From Person Centred Counselling to an Integrative Approach: One Client Inviting Change
A Beginning – Morley College
I started officially training to be a counsellor in 2006. The introduction to counselling course was at Morley College in London and taught me what Counselling entails. Iain Mendelberg was the tutor and was able to offer a model for the type of counselling professional I wanted to be for clients: patient, wise, honest and courageous.
As a group of trainee counsellors, we were introduced to Carl Rogers and his passage into counselling and psychotherapy. Rogers was closely followed by Fritz Perls and Gerard Egan which gave us a thorough grounding of person centred and humanistic perspectives of counselling.
Freud’s scientific method was often referenced as a starting point that was used to frame our learning. What I gained insight to was from Mr Mendelberg’s calm humorous approach to teaching. His generosity as an educator gave me an indication of what lay ahead for me as I trained – I too could become for those that I worked with a reflective, calm and person centred mental health practitioner. Or so I thought.
On completing the Morley course I took a year out of study. My first son Coltrane, was born shortly after the course ended in June 2007. 1 year later September 2008 I began at Greenwich University on the MSc Therapeutic Counselling an integrative counselling course.
What Does Integrative Mean?
I had little understanding of what integrative meant in the 1st year. Some of the information that was covered in the first term refreshed my awareness of counselling theory from my time at Morley college. The main difference of the Greenwich course, was apart from the workload was the amount of reading material to be digested on a weekly basis and the depth the writing therein went to.
Each article was intricately written, often with intimate insights that frequently altered my perspective of counselling. There was also a general understanding that the reader would grasp some, if not all of the concepts discussed. The first year of the course I found to be a struggle but I worked hard at attempting to meet the requirements the course asked of me including; Placement and application of counselling theory, Skills, Experiential group, Theory, and Personal logs. The requirements life asked of me were a frequent source if inspiration, tension and fatigue and these included; my marriage, fatherhood, work, coaching basketball, amongst a few other responsibilities…
Integration of Perspectives
For the 2nd year of the course at Greenwich in Oct 2010, I was fortunate in securing a 2nd placement at a prison. My first placement was at a Doctor’s surgery in SE London which I was fortunate to be awarded in Aug 2009. My learning as a trainee counsellor I feel was enhanced by both placements as I was able to witness how mental illness is supported in the community and in a prison setting. The significant differences noted were the efforts made by the mental health team in prison collaboratively working together to reduce risk – efficiently.
In the community, fast access to mental health support is desirable but not always achievable. Due to the volume of people in GP’s wards. The range of services and referrals to and from specialist support is difficult to meet. Providing treatment for mild to moderate cases of mental illness can take 6 weeks – 8 months to be received. With the advent of IAPT (Increased Access to Psychological Therapy), the idea was to drastically reduce waiting times and be able to support more people in the UK, that experienced depression and anxiety.
Laos – Understanding Integration
I met Laos (not his real name) in January 2011. Laos was a tall, well-built Asian man in his 30’s who repeatedly offended. He was held in custody for charges related to attempting to rob with a bladed article. Laos shared with me the incident in question and much of his life history. Which is to follow.
I worked with Laos for 5 sessions in total and throughout that short time my counselling approach changed. During the 2nd and 3rd appointments an idea formed that person centred counselling did not appear to be touching the core of this man’s particular set of difficulties. I took it upon myself to investigate and develop a psychological perspective to gain an understanding of his formative life experiences and how I could support him more effectively as a counsellor.
Reflecting on my counselling journey it was this choice that changed my perspective on how I practice as a therapist. As an aside I have enjoyed the Kung-Fu Panda series of movies. The 3rd Kung-Fu Panda stood out as a perfect collaboration of contextual realities, concluding with a seminal experience and eventual crystalisation of identity for Po. My light-bulb moment wasn’t as spectacular but had elements of the clarity Po achieved in this movie clip.
Drug Use – An Escape?
Laos reported that he had many change experiences including moving home a number of times across much of Asia, the far east, Australia, Canada and to U.A.E. Laos had begun using various substances in his teens starting with Marijuana, Heroin, Cocaine and Crack. He mentioned that he had also used amphetamines but stated that he preferred cocaine. With other drugs he reported that it was always a gamble.
He described himself as a bright student and that he found G.C.S.E’s easy. Laos said that he started smoking marijuana to celebrate with friends on completing his exams. Initially it was purely recreational. A levels, Laos said were more difficult and he changed to the International Baccalaureate. These qualifications he said suited his learning style more. Laos was introduced to harder drugs at AS level and began selling and distributing to supplement his own use.
Laos shared that he and his father didn’t really get on. His father was the main reason that the family moved as much as they did. Laos described his father as strict and the one who dealt with his indiscretions severely.
Laos described his mum as kinder and nurturing towards him. His mother died when Laos was in his late teens and he mentioned that for the family it was a difficult time. Laos experienced his 1st Jail term in a Malaysian prison shortly after his mother’s death. He was convicted as a minor of selling and distributing cocaine to fellow students at his school. He reported being in jail for a period of 9 months. He was released early as a result of his father’s connections. Laos described this period as hell on earth. He was away from family for the first time and his mother had passed away. Laos mentioned that his father had practically disowned him for the sense of shame he had brought on the family. His siblings were angry and upset with him. All that he had known was irrevocably changed.
