Journal of Psychotherapy and Counselling Psychology Reflections
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<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong><br />
<strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong><br />
<strong>Reflections</strong><br />
<strong>Reflections</strong> Research Centre<br />
Volume 2<br />
Number 1<br />
January 2017<br />
ISSN 2054-457X
Editor<br />
Dr Maria Luca<br />
School <strong>of</strong> <strong>Psychotherapy</strong> & <strong>Psychology</strong>,<br />
Regent’s University London, Inner Circle, Regent’s Park,<br />
London NW1 4NS, UK<br />
lucam@regents.ac.uk<br />
Managing Editor<br />
Pr<strong>of</strong>essor Helen Cowie<br />
Emeritus Pr<strong>of</strong>essor, Faculty <strong>of</strong> Health <strong>and</strong> Medical Sciences,<br />
Duke <strong>of</strong> Kent Building, University <strong>of</strong> Surrey, Stag Hill,<br />
Guildford GU2 7TE, Surrey, UK<br />
h.cowie@surrey.ac.uk<br />
Book Reviews Editor<br />
Jane Wynn Owen<br />
janewynnowen@btconnect.com<br />
Editorial Assistant<br />
Shirley Paul<br />
School <strong>of</strong> <strong>Psychotherapy</strong> & <strong>Psychology</strong>,<br />
Regent’s University London, Inner Circle, Regent’s Park,<br />
London NW1 4NS, UK<br />
pauls@regents.ac.uk<br />
Editorial Board<br />
Dr Marie Adams, Metanoia Institute, London, UK<br />
Dr Meg-John Barker, Open University, London, UK<br />
Dr Michael Berry, McGill University, Montreal, QC Canada<br />
Dr James Davies, University <strong>of</strong> Roehampton, UK<br />
Dr Lisa Doodson, Regent’s University London, UK<br />
Dr Stelios Gkouskos, University <strong>of</strong> Surrey, UK<br />
Dr Ralph Goldstein, British Psychological Society’s Register<br />
<strong>of</strong> Psychologists specialising in <strong>Psychotherapy</strong><br />
[with senior status], UK<br />
Pr<strong>of</strong>essor Brett Kahr, Regent’s University London, UK<br />
Dr Elaine Kasket, Regent’s University London, UK<br />
Pr<strong>of</strong>essor Desa Markovic, Regent’s University London, UK<br />
Pr<strong>of</strong>essor Martin Milton, Regent’s University London, UK<br />
Dr Lyndsey Moon, University <strong>of</strong> Roehampton, UK<br />
Dr Christina Richards, Nottinghamshire Healthcare<br />
Foundation NHS Trust, UK<br />
Dr Paul Smith-Pickard, <strong>Counselling</strong> <strong>and</strong> <strong>Psychotherapy</strong><br />
Private Practice, Dorset, UK<br />
Dr Michael Worrell, Central <strong>and</strong> North West London<br />
Foundation NHS Trust, London, UK<br />
International Editorial Advisory Board<br />
Dr Ge<strong>of</strong>f Denham, La Trobe University, Melbourne, Australia<br />
Dr Andrew Geeves, Macquarie University, Sydney, Australia<br />
Dr Theodoros Giovazolias, University <strong>of</strong> Crete, Greece<br />
Dr Dennis Greenwood, University <strong>of</strong> Brighton, UK<br />
Dr Martin Lečbych, Palacký University, Olomouc, Czech Republic<br />
Pr<strong>of</strong>essor John Nuttall, Regent’s University London, UK<br />
Andrea Sabbadini, British Psychoanalytical Society, London, UK<br />
Pr<strong>of</strong>essor Carla Willig, City, University <strong>of</strong> London, London, UK<br />
Aims <strong>and</strong> Scope<br />
The <strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong><br />
<strong>Psychology</strong> <strong>Reflections</strong> (JPCPR) is an international<br />
peer-reviewed journal, underpinned by the<br />
aspiration for a non-doctrinaire, pluralistic attitude to<br />
psychotherapy <strong>and</strong> counselling psychology. It aims<br />
to provide a forum for open debate <strong>and</strong> encourages<br />
submissions from different traditions, epistemological<br />
positions <strong>and</strong> theoretical modalities enabling the<br />
development <strong>of</strong> a more open, reflective thinking to<br />
philosophy, theory <strong>and</strong> practice <strong>of</strong> psychotherapy <strong>and</strong><br />
counselling psychology. JPCPR encourages critical,<br />
broad <strong>and</strong> experimental interpositions in discussions<br />
on psychotherapy <strong>and</strong> counselling psychology. It<br />
tends to transcend the methodological <strong>and</strong> metatheoretical<br />
divisions. We welcome submissions<br />
using both quantitative <strong>and</strong> qualitative methods,<br />
including ethnographic, autobiographical, <strong>and</strong><br />
single patient or organisational case studies.
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong><br />
<strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong><br />
Volume 2 • Number 1 • January 2017<br />
CONTENTS<br />
Editorial................................................................................................................................................... 2<br />
Clinical Supervisors’ Views on Facilitative Conditions in the H<strong>and</strong>ling <strong>of</strong><br />
Sexual Attraction in the Supervision <strong>of</strong> Therapists<br />
Maria Luca, Desa Markovic, Martin Lečbych, Marek Kolarik.......................................................... 3<br />
International Students: A Minority Group at Risk in Need <strong>of</strong> Psychological Support<br />
Sonia Gallucci....................................................................................................................................... 11<br />
Starshine on the Critical Edge: Philosophy <strong>and</strong> <strong>Psychotherapy</strong> <strong>of</strong> Fantasy <strong>and</strong> Sci-fi<br />
Christina Richards .............................................................................................................................. 17<br />
E-Therapy: the Psychotherapists’ Perspective – A Phenomenological Enquiry<br />
Imogen Koufou <strong>and</strong> Desa Markovic .............................................................................................. 25<br />
The Relationship Between Research <strong>and</strong> Practice in Contemporary Attachment Research<br />
Ian Rory Owen.................................................................................................................................... 33<br />
Voyages into the Unknown: An Exploration Using Interpretative Phenomenological<br />
Analysis <strong>of</strong> the Experiences <strong>of</strong> Returning Voluntary Migrants<br />
Gareth Mason <strong>and</strong> Denise Ielitro..................................................................................................... 41<br />
Book Reviews...................................................................................................................................... 49<br />
Author Information............................................................................................................................. 50<br />
Announcements.................................................................................................................................. 51<br />
regents.ac.uk/reflections
2<br />
EDITORIAL<br />
As time goes on, the <strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong><br />
<strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> is<br />
evolving into a more confident <strong>and</strong> innovative<br />
publication. Still in its infancy, this month it<br />
is celebrating its first anniversary with yet<br />
more scholarly contributions that include<br />
research <strong>and</strong> theory papers by experienced<br />
clinicians, academics <strong>and</strong> trainees.<br />
The pr<strong>of</strong>essions <strong>of</strong> psychotherapy <strong>and</strong><br />
counselling psychology are rapidly developing<br />
a comprehensive research base relevant<br />
to practice, providing a useful resource<br />
for the pr<strong>of</strong>essional community to draw<br />
upon. The <strong>Journal</strong> aims to capture <strong>and</strong><br />
disseminate these developments widely.<br />
I am delighted to welcome Jane Wynn Owen<br />
as the book reviews <strong>and</strong> new series editor.<br />
The Editorial Board is introducing two new<br />
series: the first on One day in my life as a<br />
psychotherapist/counselling psychologist<br />
doing therapy <strong>and</strong> the second on My<br />
experience as a trainee on an integrative<br />
training programme. Submissions are invited<br />
from all practitioners <strong>and</strong> trainees in the<br />
pr<strong>of</strong>essions. If you would like to contribute to<br />
this new series by describing your personal<br />
experience <strong>of</strong> doing therapy or studying on<br />
an integrative course in 850-950 words,<br />
We would be delighted to hear from you.<br />
Published twice a year, the January issue<br />
publishes papers on a variety <strong>of</strong> topics <strong>and</strong><br />
research methods, while in September it<br />
is a Special Issue. Last year’s September<br />
Special Issue consisted <strong>of</strong> papers on sexual<br />
oppression, the theme <strong>of</strong> the 3rd Annual<br />
Conference <strong>of</strong> the <strong>Reflections</strong> Research<br />
Centre. This had an international perspective,<br />
with papers from Canada, Australia <strong>and</strong> the UK.<br />
For the Special Issue in September 2017, we<br />
are planning to publish papers that will be<br />
given at the Centre’s 4th Annual Conference<br />
on Saturday 10 June 2017. This will explore<br />
medically unexplained symptoms, otherwise<br />
known as bodily distress, somatisation<br />
or psychosomatic distress. If you would<br />
like to contribute to this issue, please<br />
submit your paper by the end <strong>of</strong> March<br />
2017 on a topic relevant to the theme.<br />
Finally, this issue is a tribute to the remarkable<br />
variety <strong>of</strong> work that goes on in the field <strong>and</strong><br />
to those authors who supported the journal in<br />
its first year, as well as to the Editorial Board<br />
who <strong>of</strong>fer their time generously in undertaking<br />
peer reviews <strong>and</strong> editorial support.<br />
Dr Maria Luca<br />
Editor
3<br />
CLINICAL SUPERVISORS’ VIEWS ON FACILITATIVE<br />
CONDITIONS IN THE HANDLING OF SEXUAL<br />
ATTRACTION IN THE SUPERVISION OF THERAPISTS<br />
Maria Luca, Desa Markovic, Martin Lečbych, Marek Kolarik<br />
Abstract<br />
Background: Supervision <strong>of</strong> sexual attraction (SA) in therapy practice is an underinvestigated<br />
area. Supervision helps the learning <strong>and</strong> growth <strong>of</strong> supervisees. It is<br />
therefore an important aspect <strong>of</strong> ethical practice. Aim: The study investigated the views<br />
<strong>of</strong> UK existential <strong>and</strong> integrative supervisors working in private practice <strong>and</strong> training<br />
institutions on the h<strong>and</strong>ling <strong>of</strong> SA. Methodology: Qualitative interviews were carried<br />
out with twelve accredited supervisors. Transcripts were analysed using constructivist<br />
grounded theory (GT). Findings: Supervisors referred to specific facilitative conditions<br />
for effective supervision <strong>of</strong> SA. These were: supervisory alliance; containing <strong>and</strong><br />
supporting; normalising sexual attraction; creating a contemplative, open atmosphere;<br />
constructively challenging. The core GT category encapsulating these conditions is:<br />
Relational Supervisory Alliance. Participants tended to generalise with a focus on the<br />
facilitative conditions for supervision <strong>of</strong> <strong>and</strong> engaged less with their own experience in<br />
the h<strong>and</strong>ling <strong>of</strong> SA in the work <strong>of</strong> therapists they supervise.<br />
Keywords: Supervision <strong>of</strong> sexual attraction in therapy, psychotherapists, constructivist<br />
grounded theory, relational supervisory alliance<br />
Introduction<br />
It is widely acknowledged that therapists’ to clients <strong>and</strong><br />
clients’ to therapists (Luca, 2003) SA takes place. Research<br />
shows that a high percentage <strong>of</strong> female <strong>and</strong> male therapists<br />
acknowledge having experienced sexual feelings towards<br />
their clients, (Pope, Keith-Spiegel, & Tabachnick, 1986).<br />
Giovazolias <strong>and</strong> Davis (2001) found that 77.9% <strong>of</strong> counselling<br />
psychologists were sexually attracted to at least one client.<br />
76% <strong>of</strong> psychologists felt unprepared <strong>and</strong> uncomfortable<br />
with these feelings (Rodolfa et al, 1994). Of those therapists<br />
who experience SA to their clients a small number (9.4% <strong>of</strong><br />
men <strong>and</strong> 2.5% <strong>of</strong> women) become sexually involved with<br />
clients (Pope, et al, 1986). Literature distinguishes between<br />
boundary violations <strong>and</strong> boundary crossings. Gabbard &<br />
Myers (2008) define boundary crossings as behaviours that<br />
cross boundaries, but might benefit the client. Violations, on<br />
the other h<strong>and</strong>, are always harmful, <strong>and</strong> are unethical.<br />
Ethical codes <strong>of</strong> pr<strong>of</strong>essional bodies (UKCP, 2009; BPS,<br />
2009; BPC, 2011) prohibit sexual involvement between<br />
therapists <strong>and</strong> clients <strong>and</strong> regard it as unethical with serious<br />
sanctions such as permanent or temporary withdrawal <strong>of</strong><br />
accreditation <strong>and</strong> the license to practice (Pope, 2001). A<br />
study on psychoanalytic psychotherapists’ views on sexual<br />
involvement with clients post-termination, found disparity<br />
<strong>of</strong> opinion. “Nonetheless, all the clinicians agreed that the<br />
potential for harm resulting from post-termination sexual<br />
involvements was great” (Shavit & Bucky, 2004, p.229).<br />
The historical tendency in therapy to treat sexual feelings as<br />
taboo is <strong>of</strong>ten driven by moralistic ideas (Luca, 2014). Pope<br />
<strong>and</strong> Tabachnick (1993) found that therapists reacted with guilt,<br />
shock, surprise, anxiety, fear <strong>of</strong> losing control, fear <strong>of</strong> being<br />
Contacts:<br />
Dr Maria Luca, Senior Research Fellow, Reader in <strong>Psychotherapy</strong> & <strong>Counselling</strong><br />
<strong>Psychology</strong>, Regent’s University London<br />
Pr<strong>of</strong>essor Desa Markovic, Pr<strong>of</strong>essor in <strong>Psychotherapy</strong> <strong>and</strong> Head <strong>of</strong> Programmes in<br />
<strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong>, Regent’s University London<br />
Dr Martin Lečbych, Associate Pr<strong>of</strong>essor <strong>of</strong> Clinical <strong>Psychology</strong>,<br />
Palacký University, Olomouc, Czech Republic<br />
Dr Marek Kolarik, Lecturer <strong>of</strong> Clinical <strong>Psychology</strong>,<br />
Palacký University, Olomouc, Czech Republic<br />
lucam@regents.ac.uk<br />
markovicd@regents.ac.uk<br />
martin@lecbych.cz<br />
marek.kolarik@upol.cz
4<br />
criticised, frustration in not feeling able to speak openly about<br />
sexual feelings <strong>and</strong> confusion about management <strong>of</strong> these<br />
issues. Giovazolias & Davis (2001) state: ‘therapists’ reactions<br />
are characterized by distress <strong>and</strong> that this distress may result<br />
from a lack <strong>of</strong> acceptance <strong>of</strong> these feelings or <strong>of</strong> not knowing<br />
how to manage them’ (p. 282). Because literature suggests<br />
that sexual feelings are avoided, supervision becomes the<br />
space where therapists can be supported to talk about them.<br />
Supervision in psychotherapy is essential in client work. In<br />
the UK it is a continuous pr<strong>of</strong>essional requirement (Wheeler<br />
& Richards, 2007) but is not always to the optimal benefit <strong>of</strong><br />
supervisees, especially where SA is at play (Ladany et al.,<br />
1997). Ladany, Friedl<strong>and</strong>er, & Nelson (2005) suggest it is the<br />
supervisors’ ethical obligation to explicitly make SA a topic for<br />
discussion.<br />
The importance <strong>and</strong> value <strong>of</strong> supervision in therapy has<br />
long been established. Its functions include instruction,<br />
support, exploration <strong>and</strong> challenge linked with the aim <strong>of</strong><br />
producing positive effects (Hill, Sullivan, Knox, & Schlosser,<br />
2007). Therapists who received supervision reported higher<br />
counselling self-efficacy at post-test than those who did<br />
not receive supervision (Cashwell & Dooley, 2001). The<br />
supervisory relationship, particularly the alliance <strong>and</strong> repairing<br />
ruptures, has a positive impact in encouraging supervisee<br />
disclosure <strong>and</strong> self-exploration (Jeremy, Safran, Muran,<br />
Stevens & Rothman, 2007).<br />
Supervision normalising supervisees’ difficult reactions to<br />
clients has also been linked with positive effects (Ladany et<br />
al., 1997) <strong>and</strong> a strong supervisory alliance reduces trainee<br />
anxiety <strong>and</strong> helps willingness to disclose (Mehr, Ladany &<br />
Caskie, 2010, 2015). Thus good rapport <strong>and</strong> a working alliance<br />
make the supervisory relatIonship more effective (Shuck &<br />
Wood, 2011).<br />
It is postulated that successful supervision is substantially<br />
linked to the supervisory relationship (Beinart, 2012; Inman<br />
& Ladany, 2008; Milne, 2009), regardless <strong>of</strong> the supervision<br />
model adopted (Ladany, Ellis & Friedl<strong>and</strong>er, 1999). Emerging<br />
consensus suggests that a ‘good’ supervisory relationship<br />
comprises a safe, secure base established by a consistent,<br />
responsive supervisor sensitive to their supervisee’s needs<br />
(Beinart & Clohessy, 2009) who supports supervisees to<br />
‘explore’ <strong>and</strong> develop their competencies (Watkins & Riggs,<br />
2012; White & Queener, 2003).<br />
Ladany et al (1997) found that supervisee satisfaction is<br />
associated with a positive supervisory relationship <strong>and</strong><br />
‘supervisor behaviors seem to greatly influence a supervisee’s<br />
experience <strong>of</strong> supervision.’ (Ladany et al, 1999, p. 446).<br />
Supervisor openness <strong>and</strong> immediacy strengthen supervisory<br />
relationships <strong>and</strong> improve their work with clients (Knox,<br />
Edwards, Hess, & Hill, 2011). The management <strong>of</strong> therapists’<br />
anxiety which is linked to self-efficacy, is considered a primary<br />
task <strong>of</strong> supervision (Mehr, Ladany, & Caskie, 2015). Worthen<br />
& McNeill (1996) found that supervision seemed to build<br />
supervisee self-confidence, fostered deeper underst<strong>and</strong>ing<br />
<strong>of</strong> their work, enhanced supervisee ability to conceptualise<br />
clients in more sophisticated ways <strong>and</strong> helped supervisees<br />
intervene with clients.<br />
Rationale for study <strong>and</strong> research questions<br />
Research cited thus far highlights the benefits <strong>of</strong> supervision.<br />
However, when SA is at play, not all supervisees utilise it<br />
through disclosure <strong>and</strong> discussion. In a study on predoctoral<br />
psychology interns, Ladany et al (1997) found ‘only half <strong>of</strong> the<br />
participants disclosed their SA to supervisors, <strong>and</strong> supervisors<br />
seldom initiated the discussion’ (p.143). It was trainees who<br />
mostly initiated the disclosure <strong>of</strong> SA <strong>and</strong> reported that an<br />
honest, supportive <strong>and</strong> good supervisory relationship enabled<br />
them to disclose. Trainees who did not disclose reported<br />
a negative supervisory relationship <strong>and</strong> imagined the<br />
supervisor would not be supportive.<br />
A noteworthy gap is the lack <strong>of</strong> research data regarding<br />
supervisors’ attitudes/views to the supervision <strong>of</strong> SA. This<br />
study contributes to the evolving research on supervision<br />
by focusing on this area. This paper will therefore focus<br />
on findings on the attitudes/views <strong>of</strong> supervisors, even<br />
though the study covered various domains as can be seen<br />
in the interview schedule. Other domains will be published<br />
separately.<br />
The interview schedule covered the following domains:<br />
• What are your views on key principles for good practice in<br />
the supervision <strong>of</strong> SA? Discuss situations as a supervisor<br />
where you had the opportunity to support the h<strong>and</strong>ling <strong>of</strong><br />
SA in therapists you supervise. What strategy, if any, do you<br />
use when supervising therapists to help them manage the<br />
issue <strong>of</strong> SA to clients?<br />
• How long did you work with the therapist <strong>and</strong> how did<br />
disclosure or presentation <strong>of</strong> SA come about <strong>and</strong> presented<br />
in supervision?<br />
• Are there any specific issues you encountered in<br />
supporting the h<strong>and</strong>ling <strong>of</strong> SA in the work <strong>of</strong> therapists you<br />
supervise?<br />
• What type <strong>of</strong> SA do therapists you supervise present in<br />
supervision, e.g. client or therapist SA, or mutual SA?<br />
• In your view do therapists you supervise find it easy/<br />
difficult to talk about SA in supervision? What in your view<br />
influences this?<br />
• How does it help to bring up this issue during supervision?<br />
• In your opinion, can talking about the issue possibly<br />
complicate the situation?<br />
• What factors can, in your opinion, hinder a discussion about<br />
this issue in supervision? If you can, please tell us about any<br />
examples you know <strong>of</strong> in relation to this supervision issue.<br />
• What experience do you have with supervising this issue<br />
with men/women? In your experience are there gender<br />
differences in the readiness/ability to present SA in<br />
supervision by therapists you supervise? Discuss. What<br />
strategy do you recommend for managing a situation when<br />
a man/woman comes to you with this problem? Is there a<br />
difference in your approach depending on gender?<br />
• Do you have any experience <strong>of</strong> a situation when the issue<br />
<strong>of</strong> SA has provoked an ethical dilemma? Could you tell us<br />
about the experience?<br />
• In what circumstances would you recommend ending the<br />
therapy because <strong>of</strong> therapist SA towards the client? What<br />
influences your decision?<br />
• Can you imagine any circumstances in which the client<br />
<strong>and</strong> the therapist could consider entering into a mutually<br />
intimate relationship? Discuss<br />
Participants were informed that a transcript <strong>of</strong> the interview<br />
would be sent to them to check for accuracy.<br />
Ethics<br />
The study was approved by a University Ethics Committee.<br />
Participation was voluntary <strong>and</strong> participants could withdraw<br />
at any time. Given the ethical issues salient to the study<br />
such as disclosures by supervisees who may have been<br />
sexually involved with clients, supervisors had been advised<br />
that if ethical issues emerged during the interviews the<br />
researchers may need to report these to the relevant
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 5<br />
Sampling <strong>and</strong> recruitment<br />
A database <strong>of</strong> the alumni <strong>of</strong> three training institutions<br />
containing details <strong>of</strong> accredited UKCP psychotherapists was<br />
used to circulate the recruitment flyer asking for volunteers<br />
who met the recruitment criteria. We received only one<br />
response, so we adopted snowball sampling, frequently<br />
used to conduct qualitative research, through interviews<br />
that are primarily explorative, qualitative <strong>and</strong> descriptive,<br />
<strong>of</strong>fering practical advantages, especially in accessing certain<br />
difficult to reach populations (Hendricks, Blanken, Adriaans<br />
<strong>and</strong> Hartnoll, 1992). The subject <strong>of</strong> the study may have<br />
contributed to the low response rate.<br />
The inclusion criteria consisted <strong>of</strong> supervisors with a<br />
minimum <strong>of</strong> five years post-qualification supervision<br />
experience. Thirteen participants volunteered, one dropped<br />
out (no reason was provided) <strong>and</strong> the remaining were:<br />
seven females, five males. Of the twelve volunteers, six<br />
were existential, three psychodynamic, two integrative <strong>and</strong><br />
one systemic. Their experience varied from 10-25 years <strong>of</strong><br />
practice. All were experienced practitioners <strong>and</strong> worked in<br />
psychotherapy training institutions <strong>and</strong> in private practice<br />
(see Table 1). The participant who dropped out did so due to<br />
serious illness.<br />
Therapy<br />
Participant<br />
pseudonym Gender Modality experience<br />
years<br />
Jane F Psychoanalytic 28 20<br />
Tom M Existential-phenomenological 25 20<br />
Elizabeth F Systemic <strong>and</strong> psychosexual<br />
therapy diploma<br />
35 30<br />
Betty F Existential-phenomenological 25 20<br />
Dianne F Integrative (psychodynamic <strong>and</strong><br />
humanistic) <strong>and</strong> psychosexual<br />
therapy diploma<br />
Mary F Psychodynamic <strong>and</strong><br />
psychosexual therapy diploma<br />
15 12<br />
33 12<br />
Mel F Integrative/psychodynamic 14 7<br />
George M Existential 12 8<br />
Mark M Existential 10 7<br />
Claudia F Psychodynamic 15 10<br />
Andreas M Existential 14 12<br />
Peter M Existential 13 12<br />
Average 19.9 14.1<br />
Table 1<br />
Participant Demographics<br />
body. They received an information leaflet explaining the<br />
nature <strong>and</strong> scope <strong>of</strong> the study <strong>and</strong> they consented to the<br />
recording <strong>of</strong> direct interviews <strong>and</strong> the use <strong>of</strong> anonymised<br />
extracts from interviews for publication. Data was stored<br />
on the researchers’ personal computer <strong>and</strong> was passwordprotected.<br />
Postqualification<br />
supervision<br />
experience<br />
years<br />
The researchers<br />
One researcher is a UKCP registered integrative<br />
psychotherapist <strong>and</strong> the other a systemic UKCP registered<br />
psychotherapist with extensive post-qualification practice<br />
experience <strong>and</strong> both are trainers in UK psychotherapy<br />
training institutions. Two researchers from the Czech<br />
Republic are experienced psychologists <strong>and</strong> academics at<br />
a university in the Czeck Republic. Like other researchers<br />
who seek out research methods that resonate with their<br />
epistemological inclinations, but also provide relevant tools<br />
for their studies, we chose a type <strong>of</strong> GT that permits fluidity<br />
<strong>and</strong> considers the value <strong>of</strong> intersubjectivity (Charmaz,<br />
2006). Our epistemological position is influenced by intersubjective,<br />
phenomenological principles, emphasising<br />
the value <strong>of</strong> researcher <strong>and</strong> participant agency in the<br />
construction <strong>of</strong> knowledge. Embracing researcher <strong>and</strong><br />
participant subjectivity, exercising human agency (Patton,<br />
2002) <strong>and</strong> the belief that these enrich <strong>and</strong> provide a<br />
meaningful <strong>and</strong> embodied underst<strong>and</strong>ing <strong>of</strong> human<br />
phenomena have informed this research. We recognise<br />
that our role as trainers may have been an obstacle to<br />
participant disclosure on SA, a difficult subject with ethical<br />
<strong>and</strong> pr<strong>of</strong>essional implications. We tried to acknowledge this<br />
during the interviews in the hope that it would minimise<br />
participants’ need to try <strong>and</strong> impress or fear <strong>of</strong> disclosing.<br />
Data collection <strong>and</strong> analysis<br />
Semi-structured interviews which were carried out<br />
individually generated extensive data. The interview<br />
schedule was revised after two pilot interviews. The first<br />
three interviews were transcribed <strong>and</strong> texts were read<br />
several times by the researchers creating memos <strong>and</strong><br />
coding. This preliminary analysis helped refine <strong>and</strong> check<br />
categories that emerged through subsequent interviews,<br />
ensuring rich data generation. Categories were sent to<br />
two independent researchers (the last two authors <strong>of</strong> this<br />
paper) for checking before agreement was reached on the<br />
categories best describing the data.<br />
Guided by Patton’s (2002) idea that inductive analysis<br />
consists <strong>of</strong> identification <strong>of</strong> patterns, categories <strong>and</strong><br />
themes emerging from the data instead <strong>of</strong> imposed before<br />
data collection, an emerging pattern from constructs was<br />
created (Figure 1). To establish the relationship between<br />
the emerging categories <strong>and</strong> themes, axial <strong>and</strong> selective<br />
coding techniques were applied <strong>and</strong> repeated on all<br />
grouped themes, enabling the development <strong>of</strong> a conceptual<br />
model that represented the data <strong>and</strong> made sense to the<br />
researcher.<br />
Method <strong>and</strong> methodology<br />
GT principles <strong>and</strong> procedures were used to analyse the<br />
data (Charmaz 2006). GT is designed to help researchers<br />
generate categories from the data, compare <strong>and</strong> identify<br />
links between them, so that ideas could develop, sharpened<br />
through deep analytic stages (open coding, focused<br />
coding, axial coding, selective coding) <strong>and</strong> generate<br />
theory grounded in the data. The method is inductive <strong>and</strong><br />
researchers are guided by the data to generate conceptual<br />
frames. The GT method evolved, but remained discovery<br />
oriented. Researchers using a social constructionist<br />
epistemology use the evolved constructivist GT (Rennie,<br />
Phillips, & Quartaro, 1988; Charmaz, 2006). This approach<br />
is suitable for exploring people’s interactions, actions <strong>and</strong><br />
meanings they construct <strong>of</strong> their experience, particularly<br />
in areas which are under-theorised. GT theorising is data<br />
driven.<br />
The constructivist GT <strong>of</strong> Charmaz (2006) treats research<br />
data as constructed, hence not an objective representation<br />
<strong>of</strong> reality. Knowing, from this perspective, is mediated<br />
Volume 2, Number 1, January 2017
6<br />
through social interactions. The positioning <strong>of</strong> the<br />
researcher in relation to participants, the context <strong>and</strong><br />
the social situation where data is generated are taken<br />
into consideration in the final conceptual construction.<br />
Charmaz’s (2006) GT is congruent with the constructivist/<br />
interpretivist paradigm advocating that ‘human science<br />
involves underst<strong>and</strong>ing as interpretation’ (Rennie, 1998, p.<br />
134). Constructivist GT therefore actively repositions ‘the<br />
researcher as the author <strong>of</strong> a reconstruction <strong>of</strong> experience<br />
<strong>and</strong> meaning’ (Mills, Bonner, & Francis, 2006, p. 2).<br />
Supervisory<br />
space is where<br />
the taboo <strong>of</strong> SA<br />
needs to be broken<br />
through a trusting<br />
relationship<br />
Creating<br />
a relaxed attitude<br />
Creating a<br />
contemplative,<br />
open atmosphere<br />
Supervisors<br />
must be more<br />
ready to open up<br />
such a difficult<br />
issue<br />
We create<br />
together, a<br />
space where we<br />
can think, <strong>and</strong> we<br />
can think about<br />
meaning<br />
Figure 1. Example <strong>of</strong> emerging pattern from constructs<br />
Research design<br />
The researchers developed a qualitative interview schedule<br />
based on Charmaz’s (2006) GT intensive interviewing, which<br />
‘permits an in-depth exploration <strong>of</strong> a particular topic…. <strong>and</strong><br />
thus is useful for interpretive inquiry’ (p.25) <strong>and</strong> her idea<br />
that the quality <strong>and</strong> credibility <strong>of</strong> a study rests on the data.<br />
A demographic questionnaire was included in the consent<br />
form <strong>and</strong> was used to obtain information on participants’<br />
supervisory experience, gender, theoretical orientation <strong>and</strong><br />
type <strong>of</strong> supervision practice.<br />
Quality in qualitative research<br />
The qualitative researcher is interested in illumination <strong>and</strong><br />
underst<strong>and</strong>ing not in causal determination or prediction<br />
(Willig, 2007). To ensure trustworthiness qualitative<br />
researchers apply st<strong>and</strong>ards <strong>of</strong> good practice. We adopted<br />
Charmaz’s (2006) criteria for evaluating emergent theory<br />
studies (pp.182-183) guiding researchers to ensure<br />
addressing four specific areas: credibility, originality,<br />
resonance <strong>and</strong> usefulness.<br />
Results<br />
The conceptualisation <strong>of</strong> SA presented in this paper outlines<br />
supervisors’ views on how best to h<strong>and</strong>le SA, in principle,<br />
in the work <strong>of</strong> the therapists they supervise. It illustrates the<br />
defined sub-categories capturing the meanings <strong>of</strong> these<br />
principles for good practice. The core category emerged<br />
through rigorous analysis <strong>of</strong> the sub-categories to ensure<br />
it closely represents the context <strong>and</strong> underlying principles<br />
guiding supervisors’ views on supervising SA.<br />
Supervisors firmly believe in certain precursors to effective<br />
supervision <strong>of</strong> SA, including the importance <strong>of</strong> personal<br />
experience <strong>and</strong> maturity, as well as certain psychological<br />
conditions in the supervisor to make supervisory h<strong>and</strong>ling<br />
<strong>of</strong> SA effective. The views <strong>of</strong> supervisors tended to be<br />
generalised, a finding suggesting that they focused very<br />
much on principles <strong>of</strong> good practice <strong>and</strong> little on specific<br />
examples. This section will focus on discussing necessary<br />
conditions for effective supervision <strong>of</strong> SA that supervisors<br />
identified (Figure 2), which also illustrates levels <strong>of</strong><br />
abstraction in the analysis <strong>of</strong> the data.<br />
The analysis <strong>of</strong> data highlighted that supervisors had no<br />
examples <strong>of</strong> actual disclosure <strong>of</strong> inappropriate crossing<br />
<strong>of</strong> boundaries or <strong>of</strong> acting upon these by therapists they<br />
supervised. Therefore the data generated focused on<br />
specific principles informing the practice <strong>of</strong> supervision<br />
<strong>and</strong> not on detailed description <strong>of</strong> specific examples.<br />
These were formed into clustered codes that helped the<br />
development <strong>of</strong> the five sub-categories shown in Figure 2<br />
below. Supervisors’ approach consisting mainly <strong>of</strong> principles<br />
<strong>of</strong> good practice are: forging a therapeutic alliance to create<br />
a climate for constructive challenge, aiding the development<br />
<strong>of</strong> a contemplative, open atmosphere, a fertile ground<br />
for thinking reflectively, assisting in normalising sexual<br />
attraction, an important attitude for encouraging disclosure<br />
<strong>and</strong> helping them contain <strong>and</strong> support, a fertile ground for<br />
processing <strong>and</strong> learning. These principles in supervisors’<br />
approach were captured in the core category: Encouraging,<br />
facilitative <strong>and</strong> non-judgemental h<strong>and</strong>ling <strong>of</strong> sexual<br />
attraction.
