And what about you?

Disclosure

That’s what the jargon is for your therapist telling the client something about their own lives.

According to which model you practice it can range from never – ever tell the client about yourself, your family, your opinion, anything that would get in the way of therapy. The classical psychoanalysis model wants the practitioner to be the ‘blank canvas’, so clients project onto this as they know nothing about you, therefore how they react will not be coloured by personal knowledge of the therapist. It brings up a great deal of transference and ensures that the sessions are totally about the client.

In this internet age, unless you have privacy settings on everything, or have no social media presence, it is not hard for clients to know something about you. Bing and Google are the best friend of the curious.

Other humanistic models, such as Gestalt suggest that some disclosure, always to either further the therapy or solidify the relationship believe that some disclosures are worthwhile and necessary.

As a therapist practicing a humanistic way of working and particularly centring on the relationship have to make balancing this an art form. Some clients never ask you how you are, what you are doing at the weekend, where you are holiday-ing. Others ask weekly. Balancing the ‘enough’ can be hard.

Each practitioner has to work out with each individual what is enough. Recognising that once some information has been disclosed there is no eraser that can delete it. That client knows  that about you. They will make assumptions based on that information. Consider how a client may feel if you disclose that you are going on a four week world tour staying in five star hotels and flying first class. Their reaction may be different if you say that you are vacationing in a yurt or Blackpool for a week.

So information can still bring up transferences which are valuable to work with, however the client may also feel so close to you that they withhold. It’s the balance between professionalism and being human.

I can get it wrong at times. Experience shows me when I have. As I work more and more I get the balance right more often than not. I am human and know that sometimes it is the mistakes we make as practitioners can be the therapy for the clients…. next blog is there for the writing

Karen

Update Busy-ness

I have been busy – no that is not an excuse it is the truth

I have been busy with life and working and … and …

The result is that I had not updated my website for some time

I now have

I have removed the contact form (email) as it was being abused – generally by scammers or advertisers. Now to contact me please use the mobile phone number clearly indicated on every page

I’ve also noticed/realised how long it is since I have uploaded any new videos so I will over the autumn and winter of 2018 make a concerted effort to post new videos

 

I will also try and write more blogs too … they may be shorter than previous ones however I will diarise a new post each month and more if time allows

 

 

Information sharing and confidentiality when working with children

Within agency working I have found that the information shared is often different to the therapeutic concept of confidentiality. It is expected that when working within an agency that other colleagues know the identity of my clients. This would not happen within my private practice. Confidentiality is explained in child friendly language to the child or adolescent and it is also explained to the parents and care givers. As well as it being printed in my written contract I discuss this openly and in a matter of fact way during the initial session with the child or adolescent and parents or caring adults.

As previously discussed there can be ‘gaps’ in information where it is not documented where, or with whom children were, during some periods of their early life, if they were living within a transitory or not registered community. This can be difficult for children who wish to understand their past. Children themselves can often find that due to their physical and mental development they do not have memories of their early life.

This is ordinary, due to the hippocampus, which processes memory in order for it to be stored as explicit memory is not developed fully until the age of 3 or four years of age. Loving, caring parents can often fill these ‘gaps’ in the memory. When their primary care givers have been unable due to their own deficits to know what happened or where (having a coherent narrative)

They will be unable to explain to the child or adolescent what happened to them in their early years.

Personal data is information, which relates to an identifiable living individual that is processed as data. This would include names, dates of birth, addresses, medical information and reviews.

Sensitive personal information is information that relates to ethnicity and race, political beliefs, religious or faith beliefs, physical or mental health issues, sexuality and any criminal offences.

In holding both personal and sensitive personal data, I am aware that there are greater legal restrictions on the latter, as some of the personal information may be freely available, for example on line, or in a telephone book.

The way that I hold the information is protected by the data protection act that ensures that in holding such information I make certain steps to ensure this is kept safe and that reasonable steps are taken to ensure the information remains private. I see this about respecting other’s privacy and protecting that information that I have been privileged to be party to.

There are times when I will break confidentiality, this is when I believe there is a probability that either the client will hurt themselves, or others, or others property. In these scenarios I will usually discuss the situation and tell the client I am going to act upon the information they have told me. If a disclosure of a crime against children is made, an act of terrorism either planned or executed or money laundering then without prior consent I will not discuss this with the client, unless they are the victim, not the perpetrator of a crime against children and break confidentiality and inform the relevant authorities.

