Journal of Psychotherapy
and Counselling Psychology
Reflections
Reflections Research Centre
Volume 2
Number 1
January 2017
ISSN 2054-457X
Editor
Editorial Board
Dr Maria Luca
School of Psychotherapy & Psychology,
Regent’s University London, Inner Circle, Regent’s Park,
London NW1 4NS, UK
Dr Marie Adams, Metanoia Institute, London, UK
Dr Meg-John Barker, Open University, London, UK Dr Michael Berry, McGill University, Montreal, QC Canada
Dr James Davies, University of Roehampton, UK
Dr Lisa Doodson, Regent’s University London, UK
Dr Stelios Gkouskos, University of Surrey, UK
Dr Ralph Goldstein, British Psychological Society’s Register
of Psychologists specialising in Psychotherapy
[with senior status], UK
Professor Brett Kahr, Regent’s University London, UK
Dr Elaine Kasket, Regent’s University London, UK
Professor Desa Markovic, Regent’s University London, UK
Professor Martin Milton, Regent’s University London, UK
Dr Lyndsey Moon, University of Roehampton, UK
Dr Christina Richards, Nottinghamshire Healthcare
Foundation NHS Trust, UK
Dr Paul Smith-Pickard, Counselling and Psychotherapy
Private Practice, Dorset, UK
Dr Michael Worrell, Central and North West London
Foundation NHS Trust, London, UK
[email protected]
Managing Editor
Professor Helen Cowie
Emeritus Professor, Faculty of Health and Medical Sciences,
Duke of Kent Building, University of Surrey, Stag Hill,
Guildford GU2 7TE, Surrey, UK
[email protected]
Book Reviews Editor
Jane Wynn Owen
[email protected]
Editorial Assistant
Shirley Paul
School of Psychotherapy & Psychology,
Regent’s University London, Inner Circle, Regent’s Park,
London NW1 4NS, UK
[email protected]
International Editorial Advisory Board
Dr Geoff Denham, La Trobe University, Melbourne, Australia
Dr Andrew Geeves, Macquarie University, Sydney, Australia
Dr Theodoros Giovazolias, University of Crete, Greece
Dr Dennis Greenwood, University of Brighton, UK
Dr Martin Lečbych, Palacký University, Olomouc, Czech Republic
Professor John Nuttall, Regent’s University London, UK
Andrea Sabbadini, British Psychoanalytical Society, London, UK
Professor Carla Willig, City, University of London, London, UK
Aims and Scope
The Journal of Psychotherapy and Counselling
Psychology Reflections (JPCPR) is an international
peer-reviewed journal, underpinned by the
aspiration for a non-doctrinaire, pluralistic attitude to
psychotherapy and counselling psychology. It aims
to provide a forum for open debate and encourages
submissions from different traditions, epistemological
positions and theoretical modalities enabling the
development of a more open, reflective thinking to
philosophy, theory and practice of psychotherapy and
counselling psychology. JPCPR encourages critical,
broad and experimental interpositions in discussions
on psychotherapy and counselling psychology. It
tends to transcend the methodological and metatheoretical divisions. We welcome submissions
using both quantitative and qualitative methods,
including ethnographic, autobiographical, and
single patient or organisational case studies.
Journal of Psychotherapy
and Counselling Psychology Reflections
Volume 2 • Number 1 • January 2017
CONTENTS
Editorial................................................................................................................................................... 2
Clinical Supervisors’ Views on Facilitative Conditions in the Handling of
Sexual Attraction in the Supervision of Therapists
Maria Luca, Desa Markovic, Martin Lečbych, Marek Kolarik.......................................................... 3
International Students: A Minority Group at Risk in Need of Psychological Support
Sonia Gallucci....................................................................................................................................... 11
Starshine on the Critical Edge: Philosophy and Psychotherapy of Fantasy and Sci-fi
Christina Richards .............................................................................................................................. 17
E-Therapy: the Psychotherapists’ Perspective – A Phenomenological Enquiry
Imogen Koufou and Desa Markovic .............................................................................................. 25
The Relationship Between Research and Practice in Contemporary Attachment Research
Ian Rory Owen.................................................................................................................................... 33
Voyages into the Unknown: An Exploration Using Interpretative Phenomenological
Analysis of the Experiences of Returning Voluntary Migrants
Gareth Mason and Denise Ielitro..................................................................................................... 41
Book Reviews...................................................................................................................................... 49
Author Information............................................................................................................................. 50
Announcements.................................................................................................................................. 51
regents.ac.uk/reflections
2
EDITORIAL
As time goes on, the Journal of Psychotherapy
and Counselling Psychology Reflections is
evolving into a more confident and innovative
publication. Still in its infancy, this month it
is celebrating its first anniversary with yet
more scholarly contributions that include
research and theory papers by experienced
clinicians, academics and trainees.
The professions of psychotherapy and
counselling psychology are rapidly developing
a comprehensive research base relevant
to practice, providing a useful resource
for the professional community to draw
upon. The Journal aims to capture and
disseminate these developments widely.
I am delighted to welcome Jane Wynn Owen
as the book reviews and new series editor.
The Editorial Board is introducing two new
series: the first on One day in my life as a
psychotherapist/counselling psychologist
doing therapy and the second on My
experience as a trainee on an integrative
training programme. Submissions are invited
from all practitioners and trainees in the
professions. If you would like to contribute to
this new series by describing your personal
experience of doing therapy or studying on
an integrative course in 850-950 words,
We would be delighted to hear from you.
Published twice a year, the January issue
publishes papers on a variety of topics and
research methods, while in September it
is a Special Issue. Last year’s September
Special Issue consisted of papers on sexual
oppression, the theme of the 3rd Annual
Conference of the Reflections Research
Centre. This had an international perspective,
with papers from Canada, Australia and the UK.
For the Special Issue in September 2017, we
are planning to publish papers that will be
given at the Centre’s 4th Annual Conference
on Saturday 10 June 2017. This will explore
medically unexplained symptoms, otherwise
known as bodily distress, somatisation
or psychosomatic distress. If you would
like to contribute to this issue, please
submit your paper by the end of March
2017 on a topic relevant to the theme.
Finally, this issue is a tribute to the remarkable
variety of work that goes on in the field and
to those authors who supported the journal in
its first year, as well as to the Editorial Board
who offer their time generously in undertaking
peer reviews and editorial support.
Dr Maria Luca
Editor
3
CLINICAL SUPERVISORS’ VIEWS ON FACILITATIVE
CONDITIONS IN THE HANDLING OF SEXUAL
ATTRACTION IN THE SUPERVISION OF THERAPISTS
Maria Luca, Desa Markovic, Martin Lečbych, Marek Kolarik
Abstract
Background: Supervision of sexual attraction (SA) in therapy practice is an underinvestigated area. Supervision helps the learning and growth of supervisees. It is
therefore an important aspect of ethical practice. Aim: The study investigated the views
of UK existential and integrative supervisors working in private practice and training
institutions on the handling of SA. Methodology: Qualitative interviews were carried
out with twelve accredited supervisors. Transcripts were analysed using constructivist
grounded theory (GT). Findings: Supervisors referred to specific facilitative conditions
for effective supervision of SA. These were: supervisory alliance; containing and
supporting; normalising sexual attraction; creating a contemplative, open atmosphere;
constructively challenging. The core GT category encapsulating these conditions is:
Relational Supervisory Alliance. Participants tended to generalise with a focus on the
facilitative conditions for supervision of and engaged less with their own experience in
the handling of SA in the work of therapists they supervise.
Keywords: Supervision of sexual attraction in therapy, psychotherapists, constructivist
grounded theory, relational supervisory alliance
Introduction
the other hand, are always harmful, and are unethical.
It is widely acknowledged that therapists’ to clients and
clients’ to therapists (Luca, 2003) SA takes place. Research
shows that a high percentage of female and male therapists
acknowledge having experienced sexual feelings towards
their clients, (Pope, Keith-Spiegel, & Tabachnick, 1986).
Giovazolias and Davis (2001) found that 77.9% of counselling
psychologists were sexually attracted to at least one client.
76% of psychologists felt unprepared and uncomfortable
with these feelings (Rodolfa et al, 1994). Of those therapists
who experience SA to their clients a small number (9.4% of
men and 2.5% of women) become sexually involved with
clients (Pope, et al, 1986). Literature distinguishes between
boundary violations and boundary crossings. Gabbard &
Myers (2008) define boundary crossings as behaviours that
cross boundaries, but might benefit the client. Violations, on
Ethical codes of professional bodies (UKCP, 2009; BPS,
2009; BPC, 2011) prohibit sexual involvement between
therapists and clients and regard it as unethical with serious
sanctions such as permanent or temporary withdrawal of
accreditation and the license to practice (Pope, 2001). A
study on psychoanalytic psychotherapists’ views on sexual
involvement with clients post-termination, found disparity
of opinion. “Nonetheless, all the clinicians agreed that the
potential for harm resulting from post-termination sexual
involvements was great” (Shavit & Bucky, 2004, p.229).
Contacts:
The historical tendency in therapy to treat sexual feelings as
taboo is often driven by moralistic ideas (Luca, 2014). Pope
and Tabachnick (1993) found that therapists reacted with guilt,
shock, surprise, anxiety, fear of losing control, fear of being
Dr Maria Luca, Senior Research Fellow, Reader in Psychotherapy & Counselling
Psychology, Regent’s University London
[email protected]
Professor Desa Markovic, Professor in Psychotherapy and Head of Programmes in
Psychotherapy and Counselling, Regent’s University London
[email protected]
Dr Martin Lečbych, Associate Professor of Clinical Psychology,
Palacký University, Olomouc, Czech Republic
[email protected]
Dr Marek Kolarik, Lecturer of Clinical Psychology,
Palacký University, Olomouc, Czech Republic
[email protected]
4
criticised, frustration in not feeling able to speak openly about
sexual feelings and confusion about management of these
issues. Giovazolias & Davis (2001) state: ‘therapists’ reactions
are characterized by distress and that this distress may result
from a lack of acceptance of these feelings or of not knowing
how to manage them’ (p. 282). Because literature suggests
that sexual feelings are avoided, supervision becomes the
space where therapists can be supported to talk about them.
Supervision in psychotherapy is essential in client work. In
the UK it is a continuous professional requirement (Wheeler
& Richards, 2007) but is not always to the optimal benefit of
supervisees, especially where SA is at play (Ladany et al.,
1997). Ladany, Friedlander, & Nelson (2005) suggest it is the
supervisors’ ethical obligation to explicitly make SA a topic for
discussion.
The importance and value of supervision in therapy has
long been established. Its functions include instruction,
support, exploration and challenge linked with the aim of
producing positive effects (Hill, Sullivan, Knox, & Schlosser,
2007). Therapists who received supervision reported higher
counselling self-efficacy at post-test than those who did
not receive supervision (Cashwell & Dooley, 2001). The
supervisory relationship, particularly the alliance and repairing
ruptures, has a positive impact in encouraging supervisee
disclosure and self-exploration (Jeremy, Safran, Muran,
Stevens & Rothman, 2007).
Supervision normalising supervisees’ difficult reactions to
clients has also been linked with positive effects (Ladany et
al., 1997) and a strong supervisory alliance reduces trainee
anxiety and helps willingness to disclose (Mehr, Ladany &
Caskie, 2010, 2015). Thus good rapport and a working alliance
make the supervisory relatIonship more effective (Shuck &
Wood, 2011).
It is postulated that successful supervision is substantially
linked to the supervisory relationship (Beinart, 2012; Inman
& Ladany, 2008; Milne, 2009), regardless of the supervision
model adopted (Ladany, Ellis & Friedlander, 1999). Emerging
consensus suggests that a ‘good’ supervisory relationship
comprises a safe, secure base established by a consistent,
responsive supervisor sensitive to their supervisee’s needs
(Beinart & Clohessy, 2009) who supports supervisees to
‘explore’ and develop their competencies (Watkins & Riggs,
2012; White & Queener, 2003).
Ladany et al (1997) found that supervisee satisfaction is
associated with a positive supervisory relationship and
‘supervisor behaviors seem to greatly influence a supervisee’s
experience of supervision.’ (Ladany et al, 1999, p. 446).
Supervisor openness and immediacy strengthen supervisory
relationships and improve their work with clients (Knox,
Edwards, Hess, & Hill, 2011). The management of therapists’
anxiety which is linked to self-efficacy, is considered a primary
task of supervision (Mehr, Ladany, & Caskie, 2015). Worthen
& McNeill (1996) found that supervision seemed to build
supervisee self-confidence, fostered deeper understanding
of their work, enhanced supervisee ability to conceptualise
clients in more sophisticated ways and helped supervisees
intervene with clients.
Rationale for study and research questions
Research cited thus far highlights the benefits of supervision.
However, when SA is at play, not all supervisees utilise it
through disclosure and discussion. In a study on predoctoral
psychology interns, Ladany et al (1997) found ‘only half of the
participants disclosed their SA to supervisors, and supervisors
seldom initiated the discussion’ (p.143). It was trainees who
mostly initiated the disclosure of SA and reported that an
honest, supportive and good supervisory relationship enabled
them to disclose. Trainees who did not disclose reported
a negative supervisory relationship and imagined the
supervisor would not be supportive.
A noteworthy gap is the lack of research data regarding
supervisors’ attitudes/views to the supervision of SA. This
study contributes to the evolving research on supervision
by focusing on this area. This paper will therefore focus
on findings on the attitudes/views of supervisors, even
though the study covered various domains as can be seen
in the interview schedule. Other domains will be published
separately.
The interview schedule covered the following domains:
• What are your views on key principles for good practice in
the supervision of SA? Discuss situations as a supervisor
where you had the opportunity to support the handling of
SA in therapists you supervise. What strategy, if any, do you
use when supervising therapists to help them manage the
issue of SA to clients?
• How long did you work with the therapist and how did
disclosure or presentation of SA come about and presented
in supervision?
• Are there any specific issues you encountered in
supporting the handling of SA in the work of therapists you
supervise?
• What type of SA do therapists you supervise present in
supervision, e.g. client or therapist SA, or mutual SA?
• In your view do therapists you supervise find it easy/
difficult to talk about SA in supervision? What in your view
influences this?
• How does it help to bring up this issue during supervision?
• In your opinion, can talking about the issue possibly
complicate the situation?
• What factors can, in your opinion, hinder a discussion about
this issue in supervision? If you can, please tell us about any
examples you know of in relation to this supervision issue.
• What experience do you have with supervising this issue
with men/women? In your experience are there gender
differences in the readiness/ability to present SA in
supervision by therapists you supervise? Discuss. What
strategy do you recommend for managing a situation when
a man/woman comes to you with this problem? Is there a
difference in your approach depending on gender?
• Do you have any experience of a situation when the issue
of SA has provoked an ethical dilemma? Could you tell us
about the experience?
• In what circumstances would you recommend ending the
therapy because of therapist SA towards the client? What
influences your decision?
• Can you imagine any circumstances in which the client
and the therapist could consider entering into a mutually
intimate relationship? Discuss
Participants were informed that a transcript of the interview
would be sent to them to check for accuracy.
Ethics
The study was approved by a University Ethics Committee.
Participation was voluntary and participants could withdraw
at any time. Given the ethical issues salient to the study
such as disclosures by supervisees who may have been
sexually involved with clients, supervisors had been advised
that if ethical issues emerged during the interviews the
researchers may need to report these to the relevant
Journal of Psychotherapy and Counselling Psychology Reflections
body. They received an information leaflet explaining the
nature and scope of the study and they consented to the
recording of direct interviews and the use of anonymised
extracts from interviews for publication. Data was stored
on the researchers’ personal computer and was passwordprotected.
Sampling and recruitment
A database of the alumni of three training institutions
containing details of accredited UKCP psychotherapists was
used to circulate the recruitment flyer asking for volunteers
who met the recruitment criteria. We received only one
response, so we adopted snowball sampling, frequently
used to conduct qualitative research, through interviews
that are primarily explorative, qualitative and descriptive,
offering practical advantages, especially in accessing certain
difficult to reach populations (Hendricks, Blanken, Adriaans
and Hartnoll, 1992). The subject of the study may have
contributed to the low response rate.
The inclusion criteria consisted of supervisors with a
minimum of five years post-qualification supervision
experience. Thirteen participants volunteered, one dropped
out (no reason was provided) and the remaining were:
seven females, five males. Of the twelve volunteers, six
were existential, three psychodynamic, two integrative and
one systemic. Their experience varied from 10-25 years of
practice. All were experienced practitioners and worked in
psychotherapy training institutions and in private practice
(see Table 1). The participant who dropped out did so due to
serious illness.
Participant
Gender Modality
pseudonym
PostTherapy
qualification
experience supervision
years
experience
years
Jane
F
Psychoanalytic
28
20
Tom
M
Existential-phenomenological 25
20
Elizabeth
F
Systemic and psychosexual
therapy diploma
35
30
Betty
F
Existential-phenomenological 25
20
Dianne
F
Integrative (psychodynamic and 15
humanistic) and psychosexual
therapy diploma
12
Mary
F
Psychodynamic and
33
psychosexual therapy diploma
12
Mel
F
Integrative/psychodynamic
14
7
George
M
Existential
12
8
Mark
M
Existential
10
7
Claudia
F
Psychodynamic
15
10
Andreas
M
Existential
14
12
Peter
M
Existential
13
12
Average
19.9
14.1
Table 1
Participant Demographics
5
The researchers
One researcher is a UKCP registered integrative
psychotherapist and the other a systemic UKCP registered
psychotherapist with extensive post-qualification practice
experience and both are trainers in UK psychotherapy
training institutions. Two researchers from the Czech
Republic are experienced psychologists and academics at
a university in the Czeck Republic. Like other researchers
who seek out research methods that resonate with their
epistemological inclinations, but also provide relevant tools
for their studies, we chose a type of GT that permits fluidity
and considers the value of intersubjectivity (Charmaz,
2006). Our epistemological position is influenced by intersubjective, phenomenological principles, emphasising
the value of researcher and participant agency in the
construction of knowledge. Embracing researcher and
participant subjectivity, exercising human agency (Patton,
2002) and the belief that these enrich and provide a
meaningful and embodied understanding of human
phenomena have informed this research. We recognise
that our role as trainers may have been an obstacle to
participant disclosure on SA, a difficult subject with ethical
and professional implications. We tried to acknowledge this
during the interviews in the hope that it would minimise
participants’ need to try and impress or fear of disclosing.
Data collection and analysis
Semi-structured interviews which were carried out
individually generated extensive data. The interview
schedule was revised after two pilot interviews. The first
three interviews were transcribed and texts were read
several times by the researchers creating memos and
coding. This preliminary analysis helped refine and check
categories that emerged through subsequent interviews,
ensuring rich data generation. Categories were sent to
two independent researchers (the last two authors of this
paper) for checking before agreement was reached on the
categories best describing the data.
Guided by Patton’s (2002) idea that inductive analysis
consists of identification of patterns, categories and
themes emerging from the data instead of imposed before
data collection, an emerging pattern from constructs was
created (Figure 1). To establish the relationship between
the emerging categories and themes, axial and selective
coding techniques were applied and repeated on all
grouped themes, enabling the development of a conceptual
model that represented the data and made sense to the
researcher.
Method and methodology
GT principles and procedures were used to analyse the
data (Charmaz 2006). GT is designed to help researchers
generate categories from the data, compare and identify
links between them, so that ideas could develop, sharpened
through deep analytic stages (open coding, focused
coding, axial coding, selective coding) and generate
theory grounded in the data. The method is inductive and
researchers are guided by the data to generate conceptual
frames. The GT method evolved, but remained discovery
oriented. Researchers using a social constructionist
epistemology use the evolved constructivist GT (Rennie,
Phillips, & Quartaro, 1988; Charmaz, 2006). This approach
is suitable for exploring people’s interactions, actions and
meanings they construct of their experience, particularly
in areas which are under-theorised. GT theorising is data
driven.
The constructivist GT of Charmaz (2006) treats research
data as constructed, hence not an objective representation
of reality. Knowing, from this perspective, is mediated
Volume 2, Number 1, January 2017
6
through social interactions. The positioning of the
researcher in relation to participants, the context and
the social situation where data is generated are taken
into consideration in the final conceptual construction.
Charmaz’s (2006) GT is congruent with the constructivist/
interpretivist paradigm advocating that ‘human science
involves understanding as interpretation’ (Rennie, 1998, p.
134). Constructivist GT therefore actively repositions ‘the
researcher as the author of a reconstruction of experience
and meaning’ (Mills, Bonner, & Francis, 2006, p. 2).
Supervisory
space is where
the taboo of SA
needs to be broken
through a trusting
relationship
Creating
a relaxed attitude
Creating a
contemplative,
open atmosphere
Supervisors
must be more
ready to open up
such a difficult
issue
We create
together, a
space where we
can think, and we
can think about
meaning
Figure 1. Example of emerging pattern from constructs
Research design
The researchers developed a qualitative interview schedule
based on Charmaz’s (2006) GT intensive interviewing, which
‘permits an in-depth exploration of a particular topic…. and
thus is useful for interpretive inquiry’ (p.25) and her idea
that the quality and credibility of a study rests on the data.
A demographic questionnaire was included in the consent
form and was used to obtain information on participants’
supervisory experience, gender, theoretical orientation and
type of supervision practice.
Quality in qualitative research
The qualitative researcher is interested in illumination and
understanding not in causal determination or prediction
(Willig, 2007). To ensure trustworthiness qualitative
researchers apply standards of good practice. We adopted
Charmaz’s (2006) criteria for evaluating emergent theory
studies (pp.182-183) guiding researchers to ensure
addressing four specific areas: credibility, originality,
resonance and usefulness.
Results
The conceptualisation of SA presented in this paper outlines
supervisors’ views on how best to handle SA, in principle,
in the work of the therapists they supervise. It illustrates the
defined sub-categories capturing the meanings of these
principles for good practice. The core category emerged
through rigorous analysis of the sub-categories to ensure
it closely represents the context and underlying principles
guiding supervisors’ views on supervising SA.
Supervisors firmly believe in certain precursors to effective
supervision of SA, including the importance of personal
experience and maturity, as well as certain psychological
conditions in the supervisor to make supervisory handling
of SA effective. The views of supervisors tended to be
generalised, a finding suggesting that they focused very
much on principles of good practice and little on specific
examples. This section will focus on discussing necessary
conditions for effective supervision of SA that supervisors
identified (Figure 2), which also illustrates levels of
abstraction in the analysis of the data.
The analysis of data highlighted that supervisors had no
examples of actual disclosure of inappropriate crossing
of boundaries or of acting upon these by therapists they
supervised. Therefore the data generated focused on
specific principles informing the practice of supervision
and not on detailed description of specific examples.
These were formed into clustered codes that helped the
development of the five sub-categories shown in Figure 2
below. Supervisors’ approach consisting mainly of principles
of good practice are: forging a therapeutic alliance to create
a climate for constructive challenge, aiding the development
of a contemplative, open atmosphere, a fertile ground
for thinking reflectively, assisting in normalising sexual
attraction, an important attitude for encouraging disclosure
and helping them contain and support, a fertile ground for
processing and learning. These principles in supervisors’
approach were captured in the core category: Encouraging,
facilitative and non-judgemental handling of sexual
attraction.
Journal of Psychotherapy and Counselling Psychology Reflections
Due to space limitations only some extracts from some
interviews will be used to highlight how the sub-categories
were formed.
Sub-categories
Constructively
challenge
Examples from Codes
Constructive challenge
of the supervisee
Asking direct questions of supervisees
feelings and conveying the importance of
not blocking feelings
Supervisory space is where the taboo of
SA needs to be broken through a trusting
relationship
Creating a
contemplative,
open atmosphere
The alliance involves trust and respect:
We create together, a space where
we can think, and we can think about
meaning
If any of my supervisory relationships didn’t have a strong
level of that trust and respect, I’d probably question
whether we are right as supervisor and supervisee.
(Andreas).