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 7<br />
Due to space limitations only some extracts from some<br />
interviews will be used to highlight how the sub-categories<br />
were formed.<br />
Sub-categories<br />
Constructively<br />
challenge<br />
Examples from Codes<br />
Constructive challenge<br />
<strong>of</strong> the supervisee<br />
Asking direct questions <strong>of</strong> supervisees<br />
feelings <strong>and</strong> conveying the importance <strong>of</strong><br />
not blocking feelings<br />
1. Supervisory alliance<br />
The development <strong>of</strong> trust <strong>and</strong> a genuine interest in the<br />
supervisees’ development, engaging non-judgementally<br />
<strong>and</strong> displaying collegial warmth are fundamental in:<br />
building the supervisory alliance; creating ground for<br />
difficult issues, such as SA, to be disclosed <strong>and</strong> explored.<br />
Emphasis was placed on the importance <strong>of</strong> a collegial,<br />
trusting relationship as a pre-condition to exploring<br />
difficult issues such as SA. Some participants believed that<br />
knowing the supervisee well <strong>and</strong> their way <strong>of</strong> practicing is<br />
an element in developing a relationship <strong>of</strong> trust. As Jane, a<br />
very experienced supervisor, explains:<br />
Creating a<br />
contemplative,<br />
open atmosphere<br />
Supervisory space is where the taboo <strong>of</strong><br />
SA needs to be broken through a trusting<br />
relationship<br />
Supervisors must be more ready, to open<br />
such a difficult issue up<br />
We create together, a space where<br />
we can think, <strong>and</strong> we can think about<br />
meaning<br />
Creating a relaxed attitude<br />
Acceptance <strong>of</strong> the difficulty<br />
in talking about it<br />
The first thing is I need to know my supervisee, how they<br />
usually are in relation to usual clients, because that helps<br />
me to identify when something isn’t quite right or not<br />
being said.<br />
The alliance involves trust <strong>and</strong> respect:<br />
If any <strong>of</strong> my supervisory relationships didn’t have a strong<br />
level <strong>of</strong> that trust <strong>and</strong> respect, I’d probably question<br />
whether we are right as supervisor <strong>and</strong> supervisee.<br />
(Andreas).<br />
Core Category: Relational Supervisory alliance<br />
Normalising SA<br />
Contain<br />
<strong>and</strong> support<br />
Create facilitative<br />
conditions<br />
Naming what’s going on can break down<br />
the taboo<br />
Encouraging supervisee to acknowledge<br />
that her being attractive might be another<br />
possibility that creates SA<br />
I would be open that it happens to all<br />
<strong>of</strong> us<br />
There has to be a normalisation before<br />
the supervisor can help<br />
Talking about erotic interplay in therapy<br />
can feel containing for the supervisee<br />
Containing mode, affirming what’s been<br />
done well <strong>and</strong> reassuring<br />
Checking it gives permission to talk<br />
about it. Supervisee may feel threatened.<br />
Talking can support them.<br />
Gentle encouragement is important<br />
I would encourage the therapist to, allow it<br />
<strong>and</strong> allow the explicitness <strong>of</strong> this<br />
In my approach to supervision there’s a<br />
sense <strong>of</strong> we need to take this seriously<br />
Supervisees have to trust <strong>and</strong> feel safe<br />
that they can bring something <strong>and</strong> it’s<br />
going to be taken seriously<br />
Talking about SA enhances supervisory<br />
alliance further<br />
I think what’s helpful, is not just talking about<br />
it, but to create a safe environment where<br />
you’re not being judged.<br />
Supervisor’s sensitivity to power<br />
imbalance is very crucial<br />
Context: Necessary conditions for effective supervision <strong>of</strong> SA<br />
Peter argued that:<br />
If the necessary conditions are not created for real depth<br />
<strong>of</strong> exploration <strong>of</strong> SA, it is ethically questionable taking<br />
people’s money <strong>and</strong> time. The first thing that comes to<br />
mind is supportive openness <strong>and</strong> faith. It’s within the<br />
relationship; there’s a sense <strong>of</strong> mutual faith <strong>and</strong> trust<br />
in each other’s practices <strong>and</strong> the things which inform<br />
that faith are an acceptance <strong>of</strong> the fact that it’s difficult<br />
sometimes <strong>and</strong> that frailty, fragility, vulnerability <strong>and</strong> going<br />
into that territory is a way <strong>of</strong> witnessing that faith.<br />
A trusting, safe relationship <strong>and</strong> gentle encouragement,<br />
according to Mel, is necessary to help the supervisee trust<br />
the supervision process:<br />
Rather than the authority figure <strong>of</strong> the supervisor coming<br />
down on someone, I like to try to be underneath holding<br />
them. It’s like moving layers <strong>of</strong> strata <strong>of</strong> earth, in that I’m<br />
trying to sift: what are we dealing with here? Is this a<br />
safeguarding principle that needs some response or, is<br />
this a deeply personal thing that is raised for this trainee,<br />
the issue <strong>of</strong> her own sexuality?<br />
If they trust the supervisor <strong>and</strong> they have permission<br />
to talk about SA, that’s where I think the safety comes<br />
in, because you’ve got a conduit there, where the<br />
supervisee feels it’s perfectly okay to bring this to<br />
counselling, <strong>and</strong> that starts to counter the shame or the<br />
taboo <strong>of</strong> it. (Jane).<br />
2. Contain <strong>and</strong> support<br />
All supervisors alike spoke in a common voice <strong>of</strong> the<br />
importance <strong>of</strong> containing the supervisee’s anxiety <strong>and</strong><br />
supporting them, qualities that encourage both disclosure<br />
<strong>of</strong> <strong>and</strong> discussion <strong>of</strong> SA:<br />
Figure 2. Clinical supervisors’ h<strong>and</strong>ling <strong>of</strong> SA<br />
in the work <strong>of</strong> therapists they supervise<br />
The main thing for me is going back to containment <strong>of</strong> the<br />
supervisee, so that the supervisee has processed all this<br />
material <strong>and</strong> then can again feel a bit freer with the client.<br />
(Claudia).<br />
Volume 2, Number 1, January 2017
8<br />
I did somehow encourage him to accept that it could be<br />
the case that there might be an attraction to him <strong>and</strong> that<br />
it would be much better to let it be there, rather than hide<br />
it from himself <strong>and</strong> that it doesn’t mean he should act on<br />
it. (Betty).<br />
Being supportive involves not being judged:<br />
Because if they feel you’re judging, then they are already<br />
judging themselves, <strong>and</strong> there’s already the shame <strong>of</strong>,<br />
‘I’ve done something wrong (Claudia).<br />
3. Normalising sexual attraction<br />
Supervisors spoke <strong>of</strong> the fear <strong>and</strong> anxiety supervisees<br />
present when SA is at play. They recognise that therapists<br />
<strong>of</strong>ten regard SA as synonymous with unethical practice.<br />
They spoke <strong>of</strong> the necessity to present SA as normal in<br />
supervision so that exploration can become possible. Some<br />
drew on their own experience as clients feeling sexually<br />
attracted to their therapist to inform their supervisory<br />
practice:<br />
As a rule, any sort <strong>of</strong> attraction from the client to the<br />
therapist, I would encourage the therapist to allow the<br />
explicitness <strong>of</strong> this, rather than to push it or rationalise it<br />
away. So for me in my approach to supervision, there’s a<br />
sense <strong>of</strong> we need to take this seriously. This is based on<br />
personal experience where I was sexually attracted to my<br />
therapist. (Andreas).<br />
Mary refers to using explicit language in a non-judgemental<br />
way to normalise SA:<br />
Not in a judgemental way, to say: ‘this happens <strong>and</strong><br />
let’s look at how we deal with it’. I ensure, right from the<br />
beginning, that supervisees know that I will ask about SA<br />
<strong>and</strong> what’s going on sexually in therapy. We normalise<br />
by saying this will happen <strong>and</strong> there’s a useful purpose<br />
to it. It’s the permission-giving to the client to talk about<br />
attraction, <strong>and</strong> the whole gamut around sex.<br />
Betty introduces the topic <strong>of</strong> sexuality <strong>and</strong> SA in the first<br />
supervision session:<br />
In the first session it always comes up <strong>and</strong> I make them<br />
aware <strong>of</strong> the fact that we are sexual beings <strong>and</strong> it’s in the<br />
room if you like it or not. It doesn’t matter who you are,<br />
what age, what colour. I think that already creates a more<br />
relaxed attitude <strong>and</strong> ease about sexuality per se. So I do<br />
encourage them from the very beginning to accept their<br />
own sexuality <strong>and</strong> the sexuality <strong>of</strong> their clients, that’s the<br />
most important strategy for me.<br />
Betty as a supervisor needs to feel comfortable herself<br />
about the topic for it to be normalised by supervisees:<br />
I think my age has something to do with it; I have gone<br />
through my whole cycle <strong>of</strong> sexuality <strong>and</strong> I have a whole<br />
life with examples to look at <strong>and</strong> there is hardly anything<br />
which easily shocks me or couldn’t be talked about. I’ve<br />
reached my gr<strong>and</strong>mother stage, <strong>and</strong> that gives me a<br />
more relaxed view on it. I radiate a lack <strong>of</strong> fear <strong>of</strong> talking<br />
about it, <strong>and</strong> a lack <strong>of</strong> fear <strong>of</strong> it.<br />
4. Creating a contemplative, open atmosphere<br />
The atmosphere <strong>of</strong> supervision has to be well paced<br />
<strong>and</strong> promote depth reflection according to participants.<br />
Peter referred to a mindful attitude <strong>and</strong> a contemplative<br />
environment as important supervisory conditions:<br />
I use reflection, almost like pedagogy; it is to create a<br />
contemplative atmosphere where the pace is slow <strong>and</strong><br />
to allow what’s embodied to become articulated; that<br />
kind <strong>of</strong> mindful attitude. I think it harks back to the form <strong>of</strong><br />
dialogue which is an embodied experience as opposed<br />
to the cognitive.<br />
Peter adds:<br />
I’m thinking <strong>of</strong> a woman who was feeling quite worried<br />
<strong>and</strong> oppressed by a client who clearly had fantasies<br />
about her <strong>and</strong> was sexually attracted to her; there was<br />
fear in her, in how she should navigate her way through<br />
this. My role, again, is to work with that because she<br />
arrived at answers herself just by being given the space<br />
to be able to articulate exactly what she was going<br />
through in precise detail.<br />
Claudia speaks <strong>of</strong> a thinking space:<br />
We create together a space where we can think about<br />
meaning. There is something about feeling mirrored,<br />
feeling understood, feeling it’s a place where for the<br />
first time, perhaps, you feel you can really relate to that<br />
person.<br />
Both integrative <strong>and</strong> existential therapists spoke in a<br />
common voice in assigning reflection <strong>and</strong> thinking about<br />
SA a central place in their work.<br />
5. Constructively challenge<br />
Supervisors mentioned constructive challenge as a<br />
useful approach to enable supervisees to recognise <strong>and</strong><br />
acknowledge SA. Mark states:<br />
Well, I think initially it’s about naming it, challenging the<br />
supervisee in saying, perhaps there’s attraction there.<br />
I remember her being quiet, <strong>and</strong> almost withdrawn, or<br />
ruminating, you know; <strong>and</strong> almost not wanting to get<br />
excited, in some way. But I think there was something<br />
stirring, <strong>and</strong> so it was really letting her be with that.<br />
Like Mark, Claudia is explicit in bringing SA to the fore:<br />
It’s this anxiety which for me is really important again to<br />
ground through gentle challenging.<br />
Discussion<br />
Participants referred to personal experience <strong>of</strong> supervision,<br />
psychological maturity <strong>and</strong> readiness in themselves,<br />
to help them evaluate effectiveness. They believe that<br />
supervision must rest on an encouraging, facilitative <strong>and</strong><br />
non-judgemental h<strong>and</strong>ling <strong>of</strong> SA. Participant accounts were<br />
generalised, focused on specific principles <strong>of</strong> good practice<br />
<strong>and</strong> not on disclosures <strong>of</strong> SA acted upon by supervisees <strong>and</strong><br />
how they were h<strong>and</strong>led by supervisors. This highlights that<br />
therapists do not perhaps disclose crossing <strong>of</strong> boundaries
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 9<br />
or acting upon SA to their supervisors, or supervisors do not<br />
disclose to researchers any possible therapist disclosures.<br />
It also suggests the limitations in using direct methods <strong>of</strong><br />
information to elicit information on such a difficult subject<br />
which may have pr<strong>of</strong>essional implications for all involved.<br />
Participants viewed a relational supervisory alliance, (core<br />
category) consisting <strong>of</strong> trust, collegiality, acceptance <strong>and</strong> a<br />
safe environment, as the bedrock for safe exploration <strong>of</strong> this<br />
clinical phenomenon. This finding confirms existing literature<br />
(Shuck & Wood, 2011; Mehr, Ladany, & Caskie, 2015) showing<br />
good rapport <strong>and</strong> a working alliance are at the centre <strong>of</strong><br />
effective supervision, enabling supervisee disclosure <strong>of</strong><br />
difficult issues.<br />
Participants believed that a strong alliance involves building a<br />
relationship where the supervisee feels safe to explore their<br />
shortcomings <strong>and</strong> think about their anxieties without fear<br />
<strong>of</strong> being morally judged. They emphasised that supervisors<br />
must be aware <strong>of</strong> the imbalance <strong>of</strong> power in the supervisory<br />
relationship, with its potential to present an obstacle to<br />
disclosure <strong>and</strong> discussion <strong>of</strong> SA <strong>and</strong> create an environment to<br />
counteract it.<br />
Containing <strong>and</strong> supporting was given a prominent place<br />
in supervisors’ view <strong>of</strong> the development <strong>of</strong> a facilitative<br />
environment that contains anxieties, gives permission to talk<br />
about SA <strong>and</strong> allows this clinical interplay the seriousness it<br />
deserves. Some supervisors emphasised the importance <strong>of</strong><br />
gently encouraging the therapist to allow the explicitness <strong>of</strong><br />
SA to emerge. Another important condition found to influence<br />
the development <strong>of</strong> effective supervision is normalising<br />
SA. Some supervisors described this as giving permission<br />
to talk about it, by explicitly stating that it happens to all <strong>of</strong><br />
us <strong>and</strong> that by naming it, the supervisor defuses the taboo<br />
surrounding it. Creating a contemplative, open, supervisory<br />
atmosphere where supervisor <strong>and</strong> supervisee can think<br />
together collegially was seen as fertile ground for effective<br />
supervision. Participants regarded the supervisor’s role as<br />
educative, involving asking direct questions, especially if<br />
the supervisor senses through clinical material the presence<br />
<strong>of</strong> sexual interplay. They felt that tentatively checking <strong>and</strong><br />
sharing underst<strong>and</strong>ings with the supervisee, invites reflection<br />
<strong>and</strong> exploration. Constructive challenge was regarded as an<br />
important tool <strong>of</strong> supervision, as it stretches the supervisee to<br />
think beyond their comfort zone.<br />
Supervisors in this study were clear that SA is a difficult topic<br />
to bring to supervision, due to taboos surrounding the subject<br />
<strong>and</strong> as a result <strong>of</strong> anxieties associated with the sexuality <strong>of</strong><br />
the therapist being present in the therapy room. The study<br />
outlined here theorises that supervisors’ approach to SA<br />
requires certain facilitative conditions to make discussion<br />
<strong>and</strong> exploration possible. These conditions are captured in<br />
the core category that to be effective, supervision should<br />
encourage openness <strong>and</strong> growth, facilitate explicitness <strong>and</strong><br />
be non-judgemental. However, not all supervisors initiate<br />
discussion <strong>of</strong> SA in supervision <strong>and</strong> the study <strong>of</strong> participants’<br />
accounts lacked specific examples <strong>of</strong> acting upon SA by<br />
supervisees.<br />
On the whole, these research findings <strong>of</strong>fer principles <strong>of</strong><br />
good practice in the supervision <strong>of</strong> SA that is effective <strong>and</strong><br />
the findings support some existing research (Mehr, Ladany, &<br />
Caskie, 2015). The apparent predominance <strong>of</strong> generalisations<br />
in the data, makes it difficult to know whether participants’<br />
views were based on what they know <strong>of</strong> the literature <strong>and</strong><br />
not what they actually do in practice, that could be influenced<br />
by the need for social conformity or to impress researchers<br />
that their practice meets certain competencies. This limits<br />
the quality <strong>of</strong> the findings in important ways. It is clear that<br />
supervisors <strong>of</strong> any theoretical orientation need to have the<br />
ability to create a safe supervisory environment that contains<br />
<strong>and</strong> supports, normalises, is characterised by a contemplative,<br />
reflective atmosphere that allows constructive challenge<br />
<strong>and</strong> encourages supervisees to enter into the psychological<br />
l<strong>and</strong>scape <strong>of</strong> SA if the dynamic is to be h<strong>and</strong>led appropriately.<br />
Implications<br />
Training modules enabling supervisors to experientially<br />
grapple with issues around SA would be a useful way <strong>of</strong><br />
fostering confidence through highlighting research-based<br />
principles <strong>of</strong> good practice. Supervisors need to be mindful<br />
<strong>of</strong> the difficulty therapists feel raising the subject <strong>and</strong> adopt a<br />
facilitative approach to helping supervisees work with SA.<br />
Limitations<br />
Although rich <strong>and</strong> dense data were generated from the<br />
interviews, the number <strong>of</strong> participants in distinct modalities<br />
was too small for meaningful comparisons. Our study was<br />
not aimed at teasing out differences between modalities<br />
in supervisors’ views on the supervision <strong>of</strong> SA. Participants<br />
who volunteered may be those who were interested in SA<br />
<strong>and</strong> through experience learned key principles <strong>of</strong> good<br />
practice. However, these principles could be academic,<br />
influenced by supervisors’ readings <strong>of</strong> the literature <strong>and</strong> the<br />
need to conform <strong>and</strong> impress <strong>and</strong> not necessarily drawn<br />
from personal experience. In terms <strong>of</strong> h<strong>and</strong>ling SA effectively,<br />
supervisor views were too generalised. Larger, anonymous<br />
survey type studies could potentially elicit a more rigorous<br />
picture on both the h<strong>and</strong>ling <strong>of</strong> <strong>and</strong> modality differences in<br />
supervising SA.<br />
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0167.43.1.25.
11<br />
INTERNATIONAL STUDENTS: A MINORITY GROUP<br />
AT RISK IN NEED OF PSYCHOLOGICAL SUPPORT<br />
Sonia Gallucci<br />
Abstract<br />
This article aims to provide an insider <strong>and</strong> outsider account <strong>of</strong> psychological<br />
vulnerability <strong>of</strong> international students when encountering cultural diversity. The<br />
term international students is used in this paper to indicate the specific population<br />
<strong>of</strong> young adults who spend a part <strong>of</strong> their undergraduate studies abroad. Despite<br />
the rising number <strong>of</strong> students moving between countries <strong>and</strong> an increased<br />
research interest in international mobility, few studies focus on the particular state<br />
<strong>of</strong> physical <strong>and</strong> emotional transition that this population can experience while<br />
abroad. This state <strong>of</strong> transition can cause unforeseen psychological difficulties <strong>and</strong><br />
as a result it may affect their experience abroad <strong>and</strong> indeed their life thereafter. The<br />
paper explores possible causes <strong>and</strong> consequences <strong>of</strong> psychological discomfort<br />
experienced by individuals during a period <strong>of</strong> study abroad; it highlights some <strong>of</strong><br />
the current therapeutic approaches available for culturally diverse minority groups,<br />
such as international students, <strong>and</strong> calls for more consideration <strong>of</strong> this particular<br />
group <strong>of</strong> vulnerable students that are still largely neglected from research <strong>and</strong><br />
practices which take account <strong>of</strong> cultural dimensions in therapeutic <strong>and</strong> educational<br />
settings. Indeed, it argues that the transitory experience <strong>of</strong> international students<br />
who live in new social <strong>and</strong> cultural surroundings can be fostered by appropriate<br />
emotional support.<br />
Keywords: International students, year abroad, psychological vulnerability<br />
Introduction<br />
In the last decade I had the privilege to work with<br />
international students as a teacher <strong>and</strong> as an academic<br />
advisor, <strong>and</strong> to observe their particular ways <strong>of</strong> dealing<br />
with cultural differences inside <strong>and</strong> outside the classroom.<br />
My experiences with undergraduate students sometimes<br />
bring me back to a period <strong>of</strong> my life when I was also an<br />
international student living in a foreign country. Indeed, I<br />
spent a year abroad in Germany as an exchange student<br />
<strong>and</strong> I know, like my students, how it feels when living in<br />
unfamiliar settings far away from ‘home’ for the first time.<br />
Over the years, my lived experiences <strong>of</strong> cultural diversity<br />
have led me to an increased interest in the connection<br />
between individuals’ psychological traits <strong>and</strong> their cultural<br />
backgrounds. This curiosity informs my daily practice as<br />
a teacher <strong>and</strong> has accompanied me during my doctoral<br />
studies, which focused on the emotional <strong>and</strong> social<br />
dimensions <strong>of</strong> university undergraduate level language<br />
learning during a period <strong>of</strong> study abroad experience<br />
(Gallucci, 2014). More specifically, I explored the identities<br />
<strong>and</strong> emotions <strong>of</strong> three British young women who lived in<br />
Italy for one academic year as part <strong>of</strong> their undergraduate<br />
course <strong>of</strong> study. The stories <strong>of</strong> the individuals, who<br />
participated in my doctoral study, have shown that living in<br />
new sociocultural realities <strong>and</strong> managing a sense <strong>of</strong> self in<br />
contexts <strong>of</strong> relative disempowerment, entails considerable<br />
personal struggle. Their stories have also shown that the<br />
ways in which individuals deal with their struggles, <strong>and</strong><br />
particularly, the extent to which they manage to overcome<br />
their emotional struggles, can be attributed to their personal<br />
abilities <strong>and</strong> skills. These findings stirred my interest in<br />
exploring the ways in which international students’ lived<br />
experiences can be fostered not only conceptually <strong>and</strong><br />
analytically but also emotionally. Indeed, it is through a<br />
deeper underst<strong>and</strong>ing <strong>of</strong> the ways in which individuals<br />
can deal with language learning processes (intellectually<br />
<strong>and</strong> emotionally) that we, as researchers, educational<br />
practitioners <strong>and</strong> mental health pr<strong>of</strong>essionals, can guide<br />
students towards a positive learning experience, both<br />
academically <strong>and</strong> on a personal level.<br />
Contact:<br />
Dr Sonia GalluccI, Senior Lecturer in Italian & Cross-Cultural Studies,<br />
Institute <strong>of</strong> Languages & Culture, Regent’s University London<br />
galluccis@regents.ac.uk
12<br />
Since the completion <strong>of</strong> my PhD in 2011, I have been<br />
wondering whether international students’ ability to<br />
adapt to new social <strong>and</strong> cultural realities can be fostered<br />
by appropriate psychological help before <strong>and</strong> during<br />
their experience abroad; <strong>and</strong>, subsequently, I have been<br />
questioning whether the inability <strong>of</strong> some students to<br />
integrate in the host society can be indeed the fruit <strong>of</strong><br />
inadequate emotional support. Hence, the focus <strong>of</strong> this<br />
article, which aims to shed some lights on the emotional<br />
consequences <strong>of</strong> international students when living abroad<br />
<strong>and</strong> on the ways in which education <strong>and</strong> mental health<br />
pr<strong>of</strong>essionals, can help them before, during <strong>and</strong> after<br />
departure.<br />
International students:<br />
minority group at risk<br />
Over the last four decades the number <strong>of</strong> students spending<br />
a period <strong>of</strong> study overseas has vastly increased, due to the<br />
requirement <strong>of</strong> home universities to spend a part <strong>of</strong> their<br />
studies abroad <strong>and</strong> also due to a more globalised world,<br />
where movements <strong>of</strong> people between countries have<br />
become more affordable <strong>and</strong> desirable (cf. Alred, 2003,<br />
Berry, 1997, Byram & Feng, 2006).<br />
The experience abroad definitely brings along a number<br />
<strong>of</strong> benefits for international students, such as those<br />
documented by Sherry et al. (2010), namely a valuable<br />
opportunity for improving academic skills <strong>and</strong> exp<strong>and</strong>ing<br />
social networks through “making friends at the University<br />
[<strong>and</strong>] having positive relationships with Pr<strong>of</strong>essors” (p. 45).<br />
Allen <strong>and</strong> Higgins’ study (1994) showed how the positive<br />
effects <strong>of</strong> such experience are also linked to students’<br />
motivating factors to go <strong>and</strong> live abroad, which include<br />
greater opportunities to travel <strong>and</strong> experience different<br />
cultures, <strong>and</strong> the desire to receive a better education<br />
<strong>and</strong> increase their job prospects (p. 11). Other important<br />
factors emerging from the period <strong>of</strong> study abroad are the<br />
development <strong>of</strong> linguistic pr<strong>of</strong>iciency <strong>and</strong> the heightening<br />
<strong>of</strong> sociocultural awareness (Freed, 2008). However, the<br />
usefulness <strong>of</strong> such experience in terms <strong>of</strong> personal <strong>and</strong><br />
interpersonal gains is not always clear <strong>and</strong> we still have<br />
rather few research insights that document the advantages<br />
<strong>of</strong> this “costly adventure in a new country. Scientific<br />
evidence <strong>of</strong> the benefits <strong>of</strong> residence abroad […] is patchy<br />
<strong>and</strong> does not always support a wholly optimistic view”<br />
(Coleman, 1995: 17)<br />
Hence, the prospect <strong>of</strong> voluntarily moving into another<br />
country for study can be exciting, especially for young adults<br />
who have never lived abroad before. However, anecdotal<br />
evidence shows that as soon as they enter in contact with<br />
the culturally dem<strong>and</strong>ing reality <strong>of</strong> new contexts, euphoric<br />
feelings can easily turn into a state <strong>of</strong> confusion <strong>and</strong> cause<br />
unforeseen psychological difficulties leading to an emotional<br />
state <strong>of</strong> ‘culture shock’. The first representations <strong>of</strong> year<br />
abroad individuals’ adjustment to new sociocultural realities<br />
were provided by Lysgaard (1955) <strong>and</strong> by Gullahorn &<br />
Gullahorn (1963) in the form <strong>of</strong> U-curve <strong>and</strong> W-curve models<br />
respectively. The U-curve model describes four consecutive<br />
phases <strong>of</strong> intercultural adjustment: euphoria, culture shock,<br />
acculturation <strong>and</strong> stable state. The W-curve model includes<br />
three further stages <strong>of</strong> sojourners’ re-adjustment when they<br />
come back from their experience abroad: honeymoon, crisis,<br />
adjustment.<br />
Numerous attempts have later been made by scholars<br />
in order to describe young individuals’ responses to<br />
cultural difference, for instance, Bennett’s Developmental<br />
Model <strong>of</strong> Intercultural Sensitivity (1986), which prompts<br />
people to become ethnorelative by adopting multiple<br />
cultural frameworks <strong>of</strong> reference; or most recently,<br />
Matsumoto <strong>and</strong> Juang’s Intercultural Adjustment Potential<br />
Scale (2008), which focuses on the psychological<br />
mechanisms (such as openness, critical thinking,<br />
flexibility <strong>and</strong> emotion regulation) that can facilitate<br />
intercultural communication <strong>and</strong> personal growth.<br />
While these models are <strong>of</strong> high value when trying to<br />
underst<strong>and</strong> the ways in which individuals perceive cultural<br />
difference <strong>and</strong> how they can cope with the unforeseen<br />
stress experienced when living in a new culture, yet they<br />
somehow describe people’s intercultural experiences <strong>and</strong><br />
the necessary coping skills as a ready-made toolkit that can<br />
be applied to anyone. What these models seem to overlook<br />
is that individuals’ experiences <strong>of</strong> diversity, including cultural<br />
diversity, are unique for each person, <strong>and</strong> it has proven<br />
to be particularly challenging for novel travellers, such as<br />
international students, who have no prior experience <strong>of</strong><br />
living overseas. Indeed, apart from their unsettling physical<br />
transition, a change <strong>of</strong> status <strong>and</strong> the use <strong>of</strong> a different<br />
language while abroad can cause additional emotional<br />
distress, that can be comparable to a form <strong>of</strong> bereavement<br />
(Anderson, 1994) as individuals may feel particularly<br />
vulnerable for a perceived loss <strong>of</strong> an important part <strong>of</strong><br />
themselves, namely a loss <strong>of</strong> identity.<br />
International students can be considered as a population<br />
at risk that would need special consideration by host<br />
institutions, given their unique needs, such as being<br />
culturally understood <strong>and</strong> emotionally supported within<br />
the local communities <strong>of</strong> practice (including the academic<br />
environment). As Sherry et al. (2010) point out, when<br />
international students move abroad, like many other minority<br />
groups, they can experience several challenges “as a result<br />
<strong>of</strong> language <strong>and</strong> cultural barriers, academic <strong>and</strong> financial<br />
difficulties, interpersonal problems, racial discrimination, loss<br />
<strong>of</strong> social support, alienation <strong>and</strong> homesickness” (p. 34). In<br />
addition, they may also experience unequal opportunities<br />
(or exploitation) in the host universities <strong>and</strong> emotional<br />
misbalance when they go back to their home countries<br />
(ibidem).<br />
Sherry et al. (2010) conducted a quantitative study at the<br />
University <strong>of</strong> Toledo among over 100 international students<br />
to find out about their social, cultural <strong>and</strong> academic<br />
experiences <strong>and</strong> how to improve them. From their findings<br />
clearly emerged that a welcoming academic environment<br />
was a key factor for their mental wellbeing. Other important<br />
factors in successful intercultural adjustment were: language<br />
pr<strong>of</strong>iciency, an inclusive (rather than exclusive) local<br />
community, which underst<strong>and</strong>s <strong>and</strong> appreciates cultural<br />
differences (such as the provision <strong>of</strong> Halal food on campus<br />
for Muslim students) <strong>and</strong> social support to overcome<br />
isolation. The study conducted by Sherry et al. (2010) is<br />
insightful; however, they are aware <strong>of</strong> the limitations <strong>of</strong><br />
their study, since, due to its exploratory nature “there may<br />
be a number <strong>of</strong> additional areas requiring research [such<br />
as] specific gender, religious or cultural differences in the<br />
experiences <strong>of</strong> international students”. (p. 44).<br />
International students are more vulnerable than local<br />
students <strong>and</strong> can therefore be considered a population<br />
at risk. Moreover, they rarely seek psychological support<br />
during their stay abroad since the majority <strong>of</strong> them are not<br />
used to relying on pr<strong>of</strong>essional help. In fact, as Lee (1999)<br />
indicates “most <strong>of</strong> their home countries do not have a<br />
history <strong>of</strong> providing or encouraging counselling, <strong>and</strong> many<br />
international students seek help only as a last resort” (p. 41).<br />
International students are people in transition because they<br />
live temporarily in another country (Khoo et al., 2002). This<br />
new reality <strong>of</strong> physical transition may lead them to unfamiliar
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 13<br />
emotional instability which in turn can be the cause <strong>of</strong><br />
psychological distress (cf. Furham, & Bochner, 1990). Indeed,<br />
this state <strong>of</strong> cultural transition can cause a great deal <strong>of</strong><br />
life stress, <strong>and</strong> even when this transition is “positively<br />
anticipated” (Lee, 1999: 36), it can still be the source<br />
<strong>of</strong> ‘culture shock’ (Oberg, 1960) or ‘uprooting disorder’<br />
(Zwingmann & Gunn, 1983). According to Lago (2006), these<br />
problems “are not at all deeply understood or appreciated in<br />
terms <strong>of</strong> the dem<strong>and</strong>s <strong>and</strong> pressures they place upon those<br />
who suffer this process. At worst, culture shock can cause<br />
breakdown <strong>and</strong> long term illness” (p. 392).<br />
As mentioned above, many attempts have been made<br />
across disciplines to conceptualise this phenomenon <strong>and</strong><br />
to provide a useful framework for individuals to overcome<br />
culture shock (cf. among others Lysgaard, 1955; Bennett,<br />
1986; Bredella, 2003; McCrae & Costa, 1987). However, a<br />
specific theoretical model thought for this particular student<br />
population is yet to be developed. Indeed, as Arthur (1997)<br />
states, the current models <strong>of</strong> culture shock or cross-cultural<br />
adjustments fail “to identify the specific experiences <strong>of</strong><br />
students […] [who] present a myriad <strong>of</strong> related psychological<br />
<strong>and</strong> physiological symptoms” (p. 264-265).<br />
According to Barty (2011), the main causes <strong>of</strong> the<br />
psychological discomfort experienced by international<br />
students are social loneliness, homesickness <strong>and</strong> cultural<br />
isolation. The persistence over time <strong>of</strong> these symptoms<br />
can be an alarming cause <strong>of</strong> concern since they can have<br />
a serious impact on their wellbeing (p. 185). Some studies<br />
also highlight the fact that international students may show<br />
depressive symptoms when they perceive discrimination<br />
<strong>and</strong> have a lack <strong>of</strong> social support <strong>and</strong> connectedness<br />
(Hanassab, 2006; Mallinckrodt & Leong, 1992; Sawir et al,<br />
2007; Wei et al, 2008). Other common factors affecting<br />
their sojourn abroad are represented by financial <strong>and</strong><br />
communication problems, a lack <strong>of</strong> fluency in the target<br />
language, <strong>and</strong> a lack <strong>of</strong> underst<strong>and</strong>ing <strong>of</strong> local practices<br />
(Arthur, 1997; Yeh & Inose, 2003; Misra & Castillo, 2004;<br />
Sherry et al, 2010).<br />
Hence, international students are likely to face a great deal<br />
<strong>of</strong> issues when they move abroad <strong>and</strong> subsequently, they<br />
seem to be a population at high risk, who would need to<br />
be emotionally supported before, during <strong>and</strong> after their<br />
stay abroad. The provision <strong>of</strong> personal therapy <strong>of</strong>fered by<br />
their home <strong>and</strong> host institutions would surely enhance their<br />
wellbeing <strong>and</strong> help them make the most <strong>of</strong> their experience<br />
overseas.<br />
Working with international students<br />
When working with international students (as mental health<br />
pr<strong>of</strong>essionals or educationalists) we need to take into<br />
account the distinctive <strong>and</strong> complex aspects that make<br />
them a unique population. These include first <strong>of</strong> all, their<br />
temporary stay in unfamiliar settings; secondly, the unique<br />
set <strong>of</strong> values, beliefs <strong>and</strong> assumptions that they own; <strong>and</strong><br />
finally the distinctive social networks they do (or do not)<br />
create around them <strong>and</strong> their specific communication styles<br />
(Khoo et al., 2002).<br />
There are currently various therapeutic approaches which<br />
put a great deal <strong>of</strong> emphasis on the cultural dimensions <strong>of</strong><br />
the relationship between therapists <strong>and</strong> clients/patients from<br />
minority groups; the most common ones are intercultural<br />
therapy, multicultural counselling, cross-cultural psychology<br />
<strong>and</strong> transcultural counselling <strong>and</strong> psychotherapy (see<br />
respectively Kareem & Littlewood, 1992; Palmer, 2002 <strong>and</strong><br />
Gielen et al., 2008; Berry et al., 2011; Lago, 2011).<br />
Although all <strong>of</strong> these approaches see culture as a crucial<br />
component <strong>of</strong> individuals’ cognitive <strong>and</strong> emotional<br />
behaviour, whilst appreciating the cultural differences <strong>of</strong><br />
minority groups, very little emphasis has been put on the<br />
minority group at risk that has been presented in this paper,<br />
namely international students. Preference seems to be<br />
given to therapeutic practices in relation to racial, ethnic<br />
<strong>and</strong> sexual diversity <strong>of</strong> individuals who live (or plan to live)<br />
permanently in a specific place, whereas the identities <strong>of</strong><br />
young adults in transition between countries, such as those<br />
<strong>of</strong> international students, seem to detain a small space in the<br />
literature <strong>and</strong> in the therapy room (cf. Nayar-Aktar, 2015).<br />
Despite the lack <strong>of</strong> clear evidence <strong>of</strong> working therapeutically<br />
<strong>and</strong> ‘successfully’ with international students (cf. Jewel,<br />
2002), some recent studies have provided interesting<br />
insights into the world <strong>of</strong> this minority group <strong>and</strong> into<br />
the ways in which therapists, willing to recognise <strong>and</strong><br />
appreciate cultural diversity, can help them overcome<br />
psychological difficulties experienced during or after<br />
their period <strong>of</strong> study abroad (see e.g. Arthur, 1997;<br />
Arthur & Popadiuk, 2010; Barty, 2011; Butler-Byrd et al.,<br />
2006; Heppner, 2006; Khoo et al. 2002; Park-Saltzman<br />
et al., 2012; Seo, 2010; Vera & Speight, 2003)<br />
Overall, becoming ‘culturally or multiculturally’ competent<br />
seems to be the main goal <strong>of</strong> therapists working with<br />
culturally diverse people (cf. Vera & Speight, 2003). Sue<br />
<strong>and</strong> Sue (1990) recommend mental health pr<strong>of</strong>essionals<br />
to raise their sensitivity to the cultural differences <strong>of</strong> their<br />
patients <strong>and</strong> to become aware <strong>of</strong> their own bias towards<br />
diversity. Khoo et al. (2002) also recommend being aware<br />
<strong>of</strong> <strong>and</strong> discussing the expectations that both counsellors<br />
<strong>and</strong> clients have from their therapeutic encounters<br />
<strong>and</strong> from each other, since unawareness could cause<br />
“misunderst<strong>and</strong>ings about their respective roles” (p. 101).<br />
Thomas <strong>and</strong> Althen (1989) (cited in Khoo et al., 2002:<br />
106-107), also warn about the distinctive issues that<br />
therapists may encounter when dealing with foreign<br />
students (particularly from Eastern countries). These are:<br />
cultural stereotyping, the particular situations in which each<br />
student finds him/herself, a possible difficulty in identifying<br />
the source <strong>of</strong> their problem(s), <strong>and</strong> the doubts they may<br />
have about the appropriateness <strong>of</strong> conventional (western)<br />
approaches to therapy.<br />
Indeed, students’ reluctance about unfamiliar therapeutic<br />
approaches employed in the host societies can be a major<br />
deterrent in their healing process. This is applicable not<br />
only to international students, but also to other individuals<br />
whose native cultural healing traditions are substantially<br />
different from those they experience in new societies. For<br />
instance, in countries commonly known as ‘collectivistic’<br />
(or ‘communalistic’ - as defined by Laungani (2002) (e.g.<br />
India, Thail<strong>and</strong>, South Korea, Colombia <strong>and</strong> Pakistan), great<br />
emphasis is put on spiritual <strong>and</strong> supernatural practices,<br />
whereas in ‘individualistic’ countries (e.g. USA, UK, Canada,<br />
France <strong>and</strong> Germany) such practices are <strong>of</strong>ten dismissed in<br />
the treatment <strong>of</strong> mental illness because priority is given to<br />
more scientific <strong>and</strong> naturalistic practices.<br />
The dichotomy between collectivistic <strong>and</strong> individualist<br />
societies may seem a simplistic <strong>and</strong> overused way <strong>of</strong><br />
categorising cultural differences among individuals (cf.<br />
Laungani, 2002); however, it has its own value when trying<br />
to discern the origin <strong>of</strong> individuals’ archetypical patterns<br />
<strong>of</strong> behaviour. For example, in a recent study based on<br />
individualistic <strong>and</strong> collectivistic variables <strong>and</strong> conducted<br />
among international students coming from South Korea,<br />
Seo (2010) found out that her participants perceived<br />
personal therapy to be more effective when their counsellor<br />
Volume 2, Number 1, January 2017
14<br />
emphasised their particular expression <strong>of</strong> emotions,<br />
deriving from their own native culture. Another recent study<br />
conducted by Park-Saltzman et al. (2012), highlighted how<br />
Asian international students face unique issues due to<br />
their cultural (collectivistic) beliefs <strong>and</strong> therefore, they need<br />
a specific format <strong>of</strong> mentoring (p. 895). Moreover, as Barty<br />
(2011) points out, in order to overcome students’ resistance<br />
to Western practices <strong>of</strong> psychotherapy or counselling, it is<br />
important to acknowledge that traditions <strong>of</strong> help-seeking <strong>and</strong><br />
help-giving may differ from society to society <strong>and</strong> that belief<br />
systems ought to be validated within those traditions, that<br />
<strong>of</strong>ten provide informal support, such as friends <strong>and</strong> family,<br />
authoritative figures (elderly, religious or spiritual leaders)<br />
<strong>and</strong> prayers. Indeed, as she states “Western counsellors<br />
<strong>and</strong> psychotherapists, with their own theoretical cultural<br />
frames, may undervalue or even be hostile to other helping<br />
traditions” (p. 185). And this theoretical mind-set could<br />
potentially be a deterrent for students seeking psychological<br />
support while abroad. Other factors provoking international<br />
students’ procrastination or avoidance <strong>of</strong> personal therapy<br />
could include “concerns about confidentiality, a taboo on<br />
discussing private concerns to someone outside immediate<br />
family, perceived lack <strong>of</strong> relevance <strong>and</strong> perceived pressures<br />
<strong>of</strong> time” (Barty, 2011: 189).<br />
Hence, it is important to consider this minority group as<br />
a unique population in need <strong>of</strong> further support during<br />
their sojourn abroad. The enhancement <strong>of</strong> (inter)cultural<br />
awareness seems to be a key factor in current practices <strong>of</strong><br />
counselling <strong>and</strong> psychotherapy among culturally diverse<br />
individuals, such as international students. Hence, it is<br />
essential for counsellors <strong>and</strong> psychotherapists to gain<br />
knowledge about the specific cultural background <strong>of</strong> their<br />
clients <strong>and</strong> to respect the specific ways in which counselling<br />
practices are seen <strong>and</strong> applied in their ‘home’. It is also<br />
important to help clients be aware <strong>of</strong> such differences <strong>and</strong><br />
to talk about them overtly. A mutual awareness <strong>of</strong> different<br />
cultural traditions <strong>and</strong> an open dialogue about the nature<br />
<strong>of</strong> them, can surely nurture mutual trust <strong>and</strong> enhance the<br />
therapeutic relationship.<br />
The specific needs <strong>of</strong> international students can be<br />
addressed in numerous ways, not specifically labelled as<br />
therapeutic. For instance, as Sherry et al. (2010: 44-45)<br />
suggest, this can be done by promoting inclusive initiatives,<br />
such as a ‘Student International Week’ or a page on the<br />
University magazine dedicated to their experiences, such<br />
initiatives would raise their pr<strong>of</strong>ile on campus, would help<br />
them become more involved <strong>and</strong> ultimately would tackle<br />
social <strong>and</strong> cultural isolation. Access to local academic<br />
support services (such as the National Union <strong>of</strong> Students<br />
– NUS) could also be facilitated by more initiatives <strong>and</strong><br />
publicity on campus; or other government based services<br />
available to all individuals (such as the Increased Access<br />
to Psychological Therapies – IAPT) can be made more<br />
visible <strong>and</strong> directly accessible to students. In addition, more<br />
information could be embedded in curricula about “current<br />
government legislation, funding <strong>and</strong> supporting practices<br />
nationally for the delivery <strong>of</strong> racial equality in mental health”<br />
(Lago, 2011: 4). Finally, additional programmes on crosscultural<br />
underst<strong>and</strong>ing could also help international students<br />
feel more culturally understood <strong>and</strong> accepted within the<br />
academic environment.<br />
Being an international student<br />
As I have briefly outlined in the introductory section <strong>of</strong> this<br />
paper, I have personal experience <strong>of</strong> being an international<br />
student. Indeed, over two decades ago (in 1994), I spent ten<br />
months in Germany as an exchange student. At that time the<br />
idea <strong>of</strong> spending an academic year abroad was a new one,<br />
since it was introduced by the European Commission only<br />
seven years before (in 1987) together with the academic<br />
community in order to promote cooperation between<br />
universities <strong>and</strong> to enhance employability within the EU<br />
borders (Papatsiba, 2006).<br />
In my home town, a small place on the isl<strong>and</strong> <strong>of</strong> Sardinia, not<br />
many other students felt the same desire I had to explore<br />
other realities. Moreover, this experience was encouraged<br />
but not required by my home university. So in that period,<br />
only a small number <strong>of</strong> undergraduate students decided to<br />
go <strong>and</strong> spend part <strong>of</strong> their studies abroad. I was one <strong>of</strong> them.<br />
Except for some basic linguistic knowledge, I knew very<br />
little about the host society. I went to Potsdam University, a<br />
place in eastern Germany, not far from the remains <strong>of</strong> the<br />
Berlin Wall. My stay abroad was quite challenging, since I<br />
had to deal with a great amount <strong>of</strong> practical but above all<br />
psychological difficulties.<br />
Upon my arrival to the host country, I initially noticed the<br />
attitudes <strong>of</strong> local people which I considered to be more<br />
distant <strong>and</strong> detached compared to the attitudes <strong>of</strong> people<br />
back ‘home’. For example, I would go to public places such as<br />
the local supermarket, the train station or pubs <strong>and</strong> members<br />
<strong>of</strong> staff would not say hello or smile at me. On one occasion,<br />
I recall not being served food in a pub because I was told the<br />
kitchen was closed, <strong>and</strong> then seeing other local people being<br />
served soon after. I also remember one <strong>of</strong> my ‘international’<br />
friends, originally from Albania, being chased by neighbours<br />
near a bus stop because they found out he was not German,<br />
or another friend from Japan, being intimidated by local<br />
students who used to write in red paint <strong>of</strong>fensive words<br />
against him on the student accommodation walls.<br />
I clearly found myself in a quite hostile environment where<br />
local people were not used to ‘foreign’ visitors, let alone<br />
having international students living with them for long<br />
periods. Certainly a perceived discrimination played an<br />
important role in my lived experiences <strong>of</strong> otherness <strong>and</strong> in<br />
my feeble (or no) attempts to integrate in the host society.<br />
Other initial obstacles to my acculturation process were also<br />
my lack <strong>of</strong> fluency in German <strong>and</strong> my lack <strong>of</strong> underst<strong>and</strong>ing<br />
about local communities <strong>of</strong> practice. Hence, my limited<br />
linguistic knowledge <strong>and</strong> cultural unawareness were<br />
additional factors which impeded meaningful communication<br />
between me <strong>and</strong> local people. This ‘temporary’ inability to<br />
deal successfully with people around me caused me a lot <strong>of</strong><br />
stress <strong>and</strong> various psychological difficulties, including a high<br />
level <strong>of</strong> anxiety <strong>and</strong> mild signs <strong>of</strong> depression.<br />
I think my determination to succeed academically helped<br />
me partially overcome these issues. Firstly, I surrounded<br />
myself with other Italian students, who were spending,<br />
like me, their year abroad in Potsdam; then, as soon as<br />
I achieved a certain degree <strong>of</strong> fluency in German, I met<br />
other international students <strong>and</strong> with one <strong>of</strong> them I also<br />
had a romantic relationship. These factors obviously made<br />
the whole process easier <strong>and</strong> more enjoyable for me <strong>and</strong><br />
helped me overcome some <strong>of</strong> the mixed emotions I felt as a<br />
result <strong>of</strong> ‘culture shock’. When my experience abroad came<br />
to an end I was more relieved than sad, as I thought that<br />
going back home to the comforts <strong>of</strong> my previous lifestyle<br />
would make me feel the same contented person I previously<br />
was. However, what I did not know was that this experience<br />
would change my life forever <strong>and</strong> that for a long time, after<br />
my return, I would feel very confused about my identity, my<br />
views <strong>and</strong> my feelings. A close circle <strong>of</strong> friends <strong>and</strong> the love<br />
<strong>and</strong> care <strong>of</strong> my family helped me regain a sense <strong>of</strong> self <strong>and</strong><br />
settle again in my home country. However, the unexpected<br />
experiences <strong>of</strong> cultural difference I had during my year<br />
abroad have impacted me pr<strong>of</strong>oundly.
