(c) Wen-Yan King, Flickr

If you are a in a relationship – regardless of either of your sexualities – and you are having relationship problems after an HIV test gave a positive result then contact me, Dean Richardson, today to arranging a no-obligation initial session to see if couples counselling could be suitable for both of you. My contact details are here, or you can click here to send me a secure email .

Counselling following an HIV Diagnosis.

It has not been unusual for a couple – gay, lesbian or straight – to come to see Dean Richardson for couples counselling after one (or both) have been diagnosed as HIV positive.

• Sometimes the couple therapy is about the shock of receiving a positive diagnosis.
• Sometimes the counselling is about trust issues raised by one partner being diagnosed.
• Sometimes the diagnosis is cathartic in releasing other matters that have been put off – but now need someone to help the couple discuss.

Whatever the core reasons of seeking couples counselling, Dean is a qualified and experienced couples counsellor who works with couples that have received a positive HIV diagnosis (amongst many other couple relationship reasons for counselling).  His couples counselling service can help a couple negotiate their way through difficult problems resulting from HIV diagnoses.

The GU clinic may give you and your partner support after an HIV positive diagnosis, but longer term therapy is available privately through meeting with Dean.

What to do next.

You don’t need to be referred to Dean via your local GUM clinic, nor your doctor.  Initiating private counselling is totally up to you and can be arranged as soon as you make contact with Dean.  It is a confidential service that can compliment the medical treatment that you will continue to receive through your GUM clinic and/or your doctor.

Click to contact me for more information or to make an appointment.

(c) danielbrezina.com, Flickr

Introduction.

A current problem (2010) is that counselling and psychotherapy is not yet governed by UK law.  Anyone can advertise themselves as a counsellor or therapist without actually having any professional training, appropriate qualifications or any actual experience. Unfortunately, this might suggest that the client seeking therapeutic treatment could be at risk of working with an unqualified therapist.

However, finding a qualified and experienced counsellor can be a straightforward process if you know of some helpful things to look for.

This post describes how to find a suitable therapist – and offers some topics to check out with your potential therapist.  At your first meeting, most – if not all – therapists should not be phased by you asking about the topics (in later sessions, however, some therapists may not answer your questions about them directly, but be interested with you in the purpose of your question – keeping the focus upon you.  This is a legitimate form of therapy (eg psychodynamic / psychoanalytical) – but I include it here just so that you are aware).

Advice for Clients.
Read: “How to get the best out of your therapist”
(c) BACP – 2010

Search a Professional Body

An easy way to find a suitable therapist is to use a professional therapists’ body that offers a “find a therapist” type of service. The therapists listed may have had to pay for an entry, but would also have had their qualifications checked before being allowed to pay for an entry in the list.  It’s a good place to begin searching for a therapist.

• British Association for Counselling and Psychotherapy
  http://www.bacp.co.uk/seeking_therapist
• British Association for Psychotherapy
  http://www.bap-psychotherapy.org/
• The British Psychological Society
  http://www.bps.org.uk/

… however, if you wish to find your own therapist – or you would like some advice on what to check out about your potential therapist – then read on.

Finding your Own Therapist.

Finding your own therapist can be easier when you want to find a counsellor with specific criteria.  Sometimes professional bodies do not include such criteria.  Use search engines such as Google, Yahoo and Bing to begin your search – and then refer to the information below about what you might want to check about each potential therapist.

Qualifications.

Does the counsellor has a recognised qualification in counselling.

Diplomas and Degrees – check that the qualification included actual supervised practice (eg 100 hours counselling practice to achieve the qualification).  Having a qualification in the theory of counselling without any actual practice may be insufficient for your needs.

Certificates in counselling may not include any actual practice to gain the award if they are just certificates of attendance.

Membership of Professional Body.

Is the counsellor a registered member of a professional body?  Do they subscribe to a recognised code of ethics or an ethical framework for their therapeutic work?  Is there anyone to whom you could report your complaint if you needed to?

Special interest/experience.

Does the counsellor have any special interests or special experience in working in particular therapeutic areas?

Theoretical approach.

There are different forms of counselling and psychotherapy – and whilst it’s the relationship between therapist and client that is shown to matter, some approaches might suit you better than others.

See Wikipedia – http://en.wikipedia.org/wiki/List_of_psychotherapies for information on therapy models.

Who does the counsellor work with?

Does the counsellor state what types of person they can work with (eg adults, couples, young people, children, elderly etc).

“This is how I work”.

Does the counsellor give you an idea of how they work therapeutically?

Fees.

Do you understand what the therapy will cost?

Supervision.

Counselling supervision is a formal meeting in which the counsellor meets with a qualified supervisor (or another counsellor) to review their clinical work.  Sometimes their professional development and their personal development is reviewed too – depending on the counsellor’s needs. A supervisor is not a managerial role, but more of a professional service designed to support the counsellor.

Is the counsellor taking regular supervision?  Some therapists’ professional bodies require the therapist a minimum amount of supervision every month (eg 90 minutes).

Continual Professional Development.

