Category Archives: Psychotherapy

The Recovery Model


The Recovery Model

A few years ago the manager of a mental health charity that I was volunteering at asked me to help them communicate the concept of ‘The Recovery Model’ to their staff in an accessible and easily digestible form.  I’d never heard of the recovery model but they handed me a couple of articles: one by Jacobson and Greenley, and a print out of the recovery model’s wikipedia page (which is now re-directed to what wikipedia calls the ‘Recovery approach’).

Draw a f***ing diagram!

My old physics tutor Howard Stockley taught me that whenever approaching a new problem one should always set about drawing (a f***ing) diagram.  As I read the sources I’d been given I set about trying to piece together what they were both communicating.  This presentation is the result of that process.  Almost all of the content comes from those two sources.  All I did was add my own spin and draw a diagram to knit the information together.

You are welcome to use this presentation or parts of it in your own work.  All I ask is that you please credit me and give a link to my website.

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Nonviolent (Courageous) Communication (NVC)

Imagine the scene: Jane, who is a bit OCD, comes home to find some shoes in the middle of the hall.  She flashes with anger.  ‘How dare he treat my home with such disrespect?’ she says to herself and she storms into the lounge to give him a piece of her mind.

Imagine the scene: Peter’s boss is angry because he thinks Peter has lost a key account.  He has come right up to Peter and is giving him a piece of his mind.  Peter doesn’t seem to be responding and this is winding his boss up even more.

Imagine the scene: David’s long term live-in girlfriend is packing the van with all her stuff.  He is standing, dumbstruck, on the side of the road watching.  Will he ever see her again?

Nonviolent communication

Eckhart Tolle says that if you are not comfortable in a situation then you have 3 options:

  • Completely accept the situation as it is (i.e. suck it up)
  • Change the situation
  • Move away from the situation (preferably having accepted it first)

The question is, when you would prefer to stay and other people are involved in creating that situation, how can you change it without resorting to some kind of coercive tactic using reward or punishment?  For years I’ve been teaching clients a way of doing this.  Recently I’ve come across a very similar structure, developed by Marshall Rosenberg which he calls Non Violent Communication. In this case violence is not limited to the physical but could include the induction of sadness, fear, guilt, or the promise of some reward if the other person does what you want.

In this article I’ll introduce my personal take on this way of communicating and provide a link to a brilliant YouTube video of Marshall introducing NVC.

If not violent then what?

Anyone who has worked with me will know that I often ask clients to discover the positive in the negative.  For example, if a client says they are un-comfortable then I’ll ask them ‘And when you are NOT comfortable, how are you?’  Their answer could be anything that is not comfortable: angry, stressed, afraid, or even happy.  Though these feelings may not be comfortable they are positive in that they are stating what IS rather than what is NOT.

In the same way, I’d ask Marshall Rosenburg, when communication is NOT violent, how is it?’  My guess is that he would answer could include the words loving, direct, compassionate, assertive, and honest.  If I had to choose a word to describe it I would say it is courageous.

What is courageous communication?

Courageous communication is not about compromise.  Compromise is where nobody gets what they want.  Courageous communication seeks something higher, a different way of relating in which everyone gets their needs met.

Courageous communication comes from the heart.  It tells it how it is without seeking to make the other person feel afraid of you or sorry for you.  By being open and honest about your feelings and the values that drive them and genuinely curious about the other person’s experience it bypasses adversarial patterns and encourages a natural co-operation.

The courageous communication process I teach has 5 parts:

  • Identifying the external behaviour / triggers
  • Describing your internal experience / reactions
  • Explaining your needs
  • Suggesting an alternative
  • Opening up the discussion

Identifying the external behaviours / triggers

Assuming that you have the other person’s attention then the first stage is to let them know exactly what is getting to you.  When you are doing this is is important that the other person does not feel threatened or blamed or they will close up and go into a defensive mode.  The way you do this is by using very specific sensory language in order to describe something in the way that any impartial observer would understand.  It is best to avoid metaphors or blaming labels.

For example:

  • ‘When you treat this place with disrespect’ becomes ‘When I see shoes in the middle of the hall’
  • ‘When you threaten me’ becomes ‘When I see you close to me and hear your loud voice’
  • ‘You betrayed me’ becomes ‘When you tell me you are leaving for a month and then I see that you have packed all your things’

Describing your internal experience / reactions

None of the internal stuff would be a problem if you didn’t have some kind of reaction to it.  These are either going to be thoughts or feelings.  Behind a thought is likely to be a feeling.  The next stage of the process is to explain what you are feeling.  This requires you to actually know what you are feeling.  A feeling has a location in the body.  It is your feeling so be sure not to describe it in terms of what has been done to you.  A useful checklist is: Glad, Mad, Sad, Bad, Scared.

