I’ve been a long time admirer of Donald Winnicott,1 the famous child psychiatrist and child therapist who was doing most of his work in the 50s and early 60s. He invented all sorts of useful mantras probably known to you, such as ‘There’s no such thing as a baby’, ‘the good enough mother’ and ‘alone in the presence of another’. He also provided himself with a set of rules for how he should behave as a therapist, one of which was ‘Being myself and behaving myself’. This still makes me smile – I think he knew himself and the therapist breed very well – but in the last year or two I have started to think about what that injunction might mean for me, and for therapists generally.
I guess that humans are pretty good at spotting inauthenticity – phonies, fakes, pseuds. We have all sorts of words and phrases that suggest we are constantly scanning for integrity, honesty, transparency: putting it on, faking it, pretending. I am sure that clients have a particularly heightened awareness of how real we are when we are wearing our counsellor hats, and are appropriately suspicious of us until we prove ourselves (or don’t). So how can we allow ourselves to be just who we are, while at the same time restraining our less attractive impulses?
What brought me into counselling
When I was 21 I had a depressive breakdown and was hospitalised for three months. I was extremely fortunate: instead of being heavily sedated or put on bed rest, as happened in many hospitals, I was admitted to an adolescent unit that attempted a therapeutic environment. There were daily group meetings; the staff were all engaged in getting us (about 25 of us) to think about what had brought us to our current state of mind, and we each had individual meetings with a psychiatrist. For me this was a revelation: I had no concept of how my difficult beginnings might have brought me to the state I was in, but I very soon found that making meaning of my situation was extremely therapeutic.
After three months I was discharged and had follow-up weekly sessions for six months (how awful that, 47 years later, this sounds like wonderful luxury). Although that period was more like a preliminary skirmish with my history rather than a definitive resolution, I was permanently convinced of the utility of the ‘talking cure’.
In my mid-30s I embarked on training to be a counsellor and later completed more extended therapy training. My immediate motivation for beginning training was to find some resources for managing the pastoral care of the students from abroad for whom I was responsible. The deeper-rooted urge was to provide for others the infinitely healing and enabling experiences from which I had benefited so much. Like most trainees I was idealistic, optimistic and naïve. I believed that, with the magic of therapy, I could cure all ills. In those 30 years since I first began to practise I have learned a great deal more humility, but I do still believe in the power of therapy to enable (some) people to develop into the individuals they have the power to be. However during those 30 years I have revised pretty extensively most of what I was taught.
The rules I thought I had to play by
Both of my original trainings were psychoanalytic. Emphasis on the past and the tracing of patterns of behaviour made perfect sense to me. It was a process that had started to make sense of my life to me and I could see how useful it might be to others and how it might illuminate current difficulties. I could also understand the power of the relationship, even if from a negative point of view: I had a series of therapists and one psychoanalyst, who caused me enormous pain and was, I now think, sadistic. Despite this experience I believed the party line about ‘abstinence’ and ‘the blank screen’. I was newly qualified and was bound to follow what I had been taught; I certainly had no better ideas myself at that point. I can remember worrying about greeting a ‘patient’ with a smile.
Similarly, I allowed myself to be convinced by the idea that the interpretation of the transference was the crucial activity. This was severely dented by the ‘patient’ who asked me with some irritation why I was always bringing myself into my responses to her. It was finally knocked on the head by reading Robert Langs,2 whose central conviction was that all communication in therapy is about the immediate situation with the therapist. It seemed to me that people had concerns that were a great deal more pressing than wondering how I would respond, and that Langs’ theory diminished the client.
Other rules for practice delivered as revealed truth included the idea that the client should always speak first. My application of this rule to a shy, frightened, miserable teenager, so that we sat together in silence for 50 minutes, made me truly ashamed of myself. I think I tortured that girl and I am not proud of it. I began to realise that I needed to find my way to a practice that felt more authentic, more like me. I had rather little experience, but I had to resolve the incongruence between what I had been taught and the values of warmth, kindness, friendliness and humanity that felt core to me.
