Institute Inbrief - 22/04/2015
Welcome to Edition 223 of Institute Inbrief! In this edition’s featured article, we focus on what a therapist/counsellor can do in session to make any therapy more intellectually attainable, or user-friendly, to someone who has at least cognitive limitations, but who also may be struggling with communicative deficits, sensory impairment, and/or psychological conditions.
Also in this edition:
- Latest news and updates
- Articles and CPD information
- Wellness tips
- Therapist Q&A
- Social media review
Enjoy your reading!
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Imagine Being Passionate About Your Work
And Assisting People Every Day Lead Better Lives
It’s rare these days to hear people talk about their work with true passion. You hear so many stories of people working to pay the bills; putting up with imperfect situations; and compromising on their true desires.
That’s why it’s always so refreshing to hear regular stories from graduates living their dream to be a Counsellor. They’re always so full of energy, enthusiasm and passion. There’s no doubt that counselling is one of the most personally rewarding and enriching professions.
Just imagine someone comes to you for assistance. They’re emotionally paralysed by events in their life. They can’t even see a future for themselves. They can only focus on their pain and grief. The despair is so acute it pervades their entire life. Their relationship is breaking down and heading towards a divorce. They can’t focus on work and are getting in trouble with their boss. They feel they should be able to handle their problems alone, but know they can’t. It makes them feel helpless, worthless. Their self-esteem has never been lower. They’re caught in a cycle of destruction and pain.
Now imagine you have the knowledge and skills to help this person overcome their challenges. You assist to relieve their intense emotional pain. You give them hope for the future. You assist to rebuild their self-esteem and lead a satisfying, empowered life.
As a Counsellor you can experience these personal victories every day. And it’s truly enriching. There is nothing more fulfilling than helping another person overcome seemingly impossible obstacles.
Transference and Projection
The phenomena of transference and projection, although solidly accepted in the analytical and psychodynamic schools of psychology in which they originated, are nevertheless complex and often misunderstood concepts. Yet some claim that projection is the single most important phenomenon in psychotherapy.
In this video, Richard Hill (MBMSc, BA (Linguistics), DipProfCouns, MA (Social Ecology), MEd, DPC) helps you understand what transference and projection are, how they develop in a therapeutic relationship, and what forms they tend to take, so that you can recognise them as they occur in your therapy rooms and in your life.
User-friendly Therapeutic Strategies for Intellectual Disability
In this article, we focus on what the therapist/counsellor can do in session to make any therapy more intellectually attainable, or user-friendly, to someone who has at least cognitive limitations, but who also may be struggling with communicative deficits, sensory impairment, and/or psychological conditions.
In a nutshell, some writers have advocated “Go slow, be concrete, repeat” as a useful formula regardless of the therapeutic approach used (Prout & Strohmer, 1998). Fleshing out that advice, Morasky (2007) proposes a series of dimensions along which strategies can be evolved to adapt counselling and therapy (and he says, also vocational and life skills instruction) for persons with intellectual disability.
The adaptations revolve around the central question: what makes an intellectual activity difficult? He discusses four parameters which commonly impact intellectual tasks: speed, number, abstraction, and complexity. We look at them in turn.
The poles for this continuum are fast to slow. The faster an intellectual task must be performed, the more difficult it is and the more intelligent someone is deemed to be when they can perform it fast (think about all those timed intelligence tests you took in school where there were so many items you knew no one could finish before the time was up!). When we are exposed to a stimulus for a short period of time, memory storage and retrieval are both more difficult. Also, having to retrieve items quickly increases the difficulty level of an intellectual activity. So with clients with intellectual disability, the idea is to slow the pace way down, allowing as much as twice the time a non-disabled client would take to respond.
This continuum goes from few to many. The more components one has to process, the more difficult the task. We see this with memory. It is said that a person can remember seven items more or less; eight or nine might be possible for some. 39 items would probably challenge anyone! Decision-making also becomes more difficult as the number of possible options increases. Consider, for instance, how much harder it is to choose a meal from a long restaurant menu than from one that has only two or three choices for mains.
