Presentation 1

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Person-Centred Therapy:A LEADING EDGE

Professor Dave Mearns

The Counselling Unit,University of Strathclyde,Jordanhill Campus,Glasgow G13 1PPwww.davemearns.com

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Contents• PCE Worldwide;

• A schema of working at relational depth;

• Client processes;

• Working with the client’s ‘configurations’ of self;

• Configuration Theory;

• Revising Rogers’ Self-Theory;

• The developmental agenda for the therapist working at relational depth;

• ‘Existential Touchstones’;

• Working with Dominic.

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Same family – different emphases

• emphasising ‘non-directivity’ (Brodley, Bozarth)

• emphasising the client’s ‘process’ (Greenberg, Elliott)

• emphasising ‘focusing’ (Gendlin, Lietaer)• emphasising the client’s existential

experiencing (Cooper)• emphasising the relationship (Schmid,

Mearns)

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A World View of PCE

• The World Association of Person-Centered and Experiential Psychotherapy and Counseling (WAPCEPC) <pce-world.org>

• The Triennial World Conference– July 12-16, 2006 Potsdam, Germany– July 6-10, 2008, Norwich, England

• The International Journal: Person-Centered and Experiential Psychotherapies. 2001-present.

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PCE Worldwide

U.S.A.

Britain

Germany

Austria

Holland

Belgium

France

Italy

Greece

Croatia

Slovakia

Portugal

Brazil

Argentina

Japan

China

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Contents• PCE Worldwide;

• A schema of working at relational depth;

• Client processes;

• Working with the client’s ‘configurations’ of self;

• Configuration Theory;

• Revising Rogers’ Self-Theory;

• The developmental agenda for the therapist working at relational depth;

• ‘Existential Touchstones’;

• Working with Dominic.

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A Schema of Working at Relational Depth

AA

Offering relational

depth

BBNegotiating

client processes (including ‘difficult’

process)

CC

Contact with the existential

process

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Definition

‘Relational depth’ is a state of profound contact and engagement between two people, in which each person is fully real to the Other, and able to understand and value the Other’s experiences at a high level.

Mearns, D. & Cooper, M. (2005) Working at Relational Depth in Counselling and Psychotherapy. London: Sage.

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(Buber) (Schmid)

‘I-thou’ ‘Thou-I’ relating

Schmid, P.F. (2002). ‘Knowledge or acknowledgement? Psychotherapy as “the art of not-knowing” – prospects on further developments of a traditional paradigm’, Person-Centered and Experiential Psychotherapies, 1(1/2): 56-70.

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Encounter, not invasion

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Two Aspects of Relational Depth

• ‘moments’ of relational depth;

• relational depth experienced as a continuing relationship

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‘Presentational Level’ of Self

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‘Approach/ Avoidance’ towards being met at relational

depth

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Disguises, Clues, Lace Curtains and

Safety Screens

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How do we show our client that we are willing and able to meet him at relational depth?

• We touch him in his experiencing;• We ‘knock on his door’ at a deeper level

of his experiencing;• We respect his positioning;• But we do not collude with a

superficiality norm.

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Creating the conditions for meeting the client at ‘relational depth’

• High levels of the ‘therapeutic conditions’ in mutually enhancing interaction.

• The ‘stillness’ and ‘fearlessness’ of the therapist.

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• ‘Listening to the expressing rather than the expression’

• ‘Meeting the client inside his experiencing’

Two aims in offering the client an engagement at relational depth

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‘Listening to the Expressing/Entering the experiencing’

• Tony: I can’t, I can’t, I can’t, I can’t, I can’t …..

• Bill: No, ….. you can’t.• Tony: No one can.• Bill: Silence• Tony: (Thumping his fist on the floor and

screaming) I need to kill myself.• Bill: Silence.• Tony: I need to go ….. I must go ….. I

must go away from me.• Bill: Silence.

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• Tony: I don’t know how to do it.• Bill: It’s hard, Tony …. It’s hard …..

there’s no way …..• Tony: No way ….. no way ….. How

do people do it?• Bill: God knows Tony.• Tony: Can you warm me Bill?• Bill: Puts his arm round Tony.

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Much later Bill comments on this meeting:

It’s an example of how you can be with someone and have conversation without having any idea what it’s about. Yet all the time you can feel them - and be with them feeling. It was weeks later that I found out the ‘content’ of this meeting. Tony was ‘being’ the part of him which had done some bad stuff. In war people can do bad stuff that they can’t live with later. Tony was feeling that part - he wanted to get rid of it - to kill it or for it to go away - to ‘exorcise’ it might be a good metaphor, But, of course, there was no way to do it - that’s what we were in.

