Winter 2019 •

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py a Volume Volume 19 •

Irish Association for Counselling and Psychotherapy Road to Road Recovery formerly formerly

l of Counselling Counselling l of a

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a Journ A World of Dichotomies: Empirically Supported World A or the Common Factors? Treatments each other? Supporting Couples to Improve their Communication Part 2 – The Process of Psychotherapy The Process Part 2 – we just talk to Can’t private practice William Glasser: A simulated interview with Powerful, seductive and alluring? Money inPowerful, The Irish The

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Volume 19 • Issue 4 • Winter 2019 IJCP Volume 19 • Issue 4 • Winter 2019

Contents

From the Editor 3 Our Title In Autumn 2017, our title changed Powerful, seductive and alluring? Money in private practice 4 from “Éisteach” to “The Irish Journal By Terry Naughton of Counselling and Psychotherapy” or “IJCP” for short.

A simulated interview with William Glasser: 10 Disclaimer: Part 2 – The Process of Psychotherapy The views expressed in this By James C. Overholser, Ph.D., ABPP publication, save where otherwise indicated, are the views of Can’t we just talk to each other? 15 contributors and not necessarily the Supporting Couples to Improve their Communication views of the Irish Association for By Brendan O’Shaughnessy Counselling and Psychotherapy. The appearance of an advertisement in A World of Dichotomies: Empirically Supported 19 this publication does not necessarily Treatments or the Common Factors? indicate approval by the Irish Utilising Evidence Based Practice and Practice Based Association for Counselling and Evidence to mediate this Discourse and Improve Practitioner Psychotherapy for the product or Outcomes. service advertised. By Daryl Mahon Next Issue: Book Review 25 1st March 2020

Poetry 26 Deadline for Advertising Submissions for Next Issue: Noticeboard 27 1st February 2020 For more information regarding advertising please contact Hugh O’Donoghue, Communications and Media Officer by email: [email protected] Editorial Board: or by phone: (01) 214 79 33 Mike Hackett (Chair & Editor, Winter 19), Cóilín O’Braonain, Hugh Morley, Maureen McKay Redmond, Kaylene Petersen (Assistant Editor), Annette Scripts: Murphy. Each issue of IJCP is planned well in Design and layout: advance of the publication date and GKD.ie some issues are themed. If you are interested in submitting an article ISSN: for consideration, responding to 2565-540X the Therapist’s Dilemma or wish to Advertising rates and deadlines: contribute a book or workshop review Contact the IACP for details. (Early booking essential) or Letter to the Editor, please see ‘Guidelines for Submitting Articles’ © Irish Association for Counselling and Psychotherapy – IACP on the IACP website, www.iacp.ie. All rights reserved. No part of this publication may be reproduced, stored in, or introduced into a retrieval system, or transmitted in any form or by any means (electronic, mechanical, Contacting IJCP: photocopying, recording, or otherwise), except for brief referenced extracts for the purpose [email protected] of review, without the prior written permission of the copyright owners.

Irish Association for Counselling and Psychotherapy Volume 19 • Issue 3 • Winter 2019 IJCP

From the Editor:

significance of money” in their lives practice nascent communication and one I’m sure will be very helpful skills at home. To conclude, he in your work with clients for whom invites therapists to move beyond money is a therapeutic theme. simply supporting clients with skills In our second piece, we present development, but to help them part two of James Overholser’s “inoculate against future damage and article series focussing on the work hopefully salve past injuries inflicted Dear Colleagues, of William Glasser. In this article, by hurtful words”. James takes a reflective stance in his In our fourth article, the We wish you a very warm welcome to questions pertaining to The Process controversy and ongoing discourse the Winter edition of the Irish Journal of Psychotherapy in his simulated between evidence based practice, of Counselling and Psychotherapy. interview with Glasser. The piece empirically supported treatments As I write, the clocks have just been ranges broadly, exploring the nature and common factors (those which set back for winter time, day length is of therapy, advice for new therapists, span all therapeutic modalities) is diminishing rapidly, and the colours questions which help clients reflect presented in detail by Daryl Mahon. of the season fading from green to on their needs and need satisfaction, Though quite a technical article, rust. This is often a time for reflection to matters of personal choice, being Daryl creates extremely helpful and restoration following a hectic accountability for their wellbeing moments of contact with the extant year of work and responsibility, an and the nature of Reality Therapy as research literature at the heart of opportunity to take stock and maybe a means to effect positive, lasting the debate leading us to consider even do some celebrating in the change in the lives of clients. The how we as therapists position upcoming holiday period. In this article ends with a cliff-hanger ourselves within the measure/no- edition then, we present four articles moment, whetting our appetite for measure continuum. As a useful which in their own way reflect on key part three of the series which we look starting point, Daryl highlights aspects of what we do as therapists. forward to presenting in the Spring Routine Outcome Monitoring In our first articlePowerful, 2020 edition. systems which are straight forward seductive and alluring? Money in Our third contributor, Brendan to implement in practice and have private practice, Terry Naughton O’Shaughnessy offers a practitioner been demonstrated to be helpful comprehensively explores the reflection with practical suggestions in tracking “client progress, identify subject, object and symbolism of for working on the topic of those at risk of deterioration, and money in the therapeutic space. communication in couples therapy. drop out and those responding to Highlighting the dearth of attention Based on nearly 30 years of interventions”. paid to the topic of money in therapy experience, Brendan describes the We hope that the diversity of training, Terry explores money beyond impact of communication difficulties thought, presentation, theme and the apparently simple fee transaction on divorce rates, offers insight into content in our winter edition provide between client and therapist. In traditional approaches used to help useful insights and plenty of food for particular, Terry charts its relevance couples improve their communication thought. But for now, all that remains in the process of therapy. For skills and charts an additional for this edition is for me to wish you professionals, she provides a useful approach grounded in his adaptation all a very Merry Christmas, Happy tool to reflect on our relationship of the work of Joseph Zinkler Holidays and Compliments of the with money - The Money Genogram. (renowned Gestalt couples and Winter Season ahead. For clients, the Family Financial family therapist). In the final section Questionnaire provides a means to of his work, Brendan offers practical Mike Hackett, “explore the historical and emotional suggestions should couples aim to Editor, Winter 2019

Committee update: On behalf of the IJCP Editorial Committee, I would like to extend our most sincere thanks for the wonderful response from members calling for volunteers to join our committee. We are still working through the approval process and will make an announcement to each of our applicants in the next few weeks, with a formal announcement to follow in the editorial of the Spring 2020 edition. We are also heartened by the volume of submissions we have received over the last couple of months from members of the IACP and from our international contributors. Please keep your articles, papers, research coming (and if you do not want to write something in an academic format, please consider submitting a reflective or practitioner perspective based on your experience as a therapist). Contributions from members are the life blood of our journal. Thank you to all of our applicants and contributors.

Irish Association for Counselling and Psychotherapy 3 IJCP Volume 19 • Issue 3 • Winter 2019

Academic Article Powerful, seductive and alluring? Money in private practice By Terry Naughton

Money and therapy Rowe (1997) states that “we recognise money, but we don’t know what it means. We alone of all the animal species use money, but we don’t understand it. How could we, when money has for us many different meanings?” (p.12). Referring to money, Krueger (1986) observed that it is one of the most emotionally charged elements in present-day life. The only other two competitors for such varied and strong emotions, fantasies and strivings are sex and food. Some of the words used by Trachtman (1999) to describe money are – “powerful”, “seductive” and “alluring” (p.275). Unexamined thoughts and feelings about money can have a great impact on the therapeutic n the practice, literature and training of process (Newman, 2005). Money psychotherapy, money is one of the most ignored may be associated with a number “I of themes that are relevant in topics and, while it remains unaddressed, it leads to an therapy as suggested by Shapiro emotional taboo regarding financial matters” (2007), which include boundaries, family of origin, trust, conflict and (Trachtman, 1999; Tudor, 1998) power. Chan-Brown, Douglass, Halling, Keller and McNabb Introduction money, money as a taboo, lack (2016) highlight the importance ne of the most commonly of training, therapeutic process, of thought and personal history Oignored aspects of fee setting, fee concessions, while Barth (2001) believes issues psychotherapy in training, literature discomfort charging a fee and related to self-worth, feelings and practice is money, often ethics will be explored in detail of deprivation, concerns about resulting in therapists disregarding in addition to considerations for envy and competition may also it (Krueger, 1986; Monger, changing current practices with be present. Meaning making is a 1998).This article will explore and regard to how money is dealt with common theme in therapy and is outline the relevant literature on in therapy. Finally, conclusions an important component in the money as it relates to counsellors reflecting on the importance of the therapeutic process and Tudor and psychotherapists who work role of money in private practice will (1998) suggests that the meaning in private practice. The topics of be outlined. of money becomes a central focus money and therapy, symbolism of of therapy.

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Symbolism of money mental illness and drug and While it is accepted that money he teaching is alcohol issues, therefore, they is essential to living, it is also “Tfocused on the work can also be trained to sensitively shrouded in symbolic meaning. of psychotherapy while facilitate the significance of Geistwhite (2000) notes that excluding exploration money. This is confirmed by money has been symbolically linked of the business of doing Shields (1996) in declaring that to faeces, penis, and breast. Tudor psychotherapy” the teaching is focused on the (1998) suggests it represents work of psychotherapy while guilt and dirt. However, Krueger (Pasternack, 1988) excluding exploration of the (1991) maintains that money can business of doing psychotherapy. symbolise self-esteem, esteem of In conducting research with others, potency, power, worldliness, candidly about money is regarded psychotherapists, Power and Pilgrim or acceptance and for some as inappropriate, intrusive and (1990) discovered that money was clients, money may be viewed as a rude, by much of society. Lanza generally not discussed in training, method to prevent separation and (2001) confirms this, adding that while Trachtman (1999) aligns individuation. According to Freud money is a complex of paradoxes. the poor training in fee dynamics (1913) “money matters are treated Gans (1992) asserts that while with fuelling the money taboo. by civilised people in the same money is a taboo subject, it is also Pasternack (1988) proposes that ways as sexual matters, with the a gateway to the unconscious, training in psychotherapy should same inconsistency, prudishness which includes primitive affect, include learning and familiarity and hypocrisy” (p.131). In the features of personality and aspects about fee setting and collection just literature on this topic, there are of orality and anality especially as much as it does the promotion references to the similarities withholding, depletion and greed. of other boundaries in the therapy. between therapy and prostitution. Challenging topics that were once This relates to the acceptance of a combined with money issues Therapeutic process fee (often cash) for a service. This were split off from the rest of From a negative viewpoint, money is what Schonbar (1967) refers self. By inviting elements of the may be a contributory factor in to as the “selling” of a human unconscious to present themselves, the disruption of the therapeutic relationship, however, he later these topics may be reacquainted. relationship (Chodoff, 1996; suggests that such concepts may This may result in their importance Holmes, 1998; Lanza 200; Dimen, be devised by clients in order to being highlighted in aspects of life 2012). One example offered defend against closeness towards other than purely financial. by Power and Pilgrim (1990), is the therapist (Schonbar, 1986). through failure to respond to a Lack of training client’s economic circumstances. Money as a taboo It is generally agreed that one such However, on a more positive In the practice, literature and subject matter that requires explicit note, Power and Pilgrim (1990) training of psychotherapy, money attention in training is the topic suggest issues of money in therapy is one of the most ignored topics of fees. While there is a dearth of (payment of the fee) may become and, while it remains unaddressed, literature on the subject of fees in pivotal in the therapeutic process it leads to an emotional taboo therapy, there is even less on the by introducing areas of shame, regarding financial matters issue of fees and training (Monger, vulnerability, dependence and (Trachtman, 1999; Tudor, 1998). 1998; Tudor, 1998; Trachtman, self-worth. Zur (2007) believes “Most of us have learned to 1999; Newman, 2005). Shields the fee is essential to the talk more easily about sex, yet (1996) proposes that in the training therapeutic boundary separating remain seclusive, embarrassed, or sphere, without examination of the relationship in the therapy room conflicted about discussing money. the resistance related to money from other types of non-professional Money may be the last taboo in that may be present for both client relationships (friendships or our society” (Krueger, 1986, p. vii). and therapist, an opportunity to romantic relationships). It is This theme of money as taboo runs facilitate the client’s experience accepted that transference and throughout the literature (Dibella, is lost. Shapiro (2007) notes countertransference are common 1980; Tudor, 1998; Trachtman, that therapists have been trained elements of the therapeutic 1999) and is confirmed by Shapiro to explore issues of abuse and encounter and when issues of (2007) who states that talking sexual behaviour, eating disorders, money are being explored or

