Intensive Counselling

John Heron

1978, revised edition 1998



See also my:


Foreword

Part II of this manual is a revision of the original 1978 text. It lists counsellor interventions under eight different aspects of intensive counselling, and concludes with my account of the primary qualities that distinguish effective intensive counselling. Part I is a more recent model of counsellor interventions. It starts with a four-part grid which relates both the client's content cues, and the client's process cues, to the counsellor prompting the client to be active, and to the counsellor being active while the client is receptive and responsive. This is followed by an overlapping account of counsellor interventions, simply listed under 'Working with content' and 'Working with process', and taken from Chapter 7, 'Cathartic Interventions' in my book Helping the Client: A Creative, Practical Guide, London: Sage, 1990.


Part I

1. Diagram of the four-part grid

CONTENT CUES
The client's story: word/image/idea
PROCESS CUES
The client's energy: body/breath/sound
Client cue: What client is invited to say Client cue: What client is invited to do
Counsellor

prompts

Client

to be

active

Evasive talk or analytic talk:

how feeling, how being in the body

find agenda critical incident

Stated problem: critical incident

Stated occlusion: imagine critical incident

Critical incident: scan: forward or back

earliest available memory

Critical incident: literal description

Literal description: psychodrama

Psychodrama: shift level within it

Monodrama: play internal parts

Association: thought

critical incident

follow chain of memories

verbalize insight/re-evaluation

positive affirmation and reprogramming

action planning and goal setting:

Slip of tongue: repeat, associate

Sudden aside: repeat, associate

Self-deprecation: contradiction

Evasive pronoun: first person

Evasive verb: responsible verb

Dream: literal description in present tense

psychodrama

monodrama: play all dream symbols

Lyrical cue: recite, hum or sing

Rapid speech, shallow tone:

slow down speech, deepen tone

Distress-charged sound on word/phrase:

repeat, increase, associate

Sudden deepening of the breath:

repeat, increase, associate

hyperventilate

Eyes closed or evasive:

make eye contact

Distress-charged movement:

repeat, exaggerate, find sound/words

Distress-charged rigidity:

exaggerate, find sound/words

contradict, find sound/words

Matching or mismatching: treat alike

Chronic archaic/defensive tone of voice:

exaggerate, find its words

Chronic archaic/defensive body armour:

amplify kinaesthetic micro-cues

stress positions

mobilization

hyperventilation

regression positions

frozen need expressions

spatial quadrants and polarities

Pensive cue: verbalize thought, image

Client cue: What practitioner says Client cue: What practitioner does
Counsellor:

acts

while

Client

is

receptive

and

responsive

Stated problem: hypnosis, suggestion

Psychodrama: negative accommodation

positive accommodation

Negative talk: mirror with awareness

Emergence of hurt child's story:

affirm validity of the client's hurt, affirm their need for discharge and healing, their deserving of time, the past need for their defenses, the safety of this situation, the present redundancy of their defenses, the deep worth of their inner child, the value of this work of healing and their courage in doing it.....

Chronic archaic/defensive body armour and intermittent rigidities:

light holding, light contact/massage

light vibration/pulsing

loosen muscle groups

light/strong pressure on tense areas

gentle opening/extension of joints

long leverages, psychodynamic osteopathy

energy passes with hands, breath, eyes

Eyes evasive: seek eye contact

2. From Helping the Client

Working with content.

This means working with what the client is saying, with their stated difficulty, with meaning, story-line and imagery. The content may start out anecdotally evasive or analytically defensive; may evolve into talking about some real difficulty or problem area; and culminate in working on some traumatic scenario.

