How I work, as a psychologist

I came across some work I had undertaken as part of my doctoral training many years ago and I find it as fitting for today as it was then, in terms of how it informed and continues to inform my practice. If you are interested in getting a better ‘feel’ for all the approaches that have made me into the psychologist I am today, I shall put up snippets of my training over the next couples of days.

Year one

In this placement I found one of my therapeutic homes; the relationship. As a practitioner, first and foremost I value the therapeutic relationship as a crucial factor in effective therapy, regardless of the model in which I am working. Indeed, there is a vast body of research that argues that it is the relationship more than any other factor that result in the efficacy of therapy (Bergin & Lamber, 1978; Hill, 1989; Luborskdy, Crits-Chrisoph, Alexander, Margolis & Cohen, 1983; OíMalley 1983;). The relationship is conceptualised differently by different models and is part of the philosophy of counselling psychology.

Counselling Psychology is distinctive in its competence in the psychological therapies, being firmly rooted in the discipline of psychology whilst emphasising the importance of the therapeutic relationship and process

(Division of Counselling Psychology).

It was the beginning of my training, my humanistic year and I was about to embark on a steep but rewarding learning curve as I became aware of the competing paradigms within any one system.

You can read more about humanistic therapy here.

Working within a multidisciplinary setting meant that I was working within a Team of professionals, who by warrant of their training and underlying assumptions of the person, viewed psychological disturbance through their own metaphorical lens. I was ready to work on establishing the relationshipí with clients wanting to experience a person-to-person relationship (Clarkson, 2002) looking for points of meeting between myself and the client that could facilitate the process of therapy. But the reality of my lack of understanding of the theoretical underpinnings of other professionals created tension within me when I encountered ëdiagnostic labelsí and tools for the client to acquireí In hindsight, I now have the experience and language to conceptualise this tension. At the start of my training however, with only limited knowledge of other models, I was not able to grasp how different training methods of other professionals affected not only how they viewed the individual and psychological disturbance, but how the underlying assumptions of the model affect the assessment and formulation process.

Now coming to the end of my training, I am now in a position to appreciate the breadth of my own training and understand what it affords to me.

Chartered Counselling Psychologists are competent delivers of evidence- based psychological therapy. Their training requires them to be competent to practice from more than two perspectives, and to have an understanding of the application of the three major theoretical theories of therapy (psychodynamic, humanistic, cognitive-behavioural). They are accordingly in a strong position to respond appropriately and flexibly to the therapeutic needs of specific clients and/or contexts. Some Chartered Counselling Psychologists may choose to work primarily from one or more particular theoretical perspective (e.g. psychodynamic) whereas others will take a more integrative approach to their practice.

(Division of Counselling Psychology).

Being exposed to the three main models throughout my training has allowed me a critical and evaluative stance towards my own practice. It has allowed me an understanding of the underlying philosophical bases of the models that may be employed by other professionals. The importance of this understanding is exemplified in my work with the following client.

Ms A was referred for depression. She had been engaged in professional relationships for most of her adult life and described herself as anti-professional as she felt that she had been judged harshly by professionals in the past. A review of her notes informed me that she had been offered the diagnosis of borderline personality disorder. I agree with Mearns and Thorne (2000) in their humanistic understanding that

no two persons are alike and that the human personality is so complex that no diagnostic labelling of persons can ever be fully justified.

The tension I was facing was between my humanistic training year and the reality of assessments from other professionals. O’Brien and Houston (2000) refer to the attention paid to pathology within differing theoretical models, noting minimal attention paid by humanistic therapists to those psychologists who subscribe to the diagnostic criteria contained within the Diagnostic and Statistical Manual of Mental Disorder (APA, 1995). Although I acknowledge that labels can be useful as a means of communication between therapists, I agree with O’Brien and Houston (2000, p.103) that there is

a radical difference in the attitude and approach of a therapist who assesses and works with a person who may also be obsessional or phobic, and the therapist who focuses in her assessment and treatment on the disorder that the client brings.

This is in stark contrast to the model in which I was currently working

the humanistic/existential tradition can be characterised by a focus on existence, choice, autonomy, responsibility, anxiety, death, despair, freedom, values, potential for change, the desire for growth or self-actualisation, social involvement and future orientation

(Woolfe & Dryden, 1996, p.262).

This was evident in subsequent work with Mrs A whom as Clarkson (2002) aptly put it, was couch broken in that she had been given psychological insight into her way of being, but she still did not feel good about herself. I tried to overcome this by not working too hard at being a therapist and just listen to her experiences in order to get an empathic understanding of her world. I hoped that this would encourage her to access her own feelings that were beneath the psychological language that she was using. For example, she labelled herself as ëbipolarí and ëmanicí and used psychological terms such as not being worthy.

Clarkson (2002) noted that the first few minutes of the opening session can act as a signal to the themes and issues that are likely to arise in the process of therapy. As Ms A asked if I had read her notes, I took this to be an unexpressed concern that I would judge her in the way she felt others had done. I attempted to overcome this as it arose in this and subsequent sessions by allowing her to talk about her experience of professional relationships.

As she became more trusting in our relationship she began to express her fears of therapy and was able to voice what had previously been an unexpressed fear, that I would be judging her on basis of her completing the Beck Depression (BDI) and Beck Anxiety Inventory (BDA) that I would eventually label her. I was required by my placement to complete both a BDA and BDI with all clients. Again, with the experience I have since gained I can appreciate the tensionand importance of trying to establish a person-to-person relationship within the organisational setting, which this client had been a part of.

My placement utilised a predominately medical model of therapy where for example, psychiatrists sought to diagnose disorders and Community Psychiatric Nurses trained in CBT, implemented treatment based on this diagnosis. The humanistic model within which I was working however, does not readily accept diagnostic labels. The aims of my therapy, working within a humanistic model, were to provide Ms A with a real person-to- person relationship (Clarkson, 2002) where she would not be judged and as she dictated the pace of the sessions, this would facilitate her in gaining some control in the relationship, which she may not have previously felt. It was hoped that by adopting this approach she would be able to engage in the relationship and I planned to facilitate this by working within the core conditions of the person centred approach (Rogers, 1975).

My supervisor worked integratively and towards the end of therapy I began to incorporate psychodynamic ideas as it was evident that Mrs A was bringing her past experience of professionals and others who had judged her in the past, into her therapeutic relationship with me.