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‘Relational Depth’

‘Emotional Depth’

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Relational depth is about the quality of

the relational contact, not the quantity

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Relational Depth in Everyday Life

• Doug the teacher

• Mhairi the nurse

• Lillian the social worker

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Contents• PCE Worldwide;• A schema of working at relational depth;• Client processes;• Working with the client’s ‘configurations’ of

self;• Configuration Theory;• Revising Rogers’ Self-Theory;• The developmental agenda for the

therapist working at relational depth;• ‘Existential Touchstones’;• Working with Dominic.

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Client Processes

‘Existential Process’

‘Psychotic Process’ (Prouty)‘Fragile Process’ (Warner)‘Dissociated Process’ (Warner)‘Ego-Syntonic Process’‘Existential Disconnection’‘Transference’

RestrictingExistentialContact

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The Developmental Basis of ‘Ego-Syntonic Process’

• The person has survived a parenting in which love and acceptance was not reliable. Negative experiences would follow when positives might be expected – there was no way to rely on the relationship. Ridicule, hate or abuse would come when love might be expected.

• To survive, the person needed to:1) Withdraw their emotional attachment.2) Find ways to control the relationship3) Find ways to control themselves in relationship.

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‘Sandy’The fellow who has a parent who is sometimes nice and sometimes horrible thinks that is the way the world is. Now, in my own case, that is how it was. At the time when I came to the school I think the difficulty was, among other things, that I was confronted by Patti [his counselor], who was an exceptionally fine human being and a very affectionate and decent human being. I wasn’t able to accept the affection, which caused even more anger because everyone likes to accept affection.

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But if you condition yourself to not accepting affection because, if by accepting it you only let yourself in for the next downfall, you put yourself in a position where you don’t dare to hope that the affection is for real and you keep testing to find out if it is for real, and that’s the process where, step by step, you find out whether it is. In a sense, maybe, that explains my own need to hurt them, whether or not the affection would continue to come…

Bettelheim, B. (1987). ‘The man who cared for children’. Horizon. London: BBC Television.

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Ego-Syntonic Process in Adult Life

• popular but ‘unreachable’;• alone and lonely;• controlling;• cold;• cruel;• homicidal and suicidal;

The person’s self-protective systems become generalised to other relationships (cf Sterne’s ‘RIGs’ – ‘Representations of Interactions that have become Generalised’). The seriousness of the resulting pattern can vary hugely. The person may become:

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In its mild expression their ego-syntonic process leads the person to be confused and scared in relationships. They know that things go wrong for them and they come to expect things to go wrong. But they genuinely do not understand why they go wrong. They have done their best. They have even tried to think about what the other person wants, and be that (within limits). But it always goes wrong.

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In another expression they attract relations but fail in relationships because, ultimately, they have to be so controlling. They need to define the reality and protect against its changing. They provide well on a material level, function well enough in more superficial relationships, but they must not make themselves existentially vulnerable. Usually they are genuinely surprised when the other person leaves them. Again, they had done their best.

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In a more serious expression, the person is dangerous to themselves and others. They are so threatened by relationship that their self-protection manifests itself not in confusion or controlling, but in detachment and even violence. Their fear is so profound and the degree of adjustment they have obtained so tenuous that detachment and even destruction (of self or other) are the only existetial ‘protections’ they have left.

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The ‘Hook’ in Ego-Syntonic Process

• ‘But there really was someone there to love – I saw him – I saw him often’.

• ‘It’s not just a “rescuer” thing – it’s much stronger than that’. I couldn’t let him go because there were times I really saw him.

• ‘It’s so frustrating – sometimes she was a wonderful person – she was the fullest human being anyone could want…but then it would evaporate in tears and anger’.

• ‘He couldn’t let me in. For 20 years he couldn’t let me in. We could even talk about how he couldn’t let me in – Maybe that was it – at times he wasn’t who he was’.

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Client Processes




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‘EXISTENTIAL DISCONNECTION’

The separation of the person in their everyday life from the existential

significance of their life (c.f. Bill Murray and Scarlett Johansson in ‘Lost in

Translation’)

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Client Processes




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Getting beyond Transference

• ‘A part of me is not sure she should trust you, but…’.

• ‘I can’t believe I’ve just talked about me, like that, with an old man like you.’

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‘Difficult process’ rarely defines the whole of the person. Often there is a dissonant part that houses a different conception of self. Its appearance can be erratic and its voice very small. Often its dominant feeling is sadness.

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Working with the Client in his Existential Process

• He gives you his self as he experiences his self.

• What he gives is not dominated by relational self- protective strategies

• He finds it impossible to lie.

