In order to establish a successful therapeutic situation there has to be “life” in all three poles just as there has to be a certain balance between the poles.
Many years ago research comparing efficiency of different therapeutic methods concluded that there was no difference in efficiency of different therapeutic methods. The research showed that two essential aspects had to be present during the therapeutic process:
- Therapists has to work from a coherent and consistent understanding and methodology.
- Therapists has to be able to be present and to act in contact in an integrated and/or authentic way.
To a therapist who is educated in a specific therapeutic and theoretical tradition this is a very provoking conclusion. My personal experiences confirm however the results of the research. During the years, I have met a lot of really skilled therapists from different schools and with different specials. What they had in common was:
- a higher degree of contact skills
- an equal respect to other persons
- a thought through and coherent concept and
- an at least implicit understanding of a wholeness.
Similar later research in the area of psychotherapy results in the same conclusion. Factors that has to to with:
- client’s prerequisites
- therapist’s authenticity and
- the interaction and contact between the therapist and client
is much more important in outcome perspective than which tradition the therapist represent and is trained in. (Carsten Jørgensen, 2000)
With a specific focus at the toolbox and my supervisees I translate to this: Make sure that you can use different methods but more important – make sure that you can do some methods very well. Be well educated and trained in one or another form of work. Chose from interest and temperament. Create a personal relation to the techniques and methods you use. An old well known principle is to have tried the methods on your own body before You use them on clients.
Be aware of the strengths and weaknesses of your preferred ways of working. It would be a good idea to have knowledge about other ways of working as well.
In relation to the model we are in a field which is about the relationship between two poles: authenticity in relation to your personal toolbox. A given therapeutic tool is only effective if the user has an authentic relation to it. (has tried it on own body – has several experiences with it – have seen on the tools in supervision (at least collegial supervision) – and has given thoughts to advantages and disadvantages to the tools/metodics and to possible charateristics in relation to other techniques….)
The techniques and I:
First step in getting a personal relationship to your tools is to test them and then share your experiences with qualified colleagues.
What can you recommend your supervisees (and yourself) in order to create connection between own life values and experiences on the one hand and therapeutic methods on the other hand?
A lot of my supervisees has found the following simple questions very useful:
- what makes in my opinion therapy successful? – write down spontaneous and considered answers from my experiences as client.
- What makes in my opinion therapy successful? – write down spontaneous and considered answers from my experiences as therapist.
Separate successful and less successful progresses in two groups.
- What is common in the successful progresses?
- What is common in the less successful progresses?
In process with answering these questions – might be placed between two supervision lessons – it is important that supervisees do not consults their books or notes.
Doing the answers, they should instead be well seated in a good chair.
The answers is discussed with colleagues or supervisor. During the discussion, it is not a task to the others to theorize but more to concretize with questions as:
- How it felt in the body?
- Which of your inner values is it connected to?
It is my experience that these questions and the work with them supports a personal positioning and systematization of learned methods. In other words, a kind of centering in personal values. Another way to put it: Theory and method grounded in the personal universe of values.
Later I will come with suggestions to how supervisors and supervisees can create a kind of more overview to different therapeutic schools and methodic from a less personal and more substantive point of view.
Authenticity, contact and a personal anchoring related to different models of understanding.
I the first chapter I asked: ”What is important to have as a therapist”. Intention in considering this question was to get an overview to different types of challenges supervisors might get into.
My answer to this was that the therapist has to be able to manage three different issues:
- Have an overview to chosen methods and tools
- Acting from a clear clear self-perception
- Being able to see, hear and understand the client.
I took a closer look to how to support supervisees in getting a personal relation to the different techniques and methods each of them has in their individuel toolbox.
In the next chapter I will investigate the meaning of authenticity and genuine contact and what issues that might occur if these aspects are not balanced
Authenticity and Capacity of Contact.
In order to be a successful therapist it is important to therapist to know himself that much that his perception of himself is realistic. This implies:
- Knowledge of foundation of own values and
- To have access to and being able to recognize own emotions and reactions from situation to situation and from minute to minute.
This is what authenticity in this model is about – an essential element and furthermore a necessary condition in order to be present in a consistent an authentic way in the therapeutic contact.
This pointe might seem obvious but it is my experience that this is a common working issue to supervisees.
Rarely at a superficual positioning level but very often when you get into the details:
- Should you allow myself to say what I believe is right?