For example:

  • ‘I feel disrespected’ becomes ‘I feel angry’
  • ‘I feel threatened’ becomes ‘I feel frightened’
  • ‘I feel betrayed’ becomes ‘I feel like the life is draining out of me’

Explaining your needs

The reason you are having the emotion is that one or more of your needs are not being met.  A need is the thing that you need to be fulfilled in order to achieve a certain outcome in a certain context.  A popular generalised model is called Maslow’s hierarchy of needs.  In order to stay alive for an hour I need breathing.  In order to stay alive for a month I also need water, sleep, and excretion.  In order to live a happy and fulfilling life then there are many needs that need to be met.

When we have pre-existing emotional wounds we can need certain things in order to avoid these being triggered.  If, for example, you have a broken toe then even a slight tap could hurt like mad.  In this case you may need extra space around your foot in order to feel safe.  It is not unreasonable to ask for special treatment while you are healing from something.  It is unreasonable to EXPECT it.  Not everyone carries the same wounds so not everyone has the same needs.

Talking about your needs in a certain context helps explain what is going on for you in a way that the other person can think ‘Oh, OK, I get that’.

For example:

  • ‘I need things to be really tidy in order to feel relaxed.’
  • ‘I need to feel safe in order to take in information.’
  • ‘I need honest communication in order to make a relationship work.’

Suggesting an alternative

Your listener may well be somewhat surprised at your openness and honesty so far.  This is a great time to suggest something new.  Paint a picture of how things could be.

For example:

  • ‘I’d like it if we could agree where things are stored.’
  • ‘I’d like to talk about this after lunch so that we can understand what has happened and learn from the experience.’
  • ‘I’d like you to leave some bags here now and for us to talk on the phone this evening.’

Opening up the discussion

Your suggestion is not a demand.  It does not require the other person to comply with it.  But it could be the start of a negotiation.  A conversation in which you find out what their needs are and how you can help them fulfil them.  The way I would suggest you ask this is:

  • ‘How would that be for you?’

Is courageous communication always enough?

I’m not sure if Marshall would agree but I believe there is still a place for violence.  In my opinion the only legitimate use for violence is to get someone’s attention.  (And I’m open to having my mind changed on this one too.)

  • If a child is walking towards the dangerous cliff top then just grab them … leave the conversation till later.
  • If someone is ignoring you then a shout may surprise and shock them a little but get their attention.
  • If someone is in a panic and action needs to be taken a slap around the face could break them out of that pattern.

If you have the other person’s attention courageous communication may not change their behaviour.  You must accept that.  It could be that their values are very different to yours, if they are then it could take a lot more than a simple script to come to an understanding.

The basics of Nonviolent Communication (NVC)

Here is the first video in a series by Marshall Rosenberg.  I warn you that he will get his guitar out and sing a song.  Get over it.  Continue watching.  And find your inner giraffe 🙂

What is the difference between outcome oriented coaching and systemic psychotherapy?

More and more people seem to be offering different types of coaching these days: ‘life coaching’, ‘relationship coaching’, ‘wealth coaching’, and ‘executive coaching’ are all available. The websites are often slick with young, glamorous looking coaches promising the outstanding success, achievement, wealth and happiness you deserve. Compare this with many people’s image of the grey cardigan clad counselor listening earnestly as you talk to her about your problems or the pipe smoking psychoanalyst in his wing back chair talking about your ‘id’ and asking about your toilet training and it is no surprise that many people are attracted to this seemingly new approach. But what are the real differences between therapy and coaching? In this post I’ll look at some of the distinctions that are commonly made and offer you some of my opinions.

Coaching and therapy mean different things

Oxford-Tube_1705197cFirstly lets look at the roots of the words. According to the Online Etymology Dictionary the use of the word ‘coach’ to mean ‘instructor or trainer’ dates back to around 1830 when it was Oxford University slang for a tutor who carries (like a carriage) a student through an exam. The word ‘therapist’ goes back much further and comes from the Greek ‘therapeia’ meaning ‘curing, healing’.

Looking at these roots gives us a clue to a key difference between coaching and therapy: the coach acts as an external assistant to help the client move from A to B in life; the therapist supports the client’s natural healing processes in order to liberate energy that is currently being used to cope with illness and trauma.