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Striving to meet at Relational Depth with the Client in her Existential Process

Sandie: Do you really want to know me? Like, do you want to meet the ‘me’ that I am to myself?

Dave: Yes, I want to meet all of you.(Pause)Sandie: I kill my babies.Dave: Is that meant to put me off?Sandie: No, it’s just what I do.Dave: (serious eye contact) You ‘kill your babies’ …..

It’s a difficult thing even for me to say. I have to ‘steel’ myself to say the words. They are hard words for me to say - I think that’s why I was glib.

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Sandie: It’s what I do - the words are me - I’ve killed three babies inside me.

Dave: You sound ….. You sound ‘flat’ about it - on the outside at least - I don’t know what you are ‘inside’ about it …..?

Sandie: I need to feel ‘flat’ inside about it as well.Dave: Yes ….. I think I can understand that ….. I think

I really can ….. it’s the only way ….. to …..Sandie: Survive.Dave: Yes.Sandie: Isn’t that funny …..Dave: That when you feel as you do, you still want to

survive?Sandie: Yes - I’ve never thought about that before.

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Striving to meet at Relational Depth with the Client in his Existential ProcessBobby: I’ve been feeling really bad things Dave - really bad

things.Dave: Tell me Bobby.Bobby: I don’t know if I can Dave ….. I don’t know if I can.Dave: This is really tough for you Bobby - I can see that in

your face. You’ve tried to make yourself tell me by bringing it up. But it’s still maybe not possible. I say ‘tell me Bobby’ like I usually do ….. but this is not ‘usual’ stuff - this is ….. different …..

(Pause)Bobby: Dave ….. I want to kill me.(Long silence)Bobby: All the roads lead there - I could make a good job of it

too.

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Dave: I bet you could, Bobby - I’m scared to use my imagination.

Bobby: It would be one thing I could do well.Dave: What are all the feelings Bobby - how do ‘all the

roads lead here’?Bobby: I don’t know if I want to go into it Dave - I’ve got to

this point and I feel a kind of ….. peace.Dave: Christ Bobby, this is tough for me. I knew you were

going to say that. I want to stay with you in that and I want to pull you away from that. I’m no use to you unless I can stay with you in it.

Bobby: That’s not true Dave - it’s nice for me to hear that. Anyway, you couldn’t stop me.

Dave: I really knew you were going to use that ‘peace’ word. I could feel how ‘all the roads lead there’. I can see how that is a conclusion for you ….. and a retribution for you …..

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It’s the same as cutting yourself used to be for you, isn’t it?

Bobby: Yes, it has the same sense of ‘punishment’ and ‘control’ ….. Do you understand how important it is for me to face this?

Dave: Yes, I do. You must face the question that perhaps the only way to make retribution is to execute yourself.

(Long silence)Dave: You will have worked it all out?Bobby: In detail, Dave - in detail.(Long silence)Bobby: It’s funny to feel so alone, yet with someone.(Long silence)

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When a client is met at relational depth and enters his existential process, he takes an ‘inside’ view of his Self. From that perspective he sometimes experiences his Self in terms of different ‘parts’ rather than a single ‘whole’.

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Contents• PCE Worldwide;• A schema of working at relational depth;• Client processes;• Working with the client’s

‘configurations’ of self;• Configuration Theory;• Revising Rogers’ Self-Theory;• The developmental agenda for the


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‘Taking an “Inside” View of me’

When you are close to me I go ‘inside’ myself - and see the different parts of me. From the outside I look confused and self-defeating - I don’t look alive at all. But ‘inside’ me I see the different parts in their own right. I see the scared and angry ‘little girl’ and her ‘big sister’ who bosses her around, but who really loves and protects her. Both of these parts are very alive.

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‘Configurations’

• Mearns, D. (1999) ‘Person-centred therapy with configurations of Self’. Counselling, 10(2): 125-130.

• Chapter 6: ‘The nature of “configurations” within Self’.Chapter 7: ‘Person-centred therapy with “configurations” of Self’ in Mearns, D. & Thorne, B. (2000) Person-Centred Therapy Today: New Frontiers in Theory and Practice. London: Sage.

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Definition

A ‘configuration’ is a hypothetical construct denoting a coherent pattern of feelings, thoughts and preferred behavioural responses symbolised or pre-symbolised by the person as reflective of a dimension of existence within the Self.

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Definition of ‘Configuration’ (Non-Jargon Version)

Sometimes people experience themselves as having different ‘parts’ to their Self. Each part, or ‘configuration’, is well-developed, with its own feelings, thoughts and ways of behaving which may be quite different from other parts.

