editor’s welcome
Executive contacts
Ann Beynon (Chair)
[email protected]
Kathy Bell (Deputy Chair)
[email protected]
Susan Pattison
[email protected]
Maggie Robson
[email protected]
Wendy Brown
[email protected]
Liz Cairns
[email protected]
Wendy Kinnin
[email protected]
Alison Theaker
[email protected]
Monika Jephcott
[email protected]
Caryl Sibbett
[email protected]
BACP contacts
Karen Cromarty
Senior Lead Advisor
[email protected]
Richard Smith
Special interest lead
[email protected]
Julie Camfield
Divisional officer
[email protected]
Welcome!
s I walked along an expanse of sandy beach recently, I pondered
on the many footsteps that would disappear with each tide, erasing
those people’s evidence of existence. And this reminded me of my
clients over the last 10 years. Their names have vanished from my mind,
but the encounters live on inside me, having contributed to my professional
development by fuelling new understanding of young people and my
therapeutic work.
OK, I told myself, that’s a great idea, but trite. The words positively tripped
off the tongue. What I needed to ask myself is: in exactly which way has my
work developed over the years. And the specific words that accurately sum
it up are ‘gut instinct’, ‘flexibility’, and ‘willingness to learn from client to
client’ – all based in my theory, of course, but not kowtowing to manualised
evidence-based treatment. (The phrase didn’t exist when I first started,
anyway, which shows what gigantic wheels the ‘proof’ wagon has recently
rolled on.)
In this respect, I quite like Chris Scalzo’s article on existentialism, which
at first seems hard to differentiate from the person-centred approach. But
when it comes to acknowledging and accepting the two givens (birth and
death – plus a few others for young people) and emphasising relationship,
responsibility and making choices, then that really does free up everything
else. Existentialism, in one sense, seems to give a carte blanche to work in
the most intuitively creative way we can, grounded in the philosophy and
theory of the model. Proper training plus seat-of-the-pants.
But as we move towards establishing good guidelines for the training of
CYP counsellors, what do we really mean by ‘proper training’? Trained to
work only to the initial model, and/or to evidence-based systems, and/or
from a manual? Or trained to know the theory and understand how to
work creatively? Which doesn’t necessarily mean handing out worksheets
from the plethora of books on sale or using someone else’s games, though
they have their part to play (see the Review books this month). What
I understand by creativity (and by my chosen words of ‘gut instinct’ and
‘flexibility’ is the sort mentioned by Duncan and Miller1: ‘Experienced therapists
know that the work requires the tailoring of any approach to a particular
client’s unique circumstances. The nuances and creativity of an actual
encounter flow from the moment-to-moment interaction of the participants
– from the client, relational and therapist idiographic mix – not from step A
to step B on page 39.’
Now this is what we learn as we go, as we develop as counsellors and
therapists – but surely there must be a way to introduce such competence,
by degrees, into training for counsellors working with young people? In only
10 years I have met far too many rigidly ‘correct’ counsellors, checking
formalities with their supervisors and self-righteously toeing the official line
from session to session. Let’s erase that kind of work and revel in opportunities
to forget page 39, even as the sand forgets the footprints that covered it.
Every article in this issue points that way forward.
A
Eleanor Patrick
Editor
All case studies in this journal,
whether noted individually or
not, are permissioned, disguised,
adapted, or constructed from
several clients in order to protect
the confidentiality of the work.
Reference
1 Quoted in Haen C. (ed) Engaging boys in treatment. (p25) London: Routledge; 2011.
CCYP June 2011 1
misdiagnosis
Misunderstood
and misdiagnosed
Many abused and neglected children are squeezed into
diagnostic categories that show misunderstanding of their
true needs. Others with developmental difficulties originating
in such trauma fail to meet the threshold for accessing
appropriate therapeutic support. Graham Music discusses
what must be understood to prevent this
ociety is failing a huge number of children
who are, or who have been, looked after. For
example, a disproportionate number of these
children end up in the prison or psychiatric systems,
or get excluded from school1. Here, I argue that our
child mental health services might also be failing
them in a similar way, albeit inadvertently.
My clinical work in CAMHS is primarily within
the Tavistock Clinic’s fostering and adoption and
kinship care team, and I know that my colleagues
and I never become inured to the shocking states
of mind we come across in the children we work
with. Often, their inner worlds are filled with
horrific fantasies; they show extremes of violence
and aggression; and they have little capacity to
understand or be interested in minds and emotions,
whether their own or others’. There is now plentiful
evidence that such high levels of early stress, abuse
and trauma are extremely predictive of many poor
outcomes in adulthood2, including high levels of
illness and early death3.
Yet despite the extraordinarily high level of
emotional need seen in so many of these children,
too many of them do not gain access to mental
health services, and when they do, they do not
receive the kinds of help they need. Paradoxically,
the increasing influence of evidence-based practice
agendas, NICE and accompanying developments
such as IAPT for children is quite likely to decrease
rather than increase the chances of these children
gaining appropriate access to therapeutic support.
An important reason for this is that service
provision is increasingly organised with the
expectation that clinics must only treat diagnosable
mental health disorders, and do so with NICEapproved treatments. The catch for this client group
is that being looked after or maltreated is not a
disorder, and that the issues with which such
children present often simply do not fit into the
main diagnostic categories as defined by DSM-IV
or ICD10, although it can look at first glance as if
their behaviours might fit such categories. For
example, many children have presentations that
seem just like autistic spectrum disorders, ADHD,
or conduct disorders, and sometimes the children
S
‘
Despite the
extraordinarily high
level of emotional
need seen in so
many of these
children, too many
of them do not gain
access to mental
health services
2 CCYP June 2011
are given these diagnoses. But very often, the
children fall just under the thresholds to receive
the diagnosis4. For want of better understanding of
them, many children are squeezed into categories
that are a very poor fit, much like Cinderella’s fabled
stepsisters trying desperately to squeeze wrongsized feet into a slipper meant for someone else.
Developmental difficulties and
co-morbidity
What we do know is that many traumatised and
maltreated children show a range of developmental
difficulties and ‘co-morbidity’5. This has led
researchers such as Tarren-Sweeney to develop
alternative profiles and ways of conceptualising
the range of issues such children have6 – arguing
OSCAR ORTIZ/GETTY
misdiagnosis
that these children do not access the correct
services sufficiently because they are not wellenough understood7. A diagnostic category that is
little used by psychiatry but often overused and
misused by therapists is that of Reactive Attachment
Disorder, a category whose psychiatric diagnostic
meanings have often not been properly grasped
but which is nonetheless used very loosely by a
host of therapists, sometimes to justify therapies
of dubious helpfulness8.
I will now briefly describe a couple of case
examples to illustrate these points, one case of
a primarily abused child and another case of
a neglected child. After this I will explain how
I have come to understand such children from a
developmental perspective.
Mick: abused and traumatised
Mick was the older of two siblings, adopted at age
four from a drug-using and neglectful mother almost
definitely involved in prostitution, and a violent
father. There were suspicions that the children were
used in a paedophile ring. His younger sister, adopted
at nearly two, was doing much better. She had been
in care from the age of 11 months, and had escaped
the worst treatment. Mick was another story. He was
nearly excluded in his first week at school, seemed
to have a tough, steely side to him, and seemed to
take pleasure in seeing others hurt and in pain. In his
play, dolls were cut up, mutilated and tortured to his
evident enjoyment, in such a way that made me
feel like my blood was running cold. While he was
hypervigilant enough to be able to monitor me and
CCYP June 2011 3
misdiagnosis
‘
The catch is that
being looked after
or maltreated is not
a disorder, and the
issues with which
such children
present often do
not fit into the main
diagnostic
categories
4 CCYP June 2011
others for signs of danger, he seemed to have no
interest in other people’s minds and was almost
incapable of understanding that another person had
feelings. Maybe this was not surprising, as from the
reports we had, it seemed unlikely that in his life
before adoption anyone would have offered him
anything like kindness or caring or attunement, or
shown interest in his thoughts or feelings.
Mick had been given a diagnosis of ADHD, and
it is true he was a very active boy, but, I think,
hypervigilant due to trauma and the inability to
regulate his emotions. He was also given a diagnosis
of conduct disorder and due to his almost complete
inability to understand other people’s minds and
emotions, several people were also clamouring for
an autistic spectrum disorder diagnosis. His inner
world might have been particularly contorted by the
madness-inducing horrors that he had experienced,
but many maltreated children I have seen show
some similarities with Mick. In particular, they often
have very poor peer relationships, which as we
now know links with a lack of early attunement
and insecure attachment relationships9. They can
be both rigid, not managing any change, yet easily
dysregulated and out of control, both being common
features of children with disorganised attachments10.
Many of these children do not seem to be able to
fit in anywhere, get excluded from school, have
few friends or relationships that last, and many,
especially the boys, find themselves quickly in the
criminal justice system.
Stephen: a neglected boy
Where Mick was abused and overtly traumatised and
showed more externalising symptoms, other children,
like Stephen, can present in a quieter, more
internalising way. Stephen was six when I first saw
him. He had dull, sunken eyes, seemed expressionless,
his skin tone was pale and he looked lifeless. He was
reported at school to have few friends, rarely smiled
or seemed to enjoy anything much, and kept himself
to himself. He liked to spend as much time as
possible on computers or watching television, or
sometimes playing Lego. Children like Stephen rarely
come to our attention, but he was referred when his
adoption was at risk of breakdown. He had already
had a previous placement breakdown. His adoptive
parents reported that he seemed not to need them
at all, that he gave nothing back, that he did not
seem to care if he was with them, or indeed with
anyone, and that he was cold and unemotional. He
was extremely unrewarding to parent, and like many
such children, it was sometimes hard to put a finger
on what was disturbing about being with him. He
had also been given a diagnosis of Asperger’s
syndrome and had some extra help at school.
Stephen’s history was one of profound neglect. His
learning-disabled mother had had previous children
taken into care and she had left her town of origin
and settled elsewhere, slipping under the radar of
statutory services. When Stephen was three years old,
social workers, alerted by neighbours, found a home
with almost no furniture, little food, and the mother
living with an unknown and extremely learningdisabled man, sleeping on the floor without even a
mattress but only blankets. The main feature of the
home was a large television. Stephen had few words,
and it seemed he had suffered more from a lack of
good experiences than overtly traumatising ones.
His arrival in our service heralded a long period
of work that I cannot describe in detail here,
except to say that this was at first primarily with
the adoptive parents, helping them understand the
impact of early neglect, and beginning to help
them spot and build on small developmental and
hopeful signs in Stephen’s behaviour that could
easily be missed. I have described work with such
neglected children elsewhere2,11,12 and a lot of such
work is about keeping hold of hope and not
feeling deadened or disheartened in the face
of what can seem a relentless grind with few
rewards. Children like Stephen can develop and
grow, but it is slow, painstaking work, and not
work that is sufficiently available in clinics.
Developmental understandings
In my experience, CAMH services often do not have a
good enough understanding of children like Mick or
Stephen, who have suffered abuse or neglect. Despite
the increase in Britain of specialist teams of CAMHS
professionals attached to social services departments,
as well as the recent NICE guidance suggesting the
need for such specialist developments13, many such
children do not meet the thresholds that allow them
to receive a service. Often, services manage waiting
lists by insisting on a diagnosable mental health
disorder as a passport. Unfortunately, such children
lack the passport to gain access to a service, or end
up with diagnoses that do not really fit them, such as
Stephen’s autistic spectrum disorder/Asperger’s
diagnosis, or Mick’s ADHD and conduct disorders. It is
therefore, I believe, more appropriate to develop
in-depth developmental understandings of such
children, using complex profiling of the kind TarrenSweeney suggests7.
A typical example of this dilemma was
demonstrated by as yet unpublished research
undertaken by a colleague14 with a small number
of looked-after children, all of whom had been
given an autistic spectrum disorder diagnosis. She
gave these children a battery of tests, including
the Autistic Spectrum Quotient, Story Stems, the
Sally-Anne test, which classically measure theory
of mind abilities, the Baron-Cohen ‘Reading the
Mind in their Eyes’ test and several others, and her
finding was that on such measures there was no
evidence of autism. These children had all been
maltreated and were typical in displaying ‘subthreshold’ levels of behavioural difficulties, of
inattention, poor symbolic and imaginary capacities,
misdiagnosis
basic levels of language skills, and they also struggled
with peer relationships. Such findings fit well with
our clinical experience and there are clear
developmental explanations for why maltreated
children end up with such presentations.
Much of the developmental research has
emphasised how trauma and abuse can give rise to a
range of typical personality features. For example, one
is likely to see hypervigilance with accompanying
strong amygdala activation, and high cortisol levels,
giving rise to difficulties in concentrating that can
seem rather like ADHD15. Not having an experience
of an attuned adult in touch with one’s own mental
states will stymie the development of mentalising
capacities16, and stress and anxiety diminish any
latent capacities to be reflective and thoughtful
about one’s own and others’ psychological and
emotional experiences. None of us is very empathic
when someone is threatening us! As Ogden17 argues,
a major task of therapeutic work is helping our
clients find a window of safety, a place where they
are neither too over- or under-aroused, and in
which reflective therapeutic work can take place.
Normal developmental capacities
Not surprisingly a whole host of developmental
capacities tend to ‘co-emerge’ when things go
reasonably well and children receive parenting
which is somewhere on a continuum that one
might describe as what humans have evolved to
expect18. For example, research shows that the
capacities for empathy and altruism are part of a
whole swathe of developmental capacities that are
related and that tend to come on line together.
Humans are adaptive and have evolved to develop
in a range of emotional environments, but I think
that the extremes of neglect and abuse are not
what we have evolved to grow in.
Central to these capacities is the ability to be
empathic or helpful, which in turn requires the
ability to understand the ‘intentions’ of others, to
make sense of what another is thinking and
feeling. To work out the meaning of a word or a
gesture, or whether we think an act is right or
wrong, one needs to have developed an ability to
understand another’s intentions. Deliberately
hitting someone or just accidentally knocking
them over will be judged by most of us differently,
as we understand that the intention is different.
A classic example is the way in which even very
young children normally recognise another’s
intentions. Reddy19 showed that infants as young as
about five months can ‘tease’ their parent, such as by
offering something and then taking it back, which
requires an ability to make sense of the parent’s
wishes. We know that the ability to understand
another’s intentions in a relaxed and interested way
develops from the first few months, and is a
precursor of having a Theory of Mind later, and this
depends on having ‘mind-minded’ input20, the lack of
which partly explains the misdiagnosis of autistic
spectrum disorders in so many of these children.
Linked to these capacities is what is often called
‘autobiographical memory’ and the ability to
conceptualise oneself as part of a story, one’s own
and other people’s, having a past, present and future.
Of course, tragically, so many looked-after and
traumatised children have never really experienced
themselves as in anyone else’s mind properly, as
central to any narrative. Usually, given the right
building blocks, autobiographical memory starts to
develop apace after children begin to recognise
themselves in mirrors, often between about 18 and
24 months. The classic ‘mirror-recognition’ test places
a blob of ‘rouge’ on an infant’s face, and children
‘pass’ this test if they recognise that it is their face
with rouge on in a mirror. Passing the test is also
linked to starting to use more personal pronouns21,
often seen as a sign of a separate ‘self’ forming.
Yet another piece of the ‘co-emergence’ jigsaw is the
fact that the ability to play in an imaginary way and
to pretend is a linked capacity and particularly related
to achieving understanding of other minds22. We
know how often children who have been traumatised
or neglected seem unable to play symbolically.
It seems that these abilities are also linked with
the capacity to defer gratification and to selfregulate, something that, again, so many maltreated
children struggle with, and which also tends to be
related to good early caregiving and attachment
relationships. We know that the inability to selfregulate affects a child’s ability to negotiate peer
and other relationships. And it seems that the ability
to defer gratification depends on being able to
understand and regulate one’s own thoughts and
feelings23. Deferred gratification and altruism are
linked, in that they both entail thinking about minds
and feelings, either one’s own or those of others.
Thus in most children a range of developmental
capacities are linked and tend to ‘co-emerge’.
However, in children who have been abused or
neglected, we often see the opposite, a range of
developmental deficits in such areas as the ability to
empathise, understand other minds, autobiographical
memory, self-regulation, and symbolic play. It is
likely that important, ordinarily expected
developmental trajectories simply do not occur in
severely maltreated populations, because they have
lacked the ‘experience expected’ inputs that we might
variously know as mentalisation, containment,
mind-mindedness, attunement and such.
Where now?
In the last few years, the Tavistock, Anna Freud Centre,
Great Ormond Street Hospital, BAAF (British
Association for Adoption and Fostering), Adoption
UK, Coram and the Marlborough Family Centre
have formed a consortium to try to think about
the particular issues that arise when working with
children who have suffered serious maltreatment.
‘
Many looked-after
and traumatised
children have
never properly
experienced
themselves as in
anyone else’s mind
CCYP June 2011 5
‘
misdiagnosis
We must move
beyond the narrow
diagnostic labelling
to a clear
understanding of
developmental
trajectories
As part of our work, we received a grant to
research what local practitioners, particularly
CAMHS therapists and social workers, understood
about this client group and the help that was
available. Importantly, it was found that many
responsible for such children, such as social
workers, felt that it was much more difficult than
it should be to get these children into services –
and there were more CAMHS services than we
hoped that did not feel they had the expertise to
work with this client group. There are lessons here
for policy makers to heed from such findings if
the shocking longitudinal outcomes for lookedafter children are not to continue or even worsen.
It seems to me that for change to occur we need
to really understand the children who have been
severely maltreated or neglected. To do this we must
move beyond the narrow diagnostic labelling to a
clear understanding of the developmental trajectories
that are likely to arise following maltreatment and
abuse. I believe that, rather than being side-tracked
by NICE guidelines and diagnostic categories, we
need to ensure that we and our colleagues
understand the nature of these issues. Otherwise
too many children will not meet the thresholds to
gain access to CAMHS, and too many who do make
it to clinics will be wrongly diagnosed and not
receive the help they so badly need. Graham Music is a consultant child and adolescent
psychotherapist at the Tavistock Clinic in London and
an adult therapist in private practice. He is author of
Nurturing Natures: Attachment and Children's Emotional,
Sociocultural and Brain Development, and he has also
been developing a course for adult counsellors who
want to work with children, families and young people.
[email protected]
References
1 Ford T, Vostanis P, Meltzer H, Goodman R. Psychiatric
disorder among British children looked after by local
authorities: comparison with children living in private
households. The British Journal of Psychiatry. 2007;
190(4):319.
2 Music G. Nurturing natures: attachment and
children’s emotional, sociocultural and brain
development. London: Psychology Press; 2010.
3 Dube SR, Felitti VJ, Dong M, Giles WH, Anda RF. The
impact of adverse childhood experiences on health
problems: evidence from four birth cohorts dating back
to 1900. Preventive Medicine. 2003; 37(3):268-277.
4 DeJong M. Some reflections on the use of psychiatric
diagnosis in the looked after or ‘in care’ child
population. Clinical Child Psychology and Psychiatry.
2010; 15(4):589.
5 Oswald SH, Heil K, Goldbeck L. History of
maltreatment and mental health problems in foster
children: a review of the literature. Journal of Pediatric
Psychology. 2010; 35(5):462-72.
6 Tarren-Sweeney M. The Assessment Checklist for
6 CCYP June 2011
Children – ACC: a behavioral rating scale for children in
foster, kinship and residential care. Children and Youth
Services Review. 2007; 29(5):672-691.
7 Tarren-Sweeney M. It’s time to re-think mental health
services for children in care, and those adopted from care.
Clinical Child Psychology and Psychiatry. 2010; 15(4):613.