Irish Association for Counselling and Psychotherapy 5 IJCP Volume 19 • Issue 3 • Winter 2019 ignored, these unconscious aspects believes this is difficult to detect of relating can be heightened. f fees are modified but is essential to uncover in Holmes (1998) outlines the “Iduring the course order to promote a positive importance of attending to of therapy, the therapist therapeutic environment. If fees countertransferential emotions should remain alert are modified during the course and to use them in the service of to transference and of therapy, the therapist should therapy. countertransferential remain alert to transference and elements of the countertransferential elements Fee setting therapeutic process” of the therapeutic process A common belief among members (Pasternack, 1988). Newly of the mental health community (Pasternack, 1988) qualified therapists can often is that paying for services is a feel conflicted about charging for positive element of psychological therapy, occasionally accompanied treatments (Aubry, Hunsley, rigid fee policy. A flexible approach by feelings of guilt about the Josephson & Vito, 2000). Certain encourages the client to engage quality of the service they provide. authors believe that the fee is in the treatment process and The introduction of a reduced a crucial element for effective invite unconscious conflicts to the fee can often assist in lowering psychotherapy (Freud, 1913; Power fore. Schonbar (1967) proposes performance pressure on the & Pilgrim, 1990) inviting the client invitation of an open discussion fledgling therapist (Myers, 2008). to value the process (Herron & regarding missed appointments Sitowski, 1986). Fee setting invites and aspects of non-payment rather Discomfort charging a fee the therapist to acknowledge the than invoking an automatic charge Knapp and VandeCreek (2008) role of the unconscious and any on an administrative basis. A state “Most psychotherapists are existing emotional factors that may flexible approach aids productive reluctant businesspersons. They be relevant (Pasternack, 1988). therapeutic exploration and assists consider the business side of their Newman (2005) outlines the therapist in meeting their profession to be a necessary evil possible feelings on behalf of own countertransferential issues, that allows them to do what they the client that may include guilt, should they arise (Schonbar, really love: psychotherapy” (p.613). contempt, hostility, seduction 1967). A study conducted by Clark Lanza (2001) proposes that and anxiety. Pasternack (1988) and Kimberly (2014) found that many clients and therapists feel reminds us that the modern-day the fee paid for therapy has no a discomfort discussing fees and flexible fee policy employed by impact on a client’s attendance. suggests this may emanate from many therapists originated from While conducting a review of the the Protestant ethic of praising hard a more rigid system proposed literature on the effect of fees work but never enjoying the fruits by Freud who obeyed a policy of on psychotherapy, Herron and of the labour. However, according to leasing by the hour. His insistence Sitowski (2014) discovered that Geistwhite (2000) the process of on fee-paying arose from a belief the therapeutic value of fee-paying fee setting, despite its discomfort, that it reduced the resistances has not been theoretically proven. is a precursor for all future (unnecessary gratitude and discussion of challenging topics in obligation) of the patient in therapy Fee concessions therapy. (Freud, 1913). He invoked a Pasternack (1988) suggests that cancellation policy and believed a reduced fee may represent Ethics it was ethical to acknowledge collusion on behalf of the therapist From an ethical values viewpoint, the business aspects of therapy. in an attempt to foster dependency. focusing on the business element Separating the psychological This may result in the client feeling of a therapeutic practice (including meanings from the business “special” or, alternatively, it may setting fees) is essential (Knapp aspects of therapy was a strong generate feelings of indebtedness & VandeCreek, 2008). In its 2016 theme for Freud, but in the to the therapist. Unconsciously, Ethical Principles of Psychologists present-day, Barth (2001) believes this may encourage a lack of and Code of Conduct, the American that the two are solidly connected. progression within therapy and Psychological Association (APA) Schonbar (1967) outlines a could lead to the client perceiving expects therapists to accurately therapeutic attitude toward fee the reduced fee as a form of represent their fees (APA, 2016). setting and the avoidance of a seduction. Pasternack (1988) The British Association for

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Counselling and Psychotherapy negative effect on the therapeutic (BACP, 2018) suggests that when iscussion with encounter, the research identified contracting with clients, therapists “Dpeers, supervision, the importance of exploring should inform them of the terms personal therapy, the meaning of money and its on which their services will be training or workshops are impact on both transference and provided. The Irish Association for fora that may be useful countertransference. Inviting space Counselling and Psychotherapy while simultaneously and time for the client to openly Code of Ethics and Practice (2018) discuss their thoughts, feelings, refers to making a contract with a helping to dispel the attitudes and behaviours about client and to “include issues such taboo of filthy money” money may be a helpful offering. as availability, fees, and cancelled A tool to explore the historical and (Tudor, 1998). appointments” (Section 2.3(b)). emotional significance of money in This encourages the therapist to the life of the client may be useful. be open about fees and any extra Therapists who may be hesitant Once such tool is the Family costs that may arise. However, about setting a fair fee structure or Financial Questionnaire (Shapiro, Shapiro and Ginzberg (2006) who feel unsure about the therapy 2007) (See Appendix B). suggest that limited guidelines in they provide may undermine the Therapists should be wary codes of ethics result in fee setting value of the therapeutic offering of unusual fee arrangements being left to the discretion of the (Pasternack, 1988). As has been suggested by clients, noting that therapist. outlined, private practice is a comments and behaviour related business. I would suggest that to payments are often not just Considerations for change prior to beginning this process, administrative details. Broadening Informed by the research outlined the therapist reflect on their own a focus that incorporates all money above, as therapists, I suggest we personal relationship with money. matters as “royal roads” to insight, consider changes in how we reflect This may highlight values held may alert the therapist to consider on and approach money in private by the therapist about money this as material for processing in practice. and invite reflection on the place therapy. This may open a view to One of the gaps identified in the of money in their life, past and the client’s internal dynamics and research is the lack of business present. Unconscious sabotaging perhaps unconscious material training for therapists (Tudor, beliefs may be uncovered. Insight and pave the way for exploration 1998; Power & Pilgrim, 1990; into the role their personality style of negative adaptations and wider Monger, 1998; Newman, 2005; plays in their relationship with impacts on life. Shapiro, 2007). Considering money may be achieved. A tool the therapists’ beginnings is at similar to the money genogram Conclusion the training stage, I suggest the may be useful in this regard. (See Money is needed for everyday provision of enhanced training Appendix A). I would strongly life and is also “a metaphorical in the area of the business of recommend that therapists avail currency for power, control, therapy. The identified research of any platform that may provide acknowledgement, self-worth, highlights the need for solid, an opportunity to discuss or competence, caring, security, financial arrangements to be put explore money issues. Discussion commitment, and feeling loved in place for all therapists. If this is with peers, supervision, personal and accepted” (Shapiro, 2007, p. undertaken the therapist provides therapy, training or workshops 290). As outlined, money has an the “safe therapeutic frame that are fora that may be useful while emotional as well as a financial reinforces professionalism and simultaneously helping to dispel component to it. Miller (2007) predictability” (Apostolopoulou, the taboo of filthy money (Tudor, suggests that the therapist never 2013, p. 315). This could begin in 1998). underestimate the complexity of training colleges and institutions. An ethical stance suggests setting a fee that is comfortable, Fee setting (along with fee that a solid payment policy achievable, reasonable and concessions and discomfort should be considered, supplying ethical. Lanza (2001) proposes charging a fee) has been identified clients with accurate information that it is not greedy to seek as a strong theme in the literature about the costs of starting or compensation for the provision and every therapist who begins in continuing therapy. Bearing in of therapeutic services, but private practice faces this task. mind that a money taboo has a rather a form of self-respect.

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As a business, it is helpful for facilitated by working creatively and based in Ballincollig, Cork. Terry practitioners to acknowledge the therapeutically with money. Who holds a BA(Hons) in Counselling tension between being a therapist knows, in the process, we may even and Psychotherapy from the Cork and a businessperson, between “uncover buried treasure – a richer altruism and professionalism understanding of the self” (Shapiro Institute of Technology and an (Knapp & VandeCreek, 2008). By & Ginzberg, 2006, p. 493). MA in Pluralistic Counselling and acknowledging that tension, we Psychotherapy from the Institute offer our clients an opportunity to of Integrative Counselling and explore their underlying values, Terry Naughton Psychotherapy, Tallaght. beliefs, thoughts and feelings as well (Shapiro & Ginzberg, 2006). Terry Naughton is an accredited Cooper (2017) asserts that counsellor and psychotherapist Terry can be contacted at movement within therapy can be working in private practice. She is [email protected]

