The Change Process in Psychotherapy During Troubling Times

Sue Wright, Sue Wright

• Editore: Routledge
• Anno: 2021
• ISBN:
  9781000450439
• Edizione: 1
• Argomento: Psychologie
• Categoria: Psychothérapie

The Change Process in Psychotherapy During Troubling Times invites readers to consider what it is psychotherapists do that leads to change. The book highlights different theoretical approaches, questions old paradigms, and illustrates the change process when working with people facing a range of life challenges such as the survivors of childhood trauma, refugees, and people dealing with traumatic loss.

Moving between consideration of micro-moments when working with individual clients and bigger questions about how to promote change in the face of current world problems, it addresses issues that touch us all. At the same time, the book acknowledges the unprecedented challenges in today's world such as the pace of change, the thousands of displaced people who seek refuge in other countries, the illness and loss caused by the coronavirus pandemic, and the impact of climate change on lifestyles and the environment.

The book presents a topical consideration of the relevance of therapeutic assumptions, theories, and practices to current global crises. With the breadth of presenting issues considered and the examples of a variety of creative approaches supporting change, the book will be useful to psychotherapists in practice and in training working in a range of settings with different populations. It will also be of interest to others working in the helping professions.

1
What leads to change in psychotherapy?

Theory and research

Richard Davis

DOI: 10.4324/97810033111511-1

Spiegel im spiegel.

Mirrors in mirrors,

each reflecting something new.

Our conversation grows

As excitedly we share ideas.

It grows into something more.

The mirror I hold up

shows you something new.

The mirror you hold up to me

reveals things hitherto unseen.

We learn.

We grow.

Aims of the book and who this is book for

This book consists of a series of related essays concerning the nature of psychotherapeutic change. These essays sprung from an idea of inviting a diverse spectrum of therapists to present their ideas, practices and conceptualisations on change across two conferences held in Stroud between 2017 and 2019. The idea of these conferences presented itself from the vast amount that has been written about therapeutic change by psychotherapists from different theoretical backgrounds, while from time to time every therapist has probably grappled with the question “What do I do that makes a difference?” Following these events, the speakers reviewed the material and wondered if the themes warranted an assembly into an integrated and coherent narrative while respecting the distinctive flavours of each essay.

The papers in the book invite readers to consider what it is they do as psychotherapists that leads to or is necessary for change and how we can position ourselves to be more effective agents of change. With this in mind the book aims to:

1. Bring together a group of psychotherapists who work in different settings to illustrate how they view the change process based on their experience and core models
2. Illustrate different and novel ways of helping individuals, families and communities to come to terms with the past and transform past traumas and losses
3. Invite the reader to think about what they are reading as contributing to, challenging or adding to their existing experiences and conceptualisations of change
4. In highlighting the importance of context and the wider world, to challenge psychotherapists and counsellors to re-think their theoretical assumptions and how we can position ourselves in a rapidly changing world
5. Encourage readers to ask their own questions about what facilitates change

In reading the book, my hope is for all practitioners to put to one side the excluding boundaries that divide them based on their model and be open to the multiple perspectives which it contains. The book certainly advocates for the place of both relational and technique factors in psychotherapeutic change. To the student-reader, my ambition is that that by the end of it you are energised to reflect on your training and practice from perhaps novel concepts such as those presented by Sue Wright in Chapter 9, “Journeying in time: psychotherapy and the change process”.¹ In this chapter Wright brings to the debate the place of the temporal dimension when she questions what occurs during the life of a therapeutic journey, however long it lasts, that makes a difference. She proposes nine conditions for change, each involving something new in the present that transforms our relationship to our memories. Intersubjectively, she argues, there is a need for the therapist to act as a supportive witness, whilst intrapsychically, it is important to develop a non-judgemental internal witness. Change is supported using metaphor and imagination, both tapping into right-brain processing, and new somatic experiences.

For something else different, Tree Staunton’s Chapter 4 “Holding the body in mind in times of transition” opens with provocative questions for the trainee and experienced alike such as “Does therapy itself need to change?” “Do you believe that treatments cure disorders or that relationships heal people?” and “Is what you do the most important thing or who you are?” In the ensuing discussion Staunton poses further challenging questions about the therapeutic project and invites you to step back and think about your own beliefs and ways of working. Staunton’s view is cultural – that the big problem is society’s obsession with progress and in trying to make people fit in. She takes us through theories about the change process since Freud to the present day with its “new science” grounded in what we know now about the brain and about how relationships can heal and its increasing stress on outcome measures. Staunton challenges the focus in randomised controlled trials on the extent to which symptoms are relieved and suggests that perhaps it is not unhealthy to be anxious or to experience internal conflicts such as that between mind and body. Indeed, Staunton argues, “symptoms” can reveal important information, and change can occur by becoming curious about them. As a body therapist Staunton sets her discussion in the context of our existence as embodied beings. The other contextual element in the chapter is the world we live in today. Tree’s thesis is that society is facing a dramatic life crisis and that psychotherapists have the skills to support people to face the fact that we are going along the wrong path, to mourn losses, to turn to earlier forms of support, including nature, and to make big changes.