- When – and when not?
- What to do if a client move into actions you would never dare to do your self or if you can sense that you are very ambivalent into?
- Is it OK to be angry with a client – be offended – or proud of?
- How to find one’s personal balance between acceptance and boundaries in specific situations with the client?
- What to do when clients personal issues affect you as s therapist?
Some of my time spent with supervisees is about questions like these. It’s about to find out:
- how the personal reactions are in concrete relations with single clients
- what does it do to supervisees freedom of action and potential into acting (in reality this is a question about the meaning of counter-transference to the therapist) – and how to put it into words.
Possibly there are therapists who just have this ability to create contact inside themselfes – (but after 15 years as supervisor I still have not met them….) In reality the rule sounds more like this: Even succesful therapists has now and then to move focus from the client to themselves in order to investigate in concrete relations, what is going on in themselves and how to navigate to this.
One – og perhaps more realistic several periods with own therapy and/or participating in groups with own therapy and training into relations is an essential condition to achieve access to get closer to an authentic self-perception and a more visible appearance into the contact area.
Supervision where some of the energy is spend on attention to yourself, i.e. own emotions and reactions in situations with a relation, is a necessary follow-up – a necessity to the serious therapist.
In my experience, not all psychologists have discovered this in the study years and I find this worrying.
It has now been enshrined as a principal to the guiding lines for psycho therapeutic educations for some years which is good.
In relation to the triangle model are we in – and between two of the poles: authenticity and capacity of contact. A not yet expanded aspect of capacity of contact is to be able to see and hear the client precisely. I will return to this issue in another article.
The danger of being locked in one track.
Two of the points in my simple triangle-model is that therapist should have:
- ”enough” skills in each pole
- enough capacity to handle issues going on between the poles two and two –
It is very important that the therapist has:
- an authentic relation to his tools
- a deep knowledge to himself
- ability to be authentic og consistent present in contact with the client.
How about the interaction between the contact pole towards the tool pole or the methodic pole?
Difficulties that might occur between these two poles is very much about loosing balance.
- To much focus to models and methods will cause lack of contact (too much distance) and lack of sensory perception towards the client.
- To much focus to the contact will cause lack of being able to understand the client from it’s conceptual framework (too little distance), i.e. loosing overview/the head.
A lot of therapists remain locked in their knowledge. They get too stuck in it. First of all, they need help to be more aware to the client, to the contact and possibly towards themselves in the process.
If this kind of supervisees has traded from performance orienting where doing “the right thing” is important it might occasionally be a good, however, paradoxical advise to forget about theories and methods and at the same time share ideas in how to promote seeing and sensing the client and to get closer contact to itself. (the therapist)
Some therapists is more to be too ”swallowed up” to the contact why they need support in ”getting home” either to themselves or to their conceptual framework.
Occasionally therapists gets too filled up with personal emotions, memories and emotions ”pushed” forward through the contact to the client or through the clients story – sometimes caused by resentments and distancing why they momentarily ”loose” their knowledge as well as their ability to be in contact with the client.
Many therapists have to work with nuances in the balance between the three poles – occasionally the balance disappears why it has to be adjusted.
Finally, I want to transform the presented model from at description towards what a therapist has to be able to – to an overview to possible fields of problems – a kind of searching model to the supervisor. It is to the role as supervisor as well as to the ”inner supervisor” in the therapist.
Search model to supervision and self-reflection.
The model illustrates several factors.
First: issues or themes can be taken care of according to the level where they expose themselves.
Second: to each problem level there is a model of understanding and ways to intervene.
Third: levels of problems are to some extent related.
Being introduced to an issue from a person or a group it can be useful to ask yourself which kind of issue it actually is. Is it a communicative problem, a structural problem or an undefined personal problem? It is a relevant question to give to yourself as therapist or teacher. It might also be very important to ask as a supervisor to material presented by the supervisee and of course to the supervisee.
Not every time issues have roots at the same level as where they are exposed. Issues in an organization structure will probably reflect in level of stress i.e. in psychological and bodily reactions (the two lowest level, without actually being the ”cause”.
Clients regularly somatize their mental and interpersonal difficulties – or to be more precise; client difficulties exposes/reflects regularly into somatic reactions where clients easily ”loose” sensory perception and experience of hang together. According to the same principal interpersonal issues often gets intro-projected or accumulated internal tension gets projected.
