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Question - How do clients make therapy work

Submitted by counsellor John Threadgold

 

The question that therapists don’t like to ask (the answer to which every person who uses therapy needs to know) is: why do some people succeed in therapy, when others do not?

How do I define ‘success’? Well, one way of defining it is that you are successful in therapy when you begin to feel better about yourself and feel empowered to make constructive changes to your life.

When a client succeeds in therapy, the counsellor or psychotherapist will often privately believe that this resulted from their own skills, or perhaps their model of counselling. But therapists are less willing to talk about those who do not succeed in therapy.

Back in the 1950s, Kirtner and Cartwright, two researchers at the University of Chicago counselling centre, tried to find out answers as to why some people succeed with therapy when others do not. They listened to hundreds of tape recordings of therapy sessions.

The started out with the assumption that therapists who could offer their clients a therapeutic relationship based on empathy, unconditional acceptance and being genuine, would have successful clients, as compared to therapists who did not offer these conditions. There was some evidence consistent with that view, but something did not fit. Such therapists still had clients who did not benefit from therapy, while other therapists, who did not embody these qualities, nevertheless had successful clients.

Kirtner and Cartwright decided to start listening to the clients and they made a startling discovery. They could spot successful (and unsuccessful) clients within the first two sessions. The question surfaces: what is the difference between how successful and unsuccessful clients use therapy?

Unsuccessful clients often talked about their issues in any or all of the following ways:
• Some clients had a very clear intellectual understanding of their issues. They could pinpoint with some accuracy how their problems arose from (for example) a childhood experience, but nothing ever felt different or shifted for them.
• Other clients told stories without any emotional depth. They could talk about traumatic incidents in the same way as they might describe going to the shops or what they had for dinner. Again nothing shifted for them.
• Some clients, in contrast, experienced their emotions with full force. They could experience their anger depression and hurt again and again, but these feelings never changed.

How did successful clients work on their issues? Successful clients would at times talk in the same way as unsuccessful clients. But they also had a special way of talking that, once it had been identified, could be spotted in the first two sessions.

Successful clients:
• Talked about their issues, but frequently slowed down their talking and became less fluent.
• Paused what they were saying and checked out whether their words accurately reflected what they were experiencing.
• Would sense into their issues and change their language to fit their experience.

As the issue would unfold, change and feel different in their body, such clients would often feel a release of tension in their bodies.

The following is a fictionalised example and the brackets () show the client pausing:

Client: "well I was really angry with her (pause hesitates), well (sensing into issue, sensing a murky edge to this) – no – not quite angry – (pause) well sort of --- maybe.

Yeah – when she walked off with my best mate, I felt betrayed (now sensing, does the word betrayed really symbolise that bodily-felt sense), yeah there is more ----- (sensing in) oh yeah that's it, I just felt so alone."

Now although the content of what happens is horrible, nevertheless the clients would often feel a release of tension in their body at the end of the process, as if the issue had somehow changed or been processed. By being aware of their issue, and sensing into the issue without being overwhelmed by it, somehow the issue had changed, felt better in their body.

Clients who characteristically had these ‘moments’ in their therapy, also began to feel better about themselves and tended to make constrictive changes to their lives.

The question surfaced: Can unsuccessful clients learn to do what the successful clients were doing naturally? Dr Eugene Gendlin carried forward this research.

Dr Gendlin closely observed what successful clients were doing and then broke this down into a series of teachable steps that potentially unsuccessful clients could learn. He called this process ‘focusing’.

Those steps have changed over the years, but commonly include:
• Sensing into the body, getting a felt sense of the issue.
• Slowing down language, just sensing (e.g. ‘is this anger or is there something else there?’) - checking that the language accurately symbolises and carries forward the bodily experience of the issue.
• Sensing something that starts off as intellectually vague and seems to be at the edge of awareness.
• The edge of awareness feeling then comes into focus, and becomes clearer as the process continues.

Dr Gendlin set up the Focusing Institute, to promote focusing, and developed courses for people to learn focusing outside of therapy. He also developed focusing courses for therapists.

Dr Gendlin discovered that people could use the focusing tool for all sorts of purposes, and not just therapy. For example:
• People could use focusing for finding out how they really felt at any given time.
• People could use it to help them make better and more informed decisions.
• To interpret dreams.
• To help with therapy when it has become stuck.
• To remove writers block.
• To help with artwork, creative projects.
• There is even a group of focusers who use focusing to help with buying and selling shares.

More about Focusing Oriented Therapy:

In Denmark focusing oriented therapists will often ask potential counselling and psychotherapy clients to learn some focusing from a fellow practitioner before they begin therapy.

In the UK there are less focusing oriented therapists, and such therapists will often incorporate focusing suggestions into their standard therapy. Examples may include: ’you talked about being angry, can you just slow down and sense into that’ or ‘can you sense where you feel that in your body’. Some people will immediately know what the therapist is talking about, although not all. Some focusing therapists will also offer ‘guided focusing sessions’ as part of the therapy. I have seen therapy clients literally transform after learning focusing.

Focusing outside of therapy:

You can learn focusing outside of therapy. Members of the British Focusing Teachers Association offer two day introductory workshops, individual guided focusing sessions, and also individual tailored courses on how to do focusing and how to be a focusing companion for others.

You can find out more about focusing oriented therapy and focusing courses that are run in the UK from the Focusing Institute (www.focusing.org) and also the British Focusing Teachers Association (www.focusing.org.uk) and also my own website www.newfocustherapy.co.uk

If you want to read more then see the following self-help books:

The Power of Focusing. Ann Weiser Cornell PhD. Published by New Harbinger Publications.

Focusing How to gain direct access to your body’s knowledge. Eugene T Gendlin PhD. Published by Rider.

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