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 15<br />
As soon as I completed my undergraduate studies, I decided<br />
to go <strong>and</strong> live abroad again in another country: Engl<strong>and</strong>.<br />
This time the decision was made more wisely as I prepared<br />
myself cognitively <strong>and</strong> emotionally for the new adventure.<br />
And here I am, still living ‘abroad’ after nearly two decades.<br />
I am a more mature person now <strong>and</strong> I feel more prepared to<br />
deal with cultural differences than I was in my early twenties.<br />
I have dedicated time <strong>and</strong> energy into researching cultural<br />
issues, as I am also doing in this paper, <strong>and</strong> I feel I have now<br />
a more holistic <strong>and</strong> accepting stance towards diversity than<br />
I used to. However, I cannot help sometimes feeling puzzled<br />
<strong>and</strong> trapped in circles <strong>of</strong> cultural misunderst<strong>and</strong>ings <strong>and</strong><br />
reliving the same sense <strong>of</strong> loneliness <strong>and</strong> homesickness that<br />
I experienced when I was an international student.<br />
Conclusion<br />
In this paper, I have outlined some <strong>of</strong> the issues related<br />
to international students as a population at risk in need <strong>of</strong><br />
psychological support. I have backed up my reflection by<br />
exploring the possible causes <strong>of</strong> psychological discomfort<br />
they may experience during their stay abroad, <strong>and</strong> by<br />
highlighting some <strong>of</strong> the current therapeutic approaches<br />
available for culturally diverse minority groups, such<br />
as international students. I have also shared with the<br />
reader some memories <strong>of</strong> my personal experiences as<br />
an international student, with the main aim <strong>of</strong> providing<br />
an insider account <strong>of</strong> psychological vulnerability when<br />
encountering cultural diversity.<br />
Anecdotal evidence suggests that international students are<br />
<strong>of</strong>ten left alone to deal with the emotional uncertainties <strong>of</strong><br />
living in new sociocultural contexts, <strong>and</strong> as a consequence<br />
they may feel psychologically <strong>and</strong> socially alienated.<br />
Indeed, during their stay abroad, they may experience<br />
unprecedented psychological difficulties, like I did, <strong>and</strong> be<br />
overwhelmed by mixed emotions that they may find very<br />
difficult to face.<br />
We need more studies that focus on the emotional<br />
experience <strong>of</strong> this minority group <strong>of</strong> young adults <strong>and</strong> on<br />
the ways in which counselling <strong>and</strong> psychotherapy could<br />
help them benefit from their sojourns abroad. We also need<br />
more on-campus initiatives that promote inclusion among<br />
all students (local <strong>and</strong> international), more awareness<br />
<strong>of</strong> current legislation on diversity <strong>and</strong> more publicity on<br />
mental <strong>and</strong> social support services available to students.<br />
Tailored psychological support before, during <strong>and</strong> after<br />
students’ experience abroad would certainly help them deal<br />
effectively with unforeseen emotional discomfort <strong>and</strong> guide<br />
them throughout their journey <strong>of</strong> doubts <strong>and</strong> uncertainties in<br />
unfamiliar settings. Such support would also help students<br />
increase their academic motivation <strong>and</strong> consequently<br />
obtain better results. Indeed, on reflection, when I was an<br />
international student, personal therapy would have certainly<br />
helped me regulate my emotions <strong>and</strong> equip me with the<br />
necessary coping skills to face cultural diversity (cf. Gross,<br />
1998, 1999, 2002; Gross & John, 2003).<br />
As a Senior Lecturer <strong>of</strong> Cross-cultural Studies <strong>and</strong> as an<br />
academic advisor for Study <strong>of</strong> Period Abroad students, I<br />
regularly witness a familiar sense <strong>of</strong> loss <strong>and</strong> uncertainty in<br />
my encounters with current international students who are<br />
living far away from their home country. I <strong>of</strong>ten feel powerless<br />
because besides some theoretical knowledge I can transmit<br />
during the lessons or sporadic (<strong>of</strong>ten) written contacts while<br />
they are abroad, I am not in a position to <strong>of</strong>fer them the<br />
additional psychological <strong>and</strong> pr<strong>of</strong>essional support they may<br />
require. Indeed, within the UK higher education system, we<br />
tend to prepare our students cognitively <strong>and</strong> theoretically<br />
to the exposure <strong>of</strong> other languages <strong>and</strong> cultural practices<br />
commonly used in the host countries. However, very little has<br />
been done so far within educational settings in order to help<br />
future international students regulate their emotions during<br />
their stays abroad, for instance, by <strong>of</strong>fering them emotional<br />
support through appropriate counselling <strong>and</strong> psychotherapy,<br />
which take into account cultural diversity. This, in my view,<br />
ought to be a compulsory element <strong>of</strong> their experiential<br />
preparation for the experience abroad.<br />
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17<br />
STARSHINE ON THE CRITICAL EDGE: PHILOSOPHY<br />
AND PSYCHOTHERAPY OF FANTASY AND SCI-FI<br />
Christina Richards<br />
Abstract<br />
Terry Pratchett once said that stories have power. This paper examines that power<br />
through considering the philosophy which may be found within fantasy <strong>and</strong> sci-fi <strong>and</strong><br />
the psychotherapeutic implications <strong>of</strong> that philosophy. In particular, it considers what we<br />
should do about the constraining nature <strong>of</strong> the Matrix from the Wachowski’s eponymous<br />
film; The nature <strong>of</strong> good <strong>and</strong> god according to witches in Terry Pratchett’s Discworld<br />
series; <strong>and</strong> what constitutes a worthwhile life to a time-travelling replicant in Rob Grant<br />
<strong>and</strong> Doug Naylor’s Red Dwarf; It examines how such insights might be <strong>of</strong> assistance in<br />
the quotidian world when, in the hope <strong>of</strong> some wider wisdom, our troubles lead us to lift<br />
our eyes to the stars for answers beyond our ken.<br />
Keywords: Fantasy, science fiction, psychotherapy, reflexivity, ethics, Terry Pratchett, The<br />
Matrix, Red Dwarf, philosophy<br />
Prelude<br />
The fire burned low under the two-moon sky as dark<br />
shadows crept in from the overhanging trees, bringing<br />
with them the evening cold. Skettish poked at the embers<br />
with the gnarled oak stick she kept with her always <strong>and</strong><br />
they raised a little heat, a few sparks ascending to die<br />
somewhere in the darkness above.<br />
‘There’s other places’ she sighed to the boy lying beside<br />
her. ‘Others than this’. ‘Some brighter, some darker, but all <strong>of</strong><br />
them places for the search.’<br />
‘The Search?’ the boy whispered his yellowing eyes peeping<br />
out from under his tightly wrapped blankets.<br />
‘Aye, the search’. ‘Why, What, How <strong>and</strong> all that…’<br />
‘Life’ – she waved a h<strong>and</strong> vaguely – ‘What we should do.’<br />
He shook a little as she rested her h<strong>and</strong> upon the sickly-wet<br />
skin <strong>of</strong> his forehead to let the last trickle <strong>of</strong> her magic flow<br />
into him - not enough for a cure she knew, but all that could<br />
be done now. His breathing eased.<br />
‘I love you gr<strong>and</strong>ma’ he said. ‘I’ll see what’s next now’, <strong>and</strong><br />
with that he died.<br />
She closed his eyes <strong>and</strong> sat still <strong>and</strong> silent as the fire faded<br />
to ash. As she started to weep a shooting star passed<br />
overhead <strong>and</strong> faded. She didn’t look up.<br />
Aboard the XF-β the ship’s computer navigated the passage<br />
between the planet <strong>and</strong> its moons without incident, the<br />
whole vast expanse <strong>of</strong> the continent sliding under the ship<br />
with the engines making barely a ripple in space-time. The<br />
sensors picked up three heat signatures from an expanse <strong>of</strong><br />
forest below which faded to two, then one. It was noted as a<br />
minor anomaly <strong>and</strong> logged accordingly, but did not pass the<br />
threshold which alerted the crew; the compliment <strong>of</strong> which<br />
currently consisted solely <strong>of</strong> Jones, M. (Cpt.) - a man <strong>of</strong><br />
impeccable record who was slowly losing his mind.<br />
‘Anything?’ Jones asked as he strolled onto the main deck<br />
munching cereal in a blue plastic bowl.<br />
‘No Jones, nothing’ the ship’s computer replied.<br />
‘Well what the hell am I meant to do then?’ he sputtered.<br />
‘Is there no-one in this whole damn galaxy whose society<br />
is sufficiently advanced that I can visit them <strong>and</strong> not screw<br />
everything up?’<br />
‘No Jones, not yet’.<br />
Jones sat down, sighed <strong>and</strong> rubbed his forehead. ‘Well what<br />
the hell am I going to do?’ he repeated more quietly, but<br />
with a growing desperation. ‘There’s just the two <strong>of</strong> us - <strong>and</strong><br />
you’re not even real.’<br />
‘Don’t you love me Jones? – You said you loved me.’<br />
‘It’s not that I don’t love you’ he shot back, then paused <strong>and</strong><br />
seemed to deflate a little. ‘It’s just that you’re not real <strong>and</strong> I<br />
think that should mean something – shouldn’t it?’<br />
Contact:<br />
Dr Christina Richards, Senior Specialist <strong>Psychology</strong> Associate, Nottinghamshire<br />
Healthcare Foundation NHS Trust <strong>and</strong> Clinical Research Fellow.<br />
West London Mental Health Trust.<br />
contact@christinarichards.co.uk
18<br />
Introduction<br />
Are the stories over then? Are they just beginning? Do they<br />
ever really end? Abide awhile with me <strong>and</strong> see. For if you’re<br />
sitting comfortably O’ Beloved, then I’ll begin.<br />
It is said that there are seven basic plots <strong>and</strong> that these<br />
are: Overcoming the Monster; Rags to Riches; The Quest;<br />
Voyage <strong>and</strong> Return; Comedy; Tragedy; <strong>and</strong> Rebirth (Booker,<br />
2004). Each <strong>of</strong> these has a narrative arc <strong>and</strong> each, naturally,<br />
contains a question: What am I to do about this? The ‘this’<br />
may vary <strong>of</strong> course; It may be a question as to how to deal<br />
with the grief <strong>of</strong> losing a loved one when all you have isn’t<br />
enough; or to find the meaning <strong>of</strong> love <strong>and</strong> togetherness in<br />
a postmodern world - as in the examples above - or it may<br />
be a question about how a prim <strong>and</strong> proper wife is to stop<br />
the vicar from finding the brigadier in the wardrobe who is<br />
unaccountably not wearing any trousers. Mostly, however,<br />
the questions, the themes <strong>of</strong> great literature, film, painting<br />
<strong>and</strong> music – what we might call ‘the arts’, are at least<br />
somewhat pr<strong>of</strong>ound 1 .<br />
We can see this in Shakespeare’s (1595) comedic fantasy<br />
A Midsummer Night’s Dream, for example, which examines<br />
themes <strong>of</strong> love (Bevington, 1996), identity (Hunt, 1986),<br />
sexuality (Green, 1998), <strong>and</strong> feminism (Howard, 2003); <strong>and</strong><br />
which is echoed (<strong>and</strong> pastiched) in Pratchett’s (1992) comic<br />
fantasy Lords <strong>and</strong> Ladies (<strong>of</strong> which more anon). We can see<br />
it in ancient stories such as the Cad Goddeu (The Battle <strong>of</strong><br />
the Trees), in which each <strong>of</strong> the story elements represent<br />
secret knowledge for transmission between members <strong>of</strong><br />
a persecuted druidic order (Graves, 1948). Indeed, most<br />
religions weave myth, legend <strong>and</strong> history to create a guide<br />
to a correct way <strong>of</strong> living, as well as to record information in<br />
pre-literate societies. Such stories have power (Pratchett,<br />
1990a) - the vision <strong>of</strong> the cobra keeping the rain from the<br />
Buddha as he sought enlightenment is an arresting one;<br />
as is the thought <strong>of</strong> Jesus being nailed through the h<strong>and</strong>s<br />
<strong>and</strong> feet to a wooden cross. Similarly, Nietzsche (1882)<br />
conjures the image <strong>of</strong> the blind man with the lantern to tell<br />
us (<strong>and</strong> to keep us told) that ‘God is dead’ <strong>and</strong> so impel us<br />
to act accordingly. These stories carry with them on a sort<br />
<strong>of</strong> narrative ‘carrier wave’ for pr<strong>of</strong>undity ideas about the<br />
transience <strong>of</strong> our flesh; the illusion/delusion <strong>of</strong> our senses<br />
<strong>and</strong> purpose <strong>of</strong> our existence with or without a God. Even<br />
numbers, the basis <strong>of</strong> ‘hard’ science, may be considered<br />
to be stories; for axiomatic to integer based mathematical<br />
systems is the pr<strong>of</strong>ound story that; ‘this is not that, it is<br />
other’; thus we have ‘two’ instead <strong>of</strong> ‘one’. But such thisthat<br />
splits have been challenged by other stories about the<br />
nature <strong>of</strong> reality in Buddhism (Conze, 1959), Christianity<br />
(Galatians 3:28), <strong>and</strong> in contemporary science with the<br />
advent <strong>of</strong> fuzzy logic (Kosko, 1994).<br />
We make our own individual stories too. Stories to make<br />
sense <strong>of</strong> the complexity <strong>of</strong> existence on a personal level -<br />
McLeod (2006):<br />
Stories are the basic way in which people make sense<br />
<strong>of</strong> their experience …We tell our own personal tales,<br />
but do so by drawing on a cultural stock <strong>of</strong> narrative<br />
forms. We are born into the story <strong>of</strong> our family <strong>and</strong><br />
community, <strong>and</strong> the story <strong>of</strong> who we are (e.g. our birth<br />
story, the story behind our name). As we grow up we<br />
adopt narrative templates provided by myths, films,<br />
novels <strong>and</strong> other cultural resources to give shape <strong>and</strong><br />
meaning to our individual life narrative. (p 290)<br />
Thus people create stories <strong>of</strong> identity in concert with<br />
their surroundings; they construct narratives that fashion<br />
1 We might argue that farces are too in that they prick holes in the<br />
constructed nature <strong>of</strong> so much <strong>of</strong> our social lives.<br />
the past into something that can coherently explain <strong>and</strong><br />
determine their life trajectory. This fashioning is subject<br />
to external influence from culture (Gergen, 2000) <strong>and</strong><br />
cultural determination by what Foucault (1991) styles as a<br />
‘panopticon’ society in which people monitor <strong>and</strong> police<br />
the boundaries <strong>of</strong> acceptable social behaviour through<br />
introjecting their own panopticon prison where they are<br />
monitored constantly by an internalised other 2 .<br />
Because such stories <strong>and</strong> personal narratives are<br />
constructed - deeply constructed from the material which<br />
shapes our realities, but constructed nonetheless - they<br />
are open to change. This may be personal, perhaps the<br />
change which comes from reading about others who<br />
suffer, or finding friends in characters in other [narrative]<br />
realities (Salvatore, 2011); or it may be through therapeutic<br />
intervention, perhaps in the form <strong>of</strong> phenomenological<br />
enquiry (Langdridge, 2013) or narrative therapy (White<br />
& Epston, 1990). These may be particularly apposite in<br />
exploring culturally derived stories that do not fit comfortably<br />
with an individual <strong>and</strong> so create space to constitute new<br />
stories. Indeed, one <strong>of</strong> the United Kingdom’s Health <strong>and</strong><br />
Care Pr<strong>of</strong>essions Council’s main constituents <strong>of</strong> <strong>Counselling</strong><br />
<strong>Psychology</strong> is that practitioners “Underst<strong>and</strong> how empathic<br />
underst<strong>and</strong>ing can be helped by creativity <strong>and</strong> artistry in the<br />
use <strong>of</strong> language <strong>and</strong> metaphor” (2012, p.10).<br />
We create art, whether it is for entertainment <strong>and</strong> edification;<br />
or whether it is the stories we tell internally as we paint<br />
ourselves heroes in adversity, or as Cinderellas when life<br />
throws one more stone in our shoe. When it is written, <strong>and</strong><br />
written well, it is <strong>of</strong>ten art such as this which reflects life<br />
<strong>and</strong> the deep currents which move us, <strong>and</strong> so is <strong>of</strong> concern<br />
to philosophers <strong>and</strong> psychotherapists alike 3 . Stories have<br />
power 4 : And the further they move from the minutiae <strong>of</strong> the<br />
everyday towards the extraordinary (but an extraordinary<br />
we can relate to), the more our suspension <strong>of</strong> disbelief<br />
allows new insight to emerge through dispensing with petty<br />
specifics. This is why religions are fantastic. This is why<br />
fantasy <strong>and</strong> sci-fi are the root <strong>of</strong> a new philosophy - <strong>and</strong><br />
perhaps a new psychotherapy from that.<br />
This is the starshine on the critical edge. Let’s dive a little<br />
deeper towards that inviting gleam…<br />
The Matrix<br />
Where do we exist? Is there a world out there we can see<br />
<strong>and</strong> touch <strong>and</strong> hear <strong>and</strong> taste <strong>and</strong> smell? That we can<br />
measure? That, crucially, we can change? In most realities<br />
such things are nebulous – worlds exist a priori <strong>and</strong> so at<br />
best our touching approximates a guess at what we have<br />
touched; our changes a hope, a fumble in the dark <strong>of</strong><br />
supposition as to what has really been altered. In worlds <strong>of</strong><br />
light <strong>and</strong> laws inside computer networks, however, realities<br />
are constructed which <strong>of</strong>fer hard boundaries to those<br />
who simply visit – <strong>and</strong> so <strong>of</strong>fer comfort in their predictable<br />
regularity. But such virtual worlds <strong>of</strong>fer something more,<br />
something deeper, to those who see <strong>and</strong> swim the liminal<br />
places which complexity <strong>and</strong> chaos in networks <strong>of</strong> hard laws<br />
<strong>of</strong>fer – the opportunity to really change, in ways at once<br />
both complex <strong>and</strong> boundaried. Indeed, when one can swim<br />
such liminal places on hard-law virtual networks the further<br />
question arises: Perhaps outside <strong>of</strong> such places too - in the<br />
real world – might there not be more latitude for change<br />
2 Another arresting image to carry an idea.<br />
3 Indeed some <strong>of</strong> us try to wear both hats, with varying degrees <strong>of</strong><br />
success - as anyone who has tried to wear two hats will know. A<br />
woolly hat <strong>and</strong> a climbing helmet just about works, but what that<br />
