Professional Documents
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A HANDBOOK OF
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PSYCHOTHERAPY
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6 Penny Rawson
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First published in 2005 by
Karnac Books Ltd.
118 Finchl!':}' Road, NWJ SHT
978 1855753044
10987654321
www.kamacbouks.coln
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111 Contents
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9 ACKNOWLEDGEMENTS xi
1011 ABOUT THE AUTHOR xiii
1 INTRODUCTION xv
2 Quick reference note xvii
3 AIMS OF THE BOOK xix
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5 CHAPTER ONE
6 What is brief psychodynamic psychotherapy? 1
7 An overview
8 Quick reference notes 19
9 Focal and short-term psychodynamic
psychotherapy 20
2011
Suitability of client 21
1
Counter indications to suitability of client
2
for short-term therapy 21
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Selection of patients 22
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Motivation 24
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Basic principles of focal and short-term therapy 25
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HolmesRahe scale 26
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Article Focal and short-term psychotherapy
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in a treatment of choice (Rawson, 1992) 27
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30 CHAPTER TWO
1 Focus 33
2 Quick reference notes 46
311 Finding the focus 47
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1011 This book is dedicated to the late Louis Marteau who
1 introduced me to the method of brief psychodynamic
2 psychotherapy.
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111 ACKNOWLEDGEMENTS
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1011 I would like to thank those who have assisted me in
1 compiling this book. I am grateful to those clients who
2 have permitted me to use material from their situations,
3 using a pseudonym. I have amalgamated some of the clin-
4 ical examples for confidentiality and all names are ficti-
5 tious; any resemblance to an individual is therefore
6 chance. I am indebted to Fr Tom, who has read, encour-
7 aged, and supported this work, and to Terry Baker, who
8 has also proof read for me. I will always remember with
9 gratitude the late Louis Marteau, who taught me so much
2011 about this brief method of psychodynamic psychotherapy.
1 Also thanks are due to Karnac for publishing this, my
2 third book.
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111 INTRODUCTION
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5 Why the book?
6
7 This book has been written in response to the interest
8 shown in the short-term approach. Very many health
9 authorities and doctors surgeries now work predomi-
1011 nantly in the brief approach, as do most university coun-
1 sellors. The profession has begun to offer an increasing
2 number of courses in various forms of brief work.
3 Professionals are seeking to increase their knowledge of
4 short-term therapy with a view to practising it, teaching
5 it, or supervising others who are now working in this way.
6
7
8 Who the book is for
9
2011 This book focuses on the basics for working in short-term
1 psychodynamic psychotherapy. It is aimed primarily at the
2 experienced therapist. The basic tenets of counselling and
3 therapy are therefore assumed to be part of counsellors
4 existing repertoire of skills. This book might also be useful
5 to any other therapist, supervisor, or trainer who wants to
6 think about the basics of brief psychodynamic
7 psychotherapy.
8 Additionally, this book will provide the lay person who
9 is interested in knowing a little more about the brief
30 approach with an outline of the method. In fact, many
1 people are using aspects of counselling and therapy in
2 their day to day dealings with others. The counselling
311 continuum (see p. xvi) indicates the different levels of
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A Counselling Continuum
LEVEL 1 LEVEL 2 LEVEL 3 LEVEL 4
Interest in the persons concerns Depression Depression Psychotic
Broken relationships Unhealed bereavements Suicidal
Homesickness Bereavements Long-standing anxieties
Wrong course Decisions Difficulties re study
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Careers Advisers
This differs from counselling, Formal contract Formal contract Referral out
which is time-consuming to look at the to look at the
and would interfere with issues. issues.
objectivity of academic process;
danger of tutors getting too
involved.
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111 My hopes
2
3 I write from a position of faith in the approach. It is a
4 treatment of choice, as you can see in the copy of the arti-
5 cle in the quick reference notes at the end of Chapter
6 One. I have not been compelled through pressure of
7 numbers or financial limits to adopt this method. Rather,
8 I have seen the good effects that can be achieved in a rela-
9 tively short time. I want to see clients helped out of their
1011 pain and towards a more free existence in the shortest
1 possible time. This is an approach that I have practised for
2
some twenty-five years. Having been asked to teach the
3
approach and to supervise those working in it for many
4
years, I am often asked what it is. To answer this I have
5
decided to provide a very basic guide to the practice of the
6
method. This is in the hope that the approach may
7
become more accessible to professionals and that more
8
people may be helped more quickly by counsellors and
9
therapists adopting the method.
2011
I cannot claim that this method of therapy is my own.
1
It is, in fact, rooted solidly in a tradition. Those who are
2
3 interested in the history and development of brief psycho-
4 dynamic psychotherapy might wish to refer to Rawson,
5 2002, pp. 3947. Clearly I have adapted and modified the
6 concept, as any therapist does. I learned the approach
7 from the late Louis Marteau, and refined his eight model
8 approach down to four to six sessions. This approach has
9 been equally successful in colleges, in private practice, and
30 in an employee assistance programme. My approach is not
1 rigid or restrictive. It is flexible and the number of sessions
2 offered is adapted to the particular needs of the client.
311 Even so the mean tends to be four to six sessions.
2 xx
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111 Activity
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3 Brief therapy involves a certain activity on the part of the
4 therapist, who has to draw the client back if they wander
5 off the subject, or question how this seemingly unrelated
6 area fits in with the agreed focus.
7
8 Therapeutic alliance
9
1011 It is important for the client and therapist to have an
1 agreed focus and time frame. This will be reached after a
2 period of exploration. This process already involves the
3 client in the therapeutic relationship and creates the ther-
4 apeutic alliance. In searching with the therapist for the
5 focus and in explaining why they are there, the clients
6 motivation becomes apparent. If they are not motivated it
7 will be very hard to come to this agreement.
8
9 Flexibility
2011
1 The therapist needs to be very flexible in working briefly,
2 being ready to adapt skills to fit the client and to renego-
3 tiate both contract and time scale if this seems necessary.
4 I believe that if the therapist has experience this helps to
5 speed the therapy. This is because the experienced thera-
6 pist is less afraid to experiment. The person with experi-
7 ence has a range of skills to call upon and has seen many
8 problems over the years, all of which contribute to the
9 body of knowledge now available to the therapist.
30 Flexibility of skills means that the therapist will use what-
1 ever tool seems appropriate at the time. This approach
2 allows for a fusion of skills and experience. I like this
311 word, one that Wolberg uses in his writings about short-
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111 term therapy in the 1960s. So, as you see, this approach
2 is not a new one at all! Nowadays, the word used would
3 probably be integrative, the term eclectic having seen
4 better days. The concept of fusion seems to me to imply
5 a seamlessness in the use of many skills and that is how I
6 believe it should be.
