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Why do some clients seem to do better in therapy than others?

Why do some seem to know ‘what to do’ in their sessions in order to progress whilst others never quite get it?

Is it all down to the quality of the relationship between therapist and client, or the therapeutic method being used?

Or is there something else going on as well?

This workshop is an introduction to the theory and practice of Focusing Oriented Therapy, aimed at counsellors, psychotherapists, trainees and other mental health professionals who wish to:

• deepen their understanding of how some clients use therapy more successfully than others
• learn how to help clients develop their body awareness skills so as to make the most of their therapy sessions
• add new depth to their own personal development and self awareness
• augment their therapeutic toolkit with a practical, powerful and empowering skill

What is Focusing Oriented Therapy?

Focusing is a gentle but powerful non-touch ‘body awareness’ skill, which helps us and our clients to heal the hurting feelings which bring us to therapy or get in the way of living a more fulfilled life.

Focusing was originally identified in the 1950s when researchers W. Kirtner and D. Cartwright – two colleagues of Carl Rogers – asked a question that many therapists don’t like to ask and which every person considering therapy most needs to know:

Why do some clients recover in therapy and others do not?

Kirtner and Cartwright discovered that successful clients could be spotted during the first two therapy sessions, and that these clients had a special way of working with their issues.

They had higher ‘experiencing’ levels, and knew what to do in their therapy sessions from the start.

This research was then duplicated and confirmed by Dr Eugene Gendlin, who went on to develop ways of helping potentially unsuccessful therapy clients to learn the skills that the successful clients knew about already.

Workshop Content

• How successful and unsuccessful clients use therapy
• How to spot and facilitate successful clients – and not get in their way
• How to offer all clients the opportunity of deepening their experiencing levels, and improve their chances of recovery through offering reflective listening and deepening propositions (also called focusing invitations)
• Integration of skills into existing practice
• Taster and demonstration of Guided Focusing (explored more deeply in future training)

During this workshop, all participants will have an opportunity to develop their skills and experience of focusing-oriented therapy for themselves through:

1. Group work – exploring how clients use therapy – spotting successful and unsuccessful clients
2. Teaching on the basic principles of focusing oriented therapy
3. Triad work – practising the principles of focusing oriented therapy
4. Group discussion on integration of focusing oriented therapy into existing practice
5. A look at how to access further focusing resources and training

More information

To learn more about focusing oriented therapy, please read John Threadgold’s article here on our website. There’s also a wealth of information about focusing on the website of the British Focusing Teachers Association.

Workshop participants will receive a certificate for 6 hours Continuing Professional Development and will have the opportunity to sign up for further training in focusing oriented therapy to be held at Marple Cross at a later date.

For a further insight into Focusing Oriented Therapy, you can view this video of John Threadgold talking about FOT and the workshop he’s presenting at Marple Cross.

About the trainer

John Threadgold is a Focusing-Oriented Person Centred and integrative therapist. As well as holding Level 6 Diplomas in Humanistic Counselling and Psychotherapy, and in Therapeutic Supervision, he also holds an MA in Focusing and Experiential Psychotherapy. He is BACP-Accredited for Counselling and Psychotherapy and recognised by the Focusing Institute as a Focusing-Oriented Therapist and Focusing Teacher. He is a member of the British Focusing Teachers Association and runs a private practise called New Focus Therapy, offering therapy, supervision, and focusing training for therapists and the public.

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Focusing-Oriented therapy has been defined as therapy that ‘facilitates the clients into their own experiential process’¹.

It has its roots in Carl Rogers’ Person Centred approach to therapy, and is described as being one of the ‘tribes of the person centred nation’².

The relevance of FOT however goes beyond that of the person centred approach, in that its roots lie in research into the vexed question, ‘Why do some clients succeed in therapy, when others do not?’.

Where did Focusing come from?

Back in the late 1950’s, Kirtner and Cartwright, two of Carl Rogers’ colleagues at the University of Chicago, researched the phenomena of client success and failure in client centred therapy. They defined success as the point at which clients began to feel better, and make constructive changes to their lives, over the course of therapy³.

At first they concentrated on the therapists, believing that therapists who offered the client a relationship characterised by unconditionality, empathy and congruence, would have better client outcomes than those who did not.

Their findings gave some support to this, in that such therapists did have clients who got better. But the results were puzzling. Such therapists also had unsuccessful clients. Also some therapists, who seemed less able to offer these core conditions, nevertheless also had successful clients.

A change of focus

These researchers decided to change their focus, and concentrate instead on what the clients were doing. It was here that they made a startling and controversial discovery:

In other words, successful clients already knew what to do before they entered therapy.

This research had been duplicated, and extended to other therapeutic approaches, and had been borne out across the different therapeutic modalities⁴.

How do clients use therapy?

As therapists, we all experience the phenomena of clients who seem to succeed in therapy while others really struggle. I am defining success here as being when a client begins to feel better, and to make constructive changes to their lives.

Clients use therapy in a variety of different ways, and also will change the way that they use therapy from session to session. Clients will often explore their issues with any combination of storytelling, analysis, and sometimes being caught up with their emotions.

None of these ways are wrong, and they are all right in their place. Successful clients however do something else, in addition to this, that the unsuccessful clients did not know how to do, and did not usually learn to do over the course of therapy.

Focusing in therapeutic practice

Here is a fictionalised example of how a characteristically successful client talked about their issues. The ellipses, and hesitations are exaggerated for effect. But try reading this extract out loud, try to get a sense of how this sounds and feels.

Your client Tom is talking about the sad and distressing breakdown of his relationship with his partner. Get a sense of how he is doing this: Look out for the story telling, analysis, and emoting. Also look out for something that feels a bit different.