Does the therapist make you aware that they attend CPD (a form of contining their training and experience throughout their practice).  Some professional bodies, such as the British Association for Counselling & Psychotherapy, require that the counsellor obtain a specific number of CPD hours per year.

(c) antwerpenR, Flickr

Introduction.

This is not meant to be a detailed formula regarding couple therapy, and no couple’s relationship – or problem – is quite the same as another, but as a very brief overview this post describes an overview of systemic- and psychodynamic-based counselling for couples.

Major aims.

Major aims for couple counselling would include:-

• Identify what we all agree the focus of the counselling should be.
• With the focus agreed, we begin looking at the couple’s relationship “system” … in other words, what’s happening in the way that the couple relates to each other that the couple believe is going wrong (or that one partner might think is going wrong, but the other partner disagrees).
• Encourage hypotheses – what do the couple think is make the relating “system” go astray and become unsatisfactory (initially the couple is helped by the therapist’s curiosity towards learning how the “system” works and how the problems arise – but the couple would be encourage to hypothesise for themselves).  Hypotheses can change quickly as more information about the system is learned.  Hypotheses do not need to remain static.
• Be curious with each individual’s past history … what might there be in each person’s history that might be getting replayed in this relationship.
• State the obvious – the therapist helps the couple to see how they behave with each other and react to each other.  Whilst this might be obvious to an onlooker, the behaviour may not be so obvious to the couple themselves.  This helps to provide more information towards the hypothesising activity.
• With working hypotheses, theorise on what triggers the system into becoming unsatisfactory, and theorise on how the triggers can be changed / shifted / perturbed.
• Continue the process of hypothesising, theorising and perturbing until sufficient change comes into effect that counselling can conclude.

If, during the therapy, a couple decides that they do not wish to stay together, then the therapy can move into preparing separation:-

• What needs to happen for the couple to separate?
• Who will be affected (children, family etc)?
• Does the law need to be involved (ie formal divorce or civil-partnership dissolution)?

Moving into a separation process does not necessarily guarantee that the couple will separate.  Separation can always be reversed if the couple wishes … even after divorce.  Couples counselling can (and does) continue during the separation process in order to help both partners separate satisfactorily from their relationship.

Domestic Violence.

If domestic violence is revealed in the assessment – or in the counselling work – then we will talk about stopping the violence immediately.

We will discuss the “Safety Plan”.  In summary: during a situation between the couple that may be leading to violence, one partner will take responsibility for leaving the room/leaving the situation.  The other partner will take responsibility for not following the leaving partner (the partners don’t need to decide beforehand which role they are going to take).  The partners will stay separated until such a time when both partners feel that it is safe to come back together.  Then can then have a conversation about what lead up to the safety plan being executed.  They will also discuss with the counsellor what happened when they next meet with the counsellor.  Whilst this sounds like a simple plan – and in essence it is simple – it can be very difficult for a couple to execute the plan.  In counselling we will discuss the plan in detail and discuss things every time the plan is put into action.

Relationship counselling can helpful but it can initially make things worse because we are perturbing with a relationship system in order to help re-build it more safely and successfully.  Disturbing a disturbed relationship can be very difficult for both partners.  Both of you must convince me that it is safe for you both to work with me in counselling – and discussing the safety plan is the main way we will achieve this.

Conclusion.

This has been a brief overview of the aims of systemic- and psychodynamic-based couple counselling.

(c) Daquella manera - Flickr

Couples Counselling can help a couple to separate -  if this is what they wish to do – whether this is decided at the start of therapy or if such a decision is made during couple counselling.

It can be a common misunderstanding when couple counselling is considered simply as “a therapy to prevent a couple separating“.  This single point of view is not entirely true, of course, because some of the aims of couple therapy are much more complicated than a simple situation of staying-together-or-not.  Outcomes of couples therapy are at the (informed) decision of the couple themselves and not the therapist nor the intention of couples therapy in general.

Couple counselling is a therapy targeted toward the couple’s relationship, rather than therapy for two individuals in a relationship.  The focus of a couple’s therapy will be what the couple want to change about the relationship, their behaviour within the relationship and as a qualified couples counsellor and BACP accredited therapist, I have training, experience and supervision in working with couples whose chosen outcome for therapy is not staying together.

Therefore, in the assessment, a couple and I will discuss what the couple wants from counselling … and separation is a legitimate option for couples counselling.  Sometimes this decision is made at the beginning of counselling, sometimes it’s made during counselling.  Either is a legitimate option for couples therapy.

Separating / Staying together / Unsure?

I have worked with couples who wish to work to stay together, and with couples of wish to separate.  I have also worked with couples who, at the time of the assessment … and for several months after, did not know what they wanted to do with their relationship – and so part of the counselling was to discover what our focus for the therapy should be.

Also, the focus we agree upon in the assessment is not set in stone.  Sometimes, during the course of counselling, one (or both) partner(s) may change their mind … or find their voice … and begin talking about wishing to separate.  Vice versa, a couple wishing to separate can change their minds during the therapy.  All of these situations are legitimate and as a couples counsellor I can help facilitate a couple in discovering what they want to do with their relationship. And when mixed-agendas appear (partner “A” wishes to stay together, partner “B” wishes to separate) I can assist the couple in working with those differing agendas too.  When a couple change their mind and wish to change their focus of their work (ie separating instead of staying together, and vice versa) I can help a couple work with that change too.