Gillick competency and Fraser guidelines refer to a legal case which looked specifically at whether doctors should be able to give contraceptive advice or treatment to under 16-year-olds without parental consent Gillick was the family name of the 16 year old girl and mother at the centre of the case and Fraser refers to Lord Fraser who following the ruling, looked at the case in the House of Lords. After this, they have been more widely used to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions. When working with children and adolescents it is necessary again with the use of developmental models and recognising and knowing your client to assess their competency and maturity.

I make it very clear to the child or adolescent in the initial and if necessary at later sessions that if I believe it is necessary to disclose information to their parents or care givers to ensure they stay safe, that I will do. If the adults can help them by knowing certain information that can and will be shared in a safe and sensitive way, as I cannot keep them safe the remaining 167 hours a week.

I also let the child or adolescent know that professional and safe adults share information, to ensure that everyone can have a more rounded knowledge and understanding of what is happening for them.

Psychotherapeutic Communication, Relationship and Process when working with children and adolescents

In Gestalt therapy, language and the spoken word are very important and great value is placed upon it. The semantics and linguistics are valuable tools, which are used frequently. Using language efficiently and with curiosity gains a greater understanding of the child’s inner working model. I always ensure that I use appropriate language in relation to the child’s age and understanding.

As a holistic therapy emphasis is put upon body language and the internal somatic feelings. Often within my child and adolescent work I find that many children I see are unable to name/label feelings that they are experiencing. It is generally part of my work to share my own thoughts on what the ‘buzzy’ feeling in the tummy maybe, or say what I feel in my body when I feel scared for example. This use of role modelling is often needed when working with children and adolescents who have not had adequate parenting or there has been a breech in their developmental experience. I will view with curiosity any non verbal leakage, whilst not shaming the child or putting my own interpretation upon their body movement, until it has been considered by the client.

There are times when there can be barriers to communication, this can be with children or adolescents that are scared, angry or have gained their own ‘way’, by simply refusing to work with professionals. Indeed there have been times when I have worked with clients who have physical impairments, which challenges usual forms of communication. Examples of these times have been when I have worked with children and adolescents with autism and once when the female had no speech at all. In these situations I have found Theraplay © invaluable and of great therapeutic advantage.

Of course, there maybe a counter transference and the barrier may be mine, this is when supervision is supportive and of significant value and my own blind spots can be reviewed and considered. It is imperative that a therapeutic relationship is gained. Many adults have concerns about how different the therapeutic relationship is to any other form of contact, so it is understandable when children and adolescents who may have never been able to trust an adult previously, or have done so with great difficulty have issues with accepting trust and being trusting to a professional. I believe that if the only work that is done with children and adolescents that a relationship is formed, it is a skill and an experience they can use for the rest of their lives (Bowlby etal)

For most children, although not all adolescents I am generally taller and bigger than they are. I generally guide the sessions and I do believe in being directive within therapy sessions when and if appropriate. I have very simple and steadfast rules that I follow, in turn expect that the child will follow too. These are all discussed either prior to the therapy beginning or as they arise within the session. All of the rules are there to keep the child and adolescent safe.I am happy to explain why the reason is there, although I will not get into a debate.  It is my room and I am in charge to keep the client safe whilst they are in my session. The fact that I am a middle aged, white, middle class, educated, professional woman does mean that it is impossible for the relationship to be horizontal. I do not believe that with any client, therapy would work if there was not a power imbalance, however that does not mean that the client, no matter what age is subjected to marginalisation or patronisation. For children, adolescents and adults that have been compromised by either neglectful or over bearing parents can benefit from having solid boundaries in place. This when working means for a practitioner to, ‘say what they mean and mean what they say’. The therapeutic relationship is honoured, as are the participants by having firm boundaries. There can be a ‘meeting’ in the Buber (1938) ‘I-thou’ sense with children and adolescents that is both confirming and healing. Whilst difficult it is not impossible and honouring their sense of self and their differences can erase the power imbalance within the work.The relationship building is not only with the young client it also needs to be to a lesser and still important extent with their families and/ or caregivers. A professional relationship with other practitioners and professionals is also necessary in this field of work.

For some children, for example for those that are ‘superficially charming and engaging’ ( in an attachment theoretical way) maybe difficult. They have learnt to exist by being ‘seducers and /or non confrontational’. These children and adolescents will be well practised at ‘pretending’ to engage, whilst never truly investing in another, due to early experiences.

It is likely that during the therapeutic process that I may need to change my theoretical thinking, as the child or adolescent progresses or I gain a greater insight into their world view. This often happens following the child or adolescent having tested the boundaries, I have found. It is then that it can be valuable to have a number of various theories to consider different therapeutic requirements the client may need.In this changing world of media appropriateness and new technology it would be incongruent with what is happening in the world for children and adolescents not to have knowledge of, use the internet and other forms of communication. These tools can be used therapeutically however it is important to ensure that young people are keeping them selves ‘safe’ online and are not being bullied or groomed. Part of the communication process would be working out their reliance on the internet, social networking sites and RPG sites. Again open communication with the young person and the adults around them to gain an idea of how much energy and time is spent in the virtual world is necessary. It is also important I believe for professionals to have an idea, although not necessarily an indepth knowledge of all player platforms and games, or sites and new fads.