8 Prior V, Glaser D. Understanding attachment and
attachment disorders: theory, evidence and practice.
London: Jessica Kingsley; 2006.
9 Sroufe LA. The development of the person: the
Minnesota study of risk and adaptation from birth to
adulthood. New York: Guilford Press; 2005.
10 Solomon J, George C, De Jong A. Children classified
as controlling at age six: evidence of disorganized
representational strategies and aggression at home and at
school. Development and Psychopathology. 1995; 7:447-447.
11 Music G. Neglecting neglect: some thoughts about
children who have lacked good input, and are ‘undrawn’
and ‘unenjoyed’. Journal of Child Psychotherapy. 2009;
35(2):142-156.
12 Music G. When life has been sucked out. CCYP. March
2010.
13 NICE/SCIE. NICE Guidelines: Looked After children. 2010.
Available from: www.nice.org.uk/nicemedia/live/13244/
51173/51173.pdf
14 McCullough E. Narrative responses as an aid to
understanding the presentation of maltreated children who
meet criteria for Autistic Spectrum Disorder and Reactive
Attachment Disorder: a case series study (unpublished).
15 Perry BD, Pollard RA, Blakley TL, Baker WL, Vigilante D.
Childhood trauma, the neurobiology of adaptation and usedependent development of the brain: how states become
traits. Infant Mental Health Journal. 1995; 16(4):271-291.
16 Fonagy P. (ed) Affect regulation, mentalization, and the
development of the self. New York: The Other Press; 2002.
17 Ogden P. Trauma and the body: a sensorimotor
approach to psychotherapy. New York: Norton; 2006.
18 Cicchetti D, Valentino K. An ecological-transactional
perspective on child maltreatment: failure of the average
expectable environment and its influence on child
development. In: Cicchetti D, Cohen DJ. (eds)
Developmental psychopathology: risk, disorder, and
adaptation. New York: Wiley; 2006.
19 Reddy V. How infants know minds. Cambridge, Mass:
Harvard University Press; 2008.
20 Meins E, Fernyhough C, Wainwright R, Gupta MD,
Fradley E, Tuckey M. Maternal mind-mindedness and
attachment security as predictors of theory of mind
understanding. Child Development. 2002; 73(6):1715-1726.
21 Lewis M, Ramsay D. Development of self-recognition,
personal pronoun use, and pretend play during the 2nd
year. Child Development. 2004; 75(6):1821-1831.
22 Harris PL. Hard work for the imagination. In: Goncu A,
Gaskins S. (eds) Play and development: evolutionary,
sociocultural, and functional perspectives. London:
Psychology Press; 2007.
23 Moore C, Macgillivray S. Altruism, prudence, and
theory of mind in preschoolers. New Directions for Child
and Adolescent Development. 2004; 2004(103):51-62.
progressive counting
Progressive counting
his article describes the development and use of
what may prove to be ‘the next big thing’ in
trauma treatment. Because I am a pioneer and
leading authority in EMDR for children, you probably
wouldn’t expect me to be touting some other trauma
treatment – EMDR is proven effective, well tolerated
by children, and, in direct comparisons, has been
found to be more efficient than CBT1,2. Thus many
have considered EMDR the child trauma treatment of
choice until now. The problem with EMDR is that it’s
a complex treatment that takes a lot of time, practice
and supervision to master, making it troublesome to
teach and prohibitively resource-intensive to learn3.
I first came across the counting method (CM) in
a paper published many years ago4. The therapist
directed the client to visualise the story of the
trauma memory as if watching a movie of it in
the mind, while the therapist counted aloud from
1 to 100, with the movie beginning at ‘1’ and
ending at ‘100’. I read the paper, said to myself,
‘That’s stupid!’ and promptly forgot about it.
T
A surprise
Fast forward about a decade. I came upon a paper
in which CM was compared to EMDR and to
prolonged exposure5. This rather well-designed study
had lots of bells and whistles: random assignment,
efforts to ensure that the treatments were done
properly, blind independent evaluators etc. As
expected, everyone got better from their PTSD, and
those receiving EMDR got better in about two-thirds
of the time it took those receiving prolonged
exposure. The surprise was that those receiving CM
got better just as quickly as those receiving EMDR.
This outcome gave me quite a start. As an
experienced EMDR instructor, I was all too familiar
with the difficulties in getting my trainees to
actually become competent in EMDR. Was it
possible that this simple and ‘stupid’ technique of
counting during client visualisation of the memory
could be just as efficient and effective as EMDR?
If so, it would greatly simplify my efforts to train
therapists in trauma treatment.
So I asked David Johnson (the study’s lead author)
if I could attend a CM training. ‘Sorry,’ he emailed
back. ‘We don’t have any trainings scheduled at
present.’ Then I asked for a copy of the treatment
manual. ‘Sorry,’ he replied. ‘It’s under revision right
now. I’ll be glad to send you a copy when it’s finished.’
While awaiting the treatment manual, CM was on
my mind when, in the summer of 2007, I was giving
a five-day training in child trauma treatment for a
group of therapists in a children’s hospital in northern
4 5 66 77 8 9 10
1
0
1 2 3344 55 6 7 88 99 10
2
11 2 3
Ricky Greenwald details the development of a new trauma treatment that is simple,
efficient and well tolerated
Israel. On the fourth day, when I would have normally
taught a child-adapted version of prolonged
exposure6, I asked the group, ‘Do you mind if I teach
you something I’ve never tried before?’ They all said,
‘Sure!’ It was, after all, the fourth day, and we were
comfortable with each other by then. I said, ‘OK,
but I’m not going to teach it to you the right way.
I’m going to teach it the way I would modify it to
use with children.’ I would not want to start a child
on a movie to a count of 100; that seems like too
much at once and could be overwhelming. Thus
instead of guiding the client to visualise a movie
going to a count of 100, we started with a count
of only 10, and the next time 20, next time 30 etc.
The participants practised the technique on each
other, and it proved to be quite a hit. The following
week, I tried it again with another group, and again
the response was very positive. Upon consideration,
I realised that visualising the movie of the memory
during therapist counting incorporates many of the
same features as EMDR7, including:
client option for privacy regarding details of the
memory
client working at speed of thought, not slowed
down by the talking (or writing, drawing etc)
required in most other trauma resolution methods
dual focus of concentrating on the memory and
a distractor at the same time; this seems to create
an observer or distancing effect that minimises
overwhelm and facilitates healing.
Finally, I received the revised CM manual8 and
discovered that I had bungled the whole thing.
That is, I had substantially misunderstood the CM
procedure, and had inadvertently changed it more
than I had realised. I had thought that CM was all
about the movies, but no. In CM, I learned from
the manual, the movie is only done once, near the
beginning of the session. The remainder of the
session is devoted to review, the procedure for
discussing the contents of the movie. It seemed to
me that the many advantages of the movie portion
of CM – the privacy option, working at thought
speed, and dual focus – were lost during the talk
portion of the session, which would be a gruelling
ordeal for many clients.
In the EMDR community, we have a joke about
psychoanalysts who learn EMDR: ‘The analyst does an
EMDR session, the client has a major breakthrough,
and for the next six months, they talk about that
session.’ This is how I came to view CM: someone
came up with a brilliant intervention, and spent the
rest of the session talking about it. Even so, adding
CCYP June 2011 7
progressive counting
1
5
4
1
1
6
3
1
7
1
2
1
1
5
1
4
1
1
1
8
1
6
3
1
7
1
2
1
1
1
5
1
9
4
1
1
1
8
1
6
3
1
7
1
11 12
18 1919 2200
20
that 100-second movie to a session otherwise
devoted to ‘talking about it’ had increased treatment
efficiency by 50 per cent, compared to ‘talking about
it only’, as done in prolonged exposure5.
Progressive counting
This is when I started losing sleep. ‘How efficient
would the treatment be,’ I wondered, ‘with lots of
movies and not so much talking?’ Thus progressive
counting (PC) was born, a spin-off of CM.
PC is designed not only for enhanced treatment
efficiency, but also to be better tolerated by clients
(including children) who may have difficulty working
through trauma memories due to limited tolerance
of negative affect. The primary innovations are:
1. Multiple dual-focus exposures (visualising the
movie during therapist counting) within a single
session. If this is the element that maximises
efficiency and tolerability, it seems wise to make
the most of it.
2. Starting with a movie-duration count of 10
and increasing by a count of 10 each time (to 20,
then 30 etc) up to the maximum count of 100.
This is to further control the dose and allow for
progressively greater exposure as the client makes
progress on mastering the memory. Later, when
the client has nearly completed trauma processing,
the count becomes progressively shorter as there
is less work to do.
3. Minimising the review (talking about it) phase,
so the client is only asked to briefly comment on the
experience, but not to recount the details of the
movie (unless the client takes the initiative to do so).
This virtually eliminates the portion of CM that
some clients might find intolerable, while leaving
more time for the dual-focus exposure component.
4. The movie goes all the way to the full-relief
ending, even if that requires going far beyond the
immediate conclusion of the most traumatic part of
the memory (in CM the movie ends shortly after the
most traumatic component is over). This enhances
the likelihood that the memory can be fully resolved.
5. Continuing until SUDS (the 0-10 distress scale)
is zero and there is no further change (in CM, the
work can stop when SUDS is two or lower). This is
to ensure that the memory is fully resolved, which
may be especially important for multiple-trauma
cases, in which work on chronologically later
traumas is believed to be facilitated by complete
resolution of those that came before9,10.
Many PC clients who have previously experienced
EMDR describe PC as:
a bit faster
a bit less emotionally intense and thus easier to
tolerate
better contained, in that it stays more focused
on the target memory, whereas EMDR engenders
more associations to other memories
on rare occasions, less thorough, in that the
8 CCYP June 2011
SUDS did not get lower than 1 or 2 whereas with
EMDR it might have reached 0.
I have been quite busy in the past couple of years
developing PC. By now I have personally treated
roughly a thousand trauma memories with PC,
supervised hundreds of PC practice sessions in
workshops, and supervised a number of therapists on
their use of PC. This has afforded many opportunities
for supervision, problem-solving and further learning.
PC publications include cases on treatment of
children11 and adults12, a large open trial13, and a
book14. A controlled study comparing EMDR and PC
is in progress, with preliminary results indicating
that outcomes are roughly equivalent. Of course,
considerable research will be required to establish
PC’s position relative to other trauma treatments.
I’m interested in further opportunities for research,
particularly in clinics in which trauma cases (possibly
including abuse, bereavement, road accident etc) are
routinely treated with another empirically supported
treatment such as EMDR or TF-CBT. Meanwhile,
there is ample reason to regard it as at least being in
the same league as EMDR in efficiency and client
acceptability, while being far simpler to master.
A number of therapists are now using PC as the
first-line treatment for trauma or loss memories,
for adults, teens, and children down to about age
five. Adaptations of PC for younger children have
not yet been developed.
Case example: Becca
To illustrate PC’s use in clinical practice, here is a
case of an eight-year-old girl who was repeatedly
molested by her father, with whom she no longer
has contact. ‘Becca’ had numerous symptoms,
including severely disrupted sleep, nightmares, fears,
intrusive memories, clinging, frequent dissociation,
and a restricted range of activities. She went
through the standard trauma treatment
preliminaries5 including considerable focus on
practical actions that she and her mother could do
to help her to feel more safe and secure. For
example, because of her irrational fear that her
father would go to her school to kidnap her, she and
her mother met with school staff and gave them a
photo of the father, and secured their assurance
that he would not be allowed on school grounds.
We also worked on strategies for coping with her
strong reactions to trauma-related reminders.
When it was time to begin the trauma resolution
work, we started on the memory of when her pet
dog had died. Although recalling the death of her
dog made her sad, I did not view this as the source
of her symptoms; rather, this memory was treated
as a test run. I wanted to ensure that Becca could
tolerate trauma resolution work, and I wanted her
to experience success and competence with PC,
prior to facing the abuse memories. Indeed, she did
quite well with this memory, as transcribed below.
progressive counting
Movie
duration of:
10
20
30
40
50
60
50
40
30
20
10
Response to
SUDS at
‘How did that go?’: worst moment:
Good
4
Good
6
Good
7
Good, but it’s sad
7
Good; at least he
3
doesn’t hurt any more
Good, he’s happy now 2
Good
1
Good
0
Our new dog is
0
really nice too
Good
0
Good
0
Whereas the test-run memory was resolved rather
quickly, most of the abuse memories took many
more movies to resolve, the worst one taking
perhaps 40 minutes (and with another child I have
seen, a single abuse memory took over two hours
to resolve). We went through all of the identified
abuse memories, in chronological order, as per
Greenwald et al15, over the next several sessions.
At that point her mother reported considerable
reduction in symptoms, including reduced fears,
expanded range of activities, only occasional
dissociation, and sleeping through the night for the
first time since the abuse had begun many years
prior. However, although Becca was starting to feel
and behave more like a ‘normal’ girl, she still had
occasional strong reactions to situations that, often
in unpredictable ways, reminded her of the abuse.
Therefore, I instructed Becca and her mother to
keep track of these events, which we could then
address. For example, they reported that Becca had
observed a boy on the playground making a playful
gun-shooting hand gesture, and then Becca had
become very upset and remained so for the rest of
the day. This led to her recalling the time that her
father had threatened her with a gun – she had not
previously thought to mention this – and we were
able to treat the memory with PC. For the past half
year or so, we have been meeting monthly for this
type of work, and, other than occasional reactions
to such reminders, Becca is nearly symptom-free.
Conclusion
PC functions like any other effective trauma
resolution method in terms of its role in the overall
treatment approach. Because PC is so simple,
efficient and well tolerated, it has been well received
by therapists and clients. Children, in particular, have
consistently reported that they appreciate PC
because it is ‘not too hard’, they are not required to
talk about the memory more than they wish to, and
of course because it helps them to feel better.
Although much more research will be needed before
PC can be considered a trauma treatment of choice,
it is already at least a responsible choice, and
certainly an appealing one. 5 26 27 28 2
23 244 225 26 27 28 299 30
21 1 22222233 224 25 26 27 28 29 3300
221 22
Movie beginning, before anything bad happened:
Playing with the dog.
Movie ending, after bad part over: A year later,
going to bring the new dog home.
Ricky Greenwald is director of the Trauma Institute and
Child Trauma Institute, Greenfield, MA, USA. For more
information on PC, the latest book is available from the
institute’s website (www.childtrauma.com), which also
lists additional resources as well as opportunities for
training. [email protected]
References
1 Jaberghaderi N, Greenwald R, Rubin A, Zand SO,
Dolatabadi S. A comparison of CBT and EMDR for
sexually abused Iranian girls. Clinical Psychology and
Psychotherapy. 2004; 11:358-368.
2 de Roos C, Greenwald R, den Hollander-Gijsman M,
Noorthoorn E, van Buuren S, de Jongh A. A randomized
comparison of CBT and EMDR for disaster-exposed children.
European Journal of Psychotraumatology. (in press)
3 Greenwald R. The peanut butter and jelly problem:
in search of a better EMDR training model. EMDR
Practitioner. 2006.
4 Ochberg F. The counting method. Journal of Traumatic
Stress 1996; 9:887-894.
5 Johnson DR, Lubin H. The counting method: applying
the rule of parsimony to the treatment of posttraumatic
stress disorder. Traumatology. 2006; 12:83-99.
6 Greenwald R. Child trauma handbook: a guide for
helping trauma-exposed children and adolescents. New
York: Haworth; 2005.
7 Greenwald R. Progressive counting: asking recipients
what makes it work. Traumatology. (manuscript
submitted for publication)
8 Johnson DR, Lubin H, Ochberg F. The counting method
manual, revised 2007. Author.
9 Greenwald R. EMDR within a phase model of traumainformed treatment. New York: Haworth; 2007.
10 Shapiro F. Eye movement desensitization and
reprocessing: basic principles, protocols and procedures.
New York: Guilford; 2001.
11 Greenwald R. Progressive counting: a new trauma
resolution method. Journal of Child & Adolescent
Trauma. 2008; 1:249-262.
12 Greenwald R. Progressive counting for trauma resolution:
three case studies. Traumatology. 2008; 14:83-92.
13 Greenwald R, Schmitt TA. Progressive counting:
multi-site group and individual treatment open trials.
Psychological Trauma: Theory, Research, Practice and
Policy. 2010; 2:239-242.
14 Greenwald R. Progressive counting within a phase model
of trauma-informed treatment. NY: Routledge. (in press)
15 Greenwald R, Douglas AN, Seubert A. The effect of
resolving recent vs. older traumatic memories.
Manuscript in preparation. 2011.
CCYP June 2011 9
breathing
On breathing
Breathing takes place whether or not we attend to it. Dawnie
Browne explains the benefit for our young clients and
ourselves when we make this universal process conscious
his article aims to help you understand how to
offer the core conditions not only via your way
of being and relating to young clients, but also
by first occupying the spiritual home of your body
through your breath. This automatically takes relating
to a level that we can understand as energetictranspersonal – moving beyond our reduced mindbody identities to a broader identity that also
encompasses spirit through inner quiet. When
synthesising East-West insights – effectively
developing a more global understanding – what is
immediately apparent is the common interest in the
regulatory function of the autonomic nervous system,
through which the process of breathing is controlled.
T
The job of the autonomic nervous system
‘
When external
conditions are too
stressful, as in the
homes of so many
of our young
clients, the breath
is restricted and
contact with the
organismic base
is lost
10 CCYP June 2011
The human body continuously strives to maintain
homeostasis (balance) – adjusting internal conditions
to meet external demands. Regulation is reliant
upon the effective transition to and from the calm
‘being state’ of rest and repose and the active ‘doing
state’ of fight or flight. This defines a balanced stress
response and is accompanied by the production of
endorphins (happy chemicals) and stress hormones,
both of which are essential for living. When external
conditions (including the ‘way of being’ of the
attachment figure) are too stressful, as in the homes
of so many of our young clients, the breath is
restricted and contact with the organismic base is
lost. The breath-space then moves upwards and,
metaphorically speaking, we ‘move out’ – becoming
homeless amidst the discomfort of our stressed
bodies. Over time, the autonomic nervous system
resets itself to chronic stress mode and this is
mirrored in a disordered breathing process.
This also applies to us as counsellors. How was our
attachment process? What have been the traumatic
experiences of our lives and how do we cope with
the treadmill of daily life? Do we have resilience?
Are we able to get to a comfortable space inside
ourselves whenever we wish, or do we zone out in
order to switch off?
A brief history
For thousands of years, the East has understood
health as related to quality of ‘being’, explored
through practices such as yoga, t’ai chi/chi gung
and meditation. Breathing is a key aspect of all of
these practices, which share a common interest in
experiencing the here and now with awareness.
This is called mindfulness. Siegel1 explains that
mindfulness is
‘an ancient useful
form of awareness
that harnesses the
social circuitry of
the brain to enable
us to develop an
attuned relationship
within our own minds’.
In order to be present
to our clients and the
experience of the ‘now’, we
first need to be present in our bodies and reacting
to ‘now’, in order that we may be open to the
messages of our senses, and able to respond from
a centred space inside, rather than flitting between
thoughts of the past and future.
In the West, however, we are generally more
focused on quantity of doing as opposed to quality
of being. Focusing on doing takes us out of contact
with the here and now – out of our bodies into our
heads. In recent years, the West has acknowledged
the aforementioned wisdom teachings from the
East, and called this ‘New Age’. The ‘New Age’ is in
fact ancient wisdom, one aspect of this being
‘mindfulness’ practices, which NICE acknowledges
in the treatment of stress and anxiety2. Mearns and
Thorne3 cite the inner life of the counsellor as a
cornerstone of person-centred counselling, noting
that, increasingly, the way we live deduces from
experiences of inner calm.
