Navigating the Therapeutic Landscape

When I first engaged with the case study, I felt excited as I felt this suited and recognise how I could demonstrate my counsellor role as I believe that, the heuristic research method is already a way that I can conduct self-supervise and interpret the therapeutic process. However, I did not anticipate becoming stuck over the client selection andby working creatively with clay. I was able to engage in the process and feel more drawn to one client (See Appendix II). My supervisor supported me by providing an analogy of having two children but only able to take one on holiday. This was helpful for me and gave me insight to my commitment to both my clients and not wanting to disregard one. I decided that, one was more complex and opted for my selected client, as I felt passionate about how the Humanistic approach has provided the client a healing and growth promoting climate away from psychiatry care. Out on a run I was reflecting on my client work and found myself being drawn to a stream that I believe illustrates how the counselling process is continuously moving and hastily shifting; whereby it is difficult to capture the absolute total of the meaning (see Appendix I). (Wosket argued that: ‘psychotherapy is a lengthy interaction in which it is difficult to separate process from outcome’ (Wosket, 1999, p. 72).

To place words to the strands that constitute how I can best describe the therapeutic process in this case study, I have written a poem that I feel captures this compellingly:

TANGLED WEB”

The trees are rustling in the wind of the dense forest and the wind is howling, there is a sense of bewilderedness, yet a calmness of stillness is present – I can see you and hear you, yet you are hiding, you look unsteady, I sense you are lost.

I reach out to you, our hands reach each other and together we find a place of peace where we capture the moments and place what is spoken, what is lost and what is feared safely upon the ground away from what has become so tangled and where you can rest yourself by taking in the woodland air and regain a ‘sense of self’ as you look upon your journey, the times spent unravelling and expanding the elements of your being that carry you through the darkness into the light where you can be seen and where you are met with unconditional love and acceptance. It is here where you meet again with yourself, as you notice your reflection in a stream and your heart radiates through the forest where all the animals come together and sing a joyous melody that brings you home.

I have changed the names to protect anonymity and obtained written content of my client for taking permission to use relevant information. My open-ended counselling journey with Julia began in 2017, when Julia came to me from a psychiatry setting. At times, containing the therapeutic space has been challenging and safeguarding issues have arisen. Julia is a 67-year-old white British female, a married mother of two and unemployed. Julia has suffered with long standing depression, daily feelings of panic and anxiety, and is diagnosed with Bipolar Disorder. Julia found her childhood as an only child difficult, and her relationship with her mother strained. Julia has expressed significant traumas of being raped by a family friend, her first husband being an abusive alcoholic and the separation of the close relationship she had with her father at the age 4. Julia suffered from an episode of mania prior to her marriage to her present husband Peter. In 2016, Julia lost her home and Julia’s father passed away. In 2017, Julia spent two weeks in hospital, due to (describe by Julia) a “massive breakdown” and consequently placed under the care of a psychiatry team. Julia’s thirty-year marriage has been burdened by her husband’s alcohol and drug abuse, which she labelled a “dense dark forest”. In the beginning of our work, Julia withdrew herself from her interests and isolated herself from her friends. She is now participating in her book club, making felt animals and enjoys daily walks with her dogs. Julia has made many positive changes and gained many new insights as well placed significance of her healing journey on her passion for noticing nature; which has often been brought into the therapeutic space. An example of this was the sighting of a wren bird, which instilled hope for her when she felt at her lowest. I have been able to relate to this experience by seeing a wren prior to our first session, which had no significance to me, until I entered this relationship (see appendix journal notes) and recently the wren captured my attention during a reflective recording post session (Jungian psychology synchronicity) (see Appendix _ faithful recollection)

Particularly recently, It feels that within our work, a lot of the time and focus is placed on Peter. This was also visible in the clay work that was created in 2019 whereby Julia distinguished the largest piece of clay as an impression of him and expressed a need to protect and take away the pain of the anxieties experienced by Peter and their children (see Appendix III).

(I’m noticing that the discussion chapter gives a sense that draws to a place of the unknown?) (Johari window)

I am going to evaluate ten sessions over recent months with reflection to past sessions to help illuminate the process. I have selected specific parts of the work that appear to be the client’s process over a sustained period (session 5) and include parts of a session (Session 8,9) that appeared to have more of a positive direction and turning point (mothers affection).When I was reflecting on my way into work, I was thinking about how the recent sessions appear centred around the care for Peter and understandably, but I am sensing some frustration in me.