Here our poles go from concrete to abstract. Concrete concepts or items are generally tangible, meaning that we can see, hear, touch, taste, or smell them, whereas abstract concepts are usually intangible: not available to detection from the five senses. Consider the difference between discussing, say, a cloud and cloud computing. The intellect works harder to comprehend abstract notions than concrete ones. The sentence, “Conscientious people are well thought of” is more difficult to logically process than “The boss praised George for getting the report in on time”.
Ha! This is a topic that in itself is complex! One way to characterise this continuum, especially for clients with intellectual disability, is to think of going from simple to complex. Complexity can then be defined as the number of relationships encountered. Simple systems have fewer components and these have few to zero relationships between them. More complex systems have greater numbers of components and these have relatively more relationships between them (Morasky, 2007).
Imagine, for a moment, that you are trying to work out how to organise your day. You really would like to go ice-skating, and you can get there by bus (you don’t drive), but if you go do that, you will get back too late to go grocery shopping, and you have nothing to eat in the house. Grocery-shopping is therefore a priority, but you realise that today you would be dependent on your friend being free to take you to the shops, as you need too many items to go by bus and carry them home. By the time your friend can take you grocery shopping, you would miss the ice-skating. Because the free pass to the ice rink expires today, you would not be able to afford to go skating for some time if you don’t go today.
Another option is to join your cousins – who are in town just a short time – for a planned walk and swim in the ocean followed by lunch out. Your cousins might wait while you do the grocery shopping and then drop you home, but if you go out to lunch, you will not have enough money for the groceries you need. What to do? The relationships between the various options make the situation more complex, and thus more difficult to work through for someone who has intellectual disability.
What types of intellectual tasks are difficult?
Morasky also asks the question of which intellectual tasks are inherently difficult, reminding the reader that memory, reasoning, generalisation, decision-making, planning, and problem-solving are often reported as tough intellectual operations for people with intellectual disability (Morasky, 2007).
Counsellors and other mental health helpers will do well to examine how the difficulty levels of the above tasks requested of clients with intellectual disability clients are impacted by the parameters of speed, number, abstraction, and complexity. Where possible, the word is to go for slower, fewer, more concrete, and simpler.
Morasky, R.L. (2007). Making counseling/therapy intellectually attainable. NADD Bulletin, Volume X, No 3, Article 3. Retrieved 14 Jan., 2014, from: hyperlink.
Prout, H.T. & Strohmer, D.C. (1998). Issues in mental health counseling with persons with mental retardation. Journal of Mental Health Counseling, 20, 112-120.
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Essential steps to a new you
Not feeling like you’re living it up to your full potential? Below are some essential tips to get out of your rut and towards renewal.
Cycles of life
Northern hemisphere plants burst forth with new green shoots while south of the equator we prepare for winter’s dying-off as trees drop leaves and animals hibernate. Both seasons are part of the infinite cycle of birth, growth, and death through which all things on earth pass. Human beings, too, participate in cycles, undergoing a continual process of replacing most cell-types in our bodies.
Yet while most of nature – including our physical body – cooperates with ongoing life cycles, many people say they feel stuck or at an impasse on a psychological level. If that describes you, a sense of feeling stuck may be a clear sign that you are somehow fighting your own process of renewal. So we can ask: what is trying to birth itself into – or perhaps go out of – your life? What is blocking the flow, and how can you do something positive about it?
When it’s time to renew
Renewal means making new again: the sense of seeing things with fresh eyes, with inspiration: a word meaning “breathing in.” Life renewal is the conscious process of examining your life and making changes that bring in excitement and vitality. How you approach your job, how you run your relationships, and even how you view yourself in the mirror are all processes being birthed, growing, or becoming stagnant. In fact everything you participate in is part of a cycle. You can identify new cycles by the sense of aliveness and passion when you consider what will be involved with them. Likewise, you will know that something has finished when what you are seeing or doing feels stagnant or stale, like a room without fresh air.