It has long been acknowledged that the lobes
of the brain have different functions. Generally
speaking, the left hemisphere is related to logic
and the right to intuition, emotion and creativity.
Bowlby4 identified that it is on the basis of the
experience of quality relationship with the primary
caregiver that an infant develops a fundamental
sense of safety/security in the world. Neuroscientists
have more recently mapped this to the nervous
system and the production of chemicals (physiology)
and emotions (affect) in response to our experiencing.
The autonomic nervous system is an aspect of the
central nervous system, which runs from the brain
down to just above the base of the spine. Eastern
traditions focus on the centre of gravity in the body,
an area that is approximately two inches below your
belly button. Take your attention there now.
breathing
If we took a microscope and looked at the makeup of the physical body, we would see
vibrating molecules. If we took a microscope
and looked at the make-up of air, we would
see vibrating molecules. If we took a
gigantic microscope and looked down on
earth, we would see vibrating molecules.
Everything you can and cannot see is
composed of vibrating molecules. From this
perspective, everything in the universe is
vibrating in relation to everything else. You are
vibrating in relation to your clients. Schore5 calls
this affective resonance – the impact of our
emotional states upon the emotional states of our
clients. Have you ever sat next to someone and
felt good vibes? This is their aura, the energy field
that surrounds them. When we are stressed, we
occupy less space (our aura is contracted).
When we are grounded and calm, happy, we
occupy more space (our aura is expanded,
we appear lighter). By learning to breathe
in such a way as to occupy the space that
is within us we can occupy a bigger, more
expanded space in the world, which we can then
take to clients.
When we breathe, we oxygenate the cells of our
body and, on a subtler basis, we invite life force
into our body. Do you recall ever being ill and
feeling depleted of energy, heavier? This is your
life force. Therefore, breathing innervates the
physical body and the spiritual space we occupy in
the world. And when we lose connection with this
calm inner space, we are unaware of that with which
we have lost connection because this process of
disconnect has perhaps been ongoing since we
were infants and maybe we are most comfortable
now living in our heads. Relating to inter-affect,
McCraty et al6 note that the electromagnetic pulse
from the heart reaches out around the body for a
distance of almost two metres. This indicates that
an electromagnetic field is interactive not only
inside the body but outside too, with the potential
for interaction with the environment and with others
in the form of sensory information exchange.
Electrical fields, our own electrical fields, are
integral to the way we affect clients.
This is the space within which neural pathways of
peace and calm are cultivated.
3 Engage intention What is your deepest
intention in your work with young clients? Does
this relate to your chest carriage (non-possessive
love/unconditional positive regard)? Open up your
chest. Is there anything interrupting this intention?
For example, if you notice you are feeling stressed
you can inhale ‘peace and calm’, and exhale ‘stress’.
Working with intention is very powerful, as it changes
the messages in your mind, which changes your
body chemistry.
4 Belly breathe Breathing in through your nose,
become aware of your breath and invite the air to
flow into your abdomen, blowing up your belly
like a balloon. As you exhale, let any stress flow
out of your feet into the floor and ‘think liquid’:
invite your body to soften and become more like
water. If you want to, place one hand on your
belly. Every time you breathe in, invite a deep,
even, relaxed breath – filling your open belly, with
your feet placed firmly on the floor.
Do this for a minimum of five minutes! If you
wish to, do it for 20 minutes a day.
Are you home now? How do you feel? What has
been the benefit for you of becoming more
conscious of your breath? Remember, you can take
this journey inside yourself, whenever or wherever
you wish. After two sessions of breathing in this way,
a 10-year-old client, who had previously expressed
an inability to relax, recently said: ‘Dawnie, when
I feel stressed, I breathe deeply. Really deeply.’
It’s difficult to know sometimes if and how what
takes place in the counselling room affects young
clients in the outside world. Yet in this instance, as
I listened to her, I couldn’t help thinking: I wish
someone had shown me this when I was her age. Dawnie Browne is a counsellor, trainer and Reiki
teacher and practitioner based in County Durham. She
runs workshops on Breathing for Stress-Management
and Self-Care for adults and for counsellors working
with children. [email protected]
References
Try this four-step process
1 Ground Place your feet squarely on the floor
and ground yourself. When your legs are crossed
you are automatically less grounded, like a tree
with some roots pulled out of the earth.
2 Centre Take your attention to the area two
inches below your belly button. This is the centre
of gravity in your body and also at the level of the
bottom of your central nervous system, which is
contained within your spinal cord spanning up
into your brain. Picture this in your mind’s eye.
1 Siegel DJ. The mindful brain. New York: Norton; 2007.
2 For quick reference, see http://bit.ly/gQ3VQz
3 Mearns D, Thorne B. Person-centred therapy today.
London: Sage; 2000.
‘
Everything you can
and cannot see
is composed of
vibrating molecules.
From this
perspective,
everything in
the universe is
vibrating in relation
to everything else
4 Bowlby J. Maternal care and mental health. Monograph
series no 2. World Health Organization; 1951.
5 Schore AN. Affect dysregulation and disorders of the
self. New York: Norton; 2003.
ELEANOR PATRICK
Beyond the physical
6 McCraty et al. Electrophysical evidence of intuition.
Part 2. Journal of Alternative and Complementary
Medicine. 2004; 10(2):325.
CCYP June 2011 11
online counselling
Online identity formation
Lindsay Dobson discusses how the internet provides a space where young people dare to begin
exploring who they are
rik H Erikson1 felt that identity formation
goes on from birth to adulthood, but is most
prominent during adolescence. He felt that
in order to arrive at ‘identity achieved’ we need to
experience, confront and resolve an identity crisis
during this time. I believe the online environment
provides one space where young people can
explore their identity and do this important work.
I work online for kooth.com with 11- to 25-yearolds, who seek out therapy for many reasons. But
regardless of the issues they present with, part of
the therapy is about exploration of who they are
and how they function in the world. In this article,
I would like to share how I work online and how I
feel this is helpful for my clients. I do believe that
the internet is a place where useful therapy can
take place, so I make no apologies for my positive
attitude towards this. However, I do believe, as
with most things in life, it’s the proverbial horses
for courses, and online counselling works well for
some people, but not for every client. And I also
believe that for online therapy to be most useful, it
needs to help the young person integrate both
online and offline worlds.
So what do I believe the world of technology,
and in particular the internet, can bring to
therapy? In his online book2, John Suler talks about
this, and I summarise some of his ideas here, and
mention how I adapt them into my own practice.
There is a wealth of information online. Some of
it is good, some bad, but pretty instantly we can
find out almost anything we want to know, and
for the client who has perhaps just received a
diagnosis, or wants to know something more about
therapy or an aspect of themselves, this gives them
a feeling of empowerment – they don’t have to ask
questions of the doctor or therapist, always feeling
one (or many) steps behind. They can explore and
learn about things in the privacy of their own safe
space. Of course, since not all information online is
reliable or useful, sometimes it’s good to help our
clients work out how to judge and assess what
they are reading – for example, helping them pay
attention to the author, where the information is
coming from, what is likely to make that particular
information more reliable than some other etc.
Online, there is also space to play with different
aspects of our personality. We have both a
personal identity (who we believe we are, based
on what makes us unique eg extroverted,
motivated, caring etc) and a social identity (which
groups we belong to, the value that group places
on us, our role in that group, and the value society
E
‘
For online therapy
to be most useful,
it needs to help
the young person
integrate both
online and offline
worlds
12 CCYP June 2011
places on that group eg white, English speaking,
counsellor etc). If you’re interested, there is more
information on social identity on the University of
Twente website3 or in Wikipedia4.
We can explore these aspects of ourselves online in
many ways – Facebook, blogs, virtual worlds such as
Second Life5, or virtual games like World of Warcraft6
etc. The different modes of working online can also
bring out different aspects of our personality. For
example, communicating mostly via text – writing
emails, or using the text chat box in virtual worlds –
rather than using a microphone to speak, means
using written language and typing skills. Perhaps
those who choose to communicate in this way tend
to be literate, good verbalisers, who can illustrate
and describe things well with words; perhaps they
are those who like to express themselves in their
diary or by writing poems and stories. This would be
in contrast to those who use more visual modes of
communication, ie avatars in virtual worlds and
games, art programs, photos and drawings. I suspect
that these latter young people who prefer to interact
online in this way are those who have a more visual
way of communicating – in face-to-face therapy,
they might prefer to show, rather than tell, using art,
symbols or play as their way of communicating and
working through feelings.
Both visual and text-based modalities can again
be separated into two groups. Firstly, those that
happen in real time – ie live chat, or a virtual world,
where the other person is there at the same time as
you. They can see your words, or your avatar, or
your artwork as it is being created, and this is very
much in the here and now and can be spontaneous
and actually carry a sense of the other being
present. Secondly, modalities that are asynchronous
– ie the other is not there when it’s being created,
and the response will be given at a later date eg
email or message boards. Here, the person can take
their time, reflect, change, work out what they are
wanting to say or show, the message can be retyped,
spell-checked, made exactly as they want it before it
is sent, or the artwork finished, completed, changed
until it is just right, before it is seen by another.
When working with young people online, I often
use many of these different modalities to help the
young person explore different aspects of themselves
and different ways of communicating.
First contact
In my first contact with a client – quite often this is
in a live chat – I will use that space to make a brief
assessment of the young person’s computer and
ASLI BARCIN/GETTY (POSED BY MODEL
–
FOR ILLUSTRATION PURPOSES ONLY)
online counselling
CCYP June 2011 13
online counselling
‘
As she used the
boards more, she
would respond to
other young people,
encouraging them
to ask for help, and
giving suggestions
of ways to cope
14 CCYP June 2011
literacy skills. It’s not a formal assessment, but it helps
me to understand how we might work together
online. I will look to see how they’re coping with
using words – some type fast and fluently, and are
able to use words and language to beautifully
illustrate where they are at, but others may struggle,
typing very slowly, or perhaps seeming unable to find
the words, perhaps resorting to repeating the same
words over and over, or lapsing into long silences. We
will also contract and talk about what it is they are
hoping for from counselling, and what has led them
to choose online rather than in-person counselling.
We will often explore different ways of working
together. Some may stick to one main form of
contact eg chat rather than messaging, but with
many we integrate both one-to-one live chat and
messaging. We may also integrate into our work
the use of stories, both written and verbal, via
links to other sites that have stories on them that
the young person can play back and listen to.
Many young people now have their own spaces
online, and, using links to their own webpages,
they share photos or artwork with me, and in chat
we will often use emoticons if it seems they have
difficulty finding words.
Throughout our work, I will often point out
different resources for the young person – some
of them will be online (perhaps other websites or
articles), or I may suggest our message boards or
the articles we have within the Kooth magazine;
and some may be offline, such as the GP or other
services in their area, for instance alcohol or drugs
services, support groups etc.
On Kooth’s message boards, young people can
explore themselves in relation to others, their
group identity, and play around with new ways of
interacting. They can also write their own articles
for the magazine, giving them a sense of
empowerment and achievement.
And they can choose their own avatar and use
their own space to express their identity. Doing
this can often be a useful self-reflection exercise
as we explore what they choose to share and why.
Next steps
As the young person builds a relationship with me
and starts to feel secure in this space, we often
then start to work on integrating the online and
offline worlds. From the secure base of the online
relationship, the young person may feel more able
to explore areas that before felt scary, engaging
with in-person support via the doctor or crisis
team. They can identify offline real-world supports,
family and friends they can talk to, and take
elements of new ways of interacting, which they
have now tried out online, and use them to build
positive relations offline. This, I feel, is the ultimate
aim of any therapy – to integrate what you have
learnt there into your everyday life. And online
therapy is no different.
Sometimes a case study can help demonstrate
something better, so I thought I would share with you
one way in which a client has used this online space.
Case: Sophie
Sophie is an 18-year-old who was sexually abused
by her stepfather as a young child, whilst her
mother ignored what was happening and refused to
believe it when Sophie tried to tell her. She came
online for therapy at the point where she felt there
were no more options – she had left home at age
16 and spent the previous two years moving around
from place to place, sometimes prostituting herself
to earn money to live on, and using drink and drugs
to self-medicate. She self-harmed and, at the point
of coming online, had attempted suicide many
times, but through a refusal to engage with any inperson support felt abandoned, alone and very
desperate. She came online feeling she had no hope
that this would help, but knowing she felt alone
but unable to reach out to someone real – the
computer, and by default me, felt less scary and
more accessible, as I was not there, not real, and
she could not see me and I could not see her. She
felt more in control; she could just leave the chat
when she wanted, without any comeback from me.
At first she could only tolerate a short length of
time in chat, leaving when it became too much,
but often returning before the end of the hour –
to check I had stayed available for her. She showed
a very intelligent and eloquent use of language,
and expressed herself well. But when triggered by
something, often someone in her life who she felt
was angry with her, she would revert to presenting
as a small child, with the associated lack of
emotional language to express herself. She felt
shame and deep pain over the abuse, having been
told repeatedly by Mum that she was lying and by
the abuser that it was her fault. She also felt shame
because it was the only time she’d been special,
and at times had liked the abuse despite the pain.
We worked together for two years – having regular
weekly chats of one hour and contact via messages
(emails) between chats. In the live chat, we used
stories to help her inner child express herself, and
letter writing to help her start to get in touch
with how she felt as a child when the abuse was
happening. (For those looking for more information
on this, you can consult Parks Inner Child Therapy7,
the Changing Tales website8 and Using Story Telling
as a Therapeutic Tool with Children9.) Sophie’s
transference online was strong. As she could not
see me, at times she was furious with me, rejecting
and abusive, and at others clingy, needing me to
love her, care for her, begging me to come and
take her home with me. We explored these feelings,
using them to help her in turn explore her feelings
towards her mum and to help her form a healthy
secure attachment, one where she could tolerate my
absence and which also gave her a secure-enough
online counselling
base that she could start to explore. We also looked
at developing Sophie’s ability to self-soothe, finding
other ways for her to deal with her difficult feelings
– sometimes, we used links to relaxation recordings
online, music, or (one way she worked out for
herself) re-reading her sessions and in particular the
therapeutic stories we had shared because all our
work is recorded and saved online. Sometimes,
telling her story was impossible in words and then
she would draw and use photographs – which we
looked at together via a link she had sent me to the
place where she kept them online. (For more
information on using photographs in therapy,
perhaps read Beyond the Smile: therapeutic use of
the photograph10.) This was particularly useful at a
point in therapy where Sophie felt convinced that if
I could see her, I would reject her – through much
drug use she had lost her teeth, and after jumping
off a building prior to therapy, had some facial
disfigurement. By sharing photographs of herself,
we were able to explore this more. She also used
a collage of herself from young child to present day
to show her story, and photos of her environment to
build on that story and show how her ability to start
to care for herself affected her life and environment.
For example, photos of a squat that was dirty, cold
and empty later became photos of a clean and tidy
flat with objects that were hers around her.
She also used the message boards, initially to
share her suicidal feelings, and through this we
were able to find out that her suicide attempts
were the only way she knew to get care and
attention from another. As she used the boards
more, she would respond to other young people,
encouraging them to ask for help, and giving
suggestions of ways to cope. In doing this, she
slowly became able to use the suggestions for
herself, and to care and value herself. She also
learnt she could be a valued member of a group
and joined some support groups outside of Kooth
for survivors of abuse and self-harmers. The
message boards together with the one-to-one
therapy also helped her shake off the blame she
had taken on board – and to place it with the
adults who had abused or not protected her.
Whilst therapy was helpful in this, it was very
powerful for Sophie to hear other young people
also express that what had happened was not her
fault. She had been living with the belief that if
Mum blamed and did not believe her, nobody else
would either.
Sophie has started to successfully integrate her
online worlds and her offline worlds – she moved
to an area where she was able to break free of her
identity as victim, and now has her own flat. She
signed up for college and engaged with the crisis
team and her doctor, accepting a referral to a
specialist drugs and alcohol service, and, at the
time I write this, has not taken drugs or alcohol for
three months. Her self-harm is drastically reduced
and she has made no suicide attempts for over a
year. She also volunteers for other support sites,
mentoring and talking with others – she feels she
uses the skills she learnt online to do this. We have
now ended our work online and she has started the
next stage of her journey with an in-person
counsellor at a specialist sexual abuse service. She
believes that without the option of online therapy
she would have eventually succeeded in her
attempts to kill herself. She feels she would not
have been able at that point to engage with
someone sat in front of her, someone whose face
she could see, voice she could hear and whose
reactions she would have had to deal with. Online,
she could pace herself, dealing with my responses
when she was ready to, which gave her a feeling of
control she felt she had nowhere else in her life.
For my part, I am amazed by the courage and
creativity of Sophie and all my clients online, and
by how, without my presence there in the flesh,
they are able to find ways to compensate for that,
to ask for and get what they need, and use the
world of computers and virtual relationships to
help them heal and grow.
I would never advocate that online work should
replace in-person work – but for some young
people, it is an invaluable option when
circumstances otherwise mean they might never
access therapy. Lindsay Dobson MA is a counsellor online for
www.kooth.com and a member of BACP. She is also a
psychotherapeutic counselling tutor and has training
in therapeutic play. Lindsay’s main interest lies in the
use of technology as a therapeutic tool when working
with children and young people.
[email protected]
References
1 For a summary, see www.psychologistworld.com/
behavior/erikson.php
2 John Suler’s hypertext book is at www-usr.rider.edu/
~suler/psycyber/psycyber.html
3 The University of Twente portal is at http://bit.ly/a4ZZOJ
4 http://en.wikipedia.org/wiki/Social_identity
‘
Many young people
have their own
spaces online –
using links to their
webpages, they
share photos or
artwork with me
5 Second Life is at http://secondlife.com/
6 See www.warcraft.com or http://us.blizzard.com/
en-us/games/wow/
7 Parkes P. Rescuing the inner child.
London: Souvenir Press; 1994.
8 www.changingtales.co.uk
9 Sunderland M. Using story telling as a
therapeutic tool with children. Bicester:
Speechmark; 2000.
10 Berman L. Beyond the smile:
therapeutic use of the photograph.
London: Routledge; 1993.
CCYP June 2011 15
groupwork
TA meets teenagers
Freda Anning presented a workshop at the November 2010 CCYP conference in Solihull, talking
about how she introduces Transactional Analysis with great success to groups of teenagers in a
comprehensive school
he project I am going to describe developed
in response to an identified need that emerged
from within the large comprehensive school
where I was employed as a learning support teacher.
There were 1,600 pupils aged 11 to 16 from a full
range of cultural, social and economic backgrounds
and I became conscious of the number of students
who had difficulties in their relationships with
others and how this impacted on their self-esteem
and their educational progress. Some students had
told me that they were unhappy because they felt
victimised by another student. In addition, some
parents used to contact the school because their
son or daughter was being bullied, and they
rightly wanted us to act on this. The school did
have an anti-bullying policy and as a school we
adhered to this as closely as possible. But my view
is that, in conjunction with this, students need
to develop their own strategies for self-defence.
I believe each child has the right to an education
in order to fulfil his potential.
My philosophical assumptions are those of TA1,
namely that:
People are OK.
Everyone has the capacity to think.
People decide their own destiny, and these
decisions can be changed.
T
I find Transactional Analysis to be a very practical
approach, using everyday language to explain
complicated happenings, as Eric Berne says in
A Layman’s Guide to Psychiatry and Psychoanalysis2.
So, using concepts of Transactional Analysis, I planned
my course.
Confidentiality
Firstly, it was essential that I established ground
rules within the group. I had concerns about
confidentiality and how much each student would
be able to respect the confidences of another. We
established an initial rule that each student might
talk outside the group about their own experience
and their own feelings but that they must not
repeat anything they heard from another student
or talk about them. Each student was invited to
make their own contribution, and a list of rules
was drawn up and displayed. We also included the
clause that some rules could be changed at a later
date as and when appropriate.
