Psychotherapy book review

Socially and culturally we interact with other people, each day in our working and private lives we seek to express ourselves to be heard and to see and hear others.  What and how we communicate varies from person to person.  We each have our own special interpretation of how things are.  The society we were born into and the unique cultural attitudes of our carers has significant bearing on the views we have.  Sometimes we experience emotional problems that cause us pain and left unexpressed this can lead to physiological illnesses.  In an ‘Introduction to psychotherapy’ Dennis Brown and Jonathan Pedder state that about a third of all patients who go to their family doctor have primarily emotional problems.

Psychotherapy is essentially a method of healing the psyche.  No matter how well intentioned our caregivers may have been there will have been many times when as a baby and child growing up that our needs will not have been met1.  How we responded and how these unmet needs affected us also depends on a multitude of other factors, ranging from genetic to cultural.  In Psychotherapy we assist people to get in touch with the feelings associated with those unmet needs, which may be interfering with current relationships.  This involves listening to and talking with a client, with the aim of helping them understand and resolve their predicament2, the goal is self-empowerment.

Practices today have been strongly influenced by Freud’s early work, although later studies also look to more ancient traditions and cultures. There are many different schools of psychotherapy using different methods and called by different names.  These have been shaped by the studies of later doctors, psychiatrists, psychologists, psychoanalysts, anthropologists and others.  Many studies have addressed religious attitudes, cultural, scientific and historical influences on why we behave as we do.  All the different approaches and techniques have the same goal in mind – to help people to improve their lives by understanding themselves better3

Why is it necessary to understand ourselves better? What is the relevance of Psychotherapy?

Many psychiatrists, psychotherapists, psychologists and writers of books on techniques for therapy are exploring these questions. Many look at our society as it is and examine what goes on in our lives.   Much of what we hear about on news programmes and read about in newspapers is designed to stimulate an emotional experience, it can even be regarded as sensationalised – that ‘s what sells newspapers.  Whole groups, organisations, cultures and individuals can experience strong emotions in response to hearing and reading other people’s arguments, propaganda and directives.   Each day in our interactions and watching TV soaps we are emotionally stimulated, which can stir up our own past experiences.  Sometimes our responses can cause us problems if we act out what we are feeling without filtering it to find out what it means for us.   For a healthier society we need to learn the skills of emotional expression, communication and effective handling and understanding of emotional experiences

Margot Sunderland, Director of the Institute for Arts in Therapy and Education, London, says in the opening of her book, ‘Drawing on the Emotions’4: ‘The focus in our schools is on education for future employment, on competence in surviving in a technological society, which has meant that pupils are increasingly being left emotionally illiterate.  Education in our system places emphasis on external reality.  What is happening ‘outside’ ourselves, with merit for high grades on what information we have absorbed?  Very little attention is given to ‘internal’ reality, the world of thoughts and feelings.   Yet, it is also clearly evident that our young pupils are dealing with huge emotional conflict as divorce rates soar and families divide.  Many of these children find it difficult if not impossible to concentrate and have no tuition in how to handle this confusion.  Parents are experiencing stress in the workplace and this is reflected back into the family environment which is perhaps why we are looking for alternative perspectives, some kind of antidote to the anxiety and unhappiness which is reflected back at us through the media.’

 

In his book, ‘Emotional Intelligence’5 Daniel Goleman argues that emotional literacy is as important as academic intelligence, that we are not whole, without  being literate in both fields.  He applies his research to how our corporations operate, how managers interact with each other and their employees.  It is vital that we are able to operate well socially.   To do this we need the ability to be independent and interdependent in our private and working lives6   We seek to be both autonomous and intimate7, to maintain a balance in order to function well, effectively and happily as members of the human race.  Another writer, Josephine Klein in her book ‘Our need for others and its roots in infancy’, shows by her research how we develop physiologically and how our view of the world is shaped in infancy by our genes, by our caregivers and by our society.  So how can we learn to live harmoniously with each other when we have been shaped by so many different factors that seem so different from the next person.

 

If we have problems with relationships, work, our self- esteem, depression and life generally, psychotherapy is one way of learning about more about ourselves.  It uses the knowledge and understanding of research and training and puts into practice the process of healing the hurt and damage we may have experienced.  The young baby and growing child make decisions about themselves in relation to others, sometimes those decisions may be painful.  How painful must it be for the infant who has had inadequate and abusive handling, they have made decisions about themselves in response to this.  Counselling and Psychotherapy provide a confidential, safe and supportive environment to facilitate individuals to re-make those early decisions and to become free of old messages and to move into a more healthy and nurturing understanding of themselves.

