Annie Sloss, Therapist
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The Identity Project - An arts based adaptation of Narrative Therapy practice.

10/28/2016

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The identity project - An arts based adaptation of Narrative Therapy Practice.

An arts based adaptation of a Narrative Therapy
​      process.
    
​

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​I am inspired to write about a group that I facilitated this week which combined elements of MIECAT arts therapy procedures with Narrative Therapy outsider witness practice. 
Outsider witness practice is well documented in Narrative Therapy literature if you are interested to read more but I give a basic description of it at the end of this post.
In recent years I have been adapting this practice using arts based activities to enrich  the already transformative experience.
Yesterday I was asked to run a group therapy session on identity using an art based approach. The clients were a group of people coming to our trauma treatment program and I had not worked with them before. I was told that the group were a bit flat and struggling in the morning and later that day I discovered that the group had previously been having difficulty feeling connected.

Here is a brief outline of the group process I used.


Selecting images
I asked participants to select postcard images (free ones collected from cafes over the years) to describe aspects of themselves which were nothing to do with the experiences or struggles that brought them to our program. Naturally that was difficult as they were feeling overwhelmed by the problems they face, I let them know that even one card that did not relate to problems would be a good job done.
Then I asked them to cluster the cards into groups that seemed to fit together and give each group a name. (This clustering and naming process is a standard MIECAT arts therapy process it helps people make sense of the images and reduce the information held in the cards down to its core message)

The interview process
Group members were instructed to listen to the interview and take down any words or statements that they heard coming out of the interviewees mouth, which stood out to them for any reason. (this is another wonderful MIECAT technique called Key Words. It can be utilised in numerous ways; in this instance, it is serving the purpose of helping the listeners stay focused and engaged and the words collected are essential in our witnessing process)

Facilitator I interviewed each person about the cards they had chosen for about ten minutes.  I invited participants to speak of the cards that were not dominated by problems and listened intently for the slightest opportunity to enquire into storylines which would lead the conversation to areas of the participant’s values, skills, knowledge, meaning full relationships etcetera. (In Narrative Therapy these are sometimes called windows of opportunity)
Participants After each interview participants took note of any key words or statements that had strongly resonated with their own experience and then gave all the words they had recorded to the speaker. Participants received these key words with delight.

Key word poetic statements Once everyone had been interviewed I invited participants to pluck out the words and statements that held the most meaning to them from the key words they had been given. (picking out the key words from the key words) they then created poetic statements with the words which they shared with the group. (this is another tried and true MIECAT procedure which again brings the many words down to the essence of what is most important to the individual)

​Double listening

Not surprisingly speaking about stories not dominated by problems was very difficult for all the group members on this occasion so I needed to listen intently employing what is sometimes called double listening. Double listening is when you are with one ear hearing the problem dominated story and with the other ear listening for implicit or explicit fragments of preferred identity stories for example values held, skills and knowledge acquired, capabilities developed, relationships of meaning etcetera. By remaining curious, paying close attention and asking skilful questions informed by my narrative therapy training to draw out these alternate stories our conversations took surprising and delightful paths.
Some of the noteworthy things we learned about the group members were: of a powerful and protective sense of wit, a capacity to make life enhancing choices at life’s important junctures, ability to step out of the critical mind whilst play music which might translate into other parts of life, a passion for art and activism, values of living life to its fullest and an emerging capacity for self-compassion.

The power of being witnessed.
Through these conversations the group learned a great deal about each other’s lives which had not previously been explored and participants expressed a new-found appreciation for their group members. The stories we heard in this group stand in stark contrast to the stories of childhood abuse, workplace bullying and injury, emotional suffering, and decreased functioning through which the group had previously known one another. Having your courage, humour, passion, values and capability witnessed by an audience and reflected to you in your own words or through visual image is a powerful tool in reclaiming your sense of self from the effects of traumatic experience or illness.
When the team leader met with the group at the end of the day he described participants as buzzing with excitement when he entered the room and the group reported feeling much more connected with one another than they previously had.

Possibilities to include further art making
There are numerous ways to include more art making into this exercise here are some I have included in the past.
Initial representation can be made in any arts modality.
Visual representation of the essence of the key words can made by interviewee.
Each audience member makes a response in arts modality inspired by the key words they have collected to give to the interviewee.
Audience members make a representation of how the interview might inspire them in their own lives.

