Unblocking the writing block – what works for me

So, it appears I will be able to continue into 2nd year as the examination board of my course has agreed that I can carry on the expected 100 hours of client work into the next stage of my studies. This is quite a relief but it comes with the pressing thought that I’d need to catch up with hours whilst trying to meet the 150 hours expected for year 2!*gulp*… I have also finally received all my grades on work I’ve done during year and I’m beyond pleased to realise that I haven`t failed anything in year 1! To be honest, I find this hard to believe and I’m still thinking things like ‘’maybe there is some other assignment left that I’ve forgotten about’’. Fortunately, in year 1 most of the work took form of assignments, reports, studies etc., and nothing from the sort of a viva or presentations, like M had to do.. *phew*.

I don’t think I got great marks and I don`t consider myself an excellent academic, but it seems I have done something right and will attempt to repeat it. I was told that year 2 will bring along an increased number of written works and of course – more close deadlines. So, I was thinking back on all those times when I felt that I just don`t want to think or touch anything psychology related, let alone complete a decent assignment, added to the stress..stress..stress of placements, supervision and whatever else.

Thinking back, I can say that I have come up with a personalized working strategy which I’m gonna share here (in case I forget it :P ) that seems to have helped me go through the year. First and most important is the old saying ‘’know yourself!’’ What I mean is this- I know that I am NOT able to write anything in the last minute. It’s simply impossible for me to start 3-2-1 days before the deadline, and no, it’s not because I’m such a diligent student. It is purely because if I have so little time left I just wouldn’t want to go through the pain and struggle of sleepless nights..not even one! No way! I just value my sleep too much and no assignment is worth more than my peaceful sleep!! I know many students would disagree, but this is what I mean when I say –know yourself and what works for you.

What works for me in fact is much beyond a peaceful sleep. It’s more like a Zen-chilled type of mood that I need. I’m aware of how pretentious what I’m gonna write down may sound..but writing is not something that comes easy at times when I just have to do it. I normally start an assignment about 3 weeks before the deadline and try to follow a very chilled routine. This includes waking up at around 9, having my coffee and emails in the morning..dog out for a long walk, clean up a bit or do some workout, or just lazy around at home if that’s what I fancy. At around 1 or 2pm I try to gradually start writing, not pushing myself too much. If I’m not in the right mood yet (this happens if I get pissed off in the morning by some unpaid or new bill in the post, annoying email, or even my dog pulling me around too much, lol, god..i can be such a princess) Anyways, if I’m in a bad mood I would try to do some creative work normally decorate, move furniture or fix something in the garden and let my serotonin does its job.

Once I’m beginning to write, music is also very important. Whilst writing I can`t listen to music with lyrics (especially in a language I understand). This is because I end up listening to the songs, so I typically go for relaxing feng shui music. Apparently, some of those songs contain sounds with brainwave stimulation that improves your concentration (I don`t know if that’s the case but it works for me regardless). In fact, I have a favourite album which comes to the rescue when I’m completely blocked in my work. I think knowing the songs well allows my mind to relax. This is the one,lol:

So, at times I’d stop writing at around 5-6pm or go on till late in the evening. In case that the day is too busy or doesn’t allow me to chill, I just decide not to write (I try not to postpone, I just decide – so that I don’t need to think about it for the rest of the day).

The problem with the above scenario is that it’s hard to achieve on daily basis, considering traveling around and other money-related responsibilities. So it’s been very hard to find the time and have a reduced stress assignment-writing experience, but it has definitely worked for me, and I intend to keep using it..hopefully it will get me through year 2 as painless as possible (which btw starts next week :/ ). I wonder what other people’s copying strategies are..or do they have ones?!?

 

A.

Harm Minimisation

Came across a rather new concept for me today- Harm minimisation. It’s an approach used in working with individuals who self harm. It recognises that life can sometimes be too unbearable for some and self harming may be the only way to cope perhaps for the time being. So, although it doesn’t encourage the act itself, it educates individuals on how to self harm safely. For instance, using a sterile blade to cut instead of a dirty one to prevent infection or cutting lengthwise instead of across to reduce the risk of severing tendons. This approach is also used in other areas in public health such as drug use, safe sex and prostitution. It makes sense in a way but I am not sure if it’s a long term solution (or that it’s meant to be one) as I feel that there are definitely underlying issues to be explored if self harming is elected as a coping mechanism.