Psychotherapy will be as varied as the individuals providing it.  Individual associations have ethics committees and bodies such as the PCSR (Psychotherapists and Counsellors for Social Responsibility), UKCP and BAC, which exist to address challenging and discriminatory practices at all levels.  Still young, as a profession, psychotherapy is not without its discontents8, and this is healthy.  It is an important element of any profession that there is opportunity for open debate about methods of practice9.  This provides opportunity for growth and refinement and emphasises the importance of monitoring of methods and regular supervision within the professional bodies. There are ongoing studies in techniques in the effectiveness of psychotherapy,  and because of the difficulty in assessing outcome the debates continue and develop10.

As we move into a new century and we travel more widely, experience different cultures and seek to integrate with other cultures we also need skills to assist us with these moves.  For many of us psychotherapy can provide us with these skills. In the future as we help our children and future generations become more emotionally literate, we can encompass other attitudes, societies and cultures with understanding and respect.   All schools of psychotherapy have an ethos of respect and protection for individuals and pursuit of excellence.   Psychotherapy continues to grow and develop to modify and expand with developing insight and greater experience.

Celia Roberts

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Where to begin?

After a brief flirt with the Armed Forces ,at the tender age of 17-19 years, where I realised very quickly was not my ‘genre’, was one of a

Political Lecturer at Rochdale technical college.

My career was built on many years in the academic field ,and what seemed a lifetime of fighting for the underdog, and compassion for

that position.

It was during the ‘Marches’ of the 1970’s, the Miners Strikes of the1980s, the punitive years of the Thatcher era ,that my resolutions and principles

were sharpened.

Indeed  the early decisions of a young boy brought up in a Capitalist family,was where I learnt and experienced injustice at first

hand. It was from this setting then that my heart and spirit was moulded into the left wing radical  soul of those years, and the Therapist I am today.

Paradoxically it was during the early 1980’s that I experienced my lowest point.

I felt suffocated in my job as a Politics Lecturer, I did however enjoy working with new ideas ,and offering them to alert ,and engaging minds. It

was more to do with the deadening climate I worked in the mind-boggling bureaucracy of a Further Education College that was so stifling to me. I had in many

ways come to a full stop!

It was from this environment that I decided on yet another career change, and from here that “Lifestream” was formed. As

Freud said “it is out of the maximum frustration and despair that real change can often grow” Certainly this was the case for me at this particular time in

my history.

In September 1986, I undertook my first training in Clinical Psychotherapy,in many senses, it was a journey of the soul and spirit, the hope of finding

the key, and perhaps answers from another book or training course.  Of course what I finally came to realise was,that my real answers were to be found in

myself.

My Philosophy has always been, and still is, that we all have the capacity within our Spirit and Psyche for change and growth, what Berne in his book,

“TA in Psychotherapy” called “Physis”.   Which is the capacity for inner growth and change, I also believe that as human beings we must bear the individual

responsibility for that change.

However for us to really flourish ,the seed for change needs to be nurtured and cared for, so that we can finally believe in ourselves ,and in our destiny!

An essential requirement in the pursuit of the above ,is that we need to surround ourselves by people who inspire us, love

us, and have faith in our abilities, even if we hide them from ourselves.To be believed and validated is one of the vital ingredients towards us believing in

and developing our true self,

It was with the evolution of these beliefs that my Psychotherapy Training began to take shape. I studied primarily in the Humanistic School, from Carl

Rogers, through to Erie Beme and beyond. I avidly read books, which included Satre, Camus ,and some of the more influential existential writers.

I undertook training in the Psychoanalytical Theories from Freud to Christopher Bollas,and became engrossed in the inspiring schools of Self-Psychology of

Kohut and Gill.

I loved the ideas and compassion of these writers; it was an a life changing period.

I entered the late 1980’s, with a more fulfilled soul,and with a determination to make a difference ,and an impact in the world of Psychotherapy.

I passionately believed in my innate and learnt abilities, to help facilitate people in their own personal search for inner happiness and wisdom. Perhaps this is

where Politics and Therapy really meet.

 

In March 1987 I formed the “Lifestream Centre”, which was my first step towards this direction.

The “Lifestream Centre” was the early embryo of The Manchester Institute for Psychotherapy.  For me it epitomised my belief systems,The “Lifestream” was and is

the Stream of life, which is essential to our inner spirits, and the quest for growth and change, whether conscious or unconscious. It is within this Stream of life

that we must work to inspire,nurture love and cultivate life, so that our own energy force continues in a creative and dynamic manner working towards a collective

merging.