Coaching tends to be more outward looking and outcome oriented, psychotherapy is more inward looking and process oriented

Coaches will generally ask you what your goals are and work with you to enable you to get them. These goals are generally in the real world and in the future. Most coaches will work with you to define goals that are SMART, that is to say that they are specific, measurable, achievable, relevant and time bounded (different people use different words for the letters but you get the idea). For a sports coach it could be to win a certain event or to set a new personal best; for a relationship coach it could be that you get a new partner; for an executive coach it could be to successfully complete a project or boost sales. Sometimes a coach will base their fees around some kind of guarantee that you will achieve the goals that you have set. Coaching aims to get you more of what you want.

Psychotherapists are often more interested in how it is to be you right now. Rather than focusing on specific external goals they will work with you to explore how you are creating the life that you have and where those patterns and motivations are coming from. Rather than aiming to change your life, therapy generally changes your relationship with life. On the outside not much may be changing but your experience of it could transform. In sports you may enjoy playing the game more; in relationships you may see more in your current partner or be more comfortable in your own company; in work you could find that the compulsive drive to succeed is replaced by a more balanced and relaxed attitude. Psychotherapy often results in you wanting different things.

Coaches are motivational, psychotherapists are exploratory

full+metal+jacketMany successful people are where they are today because they are good at kicking their own backsides and pulling themselves through life. While this strategy can work very well for a while, eventually the self that keeps getting kicked and pulled can get fed up and stops doing what she’s told. When this internal motivation strategy that worked so well starts to falter the person may be tempted to seek out a coach with a bigger boot or a stronger arm. The coach holds the coachee to account for his actions, checking that he has done what he said he would do, providing encouragement and chastisement accordingly (especially if the payment of the coaches fees are dependent on success). One way or another the coach helps the client to work hard and overcome or get around the blocks to success.

In comparison, the psychotherapist works with the client to explore those blocks to success, and to reveal how the client is blocking his own success. Why and how would a client block his own success? Psychotherapists look for hidden ‘secondary gains’ … the benefits of not getting what, on the surface, you want. Perhaps the client believes that the value of something is measured by how hard it was to get it? Perhaps struggling is familiar and comforting or supports a client’s belief around their own victimhood? Or perhaps success in this area of life would mean that another area would be neglected?

A psychotherapist may even get the client to explore the consequences of failing … a thought that may be a bit of a no go zone for many successful individuals.

Coaching works towards a desired future, psychotherapy discovers the influence of the past

homer-on-failureA compulsion is a motivation that is driven by fear. One of the biggest problems experienced by successful and high achieving people is that they become dependent on that success for their sense of self. They are so motivated to succeed because they are terrified of failing.

Many of us have experienced trauma following what we (or others) have deemed failure. Some people were punished physically for their mistakes, some were publically humiliated for getting things wrong, others were simply terrified that failing would lead to the withdrawal of approval from parents, partners, or friends. All of that hurts; and is the kind of thing we would prefer to forget. But we don’t forget it – we often just cover it up with what these other people would judge as success. We may even internalize their punishments and ‘beat ourselves up’ when we fail. A psychotherapist will often work with you to reveal the pain of failure and to resolve things with the memories of the people who caused it in the first place.

The healing of wounds from the past can involve intense emotions. For a client to allow themselves to experience and work through these emotions they need to feel safe. To create safety the facilitator needs to be confident in their ability to stay present when the client is experiencing intense feelings and not to be distracted by their own unresolved issues resonating into awareness. Psychotherapy training is long and rigorous and designed to train therapists to handle strong emotions.

While coaches may have a lot of experience in their given field their coaching training may amount to just a few weeks. At best a coach can hope to recognize trauma when it is there and refer the client on to a therapist who can handle it; at worst they will unwittingly take their client into emotional areas that the coach is not equipped to handle.

Consequently it is prudent for most coaches to avoid the dark stuff from the past and focus on the client’s desired future. Creating strongly motivational goals and working back from them to deduce the actions that must be taken to achieve them does not require any delving into the past. However, if this desired goal is a reaction to a feared alternative future (including the fear of the unknown) today’s achievement simply procrastinates the facing of that fear. A coach may be giving the client exactly what he thinks he wants, but not what he would really benefit from – including the experience of failing and handling that failure.

Coaches encourage positivity, psychotherapists encourage acceptance

I was on a course with a life coach a few weeks ago and something started to push her buttons … tears welled up in her eyes and she quickly shook them off and composed herself. When the facilitator asked her why she was doing that she explained that she didn’t like being negative and tried to stay happy.