1. From analysis to incident. You ask a client who is busy analysing a current difficulty or problem in their life to describe a specific, concrete critical/traumatic instance of it. You gently persist until the client gets there. Then:

2. Literal description. You ask the client to describe the traumatic incident in literal detail, not analyse it or talk about it but summon the story-line through vivid recall of sights and sounds and smells, of what people said and did. Distress is lodged in imagery of all kinds, and is drawn up by its evocation. And to increase this effect:

3. Present tense account. You ask the client to describe the incident in the present tense, as if it happening now. You keep them to the texture of the scene, the imagery, in the present tense, maybe going over it several times, and with discreet questions edge them to the distressed nub of the matter. Working with process cues (see below) evident during the description will help a lot. Catharsis may occur at any point. What is certain is that the threshold of catharsis is lowering: the person is getting closer to feeling the distress.

4. Psychodrama. As the distress emotion comes to the fore through literal description of a critical incident, you invite the client to re-enact the incident, that is, to re-play it as a piece of living theatre: they imagine they are in the scene and speak within it as if it is happening now.

5. Shifting level. If the psychodrama is about an incident later in the client's life, when they are making a charged statement to the central other, such as 'I really need you to be here', you quickly and deftly asks 'Who are you really saying that to?' or 'Who else are you saying that to?' At this point, at the heart of the psychodrama, they can very rapidly shift level to a much earlier situation and become the hurt child speaking to its parent. They continue to use the same line but in relation to a more basic agenda. Often the catharsis dramatically intensifies as the deeper level is reached.

6. Earliest available memory. Instead of asking the client to think of a recent critical incident of a current difficulty, do a psychodrama on it and shift level within the psychodrama to an earlier and more basic incident, you can simply ask for their earliest available memory of that sort of incident, and work on that with literal description and psychodrama. Depending on how it goes and how early it is, you may get them to shift level inside that psychodrama too. Distresses line up in chains of linked experiences going right back to the start of life. However, there's no need always to shift level to earlier incidents. It may be appropriate to defuse the incident you happen to be working with.

7. Hypnotic regression. When the client states a current difficulty, you invite them to lie down with eyes closed, and then count them down from 10 to 1 into deeper and deeper states of relaxation, and further into their past toward early incidents at the start of the chain linked with the current difficulty. They recount what memories surface. Follow through with psychodrama and/or process work.

8. Scanning. When the client states a current problem, you invite them to scan along the chain of incidents, all of which are linked by the same sort of difficulty and distress. They evoke each scene, then move on to the next, without going into any one event deeply. They can start with the earliest incident in the chain which they can recall and then move chronologically forward. Or they can move chronologically backward from the most recent incident. This loosens up the whole chain and brings the more critical incidents to the fore to be discharged.

9. Imagining reality. When the content indicates that there is some trauma lodged in an incident which the client knows has happened but cannot recall (e.g. circumcision), you can suggest that they simply imagine the event without worrying whether it really was like that. Follow through with nos. 2 to 4 and process work. Hypnotic regression is another possibility here, of course.

10. Eschatological drama. When the client is talking about feeling cut off from other realms, from the sacred and the divine, you suggest that they talk directly to these realities, saying whatever they need to say. This can be very cathartic, with a re-evaluation of the relationship, leading into further transpersonal work.

11. Slips of the tongue. When a word or phrase slips out that the client didn't intend to say, you invite them to repeat it a few times, and to work with the associations and/or process cues. This invariably points the way to some unfinished business.

12. Monodrama. The client is invited to play both sides of an internal conflict which may be between the claims of two different roles they have, or more basically between their internal oppressor and their internal victim. There are two chairs, one for each side of the conflict, and the client moves from chair to chair, speaking the lines for each of their internal protagonists. This is certainly consciousness-raising, and can become rapidly cathartic if you work skilfully with the process cues on either side of the conflict.

13. Contradiction. The client is invited to use statements and a non-verbal manner that contradict, without qualification, their self-deprecating, self-denigrating statements and manner. In full contradiction, both statement and manner (tone of voice, facial expression, gesture - arms well out and up, posture) are self-appreciative and unqualified. In partial contradiction, their statement is self-deprecatory but their manner is totally self-appreciative: it's the irony of this that is cathartic. In double negative contradiction, both statement and manner are exaggeratedly self-deprecating: the caricature implodes into catharsis.

