I am reading an article by Greenberg on Emotion Focused Therapy. He introduces the Principles of Emotional Intervention of EFT, explains that experiencing transforming and making sense of emotions is what causes change and then adds at the end of the paragraph that…”it is important to note that these principles are discussed below in relation to working with emotion in therapy not with reference to managing emotion in life.
Emotion-Focused Therapy: A Clinical Synthesis Leslie S Greenberg York University, Toronto
Emotion in Psychotherapy L Greenberg & J Safran
Attachment Theory and Emotion Focused Therapy Susan Johnson
So does therapeutic psychology need to make a distinction between therapy and life? Surely that which claims to be healthful must be relevant both for therapy and for life? How could it not?
One of my fellow students on the clinical training was of the firm conviction that clinical psychology was fundamentally about psycho-education and that therefore was his job as opposed to the hard to define messy practice of therapy. I understood what he was saying but I didn’t totally agree.
So if one works with emotional regulation in therapy is that different from emotional regulation in life? If one talks about psychological freedom in therapy is that different from psychological freedom in life?
I used to work with kids in groups at the school. I spent time helping them to understand the difference between expressing ones emotions and regulating and processing one’s emotional experiences and why this was so important.
I also supported (in the school setting) a young man whose drawings worried us a lot. Pages upon pages were covered in black marker symbols and images of death in many guises, weapons and the complete absence of light in any sense of the word. His life was organised (disorganised) around self-loathing, worthlessness, passivity and isolation from any kind of expressive relationship. His concealed core was imprisoned in inexpressible anger and crushing shame; the absence of any life affirming or coherent regulation of his emotional experiences
Can these two be equated with each other? I suppose the difference which defines the one more so than the other is the nature and degree of psychological freedom the people in each context possess and experience. So perhaps it might be useful to attempt to be clear about what psychological freedom actually represents and why it is important.
Rollo May explained that freedom is “the capacity to pause in the midst of stimuli from all directions and in this pause/silence to throw our weight toward this response rather than that one”.
Freedom and Destiny (Norton Paperback): Rollo May: 9780393318425: Amazon.com: Books http://www.amazon.com/Freedom-Destiny-Norton-Paperback-Rollo/dp/0393318427
The young man crushed by his experience along with his particular profile of risk and protective factors and subjective mediators (because his sister in the same family did not experience the same psychological outcome as her brother) immersed in death had no freedom by this definition. How can we speak of knowing who you are, and manifesting your authentic intentionality in the world if one is not free to stop, consider, make sense, evaluate worth, experience organising coherence and then with equanimity respond this way or that on the path of one’s life because one is weighed down by suffering, symptoms, conflict whatever? It’s an equation of the conservation of energy. The answer in all good faith, honestly, is that we can’t.
So I need to stop at this point and share my understanding of the role and tasks of therapeutic psychology; both in therapy and in life. Therapeutic psychology…in South Africa I see very little distinction in practice between clinical, counselling and educational psychologists despite attempts to regulate practice domains. They can all do child, adolescent and adult psychotherapy along with couples and marital therapy and of course they all practice play therapy and do psychological assessments of all sorts. J
I was searching for a long lost colleague from Rhodes…Neil Barrett if you’re out there contact me! I came across a directory of South African therapists of all sorts including clinical psychologists. At the foot of the page an explanation of clinical psychology was offered, an explanation that focused on two key aims.
- Psychotherapy aims to reduce distress and improve the psychological well-being of clients.
- Psychotherapy can be seen as an invitation offered by psychotherapists to assist the individual to reach their full potential
So which is it symptoms or potential?
The site I refer to above that lists clinical psychologists refers to professionals trained at top South African university clinical programmes, with years of practising and teaching experience held in high professional regard by their equally qualified peers.
There is a raging battle within the family of psychology and as usual it has to do with money…money and family…just don’t go together! If patients / clients / customers and medical aids are going to pay money for therapy there better be empirical evidence that such therapy works!
