Description of Therapy Process - Assignment Example

s for the reader To keep the anonymity of the client I have changed his and any other s that you might encounter both in verbatim and inthe report. I have also numbered the interventions used in the process so that the reader can follow them more easily. Finally, I have used A if the intervention comes from the client and T if it comes from me the therapist. Process Report Andrew’s interesting first sentence (A1) after the long initial silence seemed to contradict his body language. The latter played an important part in our therapeutic relationship, and on many occasions was the only means that I had to try to understand where he was with his feelings. Working with polarities/dualities -- body and mind, duty and pleasure, straight and gay -- very much set the mood of this and past sessions and has been very challenging for me. Challenging because it brought me back to the way I was processing some aspects of my life, when I felt it was safer to be at one side or another of the spectrum, rather than the middle where unpredictability would jeopardise my safety and make me feel anxious. In (2T), when I asked Andrew what type of medication he was taking, I learned how little he has revealed to the assessor and indeed to me in the previous sessions. For example, he has not revealed to anyone that he is going to therapy or his doubts about his sexuality, and his depressive condition. The latter makes me aware of some kind of similar narratives that I could encounter in other therapeutic alliances. I feel that with Andrew I am struggling to follow the rhythm and the pace he gave to the session. The ‘dance’ between us sometimes goes out of synch, as he unexpectedly stops and starts (with his silences and overwhelming recounts). This produces in me a constant vigilant state that makes the therapeutic relationship very tiring. However, there are also times in this unsynchronised dance where I am in and out of our therapeutic alliance; the ‘in time’ is when I am present and part of the client’s world and the ‘out’ is when I am the spectator of his world. During this time I move back into my own space where I can reflect and try to make sense of my, his and our world. I am realising more and more the wide river that runs through the client’s intellect and the solid bridge that we need to construct to be able to move freely from one shore to the other. Sometimes I feel that building that bridge is a huge task, and I wonder if we will succeed. The doubt is possibly to do with Andrew being my first client and the complex world that he brings in the therapeutic alliance. The doctor that sits in front of me every Tuesday has a great intellectual capacity, which does not necessarily match the way he operates when dealing or expressing his feelings. While part of our process is done at the intellectual level and we connect very easily, when emotions and feelings are exposed the connection changes, and we change. Andrew’s difficulty processing his feelings made me feel like I was walking on my tiptoes; I became aware of how basic and well ‘boxed’, to use one of his favourite words (19A), my intervention needed to be in order to overwhelm or overthrow the fine balance so far achieved in our therapeutic relationship and frame. Creating a relationship is at the core of the therapeutic alliance with Andrew. Two of Donald Winnicott’s principles are very much part of my way of being with him. When Winnicott talks about the role of the therapist, he states that the setting is often more important than interpretations; by being on time, being there, being real we can create a secure space for the client that will facilitate in him a sense of basic trust. That secure space is the one that I aim to provide for Andrew during our therapeutic alliance and I sense that with him the more secure the space I provide, the higher the likelihood he will be able to trust me and explore together his concerns and issues. I also appreciate Winnicott’s idea of holding the client as “a form of love” (1965, p. 65), the love where reliability and empathy are crucial and sincere. I would say that my approach with Andrew is based on an empathetic level and personal neutrality. When I was trying to bracket my biases and prejudices I encouraged the client to describe rather than explain the interventions (18T) (21T), by using a more phenomenological approach and methodology. Andrew’s resistance and difficulties in talking about his unconscious world or his childhood experiences, or anything that belongs to his past, is very clear to me and any attempt to work towards that direction would, at this early point, jeopardise the therapeutic alliance. During A. silence (8T) I sensed a growing need to rescue him. The latter is a mode that I experienced in my previous sessions, especially after prolonged silences were his body language would inform me of his high level of anxiety and possible pain. Reflecting on why I feel this urge my thoughts go to the idea that in wanting to rescue someone from an anxious and painful situation I might want to avoid my own anxiety and pain. Moreover, I am also wondering if the desire to “intervene” that I felt after my intervention in (8T) was more to do with my need than his. I am learning that the rescue mode, instead of facilitating the client to release some of the anxiety and pain, can also be an obstacle as it can interfere with his own process. An example of halting the client’s process could have happened in (13A) when I felt that A “was immersed in his own thoughts.” At that point I could have possibly prevented the client to process some of his concerns and not give him the time to do so. The body language that Andrew displayed during this, and past sessions, is complex and varied and I sense that he uses it as a way of communicating distresses that he is not yet able to voice. For instance, after my intervention in (8T) and (12T) he stretched his arms in the air and locked his hands in a position that reminded me of a painting by Dossi of Saint Sebastian ( pic 1). Reflecting on the latter, the image evoked in me a sense of pain and vulnerability. The pain I felt in that moment of struggle, possibly coming from both of us, in me had its source in wanting to rescue him and consciously resting from it, while feeling how vulnerable and fragile our therapeutic relationship still was. After the session I realised that some of the interventions that I had made contained some assumptions (26T), (29T). It was very useful for me to be able to think about them and how I could have better intervened, or used the material that A. gave to me. In (14T), for instance, a more open intervention like: ‘in what way have you changed?’ would have possibly given to the client more leeway to interpret and respond to my intervention. Being able to move away from assumptions and interpretations is not an easy task especially when the culture that we live in is embedded with assumptions or readymade interpretations. Ernesto Spinelli also commented that “as human beings, we attempt to make sense of all our experiences. Through our mental acts, we strive to impose meaning upon the world” (p.1). The latter does not want to justify the reason of my interventions, but wants to highlight how the culture that we live in has a strong influence on who we are and what we do or say. A quote from Patrick Casement offers me an alternative and food for thought from some of my interventions; he says: "whenever possible, we should interpret what a patient is actually feeling at the time, and not attempt to speak to what we would like the patient to feel instead" (1985 p.137). At the end of the session Andrew announce that he had not enough money to pay me ( 31A). I felt anxious and unprepared for a response. In that second many thoughts went through my mind. I had thoughts about my self-worth and him leaving therapy. However, I also felt that it could have been a genuine accident although something to remember and discuss if it would occur again. An idea about trust came into my mind, and that was possibly the analytical kind of trust that Andrew needed to check and be sure before he would allow me to gain access to his internal world. As mentioned at the beginning of this paper, with Andrew I feel it has to be a very slow process. At present what I perceive is most important for our therapeutic alliance to work and make some progress is for a sense of containment to be present at all times According to Casement, "it can be crucial for a patient to be thus held in order to recover, or to discover maybe for the first time, a capacity for managing life and lifes difficulties without continued avoidance or suppression" (1985 p.133) Read More