7
8
9 Who can do it?
1011
1 Because we are, so to speak, sprinting in this method of
2 therapy, there is a certain energy required of the therapist
3 and an alertness, and attention to detail. I believe that the
4 approach is best handled by an experienced therapist. This
5 is simply because the experienced therapist will perhaps be
6 less thrown by anything that the client brings up, will
7 have more skills at their disposal, and more confidence to
8 adapt and try new things than the newly qualified coun-
9 sellor. There is, however, debate about this issue, since
2011 often the experienced counsellor may have a certain preju-
1 dice against the brief approach and will therefore block
2 progress by virtue of this. The new therapist, who has
3 come freshly to the approach and who is prepared to
4 believe in it, can in fact achieve very good results despite
5 inexperience. So there are pros and cons here!
6
7
8 Involvement
9
30 I have already alluded to the sprinting idea and to the
1 flexibility of skills that make the approach an active one.
2 The therapist is active and so is the client. The client is
311 expected to be involved and indeed involvement is seen to
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111 Motivation
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3 Quotation from Frontier of Brief Psychotherapy, with
4 regard to assessing the clients motivation
5
6 We have emphasized the importance not merely of moti-
7 vation for treatment, but motivation for insight; in
8 Sifneos statement, There should be motivation for
9 change, not motivation for symptom relief (1968b), the
1011 words are different but the meaning is essentially the
1 same.
2 The criteria relevant to motivation to which Sifneos
3 directs his attention are as follows (these are taken from
4 Sifneos, 1968a: see also Sifneos, 1972, pp. 85ff):
5 1. An ability to recognize that the symptoms are
6 psychological in nature.
7 2. A tendency to be introspective and to give an honest
8 and truthful account of emotional difficulties.
9 3. Willingness to participate actively in the treatment
2011 situation.
1 4. Curiosity and willingness to understand oneself.
2 5. Willingness to change, explore, experiment.
3 6. Realistic expectations of the results of psychotherapy.
4 7. Willingness to make reasonable sacrifices in terms of
5 time and fees.
6
To these criteria, McGuire(1968) has added two that are
7
probably implied by Sifneos, namely:
8
9 8. That the patient should not demand that particular
30 symptoms should be relieved.
1 9. That he should not regard the problem as being
2 purely concerned with the present situation or as being
311 purely external. [Malan, 1976, pp. 2223]
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Focus
Focus
111 that once we have named our focal area everything else
2 then relevant to that tends to emerge.
3 Some techniques are particularly useful in helping the
4 client to find the focus, e.g., a body memory exercise. This
5 will be explained in greater detail in a later chapter.
6
7
8 Triggers for emotional problems
9
1011 Anniversaries
1 Anniversaries may be the trigger for a problem. The
2 anniversary of a death, or losing a job, or the breaking up
3 of a relationship may be the trigger. The body somehow
4
remembers these traumatic events even though,
5
consciously, we have moved on and forgotten all about
6
them. It sometimes only emerges as we explore the situa-
7
tion, because the client has come to us complaining of
8
depression and one asks: Is this time of year or this date
9
of any significance? Often, it then transpires that there
2011
was a death, or a break-up of the family, a redundancy, or
1
an accident exactly at this time, but years ago. Sometimes
2
the memory is immediately accompanied by tears or
3
anger. There is often a sense of recognition by the client
4
5 as they see that this is what is the cause of their present
6 depression.
7
World events
8
9 World events can trigger problems for our clients, perhaps
30 a memory or an actual event in the here and now. For
1 example, someone whose father or husband or daughter is
2 off to war. Or where another member of the family has
311 been killed or injured, or is fighting overseas and is in
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Focus
Focus
111 The questions are divided into two sections, the first of
2 which deals with:
3
4 (i) work and hobbies, since these are often the areas that
5 people find easiest to talk about;
6 (ii) finance and whether the clients can save;
7 (iii) primary family;
8 (iv) secondary family;
9 (v) how they feel about themselves.
1011
1 The second section is very revealing, in particular with
2 respect to a question that is looking for any indication of
3 suicidal thoughts. The very fact that the question is asked
4 gives the client permission to reveal their feelings in this
5 regard very quickly. These questions cover :
6
7 (i) whether alcohol or drugs are a problem;
8 (ii) whether the person ever wishes they were dead;
9 (iii) some general question as to how they feel about life
2011 in general.
1
2 Of the first five areas a person can usually handle as
3 many as three of these being bad, but at four they are
4 becoming rather wobbly and with five even worse.
5 However, we can help them to strengthen each of the
6 areas. We can ask if they would like to explore these vari-
7 ous areas with us so that we can enable them to build up
8 sufficient positives to be able to dare to look at the real
9 problem areas. For example, if work is hated, we can
30 encourage greater focus on hobbies, if finance is in trou-
1 ble, we can encourage them perhaps towards a part-time
2 job, or in exploring how they spend their money, which
311 may allow us to encourage less eating out and more home
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111 that the therapist and they are on the same track. But this
2 may not be the case.
3
4
5 Dont miss the moment
6
Often, clients will blurt out what they have come for in
7
the first few minutes. At times therapists are too busy with
8
their own agenda of, say, putting the client at their ease.
9
For example, asking if they found the venue all right,
1011
explaining about confidentiality, and taking some factual
1
information, name address, referral agent, etc. All of this
2
may be done in the good intention of helping the client
3
to relax and because the information is, indeed, required.
4
These matters are important, but I suggest that some-
5
times, in this process, something important can be lost.
6
We may well overlook what the client is actually saying.
7
We may miss the moment. One must avoid the first
8
session being a kind of throw-away, warming-up, or intro-
9
ductory session.
2011
1
2 The sacred moment
3
4 Winnicott used to refer to the sacred moment. He found
5 that the children who were coming for therapy had been
6 waiting perhaps some days for their appointment. They
7 would rehearse what it was that they wanted to say and
8 would blurt out why they had come in the first few
9 moments. It is important not to lose this. An example of
30 this is client F (Rawson, 2002, p. 184). I asked, What has
1 brought you here? Her answer: Ive been depressed
2 well, since I was nine years old, gave the clue to the whole
311 of her problem.
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111 has come for therapy. Even if the therapist has been given
2 very accurate notes from the intake worker, the therapist
3 needs to satisfy themselves that they and the client are
4 working on the same issues. I think it is helpful to almost
5 recreate a first session. One has to make sure that the client
6 does not feel as if they are just repeating things that they
7 have already said to the intake worker and are getting
8 nowhere. The therapist might approach this from the
9 following angle: Since some time has elapsed now since
1011 you saw the assessment worker, perhaps you could fill in
1 what was going on for you at that time and what the situa-
2 tion is now. Or one might say something like: I know that
3 you have spoken already to the intake worker and they have
4 passed on to me a summary of your conversation, as they
5 told you they would, but I would find it most helpful if you
6 could tell me in your own words what made you decide to
7 come for therapy, so that I can be quite sure I have under-
8 stood what it is that you are seeking from the sessions.
9
2011
1 The beginning of therapy
2
3 In the brief approach, session one is very much the begin-
4 ning of the therapy. The therapist will endeavour to be
5 very focused as to what their client wants and expects
6 from therapy. They will attempt to tease out the issues and
7 to pin down their client to gain clarity as to the issues.
