Becoming and Being, Existentialism in a Nutshell

What makes us good humans? What makes us become who we are? Why do we suffer? What is the meaning of our existence? Big questions. These are the questions tackled by existentialist counsellors and psychotherapists. If we look back to the great psychologists the fathers and mothers of these fields of study, they have all suffered in life. They haven't been perfectly put together human beings. Many have come from difficult backgrounds, have struggled in life and struggled in obtaining their academic achievements. Its totally arguable that we must struggle ourselves in order to really connect with those who are struggling. It's my belief that we are constantly learning, we are constantly struggling and with each hardship we overcome we learn a little more about the world around us and who we are within it every time we overcome a hardship or an obstacle. Today's blog is about existential counselling and what you might expect to find in the office of an existential counsellor.

My all time favourite existential humanistic counsellor is Dr Irvin Yalom. I like him because he isn't perfect and is proud to say so. I like him because he examines life and death on a very deep level. He is an atheist as I am. I admire the way in which existential counsellors perceive life and how they can help clients find meaning in their lives and in their deaths. The idea of being vulnerable as a counsellor and sharing the experience of counselling as an exploration shared equally between client and practitioner. The existential counsellor may encourage you to look forward rather than backward into your past however, they may explore elements of it as it pertains to your life's meaning and the direction you have taken so far. Your existential counsellor will be viewing each session as a growth experiment for both of you. Your existential counsellor will seek out methods that work the best for you as a team working toward the shared goal of your improved mental health and their improved counselling skills.

Dreams are important to existentialism you may be asked to keep a dream journal as the existential counsellor will be looking with you at these dreams and why they may occur. There might be a theme which can be unlocked and examined to find ways in which you can know yourself better. There won't be a set time limit in this type of therapy therefore, it doesn't fit in very well with the Medicare model of the mental health process. I have never been to an existential counsellor however, the lecturers I got the most value from as a student were existential counsellors.

When studying the different modalities Existential counselling seemed to ring true to me. I noticed that some of the time I do use existential tools when I'm counselling and only realise later that is what I have done. This usually comes to light when discussing cases with my supervisor after sessions. Your existential counsellor probably won't be aiming for you to be happy all the time, rather expecting your sad times to provide you with moments of reflection, accepting this times as part of the human experience. Existentialism is based from philosophical views on life therefore, creating meaning is of utmost importance, being a part of the social fabric is also important. Who you become as human being within this social fabric, what you leave behind and how you nurture not only your own growth also nurturing the growth of the community you live in.

 As last week's modality, Narrative Therapy, to hear the existential counsellor it's evident that this type of therapy is an Art form in many ways. Drawing out the client's strengths allaying fears and normalising their experiences. As you watch the above linked videos you can see that Yalom "is" an existentialist and lives his life in this way. I particularly like the fact that Yalom worked with patients for ten years who were dying of cancer. He wanted to immerse himself in what it means to be dying what can come from the experience of death which will enhance the experience of life.

I was recently speaking to someone who was experiencing fear perhaps even anxiety related to death. I described death as part of the experience of life, death after all is the destination to which we are all heading. Existentialism as in buddhism emphasis the journey.  As a support worker and nurse I have experienced many of my patients dying.  I feel the ripples of their life upon my own life, in this way their footprint is in my life and therefore in the lives of everyone that I know. If we live our lives with meaning and purpose we will leave a legacy. If we live our lives with the knowledge that it will end we may well live our life with more intentionality and direction. I know that being a part of the death experience of so many other people I am acutely aware that my time is limited. I try to enjoy the little things in life such as; being able to walk with ease, beautiful sunsets, the company of friends and family, sometimes I just like silence and peace other times I enjoy laughter and also tears. I enjoy doing things like painting and writing this blog. I enjoy the stories of my counselling clients just as I enjoyed the moments I shared with my clients when I worked as a nurse. These things for me are the fabric of life and create meaning for me. These things are what draw me to Existential counselling and the philosophy behind it.

If you are interested in finding out more about existential counselling you can click on the links below these will take you to sites where you can obtain training in existential counselling or find a counsellor who specialises in existential counselling. There are plenty of books written by Yalom the article here provides a more indepth look at existentialism and the philosophy behind it.


