Somerset Counselling: What is Integrative Counselling?

When we look into the world of counselling and psychotherapy the buzzword these days appears to be `Integrative Counselling and psychotherapy`. The phrase is tossed into conversations and the written word like the bread thrown to the ducks in the park. But what exactly is Integrative Counselling and psychotherapy and how does it work?

We all know that there are many different approaches (or methods) to counselling and psychotherapy which are built on a wide range of ideas and theories. These include Psychodynamic, Gestalt, Behavioural (CBT), Humanistic (Person Centred) Psychosynthesis and Existential.

The Advantage of Integrative Counselling

The advantage of the Integrative Counselling Model is that it draws from all these major orientations and includes them in a counselling method which treats the person as a whole. This wider view is in contrast to some Psychodynamic purists who will generally look towards the client’s younger years and symbolism like dreams and Freudian slips to attempt to unravel the person’s unconscious.

Behavioural therapies such as CBT will be concerned with the here and now and look at unhelpful aspects of a person’s thinking such as Negative Automatic Thoughts (NATs). Here the CBT therapist will communicate very little Empathy, instead concentrating on how the client is affected right now by their problems and issues.

Humanistic counselling which includes the work of Carl Rogers and his Person Centred approach leans heavily on the relationship between client and therapist and the communication to the client by the therapist of what Rogers called the `core conditions`. While Psychosynthesis itself and other Existential approaches relate more to the `unexplainable` and has a spiritual side or edge to it. Therefore we in Integrative Counselling see it’s possible to have one’s gateau and eat it in as far as treating the client as a whole and also having the benefits of the major orientations.

It is said that Integrative counselling is the growing approach within psychotherapy which links it nicely to another buzzword of `postmodernism`. Postmodernism captures the trend and mood that we see in the decline of purist approaches. In many walks of life we witness the move to more flexible and pragmatic solutions to problems that were tackled in a more rigid fashion in times past.

Integrative Counselling Framework 

So who’s responsible for Integrative counselling theory that supports Integrative counselling and the surge of interest that it has caused? One of the leaders has been Dr Petruska Clarkson, who with almost 30 years international experience and 150 publications to her name was the designer of the first MSc level Integrative psychotherapy course in the UK. Her Integrative counselling framework has been used in various colleges to provide a sound qualification for recipients to embark upon a career in counselling.

Clarkson’s Integrative counselling framework includes the Five Relationships between therapist and client of Working Alliance, Tranferential, Reparative, I-you and Transpersonal. Also present are the Seven Levels of Functioning of Physiological, Emotional, Normative, Nominative, Rational, Theoretical, and Transpersonal.

What Is Integrative Counselling?

For those still wondering what Integrative Counselling is, it’s clear that the Integrative approach to counselling is different than eclecticism. Eclecticism is said to be about the process of `selecting out` and also more about taking something apart while Integration is more about `bringing together`. So the Integrative approach to counselling is a bringing together of different approaches to form a new orientation that stands in it’s own right.

Is it possible to see how an Integrative approach to counselling works and hear a little more about these 7 levels of functioning?

The following case study is a fictitious and is unlikely to occur in real life, however it’s useful to explain a little of Integrative counselling theory. `Mrs Smith` arrives at her counsellor’s for her first session of Integrative counselling. While presenting her problem to the therapist she appears to be shaking slightly while wrapping her arms around herself. The therapist views this Physiological level of his client. Is she cold, is she frightened or is there some other reason for her shaking? Maybe chemical? This is discussed with the client.

While the client talks, she becomes upset and starts to cry, the client’s Emotional level is clear for the therapist to see and work can be done on this. Feeling a little better now, Mrs Smith talks of the fact that she has not seen her grown up children for fifteen years – she shows no emotion and appears to see nothing strange in this – this is her Normative level – what is normal to her, her bench mark and her frame of reference to judge the goings on in her external world.

Mrs Smith now talks of her neighbour who she alleges runs a black magic cult in his garden every other Thursday evening. She calls him “the evil one”. The therapist notices that this is the name she has nominated for him – this name brands him and links him to how she sees him and his activities. This is her Nominative level. As mentioned before this is a fictional tale and it’s unlikely that all aspects of the 7 levels of functioning would be witnessed in one single session. However it does help to explain the question `What is Integrative Counselling?` and what is behind Integrative Counselling Theory.