“Well, I was really angry – ( banging his fists  on the table), ( tears in eyes), silence –  looks a bit calmer – well- its- anger-  but there is something else as well ( silence)- my wife and my best mate went off together – ( silence) –  I can feel it just here ( pointing to stomach) – – its emh –  a real sense of –  loss –  yeah that feels right – yeah I lost my supposed best mate and my wife –  so that fits. And— More—-  its relief — emh yeah relief that all the lies were over….. Mike, my mate, stopped going to the football with me, said he was working, but it turned out he was meeting my Mrs during that time. So I can understand that I would be relieved that all the lies were over- from him and her….”

Ok, so having read that extract, can you spot the times that Tom was storytelling, being in the middle of his emotions, and analysing ? Can you also spot when there was something else happening, a little bit different from that?

The times that he hesitates and takes a moment to really check out what he is feeling are the times when the issues that he has begin to shift, change, feel different to him.

Take the sentence: “well- its- anger- but there is something else as well ( silence)-”. Here the client knows that there is more to his experience than the anger. He is sensing something that is conceptually vague, but concretely experienced. He goes on to then give a context to that feeling: ‘My wife and my best mate went off together’

He has done some story telling here, but is still in contact with that ‘something’, and there is silence. And then he says: “(silence) – I can feel it just here (pointing to stomach) – – its emh – a real sense of – loss – - yeah that feels right –”.

On staying with that ‘something’, he now knows that it’s a sense of loss, the word fits the experience, its exactly right for the experience. He then goes on to explain the context or life situation from which his feelings emerged.

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As a counselling psychologist and therapist, I often incorporate Mindfulness into my work with clients.

One of the delights of Mindfulness is the colourful imagery it uses. Mark Williams – one of the early pioneers of Mindfulness-based therapy  - talks about “emotional quicksand”, that is the process by which struggling to be free of anxiety or depression often makes things worse – the more you struggle to be free, the deeper you sink.

He talks of how our histories can “whip up an emotional squall” because our memories can have a powerful impact on thoughts, feelings, drives and, of course, our bodies.

How Mindfulness helps us calm the storm

Rather than simply analysing and continually worrying about problems, an awareness can be developed that allows you “to step outside of the chattering negative self-talk” and all the uncomfortable feelings that go along with it.

Adopting a non-judgemental approach to ourselves, and our lives, we can become aware of the “shoulds” and oughts” that drive us on until we are exhausted. Being mindful of the “careworn ruts” that deplete us and introducing new avenues to explore, our lives can become “moment-rich” rather than “time-poor”.

Mindfulness and client work

Can this help our work with clients? Apart from the attraction of the language of Mindfulness, which can renew the therapist’s perspective, I believe it can be so beneficial for clients.

Take, for example, Alice’s case described in Mark Williams book ” The Mindful Way through Depression”, he writes:

“Whenever Alice’s mood began to sink, and she felt that the energy was draining out of her, she consciously adopted a strategy of giving up her ‘unimportant’ and ‘non-essential’ leisure activities, which actually gave her pleasure, such as seeing friends or just going out and having fun. As she saw it, this strategy made sense because it meant that she could focus her dwindling energies on her more ‘important’ and ‘essential’ commitments and responsibilities.

 

This is understandable, except that her essential commitments included being the perfect home maker, mother and employee, and meeting all the demands and expectations of family, friends, colleagues, and bosses, whether these were reasonable or not. In giving up the ‘non-essential’ and ‘unimportant’ leisure activities that might have lifted her mood, and extended rather than depleted her reserves of energy, Alice deprived herself of one of the simplest and most effective strategies for reversing a decline into depression.”

What Alice was thinking was, “stop the world, I want to get off!” With mindfulness, she could do just that.

Mindfulness, with compatible elements from other therapies, allows for “distancing” from unhelpful thoughts and belief systems. By cultivating great mindfulness with respect to unhelpful thoughts and behaviours, they can be regarded in a different way and better choices made.

By bringing a moment by moment awareness to our difficulties and worries, new possibilities for our minds and bodies can be opened. Put another way, returning to the poetical framework I like so much, “Let’s allow the difficulty to be here – I’ll just be with it now, in each moment, as if it were a sick child in the middle of the night needing to be held tenderly and reassured”.

Want to know more about Mindfulness and therapy?

Poet or therapist, or both! if you are a counsellor, psychotherapist or other mental health professional and would like to know more about Mindfulness and how it can be used with other therapeutic models, Ronnie Freeman and Clive Everist will be running a workshop at the Marple Cross Centre on Saturday April 13th entitled “Mindfulness based therapy : an introduction”.

Offering Mindfulness to clients, requires the therapist to be practising Mindfulness themselves, so this is an introduction allowing the opportunity for those attending to update themselves on this fast-becoming model of choice and see whether it would be something they might like to explore further.

Please visit the Workshop booking page to secure your place.

Image copyright: Scales of Justice © http://www.flickr.com/photos/donkeyhotey/

When a therapist is employed in areas that include working with vulnerable adults and/or with children, the employer will usually obtain a Disclosure & Barring Service (DBS^[1] ) Enhanced Certificate on the therapist.

There are mainly two types of DBS certificates:

• The Standard Certificate - this simply lists any unspent convictions of the certificate holder, but nothing else.
• The Enhanced Certificate  – this lists any unspent convictions, any previous convictions, shows if the certificate holder is on a register for adults or children, shows if the police holds any information on the certificate holder.

Read: Who are DBS Checks for?.

Self-employed therapists may also need to verify that they have no criminal record that would prevent them from working with vulnerable adults and/or children. A major problem of obtaining such a certificate, though (March 2013) is that individuals are not allowed to apply for their own certificate. This situation leads some therapists to simply not bother obtaining a DBS certificate – after all, it’s not compulsory.

CHANGE IN LAW:  later in 2013 DBS Certificates are said to become mandatory.

“Although getting a DBS check is not mandatory at the moment, it will be later this year and so it will be illegal not to have one at that point.”

LinkedIn – March 4th, 2013

As it’s been 4 years since my last CRB Certificate, in this article I will discuss with you how I went about obtaining my own, new, DBS Certificate.

