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July 13, 2020 by Brighton and Hove Psychotherapy Leave a Comment

A Primary Task

This is second of eight short blogs exploring the elements of therapeutic change as proposed by Dr Sebastian Kramer.  Click here to read the first one – ‘A Desire to Change‘.

2.  A primary task, a goal . . .

When a client enters therapy they give us permission, to help them with an initial task or goal.  This goal may change throughout the therapy so it can be discussed and the ‘therapeutic sat nav’ can be reset. 

It is important that both of therapist and client understand and agree with what is being worked towards. 

We call it a ‘therapeutic contract’. It helps to keep our talking on subject and the last thing a therapist wants is for a client to walk out of the room thinking that the session had not been useful, that the conversation may have drifted around too many subjects or they had not been asked the questions they were hoping to be asked.  

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In systemic psychotherapy it is not unusual for us to ask for feedback from our clients a little way into the session to help us understand if the session feels on track and useful so we can change direction to recalibrate the conversation.

When I was training I thought it was the therapist’s job to solve all of the client’s problems and dilemmas – this was an overwhelming and crippling thought.

I now understand that therapy can exist in chapters, in segments and in episodes.  You can move in and out of therapy with different goals.   

Therapy is an on-going dialogue with the therapist’s job being facilitate, encourage, cajole, challenge, question, celebrate and witness the reflection, insights and successes that our clients experience.

 

Sharon Spindler is an experienced Systemic Family Therapist with twelve years experience within the NHS and private practice.  Sharon is available at the Brighton & Hove Practice.

 

Further reading by Sharon Spindler –

A Desire to Change (part 1)

Covid 19 – Talking with children in uncertain times

Family Therapy for Beginners

 

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Filed Under: Mental Health, Psychotherapy, Sharon Spindler Tagged With: Counselling, Psychotherapy, systemic psychotherapy

June 1, 2020 by Brighton and Hove Psychotherapy Leave a Comment

A desire to change

One of my favourite papers is by Dr Sebastian Kraemer, called ‘Something Happens: Elements of Therapeutic Change’.  This blog helps break down what therapists and clients set out to do, as they sit together in a therapy room both hoping that change can be immobilised from a stuck situation.

This is first of eight short blogs exploring the eight elements of change identified as:

1. A desire to change

2. A primary task

3. A theory of mind and a method of treatment

4. Courage and honesty

5. A specific narrative

6. Neutrality and reflectiveness

7. A tradition

8. Something happens

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A desire to change: As the client and therapist sit face to face in their first session progress has already begun  – the desire to change has been acknowledged and acted on.  The request for help to a therapist has been made and the therapist has accepted this. 

However long a therapist has been practicing – having collected skills, theories and techniques along the way – each new client brings a unique story and request for help.  They bring their stories of strength, courage and endurance alongside their stories of distress, confusion and pain.  Just turning up to the appointment is an act of bravery, it is our role as therapists to acknowledge and respect the clients vulnerability; walking alongside them as they take action to change.

On first meeting, many clients report that they have noticed shifts in their thinking, changes in behaviour and an increased sense of hopefulness that things can be different – this is before the first session.  This could possibly be a placebo effect or could be understood further in the context of the research around models of change.

In the early 1980’s Proschaska and DiClemete set out five stages of change. Upon arriving at their first session clients are already in transit between Stage Three and Stage Four 3 of this theory – monumental shifts in awareness and readiness have already taken place:

Stage One. Pre-contemplation – the ‘I’m not ready’ stage

I am unaware or under-aware of a problem and have not got plan to change – leave me alone.

Stage Two. Contemplation – the ‘I’m getting ready’ stage

I am aware I have a problem to address but do not have the motivation or commitment to change my behaviour as yet. – leave me alone but watch this space.

Stage Three. Preparation – the ‘I am ready’ stage  

I have researched and planned a way to change.and my initial goals are clear – no time to talk I’m busy!

Preparation is considered the most important stage of the model – relapse is considered to be 50 per more probable if the preparation stage is not undertaken

– ON YOUR FIRST SESSION YOU ARE HERE –

Stage Four. Action – the ‘I am implementing my plan’  

I am making changes to my behaviour, my environment and my choices. I have sought help in this process and am being encouraged to feel more hopeful about the future

Stage Five. Maintenance – ‘I have changed and I want to keep it that way’ stage.

Work and effort is still required to maintain positive changes and prevent relapse.

A desire for change is important to begin the work however sometimes it becomes clear change may bring difficulties and risks that had not been contemplated originally.  Resistance to the change may then come into play and the work takes a different turn as goals are reviewed.

 

Sharon Spindler is an experienced Systemic Family Therapist with twelve years experience within the NHS and private practice.  Sharon is available at the Brighton & Hove Practice.

 

Further reading by Sharon Spindler –

Covid 19 – Talking with children in uncertain times

Family Therapy for Beginners

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Filed Under: Brighton and Hove Psychotherapy, Mental Health, Sharon Spindler Tagged With: Counselling, Mental Health, therapy rooms

April 29, 2020 by Brighton and Hove Psychotherapy Leave a Comment

Covid-19 – talking with children in uncertain times

How do we contain our children’s anxiety in such uncertain times, when we too feel anxious and unsure ourselves?