Now back to Mrs Smith;

Although seemingly unhappy about the exploits of her Satanist neighbour, Mrs Smith surprises her therapist by declaring that he’s not really hurting anyone and everyone needs a hobby, as did her late husband Mr Smith, who was an avid collector of eggcups. The therapist notes down her Rational level of functioning.

Moving on, Mrs Smith talks again of her late husband and his hobby of eggcup collecting. She theorises as to why he did it – poor upbringing, he didn’t have much, nasty father, very mean. I think eggcups was a safe place to be, gave him something he never had as a child. The therapist jotted down her Theoretical level.

With 10 minutes to go the therapist tells Mrs Smith that they are near the end of their time together and begins to summarise their session. Although not a good time to start with anything new, Mrs Smith mentions that she often feels her late husband’s presence, especially in times of worry and stress.

The therapist asks her to try to hold that thought and the feeling that goes with it and they can let it unfold in their next session together. The therapist makes a mental note of the Transpersonal experience that Mrs Smith has mentioned.

What are the Five Relationships?

Within Dr Petruska Clarkson’s framework are the Five Relationships that are identified as being between the client and the practitioner, these are the Working Alliance, Transferential, Reparative, the I-You and Transpersonal.

By its very nature the Working Alliance is common to all approaches found within counselling and psychotherapy. For many practitioners the working alliance is the crucial and sometimes only relationship necessary for effective therapy. Central to this process are the core conditions of empathy, unconditional positive regard and congruence. The Working Alliance centres around the contract between the adult of both the practitioner and the client.

The Transferential relationship has its roots in the Psychodynamic and Gestalt approachs. I believe transference is everywhere and will almost certainly appear at some point in most orientations, even if the chosen approach has not got Psychodynamic roots. Transference itself is the past manifested in the present. So an example might be the client unconsciously seeing the practitioner as a figure of authority from their childhood.

The Reparative relationship draws from Psychodynamic, Gestalt or TA. Maintaining the core conditions is a general way of offering the client a reparative relationship, with support from the counsellor in the present, the client experiences the relationship they lacked at a past time.

The I-You relationship is an authentic and real relationship requiring the counsellor not to be hiding behind their role as a counsellor or expert with the associated imbalance of power that can result. The I-You relationship draws on the Person Centred approach and is all about the relationship between client and counsellor.

The Transpersonal relationship which has its roots in Psychosynthesis, Existential and Gestalt therapy and has a spiritual identity is a hard one to identify. Based on research I did at a specialist counselling section in a local Somerset hospital, where patients with serious medical conditions can talk about their fears and concerns to a trained counsellor. It seems likely that people with life-threatening illnesses may well enter a Transpersonal relationship with their counsellor as they maybe contemplate death, the hereafter and the meaning of their existence.

So, to summarise briefly, we see the post modernist trend seems to lean towards Integration in Counselling and psychotherapy with its advantage of flexibility in the way therapy can be adapted to the meet the wide range of client’s issues and problems. This is reinforced by the growing realisation that `one size does not fit all` and the benefits the client gains from being treated as a whole i.e. mind, body, behaviour and emotions.

Copyright David Trott 2012 What is Integrative Counselling?

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Somerset Counselling: What’s it all about, Sigmund?

While Psychotherapy has had a relatively short history of a hundred years or so, the role of the psychotherapist reaches back through the murky mists of time to the earliest days of human existence, where we picture early man engaged in that age old endeavour of attempting to make whole the soul or inner being. Villagers who felt confused or worried about something would make the short journey through the mud and smoke to visit the wise-woman of the village to seek counsel and be helped to make a sensible decision based on the personal knowledge and life experience of the elder.

This situation remained largely unchained through the centuries until Sigmund Freud (1856 -1939) arrived on the scene. Freud was born into a Jewish family, firstly becoming a medical doctor but then quickly moving into Psychology. For most of his life he lived and worked in Vienna, Austria where he founded a system of Psychology which he called Psychoanalysis in 1896.

Psychology, Psychiatry and Psychoanalysis words all share the same link to the Greek word Psyche which means breath, soul or life. However Psychoanalysis was not yet for the masses and Freud’s patients were mostly from Viennese bourgeois society, which was very middle class, conservative and materialistic in it’s attitudes. Freud’s work largely centered on a person’s unconscious and he decided that there are three states of Consciousness. These being the `Conscious`– our awareness of all that is happening around us at any one time. The `Pre-conscious` – things like telephone numbers, addresses and car numbers, which are not present in our thoughts all the time but can be easily recalled when required. And lastly the `Unconscious`– information that is repressed and cannot easily be accessed.