There are sections of professional and academic psychology that raise in their view critical concerns about the path that clinical and counselling psychology is taking. Some cogent excellent South African examples are provided below.
Where is the evidence in South African clinical psychology? Ashraf Kagee.
Commentary: The complexity of evidence or the evidence of complexity. A response to Kageel. Leslie Swartz
The complexity of evidence notwithstanding: A reply to Swartz Ashraf Kagee.
Despite the genuineness of the concerns expressed in this polemic I am most moved, relieved and comforted when reading the articles to note Swartz’s response to Kagee where he reminds us of the theatre of non-rational incorporation into new identities, ‘the thoughtful posing of questions by the psychologist, the medical doctors white coats, ward rounds and case conferences’, the scientist(ic) devout attachment to the holy grail words empirical evidence, control groups, peer review. As Swartz says “there are ritualised (theatrical) rules for performing science for performing evidence as there are rules for performing insightful psychologist”.
If we forget to remember the importance of what Swartz is saying we are all at risk and so are our patients, clients or customers, children and pupils.
I have never found it easy to take sides; I am usually left with a nagging sense of inauthenticity, a sense of partisanship rather than a sense of coherence and equanimity. Belonging is good yes, but truth is better. (Can you discern which theatre group, guild, or group I forget that I belong to, rugged anti-establishment individualists, Jean-Paul Sartre in hand, Levis and plain t-shirts with no words?).
Nonetheless there is an inexorable movement in the market-place. One can see this most clearly in the shifts in language used by some to describe both clinical psychology and the job titles of psychologist and the rise in non HPCSA regulated counselling and coaching. The closed guild known as clinical psychology has to deal with the growing counselling and coaching movement not steeped, inclined or interested in a nosological medical model of psychological health and symptomatology or CBT or psycho-dynamics.
I know many clinical psychologists trained at top programmes in ‘A’ rated universities who call themselves, coaches, executive coaches, mentors anything but or sometimes in addition to clinical psychologist. This is partly due to the burgeoning field of counselling coaching and the pressure being exerted on clinical psychology to move beyond traditional narrow parameters of operation or alternatively to set up the laager.
As mentioned above this assertion however may not apply to those who adamantly define themselves as scientist clinical psychologists working in an empirical evidence model.
Manifesto for a Science of Clinical Psychology – SSCP Website https://sites.google.com/site/sscpwebsite/Home/manifesto-for-a-science-of-clinical-psychology
Empirically Supported Treatments | Society of Clinical Psychology APA
A review of empirically supported psychology… [Depress Anxiety. 2010] – PubMed – NCBI
We could speculate probably with some accuracy how this blood feud in the psychology family will unfold and result.
It was the time of year when we honours students were applying to the clinical psychology master’s degree programme. In my attempts to gain admission I was told by a lecturer who was a clinical psychologist that I would make a good Jungian analyst and an eminent academic.
Wow sounds great hey! This is what he was really saying. You cannot seriously entertain the notion that you with your wildly irreverent non-mainstream esoteric views could be a clinical psychologist, surely? You have some abilities I concede and you are interested in psychology I suppose and you do say that you want to help people so you could tell shadowy myths about recurring universal human experiences and the symbols and stories told about them or you could teach psychology …you know what they say about those who teach…”
I am not persuaded by the ardent and protesting proselytising of the scientific (scientistic) psycho- technicians, the eschatological secular priests or the abundant and abundant teacher coaches…they all have elements of truth and validity….and they all have to live their lives and face the tasks of life day by day with the resources they have or don’t have.
Perhaps we need an agreed upon division of labour….perhaps moderated by principles of triage…..how eclectically trite banal and soporific! J
Psychological health and well-being is reciprocally related to the identification, emergence and manifestation of a person’s abilities and authentic intentionality in the world. This requires us to know who we are and to have sufficient responsive freedom to commit to the life-long challenge of manifesting our intentionality whatever form that might take.
