Learner therapist (44)…… A first session strategy

Torrey Orton

May 28, 2014

Making contact – aims and methods of the first therapy session

My objectives in Session One: to provide my patients with …

…experience of recognition and acceptance                                                                             

…increased understanding of presenting issue(s)

…hope that change is possible and that some directions towards it exist

…relief of pressure(s) by live exposure and containment of them

…a live model of the therapy experience which will follow

…an appreciation of their existing competences relevant to handling presenting issue(s)

…a sense of personal wholeness

Stages in Session One (and most others) – a collection of conscious processes

Coming into our ‘house ‘– arrival ritual(s)

·         Arriving, paying, waiting, being called up

·         Hello’s, handshakes, seating, name checking?

Opening

·         Blank slate assumption – getting them to start ASAP (prompted by questions like What are you here for? What do you need? What can I do for you? if necessary)

·         Listening for key players, key feeling(s), key theme(s)

·         Initial validations - ‘Noticing’ feelings, themes and players; remarking these as they emerge.

• Initial feedback – summaries of story chunks for disconfirmation, capturing themes, feelings and players; relevant therapist self-disclosure(s).

Engagement - Joining their story

·         Perspectives – framing their story, similar stories, psych facts conceptualising the ‘problem’

·         Implications – extending their story – how it affects whole life?

·         Objectives – what outcomes wanted; sharpen the focus

·         Work processes – through feelings to truths and new actions, as we are doing here now

·         “Am I crazy?” – a common question to be grasped directly as early as possible.

Closing

·         Summary of overall session tone, topics and tendencies

·         Check fit of my style with their needs

·         Therapeutic prediction – time and labour to ‘recovery’

·         Home works

Leaving our ‘house’ – departure ritual(s)

·         Walk to gate

·         Encouraging word(s)

·         Handshake

·          C u next week…

(Some of) my therapeutic assumptions…

·         Feeling is the pathway to resolutions

·         The pathway to feeling is non-verbal, assisted by feeling language and concrete expression

·         Resolution requires acceptance of the injured self

·         Skills for resolution are mostly present in non-injured self, but inaccessible to the injured at the moment

·         Change emerges from the unconscious and reveals itself in little steps of which a first is starting therapy

·         Many issues arise from misshapen or over-developed life habits based on normal functions and needs.

·         Awareness is the key tool for shifting ineffective habits

·         Getting back own power and defending against others’ power is usually a major covert outcome in depression /anxiety spectrum disorders

·         Our times are net stressors for everyone

·         Sharing secrets w/ significant others reduces internal stressors

·         Families matter cultures matter gender matters age/life-stage matters…

·         Therapeutic progress must occur at thought, feeling and action levels to be resilient and resistant to backsliding.

 

 

What’s normal now (6)…we are the worlds of our hosted bugs

Torrey Orton

May 25, 2014

 

Levels of life in fact …

 

Recently SBS TV hosted a series on the bugs upon and within us. We provide them with a living and they provide us with life. The uncounted hordes cleaning up our exterior are exceeded in number and diversity by those inside which give tangible meaning to a ‘gut feel’. Even knowing they are there vigorously gathering away does not give access to any perception of their presence in their reality – invisible and intangible things to us which yet succeed in comforting us, or not. We just have to believe they are so until we get a look though a scanning microscope at the myriad creeping and crawling things polishing our armour (skin) and processing our roughage (digestion).

We and they are all alive for a while, but only aware of each other in moments of failure to provide our respective services to each other, such as the result of an unintended injury like an antibiotic attack on a germ which defaults indiscriminately to all bugs and disables digestion in one way or another. However, our communication is indirect, by gesture as it were – ‘I’m sick to my stomach with…’ or, ‘It was a gut wrenching experience…’ from the inner residents to the host and ‘Here’s something soothing for that diarrhoea...’ from the host to the residents. Both are well within reach of the others’ sensibilities, but almost without regard for each other except in an emotional storm driven by objective threats to viability – menaces of death of various kinds.

… and perception

When the bugs’ world is distorted by ours, we, for those moments, are focussed by their collective distress away from our concerns, taking up theirs as if they are ours – which they are, so to speak, but we cannot conduct a life at the microscopic level. When we do so by force of disease we are heading for the doorways of perception’s close. That’s how a serious gastro-enteric stomach bug feels, as it literally lays waste with us.