A rough outline of Outsider witness process

One person is interviewed by a narrative therapist in front of an audience of one or more.
The audience is then interviewed and asked to reflect on the following.
Some aspect of the interviewees story that caught their attention.
What that aspect of the evoked for them in terms of the interviewees hopes, values ambitions and identity.
How this relates to their own experience.
Where they might have been moved to or how they might be inspired by the experience of listening to the interview.
The original interviewee then speaks about their experience of listening to the audience (the retelling)

If you would like to read more about the use of outsider witness practice in Narrative Therapy I recommend the following article it is readily available on the internet.
Outsider-witness practices: some answers to commonly asked questions”  
​Maggie Carey & Shona Russell
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Personal and professional reflections on Acceptance and Commitment Therapy. (ACT)

5/10/2016

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Personal and professional reflections on Acceptance and Commitment Therapy.
​ (ACT)


When I first overheard my workmate talking about the Acceptance and Commitment Therapy (ACT) in 2008 I immediately knew it was a therapy aligned with the way I live my life and volunteered to co facilitate a group with her.
In the weeks that followed my philosophical alignment with Acceptance and Commitment Therapy was confirmed and my professional and personal life was irrevocably changed.

ACT is about getting connected to what really matters to you in life, who you want to be, and how you want to be.
Through mindfulness (being in the here and now with awareness) we learn to be with unhelpful thoughts and uncomfortable emotions in a safe way. This allows us to be more in control of our behavior, and where we put our attention, so that we can stop enacting unhelpful habitual behaviors and instead take ongoing action to create the life we want to be living.


Connecting with my values enabled me to stop feeling bad about myself when I chose to spend my time and energy on areas of life and activities which were different to my friends and family. It taught me to safely experience and make sense of emotions which had previously been unbearable. Most importantly of all the principals of ACT allowed me to see the underlying beliefs which were attracting me into relationships which had no future. And it gave me the courage to follow my heart and risk so much to tell my then friend, now husband that I loved him when we had never even kissed.

My years of mindfulness training and practice created a solid foundation for my innate understanding of the principals of ACT and my ability to communicate these ideas in simple, accessible ways. As soon as I was given the opportunity to run my own program I began to strip away the jargon and technical language, and calling upon my Narrative Therapy and Creative Arts Therapy background I created an easy to understand strength focused program rich with metaphor and visual representation.

Narrative therapy and MIECAT Creative Arts Therapy are both post-modern therapies which understand that the people who come for therapy are the experts in their own lives. Both therapies are emergent and strive through different but complementary methods to assist in helping people find their own meanings and come to their own understandings. The structure of ACT came as a relief and gave me a sense of reassurance that important aspects of my clients experience and patterns of behaviour were not being left unattended.

In an individual counselling setting it is possible for a skilled practitioner to weave the principals of ACT into a session experientially without being drawn into lecturing or taking the stance of expert. However, in the group therapy setting this is considerably more challenging.
Psycho education by nature places the therapist into the position of expert which has the immediate effect of undermining the knowledge of and dis-empowering the participants in the group. For the last eight years it has been my aspiration to develop an ACT group in which is entirely free of psycho education but instead facilitates participants to come to the know the principals of ACT through experiential practices and arts based exploration.
​
I have at this time, by no means accomplished this ambitious task.  I have developed some interesting and effective idea for helping people take perspective on their thinking, come to their own understanding of the importance of connecting to what really matters in life and the unavoidable necessity of safely experiencing emotional discomfort as they move toward it.
It is these ideas that I will be sharing in the experiential Arts based approach to Acceptance and Commitment Therapy workshop being held in Melbourne on August 6th & 7th. 
Bookings available at https://www.trybooking.com/KMBN  and  https://www.trybooking.com/183911


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Is this compassion fatigue?

4/7/2016

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Is This Compassion Fatigue?

I guess compassion fatigue will be experienced differently by everyone who works in the helping professions but I thought it might be helpful to describe my experience as a way of helping other clinicians pay attention to their well being.