Brisbane Existential Counsellors

Center for Existential Training Australia

Existential Counselling Resources

References

Gerald, D., & Gerald, K. (2001). Basic Personal Counselling. Frenchs Forest NSW: Pearson Education Australia.

Psychotherapy, C. (Director). (2006). Video Interview, The Gift of Therapy; A conversation with Irvin Yalom M.D. [Motion Picture].

Yalom, I. (1980). Existential Psychotherapy. New York: Basic Books.

Yalom, I. (2010, June 10). Dr Yalom 1-3 Death & Existential Psychotherapy. Retrieved October 11, 2014, from youtube: https://www.youtube.com/watch?v=_-1dfH_kVZA

Narrative Therapy

There are so many different modalities of counselling therapies although, we only seem to hear of one or two of the more popular models. Over the next few weeks I'll be writing about some of my favourite kinds of therapy and variations on these. Many counsellors use a mixture of a variety of modalities they may use several different ones through the course of their practice. Some therapist and counselling practice only advocate one type of therapy. It is quite alright to phone ahead and ask the counsellor what type of therapy they practice.

One of my favourite kinds of therapy is Narrative Therapy.  Narrative therapy is as the name suggests all about Narrating your story to the therapist. It's a collaborative style of counselling where you are both equal contributors to counselling process. Traditionally Narrative Therapy is a free flowing therapy which doesn't have time limits. It is one of the few therapies that advocates self disclosure from the counsellor. It should be used sparingly with a therapeutic focus for example, a client may say, "Many years ago I had a pregnancy terminated....." the therapist might say "I understand how difficult that decision can be  I also had a pregnancy terminated. Its different for everyone.  How was this experience for you?". This kind of self disclosure often makes the client feel more at ease in sharing their story. Having a lived experience of this kind demonstrates to people that the knowledge that their therapist has comes from having similar feelings and having worked through them.  In this way the therapist becomes a role model. If the therapist hasn't had this experience or hasn't worked through their own emotions, they might say "I can't imagine how difficult that decision was for you, what was that like for you?"  One of the most important things in this kind of therapy is being genuine and open.

A narrative therapist may shed a few tears with you. This is an expression of genuine sorrow. The narrative therapist will then go away and examine what issues were bought up for them in sessions and why, in their professional supervision. The narrative therapist is not afraid of their own emotions and seeks to understand themselves as well as their clients. I think this is a very healthy approach to doing the job of counselling. As an Assistant in Nursing and a Support Worker  I have certainly shed a few tears with my clients particularly as they faced difficult times. Perhaps this is why narrative therapy is so appealing to me.

A narrative therapist will use all kinds of methods to assist a conversation to occur. They might use diary writing in which both the client and the therapist keep a diary of the sessions and how they felt about the therapy each week. A narrative therapist might ask you to write a letter to someone you are having difficulties communicating with. Another method used by narrative therapist is role playing.  Your narrative therapist might ask you to draw or paint something. Art therapy by the way is not about drawing pretty pictures it's more about expressing your feelings. This kind of therapy is very helpful to children who haven't yet developed the language skills to express their feelings verbally. A narrative therapist won't decide when the counselling is over, the client will decide. They might then organise a symbolic celebration to mark the end of the therapy.  I think Narrative therapy is a great therapy modality which should be used more often.

Michael White is one of the founders of Narrative Therapy. There is a real artistry to Narrative Therapy, it's very moving to watch a narrative therapist in action. You can see Michael and Salvador Minuchin here. Just listening to these two guys you can see the depth of Narrative therapy just in this snippet of their conversation. How considered these men are of the things they say to each other. Narrative therapy shows us the power of language. How we use it to define ourselves and our social environment. Your Narrative therapist will be interested in unlocking your subconscious mind and looking for ways in which you can change your story so you can be the best version of yourself.

If you are a therapist you can learn more about narrative therapy via this website. If you are a person seeking a Narrative therapist you can check with Australian Counselling Association and PACFA

References

Corey, G. (2009). Theory and Practice of Counselling and Psychotherapy. Belmont CA: Brooks/Cole.