Couple Counselling & Divorce.

Couples who have engaged in marriage or a civil-partnership may decide that they wish to formally separate.  Of course, solicitors will be involved for the legal matters but the couple can still meet weekly with me to discuss matters about their separation.

It is often the case that an individual wishes to leave a relationship by “saving face” … and there can be pressure to denigrate their partner (because doing so helps the individual to appear or feel better than the partner).  Couples counselling can assist with the separation processes so that both partners leave the relationship in a neutral (perhaps even friendly – though not essential) position.

Advice on Separating.

Couple counselling can be helpful when a couple decide to end their relationship and need help in separating out the emotions and building blocks that originally joined them together. My qualification is in systemic and psychodynamic couples counselling (similar to the training that Relate (ex “Marriage Guidance Council”) counsellors receive.

Therefore, I do not give directive advice on how to separate, but instead I help facilitate the couple in finding their own solutions to how they wish to separate. I do this by remaining neutral in the relationship and being curious about many things. This can help the couple in discovering new information about their relationship, how they operate, and how things go wrong.  With such discoveries, the couple can put into place difference behaviours that can be helpful in relieving some of the distresses of separating.

Are you thinking about Couples Counselling?

See my Contact Me page or click here to send me a secure message to make an initial no-obligation appointment for an assessment for counselling.

(c) armigeress, Flickr

This is not an exhaustive list, but this post lists some of the problems that clients have brought to my psychodynamic counselling/psychotherapy practice over the years:

See also What could Couples Counselling help with.

(c) a_kep (Flickr)

This section discusses common questions asked about counselling.

To ask a question that is not answered here, either use the comments section (below) or contact me directly.

How do I know that counselling will benefit me?

By using a survey called CORE-OM, counselling can be demonstrated to benefit a majority of people. My own CORE-OM statistics show that every client who has chosen to take the CORE-OM survey has benefited from counselling.

This data suggests that counselling could benefit you too, although meeting with your counsellor for a proper assessment session is always a wise & necessary procedure to make sure that counselling is a suitable treatment for you.

However, we cannot know if counselling will benefit you, and so an ethical counsellor will be paying attention to the counselling work, and discussing in his/her supervision, if the counsellor has concerns that the therapy work seems not to be helping you … and discussing this with you if it is felt it would be helpful to do so.  It’s not in the counsellor’s client’s interest to keep a client attending therapy that is not being beneficial.  Plus, as the client, you too can discuss with your counsellor any concerns that you’re having at any time.

Read more about my CORE-OM Statistics…

How do I find and evaluate a counsellor?

See my separate post on this topic.

Download this free pamphlet on “How to get the Best out of your Therapist.”

(c) BACP – 2010

How do I start counselling?

1. Make contact with me to arrange an appointment for an assessment.
2. Following the assessment, we will both be in a position to discuss if counselling could be beneficial for you.
3. If we proceed into counselling we will arrange a weekly appointment (usually same day, same time, same location each week).
4. If we decide not to proceed into counselling I can either make a referral for you to a colleague, or you are free to find your own counselling.
5. If we proceed into counselling, we will continue to meet together either until a fixed number of sessions is up, or until the issues you came into counselling for are worked through sufficiently for you to feel that counselling can come to an end.

See individual assessments &/or couple assessments.

What Counselling Services are Available?

I offer counselling for the following main services in both my Portsmouth & Southsea (Hampshire) and Chichester (West Sussex) practices:-

• Counselling for Individuals (read more).
• Counselling for Couples (read more).

LGBT Counselling Specialities.

I also practice counselling for on lesbian, gay, bisexual and transgender clients’ specific needs in the areas of Portsmouth & Southsea (Hampshire) and Chichester (West Sussex).

• Counselling for Gay, Lesbian, transgender & Bisexual Individuals (read more).
• Counselling for Gay, Lesbian, transgender & Bisexual Couples (read more).

Is Couples Counselling different from Individuals Counselling?

Counselling for couples is similar to individuals, but with some obvious (and not so obvious) differences.

Primarily, in couple counselling my “client” is the couple’s relationship - I am not working with two individual peoples’ seperate problems. I assist the couple in finding their own solutions to their relationship issue. I work systemically and psychodynamically, meaning that I help the couple to peturb their relationship system sufficiently to gain new information that helps the couple take different approaches to their relationship problems, and I use some of their history to help them understand what each person may be bringing to the table that is helping and hindering the couple’s relationship.

Individual counselling my client is the individual him/herself.  I work psychodynamically with individuals, helping them gain insight into their problem and assisting them in working through the issues to a more satisfactory state.

Which counselling to choose?

An individual coming to counselling for her/her own issues is suitable for an assessment for individual counselling.

A couple coming to counselling for issues with their relationship are suitable for an assessment for couples counselling.

An individual coming to counselling to try and change relationship problems is likely better coming to counselling with her/her partner to work in couples counselling together.

