The skill session - Essay Example

The skill session Introduction The skill session, possibly more than any other learning process, has given me firsthand experience of what my future career will be. It gave me the opportunity to assess myself in a context where real events and issues were raised and discussed via a therapeutic process. Due to the limited amount of words available in this essay, I will briefly try to give an insight to what have been some of the most important psychodynamic concepts and tools that I have experienced during the sessions. I will describe them as well as some personal experiences and considerations. As each skill session was only fifteen minutes long, during the trimester I was able to cover the roles of therapist, client, and observer. My examples will take into consideration my own point of view based on the role that I was assigned during a particular session. However, while writing this essay, I have also considered some general feedback given to me and my peers, as the latter were equally important and a great source of learning. They gave me further insight into the therapeutic alliance. Relationship between the Therapist and Client If I was going to be asked the question “What is the one of the most important things that you have learned after ten weeks on working psychoanalytically in the skill sessions?” then my answer would be the relationship. Before divulging into any details of my personal experiences during my skill sessions in my last ten weeks of the course, it is important to explain that, for me, at the base of any successful therapeutic alliance, the most significant aspect is for a therapist to develop a healthy relationship with his or her client. “The relationship is important in itself because the quality of this person-to-person encounter in the therapeutic situation is the stimulus for positive change” (Corey 2009, p.150). Therapists must understand that their personal and professional ethics and values have a great impact upon their relationship with a client (Casement, 1984). Although, every therapeutic relationship is different, it is also true that every school of thought, theories, or approaches agree that it is the relationship that will make the difference whether there will be an effective outcome. At the base of the client’s and therapist’s relationship, a fundamental trust and respect needs to be present as well as an un-judgmental stance from the therapist. In addition, one also needs to remember that any successful therapeutic relationship requires genuine care and love towards clients. This can be described metaphorically as the fuel that makes that special engine progress and work. During the therapeutic alliance, different processes are taking place—the client’s social, economical, racial, and cultural backgrounds influence the latter. A therapist needs to have an open attitude and mind to be able to completely understand and accept the client for who they are; no preconceptions should be made, as this would jeopardize the relationship and its outcome. During the collage skill practice, in which I was at one time or another playing the role of a therapist, client or observer, I was able to experience and discover some of the processes that can take place during a session. Although it is a limited amount of time, it gave us a glimpse of a full therapeutic session. I nonetheless found myself in a group of students where their openness and trust gave me and my colleagues some valuable insights in their personal lives. The latter allowed me to witness and work with a range of psychoanalytic concepts that I had learned and become familiar with during the theoretical lectures preceding the skills practice. Transference According to Bauer (1994), transference is a therapeutic process in which the patient transfers his feelings to the therapist. These feelings arise because of inappropriate relationships in the past. While they may not seem important now, they can help the therapist to understand their patient’s present condition. In “Studies of Hysteria,” Freud (1905) introduced this concept and phenomenon. Although he initially thought of it as an obstacle, with time (1910) he understood the great contribution and value it had during therapy. It is known as a very important part of the psychoanalytic tool in which the patient transfers his attitudes and feelings linked with their significant others to the therapist. The patient, in turn, gains an insight into the present distortions in his life by looking at past conflicts in relationships that may have remained hidden or inactive in his memory. In one of the skill sessions in which I was the therapist, the client, who, in a very agitating and angry tone of voice, was narrating the ordeal that he had with his brother. During the session he became more and more infuriated. I could not see or feel any reasons why he was projecting that anger by talking to me in that way. I tried to respond to him by reflecting it back to him and making him aware of what I felt was taking place in the room. At the end of the session during feedback time, I went through with him about what happened and why he felt anger towards me. The client, in a puzzled expression, could not respond to my question; however, he later added that I could have reminded him of his own “good to-do” brother and that could have ignited his anger. While he was saying that, I was starting to acknowledge that I also have those reactions. By identifying them in others, I was becoming more aware of my own transference. Although at this stage I still find it very difficult not to avoid it. Counter-transference Counter-transference involves the intuition, feelings, attitudes, and behavior that the therapist shows in reaction to the client’s experiences. The stimulation in the therapist’s mood, the excitement, curiosity, anger, sympathy or whatever arouses the therapist, is what we call counter-transference. Freud (1910) also introduced the concept of counter-transference in his article “The Future Prospect of Psycho-analytic Therapy.” The therapist must be aware enough to recognize this stimulation within him and must be able to figure out if this stimulation is coming from the client or is arising from within. As a client, I remember a moment within a session where the therapist made an intervention about me being really tired and possibly exhausted from previous lectures. However, I was not tired at all. On the contrary, the topic that I was discussing with her was not of any soporific nature. I did not understand where her remarks came from. It was only at the end of the session when we had a chance to talk openly about our experiences during the session that I pointed this out to her. Other students who were also present during that session pointed out the same intervention. The therapist realized that the feelings of tiredness and exhaustion were her own. This was reinforced when one of the observers picked up on her yawning. Working with Silence Silence can also be a mode of communication during a psychodynamic session. It is a very powerful tool that