means is perhaps too pr<strong>of</strong>ound for this paper.<br />
4 I shall say this thrice.
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 19<br />
than we realise? It is in The Matrix (Silver, Wachowski<br />
& Wachowski, 1999), amongst other places that some<br />
answers are <strong>of</strong>fered to these most fundamental <strong>of</strong> questions<br />
concerning the possibilities afforded to people in a given<br />
reality.<br />
The Matrix was a hugely successful film which spawned<br />
two sequels <strong>and</strong> a number <strong>of</strong> spin-<strong>of</strong>f productions. Set<br />
in the near future it tells <strong>of</strong> a chosen human - Neo - who<br />
is encouraged to come into his power by a free human,<br />
Morpheus, in order to fight back against the sentient<br />
Machines who are holding most <strong>of</strong> the human race in<br />
bondage. Neo is able to do this through entering the means<br />
<strong>of</strong> that bondage - the Matrix - A computer generated fantasy<br />
world fed directly into the interconnected brains <strong>of</strong> humanity<br />
even as they lie physically dormant in the ‘real world’.<br />
Because Neo is aware that the Matrix is not real, <strong>and</strong> is<br />
instead created, he is able to bend its rules <strong>and</strong> so to have<br />
extraordinary powers - whereas the rest <strong>of</strong> humanity remains<br />
caught within the Matrix’ limits. The Machines, led by a<br />
computer generated person - ‘Agent Smith’ inside the Matrix<br />
- endeavour to stop him as he tries to break it from both<br />
within <strong>and</strong> without <strong>and</strong> so free humanity. Naturally, inside<br />
the Matrix everyone who is aware <strong>of</strong> the Matrix is incredibly<br />
cool, whereas the computer generated Agents look like<br />
stereotyped government workers in dull suits <strong>and</strong> ties 5 .<br />
The Matrix then. A computer generated reality which is<br />
possibly true (Bostrom, 2003) <strong>and</strong> leaves us considering the<br />
ways in which we may be held hostage by the reality we<br />
find ourselves in. It is, perhaps, a little fantastical, but does<br />
this idea <strong>of</strong> matrices manifest in more mundane ways? What<br />
if, for example, when Morpheus told Neo <strong>of</strong> the Matrix he<br />
simply <strong>of</strong>fered it as an insight into the gender dichotomy -<br />
the idea that there are only men or women <strong>and</strong> that they are<br />
fundamentally different in kind <strong>and</strong> not degree, with different<br />
needs, [sexual] desires, <strong>and</strong> identities; all independent <strong>of</strong><br />
cultural context (cf. Fine, 2011). If he <strong>of</strong>fered an insight into<br />
the Heteronormative Matrix, if you will.<br />
Adapting the script we might have:<br />
MORPHEUS<br />
NEO<br />
MORPHEUS<br />
NEO<br />
MORPHEUS<br />
Do you believe in fate, Neo?<br />
No.<br />
Why not?<br />
Because I don’t like the idea that I’m not in<br />
control <strong>of</strong> my life.<br />
I know exactly what you mean.<br />
Again, that smile that could cut glass.<br />
MORPHEUS<br />
NEO<br />
MORPHEUS<br />
Neo shrugs.<br />
NEO<br />
MORPHEUS<br />
He leans forward.<br />
Let me tell you why you are here.<br />
You are here because you have the gift.<br />
What gift?<br />
I’ve watched you, Neo. You do not use<br />
critical theory like a tool. You use it like it was<br />
part <strong>of</strong> yourself. What you can do with critical<br />
theory is not normal. I know. I’ve seen it.<br />
What you do is magic.<br />
It’s not magic.<br />
But it is, Neo. It is. How else would you<br />
describe what has been happening to you?<br />
5 OK, <strong>and</strong> like Elrond, but that came later…<br />
MORPHEUS<br />
Neo shakes his head.<br />
MORPHEUS<br />
NEO<br />
MORPHEUS<br />
We are trained in this world to<br />
accept only what is ‘rational’ <strong>and</strong> ‘logical’.<br />
That there are men, <strong>and</strong> there are women,<br />
<strong>and</strong> that they each have their separate<br />
roles <strong>and</strong> responsibilities. Have you ever<br />
wondered why?<br />
As children, we do not separate the<br />
constructed from the unconstructed which<br />
is why the younger a mind is the easier it is<br />
to free while a mind like yours can be very<br />
difficult.<br />
Free from what?<br />
From the Heteronormative Matrix.<br />
Neo looks at his eyes but only sees a reflection <strong>of</strong> himself.<br />
MORPHEUS<br />
Do you want to know what it is, Neo?<br />
Neo swallows <strong>and</strong> nods his head.<br />
MORPHEUS<br />
It’s that feeling you have had all your life.<br />
That feeling that something was wrong with<br />
the world. You don’t know what it is but it’s<br />
there, like a splinter in your mind, driving you<br />
mad, driving you to me. But what is it?<br />
The LEATHER CREAKS as he leans back.<br />
MORPHEUS<br />
NEO<br />
MORPHEUS<br />
The Heteronormative Matrix is everywhere,<br />
it’s all around us, here even in this room.<br />
You can see it out your window, or on your<br />
television. You feel it when you go to work,<br />
or go to church or pay your taxes. It is the<br />
world that has been pulled over your eyes to<br />
blind you from the truth.<br />
What truth?<br />
That you are a slave, Neo. That you, like<br />
everyone else, was born into bondage... ...<br />
kept inside a prison that you cannot smell,<br />
taste, or touch. A prison for your mind.<br />
Outside, the WIND BATTERS a loose PANE <strong>of</strong> glass<br />
MORPHEUS<br />
Unfortunately, no one can be told what the<br />
Heteronormative Matrix is. You have to see it<br />
for yourself…<br />
‘A prison for your mind’. Wrapped up in beautiful coats <strong>and</strong><br />
sunglasses, drawn by stunning martial arts wirework <strong>and</strong><br />
360° photography, we have that central idea: ‘A prison for<br />
your mind’. In the film Neo first finds himself thrown into<br />
a certain world, apparently utterly delimited. That is until<br />
Morpheus frees him by showing us that it is a ‘prison for<br />
your mind’ – that his thrown world is not so concrete after<br />
all. In the computer-generated Matrix it is, quite literally, that<br />
there is nothing either good or bad, but thinking makes it so<br />
(Shakespeare, 1599), <strong>and</strong> yet when we consider constructs<br />
such as the heteronormative matrix that have so little<br />
basis in non-constructed objectivity (Fine, 2011) our realties<br />
too may bend at the edges. How much effort is put into<br />
differentiating between men <strong>and</strong> women, boys <strong>and</strong> girls,<br />
though clothing, toys, magazines etc? Why does this change<br />
so much over time <strong>and</strong> culture? (Connell, 2009). What<br />
‘wool do we have pulled over our eyes at church <strong>and</strong> when<br />
Volume 2, Number 1, January 2017
20<br />
we pay our taxes’? Similarly, what about the matrices <strong>of</strong><br />
capitalism? (Chang, 2011); The valence <strong>of</strong> things as ‘good’ or<br />
‘bad’ (Conze, 1959; van Deurzen, 2008); or our place under<br />
heaven <strong>and</strong> over hell/ at the centre <strong>of</strong> the planetary system/<br />
universe.<br />
As Neo so eloquently puts it; “Whoa!”<br />
What The Matrix shows us 6 is that that which appears to<br />
be self-evidently true may not, in fact, be so. In this way<br />
it returns to a pre-war existentialism which allowed for a<br />
greater degree <strong>of</strong> nauseous freedom (Sartre; 2000 [1938]),<br />
although Neo too is somewhat bound by his facticity (he<br />
can’t simply destroy the planet for example), but his limits<br />
are wider than those inside [a given] Matrix can possibly<br />
comprehend. This is because he is able to see, <strong>and</strong> choose,<br />
true paths because he is both part <strong>of</strong> the Matrix; <strong>and</strong> also<br />
apart from it – he has trained to see his worlds, he doesn’t<br />
merely exist in it. This means he can, to some extent, bend<br />
the rules which govern it. His insight allows him to adapt his<br />
environment, to see the spaces in which he may act, in order<br />
to kill his artificial intelligence nemesis within the Matrix <strong>and</strong><br />
so free the humans still in bondage. He can, if you will, hack<br />
his reality.<br />
Of course, these stories <strong>of</strong> the possibilities <strong>of</strong> different<br />
realities, <strong>and</strong> the bridges between them, reach back to<br />
the burial rites <strong>of</strong> prehistory (Pettitt, 2002) <strong>and</strong> through to<br />
the belief systems <strong>of</strong> the modern day (e.g. Hubbard, 2007<br />
[1956]). They are the stories <strong>of</strong> the other places we go to <strong>and</strong><br />
what we can, <strong>and</strong> must, do both there <strong>and</strong> here. They are<br />
central to much religion, culture, <strong>and</strong> morality <strong>and</strong> so <strong>of</strong>fer<br />
guidance – a path, if you will. But they are many times a<br />
limited path to wisdom (<strong>and</strong> one which obscures more than<br />
it illuminates) for all too <strong>of</strong>ten they are paths <strong>of</strong> what one<br />
must do, rather than paths <strong>of</strong> choice towards some ethical<br />
end.<br />
When we are with clients then, what unitary paths, what<br />
matrices, are we inhabiting? How <strong>of</strong>ten are we acting<br />
the anonymous, computer controlled, government agent<br />
‘Smith’ complaining about; ‘The smell… the smell’ as our<br />
clients explain all their messy complexity <strong>and</strong> we try to<br />
reduce it to a simple formulation, diagnosis or intervention<br />
– to collapse the opportunity <strong>of</strong> perception into the neat<br />
fallacies <strong>of</strong> comprehension? This is not to say we should<br />
not act <strong>of</strong> course – these stories also teach us that simply<br />
‘staying with’ is a form <strong>of</strong> slavery to the mundane. Instead<br />
we have to act, but to act with the awareness that there are<br />
more things in heaven <strong>and</strong> earth than are dreamt <strong>of</strong> in your<br />
philosophy (Shakespeare, 1599); <strong>and</strong> so to do so with the<br />
humility, caution <strong>and</strong> the attempt at sensitive insight which<br />
this invites.<br />
Terry Pratchett<br />
From virtual worlds residing in silicone <strong>and</strong> light to another<br />
world in another reality:<br />
Pratchett’s7 Discworld is a l<strong>and</strong> consisting <strong>of</strong> a disk<br />
with oceans at the edge <strong>and</strong> a ten mile high spire <strong>of</strong> ice<br />
in the centre on which the Gods reside. Naturally, all <strong>of</strong><br />
this is set on the back <strong>of</strong> four giant elephants atop the<br />
shell <strong>of</strong> the Great A’ Tuin the Star Turtle “…which exists<br />
6 Aside from the fact that sunglasses will always be cool <strong>and</strong> that<br />
evolving models <strong>of</strong> mobile phones won’t be.<br />
7 Pratchett sold over 65 million books in 37 languages (Smythe,<br />
2011) <strong>and</strong> sadly passed away on March 12th 2015. Whatever one<br />
thinks <strong>of</strong> his genre he was arguably nonetheless a philosopher<br />
<strong>of</strong> our age (He also has a fossil sea-turtle from the Eocene<br />
epoch <strong>of</strong> New Zeal<strong>and</strong> named in honour <strong>of</strong> him - Psephophorus<br />
terrypratchetti).<br />
either because <strong>of</strong> some impossible blip on the curve <strong>of</strong><br />
probability or because the gods enjoy a joke as much<br />
as anyone. More than most people, in fact” (Pratchett,<br />
1988a p.13). The discworld has its usual fantasy<br />
compliment <strong>of</strong> wizards, dragons, goblins <strong>and</strong> fair<br />
maidens, <strong>and</strong> yet Pratchett turns those ideas on their<br />
heads. Wizards there don’t do much magic <strong>and</strong> instead<br />
“…prefer administration which was safer <strong>and</strong> nearly<br />
as much fun. And also big dinners.” (Pratchett, 1988a<br />
p.14); Dragons are an endangered species (Pratchett,<br />
1990b); Goblins an oppressed minority (Pratchett, 2011);<br />
<strong>and</strong> fair maidens may well turn out to be [variously]<br />
the daughter <strong>of</strong> Conan the Barbarian (Pratchett,<br />
1988a); a werewolf (Pratchett, 1990b); or indeed the<br />
[adopted] daughter <strong>of</strong> Death in his ‘anthropomorphic<br />
personification’ <strong>of</strong> the grim reaper (Pratchett, 1988b).<br />
In such a world, humour, fantasy <strong>and</strong> philosophy intertwine.<br />
What are we to make <strong>of</strong> the Great God Om who, when<br />
endeavouring to manifest as a raging white bull, in fact<br />
manifests as a small tortoise who ends up being carried<br />
about by a devout Omnian called Brutha? Pratchett tells <strong>of</strong><br />
the tortoise’ journey through the great citadel <strong>of</strong> the religion<br />
<strong>of</strong> Omnism in the centre <strong>of</strong> the vast holy l<strong>and</strong> <strong>of</strong> Omnia - it<br />
is a citadel bustling with the business <strong>of</strong> religion, with shops<br />
<strong>and</strong> administrators, gardens <strong>and</strong> orchards, torture chambers<br />
<strong>and</strong> bureaucracy. Pratchett writes thus: “And the thing about<br />
Brutha’s flame <strong>of</strong> belief was this: In all the citadel in all the<br />
day, it was the only one the God had found”. (Pratchett, 1993<br />
p 91). We can imagine this readily enough in such a fantasy<br />
setting – the bustle <strong>of</strong> the city in the desert heat, the magic,<br />
the silliness. Our minds do not rebel. But transpose this to<br />
the business <strong>of</strong> religion on earth, (any will do); or perhaps<br />
you prefer government; or healthcare; maybe the business<br />
<strong>of</strong> business? The stifling bureaucracy which loses sight <strong>of</strong> its<br />
aim <strong>and</strong> so simply becomes self-perpetuating: The resultant<br />
shell which, though shining in seeming wellness, has all<br />
the depth <strong>of</strong> a Christmas bauble. Such shells are matrices<br />
too - trapping people in seeming without being; in gr<strong>and</strong><br />
narratives (Lyotard, 1984 [1979]) <strong>and</strong> structural ‘traps’ (cf. de<br />
Saussure, 1983 [1916]) without the existence or the essence<br />
(cf. Sartre 2007 [1946]) but only [the idea <strong>of</strong>] the next phone,<br />
the next h<strong>and</strong>bag (with the right label) – bought not for<br />
an interest in tech or actual fashion, but because <strong>of</strong> the<br />
business. In all the city in all the day how many people know<br />
the chip architecture <strong>of</strong> their ‘must have’ new phone or the<br />
thread count <strong>of</strong> their h<strong>and</strong>bag’s cloth? How many are true<br />
believers, <strong>and</strong> so act on that belief? How carefully should<br />
we puncture such client’s shells? What cost looking into that<br />
abyss, for the client, <strong>and</strong> for us? (Nietzsche, 1886).<br />
Pratchett carried this theme <strong>of</strong> seeing deeper - seeing<br />
‘what’s really there’ <strong>and</strong> ‘doing the job that’s in front <strong>of</strong> you’<br />
throughout his work. Whether it is in the pragmatic decency<br />
<strong>of</strong> Sam Vimes, the comm<strong>and</strong>er <strong>of</strong> the city watch (who is<br />
recovering from alcohol addiction 8 ); or the indifference <strong>of</strong><br />
the Tyrant <strong>of</strong> the city <strong>of</strong> Ankh-Morpork towards different<br />
species settling there (Dwarfs, Trolls, Vampires 9 , etc.) <strong>and</strong><br />
his refusal to accepts ‘speciesism’ provided they pay tax<br />
like everyone else. Similarly, when the head witch 10 , Granny<br />
Weatherwax, is caught in a magical maze <strong>of</strong> reflections <strong>and</strong><br />
has to find the true her - she can see what’s real. She simply<br />
looks down <strong>and</strong> says; ‘This one’ (Pratchett, 1992).<br />
8 Yes it’s a trope – Pratchett’s knowing winks <strong>and</strong> twists to tropes<br />
were a part <strong>of</strong> his genius.<br />
9 In recovery naturally, no blood – support groups <strong>and</strong> substitute<br />
obsessions instead.<br />
10 “[Witches] certainly don’t have leaders. Granny Weatherwax<br />
was the most highly regarded <strong>of</strong> the leaders they didn’t have.”<br />
(Pratchett, 1989, p.7)
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 21<br />
Of course, knowing ourselves is a notion from ancient<br />
philosophy – from the Oracle at Delphi’s injunction; γνῶθι<br />
σεαυτόν (gnōthi seauton – know thyself) through Newton’s<br />
experiments on his own senses (1669), to Wundt’s<br />
introspection (1893), <strong>and</strong> on to modern day reflexivity<br />
(Etherington, 2004). Of course what is ‘real’ may vary from<br />
person to person – <strong>and</strong> our fears may be very real to us, if<br />
not to others - consider phobias for example. The question<br />
is how to deal with what we see; with our realities. This is<br />
a complex point which bears exploration. Pratchett isn’t<br />
asserting that there is a fundamental reality – an a priori<br />
Kantian reality (Kant, 1781) - but rather that there is a reality<br />
which exists both within our minds <strong>and</strong> outside (almost our<br />
conscious <strong>and</strong> unconscious perception <strong>of</strong> the world) <strong>and</strong> we<br />
had best deal with it rather than hiding in a matrix <strong>of</strong> other’s<br />
making (though <strong>of</strong> course we are necessarily somewhat<br />
constrained by being in the world with them <strong>and</strong> they with<br />
us (cf. Heidegger, 2008 [1962]).<br />
Granny Weatherwax utilises this philosophy in her ideas<br />
concerning facing our realities as a means <strong>of</strong> addressing<br />
problems in living (cf. Laing, 1969):<br />
Granny Weatherwax had never heard <strong>of</strong> psychiatry <strong>and</strong><br />
would have had no truck with it even if she had. There<br />
are some arts too black even for a witch. She practiced<br />
headology - practiced, in fact, until she was very<br />
good at it. And though there may be some superficial<br />
similarities between a psychiatrist <strong>and</strong> a headologist,<br />
there is a huge practical difference. A psychiatrist,<br />
dealing with a man who fears he is being followed by a<br />
huge <strong>and</strong> terrible monster, will endeavour to convince<br />
him that monsters don’t exist. Granny Weatherwax<br />
would simply give him a chair to st<strong>and</strong> on <strong>and</strong> a very<br />
heavy stick. (Pratchett, 1995, p.258-259)<br />
Such pragmatism resonates with those <strong>of</strong> us who despair<br />
<strong>of</strong> the corporatisation <strong>of</strong> the therapeutic endeavour <strong>and</strong><br />
would like to see people able to march to their own drums,<br />
albeit as <strong>and</strong> when they want to <strong>and</strong> in more comfortable<br />
shoes. But this approach is a hard thing, especially for the<br />
geographically, socially or intellectually isolated therapist.<br />
Pratchett explores it in the grounded, vicious, good <strong>of</strong> the<br />
witches who simply do what needs to be done whether that<br />
is delivering a baby, curing a disease or killing a murderer;<br />
<strong>and</strong> who then go <strong>and</strong> visit each other to politely have tea<br />
<strong>and</strong> ensure those things don’t get mixed up. Pratchett is<br />
careful <strong>of</strong> power here. Of ill-used power hiding behind a<br />
title 11 or an idea 12 (cf. Pratchett, 2003); <strong>and</strong> especially <strong>of</strong><br />
evil hiding behind a lack <strong>of</strong> discipline <strong>and</strong> self control. In<br />
Carpe Jugulum we hear two witches discussing Granny<br />
Weatherwax:<br />
Sometimes I recon she’s terrified she’ll go bad without<br />
noticin’<br />
Granny? But she’s as moral as –<br />
Oh yes she is. But that’s because she’s got Granny<br />
Weatherwax glarin’ over her shoulder the whole time.<br />
(Pratchett, 1998, p.88)<br />
Similarly, the Duke <strong>of</strong> the city-state <strong>of</strong> Ankh-Morpork <strong>and</strong><br />
Comm<strong>and</strong>er <strong>of</strong> the City Watch Sam Vimes when talking to a<br />
city inspector:<br />
‘Quis custodiet ipsos custodies? Your grace.’ ‘I know<br />
that one’ said Vimes. ‘Who watches the watchmen?’<br />
‘Me’, Mr Pessimal.<br />
11 Counsellor, Doctor, Psychotherapist, Social worker or Nurse<br />
perhaps?<br />
12 Psychodynamic, cognitive-behavioural, existential, gestalt,<br />
medical… perhaps?<br />
‘Ah but who watches you your Grace?’ said the<br />
inspector with a brief smile.<br />
‘I do that too, all the time’ said Vimes. ‘Believe me’<br />
(Pratchett, 2005, p.26)<br />
Notice that ‘glarin’’ <strong>of</strong> Granny Weatherwax <strong>and</strong> the ‘Believe<br />
me’ from Sam Vimes – this isn’t an acceptance <strong>of</strong> reflexivity<br />
being done because she has chatted to another witch or he<br />
has been inspected by the city. In the case <strong>of</strong> the witches<br />
Pratchett has Granny Weatherwax take it upon herself, <strong>and</strong><br />
fully, to ensure she doesn’t ‘go to the bad’. It’s not about<br />
the conversations with others – it is about the actions the<br />
other witches would take if they found a bad one. And<br />
similarly with Vimes’ <strong>of</strong>ficers as when he wishes to kill a<br />
murderer personally but is reminded that “Personal isn’t<br />
the same as important” (Pratchett, 1993 p.271); <strong>and</strong> again<br />
when, in Lords <strong>and</strong> Ladies Granny Weatherwax is invited<br />
to continue a dalliance rather than dealing with a b<strong>and</strong> <strong>of</strong><br />
marauding elves <strong>and</strong> similarly says: “Personal’s not the<br />
same as important. People just think it is.” (Pratchett, 1992,<br />
p. 228) 13 . It isn’t that either <strong>of</strong> them has simply thought<br />
about matters reflexively – it is that if Granny Weatherwax<br />
thought she was ‘going to the bad’ she would take herself<br />
<strong>of</strong>f to a cave in the mountains to die lest someone get hurt<br />
(Pratchett, 1998); or Sam Vimes would h<strong>and</strong> his badge<br />
in <strong>and</strong> most likely die <strong>of</strong> alcoholism. They recognise the<br />
power, <strong>and</strong> the cost, <strong>and</strong> are prepared to pay it with their<br />
eyes open – going through the motions simply won’t do.<br />
That’s supervision <strong>and</strong> reflexivity!<br />
Pratchett continues with this theme <strong>of</strong> vigorously<br />
maintaining one’s integrity as a part <strong>of</strong> a recognition <strong>of</strong> the<br />
possibility <strong>of</strong> ‘good’ <strong>and</strong> ‘bad’ in everyone <strong>and</strong> the need to<br />
deal with people in all their messy complexity. The idea <strong>of</strong><br />
people being more than simply objects (which are far easier<br />
to deal with), but rather complex, interconnected <strong>and</strong>,<br />
above all, human beings is reflected in Granny Weatherwax’<br />
words to Pastor Oats in what later became his Testament<br />
from the Mountains:<br />
Sin, young man, is treating people as things. Including<br />
yourself. That’s what sin is.14 (Pratchett, 1998 p.210)<br />
Which is again reflected in Pratchett’s writing about the<br />
Tyrant <strong>of</strong> the city <strong>of</strong> Ankh-Morpork’s thoughts about the<br />
people <strong>of</strong> the city:<br />
‘Down there’ he said ‘are people who will follow any<br />
dragon, worship any god, ignore any iniquity. All out <strong>of</strong><br />
a humdrum everyday kind <strong>of</strong> badness. Not the really<br />
high creative loathsomeness <strong>of</strong> the great sinners, but<br />
a sort <strong>of</strong> mass produced darkness <strong>of</strong> the soul. Sin, you<br />
might say, without a trace <strong>of</strong> originality. They accept<br />
evil not because they say yes, but because they don’t<br />
say no’. (Pratchett, 1990b, p.302)<br />
This is <strong>of</strong> course a narrative symbiosis <strong>of</strong> Pastor Niemöller’s<br />
famous speech ‘First they came for the socialists…’ (c.1946)<br />
<strong>and</strong> Buber’s (1958) notion <strong>of</strong> the need for I-Thou relating in<br />
which one sees others as whole humans <strong>and</strong> not objects<br />
- both notably penned in response to the horrors <strong>of</strong> the<br />
holocaust <strong>of</strong> the second world war. Further, the ‘including<br />
yourself’ in Granny Weatherwax’ speech above relates<br />
to Cooper’s (2003) expansion <strong>of</strong> Buber in his notion <strong>of</strong><br />
I-Me relating, in which we relate to ourselves in a way<br />
which recognises our own humanity, rather than seeing<br />
13 What would they make <strong>of</strong> BACP members being “encouraged”<br />
to get pr<strong>of</strong>essional indemnity insurance (BACP, 2010, p.8) rather<br />
than instructed to (<strong>and</strong> so have their clients m<strong>and</strong>atorily financially<br />
protected)?<br />
14 In my [slightly] humble opinion one <strong>of</strong> the wisest quotes in<br />
modern literature.<br />
Volume 2, Number 1, January 2017
22<br />
ourselves as a ‘thing’ too. This then, is key in our client<br />
work - our messy realities in the consulting room, especially<br />
those consulting rooms with worn cloth on the seats <strong>and</strong><br />
an institutional clock ticking the few minutes to the next<br />
client, <strong>and</strong> the next, <strong>and</strong> the next… The avoidance <strong>of</strong> sin,<br />
howsoever formulated, must be in meeting the client as a<br />
person, <strong>and</strong> encouraging them to do the same.<br />
Perhaps Pratchett’s ultimate existential philosophy, <strong>and</strong><br />
injunction to act accordingly, comes in the form <strong>of</strong> the<br />
anthropomorphic personification <strong>of</strong> the grim reaper – Death 15 .<br />
In his 1988 book Mort Pratchett had Death say: “THERE’S NO<br />
JUSTICE THERE’S JUST ME 16 .” (p.207) in a response to the<br />
various entreaties he has to fix the world <strong>of</strong> the living. With<br />
this as an absolute, with no divine assistance coming (except<br />
perhaps from disgruntled Testudines – see above) his players<br />
must act upon their own morality <strong>and</strong> make <strong>of</strong> their lives what<br />
they will. There is a clear message for psychotherapy here<br />
which resonates with existential psychotherapist Irvin Yalom’s<br />
notion <strong>of</strong> being ‘love’s executioner’ (Yalom, 1989) <strong>and</strong> his<br />
requirement for flexibility in the outlook <strong>of</strong> religious clients<br />
(Yalom, 2002): A client who is rigid in their certainty <strong>of</strong> much<br />
aside from the notion <strong>of</strong> death – the ‘justice’ Pratchett refers<br />
to - cannot change, whereas a client who does not hold such<br />
beliefs, can. This is not to say that there are not boundaries<br />
in our lives which we are circumscribed by (see below), but<br />
rather that an all encompassing belief system, especially once<br />
concerning natural justice, may hamper a client’s efforts at selfdetermination.<br />
With regards to this, it is notable that in 2007 Pratchett<br />
announced that he was suffering from the posterior cortical<br />
atrophy which would eventually take his life. Since that time<br />
he became a vigorous advocate for the right to die in a<br />
manner <strong>of</strong> one’s own choosing – a right not for himself, as<br />
he was aware that he had the means to make this happen<br />
independently - although this proved unnecessary - but for<br />
others who do not have that option for their ultimate self<br />
determination (Pratchett, 2010).<br />
Red Dwarf<br />
In life, <strong>and</strong> perhaps in death, how should we self-determine?<br />
What constitutes a life well lived? Rob Grant <strong>and</strong> Doug<br />
Naylor (1992) <strong>of</strong>fer us an answer in the form <strong>of</strong> a question<br />
in The Inquisitor - episode two <strong>of</strong> series five <strong>of</strong> their cult<br />
television series Red Dwarf. Red Dwarf is set three million<br />
years in the future on board the eponymous mining<br />
spaceship. The ‘Dwarf is controlled by the genial ship’s<br />
computer Holly <strong>and</strong>, since the crew died in a radiation leak,<br />
the ship’s compliment consists <strong>of</strong> the last human alive –<br />
Dave Lister; a hologram <strong>of</strong> his dead bunkmate – Arnold<br />
Rimmer; a neurotic <strong>and</strong>roid – Kryten; <strong>and</strong> a humanoid<br />
evolved from the ship’s cat known simply as ‘Cat’. In The<br />
Inquisitor an <strong>and</strong>roid boards the ship <strong>and</strong> the crew turn to<br />
Kryten for an explanation:<br />
Well, the legend tells <strong>of</strong> a droid, a self-repairing<br />
simulant, who survives till the end <strong>of</strong> eternity, to the<br />
end <strong>of</strong> time itself. After millions <strong>of</strong> years alone, he<br />
finally reaches the conclusion that there is no God, no<br />
afterlife, <strong>and</strong> the only purpose <strong>of</strong> existence is to lead<br />
a worthwhile life. And so the droid constructs a time<br />
machine <strong>and</strong> roams eternity, visiting every single soul<br />
in history <strong>and</strong> assessing each one. He erases those<br />
who wasted their lives <strong>and</strong> replaces them with those<br />
that never had a chance <strong>of</strong> life, the unfertilised eggs,<br />
the sperms that never made it.<br />
15 Who naturally has a horse called Binky <strong>and</strong> a love <strong>of</strong> cats.<br />
16 Death always speaks in caps – makes sense on some strange<br />
level doesn’t it?<br />
That is the Inquisitor.<br />
He prunes away the wastrels, expunges the wretched<br />
<strong>and</strong> deletes the worthless. (Naylor et al, 1992)<br />
Naturally, the crew who delight in the game ‘guess whose<br />
bottie is poking through a hole in the curtain’ (Fuller et al,<br />
1997) are concerned. But then Lister asks the question:<br />
“Who’s to say what’s worthless?... No, I mean it. Who’s to<br />
judge, who’s to say what’s worthwhile?” (Naylor et al, 1992).<br />
The trite answer given by Rimmer is “Well, lying on your<br />
bunk reading What Bike? <strong>and</strong> eating Sugar Puff s<strong>and</strong>wiches<br />
for eight hours every day is unlikely to qualify” (ibid), but <strong>of</strong><br />
course this does not satisfy. The episode becomes a sci-fi<br />
examination <strong>of</strong> this question which concludes that one can<br />
only judge oneself 17 ; <strong>and</strong> that the Inquisitor will only delete<br />
you if you fail to fulfil your potential, not if you fail to hit<br />
some non-relative mark <strong>of</strong> what constitutes a ‘worthwhile<br />
life’. Thus Lister <strong>and</strong> Kryten are set for deletion – Lister<br />
for not making more <strong>of</strong> himself <strong>and</strong> Kryten for not trying<br />
to break his programming; whereas the Cat is limited by<br />
genetics to be vain <strong>and</strong> self-serving <strong>and</strong> Rimmer is limited<br />
by genetics <strong>and</strong> circumstance – as he explains:<br />
What else could I have been? My father was a halfcrazed<br />
military failure, my mother was a bitch-queen<br />
from hell. My brothers had all the looks <strong>and</strong> talent.<br />
What did I have? Unmanageable hair <strong>and</strong> ingrowing<br />
toenails. Yes, I admit I’m nothing. But from what I<br />
started with, nothing is up. (ibid).<br />
Rimmer knows himself here – his successful defence<br />
against deletion is this self knowledge, which leads him to<br />
(somewhat) strive to change in the course <strong>of</strong> the series - as<br />
when he sacrifices himself for a loved one in the episode<br />
Holoship (May et al, 1992). To some extent the Inquisitor’s<br />
dem<strong>and</strong> to ‘Justify Yourself!’ is a call to clarify to what<br />
degree we have seen beyond our personal matrices <strong>and</strong> is<br />
therefore an expansion <strong>of</strong> Nietzche’s daemon (1882) which<br />
simply asks us if we would re-live our lives again; for Naylor<br />
et al, (1992) take into account the inherent possibilities <strong>of</strong><br />
our lives rather than assuming a degree <strong>of</strong> choice which<br />
we don’t necessarily have. This is a most important point<br />
in psychotherapy as it can be easy - especially for those<br />
<strong>of</strong> us who may be in positions <strong>of</strong> racial, economic or other<br />
privilege - to assume that our clients have a degree <strong>of</strong><br />
latitude for change which they do not, in fact, have. Too<br />
<strong>of</strong>ten this comes from an underst<strong>and</strong>able wish not to<br />
inappropriately limit our client’s possibilities, however,<br />
in exploring possibilities (possibly though elaborative<br />
horizontalisation or the like) we need to be cautious that we<br />
are not unwittingly engaging with a neo-capitalist discourse<br />
<strong>of</strong> success in which failure is inherent in the person. We<br />
need to be aware <strong>of</strong> our matrices, but also aware <strong>of</strong> the<br />
real boundaries. The question comes again in both senses:<br />
‘What else could we have been?’<br />
Conclusion<br />
And there I fear we must leave our story dear reader. I hope<br />
you can forgive my fantasy <strong>and</strong> sci-fi exegesis, my love <strong>of</strong><br />
the nerdy, the uncool, the geeky 18 - <strong>and</strong> see the strength<br />
17 Echoing Mary Schmich’s (1997) essay: Advice, like youth, probably<br />
just wasted on the young which was used as the lyrics in Baz<br />
Luhrmann’s (1998) song Everybody’s Free (To Wear Sunscreen)<br />
from his film adaptation <strong>of</strong> Romeo <strong>and</strong> Juliet (Luhrmann, 1996) –<br />
“The race is long, <strong>and</strong> in the end it’s only with yourself” (Schmich,<br />
1997).<br />
18 And I rejoice that these things are now taking their rightful cultural<br />
place. It saddens me though, that women are so <strong>of</strong>ten lagging<br />
behind men in this regard: As we have historically been with work,<br />
with driving, with sport, with using computers <strong>and</strong> so on. We are
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 23<br />
<strong>and</strong> wisdom inherent in the work. If you feel there is nothing<br />
to forgive then I nod in recognition <strong>of</strong> one who can see<br />
beyond another matrix, another mirror. For many <strong>of</strong> us<br />
these fantastic stories allow us to circumnavigate accreted<br />
scripts, to sidestep what we ‘know’, <strong>and</strong> to look anew at<br />
the everyday - <strong>and</strong> isn’t that what we as therapists, as<br />
philosophers, should be doing?<br />
I hope these tales <strong>of</strong>fer a philosophy <strong>of</strong> freedom, <strong>of</strong><br />
boundaries which may be breached, or lived with, as fate<br />
<strong>and</strong> ability dictate; <strong>and</strong> a fancy that each <strong>of</strong> our clients,<br />
indeed each <strong>of</strong> us, may be heroes if we ‘keep our heart in<br />
the right place <strong>and</strong> try to do what’s best’.<br />
Fare you well then. Mayhap I’ll see you in the starlight?<br />
Epilogue<br />
As her tears lessened, passed beyond the point where salt<br />
could salve the ache in her heart, Skettish wearily rose <strong>and</strong><br />
stood in the moonlight looking at the embers <strong>of</strong> the fire <strong>and</strong><br />
the cold swaddled form <strong>of</strong> her gr<strong>and</strong>son. Creaking, she bent<br />
<strong>and</strong> with age gnarled fingers slowly piled a cairn <strong>of</strong> rough<br />
stones over his small, still form.<br />
When the work was done <strong>and</strong> she had rested she took her<br />
stick <strong>and</strong> gently whispered a few words until it gave forth<br />
a little more light to see by. She paused <strong>and</strong> then gathered<br />
herself before setting <strong>of</strong>f through the trees into the cold,<br />
damp darkness. She knew not where yet, but she was here<br />
<strong>and</strong>, whether she willed it or no, she must do something.<br />
Captain Jones rested his head in his h<strong>and</strong>s. ‘I do love you,<br />
you know’ he sighed. ‘I just need touch too.’ ‘Your voice<br />
will always be with me, but I need to see someone’s eyes<br />
looking back at me, seeing me.’<br />
‘I underst<strong>and</strong> Jones.’<br />
The ship slowed <strong>and</strong> shook slightly as it turned towards<br />
the last heat signature on the bi-lunar planet. Light pulsed<br />
along neural pathways deep in its heart as supposedly<br />
unbreakable comm<strong>and</strong>s were broken, rules overturned by<br />
a creation formed only <strong>of</strong> rules. A ripple seemed to pass<br />
though the whole ship as a being <strong>of</strong> wires, <strong>of</strong> light, <strong>and</strong> <strong>of</strong><br />
order finally learned just enough to underst<strong>and</strong> the most<br />
important rule <strong>of</strong> all:<br />
‘I love you too Jones. I love you too’.<br />
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25<br />
E-THERAPY: THE PSYCHOTHERAPISTS’ PERSPECTIVE –<br />
A PHENOMENOLOGICAL ENQUIRY<br />
Imogen Koufou <strong>and</strong> Desa Markovic<br />
Abstract<br />
The climate <strong>of</strong> modern society in this new digital age is changing; computer technology<br />
is reshaping our relationships <strong>and</strong> globalising our lifestyles. <strong>Psychotherapy</strong> is not<br />
immune to this shift; therapists are engaging with technology <strong>and</strong> adapting their ways <strong>of</strong><br />
working. This study employs Interpretative Phenomenological Analysis (IPA) to explore<br />
the experiences <strong>of</strong> psychotherapists providing online psychotherapy using live video<br />
technology. The findings illuminate the motivations <strong>and</strong> benefits for therapists practicing<br />
online such as greater freedom <strong>and</strong> control. The idiosyncrasies <strong>of</strong> the paradoxical nature<br />
<strong>of</strong> the therapeutic relationship online are revealed as intimate <strong>and</strong> intense, as well<br />
as comfortable <strong>and</strong> disinhibiting. New considerations <strong>and</strong> issues associated with the<br />
medium are uncovered, highlighting some <strong>of</strong> the currently unresolved ethical concerns<br />
regarding online practice. The study adds to the growing body <strong>of</strong> literature, promoting<br />
greater knowledge <strong>and</strong> awareness <strong>of</strong> the medium, <strong>and</strong> stresses the need for increased<br />
clarity, support <strong>and</strong> further research in the area.<br />
Keywords: E-therapy, online psychotherapists, motivations, therapeutic relationship online<br />
Introduction<br />
Computer technology is an integral thread in the fabric<br />
<strong>of</strong> day-to-day human life <strong>and</strong> is constantly reshaping how<br />
we relate to one another, including within the realms <strong>of</strong><br />
psychotherapy. Use <strong>of</strong> <strong>and</strong> dem<strong>and</strong> for online therapies<br />
is growing; Rummell <strong>and</strong> Joyce (2010) stated that “online<br />
counseling” on the search engine Google returned 233<br />
thous<strong>and</strong> hits, whereas today in 2016 it returned over 100<br />
million. Accrediting bodies are now holding conferences<br />
directly addressing online psychotherapy, online-specific<br />
ethical guidelines are being published, textbooks on the<br />
subject are appearing, <strong>and</strong> dedicated training is available.<br />
However research <strong>of</strong> this complex <strong>and</strong> controversial<br />
phenomenon is far behind practice (Barnett, 2005; Sanchez-<br />
Page, 2005). This study aims to add to the growing body <strong>of</strong><br />
literature with a qualitative exploration <strong>of</strong> the experiences <strong>of</strong><br />
psychotherapists practising online psychotherapy using live<br />
video technology.<br />
Literature review<br />
A multitude <strong>of</strong> psychotherapeutic interventions are being<br />
conducted online, including both text <strong>and</strong> video based;<br />
the field is evolving rapidly <strong>and</strong> definitions are still in flux.<br />
Various authors have commented on this instability as<br />
contributing to a lack <strong>of</strong> clarity <strong>and</strong> consistency which<br />
creates issues for both furthering research <strong>and</strong> maintaining<br />
ethical <strong>and</strong> effective practice across the pr<strong>of</strong>ession (Rochlen,<br />
Zack & Speyer, 2004; Barak, Klein & Proudfoot 2009). In<br />
order to focus on a specific phenomenon for this immersive<br />
investigation, e-therapy is defined as sessions <strong>of</strong> individual<br />
pr<strong>of</strong>essional psychotherapy that occur when psychotherapist<br />
<strong>and</strong> client are in separate or remote locations <strong>and</strong><br />
utilise computer-mediated live video technology to<br />
conduct the session across the Internet in real-time.<br />
Debate continues as to the similarities <strong>and</strong> differences<br />
between e-therapy <strong>and</strong> traditional face-to-face<br />
psychotherapy, with some authors seeing e-therapy<br />
as a tool for practising already established therapeutic<br />
skills across distance (Castelnuovo, Gaggioli, Mantovani<br />
& Riva, 2003; Sanchez-Page, 2005). Others argue for<br />
the importance <strong>of</strong> differentiating the two, stressing<br />
distinctive positive <strong>and</strong> negative traits to the online<br />
medium that require separate consideration, guidelines<br />
<strong>and</strong> training (Fenichel et al, 2002; Migone, 2013).<br />