Footnotes:

1. DBS is the new scheme replacing the previous Criminal Records Bureau (CRB) service ^

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Image copyright: 'Funny Internet Spam' © http://www.flickr.com/photos/epsos/

If you own your own Internet Domain, and you use an email service that allows a ‘capture all’ configuration^[1] this technique will help you catch out companies & organisations that pass on your email address without your authorisation.

What’s the problem?

You have a single email address which you use when signing up to services:

• BACP’s directory of counsellors/psychotherapists,
• A local video rental service,
• AA Car Rescue service,
• Buying a bottle of aftershave you ordered for your partner on eBay.

Then, a couple of months later you start to receive an inordinate amount of SPAM / unsolicited Junk EMail.

How did the junk mailer get hold of your email address?

Here’s a solution.

Let’s take the scenario above, except this time instead of using the one email address you use multiple:-

… when receiving unsolicited email you simply look at the address to which the junk email had been sent!

Example Junk Mail:

… now take a look at the line I’ve highlighted – ‘localvids’.  Somehow, the email address you gave to your Local Video Rental company got passed onto this company sending you unsolicited junk (and junk about carrots, for goodness sake … euphemism ).

Blocking Incoming Junk Email.

In this example, you might decide to block the email address that has been sold on.  Simply block localvids@fredjohnscounselling.com and all your other email addresses continue to accept email. Simple, huh?

However – NEVER, EVER click on the link that says ‘To Unsubscribe from receiving emails from us, click here…’ If the email came from a company you’ve never heard of – then clicking on that link confirms that a human being received their email and the value of the email address rockets.  A live, legitimate email address is worth more money to sell on than an unconfirmed email address.

How to get a Domain Name.

A domain name is a like a house address eg “Hedgehog’s Bottom”.  When the owners of Hedgehog’s Bottom move house, they can take the name with them if they like.

Internet Domain Names work in a similar way – you buy an address and you associate the address with different services (such as a website, an email service & other internet services).

Domain names are easy to obtain – and cost as little as £3 a year upwards of £20 or more per year. You rent a domain name for a set period.  The cost depends on the Top Level Domain – eg JohnSmithCounselling.com will cost more than JohnSmithCounselling.co.uk … because .com domains cost a bit more to rent than .co.uk domains.

Once you have your own domain name, you can buy other services – a website service, an email service and so on.

Obtaining a Domain Name for your Therapy Service.

Try UK2′s Domain Name service.

If you’d like to discuss domain names, pop your question into a comment below and I’ll respond to you here.

Finally.

If your current email service doesn’t allow you unlimited email names on your domain, and doesn’t give you the ability to block (or automatically delete) incoming emails on your choice of email addresses, then maybe it’s time to consider another email service provider.

For example:

• If you began receiving unsolicited email from an certain  Telecoms company (who always greet you kindly, say they’ve read your website with interest, but somehow seem to offer you useless services – which they’d know if they had even glanced at your  website), does your email service provider allow you to block all emails from their single domain regardless of the thousand-or-so variations they use in the email’s name (Fred, Katie, Joanna etc)?
• If you began receiving unsolicited email from a CPD training organisation in Scotland – even though you didn’t request their marketing material as there’s no way you’re going to travel to the outer Hebrides for a 3 hour workshop – does your email service provider allow you to block these emails?
• You keep receiving email inquiries from advertisers who (a) don’t write quite as though they’re adults, (b) use a foreign-country domain and (c) offer you super advertising in a therapy directory “of your country” just by sending your credit card details, can your email service provider allow you to block these emails?

Cybersrink.co.uk does …

Footnotes

1. Cybershrink.co.uk is a specialist website & email service exclusively for professional therapists. When using your own domain name, Cybershrink will accept all email for your domain regardless of the name used (name@yourdomain.com, anothername@yourdomain.com etc). Plus Cybershrink offers free tools to manage unsolicited junk mail, such as being able to block incoming email from certain senders. ^

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I used to believe that to get my 30 Continued Professional Development hours each year I had to attend 30 hours worth of workshops.

That was until the year struggled to find 30 hours of workshops relevant to areas of my practice to be developed!

It was then that I discovered that workshops are not the only appropriate source of CPD … studying online articles that focuses on ones areas of therapy also count.

Using a Tablet (iPad, Android, Blackberry, Amazon etc) or Smartphone device you can install an RSS Reader ^[1] , tell it about the sorts of therapy websites you would like to read, and your RSS Reader will regularly download all the articles & incorporate them into an magazine-like collection.

For example, I’ll discuss Flipboard and the Marple Cross Centre‘s therapy-related articles.

Flipboard.

Flipboard – bring News sources to your tablet

Flipboard (http://flipboard.com/) is easy to use, easy to set up and delightful to use.  It takes its name from the way you move from page to page: flipping your finger across the screen turns (or ‘flips’) to the next or previous page.

When you open Flipboard it automatically checkes your news sources for any new articles, and downloads them to your table.

When configured with your best selection of therapy-related websites, your tablet becomes an limitless source of CPD material.

Marple Cross Centre’s RSS Feed.

The Marple Cross Centre is fully RSS ready – all of our articles are instantly prepared for RSS.

By telling your RSS Reader – like Flipboard – to read The Marple Cross Centre, your tablet will be loaded with articles written by our therapists, aimed at both the public and other therapists.  It’s a valuable source of knowledge, professional experience, and CPD hours.

Configuring your RSS Reader.

Telling Flipboard (or any other RSS reader) about the Marple Cross Website is easy.

Option 1: tell Flipboard to search for Marple Cross Centre.  When found, select it. Bingo!

Option 2: tell Flipboard the address of the Marple Cross Centre’s RSS feed.

Other Sources for Therapeutic Articles.