16 CCYP June 2011
Ethical issues
I was aware of how important and how delicate this
piece of work was to be. There was the potential
for personal disclosures to emerge, and in such a
case I would refer them to the appropriate body,
our designated teacher for child protection or the
school counsellor.
Course content
The ego states: parent, adult and child3
During this session, I wanted the students to begin
to develop an awareness of themselves and the
fact that they do feel, think and act differently at
different times. I intended that they would come
to identify their own ego states. I introduced this
concept by means of PowerPoint presentation,
allowing for discussion with the introduction of
each one. They very easily and quickly gave me
incidents where they found themselves in each
state. For example, James said: ‘I was in my Parent
this morning when I packed my bag for school.
I just did it, no one told me to.’ Angela identified
being in her Child when she lost her temper with
her little sister.
They enjoyed moving, in their minds, from one ego
state to another and experiencing corresponding
behaviours. They found the theory stimulating and
thought provoking.
Transactions1
The aim of this session was to teach the students
that we have a choice in how we respond to others,
that we do not have to respond in the way that the
other person expects or demands.
Again, using PowerPoint, I presented the concept.
The presentation for this session included slides
that I had customised, thus allowing me to
demonstrate how the stimulus of a transaction
travels from one person to another and how the
response travels back. It is effective in demonstrating
parallel and crossed transactions, as the vectors
are visually represented. One example I gave was
as follows:
If Ann were to say to her friend, ‘Don’t go in
that room,’ she is speaking from Controlling Parent
(CP) to the Adapted Child (AC) of her friend Jenny.
If Jenny answered, ‘Oh, I won’t then,’ we have
parallel transaction. All is well (at least for Ann),
as Jenny is doing what she was told.
groupwork
CP NP
CP NP
A
A
FC AC
FC AC
But if Ann were to say to Jenny, ‘Don’t go in
that room,’ and Jenny answered, ‘I think you’ll
understand I prefer to see for myself,’ then we
have a crossed transaction. Jenny is coming from
her Adult, having taken in the information and
needing to make her own assessment.
CP NP
CP NP
A
A
FC AC
FC AC
FREDA ANNING
Ann tried to ‘hook’ Jenny into Adapted Child –
just as a bully does with a victim.
For the transaction exercises, I placed hoops on
the floor, arranging them in threes in the Parent,
Adult and Child order. I labelled them and then put
corresponding hoops opposite to them. I then gave
the student a ball of string that he rolled over to the
selected ego state of ‘the other person’. The student
in the corresponding set then had the choice of
responding from this ego state or they could decide
to move to a different one and respond from there,
rolling the ball of string back to represent the
vectors of the parallel or crossed transaction.
The students did find this very difficult to do
and needed a great deal of intervention on my
part. But they learnt how they could be ‘hooked’
into responding from one ego state and how they
could in fact choose to reply from another.
Carol was particularly taken with this idea. ‘Miss,’
she said, ‘I didn’t say what she wanted me to say.
I moved into my Adult hoop and said, “I don’t want
to go tonight.”’
‘Show me what you did,’ I replied. And as she
showed me, I said, ‘Did you notice anything about
yourself?’
‘I did,’ piped in Hannah. ‘She looked different.’
‘In what way?’ I asked.
‘Well, look! She’s standing up straighter. Her
shoulders were all sort of...’ (She demonstrated.)
‘Hunched up, like this?’ I asked with a similarly
hunched-up stance.
‘What does that feel like?’ I asked Carol.
‘I feel more sort of confident. I feel I can talk
better.’
I was curious. ‘What does that mean, talk better?’
‘Well, you know, like, clearer.’
‘Assertive, do you mean?’
‘Yes, assertive,’ she said, in an assertive manner.
Racket behaviour4
The aim of this session was to help students to
understand their own feelings and to begin to
identify their authentic feelings, which can be
covered up.
We had a discussion about times when others
had been able to take advantage of them. Joel
was able to talk of something that had happened
to him. He told the group of the incident where
a boy approached him and demanded that he give
him some money. Joel easily acquiesced to the
other student by saying to himself, ‘I don’t mind
not having any money to buy my lunch,’ and
therefore felt no anger as a result. He wanted to
give others the impression that he was very easy
going and unaffected by such trivia, but in fact
he was collecting a stamp of some archaic feeling,
maybe inadequacy, and so resorted to racket
behaviour, kept quiet, saying to himself, ‘Well, I can’t
do anything, anyway.’
This demonstrates how racket behaviour is a
discounting of our true feelings, how we adopt a
series of behaviour in order to avoid experiencing
the pain of the authentic feeling that has been
aroused. We are therefore disguising ourselves
from others and from ourselves and ultimately
can lose the sense of our own identity and forget
who we really are. I wanted to bring this into the
awareness of my students and encourage them
to begin to identify authentic feelings in order to
bring resolution to a problem.
In my presentation, I referred to the story of
the ugly duckling. We compared the two images
I showed them (one with his feathers all tattered
and brown, and the other as a beautiful cygnet).
We discussed his self-image and the students
acknowledged that he had formed this as a result
of the jibes and opinions of others.
‘
They enjoyed
moving, in their
minds, from one
ego state to
another and
experiencing
corresponding
behaviours. They
found the theory
stimulating and
thought provoking
CCYP June 2011 17
groupwork
‘
I explained that
since this was a
‘game’, they did not,
in fact, have to join
in. They could ‘step
out of the triangle’
and behave
differently
They enjoyed the second picture I showed them
of the ‘lovely duckling’ and accepted that this was
more like a real duckling (with a little poetic
licence). I explained that we react in the same way
when we take on board the negative comments
of others. Instead of becoming angry and
subsequently assertive, we cover up our feelings
and take on a false image of ourselves. I used the
analogy of putting on one coat after another to
cover up our feelings, resulting in a false image
being presented to the world.
Strokes5
The aim of this session was that students would
learn the importance and impact of positive
strokes, that is, positive comments.
The session was the favourite of the majority of
my students. They were hesitant at first to give and
receive strokes but it was quite remarkable how they
began to carry out the exercise and really enjoyed
being affirmed for who they are. This was an ideal
opportunity for me to highlight the importance of
positive strokes and accepting positive strokes. It
surprised me how everyone’s back straightened as
the activity progressed. I concluded the session by
giving each person a small but very shiny notebook
and asked them to fill in at least one positive thing
about themselves each day.
I had not been sure how the students would
receive Steiner’s story The Warm Fuzzy Tale6. I feared
they would think I was patronising them. However,
buoyed on by the success of the previous session,
I decided to use it and they loved it.
The Drama Triangle7
In this session, I introduced the students to the
concept of The Drama Triangle and helped them
identify where they sometimes find themselves
in this drama. I used a clip from the film of Harry
Potter and the Chamber of Secrets8. I use this
technique to demonstrate how a hero can also be
a victim. This helps reduce the feeling of shame
that many victims experience. For example:
Harry Potter is left standing with a look of horror
on his face. (Victim)
‘Bet you loved that, didn’t you, Potter?’ drawled
Malfoy. ‘Famous Harry Potter can’t even go into a
bookshop without making the front page.’
(Persecutor)
‘Leave him alone, he didn’t want all that,’ snapped
Ginny. (Rescuer)
‘Potter, you’ve got yourself a girlfriend,’ mocked
Malfoy (Persecutor)
They loved watching the clip and I particularly
noticed the silence as the episode finished.
‘Harry was a victim,’ whispered Steve. Various
students nodded in agreement.
I gave them a small scenario to act out in role
18 CCYP June 2011
and I explained that since this was a ‘game’, they
did not, in fact, have to join in the ‘game’. They
could ‘step out of the triangle’ and behave
differently.
The Winner’s Triangle9
This session illustrated the alternative modes of
behaviour that can be learnt.
The Persecutor can learn to ask for what they
need.
The Rescuer can learn to ask if a person needs
help.
The Victim can become assertive.
Feedback from the group
My students reported feeling vulnerable in a
group and were very reserved at first. However,
after some time, the fact that they were in a
group is what provided them with comfort and
more confidence. The group’s sharing acted as
a way of normalising their experiences and they
benefited from telling and hearing each other’s
stories. They told me of their reassurance in
knowing that there were others in school that
had experiences similar to their own. They enjoyed
the discussion, the sharing of ideas and group
activities of these sessions. They enjoyed the
companionship of each other outside of the group
as they went around school. I have repeated this
project many times now and each time the
response is the same. And, what’s more, I enjoyed
it too. Freda Anning is a Certified Transactional Analyst in
Education.
References
1 Stewart I, Joines V. TA today: a new introduction to
transactional analysis. Melton Mowbray: Lifespace
Publishing; 1991.
2 Berne E. A layman’s guide to psychiatry and
psychoanalysis. Harmondsworth: Penguin; 1971.
3 Berne E. Games people play. Harmondsworth: Penguin;
1964.
4 Erskine RG, Zalcman MJ. The racket system: a model
for racket analysis. Transactional Analysis Journal. 1979;
9(1):51-59.
5 Steiner. Scripts people live: transactional analysis of
life scripts. New York: Grove Press; 1990.
6 Steiner C. The warm fuzzy tale.
www.claudesteiner.com/fuzzy.htm
7 Karpman SB. Fairy tales and script drama analysis.
Transactional Analysis Journal. 1968; 7:26. See
www.itaa-net.org/tajnet/articles/karpman01.html
8 Harry Potter and the chamber of secrets. Warner
Brothers; 2002.
9 Choy AC. The winner’s triangle. Transactional Analysis
Journal. 1990; 20(1).
PhD research project
Destination PhD
As Val Taylor continues documenting her research project concerning supervision
of school-based counsellors, we hope that her ongoing account will inspire us to
undertake a similar journey
I
Good developments
I realise that, far from ‘done’, my literature search
will be a work in progress, definitely something
to be regularly revisited and dusted down. For
example, I frequently come across new pieces of
research or hear about projects in different countries
that lead me to new reading and new information.
I’ve also heard some inspiring speakers at the
various conferences and seminars I’ve attended so
far, including at the BACP research conference in
May, where school-based counselling was one of
the strands.
A little gem of information I also came across
was a CPJ (now called Therapy Today) article from
2004. Some years ago, I started a file of journal
articles that interested me. I’ve added to this file
over the years and it now runs to several volumes.
Whether through fate, foresight or plain good luck,
The next step
for me is to plan
the collection
of my own data.
But it’s not simply
a matter of
dashing out into
the field, clutching
my questionnaire
I rediscovered this article by Mary Wright1, which
was about supervising school counsellors and
considering whether this should be a case for
specialisation. I was interested to read about her
‘mini survey’ where she was exploring the added
value of having a supervisor who had hands-on
school experience and linking it with Hawkins and
Shohet’s seven-eyed supervisor model2 to see which
‘eye’ gained most added value. Her conclusions
were that, despite her data set being too small to
be statistically significant, it seemed that – all
other aspects being equal – specialist supervision is
more effective for those working in a school-based
context. Unfortunately, there is no email contact
and I realise the article was written many years
ago, but if Mary Wright happens to be reading this,
I would love to get in touch and discuss her work!
Energised by the knowledge that at least one
other person in the United Kingdom is possibly
interested in my area of research and may also
think along the same lines, I need to launch into
year two and decide on my research question.
The research question
The next step for me is to plan the collection of
my own data. However, it’s not simply a matter
of dashing out into the field, clutching my
questionnaire and collecting my data. This step
needs to be carefully thought through. When you
write a research proposal, you are expected to
frame research questions. These questions provide
a structure for your research by breaking down
your ideas into manageable chunks that can be
worked with and help direct your research. By
turning your topics, themes or objectives into
questions, you can make them researchable. The
greater clarity your research questions have, the
easier it will be to decide on your research design,
your methods and how to reach your conclusions.
Referring back to my original research questions
on supervision of school-based counselling services,
I realise that I will now have to refine and improve
them so that they act as a better guide for the
research methods I may use. The original research
questions I framed are too vague and poorly
structured. I was warned that I would need to refine
them and I’m guessing that this is a constant
process during the early stages of research work.
Many textbooks have written about research
design and there is not enough space or time to go
ELEANOR PATRICK
have just re-registered for the second year of my
PhD and I can’t believe how quickly the time has
gone. Five years seemed to stretch endlessly ahead
when I first registered – that was the time I spent
doing GCEs and it dragged! Now, I appreciate the
comment my research supervisor made when she
warned me that the time would go quickly and
I would need to make good use of it.
The positive thing about re-registering each
year is that you have to write a review of the past
year, summarising the progress you made. Having
convinced myself I’d done very little, as I didn’t
have a tremendous amount on paper to show for
it, I realise that I have actually done quite a bit of
work and I certainly have a better understanding
of what I want to do and how I need to go about
it. This realisation has served to allay some of my
anxieties, and I’m now considering what the next
step should be.
CCYP June 2011 19
PhD research project
‘
You need to spend
quite a bit of time
working on research
questions and
refining them
into too much detail here. However, development
of good research questions is very important and
can save you a lot of time further down the line, so
I thought it might be helpful to give you an idea of
how your ideas might be translated into a set of
research questions.
To do this, I have used a method suggested by
White3. He has refined a method outlined by Booth
et al4 on how an idea can be broken down into
researchable questions. If you have a research idea
in mind, this may be worth trying out for yourself.
I will use Mary Wright’s topic of exploring the added
value of using supervisors with school experience to
help illustrate how the process might work.
1. Name your topic
‘I am trying to learn about…’ For example: ‘I am
trying to learn about how experience of working
with children and young people may add value to
the supervision process.’
2. Make your topic more specific
Here, White suggests that you use one of what he
calls ‘Six-W’ words: ‘…because I want to find out
who/what/when/where/whether/why/how...’ For
example: ‘...because I want to find out whether
models of supervision such as the Hawkins and
Shohet model will have value added to them if
the supervisor has experience of working with
young people.’
3. Motivate your question
This is really the justification for your research.
It explains why you are interested in this
particular topic: ‘...in order to understand...’
For example: ‘…in order to understand how the
supervisor’s experience of working in specific
contexts impacts on supervision outcomes.’
I am not holding this up as a good example of
formulation of research questions. You need to spend
quite a bit of time working on them and refining
them. It is also helpful to share your research
questions with a colleague. If they understand
clearly what you are trying to do, that is a litmus
test of how good your research questions are. If
they look puzzled, you may have to think again!
The example I suggested above is ragged, but I
hope it illustrates how you can break down your
topic of interest. You can then break each question
into sub-questions. For example, if we take the
answer to question 2 – ‘because I want to find out
whether models of supervision such as the Hawkins
and Shohet model will have value added to them
if the supervisor has experience of working with
young people’ – sub-questions will then be
generated:
2a. How can the Hawkins and Shohet model of
supervision be applied in a school-based context?
20 CCYP June 2011
2b. Are there any particular aspects of the model
which will be enhanced by supervisor knowledge
of the school context?
2c. How can I measure the impact of supervision?
You can then see how framing these questions can
help inform your research design. You may want to
carry out a survey of supervisors of school counsellors
to find out their preferred model of supervision, in
which case you can carry out a search to see if one
has already been designed or whether you have to
construct your own. For 2c you will have to be
thinking about how you can measure supervision
outcomes using something like the Supervisory Styles
Inventory5. You would then need to consider how
you are going to organise your data collection.
As you go through this process your research idea
will begin to take shape and you will begin to
formulate a plan in your mind as to how you need to
go about researching your topic. The next step will be
moving from your research questions into research
design. A few years ago, an extract in CCYP from a
book by Greig et al6 offered a thorough explanation
of how research questions and design are interlinked,
explaining how research questions can be developed
and subsequently used to inform research design
when planning research with children.
I think I am just about at this stage, but I do
have a meeting soon with my research supervisor,
so I will suspend judgement until then. Which
brings me to my closing comment that throughout
all of this you do have a supervisor for your research
and they will guide you and give you advice. As
with all supervision, however, it only works if we
engage in the process and work well with our
supervisors. I am warned! Val Taylor works in the Dyfed Powys area of West Wales
as counselling coordinator for Helping Groups to Grow
and also as a practitioner specialising in counselling
children and young people.
References
1 Hawkins P, Shohet R. Supervision in the helping
professions: an individual, group and organizational
approach. Revised ed. Oxford: OUP; 2000.
2 Wright M. Supervising school counsellors: a case for
specialisation? Counselling and Psychotherapy Journal.
2004; 15(1):40-41.
3 White P. Developing research questions: a guide for
social scientists. Basingstoke: Palgrave Macmillan; 2009.
4 Booth WC, Colomb GG, Williams JM. The craft of research.
2nd ed. Chicago: University of Chicago Press; 2003.
5 Friedlander ML, Ward LG. Development and validation
of the Supervisory Styles Inventory. Journal of
Counselling Psychology. 1984; 31:541-557.
6 Grieg A, Taylor J, MacKay T. A question of design.
Counselling Children and Young People. December 2007.
existential therapy
Firmly rooted
What does existential child therapy look like? Chris Scalzo, author of the recent Therapy with
Children: an existential perspective, introduces us to the main ideas and offers some examples
xistential psychotherapy draws its frame of
reference from a philosophical tradition rather
than medical or diagnostic principles. Unlike
other more prescriptive approaches, existential
therapy acknowledges that within life, all of us –
whether adults, adolescents or children – may face
times when our particular struggles can feel
overwhelming. Existential-phenomenology takes
the human condition as the focus of investigation
and therapy focuses on the uniqueness of each
individual’s particular experience.
Commonly, attention is paid to the child’s need to
develop and establish a firmly rooted sense of
existence, to be true to themselves and to ultimately
advance an authentic identity of their own. Problems
of uprootedness and alienation – issues that appear
widespread amongst children and adolescents in
Britain today – are of particular interest to
existential psychotherapists. There is also a need to
accept anxiety, guilt and contradiction as essential
components of human existence, to be explored in
therapy, and not treated as pathological symptoms.
E
Awareness and relationship
Through the therapeutic relationship, existential
practice creates an opportunity for children to
develop new awareness of the challenges they feel
confronted with, and therefore uncover new choices
and paths in overcoming life’s emotional difficulties.
By building self-knowledge and self-awareness,
children are able to grow and conquer issues that
may at times feel all-consuming and insurmountable.
Suffering with severe anxiety or panic attacks, for
example, can be addressed through an understanding
that anxiety is not similar to a virus, which can be
caught (in the same manner as a cold or flu), but is
the outcome of choices they have made in the past,
and can make in the future, in life and the context
they find themselves in.
Choice and relationship
By exploring the child’s context or ‘worldview’ in
therapy, it becomes possible to understand these
choices and create new opportunities for them
to develop and see a way out of their personal
suffering/situation. In exploring relationships, we
are also exploring the way by which everything we
do is dependent on the context of our lives, whether
as adults or children. We are all subject to the
existential givens of being human, most importantly
that we did not choose to be born, but are ‘thrown’
into the world, that we are always part of the world,
unable to remove ourselves from its limits, and that
within these limits we face choices for which we are
responsible. As counsellors or therapists working
with children, it is important to remember that we
are always in the room, too, and always an integral
part of the therapeutic relationship: viewed
existentially, the child cannot be understood alone,
as a unique entity, but is always in relation to the
world, ‘being-in-the-world’.
