Learning Journal 6

My understanding of empathy is that it is a connection between one person and another. It is very much a humanity with that connection and a reaching, experiential understanding for how it is for that other person. It cannot be a static or isolated momentary experience, it must be a process of developing this shared experience and mutual understanding or congruence.

Beyond simply reflecting what you hear in another way, empathy as I understand it is a deeper and more comprehensive sharing of what is felt by the counsellor to the client that may be not said, not even known by the client. Further to simply knowing that another person can understand the client’s world they may well experience, by way of the counsellor’s empathic responses over a process, a learning about themselves and their true feelings that they didn’t even realise. By this happening empathy can reveal an understanding can be supportive, growth promoting, healing and revealing to the client in a way not previously possible or accessible to them.

This week I had a discussion about the nature of empathy and its significance in the therapeutic relationship with two other students. As mentioned the role of empathy as laid out by Rogers is “potentially the most potent factor in bringing about change and learning”. It is significant because of the power it has for the client to develop their own understanding, but also for them to be held safely while this is happening. The counsellor must be able to experience the same emotions and internal references without being taken away with the feelings into the same place as this would cease to be empathy and would morph into something more akin to identification.

To be able to give the person a complete empathic and non-judgemental and congruent understanding of what it is they are going through, experiencing or enduring and still maintain the solidity to hold the client, now that is a potentially very supportive role indeed. To manage this the counsellor must be able to guide this client through this new understanding without themselves being drawn into the emotive consequences that can place impediments on our ability to understand, decide or appreciate given situations and so enable or empower the client to make sense of their world. This must be like experiencing and understanding the gravity, the emotions and the realities without being constricted by them in order to be a guide for the client.

We began by exploring the unsympathetic nature of empathy piece by Egan. Egan describes empathy as a something that the counsellor benefits from in some way, I think inferring that there is a power dynamic and that this dynamic is fed by this benefit. By somehow being able to master the reflective responses and take command of knowing the clients feelings in such a way as to show them how they really and truly experience something back to themselves is somehow mutually beneficial, but in a rather vulgar way.

That the counsellor may well get a kick out of being supportive is of no doubt to me. But I feel challenged by the words of Egan in telling me this overtly in a manner that makes me feel that it is more in favour of the counsellor than the client. That surely is down to the nature of the counsellor himself. If a counsellor is of a mind to so revel in the ability to empathise with a client, I feel that this is a dangerous pre-occupation that would surely interfere with the very act itself. Therefore by definition is not possible to a harmful degree in terms of supporting the client. Yet, it doesn’t sit well with me that the counsellor could ever be taken over by this feeling in such a form. Could this happen to me? How then can I reconcile this as a helping profession? Is it me that has the need to be held, in a similar way to the client? Is it naïve to think otherwise? Perhaps so, but I find Egan’s take on this somewhat uncomfortable. Will me getting strokes from the relationship I make with clients be my motivation for going into the helping profession, or is it an occupational benefit? I know from my life experience that all jobs have their upsides and this is obviously the side of the helping profession that makes it so appealing perhaps. However, what Egan is saying is that it may be an empowering bias in favour of the counsellor over client, which must potentially be an motivational corruption of sorts. This would potentially disturb the ethically governed relationship I imagine, as the counsellor must become attuned to his inner strokes, consciously or otherwise. If this were the case, wouldn’t he naturally seek them further, engineer empathic continuums with clients participating in their intimacy and exploration? Is it possible to know that this is going on from self-awareness or supervision? I suspect not.

A second Egan extract that made me think closely about my understanding of empathy was the sentence “the likelihood of empathy may increase the more therapists get to know their clients, but its always going to be easier for them to empathise with those clients who are most similar to themselves.” This statement I feel is contrary to how I perceive the nature of empathy, in so much as empathy cannot originate from a place of knowing already. On one hand the ability to identify with clients most like ourselves is incredibly apparent as we can relate to what they are, have been through or describe, however surely Egan cannot be so simplistic in this interpretation and carry it across to empathy.

