After attempting to meet competency 2.1 – Establish boundaries as a helper in a particular setting and within the limits of time available – at the beginning of this course, I can now see why my last journal on this topic was insufficient.

It is only now that I truly feel that I have grasped the importance of setting boundaries within the limits of the time available.  After a couple of months of 15-minute skills practice sessions, where it has been necessary to maintain very firm time boundaries, it has become more evident as to how there is so much more to this topic than time.

Indeed, using a structured framework is very much about ‘holding’ the client within the time and space that is available, allowing them to gain as much as they can from however much time they have. 

This is achieved by keep their time, which is extremely precious, safe. By having a beginning, middle, and end to every session, the client is provided with the message of just how valuable the time that is dedicated to them is.  This value is demonstrated not merely by ensuring sessions don’t over-run, but also that they aren’t cut short.

This deeper understanding has translated into my own personal counselling, where I no longer wait for my counsellor to signal the end of the session.  Most of the time, I find myself winding down the session as it is approaching an end.  Therefore, I can understand how boundaries with time are important to both the counsellor and the client.  In many ways, such boundaries are a sign of respect, as well as a way to commit your undivided attention to the client over a duration that has a clear end point.  In this sense, such a structured framework can also act to create a sense of achievement by the end of the session, however long it is.

Whether it was 15-minutes or 1-hour, that time has been utilised to make an important journey of self-discovery and understanding. 

I make an effort to emphasise this to the helpee during skills practice with comments such as:

• “We’ve covered a lot today”

• “You have made a lot of progress during this session”

• “Well done. You addressed some really difficult feelings today.”

I feel that it is important to end the session in a way that acknowledges the clients journey and validates just how valuable that journey is.

I have found through skills practice that adhering to such a structured framework not only allows me, the helper, to keep any unrelated thoughts and feelings outside of the helpee’s session; it also appears to provide the helpee with a sense of purpose.

By this, I have witnessed how time boundaries empower the helpee to utilise that time in the way that they feel would be most purposeful for them. 

In this sense, time boundaries also act to ensure that the focus of sessions remain on the helpee’s agenda.

What is Postnatal Depression (PND)?

Have you just given birth and are feeling depressed, irritable, tired, sleepless, isolated, or hopeless? These are all signs that you could be experiencing PND.  You might feel distant from your baby or resent your baby.  You might feel guilty that you don’t feel love towards your newborn. With PND, it is also common to fear harming your baby, although it is extremely rare that this occurs, especially if you seek help.

Did you know…?

·         About 1 in 10 women in the UK don’t realise they have PND.

·         PND is more likely if you have had mental health problems in the past or during pregnancy.

Contact: The Association for Post-Natal Illness: http://apni.org/; 0207 3860868.

Rose West had far from an idyllic upbringing, even before leaving her mother’s womb. Although research suggests that ECT during pregnancy does not harm the baby, Rose appeared troubled from the start. This is indicated in her rocking behaviour, which in children is usually a sign of self-soothing or frustration. Either way, as a baby Rose clearly gained some sense of comfort or coping from rocking in her cot and pram. Even the youngest of children pick up on disharmony in the home and the violence and unhappiness that little Rose witnessed would surely have an impact, in this case a devastating one.

While some people internalise a rocky childhood, Rose learned from her domineering father to express her anguish by causing harm to others. The sense of control and power this brought was the complete opposite to the lack of control a small child has within a violent household. Rose saw the power her father had in comparison to her mother, choosing to live with her father and follow in his footsteps. However, her behaviour was much more extreme, although based on much of what she’d seen during her childhood. Even the burying of victims in the ‘corpse garden’ mimicked the regimental digging up of the garden that her father imposed on her and her siblings.

Rose West’s future appeared damned from the start, but no one could have predicted just how much tragedy she would go on to cause.