I think this quote explains this concept very well:

“Habit is habit and not to be flung out of the window by any man but coaxed downstairs one step at a time” Mark Twain (Pudd’nhead Wilson’s Calendar, chapter 6), cited an article by Marlatt, Somers and Tapert (1993) on Harm Reduction: Application to Alcohol Abuse Problems.

If you would like more information you can go to this website: Self harm.co.uk or HarmLESS Psychotherapy 

Reference:

Marlatt, G.A., Somers, J.M., Tapert, S.F. (1993) Harm Reduction: Application to alcohol abuse problems. NIDA research monograph. 147- 166

Naranjo, M. (2012) Webinar on Self-harming Behaviours. Online Events. 23rd August 2012

M.

The sob story- What did I do wrong?

I think the fundamental thing that I did wrong on this assignment was that I had not done a thorough assessment and this affected the quality of my psychological formulation. A weak assessment does not provide a good background history for the marker/reader. In retrospect, this is perhaps my biggest struggle especially at the beginning of my counselling work. How much do we need to know about the client for therapy to work? Also, with a non-directive approach such as person centred, how do one then ‘question’ the client about their past? From a counselling perspective, if we are working on the current issues that clients bring, why do we need a detailed background history of the client? Why do we need to chart their childhood and adolescent relationships? Why are these relationships then used to produce a formulation of the client? Why doesn’t the formulation just describe how the client presented him/herself in therapy, what was worked on, what could be different and why.

In my defence, I had sought for these questions to be answered but perhaps due to my trainee status I was told that I was being too anxious (which I was, more so when I don’t know how to marry practice with professional requirements), uncomfortable with the non-directive nature of therapy, trying too hard, just need the therapy to be etc…  however I was also told that I should make my own assessments which was a very useful piece of advice. Now, why hadn’t I thought about this before? At the beginning of the year, I got a sense that one has to be qualified or experienced to make an assessment of the client after hearing from my colleagues how they shadow qualified practitioners while they make assessments or that they were simply provided with case notes that contain client background information. However, after recent discussions with my colleagues and reflection, I now know that being informed about their past allows for much greater depth in my understanding of the client. It puts the issues presented by clients into a wider social context where the interaction between the self and environment can be examined. This in turn allows for a more holistic therapeutic intervention and perhaps epitomise the idea of an idiosyncratic approach that prioritise subjective experience of individuals.

Having said all that, I think that there is another reason to the disappointing results I got – emotions or more accurately not communicating enough personal feelings about the client. A story for another time. :)

M.

The sob story

After months of getting to terms with the news, it’s now easier for me to say yes I failed an in depth client study/ process report. I have grappled whether I should share that here but what’s the sense in only sharing the superficial difficulties of the course and not the real challenges faced by me on the course. After all the reason I started this blog is to offer those considering this field a better idea of it when back then I couldn’t find qualitative information.

On reflection, it was a huge shock considering that the assignment was the last piece of work for the year and I thought I had improved from when I first started on this course. To make things worse, it was just by 2%! Well I know a fail is a fail but 2%! Sigh…

So many feelings flushed through me the past 1 and half months; justifications, excuses, self defeat, increased motivation, challenged, questioning, blaming, jealousy, unfairness, apprehension, uncertainty, hope, supported, confusion… Some have resolved itself, some consolidated itself.

Perhaps the best way to start is to consider and clarify what is an in depth client study/process report. It is essentially an assessment and psychological formulation of the client’s presenting issues. The second part of the assignment then requires a transcript of a session with the therapist’s thought process and reasons for intervention. Finally, what you have learnt from the client as well as the placement. So as you can see, the first part requires a professional examination and evaluation of the client’s mental health and the second and final part considers the effect the client and the therapeutic relationship have on the therapist. Having said that, the piece of work relies heavily on the subjective opinion of the psychologist and is in no way claiming the absolute truth to the client’s issues. Another person might come along and come up with a different formulation based on their impression of the client.

Hm, I wish I had such a clear idea of it then. Takes a fail to really push me huh.

So what did I do wrong then? – to be continued.

M.

Poster presentation?

So, my research supervisor just emailed me and ‘asked me’ if I have the time and whether I would be able to come up with a draft poster (based on a piece of literature review I wrote as part of the course) for a conference in November. My answer? Hell ya!

I know I’m all geeky but this is exciting news! Boosts my confidence again after the failing of one of my other assignment (story for another time, a loong sob story). Life is all about ups and downs- momentary ones at that too.

M.

