6 x Therapy Today: The Magazine for Counselling and Psychotherapy Professionals (Volume 22)

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6 x Therapy Today: The Magazine for Counselling and Psychotherapy Professionals (Volume 22)

6 x Therapy Today: The Magazine for Counselling and Psychotherapy Professionals (Volume 22)

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What is it to step into the other’s world when they have lost their moorings? How can we be with this in our own bodies as counsellors and psychotherapists? Confronted by loss, carers and therapists can experience strong embodied counter/transferential feelings for the person with dementia. Butler is aware of this incorporation too: ‘I think I have lost “you” only to discover that “I” have gone missing as well.’ 17 How does the body of the other summon us to engage? It is the embodied relational engagement that sustains us in the living of everyday life. And, as Jonathan’s words vividly attest, relationships are made up of gesture, voices, spoken, soft, harsh, touch, skin, breath, embrace. Chatbots are providing ‘therapy’ to thousands of people around the world. Sally Brown learns what artificial intelligence can offer counselling.

As a helping profession, and as human beings, our instinct is to want to do something, which makes Anthea Kilminster’s article on providing culturally sensitive, trauma-informed counselling for displaced people, written before the recent events, seem all the more pertinent. She shares how the Yorkshire-based service, Solace, has supported displaced people from around the world, including Syria and Iraq. The thousands of people fleeing Ukraine will join the estimated 70 million already displaced worldwide, greater than the total population of the UK. A number will make their way to the UK, and counsellors like Anthea will be there to help them adjust. As a CBT practitioner, he uses exposure to challenge the avoidance: ‘What is striking in research is that a strong predictor of complex grief is the fear people have of the intensity of their pain – they endorse statements saying the pain would be unbearable, too intense. Such catastrophic misinterpretations or phobia-like predictions are strong predictors of complex or prolonged grief. CBT is about targeting that avoidance and gradually confronting the loss, the irreversibility, the pain, the implications, but very gently, at the pace of the client, which is central to the approach. CBT asks the client to test these fears. We don’t aim to take away the pain; we try to turn the unhealthy grief into healthy grief that people can live with. So the grief doesn’t necessarily decrease but people learn how to build their activities around it and are less preoccupied with their loss.’

She died a week later. The home had told me I could go and see her just for five minutes to say goodbye before she died and I donned all my own PPE – cagoule, waterproof trousers, goggles, dust mask – I didn’t want to use up the PPE at the care home. I think she knew I was in the room, but she was very heavily sedated. I just stood at a distance and spoke to her and said goodbye and came away. I didn’t touch her, I didn’t know if I could do that. And she died the following evening. I was told she wasn’t on her own when she died, which was some comfort. Allegranti B, Silas J. Embodied signatures: a neurofeminist investigation of kinaesthetic intersubjectivity in capoeira. The Arts in Psychotherapy (forthcoming). If you include material about individuals (clients, colleagues or participants in any research or study), please provide written confirmation that you have their permission to publish the material in a print and online journal and that you have anonymised all identifying details. Depending on the nature and detail of the material, we may also ask you to confirm that they've read the article. Conversations and correspondence