Michel Fourniret, also known as the ‘Ogre of the Ardennes,’ was driven towards these monstrous acts through a desire to take the innocence from others that his mother had taken from him. Fourniret’s own account of his childhood suggests that he lost his virginity through incest perpetrated by his mother.  This, along with the portrayal of women during the time when the Nazis had taken over Sedan, created a hate of women.

The abuse carried out by his mother also created in Fourniret a thirst for reclaiming his virginity by taking this from the young females from whom he sought revenge for his troubled childhood. It was the anger built up from Fourniret’s childhood, along with the assistance of his ‘bloody muse,’ Monique Olivier, which culminated in the rape and murder of nine or more young girls and women.

The horrific nature of Fourniret’s crimes is so disturbing that psychologists advised that the jury might need counselling. Fourniret expressed no remorse, suggesting his troubled childhood would have led to these tragic events either with or without the help of Olivier. Fourniret’s mother, his abusive childhood, and the Nazi portrayal of women witnessed by Fourniret combined in the making of a monster.

Body Dysmorphic Disorder (BDD) is a condition whereby the individual is preoccupied with their image, in particular with any perceived flaws in appearance.  Traditionally associated with individuals who want to have a limb amputated due to it feeling foreign and not part of them, it is now recognised that people with eating disorders or weight issues can also suffer with this condition.  Indeed, individuals who have lost weight are particularly vulnerable to remaining dissatisfied with their body image due to perceived defects in their appearance.  They have become so used to scrutinizing their body and being scrutinized by others that even after they have achieved their desired weight, they remain hyper alert to the slightest signs of bodily imperfection.  Not only will they still see their previous selves when they look in the mirror, but they may also perceive new flaws with different areas of their changing body.

So, how do you know if you have BDD?  Individuals with BDD feel the urge to continuously check their appearance in the mirror or even in reflective surfaces such as shop windows.  They frequently seek reassurance about their appearance, check for skin defects with their fingers, pick their skin to make it smooth, and compare themselves to others.  We are all fallible to this, but for someone with BDD it becomes a compulsive and time-consuming behaviour.  This preoccupation is incredibly distressing and can disrupt everyday life, resulting in social isolation, depression, and extreme anxiety.  At its worst, it is an incapacitating condition that severely reduces self-esteem and sense of worth.

Fortunately, there is help available. Cognitive-behavioural therapy (CBT) has been found to be particularly effective for treating BDD.  This is a combination of psychotherapy and behaviour therapy that helps you challenge your negative thoughts about yourself.  The process helps you develop new ways of thinking and coping to help you see yourself more realistically. For people who have lost a lot of weight, either through surgery or diet, CBT helps you to adjust your thinking in line with the new you.  CBT can be delivered individually or in groups and you can be referred by your GP.  If you are concerned that you are suffering with BDD and this is preventing you enjoying your new body, contact your GP straight away.  You can learn to accept and love yourself!

Thinking over my life history can be difficult, but also empowering. From a young age, I was always the parent within my family.  My father was an alcoholic and I recall countless hours spent wiping away my mother’s tears and trying to cheer her up.  I was desperate to rescue her and make everything ‘ok.’  I hated seeing her sad.  Today, I can see how no child should have that responsibility on their shoulders.  That little girl should have been having fun and playing with friends, not hiding away in the bedroom with her mother, both crying and wishing for a better world.

Despite this realisation, I wouldn’t change things.  I feel this experience made me who I am today, which is someone who wants to provide a safe environment for others to express their emotions and deal with their problems.  This is why I am on this counselling course.  The difference this time around is that I am not a child, but more importantly, I am not trying to take responsibility for the way clients feel.  I recognise that I am not there to rescue them, but to offer them empathy, unconditional positive regard, and congruence, so that they can help themselves.  In this sense, my childhood has impacted my decision to go into a counselling profession, but at the same time it has also provided me with invaluable insight into what the counselling role can and cannot entail.  It can entail the provision of a trusted and safe environment for clients to explore their true selves. It cannot entail rescuing or taking on any responsibility that should remain with the client.

