiated language what I sometimes said in an imperfect, babbling fashion.’ Essential to this creative process is an honesty and transparency about the struggle itself, as these exchanges illustrate. Paula says: ‘I just spontaneously say like I am talking to a friend. I say “I am not making sense today” or something… and we laugh… I don’t see it as a struggle now.’ Similarly, Nefeli tells me: ‘I think it’s important to have a joke and a laugh. Sometimes I might have said “Oh, that’s my accent.” And in the interview process itself, we find we have achieved this shared joke.’ Gala: ‘So it does come up?’ Nefeli: ‘Yeah… it comes up s---ly [indistinct] and…’ Gala: ‘Sadly?’ Nefeli: ‘Subtly, not sadly (laughs).’ Gala: ‘Ah (laughs).’ Nefeli: ‘You see? And then I say, “It’s probably my accent.”’ The moment of misunderstanding because of the accent is resolved by simply being open about it. When this happened between us, I felt excited and energised. It was mutual, as shown in the lightness of the interaction and in the laugh that we shared. It was a moment of meeting12 marked by relief of resolving misunderstanding and by noticing that the misunderstanding was a gift to both of us, a spontaneous illustration of what we were talking about. The struggle to find words becomes a metaphor for the existential struggle to connect, to understand and to be understood. I remember my own struggle in the early stages of learning English: there was so much to say, but I could barely put enough words together to form a simple sentence. How could my client ever understand what I was about? Even now, writing this article, I struggle: so much to say yet my means feel so limited. Struggling with the language now or the memory of feeling silenced in the first stages of acquiring a new language helps me understand the client’s distress, her struggle to communicate something about herself that is beyond words, even in her own language. This personal experience has ‘given us glimpses of different dimensions of ourself… which we can enter to put us into a feeling state that is closer to our client’s present experiencing and thus act as a “bridge” for us into a fuller meeting with our client’.13 The act of disentangling meaning together – first at the preverbal level, jumping straight to feelings, and then pulling back and trying to put it in words – with all the imperfections, failed attempts and misunderstandings – becomes a metaphor for existential meaning making in a wider context of therapy and beyond. Gala Connell is an integrative counsellor and psychotherapist. She is one of a team of IAPT counsellors for depression working with NHS patients at Leeds Counselling, a registered charity in the centre of Leeds. Email gala.connell@leedscounselling.org.uk References
2. Georgiadou L. ‘It is difficult... it is a huge challenge, but...’: trainees’ experiences of counselling practice in a second language and culture. Unpublished paper presented at the BACP Research Conference 2012. 3. Christodoulidi F. The therapist’s experience in a ‘foreign country’: a qualitative inquiry into the effect of mobility for counsellors and psychotherapists. PhD thesis. Manchester: University of Manchester; 2010. 4. Connell G. Through the looking glass: making meaning in a second language. Unpublished MA dissertation. Leeds: University of Leeds; 2012. 5. Ayora Talavera DA, Faraone M. Language barrier or porthole to discovery? Dialogical experience within a therapeutic relationship: revisiting the process of dialogue. International Journal of Collaborative Practices 2012; 3(1): 53–63. 6. Akhtar S. Technical challenges faced by the immigrant psychoanalyst. The Psychoanalytic Quarterly 2006; 75(1): 21–43. 7. Akhtar S. A third individuation: immigration, identity and the psychoanalytic process. Journal of the American Psychoanalytic Association 1995; 43: 1051–1084. 8. Lacan J. The seminar of Jacques Lacan (1975). Book I. New York: Norton; 1991. 9. Ogden T. The analytic third: working with intersubjective clinical facts. International Journal of Psychoanalysis 1994; 75: 3–20. 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:
|