WORKING WITH TRAUMA IN A PERSONCENTRED WAY

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WORKING WITH TRAUMA IN A PERSON-CENTRED WAY

• Nexus 25th Anniversary Conference, Belfast, 21
  October, 2009
• Professor Dave Mearns
• www.davemearns.com

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CONTENTS

• Person-Centred Counselling A radical therapy
• Working at Relational Depth
• Working with survivors of trauma
• Earning the right to work with Rick a
  traumatised patient.

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PERSON-CENTRED COUNSELLING A RADICAL THERAPY

• The importance of entering the clients
  experiencing
• The therapists technical expertise is not
  particularly important
• The client exercising their own power is
  important.

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Entering the clients experiencing

• Rogers, C. (1951). Client-centered therapy.
  Boston Houghton Mifflin. (p. 494).
• Proposition 7
• The best vantage point for understanding
  behavior is from the internal frame of reference
  of the individual himself

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Entering the clients experiencing

• An outside view
• Vs
• An inside view

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JOHN An outside view

• Clinical Report John is socially isolated. His
  inability to form social relationships has been
  with him throughout his teenage years. He has
  simply failed to develop the normal social skills
  upon which relationships are based. His isolation
  is now so chronic that he has built his life
  around it, spending most of his time in his room
  in the family home. His parents efforts to bring
  him out are rebuffed and even their

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• attempts to make his life more stimulating by
  giving him a computer, are ignored. When he does
  come out of his room he soon goes into a panic
  state where he can be threatening to his parents
  and destructive to property. He has frequent
  paranoid delusional experiences, short lasting
  catatonic episodes and deeply depressive moods.
  It is too early for a precise diagnosis within
  the psychotic spectrum.

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JOHN An inside view

• Im frightened. Ive been frightened for a long
  time. I cant remember why Im frightened. Im
  frightened of other people. Sometimes I know that
  I shouldnt be frightened like with Mary his
  cousin. Shes kind to me she doesnt ask me to
  change. I make myself smile at her, because
  inside I want to smile at her. I like being in my
  room. Im safe there. I used to lock
• myself in, but they his parents took the lock
  off

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• the door in case I starved myself. I can still
  wedge a chair under the door handle. I cry a lot
  in my room but I dont mind crying it feels
  OK. I think a lot too and I write all the time.
  I hide the writing they would never guess where
  it is. They would get really angry if they found
  it. Im frightened of them his parents and I
  hate him (his father). I dont hate my mother but
  I mustnt love her I need to ignore her to stay

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• safe from him. When Im out of my room I get
  really frightened and the bad hate comes out. I
  need to get back in my room. He set up a computer
  in my room. I leave it alone its part of him.
  I like my room I can live inside my head there
  Im safe there.

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• THERE IS A PERSON IN THERE

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PERSON-CENTRED COUNSELLING A RADICAL THERAPY

• The importance of entering the clients
  experiencing
• The therapists technical expertise is not
  particularly important
• The client exercising their own power is
  important.

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• Asay, T. Lambert, M. (1999). Therapist
  relational variables. In D. Cain J. Seeman
  (Eds.), Humanistic psychotherapies Handbook of
  theory and practice (pp. 531-557). Washington DC
  APA.

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What makes therapy effective?

• Asay, T. Lambert, M. (1999). Therapist
  relational variables. In D. Cain J. Seeman
  (Eds.), Humanistic psychotherapies Handbook of
  theory and practice (pp. 531-557). Washington DC
  APA.
• 40 - Client factors
• 30 - The therapeutic relationship
• 15 - The technical skills of the therapist.

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PERSON-CENTRED COUNSELLING A RADICAL THERAPY

• The importance of entering the clients
  experiencing
• The therapists technical expertise is not
  particularly important
• The client exercising their own power is
  important.

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Can we create a therapy where the client

• is not trapped into seeing the therapist as the
  expert in them?
• is empowered rather than disempowered?

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• DEFICIENCY MODEL THERAPIES
• Vs
• POTENTIALITY MODEL THERAPIES

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WORKING AT RELATIONAL DEPTH

• Mearns, D. Cooper, M. (2005). Working at
  Relational Depth in Counselling and
  Psychotherapy. London Sage. ISBN 0-7619-4458-3

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THE PROCESS OF RELATIONAL DEPTH

• The counsellors humanity is focused upon the
  client
• the client lets himself experience that humanity
• this creates a huge therapeutic space/safety for
  the client
• the client experiences himself more fully
• On an on-going basis the client is more sensitive
  to himself-in-relation.

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I stopped needing to pretend

• Box 3.6 on page 65 of Mearns, D. Thorne, B.
  (2007). Person-Centred Counselling in Action,
  Third Edition. London Sage (ISBN
  978-1-4129-2855-7).