If your favourite website is not here, try looking for the icon on the website, or try adding the main address followed by /rss/ or /feed/ (such as http://www.thewebsiteaddress.com/rss/)

• Good Therapy (http://www.goodtherapy.org/Therapy-News-article.html)
• Psych Central (http://www.psychcentral.com)
• Psychology Press (http://www.psypress.com)

Table of Footnotes

1. RSS stands for Really Simple Syndication and is a standard way for website to communicate to your device what sort of articles it has for you to read ^

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iZettle (http://www.iZettle.com/) is a card payment system developed in Sweden and available in Great Britain.

Using your Smartphone or Tablet, your client can make a session payment (in person only) using their credit or debit card.

iZettle takes a small portion of the fee as its commission (2.75% when using a card reader, 3.5%+10p when not), so a £50 session fee will cost £1.38 to pay by card

Payments are transferred to your bank account automatically on a daily basis.

Comment: In my experience, all of my clients have been happy to pay an admin fee for the convenience of paying by card. Therapists may choose to absorb the admin fee into their existing fees, or to add a flat charge to the fee to cover card payments expenses.

Click to watch a video of iZettle in action…

Methods of Payment.

Chip & Signature
Card payments for everyone: individuals and small businesses. iZettle Chip Card Reader (connects via the audio jack) Plugs into your Smartphone’s or Tablet’s audio jack. Card is placed into the device and an app on your Smartphone/Tablet reads the card. You enter how much to charge and the card owner signs the payment using their finger. Visa cards have an alternative stage involving an SMS text message being sent to the card owner to verify the payment. Accepts most credit/debit cards. Cost: £20 (with a voucher for £20 credit on your account)
Chip & PIN
Card payments for small and growing businesses. iZettle Chip & Pin Reader (connects via Bluetooth) Connects to your Smartphone or Tablet using Bluetooth (ie wireless). Card is placed into the device and the payment is authorised by the card owner entering their PIN number. Accepts ALL major credit/debit cards. Cost: £49 + VAT (at time of writing this was a special offer – expect prices to fall over the new few months)

Conclusions (so far).

• iZettle is worth a trial using the Audio card reader (because you get the cost of the reader back through free transaction fees).
• Signing up for an account is free of charge (and there are no period (eg monthly) fees).  There are often special offers on the card-reader devices (such as a refund for the Audio reader by a £20 voucher).
• To receive your cash you have to verify your bank account.  You do this by transferring £1 from your bank account.  This mechanism is fallible, because iZettle don’t actually compare the sort code & account number you use to register with izettle with the sort code and number used to transfer the £1 (I made a type when regisgtering – which iZettle accepted and didn’t query, resulting in my iZettle money not being transferred for several weeks until I chased this up).   This approach seems rather odd to me.
• When I started my private practice, I installed PayPal on my website to invite card-based payments.  Most clients haven’t minded going to my website to make a card payment (one or two have not liked this and resorted to paying in cash).  However, making payments away from the consultation room can bring up interesting phenomena that may benefit from some clinical attention (repeated forgetfulness to pay the fee etc).  As iZettle can only be used ‘in-person’ the client must makes their payment in front of you (as they would cash etc).  Bringing this interaction into the room might initially disturb some therapists (potential of showing vulnerability with technology in front of the client etc).

Overall, iZettle is an innovative approach and one of the first … but iZettle do tend to come across as an immature company.  Helpdesk staff are somewhat disinclined to be helpful, taking a seemingly “well it’s your fault” approach to customer’s ignorance due to lack of online help information. Products are released (and sold) before the whole supporting system is ready (i.e. the software that runs the product).  Marketing is somewhat  misleading (yes, payments are made daily from your account, but a payment is not released  until 5 week-days have elapsed from a payment being received).

Overall: 7 out of 10 – could do better.

See http://www.iZettle.com/ for more information – or ask Dean a question below in the comments section.

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 When a client asks for a referral.

Scenario: A new client comes to you for an assessment for counselling.  During the session, she asks you about hypnotherapy and how it might help her.  Interestingly, you’re not a hypnotherapist … you’re a counsellor with a psychodynamic core model with no professional knowledge of hypnotherapy. What might be a helpful and ethical response to this client’s request?

I’d suggest that there are (at least) two things going on here.

Unconscious Processes.

Firstly, based more on working with unconscious processes, the client appears to be inviting the therapist to speak from a position of authority (i.e. knowledge).  As this therapist is not qualified in hypnotherapy, one response might simply for him to say “I don’t know”.  However, from a psychodynamic perspective the therapist might be curious as to what could be happening within the question and to respond according to how the therapist notices his “self” is being pulled (counter-transference) by the enquiry.  For example, instead of responding from a position of false authority: “it can be very effective for all sorts of things…” the therapist might share his puzzlement with the client about what is truly being asked (and quietly pocket the sense of false authority as a tentative hypothesis for later).  Of course, this is just one example of a number of different responses.

Even though this situation might simply be that the client does not know that we therapists have different schools of training, there can still be potential learning by being tentatively interested in the interaction between this client and therapist.

Ethically Empowering the Client.

How to Email a subset list of
Marple Cross Centre Therapists

Secondly, a therapist who cannot (and, for ethical reasons, should not) make any recommendations as to the effectiveness of hypnotherapy (or any particular therapy in which the therapist has no training or experience) may still be able to effectively support and empower the client into finding the information for themselves.

By using The Marple Cross Centre’s free Find a Therapist online service, the therapist could pop in a query for “hypnotherapy” and email the list of discovered-therapists to the client.  This would be a therapist beginning a process on behalf of the client – and, of course, some therapists’ approaches might not allow for this.

The video along to the right shows how easily this can be done.

… and this (scarily long looking!) URL is an example of what the therapist might send to the client:-

http://www.marplecrosscentre.co.uk/find-a-therapist/?cmVsb2FkPXsiaW5pdGlhbFNldHVwIjoxLCJzcGVjaWFsdGllcyI6IiIsIm1vZGVscyI6Im1vZGVsLTU2IiwiZGVzY3JpcHRpb24iOiIiLCJjbGllbnR0eXBlcyI6IiIsInRvZCI6IiJ9

… click on it yourself to see what happens.