Creating a relaxed attitude
Acceptance of the difficulty
in talking about it
Core Category: Relational Supervisory alliance
Encouraging supervisee to acknowledge
that her being attractive might be another
possibility that creates SA
I would be open that it happens to all
of us
There has to be a normalisation before
the supervisor can help
Talking about erotic interplay in therapy
can feel containing for the supervisee
Containing mode, affirming what’s been
done well and reassuring
Contain
and support
Checking it gives permission to talk
about it. Supervisee may feel threatened.
Talking can support them.
Gentle encouragement is important
I would encourage the therapist to, allow it
and allow the explicitness of this
In my approach to supervision there’s a
sense of we need to take this seriously
Supervisees have to trust and feel safe
that they can bring something and it’s
going to be taken seriously
Create facilitative
conditions
Talking about SA enhances supervisory
alliance further
I think what’s helpful, is not just talking about
it, but to create a safe environment where
you’re not being judged.
Supervisor’s sensitivity to power
imbalance is very crucial
Figure 2. Clinical supervisors’ handling of SA
in the work of therapists they supervise
Context: Necessary conditions for effective supervision of SA
Normalising SA
1.Supervisory alliance
The development of trust and a genuine interest in the
supervisees’ development, engaging non-judgementally
and displaying collegial warmth are fundamental in:
building the supervisory alliance; creating ground for
difficult issues, such as SA, to be disclosed and explored.
Emphasis was placed on the importance of a collegial,
trusting relationship as a pre-condition to exploring
difficult issues such as SA. Some participants believed that
knowing the supervisee well and their way of practicing is
an element in developing a relationship of trust. As Jane, a
very experienced supervisor, explains:
The first thing is I need to know my supervisee, how they
usually are in relation to usual clients, because that helps
me to identify when something isn’t quite right or not
being said.
Supervisors must be more ready, to open
such a difficult issue up
Naming what’s going on can break down
the taboo
7
Peter argued that:
If the necessary conditions are not created for real depth
of exploration of SA, it is ethically questionable taking
people’s money and time. The first thing that comes to
mind is supportive openness and faith. It’s within the
relationship; there’s a sense of mutual faith and trust
in each other’s practices and the things which inform
that faith are an acceptance of the fact that it’s difficult
sometimes and that frailty, fragility, vulnerability and going
into that territory is a way of witnessing that faith.
A trusting, safe relationship and gentle encouragement,
according to Mel, is necessary to help the supervisee trust
the supervision process:
Rather than the authority figure of the supervisor coming
down on someone, I like to try to be underneath holding
them. It’s like moving layers of strata of earth, in that I’m
trying to sift: what are we dealing with here? Is this a
safeguarding principle that needs some response or, is
this a deeply personal thing that is raised for this trainee,
the issue of her own sexuality?
If they trust the supervisor and they have permission
to talk about SA, that’s where I think the safety comes
in, because you’ve got a conduit there, where the
supervisee feels it’s perfectly okay to bring this to
counselling, and that starts to counter the shame or the
taboo of it. (Jane).
2.Contain and support
All supervisors alike spoke in a common voice of the
importance of containing the supervisee’s anxiety and
supporting them, qualities that encourage both disclosure
of and discussion of SA:
The main thing for me is going back to containment of the
supervisee, so that the supervisee has processed all this
material and then can again feel a bit freer with the client.
(Claudia).
Volume 2, Number 1, January 2017
8
I did somehow encourage him to accept that it could be
the case that there might be an attraction to him and that
it would be much better to let it be there, rather than hide
it from himself and that it doesn’t mean he should act on
it. (Betty).
Being supportive involves not being judged:
Because if they feel you’re judging, then they are already
judging themselves, and there’s already the shame of,
‘I’ve done something wrong (Claudia).
3.Normalising sexual attraction
Supervisors spoke of the fear and anxiety supervisees
present when SA is at play. They recognise that therapists
often regard SA as synonymous with unethical practice.
They spoke of the necessity to present SA as normal in
supervision so that exploration can become possible. Some
drew on their own experience as clients feeling sexually
attracted to their therapist to inform their supervisory
practice:
As a rule, any sort of attraction from the client to the
therapist, I would encourage the therapist to allow the
explicitness of this, rather than to push it or rationalise it
away. So for me in my approach to supervision, there’s a
sense of we need to take this seriously. This is based on
personal experience where I was sexually attracted to my
therapist. (Andreas).
Mary refers to using explicit language in a non-judgemental
way to normalise SA:
Not in a judgemental way, to say: ‘this happens and
let’s look at how we deal with it’. I ensure, right from the
beginning, that supervisees know that I will ask about SA
and what’s going on sexually in therapy. We normalise
by saying this will happen and there’s a useful purpose
to it. It’s the permission-giving to the client to talk about
attraction, and the whole gamut around sex.
Betty introduces the topic of sexuality and SA in the first
supervision session:
In the first session it always comes up and I make them
aware of the fact that we are sexual beings and it’s in the
room if you like it or not. It doesn’t matter who you are,
what age, what colour. I think that already creates a more
relaxed attitude and ease about sexuality per se. So I do
encourage them from the very beginning to accept their
own sexuality and the sexuality of their clients, that’s the
most important strategy for me.
Betty as a supervisor needs to feel comfortable herself
about the topic for it to be normalised by supervisees:
I think my age has something to do with it; I have gone
through my whole cycle of sexuality and I have a whole
life with examples to look at and there is hardly anything
which easily shocks me or couldn’t be talked about. I’ve
reached my grandmother stage, and that gives me a
more relaxed view on it. I radiate a lack of fear of talking
about it, and a lack of fear of it.
4.Creating a contemplative, open atmosphere
The atmosphere of supervision has to be well paced
and promote depth reflection according to participants.
Peter referred to a mindful attitude and a contemplative
environment as important supervisory conditions:
I use reflection, almost like pedagogy; it is to create a
contemplative atmosphere where the pace is slow and
to allow what’s embodied to become articulated; that
kind of mindful attitude. I think it harks back to the form of
dialogue which is an embodied experience as opposed
to the cognitive.
Peter adds:
I’m thinking of a woman who was feeling quite worried
and oppressed by a client who clearly had fantasies
about her and was sexually attracted to her; there was
fear in her, in how she should navigate her way through
this. My role, again, is to work with that because she
arrived at answers herself just by being given the space
to be able to articulate exactly what she was going
through in precise detail.
Claudia speaks of a thinking space:
We create together a space where we can think about
meaning. There is something about feeling mirrored,
feeling understood, feeling it’s a place where for the
first time, perhaps, you feel you can really relate to that
person.
Both integrative and existential therapists spoke in a
common voice in assigning reflection and thinking about
SA a central place in their work.
5.Constructively challenge
Supervisors mentioned constructive challenge as a
useful approach to enable supervisees to recognise and
acknowledge SA. Mark states:
Well, I think initially it’s about naming it, challenging the
supervisee in saying, perhaps there’s attraction there.
I remember her being quiet, and almost withdrawn, or
ruminating, you know; and almost not wanting to get
excited, in some way. But I think there was something
stirring, and so it was really letting her be with that.
Like Mark, Claudia is explicit in bringing SA to the fore:
It’s this anxiety which for me is really important again to
ground through gentle challenging.
Discussion
Participants referred to personal experience of supervision,
psychological maturity and readiness in themselves,
to help them evaluate effectiveness. They believe that
supervision must rest on an encouraging, facilitative and
non-judgemental handling of SA. Participant accounts were
generalised, focused on specific principles of good practice
and not on disclosures of SA acted upon by supervisees and
how they were handled by supervisors. This highlights that
therapists do not perhaps disclose crossing of boundaries
Journal of Psychotherapy and Counselling Psychology Reflections
9
or acting upon SA to their supervisors, or supervisors do not
disclose to researchers any possible therapist disclosures.
It also suggests the limitations in using direct methods of
information to elicit information on such a difficult subject
which may have professional implications for all involved.
ability to create a safe supervisory environment that contains
and supports, normalises, is characterised by a contemplative,
reflective atmosphere that allows constructive challenge
and encourages supervisees to enter into the psychological
landscape of SA if the dynamic is to be handled appropriately.
Participants viewed a relational supervisory alliance, (core
category) consisting of trust, collegiality, acceptance and a
safe environment, as the bedrock for safe exploration of this
clinical phenomenon. This finding confirms existing literature
(Shuck & Wood, 2011; Mehr, Ladany, & Caskie, 2015) showing
good rapport and a working alliance are at the centre of
effective supervision, enabling supervisee disclosure of
difficult issues.
Implications
Training modules enabling supervisors to experientially
grapple with issues around SA would be a useful way of
fostering confidence through highlighting research-based
principles of good practice. Supervisors need to be mindful
of the difficulty therapists feel raising the subject and adopt a
facilitative approach to helping supervisees work with SA.
Participants believed that a strong alliance involves building a
relationship where the supervisee feels safe to explore their
shortcomings and think about their anxieties without fear
of being morally judged. They emphasised that supervisors
must be aware of the imbalance of power in the supervisory
relationship, with its potential to present an obstacle to
disclosure and discussion of SA and create an environment to
counteract it.
Containing and supporting was given a prominent place
in supervisors’ view of the development of a facilitative
environment that contains anxieties, gives permission to talk
about SA and allows this clinical interplay the seriousness it
deserves. Some supervisors emphasised the importance of
gently encouraging the therapist to allow the explicitness of
SA to emerge. Another important condition found to influence
the development of effective supervision is normalising
SA. Some supervisors described this as giving permission
to talk about it, by explicitly stating that it happens to all of
us and that by naming it, the supervisor defuses the taboo
surrounding it. Creating a contemplative, open, supervisory
atmosphere where supervisor and supervisee can think
together collegially was seen as fertile ground for effective
supervision. Participants regarded the supervisor’s role as
educative, involving asking direct questions, especially if
the supervisor senses through clinical material the presence
of sexual interplay. They felt that tentatively checking and
sharing understandings with the supervisee, invites reflection
and exploration. Constructive challenge was regarded as an
important tool of supervision, as it stretches the supervisee to
think beyond their comfort zone.
Limitations
Although rich and dense data were generated from the
interviews, the number of participants in distinct modalities
was too small for meaningful comparisons. Our study was
not aimed at teasing out differences between modalities
in supervisors’ views on the supervision of SA. Participants
who volunteered may be those who were interested in SA
and through experience learned key principles of good
practice. However, these principles could be academic,
influenced by supervisors’ readings of the literature and the
need to conform and impress and not necessarily drawn
from personal experience. In terms of handling SA effectively,
supervisor views were too generalised. Larger, anonymous
survey type studies could potentially elicit a more rigorous
picture on both the handling of and modality differences in
supervising SA.
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11
INTERNATIONAL STUDENTS: A MINORITY GROUP
AT RISK IN NEED OF PSYCHOLOGICAL SUPPORT
Sonia Gallucci
Abstract
This article aims to provide an insider and outsider account of psychological
vulnerability of international students when encountering cultural diversity. The
term international students is used in this paper to indicate the specific population
of young adults who spend a part of their undergraduate studies abroad. Despite
the rising number of students moving between countries and an increased
research interest in international mobility, few studies focus on the particular state
of physical and emotional transition that this population can experience while
abroad. This state of transition can cause unforeseen psychological difficulties and
as a result it may affect their experience abroad and indeed their life thereafter. The
paper explores possible causes and consequences of psychological discomfort
experienced by individuals during a period of study abroad; it highlights some of
the current therapeutic approaches available for culturally diverse minority groups,
such as international students, and calls for more consideration of this particular
group of vulnerable students that are still largely neglected from research and
practices which take account of cultural dimensions in therapeutic and educational
settings. Indeed, it argues that the transitory experience of international students
who live in new social and cultural surroundings can be fostered by appropriate
emotional support.
Keywords: International students, year abroad, psychological vulnerability
Introduction
In the last decade I had the privilege to work with
international students as a teacher and as an academic
advisor, and to observe their particular ways of dealing
with cultural differences inside and outside the classroom.
My experiences with undergraduate students sometimes
bring me back to a period of my life when I was also an
international student living in a foreign country. Indeed, I
spent a year abroad in Germany as an exchange student
and I know, like my students, how it feels when living in
unfamiliar settings far away from ‘home’ for the first time.
Over the years, my lived experiences of cultural diversity
have led me to an increased interest in the connection
between individuals’ psychological traits and their cultural
backgrounds. This curiosity informs my daily practice as
a teacher and has accompanied me during my doctoral
studies, which focused on the emotional and social
dimensions of university undergraduate level language
learning during a period of study abroad experience
(Gallucci, 2014). More specifically, I explored the identities
and emotions of three British young women who lived in
Italy for one academic year as part of their undergraduate
course of study. The stories of the individuals, who
participated in my doctoral study, have shown that living in
new sociocultural realities and managing a sense of self in
contexts of relative disempowerment, entails considerable
personal struggle. Their stories have also shown that the
ways in which individuals deal with their struggles, and
particularly, the extent to which they manage to overcome
their emotional struggles, can be attributed to their personal
abilities and skills. These findings stirred my interest in
exploring the ways in which international students’ lived
experiences can be fostered not only conceptually and
analytically but also emotionally. Indeed, it is through a
deeper understanding of the ways in which individuals
can deal with language learning processes (intellectually
and emotionally) that we, as researchers, educational
practitioners and mental health professionals, can guide
students towards a positive learning experience, both
academically and on a personal level.
Contact: Dr Sonia GalluccI, Senior Lecturer in Italian & Cross-Cultural Studies,
Institute of Languages & Culture, Regent’s University London
[email protected]
12
Since the completion of my PhD in 2011, I have been
wondering whether international students’ ability to
adapt to new social and cultural realities can be fostered
by appropriate psychological help before and during
their experience abroad; and, subsequently, I have been
questioning whether the inability of some students to
integrate in the host society can be indeed the fruit of
inadequate emotional support. Hence, the focus of this
article, which aims to shed some lights on the emotional
consequences of international students when living abroad
and on the ways in which education and mental health
professionals, can help them before, during and after
departure.
International students:
minority group at risk
Over the last four decades the number of students spending
a period of study overseas has vastly increased, due to the
requirement of home universities to spend a part of their
studies abroad and also due to a more globalised world,
where movements of people between countries have
become more affordable and desirable (cf. Alred, 2003,
Berry, 1997, Byram & Feng, 2006).
The experience abroad definitely brings along a number
of benefits for international students, such as those
documented by Sherry et al. (2010), namely a valuable
opportunity for improving academic skills and expanding
social networks through “making friends at the University
[and] having positive relationships with Professors” (p. 45).
Allen and Higgins’ study (1994) showed how the positive
effects of such experience are also linked to students’
motivating factors to go and live abroad, which include
greater opportunities to travel and experience different
cultures, and the desire to receive a better education
and increase their job prospects (p. 11). Other important
factors emerging from the period of study abroad are the
development of linguistic proficiency and the heightening
of sociocultural awareness (Freed, 2008). However, the
usefulness of such experience in terms of personal and
interpersonal gains is not always clear and we still have
rather few research insights that document the advantages
of this “costly adventure in a new country. Scientific
evidence of the benefits of residence abroad […] is patchy
and does not always support a wholly optimistic view”
(Coleman, 1995: 17)
Hence, the prospect of voluntarily moving into another
country for study can be exciting, especially for young adults
who have never lived abroad before. However, anecdotal
evidence shows that as soon as they enter in contact with
the culturally demanding reality of new contexts, euphoric
feelings can easily turn into a state of confusion and cause
unforeseen psychological difficulties leading to an emotional
state of ‘culture shock’. The first representations of year
abroad individuals’ adjustment to new sociocultural realities
were provided by Lysgaard (1955) and by Gullahorn &
Gullahorn (1963) in the form of U-curve and W-curve models
respectively. The U-curve model describes four consecutive
phases of intercultural adjustment: euphoria, culture shock,
acculturation and stable state. The W-curve model includes
three further stages of sojourners’ re-adjustment when they
come back from their experience abroad: honeymoon, crisis,
adjustment.
Numerous attempts have later been made by scholars
in order to describe young individuals’ responses to
cultural difference, for instance, Bennett’s Developmental
Model of Intercultural Sensitivity (1986), which prompts
people to become ethnorelative by adopting multiple
cultural frameworks of reference; or most recently,
Matsumoto and Juang’s Intercultural Adjustment Potential
Scale (2008), which focuses on the psychological
mechanisms (such as openness, critical thinking,
flexibility and emotion regulation) that can facilitate
intercultural communication and personal growth.
While these models are of high value when trying to
understand the ways in which individuals perceive cultural
difference and how they can cope with the unforeseen
stress experienced when living in a new culture, yet they
somehow describe people’s intercultural experiences and
the necessary coping skills as a ready-made toolkit that can
be applied to anyone. What these models seem to overlook
is that individuals’ experiences of diversity, including cultural
diversity, are unique for each person, and it has proven
to be particularly challenging for novel travellers, such as
international students, who have no prior experience of
living overseas. Indeed, apart from their unsettling physical
transition, a change of status and the use of a different
language while abroad can cause additional emotional
distress, that can be comparable to a form of bereavement
(Anderson, 1994) as individuals may feel particularly
vulnerable for a perceived loss of an important part of
themselves, namely a loss of identity.
International students can be considered as a population
at risk that would need special consideration by host
institutions, given their unique needs, such as being
culturally understood and emotionally supported within
the local communities of practice (including the academic
environment). As Sherry et al. (2010) point out, when
international students move abroad, like many other minority
groups, they can experience several challenges “as a result
of language and cultural barriers, academic and financial
difficulties, interpersonal problems, racial discrimination, loss
of social support, alienation and homesickness” (p. 34). In
addition, they may also experience unequal opportunities
(or exploitation) in the host universities and emotional
misbalance when they go back to their home countries
(ibidem).
Sherry et al. (2010) conducted a quantitative study at the
University of Toledo among over 100 international students
to find out about their social, cultural and academic
experiences and how to improve them. From their findings
clearly emerged that a welcoming academic environment
was a key factor for their mental wellbeing. Other important
factors in successful intercultural adjustment were: language
proficiency, an inclusive (rather than exclusive) local
community, which understands and appreciates cultural
differences (such as the provision of Halal food on campus
for Muslim students) and social support to overcome
isolation. The study conducted by Sherry et al. (2010) is
insightful; however, they are aware of the limitations of
their study, since, due to its exploratory nature “there may
be a number of additional areas requiring research [such
as] specific gender, religious or cultural differences in the
experiences of international students”. (p. 44).
International students are more vulnerable than local
students and can therefore be considered a population
at risk. Moreover, they rarely seek psychological support
during their stay abroad since the majority of them are not
used to relying on professional help. In fact, as Lee (1999)
indicates “most of their home countries do not have a
history of providing or encouraging counselling, and many
international students seek help only as a last resort” (p. 41).
International students are people in transition because they
live temporarily in another country (Khoo et al., 2002). This
new reality of physical transition may lead them to unfamiliar
Journal of Psychotherapy and Counselling Psychology Reflections
emotional instability which in turn can be the cause of
psychological distress (cf. Furham, & Bochner, 1990). Indeed,
this state of cultural transition can cause a great deal of
life stress, and even when this transition is “positively
anticipated” (Lee, 1999: 36), it can still be the source
of ‘culture shock’ (Oberg, 1960) or ‘uprooting disorder’
(Zwingmann & Gunn, 1983). According to Lago (2006), these
problems “are not at all deeply understood or appreciated in
terms of the demands and pressures they place upon those
who suffer this process. At worst, culture shock can cause
breakdown and long term illness” (p. 392).
As mentioned above, many attempts have been made
across disciplines to conceptualise this phenomenon and
to provide a useful framework for individuals to overcome
culture shock (cf. among others Lysgaard, 1955; Bennett,
1986; Bredella, 2003; McCrae & Costa, 1987). However, a
specific theoretical model thought for this particular student
population is yet to be developed. Indeed, as Arthur (1997)
states, the current models of culture shock or cross-cultural
adjustments fail “to identify the specific experiences of
students […] [who] present a myriad of related psychological
and physiological symptoms” (p. 264-265).
According to Barty (2011), the main causes of the
psychological discomfort experienced by international
students are social loneliness, homesickness and cultural
isolation. The persistence over time of these symptoms
can be an alarming cause of concern since they can have
a serious impact on their wellbeing (p. 185). Some studies
also highlight the fact that international students may show
depressive symptoms when they perceive discrimination
and have a lack of social support and connectedness
(Hanassab, 2006; Mallinckrodt & Leong, 1992; Sawir et al,
2007; Wei et al, 2008). Other common factors affecting
their sojourn abroad are represented by financial and
communication problems, a lack of fluency in the target
language, and a lack of understanding of local practices
(Arthur, 1997; Yeh & Inose, 2003; Misra & Castillo, 2004;
Sherry et al, 2010).
Hence, international students are likely to face a great deal
of issues when they move abroad and subsequently, they
seem to be a population at high risk, who would need to
be emotionally supported before, during and after their
stay abroad. The provision of personal therapy offered by
their home and host institutions would surely enhance their
wellbeing and help them make the most of their experience
overseas.
Working with international students
When working with international students (as mental health
professionals or educationalists) we need to take into
account the distinctive and complex aspects that make
them a unique population. These include first of all, their
temporary stay in unfamiliar settings; secondly, the unique
set of values, beliefs and assumptions that they own; and
finally the distinctive social networks they do (or do not)
create around them and their specific communication styles
(Khoo et al., 2002).
There are currently various therapeutic approaches which
put a great deal of emphasis on the cultural dimensions of
the relationship between therapists and clients/patients from
minority groups; the most common ones are intercultural
therapy, multicultural counselling, cross-cultural psychology
and transcultural counselling and psychotherapy (see
respectively Kareem & Littlewood, 1992; Palmer, 2002 and
Gielen et al., 2008; Berry et al., 2011; Lago, 2011).
13
Although all of these approaches see culture as a crucial
component of individuals’ cognitive and emotional
behaviour, whilst appreciating the cultural differences of
minority groups, very little emphasis has been put on the
minority group at risk that has been presented in this paper,
namely international students. Preference seems to be
given to therapeutic practices in relation to racial, ethnic
and sexual diversity of individuals who live (or plan to live)
permanently in a specific place, whereas the identities of
young adults in transition between countries, such as those
of international students, seem to detain a small space in the
literature and in the therapy room (cf. Nayar-Aktar, 2015).
Despite the lack of clear evidence of working therapeutically
and ‘successfully’ with international students (cf. Jewel,
2002), some recent studies have provided interesting
insights into the world of this minority group and into
the ways in which therapists, willing to recognise and
appreciate cultural diversity, can help them overcome
psychological difficulties experienced during or after
their period of study abroad (see e.g. Arthur, 1997;
Arthur & Popadiuk, 2010; Barty, 2011; Butler-Byrd et al.,
2006; Heppner, 2006; Khoo et al. 2002; Park-Saltzman
et al., 2012; Seo, 2010; Vera & Speight, 2003)
Overall, becoming ‘culturally or multiculturally’ competent
seems to be the main goal of therapists working with
culturally diverse people (cf. Vera & Speight, 2003). Sue
and Sue (1990) recommend mental health professionals
to raise their sensitivity to the cultural differences of their
patients and to become aware of their own bias towards
diversity. Khoo et al. (2002) also recommend being aware
of and discussing the expectations that both counsellors
and clients have from their therapeutic encounters
and from each other, since unawareness could cause
“misunderstandings about their respective roles” (p. 101).
Thomas and Althen (1989) (cited in Khoo et al., 2002:
106-107), also warn about the distinctive issues that
therapists may encounter when dealing with foreign
students (particularly from Eastern countries). These are:
cultural stereotyping, the particular situations in which each
student finds him/herself, a possible difficulty in identifying
the source of their problem(s), and the doubts they may
have about the appropriateness of conventional (western)
approaches to therapy.
Indeed, students’ reluctance about unfamiliar therapeutic
approaches employed in the host societies can be a major
deterrent in their healing process. This is applicable not
only to international students, but also to other individuals
whose native cultural healing traditions are substantially
different from those they experience in new societies. For
instance, in countries commonly known as ‘collectivistic’
(or ‘communalistic’ - as defined by Laungani (2002) (e.g.