A therapist’s (supervisees) difficulties exposes perhaps as personally frustration towards the relation to the client but can actually be a reflection of an unfortunate structural situation including therapist, client and one or several other therapists who might ”play” a (perhaps less visible, but important) role according to the issue.
The model is particularly helpful when the issue is about getting a nuanced understanding to an issue and when it is about choosing forms of intervention.
Things are connected. Forms of organizations and forms of societies reflects into social life, personal draws and patterns of muscle tensions. Conversely changes of social life arises out of lust and motivation (which has bodily roots) and slowly changes forms of organizations and structures of society.
But still it is essential to chose level of intervention.
Analyzing from the model might help supervisor and supervisee to avoid the two ditches the might fall into.
- Go to much into psychology (lacking systemic, organizational og sociological fantasy and perspective)
- To much focus to the system/structure.
The model is also workable in sorting and comparing different therapeutic forms of therapy from their mainfocus – which levels of issues you particularly has concepts and theories into – and from notising which forms of intervention they use.
Bodytherapeutic schools e.g. normally has very developed concepts and tools at the lowest level and often too when it is about connections between body level and the intrapsychological level.
In Bodynamic Analysis – the body therapeutic tradition in which I took my education – and now educate students into, we are focusing on the four lowest levels. Medicine has most focus to the lowest level even though the best doctors can see the connection to cohabitation and psychology (the nest two levels) and to organization- of social relations. (work environment)
Classic psycho analysis is clearly focusing on the next lowest level.
Structural family therapy specific focus at the levelz of group structure and organization and has developed nuanced interventions and strategies at these levels.
Gestalt therapy work with awareness to and connection between the three lowest levels. In my experience with the strongest conceptualization and the most nuanced interventions around relations and persons.
The reader can continue this work on grading different models and forms of working.
In my article: ”From amateur to Master”1995 I have developed this rating of therapeutic forms a little more.
It is my experience that therapists and supervisees during knowledge to this model gets more overview to the different tools they have achieved. It becomes easier to find out when to do what. It becomes easier to decide if a present client or case is something you dare working with, based on a realistic assessment of own knowledge and experience or if you rather want to refer to a colleague who is more skilled into this specific issue.
To therapists working in larger institution- or management systems it is extremely important to be able to navigate freely between different in terms of understanding. There are two ditches to fall in. First is to lose own energy and more important – the client in systemic negotiations. (it is not my table – we’d better have a meeting i.e.) Second is to lose clearness into system-, competence- and conflicts level. Last mentioned may cause different consequences so as stressed therapists, conflicts between different groups of therapists and confused clients – or ”letting go” of clients who avoid taking answer to own issues by splitting the groups of therapists.
The model is able to be used concrete in the supervision situation – as well as from case to case – and for a general assessment (and self assessment) of the supervisor’s skills at the different levels.
A couple of times I have planned and worked through trainings together with colleges with another training than mine. It is very instructive and is to be recommended.
Through several years, I participated in a collegial supervision group with colleges from different schools and with different specialities. This was very conducive and can be recommended to therapists who are well founded in themselves and in their favorite way to work.
About seeing, sensing, listening and asking before you act.
In this and the next chapters I will deepen into different aspects in the contact between the therapist and the client.
What is really the issue?
An ordinary mistake is that therapists don’t give enough time to get ”mapped” what the clients issue is for real.
Therapist do not spend enough time listening and going into details in order to get an exactly description to what it is the client can’t solve out – or wants to change. I see at least two reasons to this:
- First: the therapist often thinks in solutions instead of description of problems. As a therapist you are often met with an expectation that you should give solutions – or at least ideas into creating a change why it is not strange to have focus to ”what can be done.” Suggestions to act – formulated to early – or on behalf of incomplete problem descriptions will however – in best case – be imprecise – in worst case – useless or misleading. As an intermediary communicator there are two ditches ”to fall in”.
- First: putting suggestions ”too fast”
- Second: from a misunderstood insisting on clients competencies, to refuse to give suggestions to solve to problems.
As a supervisor, this is one of the most important polarities to teach supervisees to navigate carefully in.
As a therapist and supervisor, I acknowledge the pedagogical aspect of psychotherapy.
It happens regularly that clients benefit of suggestions to changes and positioning – of course mentioned in contact and with respect to the clients integrity, readiness and own assessment to the choice.