8 This process of clarification helps both client and thera-
9 pist and ensures that both are working on the same issues.
30 In this process the therapy begins from the first moments
1 of the encounter and one can be working at depth from
2 this first session, utilizing any appropriate skills. The
311 client often tries, whether consciously or unconsciously, to
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111 avoid the real and painful issue. At times, as a defence, the
2 client will talk of issues that are not really where the pain
3 is. The therapists task is gently to help them to have suffi-
4 cient confidence in the situation to dare to reveal the real
5 issue. It is the therapists task to help the client to open up
6 in this way. Observation of the clients body language will
7 often reveal where the real issue is. It is important that the
8 therapist stays where the emotion is even if the discussion
9 is moving in another direction. The emotion is in the now
1011 and is of paramount importance. For example, client
1 Oliver rattled off a number of issues that he wanted to
2 speak about, so many that I wrote them down. Then I
3 read them back to him, asking him which he wished to
4 start on. As I read there was one where I observed tears
5 welling in his eyes, but he did not choose that one to
6 discuss. I gently queried the fact that he had not chosen
7 the one that seemed to be upsetting him most and
8 suggested that, really, this one might be the most helpful
9 for him to explore with me. The tears once again welled
2011 and he began to share the painful area with me.
1
2
3 Touching the pain
4
5 At times one session may be enough. There are some prac-
6 titioners who work as one session therapists and produce
7 good results. One aspect of the first session that is of
8 prime importance is to touch the clients pain. In doing
9 this the client is given hope that the therapist knows
30 where the pain is, that they can handle it, and that it is
1 not going to destroy the therapist. In touching on the sore
2 spot, painful as that might be, the opening up is already
311 begun and the healing process is started. In touching the
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111 pain we are also letting the client know that we can bear
2 it. It is not going to destroy us. The client needs to know
3 this and one can often be aware of the client testing us out
4 as therapists. Almost like dipping a toe in the water:
5
Is the therapist going to hear me?
6
Is the therapist going to be alert to my clues?
7
Is the therapist going to be shocked, or judge, or preach.
8
Will they know what to do?
9
Can they handle my problem?
1011
Can they bear my pain?
1
2 It is hoped that by the end of the first session the client
3 will feel that the therapist has understood their issue and
4 will have the hope that they will be helped with it.
5 Table 1 provides a useful summary of the many aspects
6 to be borne in mind in the first session (see the quick
7 reference notes, p. 64).
8
9
2011 The first session needs to begin
1 the therapy
2
3 The first session is indeed an introductory session and one
4 in which the therapist and client get to know each other
5 and about the process of therapy. It may be good, for
6 instance, to allow a few minutes at the start of a session to
7 help the client to arrive and to get off their chest any-
8 thing that is impeding them from going straight
9 into the work of the contract. For example, if they have
30 just witnessed a road traffic accident on their way to the
1 therapists office, they may well need to offload about this
2 before getting down to the issues they booked the
311 appointment for. Even if such a need is apparent, the ther-
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111 the time limit for this session, i.e., half an hour. It is this
2 half-hour that begins the work of the therapy. I believe
3 that it should be undertaken by the therapist who is to
4 lead the group.
5
6
7 Starting therapy at a sprint
8
9 This chapter has stressed the need to start the work of
1011 therapy at a sprint, with the therapist being intensely alert
1 to the client from the very first moments of the encounter.
2 The first session thus begins the work of therapy, it is not
3 just an introductory session. Having stressed the impor-
4 tance of the first session, in the next chapter I say a little
5 more about the focus, that central facet of brief therapy.
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111 another on the couples faces, and so on. Then the camera
2 would shift once more to the overall picture, still holding
3 the couple in the spotlight but showing their full figures,
4 as they went at considerable speed around the rink. Only
5 at the end of the performance did the camera take in the
6 wider scene, with some shots of the audience to put the
7 whole scene in context.
8 What a superb analogy for the way focused therapy can
9 work. There is the overall focus, which is kept in mind the
1011 whole time, but as we work with the client on this we
1 focus on different aspects of it, examining these in detail.
2 Then it is all related to the main heading or focus that has
3 been agreed. Periodically, the main focus is also related to
4 the overall picture and how it fits in with the rest of the
5 clients life.
6
7
8 The strategic focus
9
2011 The issue of focus is so central to the approach of brief
1 psychodynamic therapy that more needs to be said about
2 it. We have already seen some of the ways to home in on
3 the key issue for the client and to hold the client to this.
4 We endeavour not to get distracted into exploring irrele-
5 vant sidetracks and if seemingly unrelated issues come in,
6 then we check how these relate to the contract. The
7 contract is the agreement as to what we are working on
8 with the client and the time scale that we agree to work
9 to. More will be said about contract in the Chapter Five.
30 The strategic focus is where the present and past pain
1 is. This will be apparent in the emotion shown by the
2 client, in the body language, in the atmosphere in the
311 room, or, at times, in the therapists own body awareness.
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111 The client usually has a sense of where the real issues lie.
2 However, they do not always reveal these to the therapist
3 straight away. As we said when looking at the importance
4 of the first session, there is often a certain testing out of
5 the therapist. Will they understand my pain? Can they cope
6 with my pain? Will they know what to do? Will they pick up
7 my hints? Sometimes, intentionally or unintentionally, the
8 client will give us a focus that masks the real issue. It is
9 part of our task to enable them to bring the strategic issue
1011 to the surface, the one that is at the heart of the problem.
1 At times clients will try to talk about an absent other. This
2 is of relevance only if it aids the client in response to that
3 other. It is the clients trip and no one elses.
4 I have occasionally heard supervisors and therapists
5 discussing their clients, saying, for example: I really think
6 he/she needs to do more work on x or y or z. and I think
7 she/he is acting this way because of a or b or c. While,
8 perhaps, there is a place for such speculation in training
9 as examples of what might be going on, we need to be
2011 very careful to facilitate our clients trip and not allow it to
1 become an interesting exercise for the therapist. Also, we
2 need to limit the work we do with a client to what they
3 wish to explore. That is not to limit the therapists free-
4 dom to challenge and to reflect blind spots of the clients
5 to them, this as a challenge to encourage them, possibly,
6 to explore wider issues, and simply to stress the need to
7 keep the clients needs as the focus.
8
9
30 Roots in the past
1
2 Once the strategic focus has been narrowed down and
311 both therapist and client are clear about it, the therapist
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5
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111 also needs to help the client to see that this may have its
2 roots in the past, since this is where the problem proba-
3 bly comes from. Louis Marteau refers to this underlying
4 problem as the nuclear crisis i.e., stemming from an
5 emotional crisis in childhood (Marteau, 1986, p. 81).
6 He also observes that
7
8 If this presenting crisis is truly nuclear, then getting it out
9 at the roots must be the aim of the therapy while the
1011 process will be to reach through the present crisis to grasp
1 the very roots. This means that the presenting crisis needs
2 to be the major focus through which we will attain the
3 roots. The true resolution of the presenting crisis, which
4 means reaching the roots, will be the test of the success-
5 ful outcome. [ibid.]