14. Validation. At certain times, you can gently and clearly affirm the client, their deep worth, their fine qualities, their deeds, in a way that releases a lot of grief about the denial of all these fundamental truths in their childhood.

15. Giving permission. In early stages, the client often still feels the force of the old conditioning that tells them they are not allowed to discharge their distress. You can help this by gently giving them verbal permission and encouragement as they falter on the brink of release.

16. Freeing attention. When the client's talk indicates that their attention is sunk, caught up in verbally acting out or acting in, distracted or fascinated by their distress, you interrupt this to get some attention free and ready for balance by: physical process work (see below), describing the immediate environment, the use of contradiction, describing recent pleasurable experiences, moving around in or changing the arrangement items in the room. Then see what's on top (next).

17. What's on top. When the client has got some free attention and is starting to get into balanced attention, you ask them "What's on top?", that is, what recent (or remote) experience comes spontaneously to mind, however irrelevant or trivial it may appear to be. Then work as in nos. 2 to 8, or it may be that the next one, no. 18, happens quite quickly.

18. Free association down the pile. This is content determined, but it is evidenced by a particular kind of process cue, the pensive cue. As the client is working on, or describing one event, another and often earlier one suddenly comes to their mind. They may ignore it unless you spot its arrival via the pensive cue - the slight pause and sudden reflective look. Unlike scanning (above) which is directed association along an explicitly identified chain of distress-linked events, this is free association along a chain or down the pile of interlinked chains. This may lead to a primary working area for the session.

19. Dreams. One useful way of leading your client, is to inquire about their recent dreams, or about repetitive nightmares. You can work with these just as you would with a real life incident: literal description, psychodrama, shifting level, free association, and so on. You can also invite your client - in order to grasp how the dream symbolises the relation between different parts of their psyche - to become each main item or person in the dream in turn, and to let each one speak to the others and say what it wants. Pick up the accompanying process cues.

20. Quick asides. Sometimes associated material comes up as a quick aside, which is something the client says that seems to lie a bit outside the mainstream of what they are talking about. They also tend to sweep on past it as if it were not important. You pick up on the aside and invite them to go into it, associate to it, and so on. This is invariably fruitful, but you will need a little persistence, if the client is defensively impatient and wanting to get on with their surface theme.

21. Lyrical content. When the client mentions recall of a poem, a piece of music or a song, you invite them to recite it, hum it or sing it. This can be powerfully cathartic and full of associated material.

22. Catching the thought. Again, though it is evidenced by a pensive cue, it is the content that is important. As the client is working - describing an incident, doing a psychodrama, during a pause in catharsis - a sudden thought comes to them, and they have switched briefly to the cognitive mode - some re-appraisal of an event, insight into its effects, re-evaluation of its meaning. The pensive cue alerts you to invite them to verbalise all this. This fully expressed re-structuring of awareness is the real fruit of the catharsis, not just the release itself.

23. Integration of learning. After a major piece of cathartic work that has generated a good deal of insight and re-evaluation, you prompt the client to formulate clearly all they have learnt, and to affirm its application to new attitudes of mind, new goals and new behaviours in their life now. At this point cathartic work finds its true raison d'etre.

Working with process.

This means working with how the client is talking and being, that is, with tone and charge and volume of voice, with breathing, use of eyes, facial expression, gesture, posture, movement. Here, again, I emphasise training and supervised practice.

24. Repetition with amplification and/or contradiction. The client can never totally deny or contain their distress. It continually has brief outcrops in the surface texture of their behaviour, as if it is always struggling to get out, however defensively unaware of it they have had to become. And it also has a more constant grip on some of the muscular mechanisms of their behaviour and bodily being. There are four classes of cues that they can repeat, amplify and/or contradict.