Certain client difficulties are characterized by the clients actually knowledge of what to do but lacks space to consider, contact and support in order to move on. In these cases, suggestions to act are not necessary – they might even be contraindicated.
A group of clients has another kind of issue. They simply haven’t learned, heard or seen ”how to do”. In such cases, you betray the client if you – from a misunderstood ideology (clients always know best e.g.) – retain suggestions to alternative and new actions.
The following sketch shows relations between investigations of the problem on the one side – and readiness to give suggestions to act on the other side – it might be useful to give some thoughts.
Back to start: a nuanced investigation to what actually consolidate the clients issue.
In my experience, there is another reason to why therapists don’t use enough time to investigate what the client’s issues are about – and therapists often don’t know which questions to ask.
Putted into other words: Therapists lacks sense into details or to ”the fine motor skills” in how the awareness process in humans is functioning.
See – listen – sense – ASK!
In my experience as a supervisor therapists do not spend (enough) time in investigating the clients issue.
The therapist see, listen, sense and ask to little.
To see and listen – is very much about the client’s body language and about increasing awareness to nonverbal aspects in the communication. When the therapist discover the amount of information’s there are in seeing, hearing and sensing as well, material to several considerations almost will be ”served” as well as an amount of possibly therapeutic interventions may occur.
To see and listen is to include observations of the client’s body and bodylanguage as an anchor in the process of understanding.
To feel – or sense – is about therapist gives time to own reactions and value these reactions as a foundation in the relation to the client. By acknowledging nuances in answers from one’s own organism as answers to the communication with the client the therapist receives a lot of informations about:
- the communication between client and therapist
- his own condition and reactions to the interaction – but also
- indirectedly about the proces the client goes through.
Sensing answers from own organism’s interaction to the relation is very much about including own body as anchor in the interaction and understanding formation.
To ask questions is about that the therapist allows himself to ask for nuances into the clients verbal descriptions and into connections between bodily and emotional nuances, experiences, thoughts and words.
From the supervisor angle I will recommend supervisors to pay attention to how much time supervisees give themselves into listening, sensing and asking. If lacks in any of these areas it is very easy to make exercises in order to get more ”effective”.
From zones of awareness to elements in communication and forming of experiences
Many readers might probably be familiar to the simple but very useable model about the zones of consciouness coming from gestalt therapy:
- sensing the outer world.
- sensing the inner world.
- imaginations and thoughts.
The model opens to an understanding into clarifying when to do what as well as to an understanding into the interaction between the specific person’s activity in the specific zones.
In Bodynamic Analysis we have refined the upper model to following:
- Just now I come from mood-context, initial/fundamental
Just now I feel like-actual state
- I see, I hear, facts-outer sensation (the five senses)
- I think this means-interpretation and imagination
- I sense, I feel-inner sensation
- I feel (emotion)-emotion and feeling
- I feel like-inner impulse, impulse to act
- If … then …-analysis, consider consequences
- I choose to …-choice / to choose “yes” and “no”
- I do, I say-action and expression on the basis of choice
The Bodyknot expands the gestalt therapeutic model especially in the area around the inner process; sensing, emotions, impulses, analyzes and choices.
The Bodyknot is very usable in ”putting light” into communication and ”knots” in communication (why the name ”Bodyknot”) – and into analyzing and finding out whether the client is functioning or not functioning into:
- experience forming.
- The process in – and how to work with expressing himself.
- does the client use his senses, e.g. which, or are there partly or totally lacking contact to realities? (1 in relation to 2)
- are there compliant mele or imbalances between actual sensing and imagination?
- and 2)
- is the client in contact with own sensings and emotions (3 and 4) or is the selfperception controlled by imaginations? (2, 3 and 4)
- is the client in contact with his acting impulses (5) and – in case he is – are the impulses connected to his sensing and emotions? (3, 4 and 5)
- are there an analyze or consideration before a choice ( 6 and 7) and – on what basis?
- Do the client reach the ”acting” point? If not – where in the process does the client stop?
In my point of view using the Bodyknot can clarify where in the process the client is ”functioning or not functioning”, drastically increases the gradation to the description of the problems – in an investigation of – and working with finding origin of dysfunctions – and in possible suggestions to alternative actions and verbalization’s.