6
7
8 Renegotiation
9
2011
At times, the focus that we initially agree upon turns out
1
not to be the most important issue to explore. If this is the
2
case then a process of renegotiation of the contract needs
3
to take place. This can happen for all sorts of reasons.
4
Perhaps the client has been testing us and now wants to
5
look at the real issue. Perhaps life circumstances have
6
changed and now something in the new situation is more
7
pressing. Maybe the client had not realized that one topic
8
had masked a more serious and strategic problem. The
9
30 important thing is that client and therapist are clear about
1 and are in agreement as to what they are working on,
2 jointly agreeing a change of contract if that is what is
311 required.
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111 Refocusing
2
3 At other times, it is not a change of contract that is
4 required but a refocusing on what has already been agreed.
5 Sometimes we need to get the client back on course,
6 perhaps by reminding them what the contract was, or
7 maybe asking how the topic now being talked about
8 relates to what they came for. Also, it is good to keep the
9 time limit before the client and point out the need to
1011 prioritize in order to achieve what they want in the time
1 agreed.
2
3
4 Homework
5
6 One of the elements of brief therapy is the use of home-
7 work. Some people dislike that word because of its
8 connotations with school. Essentially, we encourage the
9 client to work on their issues in some way at home in
2011 order to speed up the process. Clearly, in relation to the
1 rest of a persons life, the traditional fifty-minute hour is
2 very little. Therefore, if the client can give a little time
3 throughout the week to their issues, great progress can be
4 made in a short time. It also encourages the client to
5 become their own therapist, which is another aspect of
6 the method. Thus, they take with them into the rest of
7 their life the skills that they learn in the therapy situation.
8 One example of how this might work from early on is
9 if the client is having trouble narrowing down what they
30 want of the therapy. There may be several issues that are
1 bothering them. At home work in this instance might be
2 to ask the client to think about all the different things
311 they want to cover and to select the one or possibly two
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5
6
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111 that they would like to focus on in the next session. The
2 therapist should encourage them to choose the one they
3 most want help with, in view of the brief nature of this
4 type of work. It is worth pointing out that it is often the
5 most painful one that is most important to look at.
6 Sometimes more than one of the issues will be selected by
7 the next session. It is relevant to hear why the client has
8 chosen the two and often it becomes apparent that in
9 some way they interlink with each other. The client
1011 usually has a pretty good idea about what they want from
1 therapy, even if initially they have difficulty in verbalizing
2 it. Asking the clients to be specific helps them to begin to
3 tackle the issue and keeps them thinking and working on
4 their issues between sessions. Often a great deal can
5 change in the course of the week.
6 Homework needs to be integrated into the work of the
7 session and to arise from what has gone on there. It can be
8 thought about with the client. It may be a suggestion made
9 by the therapist or can be very open-ended, e.g., It might
2011 be helpful to think a bit more about that during the week.
1 More is said about homework in Chapter Seven. The quick
2 reference notes suggest some homework for the therapist!
3 The focus that we have examined further above and the
4 time limit are negotiated with the client to form a contract
5 for the work of therapy. In the following chapter we exam-
6 ine further the importance of time limits in brief therapy.
7
8
9
30
1
2
311
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111
2
3
4
5 QUICK REFERENCE NOTES
6
7
8
9
1011
1
2
3
4
5
6
7
8
9
2011
1
2
3
4
5
6
7
8
9
30
1
2
311
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5
6
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111 that a few number of sessions will not be long enough for
2 the client to resolve their problem. But, in fact, many
3 clients are much relieved to know that the contract might
4 be short. It is cheaper for one thing. It is less of a disrup-
5 tion to their lives, as coming for counselling surely is, and
6 it inspires hope that they may be out of their pain soon.
7 Having a time limit provides the client with a certain
8 safety and perhaps allows them to open up because it is
9 only for a little while. There is a certain pressure, if there
1011 is only a little time, that pushes the client to think Id
1 better get on with it. There is an aspect of loss that is both
2 a positive and negative thing. The good side of it is the
3 idea that they can get on with their life and, hopefully, feel
4 better soon. The less good side is that they are losing their
5 good relationship with the therapist. That can be noted
6 and brought into the sessions. Often, the ending of the
7 therapy contract brings back other losses. There is depen-
8 dence upon the therapist even though the contract is
9 brief; this is almost a necessary part of the trusting
2011 process. It is limited, though, by the knowledge that the
1 end is there right from the beginning. We will look
2 further at the issue of loss later on.
3
4
5 Spacing and length of sessions
6
7 The number of sessions and spacing of sessions for the
8 contract needs to be agreed with the client. This may
9 take the form of a certain number of sessions or a period
30 of time. The sessions do not have to be on a weekly basis.
1 In fact, a fortnightly gap can suit some people very well,
2 time seems to go so quickly. The gap allows sufficient time
311 for the client to have put into practice any aspect of
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5
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111 homework that arose from the session. (We return to the
2 concept of homework later in more detail.) In an
3 Employee Assistance Programme (EAP) I worked with in
4 Somerset, many of the clients opted for fortnightly
5 sessions, if given the choice. There is nothing sacrosanct
6 about the weekly session except, I would suggest, custom
7 and practice. Equally, the same could be said of the fifty-
8 minute hour or hour sessions, another tradition. Again in
9 the Somerset practice, where either therapist or client
1011 travelled maybe four hours return to get to the venue of
1 the session, a longer session at less frequent intervals made
2 sense in terms of economy of time. The therapeutic work
3 did not seem to be disadvantaged by this. I believe that
4 there are also some therapists who practise a kind of
5 marathon session of several hours in one go. I do not
6 know enough about that to express an opinion of its effec-
7 tiveness. I, personally, would be unable to concentrate for
8 more than a couple of hours in one stretch. Although
9 supervision is a different exercise from therapy, I find the
2011 hour and a half sessions that most of my supervisees opt
1 for a very good span of time, in terms of both allowing a
2 lot of content to emerge and concentration.
3 Having challenged assumptions a little here, most ther-
4 apists still prefer the hour, or fifty-minute hour, sessions,
5 and that applies to the brief psychodynamic model too.
6 Sessions can be organized in other formats. They can be
7 tapered off, for example, maybe three sessions on a weekly
8 basis and then a follow-up session three weeks later. It can
9 be appropriate to take account of public holidays, such as
30 Christmas or Easter, or term times as the deadline, and
1 then work out how to space sessions up to that time. I tend
2 to offer four sessions and then a review. At the same time I
311 sow the seed of the idea that probably four or six will be
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111 issue for, say, four sessions. This being satisfactorily tackled,
2 the client then goes on their way to assimilate the learning
3 from this work for a number of weeks. Later they may
4 return to explore a further issue. In long-term work much
5 the same process happens, except that the client will
6 continue to attend sessions with the therapist during the
7 assimilation period. Learning tends to happen in peaks,
8 and then there is a plateau stage as we come to terms with
9 new concepts or practise new ways of responding to situa-
1011 tions. In the brief approach, the client works in the plateau
1 stage on their own. This is cheaper for them and does not
2 encourage the dependence on the therapist that is the case
3 in longer term work. The comparison is made, not to get
4 into a debate about which is better or worse, but simply to
5 highlight the difference and some of its consequences. In
6 fact, is this not how we work with physical problems? We
7 go to the doctor when there is something specifically
8 wrong. That is treated and we dont go near the doctor until
9 some other matter causes us a problem.