Included here could be memories so terrible that they are pushed down and buried. Freud believed that the unconscious reveals itself in other ways and so he used therapy methods such as Dream Interpretation, Hypnosis, Free Association and the study of Parapraxes (Freudian slips) & jokes to unlock his patient’s innermost thoughts. His work remains the basis of various approaches used today by modern therapists and much of it has permeated into everyday language such as Freudian slip, Ego, Anal retentive & Oedipus complex amongst many others. Much of Freud’s early work was treating the ladies of Viennese society for `Hysteria` by way of hypnosis.

In modern times we think of hysteria as huge emotional trauma. Back in Freud’s time it meant a medical condition where a specific part of the body was targeted by very strong emotions. This could result in sleepwalking, paralysis, fits, memory loss, hallucinations, fainting and numbness in different parts of the body. His view was that neurotic symptoms were caused by repressed sexual experiences. Freud found Hysteria most interesting because the symptoms were so varied but oddly these symptoms would sometimes disappear altogether for no reason only then to return later. It was thought in those days that only women suffered from Hysteria, in fact in 1886 when Freud gave a lecture on Male Hysteria to the Vienna Society of Physicians he caused uproar. His lecture contained examples of Male Hysteria and this caused one surgeon to remark that because the word Hysteria referred to the uterus, it was not possible for a man to suffer in this way.

Unlike today’s modern counselling rooms which tend towards being rather neutral and bland, Freud’s room was said to be more like belonging to an archaeologist. There were ancient artifacts everywhere and the walls were covered with stone plaques showing scenes from ancient history. It makes perfect sense when we hear that Freud likened his love of archaeology with his work as a psychoanalyst. It’s easy to understand how he saw the uncovering of a person’s psyche, layer upon layer with the uncovering of ancient treasure. Today, most counsellors will use the onion analogy (stripping away layers of the psyche like layers of an onion) or a Russian Doll to demonstrate a person’s personality. As well as ancient artifacts in his room, Freud had fitted heavy curtains and thick warm carpets complemented by a number of large potted plants, maybe aspidistras in ornate jardinières. French windows led out to a small private courtyard.

It’s been said that Freud’s room was like a sanctuary for some people, where one could retreat from the hustle and bustle of modern life – a place where one could shelter from day to day problems, if only for a short time. This view of the counselling room can still apply today with the therapist who has taken the trouble to think out the interior of their therapy room. Today we see counsellors facing their clients; Freud on the other hand preferred to sit behind his patients, out of sight, to be less of a distraction. No doubt the patients sat or lay on a couch or chaise longue and it’s easy to picture the stereotypical view of a Victorian psychiatrist and patient.

Freud’s work included his study of a child’s development through biologically determined stages and their links to sexual pleasure. He described the Oral stage which focuses on the mother’s breast and the Anal stage which centers on the anus and defecation. The Phallic stage is all about the genitals and the Oedipus Complex develops when the child falls in love with the opposite sex parent. At the Latency stage, the sexual drive becomes dormant until puberty. The sex drive finally becomes focused on sexual intercourse with an opposite sex partner at the Genital stage.

Freud believed that these theories regarding how a child’s sexuality developed is indicative of the way a person’s whole personality develops but it’s worth remembering that Freud’s definition of `sexual` was much wider than just sex itself.

In January 1933, the Nazis took control of Germany and Freud’s books were high on the list of those being burnt and destroyed. Undaunted, Freud quipped “What progress we are making. In the middle ages they would have burned me. Now, they are content with burning my books.” All through this time Freud continued to underestimate the Nazi threat and stayed determined to remain in Vienna, even after Austria was annexed.

However as events unfolded it became clear that he and his family had to leave and so on 4 June 1938 Freud caught the Orient Express from his beloved Vienna, fleeing the Nazis and the horrors of the Holocaust for the comparative safety of London. Sigmund Freud died on 23 September 1939 after a long battle with cancer. Although Freud’s work has evolved and has been adapted by present day Psychodynamic and Integrative therapists, it still remains the basis of Counselling and Psychotherapy in the modern day and its value cannot be overstated. Freud remains the Father of Psychotherapy and the reason you are reading this piece today.

David Trott Copyright 2012


Somerset Counselling: Counselling in Somerset (what’s on offer?)

