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If you've included information or discussion about any member or members of your family, please confirm that what you've included is made in good faith and is true and accurate to the best of your knowledge; that you’ve considered any potential impact on them and on other family members if they read the article; and that, having done so, you wish to go ahead with publishing. I am aware that Therapy Today’s readers work in a wide range of settings and with a variety of modalities, but if we are BACP registered or accredited, one thing we all have in common is monthly supervision. Given that this is mandatory and a regular expense, it makes sense to get the most out of it, so this month we launch a new column to answer a common supervision question each issue. The first looks at the benefits of pre- and post-supervision reflection. Many others struggled with relationships and compulsive sex. It seemed drugs were omnipresent on the gay scene. At Attitude, I noticed a pattern of staff taking Mondays off. I found one asleep on his desk. Then the gay brother of our advertising manager, someone who worked with us for a while, who had struggled with drink and drugs, took his own life.
We can support those living with dementia to learn to move themselves into life after loss. As Marina reminds us, perhaps as witnesses ‘we are not looking, feeling or listening hard enough’. Embodied interventions suggest that movement, emotions, cognitions and the body are not separate – they are entangled. A kinaesthetic awareness when engaging with a person living with dementia can allow for a relational intimacy – however fleeting (to borrow Marina’s words) such moments of connection, companionship, seeing and bearing (the pain) together may be. Biologist Ann Fausto-Sterling 13 points out that our bodily self-perception is formed on the basis of past information, which by definition is always out of date with our current physical body. So, embodied attention during the psychotherapeutic relationship with people who live with dementia offers a crucial possibility to activate the mirror neuron system in the brain, thus linking bodily awareness, empathy and intersubjective processes. 14 We can invite the person with dementia to re-member through the body. In my role as both clinician and educator I have observed over the years how the materiality of movement exchange between self and other can allow for an experience of finding self in other. For the dementia family this can mean re-connecting and building new kinds of relational intimacies with a loved one; for professional carers it can mean re-learning about a relational intimacy. SummonedAmmaniti M, Gallese V. The birth of intersubjectivity: psychodynamics, neurobiology and the self. London/New York: WW Norton & Co; 2014. Articles accepted for publication in print will also be published online, and may be published across all BACP's communication channels. Submission requirements
I’ve been deeply moved by the fact that so many of our members have taken the time to write to us and call us to commend our response to this crisis. Taking outcome measures can help validate a client’s sense of distress – that they really do need help, which for some is important if they are to engage with therapy. Continuing to do so then provides a measure of progress, or an alert that progress has stopped. But McInnes’ own main reason for doing it originally was curiosity, he says. ‘I wanted to know how I compared with the overall effect rate. What’s my effect size? I’d be disappointed if therapists had no curiosity to know what difference they are making.’ I have since recommended it to a number of clients – co-written by a US psychiatrist and a psychologist, it’s an accessible and well-written introduction to attachment styles. And it seems that thanks to this book, and TikTok, young people are growing up with awareness, curiosity and understanding of the unconscious dynamics that can influence relationships. In the US, leading bereavement researcher and psychologist Professor Robert Neimeyer has published several papers on the impact of COVID-related deaths on people and their risk of developing PGD. 2Norcross and Lambert offer several ‘take-home points’ from this massive body of research: ‘One: patients contribute the lion’s share of psychotherapy success (and failure). Two: the therapeutic relationship generally accounts for at least as much psychotherapy success as the treatment method. Three: particular treatment methods do matter in some cases, especially more complex or severe cases. Four: adapting or customising therapy to the patient enhances the effectiveness of psychotherapy probably by innervating multiple pathways – the patient, the relationship, the method, and expectancy. Five: psychotherapists need to consider multiple factors and their optimal combinations, not only one or two of their favourites.’ And, they add: ‘… the patient’s perspective of the relationship proves more important to their treatment outcome than the therapist’s. The patient’s experience of the alliance, cohesion, empathy, and support relate and contribute more to their success than the practitioner’s experience.’ In other words, the client knows best when it comes to how they feel about the therapy relationship. This short multi-layered film speaks, sings and dances the lived experience of dementia. If, as witnesses, we become baffled in trying to solve the puzzle of the, at times, peculiar and other-worldly narrative (and imagery) of I Can’t Find Myself, it is because we are not looking, feeling or listening hard enough. Because dementia is peculiar, other-worldly and alienating. Most importantly, the film highlights that dementia is unavoidably an embodied, relational and affective experience. If you use any information obtained privately, for example in conversation, correspondence or discussion with third parties, please confirm that you have referenced all the individuals concerned and have their permission to use the material. Family members
We are living in a time of grief – we are grieving not just the millions of deaths from COVID-19, but the loss of much that we previously thought we could take for granted. Despite all our medical breakthroughs and technologies, we have discovered we are not in control, and that a tiny virus can evade all our protective barriers and overwhelm us. We are grieving the loss of our assumptive worlds 1 – that is, the beliefs and values that grounded and secured us, that gave us confidence that we could keep ourselves and those we love safe. Elsewhere in this issue, we look at what is arguably every therapist’s worst nightmare – being on the receiving end of a client complaint. It is a tribute to most therapists’ commitment to working ethically that complaints leading to Professional Conduct hearings are still rare, but many more could be avoided if therapists knew how to properly respond when a client first raises their dissatisfaction with their therapy experience. In our ‘In practice’ piece this month, BACP’s Acting Registrar John O’Dowd talks us through the process and offers advice for both avoiding and dealing with client complaints. I would also like to thank Matthew Campling for sharing his personal experience of how he coped when a complaint came out of the blue from a former client. I think young people are often not well supported in terms of their autonomous thinking. School is often really prescriptive and that doesn’t help young people to think for themselves. I approach working with young people with the attitude that they are the expert on themselves and I have some potentially helpful ideas and information that I might share with them with their permission. It is a subtle difference; I am offering information, not giving advice.’
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Freud originally conceptualised mourning as something that passes as the person ‘tests the reality’ and confirms the person no longer exists and so gradually detaches themselves emotionally from the dead loved one, and finds a new object for their love. But, says Rosenfeld, he changed his mind after his daughter Sophie and then his much-loved grandson Heinele died. We don’t ‘move on’, Rosenfeld says; we find a way to live with the loss, even if we do find a new ‘love object’. ‘Some losses you can never replace,’ she says, and perhaps especially the deaths of children, which can defy all attempts to make meaning of them. If you include material about individuals (clients, colleagues or participants in any research or study), please provide written confirmation that you have their permission to publish the material in a print and online journal and that you have anonymised all identifying details. Depending on the nature and detail of the material, we may also ask you to confirm that they've read the article. Conversations and correspondence So, what do these results mean for the counselling profession? Professor Michael Barkham, who led the PRaCTICED trial team at the University of Sheffield, says the levelling off in benefit from the PCET interventions by one-year follow-up suggests that practitioners need to examine how they can adapt their interventions to better equip people to cope in the long term. For Cooper, these findings highlight a need for the person-centred counselling profession – and that means most counsellors raised on Carl Rogers’ theories of personality change and the six ‘necessary and sufficient conditions’ – to re-examine their model of practice. ‘I think there needs to be a rethink around what school counselling looks like. For some clients, it may be of greater value if it delivers more direction, more structure and more skills around developing their [young people’s] coping abilities.’ Jacobson agrees that the therapy platforms wouldn’t exist if therapy was easier to access. ‘I have been asked by friends in the past to recommend a therapist and, if it was not appropriate for them to come to a therapist at my clinic, I would do my own search in their geographical region, or for the specific issue that they or their child was needing help with. And what I have found is that it is very hard to sift through the practitioners and to get insight into their reputation. Another challenge was that often neither fees nor availability were displayed. It doesn’t surprise me that people can be easily discouraged in persisting in finding a therapist.’
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