2011 I referred earlier to the energy required in this method.
1 I think that if this energy is lacking in the initial phase of
2 therapy the therapy can tend to slip into a different mode,
3 a slower and more ponderous one that will probably
4 extend it. All is not lost if this happens; one simply needs
5 to review with the client, see if we are achieving what the
6 client wants, and refocus. Then we are able to proceed to
7 work at the agreed focus and pace.
8
9 The dynamics of the deadline
30 (Rawson, 2002, p. 64)
1
2 There is a deadline effect induced by the limited contract.
311 We will all have memories of times when we rushed to
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111
2
3
4
5
6 QUICK REFERENCE NOTES
7
8
9
1011
1
2
3
4
5
6
7
8
9
2011
1
2
3
4
5
6
7
8
9
30
1
2
311
4 89
5
6
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111 about, and get in touch with, the emotional and painful
2 events of their past or present.
3 The therapists activity will draw on experience and a
4 wide range of therapeutic interventions. The structure of
5 the approach affords little time to waste so if one
6 avenue does not move things along, another can be tried.
7 Each client draws different skills from the therapists
8 repertoire but these must be integrated into the thera-
9 pists way of work, not used haphazardly or artificially
1011 applied.
1 The analogy of horse and rider is perhaps appropriate
2 here. A skilled rider will adapt to their mount, using their
3 equestian skills flexibly at one time, firm; at another,
4 gentle.
5 Every horse will draw out a different response and
6 needs a particular understanding and approach. The ther-
7 apist needs such a flexible and adaptable approach to
8 every client. Each individual therapeutic relationship is
9 unique and it is in this uniqueness that the mystery of the
2011 therapy works.
1
2
3
4
5
6
7
8
9
30
1
2
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5
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111
2
3
4
5
6
7
8
9
1011
1
2
3
4
5
6
7
8
9
2011
1
2
3
4
5
6
7
8
9
30
1
2
311
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Flexibility
Flexibility
111 persons grief and loss. To stay present in the silence can
2 be a gift any friend or companion can give to the
3 bereaved. Obviously with sensitivity and to speak or not
4 speak as appropriate. Sometimes, the friend who simply
5 stays nearby the bereaved, reading their paper or who
6 quietly gets on with some little job, can be a comfort.
7 There, but not intruding. There, if called upon to share
8 a memory or thought . . . [Rawson, 2004, p. 19]
9
1011
1 Each client draws different skills
2 from the therapist
3
4 Returning to flexibility, each client will draw different
5 skills from the therapist appropriate to their particular
6 case. Linda, in the example that follows, also needed a lot
7 of help to be able to share her problem. Again we see a lot
8 of silence and education about counselling and therapy,
9 but other skills also.
2011
1
2 Linda
3
4 Linda came and slumped in the chair, looking at the floor.
5 In response to my gentle questions, I got grunts, nods, or
6 shakes of the head. I decided to explain a little more about
7 how counselling works, i.e., that people who have some-
8 thing on their minds which is bothering them come and
9 talk to a counsellor, who has no axe to grind, or judge-
30 ment to make, but who will listen and help to clarify. I
1 went on to explain how the therapist will use the skills
2 they have learned to help the person come to terms with
311 what is troubling them, or to express the emotions that
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Flexibility
111 they are bottling up. I explained how this can help the
2 individual move on more freely and be able to get on with
3 their life once more. I could tell that Linda was listening
4 intently, but still she said nothing. I asked, Have you
5 come of your own volition?, and I got a nod. Do you
6 want to share something with me but dont know how?
7 Another nod. I decided to list a few of the problems that
8 people bring. People come here with all sorts of problems
9 and issues, relationship breakdowns, difficulties with
1011 parents, unwanted pregnancies, trouble with their tutors
1 or with the course and their studies, assault, rape, or diffi-
2 culties with flatmates, or a death. When I mentioned rape
3 there was a tangible increase in the heaviness in the room
4 that had been there since Linda came in. I went silent
5 again and waited. I could feel a squirmy sort of feeling in
6 my tummy. I knew this was nothing to do with my own
7 situation and that this in some way related to her. After
8 quite a long silence, when she still seemed quite unable
9 to speak, I asked, Im wondering if you perhaps have a
2011 kind of squirmy feeling inside? At this I got a real res-
1 ponse. She looked at me directly, with astonishment, and
2 nodded. I said, Something pretty scary must have
3 happened. Again she nodded, holding my gaze. Can you
4 tell me about it? I asked. It might help to share it. Was
5 it one of the topics I mentioned? Another nod. I said that
6 I guessed one of the most difficult to talk about might be
7 being raped; was it this? This time she began to talk and
8 told me about a most horrific incident of rape by a former
9 boyfriend. It had been a deliberate and vicious attack but
30 in her own home, which she had allowed him to enter.
1 Because of this she perceived it to be her fault and was
2 loath to tell the police about it. In fact, in time she did.
311 The woman police specialist who had dealt with rape
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5
6
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111 victims for some twenty years said it was the worst rape
2 case that she had ever dealt with, causing a lot of internal
3 damage to the girl.
4 The work of therapy continued but the point of this
5 extract is to see how we can arrive at the focus of the
6 sessions. In this example it was achieved by using silence,
7 countertransference/projective identification, education,
8 questions, noticing the body language and picking up on
9 the weight of feeling in the room, and providing a suffi-
1011 ciently safe environment for the client to open up. This
1 demonstrates the flexibility of the therapist.
2
3
4 Body memory
5
6 Another technique that is extremely valuable I call the
7 body memory exercise, and it is one that can speed up the
8 process very much. An example of this used in practice
9 follows, and an example of how to lead this is shown in
2011 the quick reference notes at the end of the chapter. It is
1 especially useful when a client is depressed but has
2 absolutely no idea why. Once we have explored the obvi-
3 ous, already mentioned things with them, such as anniver-
4 saries, key life events, and so on, I will then suggest that
5 we try an exercise and I explain how it works. It was used
6 with the following client.
7
8
9 Rob
30
1 Rob was terrified of going into lectures and was in danger
2 of dropping out of the course. He had no idea why, but
311 simply found himself unable to go into the lecture hall.
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Flexibility
Flexibility
111 He was still, however, left with the residue of the panic
2 with regard to the lecture hall, since this now was a habit.