When the client receives & clicks on the URL, they can continue their research into hypnotherapists - choosing, perhaps, to discuss the matter further with their choice of therapist from the list. Further queries are not put to the appropriately qualified people.

Image copyright: Receptionist answering phone © http://www.flickr.com/photos/suburbaneyecare/

This article describes how easy it is to obtain an inexpensive telephone number for a therapists’s private practice … and how this same method is ideal for obtaining a temporary or time-limited telephone number (eg  0800  or “freephone”) for, say, marketing a workshop.

A telephone number for your new Private Practice.

Whilst this can seem like an easy solution, the therapist must contend with managing the difficulties associated with  mixing up use of a personal telephone for business use:-

• What introduction do you use when answer a potential-business call on your home phone: “Hello?” … or “Hi, this is Joanna”, or “Joanna Smith’s Counselling…”
• How do you manage an incoming mobile-phone call when you’re in a public area?  Do you answer the call (it could only be family calling, afterall)?  Do you leave it to go to voice mail? Do you make a judgement depending on where you are?  How will you protect the caller’s confidentiality?
• Who else in the house needs to know about using the “home” phone?  Do they understand not to listen to voice messages (matters of protecting someone’s confidentiality)?  Do they understand how – or even if – to answer the phone?
• For mobile phones – does using such numbers lose any value when marketing your practice’s location?  Eg does advertising 07989 123456 (mobile / location-less) communicate anything differently to 02392 123456 (Landline / Portsmouth)?

An easier solution would cost you £2.00 a month.  For this you get your choice of local a telephone number; one that you would use exclusively for your private therapy practice.

Introducing Voipfone – Voice over IP

Voipfone (https://www.voipfone.co.uk/) is a commercial service that provides (amongst other things) telephone numbers.  It’s actually a service that’s been around for a few years now: VOIP standing for “Voice Over IP” (or voice services provided over the Internet).

I’ve been using my telephone number (02392 987 487)  on Voipfone since 2009 and it costs me no more than £2.40 (including VAT) a month.

The services I choose to use are:-

• A free telephone number that comes with every new Voipfone account (which I choose not to use because the number begins 05603…  which I don’t think many people recognise what 05 numbers are, or how much they cost.  05 numbers are “VOIP” or “Commercial” numbers (see http://www.area-codes.org.uk/05.php)).
• My choice of 023 92 number – which shows I operate in the Portsmouth area.
• Free outgoing messages that I record (“Hello … this is Dean Richardson …”) and can change at any time (“I’m on annual leave…”)
• Free emails of all income voice messages (voice messages are recorded and emailed to my own email account instantly).
• Free software to answer the phone on my computer – “SIP” compatible software that runs on Macs and PCs.
• Free connection to my SIP-compatible phone – in my case I can allow my Android mobile phone to receive calls from my practice telephone number (as well as my personal mobile number).

How I use the service.

When I someone calls any of the Voipfone telephone numbers I have connected to my account, and my computer nor my Smartphone is not accepting calls, the computers at Voipfone answer the call … and my outgoing message is played to the caller.  If the caller leaves a message, it is recorded by the Voipfone computers, converted into an audio file and emailed to me.

Within the email will be the caller’s  telephone number (if they have not blocked it), and the audio file.  The file can be played by PCs, Macs, Smartphones and tablets.

If I am going to return the call, I call use my own phone (withholding my personal number by dialling 141 first). Because I have plenty of pre-paid minutes, this suits me better than calling back using my Voipfone number.

When I’m done, I delete the email and the audio file.

Other payable services.

In addition, there are these services:-

• Attach other numbers to the account – handy to rent an 0800 number for a special promotion, or to add other location numbers (such as adding Southampton 023 80 if I began working there too).
• Re-route incoming calls to a BT telephone.
• Attach a mobile SMS number – so that I could receive SMS text messages.
• Purchase a VOIP Telephone – a physical device that plugs into the internet to receive and dial calls.
• Purchase outgoing telephone calls – so I could call a client back from my business number.
• Call Me Back – a service where a person calling you will be notified that you’re going to call them back at a particular hour of the day.
• Fax services.

Virtual PBX Service.

So, imagine that you’re all set with local telephone number, an 0800 number for special occasions and a voicemail box.

You later decide that you’d like to expand your business by adding a new service, but you want this service to be a separate telephone number, a separate voicemail box,  voice messages to be forwarded to a different email account and so on.

Onto this additional line you can attach extra telephone services like adding a different telephone number, voicemail, message forwarding and so on.

You can add and delete PBX lines as many times as you like – handy for, say, adding an 0800 number for a month to take bookings for a training workshop you might be running.

Virtual PBX Service works out to be £1 more expensive than opening a separate account, but it may be easier for you to manage multiple lines under the one account.

How to begin a Voipfone Account.

It costs nothing to open a Voipfone account – you get a free 05xxx number … and they even give you a free 20p credit to get going. Click here to get going:- https://www.voipfone.co.uk

Later, when you’re comfortable with the service, you could choose your own number

• Local (023 92)
• Regional (eg you might like a London phone number 0207…)
• Non profit (0330 …)
• Low-call (0845 …)
• Freefone (0800 …)
• Memorable (i.e. a number that’s very easy to remember, such as 08455 44 0000).

… or even expand with a PBX service (“For enquiries about my counselling services, press ’1′;  for enquiries about about my coaching business, press ’2′).

Got a Question about Voipfone?

If you have any questions about my experiences with Voipfone, please use the comments section below to put your question – and we can start a discussion.

Otherwise, please see the Voipfone website for details.

Image copyright: Thinking 2 © http://www.flickr.com/photos/wlscience/

In my time, I have been a student-counsellor assessor & mentor in a local counselling-training organisation. Two things that first-year student-counsellors have taught me:

• Firstly, they can struggle with asking open questions (eg a question that invites a client to talk (more) about a subject, and one that often contains one of the words: “who”, “how”, “what”, “where” or “why”);
• Secondly, having mastered “how” they can get stuck with over using intervention “… how do you feel about that?”