My life history has also impacted me in other areas of my life, creating experiences that I feel will inform my work with clients and equip me to work with a diverse range of people and circumstances.  I was abused by my father and his friends, which I feel will provide me with the sensitivity required when working with a client who has been abused.  I have struggled with an eating disorder, a complex condition that I feel it is hard to understand unless you have experienced it.  Linked to the eating disorder was depression and anxiety, which are frequently experienced by people who attend counselling, to lesser or greater degrees.  In addition, I have overcome social anxiety and, in many ways, taken a journey of self-discovery that I feel is inherent within the counselling process.  I will therefore be familiar with the process that clients are going through, although also recognising that their journey will be unique to them.

As a result of a number of issues I have contended with during my life time, I have received counselling.  I feel that this first-hand experience is fundamental to becoming an effective person-centred counsellor, hence why it is part of the course requirements.  Indeed, I have no doubt that my personal experience of counselling has benefitted me in terms of skills development, especially in regard to active listening and unconditional positive regard.  Experiencing these qualities helps in the recognition of how fundamental such skills are.

I feel vulnerable after writing this and being so open, but I also feel I was ready and that in itself is empowering.

Here are some examples of positive steps the government could take to help ‘nudge’ people in the healthiest direction:

Smoking:  Creating a highly visible non-smoking mass media campaign that emphasises the negative aspects of the behaviour, as well as the societal disdain for the habit.  Reinforcing this by using physical cues such as making it hard to smoke in public areas, as has been achieved in the UK (Sweney, 2008). The governments can also nudge by increasing prices.

Alcohol:  Smaller drinks as standard help people to consume less alcohol.  The government can nudge by regulating the industry, or raising the prices or drinking ages.

Diet:  The designation of fruit and vegetable sections in supermarket trolleys (Rainford and Tinkler, 2011).  At restaurants, replacing chips as a side dish with a default side salad. The government can also restrict unhealthy food advertising or ban fatty foods. Such nudges could help reduce the current obesity epidemic (Cecchini et al., 2010).

Physical Activity:  Making stairs a standard in buildings, rather than lifts.  In cities, stressing the importance of cycling to work and other activities over driving short distances. The government could also regulate by controlling the cost of petrol and car insurance  (Rainford and Tinkler, 2011).

With the ability to reach a mass public and positively affect them both in the short and long-term, it is easy to envision the many potential benefits from the effective integration of  Nudge Theory by the government.

References:

Cecchini, M., Sassi, F., Lauer, J.A., Lee, Y.Y., Guajardo-Barron, V. and Chisholm, D., 2010. Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness. Lancet, 376, pp.1775-84.

Rainford, P. and Tinkler, J., 2011. Designing for nudge effects: how behaviour management can ease public sector problems. In, Innovating through Design in Public Services Seminar Series 2010-2011: Seminar 4: Designing for nudge effects: how behaviour management can ease public sector problems, 23rd February 2011.

Sweney, M., 2008. Government online ad spending soars. Guardian.co.uk, 16 Jul. [online]. Available from:  http://www.guardian.co.uk/media/2008/jul/16/digitalmedia.advertising [cited 23 December 2011].

Thaler, R.H. and Sunstein, C.R., 2008. Nudge: Improving Decisions About Health, Wealth, and Happiness. New Haven: Yale University Press.

Thank you for sharing, Jan!

I’m very honoured that Nicola invited me to write a guest post for her. She has been an inspiration to me since we first chatted last Summer.

 My name is Jan Frayne. I am a male “survivor” of childhood sexual abuse and adult rape. I say adult rape as I was seventeen when this occurred. The sexual abuse started when I was three years old and continued for twelve years. I’ve spent my adult life knowing that I had been abused, but it was only a year ago that the extent and depth of the abuse came back to me fully.