My heart feels like a railway station at peak hour.
Long before I had heard of the term compassion fatigue when the only name I had heard to describe what happened to exhausted therapists was burn out, I experienced what I called burnt open.
When I am at the end of my helping tether my heart begins to feel like a railway station at peak hour through which too many people have passed. It is as though my skin has become porous, I feel pain and joy and love more deeply and I will cry easily at anything. It is an ecstatic compassionate experience but if I don’t take heed and rest shortly afterward I will become completely exhausted or fall ill. At these strange burnt open times I can also begin to feel like i am  exhibiting behavioral traits of the clients I have been working with. For example on occasion when my exhaustion has come whilst working with clients vulnerable to suicide, I have begun to  randomly experience the thought “I want to kill myself”. At these times I know that I must stop, rest and regenerate.

How might my fatigue impact clients?
Real or imagined I have a sense that without my emotional robustness to hold the safety and set the boundary of the therapeutic space my clients too can become more porous.  They may feel their emotions more intensely and allow more deep or personal content to arise in the therapy session.  Of course moving more deeply into trust and allowing meaningful content to emerge in session is good therapy, but it is essential that it arises in a safe way at the right time for the individual, with a therapist who has all their emotional and cognitive faculties about them.
  

At these times of fatigue I am very cautious.
 I choose my group topics mindfully and I deliberately plan therapy groups which will engage participants intellectually rather than emotionally. In individual work I check more regularly on the safety and emotional status of my clients during the sessions. In both cases I pay more attention to thorough  risk assessment and double check my decisions with my peers where ever possible.
I let my manager and supervisor and loved ones know where I am at so that they can support me and I plan a sick day and a holiday, I make a lot of art and try to increase exercise and meditation, get into nature and schedule in some gentle fun with friends.


But what causes it?
There are many contributing factors, the multiple of variable which can increase in the intensity of my client work, lack of supervision and consultation, beloved workmates resigning, interpersonal difficulties with other staff, time pressure and deadlines organisational instability, difficulties in ones personal life.
But it is never the clients i work with that cause my fatigue, quite the opposite in fact they are the source of inspiration, energy and constant learning.
What I notice brings me undone is feeling isolated or alone, not having a team, and the experience of being responsible for the therapeutic outcomes of too many people without the people power and support to deliver.

How to prevent compassion fatigue.
Make sure you know what it is to feel comfortable, content and relaxed within yourself before you begin practicing. Many training courses, particularly in clinical psychology are so demanding that clinicians begin their careers in a state of exhaustion and anxiety.
Get in touch with who you are and what really matters to you.
Bring awareness to what gives you joy and restores you to a sense of well-being.
Keep up regular exercise and mindfulness practice and find a creative outlet.
Seek out a really skilled, experienced, supportive supervisor and develop a peer support network for yourself.
Be gentle, there is too much pressure to work full time, don’t be afraid to decide for yourself how many days it is healthy for you to work as a therapist at any given time. 


Please leave a comment about your experience of compassion fatigue.
 
 

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Risky Business

10/17/2015

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Managing risk with clients who are vulnerable to  suicide

A few years ago the topic for my masters research project was prompted by my interest and concern about the impact of stress on clinicians when managing risk of clients vulnerable to suicide. 
Recently circumstance has turned my attention once again to the stressful business of assessing and supporting clients who are at risk of suicide. This is undoubtedly one of the most difficult aspects of any therapists work and the costs of getting it wrong are very high for everyone involved.

Ultimately when a client indicates to us that suicidal thoughts and urges are becoming a serious risk to them, they are putting the responsibility for their life in our hands. We are then legally and morally obliged to use our clinical expertise to inform the action we take to ensure their safety.

The following are practical tips for keeping your self and your clients safe: 

Safe foundations
1.    If you work in an organisation make sure you are familiar with the procedures around managing a          client who is vulnerable to suicide. (if you don’t follow procedure you can not rely on your                        organisation to support you and you may face disciplinary or legal action)

2.    If you are working in private practice create and document your own procedures to support you              when clients are becoming vulnerable to suicide. It is very difficult to think well when under stress,          especially if you have never faced the situation before.

3.    Keep a list of crisis lines and local CAT teams for your own reference and to give to your clients. 

4.    Assess your clients well at the beginning of your therapy especially around past suicide attempts or        ideation and loved ones lost through suicide. These questions may seem hard to ask a new client          but they are essential for everyone’s safety.

5.    Make sure you have the phone number and address of the clients you work with so that if you need        to call the police to do a welfare check or ask the Adult Community Services (ACS) team to visit              you know where to send them.

6.    Ensure you have the name, contact details and consent to contact at least one friend or family                member who has agreed to support your client in an emergency.