Responsibility
Many children find themselves seeing a counsellor
or psychotherapist at a point at which they or the
people around them feel stuck, constrained or
paralysed by the world they inhabit. Children, like
adults, can feel trapped by their circumstances,
imprisoned within a restricted world. Existential
therapy aims to draw out, through dialogue and
relationship, an awareness and understanding that
it is the child who enables the prison walls around
them to remain, and it is the child, therefore, who
is able to break them down or remove them. Like
many other therapeutic approaches, existential
psychotherapy is essentially an inter-subjective
process of empowerment through relating to
another being. This does not mean of course that
children are able to choose all aspects of their
lives; where they live, who cares for them, whether
indeed they are neglected or even abused. In fact,
quite the opposite is true, as existential therapy
starts by acknowledging that there are always
limitations to the choices adults or young people
are able to make, but it is in the unique and
individual manner by which each experience is felt,
understood and reacted to, that true choices lie.
As Spinelli suggests, it is ‘the interpretation I might
make of the event, ultimately the way I experience
the stimulus, [that] is a matter of choice’1.
For example, Jack (not his name) was a 13-yearold boy I saw for some sessions after he began
attending a special needs school for children with
moderate learning difficulties. He struggled to fit in
and frequently withdrew from socially interacting
with his peers, to the point of becoming violent and
aggressive towards them on a regular basis. He often
mocked or mimicked those children at school less
capable than himself, with more profound disabilities.
Jack longed to be back in mainstream school, but
had struggled there too, both academically and
socially, leading to his eventual exclusion. When our
sessions began, Jack strongly believed that it was
the school that defined him and gave him the label
‘
Existentialphenomenology
takes the human
condition as
the focus of
investigation and
therapy focuses on
the uniqueness of
each individual’s
particular
experience
CCYP June 2011 21
‘
existential therapy
The process of
existential therapy
with children is
essentially a
journey of
awareness, choice
and ultimately
responsibility
of being disabled or having ‘special needs’. Our
sessions regularly focused on the relationships Jack
had with his family, friends, the outside world,
and, not least, the relationship he had with me.
I frequently invited Jack to reflect on how he
imagined I perceived him, what he based his
presuppositions on and how he actually experienced
sitting in the room, drawing, talking and playing
games. Through this explicit discussion of our
relationship he was able to realise that the identity
he had constructed for himself did not need to be
fixed simply by the school he attended and what
this might or might not have stood for. In effect,
he was not able to choose to attend a new school,
but was able to experience his school in a new way.
A brief history
Existential psychotherapy grew predominantly
out of the influence of European philosophy, in
particular the writings of Martin Heidegger and
Jean-Paul Sartre. Their philosophical ideas and the
rich traditions they drew upon were adopted and
championed initially by the psychiatrists Boss,
Binswanger and, later, RD Laing. The challenges
they made to the contemporary and established
psychiatric practices acted as a catalyst for the
evolution of new theoretical approaches. Today,
existential influences on the theory of psychology,
counselling and psychotherapy can mainly be found
in three separate schools: those practitioners more
influenced by existential-humanistic ideas, based
predominantly in America; the Dasein analyst
movement, based largely in Europe; and a new
modern British school, whose main protagonists
include Professors Spinelli and Van Deurzen.
The application of an existential approach to
working directly with children is still new, however,
although increasingly practitioners trained in these
concepts are becoming more widespread, and I
have tried to raise awareness of their significance
through the publication of my recent book Therapy
with Children: An Existential Perspective2.
Relevance to counselling children
The challenging circumstances in which children
frequently find themselves appear to regularly
contain themes and struggles directly applicable to
existential practice. The loss of identity and sense
of aloneness felt by many adolescents may lead to
a displacement in the world. We can see an
increasing prevalence of self-harming behaviour as
a sometimes desperate and dangerous last resort
for young people to communicate to their families,
or regain some control over, their emotional
experiences and their life, through the heightened
stimulation of pain and a sense of ‘release’.
The frequent over-pathologising of young people
implicitly conveys a message, via medication,
diagnoses and labels, that they are unable to control
or manage their own emotions and behaviours; and
22 CCYP June 2011
in fact it is their ADHD, learning difficulty,
oppositional defiant disorder, conduct disorder and
so on that become the most widely used way to
define their identity. At first glance, the diagnosis or
categorisation of behaviour superficially appears to
be the most humane starting point to many
treatments, but from an existential perspective it
may actually deny the child an awareness that they
are able to take control of their reactions – and in
some way their emotional reactions – to everyday
experiences. Even children with learning difficulties
on the autistic spectrum face choices, within the
parameters of their understanding, about how they
choose to react and engage with the world around
them. They may feel a tremendous sense of anxiety
when faced with a new order to their daily routine,
or when confronted with overwhelming stimulation,
but there is still an element of choice in the manner
in which they respond.
How James learnt to relate and make
choices
James (not his name) was a seven-year-old boy
I worked with who had been terribly neglected and
abused throughout his formative years and also had
been diagnosed with an autistic spectrum disorder
(ASD). James had limited verbal communication
and spoke only with short commands and nods.
He appeared to exhibit little or no empathy for his
PETER BEAVIS/GETTY (POSED BY MODEL
–
FOR ILLUSTRATION PURPOSES ONLY)
existential therapy
peers or teachers, and even less towards me in the
sessions. When excited, or even just slightly nervous,
James would harm himself by biting his own hand
around the base of the thumb. When first assessed
by social services, the scarring on his hand was so
bad from his biting that it was thought to have been
caused by cigarettes burns. In sessions he spent time
colouring red over the eyes of the dolls in the room,
describing it as blood. On occasions, he would
pretend to have cut his own finger and then proceed
to cover it in red paint or pen. After about eight
weeks, he chose to pretend to be cutting my finger,
and this, also, soon became part of his routine. When
I explained that it would hurt if my finger was really
cut, James would become animated and laugh
excitedly at my potential discomfort. As sessions
progressed, I began to use small steps to help James
become more aware of our relationship. I used ball
games and other simple strategies to encourage turn
taking, reflecting on the experiences we both shared.
After some time, James progressed to cleaning the
red ‘blood’ away from the eyes of the toy figures
at the end of each session. Towards the end of our
work together, he asked if I could bring a plaster
to one session and then later a bandage, which he
used to repair his own bleeding wounds and then
mine. Developing this relatedness with James took
time. Following years of neglect and abandonment,
his previous world had been a frightening and
solitary place. The importance of this work on
building a relationship was significant existentially
in different ways: slowly James had been able to see
me as another relating human being and perhaps
most significantly to see me as someone else existing
in the world and with the same types of experiences
as himself. What James had acquired through our
relationship was a greater sense of his own existence,
and therefore the choices and responsibilities which
lay in front of him in the world. Our own sense of
identity cannot be developed in isolation, but grows
as we journey into adulthood through relating to
others. By the end of our work together, James had
begun to show small signs of empathy with his peers,
sometimes playing alongside them and sharing toys.
He still required the self-soothing and arousing
stimulation felt from biting his thumb, but had by
then begun to suck his thumb instead of biting it.
The process of existential therapy with children
is essentially a journey of awareness, choice and
ultimately responsibility. The only ‘tools’ the therapist
has are the opportunity of risking a new relationship,
an ability to reflect on their assumptions and to
attend to their own experiences in the room. In
many ways, the often limited language development
and vocabulary of a child means their play is even
more revealing and explicitly communicative without
the opportunity to wear their words as a mask. As
adults, the demands of everyday life seem to take
us away from ourselves and the masks we construct
may become so numerous and well worn that we
can, in the end, forget who is underneath. Chris Scalzo is an existential psychotherapist and
supervisor, working for the NHS and a local authority
as manager of a community CAMHS team. He is
author of Therapy with Children: An Existential
Perspective (Karnac, 2010).
References
1 Spinelli E. The interpreted world: an introduction
to phenomenological analysis. London: Sage; 1989.
2 Scalzo C. Therapy with children: an existential
perspective. London: Karnac; 2010.
Book offer from Karnac
Readers may buy Therapy with Children: An Existential Perspective, by
Chris Scalzo, at the specially reduced price of £17.10 with free p&p to
any UK or EU destination.
This offer is valid for all mail orders, website orders, or for CCYP journal
readers visiting the Karnac shop in London. Postal requests should be sent
with payment to Karnac Books, 118 Finchley Road London NW3 5HT
(telephone 020 7431 1075). This is also the shop address.
Customers must quote ‘CCYP offer’ when placing their order. For online
orders, please enter this message in the comments box at the checkout.
Full details of the book are available at www.karnacbooks.com/
Product.asp?PID=27817 and this offer ends 15 September 2011.
CCYP June 2011 23
unseen worlds
When other
worlds are real
STEVIE TAYLOR/GETTY
Little people? Guardian angels? Spirits of the
deceased? Children experience other worlds
as real – it’s not just their imagination working
overtime, as Kate Adams explains
24 CCYP June 2011
unseen worlds
hen I was a child, the physical world
seemed different from how adults
perceived it. Everything certainly seemed
much bigger, and as I visited my nan’s home for
an annual summer holiday, for some time I could
not quite make sense of how her house seemed to
have shrunk slightly each year. Yet that magical
shifting in size did not seem too puzzling because
the world was open to so many possibilities. Fairies
lived in amongst the plants, I went to strange places
in my dreams, the ghost of my grandfather sat in
his armchair, I saw UFOs from distant planets
approaching the earth in the dark night sky, and
I could make myself invisible. My classmate had a
friend whom no one else could see. Other children
created spells, saw Father Christmas’ sleigh flying
towards their chimney, heard their pets talking to
them, or felt the comfort of an angel at their
bedside each night.
Yet for children, these other worlds were not simply
figments of imagination conjured up in fantasy play,
as the adults around us thought. They were real.
Indeed, such worlds have been real to children
throughout history and will no doubt remain so.
They blend and merge with the daily round of
going to school, doing homework and dealing
with life’s challenges. And they are, perhaps, more
significant for children than many adults realise.
W
Just imagination?
Usually, children simply accept the reality of these
worlds until someone else, whether adult or peer,
points out otherwise. After all, it is natural to
assume that everyone else experiences the world
as we do until we learn that this is not always the
case. Why would a child not assume that everyone
else could see fairies or ghosts if they could?
‘It’s just your imagination’ is a much-used phrase,
rarely meant in a derogatory way, but nonetheless
unintentionally damaging. Seven-year-old Jon
became angry and frustrated when his father
refused to accept that he could hear footsteps
outside his bedroom in the night. Jon was not
frightened by the sound, which he said quite
pragmatically was his deceased grandmother
coming to check that he was all right. Jon’s father
did not believe in ‘ghosts’ and told Jon that he had
an over-active imagination. Deep down, he thought
that Jon was simply making excuses for not wanting
to go to sleep. But for Jon, the thought of his father
not taking him seriously was quite upsetting.
Designating an experience as ‘just imagination’
is a simple and understandable response to explain
away an experience that adults cannot account for.
Likewise, it can be a well-intended phrase used to
reassure a child who is unsettled by an encounter.
However, its use can affect a child more than adults
might intend. Seamus, aged nine, was convinced
that little elf-like people lived in a nearby playing
field, but on mentioning it to his aunt, he soon
learnt that it was best not to. He explained: ‘Aunty
said they are just in fairy tales and I shouldn’t make
up stories,’ but he remained resolute in his belief. On
the other hand, eight-year-old Aashani, who often
saw tiny dancing lights in her bedroom, knew that if
she told her friends, she would be considered ‘crazy’,
so she chose to keep the magical world to herself.
At worst, phrases such as ‘it is just your
imagination’ can send messages to children that
their experiences are invalid, and the long-term
impact of such messages can be significant. Matt,
an American teacher in his 40s, recalled what he
termed a ‘profound’ moment that occurred when
he was nine years old, when he quite literally saw
another world. Looking at the evening sky, close to
sunset, he saw ‘a whole city in the clouds’. Far from
being a simple case of seeing pictures in the clouds,
this was an intricate image that looked like a
drawing. Rushing into the house to call his parents
outside to share the moment with him, they
commented: ‘That’s nice, what did it look like?’
but did not come outside. Matt was upset at their
apparent lack of interest and remained eager to
share his experience at school the next day. But his
teacher dismissed it as fantasy and his classmates
laughed. Matt commented: ‘And that was the
most stupid thing I ever did: I told other people.’
From that day, Matt no longer shared any sensitive
and meaningful experiences with others1.
‘Imagination’ may well be the explanation for
the other worlds that children inhabit, but this
very notion can detract from the value that these
beliefs have for children. The ideas form part of
the way in which children come to understand
and make sense of the world.
‘
By the age of
seven or eight,
most children have
become aware of
what their culture
deems appropriate
or inappropriate to
discuss, and these
unseen worlds often
fall into this
category
The darker worlds
Whilst nostalgia may tempt adults towards focusing
on the magical, ethereal aspects of children’s worlds,
darker worlds also exist. Counsellors are best placed
to manage such discussions, but parents/carers are
often unsure how to move forward, and can become
distressed if their children are unnerved by
encounters. Common examples of the more
frightening worlds include nightmares, fears of
monsters hiding in the wardrobe and of ghosts who
haunt the earth. The fact that parents/carers cannot
see the monster or ghost, or do not know how to
support the child through their nightmares, can
mean that it is easier to simply hope that their child
‘grows out of it’ particularly if their child is not in
regular contact with a counsellor or therapist.
At other times, the fear belongs to the adult and
not to the child. Marianne, a social worker in her
50s, vividly remembers her two companions from
childhood being termed ‘imaginary friends’ by
others. They were a girl and a boy named Marjorie
and Kicker, who accompanied Marianne wherever
she went. On the way home from school, the
invisible children would play around and Marianne
CCYP June 2011 25
unseen worlds
‘
Phrases such as
‘it is just your
imagination’ can
send messages to
children that their
experiences are
invalid, and the
long-term impact of
such messages can
be significant
26 CCYP June 2011
would refuse to cross the road without them, to
the immense frustration of her mother. Often, her
mother would ‘play along’ and talk to Marjorie and
Kicker, giving Marianne no reason to assume that
she was the only person who could see them. Yet
later, Marianne found herself at the family doctor’s
surgery with her mother telling the doctor she
feared that Marianne was suffering from mental
illness because she could ‘see’ people who were not
there. In this case, the ‘darkness’ was her mother’s.
The doctor commented that Marianne simply had
‘a vivid imagination’ and reassured her ‘that it was
quite normal to have imaginary friends’1. Indeed,
contemporary psychologists have confirmed that
imaginary friends are a normal and healthy part of
child development2, although Hallowell3 argues
that the word ‘imaginary’ should not be used in
this context. As he observes, to the child these
invisible people are as real as you or me.
Through a child’s eyes
Seeing these worlds through children’s eyes is a
relatively easy task when children are young. Their
natural engagement in fantasy and symbolic play is
evident for all to see, and adults and older children
actively encourage it, playing along by making
pretend cups of tea and taking on the persona of
television characters. Principe and Smith4 note that
many adults endorse children’s belief in their
fantasies by carrying out ‘rituals’ such as making a
wish when blowing out candles on a birthday cake,
or crossing fingers for good luck. Further, many
parents/carers actively create apparent ‘evidence’
to support the belief in selected fantasy beings,
such as leaving food out for Father Christmas’s
reindeer or providing carrots for the Easter Bunny.
Every culture has its own tradition of such myths
that bring great joy to children and adults alike. But
as children grow older and are told that characters
such as Father Christmas, the Easter Bunny and the
Tooth Fairy are creations invented to bring
happiness to ‘younger children’, they can be left
with unresolved issues. A new, logical and rational
worldview appears. What many call ‘imaginary
friends’ are also explained away as a made-up game,
whilst ‘ghosts’ can be tricks of the light. On the one
hand, they are being told that magic is the stuff of
stories but at the same time, they may continue to
see and hear what others cannot. Finding an
empathic adult can become increasingly difficult.
By the age of seven or eight, most children
have become aware of what their culture deems
appropriate or inappropriate to discuss, and these
unseen worlds often fall into this category. As
10-year-old Mary said, she had not told anyone
of her special dream before because it was simply
‘uncool’ to talk about dreams in her peer group.
Other children report to researchers that they have
not told anyone of their spiritual experiences for
fear of ridicule or dismissal. And so a cycle emerges.
Children often feel that they will be ignored or
dismissed for sharing encounters or beliefs that
others might deem ‘simply imagination’, so they
express them less often. As the encounters move
further into silence, they become less visible to
adults, who in turn become less aware of them and
children raise the issue less frequently.
Watching for the unseen
Professionals who work with children are ideally
placed to give children the voice they sometimes
seek. Sometimes children simply want to share
their experiences, and at other times they want to
explore possible explanations for them – there are
occasions when these worlds are very real to
children and immensely meaningful. They are part
of the very fabric of children’s reality, shaping their
worldview. Indeed, aspects of them, such as belief
in spirits or ghosts, can continue into adulthood.
No one knows if the spirits of a deceased person
can appear, if guardian angels do watch over us, if
the little people of folklore do live in the forest or
if beings from distant planets have visited the
earth. Many of these phenomena remain matters
of personal belief which may never be verified or
otherwise by scientific investigation. They will
certainly remain prevalent in children’s lives.
If children can find adults with an empathic ear,
then their confidence to discuss matters which
others dismiss may be strengthened, and their
sense of open-mindedness, which is so inherent
at a young age, may be allowed to flourish. Dr Kate Adams is reader in education at Bishop
Grosseteste University College Lincoln and is an
experienced primary teacher. She is author of Unseen
Worlds: looking through the lens of childhood (Jessica
Kingsley, 2010). Kate’s research interests include exploring
children’s understanding of aspects of their childhood.
She has a particular interest in children’s spiritual
dreams. [email protected]
References
1 Adams K. Unseen worlds: looking through the lens
of childhood. London: Jessica Kingsley; 2010.
2 Taylor M. Imaginary companions
and the children who create them.
New York: Oxford University Press;
1999.
3 Hallowell M. Invizikids: the
curious enigma of ‘imaginary’
childhood friends. Loughborough:
Heart of Albion Press; 2007.
4 Principe G, Smith E. The tooth,
the whole tooth and nothing
but the tooth: how belief in the
tooth fairy can engender false
memories. Applied Cognitive
Psychology. 2007; 22:625–642.
therapeutic coaching agency
A fusion that works
How can counselling, coaching and psycho-education live together to the benefit of young people?
Frances Masters describes how she co-founded a new charity in Bedfordshire delivering
psychotherapeutic coaching free at the point of delivery
any people find the idea of therapeutic
coaching less threatening than the thought
of seeing a counsellor. Young people, in
particular, are open to the idea of life coaching
and problem solving. At Reclaim Life, we currently
see young people in the 16+ age range but are now
being approached by local schools who are very
interested in the work we are doing and would
like us to adapt our model for use with an even
younger age range.
At a recent coaching workshop for teenagers,
hosted by a children’s bereavement charity, we came
to the conclusion that the model we use at Reclaim
Life, and which I will explain in a moment, does not
need much adaptation for this proposed new work.
In the workshop, we used a colourful version of
the coaching Wheel of Life together with stickers
and felt tip pens, and helped the young people to
scale the various areas of their life, noticing what
was working and what needed attention. We then
encouraged them to identify future dreams and
goals, helping them place current difficulties in
context and highlighting what they could do in
the here and now to begin to take them in the
direction they wanted to go. After focusing on
their dreams for the future, they were noticeably
brighter and more positive, which also showed in
the scaling of their moods pre and post workshop.
One young man, whose older brother had died,
observed that his mood had lifted from two to
seven out of 10. ‘Is it OK to feel happy?’ he asked.
It seemed he needed permission to allow himself
to feel positive again despite his bereavement.
For many young people, the term ‘counsellor’
still seems to carry a stigma and hint that
something is wrong with them, whereas the term
‘coach’ has fortunately managed to remain a
different and more positive image that overcomes
a barrier and allows young people easier access to
beneficial talking therapy.