Gerald, D., & Gerald, K. (2001). Basic Personal Counselling. Frenchs Forest NSW: Pearson Education Australia.

Henretty, J. R., Currier, J. M., Berman, J. S., & Levitt, H. M. (2014). The Impact of Counselor Self-Disclosure on Clients: A Meta-Analyic Review of Experimental and Quasi-Experimental Research. Journal of Counseling Psychology, 61(2), 191-207.

Which Counsellor does What

In the area of counselling there's a bit of confusion around which counsellor has the best credentials. As I mentioned last week the most important element in counselling is how well you connect with your counselor. This has very little to do with which university degree your counsellor has.

I think of counsellors as people who are born into the world. People who seem to have a natural desire to prop people up who are down, people who can put themselves aside and fully absorb what their friends, colleagues or family and even total strangers are saying.  They usually aren't judgemental and are very warm toward others.  I'm pretty sure most of us have encountered someone like this.

Perhaps you are this person. You will have heard people say things like. "I've never told anyone this before I  don't really know why I just told you".  I use to think I must have a neon sign over my head that said "Come here, tell me everything". I felt very privileged that people trusted me enough to share their deepest darkest secrets. I have always genuinely wanted people to feel better or have an opportunity to tell their story.  We all have a story to tell and it really is important to have a person who can really tune in to you and hear that story.

What does a degree do you might ask. The degree has a two fold benefit to counsellors and their clients. The degree you take gives the naturals ways in which they can identify what they are doing to increase the natural skills that you already have and hone the skills into something which can provide greater meaning to your clients. The second fold is that it provides the counselor with a community into which they can become a part of which serves to protect or mitigate the effects of hearing everyone's darkest secrets. This comes in the form of professional supervision and ongoing training. Hearing everyone's troubles is a privilege, it's very rare that people want to hear your story.  The person you have heard all about walks away feeling better and then you are left with at least the shadow of their story. If you hear enough of these stories it does start to weigh you down and then in the end you can hear no more. The degree teaches self care and maintaining that natural gift. Planting your natural seed of counselling into fertile soil.

Most naturals find themselves at the doorstep of some kind of training ground because really they are searching for help in how to manage this gift or perhaps this curse. Let's have a look at some of these training grounds. The three main areas are psychology, psychiatry and counselling.  Most people see Counselling as the bottom rung of these fields, Psychology as the next rung up and Psychiatry as the pinnacle. Other areas include Social Work, Nursing and Community Workers.  Lets look at the psychology degree this degree has a high level of statistical work, there's a component of understanding the areas of the brain and what they are used for. Subjects you find in psychology degrees include 4 units of stats, abnormal psychology, developmental psychology and Introduction to psychology.  As a psychologist you might branch off into research or into face to face counselling or a mixture of both. It's very interesting finding out about the brain and I enjoyed these subjects a lot. These subjects are certainly helpful in understanding human behaviour. I intend to get my Post Graduate Diploma in straight psychology subjects.

Now psychiatry is also an interesting area.  This is a medical degree. Psychiatrist get to diagnose and treat particular psychiatric disorders. The really fun stuff of prescribing medication and nailing down the appropriate label.  To get a degree in psychiatry the first step is a degree in medicine and then a further 6 years of study in psychiatric disorders, diagnosing and treatments. You might find your psychiatrist less of a natural than your psychologist or counsellor. They do want you to get results that's for sure and they do care about you, more perhaps in the biological sense of the word rather than the practical sense. 

A counselling degree is all about the nuts and bolts of humanity. In the Counselling degree you are going to be learning all the different models of counselling. You will also learn about the basics of psychology and human brain function. You are going to be able to talk to people and decide which modality will suit them best. You'll be able to identify stressors in their lives and give them tools to use throughout their lives to assist them in relationships, personal growth, anxiety and depression. You will not be able to diagnose you can say it in your head but not out loud. In a way I think these labels aren't very helpful in obtaining a happy meaningful life which is the primary role of a counsellor. To help people find a happy meaningful existence using a variety of tools.  As a counsellor you can't use medicare however most psychologists gap fee is more expensive than what a counsellor charges anyway so I wouldn't let that stop you from considering a counsellor over a psychologist.