When I started to research the question of what’s on offer in the field of counselling in and around Somerset, I was surprised and heartened by my findings. For it seems that anyone looking for a counsellor in Somerset and surrounding areas will find a rich selection of counsellors and psychotherapists offering a wide range of approaches and therapies. We are fortunate indeed to have on our doorstep many historically important, economically expanding and very pleasant towns.

These include Axbridge, Bridgwater, Burnham on Sea, Chard, Cheddar, Crewkerne, Frome, Glastonbury, Ilminster, Langport, Midsomer Norton, Minehead, Shepton Mallet, Somerton, Taunton, Watchet, Wellington, Wincanton, Winsford, Wiveliscombe and Yeovil and not forgetting the beautiful cities of Bath and Wells. Each one of these areas will have various therapists.

More good fortune lies in the fact that this green and pleasant part of the country is well served by some remarkable Colleges, who in turn provide some remarkable counselling courses for anyone looking for counselling training. The counselling courses can range from an introduction to counselling skills or concepts, through Intermediate and Advanced stages to Diploma levels which equips the recipient with the necessary qualification to practice. The titles and levels of these counselling courses may vary according to the college and awarding body. As part of counselling training on the Diploma level, the student will have to find themselves a `placement ` to hone their skills.

This may be situated with a counselling practice, a drug and alcohol rehabilitation centre, college or school, in fact anywhere that counselling takes place and where it’s suitable for a student counsellor to work. A three way contract is then drawn up between the college, the student and the placement organisation. The student then works part time at the placement to complete the required number of hours for the course. Therefore as we examine what counselling is available in Somerset, it’s worth remembering that quite a few of the counsellors we see operating will be students working voluntarily to gain experience and to complete their `hours`.

A clue to this is sometimes in the low cost of the counselling. There has always been some debate as to the impact of the voluntary sector on professional counselling practices who strive to maintain a viable business. It’s fairly safe to say that Somerset with it’s mix of impressive busy bustling towns, villages and lovely countryside will be able to offer the counselling client a good choice of counselling methods.

It’s likely that therapists working in many of the major approaches will be able to be found locally without much difficultly. These will probably include Psychodynamic, Person Centred, Integrative, Cognitive Behavioural Therapy (CBT) Psychosynthesis and Existential, among many others. It’s said that the fasted growing approach over the last few years has been Integrative.

The benefits of the Integrative approach include the fact that it draws from the major orientations previously mentioned. It does this not in an eclectic way like pulling a tool from a toolbox but instead Integrative stands as a approach in it’s own right. While clients may be looking for support in stress & anger, low self esteem, low confidence & feelings of failure, anxiety, depression, feeling isolated lonely, suicidal, bereavement, addictions and obsessions, couples might be looking for help in their relationship.

This would require a specialist counsellor, trained in relationship and couples counselling. A good place to start when looking for a counsellor or psychotherapist is to visit the BACP website and click on `seeking a therapist`. By simply entering one’s postcode, a list of counsellors who are BACP members and who work within the BACP ethical framework will appear.

Somerset Counselling: Counselling in Somerset (what’s on offer?)


Somerset Counselling: So why choose to talk to a Counsellor above a Friend or Family Member?

When we confide in a friend or family member there’s a chance that person will feel some responsibility for the talker’s situation. This in turn will colour the listener’s response and possibly cause the talker to hold back and not to let it all out, for fear of upsetting the listener. For example – a daughter attempts to talk to her Mother about her unhappiness and homesickness while away at University. The daughter feels it was a huge mistake to have gone and wishes she had taken a job near home instead.

The Mother is aware of the financial sacrifices her husband and herself have made to provide this opportunity for their daughter and feels hurt by her apparent ungratefulness. The daughter’s attempt to talk to her Mother about her unhappiness ends in a heated argument and she decides not to broach the subject again. Alternately, if the daughter had seen a professional counsellor things would almost certainly have been different.

One reason for this is that counsellors and psychotherapists are not personally connected to their client’s story. A good therapist will be genuinely interested in their client, empathic and non-judgmental and do their best to help their client, while not advising them or telling them what to do. It’s all a question of support – support while the client explores their thoughts and feelings. Support to maybe see things differently and support in working towards resolving their situation. All in a confidential and private setting.

Imagine yourself in a town far away from home. You have something on your mind which is worrying you. You walk in the park to think things over and stop for a while on a bench, where you get into conversation with a total stranger. The stranger seems understanding and interested in you and you trust them. You pour your heart out to them and talk of things you could never tell your family or friends. This is a little of how it is with counselling – there’s no past, there’s no guilt – the counsellor is maybe the perfect stranger.

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