“How do you feel about that … ?” Let’s ponder on the purpose of this question.

Before a counsellor-in-training gets the hang of the thinking-process: “what is the purpose of what I’m about to ask?”, emulating questions heard during personal therapy can be a common learning practice for student counsellors.  The thinking behind it: if my counsellor asks this question then it must be a good one (even through I don’t yet know why, yet).

But, focussing on that “how do you feel about that?” intervention, what are we really hoping to achieve? There’s a big assumption here: that all people will be able to answer a question about feelings. What about people who do not “feel”? How do they manage with counsellors who insist on asking this “feeling” question without thinking?  

Let’s discuss other approaches to “feeling…

Not Everyone “Feels”.

People process material in different ways.  Some can recognise their feelings, and some cannot.

At an extreme end of the scale, asking someone who is alexithymic (the inability to express feelings with words) how do they feel about something will be met with a client unable to answer the question.

And if alexithymia is someone who cannot express feelings with words, we might be mindful of  someone who has experienced horrific trauma leaving him in a position where he must not express feelings with words for fear or reliving the event.

On a more common, although perhaps stereotypically scale, we might also be mindful of men who tend to “think” and women tend to “feel” – what are we hoping to achieve asking a man who has never needed to recognise his feelings “how do you feel about this?”

Some therapists may take the position in some cases that helping a client to recognise his feelings, or even to teach a client about feelings, is an appropriate course of treatment. If the client agrees with this then why not?

But, what approach can we take to ask a client what’s going on for them without focussing 100% on feelings?

Borrowing from an Cognitive Behavioural Therapy (CBT) Approach.

CBT Cognition, Emotion, Behaviour, Physiology diagram

I’m referring you to a Five Areas Approach which, whilst heaving used in CBT, can be helpful in non-CBT approaches when a therapist is faced with forming questions that are (a) not necessarily focussing on feelings and (b) might be more understandable by a client.

On the right hand side is a common diagram of Five Areas.

It shows four areas:

• Cognition: about thoughts and thinking process.
• Emotion: about feelings and emotional processes.
• Behaviour: about actions and what we find our body doing.
• Physiology: about somatising and how our body makes expresses.

… and a fifth area (not shown) that encompass all the areas, which we might call environment.

This diagram suggests that the whole is an expression of various portions of each area … and that each area is connected to each other area. With such connections, what we think effects how we feel, and how we feel might effect our behaviour, and how we behave might effect our body and so on.

Hypothetically, if we ask questions about what a person is thinking we are asking implicitly about the other areas of a person (emotions, behaviour and physiology).

“How do you feel about that” can now exist with other variations.

Cognition-based Variation.

“What do you think about that?”

“What might be your thoughts around this?”

“What thoughts were going through your mind at that time?”

Emotion-based Variation.

“How do/did you feel about that?”

“How did that make you feel” (although some would suggest that feelings are a choice, so can one be made to feel?)

“Have you recognised this feeling in situations before?”

Behaviour-based Variation.

Example: a client notices herself driving past a graveyard on the way home, without intending to.

“What did you notice you were doing at that time?”

“How often do you find yourself doing this?”

Physiology-based Variation.

“What happens around your body?”

“What did you notice about your bodily sensations at the time?”

… and a general encapsulate-all variation for all:

“Tell me about [what you were thinking / what you were feeling / what you were doing / how your body was responding] when…”

So, as therapists, using the CBT “doughnut” Five Areas model can give us opportunities of re-phrasing an intervention in a way that may be more understood by our client.

ALSO: If you have some examples of more-adept variations on the above four areas of intervention, please add them to the comments section below.

Image copyright: "Shh" © http://www.flickr.com/photos/subtleromance/

How many times this week did you break your Client’s Confidentiality?

This is an article intended to stimulate you and your mindfulness, as a practising therapist, towards actively thinking about concepts of confidentiality.

Protecting a person-in-therapy’s confidentiality might seem simple enough (simply don’t talk about the client in public, surely?) … but therapists who are not mindful – or, perhaps, lapse – about actively thinking about a client’s confidentiality may find that the unintended consequences of not thinking about confidentiality is quite shocking.

Not all forms of therapy need to practice all forms of confidentiality, of course. A massage therapist, aromatherapist or hypnotherapist (for example) may not need to be prepared to keep a client’s deep secrets contained.  Nevertheless, perhaps still being mindful of the potential for what might be told in confidence whilst, say, in a state of deep relaxation could be a good position to be in.

Professional Bodies Requirements of Confidentiality.

It should not surprise any of us to find that all therapy-related professional bodies make some for of reference to confidentiality – some more than others. Interestingly, whilst the British Association for Counselling & Psychotherapy (BACP)’s Ethical Framework for Good Practice in Counselling & Psychotherapy (pdf) is a detailed construct of working with people in counselling or psychotherapy, it doesn’t contain an explicit definition of the terms confidential & confidentiality.

So, let’s refer to a couple of other sources.

(i) Wikipedia

Confidentiality: Clinical and counseling psychology.

[...]information shared by the client with the therapist in the course of treatment is not shared with others. [...] exceptions to confidentiality, namely where it conflicts with the clinician’s duty to warn or duty to protect.  This includes instances of suicidal behavior or homicidal plans, child abuse, elder abuse and dependent adult abuse.

http://en.wikipedia.org/wiki/Confidentiality#Clinical_and_counseling_psychology

(ii) The Oxford Dictionary:

Definition of Confidential.

Adjective.

• Intended to be kept secret: confidential information
• [of a person’s tone of voice] Indicating that what one says is private or secret: he dropped his voice to a confidential whisper
• [attributive] Entrusted with private or restricted information: a confidential secretary

http://oxforddictionaries.com/definition/english/confidential

Member of the BACP are required to adhere to the Ethical Framework in order to practice safely and ethically, protecting their clients during and after therapy.

