Effective Therapy from Psychologists

online, and central & east London

“Sex Addiction: a relational approach”.

Posted: 11/11/2019

All participants from the previous five events, rated the workshop as excellent/good.  Next workshops:

Manchester, Thursday 27th February, 2020.

Book here: https://www.eventbrite.co.uk/e/sex-addiction-a-relational-approach-to-assessment-formulation-and-intervention-manchester-workshop-tickets-85496782177

A relational approach to formulation and intervention for sex addiction invites us to understand how the behaviour relates to our clients emotional and relational world.  We all have characteristic patterns of relating to ourselves and others:  these can be rich clues for formulating the relational drivers behind patterns of sexual behaviour that repeat in your clients lives and so appear addictive or compulsive.

Is your client’s relationship with themselves an affirming or a belittling one?  Are they for the most part critically demanding of themselves in a way that leaves them feeling overwhelmed by the pressure to be perfect whilst feeling that nothing they do is good enough?  It is not hard to see how such a deeply ingrained relationship with self could give rise to difficult feelings of failure or anxious striving that could push someone towards sex and drugs in order to provide a powerful albeit temporary escape or respite from self-attacking or self-pressuring patterns of thinking. Similarly, does your client appear very anxious of rejection in his relationship perhaps because of earlier life experiences, and has found that having sex with others leaves him instead feeling admired or wanted, but then finds his anxiety about rejection heightened because of fears of discovery.

A relational approach offers useful ways of understating that sexual behaviours labelled addictive or compulsive can represent an attempt to find a solution to some form of vulnerability and to ease the “burden of self “, and the perceived risks of vulnerability, such as the vulnerability of living up to expectations, to be approved of by others, or to be loved and accepted. We can alleviate much of our suffering by temporarily forgetting about ourselves or getting lost.  We can forget about our self in many ways, and sex and drugs are just one.

I would like to suggest that in order to help clients we need to hold in mind the nature of escape.  It is not about a desire to self-destruct.  Apart from the potential to pathologise, this idea misses the central purpose of escape – to limit or stop the patterns of thinking or relating with others that give rise to difficult feelings about self- such as I am a failure, I am unlovable etc.  We need to help clients identify and change relational patterns that give rise to these feelings and assist them to develop more helpful relationships with themselves and others, and thereby reduce the need to escape.  As someone once put it:

It’s easy to take off your clothes and have sex.  People do it all the time.  But opening up your soul to someone, letting them into your spirit, thoughts, fears, future, hopes, dreams…that is being naked”.  

To learn more about using relational understandings to help support people struggling with “Chemsex” and other sexual activities which have come to feel out of control, join Dr Robert Watson in Manchester at the next workshop.

Written by the workshop presenter Dr Robert Watson, Clinical Psychologist in Sexual Health, Accredited Cognitive Analytic Therapist & Supervisor, & Vice-Chair of the Association for Cognitive Analytic Therapy.

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Learn more about “How to run a successful private practice: all you need to know”.

Posted: 28/06/2019

Dates of next workshops:

Saturday February 1st: online.  Access from anywhere in the UK.

Monday 24th February: London.

Friday 28th February: Manchester.

Monday 2nd March: Glasgow.

Saturday 21st March: online.  Access from anywhere in the UK.

CLICK HERE TO BOOK:

https://www.become-psychology-london.co.uk/private-practice-workshops-psychologists-psychotherapists-counsellors/

I first ran this workshop in 2015 and I will run my thirty second on 1st February.  All previous participants have rated the workshop as good or excellent, and rated their confidence in starting private practice as higher after attendance.  I’ve used the feedback over the years to help refine the workshop content.  Last year I ran the workshop as a fully interactive webinar on zoom for the first time, and I continue to run these regularly on Saturdays.

I have had my fair share of setbacks and mistakes during my ten years in private practice and what I have learnt from these I bring to the workshop content so that hopefully you will not at least make the same ones I did!  I would encourage you to book as I am sure like previous participants you will find the day highly rewarding and useful for your private practice ambitions.

So, what does it take to run a successful private practice and what do I cover during the workshop?  Well, it goes without saying that you need a successful marketing plan and the afternoon session is devoted entirely to this.  But it needs more than that: you need to be good at self-management and crucially build reliable supportive working relationships with other colleagues to avoid what I think is one of the biggest challenges in private practice: avoiding isolation.