To experienced practitioners, the book is written in the faith that you gain something fresh and revitalising or extend some ideas and theories rooted in your original training or complementing your continuing professional development even on themes beyond the immediate consulting room. The contribution from Steffi Bednarek also brings this bigger context into the foreground. “Who needs to change?” goes some way in this regard, throwing down a gauntlet at the feet of the experienced therapists. Like Staunton, Bednarek brings the bigger context into the foreground. For instance, she challenges the reader to think how in a time of climate emergency psychotherapists can move from a focus on individual work to one on our relationship with the “more than human world” and our interconnectedness. She also invites us to widen our theories, to rethink notions of mental health and to use our skills in the community. Bednarek investigates our current lens, which is aligned with the dominant neo-liberal, capitalist paradigm and its emphasis on anthropocentrism, progress, privatisation, domestication and materialism, and argues passionately that we lack theories about our connection to the natural world and our attachment to place and that a risk in individual therapy is that it can separate us from our context.

These chapters pose the question on how we learn from each other in a holistic way, involving the wider lived context we all inhabit. As therapists and counsellors, the duty of care shown to clients is based on our commitment to this lifelong learning appraisal. Hence throughout the book you will be invited to answer questions posed by the material in each chapter. We suggest that you take time to reflect between reading each chapter for the dynamics of reading to be an experience for learning as much as possible. Differential trainings tend to highlight that what separates us are shifts in time as well as different models and approaches. This means that some readers have a certain amount of clinical and practice experience which others may not possess, merely as a result of the chronology of when you trained or how old you are as much as which model you practise. Too often it seems that what separates is hierarchical and vertical rather than what is horizontal and experienced-based. I trust that this book’s format in some way helps to communitise readers, highlighting our commonalities and congruities of interest as a representation of a range of care-orientated people engaged in a tremendously important endeavour, which is that we be experienced as sufficiently therapeutic as possible to another person who just happens to be called a “client” or “patient”. To this end there are refrains throughout clustered around the theme of “what is it you do that facilitates change?” enabling a further consideration of “and where are you now with this?” by the end of the book.

This book is a joint effort, a collective sharing by a group of therapists who have in common that they give primacy to the nature of the therapeutic relationship as the major factor in change outcome. Its source material was based on a series of initially related talks on change from two symposia which produced a space of its own – is there anything next in this process, or does it end here? Meares uses this phrase “what happens next?” in a therapeutic frame to promote the reflexive qualities of the therapist being optimally available to the phenomenological self-experience states of their clients in the moment (2001).² This adage holds an aptness for me here, serving as a starting point to engage in the “what is change?” definition. If there is one quintessential feature of what aggregates therapeutic change when practising from the relational perspective, it is something about being able to be with another and then to utilise the what happens next space of betweenness in the client’s service. In more prescriptive models where the relationship is less of a factor in outcome, such variables tend to be excluded regarding therapist responses and treatment planning conceptualisations. In relational-based work, this is not the case. In Jim Pye’s chapter on “Moments of meeting”, the theme of what happens next is explored by considering the sudden, surprising moments in therapy which often seem to prompt change. Using the term MoM associated with Daniel Stern and the Boston Change Study Group, Jim took part in a United Kingdom Council for Psychotherapy (UKCP) research project into the subject and facilitated a local group of therapists who were interested in examining moments of meeting in their own work (BCPSG, 2002). He explains that they brought to these discussions their own “moments” and often made very interesting discoveries about their work, because the subject made them examine “the process” in a particularly focused way. His chapter, therefore, gives the reader ideas of how you might examine your own work in a new way. He discusses his group and three fascinating moments of meeting with his own clients that shifted their fixed beliefs and significantly altered the course of the therapeutic relationship. These examples are richly illustrative of the very relational involvement of the therapist – the relationship as the breathing heart of change, posing the question “what is change?”

What is change?