REFERENCES

American Psychological Association. (2016). Gans, J. S. (1992). Money and psychodynamic Newman, S. S. (2005). Considering fees in Ethical principles of psychologists and code of group psychotherapy. International Journal of psychodynamic psychotherapy: opportunities conduct. Washington, D.C.: APA. Group Psychotherapy, 42(1), 133-152. for residents. Academic Psychiatry, 29(1), Apostolopoulou, A. (2013). The impact of the Geistwhite, R. (2000). Inadequacy and 21-28. economic crisis on the private practice of indebtedness: No-fee psychotherapy in county Pasternack, S. A. (1988). The clinical counselling and psychotherapy: How much training programs. The Journal of psychotherapy management of fees during psychotherapy are clients and therapists ‘worth’? European practice and research, 9(3), 142. and psychoanalysis. Psychiatric Annals, 18(2), Journal of Psychotherapy & Counselling, 15(4), Herron, W. G., & Sitkowski, S. (1986). Effect 112-117. 311-329. of fees on psychotherapy: What is the Power, L. C., & Pilgrim, D. (1990). The Aubry, T. D., Hunsley, J., Josephson, G., & evidence? Professional Psychology: Research fee in psychotherapy: Practitioners’ Vito, D. (2000). Quid pro quo: Fee for services and Practice, 17(4), 347. accounts. Counselling Psychology delivered in a psychology training clinic. Journal Holmes, J. (1998). Money and psychotherapy: Quarterly, 3(2), 153-170. of clinical psychology, 56(1), 23-31. Object, metaphor or dream. International Rowe, D. (1997). The real meaning of money. Barth, F. D. (2001). Money as a tool for Journal of Psychotherapy, 3(2), 123. London, UK: Harper Collins. negotiating separateness and connectedness Irish Association for Counselling and in the therapeutic relationship. Clinical social Schonbar, R. A. (1967). The fee Psychotherapy (2018). Code of Ethics and work journal, 29(1), 79-93. as a focus for transference and Practice. countertransference. American journal of British Association for Counselling and Knapp, S., & VandeCreek, L. (2008). The psychotherapy, 21(2), 275-285. Psychotherapy (2018). Ethical Framework for the ethics of advertising, billing, and finances Counselling Profession. Leicestershire, UK: BAC. Schonbar, R.A. (1986). The fee as focus in psychotherapy. Journal of clinical of transference and countertransference Chan-Brown, K., Douglass, A., Halling, psychology, 64(5), 613-625. in treatment. In Krueger, D.W. (Ed.), The S., Keller, J., & McNabb, M. (2016). last taboo: Money as symbol and reality in What is money? A qualitative study of Krueger, D. W. (1986). The last taboo: Money psychotherapy and psychoanalysis, (pp. 33-47). money as experienced. The Humanistic as symbol and reality in psychotherapy and New York: Brunner Mazel. Psychologist, 44(2), 190. psychoanalysis. New York: Brunner Mazel. Shapiro, M. (2007). Money: A therapeutic tool Chodoff, P. (1996). Ethical dimensions Krueger, D.W. (1991). Money meanings and for couples therapy. Family Process, 46(3) of psychotherapy: A personal madness: A psychoanalytic perspective. perspective. American journal of Psychoanalytic Review, 78(2), 209-224. Shapiro, E. L., & Ginzberg, R. (2006). psychotherapy, 50(3), 298-310. Lanza, M. L. (2001). Career Perspectives: Buried treasure: Money, ethics, Clark, P., & Kimberly, C. (2014). Impact of Setting Fees: The Conscious and Unconscious and countertransference in group fees among low-income clients in a training Meanings of Money. Perspectives in psychiatric therapy. International Journal of Group clinic. Contemporary Family Therapy, 36(3), care, 37(2), 69-72. Psychotherapy, 56(4), 477-494. 363-368. Miller, J. H. (2007). Who determines value? Shields, J. D. (1996). Hostage of the fee: Cooper, H. M. (2017). Three’s a crowd: The Counsellors’ fees in a third-party funding Meanings of money, countertransference, impact of the organisation on the fee practices environment (Unpublished). University of and the beginning therapist. Psychoanalytic of volunteer therapists. Counselling and Canterbury Research Repository, New Zealand. Psychotherapy, 10(3), 233-250. Psychotherapy Research, 17(3), 181-189. Monger, J. (1998). The gap between theory Trachtman, R. (1999). The money taboo: Its Dibella, G. A. W. (1980). Mastering and practice: A consideration of the fee. effects in everyday life and in the practice money issues that complicate treatment: Psychodynamic Counselling, 4(1), 93-106. of psychotherapy. Clinical Social Work The last taboo. American journal of Mumford, D. J., & Weeks, G. R. (2003). Journal, 27(3), 275-288. psychotherapy, 34(4), 510-522. The money genogram. Journal of Family Tudor, K. (1998) Value for money? Issues of Dimen, M. (1994). Money, love, and Psychotherapy, 14(3), 33-44. fees in counselling and psychotherapy. British hate contradiction and paradox in Myers, K. (2008). Show Me the Money: Journal of Guidance & Counselling, 26(4), psychoanalysis. Psychoanalytic Dialogues, 4(1), (The “Problem” of) the Therapist’s Desire, 477-493. 69-100. Subjectivity, and Relationship to the Zur, O. (2007). Boundaries in Psychotherapy: Freud, S. (1913). On beginning the treatment, Fee. Contemporary Psychoanalysis, 44(1), Ethical and Clinical Explorations. Washington, Vol.1. London: Hogarth Press. 118-140. DC: APA.

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Appendices Appendix A – The Money Genogram Meaning and function of money 1. What does money mean to you? 2. What does it mean to have financial self-discipline? What is positive about it? What is negative about it? How do you feel when you exercise financial self-discipline? 3. What does it mean to overspend? 4. What does it mean to underspend? 5. On what terms do you tend to over or underspend money? 6. How do you feel when you overspend and underspend? Identify all feelings, those on the surface and underneath. 7. What are your overt and covert motivations for over- or under- spending or being self-disciplined? 8. What are your financial priorities? 9. In what ways do you agree or disagree on your financial priorities? 10. Who has control over the money in your relationship? What are the rules you have about how to manage your money? 11. How would you like to change some of the rules about the two items above?

Money genogram 1. What was your mother’s role concerning finances? What was your father’s role? How is your role like either of your parent’s role? 2. As a child, did you think you were rich, poor, or middle-class? How did that feeling affect your perception of money now? 3. What were the money concerns or worries you experienced in your family? What lessons did you learn from them? Have those lessons altered how you deal with money now? 4. What big financial successes occurred in your family? What lessons did you learn? How have those lessons altered the way you deal with money now? 5. What was your family’s greatest money fear or worry? Why? 6. In thinking about what your family did with money or could have done with money, what makes you the most uncomfortable? What gives you the greatest pleasure? 7. Were your parents well matched in money values? On what did they have different values? 8. Did your parents maintain separate checking and saving accounts? How did they decide which bills were to be paid out of which account? 9. How often did your parents talk about money? What were their conversations like? 10. Who paid most of the common household bills? How was it decided which parent should have the duty? 11. When there was a conflict about money, how was it resolved? Was there a pattern in either the conflict or who won?

Adapted from - Mumford, D. J., & Weeks, G. R. (2003). The money genogram. Journal of Family Psychotherapy, 14(3), 33-44.

Appendix B – Family Financial Questionnaire The following questions can serve as a guide to exploring the history and emotional significance of money for a client. (1) What are your earliest memories of money in your family? What is your best and worst memory regarding money? What feelings do these memories generate? Was money viewed as good, bad, scary, dirty, or neutral for you as a child? Did anyone help you to understand these feelings as a child? Were there any family stories about money? (2) How did your parents talk about money between themselves and with the children? Was it easy to talk about, or was it treated as a secret? What kind of tone was used in the discussions? Did your parents fight about money, and if so, how? (3) Did your parents agree about how to deal with money? Who was in charge of spending, and who was in charge of saving? Did working, or earning the bigger portion of the income, connect to control over money? (4) How did your mother think and feel about, and deal with, money? How did her parents think and feel about, and deal with, money? Did your mother enjoy working (or staying home)? How did you know and what impact has this had on you? Repeat using father. How well off did you feel growing up? How did that change over the course of your growing up, if at all? (5) What is your first memory of having an argument or disagreement about money in your family? What were your feelings regarding arguments about money, and how has this impacted you? (6) If you have siblings, were different genders or different ages treated differently in regard to money? How are your attitudes and feelings about money different from or the same as those of your siblings? (7) What is your first memory of making money of your own? How much control did you have over any money you made or received as a gift? (8) Where else did you get messages or information about money while growing up? Other relatives, religion, peers, TV, culture? How did these messages influence you? (9) What financial expectations did your parents and grandparents have of you? How was this communicated to you? What financial expectations do you have of your parents or grandparents? (10) What would you like to do differently from your parents regarding money in your relationship? What would you like to do the same?

Adapted from - Shapiro, M. (2007). Money: A therapeutic tool for couples therapy. Family Process, 46(3) p. 280-281.

Irish Association for Counselling and Psychotherapy 9 IJCP Volume 19 • Issue 3 • Winter 2019

Academic Article JCO: Thank you for meeting with me. I wish to ask you a few more A simulated interview questions. WG: “Oh, certainly” (Glasser in with William Glasser: Gough, 1987, p. 662). “Sit down and make yourself comfortable” Part 2 – The Process of (Glasser, 1976i, p. 654). JCO: I respect the central Psychotherapy importance of the therapeutic relationship. Do you agree that By James C. Overholser, Ph.D., ABPP therapists provide an essential supportive relationship?

WG: “Yes, but you do a lot more as well. You try to prevent problems from happening in the first place” (Glasser, 2000, p. 53). “It is incumbent on counselors to form good relationships with all clients” (Glasser, 1998, p. 132). “We must be warm, personal, and friendly” (Glasser, 1976h, p. 53). “Warmth, understanding, and concern are the cornerstones of effective treatment” (Glasser & Zunin, 1979, p. 316).

JCO: I thought the key to Reality Therapy was a strong push for realistic changes. So how important is the therapeutic relationship?

WG: “The relationship between the therapist and the client is very important and the type of counseling Introduction sessions, the therapist encourages only plays 15%” (Glasser, 2016, p. eality Therapy provides a clients to identify their own major 38). “It is important that I be warm Rframework that can encourage life goals and begin making daily and uncritical” (Glasser, 1996, p. choice, responsibility, and plans changes in behavior that helps 174). “An important distinguishing for change. The therapist relies them to move toward accomplishing trait of a good psychotherapist on a supportive bond to push the those goals. The therapist brings is his ability to accept patients client for immediate and visible an action-focused view, both to uncritically and understand their change in daily actions and to the goals of each session as well behavior” (Glasser, 1965, p. 28). move clients closer toward their life as the language used to describe “Patients with emotional problems goals. The therapist makes a strong various symptoms. By changing need someone who will be warm and persistent focus on helping passive nouns into active verbs, and personal with them” (Glasser, clients to make wise choices, whilst clients may be forced to accept 1976e, p. 349). “The therapist avoiding any discussion of past personal responsibility for their must be able to become emotionally events or excuses. own symptomatic behavior. involved with each patient” (Glasser, Despite a fairly directive style, These issues are discussed in a 1965, p. 28). “We must become as reality therapy remains compatible simulated interview with Dr. William involved as possible with his strong with the Socratic method and Glasser (WG) led by James C. points, his interests, his hopes” guided discovery. Throughout Overholser (JCO). (Glasser, 1964, p.140).

10 Irish Association for Counselling and Psychotherapy Volume 19 • Issue 3 • Winter 2019 IJCP

JCO: In your view, how does the I want?’” (Glasser, 1984, p. 171). therapeutic relationship help? don’t promise to “How is this choice to depress going “I produce happiness to help me deal with this situation? WG: “Involvement is the foundation or alleviate misery” If it isn’t helping me, can I choose of therapy” (Glasser, 1976h, p. something better?” (Glasser, 1998, 53). “Involvement with at least one (Glasser, 1964, p. 138) p. 78). “How long do you want to successful person is a requirement choose to be miserable?” (Glasser, for growing up successfully, (Glasser, 1976b, p. 47). “The 2000, p. 36). maintaining success, or changing therapist does not judge the from failure to success” (Glasser, behavior; he leads the patient to JCO: It sounds like you’re saying that 1975, p. 71). “Each of us wants to evaluate his own behavior” (Glasser, therapists should encourage clients be able to say, ‘Someone listens 1975, p. 85). “Unless they judge to share their burdens and express to me; someone thinks that what I their own behavior, they will not their misery in session. have to say is important” (Glasser change” (Glasser, 1976d, p. 99). “I in Gough, 1987, p. 658). “People ask questions designed to get them WG: “I know it does, but it’s really who aren’t able to say, ‘I’m at to evaluate their behavior against not” (Glasser in Gough, 1987, p. least a little bit important’ in some reality” (Glasser, 1976b, p. 42). 659). “I don’t promise to produce situation will not work hard to happiness or alleviate misery” preserve or improve that situation” JCO: Can you give me a few (Glasser, 1964, p. 138). “It is (Glasser in Brandt, 1988, p. 40). examples of questions you might unwise to talk at length about a “The therapist’s problem is to ask your clients? patient’s problems or his misery” provide enough involvement to help (Glasser, 1975, p. 77). “Long the patient develop confidence WG: “Of course” (Glasser in Gough, discussions about the patient’s to make new, deep, lasting 1987, p. 662). “The basic Reality problems can be a common and involvement of his own” (Glasser, Therapy question, ‘is what you are serious error in psychotherapy” 1976h, pp. 53-54). doing (or choosing to do) getting you (Glasser, 1976h, p. 54). what you want?’” (Glasser, 1989a, JCO: What advice would you give to a pp. 14-15). “Is what you are doing JCO: Why? novice psychotherapist? helping you?” … “Is it the kind of thing that’s going to make life better WG: “It is tempting to listen to his WG: “Try very hard not to insert for you in the future” … “Are you complaints because they seem so our beliefs into the process of doing what will help you to fulfill your urgent. Doing so may reduce his counseling” (Glasser, 2016, p. 6). needs” (Glasser, 1980, p. 51) … pain and make him feel better for “Help the patient to evaluate his “Does your present behavior have awhile as he basks in the attention own behavior … Avoid making this a reasonable chance of getting you he receives” (Glasser, 1976h, p. evaluation for him … If you usurp what you want now and will it take 55). “Talking at length about a his decision, the patient loses you in the direction you want to go?” patient’s problems and his feelings responsibility for his behavior” (Glasser, 1989b, p. 5) … “What about them focuses upon his self- (Glasser, 1976e, p. 350). “The could you choose to do tomorrow involvement and consequently gives therapist continually asks clients to that would be better than today?” his failure value” (Glasser, 1975, p. evaluate the effectiveness of what (Glasser, 2000, p. 135). 77). “Our job is not to lessen the they are choosing to do” (Glasser, pain of irresponsible actions, but 2000, p. 227). “The crux of the JCO: These are great questions. to increase the patient’s strength theory is personal responsibility Are there some questions that are so that he can bear the necessary for one’s own behavior” (Glasser & most helpful for motivating clients pain of a full life as well as enjoy Zunin, 1979, p. 302). to change? the rewards of a deeply responsible existence” (Glasser, 1965, p. 72). JCO: Is your therapy style compatible WG: “The therapist continually asks with the Socratic method of clients to evaluate the effectiveness JCO: If you do not spend time psychotherapy? of what they are choosing to do” listening to a client’s complaints, (Glasser, 2000, p. 227). “The where do you go instead? WG: “Yes that’s a fair statement” important control-theory question ‘is (Glasser in Evans, 1982, p. 461). the criticizing and misery I am now WG: “Don’t talk so much about “It is a kind of Socratic questioning” choosing helping me to get what how people feel” (Glasser, 1982,