Bear in mind always these few questions.  Do I feel comfortable talking to this person? Do I feel confident that this person can help me reach my goals? Is this person suitably qualified to meet my needs? Does what they are saying make sense to me? Is this person really tuned into me? Is this person professional in their approach to me?

Things to watch out for in deciding if they are professional or not; counsellors who are very friendly and start talking excessively about themselves are out there. It's ok for counsellors to share a little bit about their own experience however, if you leave feeling like they just got a really good counselling session then probably it's time to look else where. If someone starts to impart their religiosity to you, get out of there, this is both unethical and not allowed. If a counsellor or psychologist starts to diagnose you or your family members, out you go, this is also unethical and not allowed.  A counsellor can say things like "I can see you are internalising a lot of these problems" that is not a diagnoses.  However, if they start saying things like you've got post traumatic stress syndrome, anxiety, depression and I think you've got a personality disorder as well. Get your little butt out of that chair pronto. They are not qualified to make these statements.  If I had a client that I think might have a personality disorder I would talk to my supervisor about this and then we would probably work out a way to get an appointment with a psychiatrist.  In our referral letter we might say something along the lines of...please see my client who presents with mood fluctuations, difficulty maintaining relationships and trouble sleeping. I would then leave it up to the psychiatrist who is trained in diagnosing and wait for my client to report back.  As I mentioned earlier psychiatrist have had 12 years of study and six year primarily on assessment and diagnosis of complex mental health conditions. They are the best person to do this job.  It is common place for counsellors and psychologists to work with psychiatrist in getting the best results for their clients. 

A psychologist can diagnose some mental illness however, they can not prescribe drugs. They can refer you to a GP and in the referral ask the GP to consider antidepressants however, if a psychologist identifies that a client may have bi-polar they must then refer to a psychiatrist. Testing for these more serious conditions is very involved and can take months to reach a clear diagnosis.  Anyone who thinks that they can diagnose in the first session is questionable. I have heard of a counsellor diagnosing a client's husband with the personality disorder of Narcissism. Very unethical bad counselling right there. What she could have said is "It sounds like your husband might need to see a counsellor himself" or she could have said "I can't diagnose your husband although I'm sure it would be a huge relief for you if I could it's best if your husband speaks for himself in this circumstance" or "It certainly sounds like your husband is causing you a few problems how about we bring him in here for a session or two".

So there you have it the difference between the different counsellors. My parting advice to you is trust your instincts if you feel that there is something not right about the counselling you are receiving ask to be referred to someone else or quietly look around.  You can always phone up have a chat before you book an initial appointment look at websites and make a decision that way.  Try to find someone that you are really at ease with because after all no matter the degree, the experience level or the practice the best counsellor for you is the one you have the best relationship with. There are professionals bodies who most counsellors are part of you can locate a counsellor who is registered with one of these organisations.  If you find a counsellor who isn't following the guidelines you can report them to these bodies.  It's best if you do report them as it is possible to do real harm to people when you are in the counsellors chair.  The Links to the counselling bodies are below.  These sites also have codes of conducts and ethical practices available for you to read.

Australian Counselling Association

Psychotherapy and Counselling Federation of Australia

Psychology Board of Australia

Medical Board of Australia

References

Corey, G. (2009). Theory and Practice of Counselling and Psychotherapy. Belmont CA: Brooks/Cole.

Day, S. (2008). Theory and Case Analysis, In Theory and design in counselling and psychotherapy. California, CA: Brooks/Cole.

Gerald, D., & Gerald, K. (2001). Basic Personal Counselling. Frenchs Forest NSW: Pearson Education Australia.

Jungers, C. M., & Gregoire, J. (2013). Counselling Ethics Philosophical and Professional Foundations. New York: Springer Publishing Company.

What is Counselling?

This year I've decided to write about counselling generally. What is counselling what are the different methods of counselling? What makes a good counsellor and how to choose one that can get the best results for you. As I did in my last blog about Family and Relationships I will include topics based on questions that you ask me either on my facebook page, in person or in the comments below. This week I hope to clear up the question of what counselling is and what you might expect. In short my answer to this question is; Counselling is a series of important conversations with the joint aim being a professional assisting you to live your life with good mental health and confidence in the direction your life takes now and in the future.

