Silence in Therapy

Silence is Golden sometimes

This blog is written to query a possible way forward for psychotherapeutic work. A chance to review a change, an alteration to the way of working as a Psychotherapist/Counsellor/Mental Health Practitioner. What if the clients we supported were co-worked with - in tandem with a colleague, not alone? What if we had a colleague in the room with us?

October 2015 has been a month of developments for me as a counsellor, Forensic Mental Health Practitioner, Visiting Lecturer, blog writer, Trainer on the Knowledge and Understanding Framework for Personality Disorder and reader of Daring Greatly by Brené Brown.

I had the good fortune of working alongside a colleague at one of the probation offices I support. I checked with both service users I was to provide counselling support with if I could bring another therapist into the room. Both clients affirmed that this would be okay. My colleague would observe the work in both appointments and where necessary add comment to the interactions.

To be honest I wasn’t worried for myself or my colleague as we began our work, the client on the other hand I was nervous for. He was a new referral whom I had only met once previously for an assessment meeting. The probation officer warned us that he wasn’t in the mood for therapy or much of anything. I chose to acknowledge what the probation officer had said, and repeat their phrasing and emphasis on the clients mood. My response was to let the probation officer know that if the service user wanted to, he could leave at any point during the appointment. I then asked the service user if he were comfortable for us to proceed with my colleague in the room. I informed him that he had the right to leave the room if the need arose.

The service user was a young man between the age of 18-24. He was dressed in multiple hoodies and a pair of loose fit jeans, was from an African Caribbean back ground and as his probation officer had stated was in a quiet seethingly angry mood. When asked if we could proceed with the appointment, he offered a terse and tight lipped response of ‘uh yeah.’ Putting his head first down then looking out of the window at passing traffic.

Much of the appointment was spent in silence. I began by setting out the parameters of the space, time of the meeting and confidentiality of our work together. When asked how I might be able to help. He resolutely told me that ‘You can’t help me! No-body can. I can barely help myself.’ When prompted by myself he added ‘Na, nothing man. I’ll be alright.’

There were moments where silence drew something out of him and then there were times where silence acted like a cloak in which he hid himself and appeared as if he was not going to come out from. My colleague MM appeared comfortable with this man’s disquiet. I was disquieted by the peek-a-boo game and my inability of providing anything more than space, time, an ability to mirror, paraphrase and offer small interpretations of what was happening for him in the space. (Was I good enough?!!)

Ultimately I felt that there were 2 break through moments during the silent conversation. I am a firm believer in that stating the obvious can help clarify difficult or frightening experiences ‘Nailing the cloud down’. The other is using humour to assist in lightening the mood and move the sense of discomfort on a little further. These two moments came after the service user said ‘I don’t care!’ a number of times and after I said ‘I imagined a large car chase scene where there were lots of car wheels screeching through London’s wet streets’. He laughed at the ridiculousness of this suggestion and said ‘It’s not that bad, nah nothing like that.’ I heard MM laugh quietly and the tenseness in the room gave just a little, enough for me to offer a question about caring and if I could be allowed to care for him. To carry his caring whilst he was busy worrying about the thing we were not talking about.

The appointment came to an end and I mentioned to the service user that I looked forward to our next appointment. He gave a response which intimated that he, if he made it to next week, would like to engage in a further appointment.

Myself and MM went to my office space and talked at length about the appointment and what it’s merits were. MM was complimentary about how we used the space. He, I, and MM the observer all shared an experience barely talking about one members concerns. What strikes me is that there was a parallel process occurring throughout the time as well. The service user spoke little, I on the other hand spoke for us both and MM said barely a word. I was compensating on some level for the lack in the room and attempting to fill space and time with usefulness (subconscious mechanisms going into hyper-drive). The parallel process was in the transaction of what we brought to witness in the room. Me attempting to support and assuage the young man’s mood to another place. He dancing a line between not sharing or caring and then trusting the space investing some of his story and caring.

Returning to my workspace we, MM and I, reflected on the 50 minutes we had in the room and talked about what had just happened from a number of perspectives. Traditional counselling supervision often happens within a number of different contexts including; place, time, environment, focus and attention and intention of the therapeutic appointment.