Irish Association for Counselling and Psychotherapy 11 IJCP Volume 19 • Issue 3 • Winter 2019 p. 461). “Get to the real problem, depressed friend is to let him whine what the client is choosing to do e almost always excessively about his troubles” now” (Glasser, 1998, p. 117). “We “Whave choices, and (Glasser, 1975, p. 78). choose what we do or what we do the better the choice, the not do” (Glasser, 2004, p. 340). more we will be in charge JCO: So you feel that clients choose “We choose most of the misery we of our lives” to become depressed? feel” (Glasser, 1984, p. 2). (Glasser, 2013, p. 2) WG: “What we usually call JCO: Are you saying that people psychological problems are, in fact, choose to become depressed? the ways we choose to behave when That attitude would upset a lot of the misery we feel” (Glasser, 1998, we find it particularly difficult to people. p. 3). “Regardless of how we feel, satisfy our needs” (Glasser, 1996, we always have some control over p. 172). “We choose what we do WG: “That’s an important question” what we do” (Glasser, 1984, p. 45). or what we do not do” (Glasser in (Glasser, 2000, p. 54). “The world Brandt, 1988, p. 43). “Once you never causes us to do what we do; JCO: Why would someone choose to accept that misery is a choice, rather, we behave in certain ways to be miserable? you will look for better choices to get what we want” (Glasser, 1985, replace it” (Glasser, 1984, p. 56). p. 242). “If you don’t believe me WG: “Pretty much every behavior “Many times in life, when we are all you have to do is think back that is important to you is chosen” miserable it is because we continue to a time in your life when you (Glasser in Onedera & Greenwalt, to blame others for our misery or try really had a hard time, and you’ll 2007, p. 82). “We almost always to control others” (Glasser, 1998, p. find that when you ‘recovered’ have choices, and the better the 19). “Remember, we can only control it wasn’t because the world had choice, the more we will be in charge our own behavior, so you should talk suddenly become a better place, of our lives” (Glasser, 2013, p. 2). solely about what you are willing to it was because you made a better “What we choose is the best choice do, not what you want the other to choice” (Glasser in Brandt, 1988, at the time we choose it” (Glasser, do” (Glasser, 1998, p. 98). p. 44). “What happened is done 2000, p. 2). “If I choose all I do, and people have to satisfy their maybe I can choose to do something JCO: So action takes priority over needs now” (Glasser in Nystul & better” (Glasser, 2000, p. 26). emotion? Shaughnessey, 1995, p. 441). JCO: Does that change how to treat WG: “Absolutely” (Glasser in JCO: But some people are stuck in a depression? I have been helping a Onedera & Greenwalt, 2007, p. 82). bad situation. depressed client, and sometimes “Changing behavior leads quickly he just feels better by sharing his to a change in attitude” (Glasser, WG: “Excuse me if I don’t agree concerns with me in session. 1965, p. 34). “People often avoid with you” (Glasser, 2002, p. 73). facing their present behavior by “Nothing we do is caused by what WG: “A major purpose of all emphasizing how they feel rather happens outside us” (Glasser, 1984, psychological symptoms is to get than what they are doing” (Glasser, p. 1). “How you feel is not controlled sympathy and attention” (Glasser, 1976h, p. 56). “The most common by others or events” (Glasser, 2013, 2000, p. 72). “If we ask them how misery we choose is depressing, p. 6). “One of the most difficult they feel, it seems that our listening but we can also choose to withdraw, lessons to master … is to learn recognizes, and to them justifies, complain, go crazy, drink, or use not to label something ‘bad’ just how they feel” (Glasser, 1980, p. drugs” (Glasser, 1993, p. 109). because it is different from what we 51). “He had been getting his failure “We do not use the adjective want” (Glasser, 1984, p. 81). “Every reinforced and his pain temporarily depressed, we do not use the noun client, at the time that therapy reduced with each new complaint depression. We always use the verb begins, is choosing some sort of that was heard” (Glasser, 1975, p. form to describe behavior” (Glasser, painful, self destructive behavior 78). “It is important that depressed 1989, p. 8). in a misguided or misunderstood patients do not get sympathy attempt to regain control over a because sympathy emphasizes their JCO: Why does it matter to make this poorly controlled, need-frustrated worthlessness and depresses them change of phrasing? life” (Glasser, 1989a, p. 5). “We even more” (Glasser, 1965, p. 183). choose everything we do, including “The worst thing anyone can do for a WG: “By transforming these static

12 Irish Association for Counselling and Psychotherapy Volume 19 • Issue 3 • Winter 2019 IJCP words into actions that more JCO: As a therapist, where is your accurately reflect choices, I hope ack of success, focus? to imply that these behaviors are “Lmore than subject to change” (Glasser, 2013, p. any other one thing, WG: “The essence of Reality 3). “If I say I am depressing or I am contributes to Therapy is problem solving” choosing to depress, it is very hard nonmotivation” (Glasser & Zunin, 1979, p. 328). for me to think that this is happening “Our job is to help the patient help to me. I have to begin to think that I (Glasser, 1971, p. 18) himself to fulfill his needs right have a choice and that maybe I could now” (Glasser, 1974, p. 190). “The do something better” (Glasser, 1989, concept of choice becomes crucial p. 9). “If we choose to depress, we WG: “Absolutely” (Glasser in Brandt, when making plans for the future” can also choose to stop depressing” 1988, p. 40). “We can choose to do (Glasser, 1990, p. 584). (Glasser, 2000, p. 26). better with our lives--providing we are willing to make the effort to do so” JCO: How do we help clients fulfill JCO: So choice is the key? (Glasser, 1989a, p. 2). their needs?

WG: “I now believe that we choose JCO: One of my clients seems to be WG: “Our job as therapists is to essentially all we do” (Glasser, stuck in his bad habits. How can I teach clients how to act and think 2000, p. 225). “Emotions are get him unstuck? more effectively so they can better chosen” (Glasser, 1976a, p. 18). satisfy their needs” (Glasser, 2000, “We can gain a great deal of control WG: “Asking him for his plan tells p. 67). “I believe people choose by learning that we choose to him that he should have a plan, the behavior that has led them depress” (Glasser, 1984, p. 81). or at least start thinking of one” into therapy because it is always (Glasser, 1965, p. 46). “What their best effort to deal with a JCO: But some of my clients have are you planning to do today?” present, unsatisfying relationship- become depressed over the (Glasser, 1998, p. 78). “Successful -or, worse, no relationships at all” disruptive events in their lives. people tend to make a plan and (Glasser, 2000, p. 22). “Good or channel their efforts into that plan” bad, everything we do is our best WG: “I hate to nitpick, Jim, but (Glasser, 1976c, p. 70). “It is best choice at that moment” (Glasser, …” (Glasser, 2000, p. 43) “this that plans be discussed, written 1984, p. 3). is completely untrue” (Glasser in out, and checked off” (Glasser, Harmon, 1993, p. 45). “There’s 1996, p. 174). JCO: I have a client who rarely no way to live your life without completes his therapeutic task problems” (Glasser in Brandt, JCO: I rely on shaping, trying to help between sessions. How do I handle 1988, p. 44). “While we choose all clients start small and build up to it? of our long-term feelings, painful bigger changes. Does that fit your as well as pleasurable, … we do style? WG: “Accept no excuses” (Glasser, not choose the immediate short- 1975 p. 92). “Get to the real lived feelings” (Glasser, 1984, p. WG: “Oh, certainly” (Glasser in problem, what the client is choosing 71). “When we depress, we believe Gough, 1987, p. 662). “Make sure to do now” (Glasser, 1998, p. we are the victims of a feeling the patient commits himself at 117). “The therapist must say to over which we have no control” first to a small action - one that the patient, ‘If you are not going to (Glasser, 1998, p. 70). “To check he can accept easily and likely do it, say so, but don’t say you are out my claim that depressing is a can succeed at” (Glasser, 1976e, and then give excuses when you choice, force yourself to make a p. 350). “Never make a plan that fail’” (Glasser, 1975, p. 94). “In a different choice for a short time, attempts too much, because it will world where excuses are readily for at least an hour” (Glasser, usually fail and reinforce the already accepted, many people hesitate 1998, p. 83). present failure. A failing person to do their best. In reality therapy, needs success, and he needs small, when there is commitment to a JCO: I often tell my clients that if individually successful steps to gain plan, there is no excuse for not things are not getting better for it” (Glasser, 1975, p. 89). “Lack of following through … Maybe we them, we want to try something success, more than any other one have to drop this plan and figure different, not just keep doing more thing, contributes to nonmotivation” out a new one? But under no of the same. Would you agree? (Glasser, 1971, p. 18). circumstances will the therapist

Irish Association for Counselling and Psychotherapy 13 IJCP Volume 19 • Issue 3 • Winter 2019 accept an excuse” (Glasser, 1980, blame his present unhappiness on a WG: “I am more than happy to” p. 54). parent or an emotional disturbance (Glasser in Onedera & Greenwalt, can usually make his patient feel 2007). I’ll see you again on Monday” JCO: I agree. I am rather intolerant good temporarily at the price of (Glasser, 1976f, p. 669). of excuses, and I have heard quite a evading responsibility” (Glasser, few, but flat out rejecting an excuse 1973, p. 579). “The accepting of may damage the rapport I have with an excuse is saying to the person, Jim Overholser the person. ‘I accept your inadequacy, I accept your misery, I accept your inability’” Jim Overholser is a professor WG: “It might” (Glasser, 2000, (Glasser, 1980, p. 54). of psychology at Case Western p. 191). “We simply ask, ‘Are Reserve University, Cleveland, you still going to try to fulfill the JCO: I have a few more things I’d like Ohio and a licensed clinical commitment?’ (Glasser, 1975, p. to discuss. psychologist who provides 93). “Excuses let people off the outpatient psychotherapy through hook; they provide temporary relief, WG: “Wait a second. Let’s stop here” a local charity clinic. Dr. Overholser but eventually lead to more failure (Glasser, 1976j, p. 467). conducts research on depression and a failure identity” (Glasser, 1975, and suicide risk through a local p. 94). “The therapist who accepts JCO: Sure. Maybe we can schedule VA Medical Center and the County excuses, or allows the patient to one more time to talk? Medical Examiner’s Office.