Here are some citations from the BACP Ethical Framework :-

Definition of Secret.

Adjective.

• Not known or seen or not meant to be known or seen by others: how did you guess I’d got a secret plan?
• [attributive] Not meant to be known as such by others: a secret drinker
• Fond of or good at keeping things about oneself unknown: he can be the most secret man

http://oxforddictionaries.com/definition/english/secret

With all this this in mind, and it is a lot to keep in mind, I would like to ask you a question as one therapist to another:

How many times this week…

…did you break your client’s confidentiality?

(continued…)

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Image copyright: "Abuse cycle" © http://www.flickr.com/photos/moggsoceanlane/

In this brief guide, I will discuss an approach to domestic violence/abuse in couple relationships: The Safety Plan.

Counselling Approaches.

A majority of counselling/therapy models use variations on an approach known as “non-directive”, meaning that the therapist does not impose solutions nor instructions on how the client is to approach resolving their problems.  Cognitive Behavioural Therapy (CBT) incorporates a number of directions (“complete this form for discussing next week”) but whilst CBT is a somewhat manualised approach, experienced CBT therapists also incorporate an essential essence of a non-directive approach: inviting the client to contribute a majority to their own problem-resolution.

A Systemic/Psychodynamic approach to a couple’s relationship counselling is no-different in this respect. The therapist focusses on the couple’s relationship and the behaviour between them, rather than focussing on the problems of two separate people. However, a systemic/psychodynamic approach to domestic abuse must switch mode from a non-directive/facilitative model of therapy to a more directive approach.

The Safety Plan – an Approach to Interrupting Domestic Abuse.

Pre-requirements for this approach:-

• Both partners must be safe (or be able to become safe).  If one partner is in danger (physical attack) then this approach may not suitable.  The couple will need to be helped to understand for themselves if this approach is for them.  The process of a couple therapist assisting a partner into police protection from domestic violence is beyond the scope of this discussion.
• Both partners in the relationship must be in agreement that the abuse is to stop.  A couple bringing different agendas into couple counselling will find this approach nearly impossible to practice.
• A core belief for this process is that the abuse occurs between the couple – this is not one partner being responsible for the abuse (and the other being responsible for receiving it) therefore it must be the abusive partner that has to be treated; both partners are treated simultaneously in the relationship.

Step 1) The couple counsellor discusses with the couple how the abuse begins (for this example, let us assume that the abuse the couple experiences begins with the couple arguing):-

Therapist: “Who first notices that an argument is beginning?”

The couple are helped to discuss this.  There is no assumption that one partner will notice the process is beginning before the other.

If the partners agree that one partner notices before the other then the therapist will start with that partner.  If the couple cannot agree, or both partners find that it can be one or the other partner who notices the argument is beginning, then the therapist will talk to the hypothetical “first” partner.

The couple are invited to agree upon a safety word.  This word must be instantly recognisable by both partners when it is spoken.

Step 2) Interrupting the argument – the beginning of the Safety Plan.

Therapist (to the “first” partner identified above): “I want you to take responsibility for this step: when you notice that an argument is beginning I want you to use the safety word that both of you have agreed upon.  When you say this safety word whatever you are both doing must stop and you must leave the room.  You can leave the house, you can get into the car, you can go anywhere but you must leave your partner’s presence.”

Therapist (to the other partner): “I want you to take responsibility for the next step: when you hear the safety word you are going to ensure that you do not stop your partner from leaving the room.  Whatever it takes you to manage this, you’re going to allow yourself to let your partner leave.”

Therapist (to both partners): “When you are in this separation process, you are to stay apart for as long as it takes for both of you to calm down.  How long this takes depends on you both.  How you negotiate if it’s OK to come back together depends on you both (and we can talk about that more too).”

Step 3) Coming back and having a conversation.

Therapist (to both partners): “When you both decide that it is safe for you both to come back together, do so and begin a conversation about what was happening just before the safety word was spoken.  Some things to converse about might include:-

• What was happening for you just before the safety word?
• What did you notice was happening for your partner just before the safety word?
• How do you think that combining these experiences was leading towards the argument (and, later, towards domestic abuse).
• What could both of you do differently individually, for your partner, and as a couple to make the Safety Plan redundant?”

“… you might not get very far with the conversation to start with, and we can discuss that more in session here.

“If one of you notices that the conversation is leading towards an argument again, say the safety word and start the process again.”

Step 4) Using Couple Counselling Sessions to support the process.

It’s not unusual for a couple to find the Safety Plan is difficult to “get right” to begin with.  After all, as some level the couple have been used to the process that leads to domestic abuse – sometimes for years – and to perturb that system will be difficult, particularly as the violent approach has become somewhat second-nature.

So, couple counselling will provide a place where the plan, the experiences of the plan, the perceived “failures” of the plan can be discussed and worked through.

Creativity is encouraged – creativity is a useful antidote to responses such as “but I can think of how I will leave the house” (for example) where both partners are encouraged by the therapist to think of their own approach to working through each “but I can’t” issue.

The couple therapist must also take a proactive position asking about the process each session (for example, some therapists do not start sessions, instead waiting patiently for the client to find the subject they want to begin with).  The therapist takes responsibility for helping the couple manage and keep managing the process to change the abusive system already in place.

In summary: Domestic Abuse & the Safety Plan.

A systemic/psychodynamic approach to couple counselling can help the couple address matters of domestic abuse. The systemic approach is to help the couple perturb their conflicts by learning about the couple’s relationship-behavioural systems (when he does A, she respond with B, that sends him into C, and she with D…).

The safety plan incorporates the systemic approach – but in a more directive way, giving the couple a framework in which they can instantly stop their system that leads to abuse, learn about their system (the later conversation in safety – also in the counselling session), and put in places different behaviours that can stop the system in its tracks.

