Susan Lindsay in conversation with Mary Montaut

“A Gift To Therapists”

If I can talk about Humanistic & Integrative Psychotherapy as such, from the point of view of being newly to the chair of the Irish Association (IAHIP), I think that Humanistic & Integrative Psychotherapy is at a critical point. Over the last few years we’ve had to really look to structure and boundaries, the kinds of things that humanistic psychology threw out in the beginning, and has since needed to rediscover their importance. I also think there’s a danger that it could get so caught up in structures, in boundaries and in professionalism, that it would lose the essence of what it’s about: the living experience of people. We need not to lose the process.

I think it’s like religion – you get spiritual leaders emerging and people discovering a new sense of their own spirituality. Then you turn it into a religion and people start learning the dogma, practising the religion that may or may not lead them to the spiritual truths that are held within it. I think within humanistic psychotherapy we’re somewhat like that. There were a lot of therapists in the beginning who learnt the value of really bringing people deeply into their experience of the present moment. People like Fritz Perls, Alexander Lowen, Wilhelm Reich and others. Carl Rogers really went that extra mile to empathise with people.

We could now learn a set of “how to do it” rules – but if we’re not doing it, as these people obviously were, from being wholly present with the client ourselves, and learning to use our own inner knowledge, wisdom and experience, bringing our clients into their own experience to discover what­ever they discover, then we would lose the value of the whole thing. I think that’s the challenge – not to do that, not to lose the values of boundaries and structures but at the same time not let these stop us from still being creative and still doing therapy.

It is ten years this year since the first Humanistic & Integrative psycho­therapy training course was run by the Creative Counselling Centre in Springfield Road in Templeogue. (CCC is now based in Dun Laoghaire). There have been so many changes in that time. That first course was very much a facilitator course, with the students actually looking at what we needed to be doing. There weren’t as many therapists then, with whom students could do their individual therapy, so there was more emphasis on peer therapy.

At that time I felt a real need to have a humanistic psychotherapy training course and I went initially, to visit John Rowan to get information about how courses were run in England and how we would compare. We were inter­ested to do it at a level that would be recognised. We were also keen to have an external consultant for the course, so it would not be too cosy.

John Rowan was very supportive to me as an initial trainer, in terms of information and he did become our consultant.¹ He suggested that I should go to be part of the Rugby Standing Conference on Psychotherapy which was at a similar stage of development as our ad hoc Irish Standing Conference is now. I went to several of those meetings in Britain. The Creative Counselling Centre was one of the first courses recognised in Britain or Ireland by the Standing Conference. We had taken part in developing the criteria. There has been a huge increase in the number of courses and even more in the number applying for them. There is a lot more interest in counselling and psychotherapy than there was then. In fact, five or six years ago, if you put yourself down as a counsellor for any reason, they usually spelled it ‘councillor’ – nobody had heard of any counsellor as we know it or spell it. And ‘psychotherapist’ was quite beyond the bounds of possibility. Now there have been lots of articles and there’s much greater awareness. There are courses everywhere, as well as the Creative Counselling Centre one. Courses are not confined to Dublin but can be found throughout the other provinces.

In relation to training, I think it’s very difficult for students choosing training courses to know what they are going into. They need to make sure they’re going to have sufficient therapy for themselves during it, that they are going to have enough client hours, sufficiently supervised and that they’re going to get a solid enough grounding in theory. I think a training course should include bodywork – even if it is never used afterwards, or only used part of the time. I also think there should be one or two experi­ences of being part of a week-long group – it takes one to a greater depth of experience. Through the group experience, students also have to deal with situations that they might not come to for a long time in their individual therapy work. It would help them know how well they can deal with this level of intimacy, or with deeper levels of distress, or with the level of pain that people might reach into. It wouldn’t necessarily have to be done as part of a course. There is something to be said for people doing their group therapy work outside the course. Whatever way it is done, it is important they get that kind of experience.

Then there’s the question about whether the first years after a training course should also be seen as ongoing training? In one way you’re always in ongoing training, but certainly in the first years after you leave a training course, and especially if that’s the time you start to work with clients, you probably learn more than you do at any other time. You’re integrating a lot of what you’ve learned from the course and discovering where the challenges are for yourself, and so on. It’s also a time when people are tempted to cut back on supervision, because they haven’t got an established practice and supervision costs money. Increasingly, I see the initial super­vision as a training cost, as much as a supervision cost.

This does put to the question the whole level of training that counsellors and psychotherapists get: There are people who have done short skills courses, people who have been welfare officers who may or may not have received the kind of training they should have been offered by the depart­ment for which they are working and we have people who have been through well thought out courses. Many people in this kind of work need to have better backup in terms of supervision and consultancy. Hopefully, in time to come they’ll get it.

It’s very tough being a trainer and it’s very challenging. Most of the time, it’s very rewarding. The tough part is that criteria have to be decided. You’re constantly challenged in yourself about what psychotherapy is, what is important in it?, what is the basic minimum requirement that a student must have reached before they practice? – And that is not easy to say! As you get more experienced yourself, your basic, minimum requirement tends to rise and you have to ask yourself whether you’re raising it too far just because you’re more experienced yourself, or is it really necessary?