7.    Create a crisis plan with your clients when they are feeling well if you suspect they will require it.            (they will not be able to do it when suicidal ideas have a grip on them) 

8.    Your client’s safety needs to take precedence over your therapeutic relationship.
       You can avoid confusing conflicts by informing your clients at the beginning of  therapy that if they          reveal that they are going to harm themselves you will do what it takes to ensure their safety.

9.    Give yourself plenty of time between sessions if you have any indication that someone is                        vulnerable to suicide. (The last thing you need is to be in a rush with decision making)

Know what you are listening for.

1.    Many people experience suicidal thoughts as an escape from the pain of their existence. Some              people live with daily (chronic) suicidal ideation. There is a significant difference between thoughts          about suicide and making plans about it with an intention to die.

2.    Sometimes clients will try to backtrack and say that they are ok when they see that you are taking          action to ensure their safety. If your clinical judgment says that the person is at risk do not go back          on your clinical decision unless you have document-able evidence to the contrary. 

Consult, inform and document.

1.    Consult with another clinician and document that you have done so. You can consult via the phone        with the triage worker from the adult community services team (ACS) for your client’s local                      catchment area if no one else is available to you. The ACS provides care previously provided by            CAT, CCT, MST and PMHT 
       Ask for the workers name and document that you have consulted in your notes.

2.    Ensure you communicate with other members of the clients treating team if they exist and be sure          to keep them up to date with the client’s vulnerability if it increases. Document that you have done          so.

3.    Write clear, concise notes after the session. Include all and only the necessary facts. 
       Ensure that anything contained in your notes is factual and clinically observable.
       Examples:
       X stated “I will attend my GP appointment tomorrow at three”
       I informed X’s treating psychiatrist of her increased risk via the telephone at 3pm.
       X revealed that he has been experiencing fleeting suicidal thoughts but denies that she has any              current plans or intent to harm himself.

​
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Personal and professional reflections on the experience of Mindfulness.

5/26/2015

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Personal and Professional reflections on the experience of Mindfulness.

Personal encounters with Mindfulness Meditation.
I have been attracted to the idea of meditation ever since I first heard of it at fourteen years of age, but it was twelve years later in 1996 that I finally had the opportunity to attend my first meditation retreat. 
Of course it was life changing. I distinctly remember walking to work on return to the city, down the same dirty street I had walked every day prior to the retreat, suddenly I was shockingly aware of the vibrant green leaves contrasting the dull grey streets, as though I had never seen the trees before. Where prior to the retreat I had felt alone and dissatisfied with my friendships, post retreat I was deeply grateful for the friends I did have. Instead of lying in bed in the morning ruminating for an hour or two before I got up I was able to simply get out of bed and get into my day.

Keeping sane in my first year of practice as a therapist.
Coincidentally it was on return from this first retreat that I learned I was being given the very exciting opportunity to join the outpatient therapy team at the addictions treatment centre where I worked as a nurse.
The new role came with a steep and fulfilling learning curve and without my new found meditation practice I would have really struggled with the responsibility. Holding onto my sanity was a strong motivator to keep me committed to that first year of mindfulness practice.

Patiently waiting

For years I wanted to incorporate mindfulness meditation into my therapy practice but I felt hampered by the dominant therapeutic paradigm. Working within the mental health system, I was fearful that teaching my clients to use mindfulness would be viewed as unprofessional or religious. I had not yet seen any empirical evidence demonstrating the efficacy of mindfulness so I kept my mindfulness practice to myself. 
In recent years however it feels like the therapeutic world is abuzz with the miracle of mindfulness meditation. Every year more and more scientific evidence is emerging in support of the capacity for mindfulness to change people’s brains and therefore their lives. 

Practical benefits of incorporating Mindfulness into my therapeutic practice. 
Nowadays I rarely  start a therapy session without a brief mindfulness practice. 

Facilitating a few minutes of mindfulness at the beginning of each session helps me to become highly focused and present to the people who consult with me. Importantly it also helps me to be present to and make therapeutic use of my subtle internal responses to the events which unfold within the therapeutic relationship.
Initial research has shown that clients of clinicians who practice mindfulness meditation have better therapeutic outcomes than the clients of clinicians who do not, Grepmair, Mitterlehner, Bacheler, Rother and Nickell, (2007).