As a therapist, it is a continuous process to observe the client, and from there mirror og give back to the client which elements of the Bodyknot was represented and which was not is a central element in using the Bodyknot. We call it ”active sensing”.
What is actually the meaning of the words.
It is extremely different what people means with, or put in words and common phrases. Unfortunately, it often happens that therapist don’t investigate what the words/common phrases actually means to the client.
Attention to non-verbal aspects will often – however not always – give impulses to ask for a deeper meaning.
As a supervisor, I very often ask supervisees if they had investigated what the client actually meant when saying a specific word/phrase…. or what the supervisee meant by saying….?
Let me give some examples:
- I cannot have….
- I’m getting stucked….
- I don’t trust….
- I can’t handle…
- I have difficulties in being in contact…
- I cannot….
- I cant stand that…
- I was rejected….
- She don’t want me….
Does the word ”discussion” mean a fruitful exchange” or does it mean ”hitting” one another with arguments?
Asking the question: ”What does this means to You?” is of course about clarification and concretization.
It is also about getting the words anchored in the body not only at a general level but specifically to the client as well as the supervisee.
Not in order to ”get away” from the head, but to creat connection and coherens beween what happens in the consciousness and in the body.
Watch Me – about performance and supervision.
Often supervisees are more into telling me about what they are good and, than focusing into what they really need to have a look on – and a talk about.
Supervisees can in other words be more concerned about performing (”being” – or perhaps more ”showing” that they are really good) instead of clarify where they have difficulties, get courious, confused or maybe has to learn more. The more skilled the supervisees are – the more this tendency expands.
In a way, it is strange that supervisees pay a lot of money to let a supervisor listen to what the supervisee actually can….
Supervisees don’t only bring cases…
If you dig a little deeper it is not so hard to understand.
How many of us are raised in families where they was praised and encouraged to what they did and actually was appreciated like: ”Wow – how amazing what you just did” – ”You are so good” – ”I’m so proud of You”. On the contrary it is my impression, as a therapist and supervisor, that a lot of children and youths has lacked being seen, listened to or valued for their actions.
Another common phenomenon from how to raise children in the fifties and sixties was ”accepting on behalf of” ”You are only good enough if you do your best”(acting) – or: ”You are ok if you do your best and are good”(performance etc.)
Supervisees not only bring their cases but also their history into supervison. Supervisees way in using the supervisor and the supervision session reflects to what the supervisee was taught or not taught abut self esteem and interaction during his upbringing.
The supervisee way of interacting with the supervisor will therefore reflect several questions:
- Was he brought up in a culture with traditions of possibilities – in other words – a culture where it was allowed and common to bring difficult issues ”to the table” still maintaining contact and possibility to get help?
If yes – there are good conditions in developing successful supervisions.
If not – it has to be taught. Sometime it is enough to get a common language to the phenomenen – and the practicing together with supervisor. In other cases, it has to be worked on in therapy.
The same recipe; recognizing, common language, learning new skills, possible own therapy – counts for the following questions:
- Has the supervisee been seen and valued for his performances?
- Was the ”accept” the supervisee achieved ”because of” have been ”good” or have taken pains (if the supervisee might spend a lot of his energy to tell about his skills)
- Was the supervisee seen or valued because of his actions?
- Was the acceptance of the supervisee attached to being active, helpful i.e.? If – it is possibly a supervisee with difficulties into ”staying” and ”being” as supervisor as well as therapist.
Similar questions can be asked towards the education, the therapeutic training and evt. former supervision the supervisee has achieved.
Bad habits is therapeutical weaknesses AND the way towards therapeutic qualities.
Having a supervisee who is very oriented into performance it is very important to pay attention to this pattern. First of all because it is a condition in order to get a fruitful supervision process. Neither supervisee or supervisor will develop if orienting into performance ”controls” the supervision process.
Second, it is more likely that the supervisees orientation into performance characterizes his work as therapist as well. This might be investigated and explored together with the supervisee. Starting such a process develops therapeutic qualities. Being able to recognize and later on ”lower down” his orientation into performance in his therapeutic work ,will very soon develop a much better and more present therapist.
In other words: if you – in the supervision situation – ”catch” supervisees transference to supervisor it is very likely that you will get some of the counter transference’s the supervisee often ”falls in to” as a therapist, as well.
The ”way” from transference/projection controlled interaction in supervision to developing central therapeutic skills can ”be walked” too on the former mentioned areas.
