Major therapeutic techniques

The major techniques can be grouped into four strategies: emotional discharge, attention switching, celebrating, and target practice. To break Patterns these strategies are usually woven together, though each is a therapeutic strategy in its own right. Emotional discharge is emphasised in this section as it is the major strategy used in co-counselling.

Discharging negative feelings moves people from a patterned state, into positive feelings, thus breaking the power of the Pattern.

Helping Discharge Happen:

Using the Discharge strategy means achieving a Balance of Attention in relation to the distresses that are being dealt with. The techniques used will depend upon clients' co- counselling skills, the material they are trying to deal with, and the state they are in when an intervention is made. Typical techniques appropriate for different client states are given in Table 1 and these will be referred to by the letters of the sections they appear in.

Underlying the choice of technique is a two dimensional model of emotions. One dimension is the hedonic tone of the emotion--positive or negative. The other dimension is the level of physiological arousal the person has. On this model we can plot typical emotions as shown in figure 7a.

Emotions that can be directly discharged are those experienced in quadrant C--the more highly aroused negative feelings like anger, fear, grief, disgust, embarrassment. Discharge occurs when the person experiences such an emotion whilst also being aware that the bodily arousal and focused attention is not appropriate to the present time situation they are in. In this case, attention is divided between the states in the righthand and lefthand of the figure. Discharge can be visualised as a movement across the figure from quadrant C to A or B, as indicated by the arrows in figure 7b. Techniques for achieving a Balance of Attention are described below, with the client starting in different quadrants.

Figure 7a: Examples of simple emotions plotted onto a space whose dimensions are bodily arousal and hedonic tone.

Figure 7b: The changes occurring during discharge are indicated with heavy arrows. Note that only aroused negative feelings will discharge.

Balance of Attention

(i) Increasing client's awareness of present safety.
If the client is experiencing an aroused negative feeling without discharging, their attention is all in quadrant C. The counsellor will then seek to increase the client's awareness of present safety, to direct some of the client's attention outside the distress, focusing it in quadrant B to obtain the needed Balance of Attention. Relevant techniques are given in Table 1, section A.

(ii) Increasing the client's awareness of a distressing memory.
If the client mostly has attention in A, B quadrants, then interventions use Restimulation to enable the client to re-experience the distressing feelings, thus creating a Balance of Attention. Typical techniques given in Table 1, sections B, C, D.

(iii) Increasing the client's arousal.
This is used when clients are in low arousal states, experiencing feelings typical of quadrant D. Increasing arousal transmutes quadrant D feelings into C feelings, e.g. depression transmutes into anger, anxiety into fear, alienation into grief. Direct movement from quadrant D to quadrant A is very difficult. Techniques in Table 1, sections D and E, increase arousal directly or indirectly. If the client does not appear to be dealing effectively with the distress they chose to work on, whatever is obstructing them is worked on, as this becomes the distress on top.

The techniques used in (i), (ii) or (iii) above assumes that the client is talking through recent upsetting events, which is how people beginning co-counselling will usually start. Such events involve underlying Patterns.

After working through a series of related incidents clients will typically become aware of these Patterns. Related incidents will be remembered spontaneously at times, but these can also be evoked by working on a distress theme or by the counsellor asking appropriate questions, as in Table 1, section H.

Once Patterns have been identified they can be worked with directly, without the need for talking through events where the Patterns are restimulated. The technique used is called "Direction Holding", a Direction being a slogan which precisely and powerfully contradicts a client's Pattern, provoking Discharge. See Table 1, Section J.

Directions do not have to be believed--the client has to deliver them with energy. The resultant tension between the enactment of the Direction and the distress it is contradicting provides a Balance of Attention and Discharge results. See Table 1, Section J.

Attention Switching

This moves mind and body from negative feelings into positive ones; from quadrants C and D to quadrants A and B respectively in figure 1a. Such movements result from our feelings following our focus of attention (see figure 8). Note, however, that the lower the level of arousal, the more difficult it is for the client to succeed in Attention Switching.

We can learn to switch attention to positive experiences.

Positive pleasant memories produce positive feelings. Negative unpleasant memories produce negative feelings.

Figure 8: Our feelings follow our focus of attention

The fact that feelings follow our focus of attention is part of everyday experience. Research evidence is reviewed by Kovacs and Beck, [Izard, 1979, p. 427]. This strategy is used within sessions to enable the client to achieve a Balance of Attention. Attention Switching is also used at the end of sessions so that clients leave in the best frame of mind to face the world, and not sunk in distress. See Table 1, sections A and L.

Celebration

This involves clients attending to, and actively voicing, appreciations of their positive qualities, skills, and successes--anything mastered or learned; so enhancing self-esteem.

Celebration results in the client's positive resources being more readily remembered, so attention is less likely to be overwhelmed by distress in threatening situations. Also, although Celebration is engaged in when the client is mainly in quadrants A or B, it goes against chronic self-putdown Patterns, and hence the client will often discharge.

RC has emphasised particular celebratory type of techniques using the label 'counselling with attention away from distress.' More recently this has developed into a technique called 'the reality agreement.'

Target Practice

Target practice involves clients practising breaking Patterns, and substituting the new actions and thoughts that they wish to apply in their lives.

All the four main strategies are operated flexibly; the counsellor trying one technique after another until discharge starts. The counsellor observes the client carefully, identifies the distress cues in words, voice and body, and encourages repetition of whatever triggers client discharge. Figure 9 illustrates the observable differences that co-counsellors need to learn, in order to use the process as represented in Table 1.