A couple coming to counselling in the hope that one individual is going to be changed sufficiently to suit the other partner is possible unsuitable for couples counselling.

See also Couple Counselling & Individual Counselling.

What can I talk about in counselling?

Advice for Clients.
Read: “How to get the best out of your therapist”
(c) BACP – 2010

You can talk about anything that you think you need assistance with. I have written a separate page for this topic – click here to read.

There are some matters that would come under the law – for example if you wished to talk about your part in terrorism, intended harm to self or others, or criminal activity, then I would be obligated to break confidentiality in serious matters such as these. I will always advise you beforehand about confidentiality, and advise you before I take these matters elsewhere.

How long does a session last?

Counselling sessions with Dean last for 50 minutes. The time is there for you to do with what you need. Because every client’s time is reserved exclusively for them, if you arrive late the time cannot be made up later (eg adding an extra 10 minutes onto the end of the session). Similarly, if you arrive early the session will still begin at your appointment time.

How often do I need to come for counselling?

You will come once a week (on the same day, same time & same location) and attend one fifty minute session.

We will meet as many times as either we have initially agreed up front (eg brief counselling) or until we feel that the work has been done.

What is an assessment?

This is where you and I meet for a session (sometimes more, as required) and discuss what you need from counselling. I may also offer you a CORE survey (which is a questionnaire that helps us identify how things have been for you during the past week). I will offer you a number of tentative thoughts about what I hear from you, and maybe offer an interpretation or two based on how I might understand how matters link together. This is all part of seeing if we can work together.

This is a mutual assessment – you are seeing if you can work we me too.

If I have any concerns then I will discuss these openly with you – and you are welcome to discuss any concerns with me too.

Read more about:-

individual assessments &

couple assessments.

Do I have to pass (or fail?) a test to be allowed counselling?

No.

Unlike some newer IPT services in the NHS, where you only get to the next level of therapy by first being unsuccessful with the previous level of therapy, with me I don’t offer one level of therapy first, followed by other levels later. What you receive from me is my full service from the beginning (although, of course, I will always take matters at a pace that works for you).

Do I need to get my doctor to refer me to you?

No – I am a fully qualified and experienced counsellor/psychotherapist supervised according to BACP recommended standards. I am able to make my own judgements on suitability for counselling, can discuss matters with you directly, and you can make an appointment with me independently of your doctor.

Will you inform my doctor?

I will not inform your doctor that you are receiving therapy from me (unless, of course, you wish me to do so) as my service is confidential and independent of primary care services.

How do I decide between brief or open ended counselling?

When we have our assessment together, I will be paying attention to the problems that you are bringing, seeing how you respond to what I say, and considering if brief of open ended counselling would suit you best. Later in the session I will discuss with you what I think and ask you for your opinion. If we disagree with each other we can talk about this too.

Brief counselling: a set number of sessions, negotiated, usually six or twelve.

Open ended counselling: unlimited number of sessions, but working towards an agreed goal or improved emotional state.

Sometimes, we can also begin counselling in a form of a trial: which is open-ended counselling but starting with four or five sessions. Then we can discuss if we both think counselling is benefiting you after these sessions. If not, we can agree how and when we would like to end the trail.

What happens in a session?

After counselling has been going on for several sessions to establish itself, I usually greet you in reception, accompany you to the counselling room and then wait quietly whilst you consider what it is you want to talk about (you will lead the session).

Read more…

Do you have a particular style of counselling?

I am qualified in psychodynamic counselling for individual work, and am a qualified systemic & psychodynamic counsellor for couples. With careful consideration, I may also incorporate other therapeutic techniques that I believe may be useful to you, provided that I have had previous training and experience in these matters. I do not practice therapy models for which I have received no training nor experience.

Read more about psychodynamic and systemic models…

Are you a Christian Counsellor?

Christian counsellors (http://www.acc-uk.org/) are a form of support that follows religious beliefs at their core.  The following description is quoted from http://www.walking-wounded.net/html/christian_counselling.html :-

[the] approach is a Christian one, that is that Christian beliefs about human suffering and its causes – for example the role of sin in causing suffering, and the need for the presence of forgiveness in people in order for them to be spiritually (and also emotionally) free, is taken fully into account.

My form of therapy respects all form of religious and secular beliefs but is not based upon them.

How does counselling come to an end?

If we have agreed on brief counselling, then both you and I know when the sessions will end.

Open ended counselling is a little different, and more flexible. Usually, you or I or sometimes both of us will begin to notice that the reasons you came to counselling are no longer so prevalent. It is around that time that we can begin talking about if counselling has done its job, and if we are ready to begin an ending process. When we both agree that counselling can end, we will agree how we would like to end. For example: we might agree to end counselling in six sessions time, using those sessions to review where we’ve been, what it’s been like in counselling, and what it will be like to no longer come to counselling in the future. Then we end after the last session is complete.

What if I don’t like my counsellor?

Some clients find it very difficult to tell their counsellor what they do not like. Whether it something about the person themselves, their style, something they said in a previous session and so on.

All counsellors intend to be as open as they can to their clients, and thus we would very much like to hear when you are not very happy about something. Afterall, although this “something” might be happening between you and the counsellor, it might also be an example of something that, if we were able to work through together, might benefit you in your every day life.