Supervisee starts to move towards therapeutic qualities as:
- More authentic patience
- More authentic trust into the client’s own resources in finding solution possibilities to his difficulties
- Being able to just be present in interaction with the client
- Being able to see and stay – without immidiately start helping.
About sitting next to….
I imagine that many supervisors is ”hit” in previous mentioned transference patterns from their supervisees.
I think that most in interaction with their clients, has tried to expose these patterns, in order to – through a common language and conciousness – ”open” up to a more fruitful exchange in the supervision.
One specific – very simple approach in the work – I have never read about, why I want to describe it: It is about how to be seated. In literature about non-verbal communication often called ”positioning”.
I don’t know how other supervisors are sitting – but I often sits in front of my supervisee why this position has obvious advantages:
- I can see the supervisee more clearly
- The supervisee can easily turn a little to the side, if it is useful to imagine a therapist/client interaction etc.
- ”In front of another” position is confronting and setting the stage for showing, be seen at, etc. – in other words – setting the stage for transference and projections.
I have often succeeded in getting out from a transference field – and instead get established a real cooperation with the client – just by moving – from – in front of – to – next to – side by side.
This very simple change in position has changed the supervisees experience from: ”I have to do something specific to…., to ”be together with” – to ”be next to” , to be able to receive support from to be actually me, instead of being something defined (which was expected by….)
From this position, it has been possible to confront the transference pattern – and to break it down as well.
It is obvious that – as long as such shifts in positions are necessary to make the supervisee rest in himself – the transference pattern is still activated.
I have several times experienced that one or two times of ”sitting aside to” (for 10 – 20 minutes) has been essential to get rid of very persistant transference mechanisms.
With bodily anchor: about I-strenght – and orienting into reality.
The body can be included in the therapeutic work on several different levels – from the most obvious and simple to the more nuaced and sophistictated. Because of my background, as specialist and teacher into bodyrelated psychotherapy, the bodyrelated aspect has my specific focus. However – my errand in this connection – is not to tell about psychotherapeutic forms of work in an immersed level,
Here I want to give examples of how awareness to the body – even at a simple and immediate level – can be very helpful into psychotherapeutic work and how the body in very simple levels, can be included in wor k as supervisor – no matter which preferences one’s supervisees might have.
As previously expressed I believe that different therapeutic approaches are able to support each other, just as you as a specialized therapist ought to develop skills towards other methods as well.
Observing the simple.
When therapists discover the value of less thinking, leaning back, watching – and begins to ask into the more simple and obvious, a huge change occurs. To many supervisees and psychologists are too trained in thinking. It is here an element as using your eyes – simply to look at the client – appears. Just to look at the client and the put questions to it, like: ”I see that you wrinkle your eyebrows” – ”I see that you smile” – ”You looked away when mentioning…”? These very simple actions progress’ the contact and the therapeutic work. I want to repeat former mentioned: Look, look and ask.
Each time the therapist share an observation the client gets seen and involved into a deeper sensing of – and engagement into himself and the ongoing process. The client gets involved and responsible to his own process. This is much more potent to changes than being depended upon the the therapist’s insight.
Whenever the therapist shares an observation the contact gets more deep.
If the supervisee wants to move further next step is to look for a kind of systematic. It might be to pay attention to where the clients body seems to be more ”alive” or filled with energy – and where movements and energy seems to be blocked – or to pay attention to certain body- and tension patterns that reflects Alexander Lowens bioenergy or Bodynamic character structures.
Doing this is to bodyread. Some books (danish (Tove Hvid) as well as others) introduces to- and guides for contemplation.
Still – even if you as a therapist has started studying bodylanguage and bodyreading – this advice still counts: Watch, share and ask!!
The therapist as soundboard.
When the therapist explores the meaning of – during the therapeutic work – give time to sense, including bodily, how he actually feels it is a larger ”revolution”. How to actually lean back, enjoying the process of the client. Being aware of when you switch position in the chair because of….? or how you become totally squeezed together and tensed up because of…? focused in how to solve the clients issue. Simply sensing the body is a safe way to increased freedom of action and more genuine contact to the supervisee.
The reader might think: ”I knew that”.
I know it is very simple, but never the less, I have to state that it is astonishing few supervisees who are in continously contact to themselves during their work as therapists.
The armchair model.