I would like to see more of Julia and her individual needs, but then I concluded that, it’s still her process, I can see how it is giving her something and we often touch in on this process, when explored in supervision my supervisor also brought further insight to exploring ways of paying closer attention to the parts of Julia’s and perhaps find just one part that we can explore, which I later did when I explored what it may look like for Julia to care for herself and a moment arose, where a metaphor of a doll to care for came into my awareness and which she then related to her self-soothing she receives through caring for her children (see faithful recollection). In a previous session, when we touched in on Julia’s emotional needs, the client touched in on their losses but also expressed that they not willing to bring the fragmented parts of her, in this moment I felt curious towards Julia’s anxieties in exploring her inner world and on deeper reflection. I sensed a little fear and resistance in me to the parts of her hidden self and what they may be, I had a sense that, these may be recognised as dark or toxic and maybe I was recognising this way as they resemble the parts. I notice within Julia’s presence that at times can feel they carry unpredictability and a sense of danger (projection/counter-transference). This was particularly present in the first two years of working and has improved with time and new medication and perhaps my increased acceptance and understanding to a sense of despair and suffering that may present in symptoms that could appear frightening in the lack of control or sense of reality a person may have which can raise the sense of uncertainty and raise safeguarding issues. Julia has made immense improvements how she functions and manages herself and perhaps I have also got more experience and can embrace these symptoms in my clients without feeling uneasy and trust and monitor the way I am working professionally within the ethical framework.

I think Julia’s aware that she feels that she brings a lot about her husband (see faithful recollection) and today when I went to collect her from the waiting room (usually I can tell how she is presenting which usually gives an indicator to how she will present in session) I got this sense that she was hiding in the corner and didn’t really want to be seen (sometimes I have had a sense of fear of Julia’s presentation due to her intrusive thoughts). Although, I do not sense any fear in our work now, this used to be present in me after sessions (counter transference) (a sense that Julia was lost out at sea and later a time where I did question my own safety)

It seems hard for her because so much of her sense of self is wrapped around her husband and currently the care for Peter is shared with her daughters and perhaps coming with not so much to bring about him seems daunting (see faithful recollection). When she entered the room, I got this sense that she appeared childlike, and that she may have been feeling that there for an expectation on her (DIRECT QUOTE OR APPENDIX) FAITHFUL RECOLLECTION We’ve been working together for almost three years and there is nothing specific that she needs to bring, as this is not how we work, but it almost felt like that there had to be something to kind of avoid other stuff and having nothing to pin point felt a bit abstract, there was some fragility around her, like a bit exposed – she appeared vulnerable and said: (faithful recollection direct quote) and she responded:

I have a feeling that I spend so much time in the shadow of Peter’s illness and disease that sometimes I disappear, my sense of self is so wrapped around his problems and how to deal with them and how do I cope with them the feelings that I have about it that my own journey is put on hold I think’

I reflected: ‘It’s hard for you when you come here as you feel it is about Peter and not about you, you depend on him to function and somehow there is something about losing yourself in all of that’.