I have only recently appreciated the difficulty in mastering and managing it. Nonverbal communication can be used by the client to convey important messages of help and great significance; however, in the hands of a less than competent therapist, this intervention can result in the former feeling detached and alone, breaking the trust that was originally in place. As it contains so many meanings and is charged with different feelings, trying to give sense to it can be a difficult task. During one of my therapy sessions in which I was the therapist, my colleagues who were observing me made a very interesting and insightful remark about the way I held my silence during the session. In that therapeutic alliance, I initially used silence as a tool to let the client talk about her experiences; however, later on in the session we moved to a different stage of the process. The silence became long enough that it made the client feel uncomfortable. In the feedback, the observers also reiterated the uncomfortable feeling that permeated the room as well as the kind of persecutory tone that the long silence conveyed. I felt that what was pointed out to me was a fair comment. I realized that instead of breaking the silence and investigating what was the nature or reason behind it, I let it go without me taking control over it. Later that day, I reflected on my excessive silence as a possible counter-transference or as a psychodynamic tool that I had overlooked or overused. I was amazed to learn what it seemed a simple intervention had so much power. To find the right balance and learning the skill of working with it is something that I still struggle with. The Frame The frame includes the “therapeutic setting and boundaries” (Grohol 2004) in which the session is taking place. It can include the place or room where the session is being held, the setting of the room, the seating arrangement, the distance between the therapist and the client, the time of the meeting, the duration of the meeting, any distractions coming from within or outside the room, or the mode of payment. Any distraction in this frame leads to distraction in therapy. An ideal frame includes a single time payment, a single location where the client has to come for sessions, a set time and duration of sessions, a silent room where there is no chance of distraction from outside, and a guarantee of privacy and confidentiality. Such boundaries help to contain and hold the client and are at the base of the therapeutic alliance. In view of the constant noise that can come from the outside the kind of rooms and space that we had at our disposal, the frame in our afternoon session was, at times, apt to be broken. The tiny room that we were in made difficult to find a comfortable distance between the client and the therapist. Moreover, the limited space made the room to feel even smaller by the presence of the other three students. Although their feedback provided exceptional insight into the therapeutic relationship, it did jeopardize the results of some of the sessions. For instance, the presence of the observers sometimes distracted me. This resulted in a halt to further explore some of the issues that were coming out from the sessions, as I felt exposed in that overcrowded environment. As a therapist during the sessions, I learned the importance that I need to give to the initial stage of the session and also to the end of it. The ending of a session is very significant, as there has to be sufficient time to recap the themes and main points of the session. However, it should avoid leaving the client with big open questions or issues that one is not able to discuss further because of the time limit placed upon us. As it happened in one of the sessions in which I was an observer, I could see one of my fellow students, who was the client, confused and lost at sea when the unexpected “Is it the end of the session yet?” came in the middle of his powerful narration. A possible extra minute or just a few words to insure that what was discussed was very important, but the constraints of time would have meant that his important story was going to be brought back to the room in the next session. I think that this would have been sufficient. The differences in cultural backgrounds and ethnicities among some of the members of the skill sessions have exposed, during therapy, some stereotypes and assumptions that, although discussed and clarified, are still an easy trap to fall that could put the entire process at risk. By being aware of one’s own identity, ethnicity, and sexuality, one is also aware of the differences and reactions that the therapist could provoke in a potential client; hence it would be easier to have control over the frame. Conclusion Although a trimester may seem like a short time, the journey during the skill sessions has been a long winding road of great interest and experience that, at times, I found difficult to take in my stride. During the journey, I was able to challenge many of my assumptions and renegotiate some of my beliefs. The relationship between the therapist and the client is, for me, the cornerstone for a positive and successful therapeutic alliance and its outcome. However, to build a good relationship, the therapist needs to have personal, professional, and ethical values and principles so that the client feels comfortable in developing an honest and trustworthy relationship. My personal assumptions, cultural background, and ideas were often displayed in my behavior and responses to both the others and to myself. These were topics of discussions and a chance to reflect on them. While I had to appreciate that the “frame” that we were working with was not an ideal, it provided a platform from where I was able to witness and use some psychoanalytic concepts and tools mentioned in the essay. Thanks to the realistic contributions of my colleagues and their trust and feedback, I managed to experience and feel some unique emotions and the difficulty of dealing with them. What I will take away from this short but intense experience is some important feedback: to improve my skills to gain a more confident approach to shape and develop my own way of working psychoanalytically. References Bauer, G.P. 1994, Essential Papers on Transference Analysis, Aronson, London. Casement, P. 1984, On learning from the Patient, Routledge, London. Corey, G. 2009, “Relationship between therapist and client,” Theory and Practice of Counseling and Psychotherapy, 8th ed., Cengage Learning, USA. Freud, S. 1905, Fragment of an analysis of a case of hysteria, Hogarth Press Standard Edition, London. Freud, S. 1910, The future prospect of psychoanalytic therapy, Hogarth PressStandard Edition, London. Grohol, J.M. 2004, “Types of therapies,” PsychCentral, viewed 2 December 2011, Rainbow, C. 2002, Descriptions of Ethical Theories and Principles, 2011, Wear, S. 1992, Informed Consent: Patient Autonomy and Physician Beneficence within Clinical Medicine, Springer, USA. Yoder-wise, P.S. 2003, “Ethical principles,” Leading and Managing in Nursing, Elsevier Health Sciences, USA. Read More