If you've included information or discussion about any member or members of your family, please confirm that what you've included is made in good faith and is true and accurate to the best of your knowledge; that you’ve considered any potential impact on them and on other family members if they read the article; and that, having done so, you wish to go ahead with publishing. Case studies make interesting and valuable reading. Try to include the client's voice wherever possible, either through first-person accounts or by using brief, anonymised case studies to illustrate your points. See guidelines on client confidentiality below. Figures This short multi-layered film speaks, sings and dances the lived experience of dementia. If, as witnesses, we become baffled in trying to solve the puzzle of the, at times, peculiar and other-worldly narrative (and imagery) of I Can’t Find Myself, it is because we are not looking, feeling or listening hard enough. Because dementia is peculiar, other-worldly and alienating. Most importantly, the film highlights that dementia is unavoidably an embodied, relational and affective experience. Other key factors included restrictions on funeral and memorialisation practices that meant people were unable to support one another and mourn collectively, which in turn made it difficult to find closure and begin to grieve, she says: ‘These grief difficulties are consistent with the findings of the US pandemic study, 6,7 that disrupted meaning contributed to worse grief outcomes, and that higher levels of functional impairment occurred for all deaths during COVID-19 compared with pre-pandemic times.’ The researchers are still analysing results that will show if the degrees of distress would be enough to flag up risk of PGD.Berrol C. Neuroscience meets dance/movement therapy: mirror neurons, the therapeutic process and empathy. The Arts in Psychotherapy 2006; 33: 302–315. The supreme compendium of data on the effectiveness of relational factors in the talking therapies is Psychotherapy Relationships That Work, 3 which is based on the findings of the Third Interdivisional APA (American Psychological Association) Task Force on Evidence-based Relationships and Responsiveness. Now in its third edition, it is in two volumes: Evidence-based Therapist Contributions, edited by John Norcross and Michael Lambert, and Evidence-based Therapist Responsiveness, edited by John Norcross and Bruce Wampold. The book brings together findings from 18 vast meta-analyses of data on what makes talking therapies effective. When I read Marina’s words I immediately hear Judith Butler’s voice: 12 ‘The boundary of who I am is the boundary of the body, but the boundary of the body never fully belongs to me.’ What is afforded to us, as therapists, as carers, I wonder, if we begin to understand in our intersubjective engagements that we do not inhabit ourselves by ourselves? Our sense of self emerges from our developmental relationships; we learn to understand not from conceptual knowledge but through intersubjective bodily interactions and feelings during an early intimate dance with our primary caregiver. A common experience for the person living with dementia is losing a sense of self – what, then, of their experience of loss, vulnerability, intimacy and dependence? A sense of loss and disorientation is not uncommon in psychotic experiences generally and is a common feature of the advanced stages of dementia. This sense of loss exists in a tangled web of self–other relationships. 16 What happens when, inside the therapy room, we bear witness to a life’s unravelling? A body’s unraveling (snap – lost)? Loss of tangles and plaques – the ruthless biological process that biomedical science is labouring to impede.

If you use any information obtained privately, for example in conversation, correspondence or discussion with third parties, please confirm that you have referenced all the individuals concerned and have their permission to use the material. Family members It was in 2008 that things really started getting too much for me. Despite being one of the most high-profile gay men in the country – the editor of the UK’s bestselling gay magazine, Attitude – I was drinking too much, trapped in a spiral of low self-esteem and anxiety, always desperately looking for the next relationship in the hope it would fix me. And the result is widespread anxiety and sadness. But, she stresses, ‘anxiety and sadness are normal reactions to abnormal situations – and we have had an abnormal situation for going on three years now. And the treatment for such sadness is human connection.’ And if there’s an uncomfortable silence? ‘I’ll explore that with them. I’m interested in why. But I carry some cards with me, and I’ll sometimes bring them out and we’ll just play a game if a young person is feeling particularly anxious or uncomfortable. It’s all part of building the relationship.’To sum up: ‘... a pluralistic perspective of good practice that is inclusive of all modalities is essential. The therapeutic relationship is key to effective therapy, and a focus on ingredients such as collaboration, empathy, and responding to client preferences is vital to ensuring ethical and effective therapeutic practice. The recognition that different clients need different things promotes a more pluralistic provision of therapy services.’

Often, the focus on understanding dementia, providing treatment and engaging in communication can emphasise verbal interaction, and the value of non-verbal communication can be ignored. As Julia states, continued connection is important, and, as such, attention to kinaesthetic engagement is key – not only when people’s cognitive faculties are impaired but more so within/in dementia relationships where meaning making through language as we ‘know it’ is changed and challenged.

As two of the letters in the ‘Reactions’ section of this issue remind us, language matters. Jennifer Deacon’s letter explains the problems with describing therapy that takes place outdoors as ‘walk and talk’, while Lois Peachey expresses her frustration at the increasing use of ‘mental health’ as a euphemism for ‘mental distress’. Bearing witness to dementia and holding an embodied awareness in dementia relationships is a political call – we are summoned both personally and professionally. In this last reflection on the film, Jonathan Wyatt, Director of Counselling and Psychotherapy at the School of Health in Social Science, University of Edinburgh, speaks of this kinaesthetic and affective call:



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