The feeling that you can relate to another is quite a dangerous thing to recognise to me. This would perhaps mean that I am making economies and short cuts in listening as I feel that I already ‘understand’ or ‘know’. It is surely human nature to make these short cuts, to pigeon hole, to box up people in clusters or groups, this is a probably a form of evolved strategy. Perhaps this form of reducing people to groups or labels is a survival technique for assessing similarities or differences in order to form flocks and groups that can survive together. When it comes to a client that is however more diverse from myself I feel that this habit is perhaps less likely to manifest. For this reason to me at least surely those clients that are most different to us are perhaps the most easy to empathise with. This is because if someone is presenting completely novel situations and experiences and is able to articulate well enough for us to really and truly get into their world, then I would hold that the person listening and learning about them will have no preconceptions about them at all and not be held back by these polluting or interrupting thoughts. Anyway, when it comes to this level of diversity in empathy I feel that the more differences the better to offer a true unadulterated and pure form of unpolluted being with another person.

The example I can use most readily is that when working on Broadreach a year ago I used to listen to people’s stories about drug addiction and become totally lost in reliving my own disasters. The emotions that I heard were so clouded with my own memories that it was never anything close to empathic understanding, not at all. This was the opposite of walking in their shoes. More it was like being told we are both going show shopping, and me choosing what shoes that the client clearly should be buying, because I know best. Conversely when I listen to alcoholics I have less of this interference, possibly as so many of their issues are novel to me? There are enormous similarities of course with any addiction to another, especially the drug dependence addictions, however as I am not able to relive in my own imagination the specific ins and outs of the drink dependant person I find I am very able to offer a complete and open ear. I listen to their experiences with curiosity, not comparison. I listen to their life and loss and predicament with interest as I am learning about them all the time. It is new information and so always interesting.

Do I get a sense of power from this shared understanding and mutual experience while remaining grounded to be a safe and secure presence? I wasn’t aware that I could. I think that the one thing that Egan has brought to my mind is that to feel a sense of power out of this dynamic could be a distraction and something to be mindful of when developing this on-going process I am coming to learn about called empathy. 

Learning Journal 5

I have realise the need for a strong and clear foundation from working with clients in my drug and alcohol setting. But being 'Johnny Shortcut' has meant that in training terms at least, its always been something I've struggled with despite knowing how important it is. I remember writing one out for the level 3, like a script. I could never remember it and I have some anxieties around that.
From my own experience in RISE, a drug and alcohol service I know that it pays to be really clear about time, boundaries and expectations going into both one to one and group work. By setting out with clear explanations and expectations and boundaries that I may have a good deal of questions to ask and assessments to complete, I am letting a client know to some degree what is available at this time, in this session. This can prevent them having false expectations and being confused or unclear and, not in any small part with the often intoxicated client, that it is not a chance for them to deviate too much unload their life story and troubles. While I have let offloading and unburdening happen on frequent occasions, its not always the best move given that I may have to change tack so abruptly later in the session, which may leave them feeling ignored or not heard. Also and specific to the role the cost to me has been that I then have not achieved my goals as a recovery worker, to risk assess, to put someone into suitable treatment options, to signpost and reduce harm. Being a recovery worker is a very different role to counselling although the fact that I am in a one to one scenario often, that I offer a place for that person to talk and because the majority of what I do is about the relationship that we form, I feel that their are many similarities. Far more similarities than differences.

As a recovery worker I would go about letting a client know the time of the session by letter, and by name it in the letter that it is an assessment, for example. Then once they arrive they have it in their head that the session is about fact finding, not counselling/one-one. Once they arrive I will let them know how much time we have and that it is going to be quite a lot of questions and that they should feel the session is confidential beyond certain responsibilities I have to the safety of that person and others. I always let people know they can make a complaint and how to do this, and I always ask that mobiles are off. I also include a good deal of asking what they want out of treatment. How do they see their recovery happening? How have they had successes before? What has/hasn't worked? I'm also quite brutally honest that as a recovery worker I am not the one that's going to be doing the real work, not if its change they seek. In this way, by querying what it is they really seek from treatment, I'm pushing to see if they actually want change. I guess in a sense some of this is starting to become the therapeutic side of the contract, as they see what it is will happen between us and us working out what they want out of treatment as a thing. However given that the service I provide encounters a very specific medical need, I feel that it is ethical to be upfront about the actual reality of owning denial in readiness to change and at least letting the client know that I have put it out there that there is real chances that they are not ready but that this can be difficult to know. I need them to question the relationship that they have with substances from the off, and continue to do so. In that respect the person centered aspect of what I do is very much there as we need to get to what they want from treatment, but also that I have a duty of care to not mislead the intoxicated client by waiting around for them to realise that they have been fooling himself. Its a fine line and requires a good deal of skill I have learned, not to be insulting or patronising but honest and caring in the clients best interests for them to reveal to themselves what is really going on.