Moreover, I bring my perspective as a Cognitive Analytic Therapist to the workshop to help you reflect upon helpful ways of relating to yourself and your clients, and get you thinking about how commercial pressures can add another layer to the pressures you may experience as a therapist.  I have learnt for example through past mistakes that whilst its natural to want to try to please your clients and do a good job, this can get in the way of setting boundaries about cancellations or therapy interfering behaviours if you are unduly worried about losing a client for financial reasons.   Furthermore, I facilitate reflection on your confidence levels as therapists and any “therapist blocks” you may have, because in private practice they may relate to the extent to which you feel able to address enactments with clients or market yourself.  Participants have found the confidence building strategies useful during the day to help them identify their own blocks and focus on their professional strengths when it comes to the marketing exercises.

Of course, the workshop covers all the other essentials needed to get going including formulating and managing risk in private practice, how to maintain ethical standards and practice, and how to understand and comply with the General Data Protection Regulation (GDPR).  GDPR requirements for therapists has evolved since May 2018 and has become more complex: this workshop explains how this legislation affects your practice and how to adhere to its requirements. 

Dr Robert Watson, Clinical Psychologist, Accredited Cognitive Analytic Therapist & Supervisor, & Vice-Chair of the Association for Cognitive Analytic Therapy.

 

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Do therapists assess the quality of the therapeutic relationship accurately?

Posted: 30/05/2019

Perhaps surprisingly, the research seems to suggest that we are not that good when it comes to accurately estimating how our clients experience us.  Orlinsky et al. (1994) for example, found that therapist assessment of the quality of the therapeutic alliance bore little relationship to the outcome of therapy.  Therapists tended to rate the strength of the alliance as much higher than that of their clients. Furthermore, when the alliance was rated by clients, it was strongly related to the outcome of therapy.  

Does it matter that as therapists we may frequently inaccurately assess the quality of the alliance?  I would say yes definitely given the central role of the alliance in treatment success and that studies have shown poor alliance scores to be predictive of premature termination of therapy.  It is worth asking therefore what factors might be contributing to therapist inaccurate perception of the alliance quality and what can be done to improve these skills

It seems to me that as therapists we like to think we are doing a good job, and this might lead to some biases in how we perceive our clients perceive us.  It can be unsettling or feel awkward to think that something we have said has triggered the client.  We are human after all.  Previous research has suggested that in a fair number of cases therapists did not attend to a rupture even when the client directly commented on the relationship.  This suggests we may be a bit avoidant or unsure of how to make the alliance the focus of collaborative enquiry. I think we need to bring a healthy vulnerability to our work to be able to adopt a genuine position of curiosity in relation to how our clients experience us in any given moment.  This may mean having to stay present and empathic when faced with responses that feel attacking or that challenge our ideas of ourselves as good therapists.   

There are easy to use client alliance rating scales that can easily be incorporated into your clinical work.  I have used these from time to time and they have helped me develop my capacities to accurately assess the alliance, become more familiar with my own biases and vulnerabilities in doing so, and crucially aid my awareness when the alliance is unsatisfactory and needs attention.  I think this has been particularly helpful when the rupture has been a withdrawal rather than confrontation event.  I think we tend to think of ruptures as confrontation events involving the expression of angry feelings – often they are withdrawal events marked by subtle signs that can be easily missed.

Cognitive analytic therapy (CAT) offers us many useful approaches which can be integrated usefully into other therapeutic models to help therapists work better to accurately assess the quality of the alliance.  CAT can also help us to formulate and make the focus of collaborative enquiry any tensions within the alliance.  So please do consider joining this online workshop limited to six participants on Saturday 15th June, designed to help therapists work better when the therapeutic relationship gets stuck. 

https://www.eventbrite.co.uk/e/resolving-ruptures-in-the-therapeutic-relationship-interactive-webinar-tickets-55893371579

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What do I cover in “Out of Control Sexual Behaviour: A Cognitive Analytic Therapy informed relational approach to assessment, formulation, and intervention.”

