In the Room

A blog focussing upon cognitive behavioural & psychodynamic techniques & issues “in the room” rather than case or theoretical discussions.

Chris Allan is a Clinical Psychologist and Director of the Psychology Clinic at the University of Wollongong in New South Wales, Australia. His weblog In The Room addresses a range of therapeutic issues and the related literature.

Each post illustrates a problem encountered by therapists and offers insights into this problem, often with extensive quotes from relevant textbooks and journals. As a round up of “therapy tips & techniques you will find in your textbooks”, In the Room should be of use to any psychological therapist and is well worth a read by physical therapists also.

Dibs In Search Of Self

A detailed, session-by-session account of a therapeutic intervention. Written by the therapist and detailing all the detours & blind alleys that never make it into textbook accounts of the therapeutic process.

Many clients, some famous and some not so famous, have written of their experiences in therapy. Therapists’ accounts of therapy tend to be confined to heavily anonymised snippets of conversation illustrating a particular point in therapy textbooks, or case studies in peer-reviewed journals which focus more upon the diagnosis & outcome than upon the process of intervention.

Dibs In Search Of Self is that rarest of books, an account by a therapist of every session (and the related consultations with teachers and family) of her contact with a small boy, the titular “Dibs”.

Virginia Axline is the author of Play Therapy, which outlines the application of a Rogerian, client-centred therapy approach to the psychological treatment of children. Play Therapy is heavily illustrated with the usual one paragraph snippets of conversations with clients (including Dibs), but this book describes, one chapter per session, the actions & discussions comprising each session and the therapist’s reflections on her client’s disclosures & her own actions (including her errors).

Dibs In Search Of Self is accessible to any reader and is a fascinating, moving book in its own right. It is, of course, required reading for anyone working with children. Moreover, as an insight into the mind of a therapist as a case progresses, it serves as an illustration not just of Play Therapy, but of sensitive & reflective practice with lessons for any therapist, regardless of their profession or client group. Oh, and it has a happy ending.

Reference

Axline, V (1964) Dibs: Personality Development in Play Therapy. Penguin Books Ltd

I have to breach confidentiality – part 2

Disclosures requiring that confidentiality be breached are rare. A little preparation should permit you to focus upon supporting your client through the process, preserving your therapeutic rapport.

In part one, we considered how to react when a breach of confidentiality seems necessary, how to prepare for such an eventuality and what to say to the client.

Now we will consider how to continue your involvement with your client once you have had to breach their confidentiality. We will also consider how to proceed when your decision to breach confidentiality is reached outwith the session, whether independently, directed by your supervisor or required by law (eg: by a court order).

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Transfer control of the session with codes

Unfamiliar co-therapists can use code phrases to transfer control of the session. Both they and the client can then focus on the client’s issues rather than the dynamics between the therapists.

While there should be no confusion in the mind of the client as to who is leading the session, there may be some stress for the therapists. Trainees may wonder if and when their supervisor will take over (or in some cases, may wish their supervisor to rescue them!). Supervisors may wish to ask a question or reinforce a point, but hesitate to undermine the trainee by interrupting.

The client’s focus should be on the issues they bring to therapy. Any awareness of unease on the part of their therapist may distract from this focus. Transfer of control of the session from one therapist to the other should be obvious to the client, but wrangling between the therapists should not.

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Hypotheticals encourage proactive supervision

Using supervision to plan ahead for common and uncommon events has advantages for therapist and client. Both gain when the therapist has considered their range of responses ahead of time.

Ideally, clinical supervision is proactive. You discuss the progress of your cases and identify opportunities to be developed and pitfalls to be avoided. Inevitably, some supervision is reactive. You describe a problem or crisis and decide how such a situation can be avoided or better managed in future.

Reactive supervision can be dispiriting, even disempowering. The supervisor is given the role of dispenser of wisdom to the supplicant supervisee. A directive supervisor can leave you with the impression that you are still a novice (whatever your actual stage of training) with much to learn. Hopefully, we all still have much to learn, including our supervisors.

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Practicing Therapy

A collection of exercises for developing therapists. The insights to be derived from this book should improve the practice of any therapist.

Somewhere there’s a book that all the experienced therapists know about and it’s not about how to do therapy, it’s about how to do therapy better. It’s got all the secret little extra tricks they know about that aren’t in any of the models and that they forget to tell you about in class. And they won’t ever tell you where that book is – you just have to figure it out.

As Margaret Rambo admits in the introduction, Practicing Therapy doesn’t contain many secret tricks, but it is a book about how to do any therapy better.

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