Integrative Counselling and Psychotherapy

A Textbook

Basia Spalek, Mark Spalek

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351402552
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

Integrative Counselling and Psychotherapy: A Textbook is an engaging and comprehensive guide to integrative counselling, providing an explanation of the theoretical ideas underpinning person-centred, interpersonal, cognitive-behavioural (CBT) and hypnotherapeutic modalities.

Divided in two major sections, this book first provides a detailed exploration of the key integrative concepts - presence, emotional and psychological processing, attachment, thinking, and the unconscious – and then practically applies these concepts to the issues commonly brought by clients to therapy.

With the help of case studies, exercises and chapter questions, Integrative Counselling and Psychotherapy will be essential reading for students on integrative counselling and psychotherapy courses and for integrative practitioners.

Chapter 1
Presence for mental health and wellbeing

An integrative approach

All of humanity’s problems stem from man’s inability to sit quietly in a room alone.

Blaise Pascal, Pensées (1662)

Introduction

We begin this book by journeying into and exploring presence. The notion of presence comes from a book by Patsy Rodenburg (2007). Her argument is that we each inhabit what might be called three ‘circles of energy’. Circle one is primarily withdrawn, like a headache feeling or intense lethargy/shyness, circle three is an uncontrolled release of wild energy, like Friday night drinkers or party dancers, and circle two is a centred ‘two way street’ of giving out and taking in – an alert cat, or political interviewer, carefully taking in the responses and returning with a balanced challenge – which could also be describing advanced tennis players, Formula One drivers, surgeons etc. Presence is about becoming more balanced and inhabiting each moment; and in relation to Rodenburg’s (2007) three circle metaphor, it is about inhabiting energy circle two.

The focus on presence in Chapter 1 demonstrates the centrality of this notion when working therapeutically with our clients, and when considering our own wellbeing as mental health practitioners. It is important to be able to cultivate within ourselves a connection to the present, to the timelessness of each and every moment, and a proactive stance upon the world, and to work with our clients to help them understand and cultivate their own unique experiencing of presence. In today’s society there seems to be a constant fragmentation of who we really are, a constant pressure to achieve, a fast pattern of change, a restlessness and lack of focus. It is important to understand these societal stressors and the challenges that they pose for presence, in order to be able to empower ourselves and to effectively work with clients.

In this chapter we introduce you to presence as an integrative concept that can help to capture many different techniques that work within and across different psychotherapeutic modalities. We argue that presence is a useful way of thinking about and drawing together relaxation techniques, breathing techniques, mindfulness, body posture, grounding techniques, and pacing and leading. In this chapter we aim to introduce you to the techniques that we have found useful when working integratively with clients and we suggest exercises to practise these techniques, on ourselves, in groups, and in clinical supervision. We offer suggestions for how these techniques can be applied to clients, drawing on our own clinical experiences. There is also a theory section that links the notion of presence to theoretical concepts endemic to cognitive-behavioural therapies (CBT), person-centred (PC), interpersonal and hypnotherapeutic modalities. These are the modalities that we as practitioners integrate.

Firstly, in this chapter we provide a short summary of contemporary societal dynamics and how these can work against presence. We believe it is important for counselling students and mental health practitioners to know something about the societal pressures that surround our lives because these can overwhelm us. Developing an understanding of the wider social context to our clients’ lives is, we believe, critical to working effectively with them. We then discuss presence as an integrative concept and show you techniques that can help you and your clients to experience this, through practising and drawing upon relaxation techniques, breathing techniques, mindfulness, body posture, grounding techniques, and pacing and leading. Finally, we explore presence theoretically.

Society as an attention deficit and hyperactively disordered entity

Inattentiveness, impulsivity and hyperactivity are symptoms that are typically associated with individuals who have been diagnosed as having Attention Deficit and Hyperactive Disorder (ADHD). These symptoms can also be linked to a wider social malaise that has infected our societies. Many of us are constantly under pressure, and this pressure begins early. As therapists working predominantly with adults and young people we are often struck by how much pressure people feel that they are under. This pressure can be in the form of work and academic goals, employment and life goals. A pressure to ‘succeed’ in life!

Many books have been written about the challenges of our society over constant change, social comparison, isolation, work stress, technological advancements that have increased the pace of our lives, the insecurities of modern life and so forth. Added to this is the increasing capture of our attention by global corporations, disempowering us from simply being with ourselves, day-dreaming, meandering along life’s pathways (Crawford, 2016). Perhaps it is unsurprising that mental health issues have reached epidemic proportions in our modern societies. Perhaps we can think about presence as being an important and powerful antidote against depression, anxiety, stress, hyperactivity, and other challenges to our mental health.