And sometimes clashes cannot be resolved – no matter what good intentions both client and counsellor would like to have.

Sometimes a client simply stops coming to counselling, leaving no word why this is. Sometimes a client is able to find the courage to bring up what is bothering them with the counsellor themselves. Sometimes, moving to another counsellor is an option.

As your counsellor, I try to be attune to your needs, and as a human being sometimes I might be mistaken or I might miss something that is important to you. If I spot that something seems amiss, I will try and bring both our attentions to the matter (delicately, of course, because I might be mistaken in what I thought I spotted). Discussing with me what is bothering you about me can be helpful to us both.

Will what I say be told to anyone else?

Confidentiality.

I practice confidentiality. This means that you can speak with me knowing that your friends, your family, your work colleagues and so on will not get to learn what you have said in a counselling session.

I abide by and adhere to the British Association of Counsellors and Psychotherapy’s Ethical Framework.

As a BACP accredited therapist I am supervised to a minimum of 90 minutes per month. This is where I meet with a qualified counselling supervisor to discuss my practice and my case load. I will, from time to time and with your permission, discuss your case with my supervisor – but I will have first made sure that my supervisor does not know you, or is likely to come in contact with you (say, for example, though the workplace) and I will refer to you only by your first name (or another name if you prefer). If I cannot assure your confidentiality in this manner – for example if my supervisor knows you in the work place or socially – then I will seek supervision from another supervisor for your particular case.

Confidentiality will be broken if you disclose intent of harming yourself or others (including children) or if you disclose intent of committing a serious criminal offence. I intend to inform you of my intent to break confidentiality with you before I do so.

See also Ethical Framework.

What if I miss a session?

Missed sessions happen from time to time. Please try and let me know as soon as know that you are not going to be able to attend a future session. If you miss a session without notice, I will still be available for you at the same time and same day the following week (excluding any vacation or planned absences that either you or I have discussed).

The session fee is still payable if you cancel the session within two business-days ahead of the appointment time, if you do not attend your session without having given any prior notice of your absence.

What if I want to change our arrangements?

From time to time changes may come up. Please discuss these with me.

For example, the appointment time may become difficult or you may have heard of a treatment that you would like to try. All of these matters are worth having a conversation about because sometimes what seems to be an obvious resolution (eg changing the appointment time) can look quite different having discussed what’s going on around the potential change.

I need some paperwork completing by you.

Confidentiality is vital to this work – even when, sometimes, it’s not recognised that discussing the contents of the session outside of therapeutic containment would break this confidentiality. Therefore, I operate with some boundaries in this matter:

• Solicitors letter – I will make a charge for this. I will state you are in counselling but I will not reveal the contents of our work. I may also seek advice before agreeing to write a letter.
• Attendance forms (e.g. student placement) – I will co-sign a form that you have completed showing that you have attended counselling, but I will not reveal the contents of our work.
• Attendance forms that I am required to complete on your behalf – I will make a charge for this also.
• Most other letters that you ask of me will require a discussion, as I will not break confidentiality by discussing your counselling.

How much does private counselling cost?

See my Fees page for a description about my standard fees and sliding scale.

Could I see an example of a counselling session?

Counselling, of course, is confidential and therefore I will not demonstrate a real session with a real client.

However, as part of a university project with Pete Allen-Worth I took part in a recording of a role-played counselling session – click to see the video.

If I wished to raise a complaint.

Firstly, please try to discuss your complaint with me first. We will try to address your concerns and put things right.

However, if we cannot attend to your complaint together you are welcome to take your complaint to my professional body – the British Association for Counselling & Psychotherapy.  This will be make your complaint formal and the BACP have procedures in place to handle formal complaints.

See also BACP’s Making a Complaint page.

British Association for Counselling & Psychotherapy,
BACP House,
15 St John’s Business Park,
Lutterworth,
LE17 4HB.

Tel: 01455 883300,
Fax: 01455 550243,
Minicom: 01455 550307,
Text: 01455 560606

http://www.bacp.co.uk/

I have another question?

Please use the comments section, below, to ask your question – or contact me directly.

Introduction

This paper uses as its base Feldman’s paper: “Marital Conflict and Marital Intimacy: An Integrative psychodynamic-behavioral-systemic model” (1979)

Also references:

Harriet Lerner: The Dance of Intimacy (1989, ISBN: 0-06-097646-X)

Robert Firestone: Fear of Intimacy (1999, ISBN: 1-55798-720-3)

Experiential Exercise.

Description.

• All participants are to be standing.
  
• Each participant selects two people from the group, yet the selection remains secret.
  
• The main aim during this exercise is to place yourself equal distance between the two people. As everyone will be moving at the same time, it’s likely that your selected two people will move also. As they move, you will need to keep yourself at an equal distance between the other two people. You may ignore everyone else’s activity within the group.
  
• Movement: when the exercise begins, you may move quickly or you may move slowly. You can move quite deliberately (possibly revealing which two people you have chosen; which is quite alright) or you may move cautiously (possibly keeping secret which people you have chosen; which is also alright).
  