You may ask how can someone can not remember such horrific events. It is understood that trauma can be blanked out by the brain, especially when full knowledge of such could cause further, psychological damage to the victim. The trauma memories are buried until the victim is in a stronger state of mind. These memories can also be triggered by other stresses.  In my case the childhood trauma caused my mind to “fracture” and I developed Dissociative Identity Disorder (D.I.D).  You may know this better as multiple personality disorder (not to be confused with schizophrenia which is different again). I developed different personalities to cope with life, to help the inner me survive.  Most of these personalities have now assimilated themselves back into ME.

I grew up accustomed to being “a thing”, someone to be used, abused, tormented and put down. I had very low self esteem, was painfully shy and had few friends. I couldn’t mix with others of my own or similar age. I was in my own words, a freak. This was how I saw myself. To many I might just have seemed to be a quiet boy. I lived many lives inside my own head, was frequently told off in school for staring into space, not concentrating on my studies. I was bullied in school as well as by certain members of my family. I didn’t have a happy childhood… My only escape was within my own head, and through writing.

“Jan” today is not the man that the boy grew up to be. I am instead a combination of my old personalities, and the me I created. I am complex.  I’ve made many bad decisions in my life, based on the “truths” fed to me by the abusers. I’ve no regrets, what’s done is done. The past cannot be changed, only worked with, mistakes learnt from and then  we have to move on .

The affects of sexual abuse on males are still shrouded in mystery to the majority.  My blog covers most of the issues. I feel that I have lived many lives within one lifetime. I have experienced much, I wanted to explore all that life had to offer.  Though the abuse left me with a very low self esteem, hang ups, inabilities and fears, I pushed myself to try everything life had to offer. Sometimes it would be another personality taking the lead, I would have vague memories sometimes, or most frequently had blanks in my memory. I’d call them “losing time.”

I started blogging seriously after having had most memories return. It was my was to deal with them. Writing things down has always been a passion, this took it one step further and made those words public. The Wounded Warrior blog is my testament.  It’s my place to shed light on a subject still considered too sensitive for many to discuss, to hopefully explain how it feels to be a victim, and the journey from victim, through survivor to thriver.  In many ways my blog is my antidepressant fix.

I hope that more help becomes available for male victims of sexual assault. I was referred by my family doctor ten months ago to my nearest sexual abuse help center. I’m still waiting to be seen.

If I had not come across Steve from the Amsosa (Adult Male Survivors Of Sexual Abuse) group myself, I’d still be struggling to cope with those memories and the side affects on my own. It feels to me that male survivors are being treated as second class citizens. This has to stop.

I am still on the journey to become a “thriver”, I’ve much to do for myself and also to help others, both victims and the general public, to see that there is no shame on the victims head. It is ok to talk about what happened, to share your experiences, fears and hopes.

 Where my life is leading I don’t know. I want to write more, I want to educate people. I want to feel at home within my own skin and to actually like myself, the man I am, the man I’ve become.

 One of my favourite quotes is:-

“I’m selfish, impatient and a little insecure. I make mistakes, I am out of control and at times hard to handle. But if you can’t handle me at my worst, then you sure as hell don’t deserve me at my best.” – Marilyn Monroe.

There is life after abuse – recovery and healing are essential to living life to its fullest. I spent over thirty years living a half life, a life in the shadows. If I can help others find the path to recovery and if my work prevents another child being molested, then what I endured will have been “worthwhile.”

Article Review 

The article, ‘Being with what is’ explores the use of mindfulness practice for counsellors and how it can become an integral and informative part of the therapeutic relationship. Mindfulness has primarily been used for stress reduction, but there has been a growing interest in its applications within the counselling context. As Crane and Elias note, however, the concept of mindfulness in counselling is not new and has been the subject of exploration for about 30 years.

So, what is mindfulness? The authors describe it as a practice that develops the capacity to become aware of the process of experiencing as it is happening. This is achieved from a perspective of non-judgemental curiosity. As a result, knowledge of mindfulness can increase the counsellor’s ability to notice conditioned patterns, develop greater perceptions of choice, and gain an increasing sense of ease with reality.