Typically clients will discharge briefly and then cut it off. Tactically, repeated discharge on a situation or a Pattern is encouraged until no more occurs. This may take many sessions, with more than one form of discharge occurring sequentially with the same material.

Spontaneous ending of a discharge process is observable with noticeable relaxing of facial and bodily tension; clarity of thinking; access to new information about the distress, spontaneous interpretations, or ideas for action.

Fig. 9: Observable differences co-counsellors need to learn

Table 1: Appropriate techniques for observable client behaviours

Client behavior

Appropriate counsellor suggestions

1. Shut down or lost in distress. Insufficient attention in present time for Balance of Attention. Needs pulling out of hurts. Attention Switching. Focus attention outside distress: with simple dscriptive tasks: actions needing attention; requests for positive memories.
2. Unfoccused talking.Talks about distress. Asks "Why?" Rationalizes. Seeks interpretation. Focusing on Specific Events. "Tell me about a recent event that's an example."
Suggest that client: talk in present tense and use literal description; role-play self in past incident.
3. Whilst trying to focus on an event client:

a. moves into past tense.
b. is vague, lacks detail.
c. uses indirect speech

Focusing on Specific Events. "Say that in the present tense." "Describe the room." "What was he wearing?" "Talk directly to the person as if they're present now."
4. Gives cues for distress and negative feelings:

Stresses or stumbles over words.
Pauses.
Changes facial expression or gesture--
eyes water, fists clench.
Very tense in part or whole of body.
Scratches.
Makes aggressive or negative judgments, put-downs of self or others.
Uses 'oughts' or 'shoulds'.

Intensify Distress Cues.
Suggest client repeat distress cues; talk loudly; involve body; use counsellor to roleplay words and actions which cause distress.

Intensify by Going Against Distress Cues.
Suggest client say and do the opposite of the distress words, postures, gestures; if sagging suggest bodily arousal; if very tense, suggest relaxation.

Suggest using a parody or comic relief if distress feels heavy.

5. When client is using basic intensifying techniques, but not discharging as a result. Demand loudness and involvement of body.

Try Going against Distress; if already doing this, add a "Yippee!" to end.

6. Counsellor uncertain what's going on for client. Ambiguous cues. Change of expression without comment. General enquiry: "What's the thought?" "What's the image?" "Where are you now?"
"Tell me what's on top--any order."
7. Client not progressing with chosen distress area:

--saying "I'm stuck!" "I can't." "That's silly."

--in grip of Pattern which inhibits discharge. (Control Pattern)

--Client in conflict about what they want or having competing distresses.

Treat client's words as cues for negative feelings,

even when said as asides or earnestly
-- use intensifying as in E above.

Acting Into Discharge: acting actions which go with discharge. Going Against with physical control loosening methods: tearing up cardboard; letting out breath; loosening of body.

Suggest two cushions: one for each side of theconflict--client works first on one then the other, allowing each side of conflict a full say and aiming to discharge on both cushions.

8. Giving cues for Patterns:

a. Client verbalises an association. "I'm reminded of a person/place/event."

b. Client working on recent incidents in which people involved are authority figures, or suggestive of archetypes.

c. Client's recent distress appears out of all proportion to its cause.

Following Pattern Connections: Encourage focusing on the association. Ask client to tell story, or talk directly to key person tought of, as appropriate.

Useful interventions: "Who does this remind you of?" "Who are you really saying that to?" "Try saying that to your father/mother."

Check for earlier causes of restimulation: "What's your earliest memory of a situation like this?" "How about scanning through times when things like this happened?"

9. Client discharging. Encourage the discharge. "Let it go!" "You'll feel better if you let it out." When discharge slows down, get client to repeat the initial "trigger."
10. Client has identified major Pattern, particularly chronic Patterns. Suggest Direction-Holding: the sustained, energetic, repetition of a Direction, with appropriate posture, gestures etc. to totally contradict distresses.
11. Client emerging from discharge and having lots of attention free to choose what to do. (In Present Time.)

Client spontaneously brings up new memories, new ideas, new insights, new solutions.

Client has plenty of free attention, and there is time in the session.

Encourage taking time for re-evaluation: "Take some time to think out loud on that situation." "How will you be different in the future?" "What would you like to do instead?"

Encourage client to follow up on these.

Encourage: Creative thinking out loud on broadening topics, e.g. "My goals for the next 5 years." Specific action planning. Self expression, e.g. dancing, singing, painting.

12. Client approaching end of a session while still caught up in distress, or with discharge still occurring.

Stage reached by the client:



--Unfinished business.


--Present distress shown to originate in past; particularly when in early childhood.


--Client ready to consider and maximise changes in their life in the light of identified Patterns.

First, use Attention Switching techniques so Client finishes session with maximum attention out of distress.

Then, suggest using Target Practice--select as appropriate to time available and the work the client has done.

Ask for "What's left unsaid?" i.e. uncensored thoughts put into words. Then consider separately rehearsing for next time, e.g. "What could you say for real, next time?"

Ask for separations of present person from past distress. E.G. "I'm no longer the child who had to earn love. I'm now a smart, strong, skilled adult. I can supply my distressed child with what she needs."

Holding Directions in life: Directions the client has used for discharge in sessions noted for use in life situations when Patterns likely to be evoked.

13. End of session very close. Encourage Celebration of self: energetically, with words appropriate to work done.

Go to The change process in therapy.

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