So having the power to live this responsive (as opposed to reactive) freedom to manifest our intentionality requires at least two things; dealing with symptoms, emotional incoherence, parataxic distortions, negative or irrational beliefs…call it what you want any of those things that deprive us of the freedom to know who we are and live our lives with purpose, meaning, affiliation and authenticity.
Both these things lead to psychological health and well-being and both must be undertaken where required and necessary for a person to get from symptoms to potential.
- We can focus on symptoms alone or we can focus on potential alone.
- Sometimes there is a sufficient absence of symptoms making it easier to work with potential.
- Sometimes the disorganising and debilitating effect of symptoms makes it impossible to work with potential.
- Sometimes it is possible to work on both simultaneously and sometimes working on potential is instrumentally beneficial for dealing with symptoms.
One has the responsibility to assess many factors to arrive at a working formula of action in this regard for each person.
Is this not our greatest freedom and our greatest burden…the power and the responsibility to discern, to determine, to distinguish, to differentiate, to discriminate, to judge, to appraise… and to be accountable for our choices? Is that not what defines humans as sentient beings?
I personally like the crisis management modality of decision making with a large twist of person centred planning emerging from an existential-phenomenological psychology of people and life…it is helpful, coherent and lucid.
I believe that dealing with symptoms and building potential and intentionality go together. Being symptom free is not the sum total of psychological health. Didn’t Freud say that the goal of therapy was to facilitate the individual’s ability to love and work and live with common unhappiness? J
It is the job of therapeutic psychologists to work with both.
It is the job of therapeutic psychology in school settings to work with both symptoms and potential not incidentally, not inadvertently but consciously and purposefully in policy and structure from the start of school to the end of school.
I am going into detail because I believe that it is an ethical and epistemological imperative to present your biases from the onset; that to my mind is true for the scientific/scientistic psycho-technicians, the secular priests and the teacher/coaches.
I am also endeavouring to clarify my own thinking on the matter. I have some views which obviously have seeped in to the essay but those are less important than the task of defining and delineating my professional domain for me and others.
I hate wasting time having expectations of people and then discovering a long time later that their worldview does not offer me coherence, validity or usefulness. Say it upfront, say to me, ‘this is what you need to know about me’ …then I will be able to choose and decide.
I am primarily focused in my work on screening and then potential.
As part of my clinical training I did an internship at the psychiatric wing of Harare Hospital. At the hospital I met Jesus Christ and Mbuya Nehanda. They were dressed in candy striped pyjamas with white towelling gowns and flip flops.
“God speaks to me and has told me that I am the carrier of his word.” Jesus once proclaimed to the ward sister holding his palms open to show his stigmata that only he could see. On a regular basis he unleashed an avalanche of ‘speaking in tongues’ word of God missives that unfortunately only he understood. His loud, zealous but incomprehensible testimonies were impressive but usually resulted in him spending sedated time in a soft-walled room to bring down his high levels of excitation and restore safety to him and others.
Working in that specific setting weighed heavily on my spirit. It was not a good place for me to spend time. I struggled to work with people who have little or no connection to reality, to themselves and to others. J. H. van den Berg in his book a Different Existence states that loneliness is the nucleus of psychiatry. “The psychiatric patient is alone. He has few relationships or perhaps no relationships at all. He lives in isolation. The variations are endless but the essence is always the same, the psychiatric patient stands apart from the rest of the world. If loneliness did not exist we could reasonably assume that psychiatric illness could not either”.
The essential job of psychiatry is to help the person re-connect to the world of people and shared reality, which obviously must include a connection to himself.
A Different Existence: Principles of Phenomenological Psychopathology J. H. van den Berg | Duquesne University Press
So therapeutic psychology has its place and coaching has its place but here is the cautionary note. Therapeutic psychology can work with symptoms and potential but coaching cannot work with symptoms and potential because in its fervency for potential, coaching over-simplifies, ignores or does not comprehend symptoms where they are present in my view partly due to the coach not having been through their own journey of psychotherapy to separate their experience and needs from the experiences and needs of others; to listen and hear the other.
So this is what I do. First second and third…I listen.