The “Lifestream” becomes a positive force towards change and a fulfilment of the self. In August 1993 the Manchester Institute for Psychotherapy was established

from the lifeblood of the “Lifestream Centre”.

We had initially called it The Manchester Institute for Integrative Psychotherapy, however we decided this was too long-winded a name so we changed it after

much discussion and consideration to The Manchester Institute for Psychotherapy (MIP) in late

1993.

By this time I had become a National and International Trainer in Transactional Analysis Psychotherapy (P.T.S.T.A, and a Clinical Psychotherapist registered by

the United Kingdom Council for Psychotherapy,  and on the British Register for Psychotherapists.

My training was now recognised not only the by UKCP, but also by the National & European

Transactional Analysis Associations.

By the time of writing in September 2013,The Institute has evolved what it is today-a Psychotherapy training centre  with a strong emphasis on

Transactional Analysis and Integration.

It has a strong Clinical dimension as well as a vibrant CPD programme ,which includes Supervision and Child Adolescence trainings.

At the heart of the institute there has always been a strong belief in connectedness and relationship ,which is at the heart of its evolution.

For myself,I am proud of where we are today,and excited by the new journeys which lie before us all.

 

 

Bob Cooke 2013

 

 

 

 

 

 

 

 

 

Our first training started in the September 1993/4 intake and it was with

great excitement and satisfaction that I witnessed the beginning of these

Training’s. In July 1995 June Brereton joined me as a full time Trainer and

Supervisor on the Transactional Analysis Psychotherapy programme, bringing

with her, her own brand of dynamism and professionalism.

 

Currently the Manchester Institute offers a wide range of Training Services;

its primary training is in Transactional Analysis Psychotherapy leading to

UKCP registration and British eligibility to that National Register. We also

offer short-term courses from Brief Psychotherapy to other more specific

courses in certain Disorders of the Self.

 

What gives me most satisfaction is that all this has been achieved without

the Institute losing its clinical base and its priority to Therapy and

Counselling. Another area of particular satisfaction to me has been the

growth of The Manchester Institute into what I see as a community, a

community of like-minded people within the diverse stream of life. This

community for me is at the base of the Institute’s success and is its

fundamental life force in the quest towards change and growth

 

At the time of writing, we have a clinical staff of 12 therapists working from the Institute

either on a part-time or full time basis. They continue to fill me with

admiration and respect. The road of a Therapist is never an easy one,

however it is challenging and life enhancing and what more can we ask.

For myself the metamorphosis is nearly complete. However I see that change

is the only certainty in an uncertain world and therefore perhaps a new

evolutionary cycle is just round the corner. What is certain is that the

principles/beliefs which formed the early foundations of the “Lifestream

Centre” have now formed the essential structure of the Institute so that we

can go forward with firm and positive conviction towards our own destinies.

I love what I have been partly, with help, responsible in creating. It is more

than an Institute to me; it is a commitment and a community through which

my lifeblood runs. A community of kindred spirits who, with great integrity

and dignity have joined me in what has truly become a model of excellence

and inspiration.

 

Thank you to all of you, past present and future, for love, commitment and

strength in helping me to make some of my dreams become a reality.

Bob Cooke 1998

 

 

 

The Treatment of Multiple Personality Disorder or what today is called Dissociative Identity Disorder, is a complex and sophisticated process.

The client who presents with MPD will have had a traumatic and disturbed history.

Their therapy profile will be one of a fragile persona which is usually characterized by fragmentation and disowned parts of the self.

Indeed, with this type of character, the Therapy will be long term and complex by nature.

In its essence, the Psychotherapist, will be dealing with the client’s many and varied parts of their Personality which may be difficult and in some cases almost impossible to reach.

For the therapist there will be many Transferential processes that will occur ,and Supervision is a necessity.
Virtually every aspect of treatment depends on the strength of the therapeutic alliance which must be cultivated globally and with each individual alter or parts of the self.

In the face of severe Psychopathology, painful material, crises, difficult Transferences and the likelihood that, at least early in treatment, the alters or parts of the self may have grossly divergent perceptions of the Psychotherapist ,and test him or her rigorously, the patient’s commitment to the task of therapy and collaborative co-operation are critical.

This emphasis is implicit in a general treatment plan which has 12 steps, many of which are over-lapping or ongoing rather than sequential.

STEP 1.

Involves the development of Trust and is rarely complete until he end of therapy. Operationally it means ‘enough trust to continue the work of a difficult therapy’.

STEP 2.