A psychologist’s holiday

So what does a psychologist do on her holiday? Taking on the theme from the previous post, when does the holiday begins and when does it end? Do we ever stop analysing the world around us, applying theories to others’ plight, processing the deeper meanings behind people’s words, making hypothesis of ones’ developmental journey etc… Do we ever let our mind rest? Or is it so ingrained and so part of our being that we just can’t stop! Well, to be honest, I can’t. Even more so during holidays! I tell myself I have so much more time on my hand and this is the time to put to practice what I have learnt to see if I have achieved any self development. To push myself that bit further, challenge my insecurities and boundaries.

I was at a dinner gathering few weeks ago, and a friend asked me – ‘would you refer on a client whom you think you can’t work with?’ and that question dumbfounded me for few seconds. That is a question that have been asked many times over in interviews or in social occasions, but somehow my answer changes every time. At first I would talk about which kind of clients I think I can’t work with due to my own personal issues with the matter they bring. But having recently read Yalom’s ‘Love Executioner and Other Tales of Psychotherapy’, I wondered if there are truly anything that we can’t work with and whether it is a matter of us not wanting to work with it. Yalom found the idea of obesity repelled him, which he acknowledged at first instance but decided to take on the female client nonetheless. It is indeed admirable that he decided to challenge himself and understand more of his personal issues with obesity by learning from this client- empathising with her struggles and finally seeing the woman who desires to be loved like everyone else working hard towards achieving this goal. His own issues with obesity also helped the client to understand how others are perceiving her which highlights for me the the notion of bringing one self into the consulting room.

It is this torn between being me and being an understanding therapist that I have struggled with. Unconditional Positive Regard (Rogers, 1961) can be offered at first instance, but sometimes it does not come as easily as one thinks. Nonetheless, I believe we are equipped to delve deeper on why that is not the case with some clients.

Hm.. someone remind me I’m on holiday again please.

M.

Some of the books I have referenced here are:

1. Love’s Executioner and Other Tales of Psychotherapy by Yalom, I.D. (1991)

2. On Becoming a Person: A therapist’s view of psychotherapy. by Rogers, C.R. (1961)

Client hours,deadline after deadline..when do they end and when do they begin?

So, this summer has been (and still is) revolving around deadlines. Dead and line..oh, god..couldn’t they come up with a worse word to call it, something more motivating and encouraging perhaps?!?

Anyways, you can probably sense my annoyance with those deadlines all summer. When does summer begin? Apart from the horrible weather here in Scotland, and all those deadlines to meet I have the feeling the academic year will never end!!! Apart from trying to fit into those dates for when assignments, reflective essay, systematic review, draft, then corrections, then a log book, mid and end-placement reviews.. I’m also trying to gather enough client hours to be able to pass into 2-nd year. I just can’t help but laugh with irony and pain on the thought of meeting all the deadlines,get good-ish marks and then being told to skip a year making up for client hours!hahahah..:”(

The problem with client hours in placements is something which I feel I would have avoided if I was prepared, or simply told by a placement tutor or a student buddy or something. This is why I feel it’s important to share it here, perhaps someone will avoid this unpleasant situation. The thing with my placements was that… well, I found them early (on time lets say) to be able to start seeing clients and not panic too much that i’m the only one left without a placement. So, I found 2 placements – one in a small private counselling centre (that was offering me to start asap) and another in a big, well-known counselling organization (that wanted me to have a PVG update before I started). Even though I have been a PVG scheme member and have recently been through a Disclosure Scotland for working with vulnerable groups (which is a must here) the big centre sill wanted an update (fair enough). However, I was not told that this update will come through in 3 months time!!

So, since my start with the small private centre (which was able to give me only 1 client and later on a 2nd one) I have been waiting for that update to be able to actually start counting real hours. Well, I got the update in June and started with 1 client so that I could get used to their system. So currently, towards the end of my summer I still have only 1 client and very little placement hours. I have obviously spoken to my managers and they are trying to arrange more clients for me in the coming weeks from both placements..all I can do is cross fingers at this point and hope it’s not too late:/

University is particularly strict with client hours and do not allow students to pass into 2nd year of the course unless they’ve done a minimum of 50 placement hours. I’m trying to find where i’ve gone wrong, what have i missed out to get into this mess. I don`t like to blame others, so I suppose the mistake was all mine to think that things will be fine. However, I’m also thinking that placement tutors are responsible for advising us regarding placements and I have received only minimal support from mine..was he supposed to inform me early about such possibilities??In fact he was telling me – “Oh, don`t worry about finding a placement early, I only started mine in March”

Another thing which sort of hurt me a bit from this situation is that.. in reality – I had to “beg” my managers for more voluntary, unpaid work..not picking flowers in the field, but counselling troubled people (dont get me wrong- I love the job). .but this, considering my financial situation is quite a thing. This is another topic on it’s own and i’m not going there.