Recognising the inter-relatedness of attachment theory, Object relations, Transactional Analysis, maladaptive coping mechanisms which can support a person in functioning into adulthood. Coping mechanisms unfortunately breakdown in moments of crisis. For Laos these moments of crises were experienced when he was faced with; the mundane and monotonous, significant moments of change or stress.
He had experience of supporting himself by using alcohol and various substances including marijuana cocaine and heroin. Laos described himself as a binger (someone who used lots of a substance all at once for a few days and then stopping). It was on a binge that he lost track of the amount of cocaine he had left. Laos told me he had finished his supply and quickly needed to make a withdrawal to go and buy more. Laos was between jobs and had low cash flow to buy more drugs. He decided to go to an off license to pick up some more alcohol as his supply was low. This decision and following events lead to Laos’ 4th jail term.
Case Formulation – Speculative Coalescence
My formulation and how I started to identify that I was thinking and behaving as an integrative therapist was informed by some of the reading I was completing at the time. Petruska Clarkson’s 5 Relationship Model offered me a useful framework to recognise where I was – in my journey as a counsellor. A research project titled ‘A Son’s Journey’ written in my 3rd year of the MSc course, found points of Laos experience reminiscent of my journey to adulthood. (I will look to pick relevant points from my research in a later blog post)
Adapting to Change
Laos early attachment to his parents and to his place of birth were affected by a number of significant changes with and to his environment. Moving from one country to another may have affected his realisation of who he was. This sense of recognition would be in relation to having to repeatedly start again from the beginning in a new and different environment. He would have had to form new routines with new classmates, peers, learn new social cues and with each move be socially adapt to the new country. Laos mentioned that he had been moving home and country since he was 3 years old. The moves were a result of his father and the work he was involved with. If the family home was not a wholly warm and nurturing environment Laos could have begun developing ways to look after himself outside of his parents or family’s awareness.
It is possible that Laos did not come forward and share the difficulties he encountered with his family. Any challenges he had overcome at school or whilst playing with peers he may have kept to himself. Perhaps major achievements and triumphs he may have experienced may also have gone unnoticed as well. I wondered if he shared much with anyone. (Self dependency, self reliance)
As he entered early adolescence he may have found certain peers more appealing and started to associate with their way of viewing the world. Exciting, dangerous, rule bending/breaking, becoming argumentative/aggressive with siblings, parents, teachers and authority figures. Leading him to take ever greater risks, enjoying self-injurious actions and activities i.e. smoking or self-harming, drinking alcohol, tattooing, piercings etc. The difficulty for me as a counsellor is in recognising the difference between the actions Laos reported of his experiences during his adolescence and usual teenage behaviour.
The purpose of the actions as listed could be to give him a chance to gain a sense of belonging or to fit in with others or create a new identity. It could also have offered Laos an attempt to make the feeling of disillusionment of parental let down dissipate or not be as painful. Another consideration would be in relation to Laos’ attachments to others. If we were to observe his relationship to his mum and then her death could his spiralling drug use be in relation to having difficulty admitting to or acknowledge his feelings of loss? The realisation for Laos could be that self-injurious acts may become habitual and destructive.
The interesting thing for me as I sketched through some of these hypothetical realisations was how Laos had attempted to rescue himself or bring about an end to his behaviour. He had not gone to rehab or completed 12-step programmes. Laos being caught, found selling or incapacitated through use of drugs and going to prison put in place a semi-permanent stop to his self-destructive pattern of behaviour. This is not to say that drugs could not be found in prison. But Laos was able to recognise that through his actions he was again locked away for a period of time. It is possible that prison acted like both a punitive and supportive parent at the same time. What Laos was appeared to do by being arrested by incarceration was to learn how to find another way to live without both of his parents. It is possible he had not an internal representation of both parents and sought external controls to manage his behaviour.
Re-evaluating – Re-inventing
Within a longer piece of work from 1 year – 2 years it is possible Laos may have been able to recognise what he had lost as a result of his earlier experiences. The losses could include his sense of identity, self esteem, parental guidance, maternal attachment figure (after his mum passed away), emotional self regulation and self-protective mechanisms i.e. speaking to others and finding emotional support. A therapist could have been able to support him in identifying his current patterns of behaviour and look to establish life affirming behaviours that looked at his dependency on alcohol and drugs to alleviate boredom, anxiety and depression.
My work with Laos was informative for a number of reasons. I learned that I had been able to graduate my thoughts to appreciate a psychodynamic profile of a person’s past. What I was able to offer Laos as a counsellor was a robust level of emotional support and an awareness that there were topics from his past that with the right support he would be able to heal in time. I was able to plant an idea-seed. With good support that idea-seed could grow and I imagine bring about significant change for Laos.
Moving forward this level of reflection has supported me in all aspects of my life, noticing patterns of behaviour with those I support. Identifying personal scripts that clients operate with that limit themselves from engaging in new and exciting ways with themselves and others. My hope for Laos is that he recognises his pattern and with support from family, a partner or a trained professional can find other ways of being that are healthy and life enriching.