tom bh
#Digital Nomad

Practitioner Development

It is a requirement of my psychotherapy training to regularly provide self-assessments of my progress as a trainee. It doesn’t make for the most exciting reading but I like being transparent because in many ways a psychotherapist is really just a professional ‘open book’.

I’ve not started in a placement yet, so this self assessment of my development as a psychotherapy practitioner will only relate to my Skills Practice with other students and overall development with regards to the material and experiential processes of the last academic year. Two things stand out as notable developments so far; firstly my conflict with the course in terms of difference of opinion and secondly the relaxation of effort around self consciously practicing technique during Skills.

At the beginning of the second term I had my first session as part of the long term therapist-client relationship practice required of us. As the therapist I was aware that I was beginning a longer term relationship with the client, because of this, or perhaps for other reasons specific to my existing relationship to the client, the 20 min session was very conversational and the consensus from the feedback was that it was not therapy.

Although I completely understand the feedback, I personally felt that my style was appropriate for that particular situation. I wanted to make it clear to my client that they weren’t expected to offer me material purely for the sake of making my job as therapist straightforward. Of course this was not picked up in the feedback and so I acknowledge that my approach may have actually arisen from a defence mechanism, in other words, that I retreated to the safety of everyday conversation in the face of the intimacy of a therapeutic relationship that will last several months.

Regardless of who’s opinion is more accurate in this circumstance it highlights a significant theme in my current development as a practitioner, that is, the tension between engaging with the course material and innovation. Or perhaps in a less optimistic light, the tension between innovation and self-righteousness, after all, some level of experimentation is positive and encouraged, but avoiding tried and test tradition out of premature wisdom could easily be a convenient means of avoiding the sobering reality of the front line of therapeutic relationship.

On the one hand I feel I could do well to take the extra effort to make doubly sure that I am demonstrably doing my utmost to engage with the techniques and theories being presented on the course. There will be plenty of time in the future for more unorthodox approaches. Therapy is clearly a very delicate discipline and having good foundations are essential.

Yet on the other hand I am compelled by, what I perceive to be, the priority of the client. Psychotherapy is ultimately about the client, they should never be exploited for the ends of the therapist. For example, when given the choice between making an intervention that conveniently articulates the finer points of a particular aspect of psychoanalytic theory or an intervention that actually helps the client there and then, regardless of their function in my training, then I feel the professional and ethical choice is the latter.

It is becoming increasingly clear to me that my approach to psychotherapy is more centered in humanistic and inter-subjective traditions. I feel passionately that the immediacy of experience and the nature of the relationship that develops between client and therapist is more important than fitting the clients psychobiography into an existing model and diagnosing a psychopathology.

The other notable point I would like to touch on is the relaxation around self-conscious use of technique. I certainly still have a sense of anxiety at the beginning of each session, though I suspect this is a positive sign and in some ways I would be concerned should I find such a feeling absent from my practice. However, despite this anxiety I am finding more of a sense of being ‘in the flow’, rather than consciously doing particular techniques. An example of this would be spontaneity in a session, such as making jokes or showing genuine emotion such as concern, admiration or frustration. I have found a benefit of this relaxation is an improved ability to do more than one thing at once. I might find myself following the particular train of thought the client is on, whilst being able to consider the wider context of their material, or my own reactions to the material, or simply the amount of time we have left in the session.

My feeling is that this has developed partly from the repetitive ingraining of the therapist role and partly from the attitude that arises from the long term client relationship. I have found that longer term relationship has made me more aware and thus more sensitive to my feelings and behaviour towards the client outside the formality of a therapy session. I find there is a sense in which the therapy is still happening away from the session, even at home when I’m doing something completely unrelated. And as such I therefore feel a need to exercise some of the same sensitivity and discipline that I bring to the sessions. For instance if I find myself thinking of my client I respect those thoughts as if my client were sitting right in front of me then and there. It feels that there is significance in those thoughts, what are they saying about me, about my client and about our relationship?

If therapy is even happening outside the confines of a session then I have more time to engage with my role and thus more time to get comfortable with it. In part, this is how I imagine the relaxation around technique has come about.

Overall my experience of formal practice and feedback from observers is positive. My admiration continues to grow for the perpetually inspiring results that come from the simplicity of sincerely giving heartfelt space to allow another human to be heard.