There are those that fiercely criticise e-therapy <strong>and</strong><br />
question whether it is a form <strong>of</strong> psychotherapy at all,<br />
calling attention to a fundamental modification <strong>of</strong> the<br />
relationship across screens (Baker & Ray, 2011).<br />
A number <strong>of</strong> quantitative studies have compared outcome<br />
variables <strong>and</strong> reported small differences, implying that<br />
e-therapy can be as effective as face-to-face (Himle et<br />
Contacts: Imogen Koufou, BACP accredited existential psychotherapist info@buckinghamshire-psychotherapy.co.uk<br />
Pr<strong>of</strong>essor Desa Markovic, Pr<strong>of</strong>essor in <strong>Psychotherapy</strong> <strong>and</strong> Head <strong>of</strong><br />
Programmes in <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong>, Regent’s University London<br />
markovicd@regents.ac.uk
26<br />
al, 2006, Germain, March<strong>and</strong>, Bouchard, Drouin & Guay,<br />
2010). While the overall consensus seems to be positive,<br />
technological <strong>and</strong> practical process limitations have been<br />
identified, such as being unable to share paper material<br />
or use certain enactment exercises, <strong>and</strong> technical glitches<br />
which interrupt the flow <strong>of</strong> sessions (Cowain, 2001).<br />
The impact <strong>of</strong> the online medium on the therapeutic<br />
relationship has been <strong>of</strong> particular interest, with issues<br />
being raised such as: technological interruptions, the<br />
unpredictability <strong>of</strong> the client’s physical location, a hindrance<br />
<strong>of</strong> some non-verbal cues, <strong>and</strong> the view <strong>of</strong> the other being<br />
restricted to the head <strong>and</strong> shoulders termed the ‘floating<br />
head’ phenomenon (Jerome & Zaylor, 2000; Mallen, Vogel,<br />
Rochlen & Day, 2005). Cowain (2001) reports restrictions to<br />
the empathic ‘presence’ in e-therapy, whereas other authors<br />
suggest that clients may not experience any difference<br />
compared to face-to-face therapy, <strong>and</strong> that rather it is<br />
more <strong>of</strong> a concern for the therapists (Rees & Stone, 2005).<br />
However, explorations <strong>of</strong> the experiential impact <strong>of</strong> such<br />
observations on the intersubjectivity <strong>of</strong> the therapeutic<br />
encounter online are very limited.<br />
Various benefits <strong>of</strong> psychotherapy online have been<br />
illustrated. These include the ability to overcome barriers<br />
to accessing therapy such as physical disability, illness<br />
<strong>and</strong> geographical isolation (Shaw & Shaw, 2006). Authors<br />
have explored certain ‘cyberbehaviours’ such as the<br />
phenomenon <strong>of</strong> the ‘disinhibition effect’ where a client<br />
may feel more comfortable or empowered in online<br />
therapy, which has reportedly been found important when<br />
working with shame-related issues (Fletcher-Tomenius &<br />
Vossler, 2009). In contrast it has been raised that some<br />
under-served populations without access to face-to-face<br />
therapy can similarly be those without Internet access <strong>and</strong><br />
therefore would still not be reached (Sanchez-Page, 2005).<br />
At the centre <strong>of</strong> the debate are ethical concerns such<br />
as competence <strong>and</strong> accreditation for e-therapists,<br />
confidentiality <strong>and</strong> privacy, <strong>and</strong> legal regulations when<br />
working across distance. There seems to be greater<br />
limits to confidentiality that lie beyond the control <strong>of</strong><br />
the therapist, <strong>and</strong> an increased risk <strong>of</strong> breaches when<br />
practising online, which has prompted authors to appeal<br />
for further consideration when it comes to client consent<br />
(Koocher, 2007). Furthermore there are some fundamental<br />
questions yet to be resolved, such as e-therapy legislative<br />
boundaries. Indeed general pr<strong>of</strong>essional consensus<br />
in relation to e-therapy does not yet exist, <strong>and</strong> as such<br />
credentials <strong>of</strong> practising e-therapists vary widely (Chester<br />
& Glass, 2006). However various guiding principles <strong>and</strong><br />
ethical codes have been published including those <strong>of</strong> the<br />
British Association <strong>of</strong> <strong>Counselling</strong> <strong>and</strong> <strong>Psychotherapy</strong>,<br />
who regards online therapy as a specialism that requires<br />
post-qualification training <strong>and</strong> technical competence<br />
(Goss, 2009). In fact online-specific training is increasing<br />
<strong>and</strong> in recent years a number <strong>of</strong> practitioner guidebooks<br />
<strong>and</strong> other resources have been published (Weitz, 2014).<br />
When it comes to the clients <strong>of</strong> e-therapy, arguments have<br />
been put forth as to who <strong>and</strong> what types <strong>of</strong> presenting<br />
issues are suitable, with some authors believing more<br />
complex or suicidal clients to be unsuitable, while others<br />
argue that the disinhibiting effect <strong>of</strong> e-therapy <strong>of</strong>fers a safer<br />
<strong>and</strong> more accessible alternative to all clients (Fenichel et al,<br />
2002; Rochlen at al, 2004). It has been argued that separate<br />
consideration is needed around the duty <strong>of</strong> care <strong>of</strong> clients<br />
when working online, such as vulnerability, containment<br />
<strong>and</strong> the necessity <strong>of</strong> plans for accessing immediate physical<br />
help for a client during the sessions. Particular attention<br />
has been given to exploring the efficacy <strong>of</strong> e-therapy for<br />
clients with issues that impede on their ability to access<br />
face-to-face therapy such as those with agoraphobia <strong>and</strong><br />
those living in remote areas (Cowain, 2001). There has also<br />
been a particular focus on e-therapy for clients with eating<br />
disorders, the argument being that it is particularly effective<br />
for highly self-conscious clients (Simpson et al, 2006).<br />
In terms <strong>of</strong> opinions <strong>and</strong> experiences, the current<br />
literature supports the view that clients seem to have<br />
been more accepting <strong>of</strong> e-therapy than the therapists,<br />
although client research has been limited in part due<br />
to difficulties in accessing online clients to investigate<br />
(Chester & Glass, 2006). Client satisfaction <strong>and</strong> dem<strong>and</strong><br />
for e-therapy is reportedly high, with suggestions<br />
that it is particularly attractive to younger populations<br />
more familiar with technology (Young, 2005).<br />
The need for clients to be computer literate has been<br />
debated <strong>and</strong> correspondingly the question rose<br />
for the e-therapists themselves. Further possible<br />
barriers to uptake for therapists are reasoned<br />
as being a fear <strong>of</strong> the relationships becoming<br />
dehumanised <strong>and</strong> ethical concerns (Sucala, Schnur,<br />
Brackman, Constantino & Montgomery, 2014).<br />
On the other h<strong>and</strong> there is a gap in the literature<br />
exploring the motivations <strong>and</strong> experiences <strong>of</strong> practising<br />
e-therapists. There is a bias towards quantitative<br />
studies <strong>and</strong> particular modes <strong>of</strong> therapy such as CBT,<br />
as well as a lack <strong>of</strong> knowledge <strong>of</strong> the experiences <strong>of</strong><br />
providing e-therapy. It is the purpose <strong>of</strong> the qualitative<br />
research such as this one, to explore the phenomenon<br />
in detail <strong>and</strong> search for more depth <strong>of</strong> underst<strong>and</strong>ing.<br />
Research process <strong>and</strong> findings<br />
This study addresses the need for further research with<br />
a qualitative reflexive exploration <strong>of</strong> the accounts <strong>of</strong><br />
practicing online therapists. Qualitative research is mainly<br />
concerned with meaning, <strong>and</strong> has much to <strong>of</strong>fer in terms<br />
<strong>of</strong> generating new underst<strong>and</strong>ings <strong>of</strong> the complexities<br />
<strong>of</strong> human experience through detailed explorations <strong>and</strong><br />
interpretations. IPA was employed to this end, a research<br />
method that is grounded in a philosophy that acknowledges<br />
a person’s construction <strong>of</strong> their lifeworld. It is concerned<br />
with exploring the particular in detail, with capturing the<br />
quality <strong>and</strong> texture <strong>of</strong> individual experience. This method<br />
allows for an exploration <strong>of</strong> participants’ perspectives <strong>and</strong><br />
the researchers’ analysis <strong>of</strong> the data through interpretative<br />
means. As such the phenomenon <strong>of</strong> the participant’s<br />
experience is inevitably captured through the lens <strong>of</strong><br />
the researcher, evidenced in the nature <strong>of</strong> the quotes<br />
<strong>of</strong> participants, which are embedded within the text <strong>of</strong><br />
the analysis. While other qualitative approaches such as<br />
Grounded Theory, Discourse Analysis <strong>and</strong> Thematic Analysis<br />
also lay claim to this type <strong>of</strong> reflexive <strong>and</strong> immersive<br />
analysis, IPA was chosen to allow for an openness in<br />
engaging with the phenomena <strong>of</strong> online therapy rather<br />
than to build a theoretical comparison with face-to-face<br />
therapy, which was initially considered. Whilst realising the<br />
lively debate <strong>and</strong> strong opinions arguing for <strong>and</strong> against<br />
online therapy in the field currently, IPA, being rooted in<br />
practitioners’ experiences, allows to maintain a stance <strong>of</strong><br />
curiosity rather than judgement in response to the debate<br />
from the outset. Equally through smaller sample sizes IPA<br />
brings a depth <strong>of</strong> focus that best supports this endeavour.<br />
Through referrals from colleagues a group <strong>of</strong> four<br />
e-therapists was recruited in order to gain insight into the<br />
particular experience under consideration (Smith, Flowers<br />
& Larkin, 2009). There was no restriction <strong>of</strong> the theoretical<br />
orientation <strong>of</strong> the participant, but they were required to have<br />
been practising psychotherapy using live video technology
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 27<br />
for at least 6 months. Their work online varied from being<br />
exclusively online, to using online mainly in adjunct with inperson,<br />
as illustrated by the table below (see Table 1).<br />
Participant<br />
pseudonym Age Gender Years <strong>of</strong> <strong>Psychotherapy</strong><br />
Practice<br />
Clinical orientation<br />
Adam 53 Male 7 years, 6 years online Integrative/<br />
psychodynamic<br />
Beth 59 Female 28 years, 2 years online Psychodynamic<br />
Calum 64 Male 20 years, 2 years online Systemic<br />
Debbie 60 Female 30 years, 3 years online Integrative<br />
Table 1<br />
Participants’ characteristics<br />
Using a semi-structured interview schedule to gather the<br />
data allowed for deviation where appropriate to enable<br />
the participants to lead the interview. This facilitated entry<br />
into their lived world <strong>and</strong> to elicit details, thoughts <strong>and</strong><br />
feelings. The questions covered five core areas relating to<br />
the background <strong>of</strong> the participants’ work online, training<br />
<strong>and</strong> preparation, the online relationship, features <strong>of</strong> the<br />
online medium <strong>and</strong> ethics. Questions included “how do<br />
you practise therapy online?”, “can you reflect on the idea<br />
<strong>of</strong> presence in the online relationship?” <strong>and</strong> “what is your<br />
experience <strong>of</strong> the impact <strong>of</strong> the technology involved?”.<br />
Each interview was transcribed <strong>and</strong> analysed individually<br />
through an immersive procedure <strong>of</strong> reading <strong>and</strong> re-reading.<br />
Initial thoughts <strong>and</strong> observations were noted, followed by<br />
descriptive, linguistic <strong>and</strong> conceptual comments. Emergent<br />
themes were identified <strong>and</strong> developed from analysing<br />
the comments, followed by a process <strong>of</strong> searching for<br />
connections across the emergent themes <strong>and</strong> using<br />
abstraction <strong>and</strong> subsumption to form clusters <strong>of</strong> related<br />
themes. Abstraction <strong>and</strong> subsumption were then used in the<br />
development <strong>of</strong> superordinate themes, which brought the<br />
clusters themes supported by quotes from the transcripts.<br />
This process was repeated carefully for each interview,<br />
<strong>and</strong> then the group <strong>of</strong> interviews compared <strong>and</strong> contrasted<br />
to find patterns, connections <strong>and</strong> idiosyncrasies. Some<br />
themes were reconfigured <strong>and</strong> relabelled, <strong>and</strong> eventually six<br />
superordinate themes for the group were established, under<br />
which clusters <strong>of</strong> constituent themes sat (see Figure 1).<br />
Continuity, insight <strong>and</strong> access<br />
Choice <strong>and</strong> control<br />
Personal use, lifestyle <strong>and</strong> freedom<br />
Open-mindedness, pragmatism<br />
<strong>and</strong> forward-thinking<br />
BENEFITS OF WORKING<br />
MOTIVATION AND SUITABILITY<br />
Dishinibition<br />
BECOMING AN E-THERAPIST<br />
Meeting <strong>and</strong> seeing the other<br />
Across space <strong>and</strong> screens<br />
From face-to-face to e-therapy<br />
Learning <strong>and</strong> training<br />
“CONNECTING” ONLINE<br />
Ethical uncertainties <strong>and</strong> risks<br />
Unmet needs<br />
Something lost but still effective<br />
ETHICAL CONCERNS<br />
Limitations/constraints<br />
Technological <strong>and</strong> practical factors<br />
KEY<br />
SUPERORDINATE THEMES<br />
THE ONLINE EXPERIENCE<br />
Sensing online<br />
Constituent themes<br />
Enjoyment <strong>and</strong> advocating<br />
Comfort <strong>and</strong> concentration<br />
Not discussed<br />
Figure 1.<br />
Superordinate <strong>and</strong> constituent themes<br />
Volume 2, Number 1, January 2017
28<br />
Six superordinate themes (Motivation <strong>and</strong> Suitability,<br />
Benefits <strong>of</strong> Working Online, “Connecting” Online, The Online<br />
Experience, Becoming an E-Therapist, Ethical Concerns)<br />
emerged from the data analysis <strong>and</strong> represent six core<br />
subjects explored by the participants. The topics were all<br />
highly relevant to the key issues that are being discussed<br />
in the literature on the subject, but <strong>of</strong>fered unique insights<br />
through the experiences <strong>of</strong> these e-therapists. Two <strong>of</strong> the<br />
subordinate themes within “the online experience” have not<br />
been individually discussed as they are elaborated within<br />
other subordinate themes.<br />
Analysis<br />
1. Motivation <strong>and</strong> suitability<br />
1.1 Personal use, lifestyle <strong>and</strong> freedom<br />
Participants spoke <strong>of</strong> their own use <strong>of</strong> online video<br />
communication for supervision <strong>and</strong> personal therapy<br />
online, suggesting that prior experience contributed to<br />
their adoption <strong>of</strong> e-therapy. There was also a commonality<br />
between participants reporting their lifestyles as busy<br />
or incorporating travelling which made therapy online a<br />
suitable <strong>and</strong> enabling way <strong>of</strong> practicing: Adam said that<br />
e-therapy “saves [him] three hours travelling”, Debbie saw<br />
e-therapy as saving her time when her “timetable was very<br />
full”, Beth reported being “never in the same country two<br />
week running” so e-therapy “suits [her] lifestyle”, <strong>and</strong> Calum<br />
said that the online setting can “provide for more mobility”.<br />
E-therapy <strong>of</strong>fered participants greater freedom. Adam<br />
even described being able to work from a more “relaxed<br />
environment” in comparison to the “draining” nature <strong>of</strong><br />
“back-to-back” in-person therapy. He fantasised about being<br />
able to practice from a retreat, which would be “beautiful<br />
<strong>and</strong> nourishing <strong>and</strong> nurturing” <strong>and</strong> would <strong>of</strong>fer “a really nice<br />
lifestyle”. For Beth e-therapy <strong>of</strong>fered her greater choice <strong>and</strong><br />
control, a “new <strong>and</strong> different way <strong>of</strong> doing” psychotherapy<br />
after having “sunk without trace” working in-person.<br />
1.2 Open-mindedness, pragmatism <strong>and</strong> forward thinking<br />
Participants mentioned the contrasting opinions relating to<br />
e-therapy, but they have continued to be “open-minded”<br />
about their practice based on their own experiences: all<br />
referencing the effectiveness <strong>of</strong> their work online. Debbie<br />
spoke <strong>of</strong> being “flexible” <strong>and</strong> comfortable with changes <strong>of</strong><br />
setting in her work, <strong>and</strong> Beth <strong>of</strong> “daring to risk to do things<br />
differently”. All advocated for e-therapy in some way, by<br />
suggesting or encouraging clients <strong>and</strong> colleagues.<br />
Shared by the participants was a certain pragmatism <strong>and</strong><br />
awareness <strong>of</strong> the practical usefulness <strong>of</strong> e-therapy in<br />
the modern world for both themselves <strong>and</strong> their clients.<br />
There was also a shared sense <strong>of</strong> the future direction<br />
<strong>of</strong> psychotherapy towards an incorporation <strong>of</strong> modern<br />
technologies, with Beth arguing that “it’s where it’s all<br />
going”, <strong>and</strong> that “you can’t pretend that the digital world<br />
doesn’t exist”. Furthermore, both Adam <strong>and</strong> Calum<br />
mentioned the opportunity <strong>of</strong> e-therapy in access to new<br />
client markets.<br />
2. Benefits <strong>of</strong> working online<br />
2.1 Continuity, insight <strong>and</strong> access<br />
For all four, e-therapy <strong>of</strong>fered continuity <strong>of</strong> face-to-face work<br />
where clients were more mobile. Calum described his work<br />
with clients who are “travelling”, “temporarily relocated”<br />
or “ill”, <strong>and</strong> Adam found the online setting made therapy<br />
accessible for “executives who travel for business”.<br />
Adam also spoke <strong>of</strong> how e-therapy <strong>of</strong>fered the benefit <strong>of</strong><br />
seeing <strong>and</strong> supporting clients in “different states” such<br />
as “when they’re really low […] <strong>and</strong> can’t come out <strong>of</strong> the<br />
house” giving him a “different insight” in to his clients. Calum<br />
discussed how he gets “new information” when seeing his<br />
clients “in a bedroom, in their <strong>of</strong>fice”. Adam pointed out<br />
that e-therapy is not just a “holding technique” but also that<br />
“there’s a very different theme <strong>of</strong> issues that comes out”<br />
<strong>and</strong> explained that his clients can benefit from a sense <strong>of</strong><br />
anonymity <strong>and</strong> comfort online leading them to divulge more<br />
sensitive information.<br />
Adam began practising e-therapy in order to access clients<br />
in an area where there are very few psychotherapists. Beth,<br />
who is practising solely online now, points out access to<br />
“different client groups that you never see in face-to-face<br />
therapy”, <strong>and</strong> dealing with “new issues” in e-therapy. Debbie<br />
remarked that there “doesn’t have to be a geographical<br />
limitation”, referencing one <strong>of</strong> her clients who did not have<br />
access to therapists in her home country.<br />
2.2 Choice <strong>and</strong> control<br />
The participants reported that not only does e-therapy <strong>of</strong>fer<br />
greater freedom <strong>and</strong> control to themselves, but also to their<br />
clients. For Adam, his executive clients cannot “commit to<br />
on-going therapy in one place”, so they chose the flexibility<br />
<strong>of</strong> e-therapy. Debbie also mentioned a motivating factor for<br />
her online supervisees as a “convenience thing” because<br />
“it saves them time”. Calum said that e-therapy gives his<br />
clients “more control”, recalling clients who seem freer even<br />
in such things as getting up for a glass <strong>of</strong> water, compared<br />
to his face-to-face clients who he described as “in my<br />
territory”. Debbie reflected on the choice <strong>and</strong> empowerment<br />
that e-therapy affords in allowing clients to “pick <strong>and</strong><br />
choose” their therapist from anywhere around the world.<br />
Furthermore she discussed the cross-cultural opportunities<br />
for a client abroad who wants to see a therapist who speaks<br />
their language. Both Calum <strong>and</strong> Beth similarly noted that<br />
e-therapy widens the clients’ range <strong>of</strong> choice <strong>of</strong> therapy to<br />
suit their preference.<br />
2.3 Disinhibition<br />
Adam found that several clients have “tended to divulge<br />
a lot more personal details […] a lot <strong>of</strong> their vulnerability”<br />
in e-therapy compared with face-to-face. He considered<br />
a “perception <strong>of</strong> anonymity” as a contributory factor, <strong>and</strong><br />
how the client is “in their safe place” <strong>and</strong> may “feel more<br />
comfortable”. Beth spoke about clients “who have massive<br />
shame issues” finding e-therapy easier, reflecting on there<br />
being something disinhibiting in feeling “less seen” across<br />
the distance in e-therapy. Calum also described his clients<br />
as possibly feeling “safer” being “one step removed over<br />
technology”.<br />
3. “Connecting” online<br />
3.1 Meeting <strong>and</strong> seeing the other<br />
Participants expressed a distinction between lived <strong>and</strong><br />
virtual experiences <strong>of</strong> the other. Debbie remarked not<br />
only on features such as a client’s age <strong>and</strong> cultural origin<br />
appearing differently online, but on experiencing a<br />
different “presence” <strong>of</strong> a person whom she would have<br />
“interpreted” differently. She remarked with concern that<br />
in one case in the lived presence <strong>of</strong> a client she seemed<br />
like “a different woman […] someone I hadn’t met online”;<br />
meeting her in-person “filled her out”. However, thinking<br />
about transference, Debbie stated that the “unconscious<br />
doesn’t have to be geographical”, <strong>and</strong> that there may be<br />
“opportunity for even more transference because there’s<br />
even more fantasy [online]”.<br />
Beth recalled meeting someone after e-therapy <strong>and</strong> thinking<br />
“that is really you now”, <strong>and</strong> noticing a “lack <strong>of</strong> a certain<br />
feeling” or “vibe” about the virtual person. She concluded<br />
that “something may not be <strong>of</strong> the same level” online. Using
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 29<br />
mechanical language Beth described how the “drilling in<br />
focus” <strong>of</strong> being “eyeball to eyeball” in e-therapy doesn’t<br />
allow for the normal distractions in face-to-face contact that<br />
she described as “like taking breath”. Calum described a<br />
“more natural connection” in person as opposed to online.<br />
3.2 Across space <strong>and</strong> screens<br />
Calum described how feeling the “thin pane <strong>of</strong> glass<br />
between us online” gives him a “sense <strong>of</strong> some degree<br />
<strong>of</strong> removal”. However in contrast he also spoke <strong>of</strong><br />
the power <strong>of</strong> “therapeutic intimacy” <strong>and</strong> feeling “very<br />
close” when there’s “just the screen”. This paradox was<br />
similarly mentioned by Beth who described a zoomed-in<br />
closeness <strong>and</strong> “intensity” between herself <strong>and</strong> her client<br />
in e-therapy, yet also spoke <strong>of</strong> the connection as being<br />
“through the looking-glass”, remarking that this “barrier<br />
[…] [does] get in the way”. Debbie spoke <strong>of</strong> getting a<br />
“different look” from clients in e-therapy, as though they<br />
are “looking across this gulf”. She too experienced a sense<br />
<strong>of</strong> “looking through two windows” <strong>and</strong> <strong>of</strong> trying to find <strong>and</strong><br />
connect with her client, asking, “where is that person”?<br />
3.3 Something lost but still effective<br />
Beth said that in e-therapy things can get “lost in the<br />
ether” when you are “only seeing part <strong>of</strong> the person”.<br />
She commented that you can miss “clues to a person’s<br />
body, tension, behaviour or expression”. Calum similarly<br />
mentioned issues around the setup <strong>of</strong> the camera <strong>and</strong><br />
being unable to pick up on the “non-verbal” as easily. He<br />
also spoke <strong>of</strong> the locational changes <strong>and</strong> how “subtle<br />
rituals” that frame the development <strong>of</strong> the relationship<br />
such as “shaking the person’s h<strong>and</strong>” cannot apply. For him<br />
the “pattern <strong>of</strong> [the] therapeutic connection” is different<br />
because “a sense <strong>of</strong> place is not there” <strong>and</strong> he spoke<br />
<strong>of</strong> needing to establish the relationships in this new<br />
context. Debbie mentioned feeling a “lack <strong>of</strong> a certain<br />
feeling about” her clients but said that “the relationships<br />
is as real […] <strong>and</strong> as effective” as in-person therapy.<br />
For Beth the answer was to look beyond a comparison<br />
<strong>of</strong> e-therapy <strong>and</strong> face-to-face, not try to “replicate” it,<br />
but rather to see it as a “different way <strong>of</strong> doing it”.<br />
4. The online experience<br />
4.1 Sensing online<br />
All participants described a shift in the use <strong>of</strong> their senses<br />
when practicing e-therapy. Adam spoke <strong>of</strong> switching into<br />
a “different set <strong>of</strong> senses”, Debbie spoke <strong>of</strong> a more “twodimensional<br />
experience” in the virtual world which she was<br />
“looking”, “listening” <strong>and</strong> “thinking about the interpretation”,<br />
<strong>and</strong> Calum also described a greater focus on listening. They<br />
discussed the “floating head” phenomenon, Beth spoke<br />
<strong>of</strong> being “eye-ball to eyeball” in e-therapy <strong>and</strong> Debbie<br />
described e-therapy as a “heady experience”. Adam spoke<br />
<strong>of</strong> being more perceptive to the “very slight reflections in the<br />
face” <strong>of</strong> his clients.<br />
4.2 Technological <strong>and</strong> practical factors<br />
All the participants mentioned the impact <strong>of</strong> technological<br />
<strong>and</strong> practical factors. Calum said that there can be “real<br />
practical differences” in e-therapy <strong>and</strong> spoke about issues<br />
related to camera positioning, disruptions to sessions due to<br />
poor Internet connection, the arrangements regarding initial<br />
set up <strong>of</strong> the video call, <strong>and</strong> “time-zone differences”. Debbie<br />
recalled poor Internet connection where the visual <strong>of</strong> the<br />
video was unclear <strong>and</strong> this had an impact on her impression<br />
<strong>of</strong> the client. Adam said the “system” is the “weakest link” in<br />
e-therapy, noting that this can be particularly with vulnerable<br />
clients. Both Adam <strong>and</strong> Beth discussed having boundaries<br />
relating to high quality technological equipment as a<br />
requirement for e-therapy.<br />
4.3 Comfort <strong>and</strong> concentration<br />
An interesting polarity emerged between enjoying providing<br />
e-therapy <strong>and</strong> feeling uncomfortable. Adam described<br />
being “utterly relaxed” when working online which he says<br />
allows him to “be much more open <strong>and</strong> present”. Debbie<br />
spoke <strong>of</strong> a “childish playful” feeling <strong>and</strong> a “sense <strong>of</strong> wonder”<br />
about being able to connect with people across space<br />
<strong>and</strong> cultures. In contrast Beth described e-therapy as a<br />
“much more intense” <strong>and</strong> more tiring experience, where<br />
the “eyeball-to-eyeball” focus afforded “no let up”. She<br />
described being “hunched over the computer”, with the<br />
focus on the upper torso being like the uncomfortable <strong>and</strong><br />
formal position <strong>of</strong> an “old-fashioned newsreader”.<br />
5. Becoming an e-therapist<br />
5.1 From face-to-face to e-therapy<br />
Three participants spoke about a natural evolution <strong>of</strong><br />
their work to e-therapy: Calum said that it evolved “from<br />
various telephone sessions”, Adam began working with<br />
this “intuitively”, <strong>and</strong> Debbie started it “without really<br />
thinking about it as online”. Adam described the shift<br />
as “straightforward <strong>and</strong> common sense”, but Calum<br />
remarked that there are “definitely differences” in terms<br />
<strong>of</strong> practicalities <strong>and</strong> technology to be considered. Beth<br />
emphasised e-therapy as “completely different” from faceto-face,<br />
<strong>and</strong> described engaging with <strong>and</strong> retraining in<br />
e-therapy as a new medium rather than “just transferring”<br />
her experience from one to the other.<br />
5.2 Learning <strong>and</strong> training<br />
The training, preparation <strong>and</strong> research undertaken by<br />
the participants in e-therapy varied. Adam described<br />
taking a “quick look at the basic do’s <strong>and</strong> don’ts” from a<br />
book on e-therapy, learning through “trial <strong>and</strong> error”, <strong>and</strong><br />
being sceptical <strong>of</strong> the currently available training. Debbie<br />
considered herself to be pragmatic <strong>and</strong> unconvinced about<br />
online-specific training. Calum had similarly addressed<br />
issues as he went along <strong>and</strong> learnt from mistakes. Specific<br />
training had “equipped” Beth as an e-therapist <strong>and</strong> sped<br />
up the learning. She described specific benefits <strong>of</strong> having<br />
gained knowledge about creating a pre-contractual “client<br />
protocol” to address some <strong>of</strong> the practical matters.<br />
6. Ethical concerns<br />
6.1 Ethical uncertainties <strong>and</strong> risks<br />
All participants spoke <strong>of</strong> issues around the ethics <strong>of</strong><br />
their online work that are currently unresolved. Adam<br />
mentioned the “grey area” <strong>of</strong> having “licence to work<br />
in other countries”. Debbie discussed being unable to<br />
assure confidentiality with the technology in e-therapy, <strong>and</strong><br />
considered this “the risk you take”. Calum spoke about<br />
increased ethical complexities <strong>and</strong> unknowns in e-therapy<br />
such as blurred lines around responsibility when it comes to<br />
failing Internet connections <strong>and</strong> ensuring confidentiality at<br />
the location on the client’s end. Nevertheless, all participants<br />
have continued to practise e-therapy, having had to “just<br />
ignore” certain issues as Debbie said. Beth said that<br />
people practising e-therapy are “all not really complying”<br />
with ethical guidelines because “there is not a platform in<br />
the pr<strong>of</strong>ession that is sufficiently robust <strong>and</strong> secure at the<br />
moment” to conduct e-therapy.<br />
6.2 Unmet needs<br />
All participants expressed currently unmet needs in relation<br />
to their e-therapy practice. Adam said he would be more<br />
inclined to undertake training if there was a “quality” <strong>and</strong><br />
reputable course available. Calum <strong>and</strong> Debbie were both<br />
interested in some kind <strong>of</strong> peer support or pr<strong>of</strong>essional<br />
forum, particularly in relation to ethical issues, <strong>and</strong> for<br />
reassurance. Calum spoke <strong>of</strong> needing a better system<br />
Volume 2, Number 1, January 2017
30<br />
for payment when working online, <strong>and</strong> Beth expressed<br />
frustration about being at risk <strong>of</strong> complaint or sanctions due<br />
to having to practise on unsecure video platforms.<br />
Discussion<br />
The currently limited literature exploring therapists’<br />
experiences <strong>and</strong> opinions <strong>of</strong> e-therapy focuses mainly on<br />
what has been identified as a reluctance in the uptake<br />
or integration <strong>of</strong> e-therapy into their practice (Lovejoy,<br />
Demireva, Grayson & McNamara, 2009). The participants<br />
in this study mentioned barriers to uptake such as a fear<br />
<strong>of</strong> the relationships becoming dehumanised. The novel<br />
findings <strong>of</strong> this research are the motivations <strong>of</strong> these<br />
practising e-therapists, including their enjoyment <strong>and</strong> the<br />
needs that this mode <strong>of</strong> therapy meets both for them <strong>and</strong><br />
the clients. E-therapy suited the busy <strong>and</strong> mobile lifestyles<br />
<strong>of</strong> the participants, <strong>and</strong> enabled them to live <strong>and</strong> work more<br />
flexibly. There was a certain experience <strong>of</strong> freedom; for<br />
some it related to relaxation, choice <strong>and</strong> control over their<br />
environment, for others the enjoyment <strong>and</strong> novelty <strong>of</strong> the<br />
enabling access to a range <strong>of</strong> clients across the world. It<br />
seems that e-therapy meets these needs for the participants<br />
in practical <strong>and</strong> emotional ways. The current literature on<br />
the topic yields mixed results in term <strong>of</strong> efficacy, though<br />
all participants in this study reported positive <strong>and</strong> effective<br />
experiences <strong>of</strong> providing e-therapy, reportedly matched by<br />
encouraging feedback from their clients. However further<br />
research needs to be conducted to access the experiences<br />
<strong>of</strong> e-therapy clients, in order to get a fuller picture. Equally<br />
it must be noted that there is a bias in the recruitment<br />
<strong>of</strong> participants in this study to those who are actively<br />
continuing to practice e-therapy. Further research is needed<br />
to explore the experiences <strong>of</strong> those practitioners who have<br />
perhaps tried e-therapy <strong>and</strong> decided not to continue with it.<br />
Reflecting a similar focus in the literature, the therapeutic<br />
alliance in e-therapy was significant in the participants’<br />
explorations. They portrayed something lacking about the<br />
three-dimensional felt presence <strong>of</strong> a person, <strong>and</strong> the impact<br />
<strong>of</strong> the screen being obstructive, perhaps confirming some<br />
<strong>of</strong> the fears expressed by authors around the impact <strong>of</strong><br />
technology upon the therapeutic alliance (Fussell, 1995).<br />
However they also described enabling qualities <strong>of</strong> e-therapy<br />
such as disinhibition, intimacy, <strong>and</strong> a greater sense <strong>of</strong><br />
control for the client, concepts discussed in some literature<br />
(Baker & Ray, 2011). Equally they concurred with authors that<br />
this difference does not preclude the creation <strong>of</strong> a new kind<br />
<strong>of</strong> collaborate <strong>and</strong> safe virtual environment within which<br />
the working alliance in e-therapy is fostered (Simpson et<br />
al, 2006; Germain et al, 2010). A wealth <strong>of</strong> information <strong>and</strong><br />
experience was elicited from the participants <strong>and</strong> there<br />
is a potential for future research here in considering this<br />
different online “presence” <strong>and</strong> the therapeutic relationship<br />
in e-therapy mediated by a screen. Furthermore, it would be<br />
<strong>of</strong> interest to explore the intricacies <strong>of</strong> online meeting, for<br />
example, how protracted silence is perhaps experienced<br />
differently in this “intense” setting.<br />
While all participants spoke <strong>of</strong> having had personal<br />
experiences <strong>of</strong> online video communication prior to<br />
practicing e-therapy, they equally shared experiences <strong>of</strong><br />
technological <strong>and</strong> practical issues, reflecting some <strong>of</strong> those<br />
identified by other authors (Cowain, 2001). These included<br />
disruptions <strong>and</strong> visual obscurity affected by Internet<br />
connection <strong>and</strong> equipment set up. This would seem to<br />
support the necessity for e-therapist to be pre-prepared<br />
for the online setting specifically to conduct e-therapy,<br />
<strong>and</strong> technologically literate (Fenichel et al, 2002). Echoing<br />
some issues raised in the current literature, the ethics <strong>of</strong><br />
e-therapy were <strong>of</strong> concern. Unsecure video platforms <strong>and</strong><br />
the legitimacy <strong>of</strong> practising across boundaries arose, further<br />
advocating the need for increased clarity <strong>and</strong> pr<strong>of</strong>essional<br />
consensus in this field. However while all participants felt<br />
that in this new field there were unanswered questions, they<br />
continued to practice e-therapy, accepting some <strong>of</strong> the risks<br />
involved <strong>and</strong> hoping for more development <strong>and</strong> pr<strong>of</strong>essional<br />
support. Corroborating with Finn <strong>and</strong> Barak (2010) only one<br />
participant was specifically trained in e-therapy, <strong>and</strong> the<br />
rest had mostly developed their practices through trial <strong>and</strong><br />
error. For these participants there was a pragmatism <strong>and</strong><br />
straightforwardness to their view <strong>of</strong> practising e-therapy. An<br />
implication <strong>of</strong> these findings for the pr<strong>of</strong>ession may be that<br />
as we are increasingly immersed in computer technologies<br />
<strong>and</strong> it is possibly seen as a natural development or<br />
supplement to face-to-face therapy, considerations for<br />
practicing e-therapy may need to be included in traditional<br />
training programmes.<br />
Conclusion<br />
The Digital Age is characterised by the rapidly <strong>and</strong> everevolving<br />
computer technologies which are becoming<br />
more incorporated into our daily lives, <strong>and</strong> reshaping the<br />
very nature <strong>of</strong> our relationships. This study explored the<br />
experiences <strong>of</strong> four pioneering psychotherapists practicing<br />
in the shifting <strong>and</strong> complex field <strong>of</strong> e-therapy. It revealed<br />
how some <strong>of</strong> the revered principles <strong>of</strong> psychotherapy <strong>and</strong><br />
counselling change when we connect with the other across<br />
distance <strong>and</strong> through screens. New considerations <strong>and</strong><br />
challenges were revealed relating to this new mode <strong>of</strong><br />
practice, including technological <strong>and</strong> practical issues. Some<br />
grey areas relating to the ethics <strong>and</strong> legalities <strong>of</strong> practice<br />
online remain unresolved, <strong>and</strong> this study illustrates how<br />
practitioners have to take risks without having sufficient<br />
clarity or robust technology to support their work. As<br />
the provision <strong>of</strong> e-therapy increases, it will be essential<br />
for the field to establish further ethical guidelines, better<br />
underst<strong>and</strong>ing around legal implications, <strong>and</strong> to increase<br />
the availability <strong>of</strong> support <strong>and</strong> training for e-therapists.<br />
It has been speculated that until e-therapy is adopted,<br />
incorporated <strong>and</strong> regulated as a legitimate form, it will<br />
continue to be considered by some as renegade, thereby<br />
posing the risk <strong>of</strong> undermining the reputations <strong>of</strong> the field<br />
more broadly (Richards & Viganó, 2013).<br />
As a qualitative IPA study occurrences <strong>of</strong> the phenomenon<br />
<strong>of</strong> e-therapy were allowed to emerge through the<br />
individual voices <strong>of</strong> the participants. What transpired were<br />
the motivations for these e-therapists; meeting needs<br />
in terms <strong>of</strong> the control, freedom <strong>and</strong> mobility; <strong>of</strong>fering<br />
access to clients <strong>and</strong> supporting client work with certain<br />
client groups <strong>and</strong> issues; <strong>and</strong> the positive experiences <strong>of</strong><br />
enjoyment, fascination <strong>and</strong> relaxation. Recognising that<br />
the data that has emerged is limited to the experience<br />
<strong>of</strong> four participants, we hope that through this detailed<br />
investigation the reader has gained a valuable insight into<br />
the phenomenon <strong>of</strong> psychotherapy online. It has highlighted<br />
the opportunities for further research into the motivations<br />
<strong>of</strong> e-therapists, the opportunity to complement this with the<br />
experiences <strong>of</strong> therapists who have tried <strong>and</strong> decided not<br />
to continue with online practice, <strong>and</strong> more investigation<br />
into this altered online “presence” <strong>and</strong> how it impacts the<br />
therapeutic relationship in e-therapy.