Young people are also keen to see quick results,
relevant to the moment they’re living in. Youth
agencies all recognise the frustration that stems
from youngsters who do not attend after a few
sessions – they are not so much immersed in a
constant stream of depression or anxiety as
dipping in and out of puddles, their emotions and
moods fluctuating from week to week.
Young people are also often very creative and
imaginative and soak up new information like
a sponge. Knowledge is power, which they love.
M
The things they do not understand can frighten
them, so, at Reclaim Life, we spend time explaining
the neuroscience behind emotions to allow for
deeper understanding and a sense of empowerment.
The case of Foster
Foster came along with anger management issues.
He was in danger of being excluded by his school.
His parents had separated when he was six years old
and he had often witnessed angry outbursts by his
father. He was disruptive in class and couldn’t see
the point of studying. He said he felt confined by
school and just wanted to get out into the world.
Foster was encouraged to understand the future
difficulties which face somebody who is unable
to control their anger: in lost relationships, jobs,
opportunities and potentially worsening health,
as anger is the only emotion known to damage
the human heart. Foster could see that if he
continued to allow anger to control his behaviour,
his choices would be restricted, as it was clear
from working with the Wheel of Life that he
wanted to be a journalist and that this would be
impossible if he were excluded from school now.
He was helped to identify ways of breaking his
old pattern of behaviour, which he now felt
motivated to do, because he had clearly identified
his preferred future. School had been placed in
the context of his life and his dreams and goals
for the future. He understood, saw the point, and
his anger subsided.
As far as I am aware, there is no other service
that offers the kind of therapeutic coaching we are
delivering at Reclaim Life in Leighton Buzzard that
is also free at the point of delivery. Our volunteer
coach-therapists are trained to help people take back
control of their lives using a new and prescriptive
coaching model that combines traditional counselling
skills, psycho-education and goal-focused coaching
techniques. Now that we have been open for a
year, it is apparent that people, including young
people, are really benefiting from their sessions
with us, and the Core 10 clinical outcome results
seem to support this.
‘
Coaching, psychoeducation and
counselling are
a powerful
combination…
allowing coachtherapists to
quickly start
helping clients
regain control
of their life
The juncture of counselling and coaching
Much of what is happening in the field of modern
psychotherapy is reflected in how Reclaim Life
came to be formed – but specifically, the latest
ongoing debate about where counselling stops
and coaching begins.
CCYP June 2011 27
WWW.RECLAIMLIFE.NET
therapeutic coaching agency
Originally trained in a person-centred model of
counselling, I often felt ‘stuck’ with clients who
presented with panic attacks, severe depression,
OCD and many of the other mental health issues
that commonly occur, and so I began to look for
additional tools and skills.
Sometimes somebody says something, or you
see something or hear something, which creates
a paradigm shift, and all the papers in your head
reshuffle as perception moves to allow in new
information. Such a shift occurred for me when
I attended a brief therapy workshop hosted by
Mindfields College and suddenly became aware
of a whole toolbox of proactive skills that I felt
would be helpful to my clients.
Increasingly enthusiastic about this new way
of working, and noticing improving results, I was
approached by a local GP, Kate Smith, who was keen
to refer some of her patients as an alternative to
prescribing antidepressants. She was very interested
by this brief and proactive way of working and
soon, I had a steady stream of clients.
28 CCYP June 2011
I had been coaching in this way for over two
years before I realised it. The transition had been
seamless and organic and came from
necessity. People were often recovering
very quickly, sometimes after only one
or two sessions, but they did not
wish to stop attending until their
confidence had returned in
their mental health. That left
me with a dilemma. With
the original presenting
problem now resolved,
what would we focus
on in our sessions?
I began to use the
coaching Wheel of
Life as a therapeutic
passport to
communication that
allowed for a holistic
overview, identifying
unmet needs. This
exercise is a useful
cognitive challenge to
the often-presented
feeling that ‘everything’s a
mess, nothing’s going right!’,
and is a very visual way to
step back into the observing
self and view things ‘from further
away’, unclouded by raised emotion.
The Wheel (from which, in fact, we
had devised the young person’s version)
divides into areas such as work, money, health,
partner, family, friends, learning and environment
and it is certainly therapeutic for clients to notice
which parts of their life are working well and
which are the areas of challenge.
Our mental filtering system ensures that what we
focus on is what we see (the reticular activating
system) and using the coaching Wheel of Life now
presented an opportunity for clients to focus
away from problems and look to their preferred
future, identifying dreams and goals.
Dr Smith and I began a series of local psychoeducational lectures, drawing people’s attention
to these new and proactive approaches to mental
health, and there was a very positive response.
People appreciated what we were trying to do.
Before long, we began to wonder whether it
would be possible to offer this kind of support
to the general public, free at the point of delivery.
And with a surprising lack of fear and certain
bravado on our part, the wheels were set in motion,
a training programme devised, and we began to
look for our first volunteers.
So what makes the way we work at Reclaim Life
different? The answer has to be in the prescriptive
counselling/coaching model that we use with both
adults and young people, and the brief training
therapeutic coaching agency
programme, which means that all our volunteers
are working in the same way.
These five, three-hour training workshops for
our coaches stress the importance of psychoeducation as part of the therapeutic process. The
first session with a client focuses on ‘the essence
of the problem and the essence of the solution’
rather than a lot of history taking. Brief therapy
and coaching are future-focused, with the accent
on solutions rather than problems.
helping the client identify repeating patterns and
making them aware of choices.’
‘Well, if you want any of that,’ said the trainer
‘Don’t come to coaching!’
And that was when I realised that a counsellor
with coaching skills is very different from a
coach. A conversation with a highly experienced
executive coach confirmed this when he said:
‘I am concerned with the outside, and someone
like you deals with the inside.’ This is how Reclaim
Life is different – we are therapeutic coaches.
The case of Laura
Laura, 18, attended her first session at the office.
She described a series of worries around her parents
and complained of restlessness and poor sleep.
When asked by her coach what she felt was the
essence of her problem, she thought for a while
and replied that she needed to learn to ‘switch off’.
On that first session, Laura was taught a
breathing pattern that would allow her to calm
her overwrought emotional brain, together with a
simple technique to help her sleep more peacefully
at night time. She was also encouraged to walk
outdoors for at least 20 minutes each day to allow
for the beneficial effects of full-spectrum light to
raise her serotonin levels. Laura was offered
information about emotional hijacking and realised
that she needed to learn to ‘worry well’ so that
she could problem-solve more effectively. By her
second session, and using the techniques she had
been shown, she said she felt much calmer, her
mood had lifted and she had noticed better-quality
sleep. Now that she was less agitated, the real
coaching and therapy could begin.
We have now run the training programme twice
and seem to attract volunteers from the helping
professions, such as doctors, social workers and
health visitors, who are interested in acquiring
effective new skills to help people move on with
their lives. They learn about the functions of the
triune brain, emotional hijacking, fight or flight,
the relaxation response and the reticular activating
filter system. We also introduce an understanding
of the human givens, emotional needs and innate
resources, the observing self, working with
metaphor and guided imagery, and therapeutic
storytelling. Proactive coaching techniques are
added to the skill set in the form of scaling, SUDS
(the subjective units of distress scale), SMART
goals, strategies and homework tasks.
A little while before starting the first Reclaim Life
training workshop, I had decided that it was sensible
to attend a commercially run coaching workshop
myself to see what was current in life coach training.
The trainer opened with the question ‘What is
counselling?’ Someone said: ‘Somebody who
listens, empathises and doesn’t judge but who,
through reflecting and reframing, will allow the
client to find their own way forward… someone
who will offer psychological support whilst
What lies ahead for Reclaim Life?
As I indicated, we have been approached by
several local schools who feel that what we offer
is the way forward. There have been recent major
cuts in funding of school counselling, potentially
leaving large numbers of children without talking
therapy support. So ‘Coaching for Kids’ is
definitely on the agenda for 2011.
We have just recruited our second wave of
volunteer coaches, which is good news. Word is
spreading and we now have a steady flow of new
clients. It is also heartening to notice that GPs are
referring, as are social services and other mental
health agencies. We have received a lottery grant
to run as an official pilot project and hope to get
sufficient funding to steadily increase in size.
With continued short training programmes and
mounting volunteer numbers, we hope to open
offices in other areas in the near future.
The last 12 months have been both anxious and
rewarding. We took a risk. There is much discussion
about blurred boundaries between counselling and
coaching. At some point, however, we need to stop
talking and do the experiment. And the success of
Reclaim Life shows that coaching, psycho-education
and counselling are a powerful combination.
When something makes sense, it is easy to teach,
so the training is brief, allowing coach-therapists
to quickly start working with and helping clients
regain control of their life and take responsibility
for their emotional wellbeing. ‘
There is much
discussion about
the blurred
boundaries between
counselling and
coaching. At some
point, we need to
stop talking and
do the experiment
Frances Masters (MBACP Accred
UKRCP GHGI) is an independent
counsellor, trainer and
supervisor. She is clinical
director of Reclaim Life
and is currently writing
Psychotherapeutic
Coaching: The Fusion©
Model. For more
information, email
frances.masters@
btinternet.com or visit
www.oldthatchcoaching
and www.reclaimlife.net
CCYP June 2011 29
opinion
The way of
things to come?
Bridget Sheehan makes the case for a bottom-up
approach in schools, using the relationship strengths
some members of staff already have, and topping
up their therapeutic skills to bring interventions to
the most emotionally battered children
n my working life I have had a variety
of professions – speech therapy, teaching and
now counselling/creative therapy. In each, the
same issue has reared its head: the question of
whether someone unqualified can do part of the
job that you do, and do it as effectively or, dare we
suggest, better. In each profession, the issue results
in a great deal of anger and resentment, a feeling
of being devalued and an overwhelming fear of
finding ourselves no longer of use – an idea that
shakes the core of our being. But in each, there are
the few who pause to consider the merits of this
alternative view and who even dare to whisper an
agreement. Surely, we say, as self-aware inhabitants
of the therapeutic world, we can selflessly lay
ourselves aside for the greater good of the clients
we serve and the world we seek to improve? But
we, too, are only human, of course, and as subject
to the emotional currents of life as any other.
So in this article I would like you to remain aware,
while reading, of the emotions within, and of where
these come from, and attempt to lay them aside in
order to listen objectively to what I have to say.
I have always worked in inner-city schools in
some of the most deprived estates in our country.
As time progressed, my journey took me further
and further into the area of emotional needs, and
into working with the most needy children and
young people. And I have gradually become aware
of the power of the relationship offered by
certain staff who glint like gems. Often with few
qualifications to their name, they have the power
to connect with the most damaged children. And
day after day, they return to the slow progress of
rebuilding the self-worth of an emotionally battered
child. Then I look at the exclusive club I belong to,
where we seem to believe that the power of a piece
of paper and some letters after our name grant us
the exclusive ability to connect with a child and
offer them a therapeutic experience. I no longer
believe this is true.
My training as a counsellor and in creative
therapies leads me to believe that the most
important element of the healing experience is the
I
30 CCYP June 2011
relationship. If the therapist is unable
to connect with the client, then no matter the
range of skills and approaches, the client will
experience no long-term healing. So how do we
go about ensuring that we provide children with
someone who can connect with them? Although
the general approach seems to have been that we
bus someone in with the right credentials, I believe
there is another way, a bottom-up approach instead
of a top-down approach. This means finding the
people who already connect with these children, so
that the most important element – the relationship
– is taken care of, and then we need to give them
some new skills and support them. I can hear
alarm bells: surely we are not talking about nontherapists doing low-level therapeutic work? But
if we name it differently, we have school staff
using therapeutic skills within their role, or, as
John McLeod1 termed it, ‘embedded counselling’.
Sharing the job with school staff
This is the approach that we use in my business,
Equilibrium and Enablement. Schools identify an
existing member of staff who has this ability to
connect with pupils on an emotional level. We then
provide them (and a member of the leadership team)
with five days of training that covers a range of
educational and therapeutic theories and
approaches. The school then sets up a Th.Inc.Room®
(Therapeutic Inclusion Room) and gives it a
creative name (we have Star Houses, Butterfly
Rooms, Cloud 9, The Space, Dream Catcher Rooms
etc). The work then begins: small groups, paired, one
to one, parents, lunchtime clubs. Each Th.Inc.Room®
will be different because it is tailored to meet the
needs of the children within that school, at that
time. But each one is based on the same approaches,
underlying theories and principles. We provide
monthly supervision (following the BACP guidelines
for those using counselling skills within their work
‘
opinion
role), further training, a place for referring on…
and we collate the data. Of course, the sad fact is
that those who don’t want to acknowledge that
this approach is viable are not interested in looking
at the data. They have already made their mind up
based on their ‘ethical’ principles. But there is,
nevertheless, evidence.
In the summer term of 2007, we collated
the data from eight Th.Inc.Room®
schools. One hundred and sixty-eight
children had accessed a Th.Inc.Room®
intervention during that academic
term. Seventy-nine per cent of them
showed a reduction in their total
difficulty scores with an average
improvement of 12 per cent.
In the academic year 2009/2010 we
collated data from five schools receiving our
Supervision and Support package. One hundred
and fifty-nine children had accessed an intervention
in the Th.Inc.Room®. Seventy-eight point five per
cent showed a reduction in their total difficulties
score with an average improvement of 10.71 per
cent. (We used Goodman’s Strengths and Difficulties
Questionnaire2.) Those of you familiar with data
from other better-known therapeutic interventions
in schools, will recognise that though these samples
are small, the figures are comparable, and in some
cases marginally better, than other interventions
using therapists/trainee therapists. So, it’s time to let
our natural human curiosity ask: ‘If that is so, then
why?’ and consider the benefits of such a system.
together and the regular greeting, smile and
check-in chat several times a day in the corridor,
but for the child, that relationship is consistent,
reliable and available. Gradually, their ‘dysfunctional
relationship’ construct gets a gentle but permanent
makeover. I see this as the most likely changeinducing factor, but there is a list of other possible
contributors, one of which might be the unspoken
knowledge of a shared world (as most workers live
in the same community as the pupils) as opposed to
the arrival of yet another alien from a distant planet.
Perhaps this subtly impacts on the relationship,
making it more real and relevant?
A logistical benefit
And what about the logistical benefits of this
bottom-up approach? Even before this economic
downturn, it was unrealistic to imagine a day
when every primary school would have its own
resident therapist. And is this actually necessary?
With the correct ethos, whole school approaches
and early preventative interventions, there should
not be enough work for a full-time therapist (again,
referring primarily to primary schools). There will
always be the need for professional therapy but
this should be for the few and not the many.
Th.Inc.Rooms® can provide early preventative work
and a range of interventions. Pupils can move
from one-to-one work to paired work to small
groups as they gradually transfer their skills.
How could this happen?
How is it that this ‘not-actual-therapy’
can apparently have so significant an
impact? Obviously, without access to
time travel we cannot compare the
impact of ‘true therapy’ versus this
approach on the same child, but we
can make some hypotheses. We return
again to the impact of the relationship,
and the innate healing that a positive,
unconditional and consistent relationship can
bring3. Also the healing nature of experiencing a
safe place and time and the opportunity to play
however you want to with no imposed expectations,
as set out in Axline’s principles4. So far so similar
to ‘true therapy’. But many children experience an
endless stream of adults ‘intervening’ in their lives.
Such adults arrive, develop a relationship with the
child, then complete their intervention and leave.
The child experiences a repeated cycle of what
could be perceived as abandonment, and the
impermanence of relationships becomes a core
construct. With a Th.Inc.Room®, the level of
engagement and involvement will change, but
as long as the child and the worker remain at
the school, the relationship is maintained. Contact
may reduce to the level of an occasional lunch
With the correct
ethos, whole school
approaches and
early preventative
interventions, there
should not be
enough work for a
full-time therapist
in primary schools
Th.Inc.Rooms®
Or they may attend a group and from that be
identified for individual work. It is a many-layered
approach. Pupils accessing professional therapy no
longer have to move from that intensive support to
nothing, but can move into a small group or on to
paired work. The school no longer has to find a large
block of money. Instead they have to reallocate
staffing and redefine roles and find the small
amount required to cover training and supervision
costs. This makes for a sustainable approach.
And the parents?
Then there is the emotive question of parental
involvement. I say emotive because I feel so strongly
CCYP June 2011 31
opinion
that we continually fail our most needy children on
the basis of this issue. I heard Camilla Batmanghelidjh
speak at the ‘Health and Wellbeing in Education’
exhibition in Birmingham in November 2009 and she
stated that our systems fail the most needy children
due to them being based on the fundamentally
flawed assumption that behind every
child is a supportive parent.
‘
How is it ethical
to deny a child
the experience of
a therapeutic
relationship on
the basis that the
provider of their
primary relationship
is so damaged
themselves that
they will not engage
in interviews and
questionnaires?
Our Ethical Framework
talks of:
‘Justice: the fair and impartial treatment of all
clients and the provision of adequate services
… Justice in the distribution of services requires
the ability to determine impartially the provision
of services for clients and the allocation of
services between clients. A commitment to
fairness requires the ability to appreciate
differences between people and to be committed
to equality of opportunity, and avoiding
discrimination against people or groups
contrary to their legitimate personal or social
characteristics. Practitioners have a duty to
strive to ensure a fair provision of counselling
and psychotherapy services, accessible and
appropriate to the needs of potential clients.’5
How is it, then, that the main providers of
therapeutic interventions to primary school
children require the engagement of parents? How
is it ethical to deny a child the experience of a
therapeutic relationship on the basis that the
provider of their primary relationship is so damaged
themselves that they will not engage in interviews
and questionnaires? Common sense tell us that
therapeutic work is more effective if the parents
engage – but that does not mean that the child
whose parents do not engage will not benefit.
Children’s ability to cope with their lives, their
resilience, can be significantly improved in spite
of parents’ non-engagement, and
we see this occur time and
again. So, both at
a Th.Inc.Room®
level and at a
therapy level
we seek
to engage
parents,
but their
engagement is
not a requirement
for a child to be
involved in an intervention.
Permission is required but engagement
is not a pre-requisite. And things can turn out the
opposite way to that which we predict – working
with the child can become the way to engage the
parent. So this is an inclusive approach. The child
him- or herself becomes the one who chooses
whether this is or is not for them.
I hope you accepted the challenge to listen
objectively to what I have to say. We will continue
to train, support, supervise and change children’s
lives through the people who walk alongside them
from day to day. And I hope that one day many
more of my counselling colleagues will decide to
join us in our bottom-up approach. Bridget Sheehan is the director of Equilibrium and
Enablement Ltd (www.eqe-ltd.com). She is a qualified
teacher with a master’s in counselling. In 2006, she
received the Play Therapy International Award for the
Th.Inc.Room® approach. She has worked in schools
educationally and therapeutically for 20 years.
[email protected]
References
1 McLeod J. Outside the therapy room. Therapy Today.
2008; 19(4):14-18.
2 Goodman’s Strengths and Difficulties
Questionnaire. www.sdqinfo.org
Th.Inc.Rooms®
3 Schaefer CE, Kaduson HG. (eds)
Contemporary play therapy theory, research
and practice. New York: Guilford Press; 2006.
4 McMahon L. The handbook of play therapy.
London: Routledge; 2005.
5 BACP. Ethical framework for good practice in
counselling and psychotherapy. Revised edition.
Lutterworth: BACP; 2010.
32 CCYP June 2011
EFT in the home:
managing stress
This article is abridged and adapted with permission from Nancy Gnecco’s chapter
‘Parents as Partners’ in EFT and Beyond, where cutting edge Emotional Freedom
Techniques are explained in detail. Here, she outlines how stressed parents can
deal with their own issues and then address their children’s
arents are often so focused on caring for their
children that they forget (or don’t take time) to
take care of themselves, putting themselves at
risk of stress-related emotional and physical problems.