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Sam: A 23 year old Traumatised ‘Veteran’‘I walk around watching people and myself. I watch myself watching myself. I have a “me” that I use for everyday life. It does all the “normal’ things that other people do - it goes to work - it talks with other people - it goes to the store - it even makes love with my wife. It carries on as though nothing has happened. And I watch it. I stand in the background and wonder how I can do all that stuff’.

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Person-Centred Therapy with Configurations of Self

(See Mearns & Thorne: Person-Centred Therapy Today, Chapter 7)

• Staying close to the client’s symbolisation;• Listen for the parts, but don’t invent them;• Avoiding ‘zero-sum’ responding;• Empathic mediation: helping the parts to

hear each other;• Multi-directional partiality: prizing all the

parts; • Therapist’s use of her configurational Self.

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• Mearns, D. & Thorne, B. (2000) ‘Advancing person-centred theory’. Chapters 6&9 in Person-Centred Therapy Today: New Frontiers in Theory and Practice. London: Sage.

• Mearns, D. (2002) Further theoretical propositions in regard to Self Theory within Person-centered therapy. Person-Centered and Experiential Psychotherapies. 1(1&2): 14-27.

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Proposition 1

Configurations may be established around introjections about self.

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Proposition 2

Configurations may also be established around dissonant self-experiences.

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Proposition 3

Formative configurations assimilate other consistent elements.

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Proposition 4

Further elements may be accrued by the self-fulfilling nature of configurations.

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Proposition 5

Configurations inter-relate and reconfigure.

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‘Configuration Theory’: Using theory in the person-centred approach

• Theory does not predict the behaviour or the experience of the client.

• Theory expands the imagination of the therapist.

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‘General’ Psychological Theory

+

‘Individual’ Psychological Theory

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Rogers, C.R. (1951) ‘A theory of personality and behavior’, pp 481-533 in Client-Centered Therapy. Boston: Houghton Mifflin.

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Rogers, C.R. (1959) ‘A theory of therapy, personality and interpersonal relationships as developed in the client-centered framework’, pp 184-256 in S. Koch (ed.), Psychology: A Study of a Science, Volume 3: Formulations of the Person and the Social Contract. New York: McGraw-Hill.

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Rogers, C.R. (1963) ‘The actualizing tendency in relation to “motives” and to consciousness’, pp 1-24 in M. Jones (ed.), Nebraska Symposium on Motivation. Lincoln: University of Nebraska Press.

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Rogers’ ‘California’ Period

A ‘Unitary’ Theory

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The ‘value-added’ actualising tendency

• Feelings valued over thoughts

• Non-self-conscious ‘being’ valued over ‘considered action

• ‘Free-expression’ valued over ‘censoring’

• ‘Radical’ choices valued over ‘conservative choices

• “Volume-up” expression of feeling valued over ‘volume-down’ expression of feeling

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COULSON, W. (1987) Reclaiming Client-Centered Counseling from the Person-Centered Movement.

Center for Enterprising Families, P.O. Box 134, Comptche, Ca 95427, USA.

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Reconfiguring Rogers’

Concept of the Self

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Rogers (1959: 200)

Self = Self-Concept

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Mearns & Thorne (2000)

Self = Self-Concept+ Edge of Awareness Material

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A Dialogical Person-Centred

Theory of the Self

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‘Growthful’ Configurations

‘Not for growth’ Configurations

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Proposition 6

The actualising tendency is the sole motivational force.

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Proposition 7

The promptings of the actualising tendency inspire their own resistance within the social life-space of the person. A working label for this resistance is the term ‘social mediation’.

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• I could do more with my life but I am scared to lose what I have.

• I need to stop this road – I can see where it points and I don’t want it – not yet anyway.

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• I fought my way out of a relationship previously, and I lost more than I ever imagined.

• Part of me says ‘go for it’ and part of me says ‘watch it’ – I need to stay with ‘watch it’ for now.

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• I look at what other people have got and I want it like a child wants everything. But my child isn’t going to make all my decisions.

• Everything seemed to point in the direction of leaving the job – I needed to be free of it. But my family would have lost too much – and that would mean me losing too much. So I rolled up my sleeves and made the best of it.

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Proposition 8

A psychological ‘homeostasis’ develops between the drive of the actualising tendency and the restraint of social mediation. The configuring and re-configuring of this homeostasis is the actualising process.

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‘In this revision of the theory, the central concept becomes the actualising process which is described by the homeostasis of the imperatives of the actualising tendency and social mediation within different areas of the person’s social life space and the reconfiguring of that homeostasis to respond to changing circumstances’.

(Person-Centred Therapy Today: p184)

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Proposition 9

‘Disorder’ is caused when the person becomes chronically stuck within his/her own actualising process such that the homeostatic balance cannot reconfigure to respond to changing circumstances.