Posted: 01/04/2019

This workshop takes place in London on Monday 29th April.  Book at:

https://www.eventbrite.co.uk/e/out-of-control-sexual-behaviour-a-cat-informed-relational-approach-to-assessment-formulation-and-tickets-58111861141

And there is another in London on Monday 10th June.  Book at:

https://www.eventbrite.co.uk/e/out-of-control-sexual-behaviour-a-cat-informed-relational-approach-to-assessment-formulation-and-tickets-60133634319

Cognitive Analytic Therapy as a relational model of therapy can be applied to aid the understanding of human sexuality and patterns of sexual behaviour that are restricting or harmful. A relational approach to formulating these difficulties invites us to understand how the behaviour fits with our clients emotional and relational world.  We all have characteristic patterns of relating to ourselves and others:  these can be rich clues for formulating the relational drivers of patterns that repeat in your client’s lives. Is your client’s relationship with themselves an affirming or a belittling one?  Are they for the most part critically demanding of themselves in a way that leaves them feeling overwhelmed by the pressure to be perfect whilst feeling that nothing they do is good enough?  It is not hard to see how such a deeply ingrained relationship with self could give rise to difficult states of mind that push someone towards sex and drugs in order to provide a powerful albeit temporary escape or respite from self-attacking or self-pressuring patterns of thinking.

CAT offers us many useful ways of understating how so much of our suffering arises from our view of the self, and the ways others treated us for better or for worse, become internalised as ways we see ourselves.  Paradoxically, the better people’s lives get, the more pressure they can feel to present a good self, so the more they suffer when their self-image is damaged. We can alleviate much of our suffering by temporarily forgetting about ourselves or getting lost.  We can forget about our self in many ways, and sex and drugs are just one.

I would like to suggest that in order to help clients we need to hold in mind the nature of escape.  It is not about a desire to self-destruct.  Apart from the potential to pathologise, this idea misses the central purpose of escape – to limit or stop the patterns of thinking about self that give rise to difficult feelings about self- such as I am a failure, I am unlovable etc.  We need to help clients identify and change relational patterns that give rise to these feelings and assist them develop more helpful relationships with themselves and others, and thereby reduce the need to escape.  In other words, out of control sexual behaviour can represent an attempt to find a solution to some form of vulnerability and to ease the “burden of self “, and the perceived risks of vulnerability, such as the vulnerability of living up to expectations, to be approved of by others, or to be loved and accepted.  As someone once put it:

It’s easy to take off your clothes and have sex.  People do it all the time.  But opening up your soul to someone, letting them into your spirit, thoughts, fears, future, hopes, dreams…that is being naked”.  

To learn more about using CAT’s relational understandings to help support people struggling with “Chemsex” and other sexual activities which have come to feel out of control, join Robert Watson at the second run of this workshop on Monday 29th April in London. Read more and book at:

https://www.eventbrite.co.uk/e/out-of-control-sexual-behaviour-a-cat-informed-relational-approach-to-assessment-formulation-and-tickets-58111861141

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How a relational perspective can help understand and resolve ruptures or strains in Cognitive Behavioural Therapy and other collaborative models of therapy.

Posted: 12/11/2018

I really like the idea of interventions as relational acts – that is, the same intervention can be experienced differently depending on a client’s characteristic ways of relating to themselves and others. This can mean for example, that a therapist who provides minimal structure might be experienced as self-affirming by a client who experienced controlling and restricting parenting.  On the other hand, the same therapist may be felt as withholding and abandoning by another whose parents rarely offered emotional support and guidance.

Put another way strains in the therapeutic alliance may manifest as disagreements about tasks and goals but also could reflect tensions at a relational level. For example, a client may express uncertainty about the value of thought monitoring. This may need direct clarification or encouragement from the therapist, but it may also reflect a client feeling pressured to impress which could be a core relational theme.

Like CBT, cognitive analytic therapy (CAT) is a task focused and time limited collaborative therapy with homework as a regular feature through the course of therapy. When working with either model, I try to keep in mind that different interventions place different demands on clients and they may carry an implicit meaning at a relational level. So rather than following theory rigidly to inform interventions, I try to be guided by asking what a particular intervention might mean to the client at that moment – often influenced by core relational themes.

I explore the importance of these ideas and many others in this CAT informed workshop designed to help therapists work better when the therapeutic relationship gets stuck.

Saturday 2nd February.  Book at:

https://www.eventbrite.co.uk/e/resolving-ruptures-in-the-therapeutic-relationship-interactive-webinar-tickets-51708767315

Dr Robert Watson, Clinical Psychologist, and Accredited Cognitive Analytic Therapy Supervisor & Therapist, Vice-Chair Association for Cognitive Analytic Therapy.

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