This is very different to what I did as a counsellor in the practice role play we did on Thursday. We practiced handing the business contract over to one another. I worked with Christine and tried to explain the nuts and bolts of the business contract with her. It felt very under-rehearsed. There's an awful lot to get through in terms of the list of actual boundaries that govern the practice of counselling such as the supervision, confidentiality and actual specifics about the session time, frequency and costs. Here I explained about the supervision that I have, my level of proficiency/training and also covered confidentiality, in some depth. I studiously went through a list of what I could recall would need to be said, but it as yet felt clunky as it wasn't my own words yet. The specifics about length, time of day and frequency of session were all made up on the hoof which didn't help the concentration. When moving on to the therapeutic part of the session I began to relax more, as this part doesn't have a script. I can play jazz with this a bit. I explained how I worked in a non-directive and non-judgemental way and what that meant in terms of valuing her as a person and allowing her to find her own way. Then I was able to open the floor to ask Christine what she wanted from counselling was the first part of our therapeutic contract. At this point we got to her goals at which point we stopped.

I guess in my current role as a recovery worker a big difference on the contracting is that I have goals, in counselling I would still have goals but the emphasis would shift to the clients goals as they are seeking a more person centered level of support than recovery work is designed to be. As a counsellor I will very much still have my own rights and responsibilities, as would the client, but in counselling it may be prudent to make these clear and mutually understood by both parties. This is surely ethical as well as practical so that the client knows that they in good hands. My rights and responsibilities as a counsellor are there in black and white as part of the contract but I feel also need to be delivered verbally as this checks understanding and clarity. Also from this verbal delivery the counsellor can explain and check agreement with the client. Further the client can explore their expectations and understanding of the service and relationship they can expect.

I created my very own client contract after a session exploring what we as a mini-group felt that we would like included within it. This contract spells out what my rights and responsibilities are as a counsellor in training within Addaction Chy, a secondary rehabilitation treatment centre in Cornwall. I will be offering counselling to those leaving the main building and going into the move-on flats and so forming part of their care package. What I have constructed is most definitely a business contract. It is measurable, quantifiable and clear, I hope, about what is and isn't allowed, acceptable, and what is provided so as to be clear about what the client can expect. I spell out the need for them to be drug and alcohol free, for the amount of sessions to be agreed, for the length of a session and that I receive supervision etc. these elements are not negotiable. These elements have to be in place for there to be a robust and boundaried and ethical service to be provided.

While the amount of sessions and time of day that the session will occur will be negotiated, there is a very different type of negotiating that I feel needs to happen on top of the business side of things. Negotiating what the client wants from this counselling period.  this is obviously the therapeutic element of the contracting process and also a very important part of the laying of shared understanding about what is to happen. this is what Tony calls the alliance. We have to be on the same page, to work towards the same goals, even if they keep changing or evolving, we must both be knowing of this.

In working with clients at Chy, I hope to be able to negotiate with them what they want to aim to achieve. What are they hoping to get out of counselling? do they fully appreciate I will not be there to diagnose them, to give advice and solve problems for them. I hope to let them be aware of the way in which person centered therapy can work with my respect for their autonomy. Basically can I unpack the core conditions in client friendly language? I feel that I can and will be able to explain that I am not there to tell them what to do, more to listen and hear them in a non-judgemental manner. That being non-judgemental is just that, to listen without prejudice. And also that I will try to understand how it, whatever it is, has been for them. Then and only then we can explore new areas of understanding and clarification to help them make sense of their world.

We had an inspirational visit during this session. A lady who had been through various treatments and finally found one that had supported her at the right time to give up drugs and alcohol. "Once the client begins to feel you are interested enough in understanding how it really is for them and are taking the trouble to learn about their individual model of the world, they will be more willing to let you lead them into new areas of exploration and clarification" - taken from Working With Others. This quote I feel sums up how much it means to have the therapeutic relationship in doing supportive work with people, in helping them. What the guest described was that previously maybe this hadn't been the case, and no matter if this was true or not, it certainly showed that this person was reached by a counsellor. She had been helped and brought into a truly positive place and now was enjoying life. Not only that but that this person was ok enough to share all this with us. She had experienced enough negative relationships in her life but had still had room to trust another, given the respectful and non-judgemental and empathic person was sat opposite every week to hear her model of the world. Brilliant.