India, Thailand, South Korea, Colombia and Pakistan), great
emphasis is put on spiritual and supernatural practices,
whereas in ‘individualistic’ countries (e.g. USA, UK, Canada,
France and Germany) such practices are often dismissed in
the treatment of mental illness because priority is given to
more scientific and naturalistic practices.
The dichotomy between collectivistic and individualist
societies may seem a simplistic and overused way of
categorising cultural differences among individuals (cf.
Laungani, 2002); however, it has its own value when trying
to discern the origin of individuals’ archetypical patterns
of behaviour. For example, in a recent study based on
individualistic and collectivistic variables and conducted
among international students coming from South Korea,
Seo (2010) found out that her participants perceived
personal therapy to be more effective when their counsellor
Volume 2, Number 1, January 2017
14
emphasised their particular expression of emotions,
deriving from their own native culture. Another recent study
conducted by Park-Saltzman et al. (2012), highlighted how
Asian international students face unique issues due to
their cultural (collectivistic) beliefs and therefore, they need
a specific format of mentoring (p. 895). Moreover, as Barty
(2011) points out, in order to overcome students’ resistance
to Western practices of psychotherapy or counselling, it is
important to acknowledge that traditions of help-seeking and
help-giving may differ from society to society and that belief
systems ought to be validated within those traditions, that
often provide informal support, such as friends and family,
authoritative figures (elderly, religious or spiritual leaders)
and prayers. Indeed, as she states “Western counsellors
and psychotherapists, with their own theoretical cultural
frames, may undervalue or even be hostile to other helping
traditions” (p. 185). And this theoretical mind-set could
potentially be a deterrent for students seeking psychological
support while abroad. Other factors provoking international
students’ procrastination or avoidance of personal therapy
could include “concerns about confidentiality, a taboo on
discussing private concerns to someone outside immediate
family, perceived lack of relevance and perceived pressures
of time” (Barty, 2011: 189).
Hence, it is important to consider this minority group as
a unique population in need of further support during
their sojourn abroad. The enhancement of (inter)cultural
awareness seems to be a key factor in current practices of
counselling and psychotherapy among culturally diverse
individuals, such as international students. Hence, it is
essential for counsellors and psychotherapists to gain
knowledge about the specific cultural background of their
clients and to respect the specific ways in which counselling
practices are seen and applied in their ‘home’. It is also
important to help clients be aware of such differences and
to talk about them overtly. A mutual awareness of different
cultural traditions and an open dialogue about the nature
of them, can surely nurture mutual trust and enhance the
therapeutic relationship.
The specific needs of international students can be
addressed in numerous ways, not specifically labelled as
therapeutic. For instance, as Sherry et al. (2010: 44-45)
suggest, this can be done by promoting inclusive initiatives,
such as a ‘Student International Week’ or a page on the
University magazine dedicated to their experiences, such
initiatives would raise their profile on campus, would help
them become more involved and ultimately would tackle
social and cultural isolation. Access to local academic
support services (such as the National Union of Students
– NUS) could also be facilitated by more initiatives and
publicity on campus; or other government based services
available to all individuals (such as the Increased Access
to Psychological Therapies – IAPT) can be made more
visible and directly accessible to students. In addition, more
information could be embedded in curricula about “current
government legislation, funding and supporting practices
nationally for the delivery of racial equality in mental health”
(Lago, 2011: 4). Finally, additional programmes on crosscultural understanding could also help international students
feel more culturally understood and accepted within the
academic environment.
Being an international student
As I have briefly outlined in the introductory section of this
paper, I have personal experience of being an international
student. Indeed, over two decades ago (in 1994), I spent ten
months in Germany as an exchange student. At that time the
idea of spending an academic year abroad was a new one,
since it was introduced by the European Commission only
seven years before (in 1987) together with the academic
community in order to promote cooperation between
universities and to enhance employability within the EU
borders (Papatsiba, 2006).
In my home town, a small place on the island of Sardinia, not
many other students felt the same desire I had to explore
other realities. Moreover, this experience was encouraged
but not required by my home university. So in that period,
only a small number of undergraduate students decided to
go and spend part of their studies abroad. I was one of them.
Except for some basic linguistic knowledge, I knew very
little about the host society. I went to Potsdam University, a
place in eastern Germany, not far from the remains of the
Berlin Wall. My stay abroad was quite challenging, since I
had to deal with a great amount of practical but above all
psychological difficulties.
Upon my arrival to the host country, I initially noticed the
attitudes of local people which I considered to be more
distant and detached compared to the attitudes of people
back ‘home’. For example, I would go to public places such as
the local supermarket, the train station or pubs and members
of staff would not say hello or smile at me. On one occasion,
I recall not being served food in a pub because I was told the
kitchen was closed, and then seeing other local people being
served soon after. I also remember one of my ‘international’
friends, originally from Albania, being chased by neighbours
near a bus stop because they found out he was not German,
or another friend from Japan, being intimidated by local
students who used to write in red paint offensive words
against him on the student accommodation walls.
I clearly found myself in a quite hostile environment where
local people were not used to ‘foreign’ visitors, let alone
having international students living with them for long
periods. Certainly a perceived discrimination played an
important role in my lived experiences of otherness and in
my feeble (or no) attempts to integrate in the host society.
Other initial obstacles to my acculturation process were also
my lack of fluency in German and my lack of understanding
about local communities of practice. Hence, my limited
linguistic knowledge and cultural unawareness were
additional factors which impeded meaningful communication
between me and local people. This ‘temporary’ inability to
deal successfully with people around me caused me a lot of
stress and various psychological difficulties, including a high
level of anxiety and mild signs of depression.
I think my determination to succeed academically helped
me partially overcome these issues. Firstly, I surrounded
myself with other Italian students, who were spending,
like me, their year abroad in Potsdam; then, as soon as
I achieved a certain degree of fluency in German, I met
other international students and with one of them I also
had a romantic relationship. These factors obviously made
the whole process easier and more enjoyable for me and
helped me overcome some of the mixed emotions I felt as a
result of ‘culture shock’. When my experience abroad came
to an end I was more relieved than sad, as I thought that
going back home to the comforts of my previous lifestyle
would make me feel the same contented person I previously
was. However, what I did not know was that this experience
would change my life forever and that for a long time, after
my return, I would feel very confused about my identity, my
views and my feelings. A close circle of friends and the love
and care of my family helped me regain a sense of self and
settle again in my home country. However, the unexpected
experiences of cultural difference I had during my year
abroad have impacted me profoundly.
Journal of Psychotherapy and Counselling Psychology Reflections
As soon as I completed my undergraduate studies, I decided
to go and live abroad again in another country: England.
This time the decision was made more wisely as I prepared
myself cognitively and emotionally for the new adventure.
And here I am, still living ‘abroad’ after nearly two decades.
I am a more mature person now and I feel more prepared to
deal with cultural differences than I was in my early twenties.
I have dedicated time and energy into researching cultural
issues, as I am also doing in this paper, and I feel I have now
a more holistic and accepting stance towards diversity than
I used to. However, I cannot help sometimes feeling puzzled
and trapped in circles of cultural misunderstandings and
reliving the same sense of loneliness and homesickness that
I experienced when I was an international student.
Conclusion
In this paper, I have outlined some of the issues related
to international students as a population at risk in need of
psychological support. I have backed up my reflection by
exploring the possible causes of psychological discomfort
they may experience during their stay abroad, and by
highlighting some of the current therapeutic approaches
available for culturally diverse minority groups, such
as international students. I have also shared with the
reader some memories of my personal experiences as
an international student, with the main aim of providing
an insider account of psychological vulnerability when
encountering cultural diversity.
Anecdotal evidence suggests that international students are
often left alone to deal with the emotional uncertainties of
living in new sociocultural contexts, and as a consequence
they may feel psychologically and socially alienated.
Indeed, during their stay abroad, they may experience
unprecedented psychological difficulties, like I did, and be
overwhelmed by mixed emotions that they may find very
difficult to face.
We need more studies that focus on the emotional
experience of this minority group of young adults and on
the ways in which counselling and psychotherapy could
help them benefit from their sojourns abroad. We also need
more on-campus initiatives that promote inclusion among
all students (local and international), more awareness
of current legislation on diversity and more publicity on
mental and social support services available to students.
Tailored psychological support before, during and after
students’ experience abroad would certainly help them deal
effectively with unforeseen emotional discomfort and guide
them throughout their journey of doubts and uncertainties in
unfamiliar settings. Such support would also help students
increase their academic motivation and consequently
obtain better results. Indeed, on reflection, when I was an
international student, personal therapy would have certainly
helped me regulate my emotions and equip me with the
necessary coping skills to face cultural diversity (cf. Gross,
1998, 1999, 2002; Gross & John, 2003).
As a Senior Lecturer of Cross-cultural Studies and as an
academic advisor for Study of Period Abroad students, I
regularly witness a familiar sense of loss and uncertainty in
my encounters with current international students who are
living far away from their home country. I often feel powerless
because besides some theoretical knowledge I can transmit
during the lessons or sporadic (often) written contacts while
they are abroad, I am not in a position to offer them the
additional psychological and professional support they may
require. Indeed, within the UK higher education system, we
tend to prepare our students cognitively and theoretically
to the exposure of other languages and cultural practices
15
commonly used in the host countries. However, very little has
been done so far within educational settings in order to help
future international students regulate their emotions during
their stays abroad, for instance, by offering them emotional
support through appropriate counselling and psychotherapy,
which take into account cultural diversity. This, in my view,
ought to be a compulsory element of their experiential
preparation for the experience abroad.
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17
STARSHINE ON THE CRITICAL EDGE: PHILOSOPHY
AND PSYCHOTHERAPY OF FANTASY AND SCI-FI
Christina Richards
Abstract
Terry Pratchett once said that stories have power. This paper examines that power
through considering the philosophy which may be found within fantasy and sci-fi and
the psychotherapeutic implications of that philosophy. In particular, it considers what we
should do about the constraining nature of the Matrix from the Wachowski’s eponymous
film; The nature of good and god according to witches in Terry Pratchett’s Discworld
series; and what constitutes a worthwhile life to a time-travelling replicant in Rob Grant
and Doug Naylor’s Red Dwarf; It examines how such insights might be of assistance in
the quotidian world when, in the hope of some wider wisdom, our troubles lead us to lift
our eyes to the stars for answers beyond our ken.
Keywords: Fantasy, science fiction, psychotherapy, reflexivity, ethics, Terry Pratchett, The
Matrix, Red Dwarf, philosophy
Prelude
The fire burned low under the two-moon sky as dark
shadows crept in from the overhanging trees, bringing
with them the evening cold. Skettish poked at the embers
with the gnarled oak stick she kept with her always and
they raised a little heat, a few sparks ascending to die
somewhere in the darkness above.
‘There’s other places’ she sighed to the boy lying beside
her. ‘Others than this’. ‘Some brighter, some darker, but all of
them places for the search.’
forest below which faded to two, then one. It was noted as a
minor anomaly and logged accordingly, but did not pass the
threshold which alerted the crew; the compliment of which
currently consisted solely of Jones, M. (Cpt.) - a man of
impeccable record who was slowly losing his mind.
‘Anything?’ Jones asked as he strolled onto the main deck
munching cereal in a blue plastic bowl.
‘No Jones, nothing’ the ship’s computer replied.
‘The Search?’ the boy whispered his yellowing eyes peeping
out from under his tightly wrapped blankets.
‘Well what the hell am I meant to do then?’ he sputtered.
‘Is there no-one in this whole damn galaxy whose society
is sufficiently advanced that I can visit them and not screw
everything up?’
‘Aye, the search’. ‘Why, What, How and all that…’
‘No Jones, not yet’.
‘Life’ – she waved a hand vaguely – ‘What we should do.’
Jones sat down, sighed and rubbed his forehead. ‘Well what
the hell am I going to do?’ he repeated more quietly, but
with a growing desperation. ‘There’s just the two of us - and
you’re not even real.’
He shook a little as she rested her hand upon the sickly-wet
skin of his forehead to let the last trickle of her magic flow
into him - not enough for a cure she knew, but all that could
be done now. His breathing eased.
‘I love you grandma’ he said. ‘I’ll see what’s next now’, and
with that he died.
She closed his eyes and sat still and silent as the fire faded
to ash. As she started to weep a shooting star passed
overhead and faded. She didn’t look up.
‘Don’t you love me Jones? – You said you loved me.’
‘It’s not that I don’t love you’ he shot back, then paused and
seemed to deflate a little. ‘It’s just that you’re not real and I
think that should mean something – shouldn’t it?’
Aboard the XF-β the ship’s computer navigated the passage
between the planet and its moons without incident, the
whole vast expanse of the continent sliding under the ship
with the engines making barely a ripple in space-time. The
sensors picked up three heat signatures from an expanse of
Contact: Dr Christina Richards, Senior Specialist Psychology Associate, Nottinghamshire
Healthcare Foundation NHS Trust and Clinical Research Fellow.
West London Mental Health Trust.
[email protected]
18
Introduction
Are the stories over then? Are they just beginning? Do they
ever really end? Abide awhile with me and see. For if you’re
sitting comfortably O’ Beloved, then I’ll begin.
It is said that there are seven basic plots and that these
are: Overcoming the Monster; Rags to Riches; The Quest;
Voyage and Return; Comedy; Tragedy; and Rebirth (Booker,
2004). Each of these has a narrative arc and each, naturally,
contains a question: What am I to do about this? The ‘this’
may vary of course; It may be a question as to how to deal
with the grief of losing a loved one when all you have isn’t
enough; or to find the meaning of love and togetherness in
a postmodern world - as in the examples above - or it may
be a question about how a prim and proper wife is to stop
the vicar from finding the brigadier in the wardrobe who is
unaccountably not wearing any trousers. Mostly, however,
the questions, the themes of great literature, film, painting
and music – what we might call ‘the arts’, are at least
somewhat profound1.
We can see this in Shakespeare’s (1595) comedic fantasy
A Midsummer Night’s Dream, for example, which examines
themes of love (Bevington, 1996), identity (Hunt, 1986),
sexuality (Green, 1998), and feminism (Howard, 2003); and
which is echoed (and pastiched) in Pratchett’s (1992) comic
fantasy Lords and Ladies (of which more anon). We can see
it in ancient stories such as the Cad Goddeu (The Battle of
the Trees), in which each of the story elements represent
secret knowledge for transmission between members of
a persecuted druidic order (Graves, 1948). Indeed, most
religions weave myth, legend and history to create a guide
to a correct way of living, as well as to record information in
pre-literate societies. Such stories have power (Pratchett,
1990a) - the vision of the cobra keeping the rain from the
Buddha as he sought enlightenment is an arresting one;
as is the thought of Jesus being nailed through the hands
and feet to a wooden cross. Similarly, Nietzsche (1882)
conjures the image of the blind man with the lantern to tell
us (and to keep us told) that ‘God is dead’ and so impel us
to act accordingly. These stories carry with them on a sort
of narrative ‘carrier wave’ for profundity ideas about the
transience of our flesh; the illusion/delusion of our senses
and purpose of our existence with or without a God. Even
numbers, the basis of ‘hard’ science, may be considered
to be stories; for axiomatic to integer based mathematical
systems is the profound story that; ‘this is not that, it is
other’; thus we have ‘two’ instead of ‘one’. But such thisthat splits have been challenged by other stories about the
nature of reality in Buddhism (Conze, 1959), Christianity
(Galatians 3:28), and in contemporary science with the
advent of fuzzy logic (Kosko, 1994).
We make our own individual stories too. Stories to make
sense of the complexity of existence on a personal level McLeod (2006):
Stories are the basic way in which people make sense
of their experience …We tell our own personal tales,
but do so by drawing on a cultural stock of narrative
forms. We are born into the story of our family and
community, and the story of who we are (e.g. our birth
story, the story behind our name). As we grow up we
adopt narrative templates provided by myths, films,
novels and other cultural resources to give shape and
meaning to our individual life narrative. (p 290)
Thus people create stories of identity in concert with
their surroundings; they construct narratives that fashion
1 We might argue that farces are too in that they prick holes in the
constructed nature of so much of our social lives.
the past into something that can coherently explain and
determine their life trajectory. This fashioning is subject
to external influence from culture (Gergen, 2000) and
cultural determination by what Foucault (1991) styles as a
‘panopticon’ society in which people monitor and police
the boundaries of acceptable social behaviour through
introjecting their own panopticon prison where they are
monitored constantly by an internalised other2.
Because such stories and personal narratives are
constructed - deeply constructed from the material which
shapes our realities, but constructed nonetheless - they
are open to change. This may be personal, perhaps the
change which comes from reading about others who
suffer, or finding friends in characters in other [narrative]
realities (Salvatore, 2011); or it may be through therapeutic
intervention, perhaps in the form of phenomenological
enquiry (Langdridge, 2013) or narrative therapy (White
& Epston, 1990). These may be particularly apposite in
exploring culturally derived stories that do not fit comfortably
with an individual and so create space to constitute new
stories. Indeed, one of the United Kingdom’s Health and
Care Professions Council’s main constituents of Counselling
Psychology is that practitioners “Understand how empathic
understanding can be helped by creativity and artistry in the
use of language and metaphor” (2012, p.10).
We create art, whether it is for entertainment and edification;
or whether it is the stories we tell internally as we paint
ourselves heroes in adversity, or as Cinderellas when life
throws one more stone in our shoe. When it is written, and
written well, it is often art such as this which reflects life
and the deep currents which move us, and so is of concern
to philosophers and psychotherapists alike3. Stories have
power4: And the further they move from the minutiae of the
everyday towards the extraordinary (but an extraordinary
we can relate to), the more our suspension of disbelief
allows new insight to emerge through dispensing with petty
specifics. This is why religions are fantastic. This is why
fantasy and sci-fi are the root of a new philosophy - and
perhaps a new psychotherapy from that.
This is the starshine on the critical edge. Let’s dive a little
deeper towards that inviting gleam…
The Matrix
Where do we exist? Is there a world out there we can see
and touch and hear and taste and smell? That we can
measure? That, crucially, we can change? In most realities
such things are nebulous – worlds exist a priori and so at
best our touching approximates a guess at what we have
touched; our changes a hope, a fumble in the dark of
supposition as to what has really been altered. In worlds of
light and laws inside computer networks, however, realities
are constructed which offer hard boundaries to those
who simply visit – and so offer comfort in their predictable
regularity. But such virtual worlds offer something more,
something deeper, to those who see and swim the liminal
places which complexity and chaos in networks of hard laws
offer – the opportunity to really change, in ways at once
both complex and boundaried. Indeed, when one can swim
such liminal places on hard-law virtual networks the further
question arises: Perhaps outside of such places too - in the
real world – might there not be more latitude for change
2 Another arresting image to carry an idea.
3 Indeed some of us try to wear both hats, with varying degrees of
success - as anyone who has tried to wear two hats will know. A
woolly hat and a climbing helmet just about works, but what that
means is perhaps too profound for this paper.
4 I shall say this thrice.
Journal of Psychotherapy and Counselling Psychology Reflections
than we realise? It is in The Matrix (Silver, Wachowski
& Wachowski, 1999), amongst other places that some
answers are offered to these most fundamental of questions
concerning the possibilities afforded to people in a given
reality.
The Matrix was a hugely successful film which spawned
two sequels and a number of spin-off productions. Set
in the near future it tells of a chosen human - Neo - who
is encouraged to come into his power by a free human,
Morpheus, in order to fight back against the sentient
Machines who are holding most of the human race in
bondage. Neo is able to do this through entering the means
of that bondage - the Matrix - A computer generated fantasy
world fed directly into the interconnected brains of humanity
even as they lie physically dormant in the ‘real world’.
Because Neo is aware that the Matrix is not real, and is
instead created, he is able to bend its rules and so to have
extraordinary powers - whereas the rest of humanity remains
caught within the Matrix’ limits. The Machines, led by a
computer generated person - ‘Agent Smith’ inside the Matrix
- endeavour to stop him as he tries to break it from both
within and without and so free humanity. Naturally, inside
the Matrix everyone who is aware of the Matrix is incredibly
cool, whereas the computer generated Agents look like
stereotyped government workers in dull suits and ties5.
The Matrix then. A computer generated reality which is
possibly true (Bostrom, 2003) and leaves us considering the
ways in which we may be held hostage by the reality we
find ourselves in. It is, perhaps, a little fantastical, but does
this idea of matrices manifest in more mundane ways? What
if, for example, when Morpheus told Neo of the Matrix he
simply offered it as an insight into the gender dichotomy the idea that there are only men or women and that they are
fundamentally different in kind and not degree, with different
needs, [sexual] desires, and identities; all independent of
cultural context (cf. Fine, 2011). If he offered an insight into
the Heteronormative Matrix, if you will.
MORPHEUS
Do you believe in fate, Neo?
NEO
No.
MORPHEUS
Why not?
NEO
Because I don’t like the idea that I’m not in
control of my life.
MORPHEUS
I know exactly what you mean.
Again, that smile that could cut glass.
MORPHEUS
Let me tell you why you are here.
You are here because you have the gift.
NEO
What gift?
MORPHEUS
I’ve watched you, Neo. You do not use
critical theory like a tool. You use it like it was
part of yourself. What you can do with critical
theory is not normal. I know. I’ve seen it.
What you do is magic.
Neo shrugs.
NEO
It’s not magic.
MORPHEUS
But it is, Neo. It is. How else would you
describe what has been happening to you?
He leans forward.
5 OK, and like Elrond, but that came later…
We are trained in this world to
accept only what is ‘rational’ and ‘logical’.
That there are men, and there are women,
and that they each have their separate
roles and responsibilities. Have you ever
wondered why?
Neo shakes his head.
MORPHEUS
As children, we do not separate the
constructed from the unconstructed which
is why the younger a mind is the easier it is
to free while a mind like yours can be very
difficult.
NEO
Free from what?
MORPHEUS
From the Heteronormative Matrix.
Neo looks at his eyes but only sees a reflection of himself.
MORPHEUS
Do you want to know what it is, Neo?
Neo swallows and nods his head.
MORPHEUS
It’s that feeling you have had all your life.
That feeling that something was wrong with
the world. You don’t know what it is but it’s
there, like a splinter in your mind, driving you
mad, driving you to me. But what is it?
The LEATHER CREAKS as he leans back.
MORPHEUS
The Heteronormative Matrix is everywhere, it’s all around us, here even in this room.
You can see it out your window, or on your
television. You feel it when you go to work,
or go to church or pay your taxes. It is the
world that has been pulled over your eyes to
blind you from the truth.
NEO
What truth?
MORPHEUS
That you are a slave, Neo. That you, like
everyone else, was born into bondage... ...
kept inside a prison that you cannot smell,
taste, or touch. A prison for your mind.
Adapting the script we might have:
MORPHEUS
19
Outside, the WIND BATTERS a loose PANE of glass
MORPHEUS
Unfortunately, no one can be told what the
Heteronormative Matrix is. You have to see it
for yourself…
‘A prison for your mind’. Wrapped up in beautiful coats and
sunglasses, drawn by stunning martial arts wirework and
360° photography, we have that central idea: ‘A prison for
your mind’. In the film Neo first finds himself thrown into
a certain world, apparently utterly delimited. That is until
Morpheus frees him by showing us that it is a ‘prison for
your mind’ – that his thrown world is not so concrete after
all. In the computer-generated Matrix it is, quite literally, that
there is nothing either good or bad, but thinking makes it so
(Shakespeare, 1599), and yet when we consider constructs
such as the heteronormative matrix that have so little
basis in non-constructed objectivity (Fine, 2011) our realties
too may bend at the edges. How much effort is put into
differentiating between men and women, boys and girls,
though clothing, toys, magazines etc? Why does this change
so much over time and culture? (Connell, 2009). What
‘wool do we have pulled over our eyes at church and when
Volume 2, Number 1, January 2017
20
we pay our taxes’? Similarly, what about the matrices of
capitalism? (Chang, 2011); The valence of things as ‘good’ or
‘bad’ (Conze, 1959; van Deurzen, 2008); or our place under
heaven and over hell/ at the centre of the planetary system/
universe.