A few minutes of mindfulness helps my clients to arrive into a place of presence to themselves at the start of a session. It increases their capacity to be aware of their thoughts, feelings and reactions during the session and it provides an essential experiential learning opportunity which will translate to their lives outside the therapy room.  When a client's emotions or memories become overwhelming in a session, facilitating some moments of mindfulness helps them get grounded into the present and into their bodies, and teaches them how to keep emotionally safe when feeling overwhelmed. 
When working in a group therapy context I use mindfulness in a similar manner whenever the group energy becomes ungrounded or highly emotional.
And my favourite mindfulness of the senses exercise has never failed to calm the distressed, anxious or tearful clients who frequently call our team at the busy outpatient therapy clinic at which I am employed. 

Increase your knowledge and confidence in using practical Mindfulness techniques with your clients 
If you would like to increase your knowledge and confidence in using practical Mindfulness techniques with your clients please check out my July 4th Learn to Teach Mindfulness Workshop on the booking page of this website or go to the secure page at trybooking  http://www.trybooking.com/HOVW OR http://www.trybooking.com/133064  

Grepmair, Mitterlehner, Bacheler, Rother and Nickell, (2007). 
Promoting mindfulness in psychotherapists training influences the treatment results of their patients: A randomised double-blind control study. Psychotherapy and Psychosomatics, 76, 332-338.doi:10.1159/000107560
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Collectable Values Cards.

4/24/2015

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Sanctuary the first in my comprehensive set of Collectable Values Cards.

I am excited to begin distributing this first card in my comprehensive series of Values cards. Each card has a unique image created to evoke the feeling of the value it represents.
The values cards are designed for the use of therapists and supervisors in their practice and individuals and couples in their lives.
I have chosen Sanctuary as the first in the series of values cards as it is the value I hold as most important in my work as a therapist.


The Sanctuary card accompanies my recent Blog posts which address creating and maintaining safety in therapeutic relationships.


http://www.anniesloss.com.au/blog/the-first-thing-i-learned-about-therapy-and-group-facilitation
http://www.anniesloss.com.au/blog/conceptualising-and-communicating-the-notion-of-personal-and-therapeutic-boundaries 
http://www.anniesloss.com.au/blog/my-personal-guidelines-for-maintaining-therapeutic-boundaries

http://www.anniesloss.com.au/blog/therapist-self-disclosure-in-the-counselling-relationship

Where can you find the values cards?
I am distributing the cards to cafes, cinema's, learning institutions and relevant  health and healing  centres.
If you would like me to send you a card or have a space at your place of practice at which I could display them for collection please contact me with your postal address via my website. www.anniesloss.com.au

Incorporating arts based exploration into acceptance and commitment therapy.
The inspiration to create these cards came from my therapeutic practice with individuals and groups in which I incorporate arts based methods and acceptance and commitment therapy (ACT).
The purpose of ACT is to live a meaningful, satisfying life centred in our values.
ACT uses mindfulness or awareness training as a foundation from which we can learn to experience uncomfortable thoughts and emotions safely so that it is possible to take action toward living in accordance with what we know in our hearts really matters to us.
In my acceptance and commitment therapy work I have found stepping out of the dominant paradigm of talking therapy and into an arts based exploration for values identification indispensable. Arts based exploration allows the people I work with freedom from the self judgement, fear and void of knowing they frequently experience when asked to speak or write about what really matters to them.

Arts based values exploration in ACT group therapy.
Prior to introducing arts based values exploration to the ten week ACT group therapy program I coordinate, it was not uncommon for group members experiencing remoteness from their values to become hostile or hopeless when invited to identify what really matters to them.  By incorporating arts based exploration to the program we now find that “Introduction to values” is an engaging and energised therapy session in which the facilitator and participants become significantly more connected, group dynamics cohesive, and heart warming tears are not uncommon.


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Therapist self disclosure in the counselling relationship.

4/3/2015

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To disclose 

or not to disclose.
Therapeutic efficacy and safety.
Choices about how much or how little we disclose about ourselves to our clients are based on four important factors.
  • Therapeutic efficacy
  • Impact on the therapeutic relationship
  • Safety
  • Theoretical underpinnings 
Disclosure of your personal information within a therapeutic relationship should always be clinically driven and for the obvious benefit of your client. The content of your self disclosure should never be current or unresolved and needs to hold very minimal emotional energy or difficulty.
It is important to remember that just because you feel safe telling your client something about yourself does not mean that they will feel safe hearing it.
Poorly considered disclosure of content from your private life can change the dynamics of the therapeutic relationship and cause confusion for the client as to what the roles and expectations of the relationship are. However refusal to answer reasonable questions about yourself can leave your client feeling inconsequential or dis-empowered which may impact adversely on the therapeutic relationship.