I did not want to complain and nag here, but it seems like I did. Anyways, my point is that D.Psych students need to be informed and prepared what challenges to expect from placements and collecting client hours early enough so that they can plan their progress. I hope this example reaches those who may eventually fall into a similar trap, and helps them avoid it.

 

A.

Posttraumatic Growth… ancient, universal and not well understood

This summer I have spent most of my time researching and digging up info on what is being called Posttraumatic growth (PTG) experience. Most of what I’ve learnt about the phenomenon, in particular relation to violence and abuse, I have included in my systematic review. However, while learning about the phenomenon of PTG I wondered how far back could I trace any documented accounts? I got to learn some curious historical facts that’ve decided to share here, and hope others may find it as intriguing as me.

What is PTG on the first hand?…According to Tedeschi, one of the developers of PTG research: ‘’at least for some people, an encounter with trauma, which may contain elements of great suffering and loss, can also lead to highly positive changes in the individual. It is a change in people that goes beyond the ability to resist and not be changed by highly stressful circumstances; it involves a movement beyond pre-trauma levels of adaptation and has a quality of transformation, or a qualitative change in functioning.’’

In short PTG holds that while trauma can be painful and have highly negative outcomes, there is also an opportunity that trauma can serve as a catalyst towards personal growth in one’s life.

So, when was it that people realised that with suffering comes strength?

Starting with the Bible itself,  I found a number of suggestions of positive transformation in the aftermath of suffering, such as: ‘’we rejoice in our sufferings, because we know that suffering produces perseverance, and perseverance, character; and character, hope’’. Another example is the biblical narrative of the Great flood found in the Book of Genesis and the Quran. It depicts a symbolic rainbow with which God promises Noah not to kill again and that this is the beginning of a new life.

Another, quite touching story is about Buddha and the development of his enlightening view. Born in a royal family in North India, before his enlightenment Buddha was a prince whose parents wanted to keep away from the pain and dissatisfaction of the world. The first 29 years of his life were filled with all aspects of joy, until a time when he met with suffering in 3 subsequent days. Outside his castle ‘’he saw someone desperately sick, someone wrecked with age, and finally someone dead. He was beyond thinking of himself, but the awareness that pain strikes everyone gave him no rest’’. Stroke by this insightful experience about the inevitability of suffering, Buddha fled his palace and began his journey into the understanding of mind’s timeless essence and all beings’ wish for lasting happiness. His countless encounters with pain allowed him to mature, to learn about the human mind’s potential which later led to his enlightenment. The symbol of a rainbow is also found in Buddhism and serves as a reminder of the positive.

A quite popular example of posttraumatic growth motive, found in a non-religious context, is the myth of a phoenix being born from its own ashes after being fiercely burn. Interestingly the myth is found in the mythologies of many ancient cultures such as Arabian, Persian, Greek, Roman, Egyptian, Chinese, and Indians.

Also, from the time of the ancient Greeks to the present day, tragedy has been a dominant theme in great literary work and that the popularity of such texts has impelled authors and philosophers to ponder what attracts people to themes of suffering. For instance, Aristotle’s Poetics offers plots where the protagonist is involved in a high degree of suffering, usually involving physical harm and death. When a character is unfortunate, the hero’s remorse provides a catharsis that is purifying, and perhaps therapeutic for the spectator shared opinion among representatives of the moral understanding of tragic catharsis is that Aristotle contemplated tragedy to be ‘’particularly well suited for educating the emotions and for building character; for it offers a way we can learn to know  and develop the appropriate emotional responses without having to undergo ourselves in reality the dramatic situations represented in a play.’’

Perhaps, the best know suggestion of posttraumatic growth in written text comes from the German philosopher Nietzche, whose words: “That which does not kill us makes us stronger” still resonate in Western society. There are numerous debates regarding the accuracy of his statement.

Actually, among the most expressive defenders of the idea of positive changes following adversity was the Austrian neurologist and psychiatrist Viktor Frankl. His book ‘’Man’s Search for Meaning’’ chronicles his experiences as a Holocaust survivor, the loss of his family and his struggle to survive. He writes: ‘’The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity- even under the most difficult circumstances – to add a deeper meaning to his life.’’ During his career, Frankl developed logotherapy and taught about the two-sided face of suffering – while there might be nothing inherently good  in misfortune, it might be possible that to extract something good out of misfortune.