Finding my way to my own rules
While I was still in the early stages of my first training I wanted to explore other ideas about therapy. So, for a book review exercise, I contrasted a psychoanalytic and a person-centred point of view. This venture did not please; it was seen as a bit of intellectual showing off. I had come from an academic background where the critiquing of ideas was commonplace; such behaviour was not, I was given to understand, welcome in this environment. But that critical urge stayed with me and has nourished my thinking ever since. I realised that my training was just a beginning and that I needed to take responsibility for my ongoing development.
Perhaps the most powerful influence on me has been attachment theory. There is now a wing of psychoanalytic thinking that embraces attachment theory, but when I first trained it was regarded as heretical (just as it had been in Bowlby’s day). I remember going to a seminar where Daniel Stern and Andre Green debated with each other – or, more accurately, where Andre Green contemptuously dismissed Stern’s concern with the ‘real baby’. I spoke to Stern afterwards and told him how valuable and inspiring his ideas had been for me. He said, with some gratitude, that it was nice to hear that because he so often encountered the kind of response that had come from Green. It alarmed me then, and continues to alarm me now, that some fellow therapists are not open to considering new research and to integrating new developments into their practice.
Attachment theory was also the route for me into an interest in research. I had been an academic historian and researcher before I retrained, so it felt good to find my way back to writing that tested and explored theories. Attachment theory, it became obvious, was overwhelmingly the best researched and most convincingly argued account of emotional development. So then I started to use it as a guide. If our difficulties stem very often from our experience with our caregivers, then our role as therapists must surely be to present a more attractive and engaging version of relationship. I couldn’t see how that was to be done without smiling and without enabling communication with the clients. I began to think of the old-style analytic methodology, and indeed old-style person centred therapy with a passive therapist who said very little, as a kind of do-it-yourself therapy. What originated, at least in Rogers’ writings, as a respect for the autonomy of the client seemed to get translated into a belief that the therapist had nothing to add and indeed should add nothing. In analytic work the danger seemed to be of gnomic utterances apparently coming from nowhere.
There have been other influences on me that have also affected how I practise. One of these is positive psychology. It is fashionable to mock this approach as a Pollyanna-ish disregard for the often brutal realities and miseries of people’s lives. But I have found that identifying strengths and resources to deal with those same brutal circumstances gives clients hope and energy. Psychoanalytic theory often seems to want to rub the client’s nose in the awfulness of their history and their way of being in the world. I didn’t like it myself and I don’t want to do it to my clients.
Another strand has been cognitive therapies. It seemed obvious to me from the beginning of my training that it included large chunks of cognitive teaching, whatever the claims of psychoanalysis that it deals only with the unconscious. The codification of these elements, especially into CBT, has often felt to me to strip out some features of therapy that I think are very useful – for instance, an interest in where the current problems may have originated, or an understanding that stories need to be told and feelings expressed. Still, the emphasis on behaviour change and the finding of strategies to achieve it are often helpful. I have certainly incorporated some of these ideas into my practice.
So I suppose what I am describing is a process of integrating a range of different ideas (and more than those I have mentioned here) about what can be useful to unhappy human beings. I have often heard therapists say that such an eclectic approach is intellectually worthless because each of these theories arises from a different view of the human being. I’m not really convinced by that idea. Theoretical ideas about human beings and how they function, if they are not backed by research, seem to me to be built on sand. I’m more of a pragmatist. I am interested in what will work for this client and how this situation can most usefully be addressed. I like the increasing emphasis on research and particularly on qualitative research. Nobody has demonstrated to my satisfaction that a passive therapist is holding the golden key.
Ironically my therapeutic heroes and gurus have mostly come from the psychoanalytic world and in their writing have demonstrated a warmth and a compassion that I seek to emulate. Donald Winnicott is one such; so is Josephine Klein;3 so too are Allan Schore and Sue Gerhardt.
So how do I square that circle of ‘being myself and behaving myself’?
I am all I have
I work only with people who have problems with food and eating behaviour, and have done for 30 years. My goal is to liberate them from the compulsions that damage their functioning and dominate their lives so that they can grow into the people they have the power to be. Of course, the fact that they are sitting in front of me means their strategy for living is not very satisfying to them, but most are pretty ambivalent about giving it up. (For eating behaviour read drugs, alcohol, obsession etc.) I am in competition with what they already use as their fix. What’s more, their fix is familiar, readily available, often cheap and legal. How shall I coax them into thinking there is something better, another way? How shall I get them to experiment with relating and self-soothing in less harmful ways?