• Start the exercise.
  

Exercise Observations.

• What happened?
  
• What did it feel like?
  
• Did the exercise end on its own or did it time out?
  

Associating “Intimacy Extremes” / Purpose of Exercise.

From the exercise, imagine that the two people you elected were extremes of intimacy in a relationship. One person represented: “not enough intimacy; need more. Therefore move towards the intimacy/person”, the other person represented “too much intimacy; need less; conflict. Therefore move away from the intimacy/person”.

Sometimes the exercise ends itself and all participants find themselves equally distanced between their chosen people. This might represent a static, most-perfect state between too much and too little intimacy.

More usually, the exercise goes on for a long time until all participants agree to stop. This might represent the dynamics of relationships; constantly ebbing and flowing between too much and too little intimacy.

• Consider: how might the exercise have been different if people had spoken to each other during the task?
• Consider: what if there had been an external observer giving feedback during this event?
  
• (Further consider: what if these two aspects: too much/too little intimacy were aspects within a single person, e.g. perhaps due to narcissistic disturbance?)
  

Marital Conflict and Marital Intimacy.

Feldman uses his 1979 paper to describe experiences within marital relationships that stimulate and maintain repetitive, non-productive marital conflict behaviour.

To clarify what this means, I have summarise my understanding here:

Starting from a point in the cycle, a person requires intimacy in order to satisfy basic needs as a human being. The need for intimacy drives the individual into seeking for it, and then basking in it once found. However, unconscious anxieties can experience the intimacy attained as something that is dangerous and anxiety provoking and something that needs to be moved away from. This creates unconscious conflict which requires we step away from the intimacy in order to avoid the anxieties and conflict. However, in stepping away, the need for intimacy goes unsatisfied and at some point during the “stepping away” we find we have moved too far from the intimacy and need to begin seeking it again.

The cycle starts afresh.

This is just for one “dynamic” partner in the relationship, assuming the other partner is more “static”. Yet either or both partners maybe participating in this cycle with their own individual angles on the cycle.

The main points that Feldman includes within his model are:-

• This cycle is deliberate (albeit mostly unconscious). There is a powerful need for intimacy and yet there is also a powerful need to avoid anxieties around the intimacies; this is caused by unconscious conflict. These are two seemingly mutual states.
  
• When unconscious anxieties are in force (the “trigger”), destructive acts reduce the intimacy and the anxieties, such as verbal abuse and/or physical abuse.
  
• When the destructive acts have reduced intimacy to a level below that which the unconscious can tolerate the associated anxieties, conciliatory behaviour tries to repair any damage and to attempt to build up intimacy again.

I believe these things are not only prevalent in marital relationships but I can also see aspects in the following:-

• The pre-marital relationship such as boyfriend / girlfriend, girlfriend / girlfriend and boyfriend / boyfriend.
  
• The Parent / Child relationship.
  
• Platonic Friend/Friend relationship within and across genders.
  
• Employer / Employee relationship.
  
• Kidnapper / Hostage (perhaps).
  
• Counsellor / Client.
  
• One’s self / one’s self.

Feldman categorise some (all?!) of the reasons why intimacy may unconsciously hook into ones anxieties. He comes up with five categories.

Five Components of Intimacy.

Fear of Merger.

Intimacy can result in a weakening of self-boundaries i.e. whilst a temporary sense of “we two are one” grows, there may be an unconscious threat that the “self” maybe lost.

If the individual’s sense of self does not weaken then the merger sense satisfies the individual.

However, if the sense of self is weak then whilst intimate-merger is sought it also can be experienced as dangerous and taps into unconscious fears.

Fear of Exposure.

To some individuals, deep privacy is essential to their psyche’s safety. Within an intimate experience the “merging” aspects, described above, may also threaten to reveal the things one keeps hidden (e.g. one’s shadow side, the part of us we don’t want others to see).

A person who accepts himself or herself will not be so threatened by the intimate merger, but the weaker self may fear experiencing shame and – according to Feldman – may attempt to end the relationship rather than seek to reduce the intimacy. This suggests to me that the unconscious fear may be in the region of a threat of death, as to terminate the relationship sounds like an attempt to survive the conflict by destroying the other as an unconscious projection of the self.

Fear of Attack.

Feldman associates this fear with Freud’s Oedipal and basic trust-mistrust period of development.

I understand the trust-mistrust period to be around “testing” the other to ascertain of the other is a threat, if the other might attack us, if the other can be trusted. For example, can baby trust the breast always to give milk upon demand and if the breast is unavailable upon demand will the breast eventually return (hence baby’s life will be sustained) or will it never return (hence baby will die). This is akin to Klein’s paranoid schizoid anxieties that, say, the breast will not behave at our whim – it may even be perceived as being persecutory.

The Oedipal period is where the mother-infant dyad comes under threat when an “other” is recognised in the relationship. The new triad produces conflict due to:

• Sexual impulses towards the opposite-sex parent.
  
• Aggressive impulses towards the same-sex parent.
  
• The same-sex parent is a threat to us, but successful resolution is actually finding a way to lose to the same-sex parent and share the opposite-sex parent with the same-sex parent.
  