REFERENCES Brandt, R. (1988). On students’ needs and team 345-351). New York: Harper & Row. Glasser, W. (1993). Staying together: The control learning: A conversation with William Glasser. Glasser, W. (1976f). Dr. Glasser and Shirley. theory guide to a lasting marriage. New York: Educational Leadership, 45 (6), 38-45. In A. Bassin, T. Bratter, & R. Rachin (Eds), The Harper Collins. Evans, D. (1982). What are you doing? An Reality Therapy reader: A survey of the work of Glasser, W. (1996). A reality therapist’s interview with William Glasser. Personnel and William Glasser, M.D. (PP. 654-661). New York: perspective on Ruth. In G. Corey (Ed.) Case Guidance Journal, 460-465. Harper & Row. approach to counseling and psychotherapy (4th Glasser, W. (1964). Reality Therapy: A realistic Glasser, W. (1976g). What children need. In A. ed, pp. 172-178). Pacific Grove, CA: Brooks approach to the young offender. Crime & Bassin, T. Bratter, & R. Rachin (Eds), The Reality Cole. Delinquency, 10 (2), 135-144. Therapy reader: A survey of the work of William Glasser, W. (1998). Choice Theory: A new Glasser, W. (1965). Reality Therapy: A new Glasser, M.D. (pp. 465-481). New York: Harper psychology of personal freedom. New York: approach to psychiatry. New York: Harper & Row. & Row. Harper Collins. Glasser, W. (1971). Reaching the unmotivated. Glasser, W. (1976h). Reality Therapy. In V. Glasser, W. (2000). Reality Therapy in Action. Science Teacher, 38 (3), 18-22. Binder, A. Binder, & B. Rimland (Eds.) Modern New York: Harper Collins. Glasser, W. (1973). Reality Therapy. In R. therapies (pp. 52-64). Englewood Cliffs, NJ: Glasser, W. (2002). Unhappy teenagers: A way Jurjevich (Ed) Direct psychotherapy (pp. 562- Prentice-Hall. for parents and teachers to reach them. New 610). Coral Gables; University of Miami Press. Glasser, W. (1976i). Dr. Glasser and Shirley. York: Harper Collins. Glasser, W. (1974). Reality Therapy. In A. Bassin, T. Bratter, & R. Rachin (Eds), The Glasser, W. (2003). Warning: Psychiatry can Cosmopolitan, 176 (5), 188-193. Reality Therapy reader: A survey of the work of be hazardous to your mental health. New York: Glasser, W. (1975). The identity society (revised). William Glasser, M.D. (pp. 654-661). New York: Harper & Collins. New York: Harper & Row. Harper & Row. Glasser, W. (2004). A new vision for counseling. Glasser, W. (1976a). Positive Addiction. New Glasser, W. (1980). Reality therapy: An Family Journal, 12 (4), 339-341. York: Harper & Row. explanation of the steps of reality therapy. In Glasser, W. (2013). Take charge of your life. Glasser, W. (1976b). Youth in rebellion - why? Glasser, N. (Ed), What are you doing?: How Bloomington, IN: iUniverse. In A. Bassin, T. Bratter, & R. Rachin (Eds), The people are helped through Reality Therapy (pp. Glasser, W. (2016). Thoughtful answers to Reality Therapy reader: A survey of the work of 48-60). New York: Harper & Row. timeless questions: Decades of wisdom in letters. William Glasser, M.D. (pp. 38-49). New York: Glasser, W. (1984). Control Theory. New York: Los Angeles: William Glasser Inc. Harper & Row. Harper & Row. Glasser, W., & Zunin, L. (1979). Reality Therapy. Glasser, W. (1976c). How to face failure and find Glasser, W. (1985). Discipline has never been In R. Corsini (Ed). Current Psychotherapies, nd success. In A. Bassin, T. Bratter, & R. Rachin the problem and isn’t the problem now. Theory 2 edition (pp. 302-339). Itasca, IL: Peacock (Eds), The Reality Therapy reader: A survey of the into Practice, 24 (4), 241-246. Publishers. work of William Glasser, M.D. (pp. 68-71). New Glasser, W. (1989a). Control theory. In N. Gough, P. B. (1987). The key to improving York: Harper & Row. Glasser (Ed), Control theory in the practice of schools: An interview with William Glasser. Phi Glasser, W. (1976d). Notes on Reality Therapy. Reality Therapy: Case studies (pp. 1-15). New Delta Kappan, 68 (9), 656-662. In A. Bassin, T. Bratter, & R. Rachin (Eds), The York, Harper & Row. Harmon, M. (1993). An interview with William Reality Therapy reader: A survey of the work of Glasser, W. (1989b). A clarification of the Glasser. Quality Digest, 44 - 47. William Glasser, M.D. (pp. 92-109). New York: relationship between the all-we-want world and Nystul, M., & Shaughnessey, M. (1995). An Harper & Row. basic needs. Journal of Reality Therapy, 9 (1), 3-8. interview with William Glasser. Individual Glasser, W. (1976e). Practical psychotherapy Glasser, W. (1990). The John Dewey Academy: A Psychology, 51 (4), 440-444. G.P.s can use. In A. Bassin, T. Bratter, & R. residential college preparatory therapeutic high Onedera, J., & Greenwalt, B. (2007). Choice Rachin (Eds), The Reality Therapy reader: A school: A dialogue with Tom Bratter. Journal of Theory: An interview with Dr. William Glasser. survey of the work of William Glasser, M.D. (pp. Counseling & Development, 68, 582-585. The Family Journal, 15 (1), 79-86.

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Reflective Article s a therapist working with Acouples for 28 years, a Can’t we just talk to constant theme in the work is that of communication. Often, this is each other? explicitly named as the presenting issue as in the example above but can also become the focus of Supporting Couples to therapy after an immediate crisis is dealt with. So, how do we help Improve their Communication couples with the challenge of improving how they communicate? By Brendan O’Shaughnessy In this article, I will propose that helping them to communicate with each other, might be an alternative to talking at them or with them.

Prevalence of communications issues At a time when we have more information and means of interacting with each other, the prevalence of communication issues seems to be increasing. For example, in 2013, lifestyle website YourTango.com polled 100 mental health professionals and found that communication problems were cited as the most common factor that leads to divorce (65 percent), followed by couples’ inability to resolve conflict (43 percent). So, when couples come to us for support with communication, what can we do to help? Introduction For couples therapists, traditional approaches include activities such as; Pat: I don’t know many times I have tried to explain normalising, education and modelling. to Chris how I feel. When I can’t get through, I find myself getting angry and, to my shame, say Normalising things that I know will hurt just to get a reaction.

Chris: I try to listen but feel blamed from the off. When I try to defend myself, Pat gets angry and I just shut down. Pat will say hurtful to me and even though I know I will regret it later, shout and hurt back.

Pat & Chris: We just don’t seem to be able to get out of this Every couple is unique, but it is nice pattern and it is getting worse. If we can’t for them to hear that other couples improve our communication, this relationship are struggling with the same issues. will not last. At some point in the initial session, it is important to let the couple know

Irish Association for Counselling and Psychotherapy 15 IJCP Volume 19 • Issue 3 • Winter 2019 that while their issues are unique to Another possible approach is to interpersonal communication them, many other (if not all) couples, model a more respectful style of is a relationship difficulty, I share various communication communication. Doing so with one tentatively introduce a tool for difficulties. of the couple and having the other them to improve this aspect of observe how this results in more their relationship, one which Education positive engagement, can raise they can adopt and adapt as a awareness and offer alternatives basic model to suit themselves. to the way they have been If interested, I will explain that communicating with each other. there is a structure to improving communication which will feel Issues with the above approaches awkward in the beginning and Reflecting on the images encourage them to fake it ‘til accompanying the approaches they make it, until they learn how above, we notice however that; to use the structure on their • The therapist is working own. Often, initial awkwardness Having normalised the couples hard (arrow direction in the stems from their feeling self- experience, another step may be to normalising condition). conscious when using this educate them on the various styles • The couple are being talked to method in front of me, but that of communications and the impact and at (arrow direction in the is OK and will wear off in time. these have on their relationship. educating condition). John Gottman, Professor Emeritus • The couple are not 2. Structure and seating: The from the University of Washington, communicating with each structure involves setting a researcher focussing on couples’ other (the absence of an arrow up a system of deliberately behaviours for over 40 years, has between the members of the communicating with each other suggested that there are four types couple). and to do so in a structured of communication problems that way. The couple is invited to can lead to divorce: An additional approach move their chairs around to • Criticism of partners face each other. This often personality involves a lot of giggling to hide • Contempt the nervousness of having to • Defensiveness look at each other. • Stonewalling (the refusal to communicate at all) 3. Body language and eye contact: I sometimes tell the More information on these story of the client who had communication problems can their legs thrown out in front be found here; http://www. of them, their arm over the acouplesplace.com/Gottmans_Four_ Some time ago, I was lucky enough back of the chair, staring up Horsemen_are_Divorce_Predictors. to receive training from renowned at the ceiling and saying “I html. Explaining these concepts and Gestalt therapist and author Joseph am listening” before noting raising awareness of the complexities Zinkler. In that programme, Zinkler the importance of looking of communications can become a introduced the concept of helping at each other in the eye. steppingstone to new opportunities. families and couples to talk to each Raising awareness that our other and means by which therapists communication is not just Modelling can actively encourage and support verbal and for each of them them this activity (see diagram, left). to take responsibility for their As a result, and over man years, non-verbal messages. couples themselves have helped me to develop a way of doing this that 4. Listening and talking: The works for them and me. The following idea is for one person to talk are the main steps involved. and for the other to listen. The person who is talking is 1. Introducing the concept: When invited to help the other person a couple identifies that their understand what is going on

16 Irish Association for Counselling and Psychotherapy Volume 19 • Issue 3 • Winter 2019 IJCP

for them, without blaming. experience. The encounter of This is highlighted as one of hen couples come to being heard, understood, and the more difficult parts of this Wus requesting support having this fed back is often exercise. It is explained that with their interpersonal described as feeling amazing. conversations that start with communication, we have a It reminds couples of when “I feel bad because you …” deeper responsibility than they first met and shared every are going to lose the listener simply supporting them thought. Another common in defensiveness after the first theme is that the issues they sentence. For the person who to talk and listen to each originally brought to counselling is listening, their challenge other. now, do not appear to be is to be curious about what that serious, or the cause of the other person is telling disharmony, now that they have them about themselves while (1994, p. xxix). A good example found a way to reconnected trying to avoid thinking about of this is a vague way of with each other. answers, solutions, becoming talking e.g. one would feel, if defensive, etc. they were in my position, that What could possibly go wrong? my life could be in some ways Members of a couple often move 5. Feedback: The person talking, more something. Without the at different speeds. This can partly has 5 to 10 minutes to help choice of complaining, the be mediated by how strained the listener to understand speaker may find it difficult to their communication has become them better. Then the listener express how they feel. If one of and how hurt each remains from is invited to tell them what the couple is struggling, I will the legacy of past arguments. they heard. No interpretations, support them with questions Unsurprisingly, it is tempting no analysis, just what they to elicit what they are trying to for couples to try this at home, heard. This can vary between express or name their difficulty especially if they have had a good being an affirming experience in listening to what is being experience in-session. However, the to hear your partner “get said. In the beginning, I find following are some of the pitfalls, you” to highlighting just how my main role is to remind that need to be mentioned before difficult their communication the speaker that they are not trying this at home: habits have become. Mainly allowed to blame if they want (often due to defensiveness), to be heard and understood. i. Who will organise it? On the listener will struggle to several occasions, couples remember what was said or 7. Topics: After complaining in have left the therapeutic miss the important emotional the beginning of therapy, that space to try this at home, only content. their partner never listens to report back that each was to them, one or both of the waiting for the other to initiate 6. Role of the therapist: I explain couple may struggle to know it. It seems this is a power in the beginning that my role is what to talk about when play to establish whether the to support, observe and keep presented with the opportunity, other person is interested. the structure in the beginning. because of not being able to I have learned to work with As they become more blame. Others may start to talk couples to agree who will be accustomed to communicating about very deep feelings too responsible and how they in this new way, I may bring soon. Supporting the couple to will share this responsibility to their awareness the habits choose topics that are not too between them as a precursor they exibit that inhibit effective frivolous or too deep is one of to home trial. interpersonal communication. the key roles of the therapist at Zinkler says it best when this point. ii. Where and when? Given the describing the next step as busy lives that people lead, having “the family talk to each 8. Results: Couples have finding the time and place other, promising them that they reported that having to to have these conversations can turn to us for help or that concentrate on what they are can be difficult. It is unwise we will (respectfully) interrupt communicating to each other to embark on this emotional them to tell them of our and actually listening, is an exercise when one or both observations of their process” exhausting but very rewarding is tired after a long day.