I had a dear, elderly friend who was very upset about her dysfunctional relationship with her adult son. Very bravely she went to a counsellor and told her about her distress. The counsellor said nothing and expressed no empathy or understanding. You won’t be surprised to hear that my friend never went back. Wouldn’t you think that a conversation full of empathy, interest, curiosity and validation, an exploration of possibilities, might have been a useful modeling – a transferable skill that might have suggested how that relationship could be healed?
I have come to realise that only I can help me in my endeavours. Of course, like everyone else, I am far from perfect: my goal is to create the best relationship I can as the basis for the work and to manage those bits of myself that can get out of hand and may not contribute to the client’s progress. So I aim to be friendly and approachable; to use the client’s language; to create an interaction and an engagement with the client. I think about the client’s attachment history, and particularly about the function of the eating disorder (or other complaint) for their life management. I teach the client better, less damaging ways of self-soothing and I model, as well as I can, the benign and soothing adult voice. I encourage the client to find resources to support her both from outside and within herself. I restrain as well as I can my own narcissism, vanity, impatience and other unhelpful qualities.
I think about the extensive work that has been done by BACP, and especially by Tim Bond, on developing an ethical framework for our profession. This started as a set of guidelines that seemed like rules. These had the inevitable limitation that they could not possibly cater to every possible situation and so have been superseded by principles and themes. It seems obvious that we should always act in the best interest of the client, that we should avoid dual relationships, that we should maintain confidentiality, but in practice these principles are very hard to sustain and, at least in my experience, need constant thought and attention.
I once supervised a counsellor who was working with a woman client whose daughter had an eating disorder. I aim to be scrupulous about maintaining clients’ confidentiality so I didn’t know the real name of either the supervisee’s client or the client’s daughter. After some weeks I realised that the supervisee’s client was in fact the mother of one of my own clients, so I was hearing my client’s story from two angles. (It was interesting that it took me so long to recognise it.) When I realised this I stopped the supervisee in mid-flow and told her I couldn’t supervise her for that client. So was that an ethical thing to do? It left the supervisee high and dry; it protected me from knowing more about the client than she herself had told me. Was that good? Should I have told my client? I didn’t because I didn’t think it was helpful for her. Whose benefit would that confession have served? Not an easy situation to resolve; not obvious at all.
Similarly, when I make presentations using client material and ask participants to use their own and their clients’ material, I always ask for their explicit agreement that we are in a privileged situation and that what we learn about others is not to be repeated outside the room. When I do day-long workshops I get participants to sign an undertaking to this effect. Yet I am not at all certain that we have any deep understanding of the undertaking. Does it mean that the client examples can’t be used in any other setting; does it mean they can’t be discussed in another setting? Am I requiring any reflection on the material to be done entirely privately by the individuals present? Is that the best way to learn? And if it isn’t, what exactly does that confidentiality mean?
So what about you?
What motivated you in the first place to take up counselling training? What were the immediate reasons and the underlying reasons?
What were the messages you took from your training? Were you critical of them at the time? Have you become so since? Have you modified your approach to clients? Have you integrated new theories and understanding in your approach to clients? What is it that you think you are doing when you work with a client? How do you understand the ethical challenges of your work?
Do you think that you have arrived at a place of authentic practice?
Julia Buckroyd is Emeritus Professor of Counselling at the University of Hertfordshire. She practises in St Albans as a therapist specialising in work with people concerned about food, weight, shape or size. She also trains therapists to deliver her ‘Understanding your eating’ programme for working with emotional eaters and delivers workshops on eating disorders and other issues.
References
1. Davis M, Wallbridge D. Boundary and space: an introduction to the work of DW Winnicott. Harmondsworth: Penguin; 1983.
2. Langs RJ. The technique of psychoanalytic psychotherapy. Volume one: initial contact, theoretical framework, understanding the patient’s communications, the therapist’s interventions. Lanham, MD: Jason Aronson; 1989.
3. Klein J. Our need for others and its roots in infancy. London: Tavistock; 1987.