It’s particularly difficult with an area like humanistic psychotherapy, where you require people to have reached a certain experiential knowledge of themselves. It’s very hard to say what that is, and people do not necess­arily reach it in the same length of time. Some people might almost have it at the beginning of a course and others might reach it during the training. Still others meet a lot of pain and issues they need to work through on the way. There arc some who don’t come to that knowledge of themselves. The real difficulty is to say how much in touch with their own process is somebody? – are they sufficiently so, and have they worked at a sufficient depth in themselves to be aware of that depth in their clients.

How do you actually set criteria of skillfulness? – is it ability to ‘be’ with a client? And how do you estimate that? Every client presents differently, so there’s always the question: “If this was another client would I deal with it differently?” The ability to listen and to reflect back what’s been heard accurately, may be somewhat measurable when one listens to tapes, but empathy isn’t very measurable. And the ability to reach beyond where the client is and so challenge them – that’s difficult to estimate.

The most challenging thing about being a trainer, from my point of view, is that students constantly expect one to have answers to questions that may not have firm answers. On the one hand it’s fair enough for them to want you to have the answers: but on the other hand, in giving them, you almost cheat students out of the challenge of having to find them for themselves. Also, they are only your answers, they’re not everlasting truth!

So, it’s to get the balance right, to give enough answers to help the student feel secure in developing their practice, giving enough information, and at the same time, being able to say that while there are a lot of answers, there is also a lot of uncertainty. There’s a lot of discovering to be done still.

I remember John Rowan once saying to me in a conversation, that it was one of the really difficult things about psychotherapy, that you never know for sure that you are doing it right, because for every client, at every minute, you could have given a different response. That’s something students don’t like to be told: you may never know that you are doing it right – but you may get more comfortable with not knowing!.

I hope the training of trainers does not get pushed too quickly because who’s going to train the trainers? And, are we going to have trainers of the trainers’ trainers? Also, people train at different levels – for example, this year I’m giving input on a training course primarily as a group therapist, next year I will be acting as a supervising trainer, another time I might be introducing theory. I think it’s important we don’t do something that would narrow the skills coming in. It might be more important to look at what basic criteria ought a trainer to meet. Trainers might be expected to have consider­able experience of client work and supervision.

Equally someone with specialist knowledge in a particular area might be invited to give input from their specific experience even though they might not meet other “trainer criteria”. I think it’s important for training courses to have people from different backgrounds and experience coming in. I don’t think it’s a good idea for courses to be run by only one trainer.

One of the difficulties for trainers is the level of attention students have for the course. You may have someone who is very willing to do their own therapy and whom you would really love to encourage to keep going, but who is dealing with such a level of distress that they really don’t have enough attention to give the training aspect of the course as well as their own personal development. That’s a very difficult area to decide on, for both students and trainers. You know such a person could probably be a very good therapist in the end, but there is a question of timing, and whether their therapy is sufficiently moved on, or whether they’re sufficiently healed in themselves at this particular moment to give attention to theory and skills learning and especially to have enough attention for clients. If people could have a year or two out, they could then come back to a course, having had the space to go through whatever personal crisis they might need to resolve.

Selection is an extremely difficult procedure. Mistakes are definitely made! As a trainer you have to accept that you will make mistakes, it’s not possible to do it otherwise. We assume that academic exams don’t get it wrong, but of course, they do. People can have ‘nerves’ on the day or are not effective in exam situations. It’s not foolproof but it can appear to be more so than the kind of personal selection that we use to choose psychotherapy students. Trainers look for people who want to be therapists, not people who want to do their personal therapy through a training course. I think you have to have sufficient experience of life to handle your own and other people’s pain.

Other criteria for selection might include openness to challenge i.e. not being too defensive, an ability to look at yourself without being too dis­tressed by what you see or by questioning yourself or by having your present reality questioned. I don’t think it should be an exclusive require­ment that people have already done a degree. My personal opinion is that there should be room for people who have life experience that indicates they could handle the work. If there is evidence to suggest they could handle the academic work, then I think they should be given the chance. They might be just as good or better therapists than academic people who have not had equivalent life experience.

I think it would be helpful for trainers, who can actually be quite isolated, to talk to each other and support each other, to discover the common diffi­culties they face – like those of selection criteria and accreditation of stud­ents. This is a next step for the IAHIP – to facilitate trainers to get together.

Most people coming into therapy are now expected to have been through psychotherapy training before they are accredited. Therefore, what the courses offer is really important now. People starting a course need to be pretty sure that, if they complete the course satisfactorily, they will be accredited. Of course the difficulty about having standardised criteria is that all the valuable differences between courses might be lost. I think that would be a great pity. Hopefully courses can maintain their own culture. This can also help students to make choices that suit their outlook.

I have been very conscious in the last year that in one way therapy is a gift to therapists. I remember having a very difficult session before Christmas, and then supervising someone who had a come from a very difficult session. I found myself thinking of the challenge of being a therapist. It’s even more true of being a trainer – you are constantly challenged to be present to people in ways that stretch your own resources to the limit and that chall­enge you yourself to grow, and to look at your own issues constantly. In that way it is a gift to the therapist – not always one that is appreciated at the time, I might add.

Reference

1. John Rowan, a previous contributor to Inside Out, is well known in the world of Humanistic Psychotherapy, both in Britain and in Ireland. He has been a significant contributor to the development of this style of therapy and has published several books on the subject including The Reality Game (1983), The Horned God (1987), Ordinary Ecstasy (1988) all published by Routledge (London).

Susan Lindsay is a member of Connect Associates and a practising psychotherapist.