3 We needed to address that too. I tackled that in two ways.
4 First, I taught him a very simple relaxation exercise that
5 he could do several times a day and could also do espe-
6 cially when approaching the lecture hall, or any crowded
7 situation. The more practised he could become at this the
8 quicker the actual exercise could work to help him. It is a
9 very simple exercise of clenching and relaxing the muscles
1011 bit by bit all over the body. Eventually, just by clenching
1 a hand, the body should go into relaxation mode.
2 The second thing that I suggested he do was to take the
3 little boy by the hand as he approached any of these scary
4 situations. Then, he had to consciously remind the little
5 one, in his imagination, that he, the adult, was with him
6 now and that he could answer back and speak up for the
7 two of them. The situation, therefore, was not as it had
8 been in front of his uncle. I wondered if there had been a
9 pet name that he might have been called as a little boy,
2011 because that could help in this exercise. In fact, Bobby was
1 the childs pet name. I further suggested that he could
2 perhaps devise a short-cut code to remind himself that he
3 was not in the forest and that hes not five but thirty-five.
4 This is to help keep him in the present and not get
5 hooked into the past. For example, he might simply have
6 to say, Its OK Bobby, Roberts here or Im Robert or
7 Bobby, you go and play Ill see to this, or whatever
8 helps!
9 So he had a lot of homework to do. When he next
30 came to see me he had begun to go to classes and felt very
1 much better. The progress continued. After just three
2 sessions he felt that he had no further need of therapy. He
311 was now fine, not only attending classes but even speaking
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5
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Flexibility
111 Client E
2
3 In Rawson, 2002, pp. 9799, there is an example of me
4 relying very much on where the client led. Although I was
5 with her in her fantasy journey, I had absolutely no idea
6 what was coming next. I endeavoured, at each stage, to
7 help her to make it safe or possible, but she was the one
8 who worked out how, mostly to my total amazement. An
9 extract below, in which P stands for me and E for the
1011 client, demonstrates what I mean. I was aware of time
1 being short and wanted to bring E out of the fantasy and
2 back to the room. She had created a horse as a symbol of
3 safety for herself and they were out: in a plain . . . its
4 green and theres lots of space.
5
6 P: Can you get to the College, to the classroom. Will the
7 horse bring you?
8 E: Yes, hes here Ive opened a window and his heads
9 poking in.
2011 P: Thats not very practical can he change again to be
1 closer?
2 E: Yes hes changing shape, hes a dragon draped around
3 my shoulders.
4 P: Can he get smaller; hell frighten the others.
5 E: Yes, hes quite small now under my collar like a
6 necklace around my neck comforting.
7 P: Has he a name?
8 E: Yes Horace. That came up this morning. (and she
9 told me of an incident that morning.)
30 P: So how do you feel about what weve been doing
1 today?
2 E: Good it feels like integration. I dont think Ill lose
311 this its easier to hold on to images.
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5
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Flexibility
111 session. If the client does not do the homework, that too
2 can be part of the learning process. Why havent they?
3 What were the obstacles? If it is not done, it is not the role
4 of the therapist to be in any way punitive. It may well be
5 that the work suggested was way off the mark from where
6 the client was. It is something to explore with the client.
7
8
9 Activity
1011
1 The flexibility required of the therapist in this method
2 also points to an activity of the therapist which is unfa-
3 miliar to some. Chapter Seven addresses this.
4
5
6
7
8
9
2011
1
2
3
4
5
6
7
8
9
30
1
2
311
4 113
5
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111
2
3
4
5 QUICK REFERENCE NOTES
6
7
8
9
1011
1
2
3
4
5
6
7
8
9
2011
1
2
3
4
5
6
7
8
9
30
1
2
311
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Flexibility
111 move the emerging scenes on. In using this method one
2 needs to be very creative and work with where the client
3 is, but remember the client can be creative, too. Some-
4 times one wonders where the scene is going and what to
5 do with it, but one can say things like, Can you find a
6 way of dealing with that? Invariably the client can and
7 does.
8
9 A safe place
1011 One needs to help the client to reach a safe place with
1 their story. I have referred to E above, and the full exam-
2 ple appears in Rawson, 2002, pp. 9799. This is is an
3 example of me relying very much on where the client led.
4 Although I was with her in her fantasy journey, I had
5 absolutely no idea what was coming next. I endeavoured,
6 at each stage, to help her to make it safe or possible, but
7 she was the one who worked out how, mostly to my total
8 amazement. I was aware of time being short and wanted
9 to bring the client out of the fantasy and back to the
2011 room. She had created a horse as a symbol of safety for
1 herself and through her imagination, she was able to
2 transform this into a manageable symbol of a necklace.
3
4 How to begin
5
6 After the explanation about what the exercise is, it may
7 begin as follows:
8 If youd like to close your eyes so that you do not get
9 distracted and just breathe normally. Be aware of any
30 tension anywhere in your body. Indicate in some way if
1 you have found any tension, raise a hand or finger
2 perhaps. (Wait until the client has responded a minute
311 or two.) Be very aware of the tension and make the
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Flexibility
Flexibility
Activity
Activity
Activity
Activity
Activity
111
2
3
4
5
6 QUICK REFERENCE NOTES
7
8
9
1011
1
2
3
4
5
6
7
8
9
2011
1
2
3
4
5
6
7
8
9
30
1
2
311
4 135
5
6
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111 Activity
2
3 Activity of therapist
4 by holding the focus, keeping the spotlighton
5 the agreed focus;
6 by holding boundaries;
7 by actively holding a silence;
8 by facilitating, e.g., use of questions, use of art,
9 fantasy exercises, body memory exercise, use of
1011 transference, countertransference;
1 by being in sprint mode, sensitively aware of
2 inflections, body movements, hesitations, actively
3 holding client to agreed contract;
4 by being flexible re techniques and contract,
5 moving with client to a new contracted
6 focus/time scale as necessary;
7 by explaining the processes of counselling and
8 how various techniques might be helpful, i.e.,
9 teaching the client how to be their own therapist;
2011 by giving information, e.g., psychological process
1 of grief;
2 by being actively involved while remaining
3 appropriately detached;
4 by researching subjects as necessary.
5
6
7
8
9
30
1
2
311
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Activity
Techniques
Techniques
Techniques
Techniques
111 after a few days you notice mistakes that you overlooked
2 when reading it soon after writing it. It seems that a little
3 distance makes for a certain clarity in such instances.
4 Perhaps, certainly in the case of the tape, ones defences
5 drop a little so that we find ouselves facing the reality.
6
7
8 Stones/buttons/interlocking Russian dolls
9
1011 Some therapists will make use of different shaped stones
1 to get a picture of the clients relationships. They ask the
2 client to choose a stone for each person and to say why
3 they have chosen that one. Then the client is asked to
4 place each stone on the surface and to say why they are
5 putting them where they do in relation one to the other.
6 This can be a very powerful exercise and very revealing,
7 and can help the client to articulate what is going on for
8 them. It can enable the client to see more clearly what is
9 happening in the family dynamic and it can continue to
2011 be used creatively as therapist and client explore the
1 changes the client wishes to make. Buttons or other
2 objects can be used to equally good effect. The different
3 sizes and shapes give plenty of choice to the client as they
4 remind them of significant others in their lives. The dolls
5 that fit inside one another in different sizes can also be
6 useful in this sort of exercise. I believe that they are
7 commonly known as Russian dolls.