As Neo so eloquently puts it; “Whoa!”
What The Matrix shows us6 is that that which appears to
be self-evidently true may not, in fact, be so. In this way
it returns to a pre-war existentialism which allowed for a
greater degree of nauseous freedom (Sartre; 2000 [1938]),
although Neo too is somewhat bound by his facticity (he
can’t simply destroy the planet for example), but his limits
are wider than those inside [a given] Matrix can possibly
comprehend. This is because he is able to see, and choose,
true paths because he is both part of the Matrix; and also
apart from it – he has trained to see his worlds, he doesn’t
merely exist in it. This means he can, to some extent, bend
the rules which govern it. His insight allows him to adapt his
environment, to see the spaces in which he may act, in order
to kill his artificial intelligence nemesis within the Matrix and
so free the humans still in bondage. He can, if you will, hack
his reality.
Of course, these stories of the possibilities of different
realities, and the bridges between them, reach back to
the burial rites of prehistory (Pettitt, 2002) and through to
the belief systems of the modern day (e.g. Hubbard, 2007
[1956]). They are the stories of the other places we go to and
what we can, and must, do both there and here. They are
central to much religion, culture, and morality and so offer
guidance – a path, if you will. But they are many times a
limited path to wisdom (and one which obscures more than
it illuminates) for all too often they are paths of what one
must do, rather than paths of choice towards some ethical
end.
When we are with clients then, what unitary paths, what
matrices, are we inhabiting? How often are we acting
the anonymous, computer controlled, government agent
‘Smith’ complaining about; ‘The smell… the smell’ as our
clients explain all their messy complexity and we try to
reduce it to a simple formulation, diagnosis or intervention
– to collapse the opportunity of perception into the neat
fallacies of comprehension? This is not to say we should
not act of course – these stories also teach us that simply
‘staying with’ is a form of slavery to the mundane. Instead
we have to act, but to act with the awareness that there are
more things in heaven and earth than are dreamt of in your
philosophy (Shakespeare, 1599); and so to do so with the
humility, caution and the attempt at sensitive insight which
this invites.
Terry Pratchett
From virtual worlds residing in silicone and light to another
world in another reality:
Pratchett’s7 Discworld is a land consisting of a disk
with oceans at the edge and a ten mile high spire of ice
in the centre on which the Gods reside. Naturally, all of
this is set on the back of four giant elephants atop the
shell of the Great A’ Tuin the Star Turtle “…which exists
6 Aside from the fact that sunglasses will always be cool and that
evolving models of mobile phones won’t be.
7 Pratchett sold over 65 million books in 37 languages (Smythe,
2011) and sadly passed away on March 12th 2015. Whatever one
thinks of his genre he was arguably nonetheless a philosopher
of our age (He also has a fossil sea-turtle from the Eocene
epoch of New Zealand named in honour of him - Psephophorus
terrypratchetti).
either because of some impossible blip on the curve of
probability or because the gods enjoy a joke as much
as anyone. More than most people, in fact” (Pratchett,
1988a p.13). The discworld has its usual fantasy
compliment of wizards, dragons, goblins and fair
maidens, and yet Pratchett turns those ideas on their
heads. Wizards there don’t do much magic and instead
“…prefer administration which was safer and nearly
as much fun. And also big dinners.” (Pratchett, 1988a
p.14); Dragons are an endangered species (Pratchett,
1990b); Goblins an oppressed minority (Pratchett, 2011);
and fair maidens may well turn out to be [variously]
the daughter of Conan the Barbarian (Pratchett,
1988a); a werewolf (Pratchett, 1990b); or indeed the
[adopted] daughter of Death in his ‘anthropomorphic
personification’ of the grim reaper (Pratchett, 1988b).
In such a world, humour, fantasy and philosophy intertwine.
What are we to make of the Great God Om who, when
endeavouring to manifest as a raging white bull, in fact
manifests as a small tortoise who ends up being carried
about by a devout Omnian called Brutha? Pratchett tells of
the tortoise’ journey through the great citadel of the religion
of Omnism in the centre of the vast holy land of Omnia - it
is a citadel bustling with the business of religion, with shops
and administrators, gardens and orchards, torture chambers
and bureaucracy. Pratchett writes thus: “And the thing about
Brutha’s flame of belief was this: In all the citadel in all the
day, it was the only one the God had found”. (Pratchett, 1993
p 91). We can imagine this readily enough in such a fantasy
setting – the bustle of the city in the desert heat, the magic,
the silliness. Our minds do not rebel. But transpose this to
the business of religion on earth, (any will do); or perhaps
you prefer government; or healthcare; maybe the business
of business? The stifling bureaucracy which loses sight of its
aim and so simply becomes self-perpetuating: The resultant
shell which, though shining in seeming wellness, has all
the depth of a Christmas bauble. Such shells are matrices
too - trapping people in seeming without being; in grand
narratives (Lyotard, 1984 [1979]) and structural ‘traps’ (cf. de
Saussure, 1983 [1916]) without the existence or the essence
(cf. Sartre 2007 [1946]) but only [the idea of] the next phone,
the next handbag (with the right label) – bought not for
an interest in tech or actual fashion, but because of the
business. In all the city in all the day how many people know
the chip architecture of their ‘must have’ new phone or the
thread count of their handbag’s cloth? How many are true
believers, and so act on that belief? How carefully should
we puncture such client’s shells? What cost looking into that
abyss, for the client, and for us? (Nietzsche, 1886).
Pratchett carried this theme of seeing deeper - seeing
‘what’s really there’ and ‘doing the job that’s in front of you’
throughout his work. Whether it is in the pragmatic decency
of Sam Vimes, the commander of the city watch (who is
recovering from alcohol addiction8); or the indifference of
the Tyrant of the city of Ankh-Morpork towards different
species settling there (Dwarfs, Trolls, Vampires9, etc.) and
his refusal to accepts ‘speciesism’ provided they pay tax
like everyone else. Similarly, when the head witch10, Granny
Weatherwax, is caught in a magical maze of reflections and
has to find the true her - she can see what’s real. She simply
looks down and says; ‘This one’ (Pratchett, 1992).
8 Yes it’s a trope – Pratchett’s knowing winks and twists to tropes
were a part of his genius.
9 In recovery naturally, no blood – support groups and substitute
obsessions instead.
10 “[Witches] certainly don’t have leaders. Granny Weatherwax
was the most highly regarded of the leaders they didn’t have.”
(Pratchett, 1989, p.7)
Journal of Psychotherapy and Counselling Psychology Reflections
Of course, knowing ourselves is a notion from ancient
philosophy – from the Oracle at Delphi’s injunction; γνῶθι
σεαυτόν (gnōthi seauton – know thyself) through Newton’s
experiments on his own senses (1669), to Wundt’s
introspection (1893), and on to modern day reflexivity
(Etherington, 2004). Of course what is ‘real’ may vary from
person to person – and our fears may be very real to us, if
not to others - consider phobias for example. The question
is how to deal with what we see; with our realities. This is
a complex point which bears exploration. Pratchett isn’t
asserting that there is a fundamental reality – an a priori
Kantian reality (Kant, 1781) - but rather that there is a reality
which exists both within our minds and outside (almost our
conscious and unconscious perception of the world) and we
had best deal with it rather than hiding in a matrix of other’s
making (though of course we are necessarily somewhat
constrained by being in the world with them and they with
us (cf. Heidegger, 2008 [1962]).
Granny Weatherwax utilises this philosophy in her ideas
concerning facing our realities as a means of addressing
problems in living (cf. Laing, 1969):
Granny Weatherwax had never heard of psychiatry and
would have had no truck with it even if she had. There
are some arts too black even for a witch. She practiced
headology - practiced, in fact, until she was very
good at it. And though there may be some superficial
similarities between a psychiatrist and a headologist,
there is a huge practical difference. A psychiatrist,
dealing with a man who fears he is being followed by a
huge and terrible monster, will endeavour to convince
him that monsters don’t exist. Granny Weatherwax
would simply give him a chair to stand on and a very
heavy stick. (Pratchett, 1995, p.258-259)
Such pragmatism resonates with those of us who despair
of the corporatisation of the therapeutic endeavour and
would like to see people able to march to their own drums,
albeit as and when they want to and in more comfortable
shoes. But this approach is a hard thing, especially for the
geographically, socially or intellectually isolated therapist.
Pratchett explores it in the grounded, vicious, good of the
witches who simply do what needs to be done whether that
is delivering a baby, curing a disease or killing a murderer;
and who then go and visit each other to politely have tea
and ensure those things don’t get mixed up. Pratchett is
careful of power here. Of ill-used power hiding behind a
title11 or an idea12 (cf. Pratchett, 2003); and especially of
evil hiding behind a lack of discipline and self control. In
Carpe Jugulum we hear two witches discussing Granny
Weatherwax:
Sometimes I recon she’s terrified she’ll go bad without
noticin’
Granny? But she’s as moral as –
Oh yes she is. But that’s because she’s got Granny
Weatherwax glarin’ over her shoulder the whole time.
(Pratchett, 1998, p.88)
Similarly, the Duke of the city-state of Ankh-Morpork and
Commander of the City Watch Sam Vimes when talking to a
city inspector:
‘Quis custodiet ipsos custodies? Your grace.’ ‘I know
that one’ said Vimes. ‘Who watches the watchmen?’
‘Me’, Mr Pessimal.
11 Counsellor, Doctor, Psychotherapist, Social worker or Nurse
perhaps?
12 Psychodynamic, cognitive-behavioural, existential, gestalt,
medical… perhaps?
21
‘Ah but who watches you your Grace?’ said the
inspector with a brief smile.
‘I do that too, all the time’ said Vimes. ‘Believe me’
(Pratchett, 2005, p.26)
Notice that ‘glarin’’ of Granny Weatherwax and the ‘Believe
me’ from Sam Vimes – this isn’t an acceptance of reflexivity
being done because she has chatted to another witch or he
has been inspected by the city. In the case of the witches
Pratchett has Granny Weatherwax take it upon herself, and
fully, to ensure she doesn’t ‘go to the bad’. It’s not about
the conversations with others – it is about the actions the
other witches would take if they found a bad one. And
similarly with Vimes’ officers as when he wishes to kill a
murderer personally but is reminded that “Personal isn’t
the same as important” (Pratchett, 1993 p.271); and again
when, in Lords and Ladies Granny Weatherwax is invited
to continue a dalliance rather than dealing with a band of
marauding elves and similarly says: “Personal’s not the
same as important. People just think it is.” (Pratchett, 1992,
p. 228)13. It isn’t that either of them has simply thought
about matters reflexively – it is that if Granny Weatherwax
thought she was ‘going to the bad’ she would take herself
off to a cave in the mountains to die lest someone get hurt
(Pratchett, 1998); or Sam Vimes would hand his badge
in and most likely die of alcoholism. They recognise the
power, and the cost, and are prepared to pay it with their
eyes open – going through the motions simply won’t do.
That’s supervision and reflexivity!
Pratchett continues with this theme of vigorously
maintaining one’s integrity as a part of a recognition of the
possibility of ‘good’ and ‘bad’ in everyone and the need to
deal with people in all their messy complexity. The idea of
people being more than simply objects (which are far easier
to deal with), but rather complex, interconnected and,
above all, human beings is reflected in Granny Weatherwax’
words to Pastor Oats in what later became his Testament
from the Mountains:
Sin, young man, is treating people as things. Including
yourself. That’s what sin is.14 (Pratchett, 1998 p.210)
Which is again reflected in Pratchett’s writing about the
Tyrant of the city of Ankh-Morpork’s thoughts about the
people of the city:
‘Down there’ he said ‘are people who will follow any
dragon, worship any god, ignore any iniquity. All out of
a humdrum everyday kind of badness. Not the really
high creative loathsomeness of the great sinners, but
a sort of mass produced darkness of the soul. Sin, you
might say, without a trace of originality. They accept
evil not because they say yes, but because they don’t
say no’. (Pratchett, 1990b, p.302)
This is of course a narrative symbiosis of Pastor Niemöller’s
famous speech ‘First they came for the socialists…’ (c.1946)
and Buber’s (1958) notion of the need for I-Thou relating in
which one sees others as whole humans and not objects
- both notably penned in response to the horrors of the
holocaust of the second world war. Further, the ‘including
yourself’ in Granny Weatherwax’ speech above relates
to Cooper’s (2003) expansion of Buber in his notion of
I-Me relating, in which we relate to ourselves in a way
which recognises our own humanity, rather than seeing
13 What would they make of BACP members being “encouraged”
to get professional indemnity insurance (BACP, 2010, p.8) rather
than instructed to (and so have their clients mandatorily financially
protected)?
14 In my [slightly] humble opinion one of the wisest quotes in
modern literature.
Volume 2, Number 1, January 2017
22
ourselves as a ‘thing’ too. This then, is key in our client
work - our messy realities in the consulting room, especially
those consulting rooms with worn cloth on the seats and
an institutional clock ticking the few minutes to the next
client, and the next, and the next… The avoidance of sin,
howsoever formulated, must be in meeting the client as a
person, and encouraging them to do the same.
Perhaps Pratchett’s ultimate existential philosophy, and
injunction to act accordingly, comes in the form of the
anthropomorphic personification of the grim reaper – Death15.
In his 1988 book Mort Pratchett had Death say: “THERE’S NO
JUSTICE THERE’S JUST ME16.” (p.207) in a response to the
various entreaties he has to fix the world of the living. With
this as an absolute, with no divine assistance coming (except
perhaps from disgruntled Testudines – see above) his players
must act upon their own morality and make of their lives what
they will. There is a clear message for psychotherapy here
which resonates with existential psychotherapist Irvin Yalom’s
notion of being ‘love’s executioner’ (Yalom, 1989) and his
requirement for flexibility in the outlook of religious clients
(Yalom, 2002): A client who is rigid in their certainty of much
aside from the notion of death – the ‘justice’ Pratchett refers
to - cannot change, whereas a client who does not hold such
beliefs, can. This is not to say that there are not boundaries
in our lives which we are circumscribed by (see below), but
rather that an all encompassing belief system, especially once
concerning natural justice, may hamper a client’s efforts at selfdetermination.
With regards to this, it is notable that in 2007 Pratchett
announced that he was suffering from the posterior cortical
atrophy which would eventually take his life. Since that time
he became a vigorous advocate for the right to die in a
manner of one’s own choosing – a right not for himself, as
he was aware that he had the means to make this happen
independently - although this proved unnecessary - but for
others who do not have that option for their ultimate self
determination (Pratchett, 2010).
Red Dwarf
In life, and perhaps in death, how should we self-determine?
What constitutes a life well lived? Rob Grant and Doug
Naylor (1992) offer us an answer in the form of a question
in The Inquisitor - episode two of series five of their cult
television series Red Dwarf. Red Dwarf is set three million
years in the future on board the eponymous mining
spaceship. The ‘Dwarf is controlled by the genial ship’s
computer Holly and, since the crew died in a radiation leak,
the ship’s compliment consists of the last human alive –
Dave Lister; a hologram of his dead bunkmate – Arnold
Rimmer; a neurotic android – Kryten; and a humanoid
evolved from the ship’s cat known simply as ‘Cat’. In The
Inquisitor an android boards the ship and the crew turn to
Kryten for an explanation:
Well, the legend tells of a droid, a self-repairing
simulant, who survives till the end of eternity, to the
end of time itself. After millions of years alone, he
finally reaches the conclusion that there is no God, no
afterlife, and the only purpose of existence is to lead
a worthwhile life. And so the droid constructs a time
machine and roams eternity, visiting every single soul
in history and assessing each one. He erases those
who wasted their lives and replaces them with those
that never had a chance of life, the unfertilised eggs,
the sperms that never made it.
15 Who naturally has a horse called Binky and a love of cats.
16 Death always speaks in caps – makes sense on some strange
level doesn’t it?
That is the Inquisitor.
He prunes away the wastrels, expunges the wretched
and deletes the worthless. (Naylor et al, 1992)
Naturally, the crew who delight in the game ‘guess whose
bottie is poking through a hole in the curtain’ (Fuller et al,
1997) are concerned. But then Lister asks the question:
“Who’s to say what’s worthless?... No, I mean it. Who’s to
judge, who’s to say what’s worthwhile?” (Naylor et al, 1992).
The trite answer given by Rimmer is “Well, lying on your
bunk reading What Bike? and eating Sugar Puff sandwiches
for eight hours every day is unlikely to qualify” (ibid), but of
course this does not satisfy. The episode becomes a sci-fi
examination of this question which concludes that one can
only judge oneself17; and that the Inquisitor will only delete
you if you fail to fulfil your potential, not if you fail to hit
some non-relative mark of what constitutes a ‘worthwhile
life’. Thus Lister and Kryten are set for deletion – Lister
for not making more of himself and Kryten for not trying
to break his programming; whereas the Cat is limited by
genetics to be vain and self-serving and Rimmer is limited
by genetics and circumstance – as he explains:
What else could I have been? My father was a halfcrazed military failure, my mother was a bitch-queen
from hell. My brothers had all the looks and talent.
What did I have? Unmanageable hair and ingrowing
toenails. Yes, I admit I’m nothing. But from what I
started with, nothing is up. (ibid).
Rimmer knows himself here – his successful defence
against deletion is this self knowledge, which leads him to
(somewhat) strive to change in the course of the series - as
when he sacrifices himself for a loved one in the episode
Holoship (May et al, 1992). To some extent the Inquisitor’s
demand to ‘Justify Yourself!’ is a call to clarify to what
degree we have seen beyond our personal matrices and is
therefore an expansion of Nietzche’s daemon (1882) which
simply asks us if we would re-live our lives again; for Naylor
et al, (1992) take into account the inherent possibilities of
our lives rather than assuming a degree of choice which
we don’t necessarily have. This is a most important point
in psychotherapy as it can be easy - especially for those
of us who may be in positions of racial, economic or other
privilege - to assume that our clients have a degree of
latitude for change which they do not, in fact, have. Too
often this comes from an understandable wish not to
inappropriately limit our client’s possibilities, however,
in exploring possibilities (possibly though elaborative
horizontalisation or the like) we need to be cautious that we
are not unwittingly engaging with a neo-capitalist discourse
of success in which failure is inherent in the person. We
need to be aware of our matrices, but also aware of the
real boundaries. The question comes again in both senses:
‘What else could we have been?’
Conclusion
And there I fear we must leave our story dear reader. I hope
you can forgive my fantasy and sci-fi exegesis, my love of
the nerdy, the uncool, the geeky18 - and see the strength
17 Echoing Mary Schmich’s (1997) essay: Advice, like youth, probably
just wasted on the young which was used as the lyrics in Baz
Luhrmann’s (1998) song Everybody’s Free (To Wear Sunscreen)
from his film adaptation of Romeo and Juliet (Luhrmann, 1996) –
“The race is long, and in the end it’s only with yourself” (Schmich,
1997).
18 And I rejoice that these things are now taking their rightful cultural
place. It saddens me though, that women are so often lagging
behind men in this regard: As we have historically been with work,
with driving, with sport, with using computers and so on. We are
Journal of Psychotherapy and Counselling Psychology Reflections
and wisdom inherent in the work. If you feel there is nothing
to forgive then I nod in recognition of one who can see
beyond another matrix, another mirror. For many of us
these fantastic stories allow us to circumnavigate accreted
scripts, to sidestep what we ‘know’, and to look anew at
the everyday - and isn’t that what we as therapists, as
philosophers, should be doing?
I hope these tales offer a philosophy of freedom, of
boundaries which may be breached, or lived with, as fate
and ability dictate; and a fancy that each of our clients,
indeed each of us, may be heroes if we ‘keep our heart in
the right place and try to do what’s best’.
23
Chang, H-J. (2011). 23 things they don’t tell you about capitalism.
London: Penguin.
Connell, R. (2009). Gender. Cambridge: Polity.
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Fare you well then. Mayhap I’ll see you in the starlight?
Etherington, K. (2004). Becoming a reflexive researcher.
London: Jessica Kingsley Publishers.
Epilogue
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could salve the ache in her heart, Skettish wearily rose and
stood in the moonlight looking at the embers of the fire and
the cold swaddled form of her grandson. Creaking, she bent
and with age gnarled fingers slowly piled a cairn of rough
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When the work was done and she had rested she took her
stick and gently whispered a few words until it gave forth
a little more light to see by. She paused and then gathered
herself before setting off through the trees into the cold,
damp darkness. She knew not where yet, but she was here
and, whether she willed it or no, she must do something.
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‘I love you too Jones. I love you too’.
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25
E-THERAPY: THE PSYCHOTHERAPISTS’ PERSPECTIVE –
A PHENOMENOLOGICAL ENQUIRY
Imogen Koufou and Desa Markovic
Abstract
The climate of modern society in this new digital age is changing; computer technology
is reshaping our relationships and globalising our lifestyles. Psychotherapy is not
immune to this shift; therapists are engaging with technology and adapting their ways of
working. This study employs Interpretative Phenomenological Analysis (IPA) to explore
the experiences of psychotherapists providing online psychotherapy using live video
technology. The findings illuminate the motivations and benefits for therapists practicing
online such as greater freedom and control. The idiosyncrasies of the paradoxical nature
of the therapeutic relationship online are revealed as intimate and intense, as well
as comfortable and disinhibiting. New considerations and issues associated with the
medium are uncovered, highlighting some of the currently unresolved ethical concerns
regarding online practice. The study adds to the growing body of literature, promoting
greater knowledge and awareness of the medium, and stresses the need for increased
clarity, support and further research in the area.
Keywords: E-therapy, online psychotherapists, motivations, therapeutic relationship online
Introduction
Computer technology is an integral thread in the fabric
of day-to-day human life and is constantly reshaping how
we relate to one another, including within the realms of
psychotherapy. Use of and demand for online therapies
is growing; Rummell and Joyce (2010) stated that “online
counseling” on the search engine Google returned 233
thousand hits, whereas today in 2016 it returned over 100
million. Accrediting bodies are now holding conferences
directly addressing online psychotherapy, online-specific
ethical guidelines are being published, textbooks on the
subject are appearing, and dedicated training is available.
However research of this complex and controversial
phenomenon is far behind practice (Barnett, 2005; SanchezPage, 2005). This study aims to add to the growing body of
literature with a qualitative exploration of the experiences of
psychotherapists practising online psychotherapy using live
video technology.
Literature review
A multitude of psychotherapeutic interventions are being
conducted online, including both text and video based;
the field is evolving rapidly and definitions are still in flux.
Various authors have commented on this instability as
contributing to a lack of clarity and consistency which
Contacts:
creates issues for both furthering research and maintaining
ethical and effective practice across the profession (Rochlen,
Zack & Speyer, 2004; Barak, Klein & Proudfoot 2009). In
order to focus on a specific phenomenon for this immersive
investigation, e-therapy is defined as sessions of individual
professional psychotherapy that occur when psychotherapist
and client are in separate or remote locations and
utilise computer-mediated live video technology to
conduct the session across the Internet in real-time.
Debate continues as to the similarities and differences
between e-therapy and traditional face-to-face
psychotherapy, with some authors seeing e-therapy
as a tool for practising already established therapeutic
skills across distance (Castelnuovo, Gaggioli, Mantovani
& Riva, 2003; Sanchez-Page, 2005). Others argue for
the importance of differentiating the two, stressing
distinctive positive and negative traits to the online
medium that require separate consideration, guidelines
and training (Fenichel et al, 2002; Migone, 2013).
There are those that fiercely criticise e-therapy and
question whether it is a form of psychotherapy at all,
calling attention to a fundamental modification of the
relationship across screens (Baker & Ray, 2011).