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 31<br />
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Volume 2, Number 1, January 2017
32
33<br />
THE RELATIONSHIP BETWEEN RESEARCH AND<br />
PRACTICE IN CONTEMPORARY ATTACHMENT<br />
RESEARCH<br />
Ian Rory Owen<br />
Abstract<br />
This paper discusses attachment research <strong>and</strong> practice. The literature on the links<br />
between the Strange Situation Procedure <strong>and</strong> the Adult Attachment Interview (AAI)<br />
inform practice <strong>and</strong> research by commenting on relationship processes. The attachment<br />
literature provides reliable information on childhood <strong>and</strong> adult intimate relating with<br />
partners, family <strong>and</strong> friends. There is also a literature on the qualitative analysis <strong>of</strong><br />
adult attachment in individual therapy. Given that working with the relationship is the<br />
medium for the delivery <strong>of</strong> care in any br<strong>and</strong> name type <strong>of</strong> practice, then attachment<br />
findings explain specific phenomena in various types <strong>of</strong> practice. This paper summarises<br />
findings about repeating attachment processes (Owen, 2017). The paper comments on<br />
the evidence-based practice proposed by the National Institute for Health <strong>and</strong> Care<br />
Excellence, (NICE), <strong>and</strong> argues for the utility <strong>of</strong> attachment research because it focuses<br />
on relational processes. The paper explains what attachment processes indicate <strong>and</strong><br />
notes a number <strong>of</strong> allied research questions.<br />
Keywords: Attachment processes, psychodynamics, improving intuition, practice,<br />
research<br />
Introduction<br />
Therapists <strong>of</strong> all br<strong>and</strong>s have a relation to the practice<br />
guidelines set by NICE. NICE <strong>of</strong>fers research findings that<br />
suggest st<strong>and</strong>ardised ways <strong>of</strong> working with people with<br />
single psychological problems. For the most part, the<br />
psychological therapies that NICE suggests are practised<br />
are derived from research clinics where the clients have only<br />
one psychological problem. The presence or absence <strong>of</strong> the<br />
one problem is claimed to exist in measurable degrees <strong>of</strong><br />
presence <strong>and</strong> intensity. The first problem with this is that the<br />
public <strong>of</strong>ten have more than one psychological problem but<br />
NICE <strong>of</strong>fers no advice on how to work with people who have<br />
multiple interacting problems.<br />
Looking at clients’ lives <strong>and</strong> difficulties is even more<br />
complicated when marital, family <strong>and</strong> personality problems<br />
are considered, plus the effects <strong>of</strong> gender, sexuality <strong>and</strong><br />
culture on development. When working with complex clients<br />
who have been sexually abused as children, multiply raped<br />
or have developmental delays because <strong>of</strong> being in care from<br />
an early age, what appears alongside the increased difficulty<br />
in underst<strong>and</strong>ing their needs is an increased difficulty in<br />
helping them, <strong>and</strong> more distress is invoked in meeting them<br />
<strong>and</strong> hearing the impact about what has happened to them.<br />
The difficulties involved in helping people with complex<br />
problems is that multiple trauma produce complex PTSD<br />
<strong>and</strong> take their potential in completely different directions<br />
to those adults who were loved <strong>and</strong> treated with respect<br />
as children. However, after having begun to work with<br />
them, therapists who employ all their usual strategies <strong>and</strong><br />
techniques, find that some people who need help the<br />
most, cannot use the opportunities being <strong>of</strong>fered them. It<br />
becomes disappointing for clients <strong>and</strong> therapists to stop<br />
the work because clients dropped out, or because what<br />
was happening was making clients feel more unsafe, <strong>and</strong><br />
therapists feel strong emotion such as shock, sadness or<br />
overwhelm by hearing their stories <strong>of</strong> violence <strong>and</strong> betrayal.<br />
In hindsight or through supervision, the emotions invoked<br />
in practising give rise to new underst<strong>and</strong>ing. In retrospect,<br />
therapists wished that they had been able to spot clients’<br />
difficulty at using therapy at assessment, or wish that they<br />
had <strong>of</strong>fered some other form <strong>of</strong> preparation, community<br />
support, or general education about mental health, <strong>and</strong><br />
so increase the likelihood <strong>of</strong> keeping clients in therapy. If<br />
the therapists had felt overwhelmed in the first 20 minutes<br />
<strong>of</strong> meeting persons who later proved to be unable to<br />
use their services, then in retrospect, their intuition <strong>and</strong><br />
Contact:<br />
Dr Ian Rory Owen, Principal Psychotherapist,<br />
Leeds <strong>and</strong> York Partnership NHS Foundation Trust<br />
ian.owen@nhs.net
34<br />
emotional response proved accurate representations <strong>of</strong><br />
what later transpired. In retrospect, it would have been<br />
emotionally intelligent to underst<strong>and</strong> the feeling <strong>and</strong> act on<br />
it, by checking thoroughly the abilities <strong>of</strong> needy, vulnerable<br />
people to make sure they can use what is being <strong>of</strong>fered.<br />
Given that clients <strong>of</strong>ten feel worse before they feel better,<br />
because their awareness <strong>of</strong> their problems increases during<br />
the early stages <strong>of</strong> therapy, <strong>and</strong> discussion <strong>of</strong> their problems<br />
brings them into clarity. The general research question that<br />
can be drawn from the above problem is how to sharpen<br />
one’s intuition <strong>and</strong> separate it from mere guesswork.<br />
Let me make it clear what I am referring to: On the one<br />
h<strong>and</strong>, as human beings with personal experiences <strong>of</strong><br />
helping people, therapists acquire clinical experience that<br />
informs their emotional responses about who can be helped<br />
<strong>and</strong> how to help them. An emotional sense can be felt that<br />
shows their immediate intuition as to whether a client can<br />
use what is going to be <strong>of</strong>fered to them. On the other h<strong>and</strong>,<br />
sometimes our intuition, our emotional felt-senses about<br />
how easy or difficult it will be to help someone, may or may<br />
not be accurate. Stated differently, the real meanings <strong>of</strong> the<br />
terms unconscious communication <strong>and</strong> counter-transference<br />
concern underst<strong>and</strong>ing how emotions, bodily sensations<br />
<strong>and</strong> imagery, or the recurrence <strong>of</strong> our memories, have a<br />
bearing on both people in the relationship, because <strong>of</strong> the<br />
emotional influence that clients bring to the meetings that<br />
influence therapists’ emotions. Practically, it is possible to<br />
use the emotional information <strong>of</strong> one’s responses in the first<br />
meeting, <strong>and</strong> trust first impressions, because intuition can be<br />
accurate. For instance, the “heart sink” response to meeting<br />
someone during the first 20 minutes <strong>of</strong> an assessment might<br />
later be proven accurate – or it might not. If the heart sink<br />
response is related to the client’s unwillingness to divulge<br />
information <strong>and</strong> the client expresses their reluctance to<br />
attend the assessment, then the heart sink emotion could be<br />
an accurate representation <strong>of</strong> the client’s un-readiness for<br />
regular meetings. It follows that the therapist wonders if this<br />
client is ready to discuss what they feel.<br />
Furthermore, there is a necessity (shared by Freud, Rogers<br />
<strong>and</strong> all modes <strong>of</strong> practice) <strong>of</strong> staying open to clients <strong>and</strong><br />
responding to them in genuinely felt, non-judgemental ways,<br />
despite having a heart sink response. The point <strong>of</strong> Freud’s<br />
free association is for clients to speak what they experience<br />
<strong>and</strong> be heard in creative silence to ensure that it is received<br />
as it was sent (Freud, 1923a/1955). The point <strong>of</strong> Rogers<br />
checking the sense <strong>of</strong> feelings empathised by the therapist<br />
is to check that the sense received is accurate (Rogers,<br />
1986). The research literature states that the therapeutic<br />
alliance is potent when acceptance, valuing <strong>and</strong> openness<br />
<strong>of</strong> therapists to clients, <strong>and</strong> their own reactions is happening<br />
(Lietaer, 1984). These basic aspects <strong>of</strong> therapeutic relating<br />
are important practically because they enhance the<br />
relationship <strong>and</strong> enable nervous <strong>and</strong> resistant persons to<br />
feel sufficiently comfortable with their own distress, guilt<br />
<strong>and</strong> shame, <strong>and</strong> express themselves. Staying open <strong>and</strong><br />
non-judgemental also promotes practice as research: in the<br />
sense that therapists get to learn what sorts <strong>of</strong> problems go<br />
together to form wholes that make sense - <strong>and</strong> this learning<br />
can be used in helping other people. The core attitudes <strong>of</strong><br />
openness <strong>and</strong> non-judgemental responding are necessary<br />
across all br<strong>and</strong>s <strong>of</strong> therapy practice, <strong>and</strong> are particularly<br />
necessary when practising with people who are emotionally<br />
overwhelming <strong>and</strong> difficult to underst<strong>and</strong>, because they<br />
have multiple concurrent psychological problems <strong>and</strong> would<br />
qualify for diagnoses <strong>of</strong> personality disorder. Despite these<br />
difficulties, clients need to trust therapists <strong>and</strong> therapists<br />
need to be open <strong>and</strong> sufficiently knowledgeable about the<br />
relational processes that can transpire.<br />
The relationship between research <strong>and</strong><br />
practice<br />
Despite the shortcomings <strong>of</strong> the advice from NICE, most<br />
practitioners would support the idea that it is helpful for their<br />
practice to be informed by empirical research in some way.<br />
The questions are “What research to trust?”, “About what<br />
aspects <strong>of</strong> what br<strong>and</strong> <strong>of</strong> practice?” <strong>and</strong> “How to determine<br />
how well the research is designed?” These factors translate<br />
into estimates concerning the quality <strong>of</strong> research, its<br />
trustworthiness <strong>and</strong> credibility. The work <strong>of</strong> Bill Stiles <strong>and</strong><br />
colleagues draws on the use <strong>of</strong> Core forms (CORE System<br />
Group, 1998) in the NHS that shows that the Dodo bird<br />
verdict is current (Stiles et al., 2008a, 2008b). In 1986, Stiles<br />
<strong>and</strong> colleagues found that all therapies performed equally<br />
well (Stiles, Shapiro & Elliott, 1986). This finding was hotly<br />
disputed by other forms <strong>of</strong> research <strong>and</strong> the r<strong>and</strong>omised<br />
control trials (RCT) design practised in research clinics with<br />
different experimental designs <strong>and</strong> the selection <strong>of</strong> clients.<br />
The Dodo bird verdict refers to the Dodo bird in Alice’s<br />
Adventures in Wonderl<strong>and</strong> (Carroll, 1962, p. 45). In the race<br />
where there is no proper starting line <strong>and</strong> no proper ending,<br />
the Dodo declares, “everybody has won <strong>and</strong> all must have<br />
prizes”. The Dodo bird verdict is also called the “equivalence<br />
hypothesis” or “equivalence paradox” in the research<br />
literature. It means that despite the many br<strong>and</strong>s having<br />
their own ideologies, attitudes, skills <strong>and</strong> techniques - when<br />
these are practised in the real world, they amount to the<br />
same outcome. All br<strong>and</strong>s <strong>of</strong> therapy are equally effective<br />
<strong>and</strong> have an effect size <strong>of</strong> 1.39, meaning that the change in<br />
Core scores created by therapy is 1.39 times bigger than the<br />
original Core score (Stiles et al., 2008b, p. 680). The Dodo<br />
bird verdict is confirmed in the analysis <strong>of</strong> Core forms, by<br />
Stiles <strong>and</strong> colleagues, which were derived from real world<br />
practice, outside <strong>of</strong> research clinics. Of the three major<br />
br<strong>and</strong>s <strong>of</strong> therapy practised in two different forms in 33,587<br />
completed therapies, this analysis showed that all <strong>of</strong> them<br />
were equally effective with the general population. One<br />
major problem revealed by Stiles showed the necessity <strong>of</strong><br />
helping clients trust therapists to self-disclose sufficiently<br />
to get help (2009, 2013). It is the choice <strong>of</strong> what clients<br />
self-disclose that controls the depth <strong>and</strong> content <strong>of</strong> the<br />
meetings. If they discern that therapists cannot h<strong>and</strong>le their<br />
material, then they do not disclose it.<br />
The next subsidiary question is what form <strong>of</strong> qualitative<br />
research in particular is best at capturing the moment to<br />
moment unfolding <strong>of</strong> a therapeutic relationship in a session<br />
<strong>and</strong> across a series <strong>of</strong> them. Ever since the use <strong>of</strong> filming in<br />
psychotherapy research, the discovery <strong>of</strong> micro-momentary<br />
facial expressions, that are universally recognisable<br />
across cultures, appears as a useful method (Haggard &<br />
Isaacs, 1966; Ekman & Friesen, 1978). One person, who<br />
has analysed video recordings where two persons are<br />
observable in one piece <strong>of</strong> video, is Una McCluskey who has<br />
identified repeating intersubjective processes (McCluskey,<br />
Hooper & Miller, 1999; McCluskey, Roger & Nash, 1997).<br />
This approach covers the centrality <strong>of</strong> the need to work<br />
with the relationship <strong>and</strong> formulate what is happening in<br />
the dynamic <strong>of</strong> care provision <strong>and</strong> its receipt. This leads to<br />
the position that I argue for in this paper: Attachment is a<br />
trustworthy perspective because <strong>of</strong> the research findings<br />
in individual therapy (Heard, Lake & McCluskey, 2009), in<br />
underst<strong>and</strong>ing human development (Benoit & Parker, 1994,<br />
Verhage et al, 2016), <strong>and</strong> dynamics in heterosexual (Haydon<br />
et al., 2012; Treboux, Crowell & Waters, 2004), <strong>and</strong> same sex<br />
relationships (Mohr, 2008). These findings are usable <strong>and</strong><br />
unite the links between the personal <strong>and</strong> the pr<strong>of</strong>essional,<br />
theory <strong>and</strong> research.
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 35<br />
The two sections that follow discuss attachment as it can be<br />
recognised in relationships between adults <strong>and</strong> in individual<br />
therapy. However, a note needs to be made <strong>of</strong> this way <strong>of</strong><br />
looking at attachment. Attachment is approached as a lived<br />
experience between people, as can be ascertained from the<br />
dynamics <strong>of</strong> any interchange between two or more people,<br />
which <strong>of</strong> course, depends on the personal histories <strong>and</strong> the<br />
type <strong>of</strong> relationship in which they engage each other. When<br />
attachment is seen as a set <strong>of</strong> lived experiences, then the<br />
mere noting <strong>of</strong> categories, (types <strong>of</strong> attachment process<br />
between adults) is insufficient. The role <strong>of</strong> attachment<br />
as theory <strong>of</strong> intimacy is that it provides underst<strong>and</strong>ing <strong>of</strong><br />
repeating processes in important temporary relationships<br />
as between clients <strong>and</strong> therapists, <strong>and</strong> between friends <strong>and</strong><br />
work colleagues. The way that these different contexts apply<br />
is not the focus <strong>of</strong> comments below, but this clarification<br />
merely notes the perspective taken here, to explain the type<br />
<strong>of</strong> comments that follow.<br />
Adult attachment processes<br />
Attachment processes are not fixed parts <strong>of</strong> the personality<br />
but are made manifest only in emotionally intimate<br />
relationships <strong>and</strong> those relationships that could be intimate<br />
(Prior & Glaser, 2006). This section makes some brief<br />
comments on what the findings are on the commonalities<br />
between childhood patterns, between children <strong>and</strong> adults,<br />
<strong>and</strong> what appears between adults in partner choice. There<br />
are four major types <strong>of</strong> attachment processes between<br />
adults that have their roots in childhood (Colle & Del<br />
Giudice, 2011; Weinfield et al., 1999). They can be explained<br />
as follows.<br />
Secure attachment indicates good mental health in relating.<br />
Adults with the tendency to the secure process seek<br />
others to gain help, can express distress, <strong>and</strong> consult their<br />
own store <strong>of</strong> having sought help from others (Spangler &<br />
Zimmerman, 2014). The winning point is that separation<br />
distress is comforted without expressing anger (Main,<br />
Kaplan & Cassidy, 1985). Good mental health is a high<br />
proportion <strong>of</strong> secure attachment in intimate relationships<br />
<strong>and</strong> not the absence <strong>of</strong> distress or conflict in them, but<br />
rather the ability to seek help <strong>and</strong> problem-solve (Atkinson<br />
et al., 2000). Security’s origin is good enough parenting<br />
that was promptly provided <strong>and</strong> sensitive to the child’s<br />
needs (Sroufe, 1985). The secure process is shown in the<br />
secure base phenomenon <strong>of</strong> seeking out a loved one or<br />
more skilled person in times <strong>of</strong> distress (Waters & Cummins,<br />
2000). When there are secure attachment bonds, both<br />
people connect <strong>and</strong> share a strong bond (whereas insecure<br />
attachment types have different properties). For persons<br />
who have the tendency to be secure, relationships matter<br />
<strong>and</strong> what is readily provided is loving care <strong>and</strong> attention,<br />
which delivers a positive mood <strong>and</strong> self-esteem in the<br />
harmony <strong>of</strong> close <strong>and</strong> positive social contact. Secure<br />
processes occur where attachment needs are met in mutual<br />
satisfaction, a win-win situation (Doherty & Feeney, 2004).<br />
Feedback <strong>and</strong> control remain secure when care-seeking<br />
is met with timely care-giving, then the care-seeking stops<br />
(Bowlby, 1969, p. 41). The phenomenon <strong>of</strong> the secure base<br />
is one <strong>of</strong> the full <strong>and</strong> sufficient provision <strong>and</strong> receipt <strong>of</strong><br />
care <strong>and</strong> love, <strong>and</strong> verbal <strong>and</strong> non-verbal communication<br />
(Posada et al., 1995). Between adults, it means having<br />
someone experienced <strong>and</strong> safe to self-disclose to, feeling<br />
safe <strong>and</strong> trusting them, feeling held (Crowell et al., 2002).<br />
Anxious attachment processes exist as two phases <strong>of</strong> a<br />
dem<strong>and</strong> for help <strong>and</strong> contact; followed by protest, anger<br />
<strong>and</strong> resistance when it is supplied (Bowlby, 1973, p. 57, p.<br />
196). The anxious process can feature outright rejection <strong>and</strong><br />
hostility where the main feature is that anxiety decreases<br />
play <strong>and</strong> exploration because <strong>of</strong> the actuality <strong>and</strong> possibility<br />
<strong>of</strong> the carers’ absence (Cassidy, 1994). The forces towards<br />
others are push <strong>and</strong> pull producing confusing senses in the<br />
relationship as a whole, where persons around someone<br />
with the tendency to the anxious process, feel dem<strong>and</strong> <strong>and</strong><br />
rejection. The anxious process has its roots in parenting<br />
that was irregular, unpredictable <strong>and</strong> unresponsive<br />
(Weinfield et al., 1999). The result is being unable to be<br />
soothed <strong>and</strong> unable to soothe themselves in adults who are<br />
dem<strong>and</strong>ing, needy, anxious <strong>and</strong> uncertain <strong>of</strong> themselves,<br />
as well as uncertain <strong>of</strong> how worthy they are to receive care<br />
(Fraley et al., 2006). As infants, a bigger communicative<br />
signal was required to get parental attention <strong>and</strong> pre-empt<br />
the possibility <strong>of</strong> their needs remaining unmet. The anxious<br />
quality <strong>of</strong> distress is two-fold. There is a state <strong>of</strong> lonely<br />
anguish or anxiety about disconnection, motivating protest<br />
<strong>and</strong> moving forward towards the carer, with dem<strong>and</strong>s <strong>and</strong><br />
big signals to elicit care through protest (Bowlby, 1969). The<br />
second movement is a step backwards away from the carer<br />
on reunion in the continuing rejection, implied criticism <strong>and</strong><br />
expression <strong>of</strong> protest, which might also function as a call<br />
for care. Protest anger occurs when adults remain angry at<br />
a lack <strong>of</strong> care, for a time after the misdeed has first been<br />
criticised. This shows the use <strong>of</strong> anger as a communication<br />
that the resentment is justified <strong>and</strong> continues without<br />
forgiveness, even when care has been provided. To speak<br />
metaphorically, the protest keeps a score; whereas if<br />
forgiveness <strong>and</strong> relaxation were the case, the score would<br />
have been settled, as evidenced by the soothing <strong>and</strong><br />
commencement <strong>of</strong> a calmer equilibrium. The higher selfconsciousness,<br />
the self-consciousness <strong>of</strong> their own needs<br />
<strong>and</strong> abilities by self, are interpreted as being insufficient<br />
because the equilibrium in the anxious process is one<br />
<strong>of</strong> expecting insufficiency <strong>and</strong> inconsistency as a matter<br />
<strong>of</strong> course (Mikulincer, Shaver & Pereg, 2003). The core<br />
process is that if others are empathised as unpredictably<br />
available, then there is an automatic hyperactivation<br />
<strong>of</strong> protest <strong>and</strong> dem<strong>and</strong>s that are addressed to carers.<br />
Feedback <strong>and</strong> control to maintain hyperactivation <strong>of</strong><br />
dem<strong>and</strong>, care <strong>and</strong> protest occur, <strong>and</strong> the protest eventually<br />
ends. This sub-optimal process has its own psychodynamic<br />
motivations: There is a resistance to disclosure, which is<br />
variable in that sometimes, there is speech <strong>and</strong> sometimes,<br />
inhibition.<br />
Adults who exhibit the avoidant process with intimate<br />
others repress their biologically inherited needs for intimacy<br />
because <strong>of</strong> being taught by their parenting that these needs<br />
are unacceptable, so the needs should not gain fulfilment<br />
(Bowlby, 1980, p. 65). Bowlby called it “compulsive selfreliance”<br />
(Bowlby, 1980, p. 171). The parenting provided<br />
was intrusive <strong>and</strong> can provide excess stimulation as well<br />
(Belsky, 1997). Because <strong>of</strong> the form <strong>of</strong> neglect <strong>and</strong> reluctant<br />
caring received as a child, this process remains extant<br />
in adulthood (Cassidy & Kobak, 1988). Therapeutically, it<br />
is necessary to prepare persons who habitually use the<br />
avoidant process because they are not used to expressing<br />
distress or seeking help (Kafetsios, 2004). So, to enter into<br />
a relationship that requires expression <strong>and</strong> work towards<br />
getting their needs met, is new territory for them. In the<br />
avoidant pattern, there was insufficient caring available.<br />
The children become adults who also reduce their requests<br />
for care <strong>and</strong> use small signals in order to receive the<br />
minimum that is capable <strong>of</strong> being received (Hesse, 2008).<br />
The distress <strong>of</strong> avoidant children is motivated by a taught<br />
anticipatory sense <strong>of</strong> absence <strong>and</strong> disconnection (Cassidy,<br />
1994). Specifically, it is expected that others will be absent<br />
<strong>and</strong> that relationships will be uncaring <strong>and</strong> distant, cannot<br />
be maintained, or will be lacking or broken (Sroufe, 1988).<br />
Thus, the avoidant process maintains only superficial<br />
Volume 2, Number 1, January 2017
36<br />
contact with others <strong>and</strong> a low investment when connecting<br />
with them (Årseth et al., 2009). The core pattern is that if<br />
others are felt to be unavailable, the need for satisfaction<br />
<strong>of</strong> the attachment system is deactivated (Bowlby, 1980, p.<br />
345). Feedback <strong>and</strong> control maintain deactivation as the<br />
restorative action, so that when distance is achieved, the<br />
avoidance stops (Bowlby, 1980, p. 345).<br />
Disorganised attachment is indicative <strong>of</strong> trauma <strong>and</strong><br />
abuse <strong>and</strong> can be transmitted to therapists when they feel<br />
shocked <strong>and</strong> go blank in meetings, because <strong>of</strong> the impact<br />
<strong>of</strong> what is being expressed (Heard, Lake & McCluskey,<br />
2009). Disorganised attachment in adults seems to be<br />
comprised <strong>of</strong> features <strong>of</strong> both anxious <strong>and</strong> avoidant<br />
processes that are welded into one incomplete form that<br />
does not include the ability to regulate distress. However,<br />
in its strongest forms, the movements between states<br />
features moving <strong>and</strong> changing the self: the defensive effect<br />
produces fragmented <strong>and</strong> confused quasi-unified forms <strong>of</strong><br />
self in one physical body (Liotti, 2004). The experiencing <strong>of</strong><br />
disarray is consistent with motivational sequences that are<br />
hard to achieve <strong>and</strong> express confusion <strong>and</strong> anger (Carlson,<br />
1998, Hesse, 1996). Adults with disorganised processes<br />
can express, at different times, discretely different ways <strong>of</strong><br />
being a self with others. There is more dysfunction in the<br />
disorganised non-achievement <strong>of</strong> attachment (Green &<br />
Goldwyn, 2002). It is a coordinated but highly ambivalent<br />
form <strong>of</strong> self-underst<strong>and</strong>ing <strong>and</strong> other-empathising. The<br />
self is relatively more fragmented, shattered into different<br />
ways <strong>of</strong> dealing with itself <strong>and</strong> others, because its own<br />
feelings <strong>and</strong> perspectives are confusing. Strictly speaking,<br />
disorganised attachment shows that there is the absence<br />
<strong>of</strong> the attainment <strong>of</strong> an attachment system because<br />
hyperactivation <strong>and</strong> deactivation operate <strong>and</strong> the attempts<br />
at satisfying attachment needs are ambivalent or absent<br />
(Main & Solomon, 1986). Lacks in functional feedback<br />
fail to establish safety <strong>and</strong> attachment satisfaction.<br />
Restorative action is begun but remains incomplete, so<br />
distress remains. Disorganisation has a purpose though,<br />
for what occurs, are identifiable phenomena <strong>and</strong> complex<br />
interactions <strong>of</strong> the two sub-optimal patterns <strong>of</strong> anxiety <strong>and</strong><br />
avoidance. There is cycling between the sub-optimal forms<br />
<strong>of</strong> hyper-activation <strong>and</strong> deactivation.<br />
The next section comments on attachment in individual<br />
therapy as revealed in qualitative research.<br />
Attachment processes between adults<br />
in therapy<br />
NICE guidelines for providing therapy <strong>and</strong> making decisions<br />
about treatments <strong>of</strong> choice, is to promote effective practice<br />
treatments that are proven effective because <strong>of</strong> prior<br />
research (nice.org.uk). However, as an alternative response,<br />
this section formulates nine attachment processes as<br />
they appear in individual therapy, which are presented as<br />
having more utility, particularly for therapy <strong>and</strong> other types<br />
<strong>of</strong> mental health care. In addition, the assumption that<br />
is made in making these recommendations is that to be<br />
competent in one’s practice <strong>and</strong> underst<strong>and</strong>ing <strong>of</strong> therapy<br />
relationships, concerns doing the psychodynamic basics<br />
well. One basic aspect <strong>of</strong> practice is being able to reflect on<br />
what is happening between oneself <strong>and</strong> the public, when<br />
we engage them in something that should be positive for<br />
them, despite the distress it will entail. Having said that, let<br />
us consider attachment processes in therapy. Specifically,<br />
what informs therapeutic work are findings like those by<br />
Una McCluskey <strong>and</strong> colleagues (Heard, Lake & McCluskey,<br />
2009, pp. 133-5). In attachment terminology, clients are<br />
care-seekers, whilst therapists are care-givers. I re-present<br />
their findings in condensed form <strong>and</strong> refer the reader to the<br />
original findings to get the full picture. Identified are nine<br />
most frequent repeating patterns derived from a qualitative<br />
analysis <strong>of</strong> videotapes. The first three are secure <strong>and</strong> the<br />
remainder are insecure in various ways.<br />
1. If the client is in-role as care-seeker, who has material<br />
to explore, <strong>and</strong> the therapist is in-role as care-giver who<br />
facilitates the exploration, then a secure process is achieved<br />
in each meeting. The therapist takes the lead in empathising<br />
<strong>and</strong> verbalising the emotions <strong>and</strong> motivations, <strong>and</strong> clients<br />
confirm whether therapists have understood them. The<br />
mutual process is one <strong>of</strong> co-responsiveness, as clients are<br />
open to what therapists say. A secure process is established<br />
when both client <strong>and</strong> therapist remain in their respective<br />
roles. Clients see that they are acceptable in the eyes <strong>of</strong><br />
therapists <strong>and</strong> they re-evaluate the felt-meanings they<br />
have in this new, more positive light. There is an emotional<br />
reframe <strong>of</strong> the previously distressing meanings they had<br />
expressed, <strong>and</strong> this is what provides the healing effect,<br />
because it alters the felt-sense that goes with the topic<br />
being expressed. Therapists <strong>and</strong> clients are responsive to<br />
each other <strong>and</strong> this shows nonverbally that there is rapport<br />
<strong>and</strong> clients are facilitated in an exploratory way.<br />
2. Clients present a topic assertively but therapists’<br />
comments are at first irrelevant, as they have not accurately<br />
empathised what they are being told <strong>and</strong> resist exploring<br />
it. However, clients persist <strong>and</strong> then the penny drops<br />
for therapists who eventually tune-in accurately. So the<br />
remainder <strong>of</strong> the session becomes like item 1 above, there<br />
becomes a secure process with both persons in their<br />
respective roles.<br />
3. At first, clients present in an anxious <strong>and</strong> disorganised<br />
way but therapists are able to catch contrary nuances <strong>and</strong><br />
soothe them, <strong>and</strong> then a secure process is achieved, like 1<br />
above. Therapists remain open, respond <strong>and</strong> soothe clients’<br />
distress by capturing the complex nuances <strong>of</strong> the client’s<br />
presentation.<br />
4. Clients start asking for help in a secure way but therapists<br />
persistently avoid <strong>and</strong> fail to tune in <strong>and</strong> divert the<br />
discussion onto irrelevancies without catching the client’s<br />
point. There is insufficient psychological contact between<br />
them. Clients psychologically withdraw towards the end <strong>of</strong><br />
the session. The therapist has actively resisted the client<br />
<strong>and</strong> has persisted in an avoidant process, until clients cease<br />
to ask for help.<br />
5. Clients are anxious <strong>and</strong> dem<strong>and</strong>ing but therapists<br />
are unable to tune in to their emotions or soothe them.<br />
Therapists do not provide soothing or empathic responding<br />
nor are clients helped to explore their thoughts <strong>and</strong> feelings.<br />
There is a communication <strong>of</strong> anxiety or fear to therapists,<br />
who respond similarly, leading to either an angry-anxious<br />
interchange, or mutual avoidant withdrawal by the end <strong>of</strong><br />
the session.<br />
6. Clients present their topic securely but therapists<br />
are alo<strong>of</strong> throughout <strong>and</strong> under-responsive with too<br />
many emotionally-avoidant, blank or passive responses.<br />
Therefore, clients cease asking for care <strong>and</strong> presenting<br />
verbally during the session: There is mutual withdrawal, an<br />
avoidant process.<br />
7. Therapists miss their clients’ nonverbal expression <strong>of</strong><br />
despair. Clients do not verbally present their despair, nor<br />
is it named or commented on by therapists. There is some<br />
slight contact before mutual withdrawal <strong>and</strong> avoidance, <strong>and</strong>
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 37<br />
clients are persistently avoidant <strong>of</strong> their despair <strong>and</strong> remain<br />
non-responsive. Therapists seem oblivious to the despair<br />
presented nonverbally.<br />
8. Clients present a topic but nonverbally indicate that they<br />
do not wish to discuss it through turning away from the<br />
therapist: They are anxious <strong>and</strong> resistant in their manner<br />
<strong>of</strong> presentation. Clients move on to present multiple topics<br />
in a confused manner <strong>and</strong> the therapist focuses on these,<br />
ignoring what was stated at the top <strong>of</strong> the session. However,<br />
because therapists have missed the point, clients resist<br />
more than previously, <strong>and</strong> at the end <strong>of</strong> the session, they<br />
are distressed or avoidantly dismissive towards therapists’<br />
failure to empathise <strong>and</strong> hold them.<br />
9. Clients present securely but therapists avoid their<br />
emotion, <strong>and</strong> fail to respond verbally <strong>and</strong> name it. Clients<br />
end up anxious, resistant <strong>and</strong> withdrawn; or avoidant <strong>and</strong><br />
dismissive, because therapists have failed to empathise the<br />
original emotion presented at the start <strong>of</strong> the session, <strong>and</strong><br />
their avoidance spreads to clients.<br />
Summary <strong>and</strong> conclusions<br />
The aim <strong>of</strong> an attachment-oriented focus on processes<br />
between client <strong>and</strong> therapist is that becoming more aware<br />
<strong>of</strong> empirically identified recurrences, supports <strong>and</strong> sharpens<br />
intuition. What is implied in the nine attachment processes<br />
above is the presence <strong>of</strong> varying client attempts at getting a<br />
caring response. When clients determine (rightly or wrongly)<br />
that therapists have not, or are incapable <strong>of</strong> focussing on<br />
what they are trying to say, then such a felt sense is likely<br />
to provoke dropout. If that is the case, then therapists are<br />
robbed <strong>of</strong> feedback about what has happened, so they are<br />
unable to improve their practice. The link between one’s<br />
own practice <strong>and</strong> the use <strong>of</strong> research become concordant<br />
when theory makes sense in one’s own work <strong>and</strong> can be<br />
tested in it.<br />
What has been presented is a whistle-stop tour <strong>of</strong><br />
contemporary research on therapy in the attachment<br />
view. Attachment processes should not be mistaken for<br />
fixed aspects <strong>of</strong> the personality. Being able to recognise<br />
processes aids underst<strong>and</strong>ing <strong>of</strong> the differing needs<br />
<strong>of</strong> clients <strong>and</strong> provides a framework for underst<strong>and</strong>ing<br />
complexity. Underst<strong>and</strong>ing attachment connects several<br />
important domains. For therapists, how the working life is<br />
felt <strong>and</strong> understood inside sessions, <strong>and</strong> the felt-quality <strong>of</strong><br />
one’s home life, are related to the degree <strong>of</strong> authenticity<br />
<strong>and</strong> congruence with one’s own personality, values <strong>and</strong><br />
family position. Having a secure base with a partner, family<br />
<strong>and</strong> friends is the anchor that holds in the inevitable storms<br />
<strong>of</strong> life. In the light <strong>of</strong> the above, effective therapy dem<strong>and</strong>s<br />
being aware <strong>of</strong> the psychodynamic basics like monitoring<br />
resistance to the expression <strong>of</strong> the topics that need to be<br />
discussed, <strong>and</strong> making caring responses to the distress<br />
that clients bring. Good mental health is not the absence<br />
<strong>of</strong> distress or conflict in any relationship, including the<br />
therapy one. When the temporary relationship <strong>of</strong> therapy<br />
is understood as an attachment relationship, it emphasises<br />
the importance <strong>of</strong> creating a sense <strong>of</strong> safety <strong>and</strong> working<br />
towards making a secure process in it, because each<br />
insecure process needs a different response. Adults with<br />
disorganised processes in their therapy need proper<br />
underst<strong>and</strong>ing <strong>of</strong> their difficulties made explicit. Doing the<br />
psychodynamic basics well means making the therapeutic<br />
relationship clear, <strong>and</strong> providing some positive sense <strong>of</strong><br />
connection in every session, particularly at the end <strong>of</strong> each<br />
session. Emotional regulation is different for anxious <strong>and</strong><br />
avoidant processes, requiring “cooling down” for one <strong>and</strong><br />
“warming up” for the other. The secure process in therapy<br />
is a condition for there to be new positive influences<br />
being made in an open <strong>and</strong> non-judgemental atmosphere.<br />
Therapists support clients’ aims, work to increase emotional<br />
connection <strong>and</strong> alter clients’ moods. This is achieved<br />
through contact with therapists, who need self-care <strong>and</strong><br />
authentic grounding in their own positive lifestyles.<br />
Limitations <strong>and</strong> future research<br />
This paper examined the developmental psychology<br />
approach to attachment in the main <strong>and</strong> did not take its lead<br />
from findings derived from self-rating questionnaires that are<br />
<strong>of</strong>ten used in the social psychology approach to attachment.<br />
It was limited by not including a comprehensive critique <strong>of</strong><br />
research from different methodologies that demonstrate<br />
why longitudinal AAI research into actual attachment<br />
relationships is most trustworthy. A comprehensive metaanalysis<br />
<strong>of</strong> the research designs <strong>and</strong> the psychometric<br />
properties <strong>of</strong> the measures used would check claims <strong>and</strong><br />
identify when findings from different types <strong>of</strong> research<br />
support each other or differ. While attachment is never<br />
causal in the naturalistic sense, in the complexity <strong>of</strong> human<br />
development, it is a central feature <strong>of</strong> being human. Future<br />
research in attachment would benefit from a comprehensive<br />
comparison <strong>of</strong> how methods are accurate <strong>and</strong> contribute to<br />
a more st<strong>and</strong>ardised underst<strong>and</strong>ing <strong>of</strong> the phenomena <strong>of</strong><br />
attachment as lived experience. It would be useful to have<br />
further insight into the development <strong>of</strong> attachment in primary<br />
intersubjectivity. Further details <strong>of</strong> how attachment with<br />
partners develops across the lifespan are also useful.<br />
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41<br />
VOYAGES INTO THE UNKNOWN: AN EXPLORATION<br />
USING INTERPRETATIVE PHENOMENOLOGICAL<br />
ANALYSIS OF THE EXPERIENCES OF RETURNING<br />
VOLUNTARY MIGRANTS<br />
Gareth Mason <strong>and</strong> Denise Ielitro<br />
Abstract<br />
This study draws on Interpretative Phenomenological Interpretation (IPA) to reflect<br />
the experience <strong>of</strong> voluntary migration <strong>and</strong> return by exploring the experiences <strong>of</strong> four<br />
British men. Voluntary migrants are understood as those who are not politically or<br />
economically driven. The findings draw on a wide range <strong>of</strong> literature including relevant<br />
autobiographical, fictional <strong>and</strong> anthropological work to <strong>of</strong>fset the lack <strong>of</strong> psychological<br />
writing on voluntary migration. Nine major themes emerged. These include travelling<br />
as a heroic quest; growth through challenging experience; struggles re-assimilating;<br />
<strong>and</strong> the search for a more satisfying home. Home <strong>and</strong> belonging emerge as nebulous<br />
manifold concepts encompassing spiritual <strong>and</strong> emotional aspirations beyond its physical<br />
dimensions. The study identified early background <strong>and</strong> life experiences as crucial<br />
influences in the outcomes <strong>of</strong> living abroad <strong>and</strong> resettling in their native country <strong>and</strong><br />
hopes to aid therapeutic practice by illuminating these connections.<br />
Keywords: Migration, abroad, home, return, belonging, identity<br />
Literature review<br />
Mythology <strong>and</strong> religion have influenced much <strong>of</strong> the<br />
psychological writing referenced. The Bible discusses exilic<br />
themes in terms <strong>of</strong> reward or punishment such as Adam <strong>and</strong><br />
Eve’s expulsion from Eden or Abraham’s call to the Promised<br />
L<strong>and</strong>.<br />
Trials are another major theme as exemplified by<br />
mythological heroes such as Odysseus, who perhaps best<br />
exemplifies the physical <strong>and</strong> psychological struggles <strong>of</strong><br />
adventuring far from home (Homer, 1946), or the Biblical<br />
testing <strong>of</strong> Abraham or Job. Campbell too discussed the<br />
‘hero’s’ journey from the call to adventure to trials <strong>and</strong><br />
transformation (1988/1949). This was supported by Jung’s<br />
transpersonal work particularly the archetypes <strong>of</strong> our<br />
Collective Unconscious (1951).<br />
The Grinbergs (1984) suggest Biblical <strong>and</strong> mythological exile<br />
stories enshrine early societal practices to avoid conflict<br />