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However, even the effort it to result in yet another trigger each other’s vulnerabilities required to make time for argument. This also has a is then a way couples develop as each other is a building block secondary benefit in that it a way to remain connected in the in recovering the experience provides a release of tensions absence of intimacy. It generates of joy in the relationship. and misunderstandings that a connection, but at an enormous can accumulate over time and cost to the relationship. iii. Interruptions: Texts, calls, result in full-blown arguments When couples come to us WhatsApp messages, where legacy resentments requesting support with their Instagram and Facebook post and frustrations are aired. interpersonal communication, notifications and emails pings As the great philosopher, we have a deeper responsibility can not only interrupt these Roy Keane once said “Fail than simply supporting them to communications sessions to prepare, prepare to fail” talk and listen to each other. but can lead to further (Keane, 2002). Therefore, It is an opportunity for them to rancour if they are one of the giving themselves the best inoculate against future damage sources of discontent in the chance for this technique and hopefully salve past injuries first place. The prospect of to take hold by being well inflicted by hurtful words and intrusion by children, family, prepared and agreeing to the deeds. Words have the ability to neighbours, friends needs to terms of the arrangement is hurt and heal. Really listening be considered by the couple important. to the one you love has no and how these will be dealt disadvantages. with in advance of trying this vi. But it should not be this at home. hard: I tell couples that happy ever after is a myth and that Brendan O’Shaughnessy iv. Length of sessions and relationships take work, even sharing of time: After years to the point of the mundane Brendan O’Shaughnessy is an to not being heard, the act of planning how not to IACP accredited counsellor/ temptation for a person fail at communicating. As psychotherapist/supervisor in prone to flooding is to grab M. Scott Peck observed private practice. He worked part- the opportunity of being the “problem is that the time with the Cork Marriage heard and hang on to it for experience of falling in love Counselling Centre for the past 28 as long as possible. For is invariably temporary” years and has a higher diploma someone prone to stonewall, (Peck, 1978, pg. 67). Of in Counselling from UCC. Brendan this can be an overwhelming course, seeing your partner has been on the board of various experience and they will working with you to improve charities, including the National retreat into their safe place your relationship is greatly Domestic Violence Agency. more than ever. Agreeing in rewarding and can server as advance that these sessions a confirmation that they do in Brendan is now semi-retired from a will not last for more than fact love you. multinational electronics company 30 to 40 minutes with each and can be contacted by email at person getting time to speak Conclusion [email protected] and listen is an important We can all operate on autopilot or www.brendanoshaughnessy.org convention to establish. when communicating. Much of our effort is spent on trying to v. Planning communication persuade, cajole, manipulate or REFERENCES sounds too structured? I have influence others to get what we Keane, R. (2002, May 26). Saipan Interview, heard couples express their want. When this is affected in an Sunday Independent, P. Kimmage, reservations that planning intimate relationship, day-after- Interviewer. and working towards a style of day, it can result in neither person Peck, M. S. (1978). The Road Less Traveled: communications sound like it listening and the death of effective A New Psychology of Love, Traditional Values and Spiritual Growth. USA: Simon & Schuster. is not spontaneous and free. interpersonal communication. When However, it is offered as a tool this happens, intimate connections Zinkler, J. C. (1994). In Search of Good for them to use when they are severed, and each partner can Form: Gestalt Therapy with Couples and Families. Cleveland, USA: Gestalt Institute of have something important feel lost and bereft. Knowing each Cleveland. to share and they don’t want other well enough to know how to

18 Irish Association for Counselling and Psychotherapy Volume 19 • Issue 3 • Winter 2019 IJCP

Academic Article A World of Dichotomies: Empirically Supported Treatments or the Common Factors? Utilising Evidence Based Practice and Practice Based Evidence to mediate this Discourse and Improve Practitioner Outcomes.

By Daryl Mahon

evidence based practice and practice based evidence as two sides of the one coin, and within an integrative practitioner developmental framework.

Empirically Supported Treatments The American Psychological Association describes evidence- based practice “as the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences” (APA, 2005). Originally developed within the medical paradigm (Sacket et al, 1996) in order to improve outcomes. Nevertheless, in recent times EBP has come to be understood as a psychosocial intervention that is supported by Introduction investigates current discourses evidence of utility in the literature. sychotherapeutic discourse by illuminating these dichotomies According to Laska, Gurman Pis often filled with provocative based on a critical review of and Wampold (2014) in a recent nomenclature and split into false current literature. Furthermore, survey of clinical psychology dichotomies. The aim of the an integrative framework will graduate students, the majority current paper is to review one be provided as a method to identified EBP as synonymous with such debate regarding those mediate this discourse based on empirically supported treatments; advocating for the utilisation of current literature and within the this understanding was also diagnostic specific Empirically operationalisation of Evidence prevalent with practitioners (Pagoto Supported Treatments (EST) and Based Practice (EBP), as the et al., 2007; Wachtel, 2010; on the other side, proponents framework was originally designed Westen, Novotny, & Thompson- of the Common Factors (CF) to be utilised. By introducing Brenner, 2005). This narrative approach to therapy who offer up research at the cutting edge of is furthered by EST proponents a counter argument. This paper practice, this paper will align who postulate specific ingredient

Irish Association for Counselling and Psychotherapy 19 IJCP Volume 19 • Issue 3 • Winter 2019 therapies, for specific disorders In response to the proliferation (e.g Chambless & CritsChristoph, ommon factor of EST’s, common factor 2006; Baker et al. 2008; Barlow, Cadvocates contend proponents put forward an 2004; Chambless & Hollon, 1998; that when the specific argument that therapeutic Siev, Huppert, & Chambless, active ingredients are outcomes are the result of 2009). Provocative nomenclature removed from empirically factors common to all bona fide is utilised to support the narrative; supported treatments in psychotherapeutic approaches. words such as efficacy, statistically Indeed, theoretical orientation/ significant, protocols and fidelity dismantling studies, the techniques account for a to manualised therapies are approaches still show minority percentage of variance propagated as the gold standard. outcomes equal to the in outcomes circa 1% (Laska, The implicit message is that if full component therapy Gurman and Wampold, 2014; you are not using these therapies Wampold, 2001). As Lambert then you are not ‘evidence based’. (2013 P.43) contends, “It will However, meta-analysis comparing from studies are problematic in not generally matter which kind manualised versus non-manualised the transition to routine practice of psychotherapy is offered therapies does not support this (Margison et al, 2000). as long as it is a bona fide contention (Truijens et al, 2018; theory-driven intervention”. Vinnars et al, 2005; Navarro, Common Factors The discourse within the & Phillips, 2000). Indeed with Common factors refer to effective common factor paradigm offers these therapeutic gold standards, aspects of therapy that are shared differentiated frameworks to one would expect the outcomes by diverse schools of thought, conceptualise this phenomena within the field to have progressed they are non-specific. Those (see Rosenzweig, 1936; Duncan, substantially over the decades, yet, who purport a common factor Hubble, Miller, 2010; Wampold research suggests that outcomes approach point to a large body & Imel, 2001; 2015; Duncan & have not improved in 58 years of evidence from randomised Moynihan, 1999). Chambless (Weisz, et al, 2019). controlled trials and meta-analysis & CritsChristoph, (2006 p.199) Within the EST paradigm the showing equivalents in outcomes refute the common factor person of the therapist is not between bona fide treatments proposition on what would seem considered important as an when compared (e.g. Watts et a rigid adherence to philosophical outcome variable, protocols al, 2013; Smith & Glass, 1977; science based research; “Of all and fidelity to theory and Stiles, Barkham, Mellor-Clark, & the aspects of psychotherapy that technique are said to mitigate for Connell, 2008; Stiles, Barkham, influence outcome, the treatment differences within and between Twigg, Mellor-Clark, & Cooper, method is the only aspect in therapist outcomes and effect 2006; Wampold et al, 1997; which psychotherapists can be sizes. This argument is counter Project Match 1998). trained, it is the only aspect that to that of Baldwin and Imel Moreover, common factor can be manipulated in a clinical (2013) who contend that the advocates contend that when experiment to test its worth, and, individual therapist accounts the specific active ingredients if proven valuable, it is the only for approximately 5% - 8% of are removed from empirically aspect that can be disseminated the variance in outcome; this is supported treatments in to other psychotherapists”. in contrast to Wampold (2001) dismantling studies, the Nonetheless, the debate regarding assertion that a mere 1% of approaches still show outcomes if therapy works through the outcome variance is attributed equal to the full component activation of specific factors, to theory and technique . In therapy (e.g Cusack et al, 1999; or through the interdependent addition to these concerns, other Cahill et al, 1999; Bell, Marcus variables of common factors research suggests that studies & Goodlad, 2013; Ahn and remains, as we currently do not from EST’s don’t always transition Wampold, 2001). Indeed, the have the statistical power or into naturalistic settings due latest fad of trauma informed methodologies in research needed to controls utilised to improve treatments that include add on to evidence causality (Cuijpers, et internal validity during randomised adjunctive therapies are not as al, 2019). However, dismantling control trials; indeed, aggregated clinically effective as proponents studies and equivalent outcomes mean scores at the group level posit (Ulrich & Gergor, 2016). within the literature provide strong

