A guide for helpers

THE SERENITY PROGRAMME™

Updated 7th June 2013

SERENE.ME.UK/HELPERS/

#SERENITYPROGRAM

FACEBOOK.COM/SERENITY.PROGRAMME

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Contacts

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SERENE.ME.UK/HELPERS

#SERENITYPROGRAM

SERENITY.PROGRAMME

Today …

• The programme• Contracts and goal setting• Phone support• Governance• Therapeutic considerations

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What’s in the programme?

• A series of assessment measures

• A series of information pages

• A resource page for helpers – training materials and

documentation

• A brief self-help programme, open to anyone

• A series of interactive workbooks

• Audio files

• Possibly a bespoke microsite?

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Working with

THE SERENITY PROGRAMME™

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Assessment meeting

Modules 1 and 2

Support call

Module 3Goal setting

meetingModule 4

Support call Module 5 Support call

Module 6 Module 7

Module 8

Module 9

Support call

Support call Support call

Final meeting

The Programme …

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USERNAME:Intentionally blank

PASSWORD: Intentionally blank

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Understanding

CONTRACTS AND GOAL SETTING

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Egan’s five questions about goals

• Why should I pursue this goal?

• Is it worth it?

• Is this where I want to invest my limited resources?

• What competes for my attention?

• How strong are the competing agendas?

Egan, G. (1994) The Skilled Helper (5 th Edition). Pacific Grove, CA: Brooks / Cole

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The ‘Three P’s’

• Goals are best when they are:

• Powerful – vivid, clear and striking!

• Present tense – even stated as though already achieved!

• Positive – what you want, not what you don’t!

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‘Business’ contracts & ‘treatment’ contracts

• Berne (1966) defined a contract as

‘An explicit bilateral commitment to a well-defined course of

action’

• Business contracts clarify frequency, time, duration, payment,

place etc.

• Treatment contracts identify goals and how we will attain

them

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Why contracts?

• Keeps client actively involved

• Protects client from being steered towards what ‘should’

change

• Keeps image of goals foremost

• Provides an end-point

• Keeps process ‘on track’

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Steiner’s ‘four requirements’

A valid contract requires

• Mutual consent

• Lawful object

• Valid consideration

• Competency

Steiner, C. (1974) Scripts People Live: Transactional Analysis of Life Scripts. New York:

Grove Press.

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Stewart’s five questions about contracts

• Is the contract goal feasible?

• Is it safe?

• Is it stated in positive words?

• Is it observable?

• Does attainment mean a move towards greater health?

Adapted from Stewart, I. (1989) Transactional Analysis Counselling in Action p.

96. Sage Pubs.

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Contract ‘let outs’

• ‘I want to work on’

• ‘I would like to try’

• ‘I could’ (instead of ‘I will’)

• The hanging comparative ‘I would like to be more ...’

• Incongruence between social and psychological

communication

• The outcome of the communication is determined at the

psychological level15

An overview

PHONE SUPPORT

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A hierarchy of engagement...

• Specific software e.g. Fear Fighter, Beating the Blues, LLTTF etc.

• No visual or auditory information - asynchronous (e.g. email)

• No visual or auditory information – synchronous (e.g. ‘chat’)

• Auditory information only (e.g. ‘phone)

• Visual and auditory at a distance (e.g. Skype)

• Blended methods e.g. Serenity Programme (and many others in

practice!)

• Immediacy, contextual richness and sense of presence are key

dimensions

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A Continuum, not ‘either – or’

• The blend can be adjusted to suit the client ...

Practitioner contact time

Computer use

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Controversies ...

• If people can fall in love in chatrooms, by letter or email,

then the medium can sustain a relationship and allow

therapeutic, affective work

• If you cant see the client, can you still work effectively (ask

a visually impaired counsellor!)

• We emote ‘as if’ in virtual worlds – ‘telepresence’ and our

suspension of disbelief

• Telepresence entering social consciousness – Tron (1982,

2010), Matrix (1999), The Cell (2000), Gamer, Surrogates,

Avatar (2009), Inception (2010), more 3D ... more

‘immersive tech’19

Telephone ‘baggage’

• Telephones mean different things to different people

• May bring good news, bad news, a lifeline or curse, may bring

only work!

• What meaning does the telephone hold for you?

• Take 5 – 10 minutes to discuss with a partner, using

counselling skills to help your partner explore ...

• Can we leave this baggage behind when making a call to a

client?

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Interpersonal support – it’s important to CCBT ...

• Andersson G, Cuijpers P. (2009) Internet-based and other

computerized psychological treatments for adult depression: a

meta-analysis. Cognitive Behaviour Therapy. 38(4) p196-205

• Included 12 studies found effect size of 0.61 for supported

and 0.2 for unsupported CCBT (0.8=large; 0.5=moderate;

0.2=small)

• Attrition is high without interpersonal support

• This is ‘support’ in the broadest sense – interpersonal support

and encouragement – a containing relationship

• It’s not counselling, though counselling skills are key ... 21

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The Samaritans

• Have been providing visual cue-less synchronous support

since 1994, numbers roughly double each year!