Currently, the idea of meaning found in a suffering finds further support in the work of the existential psychologist Irwin Yalom. He teaches about four ultimate human concerns: death, freedom, isolation and meaninglessness and how confrontation with each of these may result in an existential conflict. In his words: ‘’A core existential conflict is the tension between the awareness of the inevitability of death and the wish to continue to be…A real confrontation with death usually causes one to question with real seriousness the goals and conduct of one’s life up to then.’’

The historical accounts of the PTG phenomenon go on and on. This makes me wonder whether PTG knowledge can find a place within psychotherapy and whether there is something we can learn from it about the human nature in times of adversity.  Fortunately, empirical interest has noticed the PTG potential. A more recent and scientific attention to PTG has occurred in the past decade with the development of positive psychology. The field advocates that life comprises of ups and downs and that it is naïve to hope for a life without any pain, rather to understand how to learn and grow from adversity. This makes me feel optimistic about the future of our understanding and treatment of trauma. Or, is it too naive to think that through tough experiences people are presented with a chance to develop an ability to cope with difficult situations in the future and simply because a misfortunate has happened to someone it means that they are condemned to be damaged from then on?

A.

Sources:

Frankl V.E., (1985) Man’s Search for Meaning, New York: Washington Square Press

Joseph S., (2011) What Doesn’t Kill Us: The New Psychology of Posttraumatic Growth, Basic Books, New York

Nydahl (2008) The way things are: a living approach to Buddhism, John Hunt Pub

Tedeschi, R. G.,Calhoun L., (2006). Handbook of posttraumatic growth: research and practice, Lawrence Erlbaum Associates Publishers

Yalom, (1980), Existential Psychotherapy, Basic Books

Here I come! A.

Well, there is a silly question:

- How many counselling psychologists does it take to start the elevator?

- Erm, normally one (unless they are in ‘’reflection’’ mode or sth.)… Actually, I have no answer to that question. In fact, I just wanted to direct your attention to the following: Don`t know if this ever happened to you, but I have noticed that when my colleagues and I enter an elevator everyone is so chatty and animated by being around like-minded people that for a moment everyone seems to have forgotten the purpose of the raising and lowering box and the target location.. Then, suddenly a female voice gets you back to Earth: ‘’Doors closing’’.

This blog makes me feel as though being there, in such an elevator, in some type of hypnotic state that gets my psy-mind running up and down with ideas. Thank you M. for the invite! It’s a great pleasure being part of your CP cyber world, as well as to share this staggering journey with you and your readers!

A bit about me – I am also a trainee in the practical counselling psychology doctorate. My training is in a different from M’s institution, which I guess allows us to compare and perhaps get a better impression of the commonalities and differences between the available routes of becoming a CP in the UK and Scotland (where i`m based).

Wishing best of luck and inspiration to all,

A.

 

Statistical jargons in literature review

These statistical jargons are presented as how I understood them in terms of research for psychological treatments but is generally applicable to the field. Tough learning especially when quantitative research/statistical analysis is not my strong field at all. Slightly uncomfortable about reducing individuals to subjects to be studied and talking about them as though they are something to be measured rather than each having their idiosyncracities.

Effect size : small, medium, large-
-more commonly reported in the social science research when reviewing literature’s results (if I understood correctly) in addition to statistical significance ie. p values.

between and within subjects paradigms
- between subjects is the measure of outcome for examples, across different psychological treatment
- within subjects is the measure of process for example, difference pre and post treatment
- important for issues of internal and external validity. At the moment, I only understand external validity as whether the results is generalisable to the population studied.
Edit: internal validity is whether the effect studied is indeed the one affecting the results and not some other unwanted variable. For example, in comparing a psychological therapy to waiting list- results may show a positive outcome for those being seen by a therapist but is this due to the psychological treatment per se or other factors such as further deterioration of mental health due to the passing of time being on the waiting list.

Participant used for final analysis : intention-to-treat vs completers
- Intention-to-treat is an inclusion of all participants that were originally assigned to an experimental condition into final analysis. .
- Completers analysis includes only participants that completed the course of psychological treatment. This may present bias results as individuals who do not complete a psychological treatment for example may have dropped out because they don’t feel it was working ie. negative outcome

Ok, this is as far as I have gotten at the moment in what I use in my review of the literature. I am aware there are so much more to learn. For example, different kinds of statistical analysis may have their own pitfalls for example, random effects analysis may yield a more conservative measure of combined effects. Not even going there at the moment.

M

Proudly powered by WordPress
Theme: Esquire by Matthew Buchanan.