Change. A simple, single six-letter word which has been a crucial construct in the practice and teaching of counselling and psychotherapy since the time that people went in search of others for healing, cure, restoration or solace (Ellen-berger, 1970). The word itself originates from the Latin cambiare “to exchange” and an extended form of Latin cambire “to barter”. The word also has a Celtic origin, from the root *kemb – “to bend, crook” (with a sense from this evolutionary formation to “adapt” or “to turn”) (www.etymonline.com/word/change). Inherent in these original aetiologies, specifically unrelated to counselling/psychotherapy, is the bi-lateral nature of change: that it involves an exchange; it is a two-way process. Such bidirectionally in therapy itself is not a new insight, and chapters in this book examine much of this process as a route way to aid the quality of the therapy. The degree to which clients impact on their therapist’s own subjectivity is an enduring theme too, especially related to the possible benefits that follow. I remember a humorously imparted remark in a lecture on supervision I attended where the speaker articulated the view that if clients knew how much the therapist got from the therapy that they may wish to review the fee more regularly and perhaps argue for considerable reductions. Change is multi-variable, idiosyncratic and personal. I asked my 18-year-old son – who has no interest in therapy – what was the first thought that cropped up in his mind when the word “change” was said to him? His response was “Well, Dad, it depends on what type of change it is” and further, “it’s always going on, isn’t it? Like in The Big Bang” (he meant a reference to the TV programme, not the start of the universe). Perhaps unbeknownst to him he was arguably typifying change as both a process and outcome which is constantly “here” – whether fateful or sought after – and what type of change is occurring that makes it either positive and beneficent or negative and harmful to the person or their world, which is so central to our work.

It is axiomatic that change is central to the work of counselling and psychotherapy, it is the figure and ground to the fundamentals, philosophy, techniques and practices of all the major models. How change is achieved in therapy is another case. A review of the literature for each model argues, to some extent, for a rather simplistic view of change. Making the “unconscious conscious”, or developing the “strength of the ego over the id and superego”, from the psychoanalytic perspective; “changing maladaptive thoughts into positive thoughts” is the essence of change in cognitive therapy; similarly for behaviourism: change is a reduction, preferably extinction, in the stimulus of the conditioned reflex via assorted reinforcements towards adaptation and flexibility in terms of behaviour activation. In humanistic circles, change is an outcome process of being in a relationship with oneself more fully to promote self-actualising, or physis – to fully contact self-healing forces and energies inherent in the human being (Berne, 1947). Of course, all these descriptors are simplifications.³ Often, therapists’ conceptualisations of change are rooted in their original training and how central the concept of change is in both theories, personal development and in many therapists’/trainees’ first tentative steps in practice. Change is a momentous, promising “something”, the expected successful endpoint that lies on the horizon of the client–therapist contract. In relational-based therapy, a therapist proceeds based on how significant the nature of the encounter is as it evolves as a key agent of change. In more technique/problem-solving and short-term models, the nature of the encounter is seen as less important than the use of strategies related to the diminution or extinction of the presenting conflict or distress. The ontological and epistemological position of this book on change places an emphasis on the former. However, it is not at the expense of the latter. It is well established that the therapeutic relationship accounts for significant degrees of change for clients (Norcross, 2005), and so, too, are techniques and strategies within therapy processes.

These chapters have emerged from experienced therapists’ reflections on the pervasiveness of the following patterns, patterns often replicated in their client and supervisory work:

• First that change processes occur within, and as a result of, the nature of the quality of “betweenness” of the two parties.
• The change comes through a form of exchange – in that the therapist themselves are affected, adapted and changed.
• How often therapists record making a breakthrough with a client as they themselves have experienced authentically, and often viscerally, something of the client’s pain or anguish (a gut-wrenching ache, an empty void-like feeling in the stomach as somatic countertransference and so on). Then through that experience they symbolise it in a way for the client to facilitate a form of cathartic experience of what was hitherto an unspeakable or unformulated trauma.
• This form of non-verbal communication occurs likewise through other sensory and cognitive-sensory modes such as...

Indice dei contenuti

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Acknowledgements
• Author biographies
• Preface
• 1 What leads to change in psychotherapy? Theory and research
• 2 Getting to the essence: truth seeking in psychotherapy
• 3 Moments of meeting
• 4 Holding the body in mind in times of transition
• 5 Therapy, the body and time
• 6 Supporting change and adaptation after traumatic loss: a conversation between Liz Rolls and Sue Wright
• 7 A change of time
• 8 Living with someone else’s trauma: extreme events, time, liminality and deep subjectivity
• 9 Journeying in time: psychotherapy and the change process
• 10 The change process of the trainee: a necessary rite of passage
• 11 Who needs to change? Reflections on the complex relationship between climate change, mental health and the profession of psychotherapy
• 12 Change and challenge: developing clinical fluidity
• Index