A number of quantitative studies have compared outcome
variables and reported small differences, implying that
e-therapy can be as effective as face-to-face (Himle et
Imogen Koufou, BACP accredited existential psychotherapist
[email protected]
Professor Desa Markovic, Professor in Psychotherapy and Head of
Programmes in Psychotherapy and Counselling, Regent’s University London
[email protected]
26
al, 2006, Germain, Marchand, Bouchard, Drouin & Guay,
2010). While the overall consensus seems to be positive,
technological and practical process limitations have been
identified, such as being unable to share paper material
or use certain enactment exercises, and technical glitches
which interrupt the flow of sessions (Cowain, 2001).
The impact of the online medium on the therapeutic
relationship has been of particular interest, with issues
being raised such as: technological interruptions, the
unpredictability of the client’s physical location, a hindrance
of some non-verbal cues, and the view of the other being
restricted to the head and shoulders termed the ‘floating
head’ phenomenon (Jerome & Zaylor, 2000; Mallen, Vogel,
Rochlen & Day, 2005). Cowain (2001) reports restrictions to
the empathic ‘presence’ in e-therapy, whereas other authors
suggest that clients may not experience any difference
compared to face-to-face therapy, and that rather it is
more of a concern for the therapists (Rees & Stone, 2005).
However, explorations of the experiential impact of such
observations on the intersubjectivity of the therapeutic
encounter online are very limited.
Various benefits of psychotherapy online have been
illustrated. These include the ability to overcome barriers
to accessing therapy such as physical disability, illness
and geographical isolation (Shaw & Shaw, 2006). Authors
have explored certain ‘cyberbehaviours’ such as the
phenomenon of the ‘disinhibition effect’ where a client
may feel more comfortable or empowered in online
therapy, which has reportedly been found important when
working with shame-related issues (Fletcher-Tomenius &
Vossler, 2009). In contrast it has been raised that some
under-served populations without access to face-to-face
therapy can similarly be those without Internet access and
therefore would still not be reached (Sanchez-Page, 2005).
At the centre of the debate are ethical concerns such
as competence and accreditation for e-therapists,
confidentiality and privacy, and legal regulations when
working across distance. There seems to be greater
limits to confidentiality that lie beyond the control of
the therapist, and an increased risk of breaches when
practising online, which has prompted authors to appeal
for further consideration when it comes to client consent
(Koocher, 2007). Furthermore there are some fundamental
questions yet to be resolved, such as e-therapy legislative
boundaries. Indeed general professional consensus
in relation to e-therapy does not yet exist, and as such
credentials of practising e-therapists vary widely (Chester
& Glass, 2006). However various guiding principles and
ethical codes have been published including those of the
British Association of Counselling and Psychotherapy,
who regards online therapy as a specialism that requires
post-qualification training and technical competence
(Goss, 2009). In fact online-specific training is increasing
and in recent years a number of practitioner guidebooks
and other resources have been published (Weitz, 2014).
When it comes to the clients of e-therapy, arguments have
been put forth as to who and what types of presenting
issues are suitable, with some authors believing more
complex or suicidal clients to be unsuitable, while others
argue that the disinhibiting effect of e-therapy offers a safer
and more accessible alternative to all clients (Fenichel et al,
2002; Rochlen at al, 2004). It has been argued that separate
consideration is needed around the duty of care of clients
when working online, such as vulnerability, containment
and the necessity of plans for accessing immediate physical
help for a client during the sessions. Particular attention
has been given to exploring the efficacy of e-therapy for
clients with issues that impede on their ability to access
face-to-face therapy such as those with agoraphobia and
those living in remote areas (Cowain, 2001). There has also
been a particular focus on e-therapy for clients with eating
disorders, the argument being that it is particularly effective
for highly self-conscious clients (Simpson et al, 2006).
In terms of opinions and experiences, the current
literature supports the view that clients seem to have
been more accepting of e-therapy than the therapists,
although client research has been limited in part due
to difficulties in accessing online clients to investigate
(Chester & Glass, 2006). Client satisfaction and demand
for e-therapy is reportedly high, with suggestions
that it is particularly attractive to younger populations
more familiar with technology (Young, 2005).
The need for clients to be computer literate has been
debated and correspondingly the question rose
for the e-therapists themselves. Further possible
barriers to uptake for therapists are reasoned
as being a fear of the relationships becoming
dehumanised and ethical concerns (Sucala, Schnur,
Brackman, Constantino & Montgomery, 2014).
On the other hand there is a gap in the literature
exploring the motivations and experiences of practising
e-therapists. There is a bias towards quantitative
studies and particular modes of therapy such as CBT,
as well as a lack of knowledge of the experiences of
providing e-therapy. It is the purpose of the qualitative
research such as this one, to explore the phenomenon
in detail and search for more depth of understanding.
Research process and findings
This study addresses the need for further research with
a qualitative reflexive exploration of the accounts of
practicing online therapists. Qualitative research is mainly
concerned with meaning, and has much to offer in terms
of generating new understandings of the complexities
of human experience through detailed explorations and
interpretations. IPA was employed to this end, a research
method that is grounded in a philosophy that acknowledges
a person’s construction of their lifeworld. It is concerned
with exploring the particular in detail, with capturing the
quality and texture of individual experience. This method
allows for an exploration of participants’ perspectives and
the researchers’ analysis of the data through interpretative
means. As such the phenomenon of the participant’s
experience is inevitably captured through the lens of
the researcher, evidenced in the nature of the quotes
of participants, which are embedded within the text of
the analysis. While other qualitative approaches such as
Grounded Theory, Discourse Analysis and Thematic Analysis
also lay claim to this type of reflexive and immersive
analysis, IPA was chosen to allow for an openness in
engaging with the phenomena of online therapy rather
than to build a theoretical comparison with face-to-face
therapy, which was initially considered. Whilst realising the
lively debate and strong opinions arguing for and against
online therapy in the field currently, IPA, being rooted in
practitioners’ experiences, allows to maintain a stance of
curiosity rather than judgement in response to the debate
from the outset. Equally through smaller sample sizes IPA
brings a depth of focus that best supports this endeavour.
Through referrals from colleagues a group of four
e-therapists was recruited in order to gain insight into the
particular experience under consideration (Smith, Flowers
& Larkin, 2009). There was no restriction of the theoretical
orientation of the participant, but they were required to have
been practising psychotherapy using live video technology
Journal of Psychotherapy and Counselling Psychology Reflections
for at least 6 months. Their work online varied from being
exclusively online, to using online mainly in adjunct with inperson, as illustrated by the table below (see Table 1).
Participant
pseudonym
Adam
Beth
Calum
Debbie
Age Gender
Years of Psychotherapy
Practice
7 years, 6 years online
53
Male
59
64
60
Female 28 years, 2 years online
Male
20 years, 2 years online
Female 30 years, 3 years online
Clinical orientation
Integrative/
psychodynamic
Psychodynamic
Systemic
Integrative
Table 1
Participants’ characteristics
Using a semi-structured interview schedule to gather the
data allowed for deviation where appropriate to enable
the participants to lead the interview. This facilitated entry
into their lived world and to elicit details, thoughts and
feelings. The questions covered five core areas relating to
the background of the participants’ work online, training
and preparation, the online relationship, features of the
Continuity, insight and access
Choice and control
online medium and ethics. Questions included “how do
you practise therapy online?”, “can you reflect on the idea
of presence in the online relationship?” and “what is your
experience of the impact of the technology involved?”.
Each interview was transcribed and analysed individually
through an immersive procedure of reading and re-reading.
Initial thoughts and observations were noted, followed by
descriptive, linguistic and conceptual comments. Emergent
themes were identified and developed from analysing
the comments, followed by a process of searching for
connections across the emergent themes and using
abstraction and subsumption to form clusters of related
themes. Abstraction and subsumption were then used in the
development of superordinate themes, which brought the
clusters themes supported by quotes from the transcripts.
This process was repeated carefully for each interview,
and then the group of interviews compared and contrasted
to find patterns, connections and idiosyncrasies. Some
themes were reconfigured and relabelled, and eventually six
superordinate themes for the group were established, under
which clusters of constituent themes sat (see Figure 1).
Personal use, lifestyle and freedom
BENEFITS OF WORKING
Open-mindedness, pragmatism
and forward-thinking
MOTIVATION AND SUITABILITY
Dishinibition
Meeting and seeing the other
27
Across space and screens
BECOMING AN E-THERAPIST
From face-to-face to e-therapy
Learning and training
Ethical uncertainties and risks
Unmet needs
“CONNECTING” ONLINE
ETHICAL CONCERNS
Something lost but still effective
Limitations/constraints
Technological and practical factors
KEY
SUPERORDINATE THEMES
THE ONLINE EXPERIENCE
Sensing online
Constituent themes
Enjoyment and advocating
Comfort and concentration
Not discussed
Figure 1.
Superordinate and constituent themes
Volume 2, Number 1, January 2017
28
Six superordinate themes (Motivation and Suitability,
Benefits of Working Online, “Connecting” Online, The Online
Experience, Becoming an E-Therapist, Ethical Concerns)
emerged from the data analysis and represent six core
subjects explored by the participants. The topics were all
highly relevant to the key issues that are being discussed
in the literature on the subject, but offered unique insights
through the experiences of these e-therapists. Two of the
subordinate themes within “the online experience” have not
been individually discussed as they are elaborated within
other subordinate themes.
Analysis
1. Motivation and suitability
1.1 Personal use, lifestyle and freedom
Participants spoke of their own use of online video
communication for supervision and personal therapy
online, suggesting that prior experience contributed to
their adoption of e-therapy. There was also a commonality
between participants reporting their lifestyles as busy
or incorporating travelling which made therapy online a
suitable and enabling way of practicing: Adam said that
e-therapy “saves [him] three hours travelling”, Debbie saw
e-therapy as saving her time when her “timetable was very
full”, Beth reported being “never in the same country two
week running” so e-therapy “suits [her] lifestyle”, and Calum
said that the online setting can “provide for more mobility”.
E-therapy offered participants greater freedom. Adam
even described being able to work from a more “relaxed
environment” in comparison to the “draining” nature of
“back-to-back” in-person therapy. He fantasised about being
able to practice from a retreat, which would be “beautiful
and nourishing and nurturing” and would offer “a really nice
lifestyle”. For Beth e-therapy offered her greater choice and
control, a “new and different way of doing” psychotherapy
after having “sunk without trace” working in-person.
1.2 Open-mindedness, pragmatism and forward thinking
Participants mentioned the contrasting opinions relating to
e-therapy, but they have continued to be “open-minded”
about their practice based on their own experiences: all
referencing the effectiveness of their work online. Debbie
spoke of being “flexible” and comfortable with changes of
setting in her work, and Beth of “daring to risk to do things
differently”. All advocated for e-therapy in some way, by
suggesting or encouraging clients and colleagues.
Shared by the participants was a certain pragmatism and
awareness of the practical usefulness of e-therapy in
the modern world for both themselves and their clients.
There was also a shared sense of the future direction
of psychotherapy towards an incorporation of modern
technologies, with Beth arguing that “it’s where it’s all
going”, and that “you can’t pretend that the digital world
doesn’t exist”. Furthermore, both Adam and Calum
mentioned the opportunity of e-therapy in access to new
client markets.
2. Benefits of working online
2.1 Continuity, insight and access
For all four, e-therapy offered continuity of face-to-face work
where clients were more mobile. Calum described his work
with clients who are “travelling”, “temporarily relocated”
or “ill”, and Adam found the online setting made therapy
accessible for “executives who travel for business”.
Adam also spoke of how e-therapy offered the benefit of
seeing and supporting clients in “different states” such
as “when they’re really low […] and can’t come out of the
house” giving him a “different insight” in to his clients. Calum
discussed how he gets “new information” when seeing his
clients “in a bedroom, in their office”. Adam pointed out
that e-therapy is not just a “holding technique” but also that
“there’s a very different theme of issues that comes out”
and explained that his clients can benefit from a sense of
anonymity and comfort online leading them to divulge more
sensitive information.
Adam began practising e-therapy in order to access clients
in an area where there are very few psychotherapists. Beth,
who is practising solely online now, points out access to
“different client groups that you never see in face-to-face
therapy”, and dealing with “new issues” in e-therapy. Debbie
remarked that there “doesn’t have to be a geographical
limitation”, referencing one of her clients who did not have
access to therapists in her home country.
2.2 Choice and control
The participants reported that not only does e-therapy offer
greater freedom and control to themselves, but also to their
clients. For Adam, his executive clients cannot “commit to
on-going therapy in one place”, so they chose the flexibility
of e-therapy. Debbie also mentioned a motivating factor for
her online supervisees as a “convenience thing” because
“it saves them time”. Calum said that e-therapy gives his
clients “more control”, recalling clients who seem freer even
in such things as getting up for a glass of water, compared
to his face-to-face clients who he described as “in my
territory”. Debbie reflected on the choice and empowerment
that e-therapy affords in allowing clients to “pick and
choose” their therapist from anywhere around the world.
Furthermore she discussed the cross-cultural opportunities
for a client abroad who wants to see a therapist who speaks
their language. Both Calum and Beth similarly noted that
e-therapy widens the clients’ range of choice of therapy to
suit their preference.
2.3 Disinhibition
Adam found that several clients have “tended to divulge
a lot more personal details […] a lot of their vulnerability”
in e-therapy compared with face-to-face. He considered
a “perception of anonymity” as a contributory factor, and
how the client is “in their safe place” and may “feel more
comfortable”. Beth spoke about clients “who have massive
shame issues” finding e-therapy easier, reflecting on there
being something disinhibiting in feeling “less seen” across
the distance in e-therapy. Calum also described his clients
as possibly feeling “safer” being “one step removed over
technology”.
3. “Connecting” online
3.1 Meeting and seeing the other
Participants expressed a distinction between lived and
virtual experiences of the other. Debbie remarked not
only on features such as a client’s age and cultural origin
appearing differently online, but on experiencing a
different “presence” of a person whom she would have
“interpreted” differently. She remarked with concern that
in one case in the lived presence of a client she seemed
like “a different woman […] someone I hadn’t met online”;
meeting her in-person “filled her out”. However, thinking
about transference, Debbie stated that the “unconscious
doesn’t have to be geographical”, and that there may be
“opportunity for even more transference because there’s
even more fantasy [online]”.
Beth recalled meeting someone after e-therapy and thinking
“that is really you now”, and noticing a “lack of a certain
feeling” or “vibe” about the virtual person. She concluded
that “something may not be of the same level” online. Using
Journal of Psychotherapy and Counselling Psychology Reflections
mechanical language Beth described how the “drilling in
focus” of being “eyeball to eyeball” in e-therapy doesn’t
allow for the normal distractions in face-to-face contact that
she described as “like taking breath”. Calum described a
“more natural connection” in person as opposed to online.
3.2 Across space and screens
Calum described how feeling the “thin pane of glass
between us online” gives him a “sense of some degree
of removal”. However in contrast he also spoke of
the power of “therapeutic intimacy” and feeling “very
close” when there’s “just the screen”. This paradox was
similarly mentioned by Beth who described a zoomed-in
closeness and “intensity” between herself and her client
in e-therapy, yet also spoke of the connection as being
“through the looking-glass”, remarking that this “barrier
[…] [does] get in the way”. Debbie spoke of getting a
“different look” from clients in e-therapy, as though they
are “looking across this gulf”. She too experienced a sense
of “looking through two windows” and of trying to find and
connect with her client, asking, “where is that person”?
3.3 Something lost but still effective
Beth said that in e-therapy things can get “lost in the
ether” when you are “only seeing part of the person”.
She commented that you can miss “clues to a person’s
body, tension, behaviour or expression”. Calum similarly
mentioned issues around the setup of the camera and
being unable to pick up on the “non-verbal” as easily. He
also spoke of the locational changes and how “subtle
rituals” that frame the development of the relationship
such as “shaking the person’s hand” cannot apply. For him
the “pattern of [the] therapeutic connection” is different
because “a sense of place is not there” and he spoke
of needing to establish the relationships in this new
context. Debbie mentioned feeling a “lack of a certain
feeling about” her clients but said that “the relationships
is as real […] and as effective” as in-person therapy.
For Beth the answer was to look beyond a comparison
of e-therapy and face-to-face, not try to “replicate” it,
but rather to see it as a “different way of doing it”.
4. The online experience
4.1 Sensing online
All participants described a shift in the use of their senses
when practicing e-therapy. Adam spoke of switching into
a “different set of senses”, Debbie spoke of a more “twodimensional experience” in the virtual world which she was
“looking”, “listening” and “thinking about the interpretation”,
and Calum also described a greater focus on listening. They
discussed the “floating head” phenomenon, Beth spoke
of being “eye-ball to eyeball” in e-therapy and Debbie
described e-therapy as a “heady experience”. Adam spoke
of being more perceptive to the “very slight reflections in the
face” of his clients.
4.2 Technological and practical factors
All the participants mentioned the impact of technological
and practical factors. Calum said that there can be “real
practical differences” in e-therapy and spoke about issues
related to camera positioning, disruptions to sessions due to
poor Internet connection, the arrangements regarding initial
set up of the video call, and “time-zone differences”. Debbie
recalled poor Internet connection where the visual of the
video was unclear and this had an impact on her impression
of the client. Adam said the “system” is the “weakest link” in
e-therapy, noting that this can be particularly with vulnerable
clients. Both Adam and Beth discussed having boundaries
relating to high quality technological equipment as a
requirement for e-therapy.
29
4.3 Comfort and concentration
An interesting polarity emerged between enjoying providing
e-therapy and feeling uncomfortable. Adam described
being “utterly relaxed” when working online which he says
allows him to “be much more open and present”. Debbie
spoke of a “childish playful” feeling and a “sense of wonder”
about being able to connect with people across space
and cultures. In contrast Beth described e-therapy as a
“much more intense” and more tiring experience, where
the “eyeball-to-eyeball” focus afforded “no let up”. She
described being “hunched over the computer”, with the
focus on the upper torso being like the uncomfortable and
formal position of an “old-fashioned newsreader”.
5. Becoming an e-therapist
5.1 From face-to-face to e-therapy
Three participants spoke about a natural evolution of
their work to e-therapy: Calum said that it evolved “from
various telephone sessions”, Adam began working with
this “intuitively”, and Debbie started it “without really
thinking about it as online”. Adam described the shift
as “straightforward and common sense”, but Calum
remarked that there are “definitely differences” in terms
of practicalities and technology to be considered. Beth
emphasised e-therapy as “completely different” from faceto-face, and described engaging with and retraining in
e-therapy as a new medium rather than “just transferring”
her experience from one to the other.
5.2 Learning and training
The training, preparation and research undertaken by
the participants in e-therapy varied. Adam described
taking a “quick look at the basic do’s and don’ts” from a
book on e-therapy, learning through “trial and error”, and
being sceptical of the currently available training. Debbie
considered herself to be pragmatic and unconvinced about
online-specific training. Calum had similarly addressed
issues as he went along and learnt from mistakes. Specific
training had “equipped” Beth as an e-therapist and sped
up the learning. She described specific benefits of having
gained knowledge about creating a pre-contractual “client
protocol” to address some of the practical matters.
6. Ethical concerns
6.1 Ethical uncertainties and risks
All participants spoke of issues around the ethics of
their online work that are currently unresolved. Adam
mentioned the “grey area” of having “licence to work
in other countries”. Debbie discussed being unable to
assure confidentiality with the technology in e-therapy, and
considered this “the risk you take”. Calum spoke about
increased ethical complexities and unknowns in e-therapy
such as blurred lines around responsibility when it comes to
failing Internet connections and ensuring confidentiality at
the location on the client’s end. Nevertheless, all participants
have continued to practise e-therapy, having had to “just
ignore” certain issues as Debbie said. Beth said that
people practising e-therapy are “all not really complying”
with ethical guidelines because “there is not a platform in
the profession that is sufficiently robust and secure at the
moment” to conduct e-therapy.
6.2 Unmet needs
All participants expressed currently unmet needs in relation
to their e-therapy practice. Adam said he would be more
inclined to undertake training if there was a “quality” and
reputable course available. Calum and Debbie were both
interested in some kind of peer support or professional
forum, particularly in relation to ethical issues, and for
reassurance. Calum spoke of needing a better system
Volume 2, Number 1, January 2017
30
for payment when working online, and Beth expressed
frustration about being at risk of complaint or sanctions due
to having to practise on unsecure video platforms.
Discussion
The currently limited literature exploring therapists’
experiences and opinions of e-therapy focuses mainly on
what has been identified as a reluctance in the uptake
or integration of e-therapy into their practice (Lovejoy,
Demireva, Grayson & McNamara, 2009). The participants
in this study mentioned barriers to uptake such as a fear
of the relationships becoming dehumanised. The novel
findings of this research are the motivations of these
practising e-therapists, including their enjoyment and the
needs that this mode of therapy meets both for them and
the clients. E-therapy suited the busy and mobile lifestyles
of the participants, and enabled them to live and work more
flexibly. There was a certain experience of freedom; for
some it related to relaxation, choice and control over their
environment, for others the enjoyment and novelty of the
enabling access to a range of clients across the world. It
seems that e-therapy meets these needs for the participants
in practical and emotional ways. The current literature on
the topic yields mixed results in term of efficacy, though
all participants in this study reported positive and effective
experiences of providing e-therapy, reportedly matched by
encouraging feedback from their clients. However further
research needs to be conducted to access the experiences
of e-therapy clients, in order to get a fuller picture. Equally
it must be noted that there is a bias in the recruitment
of participants in this study to those who are actively
continuing to practice e-therapy. Further research is needed
to explore the experiences of those practitioners who have
perhaps tried e-therapy and decided not to continue with it.
Reflecting a similar focus in the literature, the therapeutic
alliance in e-therapy was significant in the participants’
explorations. They portrayed something lacking about the
three-dimensional felt presence of a person, and the impact
of the screen being obstructive, perhaps confirming some
of the fears expressed by authors around the impact of
technology upon the therapeutic alliance (Fussell, 1995).
However they also described enabling qualities of e-therapy
such as disinhibition, intimacy, and a greater sense of
control for the client, concepts discussed in some literature
(Baker & Ray, 2011). Equally they concurred with authors that
this difference does not preclude the creation of a new kind
of collaborate and safe virtual environment within which
the working alliance in e-therapy is fostered (Simpson et
al, 2006; Germain et al, 2010). A wealth of information and
experience was elicited from the participants and there
is a potential for future research here in considering this
different online “presence” and the therapeutic relationship
in e-therapy mediated by a screen. Furthermore, it would be
of interest to explore the intricacies of online meeting, for
example, how protracted silence is perhaps experienced
differently in this “intense” setting.
While all participants spoke of having had personal
experiences of online video communication prior to
practicing e-therapy, they equally shared experiences of
technological and practical issues, reflecting some of those
identified by other authors (Cowain, 2001). These included
disruptions and visual obscurity affected by Internet
connection and equipment set up. This would seem to
support the necessity for e-therapist to be pre-prepared
for the online setting specifically to conduct e-therapy,
and technologically literate (Fenichel et al, 2002). Echoing
some issues raised in the current literature, the ethics of
e-therapy were of concern. Unsecure video platforms and
the legitimacy of practising across boundaries arose, further
advocating the need for increased clarity and professional
consensus in this field. However while all participants felt
that in this new field there were unanswered questions, they
continued to practice e-therapy, accepting some of the risks
involved and hoping for more development and professional
support. Corroborating with Finn and Barak (2010) only one
participant was specifically trained in e-therapy, and the
rest had mostly developed their practices through trial and
error. For these participants there was a pragmatism and
straightforwardness to their view of practising e-therapy. An
implication of these findings for the profession may be that
as we are increasingly immersed in computer technologies
and it is possibly seen as a natural development or
supplement to face-to-face therapy, considerations for
practicing e-therapy may need to be included in traditional
training programmes.
Conclusion
The Digital Age is characterised by the rapidly and everevolving computer technologies which are becoming
more incorporated into our daily lives, and reshaping the
very nature of our relationships. This study explored the
experiences of four pioneering psychotherapists practicing
in the shifting and complex field of e-therapy. It revealed
how some of the revered principles of psychotherapy and
counselling change when we connect with the other across
distance and through screens. New considerations and
challenges were revealed relating to this new mode of
practice, including technological and practical issues. Some
grey areas relating to the ethics and legalities of practice
online remain unresolved, and this study illustrates how
practitioners have to take risks without having sufficient
clarity or robust technology to support their work. As
the provision of e-therapy increases, it will be essential
for the field to establish further ethical guidelines, better
understanding around legal implications, and to increase
the availability of support and training for e-therapists.