This is a perfect illustration of one of the biggest misunderstandings within the field, the idea that emotions like anger, sadness, fear, guilt, and pain in general are negative. They are not. They are positive. They are positive expressions of what is there.

‘Not bad’, ‘uncomfortable’, ‘not sure’, ‘can’t’, ‘not good enough’, and ‘nothing’ are all negative. They literally refer to something that is not there. It is a way of us not acknowledging what is there or, put another way, avoidance (literally putting into a void). Psychotherapists are indeed very interested in these negative places as this is where we don’t allow ourselves to go and where the healing is usually most needed. When I ask a client ‘How are you’ and they say ‘Uncomfortable’, I’ll say ‘And when you’re not comfortable, how are you?’ This recovers the positive. Quite often clients will describe sensations as being like an emotional black hole. This is the perfect description of a usually terrifying nothingness. The obvious (but short term) solution to a black hole is to try to avoid it or fill it in from the outside. Rather than coaching them to do this a psychotherapist will direct the client towards the unknown, into it, and out the other side. The client faces the thing that they were unconsciously avoiding, healing takes place, and the hole fills in from the inside.

Conclusion

achievementThough coaches can often have a good degree of background in a particular field their training and experience of psychological change is often limited to a few weeks of training. This training often emphasizes the importance of orienting the client towards the future they want rather than dwelling on a past that didn’t work for them. If a coach is only comfortable or competent working with ‘positive’ goals in the future and avoids darker places within the client then this can cause their work to be superficial and short term. Their clients may well achieve that particular goal and get what they thought they wanted but they may not realize why they wanted it in the first place or why they are still not satisfied with the way things are.

Most psychotherapists have the training and experience to go into and transform the dark places they are less likely to take their client’s desires on face value. They know that desires often hide a fear (and vice versa). By working with clients to heal and transform from the inside out old compulsions fall away and clients realize what they really want out of life. Before long they are finding a new kind of inspired motivation that results in them doing and achieving because they are fulfilled rather than in order to become that way.

What is the difference between counselling and psychotherapy?

According to the UKCP website:

‘There are many similarities between these disciplines, and it is very hard to explain the differences between them.  There is usually a general understanding that a psychotherapist has had longer training that a counsellor, and can work with a wider range of clients/patients.  Psychotherapy is often considered to take longer and go deeper.  But there are also exceptions to every rule and there is no set difference.  The UKCP now has a Psychotherapeutic Counselling section that ensures its registrants are up to the same training standard as other UKCP psychotherapists.’

Now I’ll stick my neck out and give my own opinion (with sweeping generalisations of which there will, of course, be countless exceptions):

Lets start by looking at the etymology of the words themselves.  Counsellor comes from the from old French word ‘conseiller’ meaning ‘to advise, counsel’.  Psychotherapist comes from the Greek ‘psykho’ meaning ‘mind, mental’ and ‘therapeia’ meaning ‘curing, healing’.  So, from the words themselves, it seems that a counsellor would be more inclined to offer their opinion on what to do about or, perhaps, how to cope with your problem whereas a psychotherapist would be more inclined to facilitate the mental healing of that problem.

A counsellor is a good listener with whom you can talk about your problems.  Many people recovering from their own experiences of addiction, abuse, bereavement etc, are attracted to helping others who are going through the same and take on counselling roles as part of this healing process.  This means many counsellors are able to command the respect of their peers, to hold them to account, and offer no-frills ‘from the coal face’ advice that they know worked for them.  However, this personal experience can have a downside: if a counsellor has little training, poor supervision and has not fully processed their own issues they risk becoming emotionally entwined with clients and falling into a rescuer role.

Psychotherapists are much less likely to give advice on how to cope with problems.  They are more likely to see real world problems as examples of a patterns being played out in the client’s life and be curious about exploring and changing these patterns.  Psychotherapists with a broad scope of practice may have little personal experience of the specific issues they are working with which could lead to the criticism ‘you haven’t been through it, therefore you don’t understand’.  A long training, requirement for personal therapy and robust supervision is designed to reduce (but may not eliminate) the amount of rescuing behaviour and lead to a greater sense of detached perspective.

Let’s also look at the idea of a ‘talking about’ your problem with a counsellor.  In spacial terms you are exploring your problem from the outside by adding a new layer of understanding around it.  This may or may not cause the problem itself to change – there are plenty of people who know lots of things about their problems and how they affect their lives but still don’t know how to change them.