24.1. Distress-charged words and phrases. You pick up on these words or phrases not because of their meaning but because of their emotional charge. Indeed the meaning may sometimes seem quite irrelevant to the work in hand. And you must distinguish between a normal expressive emphasis and a distress charge. It is words with the latter that you invite the person to repeat, perhaps several times, and perhaps louder, and even much louder. This repetition and amplification may start to discharge the underlying the distress. Or it will bring it nearer the surface and loosen up associated material - so you watch for pensive cues. Particularly potent at the heart of a psychodrama, when the individual is expressing the hitherto unexpressed to some central other protagonist from their past.

24.2. Distress-charged mobility. While the client is talking, and unnoticed by them, their underlying distress starts to move some part of their body: the feet and legs start a kicking or jerking motion; the hands and arms start a small stabbing, slapping, thumping, scratching, twitching or wringing motion; the pelvis and thighs start a small bouncing or rotating movement; the trunk, head and neck start swaying, bending, rotating; the head starts shaking or nodding; there is a sudden deepening of the breath.

24.3. Distress-charged rigidity. The underlying distress temporarily locks some part of the client's body into a rigid state: the breathing becomes tight, restricted and shallow; the legs are rigid, the muscles locked; the thighs close tightly together; the arms are held tight to the sides of the body, or crossed tightly; the fists are tightly clenched, the arms rigid; the hands are firmly clasped; one hand or both hands tightly hold the head, or cover the eyes, or have fingers pressed over the mouth; head, neck and trunk lock together in one rigid posture; etc.

24.4. Chronic archaic-defensive cues. Cues in the previous three entries are intermittent: they crop up in and among the content of what the client is saying, they come and go, sometimes at a great rate of knots. But there is a class of process cue that is permanent, chronically entrenched in the client's behaviour. The class includes three species.

24.4.1. Chronic archaic-defensive tone of voice. The client persistently talks, whatever the content, with a tone of voice that pleads or complains or whines or self-effaces (this one may lower the volume too) or distances or irritates. The locked-in childhood distress is acted out through the tone and perhaps also the volume. This may extend into the chronic use of speech redundancies such as 'ums' and 'ers', 'you knows' and 'you sees', and stutters.)

24.4.2. Chronic archaic-defensive posture and/or gait. The client stands or walks in terms of permanently distressed adaptation to an early oppressive environment - the stance or walk is embarrassed, self-deprecating, mincing, cautious, ready for flight, defiant, or stubborn, or whatever other emotional posture the child adopted to survive.

24.4.3. A third type of chronic archaic-defensive cue is more covert. It's a rigidity of muscular tone, or a rigidity that afflicts the free and full use of a group of muscles, anywhere in the body. It's what Reich called character armour. It's a more subtle, not so obvious, psychosomatic rigidity: it may be evident in defensive posture and gait, but only to the trained eye. Its purpose is primarily to maintain a constant inhibition of the physical expression of strong pockets of repressed grief, fear and anger. Again, you can propose that the client physically amplify and/or physically contradict this type of rigidity.

25. Acting into. This is just a special case of physical contradiction. The client is already feeling the distress, wants to discharge it, but is held back by conditioned muscular tension. You suggest they act into the feeling, that is, creates a muscular pathway for it, by vigorous pounding for anger, or trembling for fear. If they produce the movements and sound artificially, then very often real catharsis will take over.

26. Hyperventilation. Already mentioned, under (24.4.3) just above, hyper-ventilation requires a special reference. It is a rapid breathing which becomes defensive if it is excessively fast or too slow. There is a frequency which opens up the emotionality of the whole psycho-physical system, if it is sustained long enough. It can be used to lead the client into discharge from scratch, by working on basic character armour. Or it can be used to follow a mobile body cue, especially a sudden deepening of the breath. To prevent tetany and excessive dizziness, have the client do it in many cycles, with pauses in-between. When carried on for a sufficient period of time, this is a very direct and powerful route to primal and perinatal experiences, which may also be interwoven with transpersonal encounters.