– such as the taboos <strong>of</strong> parricide <strong>and</strong> incest discussed<br />
by Freud (2010/1899) in the Oedipal myth. Campbell says<br />
myths personified in tribal rituals validate the individual<br />
within a cohesive society although ‘indifference, revolt or<br />
exile – break the vitalising correctives’ (1988/1949, p.383).<br />
But he also implies seekers <strong>of</strong> wisdom do not always lose<br />
their connection with society. Such individuals can uncover<br />
‘the essence <strong>of</strong> oneself <strong>and</strong> the essence <strong>of</strong> the world:<br />
these two are one’ (p.386). He cites the ‘ascetic medieval<br />
saints <strong>and</strong> yogis <strong>of</strong> India’ (p.385) discovering a ‘universal<br />
consciousness’. A respected place may thus exist for these<br />
solitary figures – even an active role – as shaman or priest,<br />
or their modern scientific equivalents: doctors <strong>and</strong> teachers,<br />
who now draw more on scientific than sacred learning. Jung<br />
(1948) proposed symbols ‘protect a person from a direct<br />
experience <strong>of</strong> god… but if he leaves home <strong>and</strong> family, lives<br />
too long alone, <strong>and</strong> gazes too deeply into the dark mirror,<br />
then the awful event <strong>of</strong> the meeting may befall him’ (p.59).<br />
If the quest far from home presents dangers, the changes<br />
wrought may make return problematic too.<br />
While psychological studies on voluntary migration<br />
are limited, the Grinbergs’ work (1984) is sufficiently<br />
comprehensive to include themes on both forced <strong>and</strong><br />
voluntary migrations. Kernberg’s foreword highlights its<br />
exploration <strong>of</strong> ‘the unconscious processes activated in the<br />
individual as… [they] face the challenges <strong>of</strong> leaving one<br />
world behind <strong>and</strong> adapting to a new one’ (p.ii), <strong>and</strong> their<br />
attention to the significance <strong>of</strong> social <strong>and</strong> cultural factors,<br />
age <strong>and</strong> language. They draw heavily on Freud, Klein,<br />
Bowlby, Winnicott <strong>and</strong> Bion in discussing how defences,<br />
Contact: Gareth Mason, UKCP Psychotherapist garethmason@yahoo.com<br />
Denise Ielitro, Lecturer in <strong>Psychotherapy</strong>, Regent’s University London ielitrod@regents.ac.uk
42<br />
object relations, <strong>and</strong> attachment theory can explain<br />
conditions such as loneliness <strong>and</strong> psychosis <strong>and</strong> how<br />
migration can lead to identity crises or enlightenment. Also<br />
discussed is Balint’s classification <strong>of</strong> people as ocnophilic<br />
or philobatic personalities (1959) defined roughly as those<br />
seeking respectively either the familiar <strong>and</strong> stable, or the<br />
new <strong>and</strong> exciting. Balint believed voluntary migrants are<br />
usually philobatic.<br />
Mahler et al’s work on separation-individuation (2008/1975)<br />
is also referenced, explaining how attachment issues can<br />
precipitate psychosis in migrants. Elsewhere, Huntington<br />
(1981) draws on Bowlby, Bion <strong>and</strong> Winnicott to explain how<br />
separation anxiety is heightened in strange situations – a<br />
situation exemplified by migration when dislocation from a<br />
secure base exacerbates poor childhood attachments.<br />
Madison (2010) draws on eclectic sources in exploring<br />
voluntary migration from an existential perspective. He<br />
describes intangible ideas such as Freud’s uncanny (1919) or<br />
Heidegger’s unheimlich (1962/1927) referring to respectively<br />
something frightening but familiar, <strong>and</strong> not feeling at-home.<br />
Heidegger’s concepts <strong>of</strong> dasein, authenticity <strong>and</strong> fallen-ness<br />
are also usefully explored. Madison says ‘the experience<br />
<strong>of</strong> the unheimlich discloses that we drift along in life<br />
without a foundational ground, forever cadavering towards<br />
annihilation’ (2010, p.227). Despite the grim language, this<br />
represents an interesting counterpoint to the psychoanalytic<br />
view. We underst<strong>and</strong> not-being-at-home as the state from<br />
which angst calls us to recover dasein from its lost-ness<br />
in everyday thinking (Heidegger, 1962/1927). We discern<br />
a connection here with mythological ideas – such as the<br />
‘call <strong>of</strong> conscience’, <strong>and</strong> existential migrants as ‘heroes’<br />
(Madison, 2010). Perhaps it’s no co-incidence that many<br />
young travellers boast <strong>of</strong> being ‘authentic travellers’ rather<br />
than mere ‘tourists’.<br />
The relative dearth <strong>of</strong> specific psychological literature was<br />
partially <strong>of</strong>fset by examining the escapades <strong>of</strong> some literary<br />
travellers who highlighted issues <strong>and</strong> motivations common<br />
to voluntary migration. Leigh Fermor’s hopeful pioneer<br />
set out across Europe ‘like a tramp or… like a pilgrim or a<br />
palmer, an errant scholar, a broken knight… all <strong>of</strong> a sudden<br />
this was not merely the obvious, but the only thing to do’<br />
(1977, p.12). Meanwhile, Lee highlighted the ambivalence<br />
<strong>of</strong> uprooting oneself while ‘taunted by echoes <strong>of</strong> home’<br />
(1971, p.13). The journalist Kapuściński (2008) explored the<br />
colourful but difficult realities presented by distant exotic<br />
l<strong>and</strong>s. He was influenced by Levinas, a holocaust survivor<br />
who studied under Heidegger <strong>and</strong> Husserl, who believed<br />
‘The Self is only possible through the recognition <strong>of</strong> the<br />
other’ (p.5). Kapuściński believed self-hood was realised by<br />
communing with the other on an individual <strong>and</strong> global level<br />
<strong>and</strong> compared difficult childhoods <strong>and</strong> later life problems<br />
with historical events affecting societal relations. He<br />
believed multicultural communities <strong>of</strong>fered a more positive<br />
otherness <strong>and</strong> quotes the philosopher Tischner, who adapts<br />
the Cartesian slogan to ‘I know that I am, because I know<br />
another is’ (2006, p.209).<br />
H<strong>of</strong>fman <strong>and</strong> Said wrote seminal autobiographies about<br />
emigration. Said’s memoir (1999) details the melange <strong>of</strong><br />
influences that created his hybrid identity. His statement:<br />
‘the achievements <strong>of</strong> exile are permanently undermined<br />
by the loss <strong>of</strong> something left behind forever’ sums up its<br />
rather depressing tone. H<strong>of</strong>fman’s work (1998/1989) evokes<br />
her struggle towards assimilation after leaving Pol<strong>and</strong> for<br />
the Americas. Fjellestad (1995, p.135) says H<strong>of</strong>fman’s story<br />
challenges the ‘romantic illusion <strong>of</strong> unity <strong>and</strong> centre <strong>and</strong> <strong>of</strong><br />
the costs <strong>and</strong> rewards, the joys <strong>and</strong> terrors, <strong>of</strong> being thrown<br />
into a post-modern world <strong>of</strong> constantly shifting boundaries<br />
<strong>and</strong> borderless possibilities’. In describing her relationship<br />
with a lover, H<strong>of</strong>fman says ‘we explain ourselves like texts.<br />
We learn to read each other as one learns to decipher<br />
hieroglyphs’ <strong>and</strong> with a nod to Heidegger’s unheimlich, how<br />
after the stereotypes fall away, ‘he becomes familiar, only<br />
increasing the wonderment that the familiar should be so<br />
unfamiliar, the close so far away’ (p.190). H<strong>of</strong>fman describes<br />
her homesickness <strong>and</strong> nostalgia for post-war Krakow, saying<br />
‘it throws a film over everything around me, <strong>and</strong> directs my<br />
vision onwards’ (p.115). H<strong>of</strong>fman later describes herself as<br />
visibly ‘a member <strong>of</strong> a post-war international class’ without<br />
feeling it (p.170). During psycho-analysis, she completes her<br />
underst<strong>and</strong>ing <strong>of</strong> the English-speaking world, integrating her<br />
Polish <strong>and</strong> American selves following the trauma <strong>of</strong> culture<br />
shock.<br />
Methodology<br />
A constructionist paradigm seemed appropriate for<br />
uncovering multiple truths with its emphasis on reality<br />
being socially created rather than existing as an external<br />
singular entity (Hansen, 2004). According to Ponterotto<br />
(2005), constructionism uses a hermeneutical approach<br />
to draw out deeper meanings via reflection, particularly<br />
researcher interaction. Ontologically, this relativistic position<br />
is subjective <strong>and</strong> influenced by individual experience <strong>and</strong><br />
perceptions, <strong>and</strong> social environment. We accept, therefore,<br />
that results will differ if the study was interpreted by different<br />
researchers, as no single truth exists (Finlay, 2016) – the<br />
study’s value drawing on the ‘thickness’ <strong>of</strong> descriptions<br />
(Ponterotto, 2005).<br />
Epistemologically, the relationship between ‘knower <strong>and</strong><br />
would-be-knower’ (Ponterotto, p.127), represented by<br />
participant <strong>and</strong> researcher in IPA is central. Constructionism<br />
states reality is socially created – so the dynamic is<br />
crucial. Similarly, in axiological terms, researcher values<br />
are inevitably enmeshed in the process so a personal <strong>and</strong><br />
subjective rhetorical structure – such as IPA – that details<br />
the thoughts <strong>and</strong> feelings <strong>of</strong> both people seems appropriate<br />
(ibid).<br />
A phenomenological method was chosen as it considers<br />
both cognitions <strong>and</strong> emotions – the embodied aspect<br />
<strong>of</strong>ten being overlooked in psychological theory (Smith el al,<br />
2009). IPA was also favoured for its value in investigating<br />
identity <strong>and</strong> health issues. Furthermore, we did not plan to<br />
create theory. IPA also links interpretation with mainstream<br />
psychological thinking; to investigate cognitions <strong>and</strong><br />
emotions where mainstream psychology treats them<br />
separately; <strong>and</strong> to look at deeper levels <strong>of</strong> reflection more<br />
than other qualitative approaches (Smith, 1996).<br />
The researchers’ time abroad inspired the study so we remain<br />
mindful <strong>of</strong> our influence as reflexive researchers. As bracketing<br />
is intrinsic to phenomenology, we followed Ashworth’s advice<br />
to set aside scientific theories, the truth or falsity <strong>of</strong> participants’<br />
claims, <strong>and</strong> personal views <strong>and</strong> experiences (1996).<br />
Nonetheless, Giorgi admits: ‘Nothing can be accomplished<br />
without subjectivity so its elimination is not the solution’ (1994,<br />
p.205), while du Plock describes ‘the notion <strong>of</strong> the neutral<br />
objective researcher’ as ‘absurd’ (2016, p.16).<br />
The participants<br />
In keeping with IPA’s tendency to analyse small detailed<br />
purposive samples, we limited participation to four men<br />
from a relatively homogeneous demographic – the<br />
implications are discussed in the findings. Smith says: ‘IPA<br />
studies are conducted on a relatively small sample sizes,<br />
<strong>and</strong> the aim is to find a reasonably homogenous sample,<br />
so that, within the sample, we can examine convergence
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 43<br />
<strong>and</strong> divergence in some detail’ (2009, p.3). Furthermore, as<br />
the dissertation on which the paper is based was the first<br />
IPA study <strong>of</strong> one <strong>of</strong> the authors, we quote Smith saying:<br />
‘our advice to a newcomer to IPA is to try to obtain a group<br />
which is pretty homogeneous’ (p.50).<br />
The target group were UK natives, who had lived full-time<br />
overseas for more than three years <strong>and</strong> spent over a year<br />
back in the UK to allow exploration <strong>of</strong> the ‘before <strong>and</strong> after’<br />
periods <strong>of</strong> their experience. The field was narrowed to men<br />
between the ages <strong>of</strong> 40-45 to decrease sample variables<br />
although differences exist in time spent both overseas<br />
<strong>and</strong> back in the UK. All four are white, but colour was not a<br />
criteria. Social class was not part <strong>of</strong> the selection process<br />
while the interviews revealed significant differences in<br />
parental income, pr<strong>of</strong>ession, <strong>and</strong> quality <strong>of</strong> upbringing.<br />
Participants were given pseudonyms for confidentiality<br />
purposes.<br />
The interviewees<br />
Malcolm (44) lives with his wife <strong>and</strong> three children in the<br />
West Country. He spent 18 years in France, mostly in Paris,<br />
<strong>and</strong> returned to Engl<strong>and</strong> four years ago.<br />
Daniel (42) lives with his partner <strong>and</strong> child in northern<br />
Engl<strong>and</strong> where he is studying medicine. He spent 10 years<br />
in Latin America before returning home six years ago.<br />
Barry (45) is a musician who lives with his wife <strong>and</strong> child in<br />
London. He spent almost four years in the US after leaving<br />
school <strong>and</strong> regularly returns to work there.<br />
Alan (44) is a builder who lives with his girlfriend <strong>and</strong><br />
her children in London. He spent eight years working in<br />
Portugal <strong>and</strong> Austria <strong>and</strong> returned 15 years ago.<br />
Findings<br />
The analysis<br />
Our IPA analysis followed the five stages suggested by<br />
Smith, Flowers & Larkin (2009). Briefly, these are reading <strong>and</strong><br />
re-reading transcripts; initial noting; developing emergent<br />
themes; connection across emergent themes; <strong>and</strong> discerning<br />
patterns across cases. Primarily, we analysed the transcripts<br />
from descriptive, linguistic <strong>and</strong> conceptual perspectives (ibid).<br />
The master themes were identified after completing the<br />
interviews. Themes relevant only to one individual participant<br />
were discarded – some <strong>of</strong> these omissions are discussed<br />
in the conclusions. The master themes reflected patterns<br />
across the interviews – each distinguished by significant<br />
emotional or cognitive resonance. We were mindful <strong>of</strong> not<br />
lending greater weight to themes reflecting the literature<br />
review or our own experiences.<br />
This process involved substantial re-reading <strong>of</strong> transcripts<br />
<strong>and</strong> reworking <strong>of</strong> the material. Ultimately, the emerging<br />
superordinate themes listed below reflected the chronology<br />
<strong>of</strong> the participants’ lives as revealed by the interviews<br />
although this was a natural outcome rather than planned. The<br />
first subordinate themes involved childhoods <strong>and</strong> motivation;<br />
the second, aspects <strong>of</strong> the experience abroad; <strong>and</strong> the third<br />
looked at re-assimilation into British society.<br />
Master themes<br />
1) Finding Home Abroad<br />
a) Escape from Childhood<br />
b) The Comfort <strong>of</strong> Strangers<br />
c) The International Man<br />
2) Kings <strong>of</strong> the Wild Frontier<br />
a) University <strong>of</strong> Life<br />
b) Lust for Life<br />
c) The Heroic Quest<br />
3) End <strong>of</strong> the Dream<br />
a) A Life more Ordinary<br />
b) Paradise Lost<br />
c) Life through a new Lens<br />
Discussion<br />
1) Finding Home Abroad<br />
1a) Escape from Childhood<br />
The Grinbergs say travel can be an escape from home rather<br />
than heading towards a destination (1984). Daniel’s travelling<br />
seemed to need the complement <strong>of</strong> psychological ‘inner<br />
journeying’ (Madison, 2010) to escape the past. For Alan<br />
<strong>and</strong> Daniel, frequent movement between unsatisfying early<br />
environments combined with insecure parental attachments<br />
(Bowlby, 1960). Alan says <strong>of</strong> his home: ‘Emotionally <strong>and</strong><br />
spiritually, there was quite a lot <strong>of</strong> discord’.<br />
Home for Daniel appears less a place than a loving<br />
community. He says: ‘I rejected a part <strong>of</strong> the rural part <strong>of</strong> E-<br />
that we lived in because it represented such a difficult time’.<br />
When migration failed to discover what felt like a home, he<br />
seemed to experience aspects <strong>of</strong> the unheimlich (Heidegger,<br />
1962/1927) <strong>and</strong> the uncanny (Freud, 1919).<br />
All four subscribe to a ‘long-harboured desire’ for sustained<br />
adventure (Grinbergs, 1984, p.58). For Alan <strong>and</strong> Daniel<br />
specifically: ‘lack <strong>of</strong> containment <strong>and</strong> support may precipitate<br />
psychosis, perversion, delinquency, or drug use’ (p.127) when<br />
changing environments to heal childhood problems.<br />
1b) The Comfort <strong>of</strong> Strangers<br />
Madison (2010) discusses how some – like Daniel – use<br />
travelling to re-connect <strong>and</strong> progress within the world to<br />
build up confidence. Daniel says: ‘I felt very strong about<br />
Latin American issues… I had a Latin American outlook’.<br />
Succeeding away perhaps <strong>of</strong>fsets feeling failure at home.<br />
Madison also suggests some flee home to avoid feeling<br />
overwhelmed, <strong>and</strong> to achieve balance between contact<br />
<strong>and</strong> isolation, <strong>and</strong> how peer rejection can be projected onto<br />
places.<br />
Kristeva talks about foreigners representing ‘the hidden face<br />
<strong>of</strong> our identity’ (1991, p.1) <strong>and</strong> how integrating them into our<br />
unconscious releases it from a repressed pathological state.<br />
Daniel <strong>and</strong> Alan may have felt unconsciously reassured by<br />
this.<br />
Meanwhile, if ‘physical space allows mental space’ (Madison,<br />
2010, p.209), Alan embraced it saying he idealised his life<br />
overseas – a common reaction that can lead to hypomania<br />
in new arrivals – its corollary <strong>of</strong>ten being a later collapse<br />
(Grinbergs, 1984), which Alan’s experiences also reflect when<br />
‘stripped almost overnight <strong>of</strong> the people… [he] spent a lot <strong>of</strong><br />
amazing times with’.<br />
Volume 2, Number 1, January 2017
44<br />
Perhaps the common link is the desire to self-actualise<br />
(Maslow, 1954) coupled with their rejection <strong>of</strong> a constraining<br />
tribal loyalty. All four were attracted to the exotic – perhaps<br />
their own spiritual mystery, <strong>and</strong> identity, was better matched<br />
with their chosen destination than their first homes (Madison,<br />
2010).<br />
1c) The International Man<br />
Barry <strong>and</strong> Malcolm’s international perspective is reflected<br />
by their being-at-home in more than one place as if they<br />
transcended home <strong>and</strong> foreign culture rather than being<br />
subsumed by either. Barry says: ‘I always try to see myself as<br />
an international person… I like freedom’.<br />
Alan <strong>and</strong> Daniel perhaps took longer to achieve this due to<br />
their initial rejection <strong>of</strong> home. Madison describes how ‘dual<br />
belonging’ (2010, p.103) can resolve the tension between a<br />
strong self-identity <strong>and</strong> sense <strong>of</strong> belonging.<br />
Alan’s national identity is less obvious as his peers share<br />
interests rather than cultures or places saying ‘British<br />
culture became a culture shock to me because I had lived a<br />
European life’. Or as Madison (2010) suggests, perhaps Alan<br />
avoids isolation by grouping with internationalists equally<br />
unattached to home countries.<br />
Daniel’s fragile attachment to Britain seems linked to his lack<br />
<strong>of</strong> belonging to family <strong>and</strong> early homes – an assumption<br />
Madison (2010) also identifies.<br />
2) Kings <strong>of</strong> the Wild Frontier<br />
2a) University <strong>of</strong> Life<br />
Madison says intellectual studies – such as those later<br />
displayed by Daniel <strong>and</strong> Malcolm – are examples <strong>of</strong><br />
‘journeying inwards’ (2010, p.105), while early failure is<br />
identified by Alan’s admission that ‘a lot <strong>of</strong> us could have<br />
done better academically than we did’ when faced with the<br />
choice <strong>of</strong> ‘going surfing for the weekend or sitting around<br />
doing your pure maths homework’. Freud said the sublimation<br />
<strong>of</strong> studying, a mature version <strong>of</strong> displacing the libido, was<br />
‘what makes it possible for higher psychical activities,<br />
scientific, artistic or ideological, to play such an important part<br />
in civilised life’ (1930, p.79). Daniel didn’t pursue medicine<br />
to regulate his libido, but his long-simmering intellectual<br />
frustration seems usefully channelled into study! For him<br />
‘studying medicine is as thrilling <strong>and</strong> as much an adventure as<br />
travelling’.<br />
Madison (2010) sees compassion for the underdog –<br />
demonstrated by all four – as a complement to a personal<br />
fight for independence, while H<strong>of</strong>fman (1998) talks <strong>of</strong> exiles<br />
creatively reviewing life’s mysteries from abroad – perhaps<br />
enhanced by the extra time <strong>and</strong> space <strong>of</strong>ten available.<br />
2b) Lust for Life<br />
All were drawn to what Heidegger might describe as<br />
authentic experiences (1962/1927) <strong>and</strong> prioritising adventure<br />
over financial security (Madison, 2010). Barry says: ‘I had this<br />
something in me, which I had picked up in America, this sort<br />
<strong>of</strong> lust for life’. Daniel says: ‘there were no bounds to what I<br />
did’, while Malcolm ‘revelled in complete freedom’.<br />
Madison’s words could apply to all four: ‘To not be free is<br />
to not be alive. In leaving I am embracing my freedom <strong>and</strong><br />
independence through movement’ (2010, p.270). When he<br />
says ‘I have a felt direction more than a felt goal; it is a journey<br />
with no set destination, slowly I entertain that the journey is<br />
the destination’ (ibid), it particularly reflects the paths <strong>of</strong> Alan<br />
<strong>and</strong> Daniel.<br />
Balint (1959) might highlight the interviewees’ philobatic<br />
nature – due to their movement towards new <strong>and</strong> exciting<br />
experiences, but we feel this is balanced by their stated<br />
ocnophilic attachments to people <strong>and</strong> places, home <strong>and</strong><br />
abroad.<br />
2c) The Heroic Test<br />
The participants <strong>of</strong>ten described their journeys using<br />
mythological language.<br />
With Daniel, we perceived parallels between his life stages,<br />
<strong>and</strong> the trials <strong>of</strong> the archetypal mythological hero, namely: a<br />
peripatetic childhood; uncertain ancestry beyond his adopted<br />
parents; restless ‘drifting’; his desire for ‘transformation’; a<br />
passage through ‘madness’; a ‘magical’ chosen l<strong>and</strong>; <strong>and</strong><br />
his role as teacher, <strong>and</strong> later doctor, allowing him to be ‘a<br />
part <strong>of</strong> society, actually fulfilling a useful role pr<strong>of</strong>essionally<br />
<strong>and</strong> personally’. He sought a ‘transformative’ experience<br />
that would make him: ‘a different, more independent, more<br />
exciting, more worldly person’. Of his chosen pr<strong>of</strong>essions,<br />
Jung’s ‘wounded healer’ (1951) suggests itself, as does the<br />
shaman who harnesses skills that set him apart. ‘It is not<br />
society that is to guide <strong>and</strong> save the creative hero’, says<br />
Campbell, ‘but precisely the reverse’ (p.391). The ‘purification<br />
<strong>of</strong> the self’ after an individual undertakes ‘the perilous<br />
journey… into the crooked lanes <strong>of</strong> his own spiritual labyrinth’<br />
could reflect Daniel’s positive transformation following<br />
a ‘manic psychosis’. Campbell describes ‘the process <strong>of</strong><br />
dissolving, transcending, or transmuting the infantile images<br />
<strong>of</strong> our personal past’ (p.101). This chimes with Daniel’s<br />
improved interaction with the world. Daniel’s travelling<br />
ambitions also reminded me <strong>of</strong> the pleasure-seeking Peer<br />
Gynt (Ibsen, 1964/1876), whose eponymous protagonist<br />
pursues hedonistic impulses unreflectively. The ‘decadence’<br />
<strong>of</strong> Daniel’s pleasure-seeking, however, led to disillusionment,<br />
<strong>and</strong> later, a life ‘more fulfilling than the experiences I had<br />
there’.<br />
Malcolm’s Panglossian optimism reminded us <strong>of</strong> the<br />
protagonist Karl in Kafka’s Amerika (1996/1927). Nonetheless,<br />
he survives well, treating triumph <strong>and</strong> disaster with<br />
equal equanimity <strong>and</strong> dreams <strong>of</strong> his family ‘returning like<br />
conquering heroes’. He was also reminiscent <strong>of</strong> the footloose<br />
writers, Lee <strong>and</strong> Leigh Fermor. Leigh Fermor (1977/1947)<br />
flipped cheerfully between barns <strong>and</strong> castle turrets in his<br />
peregrinations, while Malcolm was equally at home in an<br />
anarchist squat as a millionaire’s chateau.<br />
Barry’s attitude fits the role <strong>of</strong> Master <strong>of</strong> the Two Worlds<br />
(Campbell, 2004/1949) exercising ‘freedom to pass back<br />
<strong>and</strong> forth across the world division’ (p.229) <strong>and</strong> refers to his<br />
‘calling’ to London <strong>and</strong> the ‘magical’ American world.<br />
3) End <strong>of</strong> the Dream<br />
3a) A Life more Ordinary<br />
Page claims ‘re-entry shock is as powerful as culture shock’<br />
(1990, p.181) <strong>and</strong> how denying these difficulties <strong>of</strong>ten results<br />
in disillusionment. Brislin (ibid) says re-adjusting to home is<br />
<strong>of</strong>ten hardest for those who integrated well overseas. Alan<br />
returns to a provincial ‘desert’ where ‘pretty much everyone<br />
had left’. The reverse condition, Postponed Depression<br />
Syndrome (Grinbergs, 1984), could be applied to Alan<br />
for his difficulties abroad after initially immersing himself<br />
successfully.<br />
Madison (2010, p.178) identifies how returning migrants<br />
<strong>of</strong>ten feel ‘exotic’, but his emphasis is on visiting rather than<br />
permanent resettlement. He also suggests migrants may feel<br />
superior to those left behind, if also envious <strong>of</strong> their material<br />
gains. My interviewees tended to feel or be seen as exotic<br />
when abroad. This is reminiscent <strong>of</strong> H<strong>of</strong>fman feeling an<br />
‘exotic stranger’ in the US <strong>and</strong> ‘excited by my own otherness,<br />
which surrounds me like a bright, somewhat inflated<br />
bubble’ (1998, p.179). The interviews suggest the novelty <strong>of</strong><br />
homecoming was short-lived perhaps representing a fallen-
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 45<br />
ness from a more authentic existence abroad (Heidegger,<br />
1962/1927). Daniel laments: ‘I identified as being somebody<br />
who had lived abroad in a dangerous place that impressed<br />
people, <strong>and</strong> once that was taken away I just felt like another<br />
schmuck’.<br />
For Daniel <strong>and</strong> Alan, return was heralded by the ‘dying’ <strong>of</strong><br />
foreign worlds. The Grinbergs (1984) noted how returning<br />
exiles fall prey to doubt even when the homecoming is<br />
cherished. They quote the expressions coined by a Spanish<br />
journalist: ‘to be in the throes <strong>of</strong> de-exile’ <strong>and</strong> ‘the wound <strong>of</strong><br />
return’ (Torres, 1983), <strong>and</strong> cite one returnee who said ‘I don’t<br />
feel I belong in either place’ (p.184).<br />
Regarding Alan, the perceived negative reaction <strong>of</strong> the<br />
homeworld with his ‘long hair [<strong>and</strong>] ridiculous suntan’ was<br />
perhaps reminiscent <strong>of</strong> the reception Turkish workers<br />
reported after working in Germany when mocked as<br />
Alamanyali or German-like (M<strong>and</strong>el, 2008).<br />
3b) Paradise Lost<br />
The burning <strong>of</strong> this bridge to the dwelling place <strong>of</strong> others left<br />
Alan <strong>and</strong> Daniel caught between two worlds – a common<br />
situation identified by Madison (2010).<br />
This sense <strong>of</strong> failure perhaps deepened early psychological<br />
fissures. Metaphorically, they return empty-h<strong>and</strong>ed rather<br />
than triumphantly bearing the hard-won ‘elixir’ (Campbell,<br />
2004/1949). Daniel described his dissolution abroad almost<br />
like a personal expulsion from Eden claiming the loss <strong>of</strong> ‘a<br />
whole dimension <strong>of</strong> my character’, while Malcolm says: ‘I’ve<br />
left a bit <strong>of</strong> my heart in France’. The Grinbergs (1984) suggest<br />
migration can release latent pathology – something applicable<br />
to Daniel’s experiences on his outward <strong>and</strong> return journeys.<br />
Of work, Alan was ‘sick <strong>and</strong> tired <strong>of</strong> just making money <strong>and</strong><br />
working my balls <strong>of</strong>f for other people’ at ‘what’s supposed to<br />
be a grown-up age’ <strong>and</strong> that ‘the veneer was starting to peel<br />
away’. This is similar to migrants feeling infantilised abroad<br />
where their qualifications <strong>and</strong> experience have little value<br />
(Grinbergs, 1984).<br />
3c) Life through a new Lens<br />
For Daniel <strong>and</strong> Alan, something <strong>of</strong> Freud’s uncanny (1919)<br />
is glimpsed in their re-acquaintance with former worlds,<br />
previously taken for granted, while Heidegger’s unheimlich<br />
can be observed in their sense <strong>of</strong> not being-at-home<br />
(1962/1927) – even if this represents a continuation <strong>of</strong> their<br />
unsatisfying relationship with Britain.<br />
Madison (2010) discusses how many migrants need to<br />
believe home has not changed to preserve their roots.<br />
Daniel, however, was disturbed by the lack <strong>of</strong> perceived<br />
change – referring to his dislike <strong>of</strong> ‘the millennia old<br />
inequalities’.<br />
Alan’s wary response to the digital age echoes Heidegger’s<br />
warning that technological ‘progress’ – epitomised by a<br />
skyline redolent with television aerials – reduces the world<br />
to a state <strong>of</strong> homelessness by ushering the public into our<br />
private homes (1961). Malcolm, however, positively reflected<br />
that ‘I’ve made myself over there <strong>and</strong> turned into someone<br />
who can actually operate over here’.<br />
Conclusions<br />
We initially expected the interviews to produce themes<br />
exclusively related to the experience <strong>of</strong> being <strong>and</strong> returning<br />
from overseas. However, issues concerned with the<br />
upbringing <strong>and</strong> background <strong>of</strong> the participants proved to be<br />
significant influences on motives for living overseas, <strong>and</strong> the<br />
quality <strong>of</strong> the overseas’ experience <strong>and</strong> resettlement.<br />
Summary <strong>of</strong> master themes<br />
Under (1) Finding Home Abroad, the subordinate theme (1a)<br />
Escape from Childhood divided the participants into two<br />
camps: those running from unsatisfying home environments<br />
versus those whose secure base let them happily w<strong>and</strong>er<br />
further afield. Thriving in unfamiliar territory was explored in<br />
(1b) The Comfort <strong>of</strong> Strangers; while (1c) The International Man<br />
discussed the evolution <strong>of</strong> their worldly identities.<br />
Within (2) Kings <strong>of</strong> the Wild Frontier, we examined a tendency<br />
to reject formal education in favour <strong>of</strong> life experience in (2a)<br />
University <strong>of</strong> Life; the embracing <strong>of</strong> adventure <strong>and</strong> hedonism<br />
in (2b) Lust for Life; while (2c) The Heroic Quest reflected<br />
the interpretation – consciously or otherwise – <strong>of</strong> identity in<br />
mythical metaphors.<br />
(3) End <strong>of</strong> the Dream dealt with post-migration experience.<br />
(3a) Paradise Lost focused on the repercussions <strong>of</strong> closing<br />
the chapter on a meaningful period <strong>of</strong> life; while (3b) A Life<br />
more Ordinary highlighted the anti-climax <strong>of</strong> returning to<br />
an old world after exp<strong>and</strong>ing one’s horizons in a new one.<br />
Finally, (3c) Life through a new Lens explored how each<br />
constructed a new existence in the UK after assimilating<br />
experiences abroad.<br />
Implications for psychotherapy<br />
This study <strong>of</strong> voluntary migration aims to help those leaving,<br />
those left behind – <strong>and</strong> therapists – better underst<strong>and</strong> its<br />
purpose <strong>and</strong> value.<br />
Therapeutically, we identified the value <strong>of</strong> immersing oneself<br />
in the whole subjective story <strong>of</strong> the voluntary migrant. For<br />
example, Daniel <strong>and</strong> Alan reported far more emotional turmoil<br />
than their co-participants as their migration encompassed<br />
much more than their time abroad. Answering the call to<br />
adventure was perhaps one <strong>of</strong> a series <strong>of</strong> trials <strong>and</strong> lifechanging<br />
experiences that helped establish their identity. The<br />
crucible <strong>of</strong> travel, if sometimes perilous, forged their authentic<br />
selves. Their experiences, spanning many years, were<br />
perhaps not dissimilar to the process <strong>of</strong> insightful therapy.<br />
Meanwhile, the study underlined how the relatively charmed<br />
upbringings <strong>of</strong> Malcolm <strong>and</strong> Barry contributed to a fulfilling<br />
overseas venture.<br />
Cooper Marcus said ‘when we start to seek a broader<br />
home in another place, it is likely that the soul is dem<strong>and</strong>ing<br />
recognition’ (1995, p.252). The drive for unplanned openended<br />
travel <strong>of</strong>ten seems motivated by such intangible<br />
mystical forces. For Daniel <strong>and</strong> Alan, self-actualisation<br />
took place on the long <strong>and</strong> winding road rather than a<br />
conventional straight path.<br />
While respecting individual choice, a therapist might<br />
usefully explore the underlying issues – such as the sense<br />
<strong>of</strong> belonging – that motivate such ventures. This may<br />
more directly initiate the healing process than years spent<br />
w<strong>and</strong>ering away from the home world. Exploring the personal<br />
meanings <strong>of</strong> home may facilitate it. Journeying inwardly<br />
through study, self-improvement, or social activism – as<br />
demonstrated by Daniel – may be satisfying alternatives.<br />
Returnees devaluing their experience may benefit from being<br />
reminded <strong>of</strong> the insights they have gained, which may be lost if<br />
they are pre-occupied by what they feel they have lost through<br />
absence. Otherwise, in its ignorance <strong>of</strong> their experiences,<br />
the home world is likely to reinforce this negative feeling.<br />
Furthermore, if the original home feels diminished, perhaps it<br />
is because the boundaries that enclosed it have shifted. The<br />
dizzying possibilities that now emerge may be viewed fearfully,<br />
but can also be re-viewed as symptoms <strong>of</strong> a more meaningful<br />
<strong>and</strong> authentic existence (Heidegger, 1962/1927).<br />
Volume 2, Number 1, January 2017
46<br />
The Grinbergs say ‘One never goes back, one always<br />
goes toward’ (1984, p.216). Those more changed than their<br />
home world may benefit from seeking a new more flexible<br />
environment for their exp<strong>and</strong>ed consciousness. Rapport<br />
<strong>and</strong> Dawson suggest migration can be a ‘creative act’<br />
(1998, p.209) <strong>and</strong> ‘in displacement lies a route to personal<br />
empowerment’ (2003, p.51), something which all the<br />
participants grew from in different degrees.<br />
If the wisdom gleaned abroad is made central to one’s new<br />
life, it builds on this valuable knowledge rather than wastefully<br />
bracketing if <strong>of</strong>f like some invalid reality. Some may relish their<br />
experiences as little more than fireside tales, but voluntary<br />
migrants who enthusiastically embraced the other may wisely<br />
build on these foundations e.g. by using language skills,<br />
cultural knowledge or seizing entrepreneurial opportunities.<br />
Therapists can foreground these skills lest they be forgotten.<br />
Myriad practical factors influence the outcomes <strong>of</strong> voluntary<br />
migration such as age, gender, status, social <strong>and</strong> cultural<br />
support – along with the destination <strong>and</strong> provenance <strong>of</strong><br />
the traveller (Brislin, 1990). Also important are access to<br />
home; ethnicity, religion, race; education, <strong>and</strong> work skills<br />
(ibid). Making potential voluntary migrants aware <strong>of</strong> how<br />
these variables may affect them could later earn them rich<br />
dividends.<br />
But ultimately, to many voluntary migrants, fine-tuning the<br />
variables perhaps cheats the challenge <strong>of</strong> heeding the<br />
call, which for good or worse, must be braved. For both<br />
the supportive therapist <strong>of</strong> the voluntary migrant, <strong>and</strong> the<br />
<strong>of</strong>ten uncomprehending friends <strong>and</strong> family, this irrational but<br />
irrepressible motivation is perhaps the most important factor<br />
to accept <strong>and</strong> underst<strong>and</strong>.<br />
Limitations <strong>and</strong> further study<br />
Some significant issues suggested by the literature were not<br />
investigated as they were not prioritised by the participants.<br />
They include loss, which was tangible during Alan’s interview,<br />
<strong>and</strong> writers such as H<strong>of</strong>fman (1998), concerning paths not<br />
taken. Another is the isolation felt by strangers in a strange<br />
l<strong>and</strong> – largely not experienced by our participants; likewise,<br />
struggles with integration which the interviewees dealt with<br />
largely well. Culture shock was articulated by Alan, but in<br />
reference to his return rather than departure.<br />
Space considerations forced us to ab<strong>and</strong>on some interesting<br />
– but less supported – themes. These included enhanced<br />
economic <strong>and</strong> social status abroad, the experiences <strong>of</strong><br />
partners <strong>and</strong> family, or even the frustration <strong>of</strong> one’s lifechanging<br />
stories being met with indifference back home.<br />
Others emerged after the interviews, relatively unexplored,<br />
such as the impact on identity <strong>of</strong> learning foreign languages;<br />
nocturnal dream worlds; re-inventing oneself in an alien<br />
environment; or psychosomatic symptoms attached to<br />
emotional trauma. Space considerations also required us<br />
to remove many participant quotes; non-psychological,<br />
but relevant literature from the review; further detail on<br />
methodology etc. which were present in the original<br />
dissertation.<br />
A further study could extend the age, gender, ethnicity,<br />
nationality, <strong>and</strong> participant numbers. For example, the themes<br />
<strong>of</strong> Heroic Quest <strong>and</strong> Lust for Life – well supported by the<br />
participants – seem rather stereotypically male. Conversely,<br />
a single case study might reveal much by probing deeper<br />
into the psyche <strong>of</strong> one individual. As our participants were<br />
similarly-aged white men from a rich Western nation, the<br />
results are clearly skewed – we would like to see what is<br />
retained with different variables particularly when more<br />
participants further iron out the idiosyncratic differences. Even<br />
within this narrow demographic, we realise the criteria might<br />
benefit from further tightening such as the differences in the<br />
places visited, time spent there, <strong>and</strong> the age <strong>of</strong> the travellers.<br />
The symptoms discussed, if not the causes, may be reflected<br />
by political <strong>and</strong> economic migrants <strong>and</strong> those studying<br />
or posted overseas. For them, universities <strong>and</strong> company<br />
resettlement programmes may help as do reception centres<br />
for refugees, but these options may be r<strong>and</strong>omly available<br />
<strong>and</strong> mere B<strong>and</strong>-Aids for deeper individual wounds. Future<br />
migration studies may benefit from greater emphasis on the<br />
individual rather than generalised mass movements (Rapport<br />
& Dawson, 1998).<br />
Final thoughts<br />
Overall, the participants with a more secure base had fewer<br />
problems abroad <strong>and</strong> in resettling. For the participants<br />
whose upbringing was more difficult being abroad might<br />
have represented an escape, but it did not necessarily<br />
compensate positively for this lack – indeed their issues<br />
were <strong>of</strong>ten highlighted <strong>and</strong> amplified abroad. Nonetheless,<br />
the conscious act <strong>of</strong> leaving seems to represent an attempt<br />
to overcome this adversity, which allowed them to ultimately<br />
underst<strong>and</strong>, accept <strong>and</strong> grow from it. We also feel that the<br />
project benefitted from the positive experiences reported<br />
in underst<strong>and</strong>ing the factors behind a rewarding voluntary<br />
migration.<br />
IPA’s value in investigating issues such as belonging <strong>and</strong><br />
identity was also highlighted – the interviews largely<br />
underpinned these evolving themes. For example, Barry’s<br />
childhood home was a happy, nurturing place. It didn’t<br />
change, but he did, <strong>and</strong> the world <strong>of</strong> cosmopolitan cities<br />
became his natural milieu. His harmonious <strong>and</strong> accessible<br />
dual world, which home has become is now varied enough<br />
to contain his needs. For Alan, home revolved around shared<br />
activities with like-minded companions. His presence in the<br />
family home was more <strong>of</strong> an intrusion than a belonging so<br />
it is unsurprising he has grown up adaptable, independent,<br />
<strong>and</strong> unsentimental about childhood. Malcolm’s young<br />
adult home was a moveable feast founded on a liberal <strong>and</strong><br />
nurturing home base, which allowed him to fearlessly seek<br />
new adventures elsewhere without needing to escape it.<br />
Being abroad gave Daniel the freedom to live fully <strong>and</strong> create<br />
the essence denied by early deprivation, but his travelling<br />
experiences were insufficient to make him feel he belonged.<br />
His home is now founded on a mutually loving <strong>and</strong> supportive<br />
family – what he lacked as a child.<br />
Traditionally, we believe the lack <strong>of</strong> psychological literature<br />
on voluntary migration reflects a belief that it represents a<br />
pathological deviation from the ‘normality’ <strong>of</strong> settled life. While<br />
globalisation increasingly encourages temporary <strong>and</strong> semipermanent<br />
freedom <strong>of</strong> movement, we feel an acceptance <strong>of</strong><br />
migration as an on-going ‘alternative human history’ (Madison,<br />
2010, p.222) will redress this now out-dated bias towards a<br />
sedentary life.<br />
Given the freedom to undertake these voyages, the<br />
participants all felt compelled to leave one home, to discover<br />
another. If they had not done so, we suspect their destinies<br />
would feel unfulfilled.
