Learning Journal 25

What made me think most of all today was my communication to a fellow student, as that student, Catherine seemed to find me a focus for her argument. Not for the first time. It left me feeling slightly concerned that I had created an impression of ‘attacking’ in the modern politically correct sense. I think that I may have a role to play in this. What happened in my mind was that Catherine was quite adamant as she often is about something. I felt she was wrong and gave an example of why I thought she was wrong. The topic was dressing up for job interviews. Where I feel that I have some work to do is in my level of patience. I can be too direct when presenting an opposing view as I think that I am quite impatient and just have to get to the end line. What works better when meeting people with opposing views if presenting opinions in a more careful not to offend way, which I can do, but rarely do. Its quite an effort for me and I think that I lack the insight always to understand that almost everytime its safer and better to dress phrases up more gently. Using stock phrases like “for me, personally” and the like seems to work for others. I particularly liked the approach that Gina had to it. Gina spoke to Catherine later on in the discussion and made a very similar point, but it was dressed up so as not to offend. In this instance it had no impact but I saw that it could have done, as it was gentle and didn’t cause the person to feel they were being made to look daft, as possibly I may do on reflection at times. It’s a little bit learned banter and a little bit impatience. I can work on the patience and hold back or plan what I am going to say.

This lack of patience can affect my working with clients too hence why I bring it to this journal.

I was working with two clients this week and overall I felt that the sessions were really positive. This week with my clients (MY clients – that feels good) I was able to start thinking about further skills and just being aware of doing different things. I was seeing both clients for the second time so the revision of contracting took very little time and really was just a polite reminder and a chance for them to ask any questions about it.

However I was aware that this week I was meeting T and M for the second session. I felt quite quickly that we were building a relationship and wanted to not listen to them ramble so much this week, as both had last week. Whats that about? Ramble! But they kinda did. They both went off on really long winded and sometimes difficult to follow stories and tangents. They were interesting and that first session I felt it was important to get a feel for them and let them talk. I did summarise at times and I did ask them which of the areas they wanted to focus on but actually I think they were so nervous or ready to offload, that neither really took any notice of these attempts. That tells me I need to be more robust and supportive with the clients so that they do feel just that, supported. But in the first session it’s a tightrope. It was only really on reflection that I realise how little I had managed to make sense of. That left me feeling impatient for that not to happen again in the next session. I was more robust and made it clear that I wanted T to let me know how he wanted the session to be, however we still managed to get lost in his head. But it bothers me that I can find myself being impatient when listening to clients and I wonder whether this is ok to share with them or not. The feelings of impatience could lead to others kinds of things I think. Am I being fully accepting of the client if I am feeling impatient? Why am I feeling impatient, is it slight tiredness or burnout from work? Do I need to take some holiday? Anyway, I could try something like:

T I’m listening to what your saying to me about x, y and z and I’m kinda left feeling left with wanting to know more about the original question about how if left you feeling. I was wondering how hearing that now leaves us, just now, in this moment.

T I notice has a tendency to intellectualise things and I found it interesting so I thought I would mention it. Now that is a strange thing to notice as I notice myself living that way, but less and less so. I noticed it very quickly in this client. He gave me a story of his drift into drugs that virtually mirrored my own. Not just the timeline and events but the story and childhood frustrations. I could have been listening to myself. Now the danger with this client next time is to not imagine that what worked for me is going to be in any way a successful approach for T. That’s a given. But more than that, I need to listen and be with his individual story and events and emotions and not now look for correlations. That would take me away. I’m going to do that by concentration and empathy. Real empathy. Just being with him in the moment even more than I was, or perhaps wasn’t.

Its human nature to look for similarities and identify with them, it’s a trait called ‘homophily’ I learned today.  For me with T the challenge has become how do I be ok with the similarities and not place conditions of worth on T if my unconscious questions or reactions are now guided by this pattern matching or the opposite, pattern difference finding, that he may or may not become aware of. I need to give this person unconditional positive regard and that is in danger if I start to like the client for our similarities and this becomes somehow conditional that we match and so have similarities, if he picks up that I am thinking this. What I mean is I do not want the client to realise that we share things and I could leak that we do or respond more positively to certain traits and he could begin to perform (reveal or say things that he thinks will gain him positive feedback in our time together).

One thing dawned on me after thinking about how the sessions went this week, is that I need to make it really explicit what they are for. What can happen and what they can expect. I had already asked both clients whether they had had counselling before and because both had said yes, I’d taken that to be enough for us to kinda get cracking after the contract. But now thinking about it, there’s a lot more I want to check or update the client on.

For me the session is about them bring whatever they want to bring so that we can work on it together. I can support them to explore what it really is and what is going on for them. It can be something in the moment or something in the past, its their session, but I feel that being explicit in this may help clients be specific, or not bring too much.