27. Physical pressure. When the client is just struggling to get discharge going, or has just started it, or is in the middle of it, you can facilitate release by applying appropriate degrees of pressure to various parts of the body: pressure on the abdomen, midriff or thorax, timed with the outbreath; pressure on the masseter muscle, some of the intercostals, the trapezius, the infraspinatus; pressure on the upper and mid-dorsal vertebrae timed with the outbreath, to deepen the release in sobs; pressure against the soles of the feet and up the legs to precipitate kicking; extending the thoracic spine over the practitioner's knee, timed with the outbreath, to deepen the release of primal grief and screaming; and so on. The pressure is firm and deep, but very sensitively timed to fit and facilitate the client's process. Anything ham-fisted and unaware of what their energy is doing, is intrusive. Handle with care and skill.

28. Physical extension. As the client is moving in and out of the discharge process, you can facilitate the release by gently extending the fingers, if they curl up defensively; or by gently extending the arms; or by drawing the arms out and away from the sides of the body; or by extending an arm while pressing the shoulder back; or by gently raising the head, or uncurling the trunk; and so on. All these extensions are gentle and gradual, so that the person can yield and go with them.

29. Surrender posture. Sometimes the full release of grief needs a surrender posture. If the client is kneeling, and grief is on the way up and out, gently guide their trunk forward until their head rests on a cushion on the floor, arms out to the side, palms facing up to either side of the head, fingers unfurled. After the intense sobbing subsides, raise the person gently up again to catch some thoughts and insights; then down onto the cushion again when another wave of grief comes through.

30. Vertical and horizontal. When doing body work with your client, start with standing positions, and as the process cues emerge, shift directly to work lying down. A well-timed change from the vertical to the horizontal can facilitate catharsis.

31. Relaxation and light massage. This is an alternative mode of contradicting physical rigidity. You relax the client and give gentle, caressing massage to rigid areas. Catharsis and/or memory recall may occur as muscle groups give way to the massage.

32. Relaxation and self-release. This is yet another way of undoing physical rigidities that lock in distress. You relax the client and invite them to 'listen' for movement micro-cues within their muscles in every part of their body. The micro-cue is a continuous buried impulse to move against the distress-charged rigidity. It is normally blocked and suppressed by the rigidity. But they amplify the micro-cues and start gently to stir and move their body (and perhaps their voice) in unfamiliar ways, until they break right out of the rigidity into catharsis.

33. Physical holding. You reach out lightly to hold and embrace the client at the start, or just before the start, of the release of grief in tears. This can greatly facilitate the intensity of sobbing. Can be combined with aware pressure on their upper dorsal vertebrae at the start of each outbreath. Holding their hands at certain points may facilitate discharge. When discharging fear, they can stand within your embrace, and your fingertips apply light pressure on either side of their spine.

34. Pursuing the eyes. By avoiding eye contact with you, the client is often also at the same time avoiding the distress feelings. You gently pursue their eyes by peering up from under their lowered head. Re-establishing eye contact may precipitate or continue catharsis.

35. Regression positions. When process cues suggest birth or pre-natal material, you can invite the client to assume pre-natal or birth postures, start deep and quite rapid breathing and wait for the primal experiences to re-run themselves. May lead into deep and sustained cathartic work in the primal mode. If so, you need to keep leading them to identify the context, to verbalize insights, and at the end to integrate the learning into their current attitudes and life-style. Regression positions may be less ambitious like lying in the cot, sitting on the potty, sucking a thumb.

36. Seeking the context. When the client is deeply immersed in process work and in catharsis, you may judge it fitting to lead them into the associated cognitive mode, asking them to identify and describe the event and its context, to verbalize insights, to make connections with present-time situations and attitudes.