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‘A Tyranny of Growth’

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After countless years of going against my instinct and fitting into other people’s wishes I finally broke free. For a time after that I was impossible to live with – I couldn’t compromise at all.

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It’s like I couldn’t go against my view of events and what was right for me in the moment. Having finally got hold of myself I wasn’t going to let go – I suppose I was scared I would lose myself again.

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I can see that my sense of myself isn’t working. Other people are giving back a different view of myself, and they are pretty unanimous. They say that I look ‘cold and detached’, when I feel ‘warm’. It is difficult to know who to trust.

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Either they share the same illusion or I have a huge blind spot that I can’t see past. It is really difficult to go against my sense of myself – I have no sense of being wrong. But these are good people – I need to pause awhile.

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The Developmental Agenda for the Therapist Working at Relational Depth

• expanding our experience of humanity;

• expanding the self available in the therapy room- configurations- ‘existential touchstones’

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Expanding Our Experience of Humanity• ‘Eventually I realised that if I was going to

work professionally as a counsellor, I had better find out something about the other half of humanity. So I started to work with men!’

• ‘I never actively accepted myself as “homophobic”, but I was. Joining the men’s group soon blew that away’.

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• ‘When it would come to the edge of meeting the depths of my clients’ despair I would always pull back. I got over that edge, initially, through reading about people’s experiences of despair. That would take me into my tears – and closer to my sense of my own existence.’

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• ‘An experience which helped me to sustain myself [in the work with ‘Rick’] was attending an informal ‘rap’ group of veterans….I used that group to stay connected with the kinds of experiencing they spoke about.’

(Mearns & Cooper, 2005: 107)

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• expanding our experiences of humanity;


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The Therapist’s use of her

configurational self?

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Working all together with ‘Clair’

Dave 1: I really don’t understand why you are leaving the job.

Clair 1: No, I knew you wouldn’t.

Dave 2: You mean you knew that I wouldn’t understand it?

Clair 2: Yes ….. I’ve seen it for ages. We are o.k. when we are working on my strong Self - that work has been great - I wouldn’t take anything away from it. But my ‘little girl’ isn’t so sure about you.

Dave 3: She doesn’t trust me.

Clair 3: She doesn’t think you want to know her ….. She is pretty scared you know.

Extract 1

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Dave 4: (pause) I suppose we haven’t spent enough time on her. (pause) I guess I didn’t hear her very well - I didn’t realise how bad she felt. I see now that I didn’t hear her very well.

Clair 4: I didn’t let her come out very often with you. Maybe I thought you wouldn’t like me if I really showed you her.

Dave 5: And perhaps I wasn’t as open to her as I could have been …..

Clair 5: Well, she has got to come out now. She needs to become a big girl now. So I am holding her hand and walking her out.

Dave 6: And what are you feeling, little girl?

Clair 6: I am scared ….. and I am angry. I am not sure if I can trust you ….. But I want to trust you.

Dave 7: I want to apologise to you for not really listening to you until now.

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Clair 1: It is better now, in here. It feels as though there are four of us working together.

Dave 1: You mean, two of you and two of me?Clair 2: Yes.Dave 2: The two parts of you, you have called your ‘strong

Self’ and your ‘little girl’. But you also sense two parts to me here?

Clair 3: Yes, don’t you?Dave 3: Yes, but I haven’t given them names yet - in here at

least - what is your sense of them?Clair 4: One is watching over everything that is happening.

He is pretty competent, but he is also nervous. The other is not so used to being here but he has been invited. He has got a softness and vulnerability which is really good for me. He helps me to be ‘soft’ with myself.

Dave 4: He helps you to be soft with yourself …..?

Extract 2 (two sessions later)

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Clair 5: When it was only your ‘strong, competent’ self that was here - then my strong self just got together with you and there was no space for ‘softies’ - no space for ‘softies’ in either of us.

Dave 5: And it is important that we touch that ‘softness’ in you …..?

Clair 6: It is important that we are all here, together. My parts both have strength - but they need to ‘get along’ together, like yours do.

Dave 6: Maybe I am more ‘tentative’, than I look, my ‘soft’ part kind of feels okay with this but is a bit unsure.

Clair 7: That is what ‘soft parts’ are like, silly! Being ‘unsure’ is part of being ‘soft’.

Dave 7: I think you are more experienced at this than me, Clair.

Clair 8: Never mind, we’ll help each other along!

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• expanding our experiences of humanity;


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Definition of ‘existential touchstones’Life events and self-experiences from which we draw considerable personal strength and which help to ground us in relationships as well as making us more open to and comfortable with a diversity of relationships.