Not all couple counsellors choose to work with couples who are in a violent/abusive relationship – if you’re thinking of engaging with a couple counsellor, check with the counsellor that they will work with the relationship first.

Image copyright: © Nina Matthews Photography: http://www.flickr.com/photos/21560098@N06

As a primarily-psychodynamic counsellor/psychotherapist, I practice certain techniques which help me maintain the therapeutic-alliance between my client^[1] and I.  Two techniques I find very helpful come from Patrick Casement (1985): trial-identification and internal supervision.  These are methods, in addition to using my counter-transference, attempt to assist me in being able to put myself in the client’s place; to gain insight into how the client is feeling (even if the client may not know him/her/self/themselves) before and after I offer an therapeutic intervention to test out how it might be/have been received

A story for you: whilst preparing the room for a client some months back, it occurred to me that there might be another way to gain insight into a client’s perspective …  to literally sit in the client’s chair(s).^[2]

Whilst waiting for the next session’s start time, and with the room’s door closed, I chose to sit in the client’s chair for around five minutes.  I pondered about the counselling work that I and my client were doing together.  I noticed how different the room looked from this perspective and how odd it felt looking a the room from here.  I could see the chair that I normally sat in.  I noticed the plants behind that chair that I would not see during session.  I noticed the clock behind where my head would normally be.  The room looked quite different, rather larger in fact, and the space felt somehow at odds with itself.  During this sense of difference I considered the counselling case and the past few sessions.  By the time the session was due to begin, I had reverted back to my own chair and did not overtly^[3]  share my behaviour with my client.

Where had this inspiration come from?  I can tell you that some ten years ago, the counselling organisation^[4] in which I used to work sent down a request from the organisation’s supervisor of supervisors.  The message to all counsellors was along these lines: when your client is late for a session, try to avoid waiting for the client in the office/common room; instead wait in the counselling room itself and reflect upon the counselling work with your absent client.

To this day I still continue that practice to of waiting in the room for a late-client.  But on that particular day, several months ago, the inspiration to sit in the client’s chair, privately and prior to the session, brought some interesting insight into the case that I had not considered before; I had gained a small but important additional viewpoint, I was looking at things from a different position (literally and figuratively).  It has proved to be useful from time to time and now forms part of my therapy toolbox.

Have you experienced insight into a counselling case through sitting  in the client’s chair?

Bibliography

1. Patrick Casement (1985), On Learning from the Patient.

Footnotes

1. For this article I am defining the term “client” to include an individual, a couple’s relationship (couple counselling), a polyamorous relationship-group or a small therapy group ^
2. …before the client arrived for the session, and done so in private; this is an experience for the therapist – it is not to have the client feel threatened because the room, its layout, boundaries and the client’s own chair are being changed or invaded by this practice – though if we believe in the unconscious the client will be aware of this approach at some level. ^
3. … although I did use the experience to inform a number of potential interpretations that I considered for my client) ^
4. Chichester Counselling Services, West Sussex ^

Image copyright: Photo by mynameisharsha: http://flic.kr/p/5s24kK

How good are you at making a good first impression?

If you’re working in the area of health and wellbeing you need to look… um… healthy and well for a start!

I’ve actually had a conversation with someone who was impressed by a health product but did not get it because they thought the person promoting it did not look at all well!

What we’re talking about is walking the talk – and it applies to all businesses, including counselling, psychotherapy, hypnotherapy and complementary wellbeing.

Please choose me…

We know that clients sometimes choose their therapist on the basis of: ‘Well, I liked the look of the photo on your website!’. However that might grate on us – surely our clients are choosing us for our expertise rather than our looks! – these first impressions are important.

Is the first impression you’re making in tune with the quality and professionalism of your unique therapy business?

Are you looking good enough?

Of course therapy is about far more than just ‘first impressions’ and surface appearances, but we all make assumptions and even judgments in those first few moments of meeting someone or seeing their photo, and so it’s important to make sure the first impressions are good ones.

One thing you may not have considered before is checking whether you’re wearing the right colours to bring out the best in you. The best-known organisations are www.houseofcolour.co.uk and www.colourmebeautiful.co.uk both of which have local representatives.

Does that sound like a self-indulgent thing to do? I believe it’s essential that you come across as a vibrant energised persona and wearing beige when beige drains you is not going to help!

‘Cheap and cheerful’ doesn’t cut it

What is your business card like? Does it look as if you have a busy and thriving practice meaning that you can afford a card that looks and feel nice? Or does it look home-made or of poor quality – creating the impression that so few clients come to you that you cannot afford to get a decent card designed and printed?

Similarly your website – does it look slick and professional or does it look like your teenage son did it as a school project? You don’t need to pay a lot of money to get a decent site done. Yes, getting one done by the professionals will undoubtedly help in getting their advice about good client engagement across the internet.

But if you’re having to control the spending just now you can find no-charge templates that look very nice, using blogging software such as www.wordpress.com or www.blogger.com

Picture power

How are the photos on your website, in your marketing materials and on your social networks? Do they show you and your business to the best advantage or are they a bit out of date, slightly out of focus and something you meant to change ages ago…

How many client testimonials are you displaying – if you have none, how will someone new know that you’re any good when they first read your flyer or click onto your website?

Bottom line…?

You might be lovely, smashing at your business and the perfect person for a potential client but if you’re not consciously thinking about how you come across to a stranger you’ll be getting in your own way I’m afraid.

About our Guest Author Jane Buswell.

Since 2003, Jane has brought her marketing expertise to literally hundreds of businesses from one man bands to larger organisations. Her popular and accessible marketing workshops have been delivered for organisations including Business Link, CIBAS, PETA, Southern Entrepreneurs and Winchester University.

Her expertise is in simple step marketing that works, indeed she has been referred to as “the marketing consultants’ marketing consultant!” She is also known as the Postcard Queen for her recognisably quirky marketing postcards.

Take advantage of marketing hints and tips on her popular blog Business Fulcrum as well as on Twitter via @janebuswell.