• Also provide asynchronous support via email (< 24 hour

response time)

• More males email than ‘phone...

• People are 3x more likely to mention suicide in email than by

‘phone...

A short

film ...

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Telephone support – is it second best? (1 of 5)

• There are benefits to the client

• To the provider

• Possibly to the wider environment too ...

• Take 5 – 10 minutes to discuss with a partner, using

counselling skills to help your partner explore ...

• What are these benefits?

• Who might benefit most?

• Why, and who, might choose telephone-support over other

approaches?

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Telephone support – is it second best? (2 of 5)

• Benefits to the client

• Convenience

• Access for disadvantaged groups

• Cheaper – less travel required

• Anonymity

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Telephone support – is it second best? (3 of 5)

• Benefits to the provider

• Less physical space required

• Reception and appointment administration

• Personal safety

• Practitioner anonymity

• Cost effectiveness

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Telephone support – is it second best? (4 of 5)

• Who might benefit most (1 of 2)

• Young men – less likely to disclose in relationship

• Single parents, people with childcare problems

• Older or more physically vulnerable people

• People in remote or rural areas (access of confidentiality

issues)

• People with caring responsibilities

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Telephone support – is it second best? (5 of 5)

• Who might benefit most (2 of 2)

• People who find movement or transport difficult

• People with restricted freedom – children or people in abusive

relationships

• People on very low incomes

• Certain diagnoses – social anxiety, agoraphobia, shame-based

pathology, issues with authority or dependence, impulse

control issues

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Telephone support – is it second best?

• There are of course, disadvantages ...

• Reduced visual cues

• Caller can terminate the call easily – esp. If dealing with sensitive

subjects

• Assessment issues

• Potential distractions and interruptions

• Can’t ensure client’s privacy – potential recording, others ‘listening in’

• Cant absolutely identify the client!

• ‘Try some of this while you’re waiting’ – self-fulfilling prophecy

mentality29

Telephone support – remember ...

• Leaving messages with people? Consent to leave messages

• Block caller ID with ‘141’

• Who may answer the ‘phone? Non-committal introductions

• Call recording

• Others listening in on extensions

• Procedure in the event of repeated ‘no answer’

• ‘Last number redial’ breaching clients confidentiality

• Procedure for contingencies – drunk / abusive / deteriorating /

suicidal clients30

Telephone support – privacy

• Telling a client their call is confidential, then they hear

background voices

• Client becomes hesitant, distracted or monosyllabic – ‘It

sounds as though someone has walked in – if they have, just

say yes’

• Calls ideally take place behind closed doors – like face-to-face

therapy

• Trivialising ‘phone calls – interruptions are thought to be

permissible ‘would you like a coffee?’

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Telephone support – reasons for referral

• Because of you ...

• Your personal limits

• Your professional limits

• The limits of your competence / training

• Because of the client ...

• The client needs broader / deeper / more enduring intervention

• Because of your agency ...

• Time limits

• Restrictions on type of service offered

• Organisational policies32

Safeguarding and Governance ...

• What do you think a provider needs to have in place to

provide a high-quality telephone support service?

• Take 5 – 10 minutes to discuss with a partner, using counselling

skills to help your partner explore ...

• Consider:

• Safety

• Effectiveness

• Acceptability

• Equity

• Efficiency

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• Telepresence and non-proximal attunement

• Frustration tolerance• Object constancy• Transference to hardware• Disinhibition• Who / what is the

relationship with?

• Dissociation• Reflexive self-function? • Primitive processes• Time distortion• Learning issues• Avoidance• Suspicion and personality

disorder

Some therapeutic considerations

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What we did …

• The programme• Contracts and goal setting• Phone support• Governance• Therapeutic considerations

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Thanks for taking part!

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References

• Meltzer, H., Gill, B. & Petticrew, M. (1994) OPCS Surveys of Psychiatric

Morbidity in Great Britain. Bulletin No. 1: The Prevalence of

Psychiatric Morbidity among Adults Aged 16-64, Living in Private

Households, in Great Britain. London: OPCS.

• Cuijper,s P., Donker. T., van Straten, A., Li, J., Andersson, G. (2010). Is

guided self-help as effective as face-to-face psychotherapy for

depression and anxiety disorders? A systematic review and meta-

analysis of comparative outcome studies. Psychological Medicine, 40,

1943-1957.

• Sanders, P. (2007). Using Counselling Skills on the Telephone and in

Computer Mediated Communication. 3rd Ed. PCCS Books.37