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St Andrews Counselling & Psychotherapy Blog Opens
Working with Trauma:Early Deconfusion work
View from the Bridge ( trigger warning contains reference to suicide)
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Transactional Analysis: The Ego State Model

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My Blog

August 2013

Working with Trauma:Early Deconfusion work

Thank-you to everyone who has commented and given me such positive feedback after my 1st blog.
 
Most of the comments have been around my work with The Women's Rape and Sexual Abuse Centre.
 
This comment in particular touched me:
"I enjoyed reading about your experiences so far. Working with women who have been traumatically abused in so many ways is such special and compassionate work."
 
I reflected on how we can quickly lose sight of the work we do as therapists when immersed in the day to day routine of trauma. This does discount for the therapist and woman the "special and compassionate work" created and contained within the therapeutic relationship.
 
I have found that working with women who have experienced such a physical and psychological assault on the self early in life have a fundamental drive to seek healing.
 
Of course many do contact the service but a mixture of waiting time for a first appointment and an ebbing away of motivation or a passing of immediacy means they are perhaps not as ready as they thought to start the work.
 
I have had a number of woman who felt ready but their expectations of healing being done to them or for them couldn't sustain the reality of how hard the work will be for them and dropped out. Their honesty about their lack of readiness or underestimation of what the work would entail is truly touching. With these clients letting them know that the door is always open for them to return and although they are not ready today, this may change in the days and weeks ahead and whenever they feel ready they can get back in touch.
 
I have found that the pace of the work is key in working with traumatised clients who decide the time is right to begin their work with me. Although they feel ready they have strong injunctions not to trust or be close to others, understandable given the level of abuse they have endured from those who they trusted and were close to. This requires significant sensitivity, which I underestimated initially, in the length of time it can take to build the therapeutic alliance before work can even start.
 
I began to pay more attention to the therapeutic alliance when I shared audiotapes of my work with my supervisor and peers. I struggled with trying to find examples of therapeutic work that demonstrated a shift or even progress. Little nuggets' did exist but were of such subtlety that I felt frustrated, what was on tape didn't see to reflect how far we had come together.
 
My supervisor shed light on the clients vulnerability, level of abuse and trauma and the internal struggle of the clients Child  ego state to get close enough to me whilst weathering the unremitting cruelty of their Parent ego state. Sometimes neither of us were strong enough to hold on and hold out to the relationship especially in the early days when I was gaining experience. I simply didn't have the level of potency as a neophyte. My supervisor offered me a permission to accept this slow steady patience in the process and to recognise readiness when this came. Often the client's readiness can be felt as well as seen, the countertransference felt and experienced in a change in body posture and the contours of the face, subtle signs of relaxation and acceptance.
 
Gaining experience in therapeutic enquiry of the client's inner world and the countertransferential feelings around their Child and Parent dialogue increased my confidence and potency. Demonstrating empathy for the Child's dilemma in continual oppression and the possible cost of disloyalty. The deconfusion of the Child moves hand in hand with decontamination of the Adult ego state. I believe in transactional terms with survivors of abuse deconfusion of the Child occurs very early in the therapeutic work. The Child ego state has to believe and be enabled sufficiently to cathect enough energy to meet the power of the Parent. The therapist acts as a Nurturing Parent during this emergence of the Free'ing Child.
 
This stage of treatment can take several months and for some clients longer. The Adult ego state may be so small and vestigial and the power differential between the Parent and Child so great that to try and move on too quickly will upset the status quo and fragile equilibrium which has allowed the client to function thus far. 
 
I realise I have meandered into Transactional Analysis terminology during this blog. I make no apology for this but attach some references which may help put some of the concepts into context for you.
 
Berne, E. (1961) Transactional Analysis in Psychotherapy.
Berne, E. (1966) Principles of Group Treatment
Berne, E. (1972) What do you say after saying hello
Crossman, P. (1966) Permission and Protection. Transactional Analysis Bulletin 5(19)  p152-154
Tilney, T. (1998) Dictionary of Transactional Analysis
 

St Andrews Counselling & Psychotherapy Blog Opens

Welcome to my new blog page
 
I have recently been doing more writing for the Natural Therapy For All blog page where I advertise my counselling and psychotherapy work.
 
I set up practice last year after completing 4 years of training at the CPTI in Edinburgh which for the last year changed to Physis Training. The training is intensive and demanding and includes observed and assessed role play, written assignments, case studies and regular assessments by the trainers who are highly experienced psychotherapists with many years of practice. Group training is gruelling, demanding and intensive.
 
If you are thinking of a career in talking therapies or considering having therapy, I can highly recommend the TA 101 which gives you insight into Transactional Analysis and how as human beings we function psychologically with our 3 ego states, Child, Parent and Adult. Each of these ego states incorporate thoughts feelings and behaviours either in the here and now or Adult ego state; from our childhood, the Child ego state; or Parent where we have taken in the messages our parents and key adults have given us on what we should, ought and must do.
 
As well as the taught course I started a clinical placement with the Women's Rape and Sexual Abuse Centre in Dundee over 3 years ago and continue to work as a volunteer therapist. Women who come for weekly therapy often have had extremely traumatic childhood's in care, with relatives, have been abandoned and subjected to severe physical, sexual and psychological abuse over prolonged periods of time. As adults they have been in abusive relationships where domestic violence and rape have been a feature.
 
In the 3 years I have practised at WRASAC I have seen women who have suffered and survived ritualistic abuse within their family and who have severe and enduring mental health problems such as paranoid schizophrenia, anxiety and depression, eating disorders (anorexia and bulimia), self-harming, substance misuse, gender dysphoria, suicidal ideation and previous suicide attempts. I do feel very privileged to work with women who despite their background history and mental illness have made a decision that they want to get better.
 
During training and since this finished I have had weekly therapy myself. People are often surprised when I tell them this. TA therapists have to commit to completing 140 hours of personal therapy over the 4 years training. This does make sense when you think about seeing clients who are distressed and suffering with mental health problems and relationship difficulties that the therapist will have had enough therapy to be able to cope with what's happening in the therapy room and have their own head reasonably straight to be the best possible source of support for their client.
 
Over this period I have had monthly clinical supervision with my marvellous supervisor in Edinburgh, she travels up from England once a month to see me and 2 colleagues for group supervision. Supervision ensures we provide the best possible care for our clients through safe and effective practice. Supervision also helps us to see and work through how our work impacts on us both personally and
professionally. We learn so much from one another and share our learning together. 
 
I hope this blog has been useful for you to see my journey so far, please feel free to get in touch and let me know what you think and ask any questions.
 
If there's something you'd like me to write more about let me know..take care.... Carol
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