I believe it is appropriate to communicate by email with other professionals however it is important that the e mail is professional the way that it is written and that no confidential information is enclosed when the mails are not encrypted.  It is possible that when working for an agency that has stringent policies, either time limiting or with significant financial constraints that it maybe in direct conflict with therapeutic tenets. It is as this time, as a practitioner I need to balance between being realistic and maintaining and protecting the therapeutic process.

As a practitioner I am willing to promote my beliefs and stay my ground, if I believe cutting the process short may damage the therapeutic relationship or process.In relation to endings I always keep in mind the child’s or adolescents previous experience of endings. This may influence the way I choose to end. Whatever my decision is, the ending when possible, will be planned, spoken about and I will be a role model during the closing process. I will always do some amount of preparation and often involve the child or adolescent in the planning.  Generally I ensure that if a work book has been completed it is available for the client to take it home and it is quite ordinary that I will, within the penultimate session integrate a piece of craft work that they can take home with them, as a memento if they wish.All parents care givers and agencies will be informed that the therapy is in the final stage.I explain in great detail how I have experienced them and will often refer to how I have seen a change in them between the beginning and end of therapy. I will let them know how they have impacted me and how I recognise this is a goodbye. I will help them process that the relationship will end and it is ordinary that they at times, as will I, will think of them and that is ok.There are times when an unplanned ending happens. If this were the scenario then I would generally write to the child, using age appropriate language (and font) a short note, saying goodbye. I would use a card, with an appropriate picture on, that is age and relationship appropriate which is hand written.

Reading and Writing

In preparation for the up and coming 2 year Diploma in Psychotherapy for working with Children and Young People, conversion course for experienced adult psychotherapists and the 4 year Diploma in Psychotherapy for working with Children and Young People, for people who wish to have a career working with children and adults I have been reading.

And reading.

It has been a pleasure to spend time preparing for these up and coming Diplomas by revisiting old favourites, such as Violet Oaklander’s seminal book, ‘Windows to our Children’ and meet new friends, such as her book, ‘Hidden Treasures’. I think I have particularly enjoyed reading ‘The Heart of Development’ Volumes I and II, both edited by McConville and Wheeler. The list of books is growing and all have offered me something new, if it has been the first time I have read it, or the fifth! For me, reading is such a wonderful past time.

The ‘behind the scenes’ work is happening for the new Diplomas in Psychotherapy for working with Children and Young People, with the new publicity leaflets ready to go to press and will be available in the New Year.

I’ve been brushing up on theories of development and formulating the modules for the course, which will be held at ‘The Manchester Institute for Psychotherapy’.

It is a great reminder of my training to re-read child development theories and to critique and compare the many different ones out there. What of course is fascinating is to read ones that I never knew existed. Some bring an interesting new insight, others are that wonderful blending that happens in psychotherapy often.

I have also been involved in the rebranding and up grading of  ‘the Child Therapy World’ website and over the next two weeks will see the new improvements go live, all care of the wizard web master, Ian.

So, another busy fortnight, all fun and particularly pleasurable!

 

 

Diploma in Children and Young People Psychotherapy

Well it has been a very busy and exciting few months.

I have been asked to facilitate a brand new venture at The Manchester Institute for Psychotherapy, in proving a Diploma in Children and Young People Psychotherapy.

There will be two different diplomas, one for existing adult psychotherapists who are registered and accredited with the UKCP and another for people who are looking for a brand new career in working with children.

The Diploma will be accredited by EIATCYP/EAP and will lead, when all parallel obligations are met to be registered as a child and adolescent psychotherapist.

I am currently working on the publicity literature, the brochure and the handbooks for the two courses. This work is part of Child Therapy World, a department of The Manchester Institute for Psychotherapy. My colleagues at Child Therapy World, Steffy Cooke and Amanda Phillips are also involved in this venture and have their own interests in the Children and Family division and Education.

Both Diplomas will held at weekends for 10 modules each year. The modules, whilst being grounded in theory and theory to practice, are also didactic and experiential. The Diplomas are at Master’s level, (NVQ level 7)

 

If you are interested in receiving any information telephone The Manchester Institute for Psychotherapy (0161 862 9456) and asked to be put onto the mailing list as the information will be available in early 2014.