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Lesley’s existential ‘touchstones’

• One of my earliest memories is sitting on my grandfather’s knee. Every time I met him he had a radiant smile and he would plonk me on his knee. What I get from that is huge – it is the experience of completely unconditional love. That is a really secure part of me that helps me to feel ‘at ease’ even in difficult situations.

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• No matter what I did, I could never please my father. It happened time after time. I would be proud of myself for something and he wouldn’t respond or he would nit-pick it and so devalue it. I can feel a child’s frustration even now, as I talk about it. It is amazing how often that sense of a child’s frustration helps me to get a ‘flavour’ of my client’s distress.

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• In primary school I was frequently ridiculed for being thin. The most distressing event happened each year when we would be ceremonially measured and weighed in front of the whole PE class. In a flamboyant way, representing nothing but her own self-importance, the teacher announced, ‘Watch that Lesley doesn’t fall through the cracks in the floorboards!’ The strength I take from this experience is in feeling my own rage. At the time it happened I nearly exploded into tears but I was determined not to give her the satisfaction so all I felt was the pure rage. It is surprising how often that strong, clean feeling is a source of strength for me with clients.

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• One year, late in my primary schooling, I came top of the class. Usually I was around tenth place but in this particular year, once all the marks were averaged, I was top. To my enormous pride the teacher invited me to the front of the class. I thought that my considerable achievement was going to be honoured. However, what the teacher did was to ask me to spell the word ‘inexplicable’. I was thoroughly confused but I spelled it, accurately I think. Then, with a broad smile and a wave of her arm towards me she said, ‘inexplicable! Yes, that is the best word to describe you coming top of the class!’

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This time I didn’t feel angry, what I felt was an intense humiliation. That is something I have felt fairly often in my life. It is an absolutely dreadful feeling. It is the feeling of being stripped naked in public. And that is precisely the strength I take from it. I have been so severely humiliated so often that I know what it is. I don’t need to fear it because I know it better than most people. I don’t need to be afraid of looking silly or getting things wrong – I can take risks with my self-expression because, no matter what happens, I could never be so humiliated as I have been.

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• I learned that a very slight girl needed to use her brain rather than her brawn. One example of that was when I was surrounded pretty late at night in a dodgy area of town by a group of men. Running was not an option and fighting certainly wasn’t! so, I amazed myself by taking the initiative. I broke into talking with them and cracking jokes and making first one and then another and then another laugh. One of them clapped me on the shoulder and said, ‘You’re a good sport’ and I was allowed to walk away. As well as being a self-experience that makes me feel good about myself, incidents like this help me to feel pretty safe with just about anybody.

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• From my time as a nurse I remember one of my patients who died. It had been a medical ‘mistake’ – he was given ten times the proper dosage of medication. It didn’t happen on my shift, thank God, but I still carry a lot of guilt about it because I colluded with the cover-up to protect the doctor. At the time it felt that I couldn’t do anything else although I was incredibly angry. The feeling was one of total powerlessness. That feeling of powerlessness is an incredibly valuable touchstone for meeting many of my clients.

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• Being with someone dying and opening yourself to that helps to develop depth. Often the nursing profession runs away from that challenge but I remember a few cases – one was with ‘Mary’, who was eighty-three years of age. There was no one to spend her death with her, so I did it. I had finished my shift and I knew that Mary would not be there the next time I clocked on, so I sat with her and she used me to talk about her life. It took two and a half hours and then she died. What Mary left me is useful for me with every single client I meet.

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Dominic 1: [At the start of session 3]

D1 I shouldn’t have come today. I’ll go away if you like.

T1 Because you’ve been drinking?D2 Yeah – I’ve been drinking.T2 Do you want to go or do you want to stay?D3 I wouldn’t mind staying.T3 I would like that too. But I’d like us to keep

the tape on like we usually do. Why I say that is that I want us to have a record of what happens – when you’re pissed it’s easy to forget.

[From Mearns, D. & Cooper, M. (2005) Working at Relational Depth in Counselling and Psychotherapy. London: Sage.]

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D4 Fine – I hadn’t realised it was on.T4 Good that I mentioned it then.D5 (Long pause) How do you feel about me …..

now ….. here.T5 Dom, I want to tell you that I feel absolutely

nothing about the fact that you’ve been drinking. But you asked how I felt about you, now, here (pauses) I feel ….. a bit ….. ‘scared’.

D6 ‘Scared’?T6 It surprises me too ….. I guess it does matter

to me that you’ve been drinking ….. I’m scared in case we have to start again. It’s like I feel that we’ve made a really good connection ….. but will that still be there …..today. That’s what makes me a bit scared.