So, too, do we dally with the brain’s presence to us: we kiss lips, not neuronal networks. If the networks are distorted by injuries physical (blunt force trauma; natural declines of genetic weakness or ageing) or emotional (disregard, deprivation, and the ensuing despairs of our oppression over time), our self in its physical guise is compromised. But it is unhelpful to our management of that compromise to point out its brainy compositions. What do we expect anyone to do with that observation themselves? Well, they can affect their sense of self by a variety of means – meditation, walking, eating right, sleeping OK …– those are the levels of action which are known to affect daily well-being directly already.

What’s neuron’s got to do with us – the lip kissing us - except in that facilitative sense which the bugs also are for us? They are different levels of perception and action, like that between Newtonian and quantum physics. We are in the Newtonian world and it is in the quantum.

Learner therapist (45)…… Beating the "BLOCKS"

Torrey Orton

May 23, 2014

Beating the "BLOCKS" *

An icebreaker to bring some unspoken rules above sea-level

Précis

            "Blocks" is a tool for eliciting training group members' apprehensions about the activity they are about to enter. It focuses on expectations which will (in their view!) constrain their participation in the activity.  These, typically, are concerns about the likely attitudes and behaviour of others in the group towards them, with themes of minority difference, power hierarchy, influence of external events/concerns and the like prominent in participant contributions.

            A "Blocks" exercise also serves to legitimate practical Equal Opportunity principles in the process of training. In addition, it provides markers for the group to measure its own gains in process competence during the training experience, in terms of issues it perceived to be important from the start. And, finally it contributes to setting the climate for participation by inviting members to identify the conditions under which it can occur for them now.

            The process has been used with intact work groups, short (1 day) and long (5 day residential) programs, with staff from all levels and specializations.  It has been used as a preface to courses ranging from basic counselling skills, negotiation skills and consultant training to job redesign and collaborative decision-making, in groups from 8 to 100+.

Rationale

The purposes of the exercise are to:

            1- increase the potential for participation of all present;

            2- provide mutually agreed indicators of dysfunctional behaviours;

            3- engage participants from the very start with the fact that the sessions will deal                           in the here-and-now; and,

            4- legitimate discussing normally undiscussable matters of group dynamics which              are central to effective learning in groups.

The "Blocks" Process

Step 1: Having done basic program housekeeping and introductions -

Invite participants to reflect on the kinds of things which are likely to block their participation in the coming activity; suggest they make a few notes about these things. (2 mins.)

Step 2:

Say you are going to give everyone a chance to speak, but no one will be forced to do so. If they don't want to speak they just say 'pass' when their turn comes. It is often worthwhile asking 

Then, record on butcher’s paper all contributions, one at a time, going around the group and taking one from each participant until all are up.  If one says their idea is already there, have them say it anyway, since they often differ significantly in detail. Note duplications by starring, etc. (10-15 mins)

Step 3: (optional)

 If appropriate, add the idea of stigmatizing differences, like those of colour/race, language, national origin, sex, physical or other disability, etc., if these have not arisen naturally. Note that they are the most common level of noticeable difference in groups, and that they are the normal grounds on which majority and minority subgroups informally occur. Add that there is much evidence that being a minority member of a group makes it much harder to participate. (5 mins)

Step 4:

Invite participants to comment on any patterns or features of the "blocks" listed; if appropriate, offer the stigmatizing potential of one's own (the trainer's) characteristics to concretize the issue and bring it into the here-and-now (e.g. - I talk about my unavoidable foreignness - a US accent - and my awareness of how that touches (understandably) some stereotypes). (3-5 mins)

Step 5: (optional)

Challenge them to consider the likely effect of any contribution they make to the group's activities on increasing or decreasing the participation of others in the group. Note that the items cited suggest particular areas for this group to pay attention to (whatever they may be).

            Then, get on with the program.

Outcomes

            The kinds of issues raised in more than 100 applications of this technique include -

1- fear of negative reaction to one's input by others

2- fear of being looked down on for being foreign

3- concern about confidentiality of the activities

4- external thoughts - work pressure outside; pressing personal concerns

5- not being used to sitting in one room all day

6- unsure what this course is about and what I'll gain

7- a perceived physical shortcoming - eg. stuttering

8- fear of not knowing enough to contribute meaningfully

9- feeling intimidated by superiors

10- lacking personal credibility due to a history in the organization as office clown, etc.

11- doing something new is scary

12- not really wanting to be here; 'I'm a don't know why I was sent'.

            As an opener, "Blocks" clearly establishes we are all somewhat apprehensive about what's coming and that it is O.K. to talk about it here. Just saying these things has the effect of reducing the blocking effect of many of them.

 

*Originally published in: Training & Development in Australia

Vol. 17, No.3 September 1990; pg. 39-40

Revised 23/7/1996 and 10/10/2007 by the author