During the listening I screen for possible referral for a medical or psychiatric (or other) assessment. To factor neurology, biology organicity in or out; I see too much psychologising or should I say psycho-pathologising which by its nature reduces distress to an intra-psychic event and risks making the sufferer believe that he is responsible for the situation he is experiencing which is quite easy as a disconnected person is vulnerable and easily succumbs or acquiesces to disguised criticism.
And… psychological health is not always wholly psychological.
An Introduction to Community Psychology Prof. Douglas D. Perkins, Ph.D. Vanderbilt University
I am a firm believer, for better or for worse, in the neuro-biological basis of variations including psychiatric. I do not deny the role of the portion of variance contributed by the environment and experience. The question (for me) is why this particular person manifests in this particular way when other people don’t; the psychology (and biology) of individual differences. I have seen too much unnecessary and long-term suffering to ideologically dismiss the efficacy of medication. If psychotherapy in any form successfully changes problems, well and good, bring it on. If it does not well and good, lets accept what needs to be accepted and move on to something that might help the person live a life without unnecessary hardship. A real hardship is represented by those who do not respond to either medication or therapy.
Some years ago I received a phone call from a woman who wanted my help. She was concerned that she might have ADHD and had reached a point in her life as a person, a mother and a wife where she decided that enough was enough. I listened to her and encouraged her to consult with a psychiatrist which she chose to do. Some weeks later I received this sms/text from her.
“Hi ther. Id like to thank u fr u help n encouragement as i queried fr u whether i hd adhd n u were so kind and helpful and even phoned me. I saw a psychiatrist and he said i hv panic disorder agorophobia n ocd so at least now after 3decades i hv a answer n cn work fr ther. Thx so much n god bless u”.
Her words were spot on; now that she had an accurate and useful description of her liquorice allsorts she still had to live each day meeting the demands of life with who she was and with the resources she had; but now she knew, she had a starting point to work from.
For her there was no grief to work through, the news the psychiatrist gave her was a relief, an unburdening, a point of embarkation…forward. So now she knows more about her nature, neurology and personality, her liquorice allsorts; in disease model terms; panic disorder, agoraphobia and obsessive compulsive disorder. In existential-phenomenological terms more than the usual or ordinary anxiety in various forms is central to her life, her nature, her being. So what can she do, what can she not do, what can change, what cannot change. If this is her liquorice allsorts how does she have to live her life? What awareness, knowledge and support does she need to manifest her potential and intentionality in the world despite some of the particular liquorice allsorts she ‘won’ in the genetic lottery?
THIS IS THE DOMAIN OF THE PSYCHOLOGIST…THANK GOD…HOW EXCITING!
Model Says She Won ‘Genetic Lottery’ – ABC News
So why was the psychiatric wing not a good place for me to spend time? I need to be in the crucible of fire. That space that honours who we are that teaches us by self-awareness and life experience what it is that fuels our spirit, hearts and minds, to know who we are and who we are not and thus increase our sense of what we have to do in the world whatever that may be.
So I see my work like this.
As educator I must create opportunities and experiences in a structured purposeful way that helps children live and learn about whom they are and at least what path is the right direction for them to face. This I learned from managing the inclusive education programme. Some of the kids were not going to achieve established educational milestones and thus we had to create experiences that helped the kids know who they were, develop their competencies most of which are not valued in a parochial school context. Then I remembered the optometrist who in middle age finally got that he simply wanted to teach maths and I thus concluded that every one of us would benefit from an education that not only helps us get the tickets we need in life but also works consciously to help us know and become who we are.
Psychologically when a person presents I try to understand what life is like for this person given the liquorice allsorts they won in the lottery and the experiences they have had. I look for two things. What factors promote or inhibit the person’s freedom & power to manifest their particular attributes & intentionality in the world those things that prevent a person being connected to who they are, other people and the world and secondly I see and look for those things that constitute the spirit, purpose and intentionality of that particular person irrespective of the level of their ability or liquorice variation.
Am I psycho-technician, secular priest or teacher coach? Not sure.