Psychotherapy and Counselling in Practice: A Narrative Framework

Half-title......Page 3
Title......Page 5
Copyright......Page 6
Dedication......Page 7
Contents......Page 9
Preface......Page 15
A note on terminology......Page 16
Acknowledgements......Page 18
Introduction......Page 19
What is a concern?......Page 27
The three elements of a concern......Page 29
The ternary model of psycho-analysis......Page 32
How does the discussion of concerns differ between medical or psychiatric practice, and the practice of psychotherapy?......Page 33
Assessment......Page 34
Causes and reasons......Page 35
Being a bit more practical about concerns......Page 36
Preoccupying concerns......Page 38
Concerns about treatment......Page 39
Concerns about the therapeutic relationship......Page 41
The therapist’s concerns......Page 42
Identifying concerns......Page 45
Evidence-based approach to concerns......Page 48
Whose concern is it anyway?......Page 51
Is the client always right?......Page 52
Concerns as we tell them to others......Page 54
Consensus or conflict between therapist and client?......Page 55
Clarifying the focus......Page 59
What is psychotherapy after all?......Page 60
My values are me......Page 63
‘Helping’......Page 64
Truthfulness, honesty and effectiveness......Page 67
Authority and pathology......Page 68
Ethics......Page 70
The client’s treatment values......Page 71
3 What life means. Emotional flavour......Page 73
Shame and disgust......Page 74
Emotions as a guide......Page 76
How to act when plans fail......Page 78
Maintaining the social bond......Page 79
Making decisions, particularly ethical decisions......Page 82
Who am I?......Page 85
Emotional meaning......Page 87
Projection and emotional meaning......Page 89
Strong emotors and the fear of extinction......Page 92
Emotional meaning and choice......Page 94
Identity and emotional meaning......Page 96
Projective identification and strong emotors......Page 97
4 Narrating the treatment: the formulation, reformulation and therapeutic contract......Page 99
Exercise: how are your interviewing skills?......Page 101
Constructing a therapeutic narrative......Page 102
The struggle of narratives......Page 103
Narrative coherence......Page 105
Splitting and narrative coherence......Page 110
The therapist’s responsibility for the narrative......Page 111
Narrative types in psychotherapy......Page 112
Formulation......Page 114
Reformulation......Page 116
Contracting......Page 117
Collecting information of relevance to the organization......Page 119
Reporting on outcome to a third party......Page 120
The type of treatment......Page 121
The duration of treatment......Page 122
What the therapy is expected to bring about......Page 124
What are the limits of treatment confidentiality?......Page 129
Consent......Page 132
Record keeping......Page 133
Termination......Page 134
5 Narrating the self......Page 137
Character......Page 139
‘Me’......Page 141
Narrating a self that is convincing to others......Page 145
The significance for psychotherapy......Page 149
Boundary and salience......Page 150
Boundaries, shame and disgust......Page 152
The effacement of the ‘I’: catastrophic reactions......Page 154
6 Procedures for gaining relief......Page 157
Catharsis......Page 159
Witnessing......Page 161
Normalization......Page 163
Distraction......Page 164
Relief of future symptoms......Page 166
Diaries and homework......Page 167
Timing of symptoms......Page 168
Thoughts......Page 170
Situation......Page 171
Dealing with emotions......Page 173
Actions, beliefs and appraisals which exacerbate symptoms......Page 176
Testing beliefs about treatment and self-treatment......Page 179
The crucial role of meaning......Page 180
7 Resolution: finding out what’s doing this to me......Page 183
Interpersonal, exploratory, dynamic, analytic.........Page 185
Existential......Page 192
Supportive, expressive, person-centered problem solving......Page 195
Personal constructivist, cognitive-analytic, applied relationship theory......Page 196
Family, systems, networks......Page 200
Conflict resolution......Page 203
Metaphor......Page 204
Interpretation......Page 205
Relationship or couple therapy......Page 206
Time-limited therapy......Page 207
8 Universal technique for resolving predicaments......Page 211
Revealing what is hidden......Page 213
Speaking, or thinking, aloud......Page 215
The eyes of the therapist......Page 218
The arms of other people......Page 220
Conclusions......Page 222
9 Relinquishment and releasement: changing something about me......Page 225
Craving......Page 229
Treatment......Page 230
The emotional meaning of Lucy’s anorexia......Page 232
First steps in treating addiction: addressing the craving......Page 234
Motivation for change......Page 235
Determination to change......Page 236
Coping with craving......Page 238
The A–B–C of addiction......Page 240
Harm reduction......Page 241
Dissociation and deception......Page 244
Releasement......Page 248
Stories of happiness......Page 249
Coherence and distress......Page 251
The unspoken and the unspeakable......Page 252
Why is some therapy long-term?......Page 256
Resistance......Page 257
Transference......Page 258
Issues raised by transference......Page 262
Which justifications are justified?......Page 265
What should we make of resistance and transference?......Page 266
Interpreting the unconscious: trumping the ace......Page 268
Changing identity......Page 270
Identity and value in long-term therapy......Page 272
Shame and disgust: the other story......Page 276
The short story about long-term therapy......Page 281
General principles of managing crises......Page 285
Attribute everything that happens to the effects of the therapy unless proven otherwise......Page 288
Re-consider the focus of the treatment......Page 289
Review the therapeutic relationship......Page 290
Self-monitoring......Page 291
Recordings......Page 292
Audit......Page 293
Personal therapy......Page 294
Being stuck......Page 295
Falling in love with your client, and other kinds of acting out......Page 296
Making demands on the therapist......Page 297
Being asked for reports......Page 299
Breakdown......Page 300
Therapy breakdown......Page 301
Saying goodbye......Page 302
Confidentiality......Page 305
Family background......Page 308
Education......Page 310
Health......Page 311
References......Page 315
Index......Page 331