I feel very supportive of Julia and what she brings and I feel very strong in my position of being very respectful to her autonomy and do not feel that I have a driver that reflects my own views, but on a deeper reflection, there is a need in me for her to bring herself and not just her husband and perhaps she has picked up on that, or it is a mutual thing, or I am picking up on what she is bringing and an awareness of my focus being on her. I also feel concerned about what she may be hiding behind the care for Peter and could she be at risk of another breakdown by neglecting herself. I sometimes wonder, where Julia has disappeared to and am inquisitive to if this could be the calm before the storm possibly sceptical of the calmness and steadiness present. Often, when Julia presented a wellness in the past, I noticed she was suffering most. Although, I follow Julia’s pace and am person centred, there is a desire in me that I don’t want to just talk about Philip, and it is not about what I want to talk about, but about willing to hear about Julia more than Philip, because I feel that, it takes it out of the room and I am noticing over time how I am trying to restore her values in herself with more of a heightened focus/attention on her. So, I think the way that we are working further allowed her to not feel so bad and hard on herself for not paying attention to herself and this being all about Philip, when in fact it is still about her and I did say that (see faithful recollection) her feelings, her interpretations and how she is choosing whatever reason and what is making her tick, what is preventing her from sitting in bed all day, something is motivating her, something in this process is bringing her to life regardless to how difficult the situation is, it is pulls her through and we have explored to make sure that I am supporting her in her needs in the right way. I have previously checked in if this is really what she wants, she chooses to support him and herself and sometimes I have felt that I have lost her throughout the journey, it’s been either through medication, where this has made her more numb or distant or a through Peter’s overdoses etc, but equally this has also allowed her to be present and manage herself. I am still working with her it’s just been different ways of her processing and coping and different changes she’s making. I am attuned to how hard it is for her, I get how she wouldn’t want me to see parts of her and I think with time we are looking at those parts, possibly the parts in herself that she feels are not worthy and that she then attaches herself to, something that needs her that then makes her feel the value. I don’t know and she doesn’t know herself – we are trying to navigate around it all and think there is no conclusion, it appears that we are not looking for that, but there is so much growth and movement along the journey I always focused on her process and always bringing it back into the here and now and how she is experiencing her world. That may be difficult for her knowing that the focus is on her, it’s like a part of her wants to be seen but she is still hidden. I can see how she can find it hard to voice her or accept validation and affection. A great example for this arose last week in session 9 when Julia spoke about an interaction between herself and her mother and attention brought to the part that Julia denies herself (see faithful recollection). So, I try to understand her problems with Philip, the fear of his wellbeing, the instability of it all, the ups and downs, to be needed, that process in a way matches to and interestingly I have just lost my track of thoughts, almost had a blank mind and perhaps that is her process, Perhaps in the moments she enters therapy, perhaps in those moments and when it comes to her it is like a void and it feels hard for her to channel in to or to perhaps reveal. I think it is about validation, she feels a lot of shame (she calls it toxic shame), and guilt and we have done a lot of work around this. Example of insight gained where Julia has come to the realisation that she chose to be become ill (faithful recollection). Her experience around this, what it is like for her and how does she work through this – an example of touching in on this arose in session 9, when we explored what that part looks like and a bad experience she remembers and had shared for the first time (see faithful recollection 5) an experience that she often remembers, which saddened me and gave me insight to her world and a snippet of how it may really feel for Julia without her focus on her husband and without the medication to help numb and regulate her suffering, which felt helpless to feel with her a moment that felt bleak and in this moment I felt a heaviness in me like I was weighted into the chair and it was as though I was rubber banded back to the beginning of our work where I felt in all the darkness I was still holding light and with this I recollected a time, when she shared a vision she has of herself alone at a young age on a boat at the back of her garden and this was where she felt at peace by herself just looking out to the river and this came into my mind, and everything appeared still with a sense of freedom. I thought it was interesting how this came into my awareness when Julia was sharing her experience of her breakdown (see faithful recollection) with the thoughts of Julia being treated without the embracing of her suffering and without a view to understand her, and as she describes it having the door shut on her,this also brought awareness to her isolation and despair (and an insight to how her inner world may appear even now in her recovery that process of helplessness and the image of her crying and screaming gives a sense of hopelessness) and gave me an understanding to the messages she may have got that have been detrimental to how she can seek help for her true suffering in which the fear of being rejected and shut out (lack of value) and can see how difficult it is for her to be more transparent - equally I feel, see and acknowledge Julia’s growth, which gives me a sense of peace, a reassuring and strength that she is in a better place where I embrace jointly with her the values and identity of her individual self and especially an increased acceptance of her experiences and being even if it appears at times that we are just skimming the surface I feel that Julia is brave and courageous and bringing more of herself than we may ever discover (Existentialism)

Her organismic valuing process appears greatly dependent on others, her beliefs of herself are dependent on others, and her independence of herself is harder for her to accept. When touching in on Julia’s process and when I got a blank mind, there is a s sense that she may get a blank mind and that is very sad and I did notice she got emotional at times, which she doesn’t do much and when we touched in on exploring herself she did say that there is a fragility around herself today and maybe its that loss of identity and feeling that she has put everyone first before her in the sort of lack of value of herself (see faithful recollection) I am not sure I feel a bit confused about the process.