Stress is cumulative. Daily life in many families
has become complicated by pressures for children
to be involved in activities such as sports, scouting,
and music and dance lessons. At face value, these
activities round out the childhood experience,
keeping youngsters busy and engaged. However,
multiple activities require close scheduling and
transportation, increasing the stress for parents. It is
well known that extended or repeated activation of
the stress response can take a heavy toll on the
body as well as the emotions. In addition, there is
no question that children respond to their parents’
psychological distress. One of the areas in which
EFT is most effective is in neutralising the effects of
stress in adults and children. It is important for
parents to learn to use it for themselves, addressing
their own anxiety, fear and frustration before
dealing with the presenting issues of the child.
Whenever a child presents with a challenging issue,
the entire family system is affected. Consequently,
in order for any interventions to be successful, it is
critical that the entire family be engaged.
P
The most common sources of stress for
parents
Career-driven society – both parents working
outside the home
Constant worrying, rushing, hurrying
Economic and financial worries
Negative thinking, self-criticism, self-blame
Family member ill or in crisis
Caring for own ageing parents
Unrealistic expectations or beliefs
Low self-esteem
Unresolved or unexpressed emotions, especially anger
Victim consciousness
Hunger, pain, fatigue
Job dissatisfaction or insecurity
Unemployment
Poverty
Financial worries
Racial, age or sexual discrimination
Office politics, conflicts with co-workers
When dealing with childhood problems within the
family, the initial tendency is to focus on the
youngster in order to solve or correct the presenting
problem. Generally, this approach is unsuccessful.
This is because, often, the child’s behaviour is acting
as a barometer, measuring problems within the
whole family structure. The family will have the best
chance of helping the child when the parents can
clear their own issues first while improving skills of
communication and negotiation.
So it is important to look at issues of stress
within the whole family, not just the child.
Getting parents on the same page
Parents can use EFT to reduce overall tension and
improve communication regarding the effect the
problem is having on them individually, and as a
family. The way to do this is to sit down together
at a time they won’t be interrupted.
1 Before discussing the situation, each person
observes his or her current level of distress about
the problem they are facing. Notice and name the
feelings in the moment: eg stressed out, angry,
overwhelmed, sad, guilty, hopeless, responsible,
worried, frantic, anxious, fearful, resentful. Write
down the words that best describe the feelings
and give them, as a group, an intensity level from
0-10 with 0 being neutral, and 10 being the worst
they can be.
2 Combine the feelings into one set-up phrase
that includes all the feelings and symptoms of
both partners, and, with each tapping the karate
chop point, both partners say the following:
Even though we are having a problem with
(child’s name), and we feel (list the feelings you
have written down), we are doing the best we
can, and we are good parents.
Do this three times together.
Reminder phrases while tapping round the
points (one partner speaks, both partners tap):
Top of head: all these feelings
Eyebrow:
this problem with (child’s name)
Side of eye:
(name one feeling off the list)
eft.eft.eft.eft.eft.eft.eft.eft.eft
EFT for parents
CCYP June 2011 33
eft.eft.eft.eft.eft.eft.eft.eft.eft
EFT for parents
34 CCYP June 2011
Under eye:
Under nose:
Under lip:
Collarbone:
Under arm:
(name another)
(name another)
all these feelings
this problem with (child’s name)
all these emotions – or use the
stream of consciousness
technique, which simply means
you say whatever comes to mind.
Naming the feelings and emotions while tapping
should help to decrease the intensity of distress in
both parents so that they are better able to
discuss the problems with each other.
Under arm:
I choose to be calm if Kate wets
the bed again.
3 The next time the behaviour happens, the parent
treats his or her own emotional state – his or her
own ‘inside job’, before dealing with the child if
possible (or as soon after as possible):
Even though I’m feeling really angry that Kate
wet the bed again, I deeply and completely
accept myself.
4 Re-evaluate the intensity of each person. If both
are not at one or zero, do another round using the
reminder phrase: Remaining emotions (name them
if you wish).
A couple of rounds of EFT tapping should help
neutralise the emotional distress in the moment,
making it easier to deal with the situation from
the ‘choice’ state. The reminder phrase during
tapping on the points would be ‘this anger’ or
the stream of consciousness words.
Both parents/partners are encouraged to treat
their own emotional responses to the situation for
at least a week (daily) before introducing tapping
to the child.
Parents working independently with EFT
Common sources of stress for children
Each parent is encouraged to identify his or her
own triggers regarding the problem with the child.
They should be treated preventatively (ie when
they are not an issue) and also in the moment,
whenever possible.
Arguing, fighting between parents, rushing
Divorce, separation
Illness, death of loved one
Moving, attending new school, day care
New addition to the household (sibling, grandparent)
Over-scheduling of activities – not enough time
for creative play
Peer pressure
Social pressure – poverty, social functions, parents’
financial pressure
Unrealistic expectations by teachers or parents
Traumatic event or disaster
Primary care giver not spending enough time with
child
Parents pushing kids to excel in athletics
Media – TV shows, news, images of war, natural
disaster, terrorism
3 Do another round with the other partner doing
the talking and both tapping.
1 List the child’s behaviours, the personal
emotional response, and the intensity of that
response. For example: ‘When Kate fights me about
getting dressed in the morning I feel frustrated
and angry. On a scale of 0-10, my intensity is an 8.’
2 Remember to tap the karate chop point three
times while stating the set-up phrase with each
issue. Develop a set-up statement for each of the
triggers that includes a choice of how to feel
instead. For example:
Even though Kate may wet the bed again
tonight and I usually feel angry and guilty, I
choose to be patient and respond to her calmly.
It’s helpful to tap through the triggers once a day
when they are not an issue. Use the stream of
consciousness technique as you tap through the
points, being sure to include your choice response/
feeling. It might look like this:
Top of head: I’m afraid Kate is going to wet
the bed again
Eyebrow:
I remember how easy mornings
were before this started
Side of eye:
My usual anger doesn’t help the
situation
Under eye:
I choose patience
Under nose:
I choose to deal with Kate calmly
Under lip:
Maybe it’s my fault
Collarbone:
I’m doing the best I can –
probably Kate is too
Since children are more emotional, intuitive and
empathic than adults, they often carry the
dysfunctional energy of the family. For this reason,
it is very important for parents and teachers to
help children relieve daily distressing emotions so
that issues don’t pile up and turn into emotional,
behavioural or physical problems. EFT provides an
excellent resource that engages children at a high
level of enthusiasm and participation as long as it
is introduced in a way that resonates for them,
both developmentally and individually.
Using ‘Magic Tapping’ with a child
Choose a time when the child feels safe and
comfortable – a time when the parent can work
with the child without getting personally triggered.
Using words appropriate to the child’s level of
maturity, parents then discuss the problem and
suggest that they have something that might help.
If the child is old enough, suggest a ‘game’ that
will help with the problem, or for older children,
ask if he or she is interested in trying it.
If a child is engaged and interested in playing
the ‘Magic Tapping’ game, that is a good time to
begin. If not, don’t force the issue. Parents continue
to tap on their own frustration that the child
doesn’t want to participate, then surrogately tap
for the child’s issue, pretending to be the child, or
using a favourite doll or stuffed animal.
For example, pretending to be Kate:
Even though I wet the bed at night, mummy
still loves me/I’m still a good girl/I’m doing the
best I can.
Tap a few rounds, having the last round positive:
…I choose to sleep through the night and wake
up dry and happy.
Do this in front of the child unless he rebels or
wanders off. Complete it in any case. If he is
interested, he can tap on himself, or on the
parent, or on a favourite doll or stuffed animal.
Ideally this will be done a couple of times a day
when the problem has not just been triggered for
parent or child. It is also advisable to do EFT
whenever the problem is activated. For example:
Kate is at day care having a tantrum. Mum kneels
down to Kate’s level, taps her karate chop point
(side of her hand) and says something like:
Even though you don’t want Mummy to leave,
you are still a good girl and Mummy still loves
you.
Mum goes through the EFT points using phrases
like:
Top of head: I know you don’t want Mummy
to leave
Eyebrow:
Remember you always have fun
at day care
Side of eye:
It’s okay to be angry at Mummy
Under eye:
You don’t want Mummy to leave
Under nose:
Mummy will be back this
afternoon after your snack
Under lip:
Sad that Mummy is leaving
Collarbone:
Scared that Mummy is leaving
Under arm:
It’s okay to have fun at day
care.
Usually one to three rounds of tapping will calm
the child if the right words are being used. Always
pay close attention to the specific words the child
is saying and incorporate them into the EFT.
How is tapping with children different
from tapping with adults?
With infants and pre-verbal toddlers, one doesn’t
need to get an intensity rating. It will be dramatic
when the energy is clear because the behaviour
will stop, and toddlers will get bored and go off
to play. Infants often fall asleep.
With a pre-schooler or school age child, it is
often helpful to find out how much a problem
is bothering them by having the child hold his or
her hands wide apart to indicate a huge problem
and closer together as the intensity goes down.
Older children can use a pictorial scale or the
usual 0-10 rating.
Once the child has learned EFT and is comfortable
using it, encourage her to do it whenever distressing
thoughts, feelings or events affect her day. EFT is
often most effective when performed in the actual
moment of distress.
Once language is developed to the point where
the child can tell a story, utilising the ‘Tell The
Story Technique’ or the ‘Movie Technique’ gives
a double benefit. In addition to tapping away
any intensity, the child has the full attention of
a loving adult, which, in itself, can be enormously
healing.
Gary Craig* recommends that parents sit with
a child at bedtime and ask about the good and
bad parts of the child’s day, or the good and bad
thoughts of the day, tapping away any distress
that may be lingering before the child settles
down to sleep. This is especially useful with
children who have nightmares and other sleep
disturbances.
A different future: mentally healthy
children
By resolving issues on a daily basis, children are
less likely to accumulate what we call ‘emotional
baggage’ – the negative beliefs, limiting identities
and learned limitations that prevent us from
attaining our highest potential as adults.
Consistently done from an early age, EFT has the
potential to launch the next generation into
adulthood with self-confidence, the courage to
take risks and to stand by their own convictions.
They will have learned how to remove blocks to
peak performance, identify and neutralise difficult
emotions before they get out of hand, and be
more likely to view the world as a place of
unlimited possibility. EFT and Beyond (Energy
Publications, 2009)
is edited by Pamela
Bruner and John
Bullough and is
available from
Amazon and other
bookstores.
*Gary Craig was the
founder of EFT but
has now retired.
eft.eft.eft.eft.eft.eft.eft.eft.eft
EFT for parents
CCYP June 2011 35
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Creating children’s art
games for emotional
support
Vicky Barber
Jessica Kingsley 2010
ISBN 978-1849051637 £14.99
his book contains games
that are created by and
then acted out with
children/young people. The age
range is 7+ with many activities
suitable for teenagers. There are
some group games and others
for two people. Before the
activities start, there are
discussions around confidentiality, respect and not
judging each other, and the emphasis is on creating
the game with the young person/people and the
process that follows. The aim of the activities is to
look at situations that are causing the young person
a problem and then explore them in a light-hearted
yet meaningful way. The book is laid out such that
it makes the instructions for the activities easy to
follow and the objective of each activity clear.
The book would be useful to inform a class
activity in primary and secondary school as part of
a whole class PSHE lesson, or for a group of pupils
with specific emotional needs. Some of the activities
could be adapted for a parent to use with their
own child/children. The activities would also be
useful in group therapy sessions or even adapted
to use in supervision. There are some templates in
the book for use with the activities.
I liked the way the instructions were quick and easy
to understand. Here is a typical example of a game:
Title:
Changing Circles
Objective:
To raise awareness of problems
and to come up with solutions; to enable each child
to externalise their concerns and realise that their
problem is also shared by others.
Age range:
10+
Group size:
3 to 10
Materials:
Paper, coloured marker pens,
a box (see box instructions on p125)
Creating time:
20 minutes
Playing time:
20 minutes
Creating the game: Arrange the room so that the
children can sit comfortably in a circle. Explain the
aims and rules of the game. First clarify and lead a
discussion on the types of problems and concerns
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36 CCYP June 2011
faced by young people (eg anger, housing, sibling
rivalry, abuse). Explain that the game offers
opportunities for the group to find solutions for
each other. Sit the group in a circle. Have each
child write or draw their problems/concerns on
separate pieces of paper, which are then placed
face down in a container.
Playing the game: The children take it in turns
to choose a problem and think about solutions. The
group can then extend this with other solutions.
This is done until all the problems have been
covered. (Note: the problems are anonymous.)
I have a feeling that this book will be one that I will
dip into for ideas for my work as a counsellor with
young people. A useful addition to my collection.
Julie Griffin MBACP is a counsellor working with young
people in education.
+ clear instructions and objectives
+ range of possible applications
– none
Child-centered play therapy
Risë VanFleet, Andrea E Sywulak,
Cynthia Caparosa Sniscak
Guilford Press 2010
ISBN 978-1606239025 £24
his book offers readers
insight into the process of
child-centred play therapy
(CCPT). The three authors have a
total of 85 years’ experience in
practising, teaching and
continually learning about CCPT,
and their experience, dedication
and faith in CCPT is evident
throughout. They discuss its non-directive approach,
influenced by Carl Rogers and Virginia Axline, from
its origins to how it has evolved throughout the
years, giving an overview of current thinking.
The book is divided into five parts, starting with
an introductory glimpse into the significance of
play and play therapy, and showing some of the
challenges faced by therapists who practise CCPT.
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Part 2 contains a description of how to set up
the playroom, and suggests toys that will help
bring forth feelings while children play. This is
followed by an account of the four skills needed
to practise CCPT and the section concludes with an
overview of play themes, detailing how the CCPT
therapist might appreciate and understand the
meaning of the child’s play. There is a real sense of
the all-important relationship between therapist
and child, and the significance of the therapist’s
empathy and acceptance within the CCPT process.
Part 3 looks at the importance of parental and
teacher involvement and some of the challenges this
may bring as the CCPT therapist communicates with
them and not just with her child clients. The authors
also present a chapter on Filial Therapy, in which
parents are taught CCPT skills to help their children
overcome emotional and behavioural problems.
Following this is a narrative of the value of CCPT
for different presenting problems, and how the
CCPT therapist deals with some difficult child
behaviours. A selection of excellent case vignettes
provides enhanced awareness and appreciation of
the model. The authors also consider the sensitive
issue of touch, and the book ends with a summary
of research on CCPT and Filial Therapy, and
developing competence in CCPT.
The book would be good for clinicians who have
very limited or no experience of working with
children, as it is well structured and easy to read,
offering a complete description of the process of
CCPT. The more experienced child clinician may
also value this text as a current, expansive and
sometimes moving look into CCPT. Clinicians who
work in a more directive way with children may
also wish to consider it.
What I love about this book is the way the
authors convey the essence of being non-directive,
and the respect they offer that allows children to
communicate their feelings through play. The only
slight wish I have is for more individual, personal
reflections from CCPT therapists, compared to the
book’s general look at the CCPT therapist.
While the authors are forthright on the
importance of obtaining adequate training to
practise CCPT, I am confident that readers will gain
a much deeper awareness of this way of working
therapeutically with children, and it will therefore
benefit their practice.
Annette Mckinlay (MBACP Accred) works as a schoolbased counsellor in West Dunbartonshire, and also in
private practice.
+ excellent and thorough introduction to CCPT
– would benefit from more personal therapist
comments
Touching clay, touching
what?
Lynne Souter-Anderson
Archive Publishing 2010
ISBN 978-1906289171 £22
ubtitled The use of clay
in therapy, this is an
immensely enjoyable
read and should probably be
read by all therapists, whether
or not they currently have clay
available for their adult or
child clients. The author’s clay
credentials are impeccable, so
the content is worth taking note of. And there are
no comparable writings out there.
The book starts with a discussion about the
nature of clay that ranges across geological,
archeological, philosophical, cultural and spiritual
domains. The metaphor engendered by the idea
of fire having the power to change soft clay into
a durable and robust medium is not lost on
therapists; neither is the alchemical nature of
therapeutic work with clay – not everything can
be explained.
Nevertheless, in introducing the research she has
carried out, Souter-Anderson presents clay therapy
as having a unique theoretical base in the same
way as music or sandplay therapy. Her research
followed a ‘work in hand’ basis rather than
traditional forms of research epistemology, which
is refreshing and appropriate: the practice
preceded the theory. As a clay user myself, I find
the detail of her research components eminently
readable and engaging, covering a variety of
sources, such as testimony from non-therapeutic
groups/locations as well as therapeutic
professionals; interviews; workshop material on
forms and processes; and extrapolation of the
data – which leads to a whole chapter on Theory
of Contact: Physical, Emotional and Metaphorical.
Jung and Winnicott feature, along with Klein,
Bion, Fonagy, Gerhardt, Sunderland and Hughes,
among other notables working with children,
although this book is not intrinsically about
clay and children. I have rarely read such a pageturning narrative about someone’s research.
The following chapter elaborates the existential
themes exposed by the research, including much
commentary by others on their processes and
thoughts.
The latter half of the book concerns specific
situations where the value of clay has proved itself
therapeutically; practical considerations for wouldbe clay therapists; and ways of exploring with clay
– this last containing many coloured pictures.
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CCYP June 2011 37
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There is a full bibliography, which gives away the
research basis of the book, but there is no index.
This is a serious omission in a book of this kind
read by ‘ordinary’ readers. Should there be a
reprint (and the book certainly deserves to sell
out), I offer my services to rectify this single
shortcoming.
Eleanor Patrick is a BACP Accredited therapist working
in private practice and in school, and editor of this
journal.
+ wide-ranging research presented readably
– no index
Creative expression
activities for teens
Bonnie Thomas
Jessica Kingsley 2010
ISBN 978-1849058421 £14.99
ubtitled Exploring
identity through art,
craft and journaling, this
is a creative goldmine, packed
with ideas and information to
stimulate the most jaded
counsellor. If you feel a bit
‘stuck in a rut’ with what you
offer by way of creative
interventions with clients, then this book bursts
with inspiration and new possibilities.
Working with teens can be challenging, and
selecting the right option for the creative work
that we offer is always a balancing act. Some may
see an activity as too childish, others will delight
in being ‘allowed’ to play again with things they
once enjoyed. This compact book (138 pages)
contains not only ideas but also information
about accessing resources from the internet.
All the ideas can be tailored to suit the individual
and require minimal equipment, and there is no
requirement for the counsellor or client to be
particularly artistic.
The book is subdivided into four sections,
Art Projects and Creative Challenges, Journaling,
Miniature Projects for Personal Space, and
Incorporating the Activities into Treatment
– A Section for Counsellors. The author suggests
the activities are suitable for people aged 13 or
over. Each activity touches upon a part of the Self
(past, present and future) and gives the young
person an opportunity to express a little or a lot
about him/herself. The suggestions lead toward
the client learning to explore and communicate
personal identity.
Some young people find it very hard to use
words to express what they are experiencing
and feeling. Offering them alternative ways of
exploring their turmoil and confusion, and for
that to be worked out in a creative and fun
way, will encourage them to explore more about
themselves, and hopefully experience this as
freeing and stimulating.
The author states that there are no right or
wrong ways to use the ideas in the book. She
reminds the reader that, as counsellors, we are
there to guide and inspire, not to dictate. The
young person is the artist and the creator.
Ros Baldwin (Snr Accred) works part time in a large
public school, and also runs her own private practice.
She has more than 12 years’ experience working with
children and young people.