So, fear of attack means that the intimacy may raise fears of persecution or fears of being attacked and harmed.

Fear of Abandonment.

In abandonment, Feldman references Freud in talking about “loss of the love-object”. We’re talking here about separation anxiety, that we may have become so dependant upon the partner, that should the partner leave (abandon) us we may then not survive.

Oedipal – threat that same-sex parent and opposite-sex parent may decide to “go off” together and leave the child behind. Or if the same-sex parent is successfully killed off (as a rival) then later this parent’s love and support will have been lost. I take this to mean that a heterosexual relationship may impact upon a person where the partner may represent, in transference, the parent of the opposite-gender that may have been successfully “won” by destroying the parent of the same-gender. Additionally, a homosexual relationship may impact upon a person where the partner may represent, in transference, the parent of the same-0gender that may have been successfully disposed of (in phantasy).

Fear of ones own destructive impulses.

Klenian theory:

• Splitting– a person can be perceived as only good or bad.
  
• Projection – it is actually aspects of ourselves that we perceive in the “other”.
  
• Fear that the bad may be too overwhelming when placed next to the good implies that the bad may destroy the good.
  

To experience an intimate merging with an other may mean that the bad, destructive sides of one’s self come close to being revealed, and come close to destroying the other “good” person in the intimacy.

The Conflict and the Response.

So, intimacy was sought and intimacy was found. The intimacy is tapping upon one or more of the unconscious fears described above. Anxiety is being generated and defences must come into play to protect the hidden feelings.

Feldman describes this defensive behaviour as attempts to destroy the intimacy in order to move away from it. This can be in forms of attack such as verbal: shouting, abuse, denigration, physical: hitting, withdrawal of touch.

There is an Initiator and a Responder, and whilst these roles may be fixed in some relationships, and may fluctuate in other relationships …

…the “dance” is always lead by the person with lowest threshold (Esau, classroom, 2003).

The initiator may start an argument with the responder or may hit the responder.

The purpose of this is to reduce and destroy the intimacy to a level that no longer provokes anxiety.

Rapprochement.

Yet, the confliction behaviour may be more than just successful; it may reduce the anxiety so successfully that there is now less intimacy than the self needs. So, some form of “making up” has to be initiated in order to repair the relationship and allow intimacy to build up again.

Working in a counselling environment.

Main purpose: to diminish the anxieties and reduce the need to enact the conflict behaviour.

Examine transference: Taking the two families of origin.

Dreams – interpretation inform the nature of the transference.

Individual become more aware of their wishes, fears and defences, and become more away of the wishes, fears and defences of the other partner.

Process of change, individuals become less destructive, promote empathy and trust, intimate behaviour becomes more frequent and longer-lasting and conflict behaviour becomes less frequent and less destructive.

Bibliography

A Brief Overview.

Couple Counselling

“Is couples counselling with this counsellor suitable for us?”  “Are we both suitable to work with this counsellor’s therapeutic practices? ”   These two questions would be how I would very briefly describe the purpose of an assessment with couples.

As a BACP Accredited counsellor in private practice, I perform my own assessments with my private clients.

A Summary of the Assessment Process.

Counselling begins with an assessment process which in the case of couples is a four-session procedure involving the partners meeting together, and separately, with the counsellor.  The intent is to allow everyone to gain a full-as-possible picture of the relationship problems and to see if we can agree upon what the focus of the counselling work should be.  This is an ethical process to ensure that counselling is an appropriate treatment for the couple, and that the couple are fully aware of what therapy they are embarking upon.  Sometimes the assessment process is sufficiently therapeutic to free up a couple to be able to talk things through on their own and further counselling is not needed. All these possibilities are discussable in session.

In summary, I have found this process works well:-

• Week one: counsellor meets with the couple together for 1 x 50 minute session.
• Week two/three: counsellor meets with one of the partners separately … and the other partner the subsequent week. This allows each partner to tell their side of the story separately from their partner, and allows me to also gain some history about the individual.
• Week four: counsellor meets with the couple together again (50 minutes) to discuss previous sessions (respecting any personal confidentiality that may have come up in weeks 2 & 3), to consider if we all agree that we can work together, if counselling seems a suitable therapy, to agree what the focus of the couples counselling work should be and where we go from here.

Whilst I refer to this as an “assessment” process, it is can also be a therapeutic helpful process for the couple too.  Both partners begin to look into the relationship problems more deeply and, with the help of the therapist’s processes, from perhaps newer angles.  Some couples do not need to proceed further after the fourth week as the process has been sufficient to perturb seemingly-immovable conflicts sufficiently for them to work on their issues subsequently by themselves.  Others choose to proceed into further counselling to receive help in supporting them address the relationship issues further.

It may become clear at any of these stages whether or not couples counselling feels right for the both of you, and to me, and if it does not we would (ideally) talk this through to a conclusion.

We will, no doubt, all have questions of each other – I need to know about you and your relationship and you will need to know about me.  This is everyone’s mutual assessment of everyone.