A common therapeutic mistake is to work much to much. Driven by desire towards helping or whatever the motivation might be, the therapist often works very hard and very fast. A lot can, and should be said about that.
Another way to do it is to let the client practice leaning back. It is not easy – but it is functioning. Some of my students mentioned this as: ”The armchair model of Lennart”.
A lot of times I’ve seen supervisees ”light’en up” when they realized that it is not necessary to remained seated during the whole therapy. The ”freedom in allowing yourself to stand up – to move around, even together with the client,,,, it can really lead to radical changes to the client as well, when you start to ”put” these elements into the therapy.
You might spend a huge time talking about self esteem, loose grounding, get insecure etc, without ever leaving the ”small talk” level. If – however – the client place himself in – and shows the bodily position which reflects the experience of being insecure e.g., you immediately starts to work – it becomes concrete and operational.
Most therapists seem to have been taught following lesson: In order to be a respectful and serious therapist you has to remain seated (without moving) on your chair, having all attention on the client, who (of course) is sitting on his chair.
There are any therapeutic traditions that explicit prescripts this model – but it is however one of the strongest implied therapeutic models you can be confronted with as a supervisor.
Very early during my therapeutic training I luckily received this advice: Keep Moving – this is hereby passed by to the readers – included a few extra words about what might happen when therapist, and client as well, starts to move in the therapeutic situation.
To expand attention to bodylanguage and to use the room doesn’t mean that you have to stop thinking.
Psychologcal sizes as boundaries, being present, experiencing support, pressure etc., in a way becomes concrete, precise and operational when the client shows it, test it and works with changing it bodily as well as in the room….possible in an interaction with the therapist.
As a therapist working with assault issues, a concrete relation to the room between the therapist and the client, might not be a ”must” but obviously it might be helpful. Allowing the client to ”protect” himself with a blanket might be a therapeutic intervention that supports much more than a lot of words.
The reader might recognize elements from gestalt therapeutic training’s. Fritz Perls really had skills in demonstrating how important awareness to the simple and obvious is. In my point of view it is very important to maintain another of Perls skills as well – even though he did not put so much into it himself – his very precise ”nose” for finding the essence – in other words: his ability to make very precise analyzes.
Without an open ”vibrating” nose to find the essence – without a parallel analyze towards what happens to the client, the therapist will not come far.
The precise message I will give is: Pay awareness to the body, use your senses, look out, sense – in as well as out and keep on asking the client what he senses – and do it all explicit during the interaction – and allow the head to take part too: continue analyzing and expand the comprehension.
For even deeper understanding into including the body in therapeutic work I will refer to an article I wrote about psycho-therapeutic training and perspective in body work: ”From amateur to Master” – and to another article from 2001 that I wrote together with Steen Jørgensen: ”Bodily anchoring into psycho-therapeutic work”.
The Body-ego – ego-strength and anchoring of reality.
In psychotherapeutic work with developing the client’s ego’s and anchoring of reality, including the body is a very effective tool.
Clients in a deep crisis, in conditions shaped by ptsd, or by other reasons characterized by or overwhelmed by powerful emotions, can during very simple bodywork get helped to pull themselves together. Suitable bodywork in such cases has to focus on:
- sensing of weight
- sensing of psysical boundaries
- sensing of and possible strenghten up into positioning – and boundary muscles.
Clients having a ”weak” ego, e.g. clients who are in a limit psychotic state or clients with borderline elements, has advantage from the very same tools why they supports the ego-structure i.e. via a concrete sensing of boundaries.
Bodywork that supports the ego is about guiding the client in to the body and possible to chang tension patterns in muscles. This work has to be done being in careful contact with the client – tecniques and knowledge is good to have but it cannot stand alone.
This kind of bodywork is coming from the assumption than development of the ego is connected to the bodily or motoric development. (just as the interaction terms in the development) Try to give thoughts to Piaget and his hypotheses about the way the cognitive development starts, or arises from a sensori-motoric level. OR think at an ego-function like Boundaries. This specific ego-function is build on a mixture of actual sensing and suppression towards sensing bodily impulses.
Working with a client, with a more ore less unreal self-perception based on denial to certain sides of himself, sensing the body is an important tool in order to get a more anchored reality in the client which leads to a more authentic self-perception.