8
9
30 Goodbye letter
1
2 In Grappling with Grief, there are a number of suggestions
311 of activities to help oneself or others, especially at times of
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Techniques
111 grief (Rawson, 2004, Chapters Five and Six, pp. 73106).
2 Some of these can be adapted to fit other issues also.
3 One that come to mind is the idea of writing a good
4 bye letter to a loved one (ibid. p.76).
5
6
7
Symbolically letting go
8 A dramatic and powerful symbolic action of letting go can
9 be made using helium balloons. This might be thought
1011 about if one is ready to let go of someone who has died
1 or who is no longer in ones life through a divorce or a
2 break-up of a relationship. It could equally be applied to
3 something that is no longer available for us, such as a job
4 or career or something that is no longer wanted in our life,
5 like a bad habit. I would suggest that a nice place is found
6 to release the balloon and that one takes time to reflect
7 and think a little about both the good and the bad side of
8 the situation that is being let go; the idea being to release
9 one to get on with ones new life, enriched by the good
2011 that has been part of ones past life and unencumbered by
1 the bad that may equally have been present. With regard
2 to both the good and the bad, one hopes that lessons have
3 been learned that will help us to enhance the good and
4 avoid the bad as we continue lifes journey.
5
6
7 Symbolic remembering
8
9 Another idea is that of symbolically remembering a
30 deceased person, e.g., planting a bush or tree as a symbol.
1 The actual planting can be a ceremonial act. It can be a
2 way of putting a full stop and going on with life, a way of
311 saying goodbye (Rawson, 2004).
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5
6
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111 waste any time. As in the short piece, which was seen in
2 the quick reference notes entitled The dynamics of the
3 deadline, we all know the effect of a cut-off date for
4 essays, job applications, or a report for a board meeting.
5 A deadline has a wonderful way of concentrating the
6 mind. Many people seem unable to achieve results with-
7 out a deadline to work to. Brief therapy clearly capitalizes
8 on this.
9
1011
1 Great achievements in little time, if that is
2 all one has!
3
4 Therapists will be able to cite many examples of client
5 work, which has miraculously speeded up when the client
6 is emigrating, moving, ending term, or having to stop
7 therapy for some other reason.
8
9
2011 Joan: one session therapy
1
2 Once I had a student come to see me on the last day of
3 term. She had walked out of an exam because she simply
4 could not seem to do it. She was a good student and knew
5 the material, but couldnt get on with the exam. She went
6 to the station some forty minutes away in order to go
7 home but, sitting there, she remembered that, at the
8 student induction session a couple of years earlier, I had
9 said, Before you pack your bags to go home come and see
30 me. So she turned around and came back. I made a space
1 to see her. We explored the obvious possibilities for her
2 block, such as, had she felt prepared for the paper?; did
311 she want to pass?; did she like the course?, and all seemed
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Endings
Endings
Endings
111 why the question was important, now they might simply
2 answer the question or acknowledge the comment. In the
3 earlier part of the contract the client is often too absorbed
4 in their issues to be able to notice anything outside of
5 that. Or, on the other hand, they might be using a more
6 personal comment as a way of avoiding their issues.
7
8
9 Loss for the therapist
1011
1 For the therapist, too, there can be loss. The therapist, for
2 a brief period, has been intensely involved in the clients
3 story. The therapist needs to be able to let go, to encour-
4 age the client to go it alone and to trust that they can. In
5 the phrase teaching the client to become their own ther-
6 apist we are, in effect, giving away our skills and teaching
7 them to do without us. The therapist needs to maintain a
8 certain detachment at all times; despite the involvement
9 referred to earlier it is a detached involvement.
2011
1 Respect for and trust in the clients ability to cope
2
3 The therapist, therefore, needs to have a great deal of
4 respect for the other persons ability to cope and to trust
5 this. As therapists, we are both teacher and facilitator. This
6 perhaps demands a certain humility on the part of thera-
7 pists, as they acknowledge that they are not indispensable.
8 The therapist needs to be flexibile, to allow for more
9 sessions later, if that is what is required. A good parent has
30 to allow the child to move away, but is always there in the
1 background. The doctor deals with the presenting issue,
2 but is still available if the patient returns with another
311 unconnected, or related issue. The therapist, at times, can
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Endings
111 see areas that perhaps the client could benefit from work-
2 ing on, and these might be voiced, but it is not the ther-
3 apists business to lead the way, that is the clients task.
4 When the time is right, if they have had a good initial
5 experience of therapy, then they will not hesitate to take
6 it up again, if it is needed.
7
8 Ripple effect in therapy
9
There is a ripple effect in therapy. When one issue is
1011
resolved it tends to have a knock-on effect on other areas
1
of a persons life. (See Parables, Rawson, 1990.)
2
3
Demanding on the therapist
4
5 The quick succession of clients with the very intense and
6 deep work of brief therapy is very demanding for the ther-
7 apist. The therapist has to be very ready to let go of their
8 clients. This sort of work is very stimulating, challenging,
9 and rewarding but, pleased as we must be at their
2011 progress, there is a loss as the client with whom we have
1 worked moves on. We rarely get to hear of the long-term
2 outcome, since we are but a small part of the clients jour-
3 ney and one that they may be pleased to leave well behind
4 with its associated painful memories. It can feel, as for
5 client I almost as if the client is a stranger to the person
6 they now are. Client I read what I had written about our
7 work together and said:
8
9 After reading the report my mind began to remember how
30 I felt during those sessions and this seemed so far removed
1 from what I feel today. I realised that I was justified in
2 being so angry and that I used this anger to shield the
311 pain. When reading this there was no pain, no anger, only
4 159
5
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111
2
3
4
5
6 QUICK REFERENCE NOTES
7
8
9
1011
1
2
3
4
5
6
7
8
9
2011
1
2
3
4
5
6
7
8
9
30
1
2
311
4 161
5
6
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Endings
Endings
111 Homework
2
3 Be more aware of the following ideas:
4
5 Client as own therapist.
6 Giving the client the tools.
7 Focusing.
8 What is the contract?
9 The end from the beginning.
1011 Issues of loss for client and the therapist.
1 The dynamics of the deadline.
2
3
4
5
6
7
8
9
2011
1
2
3
4
5
6
7
8
9
30
1
2
311
2 166
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111 therapy. It is, perhaps, more for the therapist then to seek
2 help from their professional organization, or maybe to
3 seek a situation compatible with their own ideals.
4 Incidentally, if a therapist really does not wish to work in
5 the brief way and if this goes against the grain for them,
6 I question whether it is really wise for them to work in
7 this way at all.
8
9
1011 Supervision: how much?
1
2 There is ongoing debate in the profession about super-
3 vision in general and for brief therapy in particular, and
4 my responses to some of the opinions that have been
5 published appear below in the quick reference notes
6 (pp. 177185).