37. Holding up a mirror. You can lightly precipitate the discharge of embarrassment in laughter by mimicking, with loving, not malicious, attention the various self-deprecating and self-effacing behavioural cues the client is producing. If followed through deftly, with both content and process, may pave the way for much deeper catharsis.

38. Use of water. All these varieties of process work may usefully be done when the client is immersed in water, or lying on a waterbed. The stimulus of water may precipitate pre-natal and birth material.

39. Psychotropic drugs. Mescalin, LSD, can be powerful abreactive drugs if the client is properly facilitated when under their influence. See Grof's classic work Realms of the Human Unconscious (Grof, 1976).

40. Transpersonal process cue. Sometimes the client spontaneously assumes a posture or makes a gesture that has transpersonal significance, like one of the consciousness-changing postures in oriental yogas. You can ask them to repeat it, stay with it and develop it, maybe finding the words that go with it. This may generate a good deal of insight and be incidentally cathartic. It may also be the start of transmutative work (see Chapter 8).

41. Ending a session. At the end of a cathartic session, it is necessary for you to bring the client back up out of their cathartic regression into present time, by chronological progression at intervals of 5 or 10 years, by affirming positive directions for current living, by describing the immediate environment, by looking forward to the next few days, etc.


Part II

By intensive or non-permissive counselling, I mean the kind of counselling of the client that picks up every relevant cue and hones in precisely on accessible distress material the client may tend to shy away from. It is the sort of counselling the teacher uses with beginners when working with a client in front of the group, since the client is not yet in a position to be effectively self-directing. It is also an important option open to experienced co-counsellors at the request of the client to help the client deal with chronic patterns and occluded or avoided material. Intensive counselling has the following features - which overlap and interact:

  1. It enables the client to get attention out, get ready for work.
  2. It picks up relevant verbal and non-verbal cues in the client and converts them into suggestions for client work.
  3. It enables the client to get right into distress material and stay with it, to hold a direction discharging uncomfortable distress feeling, to go back in again.
  4. It enables the client to shift level, to cut from the superficial presenting restimulation to its genesis in early material.
  5. It enables the client to catch and verbalise sudden thoughts and insights, to re-evaluate past events, to express understanding of how past trauma and present problems have been interlocked.
  6. It enables the client to appreciate, celebrate, delight in her being.

  7. It enables the client to action-plan for sensitive, rational, distress-free living now and in the future.
  8. It enables the client to come back into present time, away from distress.
  9. It has certain primary qualities, outlined below.

What follows is a sample of verbal behaviour analysis of typical sorts of counsellor interventions under each of the above headings. This sort of analysis is in many ways misleading. Bunching the verbal behaviours under the different headings gives no idea of how a real sequence of counsellor interventions will move around creatively among the different headings. Again, the form of words to be chosen for any one intervention has many subtle variations: there are many different ways of expressing the same basic intervention. The analysis can give absolutely no indication of the great importance of timing and tone of voice. Headings 1 - 4 all interweave and overlap in practice. Despite all this, experienced co-counsellors have found it useful to do this kind of behaviour analysis as a backdrop to practical training in intensive counselling. I am indebted to participants in several recent advanced co-counselling and teacher training workshops for help in compiling the following.

1. Enabling the client to get attention out, get ready for work

2. Picking up verbal and non-verbal cues

3. Enabling the client to get right into material and stay with it

4. Enabling the client to shift level, to get to key early experiences

5. Enabling the client to catch and verbalise thoughts and insights

6. Enabling the client to celebrate herself

7. Enabling the client to action-plan for rational living

8. Enabling the client to come back into present time, away from distress

Finally here are what seem to me to be some of the primary qualities of really effective intensive counselling


Copyright John Heron, November 1998

South Pacific Centre for Human Inquiry
11 Bald Hill Road, R.D.1 Kaukapakapa, Auckland 1250, New Zealand
email:jheron@human-inquiry.com, jheron@voyager.co.nz
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