What happens in a counselling session? It may seem an easily answered question however, there are a lot of misconceptions about what counselling is.  I guess the first image that pops into the minds of many of us is Zigmond Freud with his patient lying on a couch, he sitting in a chair. Ink blot pictures and dream analysis. The counsellor seen as an expert of your mind and you a novice come to understand what is going wrong and the counsellor  providing the answers to your internal questionings about that mind of yours. "What's wrong? Fix it." I suppose this a reasonable thing to want. When we go to other Doctors or professionals that is actually what we get. We get a fix it solution either in the form of antibiotics or painkillers. When people come for counselling they have reached a point where they just have no idea what to do, their life may be unraveling before them or they just can't function in the way they use to.  It would probably be better if people came to their counsellor when things were just starting to go a bit pear shaped rather than waiting for things to get very bad.

Counselling is a process even way back when Freud was practicing it was a process.  The process is a little different now. If you go to counselling you probably won't be shown inkblot pictures you probably won't have your dreams analysed.  Although you might if you came to see me.  Most likely you won't be delving into your childhood and making links to your current circumstances. Most counsellors and psychologist will be working with you in the here and now. They won't be interested in  delving deeply into your past. They may ask questions about particular things in your past like how you get along in the family. They will be setting up some kind of CBT (Cognitive Behavioural Therapy) program for you to follow. Your Counselling will probably last about 10 weeks and you may never see your counsellor again. That's because CBT gets results quickly. Results that are quantifiable that can be recorded, sent to the government to show that counselling gets results.  That's what everyone wants results. They want them fast.

What do I think about this.  Great if it gets results that's awesome.  Are the results permanent? Is it providing long lasting results? Getting the statistics on these kind of questions is really difficult because as I said earlier most people only come for those 10 weeks and never come back again. Practices may not have the time to do follow ups later.  Clients may not want to spend the time coming back just to give data. To be really honest I'm not a big fan of the quick fix therapy. I think counselling should be a longer process and it should be monitored over several years. I think it should aim to provide some solutions but also some questions. It should be something that makes people cognitively stronger, give them skills to improve their life that lasts for the rest of their lives. It should also provide a space for real personal growth which may or may not require some delving deeply into the past.  It shouldn't be a weekly thing it should be as required by the client. I think the most important thing that counselling should provide is important meaningful conversations that lead to happier lives being lived.

The bottom line is that the best counselling is highly dependent on two things the first thing is how well you get along with the counsellor and the second thing is the amount of effort you are prepared to put into changing your situation.  I think your counsellor should be like your GP you should get a good one and keep going there for check-ups as a preventative measure.  The reason I think this way is Mental Health is a serious matter we have 1 in 4 people in Australia with depression and anxiety. We have a high rate of suicide in young people aged between 16 and 24. In Australia we have men over 50 years of age committing suicide at an astounding rate. Marriages have more chance of failing than succeeding with many of us choosing not to Marry at all. We live in a country where women are killing themselves with eating disorders. The rate of women dying and being treated for eating disorders who are classified as middle aged has increased in recent years.


These are things that counselling can help with. It would be much better if everyone went for counselling before they developed anorexia or when they first started feeling sad or when they felt their marriage was showing signs of trouble rather than as a last resort.  It doesn't matter if your counsellor is a psychologist, psychiatrist or counsellor. The important thing is that you get along well with the person and feel confident that you can share your problems with them.  Next week I will talk about the difference between psychologist, psychiatrist and counsellors.

References

Australian Bureau of Statistics. (2010, June 30). Population Growth: Past, Present and Future. Retrieved August 10, 2014, from Australian Bureau of Statistics: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features10Jun+2010

Corey, G. (2009). Theory and Practice of Counselling and Psychotherapy. Belmont CA: Brooks/Cole.

Gerald, D., & Gerald, K. (2001). Basic Personal Counselling. Frenchs Forest NSW: Pearson Education Australia.