The second client, M revealed sexual abuse to me towards the end of the session. He did it in a very open and explicit way but then moved away from the topic quite quickly. He returned to it later.

I listened for how it had been handled as I learned without asking that he had revealed it to another worker who had asked him what I was prepared to, did he want to do anything about this, and report it. He did not. That is his agenda, to not act and I respected that.

I feel that to have revealed this to me shows a huge amount of trust and bravery on his part. I made a point of stating how brave I had found him throughout the session. I wanted to leave him with that, that I found him to be a very brave individual. I was left wanting to give him a hug or something by the end of the session. This was quite something as after the first session I was actually not welcoming this session as I had found him a very difficult client to understand in the first week. And then we had this shared time together and I I was now rooting for him in every sense and really warmed to him.

I say this was quite something as I M has so many differences from me. He has been homeless and became alcohol dependant, both things I cannot relate to. I am not sure if this is diversity or not. He has been sexually abused and been an outcast from his family. He has no qualifications and never worked. All these things put him apart from me and into a world I know very little about. Battling to service, begging on the streets and being beaten up for being homeless are all things I have never experienced, and put this person in a different sphere to me. But I found that by caring, by actively listening and by helping him and me to focus on what he was saying I can honestly say that we are building a real bond. I was left feeling really kinda high after our session and so much so I was wondering who had gotten most out of the session and was it ok to feel this good after a session that I had been the counsellor in?

I think that because I had accepted him and from his frame of reference he had felt safe to talk about things and trust me. We had shared a very good and close time. That had felt great. I am ok with that.

Looking into the CPCAB model of service levels this week I have found it quite self explanatory to see the CPCAB model differing to the medical model of treatment as it includes rather than ignores the contextual elements of the service users experience. The client problems are contextualised by this model rather than featured as isolated from the world in which they have occurred. This is helpful to my understanding as I believe that clients and their issues are a product of interactions with all manner of stimuli, which is broken down by the model.

The model identifies this holistic view by including the such as treatment factors, the relationship between the counsellor and client and client and relational factors. I know from my experience how crucial the counsellor and client relationship is for example because that interaction and relationship depth is what enhances the ability of the client to engage. They must trust the counsellor and feel held and safe. Its imperative.

The CPCAB model goes further as it breaks down the levels of client problems from everyday life issues (level 1) to more complex mental health issues (2) and more severe and even more complex issues (3). While quite a broad church this is comfortable to a new counsellor like myself as it confirms and makes explicit what I am working with when I hear client presentations. The model breaks down the types of everyday and complex problems very helpfully, I feel, especially at this stage of my training.

Looking at common life problems is of course not isolated necessarily from  underlying causal or related factors but in building the relationship and listening to the client voice the issue may indeed enable them to learn about their own readiness to change this issue. I use the stages of change model all day long in work and am very if not over familiar with it, and its quite interesting to know that it can be in the back of your mind when counselling. In terms of being person centered though, I have yet to find my comfort level with knowing about a persons readiness to change and that being of any use as a counsellor as imparting this would be a form of directiveness surely?

Taking the more complex personal issues that could be rooted in mental health such as anxiety or depression, its useful as a counsellor to be able to think in terms of these core issues and separate them from everyday problems as will inform my approach. It would enable to me put it to a client that I was hearing an underlying issue and getting that sense and wonder how they felt about it, did they agree? Did they want to explore it? For me this is holding their hand while looking at things together. It’s a joint venture and we can go there together. We are explorers. Partners.

With more severe mental health presentations the CPCAB model makes it quite clear that I would need training, experience and confidence to work with these issues and also very much would be working with the relevant accompanying services.

I think that for me looking further at the model and its exploration of the dimensions of client problems is helpful, as it again brings to my consciousness the inter-related aspects of people lives. Knowing the complexity and dimensional relations of the internal, relational and developmental dimensions could inform questions that I put to clients. For example, when I learn about a struggle that a client has had by coming into rehab and having to conquer a physical dependence and psychological addiction, I can also be mindful of the interruptions this has had on their life plans, their internal maps. Has this got in the way of their development? Have they missed important milestones?

I was working with a client in Chy this week, recovering from time spent trying to manage physical addictions of one kind or another. During this time spent managing this all encompassing activity it is not surprising that this individual may have missed important milestones and stages or events. T is 28, but having spent 4 years on a methadone prescription it is worth exploring with him what he may have missed out from his perspective, not mine. Having spent his entire adult life involved in drugs, how does he feel about this? Have his peers done things differently? Where does this leave him? What does he intend to do next in his life?

Further, how has this addiction affected his relationships? How does he relate to people now he is sober? Has is caused any issues in his past relationships? Has he noticed any changes in the way he is relating to people?

What I feel from having checked out this CPCAB document is that it may inform my approach so that I am client led but fuller in my exploratory questions. I feel more able to know what to ask the client to think about. That doesn’t feel like guiding to me, more professional and thorough.