If the reader wants to know more about connections between ego-development and bodily and motoric development in a psycho-therapeutic perspective I will recommend this literature: ”Waking the body-Ego” an article by Peter Bernhardt, Marianne Bentzen and Joel Isaacs. Other relevant literature could be: ”11 functions of the Ego – and their bodily anchoring” (Merete Holm Brantbjerg & Lennart Ollars, 2006)
The body as a multifacetted tool.
To include the body to the therapeutic work is a rather simple process. From the supervisor perspective it is about giving support and retain the supervisees in expanding awareness towards bodily aspects of the client, themselves and the interaction.
In a way introducing the idea of the tensionpatterns of the body as a physical expression of the Ego and the Ego structure is similar simple. Having knowledge, to this very concrete and direct way to support clients in ”holding themselves together” (through sensing the body and tensing up), is very important to supervisees.
It takes a lot of training, but first of all it it important to have awareness during the communication with the client. Techniques and knowledge are important too – but can’t stand alone. This is similar to experience oriented bodywork. If this work has to give results are techniques and ”more sound” not enough. Catharsis oriented bodywork, lacking proper contact and fine adjustments, will easily get nonconstructive.
One of the most widespread prejudices concerning body oriented psychotherapy is that it is almost similar to experimental work.
”When working bodily you don’t have to think at all” is another common prejudice – ”Body is good – thinking is bad” is one more common sentence.
Body oriented therapeutic work might be practices like this – but it certainly don’t have to.
My hope is, that this article will help to a more faceted look into which possibilities attention towards the body can give in psycho-therapeutic work.
Aspects to the therapeutic process – nuances to the therapeutic role.
In the start of this article I asked: What is important to have as a therapist?
In conclusion, I will ask: What does it take to make psychotherapy functional?
A good answer to this question has interest in, as well an understanding into the therapeutic process and the nuances in the therapeutic interaction and hereby, what it is that You and others, including one’s supervisees, needs in order to develop tools and skills as a therapist.
In the following I will share a relatively sketchy and simple model, which I have found applicable in cooperation with supervisees. Applicable in verbalizing part of processes in the therapeutic room and in verbalizing different aspects to the therapeutic role. Then I will compare this model in relation to a couple of other models respectably by Esben Hougaard and Søren Willert.
Aspects to the therapeutic role.
A number of different sub-process might be necessary in order to make durable changes to the client as a result of the therapeutic process. Here is my suggestion to a list of sub-processes from therapeutic processes which I have experienced as radical ”game-changers”. I have often seen, two, three, regularly more process parts being filled or present in successful therapies.
- An accurate mapping/analyzing and a recognizing of bodily, mental and social aspects to a problem.
- A reliving, redemption and reconstruction (reframing) to central episodes from the client’s history.
- Recognize decisions and establishing re-decisions.
- Support and guiding into reestablishing emotional – and action related potential.
- Contact, support i.e. that has been lacking is added.
- Parental counteraction during the therapeutic situation.
- Reestablishing (constructive relations) in client’s network – experience being:
- Important to others
- Seen and heard
- Able to receive help and to handle conflicts.
- Understanding of own history and personality
- Acting to – and integration of (in therapy discovered) potential in the daily life – including homework.
Of course, these elements are more or less connected or overlapping.
Every element could be deepened into and discussed – but I chose to stay in the ”overview”.
If the elements should be ”rated” according to one another, the most suitable graphics, in my point of view be a circle. Each element has connection to the others and none of the are more important – at least not in general.
See the model on the next page.
Different aspects to the therapeutic work.
The model ”pinpoints” different aspects in being a therapist.
The therapist is supposed to have skills into analyzing in cooperation with the adult part of the client and has to be able to ”map” the nuances in how the clients issues exposes – and help the client to get an understanding into his resources as well as challenges. In other words – to understand his (clients) history and distinctiveness.
During this ”mapping” it is extremely important that client experience being seen, heard and contained into a common understanding. That way the client receives a ”room” where they ca be ”themselves”.
Therapist has to be able to be supportive while, at the same time support and maintain confronting experiences from the clients history – in other words – be able to ”act” as a healthy parent towards the clients inner ”child”.
In boundaried sequences the therapist must step into an ”ideal-parent” role to the clients ”inner” child, in order to allow the client to experience a new contact model.
Therapist has to maintain and support the client in taking in new forms of being- and acting – and to use them in the daily life. Support cooperation between the client’s ”child” – ”parent” and ”adult”.