20 Irish Association for Counselling and Psychotherapy Volume 19 • Issue 3 • Winter 2019 IJCP evidence against the specific and developed in relation to client ingredient propositions andomised outcomes in over four decades, Duncan (2014) puts forward the R control trials despite the emergence of hundreds following conceptual framework and meta-analysis of empirically supported treatments (see figure 1) to understand within the literature (Weisz et al, 2019; Wampold, the common factors and their on routine outcome Mondin, Moody, & Ahn, 1997). This interactions. measurements suggests data can be inferred to suggest The percentages are best that there is something other than viewed as a defensible way to that intentionally specific therapy ingredients based understand outcome variance eliciting live feedback on diagnosis-treatment paradigms but not as representing any from clients within at play. This is further reinforced ultimate truths. They are meta- sessions can improve with longitudinal research in analytic estimates of what each therapy outcomes, reduce naturalistic settings suggesting that of the factors contributes to dropout rates, and on the whole, therapists became change. Because of the overlap slightly less effective over time among the common factors, the identify those at risk for (Goldberg et al, 2016). Moreover, percentages for the separate deterioration a body of research illustrates factors will not add to 100%.” that approximately 5-10% of (p. 23). those engaged in counselling and therapeutic settings are well psychotherapy actually deteriorate Practice Based Evidence established within the extant while in treatment (Hansen & Outcomes are an area to come literature as having strong evidence Lambert, 2003; Hansen, Lambert under increasing scrutiny by of efficacy and effectiveness & Foreman, 2002; Lambert & academics, managed care providers (Lambert, 2013; Lambert & Ogles, Ogles, 2004; Mohr, 1995). More and commissioning bodies in recent 2004; Fonagy, Roth, & Higgitt, worryingly, this statistic is higher times. Swisher (2010) explains the 2005). Meta-analytic studies for young people (Nelson et al, concept of Practice-Based Evidence conclude that recipients of such 2013). Lambert (2017) postulates as, “the real, messy, complicated interventions greatly benefit when that 30% of patients fail to respond world is not controlled. Instead, compared to non-treated individuals during clinical trials, and as many real world practice is documented with aggregated effect sizes ranging as 65% of patients in routine care and measured, just as it occurs, from 0.75- 0.85 (Hansen, Lambert, leave treatment without a measured “warts” and all. It is the process & Forman, 2002; Wampold & Imel, benefit. of measurement and tracking 2015; Lambert, 2013). Randomised control trials and that matters, not controlling how Nevertheless, the overall meta-analysis within the literature practice is delivered”. Psychosocial effectiveness of counselling and on routine outcome measurements interventions delivered within psychotherapy has not progressed suggests that intentionally eliciting live feedback from clients within sessions can improve therapy outcomes, reduce dropout rates, and identify those at risk for Feedback Effects deterioration (Berking, Orth, & 21 - 42 % Lutz 2006; Harmon et al., 2007; Alliance Effects Hawkins, Lambert, Vermeersch, Treatment Effects 36 - 50 % 14 % Slade, & Tuttle, 2004). Moreover, Model/Technique: research posits that practitioners Specific Effects ( Model Differences ) do not adequately predict the 7% deterioration of clients, those at Model/Technique: risk of drop out and null outcomes when they assess clients Therapist Effects General Effects (Rational & Ritual), Client Expectancy 28% informally (Ostergard, Randa 36 - 57% & Hougaard, 2018). Thus, the utilisation of such processes and procedures will serve to improve Figure 1 - Common Factors Conceptual Framework

Irish Association for Counselling and Psychotherapy 21 IJCP Volume 19 • Issue 3 • Winter 2019 outcomes for practitioners. This practitioner framework including is further reinforced by several nterventions must be practice based evidence and studies that contend that the use I acceptable to clients’ empirically supported treatments. of such feedback systems produce cultural values, and In order to achieve a fully outcomes that are 2.5 times preferences, and make integrative approach we must better than treatment as usual sense to their idea of the turn back to the evidence based (e.g Brattland, et al, 2018) and presenting issues, onset practice framework and the that its use can cut rates of those common factor model. Evidence- at risk of deterioration and drop and possible treatment based practice as the integration out by 50% (Berking, Orth, amp, options. of the best available research with Lutz 2006; Harmon et al., 2007; clinical expertise in the context of Hawkins, Lambert, Vermeersch, patient characteristics, culture and Slade, Tuttle, 2004). 2014), it is based on a shorter preferences” (APA, 2005). According to Phelps, Eisman, version of the Working Alliance So, to operationalise this & Kohout, (1998) despite Inventory. Both instruments can be framework what must our the numerus measurement administered in different modes practitioners do? Integrate the methodologies at the disposal of (individual, couple and group best available evidence? The therapists few clinicians utilise therapy; with adults, children and literature provides us with rigours them, and outcome data collection adolescents; and across differential evidence of several factors that is rare. Hatfield and Ogles (2004) clinical presentations. Moreover, work in therapy. However, when it conducted a national survey of each scale has clinical cut off comes to the theoretical orientation psychologists and found that rates depending on the clients’ age aspect of what works the current uptake of such instruments was linked to normative data. Taken debate splits opinion. What we can limited due to perceived barriers together, both these reliable and say is the following; the average such as; time and money, and validated (Duncan et al, 2004; treated client is better off than practicalities of their in session Miller et al, 2004) psychometrically approximately 80% of untreated brevity. Interestingly, this links to sound outcome measures make up people; research provides strong wider issues of underutilisation the main components of a pan- evidence for bona fide therapies of Routine Outcome Monitoring theoretical approach, Feedback and there utilisation, however, (ROM) data by therapists (Lambert, Informed Treatment (FIT) which has the role of specific ingredients 2017; Simon et al, 2012; de Jong Evidence Based Practice status in versus common factors as change et al, 2012). Carlier and Van the Substance Abuse and Mental agents may not be as important Eeden (2017) suggest that training Health Services Administration’s as the integration of both into should be provided to clinicians (SAMHSA) National Registry. a uniformed model. To this end, in administration, interpretation practitioners are best placed to and using feedback to discuss Evidence Based Practice choose therapies that best fit their treatment, stagnation, decline and Operationalised worldview (allegiance effect); that goal setting with clients. Thus far, we have examined one they can explain the rationale for In response to some of these of the main discourse debates the use with clients; and that offer concerns, Miller and Ducan (2000) within psychotherapy. Common up a theoretical explanation to the developed two short 4 question factors and empirically supported clients presenting issue with a instruments to measure outcomes treatments pitted against one set of corresponding techniques/ based on a shortened version of and other, fighting for position rituals. However, interventions the Outcome Questionnaire 45. as the most prominent method. must be acceptable to clients’ The first, theOutcome Rating Scale However, this paper contends that cultural values, and preferences, (ORS) captures data on client such rivalry is based on a false and make sense to their idea progress that can be aggregated dichotomy as both aspects are of the presenting issues, onset in order to determine therapists interdependent and necessary and possible treatment options. overall effectiveness. The Session for therapeutic change to occur. Evidence supports these factors Rating Scale (SRS) assess the Therefore, this paper puts forward as producing favourable outcomes quality of the therapeutic alliance a framework for practitioner mediated through the therapeutic which is a key indicator of the integration based on the full alliance, client expectancy, effectiveness of therapy (Wampold, utilisation of the evidence based instillation of hope, placebo effect