Includes the making of the diagnosis and the sharing of it with the presenting and other personalities. It must be done in a gentle manner, soon after the patient is comfortable in the therapy and the therapist has sufficient data and/or has made sufficient observations to place the issue before the patient in a matter-of-fact and circumspect way. Only after the patient appreciates the nature of his situation can the true therapy of MPD begin.

STEP 3.

Involves establishing communication with the accessible Alters. In many patients whose Alters rarely emerge spontaneously in therapy ,and who cannot switch voluntarily, hypnosis or hypnotic technique without hypnosis may be useful.

STEP 4.

Upon gaining access to the alters, step 4 concerns Contracting with them to attend treatment and to agree against harming themselves, others, or the body they share.

Some helper personalities rapidly become allies in these matters, but it is the therapist’s obligation to keep such agreements in force.

STEP 5.

History gathering with each alter is step 5 and encompasses learning of their origins, functions, problems and relations to the other alters.

STEP 6.

In step 6, work is done to solve the alters’ problems. During such efforts prime concerns are remaining in contact, sticking with painful subjects and setting limits, as difficult times are likely.

STEP 7.

Involves mapping and understanding the structure of the personality system.

STEP 8.

With the previous seven steps as background, therapy moves to step 8 which entails enhancing interpersonality communications. The therapist or a helper personality may facilitate this. Hypnotic interventions to achieve this have been described, as has an internal group therapy approach.

STEP 9.

Involves resolution towards a unity and facilitating blending rather than encouraging power struggles. Both hypnotic and non-hypnotic approaches have been described. Some patients appear to need the latter approach.

STEP 10.

In step 10, Integrated patients must develop new intrapsychic defences and coping mechanisms, and learn adaptive ways of dealing interpersonally.

STEP 11.

Concerns itself with a substantial amount of working-through and support necessary for solidification of gains.

STEP 12.

If all steps are actually achieved then follow up and Psychological support will be absolutely necessary and essential.

 

In Conclusion, my experience working with these type of clients very few will complete the 12 steps.

Usually full integration of the disowned parts of the self will be too hard to bear, and the loss and grief of the different parts of their self will be too overwhelming,for this full integration, in some cases hospitalisation is often needed.

For most MPD clients an understanding and a better way of communicating with the different parts of the self could be seen as Psychotherapeutic cure, certainly this option will enhance their life.

 

Bob Cooke  1994

This blog is about the Importance of Psychotherapists using Permissions within the therapeutic relationships with clients. It is vital that therapists think of using Permissions for many reasons.

Firstly, to actually take on the negative Parent in a person’s Psychological process.

Secondly, to actually be able to voice what the client may not be able to actually be aware of, is vital for them.

and thirdly, in the service of validation for the client’s very being.

I often think of Permissions as vital in the process of helping the client develop a Robust sense of self and defeating or desensitising the negative voice they often carry around within their psychological structure.

So firstly the Permission to Exist.

This is a very important permission, to explicitly say to the client, as it gives the client the permission to allow themselves to take on board that they Exist ,and they have a right to Exist.

Secondly, the permission to Experience one’s own sensations, to think one’s own thoughts and to feel one’s own feelings as opposed to what others may believe one should think or feel.

Thirdly, Permission to be Oneself as an individual of appropriate age and sex with potential for growth and development.

Fourthly, the Permission to be emotionally close to others. This again is very important in the sense of validating someone’s sense of self and challenging often the injunction that people carry around .which is not to show feelings .or not to be close to others. S This is a very important Permission.

Fifthly, Permission to be aware of one’s own basic Existential position. In other words, that they’re ok and people are ok.

That people are born basically ok and that other people are born ok as well. Permissions to change this existential permission. So if they haven’t decided people are ok but actually perhaps come from another position that people aren’t ok or that they’re not ok then it’s important for them to realise they can actually change their fundamental view on lifeS

Seven, the Permission to Succeed in sex and in work. That is to be able to validate one’s own sexuality and the sexualities of others and to “make it”.

Eighthly, The Permission to find life Meaningful – this is important to encourage people to reflect on their own purpose in life, their own existence and that life can be meaningful to them.

These Permissions are not linear order. They’re ones that I find useful working with clients, and I see I. haven’t put permission to be Joyful here .which is also very important.

Finally, a Permission important is the Permission to be yourself.

Your unique, special self, which is so important to the validation and growth of your self-esteem.

In conclusion, these Permissions I believe are vital.

They will help the person develop a good sense of robustness in life. To be able to carry around these Permissions are the basis of Self-esteem and validation of the self.

 

Bob Cooke 2012