I have a form to complete.  On the form I have such questions as:-

• Your occupation, relationship status, children, medical health.
• Have you had counselling before? Together / separately?
• Reason(s) for seeking couple counselling.
• What is expected/hoped for?
• How has your sexual relationship been effected?
• Is there Domestic Violence/Abuse in this relationship?
• History of the relationship (how did you meet, how did you get together etc).
• Individual personal histories.
• Family, life, circumstances etc.

Informing you.

I will discuss with you about my counselling models, qualifications and ethics, about confidentiality and how it effects you, about where the law requires I disclose information (such as serious criminal activity, intended harm to yourself and/or others, or the Children’s Act) and that I will discuss with you before I make such disclosures, also about my supervision arrangements.

By the end of the assessment.

At the end of the assessment we should both have a better understanding of if we think we can work together, if couples counselling might be a helpful process (for you both) to go through together with me, and what will be the focus of our counselling work.  We will discuss fees, appointment times and vacation/absences, and what we can expect from each other (we call this “contracting”).

I offer a weekly counselling appointments (rather than several times a week, or ad-hoc ‘drop-in’ sessions) – and both partners are required to attend each session.  On the occasion where it’s not possible for one partner to attend, the other partner may attend on the understanding that (a) the session will continue to be about the relationship (not the individual, or the other partner) and (b) that the attending-partner and I will inform the other partner about what we discussed.

Domestic Violence.

If domestic violence is revealed in the assessment – or in the counselling work – then we will talk about stopping the violence immediately.

We will discuss the “Safety Plan”.  In summary: during a situation between the couple that may be leading to violence, one partner will take responsibility for leaving the room/leaving the situation.  The other partner will take responsibility for not following the leaving partner (the partners don’t need to decide beforehand which role they are going to take).  The partners will stay separated until such a time when both partners feel that it is safe to come back together.  Then can then have a conversation about what lead up to the safety plan being executed.  They will also discuss with the counsellor what happened when they next meet with the counsellor.  Whilst this sounds like a simple plan – and in essence it is simple – it can be very difficult for a couple to execute the plan.  In counselling we will discuss the plan in detail and discuss things every time the plan is put into action.

Relationship counselling can helpful but it can initially make things worse because we are perturbing with a relationship system in order to help re-build it more safely and successfully.  Disturbing a disturbed relationship can be very difficult for both partners.  Both of you must convince me that it is safe for you both to work with me in counselling – and discussing the safety plan is the main way we will achieve this.

Note taking.

I do not take written notes during a counselling session, but I do write notes during an assessment.

This article discusses the assessment sessions in couples counselling.

A question I am sometimes asked in counselling is “how long will counselling take?”

As a counsellor (see article: “How I work as a Counsellor”) I offer two main types of contract when I meet a client for an assessment.  These are Open Ended counselling and Short-term “focussed” counselling.  This article summarises both methods of working.

Short-term “focussed” Counselling.

In short-term focussed counselling, the client and I agree a set number of sessions (anything between four or twelve) and we agree a specific focus for the work (i.e. one specific element in the client’s life). The focus must be reasonable to work with within the time constraints.  We then meet weekly focussing in on the agreed topic until the number of sessions is complete.

It is not usual for the number of sessions to be altered once we have begun – although there are always exceptions which we can talk about during the therapy.

One benefit of short-term counselling is that the number of sessions and the focus is agreed upon at the very beginning … even though it can be tough work focussing upon a problem and even six sessions can fly by very quickly.

One disadvantage of short-term counselling is that it doesn’t afford any time to work upon matters that are related (or very close to) the focus in any depth.

Short-term counselling is not suitable for every situation and, ethically, if I think that such work is not suitable for a client I will discuss it with the client before offering such a counselling contract.

See also my post on Short-term, brief counselling.

Open Ended Counselling.

In open ended counselling, the client and I meet weekly for enough sessions to address the focus sufficiently -  allowing the therapy to develop in its own time.  Both client and I keep an eye on what we discussed in the first session (the assessment) and at some point during the therapy either the client, or I, or both of us will begin to talk about if the counselling work has been completed sufficiently to warrant setting an end date (or a set number of sessions in which to complete and say goodbye).

Ethically, I would not let open ended counselling continue unlimited, forever.  And having an unspecified number of sessions can be a valuable container for the client as he/she addresses his/her concerns and makes changes to his/her life before we both agree that the focus of the counselling work has been addressed and worked through – and now the work should come to an end.

In Summary.

Sometimes a client may ask “how long will this take” and estimating a set number of counselling sessions to address fully a problem is more of an art than a science … if not impossible (and unethical) in some cases.

Brief therapy offers a set number of sessions, but the focus is not suitable for everyone’s tastes.  Open ended counselling offers an unlimited number of sessions, which allows for the focus of the therapy to be addressed in its own time, until both client and counsellor agree that the focus has been sufficiently worked through.

Some personal matters cannot be adequately addressed by brief/focussed therapy because the client is not in a safe enough place to work in such a focussed manner (for example – past trauma such as an attack, rape or other forms of abuse).

As a BACP accredited counsellor working with the BACP Ethical Framework – my clients and I discuss various forms of therapy before beginning the work – finding the right counselling treatment for the client’s presenting issues.