We now consider key techniques for developing presence, for ourselves as therapists and mental health practitioners and for our clients. In practising the techniques as discussed below we can experience ourselves as empowered human beings, letting go of past experiences, of any future anxieties and fears, awakening us to embracing the here and now, experiencing the timelessness of each and every moment.

Breathing and presence

A tale of two Jacks

Imagine this scenario: footballer Jack is playing in the biggest game of his life in front of ninety thousand screaming fans. His team are trailing one goal to nil and there are ten seconds left on the clock. Jack’s team throw caution to the wind and launch the ball towards the opposing goal where three of their strikers wait in anticipation. As luck would have it the ball reaches one of Jack’s players, a tall rangy centre forward who forces his way into the penalty box only to be fouled by a defender from the opposing team [by the opposition]. The stadium erupts into a cry of ‘Penalty’ and the referee blows his whistle and points to the spot. Jack is the penalty taker. Suddenly he feels a wave of anxiety wash through him. The cries from the crowd become overwhelming. His breathing is rapid and when he places the ball on the penalty spot his heart is practically breaking out of his rib cage. Jack’s legs feel like jelly as he takes a few steps back. His breathing is short and sharp and no air seems to be going in. The referee whistles for Jack to take the penalty, making him start. He must score otherwise there will be no extra time and

his team will be out of the cup. Jack takes a few tentative steps towards the ball and kicks the ball but it seems that his foot is not part of his body and he has no control over it. The ball soars high above the goal and Jack sinks to his knees in distress. His team have lost.

Now imagine a different Jack. A version of Jack that has practised slow deep breathing as a relaxation technique and can utilise relaxed breathing in stressful situations. A version of Jack that uses breathing techniques that allow him to ‘step outside of himself’ in situations that are stressful and to empty his thoughts. When the referee blows for the penalty this version of Jack automatically starts to take long slow deep breaths, using his diaphragm to allow the air to flow into his lungs. As he does this, instead of being sucked into the maelstrom of excitement and emotions unleashed around him, he remains focussed, placing the ball on the penalty spot as he mentally rehearses which part of the goal he will aim at. As he takes a few steps back, Jack steadies himself, once more focussing on slow long deep breaths. His breathing is relaxed, his heart beats steadily, he feels in control. He feels relaxed, a direct result of the endorphins that are being produced by the brain because of deep breathing (Loehr & Migdow, 2000). He is in the moment and everything that happens now is fluid, without exertion. He runs towards the ball and strokes it into the top corner of the goal and his team are back in the game!

Through the use of diaphragmatic breathing Jack has remained calm and relaxed, allowing him to focus in on the moment – the situation – as opposed to becoming overwhelmed by it. Here is an example of utilising controlled breathing techniques in order to remain fully present and in the moment. You may wonder whether this breathing technique is outside of our scope or ability but diaphragmatic breathing, or abdominal breathing as it is often referred to, is a natural instinct within us, and very apparent in babies and infants.

As we get older the slow deep natural rhythm of diaphragmatic breathing is usually replaced with rapid shallow chest breathing. For example, if you were to join the army your sergeant major would encourage a military posture based upon standing with your chest out and stomach in, something that most of us get told to do at some point in our lives (Alman & Lambrou, 2012); this type of posture does little to promote deep abdominal breathing. Instead it gets us used to constricting our breath, losing our natural breathing mechanism and this ultimately leads to a loss of presence. After all, how we breathe in and out manifests in how we make sense of the world: our reaction to situations and events, the rich interplay of thoughts, emotions and feelings that encompasses even the simplest conversation, the concept of our very selves and how we appear to others.

How natural breathing gives you presence as a therapist

Jane has a problem with her throat. Since picking up a heavy cold several months ago, she has cleared her throat constantly and it has become a habit, something that she does without conscious thought hundreds of times a day. The habit makes Jane feel self-conscious and embarrassed and it has become so debilitating that she has begun to avoid social situations, forsaking evenings at the theatre for sitting at home on her own. Jane has decided that enough is enough and has booked a consultation with you. As Jane explains her problem in detail you notice that her anxiety increases, she leans forward and her voice rises in pitch, her breathing starts to become rapid and shallow and her throat clearing gets worse. Part of you recognises the importance of building rapport with Jane, of matching her patterns of breathing and posture with your own breathing and posture, so that they align more closely to her reality experience. Yet, another part of you acknowledges that Jane is desperate, that above all else, she wants to get rid of this annoying habit.

Jane wants results and you recognise this. So instead of matching her breathing, you focus on a natural relaxed breath that keeps you firmly grounded and focussed on Jane’s every word. Unconsciously Jane may begin to recognise that you are a centred being, that you have a certain presence about you, a calmness, an indefinable energy or aura that suggests you have the skills Jane is looking for. Jane begins to relax and to build her trust. Even though Jane’s emotions and feelings may fluctuate throughout the consultation you remain calm and relaxed. There will be opportunities in later sessions where matching Jane’s breathing may be beneficial but in this situation it may be more pertinent to unconsciously give out the message: ‘I can help you with this’.