It has been speculated that until e-therapy is adopted,
incorporated and regulated as a legitimate form, it will
continue to be considered by some as renegade, thereby
posing the risk of undermining the reputations of the field
more broadly (Richards & Viganó, 2013).
As a qualitative IPA study occurrences of the phenomenon
of e-therapy were allowed to emerge through the
individual voices of the participants. What transpired were
the motivations for these e-therapists; meeting needs
in terms of the control, freedom and mobility; offering
access to clients and supporting client work with certain
client groups and issues; and the positive experiences of
enjoyment, fascination and relaxation. Recognising that
the data that has emerged is limited to the experience
of four participants, we hope that through this detailed
investigation the reader has gained a valuable insight into
the phenomenon of psychotherapy online. It has highlighted
the opportunities for further research into the motivations
of e-therapists, the opportunity to complement this with the
experiences of therapists who have tried and decided not
to continue with online practice, and more investigation
into this altered online “presence” and how it impacts the
therapeutic relationship in e-therapy.
Journal of Psychotherapy and Counselling Psychology Reflections
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33
THE RELATIONSHIP BETWEEN RESEARCH AND
PRACTICE IN CONTEMPORARY ATTACHMENT
RESEARCH
Ian Rory Owen
Abstract
This paper discusses attachment research and practice. The literature on the links
between the Strange Situation Procedure and the Adult Attachment Interview (AAI)
inform practice and research by commenting on relationship processes. The attachment
literature provides reliable information on childhood and adult intimate relating with
partners, family and friends. There is also a literature on the qualitative analysis of
adult attachment in individual therapy. Given that working with the relationship is the
medium for the delivery of care in any brand name type of practice, then attachment
findings explain specific phenomena in various types of practice. This paper summarises
findings about repeating attachment processes (Owen, 2017). The paper comments on
the evidence-based practice proposed by the National Institute for Health and Care
Excellence, (NICE), and argues for the utility of attachment research because it focuses
on relational processes. The paper explains what attachment processes indicate and
notes a number of allied research questions.
Keywords: Attachment processes, psychodynamics, improving intuition, practice,
research
Introduction
Therapists of all brands have a relation to the practice
guidelines set by NICE. NICE offers research findings that
suggest standardised ways of working with people with
single psychological problems. For the most part, the
psychological therapies that NICE suggests are practised
are derived from research clinics where the clients have only
one psychological problem. The presence or absence of the
one problem is claimed to exist in measurable degrees of
presence and intensity. The first problem with this is that the
public often have more than one psychological problem but
NICE offers no advice on how to work with people who have
multiple interacting problems.
Looking at clients’ lives and difficulties is even more
complicated when marital, family and personality problems
are considered, plus the effects of gender, sexuality and
culture on development. When working with complex clients
who have been sexually abused as children, multiply raped
or have developmental delays because of being in care from
an early age, what appears alongside the increased difficulty
in understanding their needs is an increased difficulty in
helping them, and more distress is invoked in meeting them
and hearing the impact about what has happened to them.
Contact:
Dr Ian Rory Owen, Principal Psychotherapist,
Leeds and York Partnership NHS Foundation Trust
The difficulties involved in helping people with complex
problems is that multiple trauma produce complex PTSD
and take their potential in completely different directions
to those adults who were loved and treated with respect
as children. However, after having begun to work with
them, therapists who employ all their usual strategies and
techniques, find that some people who need help the
most, cannot use the opportunities being offered them. It
becomes disappointing for clients and therapists to stop
the work because clients dropped out, or because what
was happening was making clients feel more unsafe, and
therapists feel strong emotion such as shock, sadness or
overwhelm by hearing their stories of violence and betrayal.
In hindsight or through supervision, the emotions invoked
in practising give rise to new understanding. In retrospect,
therapists wished that they had been able to spot clients’
difficulty at using therapy at assessment, or wish that they
had offered some other form of preparation, community
support, or general education about mental health, and
so increase the likelihood of keeping clients in therapy. If
the therapists had felt overwhelmed in the first 20 minutes
of meeting persons who later proved to be unable to
use their services, then in retrospect, their intuition and
[email protected]
34
emotional response proved accurate representations of
what later transpired. In retrospect, it would have been
emotionally intelligent to understand the feeling and act on
it, by checking thoroughly the abilities of needy, vulnerable
people to make sure they can use what is being offered.
Given that clients often feel worse before they feel better,
because their awareness of their problems increases during
the early stages of therapy, and discussion of their problems
brings them into clarity. The general research question that
can be drawn from the above problem is how to sharpen
one’s intuition and separate it from mere guesswork.
Let me make it clear what I am referring to: On the one
hand, as human beings with personal experiences of
helping people, therapists acquire clinical experience that
informs their emotional responses about who can be helped
and how to help them. An emotional sense can be felt that
shows their immediate intuition as to whether a client can
use what is going to be offered to them. On the other hand,
sometimes our intuition, our emotional felt-senses about
how easy or difficult it will be to help someone, may or may
not be accurate. Stated differently, the real meanings of the
terms unconscious communication and counter-transference
concern understanding how emotions, bodily sensations
and imagery, or the recurrence of our memories, have a
bearing on both people in the relationship, because of the
emotional influence that clients bring to the meetings that
influence therapists’ emotions. Practically, it is possible to
use the emotional information of one’s responses in the first
meeting, and trust first impressions, because intuition can be
accurate. For instance, the “heart sink” response to meeting
someone during the first 20 minutes of an assessment might
later be proven accurate – or it might not. If the heart sink
response is related to the client’s unwillingness to divulge
information and the client expresses their reluctance to
attend the assessment, then the heart sink emotion could be
an accurate representation of the client’s un-readiness for
regular meetings. It follows that the therapist wonders if this
client is ready to discuss what they feel.
Furthermore, there is a necessity (shared by Freud, Rogers
and all modes of practice) of staying open to clients and
responding to them in genuinely felt, non-judgemental ways,
despite having a heart sink response. The point of Freud’s
free association is for clients to speak what they experience
and be heard in creative silence to ensure that it is received
as it was sent (Freud, 1923a/1955). The point of Rogers
checking the sense of feelings empathised by the therapist
is to check that the sense received is accurate (Rogers,
1986). The research literature states that the therapeutic
alliance is potent when acceptance, valuing and openness
of therapists to clients, and their own reactions is happening
(Lietaer, 1984). These basic aspects of therapeutic relating
are important practically because they enhance the
relationship and enable nervous and resistant persons to
feel sufficiently comfortable with their own distress, guilt
and shame, and express themselves. Staying open and
non-judgemental also promotes practice as research: in the
sense that therapists get to learn what sorts of problems go
together to form wholes that make sense - and this learning
can be used in helping other people. The core attitudes of
openness and non-judgemental responding are necessary
across all brands of therapy practice, and are particularly
necessary when practising with people who are emotionally
overwhelming and difficult to understand, because they
have multiple concurrent psychological problems and would
qualify for diagnoses of personality disorder. Despite these
difficulties, clients need to trust therapists and therapists
need to be open and sufficiently knowledgeable about the
relational processes that can transpire.
The relationship between research and
practice
Despite the shortcomings of the advice from NICE, most
practitioners would support the idea that it is helpful for their
practice to be informed by empirical research in some way.
The questions are “What research to trust?”, “About what
aspects of what brand of practice?” and “How to determine
how well the research is designed?” These factors translate
into estimates concerning the quality of research, its
trustworthiness and credibility. The work of Bill Stiles and
colleagues draws on the use of Core forms (CORE System
Group, 1998) in the NHS that shows that the Dodo bird
verdict is current (Stiles et al., 2008a, 2008b). In 1986, Stiles
and colleagues found that all therapies performed equally
well (Stiles, Shapiro & Elliott, 1986). This finding was hotly
disputed by other forms of research and the randomised
control trials (RCT) design practised in research clinics with
different experimental designs and the selection of clients.
The Dodo bird verdict refers to the Dodo bird in Alice’s
Adventures in Wonderland (Carroll, 1962, p. 45). In the race
where there is no proper starting line and no proper ending,
the Dodo declares, “everybody has won and all must have
prizes”. The Dodo bird verdict is also called the “equivalence
hypothesis” or “equivalence paradox” in the research
literature. It means that despite the many brands having
their own ideologies, attitudes, skills and techniques - when
these are practised in the real world, they amount to the
same outcome. All brands of therapy are equally effective
and have an effect size of 1.39, meaning that the change in
Core scores created by therapy is 1.39 times bigger than the
original Core score (Stiles et al., 2008b, p. 680). The Dodo
bird verdict is confirmed in the analysis of Core forms, by
Stiles and colleagues, which were derived from real world
practice, outside of research clinics. Of the three major
brands of therapy practised in two different forms in 33,587
completed therapies, this analysis showed that all of them
were equally effective with the general population. One
major problem revealed by Stiles showed the necessity of
helping clients trust therapists to self-disclose sufficiently
to get help (2009, 2013). It is the choice of what clients
self-disclose that controls the depth and content of the
meetings. If they discern that therapists cannot handle their
material, then they do not disclose it.
The next subsidiary question is what form of qualitative
research in particular is best at capturing the moment to
moment unfolding of a therapeutic relationship in a session
and across a series of them. Ever since the use of filming in
psychotherapy research, the discovery of micro-momentary
facial expressions, that are universally recognisable
across cultures, appears as a useful method (Haggard &
Isaacs, 1966; Ekman & Friesen, 1978). One person, who
has analysed video recordings where two persons are
observable in one piece of video, is Una McCluskey who has
identified repeating intersubjective processes (McCluskey,
Hooper & Miller, 1999; McCluskey, Roger & Nash, 1997).
This approach covers the centrality of the need to work
with the relationship and formulate what is happening in
the dynamic of care provision and its receipt. This leads to
the position that I argue for in this paper: Attachment is a
trustworthy perspective because of the research findings
in individual therapy (Heard, Lake & McCluskey, 2009), in
understanding human development (Benoit & Parker, 1994,
Verhage et al, 2016), and dynamics in heterosexual (Haydon
et al., 2012; Treboux, Crowell & Waters, 2004), and same sex
relationships (Mohr, 2008). These findings are usable and
unite the links between the personal and the professional,
theory and research.
Journal of Psychotherapy and Counselling Psychology Reflections
The two sections that follow discuss attachment as it can be
recognised in relationships between adults and in individual
therapy. However, a note needs to be made of this way of
looking at attachment. Attachment is approached as a lived
experience between people, as can be ascertained from the
dynamics of any interchange between two or more people,
which of course, depends on the personal histories and the
type of relationship in which they engage each other. When
attachment is seen as a set of lived experiences, then the
mere noting of categories, (types of attachment process
between adults) is insufficient. The role of attachment
as theory of intimacy is that it provides understanding of
repeating processes in important temporary relationships
as between clients and therapists, and between friends and
work colleagues. The way that these different contexts apply
is not the focus of comments below, but this clarification
merely notes the perspective taken here, to explain the type
of comments that follow.
Adult attachment processes
Attachment processes are not fixed parts of the personality
but are made manifest only in emotionally intimate
relationships and those relationships that could be intimate
(Prior & Glaser, 2006). This section makes some brief
comments on what the findings are on the commonalities
between childhood patterns, between children and adults,
and what appears between adults in partner choice. There
are four major types of attachment processes between
adults that have their roots in childhood (Colle & Del
Giudice, 2011; Weinfield et al., 1999). They can be explained
as follows.
Secure attachment indicates good mental health in relating.
Adults with the tendency to the secure process seek
others to gain help, can express distress, and consult their
own store of having sought help from others (Spangler &
Zimmerman, 2014). The winning point is that separation
distress is comforted without expressing anger (Main,
Kaplan & Cassidy, 1985). Good mental health is a high
proportion of secure attachment in intimate relationships
and not the absence of distress or conflict in them, but
rather the ability to seek help and problem-solve (Atkinson
et al., 2000). Security’s origin is good enough parenting
that was promptly provided and sensitive to the child’s
needs (Sroufe, 1985). The secure process is shown in the
secure base phenomenon of seeking out a loved one or
more skilled person in times of distress (Waters & Cummins,
2000). When there are secure attachment bonds, both
people connect and share a strong bond (whereas insecure
attachment types have different properties). For persons
who have the tendency to be secure, relationships matter
and what is readily provided is loving care and attention,
which delivers a positive mood and self-esteem in the
harmony of close and positive social contact. Secure
processes occur where attachment needs are met in mutual
satisfaction, a win-win situation (Doherty & Feeney, 2004).
Feedback and control remain secure when care-seeking
is met with timely care-giving, then the care-seeking stops
(Bowlby, 1969, p. 41). The phenomenon of the secure base
is one of the full and sufficient provision and receipt of
care and love, and verbal and non-verbal communication
(Posada et al., 1995). Between adults, it means having
someone experienced and safe to self-disclose to, feeling
safe and trusting them, feeling held (Crowell et al., 2002).
Anxious attachment processes exist as two phases of a
demand for help and contact; followed by protest, anger
and resistance when it is supplied (Bowlby, 1973, p. 57, p.
196). The anxious process can feature outright rejection and
hostility where the main feature is that anxiety decreases
35
play and exploration because of the actuality and possibility
of the carers’ absence (Cassidy, 1994). The forces towards
others are push and pull producing confusing senses in the
relationship as a whole, where persons around someone
with the tendency to the anxious process, feel demand and
rejection. The anxious process has its roots in parenting
that was irregular, unpredictable and unresponsive
(Weinfield et al., 1999). The result is being unable to be
soothed and unable to soothe themselves in adults who are
demanding, needy, anxious and uncertain of themselves,
as well as uncertain of how worthy they are to receive care
(Fraley et al., 2006). As infants, a bigger communicative
signal was required to get parental attention and pre-empt
the possibility of their needs remaining unmet. The anxious
quality of distress is two-fold. There is a state of lonely
anguish or anxiety about disconnection, motivating protest
and moving forward towards the carer, with demands and
big signals to elicit care through protest (Bowlby, 1969). The
second movement is a step backwards away from the carer
on reunion in the continuing rejection, implied criticism and
expression of protest, which might also function as a call
for care. Protest anger occurs when adults remain angry at
a lack of care, for a time after the misdeed has first been
criticised. This shows the use of anger as a communication
that the resentment is justified and continues without
forgiveness, even when care has been provided. To speak
metaphorically, the protest keeps a score; whereas if
forgiveness and relaxation were the case, the score would
have been settled, as evidenced by the soothing and
commencement of a calmer equilibrium. The higher selfconsciousness, the self-consciousness of their own needs
and abilities by self, are interpreted as being insufficient
because the equilibrium in the anxious process is one
of expecting insufficiency and inconsistency as a matter
of course (Mikulincer, Shaver & Pereg, 2003). The core
process is that if others are empathised as unpredictably
available, then there is an automatic hyperactivation
of protest and demands that are addressed to carers.
Feedback and control to maintain hyperactivation of
demand, care and protest occur, and the protest eventually
ends. This sub-optimal process has its own psychodynamic
motivations: There is a resistance to disclosure, which is
variable in that sometimes, there is speech and sometimes,
inhibition.
Adults who exhibit the avoidant process with intimate
others repress their biologically inherited needs for intimacy
because of being taught by their parenting that these needs
are unacceptable, so the needs should not gain fulfilment
(Bowlby, 1980, p. 65). Bowlby called it “compulsive selfreliance” (Bowlby, 1980, p. 171). The parenting provided
was intrusive and can provide excess stimulation as well
(Belsky, 1997). Because of the form of neglect and reluctant
caring received as a child, this process remains extant
in adulthood (Cassidy & Kobak, 1988). Therapeutically, it
is necessary to prepare persons who habitually use the
avoidant process because they are not used to expressing
distress or seeking help (Kafetsios, 2004). So, to enter into
a relationship that requires expression and work towards
getting their needs met, is new territory for them. In the
avoidant pattern, there was insufficient caring available.
The children become adults who also reduce their requests
for care and use small signals in order to receive the
minimum that is capable of being received (Hesse, 2008).
The distress of avoidant children is motivated by a taught
anticipatory sense of absence and disconnection (Cassidy,
1994). Specifically, it is expected that others will be absent
and that relationships will be uncaring and distant, cannot
be maintained, or will be lacking or broken (Sroufe, 1988).
Thus, the avoidant process maintains only superficial
Volume 2, Number 1, January 2017
36
contact with others and a low investment when connecting
with them (Årseth et al., 2009). The core pattern is that if
others are felt to be unavailable, the need for satisfaction
of the attachment system is deactivated (Bowlby, 1980, p.
345). Feedback and control maintain deactivation as the
restorative action, so that when distance is achieved, the
avoidance stops (Bowlby, 1980, p. 345).
Disorganised attachment is indicative of trauma and
abuse and can be transmitted to therapists when they feel
shocked and go blank in meetings, because of the impact
of what is being expressed (Heard, Lake & McCluskey,
2009). Disorganised attachment in adults seems to be
comprised of features of both anxious and avoidant
processes that are welded into one incomplete form that
does not include the ability to regulate distress. However,
in its strongest forms, the movements between states
features moving and changing the self: the defensive effect
produces fragmented and confused quasi-unified forms of
self in one physical body (Liotti, 2004). The experiencing of
disarray is consistent with motivational sequences that are
hard to achieve and express confusion and anger (Carlson,
1998, Hesse, 1996). Adults with disorganised processes
can express, at different times, discretely different ways of
being a self with others. There is more dysfunction in the
disorganised non-achievement of attachment (Green &
Goldwyn, 2002). It is a coordinated but highly ambivalent
form of self-understanding and other-empathising. The
self is relatively more fragmented, shattered into different
ways of dealing with itself and others, because its own
feelings and perspectives are confusing. Strictly speaking,
disorganised attachment shows that there is the absence
of the attainment of an attachment system because
hyperactivation and deactivation operate and the attempts
at satisfying attachment needs are ambivalent or absent
(Main & Solomon, 1986). Lacks in functional feedback
fail to establish safety and attachment satisfaction.
Restorative action is begun but remains incomplete, so
distress remains. Disorganisation has a purpose though,
for what occurs, are identifiable phenomena and complex
interactions of the two sub-optimal patterns of anxiety and
avoidance. There is cycling between the sub-optimal forms
of hyper-activation and deactivation.
The next section comments on attachment in individual
therapy as revealed in qualitative research.
Attachment processes between adults
in therapy
NICE guidelines for providing therapy and making decisions
about treatments of choice, is to promote effective practice
treatments that are proven effective because of prior
research (nice.org.uk). However, as an alternative response,
this section formulates nine attachment processes as
they appear in individual therapy, which are presented as
having more utility, particularly for therapy and other types
of mental health care. In addition, the assumption that
is made in making these recommendations is that to be
competent in one’s practice and understanding of therapy
relationships, concerns doing the psychodynamic basics
well. One basic aspect of practice is being able to reflect on
what is happening between oneself and the public, when
we engage them in something that should be positive for
them, despite the distress it will entail. Having said that, let
us consider attachment processes in therapy. Specifically,
what informs therapeutic work are findings like those by
Una McCluskey and colleagues (Heard, Lake & McCluskey,
2009, pp. 133-5). In attachment terminology, clients are
care-seekers, whilst therapists are care-givers. I re-present
their findings in condensed form and refer the reader to the
original findings to get the full picture. Identified are nine
most frequent repeating patterns derived from a qualitative
analysis of videotapes. The first three are secure and the
remainder are insecure in various ways.
1. If the client is in-role as care-seeker, who has material
to explore, and the therapist is in-role as care-giver who
facilitates the exploration, then a secure process is achieved
in each meeting. The therapist takes the lead in empathising
and verbalising the emotions and motivations, and clients
confirm whether therapists have understood them. The
mutual process is one of co-responsiveness, as clients are
open to what therapists say. A secure process is established
when both client and therapist remain in their respective
roles. Clients see that they are acceptable in the eyes of
therapists and they re-evaluate the felt-meanings they
have in this new, more positive light. There is an emotional
reframe of the previously distressing meanings they had
expressed, and this is what provides the healing effect,
because it alters the felt-sense that goes with the topic
being expressed. Therapists and clients are responsive to
each other and this shows nonverbally that there is rapport
and clients are facilitated in an exploratory way.
2. Clients present a topic assertively but therapists’
comments are at first irrelevant, as they have not accurately
empathised what they are being told and resist exploring
it. However, clients persist and then the penny drops
for therapists who eventually tune-in accurately. So the
remainder of the session becomes like item 1 above, there
becomes a secure process with both persons in their
respective roles.
3. At first, clients present in an anxious and disorganised
way but therapists are able to catch contrary nuances and
soothe them, and then a secure process is achieved, like 1
above. Therapists remain open, respond and soothe clients’
distress by capturing the complex nuances of the client’s
presentation.
4. Clients start asking for help in a secure way but therapists
persistently avoid and fail to tune in and divert the
discussion onto irrelevancies without catching the client’s
point. There is insufficient psychological contact between
them. Clients psychologically withdraw towards the end of
the session. The therapist has actively resisted the client
and has persisted in an avoidant process, until clients cease
to ask for help.
5. Clients are anxious and demanding but therapists
are unable to tune in to their emotions or soothe them.
Therapists do not provide soothing or empathic responding
nor are clients helped to explore their thoughts and feelings.
There is a communication of anxiety or fear to therapists,
who respond similarly, leading to either an angry-anxious
interchange, or mutual avoidant withdrawal by the end of
the session.
6. Clients present their topic securely but therapists
are aloof throughout and under-responsive with too
many emotionally-avoidant, blank or passive responses.
Therefore, clients cease asking for care and presenting
verbally during the session: There is mutual withdrawal, an
avoidant process.
7. Therapists miss their clients’ nonverbal expression of
despair. Clients do not verbally present their despair, nor
is it named or commented on by therapists. There is some
slight contact before mutual withdrawal and avoidance, and
Journal of Psychotherapy and Counselling Psychology Reflections
clients are persistently avoidant of their despair and remain
non-responsive. Therapists seem oblivious to the despair
presented nonverbally.
8. Clients present a topic but nonverbally indicate that they
do not wish to discuss it through turning away from the
therapist: They are anxious and resistant in their manner
of presentation. Clients move on to present multiple topics
in a confused manner and the therapist focuses on these,
ignoring what was stated at the top of the session. However,
because therapists have missed the point, clients resist
more than previously, and at the end of the session, they
are distressed or avoidantly dismissive towards therapists’
failure to empathise and hold them.
9. Clients present securely but therapists avoid their
emotion, and fail to respond verbally and name it. Clients
end up anxious, resistant and withdrawn; or avoidant and
dismissive, because therapists have failed to empathise the
original emotion presented at the start of the session, and
their avoidance spreads to clients.
Summary and conclusions
The aim of an attachment-oriented focus on processes
between client and therapist is that becoming more aware
of empirically identified recurrences, supports and sharpens
intuition. What is implied in the nine attachment processes
above is the presence of varying client attempts at getting a
caring response. When clients determine (rightly or wrongly)
that therapists have not, or are incapable of focussing on
what they are trying to say, then such a felt sense is likely
to provoke dropout. If that is the case, then therapists are
robbed of feedback about what has happened, so they are
unable to improve their practice. The link between one’s
own practice and the use of research become concordant
when theory makes sense in one’s own work and can be
tested in it.