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D7 Like it matters to you?T7 Yes it does Dom.D8 Like this isn’t just a ‘game’ to you?T8 I think you know that, Dom. In fact, I

know you know that Dom.D9 Yes – ‘sober me’ knows it, but does ‘drunk

me’?!T9 I don’t know. Does he? Do you?D10 Big question – maybe I’ll need another

vodka before I can answer that. T10 Dom – be here – be here drunk – but don’t

play fucking games with me. Neither you nor I deserve that.

D11 SILENCET11 SILENCE

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D12 You’re really serious about this, aren’t you?

T12 As ever.D13 I’m sorry.T13 Apology accepted - where should we start

today?D14 We started long ago – this is me – this is

who I am.T14 Yes – you’re right – I see – we started at

the beginning as usual – but the start was different – because you were different. Yes, I missed that.

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Dominic 2: [Later in session 3]D15 It’s not easy to live up to a ‘holy’ name.T15 ‘Dominic’.D16 Yes – a ‘good Catholic upbringing’ kept telling

me how important my name was. T16 Like it told you what you should be?D17 Yeah – but it was a fantasy – pure fantasy

……………. pure ……………. fantasy.T17 Their fantasy?D18 Yeah ……………… It was like I didn’t exist …

you know?T18 Like they had some image of you that was so

far from who you were that it was like they were talking about someone else.

D19 Got it in one. You’re good at this shit!T19 Hope so. What are you with just now?

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D20 (long pause) …. (looks directly at T) ……….. I don’t know what I’ m about.

T20 (looks intensely at D and moves towards him, speaking slowly). That sounds like a lot, ‘you–don’t–know–what–you’re-about…’

D21 I’m so full of crap.T21 … and …?D22 I don’t know whether to believe myself or

not.T22 Say more Dom.D23 I’m just so full of crap.T23 You don’t know whether to believe yourself

or not.D24 I think I’m serious … sincere. But, really,

I’m only a drunk … a fuckin drunk.T24 You think that you are serious … and sincere.

But you are really, only, a fuckin drunk.

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D25 Yes.T25 A fuckin drunk – that’s all you are.D26 (tears welling up)T26 A fuckin drunk.D27 (hits fist on arm of chair in apparent anger…

and cries)T27 Dom, you are angry… and you are crying.D28 I’m so fuckin full of shit (cries).T28 (moves to Dominic and puts his arm round

him)D29 (cries more and more)T29 It feels like a lonely place.D30 (looks up at T) Yes… (shivers).T30 Cold, and lonely…

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D31 The only warmth comes through the bottle – whether it’s ‘single malt’ or cheap vodka – it doesn’t matter.

T31 It still works – it still gives a feeling of warmth. D32 It does… I can’t describe it… I’m alive… but it’s

killing me… and everything I love.T32 Dom – can you really help me get hold of this – It

sounds really strong – like you feel really ‘alive’ – that sounds real powerful. But, then, it is also ‘killing’ you, and everything you love.

D33 One part of me is really ‘hooked’ on it – it is the only ‘buzz’ I get and I can’t get enough of it.

T33 And, there is another part…?D34 The other part is a loving husband and father…T34 Yes…?

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D35 Who is killing his family.T35 You are carrying a lot… a helluva lot.D36 And I can’t carry it any more.T36 That sounds serious… No. I don’t mean to be

‘glib’ – it really does sound like you are serious.D37 I’ve got to do something.T37 ‘Do’? What would you ‘do’ Dom?D38 Either give it up… or give it up.T38 I think I understand… one ‘part’ – the one that is

really ‘hooked’ would give up on your normal life… and the other ‘part’ – the one who is a ‘loving husband and father’ would give up the booze.

D39 Most people don’t realize how difficult a choice that is.

T39 Is it… does it feel like giving up on ‘living’ for the ‘life’ you have?

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D40 Yes.T40 SILENCED41 It feels like ‘living’ when you’re drunk – but it isn’t

really.T41 SILENCED42 I’ve been scared of living – all my life I’ve been

scared of living. I’ve never felt like other people – I’ve never felt ‘sure of myself’ the way other people do. If you feel ‘sure of yourself’ you can go out and do things with your life. If you don’t feel sure of yourself you can’t – you can’t really do things with your life – you’ve always got to make ‘safe’ choices – choices that don’t really test you – choices that aren’t really ‘living’.

T42 SILENCED43 And so, I have an ‘ordinary life’ – did you see that

film?T43 ‘Ordinary Lives’ – yes.

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D44 LONG SILENCET44 Are you stuck? Are you thinking about the film?D45 Yes – their ‘ordinary lives’ were blown apart

when something terrible happened. They had taken the safe choices for so long that they hadn’t developed the strength to deal with real life.