Let’s take some examples. Are you in a rut with your exercises? Do you do the same old boring things when you work out just so you can say, “I exercised today”? The same goes of your diet: are you conscious of what goes down the gullet, or just eating it because someone some time ago said you should? What about your relationships? Do you respond to relational events in the same old way, generating the same old impasse at solving the problem? When you go to work, do you see the same old road, perhaps with potholes and cracks, or notice the beauty of trees and landmarks along the way?
A four-step process to see anew
Therapists in transpersonal traditions have a process to help people move through a rut and see things freshly. We can work through this process with an exercise. All you will need for this exercise is a large sheet of paper and some coloured pens. Now divide the paper into four quarters.
First ask yourself, “Where am I now in my life?” Allow images, sensations, and feelings from your physical, social-emotional, mental, and spiritual realms to arise. Capture your response in one section of the paper, with colours, shapes, symbols, or pictures.
Now ask, “What is emerging in my life?” Again, trust whatever arises, and find a way to record this image on your paper’s next quarter. Your symbol may speak to a new purpose or vision for your life, or possibly a new aspect of yourself coming in.
Ask, “What is getting in my way? What is holding back what is emerging?” Find a symbol to represent this answer and draw it in the third quarter. Many at this stage must acknowledge fear of change, fear of not being accepted by others if they change, fear of failure, or lack of trust that the new possibility will work out.
Finally ask, “What must I do to take the next step and move through my block? What quality do I need to develop in my life in order to cooperate with what is emerging?” Next steps often include the development of spiritual or noble qualities, such as courage, trust, or simplicity. Draw whatever image comes to you in the last quarter. Observe your drawings, noticing whether any insights emerge. You may wish to talk through your images/symbols with someone you trust.
Ways to renew
In addition to the above exercise, there are tried-and-true ways of seeing things from a new perspective. Retreats, holidays (especially to new places), time in nature, and time with different people from your normal social crowd can all help you see afresh. So, too, can simple acts like de-cluttering your space, giving your mind a week of only positive content (you may have to skip the news report), and relaxing, deep-breathing exercises. Some change experts even advocate doing everything (including walking) backwards for a day – just to discover a new way of seeing familiar things! Above all, the process of life renewal calls for patience, trust, and a sense of gratitude to yourself as you work into the cycle.
At any given time in our normal development, some ways of being and behaving are trying to leave our life as we grow and expand. We must let them go. New things are trying to enter; we can live more in the fullness of ourselves if we let these in. The change in nature’s seasons is a great time for the renewing act of tuning into our own cycles – and ensuring that we are not blocking our own sublime flow.
Written by Dr Meg Carbonatto B.S., M.A., and Ph.D.
This article was originally published in Asteron Life’s Balance Blog. AIPC regularly contributes to Balance’s wellbeing blog category.
Helping and Stress Management
Stress is any pressure, demand, or threat placed on an organism (say, a human being) that causes a need to re-establish balance or “equilibrium”. The Oxford Dictionary online adds that stress is “a state of mental or emotional strain or tension resulting from adverse or demanding circumstances.” In this article, we look at stress management from the perspective of a helper: that is, anyone who is currently providing emotional or psychological support to a friend, client or loved one. Hence, the concepts outlined apply to therapists as well as people without any specific counselling or mental health training.
The Efficacy of CBT Treatment for Depression
The plethora of studies evaluating the efficacy and effectiveness of CBT (Cognitive Behaviour Therapy) over the last few decades has shown generally solid results for CBT as a treatment for depression (and many other disorders) with different groups, in different modes of delivery, and in manifold settings. There is no controversy on one fundamental finding: there is a vast amount of evidence showing that CBT is effective for depression. In this article we examine the different findings with respect to aspects such as client preference, mode of delivery of treatment, and comparisons between CBT and other treatment modalities, including antidepressant medication.