Skilled supervisors support their supervisees without ever meeting the person or person’s their supervisee speaks about. They have nothing but what their supervisee brings into the room. I like to bring all of the aspects of what has worked well, what did not work well or aspects of the work that I am confused with. Most of my supervisors are so good it is like they have been with me in the room all along seeing what I had not even begun to identify.

Having a colleague in the room, brought something immediate and responsive to the work. It was almost like the collective unconscious in the room facilitated managing a difficulty and brought solutions that a 1 on 1 encounter may not have achieved. It is likely if I had worked with the service user alone some of the realisations would have been different but may have been just as supportive.

The point I am wrestling with is could 2+1 meetings where there are 2 therapists in a room be an aspect of the work that is common rather than uncommon. The Speakmans work in a way that is similar to 2 therapists and a client. BACP and UKCP may have something to share on working as a triad however I felt that the learning was trifold as opposed to bifocal and that was immeasurably felt by all who encountered this session...

Context and Perspective a counselling Journey

Supportive Memes: Context and Perspective

I am attempting to explain why I have these two phrases in my counselling phrase log book on rapid recall/dial up.

There are a number of phrases that I use on a frequent basis when counselling; “Hmmmmmm”, happens to be my favourite, “that’s an interesting point”, “I wonder if there is another way to see that?”, “can you say a little more” and “what is the context for that” and “what is your perspective on these set of circumstances now?”

I am writing this blog to expand on the last theme which is that of context and perspective. I copied the two explanations from a word web app to broaden my understanding.

Context: Discourse that surrounds a language unit and helps to determine its interpretation. The set of facts or circumstances a situation or event.

Perspective: A way of regarding situations or topics, The appearance of things relative to one another as determined by their distance from the viewer, The technique of representing three dimensional objects on a two dimensional surface

I used the dual phrase (context and perspective) 1^st a few months ago working with a client in private practice. We had come across a few repeating patterns in their life. These patterns had followed set ways of thinking feeling and behaving in the world that were as a result of earlier experiences. A thought struck me as we walked and talked that brought the frame of what was being discussed into bright focus.

I remember we were walking along a pebble path in sunlight in August, the aroma of blackberry’s perfumed the air. At the time of our meeting the sun was beginning it’s slow descent and the moment was framed by my clients words. They spoke about “always doing X and thinking X and that if X happened in this way then it meant that Y was surely to follow and…” I can remember that it occurred to me that we had spoken about some of these ideas before when we were working at my counselling space in Lee.

There was a moment when I thought about the 2 differing environments one was a room the other was outside in a park. The context upon our meeting was different and yet some of what was being discussed was similar to a previous conversation. What I had hoped to convey was that to alter the thought feeling and behaviours facing a set of circumstances, perhaps altering the way in which one approaches them can bring change.

My 1^st degree was in Interior design. I studied at De Montfort University and enabling the client to accept the vision of the designer was an idea I came to appreciate. Interior design helped me gain an understanding of seeing life, art and psychotherapy from a number of differing perspectives. So for me when I speak about perspective I am not speaking about near or far, here or there – more about a continuum of views.

Earlier in October 2015 I worked with a probation referral as a FMHP for Together. He told me of his difficulties managing loss, incarceration and not knowing of how to get his life on track. He was able to outline some of the things he was hoping to achieve and again I was struck by this idea of context and perspective. To support the process of what was happening for this client I wanted to share that I understood what had occurred in his life, but that the context had shifted considerably and that within his new frame the perspective on the past present and future could be greater/different. I took my time to explain what I meant in relaying information about context and perspective.

What I like about these two ideas is their interrelation (how they connect) and that as two words they stand on their own. To place one’s life in context is to view how it is now, who is in it, and the things that are happening. Some attention could be spent reviewing the past in either a limited way: the past 6 months – 5 years or since birth.

Perspective invites individuals to get into a reflective space and note how life is. How life was and how they would like it to be in the future. Perspective is also seeing themselves from others point of view. When discussing aspects of a person’s life whilst in this space the space around the person I am working with appears to soften.

The aim of working with context and perspective is to develop ways with clients that promote forward movement or away from their current set of circumstances and approach a future that could be brighter.