A therapist's decision to disclose personal information should take the following questions into consideration.
  • What is the purpose of this disclosure?
  • Will this information be helpful for the client’s therapeutic aims?
  • How might this information affect our therapeutic relationship?
  • Could it cause harm in any way?

Safety of the clinician.
Appropriate self disclosure will vary according to the population with whom we work, the size of the community in which we work and live, and the proximity of our workplace to the community in which we live. Other factors will include family, lifestyle choices our involvement in social media, past experience and personality style.


Theoretical 
considerations.
The degree to which we use self disclosure in therapy is also strongly influenced by the theoretical basis of our practice. Traditional analysts have followed Freud’s instructions to remain very neutral and anonymous, with the idea that the therapist should act as a mirror or a blank screen for the client’s feelings and thoughts to be projected onto.
More recent theories hold the therapeutic relationship as the most important factor in predicting therapeutic outcome and therefore encourage well considered self disclosure for the building of the relationship.
Behavioural and cognitive therapies encourage self disclosure as a teaching tool or a way of normalising the human experience of clients. Political considerations also influence what is considered appropriate self disclosure in therapy with therapies influenced by feminist theory such as narrative therapy emphasising the importance of an egalitarian relationship between therapist and client.


How does disclosure occur?
Deliberately - Through what we choose to tell our clients, or what we put on our website or professional profile.  How we dress, what we put in our therapy room, and how we choose to respond or react within sessions.

Unavoidably – Our age, gender, physical appearance, where we practice, how we wear our hair, wedding rings or a visible tattoo, pregnancy, illness, time off work.
(If you practice from home a great deal about you is disclosed by your house itself.)

Accidentally – Unplanned meetings outside the therapy room or on social media and our spontaneous verbal and non verbal reactions.

Clients’ deliberate actions – It is quick and easy for the most well meaning client to search on the internet and find all manner of information about you, the content of which you will often have very little control.


   

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Don't be afraid to interrupt.

2/17/2015

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May I 
Interrupt 
your 
train of thought?

When people come to us for therapy it is all too easy for the conversation to be a repetition of the well worn discussion they have been having with family, friends and themselves.
It is our responsibility to ensure that this does not happen; no new understanding or change is going to come from a rehash of the already known facts.

It is difficult to refocus someone’s train of thought when they are telling their story in therapy because in social situations it is a very rude behaviour. It can be especially challenging when the person speaking is distressed or passionate and paying you to be a compassionate listener.
However the capacity to intervene and redirect the conversation is an essential skill for any therapist and it is absolutely crucial for every group facilitator.

When new people join my therapy group I always start by asking them, have you been in any kind of group before? And if so what were the good things and the not so good things about it? I do this as a way of orientating to and validating people’s prior experience and as a starting point to create group culture guidelines. Invariably the most popular ‘not so good thing’ that comes out of this discussion is the irritation of taking part in a group with someone who dominated the conversation and a facilitator who could not contain them.

It is easier to redirect a conversation if you forewarn the person that you will do so from time to time and negotiate how this could best happen.

Let them know that it is your responsibility to make sure the therapy session moves into new terrain so that the therapy is serving their therapeutic aims.

Listen for the pauses in the rhythm of person’s speech and step in when a pause no matter how slight occurs.

If no pauses are happening at all you will need to speak gently over the person and ask their permission to interrupt, a stop hand signal like that of a cyclist can help.

I use phrases such as “May I ask you to pause (hold that) for a moment?” “May I ask you about something you said earlier that caught my attention” “would it be OK if I just recap on what I have heard so far to make sure I am understanding you correctly?” "I'm curious about..."

Sometimes this will not be direct enough to interrupt a determined speaker who continues to talk over your attempts to redirect the conversation, so from time to time you may have to be quite assertive with your tone of voice, speaking more loudly and dropping the pitch at the end of the sentence.

Before the end of the session be sure to check in with how it was for the person to have their conversation refocused, and ensure they understand your motivation for doing so.