Q&A with Toula Gordillo (Clinical Psychologist)
Q. What is the best way to counsel at-risk teenagers?
A. Growing up in Katherine in the Northern Territory, attending Katherine State High School and having a mother who was the first Aboriginal youth officer to introduce traineeships to Indigenous youth in the NT, I have lived amongst the Indigenous community for many years. I love the culture – their music, their artwork and especially their storytelling. Observing Indigenous culture, studying my PhD on ways to improve resilience in Australian youth and being the mother of three teenage children has taught me a great deal about the most effective ways of helping teens and preteens.
The Indigenous community generally use a lot of stories and images to help deliver important historical or cultural information, and we can learn a lot from their methods. Through the use of stories and images, we can help to create behavioural changes and deliver important psychological or counselling information to our children and youth – particularly those who are most at risk.
The Scorpion and the Frog
One of my favourite stories to help explain human behaviour to my clients is Aesop's fable about the scorpion and the frog. In this story, the scorpion convinces a nervous and sceptical frog to piggyback him across a torrid river. During the journey the scorpion stings the surprised frog. As they both sink, the scorpion explains to the frog that he could not help himself because stinging is in his nature.
Narrative Therapy is evidence-based and supports the use of stories and images, such as the Scorpion and the Frog, to help individuals understand their own and others’ behaviour. Story Image Therapy & Tools (SITT) is based on the principles of Narrative Therapy as well as other evidence-based therapies such as CBT and ACT. For more information about Story Image Therapy & Tools (SITT), click here.
As the young person is introduced to the story, they gradually become aware that they may be acting like the frog, or acting like the scorpion in certain situations, or they may vacillate between both –depending upon the circumstances. They may also be acting like the most extreme versions of each. Extreme versions of the 'scorpion' character may be called Adolescents Without Limits (AWOL) and they may be prone to bullying, aggression and substance abuse etc., caring little about themselves, their health, others or the law.
At the other end of the spectrum, extreme versions of the 'frog' character may be called Adolescents with Narrow or Negative Opinions of Life (ANOL) who may be very narrow in their views, engage in negative thoughts patterns and have perfectionistic tendencies as a result of caring too much. Teens who are highly anxious, for example, may be acting like a scorpion and ‘stinging themselves’ by engaging in self-harming behaviour. Troubled teenagers often identify with one of the characters, or both, by reading or learning the story and without any prompting. For a pictorial diagram of the frog, scorpion, AWOL and ANOL personality dimensions, click here.
Stories and images can be particularly powerful to assist counselling-resistant or at-risk teens to become aware of the long term effects of poor behavioural choices, such as the use of recreational drugs. For more information regarding the use of stories and images to help youth with drug-related issues, click here.
Toula Gordillo is a Clinical Psychologist, AIPC private assessor/tutor and regular contributor for Institute Inbrief. Toula has an extensive work history as a Clinical Psychologist, Teacher, and Guidance Officer. For more information, visit www.talktoteens.com.au.
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A dilemma involving sex reassignment surgery
Mark, 36 years of age, is directed to counselling by his doctor after Mark decides he wants to transition from male to female, undergo sex reassignment surgery, and change his name to Sonia. Mark reports he has suffered for a long time trying to live as a man when he in fact feels like a woman.
Mark is currently experiencing feelings of sadness, anxiety, stress and anger about the way he has been treated by his family and certain friends because of his gender identity. He has started drinking alcohol on daily basis as a way to numb his emotions and fall asleep at night. What important factors does the Counsellor need to take into consideration when working with Mark? What topics do you think that the counsellor should concentrate on?
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"If we never suffer, there is no basis or impetus for developing understanding and compassion. Suffering is very important. We have to learn to recognize and even embrace suffering, as our awareness of it helps us grow."
~ Thich Nhat Hanh
Many students of the Diploma of Counselling attend seminars to complete the practical requirements of their course. Seminars provide an ideal opportunity to network with other students and liaise with qualified counselling professionals in conjunction with completing compulsory coursework.
Seminar topics include:
- The Counselling Process
- Communication Skills I
- Communication Skills II
- Counselling Therapies I
- Counselling Therapies II
- Legal & Ethical Framework
- Family Therapy
- Case Management
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