Interestingly, some of the key components of mindfulness are similar to the three core conditions offered by Roger’s in person-centred counselling: congruence; empathy; and, unconditional positive regard. In the article, the emphasis is on providing these three conditions to oneself through mindfulness-based practice. The primary aim is to be fully and unconditionally present with all that is in your consciousness as it occurs. With this in mind, I can see how mindfulness and person-centred counselling complement one another.

The seven attitudinal qualities that underpin mindfulness are also complementary of person-centred counselling. These qualities are:

1. Acceptance of the reality of the present moment;

2. Patience in understanding that things emerge in their own time;

3. Beginners mind (i.e. a willingness to see everything as if for the first time);

4. Trust in the validity of one’s own thoughts and feelings;

5. Non-striving (i.e. a willingness to accept the present as it is without trying to fix it;

6. Letting go (i.e. the ability to acknowledge arising and passing experiences); and,

7. Commitment, self-discipline and intentionality to the investigation of personal experience.

I feel these attitudes are already encapsulated in person-centred counselling theory, but are referred to using different terminology. Therefore, the introduction of mindfulness into the therapeutic process is not too far removed from what is already happening.

I was particularly interested in the authors premise that mindfulness includes an exploration of the ‘felt sense’ of experiences as they manifest in the body. This reminds me of the importance of immediacy and observation of body language within person-centred counselling. For example, noticing that someone is clenching their fists when talking about a particular person or situation is another form of communication, as well as another way for the counsellor to access the client’s world.

I enjoyed this article and found it very thought-provoking on a personal and professional level. I did, however, find that the article was not sufficient but more so ‘whet my appetite’ for more. This is not necessarily a criticism, but more so a sign of my own need to explore this further. I feel it has some relevance to my personal development as well as to my counselling training, and thus I will do some wider reading around this topic.

In this learning journal I am going to discuss how it feels to be listened to and empathically understood as opposed to being given advice.

Rogers defined empathy as:

“an accurate, empathic understanding of the client’s world as seen from the inside. To sense the client’s private world as if it were your eyes, but without releasing the ‘as if’ quality – this is empathy.”

My experience of this frequently occurs throughout my own personal counselling. It is an amazing, almost indescribable feeling. It is more than just empathy and it is more than just being understood, especially when it is also accompanied by active listening that comprises no advice giving. By this, I mean that the experience of being listened to and empathically understood is also about empowerment and providing the client with unconditional positive regard in a safe environment in which they can explore their own thoughts and feelings as well as reach their own solutions. This is at least how I feel within my own counselling experience.

At first, being provided with this safe and all-accepting environment can seem somewhat strange and unnerving. It is only over time that I realised this feeling is based on unfamiliarity. It is so rare to receive empathic understanding and active listening without advice giving in our everyday lives. They are skills that not everyone builds upon, but which could really strengthen relationships of all kinds.

On reflection, I think the initial discomfort from this experience comes from fear, at least in my case. Fear of what to do with the gift of empathic understanding – as that is what it is – a precious gift. Fear of what to do with this gift when it is offered, as well as fear of being empowered to make one’s own decisions has also been present in my own experience. For me, it has taken me a long time to gain any belief in my ability to guide my life. It is only through my experience in counselling of empathic understanding that I have been able to gain trust in my own ability within the safety of an environment that nurtures such self-growth.

To be given advice is not always the helping hand that we might believe it is. Indeed, in some cases it can act to disempower people as they can become reliant on other people.

I have learnt through my experience that advice giving is rather overrated and not always the kindest of acts we might like to think it is.

I feel that it is important to experience empathic understanding in order to be able to provide it, which I always endeavour to do throughout skills practice. By this, I don’t mean that I make a special effort to provide empathic understanding, as I don’t feel it is something you can force. On the other hand, I can increase its presence through active listening and not giving advice.  These conditions work together to allow empathic understanding into the counselling relationship in a pure and genuine form.