When children are nervous we may notice them continually searching for reassurance – the usual advice would be to acknowledge this but keep reassurances to a minimum, modelling to them that fundamentally the adults in their life believe that the world is a safe place.

However, here we are – smack bang – in the middle of unprecedented times where it may be difficult for us, ‘the grown ups’, to keep level heads ourselves around our families health and economic future.

Our most important job is to manage our own anxiety whilst engaging with our children honestly and openly about the developing situation. Their worlds of home and school have been thrown into orbit; they had to say a hastened, brutal goodbye to friends and teachers not knowing when they would see them again.  The novelty of not being is school has now probably faded a little – time at home with parents is usually pleasurable but sometimes not.  Relationships can be put under extraordinary pressure when we are in lockdown with an unclear future.

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Whilst we need to talk to children openly and find out their understanding of the pandemic, our responses should contain reassurances aplenty but we must to be careful not to give absolute guarantees.

It is within human nature to endeavour to provide an environment for our children in which they feel safe. Maybe we can begin to appreciate how these trying times can be viewed as an opportunity for us to model kindness, resilience and compassion.  We can hope that our children will remember these formative times as a period in which they learnt important life lessons along with resilience for their futures.

 

Sharon Spindler is an experienced Systemic Family Therapist with twelve years experience within the NHS and private practice.  Sharon is available at the Brighton & Hove Practice.

 

Further reading by Sharon Spindler –

Family Therapy for Beginners

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Filed Under: Child Development, Parenting, Sharon Spindler Tagged With: anxiety, child therapy, Covid-19

September 16, 2019 by Brighton & Hove Psychotherapy Leave a Comment

Family Therapy for Beginners

Professor Richard Layard, one time ‘Happiness Tsar’, wrote, ‘in every study, family relationships, (and our close private life) are more important than any other single factor in affecting our happiness’.

It’s hard to grow and feel safe and content in the world if our family stories are causing us distress and discomfort. This is especially true for children, and young people when their family is their world. When they are struggling with emotional and behavioural problems or maybe unexplained physical ailments a ‘systemic’ approach can be revealing.

Systemic therapy is relational, that means looking at the spaces in between people and their relationships with others, as opposed to looking inside individuals. Systemic therapists are interested in the ‘systems’ that people belong to, such as our families, school, work places, peers and friendships. Exploring the context of tension, distress and unhappiness can help us illuminate the possible causes.

For example we may find stories of divorce and separation, estrangement, sibling rivalry, family illness and disability, bullying, academic struggles, financial problems, loss and bereavement, or drug and alcohol use Family therapy is about having conversations that can be difficult, exposing, controversial, and upsetting.

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But also about reconnecting, understanding, sharing and being surprised. Feeling heard, understood, loved and believed. Explaining your side of a story, hearing family stories that help you understand current struggles and appreciating other people’s point of view. Feeling proud and united, relieved and supported and wondering together how you can move on.

Any therapy involves taking a risk; family therapy provides an invitation to be brave and accept that families may be worried, sad or confused about someone they love. Or maybe family relationships are feeling tense and strained, or they are missing someone who played an important role in your lives.

Established, repaired and revisited relationships give families a rich resource for healing.  Family Therapy sessions usually last 90 minutes, and as many family members who are available are welcome.  Work would begin by exploring why it had been decided now was the time for family talking and noting individual and family goals to help focus the work. Some family members may be initially reluctant to attend, its important for them to be aware that just be attending they are showing their support. They do not have to contribute verbally if they do not want to – this could be agreed at the beginning of the session. By just turning up they are able to listen to other expressing their views and will usually join in when they feel comfortable and safe within the process.

A genogram or family tree is usually constructed looking at the current family structure and remembering older generations. This provides a map of the family and a cultural context for the current problems. It generates stories, sometimes forgotten, about how positive and negative patterns and traits may have been inherited by the family in the room. This can be a revealing and emotional, with younger people hearing about relations that may have died before they were born and older ones remembering stories that help build to a clearer understanding of the family’s identity. A time-line constructing a chronology of family births and deaths and other family events is also useful. Again, this begins reveals its own narrative, which can help a family begin to plot the life story of a problem.

Family Therapy is always driven by the goals of the family and continual feedback allows the therapist to ensure that the family are having the conversations they want and need to have. Sometimes it may feel useful for family members to meet individually, in couples or sibling groups as part of the therapy.

It is not necessary to meet weekly; sometimes families find one or two sessions are enough to feel they are able to move forward. In my experience family therapy can be a powerful process with the family leaving more connected with and appreciative of each other.

Sharon Spindler is an experienced Systemic Family Therapist with twelve years experience within the NHS and private practice.  Sharon is available at the Brighton & Hove Practice.

 

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Filed Under: Families, Parenting, Relationships, Sharon Spindler Tagged With: Family, family therapy, Relationships

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We would like to reassure all our clients that Brighton and Hove Psychotherapy is operating as normal despite the current situation.

Our working practices have fully incorporated online therapy in addition to a re-opening of our Hove and Lewes practices for face-to-face psychotherapy in accordance with Government guidelines and advice on safe practice and social distancing.