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My personal guidelines for maintaining therapeutic boundaries.

2/3/2015

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Some simple guidelines I follow in order to maintain clarity and safety within my therapeutic relationships.

Ask for consent frequently– Help your clients to maintain their own boundaries by asking permission frequently as you utilise different techniques or inquire into different aspects of their experience.

Stay in one room - when a therapeutic relationship exists in one physical location it helps define and contain the experience.

Refrain from physical contact such as hugs – physical contact can be very confusing or even frightening for some clients.

Time keeping – Try not to let the session go any longer than ten minutes over the scheduled time. 

Time and day – Seeing clients out of expected working hours can compromise our safety and our boundaries.

Support between sessions - Be clear about your availability for support in between sessions. 

Make sure you get paid a fair wage – Set your price for full fee paying and concession sessions and don’t make exceptions.

Be clear about cancellations and payment – Make your policy clear from the outset and stick to it.

Be mindful about what you wear- Consider what you clothing is communicating.

Get insurance and join your professional association – Being part of an official body can bring an important sense of legitimacy.

Get regular supervision – A supervisor needs to be someone you can trust when you are feeling unsure or vulnerable about any aspect of your work.

If you feel even slightly uncomfortable – about something that is happening in your work even if you don’t have any words to explain it talk to your supervisor or a team member about it. Nothing is too small or silly to pay attention to.

Have a conversation about what will happen if you meet outside of the therapy space – I try to refrain from anything more than saying hello.

Help your clients maintain their emotional safety – If you feel that your client is at risk of revealing too much to you in a session or too early in the relationship help them to remain safe by voicing your concern and helping them to stop.

Never agree to keep a secret from other members of your client’s treatment team – except within the legal bounds of confidentiality.

Avoid doing therapy with friends and associates – Be cautious about doing therapy with friends of friends as well.

Be cautious with self disclosure - just because you feel safe sharing something personal about yourself with your client does not mean that they will feel safe hearing it.


See my next post for more about personal disclosure.


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Conceptualising and communicating the notion of personal and therapeutic boundaries.

1/15/2015

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Conceptualising and communicating

the notion
of personal
and therapeutic
boundaries.


When I talk about boundaries with my clients I often get them to consider the boundaries which surround their homes, how they are delineated and what purpose do they serve? What are they made of? What is it like living within or without them?

Around our homes boundaries are there to make it clear where my property ends and yours begins. In some cases they constructed very clearly and sometimes it is a matter of cultural understanding that beyond a certain point the property stops being public and becomes private. 

Like the boundaries around our homes personal boundaries create privacy, they prevent people venturing in where they are not welcome; they protect our resources and keep us safe when we are vulnerable. If they are too high or too thick they can isolate us and disconnect us from the people around us and restrict our world view. If they are not clear or strong enough we can end up exhausted, resentful and even unsafe.

Healthy personal boundaries allow us to make aware choices about how much and what of ourselves we share with others. We can make these choices to maintain our privacy and safety or to open up and allow others in to know who we are and even what our vulnerabilities are.

A person parented by healthy, loving, consistent, respectful, parents with good personal boundaries learns to regulate what is appropriate to share physically and emotionally and what is not appropriate, in most interpersonal situations.
For a person who has experienced trauma or neglect, especially in childhood it can be different, the sense of what and how much is safe or helpful to share at any particular stage in the development of healthy relationships is often compromised.

Maintaining both personal and professional therapeutic boundaries is a dynamic process which requires ongoing awareness, attention and communication as a relationship develops.

As therapists it is our responsibility to maintain the boundaries of our therapeutic relationships through action and clear communication. Clear boundaries enable the people with whom we work to feel safe, to know what is expected of them and what they can expect from us. This clarity is essential to create the safety required to for effective therapeutic work to take place.

As therapists our boundaries are guided by our professional codes of conduct, the foundation of which is the responsibility to ‘do no harm’. It is our ethical and legal responsibility to follow these codes to keep both our clients and ourselves safe within the therapeutic relationships we develop.

Beyond this each therapist develops their own way of building and holding their professional boundaries with clients. These more subtle aspects of our professional boundaries will be influenced by the theories and philosophies which underpin our training, our individual personalities, professional values and experiences and the different client groups with whom we work.


Read my next post for some simple, practical guidelines I have developed for myself to maintain clear professional boundaries. 








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