+ an easy, quick read
+ many ideas and resources
– some American terminology
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Inspiring creative
supervision
Caroline Schuck, Jane Wood
Jessica Kingsley 2011
978-1849050791 £16.99
nspiring Creative Supervision
aims to offer us ‘the possibility
of further enhancing the
supervisory experience by
extending creativity beyond
the bounds of everyday
language’. Reading it will
provide us with ‘a journey of
exploration, using many
different techniques and materials as well as the
rich experience of the imagination and the senses’.
Even the cover is creative with expressive
brushstrokes of colour.
The book acknowledges that some of us are
intellectual and enjoy fact-finding and ‘thinking
through’ our work, whereas some of us require
experiential work and gain more out of practice
sessions and role play. As a supervisor, I believe it
can be useful to understand what kind of learners
our supervisees are. If we can work in a way that
is accessible to each supervisee, they will feel
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comfortable working with us. Equally, it can be
useful to challenge them outside their usual
learning style.
Inspiring Creative Supervision begins by
encouraging us to observe our own creativity and
reconnect with the playfulness and spontaneity
we had as children. The reason given for this is
that experiencing rather than just reading about
creativity will increase our empathy and
understanding as supervisors, and will help us
integrate both the intellectual and the intuitive
understanding of the supervision process, allowing
us to feel more confident as a facilitator of
creative work.
An abundance of case studies is provided from
the authors’ own experience. These include
examples of guided visualisation, working with
lists, charts or picture cards, and the use of bricks,
figures and even people themselves as props, both
on a one-to-one basis and within a group setting.
Creating Narratives is a particularly interesting
chapter. It includes retelling stories using poetry
and song, telling the story from different
perspectives, acting out group issues and using
narrative as reflection in action. Using People as
Props covers role play, two-chair work, mime and
group sculpting, while Collecting and Making
Resources and Props reminds us that alongside
familiar props such as puppets, bricks and art
materials we can create our own collections of
objets trouvés, which can include anything from
pebbles to bottle tops!
This book would interest both supervisors new to
the idea of introducing creativity to their supervision
sessions, and the already creative supervisor
wishing to explore some new ideas to enhance
reflective practice. It would also be an interesting
resource for other professionals such as teachers,
social workers and healthcare workers to encourage
a new way to reflect on their work.
This is an excellent book which I think would
also help supervisees to be inspired to creativity,
reflection and humour in the supervisory process.
It is enjoyable and educational to read from
beginning to end. However it strikes me as a book
that encourages us to dip in and out as required.
I don’t think it will sit and gather dust on my
bookshelf – it is more likely to become tatty and
dog-eared from regular use.
Carole Neill is a BACP Accredited supervisor.
+ inspiration for beginners at creativity
+ new ideas for the experienced
+ applicable to other professions
– none
Young people and the curse
of ordinariness
Nick Luxmoore
Jessica Kingsley 2011
ISBN 978-1849051859 £13.99
ick Luxmoore is a UKCP
registered psychodrama
psychotherapist, and his
30 years’ experience working
with young people is evident
throughout the pages of this
book as he explores the
meaning of being ordinary.
The question that is
constantly referred to is: ‘Am I the same as other
people or am I different?’ As a whole, the book
explores the struggle for young people to find a
way of being in the world, and offers the reader
plenty of opportunity for reflection on the
complexities of being ordinary. In part, the book
offers easily digested chapters that dissect the
meaning of ordinariness, and, while reading the
different chapters, I had a sense of building ideas
and fitting thoughts together.
The book is introduced as being ‘about young
people trying to find answers or at least trying to
live more comfortably with the question’ and puts
forward the idea that this struggle to find a
balance of being the same and yet different will
affect everything for young people, including
behaviour, relationships and happiness.
Right from the start, as in his other books, Nick
Luxmoore introduces young people’s voices into
the narrative and offers the reader many vignettes
that resonate with my own experience of working
with this age group. Names are used throughout
the book and often referred back to in later
chapters, which adds to a sense of building an
understanding of the concepts being explored.
The vignettes and the actual quotes of the young
people bring their experiences into the present,
and an important aspect of the book for me is
that their struggle is alive and real within the text.
The book puts the question of ordinariness ‘at
the heart of growing up’ and the early chapters
explore difference: ‘Being the same as other
people sounds safe but also boring; being different
from other people sounds exciting but also scary.’
The book sits this conflict in the context of our
culture and questions our search and longing for
the extraordinary. Luxmoore challenges us to fully
understand the meaning of what it is to be
ordinary and why that might not feel good enough.
The chapters move from exploring what being
the same as others means to young people towards
reflection on what it is to be different or ‘other’.
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CCYP June 2011 39
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They describe the striving to be special and
interesting and the book quickly places the hearand-now conflict for his clients in the context of
psychodynamic theory, exploring the processes of
separation. The early experience of the infant has
a strong presence in the book and informs the
thinking about its current therapeutic relationships
and the struggles they bring.
There are chapters that think about young
people’s ordinary beliefs around God, sex and
death. During these middle chapters I occasionally
lost sight of the young people who elsewhere had
such a strong voice within the text. However, just
when I thought I could not link his theory to
practice, the author contextualised the theory and
referred back to the core of the book; to struggle
with the meaning of ordinariness.
The later chapters offer thoughts about loss,
what it is to make decisions and to grieve the
paths not taken while learning to live with the
‘what is and what if’.
The book presumes some knowledge and
understanding of psychodynamic theory, but the
reader is never too far away from the young
people’s experience.
Tracey Richardson is a counsellor working in secondary
schools and with Kinergy (sexual abuse counselling).
+ resonates with the voice of young people
+ explores the topic psychodynamically
– presumes some knowledge of the above
Healthy attachments and
neuro-dramatic-play
Sue Jennings
Jessica Kingsley 2011
ISBN 978-1849050142 £18.99
he aesthetic of a book
really influences my
motivation to read it, so
I was excited to receive this
rather good-looking book for
review. It even has illustrations,
something many ‘serious’
authors shy away from. But Sue
Jennings is a serious author with
a serious message, as is apparent from the outset.
And as a child psychotherapist, I discovered much
within it to interest, engage and challenge me.
The first sentence of the foreword reiterates
what I have learned to be true: that play is both
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40 CCYP June 2011
powerful and necessary and that its presence or
lack has a profound impact on children. This is a
message that cannot be shouted loud or often
enough. The book tracks the development and
application of Jennings’ concept of NeuroDramatic-Play (NDP), a process that develops
alongside and supports that of attachment. The
author begins with a review of existing theories
of attachment and play from the usual suspects
(Bowlby, Harlow, Winnicott etc) and these are
revisited throughout the book in an informative
and reflective way. Jennings is not afraid to
disagree with or develop a well-established theory,
which makes her approach brave, refreshing and,
dare I say it, playful.
A theme that runs through the book is the
relationship between nature and nurture, which,
pleasingly, is becoming thought of less as a
dichotomy and more as a mutually influencing
aspect of development. As Jennings puts it:
‘Nature gives the brain its potential but it is
the quality of the nurture (or neglect) that will
determine the eventual growth of the brain and
its capacities.’ And for the author, a vital aspect
of nurture is play. NDP, she argues convincingly,
begins from the moment of conception and
throughout a critical period of six months
after birth. It seems strange at first to think
of playfulness and attachment as starting at
conception, but if we consider, as the author urges
us to do, the contrasting situations of a pregnancy
born out of rape and one that is the result of a
playfully intimate encounter, we begin to see
where Jennings is coming from. This is striking in
its contrast to earlier theories of attachment and
play, but supports my personal view, and that of
many psychotherapists, that what happens in the
womb and during the first months of life has a
crucial impact on the capacity for relationships,
empathy, emotion and behaviour. The taking of a
detailed early history in child therapy referrals,
including details of the conception, pregnancy,
labour and early developmental milestones, is
therefore imperative in understanding the troubled
child we later meet in the consulting room.
While some established theories posit the notion
that neglect, and in particular maternal neglect,
is irreversible in terms of its negative effect
on attachment, Jennings’ view is much more
optimistic. She guides us through NDP techniques
that can be used alongside conventional models
of therapy for interventions with children of
different ages up to and including young adults,
with a chapter devoted to looked-after children,
which I found particularly encouraging. Her
emphasis on working with the family rather than
the young person in isolation also makes good
therapeutic sense. All in all, I found this an
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intelligent, thoughtful and hopeful book, which
I know will influence my clinical practice.
Jeanine Connor works as a child and adolescent
psychodynamic psychotherapist in Tier 3 CAMHS and
in private practice. She is also an author, examiner and
lecturer.
+ author not afraid to offer a different view
+ can be used within other models of therapy
– none
How to think about caring
for a child with difficult
behaviour
Joanna North
Watershed Publications 2010
ISBN 978-0952871330 £25
oanna North demonstrates
her wealth of knowledge
and richness of experience
in this innovative book. She
has worked widely in
supporting substitute parents
of looked-after children who
exhibit difficult behaviour,
and runs an Ofsted registered
Adoption Support Agency.
The book is in fact a workbook aimed at foster
and adoptive parents and carers of young people.
It consists of an introduction and 10 chapters or
‘sessions’. The introduction outlines how the book
works and why it was written, and includes a
useful overview of attachment theory, couched
in straightforward language. Complex concepts
throughout are expressed in simple language.
Nine sessions form the heart of the workbook,
with each session building on the last. Readers
can work alone or in groups, and each session
forms a valuable starting point for individual or
group exercises. The author recommends that
readers work through the book in weekly sessions
or in a concentrated programme over a series of
days or weekends.
Each session covers an aspect related to the
experience of caring for a child with difficult
behaviour. The first five sessions focus on the
adult reader’s personal experience of being a child
or of parenting. Work on the adult or adults in a
caring relationship is followed by a focus on the
child or children. Sessions six to nine turn the
focus to the perspective of children with difficult
J
behaviours who are in care. North first focuses on
how to construct a secure environment and build
an alliance with a child. She then turns to
exploring the background to difficult behaviour,
before examining the role of trauma and shame.
There is a comprehensive examination of the
impact of developmental delay in individual
children, and the author concludes by looking at
the role of reciprocity in relationships between
children and adults, with an explanation of the
impact on behaviours. The workbook ends with
a tenth session that contains encouragement and
a series of mantras to facilitate mindful working.
Throughout the workbook, experiential exercises
are contained in themed TTT (Time To Think)
panels. Many of these exercises are emotionally
demanding, with much of it reminiscent of
counselling training. The author demonstrates
good care of her students, urging readers to be
aware of self-care as well as recommending that
adults keep their personal stories and working
notes away from the children in their care, to
protect all parties. There are cameo case histories
throughout.
The book’s approach draws on a range of
therapeutic understandings and traditions, and
comprehensive references to sources are made
throughout the text, backed by a full academicstyle bibliography at the end. If the book goes
into a second edition, the addition of an index
(and the correction of typographical errors) would
increase the usefulness of this workbook, making
it easier to dip into the material or refer back to
specific subjects as a reminder of the learning.
Although this book is aimed specifically at
adoptive parents and foster carers with young
people in the care system, it could also serve a
wider audience. Professionals such as social
workers, therapists, teachers, special needs coordinators and residential care workers could all
benefit from reading this book. And some parents
of children who exhibit difficult behaviours in
their birth or blended families may also find it a
useful resource.
Sarah Press is a psychotherapist and counsellor
working in a residential school with children and young
people who exhibit challenging behaviours. She also
works with adults in her private practice.
+ thorough help for adoptive and foster
parents
+ experiential exercises in workbook style
+ comprehensive detail on developmental
delay
– lacks an index and contains typos
CCYP June 2011 41
updates
Updates
Find out more about research
If you are interested in finding out more about
research, BACP’s academic journal Counselling and
Psychotherapy Research can prove to be a valuable
resource. Along with quarterly publication of the
latest research, written with both practitioners
and researchers in mind, it hosts a web portal at
http://www.cprjournal.com that contains information
and resources about how to conduct research,
together with selected abstracts from past issues
of the journal.
BACP members can access the full journal
articles from all of past CPR publications in PDF
format, going back to issue 1, via the BACP home
page. Just log in and select ‘CPR online’ and this
takes you to the informaworld site that manages
the CPR publication.
For those who would like to know what is
happening in research, but find it difficult to keep up
to date with the full articles in the journal, there is a
user-friendly e-alert of upcoming articles which you
can subscribe to. A summary of articles appearing in
the forthcoming issue is sent out quarterly to all
those who subscribe. To receive your copy of the
e-alert (also available to non-BACP members) go to
www.bacp.co.uk/forms/rNewsletter.php to subscribe.
example school phobics, pregnant young people, or
those educated at home. It’s a huge range and our
focus is looking for gaps – areas where children and
young people cannot currently access counselling.’
Within primary schools, the service is delivered
peripatetically, with counsellors travelling from
school to school within a specified area. In secondary
schools, counsellors are assigned to a specific school.
‘The great thing about working in primary
schools is that access to counselling at that age
really helps to break down barriers. Children of
that age do not have embarrassment or feel stigma
in accessing counselling services. And having a
counsellor assigned to a secondary school works
incredibly well as we can build really strong links
and respond in the best interests of the child or
young person,’ explains Julie.
She adds: ‘We work under very difficult
circumstances and often in isolation. The BACP award
has resulted in an increase in referrals and has given
confirmation that the team is doing a fantastic job.’
For more information, email julie.armytage@
bridgend.gov.uk or visit www.bridgend.gov.uk
2011 BACP Awards
BACP Award winner
The Bridgend Child and Youth Counselling Project
was a winner of the BACP Excellence in Counselling
and Psychotherapy Practice Award. The project,
which was established in 2002, offers counselling to
children and young people between the ages of
three and 25, in 48 primary and secondary schools
and community settings throughout the borough of
Bridgend in South Wales.
The project’s origins go back to 2002 when
Bridgend Youth Service was reporting increasing
numbers of young people not coping with life
issues and who had very little support. ‘They seemed
to be stuck and couldn’t move forward,’ explains
Julie Armytage, child and youth counselling manager
for the project.
Bridgend was able to secure funding from the
Welsh Assembly and is now established as a flagship
project, with overwhelmingly positive feedback from
its users. ‘The beauty of the project is that all children
and young people can access it, whether they are in
full-time education, moving into work or training, or
not in education, employment or training,’ says Julie.
‘The service is available in pupil referral units and
to children educated other than at school, for
42 CCYP June 2011
We are pleased to announce the details for this
year’s BACP awards scheme, and are now welcoming
applications from members. We are keen to hear
from individual practitioners, researchers, or
members on behalf of their counselling and
psychotherapy organisations, who would like to
inform the wider professional community about
the excellent and innovative work they have
achieved within their sectors.
Over the years, previous winners of the BACP
awards have received significant recognition,
within the public arena as well as the professional
context. This has helped to influence others and
make a real difference within society. We hope
that more of our members will take this
opportunity to highlight their achievements and
share their success stories with others.
In this year’s awards, we will be looking to
recognise individuals or services in the following
categories:
Innovation in Counselling and Psychotherapy
This category aims to recognise and celebrate
innovative work which has:
increased access to therapy within a community
helped to better meet the needs of clients and
potential clients
updates
challenged thinking or adopted new techniques
or models within a specific therapeutic setting/
sector.
Commitment to Excellence in Counselling and
Psychotherapy
This is an evidence-based practice award and
aims to:
reward an individual/organisation who/which
demonstrates evidence of their long-term
commitment to improving quality of life through
therapy within a community, group of individuals
or organisation
recognise counselling and psychotherapy
projects, initiatives or services that demonstrate
consistently high standards and excellence in
counselling and psychotherapy practice.
All applications must include supporting evidence/
results.
Promoting the Counselling and Psychotherapy
Profession
This category aims to recognise an individual or
service that has:
proactively promoted the profession to the
public with the aim of increasing positive
attitudes towards therapy
raised awareness of the benefits of therapy or
their service within a community.
Outstanding Research Project
This category aims to:
reward excellence in counselling and
psychotherapy research
enhance awareness of the evidence basis for
counselling, psychotherapy and its guiding
principles
improve the overall quality of counselling and
psychotherapy research by example.
If you are interested in applying for the BACP
awards scheme in any of the above categories,
please email [email protected] or telephone
01455 883300 for full details and an application
form. Alternatively, please visit www.bacp.co.uk/
awards for information and to download the
application forms.
Please note the deadline for applications this
year is Monday 15 August 2011.
CCYP June 2011 43
greetings from the Chair
Greetings from the Chair
ur journal and our conferences regularly
demonstrate the psychological depth and
effectiveness of the therapeutic work that
is happening with children and young people in
the UK. And our understanding and experience
of establishing and maintaining a counselling
provision for young people in schools and the
community is a parallel process that makes
different demands on our skills and commitment.
The committee is keenly aware of the need to
take action to highlight the areas of research,
training, accreditation and evaluation necessary to
reinforce the professional standing of counselling
for children and young people in the field.
There is daily evidence of the value of counselling
as children and young people are enabled to voice
their feelings and needs in the classroom and at
home in a supportive and caring environment. This
experience needs to be translated into a growing
body of knowledge through research projects from
the field. The steering group leading on the
Practitioner Research Network will launch this
important initiative at the CCYP conference in
London on 26 November 2011.
O
‘
The committee is aware
of the need to highlight
the research, training,
accreditation and evaluation
necessary to reinforce
the professional standing
of counselling for children
and young people
The BACP Professional Standards department has
undertaken the long view towards creating an
integrated structure for specialist accreditation for
counsellors working with children and young
people based on revised standards and structures
for accredited training programmes. The committee
welcomes this decision and the working group
looks forward to contributing to the groundwork
for this development. In the meantime, an interim
structure for accreditation will be piloted for
current practitioners in the field.
Staying on the topic of training, the committee
has real concerns about the fact that the guidelines
for establishing and monitoring trainee placements
for counsellors are not always being followed – too
44 CCYP June 2011
often leaving the student counsellor isolated or
having to negotiate basic boundaries for practice.
We welcome the opportunity to revisit this
important aspect of practice in the future
accreditation of training courses.
The evaluation of the Welsh Assembly’s National
School Counselling Strategy is well underway, as you
know, with the final report to be published this
September. There is much to learn from this exercise,
in terms of understanding effective ways of
recording the process and outcomes of therapeutic
relationships with children and young people.
If you were able to come to the conferences in
Solihull or Belfast I hope you found the days
stimulating and were able to take useful contacts
and experience away with you. There were so many
contributions, and we will certainly again be inviting
presentations and workshops for the coming
conferences in London on 26 November 2011 and in
Newcastle, with a tentative date of 24 March 2012
(to be confirmed).
Wider networks are now forming to build on the
issues raised at the conferences and through the
journal. For example, a networking event was held in
Glasgow on 14 May 2011 for all BACP members who
work with children and young people in Scotland. This
was a chance for members to share their experience
and needs and make plans for continuing contact.
The Belfast conference was a day for celebration
of the large number of achievements over the years,
and ongoing networks are taking the work forward,
not only in the area of specialist training but also in
making plans for a Northern Ireland launch for
Schools Counselling for All in the UK. Meeting
Patricia Lewsley, the Children’s Commissioner for
Northern Ireland, was heartening as I listened to her
determination to keep children’s needs high on the
political and professional agenda.
May I alert you to the BACP Making Connections
events that are being repeated in the coming year?
They are free to attend and our division is
represented on each occasion, giving us a chance
to meet and share issues and concerns. We look
forward to meeting you at an event near you.
The CYPmail resource continues to be worked on
and will provide an additional way to stay in contact
before long.
I hope you are finding good support and
supervision for your counselling, and also discovering
ways of sustaining this crucial therapeutic work with
your clients in these difficult times.
Ann Beynon