How natural breathing can help your client

The sage Patanjali, who developed the oldest text on meditation that we have – the Yoga Sutras – recognised the importance of pranayama, the conscious awareness and spiritual emphasis of disciplined breathing. He identified the connection between breathing and mental states: rapid constricted breathing leading to mental illusion as opposed to relaxed natural breathing which promotes clarity and focus (Keen, 1997). Exercises that develop natural breathing can provide a mechanism for a client to experience herself, or particular situations and events, differently. Often we become so wrapped up in a problem that it becomes our world, an internal and external movie where the stage, set, characters, dialogue and scenes evolve around our issues. As a therapist, disrupting the various stages, sets, characters, dialogues and scenes, or introducing new characters, new dialogue and scenes within a client’s experience provides a way of breaking up a problem or issue. A good starting point for problem disruption is to empower the client with breathing techniques.

Integrating breathing techniques in sessions is highly recommended. Through getting a client to practise slow deep breathing, a sense of control and focus on something other than, for example, obsessive thoughts or fears, can be fostered. In this way, the client can gradually discover that she can relax and experience herself differently. In a metaphoric sense this can be like shining a light on a painting for the very first time and illuminating all the colours. Taking a step back and assessing a situation or problem or feeling or emotion when calm and relaxed may spotlight a solution, a way out of a predicament, a different scene. Think about a chess grandmaster surveying the whole board as opposed to solely focussing on a single piece. This ‘out of self into self’ process has at its foundation a relaxed deep breath. We learn to see the wood for the trees by focussing internally. Relaxed breathing is the clients’ new vantage point, a place of rest that she can look down from and get a sense of what is really going on in her life.

Recognising the relationship between breathing and internal and external states

Before you begin to recognise and make sense of breathing in others, a good starting point is to get a sense of your own breathing patterns and habits.

Consider the following questions:

• When is your breathing rapid and shallow?
• When is your breathing deep and relaxed?
• Are there situations or events where you find it difficult to breathe?
• Does the presence of some people affect the way that you breathe? If so, how do these people affect your breathing?
• Which parts of your body move when you breathe?
• How often do you notice your breathing during the day?
• What is your breathing like when you are angry?
• What is your breathing like when you are sad?
• What is your breathing like when you are happy?

If you have a good awareness of your breath then you can answer most of the above questions. To develop a better awareness of how you breathe, check your breathing patterns over the next week in relation to the above questions and note down your observations. This exercise will help you discover how your breathing reflects your internal state and the external factors around you.

Notice but don't look

Recognizing how internal and external states affect our own breathing can provide us with a greater understanding of what is going on in a client’s worldview, their experience of a problem or issue, whether they accept a suggestion that we have made or not. For example, when describing something traumatic, a client’s breathing may become rapid and shallow. When a client is upset or very emotional she may find it difficult to breathe. You notice her breathing not by directly looking at the chest, which is inappropriate, but through peripheral observation of the subtle movements of her clothing, shoulders and abdomen (Battino, 2005). Breathing patterns form part of the client’s body language and reading body language well is one of the key skills of an effective therapist.

As a therapist you may make a suggestion to the client that could potentially lead to a problem or conflict being solved or changed in a positive way. A large part of the job is to make suggestions, offer guidance and to provide support for your client as they bring these suggestions and guidance to fruition.

In many ways, this is similar to a salesman making a suggestion to a potential customer that will steer them towards purchasing a car that is more fuel efficient or perhaps safer than their current model. Successful salespeople are exceptionally good at reading the subtle nuances of body language. They will recognise situations where they need to pull back and ease off on the hard sell and situations where they can go full on to effect a sale.

At the surface level, the client may seem to accept your suggestion through her positive vocal response. Yet the way her clothes and shoulders start to move sharply, the way her abdomen starts to rise and fall quickly, suggests rapid breathing. Her breathing seems out of kilter with what she is saying which may indicate anxiety or internal conflict. It may also mean that she is excited about the prospect of trying out your suggestion so take care not to plunge in too quickly a...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Biographies
• Introduction
• 1 Presence for mental health and wellbeing: An integrative approach
• 2 Processing emotional and psychological distress integratively
• 3 Attachment as an integrative concept
• 4 Thinking, through an integrative therapeutic lens
• 5 Working integratively with our conscious and unconscious minds
• 6 Working integratively with bereavement and loss
• 7 Working integratively with anxiety
• 8 Working integratively with depression
• 9 Working integratively with relationships
• 10 Working integratively with shame and guilt
• Conclusion
• Index