What has been presented is a whistle-stop tour of
contemporary research on therapy in the attachment
view. Attachment processes should not be mistaken for
fixed aspects of the personality. Being able to recognise
processes aids understanding of the differing needs
of clients and provides a framework for understanding
complexity. Understanding attachment connects several
important domains. For therapists, how the working life is
felt and understood inside sessions, and the felt-quality of
one’s home life, are related to the degree of authenticity
and congruence with one’s own personality, values and
family position. Having a secure base with a partner, family
and friends is the anchor that holds in the inevitable storms
of life. In the light of the above, effective therapy demands
being aware of the psychodynamic basics like monitoring
resistance to the expression of the topics that need to be
discussed, and making caring responses to the distress
that clients bring. Good mental health is not the absence
of distress or conflict in any relationship, including the
therapy one. When the temporary relationship of therapy
is understood as an attachment relationship, it emphasises
the importance of creating a sense of safety and working
towards making a secure process in it, because each
insecure process needs a different response. Adults with
disorganised processes in their therapy need proper
understanding of their difficulties made explicit. Doing the
psychodynamic basics well means making the therapeutic
relationship clear, and providing some positive sense of
connection in every session, particularly at the end of each
session. Emotional regulation is different for anxious and
avoidant processes, requiring “cooling down” for one and
37
“warming up” for the other. The secure process in therapy
is a condition for there to be new positive influences
being made in an open and non-judgemental atmosphere.
Therapists support clients’ aims, work to increase emotional
connection and alter clients’ moods. This is achieved
through contact with therapists, who need self-care and
authentic grounding in their own positive lifestyles.
Limitations and future research
This paper examined the developmental psychology
approach to attachment in the main and did not take its lead
from findings derived from self-rating questionnaires that are
often used in the social psychology approach to attachment.
It was limited by not including a comprehensive critique of
research from different methodologies that demonstrate
why longitudinal AAI research into actual attachment
relationships is most trustworthy. A comprehensive metaanalysis of the research designs and the psychometric
properties of the measures used would check claims and
identify when findings from different types of research
support each other or differ. While attachment is never
causal in the naturalistic sense, in the complexity of human
development, it is a central feature of being human. Future
research in attachment would benefit from a comprehensive
comparison of how methods are accurate and contribute to
a more standardised understanding of the phenomena of
attachment as lived experience. It would be useful to have
further insight into the development of attachment in primary
intersubjectivity. Further details of how attachment with
partners develops across the lifespan are also useful.
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41
VOYAGES INTO THE UNKNOWN: AN EXPLORATION
USING INTERPRETATIVE PHENOMENOLOGICAL
ANALYSIS OF THE EXPERIENCES OF RETURNING
VOLUNTARY MIGRANTS
Gareth Mason and Denise Ielitro
Abstract
This study draws on Interpretative Phenomenological Interpretation (IPA) to reflect
the experience of voluntary migration and return by exploring the experiences of four
British men. Voluntary migrants are understood as those who are not politically or
economically driven. The findings draw on a wide range of literature including relevant
autobiographical, fictional and anthropological work to offset the lack of psychological
writing on voluntary migration. Nine major themes emerged. These include travelling
as a heroic quest; growth through challenging experience; struggles re-assimilating;
and the search for a more satisfying home. Home and belonging emerge as nebulous
manifold concepts encompassing spiritual and emotional aspirations beyond its physical
dimensions. The study identified early background and life experiences as crucial
influences in the outcomes of living abroad and resettling in their native country and
hopes to aid therapeutic practice by illuminating these connections.
Keywords: Migration, abroad, home, return, belonging, identity
Literature review
Mythology and religion have influenced much of the
psychological writing referenced. The Bible discusses exilic
themes in terms of reward or punishment such as Adam and
Eve’s expulsion from Eden or Abraham’s call to the Promised
Land.
Trials are another major theme as exemplified by
mythological heroes such as Odysseus, who perhaps best
exemplifies the physical and psychological struggles of
adventuring far from home (Homer, 1946), or the Biblical
testing of Abraham or Job. Campbell too discussed the
‘hero’s’ journey from the call to adventure to trials and
transformation (1988/1949). This was supported by Jung’s
transpersonal work particularly the archetypes of our
Collective Unconscious (1951).
The Grinbergs (1984) suggest Biblical and mythological exile
stories enshrine early societal practices to avoid conflict
– such as the taboos of parricide and incest discussed
by Freud (2010/1899) in the Oedipal myth. Campbell says
myths personified in tribal rituals validate the individual
within a cohesive society although ‘indifference, revolt or
exile – break the vitalising correctives’ (1988/1949, p.383).
But he also implies seekers of wisdom do not always lose
their connection with society. Such individuals can uncover
‘the essence of oneself and the essence of the world:
these two are one’ (p.386). He cites the ‘ascetic medieval
saints and yogis of India’ (p.385) discovering a ‘universal
consciousness’. A respected place may thus exist for these
solitary figures – even an active role – as shaman or priest,
or their modern scientific equivalents: doctors and teachers,
who now draw more on scientific than sacred learning. Jung
(1948) proposed symbols ‘protect a person from a direct
experience of god… but if he leaves home and family, lives
too long alone, and gazes too deeply into the dark mirror,
then the awful event of the meeting may befall him’ (p.59).
If the quest far from home presents dangers, the changes
wrought may make return problematic too.
While psychological studies on voluntary migration
are limited, the Grinbergs’ work (1984) is sufficiently
comprehensive to include themes on both forced and
voluntary migrations. Kernberg’s foreword highlights its
exploration of ‘the unconscious processes activated in the
individual as… [they] face the challenges of leaving one
world behind and adapting to a new one’ (p.ii), and their
attention to the significance of social and cultural factors,
age and language. They draw heavily on Freud, Klein,
Bowlby, Winnicott and Bion in discussing how defences,
Contact: Gareth Mason, UKCP Psychotherapist
Denise Ielitro, Lecturer in Psychotherapy, Regent’s University London
[email protected]
[email protected]
42
object relations, and attachment theory can explain
conditions such as loneliness and psychosis and how
migration can lead to identity crises or enlightenment. Also
discussed is Balint’s classification of people as ocnophilic
or philobatic personalities (1959) defined roughly as those
seeking respectively either the familiar and stable, or the
new and exciting. Balint believed voluntary migrants are
usually philobatic.
Mahler et al’s work on separation-individuation (2008/1975)
is also referenced, explaining how attachment issues can
precipitate psychosis in migrants. Elsewhere, Huntington
(1981) draws on Bowlby, Bion and Winnicott to explain how
separation anxiety is heightened in strange situations – a
situation exemplified by migration when dislocation from a
secure base exacerbates poor childhood attachments.
Madison (2010) draws on eclectic sources in exploring
voluntary migration from an existential perspective. He
describes intangible ideas such as Freud’s uncanny (1919) or
Heidegger’s unheimlich (1962/1927) referring to respectively
something frightening but familiar, and not feeling at-home.
Heidegger’s concepts of dasein, authenticity and fallen-ness
are also usefully explored. Madison says ‘the experience
of the unheimlich discloses that we drift along in life
without a foundational ground, forever cadavering towards
annihilation’ (2010, p.227). Despite the grim language, this
represents an interesting counterpoint to the psychoanalytic
view. We understand not-being-at-home as the state from
which angst calls us to recover dasein from its lost-ness
in everyday thinking (Heidegger, 1962/1927). We discern
a connection here with mythological ideas – such as the
‘call of conscience’, and existential migrants as ‘heroes’
(Madison, 2010). Perhaps it’s no co-incidence that many
young travellers boast of being ‘authentic travellers’ rather
than mere ‘tourists’.
The relative dearth of specific psychological literature was
partially offset by examining the escapades of some literary
travellers who highlighted issues and motivations common
to voluntary migration. Leigh Fermor’s hopeful pioneer
set out across Europe ‘like a tramp or… like a pilgrim or a
palmer, an errant scholar, a broken knight… all of a sudden
this was not merely the obvious, but the only thing to do’
(1977, p.12). Meanwhile, Lee highlighted the ambivalence
of uprooting oneself while ‘taunted by echoes of home’
(1971, p.13). The journalist Kapuściński (2008) explored the
colourful but difficult realities presented by distant exotic
lands. He was influenced by Levinas, a holocaust survivor
who studied under Heidegger and Husserl, who believed
‘The Self is only possible through the recognition of the
other’ (p.5). Kapuściński believed self-hood was realised by
communing with the other on an individual and global level
and compared difficult childhoods and later life problems
with historical events affecting societal relations. He
believed multicultural communities offered a more positive
otherness and quotes the philosopher Tischner, who adapts
the Cartesian slogan to ‘I know that I am, because I know
another is’ (2006, p.209).
Hoffman and Said wrote seminal autobiographies about
emigration. Said’s memoir (1999) details the melange of
influences that created his hybrid identity. His statement:
‘the achievements of exile are permanently undermined
by the loss of something left behind forever’ sums up its
rather depressing tone. Hoffman’s work (1998/1989) evokes
her struggle towards assimilation after leaving Poland for
the Americas. Fjellestad (1995, p.135) says Hoffman’s story
challenges the ‘romantic illusion of unity and centre and of
the costs and rewards, the joys and terrors, of being thrown
into a post-modern world of constantly shifting boundaries
and borderless possibilities’. In describing her relationship
with a lover, Hoffman says ‘we explain ourselves like texts.
We learn to read each other as one learns to decipher
hieroglyphs’ and with a nod to Heidegger’s unheimlich, how
after the stereotypes fall away, ‘he becomes familiar, only
increasing the wonderment that the familiar should be so
unfamiliar, the close so far away’ (p.190). Hoffman describes
her homesickness and nostalgia for post-war Krakow, saying
‘it throws a film over everything around me, and directs my
vision onwards’ (p.115). Hoffman later describes herself as
visibly ‘a member of a post-war international class’ without
feeling it (p.170). During psycho-analysis, she completes her
understanding of the English-speaking world, integrating her
Polish and American selves following the trauma of culture
shock.
Methodology
A constructionist paradigm seemed appropriate for
uncovering multiple truths with its emphasis on reality
being socially created rather than existing as an external
singular entity (Hansen, 2004). According to Ponterotto
(2005), constructionism uses a hermeneutical approach
to draw out deeper meanings via reflection, particularly
researcher interaction. Ontologically, this relativistic position
is subjective and influenced by individual experience and
perceptions, and social environment. We accept, therefore,
that results will differ if the study was interpreted by different
researchers, as no single truth exists (Finlay, 2016) – the
study’s value drawing on the ‘thickness’ of descriptions
(Ponterotto, 2005). Epistemologically, the relationship between ‘knower and
would-be-knower’ (Ponterotto, p.127), represented by
participant and researcher in IPA is central. Constructionism
states reality is socially created – so the dynamic is
crucial. Similarly, in axiological terms, researcher values
are inevitably enmeshed in the process so a personal and
subjective rhetorical structure – such as IPA – that details
the thoughts and feelings of both people seems appropriate
(ibid).
A phenomenological method was chosen as it considers
both cognitions and emotions – the embodied aspect
often being overlooked in psychological theory (Smith el al,
2009). IPA was also favoured for its value in investigating
identity and health issues. Furthermore, we did not plan to
create theory. IPA also links interpretation with mainstream
psychological thinking; to investigate cognitions and
emotions where mainstream psychology treats them
separately; and to look at deeper levels of reflection more
than other qualitative approaches (Smith, 1996).
The researchers’ time abroad inspired the study so we remain
mindful of our influence as reflexive researchers. As bracketing
is intrinsic to phenomenology, we followed Ashworth’s advice
to set aside scientific theories, the truth or falsity of participants’
claims, and personal views and experiences (1996).
Nonetheless, Giorgi admits: ‘Nothing can be accomplished
without subjectivity so its elimination is not the solution’ (1994,
p.205), while du Plock describes ‘the notion of the neutral
objective researcher’ as ‘absurd’ (2016, p.16).
The participants
In keeping with IPA’s tendency to analyse small detailed
purposive samples, we limited participation to four men
from a relatively homogeneous demographic – the
implications are discussed in the findings. Smith says: ‘IPA
studies are conducted on a relatively small sample sizes,
and the aim is to find a reasonably homogenous sample,
so that, within the sample, we can examine convergence
Journal of Psychotherapy and Counselling Psychology Reflections
and divergence in some detail’ (2009, p.3). Furthermore, as
the dissertation on which the paper is based was the first
IPA study of one of the authors, we quote Smith saying:
‘our advice to a newcomer to IPA is to try to obtain a group
which is pretty homogeneous’ (p.50).
The target group were UK natives, who had lived full-time
overseas for more than three years and spent over a year
back in the UK to allow exploration of the ‘before and after’
periods of their experience. The field was narrowed to men
between the ages of 40-45 to decrease sample variables
although differences exist in time spent both overseas
and back in the UK. All four are white, but colour was not a
criteria. Social class was not part of the selection process
while the interviews revealed significant differences in
parental income, profession, and quality of upbringing.
Participants were given pseudonyms for confidentiality
purposes.
The interviewees
Malcolm (44) lives with his wife and three children in the
West Country. He spent 18 years in France, mostly in Paris,
and returned to England four years ago.
Daniel (42) lives with his partner and child in northern
England where he is studying medicine. He spent 10 years
in Latin America before returning home six years ago.
Barry (45) is a musician who lives with his wife and child in
London. He spent almost four years in the US after leaving
school and regularly returns to work there.
Alan (44) is a builder who lives with his girlfriend and
her children in London. He spent eight years working in
Portugal and Austria and returned 15 years ago.
Findings
The analysis
Our IPA analysis followed the five stages suggested by
Smith, Flowers & Larkin (2009). Briefly, these are reading and
re-reading transcripts; initial noting; developing emergent
themes; connection across emergent themes; and discerning
patterns across cases. Primarily, we analysed the transcripts
from descriptive, linguistic and conceptual perspectives (ibid).
The master themes were identified after completing the
interviews. Themes relevant only to one individual participant
were discarded – some of these omissions are discussed
in the conclusions. The master themes reflected patterns
across the interviews – each distinguished by significant
emotional or cognitive resonance. We were mindful of not
lending greater weight to themes reflecting the literature
review or our own experiences.
This process involved substantial re-reading of transcripts
and reworking of the material. Ultimately, the emerging
superordinate themes listed below reflected the chronology
of the participants’ lives as revealed by the interviews
although this was a natural outcome rather than planned. The
first subordinate themes involved childhoods and motivation;
the second, aspects of the experience abroad; and the third
looked at re-assimilation into British society.
43
Master themes
1) Finding Home Abroad
a) Escape from Childhood
b) The Comfort of Strangers
c) The International Man
2) Kings of the Wild Frontier
a) University of Life
b) Lust for Life
c) The Heroic Quest
3) End of the Dream
a) A Life more Ordinary
b) Paradise Lost
c) Life through a new Lens
Discussion
1) Finding Home Abroad
1a) Escape from Childhood
The Grinbergs say travel can be an escape from home rather
than heading towards a destination (1984). Daniel’s travelling
seemed to need the complement of psychological ‘inner
journeying’ (Madison, 2010) to escape the past. For Alan
and Daniel, frequent movement between unsatisfying early
environments combined with insecure parental attachments
(Bowlby, 1960). Alan says of his home: ‘Emotionally and
spiritually, there was quite a lot of discord’.
Home for Daniel appears less a place than a loving
community. He says: ‘I rejected a part of the rural part of Ethat we lived in because it represented such a difficult time’.
When migration failed to discover what felt like a home, he
seemed to experience aspects of the unheimlich (Heidegger,
1962/1927) and the uncanny (Freud, 1919).
All four subscribe to a ‘long-harboured desire’ for sustained
adventure (Grinbergs, 1984, p.58). For Alan and Daniel
specifically: ‘lack of containment and support may precipitate
psychosis, perversion, delinquency, or drug use’ (p.127) when
changing environments to heal childhood problems.
1b) The Comfort of Strangers
Madison (2010) discusses how some – like Daniel – use
travelling to re-connect and progress within the world to
build up confidence. Daniel says: ‘I felt very strong about
Latin American issues… I had a Latin American outlook’.
Succeeding away perhaps offsets feeling failure at home.
Madison also suggests some flee home to avoid feeling
overwhelmed, and to achieve balance between contact
and isolation, and how peer rejection can be projected onto
places.
Kristeva talks about foreigners representing ‘the hidden face
of our identity’ (1991, p.1) and how integrating them into our
unconscious releases it from a repressed pathological state.
Daniel and Alan may have felt unconsciously reassured by
this.
Meanwhile, if ‘physical space allows mental space’ (Madison,
2010, p.209), Alan embraced it saying he idealised his life
overseas – a common reaction that can lead to hypomania
in new arrivals – its corollary often being a later collapse
(Grinbergs, 1984), which Alan’s experiences also reflect when
‘stripped almost overnight of the people… [he] spent a lot of
amazing times with’.
Volume 2, Number 1, January 2017
44
Perhaps the common link is the desire to self-actualise
(Maslow, 1954) coupled with their rejection of a constraining
tribal loyalty. All four were attracted to the exotic – perhaps
their own spiritual mystery, and identity, was better matched
with their chosen destination than their first homes (Madison,
2010).
1c) The International Man
Barry and Malcolm’s international perspective is reflected
by their being-at-home in more than one place as if they
transcended home and foreign culture rather than being
subsumed by either. Barry says: ‘I always try to see myself as
an international person… I like freedom’.
Alan and Daniel perhaps took longer to achieve this due to
their initial rejection of home. Madison describes how ‘dual
belonging’ (2010, p.103) can resolve the tension between a
strong self-identity and sense of belonging.
Alan’s national identity is less obvious as his peers share
interests rather than cultures or places saying ‘British
culture became a culture shock to me because I had lived a
European life’. Or as Madison (2010) suggests, perhaps Alan
avoids isolation by grouping with internationalists equally
unattached to home countries.
Daniel’s fragile attachment to Britain seems linked to his lack
of belonging to family and early homes – an assumption
Madison (2010) also identifies.
2) Kings of the Wild Frontier
2a) University of Life
Madison says intellectual studies – such as those later
displayed by Daniel and Malcolm – are examples of
‘journeying inwards’ (2010, p.105), while early failure is
identified by Alan’s admission that ‘a lot of us could have
done better academically than we did’ when faced with the
choice of ‘going surfing for the weekend or sitting around
doing your pure maths homework’. Freud said the sublimation
of studying, a mature version of displacing the libido, was
‘what makes it possible for higher psychical activities,
scientific, artistic or ideological, to play such an important part
in civilised life’ (1930, p.79). Daniel didn’t pursue medicine
to regulate his libido, but his long-simmering intellectual
frustration seems usefully channelled into study! For him
‘studying medicine is as thrilling and as much an adventure as
travelling’.
Madison (2010) sees compassion for the underdog –
demonstrated by all four – as a complement to a personal
fight for independence, while Hoffman (1998) talks of exiles
creatively reviewing life’s mysteries from abroad – perhaps
enhanced by the extra time and space often available.
2b) Lust for Life
All were drawn to what Heidegger might describe as
authentic experiences (1962/1927) and prioritising adventure
over financial security (Madison, 2010). Barry says: ‘I had this
something in me, which I had picked up in America, this sort
of lust for life’. Daniel says: ‘there were no bounds to what I
did’, while Malcolm ‘revelled in complete freedom’.
Madison’s words could apply to all four: ‘To not be free is
to not be alive. In leaving I am embracing my freedom and
independence through movement’ (2010, p.270). When he
says ‘I have a felt direction more than a felt goal; it is a journey
with no set destination, slowly I entertain that the journey is
the destination’ (ibid), it particularly reflects the paths of Alan
and Daniel.
Balint (1959) might highlight the interviewees’ philobatic
nature – due to their movement towards new and exciting
experiences, but we feel this is balanced by their stated
ocnophilic attachments to people and places, home and
abroad.
2c) The Heroic Test
The participants often described their journeys using
mythological language.
With Daniel, we perceived parallels between his life stages,
and the trials of the archetypal mythological hero, namely: a
peripatetic childhood; uncertain ancestry beyond his adopted
parents; restless ‘drifting’; his desire for ‘transformation’; a
passage through ‘madness’; a ‘magical’ chosen land; and
his role as teacher, and later doctor, allowing him to be ‘a
part of society, actually fulfilling a useful role professionally
and personally’. He sought a ‘transformative’ experience
that would make him: ‘a different, more independent, more
exciting, more worldly person’. Of his chosen professions,
Jung’s ‘wounded healer’ (1951) suggests itself, as does the
shaman who harnesses skills that set him apart. ‘It is not
society that is to guide and save the creative hero’, says
Campbell, ‘but precisely the reverse’ (p.391). The ‘purification
of the self’ after an individual undertakes ‘the perilous
journey… into the crooked lanes of his own spiritual labyrinth’
could reflect Daniel’s positive transformation following
a ‘manic psychosis’. Campbell describes ‘the process of
dissolving, transcending, or transmuting the infantile images
of our personal past’ (p.101). This chimes with Daniel’s
improved interaction with the world. Daniel’s travelling
ambitions also reminded me of the pleasure-seeking Peer
Gynt (Ibsen, 1964/1876), whose eponymous protagonist
pursues hedonistic impulses unreflectively. The ‘decadence’
of Daniel’s pleasure-seeking, however, led to disillusionment,
and later, a life ‘more fulfilling than the experiences I had
there’.
Malcolm’s Panglossian optimism reminded us of the
protagonist Karl in Kafka’s Amerika (1996/1927). Nonetheless,
he survives well, treating triumph and disaster with
equal equanimity and dreams of his family ‘returning like
conquering heroes’. He was also reminiscent of the footloose
writers, Lee and Leigh Fermor. Leigh Fermor (1977/1947)
flipped cheerfully between barns and castle turrets in his
peregrinations, while Malcolm was equally at home in an
anarchist squat as a millionaire’s chateau.
Barry’s attitude fits the role of Master of the Two Worlds
(Campbell, 2004/1949) exercising ‘freedom to pass back
and forth across the world division’ (p.229) and refers to his
‘calling’ to London and the ‘magical’ American world.
3) End of the Dream
3a) A Life more Ordinary
Page claims ‘re-entry shock is as powerful as culture shock’
(1990, p.181) and how denying these difficulties often results
in disillusionment. Brislin (ibid) says re-adjusting to home is
often hardest for those who integrated well overseas. Alan
returns to a provincial ‘desert’ where ‘pretty much everyone
had left’. The reverse condition, Postponed Depression
Syndrome (Grinbergs, 1984), could be applied to Alan
for his difficulties abroad after initially immersing himself
successfully.
Madison (2010, p.178) identifies how returning migrants
often feel ‘exotic’, but his emphasis is on visiting rather than
permanent resettlement. He also suggests migrants may feel
superior to those left behind, if also envious of their material
gains. My interviewees tended to feel or be seen as exotic
when abroad. This is reminiscent of Hoffman feeling an
‘exotic stranger’ in the US and ‘excited by my own otherness,
which surrounds me like a bright, somewhat inflated
bubble’ (1998, p.179). The interviews suggest the novelty of
homecoming was short-lived perhaps representing a fallen-
Journal of Psychotherapy and Counselling Psychology Reflections
ness from a more authentic existence abroad (Heidegger,
1962/1927). Daniel laments: ‘I identified as being somebody
who had lived abroad in a dangerous place that impressed
people, and once that was taken away I just felt like another
schmuck’.
For Daniel and Alan, return was heralded by the ‘dying’ of
foreign worlds. The Grinbergs (1984) noted how returning
exiles fall prey to doubt even when the homecoming is
cherished. They quote the expressions coined by a Spanish
journalist: ‘to be in the throes of de-exile’ and ‘the wound of
return’ (Torres, 1983), and cite one returnee who said ‘I don’t
feel I belong in either place’ (p.184).
Regarding Alan, the perceived negative reaction of the
homeworld with his ‘long hair [and] ridiculous suntan’ was
perhaps reminiscent of the reception Turkish workers
reported after working in Germany when mocked as
Alamanyali or German-like (Mandel, 2008).
3b) Paradise Lost
The burning of this bridge to the dwelling place of others left
Alan and Daniel caught between two worlds – a common
situation identified by Madison (2010).