We have worked together for so long and it is meaningful and she has really done the work, but I just get this sense that she doesn’t know who she is, she mostly talks about the care for her husband and the children and we have done a lot of work on exploring herself, which has given new insights and revelations to Julia which also created further guilt and negative feelings about herself (mention how she has come to learn through this process that she recognises that she chose to be ill as a way of controlling a situation she had no control over, huge insight that she chose to be ill) (see faithful recollection). On deeper reflection in these moments I notice the goodness in Julia which gives a sense of warmth when I recognise the wellness in Julia rather than the often (especially in previous work) what be presenting as lack of wellness. When Julia expresses her relationship being different to how her relationship is with her own mother, I also think of my bond with my children and maybe with my mother, even though we are close, she was more of an anxious mother, overprotective, which I remember could make me feel anxious. I suppose to share this with Julia. Julia also expresses her parenting being different to how she was brought up. I always feel like I am quite strong in how I can hold a lot this stuff because some parts relate to my own stuff, a divorce, my ex-husband, I had to leave him as I realised that it was all about him and it would be detrimental to my children, myself/ my identity and if I was now with him. I suppose to know who I am, and as I reflect on that I notice how I can relate to that. I feel empathic to Julia, because I know what that feels like and I can hold her and be strong for her in a safe place because I have moved beyond all of that, so it’s different for me, I can hold her in a different way as to if I was in it – then I wouldn’t be able to, how would I be able to help if I was in that same place. It does feel like we have different processes. I don’t feel overly emotionally moved by her process at the moment, I have been in the past but even then, I have been very grounded in myself and able to follow her pace and be with her. Apart from that, there is on deeper reflection there is a fear of her safety and how will she keep herself safe if something does happen to Peter. I am thinking, we explored that in the previous session and we have looked at life without Philip and I do not want to bring that in unless its brought in by her but I’m sensing there is a fear in me of the likely inevitable, I mean we never know but because he is self-sabotaging in his addiction, that fear is part of the work. It could happen any day and we do talk about it, it’s something that is present, and I suppose to hold that fear as well, with her. That if it was to happen and thinking more deeply about it has made me emotional. I can be strong her in the session in the moment and reflecting on it there is that fear of what she will go through and knowing what that is like, but then I can’t compare my experience to hers, because of course each is different, mine took me by surprise and was powerful. Even though I had no contact with my daughter's father for many years, it still impacted me like a tsunami the day I found out of his passing. So, knowing that and how it impacted me and being sensitive to her mental health and how heavily she depends on him does give me fear and do have a worry and sadness around how she will cope, but we can only take each day as it comes and I do feel that I am very supportive in her supporting herself and her supporting him, I am very supportive of both and have a strong acceptance of life that we have no control over. I do not feel any anti feelings for her, or drivers or agendas for her to leave her husband, I’ve always been very accepting of what she wants and supported her in that, because I have picked up on that is what she wants and also my own driver, I have a very strong belief that, only because someone has an addiction doesn’t mean that you can just that easily walk away although there appears a big expectation on that. It doesn’t stop you loving them. And with all this comes stigma I have that experience, and often isolating as it’s such a sensitive subject, it’s not really what they do and the logical part of the brain looks at what is right here and there is an element of bad but it is very hard to make that separation when you are in love– I know that. But I was much younger, I was able to walk away from that situation, having my daughter at the time and finding out her father was using drugs pushed me away to save my daughter, it is a different dynamic but again I never stopped loving him, I could have easily have sacrificed myself and I did the same in my marriage with elements of self-sacrificing of doing and pleasing and I suppose I can see that in Julia and relate and I suppose she has been doing that for so long.

What she can do for him and what that gives her has shaped her sense of self and identity but actually when she the removes him from herself it’s very hard for her to support herself and look at herself as a separate entity she sees herself and her husband as one entity. Co-dependency, I do worry about if she has to one day be with herself without him, and live with the loss, the grief, the cold and should have and all that comes with a loss and perhaps I have grown a dependency on her and I fear I will lose her in a way that she will continue her ability to continue her journey and I am hopeful that she can and I am fearful that she cant. By losing him it will be so impactful, having Lived and moved beyond it I am not in any of it so its different for me and I can hold her,

I feel we are very different in our views and functioning, but I have always felt passionate about working with Julia. This is where I’m at and I feel my driver is for her to help herself and nourish herself and continue what she’s doing but there is a fear that she won’t be able to continue due to the husband’s needs taking priority and it sometimes feels like we can’t really do the work, because the work also depends heavily on what is happening with him. I wonder what is about Julia and our relationship that captures my acceptance and ability to hold her with warmth and compassion. I wonder who I am to her, I don’t know and who is she to me, I was thinking how different we are. On deeper reflection, I am noticing in her is something that I have always liked in a partner where there is a part that I don’t know, that hidden part and I don’t know what it is and that may keep me captivated in my desire to support her. There is a part of her that she doesn’t know herself and we are trying to touch into to find, recognise, look after, maybe it is a theme about the inner child, and I was very interested to communicate with her mother that she expressed in today’s session was very loving and her mother was showing protection toward her and she could recognise the protectiveness of her mother. I have found that moment quite significant that may show where Julia is currently at and how she is getting in touch with her inner self and more acceptant of herself and experiences. I always find that, I can hold her well and offer a space to settle in, while calm herself I feel somewhat neutral without a driver to direct Julia in any direction other than being grounded in the moment with a strong sense of support of her needs. I always notice initially there is a bit of anxiety, but this regulates itself naturally just from being in the room from having that knowing comfort (which Julia has expressed each week is the same, she can regulate herself in that chair and that space which is quiet nice to see and I believe an important part of the therapeutic relationship i.e. the environment and consistent structure of time and place). There is something about her, she has this charm, she’s quiet charismatic, can be quiet enticing, I like how she articulates herself, easy to listen to and noticed that there was less eye contact again and in the beginning we started out with no eye contact which was new to me and at first, I found that, it is very different but I have got used to it. I noticed that sometimes when she does look at me, it seems quite intense and I feel that it is an intensity of where we have grown close within the relationship. I like to be able to ask her questions that she finds helpful if something comes up, (see faithful recollection) I think to myself that was helpful for her or that was useful because of the way she has responded to me, her facial expression or the way she has carried on with that, its allowed her to go further into something, and I like that when that happens and if ever anything, I check if it fits (add the reflection) , I don’t feel that I am the expert and at times I have used techniques in the past by bringing things together and when she has expressed that she has done what I suggested or that I was right this sits uncomfortably as much as I am pleased that she is experiencing it as useful and I always make it clear in my communication that she can hear it is herself that is doing the work and it’s not me and we explore this together.