22 Irish Association for Counselling and Psychotherapy Volume 19 • Issue 3 • Winter 2019 IJCP and practitioner allegiance to the REFERENCES therapy. Providing this within the Ahn, H., & Wampold, B. E. (2001). Where oh Chambless, D. L., & Hollon, S. D. (1998). confines of the clinicians’ expertise where are the specific ingredients? A meta- Defining empirically supported therapies. Journal analysis of component studies in counseling of Consulting and Clinical Psychology, 66, 7–18. means that the practitioner uses and psychotherapy. Journal of Counseling Chambless, D. L., Sanderson, W. C., Shoham, V., all their experience and knowledge Psychology, 48, 251–257. doi: 10.1037/O022- Johnson, S. B., Pope, K. S., Crits-Christoph, P.,... OI67.48.3.251 garnered through education, clinical McCurry, S. (1996). An update on empirically American Psychological Association validated therapies. The Clinical Psychologist, experience and ongoing research (2005): Evidence Based Practice, American 49, 5–18 in conjunction with the person Psychologist 0003-066X/06/$12.00 Vol. Cuijpers P, Reijnders M, Huibers, JH (2019) The they are working with and their 61, No. 4, 271–285 DOI: 10.1037/0003- role of the common factors in psychotherapy 066X.61.4.271 outcomes Annual Review of Clinical worldview. Baker, T. B., McFall, R. M., & Shoham, Psychology, 15(1). 207-231 V. (2008). Current status and future Finally, practitioners will be Cusack, K. & Spates, C. R. (1999). The Cognitive prospects of clinical psychology: Toward a Dismantling of Eye Movement Desensitization and best placed by utilising a Routine scientifically principled approach to mental Reprocessing (EMDR) Treatment of Posttraumatic and behavioral health care. Psychological Outcome Monitoring system to Stress Disorder (PTSD). Journal of anxiety disorders. Science in the Public Interest, 9, 67–103. track client progress, identify 13. 87-99. 10.1016/S0887-6185(98)00041-3. doi:10.1111/j.1539-6053.2009 .01036.x De Jong, K., van Sluis, P., Nugter, M. A., those at risk of deteriation, and Baldwin, S. A., & Imel, Z. E. (2013). Therapist Heiser, W. J., & Spinhoven, P. (2012). drop out and those responding to effects: Findings and methods. In M. J. Lambert Understanding the differential impact of outcome (Ed.), Bergin and Garfield’s handbook of interventions. In addition, data from monitoring: Therapist variables that moderate psychotherapy and behavior change (6th ed., feedback effects in a randomized clinical ROM can be utilised for therapists pp. 258 –297). New York: Wile trial. Psychotherapy research, 22(4), 464 – 474. to actively and intentionally Barlow, D. H. (2004). Psychological doi: 10.1080/10503307.2012.673023 treatments. American Psychologist, 59, 869– improve upon areas needing De Jong, K. (2016). Challenges in the 878. doi:10.1037/0003-066X.59.9.869 further development by providing Implementation of Measurement Feedback Bell, E. C., Marcus, D. K., & Goodlad, J. K. Systems. Administration and Policy in Mental baseline outcome stats. Chow et (2013). Are the parts as good as the whole? A Health and Mental Health Services Research, al. (2015, p. 337) refer to this meta-analysis of component treatment studies. 43(3). 467-470. Journal of Consulting and Clinical Psychology, 81, method of therapist development 722–736. doi:10.1037/ a0033004 Duncan, B. (2014 ). On Becoming a Better as Deliberate Practice. “Consistent Therapist: Evidence-Based Practice One Client Berking, Matthias & Orth, Ulrich & Lutz, at a Time (2nd Ed.). USA: American Psychological with the literature on expertise and Wolfgang. (2006). How effective is systematic Association. feedback of treatment progress to the expert performance, the amount of therapist? An empirical study in a cognitive- Duncan, B. L., Miller, S. 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The heart & soul of change: delivering characteristics, preferences, values Anxiety Disorders, 13. 5-33. what works in therapy (2nd ed.). Washington, DC: American Psychological Association and the multitude of complexities Carlier, I. V. E., van Eeden, W. A. (2017). Routine Outcome Monitoring in Mental Health Hawkins, E. J., Lambert, M. J., Vermeersch, humans bring to the therapy Care and Particularly in Addiction Treatment: D. A., Slade, K. A. & Tuttle, K. C. (2004). The endeavour. Evidence-Based Clinical and Research therapeutic effects of providing patient Recommendations. J Addict Res Ther 8. 332. progress information to therapists and doi:10.4172/2155-6105.1000332 patients. Psychotherapy Research, 14(3), 308- Chow, D. L., Miller, S. D., Seidel, J. A., Kane, R. 327, DOI: 10.1093/ptr/kph027 T., Thornton, J. A., Andrews, W. P. (2015). The Fonagy P., Roth, A., Higgitt, A. (2005). 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Hansen, N. B., Lambert, M. J., & Forman, E. Miller, S., Duncan, B. & Brown, J. (2003). The Swisher AK. Practice-based M. (2002). The psychotherapy dose-response Outcome Rating Scale: A Preliminary Study of evidence. Cardiopulm Phys Ther J, 21(2): 4. effect and its implications for treatment the Reliability, Validity, and Feasibility of a Brief Truijens, F., Zühlke-van Hulzen, L., Vanheule. delivery services. Clinical Psychology: Science Visual Analog Measure. Journal of Brief Therapy, S. (2018) To manualize, or not to manualize: and Practice, 9(3), 329-343. 2. 91-100. Is that still the question? A systematic review Hansen, N.B. & Lambert, M.J (2003) An Mohr, D. C. (1995), Negative Outcome in of empirical evidence for manual superiority Evaluation of the Dose–Response Relationship Psychotherapy: A Critical Review. Clinical in psychological treatment. J Clin Psychol, in Naturalistic Treatment Settings Using Psychology: Science and Practice, 2 1-27. 75(3):329-343. doi: 10.1002/jclp.22712. Epub Survival Analysis. Ment Health Serv Res 5(1) doi:10.1111/j.1468-2850.1995.tb00022.x 2018 Oct 28. https://doi.org/10.1023/A:1021751307358 Nelson, P. L., Warren, J. S., Gleave, R. L., & Vinnars, B., Barber, J. P., Norén, K., Gallop, R., Harmon, S. C., Lambert, M. J., Smart, D. M., Burlingame, G. M. (2013). Youth psychotherapy Weinryb, R. M. (2005). Manualized supportive- Hawkins, E., Nielsen, S. L., Slade, K., Lutz, change trajectories and early warning system expressive psychotherapy versus nonmanualized W. (2007). Enhancing outcome for potential accuracy in a managed care setting. Journal of community-delivered psychodynamic therapy treatment failures: Therapist-client feedback Clinical Psychology, 69(9), 880–895. for patients with personality disorders: bridging and clinical support tools. Psychotherapy Norcross, J. C., & Lambert, M. J. (2011). efficacy and effectiveness.J Psychiatry 162 (10), Research, 17(4). 379–392. doi: Psychotherapy relationships that work II. 1933-1940. 10.1080/10503300600702331. Psychotherapy, 48, 4 – 8. doi:10.1037/a0022180 Wachtel, P. (2010). Beyond “ESTs”: Problematic Hatfield, D. R., & Ogles, B. M. (2004). The Norcross, J. C., Beutler, L. E., & Levant, R. F. assumptions in the persuit of evidence based Use of Outcome Measures by Psychologists (Eds.). (2005). Evidence-Based Practices in practice. Psychoanalytic Psychology, 27, 251– in Clinical Practice. Professional Psychology: Mental Health: Debate and Dialogue on the 272. doi:10.1037/a0020532 Research and Practice, 35(5), 485-491 Fundamental Questions. Washington, DC: Wampold, B. E. (2001). The great psychotherapy Hawkins, E., Lambert, M., Vermeersch, D., American Psychological Association debate: Models, methods, and findings. Mahwah, Slade, K., Tuttle, K. (2014). The therapeutic Østergård, O. K., Randa, H. and NJ: Erlbaum effects of providing patient progress Hougaard, E. (2018). The effect of Wampold, B. E., & Brown, G. S. (2005). information to therapists and patients. using the Partners for Change Outcome Estimating therapist variability: A naturalistic Psychotherapy Research 14. Management System as feedback tool in study of outcomes in managed care. Journal Imel, Z. E., & Wampold, B. E. (2008). The psychotherapy-A systematic review and of Consulting and Clinical Psychology, 73, 914 common factors of psychotherapy. In S. meta-analysis. Psychotherapy Research, –923. doi:10.1037/0022-006X.73.5 .914 D. Brown & R. W. Lent (Eds.), Handbook of OI: 10.1080/10503307.2018.1517949 Wampold, B. E., & Serlin, R. C. (2014). Meta- counselling psychology (4th ed.). New York: Pagoto, S. L., Spring, B., Coups, E. J., analytic methods to test relative efficacy. Wiley. Mulvaney, S., Coutu, M. F., & Ozakinci, G. Quality & Quantity. International Journal of Ioana A. Cristea, Eirini Karyotaki, (2007). Barriers and facilitators of evidence- Methodology, 48, 755–765. doi:10.1007/ Mirjam Reijnders & Steven D. based practice perceived by behavioral science s11135-012–9800-6. Hollon (2019) Component studies of health professionals. Journal of Clinical Wampold, B. E., Imel, Z. E., Laska, K. M., psychological treatments of adult depression: Psychology, 63, 695–705. Benish, S., Miller, S. D., Flückiger, C., ... Budge, A systematic review and meta-analysis. Phelps, R., Eisman, E. J., & Kohout, J. S. (2010). Determining what works in the Psychotherapy Research, 29(1), 15- (1998). Psychological practice and managed treatment of PTSD. Clinical Psychology Review, 29. DOI: 10.1080/10503307.2017.1395922 care: Results of the CAPP practitioner 30, 923–933. doi: 10.1016/j.cpr.2010.06.005 Lambert, M. (2017). Maximizing Psychotherapy survey. Professional Psychology: Research and Wampold, B. E., Mondin, G. W., Moody, M., Outcome beyond Evidence-Based Medicine. 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D., & Chambless, D. L. York: Routledge efficacy and effectiveness of psychotherapy. (2009). The dodo bird, treatment technique, Watts, B.V., Schnurr, P. P., Mayo, L., Young-Xu, In M. J. Lambert (Ed.), Bergin and Garfield’s and disseminating empirically supported Y., Weeks, W. B. & Friedman, M. J. (2013). handbook of psychotherapy and behavior treatments. The Behavior Therapist, 32, 69 –76. Meta-analysis of the efficacy of treatments for change (5th Ed). New York: Wiley Smith, M. L., & Glass, G. V. (1977). posttraumatic stress disorder. J Clin Psychiatry, Laska, K. M., Gurman, A. S., & Wampold, B. E. Meta-analysis of psychotherapy outcome 74(6), 541-50. doi: 10.4088/JCP.12r08225 (2014). Expanding the lens of evidence-based studies. American Psychologist, 32(9), 752-760. Weisz, J. R., Kuppens, S., Ng, M. Y., Vaughn- practice in psychotherapy: A common factors Coaxum, R. A., Ugueto, A. M., Eckshtain, D., perspective. Psychotherapy, 51(4), 467-481. Stiles, W. B., Barkham, M., Mellor-Clark, J., & Connell, J. (2008). Effectiveness of Corteselli, K. A. (2019). Are Psychotherapies Margison, F, Barkham, M, Evans, Chris cognitive-behavioural, person-centred, and for Young People Growing Stronger? McGrath, Graeme & Mellor-Clark, John & psychodynamic therapies in UK primary- Tracking Trends Over Time for Youth Anxiety, Audin, Kerry & Connell, Janice. (2000). care routine practice: Replication in a larger Depression, Attention-Deficit/Hyperactivity Measurement and Psychotherapy: Evidence- sample. Psychological Medicine, 38, 677–688. Disorder, and Conduct Problems. Perspect based Practice and Practice-based Evidence. doi:10.1017/ S0033291707001511 Psychol Sci, 14(2) 216-237. British Journal of Psychiatry, 177. 123-130. Westen, D., Novotny, C. M., & Thompson- 10.1192/bjp.177.2.123. Stiles, W. B., Barkham, M., Twigg, E., Mellor- Clark, J., & Cooper, M. (2006). Effectiveness Brenner, H. (2004). The empirical status Macran, S. and Shapiro, D. A. 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24 Irish Association for Counselling and Psychotherapy Volume 19 • Issue 3 • Winter 2019 IJCP

Book Review

innovations in the psychoanalytic process and technique Title: Learning Along the Way: Further which he has developed to keep the analytic space open. Reflections In Psychoanalysis and These include trial identification, the process of internal Psychotherapy. supervision, and – from my point of view, the most Author: Patrick Casement important – learning from the patient. As professionals, Published: 2019 following Casement’s example, we have to recognize ISBN: ISBN: 978-1-138-34354. our mistakes and implicitly, to become vulnerable in Reviewed by: Anca Filip the therapeutic space. Casement emphasizes the importance of a mutual recognition of failure as being Learning along the way, a compilation of earlier published very helpful for the patient. The effects of power in papers, makes a natural pairing for Patrick Casement’s the relationship, and its influence on the possibility first book,On Learning from the Patient. of mutual learning between analyst and patient, are In it, he reflects upon his life’s work well exemplified through the clinical over the past fifty years, following an vignettes. autobiographical journey from a suicide A particular concern for Casement attempt, to careers as a social worker, is that what is needed in the psychotherapist, and psychoanalyst. analytic relationship may have been The book concludes with an account of overshadowed by a continuing Casement’s near-fatal encounter in later influence of the medical model. life with an unexpected illness. He critiques the emphasis on the Throughout the book Casement explores different ways of working and provision of short term cognitive listening, helping us to consider ways behavioural therapies within the of thinking that might help us to better healthcare system, arguing that understand what we are hearing from they do not provide enough time for our patients. He is acutely aware of how patients to find their own path. They difficult the analytical process is for both rely too heavily, he suggests, upon analyst and patient, and alerts us to techniques provided by the therapist. some of the factors that can threaten While exploring those cases where the analytical space. He is particularly cognitive therapies might be of sensitive to the danger of training benefit, he is also mindful of how they institutes asking trainees to give up their can be appealing, simply because they minds to the theoretical orientation of are brief and financially affordable. their training organizations. In fact, he demonstrates a fierce opposition to any The last few chapters of this book are a collection dogmatic use of theory which imposes itself upon the of interviews; discussions with Kate Schechter and patient and which could influence their experience to Thérèse Gaynor, along with Casement’s ‘Response to fit the analyst’s own theory. “So we can engage with Stuart Pizer’s review’ of Learning from our mistakes. the otherness encountered in each of our patients,” he This piece echoes the famous Mrs M case from the insists, “we need to maintain an open mind” (p. 59). earlier book and concludes the collection. This is nearly impossible to achieve, however, “when our minds tend to be filled with what we are expecting to Throughout, Casement’s clear, accessible writing find” (p. 59). Casement’s suggested solution is to “try creates a space where the reader can learn. I would to re-establish non-certainty” (p. 59). This, he insists, is have loved to have seen cultural factors taken more into the way “to recover an open mind and the freedom to consideration. Even so, I am grateful for this book, which continue exploring” (p. 59). shares a lifetime’s experience of being a psychoanalyst, He emphasizes the importance of monitoring how the supervisor, and – most importantly – a human being. analytic space is possibly preserved or perhaps spoiled Casement’s openness to sharing his mistakes, illness by the analyst’s contribution. In so doing, he necessarily and wonderful vulnerability will influence generations of highlights the idea of mutual change and reciprocity professionals. in the therapeutic relationship which encourages an openness in the analyst to what he calls the “otherness Anca Filip is a pre-accreditied psychotherapist working of the other”. in the Meath Primary Care Centre, Dublin 8. She can Casement returns throughout the book to several be contacted at [email protected].

Irish Association for Counselling and Psychotherapy 25 IJCP Volume 19 • Issue 3 • Winter 2019

Poetry

BULLYING By Michelle Coyne

I want to be loved, Who sees me I don’t deserve it My parents or But I do deserve to be loved, I think My teacher or So why can’t I be loved An aunt, an uncle Does anyone love me Maybe a cousin Why can I not see it Maybe it’s the shop keeper who calls me by my name but I have never noticed What makes me blind to it before The Hurt, the Rejection, the Bullying, Hello, my name is ...... been Ignored What is yours How did I come to this place You who hide behind your masks of cyber By train, by car, ferry or plane bullying Ah, now I remember I asked; What is Your NAME...... IT WAS YOU Stop hiding YOU CARRIED ME WITH THE BULLYING, Stop being afraid TELLING ME I AM NOT GOOD ENOUGH, STOP STop Stop stop, shhhh! LAUGING AT ME, MAKING FUN OF ME IN FRONT OF MY FRIENDS SNAPCHAT, FACEBOOK, INSTAGRAM AND MORE IT NEVER ENDS THEY TURN AWAY NOW I AM REJECTED .... AGAIN AND AGAIN Does anyone notice me Have I become invisible Someone sees me, I have to look up,

26 Irish Association for Counselling and Psychotherapy Volume 19 • Issue 4 • Winter 2019 Irish Association for Counselling and Psychotherapy Ph: 01 2303536 www.iacp.ie Dun Laoghaire Co. Dublin. First Floor Marina House 11-13 Clarence Street