T45 And you… what about you.D46 Part of me tries to break free, but it also hasn’t

got experience – it doesn’t know how to do it.T46 SILENCED47 SILENCET47 I am feeling sad for it. I think I am seeing it

better. It desperately wants to do something – but it has been ‘scared of living’ for so long – it doesn’t know what to do.

D48 So all I can do is to go into that feeling of being sad – and get drunk. That’s the closest I can get to ‘living’.

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DOMINIC 3: [session 4][after spending time going through part of the tape of session 3]

D49 It is difficult to listen to that.T49 Why is that, Dom?D50 Because I’m drunk.T50 Yes – yes, you are drunk.D51 I hate listening to it – it’s not me.T51 It’s not you.D52 SILENCET52 It’s not you.D53 How can I be like that? How can I be a drunk? How can I have let you tape that.T53 Dom… If you want, I can wipe that tape right now.

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D54 No………………… No………………… It’s me……………… It is me.

T54 It is you.D55 ………….. but not a part of me I want.T55 Do you recognise him?D56 Sure… he’s only a bottle of vodka away.T56 Where should we go with this, Dom? Where

should we go with this right now? Where are you with this right now?

D57 I’ve got to meet him.T57 You ‘heard’ him, didn’t you Dom… you

really ‘heard’ him.D58 Yes… yes… I heard him.T58 You are keeping him out… but, really you

heard him…

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D59 I heard ‘me the drunk’. I hate him. I cry for him. I cry with him. I am him. He is part of me.

T59 And you feel you have ‘got to meet him’.D60 I don’t know what made me say that – I hate

him. When I’m sober I believe he is gone forever. Why did I say that ‘I have to meet him’?

T60 SILENCE{Dominic meets T’s eyes}

D61 I have been running way from him for years but what I need to do is to meet him.

T61 SILENCED62 Let’s play some more of the tape.

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DOMINIC 4: [later in session 4]

D63 [Dominic begins to cry as he listens to the tape – particularly D34]

T63 SILENCED64 It’s like I’m listening to him – to me – to that part

of me, properly, for the first time. I’ve been locked into antagonism to him – antagonism and denial and hate. I had to deny he was ‘really’ a part of me. He was an evil drunk. But he is a part of me, not just when I am drunk, but every minute of every day – he is a part of me. He is ‘sad’ me, ‘lost’ me, ‘desperate’ me, ‘crying’ me – though I’m also crying now. It’s like he’s with me now, and I’m not drunk – nor am I going to get drunk… today.

T64 This sounds different – like you are ‘meeting’ him rather than ‘dismissing’ him.

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D65 It feels strange – like I am excited but also tense – this feels different. It’s not like I imagined it. I came into therapy to kill that drunk and now I am listening to him and crying for him/crying with him. He really is part of me – a part that I have not been open to – we had to be separated by a bottle of vodka.

T65 SILENCED66 LONG SILENCET66 Where are you in your silence Dom?D67 I have suddenly become aware that you are

here.T67 And how is that for you – that I am here –

with you?

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D68 The first feeling was an acute embarrassment – but that quickly passed. Now it feels good that you are here – that you are sharing this with me. I feel so excited but also tense – might this pass? Could I lose it?

T68 ‘It’?D69 This is the first time that ‘sober me’ has met

‘drunk me’ in a way that he can understand him.

T69 Can ‘drunk me’ also understand ‘sober me’?D70 Wow – that’s a big question – that’s too much

right now – that panics me.T70 In case he can’t?

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D71 Yes. It’s like I’ve won a lot at the ‘tables’ today and if we go too far I might lose it.

T71 Fair enough. I thought I might be pushing too far – I knew it was a big step. In fact, ‘part’ of me told me not to push… and another part – a kind of ‘delinquent’ part said ‘go for it’!

D72 Hah! So the therapist is crazy too – he has different parts too.

T72 I’ve been ‘found out’ – guilty as charged!D73 Can we come back to your question when

I’ve lived with this for a while? (smiles)T73 Why can’t I be as wise as that!

SESSION ENDS

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This session proved to be critical for the therapy. ‘Sober’ Dominic had met ‘drunk Dominic’ without judgement or denial but, instead, with genuine understanding. In session 5 Dominic described himself as a ‘partial drunk’, ‘part’ of him was a ‘drunk’ and part of him was ‘sober’. The problem with these configurations is that the ‘drunk’ can generally undermine the whole process and take over the definition of the person. One wonders how many other people might be described as partial drunks, if only we could be present at the meetings of their parts?

Presentation 1

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Transcript of Presentation 1