For me there is a significant moment in our work that stands out and demonstrates our relationship, my clients and my process. As she has never liked affection from her mother and she dislikes showing her mother affection a protectiveness from the mother to her and a warmth in Julia in receiving this and I also a warmth in me as I am noticing a goodness and a change in her be able to recognise it/ express it and accept the warmth of her mother faithful recollection

AND THE PROCESS OF WHEN SHE SHOWED HER EXPRESSIONS OF CRYING AND SCREAMING AND HOW SHUT IN A ROOM DIREDCT QUOTE & MY REFECETIONS ON THIS

Note my curiosity in how she is unable to feel affection to her mother and a strong disliking to it if received and in today’s session I found a significant moment to show growth where Julia was expressing an acceptance of her mother’s affection and this showed as warmth in her facial expressions and this brought me warmth and I was very interested to communicate with her mother that she expressed in today’s session that was very loving and her mother was showing protection toward her and she could recognise that, the protectiveness of the mother by asking what about if peter took the dogs out when it was raining? And in this moment, she could take on board the love of the mother and it showed on Julia’s face and I found that touching and also something about noticing that is a healthy reaction in her and I am seeing more of a healthiness in her whereas before she was often presenting so unwell and it gave me a sense of fear of her character and what she may be capable of and I work with her the more I am noticing the goodness in her and she expressed that her father was a good person and how he took on others problems and that she saw herself as her father and I notice myself really focused on her and her needs, getting her needs met, that is my main priority, by making sure that, she doesn’t lose herself in all of this.

She’s trying to hide and I’m trying to bring her out, current dynamics?

When Julia was talking about how peter is wrapped up in his own bubble through his Asperger’s I asked Julia what is that like for you and how she communicates? Julia expressed frustration and that it is very difficult, and I brought attention to how she communicates her parts and share that in a way that feels you have had a say she expressed that she doesn’t really and ‘that is what I comes here for, to be heard, I think a lot of the time I don’t even try to express things, because I know I won’t be heard, listening for him is very hard, he’s just learning to explore his feelings. He isn’t capable of emphasising’ I reflected back: ‘you’re aware of his fragility and in what he can give, but there is something that does get your needs met’

‘So, it sounds like you need to feed him, like he has a flower, but then, the moment that you might need feeding then how might that happen? Yes, it some ways the same maternal feelings we have for our children, I now lavish on him. Explored the value that he expresses indirectly via communication to others.

I reflected ‘you seem a bit preoccupied’. Paragraph 1

She expressed that she is just gathering her thoughts to think about what to bring. P1

Faithful recollection 5, 16thjan,

Initially we started talking about herself and I felt within myself that I was really consciously trying to listen, because I am aware that I think it is really important for her to be listened to and to speak (on deeper reflection I notice a pleasing in me towards her) even though I feel free to speak and I found it useful to really listen intently and notice particularly, what I try to identify and understand, I wonder who I am to her, I don’t know and who is she to me, because I was thinking how different we are. I think what I have always liked about her is that something that I have always liked in my partners that there is a part that I don’t know, that hidden part and I don’t know that is and that in a way keeps me interested and there is a part of her that she doesn’t know herself and we are trying to touch into to find them, recognise them, look after them, maybe it’s a theme about the inner child, and I was very interested in the communication with her mother

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References

A study by Pilgram concluded that: ‘it emphasized deprivation of parents and deprivation as the source of later mental health problems’ (Feltham and Horton, 2006, p.33).