7
8
9 Brief therapy for the twenty-first century
2011
1 There is also in the quick reference notes that follow, a
2 copy of an article entitled Brief therapy for the twenty
3 first century, which seems an appropriate summary as we
4 near the end of this book (pp. 174176).
5
6
7
8
9
30
1
2
311
2
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111
2
3
4
5
6 QUICK REFERENCE NOTES
7
8
9
1011
1
2
3
4
5
6
7
8
9
2011
1
2
3
4
5
6
7
8
9
30
1
2
311
4 173
5
6
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111 of one case may well move along others also. Of course any
2 special problem that the therapist may be having with a
3 client may mean that a case will need more than one visit
4 and might even be reviewed every supervision. One of the
5 key principles emerging from my research about brief ther-
6 apy was that of flexibility. This related to both time and
7 techniques. I would also recommend appropriate flexibil-
8 ity for therapist and supervisor. Additionally I am one of
9 the school of thought that believes that each supervisee in
1011 a group benefits from the supervision of other supervisees
1 cases and I have long questioned BACs way of calculating
2 the individual equivalent time of supervision for those
3 who attend group supervision.
4 One or two other aspects of her article drew my atten-
5 tion and an alternative viewpoint.
6 Her student counselling supervisees with unapprecia-
7 tive management, and student clients who have difficulty
8 engaging in the process of counselling, demonstrate only
9 one side of the coin.
2011 The student Counselling Service I managed found that
1 students readily contracted for flexible short-term
2 contracts, attended the sessions with great commitment
3 and seemed to reach satisfyingly positive results. Brian
4 Thornes article refers to my experience of committed
5 student clients too! Also was I exceptionally lucky to
6 have had appreciative management for most of my early
7 career as a College Counsellor in the Higher Education
8 sector?
9 Her suggesting to her supervisee that staff counselling
30 should be referred elsewhere is, I suggest, an over simplifi-
1 cation. Many colleges have built into the counsellors
2 contracts that they see staff for counselling as well as
311 students. So the boundary issues in this regard have to be
4 175
5
6
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111 gets round that they can be helped out of pain in a few
2 sessions for a limited amount of money. Where therapy
3 is offered free within, for example, EAPs, there is
4 certainly no shortage of clients and there is a good success
5 rate in the short number of sessions normally allowed.
6
7 Special rewards for the brief therapist
8 The rapidity with which clients move on from their
9 presenting problems to go it alone with confidence is
1011 greatly rewarding. It also serves as a reminder of the
1 resilience of the human being and the privilege we have,
2 in participating briefly but deeply, in the lives of those
3 who choose to come to us.
4
5
6 Bibliography
7
8 Clarkson, P. (1998). Beyond schoolism the implications of
9 psychotherapy outcome research for counselling and
2011 psychotherapy trainees. Counsellor and Psychotherapist
1 Dialogue 1, 1(2): 1319.
Gustafson, J. P. (1986). The Complex Secret of Brief Psycho-
2 therapy. New York: W. W. Norton.
3 Marteau, L. (1986). Existential Short Term Therapy. London:
4 The Dympna Centre.
5 Rawson, P. (1990). Parables. London: FASTPACE.
6 Rawson, P. (1992). Focal and short-term therapy is a treatment
7 of choice. Counselling, 5: 106107.
Rawson, P. (1995). By mutual arrangement. Counselling News,
8
6: 89.
9 Van Kaan, A., (1970). On Being Involved. The Rhythm of
30 Involvement and Detachment in Daily Life. Denville, NJ:
1 Dimension Books
2 Wolberg, L (Ed.) (1965). The Technique of Short Term Psycho-
311 therapy. New York: Grune and Stratton.
4 185
5
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111
2
3
4
5
6
7
8
9
1011
1
2
3
4
5
6
7
8
9
2011
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2
3
4
5
6
7
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Rawson/correx 9/1/05 10:50 AM Page 187
111 INDEX
2
3
4
5
6
7
8
9
1011 abortion, 47 F, 52, 128129
1 activity, xix, 12, 30, 9597, Jacques, 100103, 134
2 113, 122139, 168, 183, Jane, 124126
3 187, 189 Jean, 3940
4 alcohol/drugs, 4, 10, 21, 42, Joan, 152155
143, 160, 182 Kate, 144
5
anger, 3, 38, 96, 103, 118, Rob, 106110, 112, 115
6 153, 159, 182 Casement, P., 53, 145, 191
7 anxiety, 77 caution, 145146
8 compulsory therapy, 67
9 Balint, E., 191 contract, xix, 2, 7, 10, 12, 17,
2011 Balint, M., 67, 31, 34, 191
21, 2829, 51, 5658,
being with the client, 101,
1 6197, 99, 127128,
103
2 136, 151, 155158,
belief in the method, 16, 180
3 165167, 174175, 180,
body language, 4344, 55,
4 189
68, 77, 93, 102, 106,
5 122 counselling continuum, xv,
body memory, 38, 106107, xviii
6
7 110, 115, 136137, 139
break-up (of a relationship), de Shazer, S., 191
8 death, 10, 21, 26, 38, 47,
38, 47, 75, 105, 129,
9 102, 105, 129, 155
149
30 brief group therapy, 5859 experience, therapy as, 176
1 depression, 4, 2829, 3334,
2 case examples 3839, 62, 75, 77, 106,
311 E, 111, 116, 145 129
4 193
5
6
Rawson/correx 10/4/05 9:41 AM Page 194
Index
Index
111 52, 84, 93, 100, 133, supervision, xvi, 14, 82, 112,
2 149, 169170, 174, 177, 150, 170, 172, 174175,
3 179 177178
resistance, 22, 2930, 32, 86,
4
9596 talking to the block, 143
5 talking to the inner child, 144
6 sacred moment, the, 5253 tears, 3, 3839, 55, 77, 118
7 sensitivity, 18, 25, 80, 104, therapeutic alliance, 12, 25,
8 168170, 189 168, 189
9 Sifneos, P., 68, 2324, 29, time exercise, 80
1011 31, 34, 183, 192 touching the pain, 55
1 silence, use of, 30, 7677, transactional analysis (TA), 125
101102, 104106, 122, transference/
2
134, 136 countertransference, 30,
3 spacing of sessions, 8182, 44, 106, 122, 125, 130,
4 85 131, 136, 162, 174,
5 splinter image, 23 181182, 187
6 strategic focus, 34, 65, Frasier, 131132
7 6578, 91, 183
8 stress, 45, 14, 26, 41, 43, under the microscope, 44, 91
9 139
and ill health, 4 voice, tone/use of, 43, 49, 76,
2011
suicide/suicidal, 4, 22, 33, 42, 102, 121122
1 153154
2 suitability/unsuitability, 6, 9, Wolberg, L., 1112, 23,
3 2123, 64, 145 see also: 3031, 132133,
4 caution 184185, 192
5 summary of the basics, 167,
6 188190 Yalom, I., 192
7
8
9
30
1
2
311
4 195
5
6