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I stopped needing to pretend

• I stopped needing to pretend. I had been in
  counselling three times before. They had all been
  good experiences and I thought that I had got a
  lot out of them. But this time was completely
  different. At first I didnt know how to take
  Mary the counsellor. She was more direct than I
  was used to. My first thought was that she was a
  bit hard on me. I was used to something softer.
  But, she could

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• really meet me more fully than anyone before. She
  could even meet me through my defences. Once she
  challenged me by asking if I was presenting what
  I was talking about in a particular way to her
  in a way that would make her think well of me. It
  was an awful thing to say but she said it
  really well I felt it was coming from her
  understanding of me, not any judging of me. I
  just answered, Yes, and looked her

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• straight in the eye. I didnt even make my usual
• excuses. From that moment everything was
  different. I realised that I had two answers to
  every question the pretend one and the real
  one. I began to give both of them. I was speaking
  to her in a way that was different to anything
  before. Even my tone of voice was different it
  was less squeaky, more serious and, altogether,
  more fullsome. I began to experience everything
  more fully. When I felt emotions,

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• they were more powerful again, more fullsome.
• I realised, with some horror, that I had almost
  never been real in my life before. I had
  habitually put on a face to the world. With me
  not defending, we got to areas I had never been
  to before. I saw different feelings within me as
  well as the ones I was used to feeling. In
  relation to my mothers death I not only saw my
  sadness, but I felt my hate, and also my sorrow
  for her. An interesting thing was that my not
  defending

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• actually made me less scared. This is difficult
  to
• explain, but it is important. It wasnt just that
  she made it safe for me so that I didnt need to
  defend. It was that she challenged me as a truly
  caring human being and I responded. It was me
  responding and continuing to respond that made me
  less scared there was no dependence on her.
  Its unusual.

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PRESENTED DIMENSIONS OF SELF
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Approach/ Avoidance towards being met at
relational depth
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DISGUISES AND CLUES
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Two aims in offering the client an engagement at
relational depth

• Listening to the expressing rather than the
  expression
• Meeting the client inside his experiencing

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Listening to the Expressing/Entering the
experiencing

• Tony I cant, I cant, I cant, I cant, I
  cant
• Bill No, .. you cant.
• Tony No one can.
• Bill (Silence)
• Tony (Thumping his fist on the floor and
  screaming) I need to kill myself

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• Bill (Silence).
• Tony I need to go .. I must go .. I must go
  away from me.
• Bill (Silence).
• Tony I dont know how to do it.
• Bill Its hard, Tony . Its hard ..like
  theres no way ..

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• Tony No way .. no way .. How do people do
  it?
• Bill God knows Tony.
• Tony Can you warm me Bill?
• Bill (Puts his arm round Tony).

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Much later Bill comments on this meeting

• Its an example of how you can be with someone
  and have conversation without having any idea
  what its about. Yet all the time you can feel
  them - and be with them feeling. It was weeks
  later that I found out the content of this
  meeting. Tony was being the part of him which

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• had done some bad stuff. In war people can do
  bad stuff that they cant live with later. Tony
  was feeling that part - he wanted to get rid of
  it - to kill it or for it to go away. But, of
  course, there was no way to do it - thats what
  we were in.

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Relational depth is about the quality of the
relational contact, not the quantity
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Relational Depth in Everyday Life

• Doug the teacher
• Mhairi the nurse
• Lillian the social worker

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WORKING WITH SURVIVORS OF TRAUMA
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• Trauma is a profoundly existential event

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• Trauma fundamentally disrupts the whole
  assumptive frame upon which our sense of self is
  founded
• (Mearns Cooper, p. 65)

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• Trauma is so shocking at an existential level
  that it can take us completely out of our social
  worldThe trauma victim may find it difficult to
  perform the simple acts of social living even
  shopping in a supermarket can become impossible
  because of its essential meaninglessness...It
  becomes difficult to tolerate insignificance when
  something so profoundly significant has happened
  to us. (p66)

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TRAUMA IS STICKY STUFF

• SECONDARY TRAUMATISATION

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Meeting the client at the edge of their
experiencing

• at the edge between the known and the unknown
• where the persons systems of self-protection
  struggle to contain the raw experiences
• where the struggle for sanity divides the self.

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Some traumatised clients

• I generally had two answers to every question
  one set that I gave to other people to pretend
  I was OK and the other set that I could rarely
  voice

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• My wife loved me and cried when she visited.
  That was too painful. I couldnt cope with
  myself, never mind another person. So I told them
  not to let her come again.

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• During the day I had lots of routines to keep
  the devil away. But at night he got me. Every
  night I would try to stay awake. But every time I
  fell asleep I was opened up with a knife and my
  guts would fall out. I would try to pick them up
  to carry them to get help but they kept
  slithering on to the pavement.

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• I really wanted to speak to you you seemed
  a nice enough guy I wanted to give you
  something back. Sometimes, in my mind, I would
  open my lips and try to speak but, in reality,
  my lips didnt open I couldnt make them open

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Earning the right to work with Rick A
traumatised patient

• Chapter 6 in Mearns Cooper (2005) Working at
  Relational Depth in Counselling and
  Psychotherapy, London Sage.

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• The Counterfeit Universe of war
• (Lifton, R.J. 1974 Home from the War. London
  Wildwood House)

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• I have taken a sane man and made him mad
  enough to go to war
• (Captain Rivers in Regeneration).

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RICK

• Fire fight
• Fragging
• Third tour
• Mute

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The first of 72 meetings over 12 weeks

• RICKS ROOM
• RICKS SILENCE
• MY WHO I AM SPEECH

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MEETING 2

• RESPECTING AND CONNECTING

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• ENCOUNTER NOT INVASION

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• RICKS TURNING ROUND

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MAINTAINING OUR HUMANITY WHEN WE GET LITTLE BACK

• What I did get back from Rick
• Staying fresh
• The rap group
• Supervision

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• TALKING THE TALK

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MEETING 15

• THE FLYING BOOK

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MEETING 23

• THE DAY RICK CRIED

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MEETING 25

• TELL HIM NOT TO COME

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MEETING 26

• THE DAY DAVE CRIED

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MEETING 27

• DO YOU TAKE CREAM OR SUGAR?

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• THE END OF THE BEGINNING?
• OR
• THE BEGINNING OF THE END?