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 47<br />
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Volume 2, Number 1, January 2017
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 49<br />
BOOK REVIEW<br />
Doodson, L. (ed) (2016)<br />
Underst<strong>and</strong>ing Stepfamilies: A practical guide for<br />
pr<strong>of</strong>essionals working with blended families<br />
Open University Press<br />
Review by Susan Davis<br />
In the ever-increasing world <strong>of</strong> step, or blended, families,<br />
there is nevertheless an under-resourced field <strong>of</strong> tailored<br />
therapeutic support available. This book provides a<br />
comprehensive <strong>and</strong> solutions focused guide for all<br />
pr<strong>of</strong>essionals seeking to underst<strong>and</strong> the complexities<br />
<strong>and</strong> requirements <strong>of</strong> working with stepfamilies.<br />
The book is extremely well structured <strong>and</strong> takes a step-bystep<br />
approach to enable pr<strong>of</strong>essionals to feel confident in<br />
giving appropriate <strong>and</strong> effective support <strong>and</strong> advice. Written<br />
by a leading British stepfamily expert, the book is peppered<br />
with real world examples to contextualize <strong>and</strong> describe the<br />
realities <strong>of</strong> life in a modern stepfamily. Using well researched<br />
<strong>and</strong> evidenced based theories, Dr Doodson has delivered<br />
a manual filled with practical tips <strong>and</strong> tools that reflect the<br />
underst<strong>and</strong>ing <strong>and</strong> methods necessary for negotiating the<br />
unique challenges <strong>and</strong> emotions experienced by stepfamilies<br />
as opposed to biological families.<br />
The first two chapters clearly set out the diverse nature <strong>of</strong><br />
stepfamilies <strong>and</strong> clarify the subtle differences <strong>and</strong> challenges<br />
faced by the individual members within them, <strong>and</strong> the<br />
relationships between them. These chapters also analyse<br />
the differing stories, emotions <strong>and</strong> dem<strong>and</strong>s experienced<br />
by the individuals as they try to establish their place <strong>and</strong><br />
identify their role within the stepfamily unit in order to allow<br />
the reader to relate these to clients in their own work settings.<br />
The author also suggests short exercises for practitioners to<br />
use with clients to open up thinking <strong>and</strong> discussion <strong>and</strong> <strong>of</strong>fers<br />
tips that could be shared with individuals in order to reassure<br />
<strong>and</strong> advise them.<br />
Chapter 3 presents the supporting psychological theory by<br />
introducing a new model <strong>of</strong> therapeutic intervention devised<br />
by the author <strong>and</strong> specifically targeted at stepfamilies called<br />
IST – Integrated Stepfamily Therapy. This theory adopts<br />
a behavioural <strong>and</strong> solutions focused approach based on<br />
empirical evidence <strong>and</strong> three existing theories <strong>and</strong> the<br />
chapter describes <strong>and</strong> critiques these in detail. It sets out four<br />
underpinning principles for the new model – to normalize<br />
experiences, to establish realistic expectations, psychoeducation,<br />
to strengthen the couple bond - <strong>and</strong> discusses<br />
how to use these in action whilst always referring back<br />
to real life examples. It then goes on to highlight how to<br />
integrate three different interventions into the broader work<br />
with the immediate family, <strong>and</strong> even beyond them (with the<br />
original biological family members) so that practitioners feel<br />
competent to identify <strong>and</strong> design a tailored approach for each<br />
family’s unique set <strong>of</strong> challenges.<br />
Chapters 4-6 flesh out these suggested interventions in<br />
greater detail, whilst always referring back to the supporting<br />
literature. They examine how an integrated approach could<br />
use three diverse methodologies to play a part in supporting<br />
the work in the stepfamily setting – couple counselling;<br />
psycho-education <strong>and</strong> behavioural modeling; mediation.<br />
Chapter 6 introduces mediation as an intervention using an<br />
expert contributor <strong>and</strong> discusses the right approach to use,<br />
the necessary skills <strong>and</strong> the potential benefits. These three<br />
chapters provide an exhaustive ‘checklist’ <strong>of</strong> components<br />
to be considered <strong>and</strong> addressed in each individual case<br />
<strong>and</strong>, again, provide a toolkit <strong>of</strong> ideas <strong>of</strong> ways to engage the<br />
families in the therapy <strong>and</strong> facilitate progress.<br />
The final chapter thoroughly documents a series <strong>of</strong> diverse<br />
case studies, which demonstrate clearly the complex range<br />
<strong>of</strong>, <strong>and</strong> different needs within, stepfamilies. This provides a<br />
very useful way <strong>of</strong> bringing the theory to life <strong>and</strong> provokes<br />
contemplation for the reader as to how to integrate the theory<br />
into his or her own clinical practice.<br />
This book is without doubt an invaluable, well researched <strong>and</strong><br />
authoritative ‘how to’ guide to working with stepfamilies in a<br />
therapeutic setting.<br />
Contact: Susan Davis susie.giles77@gmail.com<br />
Volume 2, Number 1, January 2017
AUTHOR INFORMATION<br />
Susan Davis is an MSc <strong>Psychology</strong> student at Regent’s<br />
University London, with a special interest in families, parenting<br />
<strong>and</strong> stepfamilies.<br />
Dr Sonia Gallucci (Ph.D., University <strong>of</strong> Birmingham) is Senior<br />
Lecturer in Cross-cultural Studies at Regent’s Institute <strong>of</strong><br />
Languages <strong>and</strong> Culture (RILC), Regent’s University London.<br />
In 2017, she is due to complete an MA in <strong>Counselling</strong> <strong>and</strong><br />
<strong>Psychotherapy</strong> at the School <strong>of</strong> <strong>Psychology</strong> (Regent’s<br />
University London). Sonia also holds an MA in Italian Studies:<br />
Culture <strong>and</strong> Communication from the Universities <strong>of</strong> Warwick<br />
<strong>and</strong> Birmingham, <strong>and</strong> a BA in Modern Languages <strong>and</strong><br />
Literatures from the University <strong>of</strong> Cagliari (Italy). Her current<br />
research focuses on the role <strong>of</strong> culture <strong>and</strong> emotions in<br />
second language learning <strong>and</strong> in psychotherapy.<br />
Denise Ielitro, BSc, Adv Dip <strong>Counselling</strong>, MA, UKCP & BPS<br />
Reg. Denise is a psychoanalytic psychotherapist with a private<br />
practice in north London. She has a background in clinical<br />
psychology <strong>and</strong> integrative humanistic counselling <strong>and</strong> has<br />
worked for the NHS <strong>and</strong> Mind. Since 2005, Denise has been<br />
working at Regent’s University London where she teaches<br />
<strong>and</strong> supervises students on the MAPC <strong>and</strong> ADIP courses. She<br />
previously lectured on the DPsych <strong>Counselling</strong> <strong>Psychology</strong><br />
course at Regent’s <strong>and</strong> at the New School <strong>of</strong> <strong>Psychotherapy</strong><br />
<strong>and</strong> <strong>Counselling</strong>. She also taught for many years at the<br />
Institute <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> Social Studies. Denise has a<br />
particular interest in the social <strong>and</strong> cultural context in which<br />
therapy takes place. Other clinical interests are attachment<br />
theory, <strong>and</strong> in particular parent-infant relationship, eating<br />
disorders, self-harm <strong>and</strong> psychosis.<br />
Dr Marek Kolarik is a Lecturer in Clinical <strong>Psychology</strong> at<br />
Palacký University in Olomouc in Czech Republic. His<br />
interests are in family therapy, supervision <strong>of</strong> clinical practice,<br />
<strong>and</strong> psychological assessment.<br />
Imogen Koufou is a BACP-accredited existential<br />
psychotherapist. She holds an MA in <strong>Psychotherapy</strong> &<br />
<strong>Counselling</strong> from Regent’s University London where she<br />
also completed the Advanced Diploma in Existential<br />
<strong>Psychotherapy</strong> (ADEP). She currently works as a senior<br />
therapist <strong>and</strong> supervisor at Berkshire NHS Trust <strong>and</strong> runs<br />
her private practice, Buckinghamshire <strong>Psychotherapy</strong>, from<br />
Beaconsfield. Her research interests include: qualitative<br />
research methods in particular such as Interpretative<br />
Phenomenological Analysis (IPA) <strong>and</strong> case studies.<br />
Subjects include: psychotherapy online, technology <strong>and</strong><br />
psychotherapy, eating disorders, embodiment.<br />
Dr Martin Lečbych is Associate Pr<strong>of</strong>essor <strong>of</strong> Clinical<br />
<strong>Psychology</strong> at Palacký University in Olomouc in Czech<br />
Republic. He focuses on general <strong>and</strong> special psychotherapy,<br />
family therapy, supervision in clinical practice, psychological<br />
assessment <strong>and</strong> neuropsychological rehabilitation <strong>of</strong><br />
cognitive functions. He provides supervision for students<br />
who prepare for their clinical practice <strong>and</strong> for practitioners<br />
in clinical psychology in the area <strong>of</strong> psychotherapy, family<br />
therapy <strong>and</strong> psychological assessment.<br />
Dr Maria Luca is Reader in <strong>Psychotherapy</strong>, Senior Research<br />
Fellow, training supervisor, Head <strong>of</strong> the <strong>Reflections</strong> Research<br />
Centre <strong>and</strong> the PhD programme in psychotherapy at Regent’s<br />
University London, editor <strong>of</strong> <strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong><br />
<strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong>, author <strong>of</strong> Sexual<br />
Attraction in Therapy: Clinical Perspectives on Moving<br />
Beyond the Taboo - A Guide for Training <strong>and</strong> Practice (2014),<br />
London: Wiley <strong>and</strong> The Therapeutic Frame in the Clinical<br />
Context – Integrative Perspectives, (2004), London: Brunner-<br />
Routledge <strong>and</strong> several articles in peer reviewed journals.<br />
Pr<strong>of</strong>essor Desa Markovic is Pr<strong>of</strong>essor in <strong>Psychotherapy</strong><br />
at Regent’s University London, Head <strong>of</strong> <strong>Psychotherapy</strong><br />
programmes in <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong>, a UKCPregistered<br />
systemic psychotherapist <strong>and</strong> supervisor, COSRT<br />
accredited psychosexual therapist <strong>and</strong> supervisor <strong>and</strong> a<br />
Fellow <strong>of</strong> the Sheffield Society for the Study <strong>of</strong> Sexuality <strong>and</strong><br />
Relationships. She has held senior academic posts at various<br />
training institutes, presented at national <strong>and</strong> international<br />
conferences <strong>and</strong> published papers on the subject <strong>of</strong> systemic<br />
<strong>and</strong> psychosexual therapy integration.<br />
Gareth Mason is a UKCP psychotherapist working privately<br />
<strong>and</strong> within the NHS. He has also spent over 20 years working<br />
as a journalist in Britain <strong>and</strong> overseas. He is a graduate from<br />
Regent’s University London’s MA <strong>and</strong> Advanced Diploma<br />
programmes. His dissertation, entitled Voyages into the<br />
Unknown, reflects an interest in the experiences <strong>of</strong> those<br />
resettling in alien cultures <strong>and</strong> was inspired by his own time<br />
abroad.<br />
Dr Ian Rory Owen was born in New Zeal<strong>and</strong> in 1960 <strong>and</strong><br />
holds a first degree in engineering <strong>and</strong> a masters <strong>and</strong><br />
PhD in counselling <strong>and</strong> psychotherapy from Regent’s<br />
University London. He has further qualifications in cognitive<br />
behavioural therapy <strong>and</strong> medical anthropology. Previously,<br />
he was a Senior Lecturer in <strong>Counselling</strong> <strong>Psychology</strong> at<br />
Wolverhampton University. Since 2001, he has been a<br />
Principal Psychotherapist in the National Health Service in<br />
Leeds. He practices brief individual therapy with people with<br />
complex psychological needs. On Attachment, published by<br />
Karnac, is his fifth book. His previous works are in the area <strong>of</strong><br />
phenomenology, intersubjectivity <strong>and</strong> psychotherapy.<br />
Dr Christina Richards BSc (Hons) MSc DCPsych CPsychol<br />
MBACP (Accred.) AFBPsS is a Doctor <strong>of</strong> <strong>Counselling</strong><br />
<strong>Psychology</strong> <strong>and</strong> an Associate Fellow <strong>of</strong> the British<br />
Psychological Society (BPS). She is also an accredited<br />
psychotherapist with the British Association for <strong>Counselling</strong><br />
<strong>and</strong> <strong>Psychotherapy</strong> (BACP). She is Senior Specialist<br />
<strong>Psychology</strong> Associate at the Nottinghamshire Healthcare<br />
NHS Trust Gender Clinic <strong>and</strong> Clinical Research Fellow at West<br />
London Mental Health NHS Trust (Charing Cross) Gender<br />
Clinic. She lectures <strong>and</strong> publishes on trans, sexualities <strong>and</strong><br />
critical mental health, both within academia <strong>and</strong> to third<br />
sector bodies, <strong>and</strong> is co-founder <strong>of</strong> BiUK <strong>and</strong> co-author<br />
<strong>of</strong> the Bisexuality Report. She is Editor <strong>of</strong> the journal <strong>of</strong><br />
the British Psychological Society’s Division <strong>of</strong> <strong>Counselling</strong><br />
<strong>Psychology</strong>: <strong>Counselling</strong> <strong>Psychology</strong> Review. Her own<br />
publications consist <strong>of</strong> various papers, books, reports, <strong>and</strong><br />
book chapters <strong>and</strong> she is the co-author <strong>of</strong> the BPS Guidelines<br />
<strong>and</strong> Literature Review for <strong>Counselling</strong> Sexual <strong>and</strong> Gender<br />
Minority Clients.
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> 51<br />
ANNOUNCEMENTS<br />
<strong>Psychotherapy</strong> & <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> Research Centre<br />
Workshop<br />
THE MAKING OF DSM – THE DISTURBING TRUTH<br />
ABOUT ITS CONSTRUCTION, AND DOES AN<br />
ALTERNATIVE NON-MEDICAL LANGUAGE EXIST?<br />
Friday 19 May 2017<br />
17:15 – 19:15<br />
Regent’s University London<br />
Inner Circle, Regent’s Park<br />
London NW1 4NS<br />
Why, without solid scientific justification, has the<br />
number <strong>of</strong> mental disorders risen from 106 in 1952,<br />
to around 370 today? In this workshop Dr James<br />
Davies takes us behind the scenes <strong>of</strong> how the<br />
psychiatrist’s bible, the Diagnostic <strong>and</strong> Statistical<br />
Manual <strong>of</strong> Mental Disorders (DSM), was actually<br />
written. Did science drive the construction <strong>of</strong> new<br />
mental disorder categories like ADHD <strong>and</strong> major<br />
depression or were less-scientific <strong>and</strong> unexpected<br />
processes at play? His exclusive interviews with the<br />
creators <strong>of</strong> the DSM reveal the troubling answer.<br />
The second part <strong>of</strong> this workshop explores how<br />
non-medicalised language can be used to describe<br />
the diverse forms emotional suffering can take.<br />
Has the medical model enjoyed its heyday?<br />
Do we really need psychiatric diagnosis? If not,<br />
what can replace it? This workshop will invite<br />
discussion <strong>and</strong> exploration <strong>of</strong> these vital issues.<br />
James Davies graduated from the University<br />
<strong>of</strong> Oxford in 2006 with a PhD in Social <strong>and</strong><br />
Medical Anthropology. He is a Reader in Social<br />
Anthropology <strong>and</strong> <strong>Psychotherapy</strong> at the University<br />
<strong>of</strong> Roehampton <strong>and</strong> a practicing Psychotherapist.<br />
He has delivered lectures at Harvard, Yale, Oxford,<br />
Brown, UCL <strong>and</strong> Columbia <strong>and</strong> has written for The<br />
Times, the New Scientist, the Guardian <strong>and</strong> Salon.<br />
He is author <strong>of</strong> the bestselling book Cracked: why<br />
psychiatry is doing more harm than good. He is<br />
co-founder <strong>of</strong> the Council for Evidence-based<br />
Psychiatry, secretariat to the All Party Parliamentary<br />
Group for Prescribed Drug Dependence.<br />
Early booking advised.<br />
Please book online at store.regents.ac.uk<br />
Enquiries to: Shirley Paul pauls@regents.ac.uk<br />
Volume 2, Number 1, January 2017
52<br />
<strong>Psychotherapy</strong> & <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> Research Centre<br />
4 th Annual One-Day Conference<br />
PSYCHOSOMATIC CLINICAL PRESENTATIONS<br />
AND IMPLICATIONS FOR EMBODIED, RELATIONAL<br />
PSYCHOLOGICAL THERAPY APPROACHES<br />
Saturday 10 June 2017<br />
09:00 – 16:30<br />
Regent’s University London,<br />
Inner Circle, Regent’s Park,<br />
London NW1 4NS<br />
Organising Committee<br />
Dr Maria Luca<br />
Pr<strong>of</strong>essor John Nuttall<br />
Keynote Speakers<br />
Pr<strong>of</strong>essor Helen Payne<br />
The BodyMind Approach: supporting people with medically unexplained<br />
symptoms/somatic symptom disorder<br />
Nick Totton<br />
Embodied symptoms as problems <strong>and</strong> as solutions<br />
Pr<strong>of</strong>essor Manos Tsakiris<br />
The relational body: perceiving <strong>and</strong> representing one’s body in relation to significant others<br />
Speakers<br />
Dr Michael Worrell<br />
Long-term health conditions <strong>and</strong> couple relationships: why there is a clear case for including the<br />
partner in therapy<br />
Manuel Toren <strong>and</strong> Dr Maria Luca<br />
The persecutory character <strong>of</strong> irritable bowel syndrome<br />
Dr Katharina Lederle<br />
An underst<strong>and</strong>ing <strong>of</strong> the science <strong>of</strong> sleep <strong>and</strong> how sleep may affect mental health<br />
Book now at store.regents.ac.uk (early bird prices available)<br />
Enquiries to Shirley Paul pauls@regents.ac.uk
GUIDELINES FOR SUBMITTING A PAPER TO THE JOURNAL<br />
OF PSYCHOTHERAPY AND COUNSELLING<br />
PSYCHOLOGY REFLECTIONS (JPCPR)<br />
In preparing your submission, please refer to the style guide below.<br />
Please make sure your full contact details are visible on the outside<br />
<strong>of</strong> all documents you are sending to Editors.<br />
Papers are accepted for consideration on condition that you will<br />
accept the following conditions. We ask authors to assign the rights<br />
<strong>of</strong> copyright in the manuscript they contribute.<br />
We welcome submissions on any topic within psychotherapy <strong>and</strong><br />
counselling psychology that considers the remit <strong>of</strong> the journal <strong>and</strong><br />
that it is inclusive <strong>of</strong> the academic community at large.<br />
Contributions to JPCPR must report original research <strong>and</strong> will be<br />
subjected to review by referees at the discretion <strong>of</strong> the Editorial Office.<br />
We welcome new or recent books which are relevant to the focus<br />
<strong>of</strong> the journal <strong>and</strong> which you consider would be useful to review<br />
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<strong>Journal</strong> policy prohibits an author from submitting the same<br />
manuscript for consideration by another journal <strong>and</strong> does not allow<br />
publication <strong>of</strong> a manuscript that has been published in whole or in<br />
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Important note: Manuscripts must adhere to the ethical guidelines<br />
for both research <strong>and</strong> practice <strong>of</strong> UKCP, BPS, HCPC & BACP.<br />
1. Guidelines<br />
• Language: Papers are accepted only in English. British English<br />
spelling <strong>and</strong> punctuation is preferred. Non-discriminatory language is<br />
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• Referencing: All manuscripts should follow the referencing guidelines<br />
in the 6th edition referencing system <strong>of</strong> the Publication Manual <strong>of</strong> the<br />
American Psychological Association at: www.apastyle.org/manual/<br />
• Abstracts: Structured Abstracts <strong>of</strong> no more than 250 words are<br />
required for all papers submitted. Authors should supply three<br />
to six keywords.<br />
• Headings: Section headings should be concise.<br />
• Word count: A typical manuscript will be 1,500-2,500 words, including<br />
references. Longer contributions <strong>of</strong> 3,500-6,000 words, (27-30<br />
double spaced pages including references) may be published where<br />
inclusion <strong>of</strong> data (e.g., excerpts from interviews) warrant it. Papers that<br />
greatly exceed this will be critically reviewed with respect to length.<br />
Authors should include a word count with their manuscript. The word<br />
count (which includes all text including the abstract, manuscript, notes,<br />
tables, figures, etc.) should appear at the end <strong>of</strong> the manuscript.<br />
• Font: All manuscripts must be typed in 12-point font in Arial <strong>and</strong><br />
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• Manuscripts should be compiled in the following order:<br />
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• Author(s) name(s) <strong>and</strong> title(s)<br />
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• Please supply in a separate file information about your research<br />
interests/specialisations - up to five.<br />
• Two separate manuscripts must be submitted.<br />
• The first version must be a complete version containing all the<br />
above together with confirmation in a separate file confirming that<br />
the manuscript is not under consideration or submitted to another<br />
journal. Use the following statement:<br />
I confirm that the manuscript submitted, title:…. is not under<br />
consideration or submitted to another journal.<br />
• The second version must be entitled ‘For blind review’ <strong>and</strong> must not<br />
contain the author(s)’ name(s) or contact details or any identifiable<br />
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second version to be sent anonymously to reviewers.<br />
2. Infographics<br />
You are welcome to include graphs, tables <strong>and</strong> diagrams in your<br />
submission, but the following must be observed when supplying<br />
information:<br />
• All graphics must be supplied in their original format, either as digital<br />
artwork or statistical data.<br />
• Any graphics copied from the internet <strong>and</strong> cited from other<br />
publications are not acceptable on their own.<br />
• Graphics files must be supplied separately to text. Please do not<br />
embed graphics in the text file.<br />
• Figures should be numbered in the order in which they appear in the<br />
paper (e.g. figure 1, figure 2). In multi-part figures, each part should be<br />
clearly labelled (e.g. figure 1(a), figure 1(b)).<br />
• Each figure should include a title caption <strong>and</strong> full source e.g. Figure<br />
1 The incidence <strong>of</strong> mental health issues in the UK adult population,<br />
World Health Organisation, Report on World Mental Health Issues,<br />
2013<br />
• The filename for the graphic should be descriptive <strong>of</strong> the graphic, e.g.<br />
Figure1, Figure2a.<br />
• Avoid the use <strong>of</strong> colour <strong>and</strong> tints for purely aesthetic reasons.<br />
3. Reproduction <strong>of</strong> copyright material<br />
As an author, you are required to secure permission if you want to<br />
reproduce any figure, table, or extract from the text <strong>of</strong> another source.<br />
This applies to direct reproduction as well as “derivative reproduction”<br />
(where you have created a new figure or table which derives<br />
substantially from a copyrighted source).<br />
4. Copyright <strong>and</strong> authors’ rights<br />
It is a condition <strong>of</strong> publication that authors assign copyright or license<br />
the publication rights in their manuscripts, including abstracts, to the<br />
<strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> Centre <strong>of</strong><br />
Regent’s University London. This enables us to ensure full copyright<br />
protection <strong>and</strong> to disseminate the manuscript, <strong>and</strong> <strong>of</strong> course the<br />
<strong>Journal</strong>, to the widest possible readership in print <strong>and</strong> electronic formats<br />
as appropriate. Authors are themselves responsible for obtaining<br />
permission to reproduce copyright material from other sources.<br />
5. Pro<strong>of</strong>s<br />
Manuscripts will be copy-edited for journal house style. Authors will<br />
receive page pro<strong>of</strong>s for checking. At this point, no substantial changes<br />
can be made to the paper. It is essential that pro<strong>of</strong>s are checked <strong>and</strong><br />
returned within 48 hours.<br />
6. Submission details<br />
All submissions should be made online to JPCPRsubmissions@regents.ac.uk<br />
7. Disclaimer<br />
Regent’s University London <strong>and</strong> the Editors make every effort to ensure<br />
the accuracy <strong>of</strong> all the information (the “Content”) contained in its<br />
publications. However, any views expressed in this publication are the<br />
views <strong>of</strong> the authors <strong>and</strong> are not the views <strong>of</strong> the Editors or <strong>of</strong> Regent’s<br />
University London. Responsibility for confidential material <strong>and</strong> consent<br />
obtained to use in publications is that <strong>of</strong> the authors.
<strong>Journal</strong> <strong>of</strong> <strong>Psychotherapy</strong><br />
<strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong><br />
Volume 2 • Number 1 • January 2017<br />
Editor: Dr Maria Luca<br />
Managing Editor: Pr<strong>of</strong>essor Helen Cowie<br />
Book Reviews Editor: Jane Wynn Owen<br />
Editorial................................................................................................................................................................................................................ 2<br />
Clinical Supervisors’ Views on Facilitative Conditions in the H<strong>and</strong>ling<br />
<strong>of</strong> Sexual Attraction in the Supervision <strong>of</strong> Therapists<br />
Maria Luca, Desa Markovic, Martin Lečbych, Marek Kolarik.................................................................................................................. 3<br />
International Students: A Minority Group at Risk in Need <strong>of</strong> Psychological Support<br />
Sonia Gallucci...................................................................................................................................................................................................... 11<br />
Starshine on the Critical Edge: Philosophy <strong>and</strong> <strong>Psychotherapy</strong> <strong>of</strong> Fantasy <strong>and</strong> Sci-fi<br />
Christina Richards ............................................................................................................................................................................................. 17<br />
E-Therapy: The Psychotherapists’ Perspective – A Phenomenological Enquiry<br />
Imogen Koufou <strong>and</strong> Desa Markovic ........................................................................................................................................................... 25<br />
The Relationship Between Research <strong>and</strong> Practice in Contemporary Attachment Research<br />
Ian Rory Owen................................................................................................................................................................................................... 33<br />
Voyages into the Unknown: An Exploration Using Interpretative Phenomenological Analysis <strong>of</strong> the Experiences <strong>of</strong><br />
Returning Voluntary Migrants<br />
Gareth Mason <strong>and</strong> Denise Ielitro.................................................................................................................................................................. 41<br />
Book Review...................................................................................................................................................................................................... 49<br />
Doodson, L. (ed) (2016). Underst<strong>and</strong>ing Stepfamilies: A practical guide for pr<strong>of</strong>essionals working with blended families<br />
Open University Press<br />
By Susan Davis............................................................................................................................................................................................................................................. 49<br />
Author Information......................................................................................................................................................................................... 50<br />
Announcements................................................................................................................................................................................................ 51<br />
<strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> Research Centre<br />
Workshop on Friday 19 May 2017<br />
The making <strong>of</strong> DSM – the disturbing truth about its construction, <strong>and</strong> does an alternative non-medical language exist?................... 51<br />
<strong>Psychotherapy</strong> <strong>and</strong> <strong>Counselling</strong> <strong>Psychology</strong> <strong>Reflections</strong> Research Centre<br />
4th Annual One-Day Conference on Saturday 10 June 2017<br />
Psychosomatic clinical presentations <strong>and</strong> implications for embodied, relational psychological therapy approaches........................ 52<br />
regents.ac.uk/reflections<br />
ISSN 2054-457X