A psychotherapist, in comparison, may well believe that too much ‘talking about’ your problems as a way of avoiding getting into their effects.  They may well interrupt you and direct your attention elsewhere – often to your body and your feelings.  Rather than adding new layers of understanding to problems psychotherapists seek to work with their clients to remove layers and to discover (literally take the covers off) the traumas at the heart of them.  By healing the causes of the problems it is possible to facilitate major changes in personality with far reaching consequences in many aspects of life.  This deep work used to take a long time but with new and direct psychotherapeutic approaches it is possible for it to be done in relatively short timescales.

That was all a bit serious!  How about a joke from 1001 jokes for kids to finish off?

‘What’s the difference between a buffalo and a bison?’

‘You can’t wash your hands in a buffalo.’

What is the difference between a psychologist, a psychiatrist, and a psychotherapist?

Sounds like the start of a joke, doesn’t it?  When I was at Oxford there was an engineering joke that went around: ‘What’s the difference between a mechanical engineer and a civil engineer?  A mechanical engineer makes weapons, a civil engineer makes targets.’  (Boom, boom!)  Can anyone suggest a suitable punch line for this one?

In the mean time I’ll do my best to answer the question.  The short (and somewhat flippant) answer is:

  • If you want a theory that explains the way you are then consult a psychologist,
  • If you want drugs to make you feel better about the way you are then consult a psychiatrist,
  • If you want to transform the way you are then consult a psychotherapist.

The following information is based on definitions from the UKCP website:

  • All 3 work with people who have emotional or mental difficulties
  • All 3 work both in the private sector and in the NHS
  • All 3 have had extensive training, and should be members of the relevant professional body

Psychology

A Psychologist is a general term for someone who has studied psychology, usually to degree level or beyond.  Psychologists have observed and measured human behaviour scientifically and have produced models and therapies based on this knowledge.  There are a number of different branches of psychology including Occupational Psychology, Forensic (Criminal) Psychology, and Educational Psychology, amongst others.  A Clinical Psychologist or a Counselling Psychologist will have done further training (often to a doctorate level) to be able to administer psychological tests (personality tests, intelligence tests, etc.) and to be able to treat people with emotional or behavioural difficulties.  For further information, go to the British Psychological Society web site.

Psychiatry

A Psychiatrist works within a medical framework and so will have trained as a medical doctor first and then specialised in psychiatry.  Psychiatrists diagnose and treat mental illnesses and disorders.  Only psychiatrists and medical doctors can prescribe medications. For further information, go to the Royal College of Psychiatrists web site.

Psychotherapy

A UKCP Psychotherapist (I am one of these) has had a four-year, post-graduate, in-depth and experiential training in how to work with a variety of people with a wide range of emotional and mental difficulties.  Psychotherapists are trained in one or more of the different modalities (ways of working).  For further information, please explore the UKCP web site.

What is psychotherapy?

Psychotherapist.  Psycho the rapist.  Unfortunate that.

To me a good psychotherapist is a modern day shaman, a spiritual leader, a parent, an explorer, and a scientist.  Much more than just a scientist.  Clever thinking gets you so far but rationality, and the white coat of science can be a shield to hide behind.  To me a good psychotherapist has much more in common with Indiana Jones than Dr Jones.

The following definition is taken from the UKCP website:

Psychotherapy is the provision, by a qualified practitioner, of a formal and professional relationship within which patients/clients can profitably explore difficult, and often painful, emotions and experiences.  These may include feelings of anxiety, depression, trauma, or perhaps the loss of meaning of one’s life.  It is a process that seeks to help the person gain an increased capacity for choice, through which the individual becomes more autonomous and self determined.  Psychotherapy may be provided for individuals or children, couples, families and in groups.

A psychotherapist thus works with people who have emotional, behavioural, psychological or mental difficulties.  The actual work is mainly to encourage the client to talk and explore their feelings, beliefs and thoughts, and, sometimes, relevant aspects of and events in their childhood and personal history.  Some psychotherapists work to help the patient/client understand more about their problems and then make appropriate changes in their thinking and behaviour.  As a result, the work can last over quite a long term. Brief psychotherapy is also possible, especially to help someone resolve a more immediate crisis.  There are a number of different psychotherapeutic approaches: Cognitive Behavioural, Psychodynamic, Psychoanalytic, Systemic (Family & Relationship), Humanistic, Integrative, Transpersonal, Experiential, Hypno-Psychotherapy, etc.