This sense of failure perhaps deepened early psychological
fissures. Metaphorically, they return empty-handed rather
than triumphantly bearing the hard-won ‘elixir’ (Campbell,
2004/1949). Daniel described his dissolution abroad almost
like a personal expulsion from Eden claiming the loss of ‘a
whole dimension of my character’, while Malcolm says: ‘I’ve
left a bit of my heart in France’. The Grinbergs (1984) suggest
migration can release latent pathology – something applicable
to Daniel’s experiences on his outward and return journeys.
Of work, Alan was ‘sick and tired of just making money and
working my balls off for other people’ at ‘what’s supposed to
be a grown-up age’ and that ‘the veneer was starting to peel
away’. This is similar to migrants feeling infantilised abroad
where their qualifications and experience have little value
(Grinbergs, 1984).
3c) Life through a new Lens
For Daniel and Alan, something of Freud’s uncanny (1919)
is glimpsed in their re-acquaintance with former worlds,
previously taken for granted, while Heidegger’s unheimlich
can be observed in their sense of not being-at-home
(1962/1927) – even if this represents a continuation of their
unsatisfying relationship with Britain.
Madison (2010) discusses how many migrants need to
believe home has not changed to preserve their roots.
Daniel, however, was disturbed by the lack of perceived
change – referring to his dislike of ‘the millennia old
inequalities’.
Alan’s wary response to the digital age echoes Heidegger’s
warning that technological ‘progress’ – epitomised by a
skyline redolent with television aerials – reduces the world
to a state of homelessness by ushering the public into our
private homes (1961). Malcolm, however, positively reflected
that ‘I’ve made myself over there and turned into someone
who can actually operate over here’.
Conclusions
We initially expected the interviews to produce themes
exclusively related to the experience of being and returning
from overseas. However, issues concerned with the
upbringing and background of the participants proved to be
significant influences on motives for living overseas, and the
quality of the overseas’ experience and resettlement.
45
Summary of master themes
Under (1) Finding Home Abroad, the subordinate theme (1a)
Escape from Childhood divided the participants into two
camps: those running from unsatisfying home environments
versus those whose secure base let them happily wander
further afield. Thriving in unfamiliar territory was explored in
(1b) The Comfort of Strangers; while (1c) The International Man
discussed the evolution of their worldly identities.
Within (2) Kings of the Wild Frontier, we examined a tendency
to reject formal education in favour of life experience in (2a)
University of Life; the embracing of adventure and hedonism
in (2b) Lust for Life; while (2c) The Heroic Quest reflected
the interpretation – consciously or otherwise – of identity in
mythical metaphors.
(3) End of the Dream dealt with post-migration experience.
(3a) Paradise Lost focused on the repercussions of closing
the chapter on a meaningful period of life; while (3b) A Life
more Ordinary highlighted the anti-climax of returning to
an old world after expanding one’s horizons in a new one.
Finally, (3c) Life through a new Lens explored how each
constructed a new existence in the UK after assimilating
experiences abroad.
Implications for psychotherapy
This study of voluntary migration aims to help those leaving,
those left behind – and therapists – better understand its
purpose and value.
Therapeutically, we identified the value of immersing oneself
in the whole subjective story of the voluntary migrant. For
example, Daniel and Alan reported far more emotional turmoil
than their co-participants as their migration encompassed
much more than their time abroad. Answering the call to
adventure was perhaps one of a series of trials and lifechanging experiences that helped establish their identity. The
crucible of travel, if sometimes perilous, forged their authentic
selves. Their experiences, spanning many years, were
perhaps not dissimilar to the process of insightful therapy.
Meanwhile, the study underlined how the relatively charmed
upbringings of Malcolm and Barry contributed to a fulfilling
overseas venture.
Cooper Marcus said ‘when we start to seek a broader
home in another place, it is likely that the soul is demanding
recognition’ (1995, p.252). The drive for unplanned openended travel often seems motivated by such intangible
mystical forces. For Daniel and Alan, self-actualisation
took place on the long and winding road rather than a
conventional straight path.
While respecting individual choice, a therapist might
usefully explore the underlying issues – such as the sense
of belonging – that motivate such ventures. This may
more directly initiate the healing process than years spent
wandering away from the home world. Exploring the personal
meanings of home may facilitate it. Journeying inwardly
through study, self-improvement, or social activism – as
demonstrated by Daniel – may be satisfying alternatives.
Returnees devaluing their experience may benefit from being
reminded of the insights they have gained, which may be lost if
they are pre-occupied by what they feel they have lost through
absence. Otherwise, in its ignorance of their experiences,
the home world is likely to reinforce this negative feeling.
Furthermore, if the original home feels diminished, perhaps it
is because the boundaries that enclosed it have shifted. The
dizzying possibilities that now emerge may be viewed fearfully,
but can also be re-viewed as symptoms of a more meaningful
and authentic existence (Heidegger, 1962/1927).
Volume 2, Number 1, January 2017
46
The Grinbergs say ‘One never goes back, one always
goes toward’ (1984, p.216). Those more changed than their
home world may benefit from seeking a new more flexible
environment for their expanded consciousness. Rapport
and Dawson suggest migration can be a ‘creative act’
(1998, p.209) and ‘in displacement lies a route to personal
empowerment’ (2003, p.51), something which all the
participants grew from in different degrees.
If the wisdom gleaned abroad is made central to one’s new
life, it builds on this valuable knowledge rather than wastefully
bracketing if off like some invalid reality. Some may relish their
experiences as little more than fireside tales, but voluntary
migrants who enthusiastically embraced the other may wisely
build on these foundations e.g. by using language skills,
cultural knowledge or seizing entrepreneurial opportunities.
Therapists can foreground these skills lest they be forgotten.
Myriad practical factors influence the outcomes of voluntary
migration such as age, gender, status, social and cultural
support – along with the destination and provenance of
the traveller (Brislin, 1990). Also important are access to
home; ethnicity, religion, race; education, and work skills
(ibid). Making potential voluntary migrants aware of how
these variables may affect them could later earn them rich
dividends.
But ultimately, to many voluntary migrants, fine-tuning the
variables perhaps cheats the challenge of heeding the
call, which for good or worse, must be braved. For both
the supportive therapist of the voluntary migrant, and the
often uncomprehending friends and family, this irrational but
irrepressible motivation is perhaps the most important factor
to accept and understand.
Limitations and further study
Some significant issues suggested by the literature were not
investigated as they were not prioritised by the participants.
They include loss, which was tangible during Alan’s interview,
and writers such as Hoffman (1998), concerning paths not
taken. Another is the isolation felt by strangers in a strange
land – largely not experienced by our participants; likewise,
struggles with integration which the interviewees dealt with
largely well. Culture shock was articulated by Alan, but in
reference to his return rather than departure.
Space considerations forced us to abandon some interesting
– but less supported – themes. These included enhanced
economic and social status abroad, the experiences of
partners and family, or even the frustration of one’s lifechanging stories being met with indifference back home.
Others emerged after the interviews, relatively unexplored,
such as the impact on identity of learning foreign languages;
nocturnal dream worlds; re-inventing oneself in an alien
environment; or psychosomatic symptoms attached to
emotional trauma. Space considerations also required us
to remove many participant quotes; non-psychological,
but relevant literature from the review; further detail on
methodology etc. which were present in the original
dissertation.
A further study could extend the age, gender, ethnicity,
nationality, and participant numbers. For example, the themes
of Heroic Quest and Lust for Life – well supported by the
participants – seem rather stereotypically male. Conversely,
a single case study might reveal much by probing deeper
into the psyche of one individual. As our participants were
similarly-aged white men from a rich Western nation, the
results are clearly skewed – we would like to see what is
retained with different variables particularly when more
participants further iron out the idiosyncratic differences. Even
within this narrow demographic, we realise the criteria might
benefit from further tightening such as the differences in the
places visited, time spent there, and the age of the travellers.
The symptoms discussed, if not the causes, may be reflected
by political and economic migrants and those studying
or posted overseas. For them, universities and company
resettlement programmes may help as do reception centres
for refugees, but these options may be randomly available
and mere Band-Aids for deeper individual wounds. Future
migration studies may benefit from greater emphasis on the
individual rather than generalised mass movements (Rapport
& Dawson, 1998).
Final thoughts
Overall, the participants with a more secure base had fewer
problems abroad and in resettling. For the participants
whose upbringing was more difficult being abroad might
have represented an escape, but it did not necessarily
compensate positively for this lack – indeed their issues
were often highlighted and amplified abroad. Nonetheless,
the conscious act of leaving seems to represent an attempt
to overcome this adversity, which allowed them to ultimately
understand, accept and grow from it. We also feel that the
project benefitted from the positive experiences reported
in understanding the factors behind a rewarding voluntary
migration.
IPA’s value in investigating issues such as belonging and
identity was also highlighted – the interviews largely
underpinned these evolving themes. For example, Barry’s
childhood home was a happy, nurturing place. It didn’t
change, but he did, and the world of cosmopolitan cities
became his natural milieu. His harmonious and accessible
dual world, which home has become is now varied enough
to contain his needs. For Alan, home revolved around shared
activities with like-minded companions. His presence in the
family home was more of an intrusion than a belonging so
it is unsurprising he has grown up adaptable, independent,
and unsentimental about childhood. Malcolm’s young
adult home was a moveable feast founded on a liberal and
nurturing home base, which allowed him to fearlessly seek
new adventures elsewhere without needing to escape it.
Being abroad gave Daniel the freedom to live fully and create
the essence denied by early deprivation, but his travelling
experiences were insufficient to make him feel he belonged.
His home is now founded on a mutually loving and supportive
family – what he lacked as a child.
Traditionally, we believe the lack of psychological literature
on voluntary migration reflects a belief that it represents a
pathological deviation from the ‘normality’ of settled life. While
globalisation increasingly encourages temporary and semipermanent freedom of movement, we feel an acceptance of
migration as an on-going ‘alternative human history’ (Madison,
2010, p.222) will redress this now out-dated bias towards a
sedentary life.
Given the freedom to undertake these voyages, the
participants all felt compelled to leave one home, to discover
another. If they had not done so, we suspect their destinies
would feel unfulfilled.
Journal of Psychotherapy and Counselling Psychology Reflections
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Volume 2, Number 1, January 2017
Journal of Psychotherapy and Counselling Psychology Reflections
49
BOOK REVIEW
Doodson, L. (ed) (2016)
Understanding Stepfamilies: A practical guide for
professionals working with blended families
Open University Press
Review by Susan Davis
In the ever-increasing world of step, or blended, families,
there is nevertheless an under-resourced field of tailored
therapeutic support available. This book provides a
comprehensive and solutions focused guide for all
professionals seeking to understand the complexities
and requirements of working with stepfamilies.
The book is extremely well structured and takes a step-bystep approach to enable professionals to feel confident in
giving appropriate and effective support and advice. Written
by a leading British stepfamily expert, the book is peppered
with real world examples to contextualize and describe the
realities of life in a modern stepfamily. Using well researched
and evidenced based theories, Dr Doodson has delivered
a manual filled with practical tips and tools that reflect the
understanding and methods necessary for negotiating the
unique challenges and emotions experienced by stepfamilies
as opposed to biological families.
psycho-education and behavioural modeling; mediation.
Chapter 6 introduces mediation as an intervention using an
expert contributor and discusses the right approach to use,
the necessary skills and the potential benefits. These three
chapters provide an exhaustive ‘checklist’ of components
to be considered and addressed in each individual case
and, again, provide a toolkit of ideas of ways to engage the
families in the therapy and facilitate progress.
The final chapter thoroughly documents a series of diverse
case studies, which demonstrate clearly the complex range
of, and different needs within, stepfamilies. This provides a
very useful way of bringing the theory to life and provokes
contemplation for the reader as to how to integrate the theory
into his or her own clinical practice.
This book is without doubt an invaluable, well researched and
authoritative ‘how to’ guide to working with stepfamilies in a
therapeutic setting.
The first two chapters clearly set out the diverse nature of
stepfamilies and clarify the subtle differences and challenges
faced by the individual members within them, and the
relationships between them. These chapters also analyse
the differing stories, emotions and demands experienced
by the individuals as they try to establish their place and
identify their role within the stepfamily unit in order to allow
the reader to relate these to clients in their own work settings.
The author also suggests short exercises for practitioners to
use with clients to open up thinking and discussion and offers
tips that could be shared with individuals in order to reassure
and advise them.
Chapter 3 presents the supporting psychological theory by
introducing a new model of therapeutic intervention devised
by the author and specifically targeted at stepfamilies called
IST – Integrated Stepfamily Therapy. This theory adopts
a behavioural and solutions focused approach based on
empirical evidence and three existing theories and the
chapter describes and critiques these in detail. It sets out four
underpinning principles for the new model – to normalize
experiences, to establish realistic expectations, psychoeducation, to strengthen the couple bond - and discusses
how to use these in action whilst always referring back
to real life examples. It then goes on to highlight how to
integrate three different interventions into the broader work
with the immediate family, and even beyond them (with the
original biological family members) so that practitioners feel
competent to identify and design a tailored approach for each
family’s unique set of challenges.
Chapters 4-6 flesh out these suggested interventions in
greater detail, whilst always referring back to the supporting
literature. They examine how an integrated approach could
use three diverse methodologies to play a part in supporting
the work in the stepfamily setting – couple counselling;
Contact: Susan Davis
[email protected]
Volume 2, Number 1, January 2017
AUTHOR INFORMATION
Susan Davis is an MSc Psychology student at Regent’s
University London, with a special interest in families, parenting
and stepfamilies. Dr Sonia Gallucci (Ph.D., University of Birmingham) is Senior
Lecturer in Cross-cultural Studies at Regent’s Institute of
Languages and Culture (RILC), Regent’s University London.
In 2017, she is due to complete an MA in Counselling and
Psychotherapy at the School of Psychology (Regent’s
University London). Sonia also holds an MA in Italian Studies:
Culture and Communication from the Universities of Warwick
and Birmingham, and a BA in Modern Languages and
Literatures from the University of Cagliari (Italy). Her current
research focuses on the role of culture and emotions in
second language learning and in psychotherapy.
Denise Ielitro, BSc, Adv Dip Counselling, MA, UKCP & BPS
Reg. Denise is a psychoanalytic psychotherapist with a private
practice in north London. She has a background in clinical
psychology and integrative humanistic counselling and has
worked for the NHS and Mind. Since 2005, Denise has been
working at Regent’s University London where she teaches
and supervises students on the MAPC and ADIP courses. She
previously lectured on the DPsych Counselling Psychology
course at Regent’s and at the New School of Psychotherapy
and Counselling. She also taught for many years at the
Institute of Psychotherapy and Social Studies. Denise has a
particular interest in the social and cultural context in which
therapy takes place. Other clinical interests are attachment
theory, and in particular parent-infant relationship, eating
disorders, self-harm and psychosis.
Dr Marek Kolarik is a Lecturer in Clinical Psychology at
Palacký University in Olomouc in Czech Republic. His
interests are in family therapy, supervision of clinical practice,
and psychological assessment.
Imogen Koufou is a BACP-accredited existential
psychotherapist. She holds an MA in Psychotherapy &
Counselling from Regent’s University London where she
also completed the Advanced Diploma in Existential
Psychotherapy (ADEP). She currently works as a senior
therapist and supervisor at Berkshire NHS Trust and runs
her private practice, Buckinghamshire Psychotherapy, from
Beaconsfield. Her research interests include: qualitative
research methods in particular such as Interpretative
Phenomenological Analysis (IPA) and case studies.
Subjects include: psychotherapy online, technology and
psychotherapy, eating disorders, embodiment.
Dr Martin Lečbych is Associate Professor of Clinical
Psychology at Palacký University in Olomouc in Czech
Republic. He focuses on general and special psychotherapy,
family therapy, supervision in clinical practice, psychological
assessment and neuropsychological rehabilitation of
cognitive functions. He provides supervision for students
who prepare for their clinical practice and for practitioners
in clinical psychology in the area of psychotherapy, family
therapy and psychological assessment.
Dr Maria Luca is Reader in Psychotherapy, Senior Research
Fellow, training supervisor, Head of the Reflections Research
Centre and the PhD programme in psychotherapy at Regent’s
University London, editor of Journal of Psychotherapy
and Counselling Psychology Reflections, author of Sexual
Attraction in Therapy: Clinical Perspectives on Moving
Beyond the Taboo - A Guide for Training and Practice (2014),
London: Wiley and The Therapeutic Frame in the Clinical
Context – Integrative Perspectives, (2004), London: BrunnerRoutledge and several articles in peer reviewed journals.
Professor Desa Markovic is Professor in Psychotherapy
at Regent’s University London, Head of Psychotherapy
programmes in Psychotherapy and Counselling, a UKCPregistered systemic psychotherapist and supervisor, COSRT
accredited psychosexual therapist and supervisor and a
Fellow of the Sheffield Society for the Study of Sexuality and
Relationships. She has held senior academic posts at various
training institutes, presented at national and international
conferences and published papers on the subject of systemic
and psychosexual therapy integration.
Gareth Mason is a UKCP psychotherapist working privately
and within the NHS. He has also spent over 20 years working
as a journalist in Britain and overseas. He is a graduate from
Regent’s University London’s MA and Advanced Diploma
programmes. His dissertation, entitled Voyages into the
Unknown, reflects an interest in the experiences of those
resettling in alien cultures and was inspired by his own time
abroad.
Dr Ian Rory Owen was born in New Zealand in 1960 and
holds a first degree in engineering and a masters and
PhD in counselling and psychotherapy from Regent’s
University London. He has further qualifications in cognitive
behavioural therapy and medical anthropology. Previously,
he was a Senior Lecturer in Counselling Psychology at
Wolverhampton University. Since 2001, he has been a
Principal Psychotherapist in the National Health Service in
Leeds. He practices brief individual therapy with people with
complex psychological needs. On Attachment, published by
Karnac, is his fifth book. His previous works are in the area of
phenomenology, intersubjectivity and psychotherapy.
Dr Christina Richards BSc (Hons) MSc DCPsych CPsychol
MBACP (Accred.) AFBPsS is a Doctor of Counselling
Psychology and an Associate Fellow of the British
Psychological Society (BPS). She is also an accredited
psychotherapist with the British Association for Counselling
and Psychotherapy (BACP). She is Senior Specialist
Psychology Associate at the Nottinghamshire Healthcare
NHS Trust Gender Clinic and Clinical Research Fellow at West
London Mental Health NHS Trust (Charing Cross) Gender
Clinic. She lectures and publishes on trans, sexualities and
critical mental health, both within academia and to third
sector bodies, and is co-founder of BiUK and co-author
of the Bisexuality Report. She is Editor of the journal of
the British Psychological Society’s Division of Counselling
Psychology: Counselling Psychology Review. Her own
publications consist of various papers, books, reports, and
book chapters and she is the co-author of the BPS Guidelines
and Literature Review for Counselling Sexual and Gender
Minority Clients.
Journal of Psychotherapy and Counselling Psychology Reflections
51
ANNOUNCEMENTS
Psychotherapy & Counselling Psychology Reflections Research Centre
Workshop
THE MAKING OF DSM – THE DISTURBING TRUTH
ABOUT ITS CONSTRUCTION, AND DOES AN
ALTERNATIVE NON-MEDICAL LANGUAGE EXIST?
Friday 19 May 2017
17:15 – 19:15
Regent’s University London
Inner Circle, Regent’s Park
London NW1 4NS
Why, without solid scientific justification, has the
Do we really need psychiatric diagnosis? If not,
number of mental disorders risen from 106 in 1952,
what can replace it? This workshop will invite
to around 370 today? In this workshop Dr James
discussion and exploration of these vital issues.
Davies takes us behind the scenes of how the
James Davies graduated from the University
psychiatrist’s bible, the Diagnostic and Statistical
Manual of Mental Disorders (DSM), was actually
written. Did science drive the construction of new
mental disorder categories like ADHD and major
depression or were less-scientific and unexpected
processes at play? His exclusive interviews with the
creators of the DSM reveal the troubling answer.
of Oxford in 2006 with a PhD in Social and
Medical Anthropology. He is a Reader in Social
Anthropology and Psychotherapy at the University
of Roehampton and a practicing Psychotherapist.
He has delivered lectures at Harvard, Yale, Oxford,
Brown, UCL and Columbia and has written for The
Times, the New Scientist, the Guardian and Salon.
The second part of this workshop explores how
He is author of the bestselling book Cracked: why
non-medicalised language can be used to describe
psychiatry is doing more harm than good. He is
the diverse forms emotional suffering can take.
co-founder of the Council for Evidence-based
Has the medical model enjoyed its heyday?
Psychiatry, secretariat to the All Party Parliamentary
Group for Prescribed Drug Dependence.
Early booking advised.
Please book online at store.regents.ac.uk
Enquiries to: Shirley Paul [email protected]
Volume 2, Number 1, January 2017
52
Psychotherapy & Counselling Psychology Reflections Research Centre
4th Annual One-Day Conference
PSYCHOSOMATIC CLINICAL PRESENTATIONS
AND IMPLICATIONS FOR EMBODIED, RELATIONAL
PSYCHOLOGICAL THERAPY APPROACHES
Saturday 10 June 2017
09:00 – 16:30
Regent’s University London,
Inner Circle, Regent’s Park,
London NW1 4NS
Organising Committee
Dr Maria Luca
Professor John Nuttall
Keynote Speakers
Professor Helen Payne
The BodyMind Approach: supporting people with medically unexplained
symptoms/somatic symptom disorder
Nick Totton
Embodied symptoms as problems and as solutions
Professor Manos Tsakiris
The relational body: perceiving and representing one’s body in relation to significant others
Speakers
Dr Michael Worrell
Long-term health conditions and couple relationships: why there is a clear case for including the
partner in therapy
Manuel Toren and Dr Maria Luca
The persecutory character of irritable bowel syndrome
Dr Katharina Lederle
An understanding of the science of sleep and how sleep may affect mental health
Book now at store.regents.ac.uk (early bird prices available)
Enquiries to Shirley Paul [email protected]
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OF PSYCHOTHERAPY AND COUNSELLING
PSYCHOLOGY REFLECTIONS (JPCPR)
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Journal of Psychotherapy
and Counselling Psychology Reflections
Volume 2 • Number 1 • January 2017
Editor: Dr Maria Luca
Managing Editor: Professor Helen Cowie
Book Reviews Editor: Jane Wynn Owen
Editorial................................................................................................................................................................................................................ 2
Clinical Supervisors’ Views on Facilitative Conditions in the Handling
of Sexual Attraction in the Supervision of Therapists
Maria Luca, Desa Markovic, Martin Lečbych, Marek Kolarik.................................................................................................................. 3
International Students: A Minority Group at Risk in Need of Psychological Support
Sonia Gallucci...................................................................................................................................................................................................... 11
Starshine on the Critical Edge: Philosophy and Psychotherapy of Fantasy and Sci-fi
Christina Richards ............................................................................................................................................................................................. 17
E-Therapy: The Psychotherapists’ Perspective – A Phenomenological Enquiry
Imogen Koufou and Desa Markovic ........................................................................................................................................................... 25
The Relationship Between Research and Practice in Contemporary Attachment Research
Ian Rory Owen................................................................................................................................................................................................... 33
Voyages into the Unknown: An Exploration Using Interpretative Phenomenological Analysis of the Experiences of
Returning Voluntary Migrants
Gareth Mason and Denise Ielitro................................................................................................................................................................... 41
Book Review...................................................................................................................................................................................................... 49
Doodson, L. (ed) (2016). Understanding Stepfamilies: A practical guide for professionals working with blended families
Open University Press
By Susan Davis............................................................................................................................................................................................................................................. 49
Author Information......................................................................................................................................................................................... 50
Announcements................................................................................................................................................................................................ 51
Psychotherapy and Counselling Psychology Reflections Research Centre
Workshop on Friday 19 May 2017
The making of DSM – the disturbing truth about its construction, and does an alternative non-medical language exist?................... 51
Psychotherapy and Counselling Psychology Reflections Research Centre
4th Annual One-Day Conference on Saturday 10 June 2017
Psychosomatic clinical presentations and implications for embodied, relational psychological therapy approaches........................ 52
regents.ac.uk/reflections
ISSN 2054-457X